Rejuvenation of the skin of the hands as an important element of the complex correction of age-related changes

Olga Bondarenko , leading methodologist of the educational and methodological department, certified trainer of the international holding FloSal (Ukraine)

Everything in a person should be beautiful, so full care must be provided to both the skin of the face and the skin of the hands and forearms, without separating “important” and “unimportant” areas. Moreover, the hands experience a more intense impact of exogenous factors that adversely affect the skin.

Involutional changes in the skin of the hands

Early age-related changes in the skin of the hands are caused, first of all, by the anatomical features of the tissue structure. The back of the hands is characterized by a fairly thin epidermis and dermis, weak subcutaneous fat, and a small number of sebaceous glands compared to other areas of the skin. The stress that the skin of the hands undergoes due to constant exposure to exogenous factors (household chemicals, UV radiation, seasonal temperature fluctuations, lack of daily care) also plays an important role in stimulating premature aging.

Endogenous changes occurring in tissues are manifested in the thinning of all layers of the epidermis, in a decrease in the amount of epidermal lipids that form the protective barrier, and atrophy of the sebaceous and sweat glands is observed. Changes occur in the functioning of skin cells (fibroblasts, melanocytes, keratinocytes, etc.). Disturbances in the functioning of melanocytes lead to stimulation of pigment formation processes, as a result of which age-related dyschromia appears. Fibroblasts, being the main cells of connective tissue, also begin to lose their activity with age.

A decrease in the activity of fibroblasts leads to a decrease in the synthesis of intercellular substance by these cells, which is represented by the main (amorphous) substance, collagen and elastin fibers. The composition of the main substance includes proteoglycans, consisting of glycosaminoglycans (sulfated, such as chondroitin sulfate, keratin sulfate, dermatan sulfate, heparin sulfate, etc., and non-sulfated - hyaluronic acid), glycoproteins (adhesive proteins), water. The role of glycosaminoglycans is difficult to overestimate, since these molecules bind water in tissues. The volume of bound water depends on the number and length of glycosaminoglycan molecules, and since in the process of chronoaging the synthesis of glycosaminoglycans is limited due to the slowdown of fibroblasts, there is a need for additional intensive hydration of the skin.

In addition, fibroblasts are directly involved in fibrillogenesis (fiber formation), namely, they set the direction of connective tissue fibers. This direction corresponds to the long axis of fibroblasts, which regulate the assembly and three-dimensional arrangement of fibers and their bundles in the intercellular substance. Consequently, age-related changes occurring at the level of fibroblasts lead, firstly, to a decrease in the synthesis of collagen and elastin fibers, and secondly, to the formation of their incorrect direction.

The next marker of chronoaging of the skin of the hands and forearms is involutional changes in subcutaneous fat tissue. Adipocytes, that is, adipose tissue cells that are not capable of division, are united into lobules, separated from each other by partitions of loose fibrous connective tissue in which blood vessels and nerves pass. Between the adipocytes there are thin collagen and reticular fibers, next to which there are capillaries. With age, atrophy of adipose tissue occurs, which leads to a pronounced decrease in the volume of the hands, clear visualization of tendons and superficial veins, and a typical clinical picture of aging hands is formed.

In addition to involutional changes in the skin and soft tissues, age-related changes occur in skeletal tissue - bone and cartilage.

Bone tissue consists of bone cells (osteoblasts, osteocytes, osteoclasts), dense intercellular substance containing collagen fibers and mineral components (calcium salts). During the process of chronoaging in bone tissue, the balance of organic and inorganic compounds is disrupted in favor of inorganic ones, so bones become more fragile, their elasticity is lost, and preconditions for osteoporosis appear.

About 50–70% of the dry matter of cartilage tissue is collagen. The intercellular substance (matrix), synthesized by chondroblasts (cartilage cells), consists of proteoglycans, glycoproteins, collagen, and elastin. With age, calcium salts begin to be deposited in cartilage, and the elasticity of the tissue is lost. This is due to a decrease in the amount of collagen, one of the main components of cartilage tissue, and the components of the intercellular substance - hyaluronic acid and chondroitin sulfate. Consequently, involutional changes lead to a decrease in the main functions of cartilage tissue - mechanical, supporting, protective.

Correction of chrono- and photoaging of hand skin

Therapy for age-related changes in the skin of the hands includes several successive stages, namely:

• rehydration;
• restructuring;
• volumization

Rehydration

Restoring the normal moisture balance in tissues is the first step in the treatment of age-related changes in the skin of the hands. A decrease in the synthesis of glycosaminoglycans by fibroblasts, in particular hyaluronic acid, leads to the development of excessive dryness, the skin becomes more susceptible to aggressive exogenous factors. And disruption of the lipid layer significantly reduces protective functions, stimulating transepidermal moisture loss. Therefore, at the initial stage of correcting age-related changes, the fastest and most intensive technique aimed at restoring the moisture balance in tissues is the procedure for intradermal injection of native hyaluronic acid.

Due to the characteristic ability of hyaluronic acid to bind a large number of water molecules, a kind of reserve is created that can stimulate dermal fibroblasts for a long time to proliferation, their synthesis of endogenous hyaluronic acid and collagen . The introduction of unstabilized hyaluronic acid is a basic procedure and serves as a preparatory step for more intensive techniques aimed at tissue restructuring.

Among the huge number of native hyaluronic acid preparations, preference should be given to hyaluronic acid of biosynthetic origin of a high degree of purification, obtained by biofermentation. Particular care must be taken when choosing a manufacturer, paying attention to pharmacological specialization and the presence of its own scientific laboratories and production facilities, which guarantees the highest safety of the drug.

Restructuring

The restructuring stage involves restoration of the morphological structure of tissues, namely the fiber framework of the skin (collagen, elastin), stimulation of the proliferation of keratinocytes and fibroblasts, normalization of the functioning of melanocytes in the presence of dyschromia. Today, the most intense restructuring agents are biomimetic peptides, since these compounds have a selective effect, interacting with specific receptors on the cell membrane. Each peptide, depending on its intended purpose, has a targeted effect and works only at the site of tissue damage (age-related changes). Biomimetic peptides have a powerful biologically active effect, therefore they have deservedly taken a leading position in geroprotective programs and are the drugs of choice for intensive tissue restructuring. One of the most striking restructuring peptides is Acetyl Decapeptide-3 (CG-Rejuline), which mimics the work of fibroblast growth factor-β (bFGF). Main clinical effects of Acetyl Decapeptide-3:

• stimulation of proliferation and migration of fibroblasts (Fig. 1);
• stimulation of keratinocyte proliferation (Fig. 2);
• stimulation of collagen expression by fibroblasts.

Rice. 1. Proliferation of fibroblasts. Fibroblast proliferation depending on the concentration of CG-Rejuline after 72 hours, in percent. Peptide concentration – from 1 to 1,000 ng

Rice. 2. Proliferation of keratinocytes. Change in cell morphology on a keratinocyte line after 72 hours of incubation with CG-Rejuline (5 μg/ml)

Volumization

Volumization is a procedure aimed at restoring lost volume of soft tissue using injectable fillers based on stabilized hyaluronic acid. Since subcutaneous fat in the area of the hands is initially weakly expressed, and its atrophy with age leads to significant aesthetic defects, volumization of this area is a mandatory step in correcting age-related changes.

To restore this area, you can use soft fillers - both monophasic and biphasic. An important aspect when choosing a filler is the viscoelastic properties of the drug, since the aesthetics and correctness of the correction will depend on this. When working with monophasic fillers, preference should be given to drugs with high viscosity and elasticity, which have thixotropic properties - this will ensure effective, beautiful and long-lasting correction. But no matter how effective modern cosmetology techniques are, we should not forget about the systemic processes occurring in the human body. Cells of all tissues are susceptible to aging, so when approaching the treatment of external signs of chrono- and photoaging of the hands, one should not forget about maintaining the smooth functioning of the cells from the inside. This is especially true for connective tissue cells. The body, as a rule, does not receive components such as collagen, hyaluronic acid, chondroitin sulfate from food, so it is necessary to ensure their supply with the help of dietary supplements.

A comprehensive approach to rejuvenating a patient’s appearance should include working with all exposed parts of the body, including the skin of the hands. This increases the overall effectiveness of the procedures and thus the patient's satisfaction with the results.

First published in Les Nouvelles Esthetiques 2014/№6