Photoaging: updating the pathogenesis, diagnostic criteria and approaches to therapy

Kruglova L.S., Gryazeva N.V., Bezborodova A.V., Sokolovskaya Yu.A.

Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation, Moscow, Russia

Photoaging of the skin is a complex biological process that manifests itself mainly in the form of wrinkles, increased pigmentation and loss of elasticity as a result of exposure to ultraviolet radiation and high-energy HEV rays of the visible spectrum. The article updates the pathogenetic mechanisms of photoaging: activation of NADPH oxidase, increased production of reactive oxygen species, activation of PAR2 and suppression of the antioxidant MnSOD, leading to the formation of a vicious circle of free radical production. Another signaling pathway is the activation of TGFβ, which leads to an increase in the production of matrix metalloproteinases, which play a key role in the destruction of collagen, elastin and other structures of the extracellular matrix. The importance of accumulation of secretory phenotypic factors (SASP) by fibroblasts, including IL-1α, IL-1β, IL-6, IL-8 and MMP, which are responsible for chronic inflammation, as well as for degradation of the extracellular matrix, is emphasized. Such fibroblasts are not subject to apoptosis and cannot be eliminated by the immune system. Increased pigmentation in photoaging is associated with UV activation of the p53 protein of keratinocytes, which triggers the production of α-melanocyte-stimulating hormone. In addition, fibroblasts secrete substances that enhance this process, including endothelin-1 and cell growth factors.
The article presents modern complex criteria for the perception of skin quality: tone, relief, elasticity and radiance of the skin, as well as their parameters, definition, methods of measurement and correction.
The article describes modern approaches to restoring the quality of skin in case of photoaging: botulinum toxin, hyaluronic acid preparations, hardware technologies, including MFU-V (microfocused ultrasound) and lasers, as well as external topical agents. Examples of using the Eucerin Hyaluron Filler + Elasticity line of products with thiamidol in case of photoaging are given.

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About the Authors

Corresponding author: Yulia A. Sokolovskaya, Resident Physician, Department of Dermatovenereology and Cosmetology, Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation, Moscow, Russia; dr.alekseeva@ya.ru