THE AGEING SKIN –::A BROAD VIEW::
BY: MALVI PATELUNDER THE GUIDANCE OF: DR. ABHA DOSHI
For more presentations and information visit http://www.pharmaxchange.info
WHAT IS AGEING?
Ageing is the process of growing old.
For more presentations and information visit http://www.pharmaxchange.info
THE ANATOMY OF SKINFor more presentations and information visit http://www.pharmaxchange.info
Cells of Epidermis
Keratinocytes• They produce keratin in the skin
Melanocytes• Produce melanin pigment in the skin
Langerhans cells• Participate in immune response
Merkel cells• Touch sensation
For more presentations and information visit http://www.pharmaxchange.info
Cells of Dermis
Fibroblasts• Provides structural framework• Synthesizes extracellular dermal
constituents
Macrophages• Phagocytosis of cellular debris and
pathogens
Adipocytes• Fat storage cells
For more presentations and information visit http://www.pharmaxchange.info
THE CHEMICAL CONSTITUENTS OF DERMIS
COLLAGEN• most abundant• Provides strength and support
ELASTIN• Imparts elasticity to the skin
GLCOSAMINOGLYCANS• High water retaining capacity• Most important of them is HYALURONIC
ACID
For more presentations and information visit http://www.pharmaxchange.info
AGEING SKIN
INRINSIC AGEING
• Telomere Shortening
• Mitochondrial Damage
• Endocrine Dysfunction
EXTRINSIC AGEING
• Photo-ageing
• Smoking• Lifestyle
For more presentations and information visit http://www.pharmaxchange.info
Telomere Theory of Ageing
What are telomeres?
Its relation to ageing?• Telomere shortening = ageing
Telomerase – the savior• Helps stabilize and replenish the
telomere length
For more presentations and information visit http://www.pharmaxchange.info
Mitochondrial Damage
The bad effects of these Reactive Oxygen Species?
Lipid Peroxidation
Alteration of gene
expression pathways causing:
Degradation of collagen
Accumulation of elastin
The mitochondria generates reactive oxygen species during
ETC.
What are Reactive Oxygen Species?
For more presentations and information visit http://www.pharmaxchange.info
Endocrine Dysfunction
•Ageing causes reduced hormone production.
•Estrogen reduces with age.
•Lower Estrogen level is associated with skin ageing and telomere shortening.
Reduced Estrogen causes
Loss of Elasticity
Reduced Water
holding capacity
Increased Pigmentation
Decreased vascularity
For more presentations and information visit http://www.pharmaxchange.info
Photo-ageing
Ultraviolet (UV) rays from the sun cause skin damage and accelerate ageing of the skin.
Two mechanisms by which UV rays act are: Mechanism 1 (Induction of Matrix
Metalloproteinases) Mechanism II (Mitochondrial Damage)▪ DNA damage▪ Production of ROS
For more presentations and information visit http://www.pharmaxchange.info
Smoking
Smokers look older than non-smokers of the same age.
Tobacco smoke induces Matrix metalloproteinases.
For more presentations and information visit http://www.pharmaxchange.info
Lifestyle
Lifestyle of a person can also contribute to ageing.
Factors such as: Lack of sleep Intake of alcohol Improper diet Stress Can have ill effects on the skin and
accelerate ageing.
For more presentations and information visit http://www.pharmaxchange.info
CHANGES THAT OCCUR IN AGED SKIN
YOUNGER SKIN OLDER SKIN
For more presentations and information visit http://www.pharmaxchange.info
PHARMACEUTICAL PRODUCTS AND PROCEDURES FOR THE ELDERLY
SUNSCREENS MOISTURIZERS ANTIOXIDANTS FILLERS CHEMICAL PEELS BOTULINUM TOXIN (BOTOX) ESTROGENS PLASTIC SURGERY MAKE-UP
For more presentations and information visit http://www.pharmaxchange.info
SUNSCREENS
Most of the damage during ageing is due to the harmful UV radiations blocking these rays are the primary step to prevent skin ageing.
We will take a closer look at HOW SUNSCREENS ACT? TYPES OF SUNSCREENS
Approx Rs 100 to 150 For more presentations and information visit http://www.pharmaxchange.info
How Sunscreens Act?
PHYSICAL SUNSCREENS CHEMICAL SUNSCREENS
ACT BY REFLECTING THE LIGHT ACTS BY ABSORBING THE LIGHT
= SUNSCREEN SUBSTANCE
For more presentations and information visit http://www.pharmaxchange.info
Common Examples of Sunscreen agents
NOTE – It has even been observed that use of sunscreens helps in reversing the effects of ageing. Hence incorporation of sunscreens into your daily skin care regimen is of primary importance.
PHYSICAL SUNSCREENS CHEMICAL SUNSCREENS
• Zinc Oxide• Titanium Dioxide
• Salicylates • Cinnamates• Anthranalites
For more presentations and information visit http://www.pharmaxchange.info
An example of a sunscreen formulation
Ingredient Quantity Role
Stearic acid 18% Forms primary emulsion with NaOH and also forms an occlusive film
Sodium hydroxide 0.5% Reacts with a portion of the stearic acid insitu to form the emulsifying agent sodium stearate
Cetyl aclcohol 0.5% Emollient , occlusive
Menthyl anthranilate 5% Chemical sunscreen agent
Glycerin 10% Humectant
Water To make 100% Aqueous phase of the cream
Perfume q.s. Gives pleasant odour
A sunscreen formulation in a vanishing cream base
For more presentations and information visit http://www.pharmaxchange.info
MOISTURIZERS
In old age, it is observed that there is a dryness and dehydration of skin.
Moisturizers help the skin
retain the moisture and this helps to
make the skin soft and supple.
Approx: Rs 100 + For more presentations and information visit http://www.pharmaxchange.info
An example of a skin moisturizer
Ingredient Quantity Role
Stearic acid 4.0% Reacts with triethanolamine to form primary emulsion.
Triethanolamine 0.2%
Mineral oil 8.0%Emolient and occlusive
Lanolin 1.0%
Isopropyl Myristate 2.0%
Glyceryl monostearate
3.0% Helps form secondary emulsion
Glycerin 4.0% Humectant
Propylene Glycol 4.0%
Water 100.0 Vehicle
Perfume q.s. Gives a pleasant odour
For more presentations and information visit http://www.pharmaxchange.info
ANTIOXIDANTS
Free radicals or reactive oxygen species are the major cause of ageing and damage in cells over time.
Antioxidants act by neutralizing the free radicals and thus prevent them from causing damage to the cells.
Most commonly used are• Vitamin A• Vitamin C• Vitamin E
X
For more presentations and information visit http://www.pharmaxchange.info
FILLERS
Substitutes for lost dermal components.
•Over age, the dermis loses many components which are responsible for elasticity such as collagen.
•This loss of elastic constituent of the skin leads to wrinkles and furrows in the skin.
•Replenishing the dermal constituents by artificially injecting it helps the skin to reduce the visible ageing.
Approx Rs 1700 to 2000/ creaseFor more presentations and information visit http://www.pharmaxchange.info
List of dermal fillers
Dermal filler type Product
Collagen-Bovine collagen- human collagen
Zyderm, and ZyplastCosmoderm, Cosmoplast
Hyaluronic acid Restylane, Hyalaform, Captique and Juvederm
Biologic combination fillers Alloderm
Autogenous fat
Poly-L-Lactic Acid Sculptra
Radiesse
Polymethylmethacrylate microspheres
Artefill
Injectable liquid silicone
For more presentations and information visit http://www.pharmaxchange.info
Injection site of dermal fillers
Zyderm IZyderm II (mid dermis)
Zyplast (deep dermis)
For more presentations and information visit http://www.pharmaxchange.info
CHEMICAL PEELS
Treatment to improve skin condition using a chemical solution which would cause the old skin to blister and eventually peel off exposing new smoother skin.
Around 400 to 1000+ depending on depthFor more presentations and information visit http://www.pharmaxchange.info
Types of chemical solutions
Alphahydroxy acids (AHAs) – eg. Glycolic acid and lactic acid.
Betahydroxy acids (BHAs) – eg. Salicylic acid
Jessner’s Peel – combo of resorcinol, salicylic acid and
lactic acid. Trichloroacetic acid (TCA) Phenol peels
For more presentations and information visit http://www.pharmaxchange.info
Chemical Peels
Superficial
Very Lighteg. Glycolic acid
10 to 50%
Lighteg. Glycolic acid
50 to 70%
Medium depth eg. Combo of TCA 35% and 70% Glycolic
acid
Deep eg. Baker-Gordon Formula
Classification of chemical peels
For more presentations and information visit http://www.pharmaxchange.info
Procedure to apply chemical peels
Choosing a chemical peel
Patient counselling and consent
Washing and defatting of
skin
Protection of delicate areas
Premedication given
Peeling agent is applied using a
gauze/cotton swabs
Application of peel is done
from forehead to chin
Allow the peel to stay on till
frost formation
Stop the peeling
process using neutralization
when necessary
For more presentations and information visit http://www.pharmaxchange.info
BOTULINUM TOXIN (BOTOX)
Botulinum toxin type A is a toxin obtained by the process of fermentation using Clostridium botulinum species of bacteria.
Botulinum toxin is a highly toxic substance which when used in lower concentrations can be beneficial to reduce wrinkles by causing flaccid paralysis.
The toxin is injected in quantity of 5-10 units intramuscularly.
Approx Rs 1700 – 2000/ creaseFor more presentations and information visit http://www.pharmaxchange.info
ESTROGENS
Estrogen and its derivatives can be given Orally
Topically
Newer Selective Estrogen Receptor Modulators (SERMs) can also be used for its specific action on skin.
For more presentations and information visit http://www.pharmaxchange.info
PLASTIC SURGERY
The word ‘plastikos’ means to mold or to shape.
Many surgical techniques to enhance skin appearance exist.
Of which the most common used are:
Blepharoplasty
Rhitidectomy (face lift)
Dermabrasion
Laser resurfacing
Rs 20,000 +For more presentations and information visit http://www.pharmaxchange.info
MAKE-UP
Commonly used make-
up
Lip-liner
Lip balms
Eye liners and
mascaras– Face powders
Foundation make up
Price VariesFor more presentations and information visit http://www.pharmaxchange.info
CONCLUSION
“Youth has no age”Pablo Picasso
For more presentations and information visit http://www.pharmaxchange.info
REFERENCES
Journal Articles Skin ageing and its treatment, L Baumann* Journal of Pathology J Pathol 2007; 211: 241–
251 Elderly skin and its rejuvenation: products and procedures for the aging skin, Marcia
Ramos-e-Silva et. al., Journal of Cosmetic Dermatology, 6, 40–50 Dermal filler agents: a practical review, Sukhjit S. Johl and Richard A. Burgett, Current
Opinion in Ophthalmology 2006, 17:471–479 Effect of estrogens on skin aging and the potential role of selective estrogen receptor
modulators. S Verdier-Sévrain Climacteric; Aug 2007; 10, 4; Health Module pg. 289 Facial skin rejuvenation, David E. E. Holck and John D. Ng, Current Opinion in
Ophthalmology 2003, 14:246–252 Nutritional and Botanical Approaches to Antiaging, Chris D. Meletis, N.D., with Nieske
Zabriskie, N.D. ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2006, 268-274.
Textbooks : Principles of Anatomy and Physiology, Gerard J Tortora, Chapter 5– The Integumentary
System (pg 139 – 145) Harrys cosmeticology, J. D. Wilkinson and R. J. Moore, Longman Singapore publishers te
ltd. Pg 222 - 258(sunscreens and suntan oils) Cosmetics Formulation Manufacturing and Quality Control, P P Sharma, Vandana
Publications pvt. Ltd. Pg 195 – 198, 183 – 185.
Web References: Wikipedia: (http://en.wikipedia.org/wiki/Telomere, http://en.wikipedia.org/wiki/Skin, http://
en.wikipedia.org/wiki/Botulinum_toxin) E- Medicine ( Chemical Peels by Raymond T Kuwahara - http://en.wikipedia.org/wiki/Botulinum_toxin )
For more presentations and information visit http://www.pharmaxchange.info
THANK YOUFor more presentations and information visit http://www.pharmaxchange.info