Skin ageing: Clinical aspects and in vivo microscopic patterns observed with reflectance confocal microscopy and optical coherence tomography
Corresponding Author
Claudia Pezzini
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Correspondence
Claudia Pezzini, Dermatology Unit, University of Modena and Reggio Emilia, via del pozzo 71, Modena 41125, Italy.
Email: [email protected]
Search for more papers by this authorSilvana Ciardo
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorStefania Guida
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorShaniko Kaleci
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorJohanna Chester
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorAlice Casari
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorMarco Manfredini
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorCaterina Longo
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale – IRCCS, Reggio Emilia, Italy
Search for more papers by this authorFrancesca Farnetani
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorAriadna Ortiz Brugués
Dermatology Unit, Santa Caterina Hospital, Girona, Spain
Search for more papers by this authorGiovanni Pellacani
Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
Search for more papers by this authorCorresponding Author
Claudia Pezzini
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Correspondence
Claudia Pezzini, Dermatology Unit, University of Modena and Reggio Emilia, via del pozzo 71, Modena 41125, Italy.
Email: [email protected]
Search for more papers by this authorSilvana Ciardo
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorStefania Guida
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorShaniko Kaleci
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorJohanna Chester
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorAlice Casari
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorMarco Manfredini
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorCaterina Longo
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale – IRCCS, Reggio Emilia, Italy
Search for more papers by this authorFrancesca Farnetani
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorAriadna Ortiz Brugués
Dermatology Unit, Santa Caterina Hospital, Girona, Spain
Search for more papers by this authorGiovanni Pellacani
Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
Search for more papers by this authorAbstract
Few studies have combined high-resolution, non-invasive imaging, such as standardized clinical images, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT), for age-related skin change characterization according to age groups. This study aimed to correlate clinical manifestations of ageing with skin cytoarchitectural background observed with high-resolution, non-invasive imaging according to age-related skin pattern distribution. A set of 140 non-pathological facial skin images were retrospectively retrieved from a research database. Subjects, aged between 20 and 89, were divided into 7 age groups. Clinical features were explored with VISIA, including hyperpigmentation, skin texture, wrinkles, pores and red areas, quantified and expressed as automated absolute scores. Previously described RCM and OCT epidermal and dermal features associated with ageing were investigated. All features were assessed for distribution and correlation among age groups. Significant direct correlations between age and clinical features were proven for cutaneous hyperpigmentation, skin texture, wrinkles and red areas. As age advances, RCM epidermal irregular honeycomb and mottled pigmentation are more frequently observed and collagen is more frequently coarse, huddled and curled, while the epidermis in OCT is thickened and the dermal density is decreased with more disrupted collagen fibres. RCM and OCT feature changes correlate directly and indirectly as well as correlating directly and indirectly with standardized clinical images. Clinical manifestations of ageing correlate with skin cytoarchitectural background observed with RCM and OCT. In conclusion, complimentary information between standardized clinical images and high-resolution, non-invasive imaging will assist in the development of future studies dedicated to skin ageing assessment and treatment effectiveness.
CONFLICT OF INTEREST
G. Pellacani received honoraria for seminars on confocal microscopy from MAVIG GmbH (Germany); A. Ortiz Brugues works for the Pierre Fabre Group as Medical Director.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Supporting Information
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exd14708-sup-0001-Tables.docxWord 2007 document , 37.7 KB |
Table S1 Table S2 Table S3 Table S4 Table S5 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Farage MA, Miller KW, Elsner P, Maibach HI. Structural characteristics of the aging skin: a review. Cutan Ocul Toxicol. 2007; 26: 343-357.
- 2Farage MA, Miller KW, Elsner P, Maibach HI. Intrinsic and extrinsic factors in skin ageing: a review. Int J Cosmet Sci. 2008; 30: 87-95.
- 3Berneburg M, Plettenberg H, Krutmann J. Photoaging of human skin. Photodermatol Photoimmunol Photomed. 2000; 16: 239-244.
- 4Trautinger F. Mechanisms of photodamage of the skin and its functional consequences for skin ageing. Clin Exp Dermatol. 2001; 26: 573-577.
- 5Kimball AB, Alora-Palli MB, Tamura M, et al. Age-induced and photoinduced changes in gene expression profiles in facial skin of Caucasian females across 6 decades of age. J Am Acad Dermatol. 2018; 78: 29-39.
- 6Fisher GJ, Kang S, Varani J, et al. Mechanisms of photoaging and chronological skin aging. Arch Dermatol. 2002; 138: 1462-1470.
- 7Waller JM, Maibach HI. Age and skin structure and function, a quantitative approach (I): blood flow, pH, thickness, and ultrasound echogenicity. Skin Res Technol. 2005; 11: 221-235.
- 8Vierkötter A, Ranft U, Krämer U, Sugiri D, Reimann V, Krutmann J. The SCINEXA: a novel, validated score to simultaneously assess and differentiate between intrinsic and extrinsic skin ageing. J Dermatol Sci. 2009; 53: 207-211.
- 9Griffiths CE, Wang TS, Hamilton TA, Voorhees JJ, Ellis CN. A photonumeric scale for the assessment of cutaneous photodamage. Arch Dermatol. 1992; 128: 347-351.
- 10Fernandez-Flores A, Saeb-Lima M. Histopathology of cutaneous aging. Am J Dermatopathol. 2019; 41: 469-479.
- 11Kurban RS, Bhawan J. Histologic changes in skin associated with aging. J Dermatol Surg Oncol. 1990; 16: 908-914.
- 12Ulrich M, Rüter C, Astner S, et al. Comparison of UV-induced skin changes in sun-exposed vs. sun-protected skin-preliminary evaluation by reflectance confocal microscopy. Br J Dermatol. 2009; 161(Suppl 3): 46-53.
- 13Sauermann K, Clemann S, Jaspers S, et al. Age related changes of human skin investigated with histometric measurements by confocal laser scanning microscopy in vivo. Skin Res Technol. 2002; 8: 52-56.
- 14Calzavara-Pinton P, Longo C, Venturini M, Sala R, Pellacani G. Reflectance confocal microscopy for in vivo skin imaging. Photochem Photobiol. 2008; 84: 1421-1430.
- 15Moscarella E, Argenziano G, Lallas A, Pellacani G, Longo C. Confocal microscopy: a new era in understanding the pathophysiologic background of inflammatory skin diseases. Exp Dermatol. 2014; 23: 320-321.
- 16Lacarrubba F, Pellacani G, Gurgone S, Verzì AE, Micali G. Advances in non-invasive techniques as aids to the diagnosis and monitoring of therapeutic response in plaque psoriasis: a review. Int J Dermatol. 2015; 54: 626-634.
- 17Manfredini M, Greco M, Farnetani F, et al. In vivo monitoring of topical therapy for acne with reflectance confocal microscopy. Skin Res Technol. 2017; 23: 36-40.
- 18Segura S, Pellacani G, Puig S, et al. In vivo microscopic features of nodular melanomas: dermoscopy, confocal microscopy, and histopathologic correlates. Arch Dermatol. 2008; 144: 1311-1320.
- 19Scope A, Benvenuto-Andrade C, Agero AL, et al. In vivo reflectance confocal microscopy imaging of melanocytic skin lesions: consensus terminology glossary and illustrative images. J Am Acad Dermatol. 2007; 57: 644-658.
- 20Wurm EM, Curchin CE, Lambie D, Longo C, Pellacani G, Soyer HP. Confocal features of equivocal facial lesions on severely sun-damaged skin: four case studies with dermatoscopic, confocal, and histopathologic correlation. J Am Acad Dermatol. 2012; 66: 463-473.
- 21Boone MA, Marneffe A, Suppa M, et al. High-definition optical coherence tomography algorithm for the discrimination of actinic keratosis from normal skin and from squamous cell carcinoma. J Eur Acad Dermatol Venereol. 2015; 29: 1606-1615.
- 22Boone MA, Suppa M, Pellacani G, et al. High-definition optical coherence tomography algorithm for discrimination of basal cell carcinoma from clinical BCC imitators and differentiation between common subtypes. J Eur Acad Dermatol Venereol. 2015; 29: 1771-1780.
- 23Moraes Pinto Blumetti TC, Cohen MP, Gomes EE, et al. Optical coherence tomography (OCT) features of nevi and melanomas and their association with intraepidermal or dermal involvement: a pilot study. J Am Acad Dermatol. 2015; 73: 315-317.
- 24Mamalis A, Ho D, Jagdeo J. Optical coherence tomography imaging of Normal, chronologically aged, photoaged and photodamaged skin: a systematic review. Dermatol Surg. 2015; 41: 993-1005.
- 25Boone MA, Suppa M, Marneffe A, Miyamoto M, Jemec GB, del Marmol V. High-definition optical coherence tomography intrinsic skin ageing assessment in women: a pilot study. Arch Dermatol Res. 2015; 307: 705-720.
- 26Trojahn C, Dobos G, Richter C, Blume-Peytavi U, Kottner J. Measuring skin aging using optical coherence tomography in vivo: a validation study. J Biomed Opt. 2015; 20:045003.
- 27Wu S, Li H, Zhang X, Li Z. Optical features for chronological aging and photoaging skin by optical coherence tomography. Lasers Med Sci. 2013; 28: 445-450.
- 28Lagarrigue SG, George J, Questel E, et al. In vivo quantification of epidermis pigmentation and dermis papilla density with reflectance confocal microscopy: variations with age and skin phototype. Exp Dermatol. 2012; 21: 281-286.
- 29Wurm EM, Longo C, Curchin C, Prow TW, Pellacani G, Pellacani G. In vivo assessment of chronological ageing and photoageing in forearm skin using reflectance confocal microscopy. Br J Dermatol. 2012; 167: 270-279.
- 30Longo C, Galimberti M, de Pace B, Bencini PL, Bencini PL. Laser skin rejuvenation: epidermal changes and collagen remodeling evaluated by in vivo confocal microscopy. Lasers Med Sci. 2013; 28: 769-776.
- 31Kawasaki K, Yamanishi K, Yamada H. Age-related morphometric changes of inner structures of the skin assessed by in vivo reflectance confocal microscopy. Int J Dermatol. 2015; 54: 295-301.
- 32Longo C, Casari A, de Pace B, Simonazzi S, Mazzaglia G, Pellacani G. Proposal for an in vivo histopathologic scoring system for skin aging by means of confocal microscopy. Skin Res Technol. 2013; 19: e167-e173.
- 33Longo C, Casari A, Beretti F, Cesinaro AM, Pellacani G. Skin aging: in vivo microscopic assessment of epidermal and dermal changes by means of confocal microscopy. J Am Acad Dermatol. 2013; 68: e73-e82.
- 34Longo C. Well-aging: early detection of skin aging signs. Dermatol Clin. 2016; 34(4): 513-518.
- 35Guida S, Ciardo S, de Pace B, et al. The influence of MC1R on dermal morphological features of photo-exposed skin in women revealed by reflectance confocal microscopy and optical coherence tomography. Exp Dermatol. 2019; 28: 1321-1327.
- 36Neerken S, Lucassen GW, Bisschop MA, Lenderink E, Nuijs TA. Characterization of age-related effects in human skin: a comparative study that applies confocal laser scanning microscopy and optical coherence tomography. J Biomed Opt. 2004; 9: 274-281.
- 37Ciardo S, Pezzini C, Guida S, et al. A plea for standardization of confocal microscopy and optical coherence tomography parameters to evaluate physiological and Para-physiological skin conditions in cosmetic science. Exp Dermatol. 2021; 30: 911-922.
- 38 VISIA skin features: detection and display in VISIA user guide, software version 6.4. Canfield Scientific; 2015: 66–68.
- 39Rajadhyaksha M, Grossman M, Esterowitz D, Webb RH, Rox Anderson R. In vivo confocal scanning laser microscopy of human skin: melanin provides strong contrast. J Invest Dermatol. 1995; 104: 946-952.
- 40Pellacani G, Guitera P, Longo C, Avramidis M, Seidenari S, Menzies S. The impact of in vivo reflectance confocal microscopy for the diagnostic accuracy of melanoma and equivocal melanocytic lesions. J Invest Dermatol. 2007; 127: 2759-2765.
- 41Garbarino F, Migliorati S, Farnetani F, et al. Nodular skin lesions: correlation of reflectance confocal microscopy and optical coherence tomography features. J Eur Acad Dermatol Venereol. 2020; 34: 101-111.
- 42Sachs DL, Varani J, Chubb H, et al. Atrophic and hypertrophic photoaging: clinical, histologic, and molecular features of 2 distinct phenotypes of photoaged skin. J Am Acad Dermatol. 2019; 81: 480-488.
- 43Guida S, Ciardo S, de Pace B, et al. Atrophic and hypertrophic skin photoaging and melanocortin-1 receptor (MC1R): the missing link. J Am Acad Dermatol. 2021; 84: 187-190.