Skin dystrophy is the result of the pathological course of metabolic processes in the dermis, expressed in a change in the quantitative and qualitative composition of the skin layers and its degeneration. Clinical manifestations depend on the type of skin dystrophy, but are always accompanied by thinning of the skin with a rash of various primary elements, the appearance of skin folds that change its appearance. Skin dystrophy is diagnosed on the basis of a typical clinic, taking into account histology data. Treatment is symptomatic. If dystrophy is a symptom of some disease, first of all, it is necessary to diagnose and stop this pathological process, then skin manifestations can self-resolve.
Skin dystrophy is heterogeneous changes in the epidermis, dermis and subcutaneous fat, leading to the transformation of the elements that make up the layers of the skin: collagen and elastic fibers, intercellular substance of the dermis, epidermis cells. There are no data on the prevalence, gender coloring, age differences, and endemicity, since each of us encounters skin dystrophy as a physiological component of aging. The first mention of dystrophy is in the theory of spoilage of Hippocratic juices. In 1571, Malpighi, breaking the skin into layers, justified the physiological aging of the dermis, and at the end of the XVIII century, the Viennese physician Film described the morphology of skin dystrophy. Englishman G. Bateman in 1800 published the first atlas with illustrations of pathology. Congenital skin dystrophy began to be studied along with the development of genetics. The urgency of the problem today is associated with the development of oncological processes in some forms of dystrophy.
At its core, skin dystrophy is a disorder of its trophic, congenital or acquired, that is, a violation of tissue and cellular homeostasis. Triggers triggering the process are diverse: infections, hypoxia, impaired blood supply to tissues, enzyme inversions, heredity. As a result of one of the reasons, there is an imbalance of both the internal regulation of the cell and the systems that ensure the trophism of the skin. There is an energy deficit in the cell, enzymes stop working at full strength, which is a trigger mechanism in the pathogenesis of the development of dystrophy.
“Breakdowns” in trophic transport systems (circulatory and lymphatic) cause tissue hypoxia with the development of degenerative processes. In parallel, neuroendocrine problems arise, exacerbating trophic imbalance and stimulating the development of degeneration. At the same time, metabolic failures at the level of histochemistry (fatty and protein infiltration of tissues, synthesis of abnormal substances such as amyloid) are added, which also accelerates skin dystrophy. The main danger is that, having reached the peak of its development, without appropriate adjustment, the process of degeneration becomes irreversible. The physiological illustration of this is skin aging.
In modern dermatology there is no single classification of skin dystrophy. Depending on the morphology, it is proposed to distinguish parenchymal, mesenchymal, mixed degenerations. If we take as a basis the type of metabolic disorders, then we can divide all dystrophies into protein, fat, mineral, carbohydrate. According to the prevalence of the process, systemic and local dystrophies are distinguished. In our opinion, the most appropriate initial division of dystrophy into two large groups:
- Acquired dystrophies, among which there are independent diseases (senile skin dystrophy, skin of farmers and sailors, diamond-shaped hypertrophic neck skin, diffuse elastoma of Dubrey, hyaloma, nodular skin elastoidosis, pigmented papillary skin dystrophy – black acanthosis), and symptoms of other diseases (protein, hyaline, amyloid, hydrotopic, horny, fatty, carbohydrate, mineral dystrophy).
- Congenital degenerative changes of the skin are represented by two diseases: hyperelastic dystrophy of Unna – hereditary abnormal hyperextension of the dermis as a result of changes in the properties of collagen and sluggish Ketley dystrophy (Alibera dystrophy) – hereditary destruction of connective tissue.
Clinically, skin dystrophy is characterized by a variety of manifestations in accordance with the types of pathology. However, there are also common features inherent in dystrophy. Basically, the pathological process of skin degeneration is an involutional transformation of cells as independent structural units of the skin, connective tissue and subcutaneous fat, which lose their normal quantitative ratio. First of all, the number and structure of collagen, elastic fibers, and epidermal cells change. Externally, this is manifested by thinning of the epidermis, loss of skin turgor, rash of many urticary elements, papules, nodules, nodes, vesicles, pustules, warty formations, keratomas, cysts over the entire surface of the skin.
There is a limited hyperpigmentation of the skin, it becomes dry, acquires a grayish hue. Due to the loss of elasticity, the folding of the skin increases, and such changes begin in large folds, on the neck, in the area of natural openings, on the knee and elbow bends. It is based on an imbalance of metabolic and neuroregulatory mechanisms.
Clinical varieties of dystrophy are extremely rare. However, among them there is one type of skin degeneration – black acanthosis, which deserves special attention. It has no age-related features, but is closely associated with a violation of the endocrine sphere. In addition, black acanthosis can be malignized or exist for a long time against the background of latently developing malignant neoplasms of other organs. A distinctive feature of acanthosis is its intense gray-black color. The primary elements – papillomas – are dense, rough to the touch, can erupt both on the skin and on the mucous membranes. Interestingly, if the primary tumor is removed, black acanthosis resolves on its own. More often than others, there are two variants of the development of the disease: a false type – acanthosis of obese women with endocrine pathology (ovarian dysfunction) and a drug type that develops with an overdose of corticosteroids and other medications.
Diagnosis and treatment
Any form of skin degeneration is diagnosed clinically, relying in difficult cases on the results of histology. Differentiate different types of skin dystrophy among themselves, as well as with Addison’s disease, Darya’s follicular dyskeratosis, arsenic melanodermia, ichthyosis, keratosis.
Treatment of dystrophy is symptomatic. Consultations with an endocrinologist, oncologist, dermatologist are mandatory. If somatic pathology is detected, radical treatment is indicated, followed by dispensary observation of the patient (oncological control twice a year). In case of benign dystrophy, vitamin therapy (A, E, PP, D), salt baths, lightening and softening creams are prescribed. Individual papillomas of small size are removed by electrocoagulation or laser after consultation with a cosmetologist. In the case of massive warty growths, cytostatics are used. Patients are recommended to observe a health-protective regime, limited sun exposure, dosed physical activity, protein-vitamin diet.