Regional variability in mottled subclinical melanoderma in the elderly.

The density in melanin chromatophores becomes heterogeneous in the epidermis during the early events of photoaging. Little is known about the regional variability in the resulting mottled skin appearance on the sun-exposed parts of the body in the elderly. The relationship between these features and the dermal atrophy related to aging is also an area ripe for study. The aim of the present study was to objectively assess and compare such aspects of photoaging in older subjects. A computer-assisted video camera equipped with an internal ultraviolet-emitting unit (Visioscan) was used in combination with image analysis to quantify the infraclinical mottling of the skin on the forehead, neck and dorsal forearm. A Densi Score device served to assess the dermal atrophy by rating the skin folding capacity. A mottled subclinical melanoderma was disclosed on the three evaluation sites in all subjects irrespective of their phototypes. Three main patterns were identified corresponding to regular perifollicular dots, streaky macules along shallow wrinkles and unevenly shaped macules in the interfollicular area. The extent in melanoderma was larger on the forehead than on the neck and forearm. The age after 60 years did not influence the severity of mottled melanoderma, but clearly altered the skin folding capacity. The greatest inter-individual differences in mottled melanoderma were found in phototype II subjects. In conclusion, infraclinical mottled melanoderma is present in all individuals after 60 years of age. This type of epidermal photoaging does not appear to be influenced in older ages. By contrast, skin laxity due to dermal aging continues to progress beyond the age of 60 years.