19 - 106 - SKIN AGING

Question 1

Which type of skin aging is characterized by xerosis, formation of wrinkles, decreased elasticity, fragility?

a. Extrinsic

b. Intrinsic

c. Both

d. None of the above

Answer 1

C

Question 2

Which type of skin aging is characterized by changes such as decreased collagen production, reduced blood flow, lowered amounts of lipids, loss of rete ridges?

a. Extrinsic

b. Intrinsic

c. Both

d. None of the above

Answer 2

B

Question 3

Which type of skin aging is characterized by typical features such as deep wrinkles, laxity, coarseness, increased fragility, multiple telangiectases, darker skin with mottled pigmentation?

a. Extrinsic

b. Intrinsic

c. Both

d. None of the above

Answer 3

A

Question 4

Which condition/s is often associated with a history of habitual or intense intermittent sun exposure?

a. BCC

b. SCC

c. Melanoma

d. A and B

e. A and C

f. B and C

Answer 4

E

Question 5

What is the most pronounced and consistent histologic change of aged skin?

A. Atypia and decrease in number of functional melanocytes

B. Increased number of melanocytes

C. Decreased number of Langerhans cells

D. Flattening of dermo epidermal junction and loss if rete ridges

Answer 5

D

Question 6

includes the inevitable physiologic changes of the skin that occur with time and are influenced by genetic and hormonal factors

Answer 6

Intrinsic skin aging

Question 7

preventable structural and functional changes of the skin that occur with exposure to environmental factors, the most important source being ultraviolet radiation

Answer 7

Extrinsic skin aging

Question 8

alterations in intrinsic skin aging

Answer 8

• decreased collagen production,
• reduced blood flow,
• lowered amounts of lipids, and the
• loss of rete ridges
• result is dry, pale skin with fine wrinkles, less elasticity, and impaired reparative capacity

Question 9

most powerful source of extrinsic aging

Answer 9

ultraviolet radiation

Question 10

ultraviolet radiation–mediated structural and functional changes of the skin

Answer 10

photoaging

Question 11

Other exogenous factors that contribute to extrinsic skin aging aside from UVR

Answer 11

• cigarette
  smoking,
• diet,
• chemical exposure,
• trauma, and
• air pollutants (eg, particulate matter, CO2 , CO, SO2 , NO, and NO_

Question 12

Typical clinical features of extrinsically aged skin, which are mostly ultraviolet radiation–mediated

Answer 12

• deep wrinkles,
• laxity,
• coarseness,
• increased fragility, and
• multiple telangiectases

• Moreover, photodamaged skin may appear darker and have mottled pigmentation
• Extrinsically aged skin has an increased tendency to develop benign and malignant growths

Question 13

Question 14

Question 15

Intrinsic or Extrinsic Skin aging?

Epidermal thinning

Answer 15

Intrinsic

Question 16

Intrinsic or Extrinsic Skin aging?

Solar elastosis

Answer 16

Extrinsic

Question 17

Intrinsic or Extrinsic Skin aging?

Loss of rete ridges

Answer 17

Intrinsic

Question 18

Intrinsic or Extrinsic Skin aging?

Reduced number of fibroblasts

Answer 18

Extrinsic

Question 19

Intrinsic or Extrinsic Skin aging?

Reduced amount of extracellular matrix

Answer 19

extrinsic

Question 19

Intrinsic or Extrinsic Skin aging?

Decreased number of collagen and elastin fibers

Answer 19

intrinsic

Question 20

Intrinsic or Extrinsic Skin aging?

Xerosis

Answer 20

BOTH

Question 21

Intrinsic or Extrinsic Skin aging?

Pallor

Answer 21

Intrinsic

Question 22

Intrinsic or Extrinsic Skin aging?

Multiple telangiectases

Answer 22

Extrinsic

Question 23

Intrinsic or Extrinsic Skin aging?

Fine wrinkles

Answer 23

intrinsic

Question 24

# **Intrinsic or Extrinsic Skin aging?** Deep wrinkles

Answer 24

extrinsic

Question 25

# **Intrinsic or Extrinsic Skin aging?** decreased elasticity

Answer 25

BOTH

Question 26

# **Intrinsic or Extrinsic Skin aging?** Fragility

Answer 26

both

Question 27

# **Intrinsic or Extrinsic Skin aging?** dyspigmentation

Answer 27

extrinsic

Question 28

only penetrates into the **epidermis and upper dermis**, is a chief source of **direct DNA damage, inflammation, and immunosuppression**

Answer 28

UVB ## Footnote * Of the UV radiation that reaches the earth’s surface, more than 95% is UVA (320 to 400 nm) and approximately 5% is UVB (280 to 320 nm). * Both UVA and UVB contribute to skin aging.

Question 29

UVR that deeply penetrates the skin down to the lower dermis

Answer 29

UVA

Question 30

UVR considered a larger contributor to **skin aging**

Answer 30

UVA ## Footnote because of its greater depth of penetration and its higher percentage of surface sunlight.

Question 31

Infrared spectrum that can reach down to the hypodermis, increase reactive oxygen species production, and impact mitochondrial integrity

Answer 31

infrared A ## Footnote * Infrared B and infrared C do not penetrate the skin well * Nearly 45% of the solar spectrum reaching human skin is infrared, which is composed of infrared A (700 to 1400 nm), infrared B (1400 to 3000 nm), and infrared C (3000 nm to 1 mm).

Question 32

Impact of Estrogens on Skin Physiology

Answer 32

Question 33

what layer of the epidermis appears to be the most greatly impacted by epidermal atrophy in skin aging?

Answer 33

spinous cell layer

Question 34

what layers of the epidermis are largely unaffected by skin aging?

Answer 34

stratum corneum and stratum granulosum are largely unaffected

Question 35

most pronounced and consistent **histologic change of aged skin**

Answer 35

**flattening of the dermal–epidermal junction and loss of rete ridges, r**esulting in decreased surface contact area and presumably less nutritional support of the avascular epidermis by the vascularized dermis ## Footnote These alterations account for the increased fragility of aged skin to minor trauma as well as propensity to blister

Question 36

Although the density of melanocytes doubles in photodamaged skin, the number of functional melanocytes in the basal layer declines by up to how many percent per decade?

Answer 36

20% per decade

Question 37

Question 38

Acute UV irradiation transiently upregulates 3 MMPs the skin, with the epidermis being the major source

Answer 38

MMP-1, MMP-3, and MMP-9 ## Footnote * In contrast, chronically photodamaged skin has been shown to constitutively express higher levels of 7 MMPs (MMP-1, MMP-2, MMP-3, MMP-9, MMP-11, MMP-17, and MMP-27), which are primarily derived from dermal fibroblasts * The resulting fragmentation of collagen is unable to produce an amount of mechanical tension on the fibroblasts to stimulate collagen synthesis. * Thus, elevated MMP activity in the dermis of photodamaged skin creates a microenvironment of fragmented collagen that impairs fibroblast function leading to abnormal collagen homeostasis with increased degradation and decreased production of collagen

Question 39

the most striking histologic alteration of photodamaged dermis

Answer 39

Solar elastosis ## Footnote * characterized by the replacement of **normal elastic fibers with a disordered mass of elastotic material **(ie, degraded elastic fibers, tropoelastin, and fibrillin) that is localized near the dermal–epidermal junction

Question 40

Question 41

Elderly men commonly have a drop in the density of chest, axillary, and pubic hair, but an increase of hair in other body sites is noted where?

Answer 41

nostrils, external auditory meatus, and eyebrows ## Footnote Elderly women typically experience a new growth of coarse hair on the chin and upper lip, likely resulting from the unopposed influence of testosterone secondary to falling estrogen levels.

Question 42

age-related thinning of hair

Answer 42

Senescent alopecia ## Footnote androgenetic alopecia (or male pattern hair loss) is a distinct entity that can occur at an earlier age and results from the effect of dihydrotestosterone on hair follicles

Question 43

T/F **Both** the number and output of eccrine glands decline with age

Answer 43

TRUE ## Footnote The resulting decrease in spontaneous sweating renders the elderly more vulnerable to heat stroke.

Question 44

T/F size and function of apocrine glandsare reduced in older skin

Answer 44

True ## Footnote Although the size and number of sebaceous glands appear constant, there is a drop of sebum production that is likely associated with hormonal changes

Question 45

T/F With aging, tactile thresholds are decreased.

Answer 45

FALSE ## Footnote * tactile thresholds are increased * The d**ecrease in the size and density of Pacinian and Meissner corpuscles** may account for this finding * There is also an **increase in thermal pain thresholds** in the elderly * An age-associated decline in the spatial acuity (ability to discriminate between 2 points, light touch, and vibration) of the skin also occurs

Question 46

T/F Senile lentigines and seborrheic keratoses have **no** malignant potential and do not require therapy beyond cosmetic reasons

Answer 46

TRUE ## Footnote * Unlike senile lentigines, the development of seborrheic keratoses is independent of UV exposure and is likely a result of impaired focal epidermal homeostasis resulting in the clonal expansion of melanocytes and keratinocytes

Question 47

this regulator of melanocyte function has been implicated in the development of seborrheic keratosis

Answer 47

keratinocyte-derived endothelin-1

Question 48

small circular or oval red papules resulting from the proliferation of blood vessels that tend to increase in size and number with age and may bleed with minor trauma

Answer 48

Senile/ cherry angiomas

Question 49

nature of sun exposure in SCC and AK

Answer 49

Squamous cell cancer and its precursor lesion, actinic keratosis, are associated with** habitual sun exposure**

Question 50

nature of sun exposure in BCC and Melanoma

Answer 50

basal cell cancer and malignant melanoma correlate with a history of **habitual or intense intermittent sun exposure**

Question 51

clinical characteristics of Merkel cell carcinoma have been summarized in an acronym: AEIOU

Answer 51

* asymptomatic/ lack of tenderness, * expanding rapidly, * immune compromised, * older than 50 years, and * UV-exposed site on a person of fair skin

Question 52

cancer of the inner lining of blood vessels, most commonly occurs in the elderly

Answer 52

Angiosarcoma ## Footnote * It can affect any area of the body, but the majority present on the** head and neck** * **Rapidly proliferating and invasive anaplastic cells** are characteristic of angiosarcoma * aggressive and highly metastatic cancer is associated with a high mortality and often leads to death within 2 years of initial diagnosis

Question 53

diseases associated with xerosis

Answer 53

chronic renal failure, liver disorders, lower-leg atherosclerosis, autoimmune diseases, and hepatitis C virus infections

Question 54

xerosis complicated by dermatitis and is characterized by dry, extremely pruritic, fissured skin with scales

Answer 54

Asteatotic eczema ## Footnote * It typically presents in the elderly during the winter seasons and is often associated with low humidity in heated environments

Question 55

most frequent site of herpes simplex virus infection in older individuals

Answer 55

vermilion border of the lip

Question 56

recurrent formation of ecchymoses on the sun-exposed extensor surfaces of the arms or hands of elderly patients

Answer 56

SENILE PURPUR/ BATEMAN PURPURA ## Footnote Age-related skin thinning and sun-induced damage of the connective tissue of the dermis results in inadequate support and increased fragility of the microvasculature.