Histologic Effects of Photoaging and Skin Resurfacing

Most patients seeking evaluation for skin rejuvenation have a history of significant sun exposure. Clinical signs of actinic damage include the development of coarse rhytids, rougher skin texture, pigmentary mottling, and the development of solar lentigines and actinic keratoses. Histologically, changes in the epidermis and dermis of patients with sun-damaged skin develop as well. Epidermal dysplasia occurs, indicated by thickened epidermis and the appearance of dysplastic cells. Clinically, this finding corresponds to the development of actinic keratoses and may lead to the development of basal or squamous cell carcinomas. In addition, epidermal hyperplasia and epidermal atrophy are observed in combination with irregular pigment distribution and solar lentigines. In the dermis, dermoelastosis, the degeneration of collagen and elastic fibers, is the main diagnostic feature in sun-damaged skin. Intrinsically aged skin shows similar clinical and histologic changes, except that, in actinically damaged skin, these processes are accelerated.

Chemical peeling and laser resurfacing techniques reverse the damage created in the skin as a result of photoaging. The obliteration of many of the clinical and histologic changes varies depending on the depth of the wounding agent. Knowledge of histologic changes and the histologic effects of various peeling agents must be understood in order to obtain optimal results and prevent complications.

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