Dermoscopic Evaluation of Facial Aging in Males
Fatma Ahmed Yousef;
Abstract
Skin aging is the end result of both intrinsic aging, which is the result of the passage of time, and photoaging, which refers to alterations in skin structure and function that result from chronic sun exposure, in addition to the passage of time. It is important to distinguish between chronological skin aging and photoaging.
Chronological skin aging can be summarized as atrophy with structural and functional decline of the skin. Sun-protected aged skin is finely wrinkled with exaggeration of facial expression lines, laxity, and pallor.
Extrinsic skin aging involves hypertrophy as an inflammatory, protective response to the damaging effects of UV rays. Photoaging is manifested by xerosis, leathery skin, irregular pigmentation (freckles, lentigines), and more pronounced wrinkling. Telangiectasias, purpura, comedones, and a variety of benign and premalignant skin tumors including seborrheic keratoses, sebaceous gland hyperplasia, and actinic keratoses are frequent findings. UV irradiation from the sun damages human skin, causing it to age prematurely.
Dermoscopy is an aiding diagnostic tool that allows the in vivo evaluation of colors and microstructures of the epidermis, the dermo-epidermal junction, and the papillary dermis which are not visible to the naked eye. Its idea depends on trans-illumination of a lesion and studying it with a high magnification. Old dermoscopes requires application of certain oil over the lesion to be examined while new dermoscopes are provided with polarized light, rendering the fluid placed on the lesion unnecessary for inspecting the vascular morphology of papulosquamous diseases. Dermoscopes are classified into, dermoscopes without image capturing facility, dermoscopes with image capturing facility and dermoscopes with image capture facility and analytical capability.
Dermoscopes are used mainly for the study of melanocytic nevi and melanoma. However, it can be used to diagnose other conditions too, e.g. psoriasis, lichen planus, dermatofibroma, darier‟s disease, cicatricial alopecia, seborrheic keratosis, urticarial vasculitis, raynaud‟s phenomenon, striae distensae, mucinous carcinoma, porokeratosis, clear cell acanthoma, angioma serpiginosum, solitary angiokeratoma, fibroepithelioma of Pinkus, bowen disease, actinic keratosis, sebaceous hyperplasia, scabies, pediculosis and vitiligo.
Also some features of skin aging can be detected easily with dermoscopy. Measurement of skin aging with dermoscopy will give more reliable and objective results than the scales using clinical criteria. Prevention and treatment of skin aging can be measured with the dermoscopic photoaging scale (DPAS) and efficacy of many therapeutic application can be investigated. In this study, assessment of facial aging by dermoscopy by means of DPAS criteria. Measurement of skin aging with dermoscopy will give more reliable and objective results than the scales using clinical criteria.
This study was carried for evaluation of facial aging in male using dermoscopy and application of DPAS criteria. Also the study of the effect of the degree of sun exposure, smoking index, Glogue photoaging scale and skin type.
One hundred and seventeen male participants were classified into 3 groups representing the forth decade (30-39 years old) the sixth decade (50-59) and beyond the sixth decade (≥60 years old). They had clinical signs of skin aging, with Fitzpatrick skin types III, IV or V and Glogau's photoaging classification types I, II, III or IV. The participants were divided according to sun exposure index into mild, moderate and severe and divided into smokers and non smokers.
The most prominent dermoscopic findings were superficial wrinkles followed by hypo-hyperpigmented macules in group I, superficial wrinkles followed criss- cross wrinkles in group II, criss-cross wrinkles, yellowish discoloration and deep wrinkles in group III.
Dermosopic evaluation revealed that there was a highly significant difference among the three study groups as regard DPAS score (the mean was 15 ± 4.2) in group III. Also a highly significant difference among the three study groups was found regarding some dermatoscopic finding; as Yellowish discoloration, Yellow papules, Telangiectases, Senile Comedones, Deep Wrinkles and Criss-cross wrinkle to reach its maximum in group 3 with a percentage of 100%, 70%, 90%, 55%, 100%, 90% respectively.
Most of the participants having skin phototypes III, IV or V. There was significant increase in telangiectasia more in type III (52.8%) than IV (30.8%) than V (0%) among group I. There was no significant difference between group II and III Case skin with skin type III, I. A highly significant increase in diffuse erythema between study groups was found being maximum in group III (65%). Also There was a significant increase between the three skin types as regard blotchy erythema with type III more affected (60%) compared to (42.9%) with type IV and (0%) with type V in group II.
In this study a highly statistically significant difference was observed between the smokers and nonsmokers in senile comedon among group II (the percentage was 47.8% in smokers and 5.3%in non smokers). Also the DPAS score increases in smokers (12.3±3.7) than non smokers (11.4±2.4) in group II. And in group III, the score in smokers was (16.0 ±4.3) and in non smokers (13.1±3.7).
The study showed that increase sun exposure index is associated with significant increase in yellow papule, highest percentage (23.8%) among cases with moderate sun exposure in group I and a significant increase in score (mean is 13.5±3.7) among group II with severe sun exposure.
Among group I the study shows that there was a significant difference with increase in the Glogau's scale as regards score (8.8±2.8) with Glogau's scale 3 and hypo-hyperpigmented macule (100%) with Glogau's scale 2 and in criss-cross wrinkles (78%) in glogue scale 3. Also there was a highly significant increase in deep wrinkle to reach maximum (90.2%) in the Glogau's scale 3.
Among group II there was a significant difference in the as regards DPAS score being more in glogue scale 4 (13.8±2.9) and senile comedones (58.3%) also in glogue scale 4.
Among group III, there was no significant difference in DPAS score or criteria between the participants who were of glogue scale 3 & 4.
The study showed that R2 has higher score than R1 & R3 among the three study groups so it appears to be the most affected area by means of Dpas criteria. In group1 its score was (4.25± 1.68), in group II its score was (6± 1.71) and in group III its score was (7.05± 1.37).
Chronological skin aging can be summarized as atrophy with structural and functional decline of the skin. Sun-protected aged skin is finely wrinkled with exaggeration of facial expression lines, laxity, and pallor.
Extrinsic skin aging involves hypertrophy as an inflammatory, protective response to the damaging effects of UV rays. Photoaging is manifested by xerosis, leathery skin, irregular pigmentation (freckles, lentigines), and more pronounced wrinkling. Telangiectasias, purpura, comedones, and a variety of benign and premalignant skin tumors including seborrheic keratoses, sebaceous gland hyperplasia, and actinic keratoses are frequent findings. UV irradiation from the sun damages human skin, causing it to age prematurely.
Dermoscopy is an aiding diagnostic tool that allows the in vivo evaluation of colors and microstructures of the epidermis, the dermo-epidermal junction, and the papillary dermis which are not visible to the naked eye. Its idea depends on trans-illumination of a lesion and studying it with a high magnification. Old dermoscopes requires application of certain oil over the lesion to be examined while new dermoscopes are provided with polarized light, rendering the fluid placed on the lesion unnecessary for inspecting the vascular morphology of papulosquamous diseases. Dermoscopes are classified into, dermoscopes without image capturing facility, dermoscopes with image capturing facility and dermoscopes with image capture facility and analytical capability.
Dermoscopes are used mainly for the study of melanocytic nevi and melanoma. However, it can be used to diagnose other conditions too, e.g. psoriasis, lichen planus, dermatofibroma, darier‟s disease, cicatricial alopecia, seborrheic keratosis, urticarial vasculitis, raynaud‟s phenomenon, striae distensae, mucinous carcinoma, porokeratosis, clear cell acanthoma, angioma serpiginosum, solitary angiokeratoma, fibroepithelioma of Pinkus, bowen disease, actinic keratosis, sebaceous hyperplasia, scabies, pediculosis and vitiligo.
Also some features of skin aging can be detected easily with dermoscopy. Measurement of skin aging with dermoscopy will give more reliable and objective results than the scales using clinical criteria. Prevention and treatment of skin aging can be measured with the dermoscopic photoaging scale (DPAS) and efficacy of many therapeutic application can be investigated. In this study, assessment of facial aging by dermoscopy by means of DPAS criteria. Measurement of skin aging with dermoscopy will give more reliable and objective results than the scales using clinical criteria.
This study was carried for evaluation of facial aging in male using dermoscopy and application of DPAS criteria. Also the study of the effect of the degree of sun exposure, smoking index, Glogue photoaging scale and skin type.
One hundred and seventeen male participants were classified into 3 groups representing the forth decade (30-39 years old) the sixth decade (50-59) and beyond the sixth decade (≥60 years old). They had clinical signs of skin aging, with Fitzpatrick skin types III, IV or V and Glogau's photoaging classification types I, II, III or IV. The participants were divided according to sun exposure index into mild, moderate and severe and divided into smokers and non smokers.
The most prominent dermoscopic findings were superficial wrinkles followed by hypo-hyperpigmented macules in group I, superficial wrinkles followed criss- cross wrinkles in group II, criss-cross wrinkles, yellowish discoloration and deep wrinkles in group III.
Dermosopic evaluation revealed that there was a highly significant difference among the three study groups as regard DPAS score (the mean was 15 ± 4.2) in group III. Also a highly significant difference among the three study groups was found regarding some dermatoscopic finding; as Yellowish discoloration, Yellow papules, Telangiectases, Senile Comedones, Deep Wrinkles and Criss-cross wrinkle to reach its maximum in group 3 with a percentage of 100%, 70%, 90%, 55%, 100%, 90% respectively.
Most of the participants having skin phototypes III, IV or V. There was significant increase in telangiectasia more in type III (52.8%) than IV (30.8%) than V (0%) among group I. There was no significant difference between group II and III Case skin with skin type III, I. A highly significant increase in diffuse erythema between study groups was found being maximum in group III (65%). Also There was a significant increase between the three skin types as regard blotchy erythema with type III more affected (60%) compared to (42.9%) with type IV and (0%) with type V in group II.
In this study a highly statistically significant difference was observed between the smokers and nonsmokers in senile comedon among group II (the percentage was 47.8% in smokers and 5.3%in non smokers). Also the DPAS score increases in smokers (12.3±3.7) than non smokers (11.4±2.4) in group II. And in group III, the score in smokers was (16.0 ±4.3) and in non smokers (13.1±3.7).
The study showed that increase sun exposure index is associated with significant increase in yellow papule, highest percentage (23.8%) among cases with moderate sun exposure in group I and a significant increase in score (mean is 13.5±3.7) among group II with severe sun exposure.
Among group I the study shows that there was a significant difference with increase in the Glogau's scale as regards score (8.8±2.8) with Glogau's scale 3 and hypo-hyperpigmented macule (100%) with Glogau's scale 2 and in criss-cross wrinkles (78%) in glogue scale 3. Also there was a highly significant increase in deep wrinkle to reach maximum (90.2%) in the Glogau's scale 3.
Among group II there was a significant difference in the as regards DPAS score being more in glogue scale 4 (13.8±2.9) and senile comedones (58.3%) also in glogue scale 4.
Among group III, there was no significant difference in DPAS score or criteria between the participants who were of glogue scale 3 & 4.
The study showed that R2 has higher score than R1 & R3 among the three study groups so it appears to be the most affected area by means of Dpas criteria. In group1 its score was (4.25± 1.68), in group II its score was (6± 1.71) and in group III its score was (7.05± 1.37).
Other data
| Title | Dermoscopic Evaluation of Facial Aging in Males | Other Titles | التقييم الديرموسكوبي لشيخوخة الوجه فى الرجال | Authors | Fatma Ahmed Yousef | Issue Date | 2014 |
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