Table 3 Functional Abnormalities of Photoaging
Uneven tanning Skin easily distends Slow return to normal contour Thinned skin easily traumatized Sensory decrease Decrease in immune competence
The most casual observation of the face or neck of an individual with photo-damaged skin, even by the untrained observer, consciously and subconsciously gives an overall impression of a person older than their chronological age. Visually, wrinkles both fine and coarse are frequently the hallmark of sun-damaged skin in many individuals, although genetic differences may, in some, favor pigmentary alterations or thinning of the skin as the most prominent presenting sign.
An overall sallow, or yellowish hue, is common and presumably due to the complex interplay of light absorption and reflection in photodamaged skin that is characterized by uneven thickness of the stratum corneum and abnormalities of melanization. Additionally, circulatory alterations of endogenous origin or as a consequence of photodamage produce variable contributions of heme pigment to overall skin color.
Pigmentary alteration of photodamaged skin is very common but highly variable. Discrete alterations consistent with actinic lentigos, especially prominent on the face and hands, may alternate with mottled hyperpigmentation consisting of patchy and alternating lighter and darker macules due to diffuse abnormalities of melanogenesis and melanosome distribution in keratinocytes. Diffuse pigmentary change may also present as melasma on the face due to either epidermal melanin abnormalities or dermal macrophages containing melanin or heme pigment.
Hypomelanotic macules are vitiligenous and are frequently observed most prominently on the lower extremities.
Dryness and surface roughness, best perceived by tactile rather than visual means, are among the most common complaints related to aged and photoaged skin, but are not specific for either. Scaling due to dryness or perturbation in epidermal turnover is also common, but not specific to photodamage.
Multiple neoplastic lesions as a consequence of photodamage are common. Benign seborrheic keratoses are mostly cosmetic growths that appear in sun-exposed body areas.
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