sem informaçãoCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPnão tem2018/06973‐

Leonardi, Gislaine Ricci

Silva, Silas Arandas Monteiro e

Vasques, Louise Idalgo

Vergilio, Mariane Massufero

Journal of Cosmetic Dermatology

English

Repositorio da Producao Cientifica e Intelectual da Unicamp

J Cosmet Dermatol. 2021;00:1–3. wileyonlinelibrary.com/journal/jocd  | 1© 2021 Wiley Periodicals LLC
Received: 21 December 2020  | Revised: 20 January 2021  | Accepted: 10 February 2021
DOI: 10.1111/jocd.13999  
L E T T E R  T O  T H E  E D I T O R
Characterization of women's young and mature skin by the 
50 MHz high- frequency ultrasound technique
To the Editor,
High- frequency ultrasound imaging (HFUS) is a real- time pow-
erful tool for the diagnosis, clinical management, and therapy moni-
toring of skin conditions. This study aimed to describe the impact of 
skin aging from a dermal perspective. The images of the skin of the 
subjects were randomly collected from the flexor and extensor areas 
of the forearms. The areas were marked 10 cm up from the subjects' 
wrists, and parameters from the dermis were analyzed to character-
ize the young and mature skin.
Several skin changes caused by aging were observed. In a wom-
an's young and healthy skin (Figure 1A,B), the epidermis appears as 
a hyperechoic line (entrance echo), which is highly reflective; the 
dermis appears as a less bright hyperechoic band, with dermal echo-
genicity mainly provided by collagen and brighter than the subcuta-
neous tissue, which appears as a hypoechoic band due to fat lobes. 
The dermal content of collagen, its type, orientation, and beam size 
affect dermal reflectivity/echogenicity.1
In the other skin images indicated in Figure 1C,D, the gradual 
aging of the skin is evidenced with the advanced age. According to 
Figure 1, the echogenicity decreases with aging, especially in the 
upper dermis, due to the sensitiveness of the relationship between 
this parameter and the content and organization of collagen bun-
dles.2 With aging occurs atrophy of the dermis, elastosis, decrease 
and fragmentation of collagen fibers, increase of matrix- degrading 
metalloproteinases and inflammatory infiltrates, alteration of the 
structure of the connective tissue of the dermis, decreased dermis 
veins, etc3,4 These topics also justify the changes in echo- texture 
observed in this skin layer.
The parameters obtained by HFUS can detect both intrinsic 
and extrinsic aging. Yet, since the causes of intrinsic and extrinsic 
aging are different, many clinical signs may appear but they can be 
difficult to differentiate.3,4 We compared the characteristics of the 
flexor (with a predominance of intrinsic aging) and extensor forearm 
area (chronically exposed) of the same person (Figure 2). In the older 
subject's image, the protected region (Figure 2A) presents a less ev-
ident subepidermal low- echogenic band (SLEB) when compared to 
the exposed one (Figure 2B). SLEB has been defined as a visible low 
echogenicity band in the upper dermis immediately below the epi-
dermal input echo and it is an important indicator of photoaging and 
is probably a visual manifestation of elastosis, degradation of colla-
gen, and accumulation of glycosaminoglycans and aqueous tissue in 
the papillary dermis.5
The images of the younger subject did not present SLEB in 
any of the situations (Figure 2C,D). Plus, the images of the photo- 
exposed region and the older subject presented hypoechogenic 
dermal areas in the dermis in greater quantity and with greater con-
trast (Figure 2).
Data on changes in the deeper layers of the dermis are not yet 
well elucidated. However, in Figure 2, the younger skin shows a 
more echogenic lower dermis than the older skin, besides presenting 
greater uniformity of the echo- texture.6
In this report, several skin changes caused by aging could be de-
scribed and evaluated by the 50 MHz HFUS. In general, the younger 
skin presents greater dermal echogenicity and fewer irregularities. 
Also, it is possible to infer the severity of photoaging from the pres-
ence and dimension of SLEB in the upper dermis. Mature skin pres-
ents less dermal echogenicity, a greater amount of hypoechogenic 
infiltrates in the dermis, and a pronounced SLEB. The method can be 
used as a complementary and accurate instrument in evaluations of 
skin aging, effectiveness of cosmetics, and anti- aging dermatological 
treatments, allowing a new level of efficacy evaluation of dermato-
logical and cosmetic products.
Mariane Massufero Vergilio and Silas Arandas Monteiro e Silva should be considered first authors. 
2  |    LETTER TO THE EDITOR
KE Y WORDS
dermis age- related echogenicity, high- frequency ultrasound, skin 
aging, skin roughness, skin thickness, subepidermal low- echogenic 
band
ACKNOWLEDG MENTS
This work was funded by the São Paulo Research Foundation 
(FAPESP— 2018/06973- 4) and “Coordenação de Aperfeiçoamento 
de Pessoal de Nivel Superior— (CAPES)”— Brazil— Finance Code 0001.
F I G U R E  1  Sample of skin imaging 
using US 50 MHz (B- Scan system), 
showing the main alterations caused by 
aging. Sonographic skin images were 
obtained from the inner part of forearms 
from, respectively: a 19- y- old woman (A) 
22- y- old woman (B), a 56- y- old woman 
(C), and a 60- y- old woman (D). The arrows 
indicate regions of the dermis that show 
changes between the images, caused 
by aging
F I G U R E  2  Sample of skin imaging 
using US 50 MHz (B- Scan system), 
showing the changes caused by aging, 
through the sonographic image of the 
photo- protected region of the forearm 
of a 60- y- old person (A) and a photo- 
exposed region of the forearm of the 
same person (B). Figure (C and D) show, 
respectively, images of a photo- protected 
region of the forearm, a 32- y- old person, 
and a photo- exposed region of the 
forearm of the same person. Asterisks 
(*) represent hypoechoic regions present 
in the dermis. The arrows indicate the 
presence and dimension of SLEB in the 
upper dermis
    | 3LETTER TO THE EDITOR
CONFLIC T OF INTERE S T
None.
AUTHOR CONTRIBUTIONS
Mariane Massufero Vergilio: Conceptualization, Methodology, Formal 
analysis, Investigation, Writing- Original draft preparation, Visualization. 
Silas Arandas Monteiro e Silva: Reviewing and Editing. Louise Idalgo 
Vasques: Formal analysis, Investigation, Writing- Original draft prepara-
tion. Gislaine Ricci Leonardi: Writing- Resources, Reviewing and Editing, 
Supervision.
FUNDING INFORMATION
This work was supported by a grant from São Paulo Research Foundation 
(FAPESP— 2018/06973- 4) and Coordenação de Aperfeiçoamento de 
Pessoal de Nível Superior— Brasil (CAPES)— Finance Code 0001.
DATA AVAIL ABILIT Y S TATEMENT
The data that support the findings of this study are available from 
the corresponding author upon reasonable request.
Mariane Massufero Vergilio MD1
Silas Arandas Monteiro e Silva PhD2
Louise Idalgo Vasques B.Sc2
Gislaine Ricci Leonardi PhD1,2
1Graduate Program in Internal Medicine, School of Medical 
Sciences, University of Campinas (UNICAMP), Campinas, Brazil
2Graduate Program in Pharmaceutical Sciences, School of 
Pharmaceutical Sciences, University of Campinas (UNICAMP), 
Campinas, Brazil
Correspondence
Gislaine Ricci Leonardi, 200, Cândido Portinari St. – “Cidade 
Universitária Zeferino Vaz”, 13083- 871 Campinas, SP, Brazil.
Email: gislaine.leonardi@fcf.unicamp.br
ORCID
Mariane Massufero Vergilio  https://orcid.
org/0000-0001-5979-8860 
Silas Arandas Monteiro e Silva  https://orcid.
org/0000-0002-1584-747X 
Louise Idalgo Vasques  https://orcid.org/0000-0003-3152-8468 
Gislaine Ricci Leonardi  https://orcid.org/0000-0002-7126-1326 
R E FE R E N C E S
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with aging. Cosmetics. 2014;1(3):211- 221.
 3. Niamtu J. The aging face. In: The Art and Science of Facelift Surgery. 
USA: Elsevier; 2019:6- 20.
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Characterization of women's young and mature skin by the 50 MHz high‐frequency ultrasound technique

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Characterization of women's young and mature skin by the 50 MHz high‐frequency ultrasound technique

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