Journal Mobile Options
Table of Contents
Vol. 215, No. 4, 2007
Issue release date: October 2007
Section title: Clinical and Laboratory Investigations
Dermatology 2007;215:284–294
(DOI:10.1159/000107621)

Dermatoporosis: A Chronic Cutaneous Insufficiency/Fragility Syndrome

Clinicopathological Features, Mechanisms, Prevention and Potential Treatments

Kaya G. · Saurat J.-H.
Department of Dermatology, University of Geneva, Geneva, Switzerland

Do you have an account?

Register and profit from personalized services (MyKarger) Login Information

Please create your User ID & Password





Contact Information









I have read the Karger Terms and Conditions and agree.

Register and profit from personalized services (MyKarger) Login Information

Please create your User ID & Password





Contact Information









I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger (new!)
  • Unrestricted printing, no saving restrictions for personal use
  • Reduced rates with a PPV account
read more

Direct: USD 38.00
Account: USD 26.50

Select

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restriction apply

Rental: USD 8.50
Cloud: USD 20.00

Select

Subscribe

  • Automatic perpetual access to all articles of the subscribed year(s)
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select


Article / Publication Details

First-Page Preview
Abstract of Clinical and Laboratory Investigations

Accepted: 4/20/2007
Published online: 10/18/2007

Number of Print Pages: 11
Number of Figures: 6
Number of Tables: 1

ISSN: 1018-8665 (Print)
eISSN: 1421-9832 (Online)

For additional information: http://www.karger.com/DRM

Abstract

Background: Skin aging has long been considered only as a cosmetic problem. With the increase in lifespan, we are now more often experiencing a further dimension of skin aging, which is no longer only cosmetic, but also functional, in the sense that the skin has lost its protective mechanical function. Dermatoporosis is the name proposed to capture, in a holistic approach, all the aspects of this chronic cutaneous insufficiency/fragility syndrome. Observations: In this paper, we review the clinical aspects of dermatoporosis, its histological features and the current understanding of its etiological factors. The clinical manifestations of dermatoporosis comprise (i) morphologicalmarkers of fragility – rather trivial – such as senile purpura, stellate pseudoscars and skin atrophy, and (ii) functional expression of skin fragility resulting from minor traumas such as frequent skin laceration, delayed wound healing, nonhealing atrophic ulcers and subcutaneous bleeding with the formation of dissecting hematomas leading to large zones of necrosis. Dissecting hematomas bear significant morbidity needing hospitalization and urgent surgical procedures. Molecular mechanisms implying hyaluronate-CD44 pathways in the control and maintenance of epithelial growth and the viscoelastic properties of the extracellular matrix offer new opportunities for preventive intervention. Conclusion: We propose to group the different manifestations and implications of this syndrome under the umbrella term of ‘dermatoporosis’,because we think it will helpto capture the understanding of health professionals that, as osteoporosis, ‘dermatoporosis’should be prevented and treated to avoid complications. Dermatologists should be aware of this emerging syndrome and function as key players in prevention and therapy. Randomized clinical trials should demonstrate which intervention may best prevent and/or reverse dermatoporosis.


Article / Publication Details

First-Page Preview
Abstract of Clinical and Laboratory Investigations

Accepted: 4/20/2007
Published online: 10/18/2007

Number of Print Pages: 11
Number of Figures: 6
Number of Tables: 1

ISSN: 1018-8665 (Print)
eISSN: 1421-9832 (Online)

For additional information: http://www.karger.com/DRM


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Saurat JH: Quand la peau devient insuffisante (editorial). Méd Hyg 2004;2472:476.
  2. Saurat JH: Dermatoporosis. The functional side of skin aging (editorial). Dermatology 2007;215:271–272.

    External Resources

  3. Colomb D, Pinçon JA, Lartaud J: Individualisation anatomo-clinique d’une forme méconnue de la peau sénile: les pseudo-cicatrices stellaires spontanées. Leurs rapports avec le purpura de Bateman. Ann Dermatol Syphil 1967;94:273–286.
  4. Colomb D: Stellate spontaneous pseudoscars: senile and presenile forms, especially those forms caused by prolonged corticoid therapy. Arch Dermatol 1972;105:551–554.
  5. Prins C: L’insuffisance cutanée. Méd Hyg 2004;2472:478–480.
  6. Schoepe S, Schäcke H, May E, Asadullah K: Glucocorticoid therapy-induced skin atrophy. Exp Dermatol 2006;15:406–420.
  7. Tomic-Canic M, Brem H: Gene array technology and pathogenesis of chronic wounds. Am J Surg 2004;188(1A suppl):67–72.

    External Resources

  8. Ralston SH, De Crombrugghe B: Genetic regulation of bone mass and susceptibility to osteoporosis. Gene Dev 2006;20:2492–2506.
  9. Robert L, Labat-Robert J: Aging of connective tissues: from genetic to epigenetic mechanisms. Biogerontology 2000;1:123–131.
  10. Giacomoni PU, Rein G: Factors of skin ageing share common mechanisms. Biogerontology 2001;2:219–229.
  11. Hornebeck W: Down-regulation of tissue inhibitor of matrix metalloprotease-1 (TIMP-1) in aged human skin contributes to matrix degradation and impaired cell growth and survival. Pathol Biol 2003;51:569–573.
  12. Meyer MA, Chawla KK: Mechanical Behavior of Materials. Upper Saddle River, Prentice-Hall, 1999, pp 98–103.
  13. Toole BP, Lowther DA: The organisation of the hexosamine containing compounds in bovine skin. Biochim Biophys Acta1966;121:315–322.
  14. Harkness RD: Functional aspects of connective tissues of skin; in Balazes EA (ed): Chemistry and Molecular Biology of InterCellular Matrix. London, Academic Press, 1970, vol 3, pp 1309–1340.
  15. Viidik A, Danielsen CC, Oxlund HC: On fundamental and phenomenological models, structure and mechanical properties of collagen, elastin and glycosaminoglycan complexes. Biorheology 1982;19:437–451.
  16. Silver FH: Biological Materials: Structure, Mechanical Properties, and Modeling of Soft Tissues. New York, New York University Press, 1987, pp 75–79.
  17. Dunn MG, Silver FH: Viscoelastic behavior of human connective tissues: relative contribution of viscous and elastic components. Connect Tissue Res 1983;12:59–70.
  18. Silver FH, Kato YP, Ohno M, Wasserman AJJ: Analysis of mammalian connective tissue: relationship between hierarchical structures and mechanical properties. J Long Term Eff Med Implants 1992;2:165–198.
  19. Wainwright SA, Biggs WD, Curry JD, Cosline JM: Mechanical Designs in Organisms. London, Arnold, 1976.
  20. Silver FH, Seehra GP, Freeman JW, DeVore D: Viscoelastic properties of young and old human dermis: a proposed molecular mechanism for elastic energy storage in collagen and elastin. J Appl Polym Sci 2002;86:1978–1985.
  21. Arumugam V, Naresh MD, Sanjeevi R: Effect of strain rate on the fracture behaviour of skin. J Biosci1994;19:307–313.

    External Resources

  22. Kamath YK, Weigmann HD: Fractography of human hair. J Appl Polym Sci 1982;27:3809–3823.

    External Resources

  23. Arumugam V, Naresh MD, Somanathan N, Sanjeevi R: Effect of strain rate on the fracture behaviour of collagen. J Mater Sci 1992;27:2649–2652.
  24. Arumugam V, Sanjeevi R: Effect of strain rate on the mode of fracture in elastoidin. J Mater Sci 1987;22:2691–2694.
  25. Passeron T, Ortonne JP: Skin ageing and its prevention (in French). Presse Méd 2003;32:1474–1482.
  26. Ma W, Wlaschek M, Tantcheva-Poor I, Schneider LA, Naderi L, Razi-Wolf Z, Schuller J, Scharffetter-Kochanek K: Chronological ageing and photoageing of the fibroblasts and the dermal connective tissue. Clin Exp Dermatol 2001;26:592–599.
  27. Sellheyer K: Pathogenesis of solar elastosis: synthesis or degradation? J Cutan Pathol 2003;30:123–127.
  28. Calikoglu E, Sorg O, Tran C, Grand D, Carraux P, Saurat JH, Kaya G: UVA and UVB decrease the expression of CD44 and hyaluronate in mouse epidermis which is counteracted by topical retinoids. Photochem Photobiol 2006;82:1342–1347.
  29. Ghersetich I, Lotti T, Campanile G, Grappone C, Dini G: Hyaluronic acid in cutaneous intrinsic aging. Int J Dermatol 1994;33:119–122.
  30. Kaya G, Tran C, Sorg O, Hotz R, Grand D, Carraux P, Didierjean L, Stamenkovic I, Saurat JH: Hyaluronate fragments reverse skin atrophy by a CD44-dependent mechanism. PLoS Med 2006;3:e493.
  31. Fraser JRE, Laurent TC: Turnover and metabolism of hyaluronan: the biology of hyaluronan. CIBA Found Symp1989;143:41–59.
  32. Laurent TC, Fraser JR: Hyaluronan. FASEB J1992;6:2397–2404.
  33. Stamenkovic I, Aruffo A, Amiot M, Seed B: The hematopoietic and epithelial forms of CD44 are distinct polypeptides with different adhesion potentials for hyaluronate-bearing cells. EMBO J1991;10:343–348.
  34. Bennett KL, Jackson DG, Simon JC, Tanczos E, Peach R, Modrell B, Stamenkovic I, Plowman G, Aruffo A: CD44 isoforms containing exon V3 are responsible for the presentation of heparin-binding growth factor. J Cell Biol1995;128:687–698.
  35. Kaya G, Rodriguez I, Jorcano JL, Vassalli P, Stamenkovic I: Selective suppression of CD44 in keratinocytes of mice bearing an antisense CD44 transgene driven by a tissue-specific promoter disrupts hyaluronate metabolism in the skin and impairs keratinocyte proliferation. Genes Dev1997;11:996–1007.
  36. Kaya G, Tran C, Sorg O, Hotz R, Grand D, Carraux P, Didierjean L, Stamenkovic I, Saurat JH: CD44-dependent mouse skin hyperplasia induced by topical hyaluronate fragments. J Invest Dermatol 2004;123:A2.
  37. Didierjean L, Carraux P, Grand D, Sass JO, Nau H, Saurat JH: Topical retinaldehyde increases skin content of retinoic acid and exerts biologic activity in mouse skin. J Invest Dermatol 1996;107:714–719.
  38. Xiao JH, Feng X, Di W, Peng ZH, Li LA, Chambon P, Voorhees JJ: Identification of heparin-binding EGF-like growth factor as a target in intercellular regulation of epidermal basal cell growth by suprabasal retinoic acid receptors. EMBO J 1999;18:1539–1548.
  39. Margelin D, Medaisko C, Lombard D, Picard J, Fourtanier A: Hyaluronic acid and dermatan sulfate are selectively stimulated by retinoic acid in irradiated and nonirradiated hairless mouse skin. J Invest Dermatol 1996;106:505–509.
  40. Tammi R, Ripellino JA, Margolis RU, Maibach HI, Tammi M: Hyaluronate accumulation in human epidermis treated with retinoic acid in skin organ culture. J Invest Dermatol 1989;92:326–332.
  41. Lundin A, Berne B, Michaelsson G: Topical retinoic acid treatment of photoaged skin: its effects on hyaluronan distribution in epidermis and on hyaluronan and retinoic acid in suction blister fluid. Acta Derm Venereol 1992;72:423–427.
  42. Kaya G, Grand D, Hotz R, Augsburger E, Carraux P, Didierjean L, Saurat JH: Upregulation of CD44 and hyaluronate synthases by topical retinoids in mouse skin. J Invest Dermatol 2005;124:284–287.