Photoaging: Diagnosis and Management

00:02 Clinical manifestations. Well, you kind of already know that if you have grandparents or have just been walking around in your community and seeing recognizing old people, it's pretty obvious.

00:12 So in light skinned individuals like me, um, that always burn and tan or tan with difficulty, you're going to see a lot more of the fine and coarse wrinkles.

00:23 You're going to see the mottled pigmentation again.

00:26 That's that solar elastosis that we're going to see on another slide, actinic keratosis. These are pre-malignant lesions.

00:32 And if you are interested in those you can look up a subsequent talk when we'll talk about actinic keratosis telangiectasias.

00:39 Those are little vascular webs vascular proliferation.

00:44 Those are being driven by the change in matrix metalloproteinases as well as the reactive oxygen species causing the pro-inflammatory cytokines.

00:53 So you get little vascular tufts that may be quite prominent.

00:56 And then the skin becomes less elastic.

01:00 So the extracellular matrix of the dermis is not just type one and type three collagen, but there's a great deal of elastic tissue.

01:07 Again remember from previous talks that I could pull the skin and it would not tear or rip. It's quite elastic that goes away.

01:15 So skin becomes more prone to tearing or to damage due to physical forces.

01:20 As a result of these you've derived injury to the dermis if you don't burn, or if you've never burned or you tan deeply, the effects of the of the UV radiation can be mitigated and will typically occur if they do 10 to 20 years later.

01:40 And recall that people of dark skin who have a lot of melanocytes, who make a lot of melanin, will typically not have the same changes that we see in 40, 50 and 60 year old very white people.

01:53 So the association with tanning, the association with the fact that you're not getting as much photodamage is because you're because you're making more melanin and melanin. Importantly, produced by the melanocytes is going to be something that actually sucks up the UV radiation and turns it into heat instead of breaking double stranded DNA.

02:12 How do we diagnose this? Well, it's pretty easy. You just look. But what we're going to see histologically is evidence of that photodamage that we can actually formally quantify.

02:23 This is showing you a slide an H and E stain hematoxylin and eosin stain slide of skin.

02:29 The very kind of blue purple things on top.

02:31 That's our epidermis. Those are our keratinocytes.

02:34 We've talked about those previously and deep to that is going to be the dermis and the capillaries in there. And extracellular matrix including collagen and elastic tissue.

02:45 The area that's highlighted in red is solar elastosis.

02:49 It is on the H and E stain bluer.

02:52 It's bluer because instead of making nice collagen the fibroblast in the dermis are cranking out glycosaminoglycans that are making hyaluronic acid.

03:03 They're making other things, not collagen.

03:05 That's the degenerative kind of phenotype that happens with you've damaged you've affected dermal dermal fibroblasts.

03:15 And that's solar Elastosis can be seen on H and E stain slides.

03:20 How do we manage this? Well basically stay out of the sun or use sunscreen if you're going to go out. Um, for for people who have already had sun damage, you can apply topical retinoids.

03:33 This will help the underlying dermal fibroblasts make more collagen.

03:37 That's one of the things that they do with with the retinoids.

03:40 And they promote better vascularization to carry away or to improve nutrition to the skin, but also carry away waste.

03:49 Now treatment with the retinoids will you just need to let people know they're going to see local skin irritation, and they may see increased redness or scaling or dryness, at least initially.

04:00 But that can help reduce some of the photodamage that's happening within the dermis. Other treatment options include chemical peels, which remove the very superficial layers of the skin.

04:13 It seems to me rather dramatic, but if you are trying to get rid of some of the hyperpigmentation that can sometimes be affected by, uh, various laser treatment to get rid of the, the, the sunspots or the age spots and additional other forms of photodynamic therapy. Yes. You can use other forms of radiation to the skin to treat what radiation caused. And at that, we finished our talk on Photoaging.

04:41 And the next time you look into your grandparents face, you will know that they have had a long time, a lot of exposure to sun, and they've seen many days on this planet and they're very wise.