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NATURAL CHANGES PROPER OF SKIN AGEING

On an Epidermal level

The appearance of the epidermis is less anchoring to the dermis, the dermal papillae are flattened and have less density and therefore the epidermal anchoring is poor. The epidermal basal cells slow down their rate of multiplication and the cell renewal process is curbed. Atypical cases exist on a cellular and nuclear level, hyperkeratosis, laminar orthokeratosis, decrease in melanocytes and Langerhans cells.

On a Dermal level

A dermis affected with elastosis is thinned due to the diminishing of the collagen fibre network. The collagen is packed into irregular knots with large spaces between them instead of appearing like a homogenous mesh. The elastin is also altered, packed tightly and stopping elasticity supply to the skin, giving it less tone. The sweat glands are deactivated and are less numerous and this partially affects the skin's ability to collaborate in thermoregulation. The hair changes from fleece to terminal hair, the pores become larger in diameter and the apocrine and sebaceous glands lose their production capacity.

Histologically, a greater amount of staining more common in elastin than collagen is found. This is why the skin aging process is known as elastosis. The elastosis degeneration is a basophilic degeneration of the collagen that appears replaced by an amorphous and granular material with staining typical to the elastic fibres. In the most advanced cases, the superior reticular dermis and the papillary dermis are also affected. Normal collagen is replaced with basophilic masses of amorphous tincture leaving a small strip of normal collagen in contact with the epidermis.

There are four types of collagen that contribute to supporting the skin, collagen I and III are responsible for skin elasticity and tone, collagen V provides the interior of the dermis with structure, forming collagen pillar and collagen VII maintains the union of the dermis and epidermis giving it density and firmness.

It is important to point out the level of atrophy of the extracellular and cellular matrix. There is a reduction of fibroblasts, mastocytes (mast cells) and a marked loss of vascularisation with shortening of the capillary loops, increase in nerve abnormalities, profuse accumulation of elastin and reduction of collagen fibres (basophilic degeneration). As regards to the reticular dermis, an increase in hyperplasic fibroblasts is generated. There is an increase in Collagen III and proteoglycans as well as a perivenular lymphohistiocytosis infiltration with numerous mastocytes. (Sánchez Almanza)¹¹.

Characteristic signs of aged skin on a histological level, some of which can be observed under confocal microscopy are:

• Horizontal elongation of the epidermal crests
• Nodular aggregates of fibrous material to amorphous in the papillary dermis
• Excess production of abnormal elastin fibres
• Dilated vessels of the atrophic walls
• Loss of connective tissue support
• Superficial portion of the dilated hair follicle¹¹

On a Hypodermic level

Atrophy of the hypodermic tissue is translated in lax connective tissue made up of large lobes of fat tissue limited by partitions of thin collagen fibres and limited elastic fibres.

There is an atrophy process that reduces its heat reserve and thermoregulation functions as well as aiding in wrinkle formation. Atrophy of the hypodermis is not generalised, appearing more frequently on the face, hands and feet. The flaccidity associated with cellulite is produced as a consequence of the intrinsic aging and the devitalisation of the dermis and fibrous septa related to the more serious cases of cellulite. This is due to the vascular affectation and the influence of fat lobe gravity on the septa of collagen and elastin fibres and on the dermis proper.

The main functions of the hypodermis are thermoregulation, cushioning traumatisms, calorie reserve and the participation in the fat and hydric metabolism.

With the appearance of flaccidity associated with the cellulite, there is an alteration in the amount, thickness and quality of the fibrous bands.

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