Ageing of the skin

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Ultraviolet radiation is the main factor speeding the ageing process in skin. This may be very obvious when the wrinkled and inelastic exposed skin of an elderly person

Epidermis

Dermis

Hypodermis

Fig. 2.15 Layers of the skin.

TABLE 2.7 Functions of the skin

Function

Structure/cell involved

Protection against Chemicals, particles Ultraviolet radiation Antigens, haptens

Microbes

Horny layer Melanocytes

Langerhans cells, lymphocytes, mononuclear phagocytes, mast cells Horny layer, Langerhans cells, mononuclear phagocytes, mast cells

Preservation of a balanced internal environment Prevention of loss of water, electrolytes and macromolecules Shock absorption Strong, yet elastic and compliant covering

Horny layer ■ Dermis and subcutaneous fat

Sensation

Specialist nerve endings

Calorie reserve

Subcutaneous fat

Vitamin D synthesis

Keratinocytes

Temperature regulation

Blood vessels Eccrine sweat glands

Lubrication and waterproofing

Sebaceous glands

Protection and prising

Nails

Body odour

Apocrine sweat glands

Psychosocial display

Skin, lips, hair and nails

Ageing Picture Sequence

Fig. 2.16 Old face. Note the marked wrinkling and the lentigo on the left cheek, who has spent a Lot of time out of doors is compared with covered skin (e.g. buttock) of that same person. Ultraviolet rays, especially those of longer wavelength (UVA). damage

Fig. 2.16 Old face. Note the marked wrinkling and the lentigo on the left cheek, and destroy the collagen and elaslin in Ihe dermis, causing the skin to lose its tensile strength and elasticity. The wrinkled, prune-like faces of elderly Caucasoids living in sunny climates (Fig. 2.16) generate a substantial business in cosmetic surgery; however, prevention of photoageing by reducing excessive exposure to ultraviolet radiation is better than any facc-lift.

Hair shaft

Melanocyte

Sebaceous giand

Hair sheath Hair matrix

Epidermis

Dermis

Hypodermis

Hypodermal Plexus

Deep vascular plexus

Subcutaneous vessel

Derma) papilla

Horny layer Granular cell layer Prickle cell layer Basal cell layer Langerhans cell

Superficial vascular plexus Eccrine sweat duct

Eccrine sweat gland

Deep vascular plexus

Subcutaneous vessel

Hair shaft

Melanocyte

Sebaceous giand

Hair sheath Hair matrix

Derma) papilla

Personality disorders

Stresses or anxieties

Dermatitis artefacta

Hair Sheath
Fig. 2.17 The skin manifestations of systemic disease. B Erythema nodosum. ® Stevens-Johnson syndrome due to mycoplasma pneumonia with H Erythema multiforme ('target lesions') on skin.

THE HISTORY

The ready accessibility of the skin makes it tempting to examine patients with skin disorders without the benefit of a good history. However, the principles of a general

TABLE 2.8 Some examples of skin lesions and systemic disease

Skin Sesions Associations Ask about

Erythema nodosum

Pyoderma gangrenosum

Dermatitis herpetiformis

Generalised purpura

Dermatitis artefacta

Sarcoid, tuberculosis, post-streptococcal infection, connective tissue diseases, drugs, etc.

Ulcerative colitis, rheumatoid arthritis

Gluten enteropathy

Idiopathic thrombocytopenic purpura and other haematological disorders

Personality disorders

Cough and sputum, breathlessness, sore throat, drugs, etc.

Rectal bleeding, joint symptoms

Family history, change In bowel habit

Family history, haematuria, fever and weight loss

Stresses or anxieties medical history should be followed with emphasis on the events surrounding the onset of skin lesions and the progression of the disease. A careful enquiry into drugs (both systemic and topical), a past or family history of skin disease and details of the occupation and any hobbies are especially important.

As in other systems, the more difficult the diagnosis proves to be on examination, the more important the history. Although skin lesions may be caused by an exclusively dcrmatological problem, sometimes the history, or the lesion itself, may suggest that they are cutaneous manifestations of a more widespread condition (see Table 2,8 and Fig. 2.17).

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