Photoaging or photoageing (also known as "dermatoheliosis") is a term used for the characteristic changes to skin induced by chronic UVA and UVB exposure.
Effects of UV light
Molecular and genetic changes UVB rays are a primary mutagen that can only penetrate through the epidermal (outermost) layer of the skin and can cause DNA mutations. These mutations arise due to chemical changes within skin cells. These mutations may be clinically related to specific signs of photoaging, including wrinkling.
Melanocytes and basal cells are embedded in the epidermal layer. Upon exposure to UVB rays, melanocytes will produce more melanin, a pigment that gives skin its color. UVB can cause the formation of freckles and dark spots, both of which are symptoms of photoaging; these are most common in people with fair or light skin. With frequent long-term exposure to UVB rays, signs of photoaging might appear, and precancerous lesions or skin cancer may develop. UVA rays are able to penetrate deeper into the skin than UVB rays, damaging the dermal layer as well as the epidermal layer. The dermis is the second major layer of the skin, and it comprises collagen, elastin, and extrafibrillar matrix, which provides structural support to the skin. However, with constant UVA exposure, the size of the dermis layer will be reduced, thereby causing the epidermis to start drooping off the body. Due to the presence of blood vessels in the dermis, UVA rays can lead to dilated or broken blood vessels, which are most commonly visible on the nose and cheeks. UVA can also damage DNA indirectly through the generation of reactive oxygen species (ROS), which include superoxide anion, peroxide, and singlet oxygen. These ROS damage cellular DNA as well as lipids and proteins.
Pigmentation UV exposure can also lead to inflammation and vasodilation, which is clinically manifested as sunburn. UV radiation activates the transcription factor NF-κB, which is the first step in inflammation. NF-κB activation results in the increase of proinflammatory cytokines, for example, interleukin 1 (IL-1), IL-6, vascular endothelial growth factor, and tumor necrosis factor (TNF-α). This then attracts neutrophils, which lead to an increase in oxidative damage through the generation of free radicals. Additionally, UV radiation would cause the down-regulation of an angiogenesis inhibitor, thrombospondin-1, and the up-regulation of an angiogenesis activator, which is platelet-derived endothelial cell growth factor, in keratinocytes. These enhance angiogenesis and aid in the growth of UV-induced neoplasms.
Immunosuppression It has been reported that UV radiation leads to local and systemic immunosuppression, due to DNA damage and altered cytokine expression. This has implications for cutaneous tumor surveillance. The Langerhans cells may undergo changes in quantity, morphology, and function due to UV exposure and may eventually become depleted. One proposed explanation for this immunosuppression is that the body is attempting to suppress an autoimmune response to inflammatory products resulting from UV damage.
Degradation of collagen UV exposure would also lead to the activation of receptors for epidermal growth factor, IL-1, and TNF-α in keratinocytes and fibroblasts, which then activate signaling kinases throughout the skin via an unknown mechanism. The nuclear transcription factor activator protein, AP-1, which controls the transcription of matrix metalloproteinases (MMP), is expressed and activated. MMP-1 is a major metalloproteinase for collagen degradation. This entire process is aided by the presence of reactive oxygen species that inhibit protein-tyrosine phosphatases via oxidation, thereby resulting in the up-regulation of the above-mentioned receptors. Another transcription factor, NF-κB, which is also activated by UV light, increases the expression of MMP-9. The up-regulation of MMP can occur even after minimal exposure to UV; hence, exposure to UV radiation that is inadequate to cause sunburn can facilitate the degradation of skin collagen and, presumably, lead to eventual photoaging. Thus, collagen production is reduced in photoaged skin due to the process of constant degradation of collagen mediated by MMPs. In addition, the presence of damaged collagen would also downregulate the synthesis of new collagen. The impaired spreading and attachment of fibroblasts onto degraded collagen could be one of the contributing factors to the inhibition of collagen synthesis.
Retinoic acids and photodamage UV radiation decreases the expression of both retinoic acid receptors and retinoid x receptors in human skin, thereby resulting in a complete loss of the induction of RA-responsive genes. It also leads to an increase in activity of the AP-1 pathway, increasing MMP activity and thus resulting in a functional deficiency of vitamin A in the skin.
Signs, symptoms and histopathology Early symptoms of photoaging:
Dyspigmentation, the formation of wrinkles and other symptoms appear around regions of skin commonly exposed to the sun, mostly the eyes, mouth, and forehead. The lips may be affected. In Canadian women, the upper chest is commonly affected. Spider veins on face and neck Loss of color and fullness in the lips Symptoms of photoaging attributed to prolonged exposure to UV:
Wrinkles deepen, and forehead frown lines can be seen even when not frowning. Telangiectasias (spider veins) are most commonly seen around the nose, cheeks, and chin. Skin becomes leathery, and laxity occurs. Solar lentigines (age spots) appear on the face and hands. Possibly pre-cancerous red and scaly spots (actinic keratoses) appear. Cutaneous malignancies In addition to the above symptoms, photoaging can also result in an orderly maturation of keratinocytes and an increase in the cell population of the dermis, where abundant, hyperplastic, elongated, and collapsed fibroblasts and inflammatory infiltrates are found. Photodamage can also be characterized as a disorganization of the collagen fibrils that constitute most of the connective tissue, and the accumulation of abnormal, amorphous, elastin-containing material, a condition known as actinic elastosis.
Defense mechanisms Endogenous defense mechanisms provide protection of the skin from damage induced by UV.
Epidermal thickness UV exposure, which would lead to an increase in epidermal thickness, could help protect from further UV damage.
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