Dermoscopic assessment of xerosis severity, pigmentation pattern and vascular morphology in subjects with physiological aging and photoaging.

BACKGROUND: Skin aging can be classified as either physiological or pathological aging. Pathological aging is most often due to chronic sunlight exposure (photoaging). Age-dependent changes in dermoscopic features of normal skin have not previously been well defined. OBJECTIVES: We compared the dermoscopic features of skin from non-elderly subjects, elderly subjects with physiological aging, and elderly subjects with photoaging. MATERIALS AND METHODS: We enrolled 40 non-elderly subjects aged 20-60 years, 40 elderly subjects aged >60 years with physiological aging, and 40 elderly subjects aged >60 years with photoaging. Skin from the lower legs of subjects was examined by dermoscopy. RESULTS: Compared with non-elderly subjects, dermoscopic examination of elderly subjects with physiological aging and photoaging revealed various degrees of xerosis (mild: scaling limited to skin furrows; moderate: scaling extending beyond skin furrows with accentuation of skin markings; severe: plate-like scaling extending beyond skin furrows with formation of deep skin fissures). In addition, dermoscopic examination of skin from elderly subjects with photoaging showed increased prevalence of uneven pigmentation (small brown globules, reticular pigmentation, and homogeneous pigmentation in a patchy distribution) and vascular telangiectasia (linear and branching vessels). CONCLUSION: This study provides a novel dermoscopic grading system to evaluate the severity of xerosis and demonstrates the application of dermoscopy for the accurate assessment of subtle morphological changes (including pigmentation pattern and vascular structures) associated with physiological aging and photoaging.