Skin atrophy

Skin atrophy occurs due to disruption of the structure and function of connective skin and is clinically characterized by thinning of the epidermis and dermis. The skin becomes dry, transparent, wrinkled, gently folded, hair loss and telangiectasia are often observed.

Pathohistological changes in skin atrophy are manifested by thinning of the epidermis and dermis, a decrease in connective tissue elements (mainly elastic fibers) in the papillary and reticular layers of the dermis, and dystrophic changes in the hair follicles, sweat and sebaceous glands.

Along with thinning of the skin, focal compactions may be observed due to the proliferation of connective tissue (idiopathic progressive skin atrophy).

Atrophic processes in the skin can be associated with a decrease in metabolism during aging (senile atrophy), with pathological processes caused by cachexia, vitamin deficiencies, hormonal disorders, circulatory disorders, neurotrophic and inflammatory changes.

Skin atrophy is accompanied by a disruption of its structure and functional state, which is manifested in a decrease in the number and volume of certain structures and the weakening or cessation of their functions. The process may involve the epidermis, dermis or subcutaneous tissue separately, or all structures simultaneously (panatrophy of the skin).

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Epidemiology

Senile skin atrophy develops mainly after 50 years, the full clinical picture is formed by 70 years. The skin loses elasticity, becomes flaccid, wrinkled, especially around the eyes and mouth, on the cheeks, in the area of the hands, on the neck, easily gathers into slowly straightening folds. The natural color of the skin is lost, it becomes pale with a yellowish or slightly brownish tint. Dyschromia and telangiectasias, dryness with small bran-like peeling, increased sensitivity to cold, detergents and drying agents are common. Healing of wounds, which easily appear even with minor injuries, is slow. Greater severity of atrophic phenomena manifests itself on exposed parts of the body, due to both the anatomical features of these areas and the impact of the environment, primarily the cumulative effect of sunlight. Elderly and elderly people have an increased tendency to develop various dermatoses and neoplasms (eczematous reactions, senile angiomas, senile adenomas of the sebaceous glands, actinic and seborrheic keratoses, basaliomas, Dubreuil's lentigo, senile purpura, etc.). A special variant of age-related skin changes is colloid millum, characterized by multiple waxy translucent nodular elements on the face, neck, and hands.

[ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ]

Causes skin atrophy

The main causes of skin atrophy are the following:

1. Generalized thinning of the skin: aging; rheumatic diseases; glucocorticoids (endo- or exogenous).
2. Poikiloderma.
3. Atrophic scars (striae).
4. Anetoderma: primary; secondary (after inflammatory diseases).
5. Chronic atrophic acrodermatitis
6. Follicular atrophoderma.
7. Atrophoderma vermiform.
8. Pasini-Pierini atrophoderma.
9. Atrophic nevus.
10. Panatrophy: focal; hemiatrophy of the face.

It is known that atrophic changes in the skin are one of the manifestations of the side effects of corticosteroid therapy (general or local).

Local skin atrophy from corticosteroid ointments (creams) develops mainly in children and young women, as a rule, with irrational, uncontrolled use, especially fluorine-containing (fluorocort, sinalar) or very strong ointments prescribed under an occlusive dressing.

The mechanism of action of atrophy under the influence of corticosteroid drugs is explained by a decrease (or suppression) of the activity of enzymes involved in the biosynthesis of collagen, suppression of the effect of cyclic nucleotides on the production of collagenase, the synthetic activity of fibroblasts, as well as their effect on fibrous, vascular structures and the main substance of connective tissue.

[ 13 ], [ 14 ], [ 15 ]

Pathogenesis

Thinning of the epidermis is observed due to a decrease in the number of rows of the Malpighian layer and the size of each individual cell, smoothing of epidermal outgrowths, thickening of the stratum corneum and insufficient expression of the granular layer, as well as an increase in the melanin content in the cells of the basal layer. Thinning of the dermis is accompanied by destructive and hyperplastic changes in fibrous structures, a decrease in the number of cellular elements, including tissue basophils, thickening of the walls of blood vessels and atrophy of hair follicles, as well as sweat glands. Collagen fibers are located parallel to the epidermis, become partially homogenized. Plastic fibers thicken, closely adjacent to each other, especially in the subepidermal sections. They are often fragmented, have the appearance of lumps or spirals, in places are located in a felt-like manner (senile elastosis). Electron microscopy revealed signs of decreased biosynthetic processes in epidermal cells in aged skin. There is a decrease in organelles, clearing of the mitochondrial metric, a decrease in the number of cristae and their fragmentation, which indicates a decrease in energy metabolism in them. In the cytoplasm of basal epithelial cells, accumulation of fat droplets and lipofuscin granules, as well as the appearance of myelin structures are noted. In the epithelial cells of the upper sections of the spinous layer, lamellar granules are modified, there are signs of a high content of amorphous substance in them - a precursor of keratin. With age, changes in epithelial cells increase, destructive changes appear, in addition to atrophic ones, often leading to the death of some of them. Dystrophic changes, an increase in the number of microfibrils are also noted in collagen fibers, and a cytochemical study reveals qualitative changes in glycosaminoglycans (amorphous masses appear). In elastic fibers, lysis, vacuolization of their matrix and a decrease in the number of young elastic forms are observed. Vessels are characterized by thickening and loosening of the basal membranes, sometimes their multilayering.

Colloid millum is characterized by basophilic degeneration of the collagen of the upper dermis, deposition of colloid, the nature of which is unclear. It is believed that its formation is a consequence of degenerative changes in connective tissue and deposition of material of vascular origin around damaged fibers. It is believed that colloid is mainly synthesized by fibroblasts activated by sunlight.

Histogenesis of skin atrophy

Atrophic and dystrophic changes in the skin during aging occur as a result of genetically determined changes in cells caused by a decrease in metabolism, weakening of the immune system, disruption of microcirculation and neurohumoral regulation. It is assumed that 7 genes out of 70 that affect aging processes are especially important. In the mechanisms of aging at the cellular level, membrane disruption is of decisive importance. Of the exogenous effects, climatic factors are of the greatest importance, primarily intense insolation.

Aging of the epidermis is considered mainly as a secondary process caused by trophic disorders. During aging, specific functions of the skin decrease, the immune response weakens, its antigenic properties change, which often leads to the development of autoimmune diseases in old age, the mitotic activity of the epidermis decreases, changes in the nervous and vascular apparatus of the skin are observed, vascularization decreases, transcapillary exchange is disrupted, significant morphological changes develop in the fibrous structures of the dermis, in the main substance and appendages of the skin.

[ 16 ], [ 17 ], [ 18 ], [ 19 ]

Symptoms skin atrophy

The skin in the atrophic focus looks senile, finely folded, resembles tissue paper, and is easily injured. Due to translucent vessels and capillary dilation, which is observed with more pronounced thinning of the skin and a deeper process, the skin acquires a livid shade.

The bluish color in the foci of atrophy may be due to the anti-inflammatory action of fluorine. In the foci of atrophy, especially in the elderly, purpura, hemorrhages, and stellate pseudoscars may be observed.

Superficial atrophies may be reversible if the use of ointments is stopped in time. Skin atrophies may involve the epidermis or dermis, be limited, diffuse or in the form of stripes.

Deep atrophy of the skin and subcutaneous tissue (panatrophy) usually occurs after intrafocal injections of corticosteroids.

Differential diagnosis

Differential diagnostics are carried out with other atrophies, scleroderma, and panniculitis.

[ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ]

Treatment skin atrophy

First, it is necessary to stop using corticosteroid ointments and creams. Usually, no treatment is required. To prevent atrophy, it is recommended to use corticosteroid ointments in the evening, when the proliferative activity of skin cells is minimal. Vitamins and products that improve skin trophism are prescribed.