An official website of the United States government. Life (Basel). J. Investig. Am. Defining skin aging and its risk factors: a systematic review and meta-analysis. With advancing age, these functions are increasingly impaired. Biomed. A. Fifty years of skin aging. J. Steroids Horm. https://doi.org/10.1136/bmj.e5909 (2012). Nagata, C. et al. J. Dermatol. https://doi.org/10.1016/j.jphotobiol.2012.11.010 (2013). [1] Understanding the influence of these factors can help shape and inform a wound care assessment, treatment plan, and prognosis. Environmental influences on skin aging and ethnic-specific Dermatol. 143, 397402. A primary literature search was performed using the Embase, PubMed and Web of Science databases in October 2020. External factors that affect skin: climate. Extrinsic ageing, on the other hand, is a result of lifestyle and environmental factors. Venereol. Gao, Q. et al. 32, 330339. https://doi.org/10.1136/bmj.c6614 (2010). You are using a browser version with limited support for CSS. https://doi.org/10.1016/j.jdermsci.2015.04.001 (2015). 5a). https://doi.org/10.1080/00015550310015464 (2003). PLoSOne 5, e15270. Nonetheless, there appears to be a general male predisposition to increase likelihood of skin aging manifestation. Dermatol. Belvedere R, Novizio N, Eletto D, Porta A, Di Maio U, Petrella A. A better understanding of the influence of these factors on repair may lead to therapeutics that improve wound healing and resolve impaired wounds. The nervous system regulates tissue stem and precursor populations throughout life. Intrinsic factors can include altered nutritional status, vascular disease issues, and diabetes. 2]. Sci. Finally, this article will serve as a rough directory to the relevant original research publications at bare minimum, while providing readers with an overview of signs linked to skin aging and their associated risk factors. Acad. Bethesda, MD 20894, Web Policies 110, 176181. Sample sizes and subject characteristics varied between studies, with samples sizes ranging from 24 females only17, to 20,295 males and females from the NHANES study18. Intrinsic skin aging, also known as chronological cutaneous aging, is due to the passing of time. Pollution and skin: From epidemiological and mechanistic studies to clinical implications. Studies examining smoking status compared ever smokers to never smokers, or between current, former and non-smokers. Sci. Moreover, the confounding effect of sub-ethnicity on skin aging phenotype cannot be discounted; one study reported a non-significant difference in wrinkling between Mongolians, an Asian ethnic group, and Caucasians (OR 1.014, 95% CI 0.4682.196)34. Nonetheless, a doseresponse relationship between sun exposure and wrinkling could be discerned. J. 1). This chapter discusses in detail all the various factors that affect the process of skin aging. Intrinsic aging of the skin is a slow process that happens over many years. Of note, although SCINEXA was validated as a scale which calculates an overall skin aging score from the individual scores of 23 skin aging signs7, most studies using SCINEXA (n=10) reported individual outcome scores, instead of overall skin aging score, while only one study reported overall SCINEXA score27. Article The effects of these two types of factors overlap for the most part. 130, 11071115. 1 was sufficiently thorough. Pharmaceutics. In a subject population aged above 30, dyspigmentation was found to be more prevalent in Chinese and Japanese than in Germans only if measured on the cheeks and in subjects up to 60years old, while wrinkling in Japanese above 60years old and Chinese of any age were not significantly more severe than that in Germans (Supplementary Dataset). Please enable it to take advantage of the complete set of features! The texture, the elasticity of the skin, and the changes in the skin with age- all these can be divided into: Internal factors External factors Internal Factors The factors include Genetics, Hormones and specific health conditions like PCOS or Diabetes. Gender differences in skin aging and the changing profile of the sex hormones with age. This review focussed primarily on odds ratios. Nonetheless, there was a doseresponse relationship between pack-years of smoking and wrinkling, across four studies, where an increase in number of pack-years of smoking resulted in a stronger association with wrinkling manifestation (Fig. Cosmet. There are three types of factors which can affect wound healing: (1) intrinsic, (2) extrinsic, and (3) iatrogenic. (a) Forest plot for skin aging and current smoking (non-smoking as reference). Res. Smoking was categorised as smoking status or smoking exposure. Intrinsic structural changes occur as a natural consequence of ageing and are genetically determined. Fighting against Skin Aging - PMC - National Center for Biotechnology Biol. Adv. 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Individuals who suffer with incontinence, especially in relation to faeces, will often be at risk of skin breakdown and develop incontinence-associated dermatitis . To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Beagley, J. 1. PubMed Perner, D. et al. Dermatol. https://doi.org/10.1111/bjd.13646 (2015). are needed to determine whether certain host habits affect skin . Facial wrinkling in men and women, by smoking status. Zouboulis, C. C. & Makrantonaki, E. Clinical aspects and molecular diagnostics of skin aging. 75, 873880. Krutmann, J., Bouloc, A., Sore, G., Bernard, B. PubMed 1 We would aver that intrinsic biological, and certainly environmentally enhanced, skin aging involves a major disease component simply . Overall, most methods of outcome quantification entailed visual assessment by clinicians or researchers according to arbitrary grading scales (Supplementary Table 1), such as the Daniell wrinkling scale33 and the Beagley-Gibson grading scale for SSM26, both of which were used recurrently in different studies. Dermatol. Altered skin integrity increases the chance of infection, impaired mobility, and decreased function and may result in the loss of limb or, sometimes, life. Although no pooled odds ratio was available for menopausal status and skin aging, individual studies have previously reported a significant association for postmenopausal status with photoaging (OR 1.5, 95% CI 1.2, 1.8)41, and no significant association with wrinkling (OR 5.00, 95% CI 0.37, 67.66)25. Studies used grading scales (n=68) which were often ordinal wherein higher score values indicated greater severity of skin aging outcome. It is influenced by your body's many internal processes, including: genetic factors. 40, 467481. J. J. Clin. [Intrinsic factors, genes, and skin aging] - PubMed Sustained exposure to the sun triggers the formation of free radicals. https://doi.org/10.1016/j.clindermatol.2010.07.001 (2011). Extrinsic factors may or may not include pressure, friction, shearing, falls, immobility, and surgical procedures, among others. 2015, 318586. https://doi.org/10.1155/2015/318586 (2015). Get the most important science stories of the day, free in your inbox. The search term for all databases included skin aging or skin ageing in the title or abstract, and risk, or protective, or epidemiology in all index fields. Copyright 2017 Elsevier Inc. All rights reserved. There are many factors that affect the skin in many ways. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Ezzedine, K. et al. Free Radic. A tale of two cities. https://doi.org/10.1016/j.jdermsci.2014.08.008 (2014). For wrinkling due to more than 2h per day versus less than 2h per day, due to various categories reported between studies, only meta-analyses considering a sample with a preponderance of higher sun exposure yielded significant pORs (Fig. Sun damage in teenagers skin. J. Aust. 20, 7180. J. Investig. Unauthorized use of these marks is strictly prohibited. https://doi.org/10.1038/jid.2009.366 (2010). Eligible articles from this secondary search were subjected to the same citation screening process to obtain additional studies, which when deduplicated and included with the results from the secondary search, yielded a total of 74 eligible articles. Surg. Int. Defining skin aging and its risk factors: a systematic review - Nature https://doi.org/10.1016/j.jdermsci.2016.05.011 (2016). CAS Determinants in the Rate of Skin Aging: Ethnicity, Gender, and 40, 502515. Softw. Ann. Some of these compounds, e.g., lauric acid and sapienic acid, have inhibitory activity against G+ pathogenic bacteria, e.g., Corynebacterium bovis ]. https://doi.org/10.1016/j.jdermsci.2013.07.006 (2013). Surg. Kumal Rajpaul. Nonetheless, significant associations were reported for sunscreen use with lower perceived age68 and reduced degree of photoaging30. Sci. It affects skin with the densest population of sebaceous follicles, including the face, the upper part of the chest, and the back. However, this review identified no clear association between skin colour and skin aging. Dobos, G., Lichterfeld, A., Blume-Peytavi, U. https://doi.org/10.1016/j.jaad.2015.11.042 (2016). Sgonc, R. & Gruber, J. Age-related aspects of cutaneous wound healing: A mini-review. The association of alcohol intake was also examined by multiple studies21,23,35,36,57,65,66,67,68,69,70. Pressure ulcer or injury; Skin integrity; Skin tears; Ulcers; Wounds. ADS 6a, Model 2). Extrinsic and intrinsic factors leading to skin breakdown 33, 19031908 (1992). Clin. Defining skin aging and its risk factors: a systematic review and meta In this article, new knowledge about genes and biological processes that can significantly affect skin homeostasis in old age and can lead to the typical morphological and physiological characteristics of aging . https://doi.org/10.1016/s0190-9622(89)70227-9 (1989). Ekiz, O. et al. Sci. 2022 Dec 12;12(12):1852. doi: 10.3390/biom12121852. The hand-search process was repeated for results from the secondary search to ensure a thorough record was obtained (see Fig. Fuks, K. B. et al. An epidemiological survey of skin damage on the dorsal hand in rural populations in northern and southern China. About skin|factors that affect skin | Eucerin Ashcroft, G. S., Mills, S. J. J. Dermatol. Sleep 36, 13551360. BMJ 345, e5909. J. Dermatol. A severe chronic outdoor urban pollution alters some facial aging signs in Chinese women. Wound healing is a complex, dynamic process supported by a myriad of cellular events that must be tightly coordinated to efficiently repair damaged tissue. Another study also found that sleep deprivation led to a perceived increase in facial signs, including hanging eyelids and wrinkling86. 2016 Feb;67(2):103-6. doi: 10.1007/s00105-015-3746-2 . Notably, the term pigmentation often referred to changes in pigmentation, dyspigmentation, or the formation of pigment spots; we henceforth refer to this phenotype as dyspigmentation. https://doi.org/10.1016/j.jdermsci.2008.10.001 (2009). Gandini, S. et al. J. Dermatol. Studies indicate that aging male and female skin differs in type, consistency and sensitivity to external factors. Association between dietary intake of n-3 polyunsaturated fatty acids and severity of skin photoaging in a middle-aged Caucasian population. Rep. 7, 15329. https://doi.org/10.1038/s41598-017-15295-8 (2017). https://doi.org/10.3389/fenvs.2014.00011 (2014). Wound Care (New Rochelle) 2, 510. https://doi.org/10.1001/archderm.138.11.1454 (2002). Significant associations for increased lentigines were found with Air Quality Index (AQI)48,49, contact with fossil fuels50, nitrogen dioxide51, particulate matter of diameter 2.5 microns or less (PM2.5)50,52,53, particulate matter of diameter 10 microns or less (PM10)54, second hand smoke exposure50, soot54, and traffic-associated particles54. Relative contribution of intrinsic vs extrinsic factors to skin aging as determined by a validated skin age score. 5b). Dermatol. For example, it is unrealistic to expect a wound to heal in the same manner in a young healthy . These articles examined outcomes linked to skin aging by articles from the primary search and reported risk factor associations but did not necessarily link the outcomes to skin aging themselves. Internet Explorer). Med. A secondary search was conducted by hand-searching references cited by the eligible articles from the primary search. Environ. For each skin aging sign, we categorised associated risk factors into two types: non-modifiable and modifiable risk factors. Malvy, J.-M. et al. and transmitted securely. Interestingly, photoaging, often attributed to sun exposure, was not always significantly associated with sun exposure (Supplementary Table 6). Age Ageing 35, 110115. The other authors declare no other competing interests. As with skin aging and diet associations, no pooled association for skin aging and alcohol consumption could be obtained due to the between-study variation in the quantification of alcohol consumption. Gandini, S. et al. 27, e345-356. J. Dermatol. https://doi.org/10.1111/jdv.15865 (2020). Changes occur in the epidermis, dermis and hypodermis leading to thin, dry and sagging skin, while loss of structure and integrity . Environ. Understanding best practices in addressing skin integrity issues can promote positive outcomes with the elderly. Guyuron, B. et al. Int. & Kottner, J. Characterizing facial skin ageing in humans: Disentangling extrinsic from intrinsic biological phenomena. Park, J. H., Oh, S. J. Purba, M. B. et al. This review examines the association of epidemiological factors with human skin aging signs that are assessable by non-invasive means. https://doi.org/10.1177/0164027516658502 (2017). 22, 13121318. The definition of skin integrity is the health of the skin. Irene Karrouze. Odds ratios included in the random effects models were also ensured to compare identical or non-overlapping exposure and reference categories (i.e., subjects grouped in a given exposure category in one study did not qualify to be grouped into the reference category from another study). The narrowest sample age range reported was 1315 years19 and the widest was 1896 years20, with the youngest subject aged one18 and the oldest aged 101 years21. As we age, our skin will naturally lose dermal collagen, melanin, hair follicles, and sebaceous glands. Epidemiological evidence that indoor air pollution from cooking with solid fuels accelerates skin aging in Chinese women. & Lober, C. W. Structural and functional changes of normal aging skin. Drakaki, E., Dessinioti, C. & Antoniou, C. V. Air pollution and the skin. J. Cosmet. PubMedGoogle Scholar. Fussell, J. C. & Kelly, F. J. Oxidative contribution of air pollution to extrinsic skin ageing. Of note, non-significant associations were reported by one study for both dyspigmentation and wrinkling with carbon monoxide, ozone, PM2.5, PM10, and sulfur dioxide57; these results were attributed to imprecise quantification of air pollutants. Arch. Suppa, M. et al. 130, 27192726. Sci. Griffiths, C. E., Wang, T. S., Hamilton, T. A., Voorhees, J. J. Associations with age were obtained for eight skin aging phenotypes: cutis rhomboidalis nuchae, dryness, elastosis, ephelides, facial lentigines, higher SSM score, telangiectasia, and wrinkling (see Fig. However, the pooled estimates for cutis rhomboidalis nuchae, dryness, elastosis, and ephelides respectively with age were non-significant. CAS The SCINEXA: A novel, validated score to simultaneously assess and differentiate between intrinsic and extrinsic skin ageing. Nonetheless, it appeared that dyspigmentation (or lentigines) and wrinkling on the face were significantly associated with various types of air pollution. Article J. & Ellis, C. N. A photonumeric scale for the assessment of cutaneous photodamage. J. Dermatol. Dermatol. Am. https://doi.org/10.1371/journal.pone.0015270 (2010). Changes in Skin Condition in Relation to Degree of Exposure to Ultraviolet Light 145 (School of Biology, Western Australian Institute of Technology, 1980). Investig. Impairments in Skin Integrity - PubMed Clin. BMJ 341, c6614. The physical and chemical properties of the skin influence the dominance of specific microbiota, their proportions, and their mutual relationships. Public Health 19, 383386. Extrinsic factors include falls, accidents, pressure, immobility, and surgical procedures. The SAS is influenced by factors already recognized to affect the aging phenotypes; however, factors related to the rate of intrinsic aging, presumably genetic in character, seem to play a. 33, 13631368. Molecular Mechanisms of Skin Aging and Rejuvenation Photoimmunol. 151, 111122. 100, adv00153. 130, 167173. A related protective factor, sunscreen use, was significantly associated with wrinkling (pOR 0.50, 95% CI 0.25, 0.98) with non-significant heterogeneity (I2=0.00%, p=0.387). Dermatol. It is a consequence of both intrinsic factors and extrinsic factors. 17, 178183. However, phenotypes considered as skin aging signs or used as measures of skin aging were found to differ between studies. J. Investig. We aimed to obtain a broad overview of the epidemiology of skin aging; hence, all participant subjects available in the literature were considered. Thus, skin aging may be categorised as intrinsic or extrinsic, depending on the epidemiological factors affecting the skin aging process, whereby intrinsic aging is attributed chronological and genetic factors, while extrinsic aging is influenced by environmental factors11. Green, A. C. Premature ageing of the skin in a Queensland population. Dermatol. Use of sunscreen and risk of melanoma and non-melanoma skin cancer: A systematic review and meta-analysis. . There are two major theories for aging: the programmatic theory which . Dermatol. Sundelin, T. et al. National Library of Medicine Cosmet. https://doi.org/10.1016/s0190-9622(86)70208-9 (1986). J. Dermatol. Yin, L., Morita, A. 8, 7584. 6b). Cancer 41, 2844. Dermatol. These changes have been shown to impair cutaneous integrity, wound healing, and sensory and immune function94,95,96. Factors influencing skin ageing in a Mediterranean population from Turkey. Unique Variation of Barber's Disease: A Case Report. https://doi.org/10.1038/s41598-021-01573-z, DOI: https://doi.org/10.1038/s41598-021-01573-z. Guinot, C. et al. Although this review did not identify a formal definition of human skin aging in the literature, the rough consensus in included articles was to attribute human skin aging to both intrinsic aging and aging influenced by external factors. https://doi.org/10.2147/CCID.S226331 (2019). Evaluation of skin microtopography as a measure of ultraviolet exposure. Int. Assessing risk and preventing pressure ulcers in patients with cancer. Elfakir, A. et al. The risk factors of skin aging have been studied previously, using methods of quantifying skin aging. Dermatol. Venereol. https://doi.org/10.2105/ajph.85.1.78 (1995). Reconstr. The final database search using outcomes from the eligible primary search results did not yield other eligible studies not already included in this review. Forming an interface between the human body and the external environment, the human skin is constantly subject to both chronologically and environmentally induced changes. Clinical relevance of elastin in the structure and function of skin. Google Scholar. Causes of skin breakdown Additionally, interaction between pollutants and UV radiation has been reported: nitrogen dioxide, ozone, and UV radiation56; particulate matter and UV radiation52. Indeed, a comparison between Chinese and French females showed that increased dyspigmentation occurred more frequently in the Chinese than French, and Chinese females exhibit a marked progression in wrinkling severity at a later age than French females43. Dermatol. There is a rough consensus that skin aging encompasses several phenotypes such as, but not limited to, wrinkling, pigmentation and telangiectasis3,4,5,6,7,8. The skin, the largest organ in the human body, performs important functions such as thermoregulation, storage and synthesis, sensation and protection.
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