Skin atrophy

Skin atrophy occurs due to disruption of the structure and function of the 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 noted.

Pathohistological changes in skin atrophy are manifested by thinning of the epidermis and dermis, reduction of connective-woven elements (mostly elastic fibers) in the papillary and reticular layer of the dermis, dystrophic changes in hair follicles, sweat and sebaceous glands.

Simultaneously with thinning of the skin, focal seals can be noted 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, avitaminosis, hormonal disorders, circulatory disorders, neurotrophic and inflammatory changes.

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

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Epidemiology

Atrophy of the senile skin develops mainly after 50 years, a complete clinical picture is formed by the age of 70. The skin loses its elasticity, becomes flabby, wrinkled, especially around the eyes and mouth, on the cheeks, in the area of the hands, on the neck, it is easily collected in slowly straightening folds. The natural coloring of the skin is lost, it becomes pale with a yellowish or slightly brownish hue. Frequent dyschromia and telangiectasia, dryness with finely shaved peeling, increased sensitivity to cold, washing and drying agents. Healing of wounds, easily appearing even with small injuries, is slow. The high severity of atrophic phenomena is manifested in the open parts of the body, caused both by the anatomical features of these areas and by the environment, primarily by the cumulative effect of sunlight. In the elderly and elderly people, the propensity to develop various dermatoses and neoplasms is increased (eczematous reactions, senile angiomas, senile adenomas of the sebaceous glands, actinic and seborrheic keratoses, basaliomas, Dubentia lentigines, senile purpura and lr.). A special variant of senile skin changes is colloid-millum, characterized by multiple wax-like translucent nodular elements on the face, neck, hands.

[13], [14], [15], [16], [17], [18], [19], [20], [21]

Causes of the 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. Poikilodermia.
3. Atrophic scars (stria).
4. Anetoderma: primary; secondary (after inflammatory diseases).
5. Chronic atrophic acrodermatitis
6. Follicular atrophodermia.
7. Atrophoderma wormlike.
8. Atrophoderma Pasini-Pierieri.
9. Atrophic nevus.
10. Panathrophy: focal; face hemiatrophy.

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

Local atrophies of the skin from corticosteroid ointments (creams) develop mainly in children and young women, usually with irrational, uncontrolled use. Particularly fluorine-containing (fluorocort, synalar) or very strong ointments assigned for occlusive dressing.

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

[22], [23], [24], [25], [26], [27]

Pathogenesis

There is a thinning of the epidermis due to a decrease in the number of rows of the Malpighian layer and the size of each cell separately, a smoothing of the epidermal outgrowths, a thickening of the horny and insufficient granularity, and an increase in the melanin content in the basal layer cells. 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 vessel walls and atrophy of hair follicles, and sweat glands. Collagen fibers are located parallel to the epidermis, becoming partially homogenized. Plastic fibers thicken, closely adjacent to each other, especially in the subepidermal regions. Often they are fragmented, they look like clumps or spirals, in places are located felt-like (senile elastosis). Electron microscopy in senile skin shows signs of a decrease in biosynthetic processes in the epidermal cells. There are a decrease in organelles, enlightenment of the mitochondrial metric, a decrease in the number of cristae and their fragmentation, which indicates a decrease in the energy metabolism in them. In the cytoplasm of basal epitheliocytes, the accumulation of fat droplets and lipofuscin granules is noted, as well as the appearance of myelin structures. In the epithedocytes of the upper parts of the spinous layer, the lamellar granules are modified, there are signs of a high content of amorphous substance in them, the precursor of keratin. With age, changes in epitheliocytes increase, there are, in addition to atrophic, destructive changes, often leading to the death of some of them. In collagen fibers, dystrophic changes are also observed, an increase in the number of microfibrils, and in the cytochemical study, 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 noted. Vessels are characterized by thickening and loosening of the basal membranes, sometimes - their multilayeredness.

With colloid-milloma, basophilic degeneration of the collagen of the upper dermis is detected, the deposition of a colloid whose nature is unclear. It is believed that its formation is a consequence of degenerative changes in the connective tissue and the deposition around the damaged fibers of a material of vascular origin. There is an opinion that the colloid is mainly synthesized by fibroblasts, activated by the influence of sunlight.

Histogenesis of skin atrophy

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

Aging of the epidermis is considered in the main as a secondary process, caused by trophic disturbances. With aging, specific skin functions decrease, the immune response weakens, changes in its antigenic properties occur, which often leads to the development of autoimmune diseases in old age, 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 are developing in the fibrous structures of the dermis, in the main substance and appendages of the skin.

[28], [29], [30], [31], [32], [33]

Symptoms of the skin atrophy

The skin in the focus of atrophy looks old, melkoskladchatoy, like tissue paper, easily traumatized. Due to the translucent vessels and the expansion of the capillaries, 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 fluoride. In the foci of atrophy, especially in the elderly, purpura, hemorrhages, stellate pseudo-scars can be observed.

Superficial atrophy can be reversible if the application of ointments is stopped on time. Atrophies of the skin can seize the epidermis or dermis, be limited, diffuse or in the form of bands.

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

Differential diagnosis

Differential diagnosis is performed with other atrophies, scleroderma, panniculitis.

[34], [35], [36], [37], [38], [39], [40]

Treatment of the skin atrophy

First, it is necessary to stop the use of corticosteroid ointments and creams. Usually no treatment is required. For the prevention of atrophy, it is recommended to use corticosteroid ointments in the evening, when the proliferative activity of skin cells is minimal. Prescribe vitamins and products that improve skin trophism.