The effect of age on the thickness of the skin


Skin Thickness

The effect of age on the thickness of the skin strata is one of the more controversial
topics among dermatological researchers. Comparing measures
of skin layer thickness between individuals (and between studies) is especially
challenging due to significant variation in measurements between
individuals and between sites within each individual.
Qualitative histologic data from young and old skin provide a foundation
for discussing skin strata thickness quantitatively. Microscopic appearance

of aged skin reveals a thinner epidermis than young skin, although the
intrafollicular epidermis maintains a constant thickness. The epidermal
thinning is primarily due to a retraction of the rete pegs, resulting in a
flattened interface between the epidermis and dermis. One consequence is
that aged epidermis becomes less resistant to shearing forces and more
easily tom after trauma [4,12].
The flattening of the interface is also observed histologically at the ultrastructural
level. In young skin, basal cells display numerous villous cytoplasmic
projections into the dermis, resulting in a highly convoluted dermal/
epidermal interface. In contrast, basal cells from aged skin lack these serrations,
and the dermal/epidermal junction is flattened. Hull and Warfel used
scanning electron microscopy to determine that the corrugated papillary
interface between the dermis and epidermis is visible up through the sixth
decade; flattening occurs in the sixth through tenth decades [12]. This flattening
may also be associated with a decreased proliferative potential of
aged epidermis and could also affect absorption [12,13].
Aside from increased basal cell atypia, keratinization does not appear markedly
different in aged epidermis. Keratin filaments, lamellar bodies, and
keratohyalin granules are histologically present in usual amounts. The
appearance and number of horny cells does not appear to change or diminish
with age, so the stratum corneum retains its normal thickness of approximately
14-17 layers [12].
Ultrasound and microscopy studies focusing specifically on changes in
SC thickness with age show little or no appreciable change, even up to
the age of 97 [14,15]. However, note that there is significant variation
in SC thickness between individuals and between sites within each
Studies of epidermal thickness agree less. A confocal microscopy study of
34 women ages 18-69 found that the living epidermis thins on the back of
the arm with increased age [15]. A morphometric analysis of histological
sections from 64 individuals between 20 and 80 years old found progressive
and significant (6.4% per decade) thinning of the epidermis, beginning
in subjects as young as 30 years [16]. However, a microscopic study
of punch biopsies from the dorsal forearm, buttock, and shoulder included
71 people ages 20-68 and found no significant change in epidermal thickness
with age [17]. It is difficult to explain these differences between studies,
other than to tentatively attribute them to differences in site. Branchet et al.

[17] analyzed the upper inner arm, whereas the other studies looked at
different areas. To reach consensus, it may be important for future studies
to focus on standardized skin sites so that their results can be more easily
compared. Analyses regarding dermal thickness reveal similar results: no
change on the back of the arm [17] and progressive thinning on the upper
inner arm [16]. Again, skin site may be the main explanatory factor for
these contradictory results.
With studies conflicting on whether changes occur in epidermal and dermal
thickness, clearly studies of whole skin thickness are just as challenging to
interpret. An ultrasound study analyzed the effects of aging on two anatomically
similar areas of neck, one exposed to the sun throughout life, and the
other covered. This experiment included 30 women age 81 ± 6 and found
thinning of the skin (- 0.1 mm difference) in the photoaged region compared
to the covered area [18]. A larger study of 170 females ages 17-76 used
A-mode ultrasound to find significant thinning with age on sun-protected
skin, and thickening with age on sun-exposed skin [19]. The differences
between these studies might be accounted for by the older population in
the study by Richard et aI. [181, or by the use of different modes of ultrasound.
Richard et aI. suggested that perhaps solar elastosis causes thickening
in photoaged skin of younger individuals, but that this ceases to occur
in older people [18]. Other studies found an increase in skin thickness over
the first 20 years of life, then a period of either constant skin thickness
or progressive thinning, followed by more marked thinning in older individuals,
such that a diagram of skin thickness versus age might look like a
bell curve [20-23]. However, using B-mode ultrasonography, Pellacani
and Seidenari found an increase in facial skin thickness with age in 40
people between 25 and 90 years old [24]. Yet other ultrasound studies
showed thinning of forehead skin with age [25,26). One B-mode ultrasound
study of 61 women ages 18-94 found that skin thickness increased
on the forehead and buttock but decreased in extremity skin with increasing
age [271.
Despite extensive data, it is difficult to define the effects of aging on whole
skin thickness. Like the skin strata, individual and regional variation likely
plays a large role in the answer to this question. Also, elastoic effects
of chronic sun exposure are probably involved. Furthermore, hormonal
differences between individuals and throughout the aging process may
confound studies of skin thickness. The effects of estrogen on skin aging
are reviewed by Shah and Maibach [28]. More concordant future results
relating skin thickness and age might be obtained by greater standardization

of body site, patient population, and ultrasound method, such that different
laboratories use the same frequency and gain curves.

Author : kaabinet



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