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Photoaging

Pathogenesis, prevention, and treatment
      The term photoaging refers to premature skin aging caused by repeated exposure to solar ultraviolet (UV) radiation. The photoaged phenotype is characterized by fine and coarse wrinkles, mottled pigmentation, sallow color, and rough textures on habitually sun-exposed skin.
      • Kligman A.M.
      Early destructive effects of sunlight on human skin.
      Histologic and ultrastructural studies have revealed that the major alterations in photoaged skin are localized in the dermal connective tissue. Collagen fibrils, which constitute the bulk of skin connective tissue, become disorganized
      • Bernstein E.F.
      • et al.
      Long-term sun exposure alters the collagen of the papillary dermis: Comparison of sun-protected and photoaged skin by Northern analysis, immunohistochemical staining, and confocal laser scanning microscopy.
      and abnormal amorphous, elastin-containing material
      • Lavker R.M.
      Cutaneous aging: Chronologic versus photoaging.
      accumulates in the dermis, a condition known as solar elastosis. Recent advances in photobiology have provided substantial insight into the process by which UV irradiation causes disarrangement of dermal extracellular matrix. Elucidation of the photoaging mechanisms also has allowed for the identification of therapeutic targets and strategies to prevent photoaging. This article summarizes key findings that represent our current understanding of photoaging, in particular wrinkle formation. The state of our knowledge indicates that topical tretinoin can not only be used to treat photoaging after it has occurred, but is also likely to retard or prevent photoaging as and before it happens. Although this publication is clinical overall, the nature of the subject matter discussed in this article necessitates the inclusion of some basic materials. Whenever possible, the scientific concepts are presented in a nontechnical way.
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