Microscopic Changes in the Skin due to Aging – Dermatology Example

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"Microscopic Changes in the Skin due to Aging" is a perfect example of a paper on dermatology. A 45 years old, Caucasian female who was a truck driver by profession, presented to a dermatology clinic for her aggravating symptoms which included redness of the face, intense itching, and increasing discomfort during her duty hours. A detailed history revealed that her symptoms aggravated upon exposure to sunlight or heat. She was otherwise normal and no medical conditions whatsoever were present. Upon examination, the dermatologist noted that a number of hyperpigmented patches are present on the skin of fact.

Upper eyelids were spared, whereas the rest of the skin of the face demonstrated considerable inflammatory changes. Skin creases were markedly prominent; the wrinkling on the face was marked in photo-exposed regions of the face. A pale complexion and marked xerosis (dryness) were added features. Etiology of aging A number of factors have been associated with the process of aging. Sunlight plays a major role in the changes that are seen in skin tissue. Other environmental factors may have a role; however, the role of sunlight has been studied in greater detail.

Aging may be the result of actions of reactive oxygen species (ROS), which bring about a number of deleterious changes at the cellular level. ROS may be produced in the cell by the action of UV light or other environmental factors including pollutants, drugs, etc. Once ROS are generated, they may result in the breakdown of DNA strands, cause lipid peroxidation, or result in pyrimidine cross-linking. All of these result in defects that may render the cell incapable of survival. The regulatory mechanisms of cells may be affected and, in severe cases, malignant changes may ensue.

In addition to the role of ROS, a prominent observation is the decreased expression of pro-collagen mRNA in the photo-affected skin tissue (Rigel et al, 2004). The ultimate result of this change is a decreased production of collagen. This phenomenon is continuous, so much so that a decrease of nearly 1% in the amount of production of collagen has been documented in aging skin. Other factors that may contribute to the aging of the skin are smoking and hormonal imbalances (Brincat et al, 1985). Effect of age on repair mechanism of skin   The capacity of young skin to fight oxidative stress injury is greater as compared to aged skin.

With repeated exposure to solar radiation which is a norm in everyday life, the accumulated effect of UV light continues to increase with the passage of time. The ultimate result is a compromised function of the antioxidant defense system of the skin (Scharffetter– Kochanek et al, 2000). Another change that is detected in aging skin is the presence of elevated levels of metalloproteinases.

These enzymes are responsible for the decrease in the level of collagen that has an important role to play in the aging process of the skin. Metalloproteinases cause degradation of collagen; the immediate effect of which is the presence of below optimum levels of collagen in the skin, hence contributing to aging. Microscopic changes in the skin due to aging A number of changes are characteristically seen in any skin that is affected by aging. Histologically speaking, a marked flattening of the dermal-epidermal junction of the skin is noted, which is normal skin is rather convoluted.

Specialized skin cells known as Langerhan cells and melanocytes may demonstrate a lower number; however, in cases where hyper-pigmentation is seen, the melanocytes may be increased in number. Along with these changes, the level of metalloproteinases is elevated which corresponds to the lower level of collagen detected in samples of aged skin. The blood vessels demonstrate atrophy and due to this reason the vascular supply of such skin is compromised; this can ultimately affect the temperature maintenance mechanism of the skin as well as the hydration status of this tissue.

Beauty therapy treatments and anti-aging medication A number of therapeutic options are available for the purpose of managing aging-related issues of the skin. These may include methods like Botox, Fractional CO2 laser skin resurfacing, wrinkle injections which are commonly referred to fillers, Skin peeling which is carried out by the use of alpha hydroxyl acids like glycolic acid, de-pigmenting agents to get rid of undesired pigmentation of skin brought on by chronic exposure to solar radiation, sunscreens to prevent deterioration of skin condition by blocking the access of solar radiation to the exposed skin, chemical agents like glutathione and tretinoin which has been shown to demonstrate activity against photo-aging (Sastre & Pallardo, 1996).

There has been considerable research in the field of aging and a large number of drugs are under trial for approval to be used as anti-aging agents. Some of the prominent drugs in this class include SH-group drugs, Calcium Pantothenate, pyridoxine (Vitamin B6), procaine, melatonin, phenytoin, and chromium Picolinate, etc (Klatz & Goldman, 2003). In addition to these drugs, a number of nutritional factors like Vitamin A, B, C and E, Copper, selenium, and zinc; moreover Coenzyme Q10 and alpha-Lipoic acid all have been associated with slowing the process of aging (Goldberg & Herriott, 2003). How beauty therapy treatments and products delay aging Botox or the commonly known Botulinum toxin is primarily used for creating a condition of prolonged paralysis of a muscle of the face to get a desirable expression on the face.

This can help to get rid of unwanted creases of skin on the face. 'Fractional CO2 laser skin resurfacing' works by causing the skin to stimulate its production of collagen.

Wrinkle injections or the more commonly known 'fillers' serve the purpose of filling a crease/wrinkle or line on the skin; this is done by injecting the filler under the lesion to create the desired result. Skin peeling by the use of AHA exerts its effect in a two-fold manner; firstly it allows the removal of dead keratinocytes from the superficial layer of skin, second, it causes stimulation of skin to produce increased amounts of collagen (Moy et al, 2002). De-pigmenting agents can help to improve the tone of a hyper-pigmented patch of skin by blocking melanogenesis thereby reducing the level of pigmentation.

Sunscreens prevent sunlight from reaching the skin, thereby providing physical protection from exposure to solar radiation. Glutathione and Vitamin E have antioxidant properties, whereas the exact mechanism of tretinoin is not yet clear (Facial Plastic Surgery, 1983). The treatment plan for the patient The first thing that should be kept in mind is that patient's discomfort should be attended to; for this purpose oral antihistamines can be used which produces a level of sedation in addition to providing symptomatic relief from the troublesome complaint of pruritus.

Secondly, the reduce inflammation of the skin, mild topical steroids like 1% hydrocortisone cream may be prescribed until the condition is resolved and inflammation reduced to acceptable levels. Since the condition is caused by exposure to sunlight, the use of sunscreens by the patient will provide protection from the causative agent; thereby preventing further deterioration of the condition. After the flare is over, de-pigmenting agents may be used to help improve the tone of the skin. At the same time, Botox and dermal fillers may be offered to the patient to help alleviate her cosmetic concerns.

If the patient opts for a non-invasive procedure to improve her condition, skin peeling by the use of glycolic acid may be an appropriate choice as it will not only improve the look of skin immediately but also stimulate the production of collagen that will last for a while. To prevent relapse of the condition, the patient should be advised to adopt sun-protection measures for the rest of her life period; this may include the use of protective clothing to reduce exposure to solar radiation.

Certain nutritional factors may be added to the diet of the patient which plays a role in slowing down the process of aging.

References

Brincat, M., Moniz, C. J., Studd, J. W. W., Darby, A., Magos, A., Emburey, G., & Versi, E. (1985). Long‐term effects of the menopause and sex hormones on skin thickness. BJOG: An International Journal of Obstetrics & Gynaecology, 92(3), 256-259.

Facial plastic surgery: FPS. (1983). New York, NY: Thieme-Stratton.

Goldberg, D. J., & Herriott, E. M. (2003). Light years younger: The definitive guide to anti-aging skin care. Sterling, Va: Capital Books.

Klatz, R., & Goldman, B. (2003). The science of anti-aging medicine. Chicago, IL, A4M, American Academy of Anti-Aging Medicine.

Moy, R. L., Luftman, D., & Kakita, L. S. (2002). Glycolic acid peels. New York: Marcel Dekker.

Rigel, D. S., Weiss, R. A., Lim, H. W., & Dover, J. S. (Eds.). (2004).Photoaging. CRC Press.

Sastre, J., & Pallardó, F. V. (1996). Glutathione, oxidative stress and aging.Age, 19(4), 129-139.

Scharffetter–Kochanek, K., Brenneisen, P., Wenk, J., Herrmann, G., Ma, W., Kuhr, L., ... & Wlaschek, M. (2000). Photoaging of the skin from phenotype to mechanisms. Experimental gerontology, 35(3), 307-316.

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