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Title: A comparison of atrophic and hypertrophic facial photoageing
Author: Ayer, Jean
ISNI:       0000 0004 7655 9791
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2016
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Background: Photoageing is due to the cumulative effects of sun exposure superimposed on chronological cutaneous ageing. Clinically, amongst Fitzpatrick skin types I-IV, it is thought that two main phenotypes of facial photoageing may exist: atrophic smooth telangiectactic skin (AP) and hypertrophic coarse wrinkled skin (HP). AP is more prone to the development of non-melanoma skin cancers (NMSC). Aim: To investigate the morphological and histological differences in photoexposed facial skin and photoprotected buttock skin from prototypic subjects with atrophic skin and hypertrophic phenotypes. Patients and Methods: Subjects with atrophic and hypertrophic skin were pre-selected based on their phenotype from the general population (n=40; n=20, hypertrophic phenotype, 10 males, 10 females; n=20, atrophic phenotype, 10 males, 10 females). All subjects had a 4mm punch biopsy taken from their UV exposed facial skin (cheek) and a 6mm punch biopsy taken from their UV-protected buttock skin. All selected participants were: ex- or non-smokers, had no history of inflammatory skin disease, and aged > 50 years (mean ± SE); [AP (78.7y ±2.02) and HP (74.6y ±2.08)]. Staining for elastic fibres, fibrillin-rich microfibrils (FRMs), collagen VII and Von Willebrand Factor (vWF) as well as morphometric measurements including dermal-epidermal convolution and epidermal thickness were performed. Demographic data and VISIA® photoassessments were additionally compiled. Analysis using ImageJ software and SPSS (Statistics 20; IBM) was performed. Results: We found that AP epidermis was thicker than HP (p < 0.0001) but there were no significant differences in dermal-epidermal junction (DEJ) convolution between phenotypes (p > 0.05). The percentage of dermis occupied by mature elastin fibres was significantly greater in HP than AP (p < 0.0001), but the dermis of HP was less enriched in fibrillin-rich microfibrils than AP (p < 0.05). AP was found to be collagen VII-poor compared to HP (p < 0.05) but, as expected, was more vascular with a greater number of blood vessels (p < 0.001 & p < 0.0001, respectively). No differences were found in any of these biomarkers in sun-protected buttock skin obtained from the same patients. Conclusion: This is a novel, exploratory study which demonstrates that the stroma in AP facial skin is characterised by less solar elastosis and collagen VII expression and more fibrillin-rich microfibrils, increased vascularisation compared to the HP phenotype. HP and AP appear to be distinct clinical and histological entities.
Supervisor: Griffiths, Christopher ; Watson, Rachel Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: hypertrophic ; atrophic ; photoaging