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Pharmacol."],"abstract":"<jats:p>Skin aging involves complex endogenous and extrinsic mechanisms, driving oxidative stress, cellular senescence, DNA damage, and extracellular matrix degradation. This narrative review synthesizes preclinical evidence on traditional Chinese medicine (TCM)-derived botanical drugs and formulae targeting these pathways. We identified 19 single-botanical drug and 17 formula studies. The most consistently reported effects include Nrf2\/ARE activation, reduced reactive oxygen species (ROS) and malondialdehyde (MDA), increased superoxide dismutase (SOD) activity, matrix metalloproteinase (MMP) inhibition, and lower senescence markers [p16, p21, and senescence-associated \u03b2-galactosidase (SA-\u03b2-Gal)]. Additional modulated pathways include MAPK\/AP-1, PI3K\/Akt\/mTOR, TGF-\u03b2\/Smad, and NAD+\/Sirtuin, collectively contributing to reduced inflammation, enhanced antioxidant defense, and preserved dermal collagen. These findings suggest multi-pathway modulation rather than true pharmacological synergy. This system-level approach highlights a shift from monotherapy toward holistic intervention. However, clinical evidence remains extremely limited and consists mainly of small human studies, including trials described as randomized or double-blind but incompletely reported, and single-arm evaluations; no adequately powered, preregistered, high-quality randomized controlled trial (RCT) has yet established clinical efficacy for TCM interventions in skin aging. Therefore, future research should prioritize rigorous RCTs, dose\u2013response designs, and phytochemical standardization.<\/jats:p>","DOI":"10.3389\/fphar.2026.1792159","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T13:16:18Z","timestamp":1787145378000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Molecular mechanisms of traditional Chinese medicine in skin aging: a narrative review"],"prefix":"10.3389","volume":"17","author":[{"given":"Sisi","family":"Yin","sequence":"first","affiliation":[{"name":"Department of Medical Cosmetology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huilan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Medical Cosmetology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingjing","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyu","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianqian","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qifeng","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Medical Cosmetology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbin","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingping","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Medical Cosmetology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1038\/ncb2784","article-title":"A complex secretory program orchestrated by the inflammasome controls paracrine senescence","volume":"15","author":"Acosta","year":"2013","journal-title":"Nat. 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