ENDOCRINOLOGICAL DERMATOLOGY AND LONGEVITY
Metabolic and endocrine diseases can cause significant changes in the skin that affect its texture, color, turgor (the mobility of subcutaneous tissue), elasticity, and moisture.
The most common skin changes are related to diabetes, specifically disorders of sugar metabolism, characterized by bullous skin changes, diabetic dermopathy, and changes resembling necrobiosis lipoidica and acanthosis nigricans.
Insulin resistance is a metabolic state present in about 40% of the general population. A suboptimal (lower than optimal) biological tissue response to normal levels of secreted insulin is referred to as insulin resistance.
Throughout life, the pancreas secretes increasing amounts of insulin, but its utilization is suboptimal. This is the fundamental pathophysiological factor of type 2 diabetes, which typically persists for years before a clinical diagnosis of diabetes is established. Obesity is always associated with insulin resistance, accompanied by biochemical effects from the secretion of numerous cytokines that cause metabolic syndrome. The appearance of skin tags (acrochordons) in friction areas and on the neck, darkly pigmented thickened skin in folds (acanthosis nigricans), thinning hair (androgenetic alopecia), and increased oiliness of the scalp (seborrhea) are part of the skin manifestations of insulin resistance. The presence of these skin changes significantly facilitates the diagnosis of metabolic syndrome.
In some patients with psoriasis, there is an underlying metabolic syndrome.
Skin changes are also observed in chronic and untreated gout, manifested as deposits of urate in the skin.
Calcinosis cutis refers to the deposition of calcium in the skin due to calcium metabolism disorders, which can be classified as dystrophic, metastatic, iatrogenic, or idiopathic calcinosis.
Xanthomas represent a reflection of lipid metabolism disorders with existing hyperlipidemia or indicate the result of local cellular dysfunction.
Thyroid metabolism disorders manifest as pretibial myxedema. Autoimmune processes in the thyroid gland may be linked to the development of alopecia areata and vitiligo, while dysfunctions of the thyroid can lead to extreme skin dryness, loss of body hair, and thinning of hair on the scalp.
Skin signs associated with androgen overproduction include the presence of acne, increased hairiness, and androgenetic alopecia. An increase in androgen levels in women can have an ovarian origin or be related to the adrenal glands. The appearance of acne is often associated with polycystic ovary syndrome (PCOS), while increased sebum production correlates with elevated levels of dehydroepiandrosterone sulfate. Hyperandrogenism is suspected in adult women when acne appears suddenly, has a cystic form, and is resistant to comedolytic and antibiotic therapy.
Obesity—as a growing pathology in the general population—affects multiple organ systems, including the skin. Although obesity is more common in the adult population, the prevalence (the total number of cases in the population) is also increasing among children and adolescents. Obesity causes various skin changes, the severity of which depends on age and the duration of obesity.
The most common skin changes in obese children include acanthosis nigricans, stretch marks, fungal infections, particularly in areas where two skin surfaces rub against each other, skin tags (acrochordon), acne, increased hairiness, and viral and bacterial infections.
In obese individuals of all ages, psoriasis, xanthomas, hard calluses, dark pigmentation in flexural areas, hyperkeratosis on the feet, and miliaria are more frequently observed.
There is no doubt that a gradual hormonal deficit plays a significant role in the aging process, and hormonal replacement can slow down aging. Growth hormone, insulin-like growth factor-1, dehydroepiandrosterone, melatonin, adiponectin, adipokines, and estrogens play very significant roles and are considered target substances to be used in anti-aging medicine protocols.