aging face ppt
DESCRIPTION
role of uv rays, intrinsic and extrinsic causesTRANSCRIPT
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AGING FACE: PATHOPHYSIOLOGY
By
Dr. D R Dhaked
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Aging
Begins day we are born and highly individualized No single measure of how “old” a person is Proceeds at different rates in different people Gradual decline in organ functional reserves with
reduction in ability to maintain homeostasis under stress
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Facial Aging
Begins with surface and subsurface structural changes in multiple facial tissue layers, including skin, fat, muscle and bone.
Facial tissue layers age interdependently, contributing to overall facial appearance.
Changes in one tissue layer have an effect on the other layers.
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Skin
With age, skin undergoes several changes.
• More likely to wrinkle or sag
• Reduction in collagen
• Thinner
• Drier
• Less elastic
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Fat
-A youthful look depends on having the right amount of facial fat in right places. Redistribution, accumulation, and atrophy of fat lead to facial volume loss. • Some areas lose fat (forehead and cheeks).• Other areas gain fat (mouth and jaw).• Modification of the fat pads leads to contour deficiencies.
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Bone
•There is a significant loss of facial bone with age.•Aging of the craniofacial skeleton may be due to changes in relative dynamics of bone expansion and bone resorption. •Bone resorption leads to biometric volume loss. •Without the structural support of bone, there are noticeable changes in the other layers of overlying soft tissue and skin
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Signs of Facial Aging
• Greater visibility of bony landmarks, lines and wrinkles• Prominence of transverse forehead lines• Nasolabial folds become more prominent• Hollowing of the mid-face (loose skin)• Changes in area around the mouth (vertical wrinkles, lipthinning and flattening)• Development of prejowl depression
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Aging
INTRINSIC SKIN AGING (chronologic aging) or normal aging
EXTRINSIC AGING
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INTRINSIC SKIN AGING (chronologic aging)
Inevitable natural aging process that occurs in all people Occurs as part of a pre-programmed degeneration within
cells and extracellular matrix in all skin layers. Although begin in 20’s, visible signs are not apparent for
many decades. Intrinsic aging proceeds at highly variable rates between
different people Primarily determined by unique genetic make-up and
underlying type of skin
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Intrinsic Aging: Role of Telomeres
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Telomeres
Tandem repeats of short base sequences, ...TTAGGG... in mammals, at end of each chromosome, that are required for chromosome stability.
With continued cell division, telomeres are shortened, resulting in loss of ability of cells to divide.
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Telomeres
Telomerase activity is detected in vitro and in vivo in normal human epidermis, primarily in the proliferative basal layer
Not found in the dermal compartment of skin or in cultured fibroblasts
Harle-Bachor, C, Boukamp, P: Telomerase activity in the regenerative basal layer of the epidermis in human skin and in immortal and carcinoma-derived skin keratinocytes. Proc Natl Acad Sci USA 1996 93: 6476–6481,
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Cytoskeleton and Skin aging
Aged skin has increased rigidity Due to an increase in F actin filaments Important in age related loss of elasticity of
the skin.
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Endocrine System and Aging
With aging, the levels of epidermal precursor of vitamin D3 decrease.
Older individuals are more susceptible to vitamin D3 deficiency in absence of regular sun exposure.
May lead to osteoporosis, psoriasis and skin cancer
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Endocrine System and Aging
Estrogen stimulates fibroblasts to make collagen
Decreased levels of estrogen are associated with loss of collagen and increased wrinkling
HRT protects skin from aging
Baumann, L. “A dermatologist's opinion on hormone therapy and skin aging,” Fertility and Sterility 2005 Aug;84(2):289-290.
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Age related changes in metabolic
functions
Reduced oxidative phosphorylation by mitochondria
Diminished synthesis of structural, enzymatic and
regulatory proteins
Decreased capacity for uptake of nutrients
Increased DNA damage and diminished repair of
chromosomal damage
Accumulation of oxidative damage in proteins and
lipids (eg lipofuscin pigment)
Accumulation of advanced glycosylation end
products
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Morphological alterations
Irregular and abnormally lobed nuclei
Swollen, pleomorphic and vacuolated
mitochondria
Decreased endoplasmic reticulum
Distorted Golgi apparatus
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INTRINSIC SKIN CHANGES• Epidermis
• Keratinocytes demonstrate slower turnover.• Keratin sloughs more slowly with thickening of keratin layer.
• Melanoctyes decrease in number and produce less melanin.
• Uneven melanin pigment distribution.• Flattening of the epidermis-dermis junction. Prone to blistering.
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Dermis Fibroblasts – Decreased number and less
collagen production. Collagen – Decreased quantity. Abnormal,
weakened structure. Elastin – Thickened fibers with less elasticity. Matrix – Decreased quantity. Blood vessels – dilated, thinned and
weakened walls, prone to rupture.
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Subcutaneous Layer Fat loss and thinning. Weakening of the retaining ligaments. Fewer blood vessels. Sweat glands - decreased. Sebaceous glands – Fewer with less sebum
production. Hair shafts – fewer and thinner with less
pigment.
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EXTRINSIC AGING – Outside factors that accelerate intrinsic aging. Photoaging Smoking Malnutrition Hormonal Disorders Chronic Disease States Repetitive facial expressions Gravity
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Photoaging Caused by harmful effects of sunlight Ultraviolet light is the prinicipal cause of photoaging UVB penetrates only into epidermis and is
responsible for redness and blistering associated with sunburns.
UVA penetrates more deeply into dermis, related to photoaging
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Photoaged skin shows deep coarse wrinkling, excessive dryness, severe brown spots dry leathery texture when
compared to intrinsically aged skin
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PHOTOAGING
3 types of reactions to UV exposure: Free Radicals, essentially due to UVA Direct cell death, essentially due to UVB MMP Enzymes
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FREE RADICALS
Free radicals or ROS (reactive oxygen species) can lead to breakage of important molecules:
DNA (mutations, renewal failure, cell death)
collagen, elastin, GAG (skin firmness) lipids (membrane or structural)
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UV DAMAGE AND OXIDATIVE STRESS
DNA effects DNA fragmentation
Matrix effects MMP : TIMP ratio
Membrane effects: ROS Lipids peroxidation Hydroperoxides
Enzymatic systems SOD Glutathion peroxidase Heme oxidase
UV damage
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DNA DAMAGE
UVA acts through oxidative stress forming “reactive oxygen species” (ROS) that will damage the DNA and lead to cancer
UVB impact on DNA in the cell creating damages which may lead to cancer: non-melanoma skin cancer (NMSC)
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Advanced Glycosylation End Products
Post-translational modification of collagen
by sugar (AGE products)
Non-enzymatic attachment of glucose to
proteins
Formation of irreversible cross links
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UVB DAMAGE
Following structural changes in DNA, there is an altered expression of oncogenes and tumor suppression genes, such as p53
NMSC show a high incidence of mutation in p53 gene
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p 53 GENE
Plays an important role in: blocking the cell cycle after exposure to DNA-
damaging agents e.g. UV, in order to allow for repair before duplication
or killing the cell to avoid multiplication of damaged cells (formation of sunburn cells)
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p 53 GENE
The induction of detectable levels of p53 in human epidermis after UV exposure is relevant to skin carcinogenesis
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Collagen & Photodamage
Major structural component of ECM 70% of the dry weight of skin
Collagen degradation is believed to play a role in formation of wrinkles
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Collagen Cross Links
Intermolecular cross links between lysine
residues in adjacent collagen helices
Non-reducible cross links increase with age
Arise as a side effect of free radical damage
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MMP ENZYMES
Collagenases (1 to 4) are specific to various collagen,
Gelatinases (A & B) are non specific Stromelysins (1-3) specific of fibronectin,
laminin, collagen IV, Elastase: elastin
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Smoking Acts primarily via vasoconstriction of blood vessels going to and
through skin layers. Decreased blood flow results in
decreased nutrients, decreased oxygen supply increased inflammatory byproducts (free radical oxidation byproducts).
Net effect decreased collagen production and turnover, poor quality collagen and elastin, decreased quantity of matrix components and less gland secretions.
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Gravity. Constantly pulls on bodies. In 50s, when skin’s elasticity declines
dramatically, effects of gravity become evident. Causes tip of nose to droop, ears to elongate,
eyelids to fall, jowls to form, and upper lip to disappear while lower lip becomes more pronounced.
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