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Skin characteristics of photoaging and intrinsic aging in Southwest Chinese population: a reflectance confocal microscopy and histopathological study
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DOI：10.3389/fphys.2026.1848754.png)
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Abstract
En 中文
Despite widespread use of reflectance confocal microscopy (RCM) in dermatology; normative aging data for Chinese populations remain limited. This study aimed to analyze the characteristics of skin microstructure under RCM and histomorphological differences between photoaging and intrinsic aging in Southwest Chinese adults; and to explore potential effect modification by occupational ultraviolet exposure. A total of 150 healthy volunteers (50 per group: 18–35; 45–55; and ≥65 years) underwent RCM imaging of the right zygoma and left volar forearm. Fifteen parameters were measured; such as epidermal thickness (ET); furrow patterns; irregular honeycomb; mottled pigmentation; collagen score (higher = greater degeneration); and papillary ring score. SCINEXA scores and work environments were recorded. Perilesional skin tissues from the face and forearm of young and elderly subjects were collected for histopathological analysis of epidermal thickness; rete ridge length; and collagen-positive area. ET showed site-specific variation characteristics: the volar forearm was significantly thinner in the older versus younger group (P<0.001); whereas facial skin showed an apparent nonlinear distribution; with greater thickness in the middle-aged versus younger group (49.0 ± 8.35 vs. 45.3 ± 5.44 μm; P = 0.021) and attenuation in the older group (42.0 ± 6.44 μm; P = 0.045). Collagen scores differed by site and age group: forearm scores exceeded facial scores in the younger group (forearm: 2.000 [1.000–4.000] vs. face: 1.00 [0.000–2.000]; P = 0.0003); whereas facial scores surpassed forearm scores in the middle-aged and older groups (face: 8.000 [7.000–8.250] vs. forearm: 7.000 [6.000–8.000]; P = 0.002). Facial polycyclic rings increased across age groups; from 4% in younger to 50% in older subjects (P<0.001). Outdoor work was associated with more pronounced facial aging markers in middle-aged and older versus younger subjects (collagen loss: P = 0.011–0.003; papillary flattening: P = 0.020). Histological findings were consistent with RCM observations. In this cross-sectional cohort study; site-specific differences in age-group distributions of skin aging-related parameters were observed. These RCM-derived structural parameters may facilitate differentiation between intrinsic aging and photoaging features; however; their potential value for informing aging intervention strategies requires validation through prospective interventional studies.
Keywords:
photoaging
reflectance confocal microscopy
Asian skin
dermal collagen
dermo-epidermal junction
intrinsic skin aging
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