Decoding Skin Aging: A Review of Mechanisms, Markers, and Modern Therapies

Skin aging is a multifactorial process driven by both intrinsic mechanisms—such as telomere shortening, oxidative stress, hormonal decline, and impaired autophagy—and extrinsic influences including ultraviolet radiation, pollution, smoking, and diet. Together, these factors lead to the structural and functional deterioration of the skin, manifesting as wrinkles, pigmentation disorders, thinning, and reduced elasticity. This review provides an integrative overview of the biological, molecular, and clinical dimensions of skin aging, emphasizing the interplay between inflammation, extracellular matrix degradation, and senescence-associated signaling pathways. We examine histopathological hallmarks and molecular markers and discuss the influence of genetic and ethnic variations on aging phenotypes. Current therapeutic strategies are explored, ranging from topical agents (e.g., retinoids, antioxidants, niacinamide) to procedural interventions such as lasers, intense pulsed light, photodynamic therapy, microneedling, and injectable biostimulators. Special attention is given to emerging approaches such as microneedle delivery systems, with mention of exosome-based therapies. The review underscores the importance of personalized anti-aging regimens based on biological age, phototype, and lifestyle factors. As the field advances, integrating mechanistic insights with individualized treatment selection will be key to optimizing skin rejuvenation and preserving long-term dermal health.