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(4) Skin Disorders

 What happens as we age?

Many histological changes occur with aging and photoaging. Variation in cell size, shape, and staining results in epidermal dyscrasia of photoaged skin. Melanocytes decline, and Langerhans’ cells (intradermal macrophages) decrease in density.

The dermis becomes relatively acellular, avascular, and less dense, and the loss of functional elastic tissue results in wrinkles.

The nerves, microcirculation, and sweat glands undergo a gradual decline, predisposing them to decreased thermoregulation and sensitivity to burning. Nails undergo a slow decline in growth, with thinning of the nail plate, longitudinal ridging, and splitting. The subcutaneous fat layer atrophies on the cheeks and distal extremities but hypertrophies on the waist of men and thighs of women

Aging Skin

 Epidermal Changes

 • Melanocytes

 Approximately 15% decline per decade

Density doubles on sun-exposed skin

Increased lentigines

 • Langerhans cells

Decreased density

Decreased responsiveness

Dermal Changes

Decreased collagen—1% annual decline, altered fibers

Decreased density

Progressive loss of elastic tissue in the papillary dermis

 Skin Changes in Aging

 Loss of Elasticity and Thinning of the Skin

Clinical results-xerosis, laxity, wrinkling, uneven pigmentation, easy tearing, traumatic pupura, neoplasia

Photoaging

Clinical results-actinic keratoses, fine and coarse wrinkling, telangiectasia, blotchiness and pigmentary changes, elastotic skin with giant comedones

Many skin changes occur during the aging process, including decreased elasticity, decreased skin surface lipids and hydration, and decreased skin density and responsiveness. These skin changes can be divided into intrinsic skin changes and extrinsic changes, as explained previously.

Although intrinsic changes usually begin in our 20s, the signs are typically not visible for decades. These include the following:

• Fine wrinkles

• Thin and transparent skin

• A loss of underlying fat, leading to hollowed cheeks and eye sockets, as well as noticeable loss of firmness on the hands and neck

• An inability to sweat sufficiently to cool the skin

• Bones that shrink away from the skin because of bone loss, which causes sagging skin

• Dry skin that may itch

• Graying hair that eventually turns white

• Hair loss

• Unwanted hair

• A nail plate that thins, the half moons that disappear, and ridges that develop

Terms:

Photoaging - The damaging of skin due to sunlight exposure.

Langerhans’ cells - A type of dendritic immune cell found in high concentrations in the epidermis.

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