الفهرس 
SKIN AGINGOnly 14 pages are availabe for public view
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Abstract
P
hotoaging has become evident nowadays because of ozone deletion and increase time of exposure to UV radiation. It can be differentiated from chronological aging. Clinically photoaging is characterized by course wrinkles, surface mottling and sagging on exposed sites while in chronological aging fine wrinkles, exaggerated facial expression, and laxity are present. Histologically, thickening of epidermis, solar elastosis, and basophilic degeneration of collagen are prominent in photoaging.
In photoaging, UV rays induced metalloproteinases ; MMP-1, MMP-3, and MMP-9 expression leads to degradation of collagen resulting in impaired structural integrity of the dermis.
Mesotherapy, commonly known as ”biorejuvenation” or ”biorevitalization”, has been used to rejuvenate the skin by means of a transdermal injection of a multivitamin solution and natural plant extracts that are thought to improve the signs of skin aging.
As with any new procedure, it is important to assess the benefits, safety, efficacy, and standardization of mesotherapy before it can be advocated for skin rejuvenation treatments.
The aim of this work was to objectively study the effect induced by rejuvenation mesotherapy of aged skin through histological and immunohistochemical assessment of tissue expression of MMP- 1 and MMP-9.
Ten female subjects aged 30 to 50 years with clinical signs of photoaging, with Fitzpatrick skin types III or IV and Glogau class I-II wrinkles were subjected to a three-month course of mesotherapy injections in the forehead and cheek area.
Each subject was injected by multivitamin and hyaluronic acid using both intradermal and nappage techniques of mesotherapy. Facial injections (0.8 ml multivitamin and 0.2 hyaluronic acid) were done regularly every two weeks (six sessions administered at two-week intervals).
Clinical evaluations, digital standard photographs and skin biopsies were obtained from the treatment area at baseline, and at the end of treatment.
Efficacy was assessed using visual grading of facial skin, cutaneous remodeling was assessed by histological analyses of tissues that were stained by haematoxylin-eosin and immunohistochemical expression of MMP-1 and MMP-9. Cutaneous tolerability was evaluated clinically and subjectively with monitoring adverse events. Digital photography documented treatment-related changes in skin appearance.
Our results showed that there was a clinically detectable improvement in the appearance of fine lines, uneven skin pigmentation, and overall skin tone appearance after 12 weeks. Significant improvements were seen as regards the change of the clinical grading parameters, there was a highly significant improvement in fine lines appearance (P=0.008), significant decrease in uneven pigmentation (P= 0.014), however the overall change of skin tone after mesotherapy sessions was detected but not significant (P=0.059).
Histological changes in the form of decreased epidermal hyperpigmentation were observed after completion of treatment though non significant (P=0.317), the dermis showed a highly significant decrease in the inflammation (p=0.005), significant change in collagen degeneration (P=0.034), and significant decrease of blood vessels break down (P=0.011). Histopathological evaluation revealed marked increase of collagen fibers. We also observed that these newly formed collagen fibers had a uniform distribution following a parallel axis to the surface of the epidermis, involving the superficial, mid and deep reticular dermis.
Our patients in this study showed an improvement in their photodamaged skin that was most probably related to the increased and organized collagen fibers in the reticular dermis; in other words; increased collagen synthesis and improved solar elastosis, which promoted an overall ”skin tightening” effect in these patients after treatment.
Immunohistochemical staining pattern of MMP-1, revealed a highly significant change in the epidermal cells (P=0.005) and in dermal cells (P=0.006). Immunostaining pattern of MMP-9 showed a highly significant change in the epidermal cells (P=0.007) and in dermal cells (P= 0.004).
We also observed that younger female subjects had higher scores of improvement, as there was an inverse relationship between the age and the global improvement of fine lines and skin tone.
Taken together, our work reports that methoterapy showed statistically significant within-group improvement in the appearance of fine lines and wrinkles, uneven skin pigmentation, skin firmness/elasticity, skin tone and resilience, skin radiance and color, smoothness, and overall appearance over 12 weeks. That was evidenced by histopathological dermal collagen remodeling under the influence of decreased matrix metalloproteinases’s activity; MMP-1 and 9 which had significant decreased tissue expression, all of which were induced by such treatment.
from the findings presented above that the mesotherapy might be an effective and tolerable treatment in facial rejuvenation of aged skin as shown by clinical evaluation, routine H&E histopathological examination and immunohistochemical study of matrix metalloproteinases’s; MMP-1 and MMP-9.