Overview

Ageing skin is defined as either intrinsic or extrinsic

Ageing is a multifaceted process that begins around the age of 25 and tends to accelerate in the 40’s, and again in the 70’s.

Women’s skin intrinsically ages faster than men’s, but men tend to be more affected extrinsically by lifestyle.

People with lighter skin tones tend to show wrinkles more visibly, whereas darker skin tones often maintain a smoother appearance for longer but experience more pigmentation changes.

The symptoms of ageing skin include fine lines and wrinkles, thinning and fragility, dullness, and dryness.

The process of ageing can be seen throughout the body, with the most noticeable effects appearing on the face, which accounts for 50% of initial ageing, followed by the neck at 25%, hands at 15%, and knees at 10%.

Ageing skin is a dual mechanism:

Subtype Description Common Areas
Intrinsic

(chronological)

 The normal course of ageing, which is closely linked to the natural biological clock and the passage of time. It occurs gradually over time, irrespective of external factors Entire body, including less exposed areas like the torso, back, and buttocks
Extrinsic

(photoageing)

 The premature course of ageing by external factors that accelerate the intrinsic ageing process. It is preventable damage to the structural components of the skin and impedes its natural repair mechanisms Exposed areas of the skin, notably the face, neck, arms, and legs

Sun exposure alone attributes for up to 80% of extrinsic ageing.

While intrinsic ageing cannot be mitigated, it is becoming increasingly possible to reduce extrinsic ageing.

Causes

Intrinsic ageing occurs naturally over time, whereas extrinsic is primarily caused by prolonged exposure to UV rays

Ageing skin is caused by a loss of the skin’s ability to regenerate collagen and elastin, two essential molecules that give it its strength and mobility.

Collagen is a protein that provides structure and elasticity to the skin. After the age of 20, production declines by about 1% per year.

Elastin fibres help the skin to return to its original shape after stretching. As elastin depletes, the skin can become more lax and less resilient.

The primary causes of intrinsic ageing are the following:

Cause Description
Genetics Genetics can influence the rate at which the body ages by determining how cells replicate, repair, and respond to environmental stress. Mutations or variations in specific genes can cause faster cellular breakdown, resulting in premature signs of ageing, notably wrinkles
Cellular Cellular replication is limited to about 50 cycles before the genetic material can no longer be accurately copied. As senescent cells accumulate and damage worsens, the skin thins, loses its elasticity, and becomes more fragile
Hormones Hormones, particularly oestrogen and testosterone, decline with age, reducing skin elasticity and moisture. This hormonal shift contributes to visible signs of ageing, such as wrinkles and dryness

The extrinsic factors that accelerate ageing include:

Contributor Description
Photoageing Photoageing, caused by UV (ultraviolet) radiation, particularly between 11am and 3pm, as well as the use of tanning beds, causes thousands of DNA alterations in each cell of the skin every day. This accelerates the breakdown of collagen and elastin fibres, leading to wrinkles, rough skin texture, and age spots and patches
Nutrition Nutrition, including diets high in sugar and processed foods, can cause glycation, where sugar molecules bond with proteins like collagen, reducing their flexibility. Antioxidant-rich foods, such as fruits and vegetables, can help to combat oxidative stress. Lack of hydration can harm the skin’s health and appearance, increasing the risk of premature wrinkles and thinning
Medications Medications, such as immunosuppressive agents, along with immune deficiency diseases and the psychological stress they treat, can accelerate cellular damage and reduced skin resilience
Smoking Smoking, particularly due to nicotine, narrows blood vessels and reduces blood flow, limiting the amount of oxygen and nutrients that reach skin cells. This leads to a sallow complexion and accelerates skin ageing
Alcohol Alcohol, when consumed excessively, dehydrates and damages the skin, diminishing its natural glow. This results in dryness, wrinkles, and a dull complexion over time
Skincare Skincare becomes increasingly important as the natural exfoliation process slows with age. Not cleansing properly can cause a buildup of dead skin cells, oil, and dirt, resulting in a dull complexion
Environment Pollution, such as particulate matter and smoke, can clog pores, cause inflammation, and leave the skin looking dull. Harsh working conditions and chronic stress can have an adverse effect on hormonal levels and skin health

Understanding these extrinsic factors, particularly sun exposure, is key to manage and mitigate premature ageing and a tired, lacklustre appearance.

Diagnosis

Ageing skin presents itself through different stages, each representing the natural evolution of the skin's structure and function

A doctor, pharmacist, or nurse can determine the extent of premature ageing. This involves examining exposed areas of the skin to assess its underlying causes.

The normal course of ageing includes:

Age Symptoms Description
25-30 Fine lines on the forehead and around the eyes The skin begins to thin, reducing its barrier function and natural UV protection. Collagen mass and flexibility start depleting at a rate of about 1% per year
30’s Fine lines on the cheeks, around the mouth, and on the neck, as well as mild hyperpigmentation The skin’s barrier function weakens, and cell metabolism slows. As hyaluronic acid production declines, skin moisture loss increases. Collagen continues to deplete at 1% per year, and the first effects of sun damage appear that occurred during the teenage years and 20’s
40’s Moderate wrinkles on the forehead, around the eyes, cheeks, mouth, and neck, increased dullness and dryness, and less volume in the cheeks and neck The skin’s outer layers no longer lie in their proper order, resulting in a more pronounced dull appearance. Existing skin cells shrink, and fewer new cells are formed, leading to reduced skin volume
50’s Thinner and less elastic skin and moderate hyperpigmentation Connective tissues in the skin’s middle layer lose their fibrous structure and ability to retain water. Fat tissue in the lower layer thins
60’s Deep wrinkles throughout the face, increased sagging, and significant dryness The skin’s natural lipid production declines, as does the production of collagen and hyaluronic acid, resulting in deeper wrinkles and slower skin regeneration. The skin becomes more fragile and prone to dryness
Over 70 Impaired wound healing and severe hyperpigmentation The skin’s immune function weakens significantly, making it more vulnerable to infection. Wound healing slows, and hyperpigmentation becomes more severe due to prolonged exposure to environmental factors

While ageing skin itself is a cosmetic concern, it can be a symptom of an underlying health issue that requires attention, such as nutritional deficiency or hormonal imbalance.

Treatment

The goal is to not only treat the appearance of ageing skin, but to reduce the risk of further damage

Treating ageing skin must include adopting daily use of broad-spectrum sunscreen with an SPF30 or higher to protect it from further damage.

Prescribed topical treatments are effective at improving the skin’s appearance and reducing signs of ageing. This includes:

Topical Common Examples
Retinoids Adapalene, tretinoin, and tazarotene, vitamin A derivatives, regulate the growth of cells on the skin to improve its texture and tone
Lightening Agents Hydroquinone reduces the production of melanin to lighten patches of darker skin
Anti-Inflammatories Azelaic acid inhibits the production of inflammatory-causing molecules to reduce redness and irritation
Antioxidants Niacinamide eliminates free radicals by repairing and strengthening the barrier function of the skin, improving hydration

Prescribed oral treatments for ageing skin are uncommon, but procedures may include:

Procedure Common Examples
Injectables Botox (botulinum toxin) is injected into specific areas of the face to prevent muscle contractions that result in fine lines, wrinkles, and folds
Exfoliation Microdermabrasion exfoliates the skin’s outermost layer using a device that sprays tiny crystals or employs a diamond-tipped wand to remove dead skin cells, stimulate cell regeneration, and promote collagen production, dead skin cells, stimulate cell regeneration, and promote collagen production, which help to reduce the appearance of fine lines, wrinkles, and age spots
Chemical Peels Superficial peels use alpha hydroxy acids (AHA’s) like glycolic acid or beta hydroxy acids (BHA’s) like salicylic acid to exfoliate the skin’s outermost layer. Medium peels use stronger agents, such as trichloroacetic acid (TCA), or higher concentrations of glycolic acid to penetrate deeper into the skin. Deep peels use strong acids like high-strength TCA or phenol and penetrate the skin’s middle layers to treat fine lines, wrinkles, and age spots
Laser Therapy Fractional lasers treat small areas to rejuvenate the skin while minimising damage to surrounding tissue. Non-ablative lasers, such as Nd, heat deeper layers, stimulating collagen production. Ablative lasers, like CO2 and Erbium, remove the outer skin layer, promoting new skin growth. Treating these different layers of skin reduces fine lines, wrinkles, and age spots
Light Therapy Red light therapy (RLT) uses low-level red light to stimulate collagen production, promote cell turnover, and improve blood circulation to reduce fine lines and wrinkles
Surgery Facelift surgery (rhytidectomy) involves tightening facial muscles and removing excess skin to reduce deep wrinkles, sagging, and jowls. Brow lifts elevate drooping eyebrows and smooth out forehead wrinkles. Eyelid surgery (blepharoplasty) removes excess skin and fat from the eyelids, treating droopy eyelids and under-eye bags. A necklift, like a facelift, targets sagging skin and muscles in the neck to create a firmer, smoother contour

It is not uncommon to use a combination of prescribed topical treatment and procedures.

Complications

While dull skin is usually a cosmetic concern, it can also be a symptom of an underlying health issue

As the skin ages, cumulative damage from both intrinsic and extrinsic factors means it undergoes a series of changes that affect its appearance, texture, and function.

These visible changes include:

Complication Description
Fine Lines & Wrinkles Dynamic wrinkles, such as frown lines, crow’s feet, and laugh lines, are most noticeable when the muscles beneath them are active due to repeated facial movements. Static wrinkles, like forehead lines, cheek wrinkles, and marionette lines, are present even when the face is at rest. Gravitational wrinkles, typically jowls and neck wrinkles, appear in areas where the skin begins to sag as it loses elasticity with age. Atrophic wrinkles are fine lines that occur as a result of a decrease in the thickness and elasticity of the skin. Compression wrinkles, for example sleep lines, form due to external pressure on the face
Thinning & Fragility Thinning skin becomes more fragile and vulnerable to injury, as both the middle (dermis) and outer (epidermis) layers lose their protective cushioning. This increases the likelihood of wounds, tears, and bruising, with slower healing due to impaired cell regeneration and a weakened vascular network, raising the risk of infection. Additionally, the loss of fat tissue beneath the skin leads to a noticeable reduction in volume, creating a hollowed appearance, particularly around the temples and cheeks
Dullness Dull skin is usually the first symptom of ageing, as the skin’s ability to shed dead cells and regenerate new ones slows down, leading to a buildup of dead cells on the surface and a lacklustre complexion. Reduced blood flow to the skin limits the delivery of oxygen and nutrients, further diminishing its natural vibrancy. Without the ability to reflect light effectively, ageing skin often appears matte and flat, making pores and pigmentation more noticeable
Dryness Dry skin is common with ageing because the skin’s ability to retain moisture and produce natural oils declines. As the skin ages, the sebaceous glands, which produce oil, become less active, resulting in a reduction in the protective lipid barrier that keeps the skin hydrated. Furthermore, the skin’s natural ability to retain water decreases as hyaluronic acid production slows, resulting in moisture loss from the skin’s deeper layers. This results in a rough, flaky texture that can be itchy and irritating
Hyperpigmentation Hyperpigmentation in ageing skin is often driven by slower cell turnover, hormonal changes, inflammation, and cumulative sun damage. As the skin’s ability to renew itself declines with age, dark spots and uneven pigmentation become more prominent
Rosacea Rosacea becomes more likely as the skin ages, with blood vessels becoming more visible near the surface, making them more susceptible to dilation and damage. Additionally, the skin’s diminished ability to repair itself and control inflammation increases the risk of developing rosacea or exacerbating redness and sensitivity
Psychosocial Psychosocial factors related to early physical changes in appearance and societal attitudes associated with ageing can have an impact on self-esteem, particularly in the 30’s and 40’s

Understanding and managing these complications is important for maintaining healthier, more resilient skin and promoting overall wellbeing as one ages.

Last Updated: 11 September 2024
Next Review: 18 June 2025

Company Information

Company Number: 14567976

VAT Number: GB445540693

GPhC Number: 9012305

Quick Links

Stay Connected

Registered Address: International House, 6 South Molton Street, London W1K 5QF, United Kingdom

Trading Address: Unit 2C Gazelle Buildings, Wallingford Road, Uxbridge UB8 2RW, United Kingdom

© Monderma 2024. All Rights Reserved.

Menu