Physiologic and structural changes associated with aging skin

Different Dilutions of Mesobotox in Facial Rejuvenation: Which is Better?

BACKGROUND

Microbotulinum toxin A treatment is a technique of delivering multiple intradermal injections of diluted botulinum toxin type A into the dermis or the interface between the dermis and the superficial layer of the facial muscles to preserve the facial mobility. The current study aimed to evaluate and compare the clinical effect of different dilutions of microbotulinum toxin A in periorbital and mid-facial rejuvenation.

METHODS

This randomized prospective interventional study included 30 female patients with different types of wrinkles in periorbital and/or mid-face. Patients were divided into three groups: group I (10 patients): 100U botulinum toxin in 5 ml saline, group II (10 patients): 100U botulinum toxin in 7 ml saline and group III (10 patients): 100U botulinum toxin in 10 ml saline.

RESULTS

A statistically significant better global esthetic improvement scale (GAIS) scores after 1 month were observed in group I compared to groups II and III. Also, after 6 months better GAIS scores were observed in group I compared to group II and in group II compared to group III. Assessment of different esthetic parameters measured by the Antera 3D camera revealed a statistically significant improvement in all parameters (periorbital and mid-face) in group I and in most of parameters (periorbital and mid-face) in groups II and III with more evident improvement after 1 month compared to after 6 months.

CONCLUSION

Intradermal microbotulinum toxin A is a cost-effective method for improving periorbital and mid-face wrinkles with a better effect of 1:5 than 1:7 and 1:10 dilutions. Facial wrinkles possess a great burden on patients' psychological status, and the emergence of novel rejuvenation technique with minimal side effects is necessary. MicroBoNT-A usage in the literature was through variety of dilutions and concentrations. Therefore, a conclusive and comparative study was essential to compare the effect of different microBoNT-A dilutions. In this context, the current study aimed to evaluate and compare the clinical effect of different dilutions of microBoNT-A in periorbital and mid-facial rejuvenation.

LEVEL OF EVIDENCE III

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Evaluation of Platelet-rich Plasma and Microneedling for Facial Skin Rejuvenation

Background

The regenerative properties of platelet growth factors make platelet-rich-plasma (PRP) an attractive modality for treatment of aging skin. The main objective of this study was to determine efficacy and safety of PRP injections and microneedling compared with saline injections in women with aging skin of the face.

Methods

In this prospective, randomized clinical trial, 18 women with facial aging were randomized to receive either PRP injections to the unilateral face and saline injections to the contralateral side, or vice versa. Microneedling was performed after injections on the entire face. Physician assessment, photographs, and treatment satisfaction questionnaires were used for outcome assessment at baseline and 16- and 24-week follow-ups.

Results

There was no evidence of improvement and suggestion of worsening in skin laxity and rhytides from baseline to weeks 4, 16, and 24 for PRP and saline (all P ≤ 0.004) and no notable difference in skin roughness between baseline and follow-up time points for PRP or saline (all P ≥ 0.19). The degree of change in skin laxity, rhytides, and skin roughness from baseline to follow-up time points was similar for PRP and saline. All patients experienced some degree of pain/discomfort and burning/stinging sensation at treatment weeks 4, 8, and 12 for both saline and PRP.

Conclusions

PRP injections did not seem to be effective for treatment of aging skin of the face in women, with no notable macroscopic improvement in appearance when compared with baseline or saline injections. Advanced age of study participants (>45 years) and less-sensitive methods of evaluation may be potential contributing factors to the lack of detected response.

Single cell transcriptome profiling reveals cutaneous immune microenvironment remodeling by photodynamic therapy in photoaged skin

Background

The immune microenvironment plays a critical role in maintaining skin homeostasis, which is closely related to the dysfunction in photoaged skin such as autoimmunity and tumorigenesis. Several recent studies have demonstrated the efficacy of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in alleviating photoaging and skin cancer. However, the underlying immune mechanisms and the immune microenvironment change by ALA-PDT remain largely unknown.

Methods

To illustrate the effects of ALA-PDT on immune microenvironment in photoaged skin, single cell RNA sequencing (scRNA-seq) analysis of photoaged skin on the extensor side of the human forearm before and after ALA-PDT was performed. R-packages of Seurat, clusterProfiler, Monocle, CellChat were used for cell clustering, differentially expressed genes analysis, functional annotation, pseudotime analysis and cell-cell communication analysis. The gene sets related to specific functions were extracted from the MSigDB database, which were used to score the functions of immune cells in different states. We also compared our result with published scRNA-seq data of photoaged skin of the eyelids.

Results

The increase score of cellular senescence, hypoxia and reactive oxygen species pathway in immune cells and the decrease of immune receptor activity function and proportion of naive T cells were found in skin photoaging. Moreover, the function of T cell ribosomal synthesis was also impaired or down regulated and function of G2M checkpoint was up regulated. However, ALA-PDT showed promising results in reversing these effects, as it improved the above functions of T cells. The ratio of M1/M2 and percentage of Langerhans cells also decreased with photoaging and increased after ALA-PDT. Additionally, ALA-PDT restored the antigen presentation and migration function of dendritic cells and enhanced cell-cell communication among immune cells. These effects were observed to last for 6 months.

Conclusion

ALA-PDT has potential to rejuvenate immune cells, partially reversed immunosenescence and improved the immunosuppressive state, ultimately remodelling the immune microenvironment in photoaged skin. These results provide an important immunological basis for further exploring strategies to reverse skin photoaging, chronological aging and potentially systemic aging.

Detection of skin wrinkles and quantification of roughness using a novel image processing technique from a dermatoscope device

OBJECTIVE

Cutaneous relief analysis is crucial in the development of new skincare products, as well as in the evaluation of dermatological treatments. The analysis can be performed by qualitative or quantitative methods. We propose a new algorithm to detect wrinkles and quantify skin roughness by image processing from a dermatoscope.

METHODS

A clinical study was carried out with 33 research participants, and images were collected with the dermatoscope and PRIMOS equipment for wrinkle evaluation at two different times: Day 0 (D0) and 45 days (D45) after the use of a dermocosmetic product. Later, a new algorithm was developed to detect wrinkles in the acquired images by applying filters and image transformations that generate a segmented image highlighting the wrinkles. A roughness calculation method is proposed from the pixels belonging to wrinkles.

RESULTS

Correlation between the values obtained by the PRIMOS equipment and the proposed system was verified. No correlation was found for data obtained at D0; however, there was correlation at time D45 by Spearman's similarity coefficient. By comparing roughness between times D0 and D45, the treatment was statistically significant for both PRIMOS and the proposed methodology data.

CONCLUSION

The wrinkle detection algorithm, in addition to the roughness calculation, demonstrated a sensitivity comparable to the PRIMOS system in evaluating the effectiveness of the dermocosmetic treatment.

SIGNIFICANCE

Considering the simplicity of the dermatoscope design compared to other established devices such as PRIMOS, the proposed system is promising as an alternative for dermatological evaluations.

Evaluation and characterization of facial skin aging using optical coherence tomography

OBJECTIVES

The skin aging exposome encompasses internal and external factors that contribute to clinical signs of facial aging. Aging skin can be characterized by distinctive features such as wrinkles, lentigines, elastosis, and roughness. Optical coherence tomography (OCT) is capable of noninvasively measuring skin characteristics. This study aimed to assess bilateral features using OCT to explore temporal skin changes among decades and potential changes in facial skin aging based on laterality.

METHODS

A total of 97 subjects between 20 and 89 years old with Fitzpatrick skin types I to IV were enrolled. VivoSight, a Multi-Beam OCT system intended to gather topographical and histological images of skin, was used to scan the area inferolateral to the lateral canthus, bilaterally. Investigators compared characteristics of skin roughness, attenuation coefficient and blood flow across age groups and based on laterality to determine any differences.

RESULTS

Only data from successful OCT scans were used. Seventy subjects, 10 from each specified decade, had successful bilateral scans and were thus included in the analysis. Chronological aging was characterized by significantly decreased dermal attenuation coefficient with increased age. Skin roughness measurements showed trends of increased roughness with age; however, no statistically significant changes were seen between groups. Qualitative differences amongst scans taken on right and left sides of the face showed no significance regarding roughness, density or blood flow at depths ranging from 0.05 to 0.5 mm.

CONCLUSIONS

OCT is an effective method for evaluating changes in aging skin. Our results illustrate a decline in skin density with chronological age. Additionally, it was illustrated that structural change in the epidermis and dermis does occur, however on a microscopic scale, there are no significant differences based on laterality. OCT holds promise as a noninvasive technique for characterization of aging skin. Its utility and application in the clinical management and treatment of aged skin requires further research; however, the technology has potential to personalize therapies based on objective findings.

Genome-Wide Association Study for Screening and Identifying Potential Shin Color Loci in Ducks

Shin color diversity is a widespread phenomenon in birds. In this study, ducks were assessed to identify candidate genes for yellow, black, and spotted tibiae. For this purpose, we performed whole-genome resequencing of an F2 population consisting of 275 ducks crossed between Runzhou crested-white ducks and Cherry Valley ducks. We obtained 12.6 Mb of single nucleotide polymorphism (SNP) data, and the three shin colors were subsequently genotyped. Genome-wide association studies (GWASs) were performed to identify candidate and potential SNPs for the three shin colors. According to the results, 2947 and 3451 significant SNPs were associated with black and yellow shins, respectively, and six potential SNPs were associated with spotted shins. Based on the SNP annotations, the MITF, EDNRB2, POU family members, and the SLC superfamily were the candidate genes regulating pigmentation. In addition, the isoforms of EDNRB2, TYR, TYRP1, and MITF-M were significantly different between the black and yellow tibiae. MITF and EDNRB2 may have synergistic roles in the regulation of melanin synthesis, and their mutations may lead to phenotypic differences in the melanin deposition between individuals. This study provides new insights into the genetic factors that may influence tibia color diversity in birds.

Genome-Wide Analysis Identifies Candidate Genes Encoding Beak Color of Duck

Beak color diversity is a broadly occurring phenomenon in birds. Here, we used ducks to identify candidate genes for yellow, black, and spotted beaks. For this, an F2 population consisting of 275 ducks was genotyped using whole genome resequencing containing 12.6 M single-nucleotide polymorphisms (SNPs) and three beak colors. Genome-wide association studies (GWAS) was used to identify the candidate and potential SNPs for three beak colors in ducks (yellow, spotted, and black). The results showed that 2753 significant SNPs were associated with black beaks, 7462 with yellow, and 17 potential SNPs with spotted beaks. Based on SNP annotation, MITF, EDNRB2, members of the POU family, and the SLC superfamily were the candidate genes regulating pigmentation. Meanwhile, isoforms MITF-M and EDNRB2 were significantly different between black and yellow beaks. MITF and EDNRB2 likely play a synergistic role in the regulation of melanin synthesis, and their mutations contribute to phenotypic differences in beak melanin deposition among individuals. This study provides new insights into genetic factors that may influence the diversity of beak color.

Genome-wide association analysis reveal the genetic reasons affect melanin spot accumulation in beak skin of ducks

Background

Skin pigmentation is a broadly appearing phenomenon of most animals and humans in nature. Here we used a bird model to investigate why melanin spot deposits on the skin.

Results

Our result showed that growth age and the sunlight might induce melanin deposition in bird beak skin which was determined by genetic factors. GWAS helped us to identify two major loci affecting melanin deposition, located on chromosomes 13 and 25, respectively. The fine mapping works narrowed the candidate regions to 0.98 Mb and 1.0 Mb on chromosomes 13 and 25. The MITF and POU2F3 may be the causative genes and synergistically affect melanin deposition during duck beak skin. Furthermore, our data strongly demonstrated that the pathway of melanin metabolism contributes to melanin deposition on the skin.

Conclusions

We demonstrated that age and sunlight induce melanin deposition in bird beak skin, while heredity is fundamental. The MITF and POU2F3 likely played a synergistic effect on the regulation of melanin synthesis, and their mutations contribute to phenotypic differences in beak melanin deposition among individuals. It is pointed out that melanin deposition in the skin is related to the pathway of melanin metabolism, which provided insights into the molecular regulatory mechanisms and the genetic improvement of the melanin deposition in duck beak.

Aged related human skin microbiome and mycobiome in Korean women

We examined differences in the skin microbiome of two separate age groups to find key microbial and skin physiological indicators associated with aging. We recruited healthy Korean women 19–28 years old (Y-group) and 60–63 years old (O-group) and evaluated their cheek and forehead skin microbiome, including bacteria and fungi. The microbiome was significantly different by age group, with bacterial and fungal communities displaying higher alpha-diversity in the O-group than in the Y-group. We identified amplicon sequence variants affiliated with Cutibacterium and Lactobacillus and fungi Malassezia restricta as microbial biomarkers showing significant differences between the Y and O-group. There are more microbial communities and metabolic processes related to skin health in the Y-group than in the O-group, and there are more microbial interactions to increase the stability of the network structure of the skin. Skin physical metadata, including transepidermal water loss and sebum content, differed by two age groups. The crucial skin microbes, skin physical parameters, and microbial network found through this research will be useful key indicators in associating skin aging and skin microbiome research.

Oxidative stress in the skin: Impact and related protection

Skin, our first interface to the external environment, is subjected to oxidative stress caused by a variety of factors such as solar ultraviolet, infrared and visible light, environmental pollution, including ozone and particulate matters, and psychological stress. Excessive reactive species, including reactive oxygen species and reactive nitrogen species, exacerbate skin pigmentation and aging, which further lead to skin tone unevenness, pigmentary disorder, skin roughness and wrinkles. Besides these, skin microbiota are also a very important factor ensuring the proper functions of skin. While environmental factors such as UV and pollutants impact skin microbiota compositions, skin dysbiosis results in various skin conditions. In this review, we summarize the generation of oxidative stress from exogenous and endogenous sources. We further introduce current knowledge on the possible roles of oxidative stress in skin pigmentation and aging, specifically with emphasis on oxidative stress and skin pigmentation. Meanwhile, we summarize the science and rationale of using three well-known antioxidants, namely vitamin C, resveratrol and ferulic acid, in the treatment of hyperpigmentation. Finally, we discuss the strategy for preventing oxidative stress-induced skin pigmentation and aging.

In elderly Caucasian women, younger facial perceived age correlates with better forearm skin microcirculation reactivity

BACKGROUND

Visual and molecular changes occurring upon aging are rather well characterized. Still, aging signs show great significant inter-individual variations, and little is known concerning the link between perceived age and cutaneous microcirculation.

MATERIALS AND METHODS

To investigate this point, we recruited Caucasian women in their mid-50's to mid-70's and subsampled women looking older or younger than their age. We studied their facial skin color, as well as their microvascular reactivity to local heating assessed in the forearm skin. We also used skin biopsies from some of these women for gene expression or immunohistochemical analysis.

RESULTS

Clinical and instrumental analysis of skin color revealed that subjects who look 5 years younger differ only by a higher glowing complexion. Our most striking result is that subjects looking 5 years younger than their age present a higher microcirculation reactivity in forearm skin. Transcriptome comparison of skin samples from women looking older or younger than their age revealed 123 annotated transcripts differentially expressed, among which MYL9 relates to microcirculation. MYL9 is downregulated in the group of women looking younger than their real age. Microscopy shows that the labeling of MYL9 and CD31 are altered and heterogeneous with age, as is the morphology of microvessels.

CONCLUSION

Therefore, assessing generalized vascular reactivity in non-photo-exposed skin to focus on the intrinsic aging allows subtle discrimination of perceived age within elderly healthy subjects.

Recommendations for the treatment of tear trough deformity with cross-linked hyaluronic acid filler

Background

Recent years have seen a growing interest in the appearance of the eyes among the concerns expressed by patients in cosmetic clinics. This has led to an increase in the frequency of diagnosis of tear trough deformity, and, as a result, the number of treatments performed by specialized professionals has also risen. Hyaluronic acid filler injection is a rapid, nonsurgical technique that gives good long‐lasting, but not permanent, results. However, to achieve optimal results, the attending physician must have good anatomical knowledge of the area and involvement of the structures in the tear trough, carry out proper clinical assessment of the patient, and use an appropriate injection technique with the right product.

Aims

To support good practice among the professionals who carry out these procedures, this interdisciplinary consensus document describes the relevant issues and recommendations, in order to improve safety standards and to help successfully resolve this aesthetic problem.

Earliest stage treatment of actinic keratosis with imiquimod 3.75% cream: Two case reports-Perspective for non melanoma skin cancer prevention

Imiquimod 3.75% cream is licensed for the treatment of actinic keratosis (AK). Two case reports on the treatment of facial UV-exposed skin shall open the discussion if subclinical AKs can be detected by the use of imiquimod cream in UV-exposed areas even if no lesions can be found clinically. A 87-year old female showing small scaly AK lesions on her right cheek was treated with imiquimod 3.75% cream. A 59-year old female without obvious clinical signs of UV-damage on the face experimentally applied imiquimod 3.75% cream twice daily on the entire face for 2 weeks. In the 87-year old, inflammatory reaction developed from day 3 onward and showed field cancerization, the lesions healed without scarring. In the 59-year old at the end of the treatment phase, distinct signs of inflammation appeared, then taking 2 weeks for healing without sequalae. These results open the discussion if the use of imiquimod 3.75% cream could be recommended preventively in UV-exposed skin areas to obviate a later development of AKs/squamous cell carcinoma/nonmelanoma skin cancer.

Clinical Applications of Hyaluronidase

Hyaluronidases are enzymes that degrade hyaluronic acid, which constitutes an essential part of the extracellular matrix. Initially discovered in bacteria, hyaluronidases are known to be widely distributed in nature and have been found in many classes including insects, snakes, fish and mammals. In the human, six different hyaluronidases, HYAL1-4, HYAL-P1 and PH-20, have been identified. PH-20 exerts the strongest biologic activity, is found in high concentrations in the testicles and can be localized on the head and the acrosome of human spermatozoa. Today, animal-derived bovine or ovine testicular hyaluronidases as well as synthetic hyaluronidases are clinically applied as adjuncts to increase the bioavailability of drugs, for the therapy of extravasations, or for the management of complications associated with the aesthetic injection of hyaluronic acid-based fillers. Further applications in the fields of surgery, aesthetic medicine, immunology, oncology, and many others can be expected for years to come. Here, we give an overview over the molecular and cellular mode of action of hyaluronidase and the hyaluronic acid metabolism, as well as over current and potential future clinical applications of hyaluronidase.

Application of Cell Therapy for Anti-Aging Facial Skin

The human skin undergoes the complex process of aging which is prompted by the interplay of intrinsic mechanisms and extrinsic influences. Aging is unavoidable but can be somewhat delayed. Numerous approaches have been developed to slow down facial skin aging process as it is of interest to stake holders in the beauty and fashion world as well as to plastic surgeons. Adipose-derived stem cell [ADSC] and mesenchymal stem cell [MSC] as potential anti-aging agents to some extent have provided a promising and effective alternative in managing skin and facial skin aging. Furthermore, bone marrow-derived mesenchymal stem cells [BMMSC] have exhibited similar ability to rejuvenate aged skin. This review is aimed at giving a comprehensive account of the application of stem cells especially ADSCs and MSCs to reduce or slow down the rate of facial skin aging process.

Relevant Topical Skin Care Products for Prevention and Treatment of Aging Skin

Options for skin care are varied. New products are introduced constantly and it is important for the practitioner to have an understanding of products that impart beneficial results for aging skin. Educating patients to use products with scientifically proven benefits leads to better outcomes. Patients should be encouraged to use daily sunscreen, a topical retinoid every night, and a topical antioxidant daily. Supplementing the routine skin care regimen with alpha hydroxy acids, growth factors, heparin sulfate, and defensins can be addressed individually. Exogenous stem cells do not have sufficient evidence to warrant recommending them currently.

Cosmeceutical effect of ethyl acetate fraction of Kombucha tea by intradermal administration in the skin of aged mice

BACKGROUND/PURPOSE

Natural ingredients have been always an interesting approach to prolong youthful appearance of skin. One of the natural compounds is Kombucha tea (KT), which has been mainly used as an energy drink in Asian countries for a long time. Previous reports indicated that it has pharmaceutical and favorable wound repairing effects. The beneficial properties of KT are thought to be mainly due to the presence of fermentation products such as flavonoids and other polyphenols with inhibition of hydrolytic and oxidative enzymes and anti-inflammatory effects. These properties prompted us to study the anti-aging potential of KT and investigate its effective fraction in aged mice, METHODS: Kombucha tea was fractionated into chloroform, butanol, and ethyl acetate, and flavonoid content was determined. Young and old mice were used as control. KT ethyl acetate fraction (KEAf), which had the highest flavonoid content, was intradermally administered to old mice.

RESULTS

Administration of KEAf significantly increased the collagen content, NAD⁺ /NADH level, and concomitantly improved skin connective tissue abnormalities in the aged skin. No sensitivity or irritation was observed.

CONCLUSION

This finding suggested that KEAf can be a suitable candidate as a cosmetic product to improve aging-related skin abnormalities and regeneration of aged skin.

Evaluation of the in vivo cosmetic efficacy of the MF3 blue cell serum gel. One- and two-month test results

INTRODUCTION

Skin is changing over time showing signs of aging: dryness, increase in visual and tactile roughness, decrease in collagen content and stiffness, and eventually formation of deep and surface wrinkles, and fine lines.

METHODS

Eight-week open experimental study was conducted to test efficacy of MF3 Blue Cell Serum Gel. Main criteria to determine product efficacy by following skin biophysical techniques were as follows: skin moisturization, firmness, epidermal and dermal density, skin surface properties and sebum level, reduction in fine lines and wrinkles. Secondary criteria were as follows: participant's opinion during study and product tolerance evaluation. Days 29 and 57 assessments included visual evaluation, skin biophysical techniques, and compliance check. The self-assessment questionnaires completed.

RESULTS

After week 8, obtained results showed very good hydration effect of test product, despite the fact being serum gel. Moisturizing increased continuously during study period. Important increases on skin firmness were observed which are in line with typical anti-aging claims. Dermal density steady improvement noted especially after 4th week of study, and effect on deep skin layers was due to increase in collagen content and stiffness. Sebum regulation process was evidenced. Further significant roughness reduction in skin surface showed decrease or disappearance of fine lines and wrinkles. Products were well tolerated with no adverse events. Most of participants noticed visible improvement and increase in facial radiance, skin smoothness, and overall skin improvement.

CONCLUSION

Twice daily application of MF3 Blue Cell Serum Gel led to significant improvement in skin hydration, firmness, dermal density, sebum regulation, roughness reduction, decrease or disappearance of fine lines and wrinkles.

Facial skin rejuvenation by autologous dermal microfat transfer in photoaged patients: Clinical evaluation and skin surface digital profilometry analysis

Cumulative long-term exposure to solar ultraviolet radiation promotes premature skin aging characterized by wrinkle formation and reduced skin elasticity. In this study, we assessed whether microfat transfer could improve dermal and subcutaneous tissue thickness loss associated with photoaging. Twenty-one patients affected by facial photoaging (photodamage grade II-IV; age range 35-62 years; 19 females, 2 males; all of Caucasian origin) were treated using minimally invasive autologous dermal white fat transfer harvested with a recently designed microcannula. The results were determined by clinical assessment and patient self-evaluation and quantified by the Antera 3D^® dermal digital device for noninvasive, objective, reliable, and accurate assessment of facial skin texture, color, and wrinkle characteristics. Compared with the pretreatment condition, the increment in soft tissue volume and improvement in skin quality and texture were assessed by a dermatologist after treatment. In addition, instrumental evaluation by digital skin profilometry of the treated areas revealed a 41% reduction in average wrinkle depth (7.29 ± 1.04 × 10^-2 mm pretreatment vs. 4.31 ± 1.16 × 10^-2 mm at 90 days posttreatment; p < 0.001), improved skin texture, more homogeneous and uniform skin color, and declined facial hemoglobin and melanin concentrations. The majority of patients (above 90%) reported improvements in self-perception. No significant complications were reported throughout the study. In conclusion, by using digital profilometry analysis as an objective and innovative tool to determine the outcome of treatment, we demonstrated that autologous microfat transfer is a safe and well-tolerated procedure with measurable beneficial effects on facial skin aging.

The Power of Combined Therapies: BOTOX and Ablative Facial Laser Resurfacing

Introduction:

The etiology of facial rhytides is multifactorial. Static rhytides are caused by environmental factors and heredity, whereas dynamic rhytides are caused by the repetitive action of muscles during facial expressions. A successful multifactorial therapeutic approach is to use ablative laser resurfacing to reduce the static component and BOTOX to soften the dynamic component of the facial rhytide.

Materials and Methods:

We retrospectively analyzed the charts and photographs of 53 consecutively treated subjects to evaluate the relative strengths of the static and dynamic treatment modalities on the individual's final aesthetic result. To remove any potential for bias, the treatments were all carried out by author J.C. The photographic and chart reviews were performed by author A.C., and the subjective patient questionnaire was completed by author A.Z.

Results:

Adding BOTOX to CO2 laser resurfacing improved the result objectively from 30% to 60%. However, adding BOTOX to Erbium:YAG laser resurfacing improved the result only marginally (40% to 47%).

Discussion:

Combined therapy with CO2 laser resurfacing and BOTOX gave the most pronounced aesthetic benefit. Combined treatments with Erbium-YAG laser resurfacing and BOTOX was a less powerful treatment blend.

Thermographic assessment of skin prick tests in comparison with the routine evaluation methods

INTRODUCTION

The skin prick test is still the first and basic procedure in the diagnosis of allergic diseases. The possibility of using a sensitive thermographic method supported by the mathematical model for the assessment of skin test results will be highlighted in the studies.

AIM

To compare the proposed approach with routine planimetric and thermographic methods.

MATERIAL AND METHODS

A mathematical model of allergic reaction was developed. Simplifying assumptions of the IgE-mediated skin reaction is the essence of the model. Investigations were performed in a group of 40 patients.

RESULTS

Using the spatio-temporal evolution of temperature distributions, the ratios of the histamine released from mast cells to the control histamine were determined. The obtained values very well correlate with the standard evaluation of skin prick tests (correlation coefficient = 0.98).

CONCLUSIONS

The proposed method of skin test evaluation presents several advantages. The continuous acquisition of data provides the monitoring of time course of the allergic response. The transport of mediator and its concentration were distinctly discriminated, which may be diagnostically useful, especially for abnormal cases. The high sensitivity of the method enables studying patients regardless of age and skin sensitivity.

Effects of low-level laser therapy, electroacupuncture, and radiofrequency on the pigmentation and skin tone of adult women

[Purpose] In this study, the effects of low-level laser therapy (LLLT), electroacupuncture (EA), and radiofrequency (RF), which are used in physical therapy, on the pigmentation and skin tone of adult women’s faces were investigated to provide basic data for skin interventions. [Subjects and Methods] Thirty adult females were assigned to either an LLLT group (n=10), an EA group (n=10), or an RF group (n=10). The intervention was performed in two 15-minute sessions per week for six weeks. Subjects’ skin tone and pigmentation were observed before and after the intervention. [Results] The EA group showed significant reductions in pigmentation in the left and right eye rims, as well as in the left cheek. The RF group showed significant post-intervention reductions in pigmentation under the left eye, as well as in the left and right eye rims and the left cheek. The LLLT group showed significant increases in skin tone in the forehead and both eye rims. The RF group showed significant increases in skin tone under both eyes. [Conclusion] The application of LLLT, EA, and RF had positive effects on pigmentation and skin tone of adult women’s faces.

[The modern non-invasive methods for the evaluation of the age-specific changes in the skin]

The present review article is designed to analyse the current state-of-the-art in the field of diagnostics of the main morphological and functional parameters characterizing the involutional processes in the facial skin. The possibilities of the practical application of the available non-invasive methods for the evaluation of the age of the living people in the framework of the forensic medical identification expertise are considered. The main problems and vectors of the further development of methodological approaches to the determination of the biological age based on the results of the studies of skin and its appendages are discussed.

Evaluation of 5-aminolevulinic acid-mediated photorejuvenation of neck skin

OBJECTIVE

To evaluate the outcomes of the combination of red light or intense pulsed laser (IPL) with 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) in the treatment of photodamaged neck skin.

METHODS

The anterior of the neck was divided into four 2 cm × 2 cm sections and randomly assigned to red-light, red-light-PDT, IPL or IPL-PDT group. ALA cream of 5% was applied to PDT regions for 2h prior to light irradiation. Treatment was repeated once. The stratum corneum (SC) hydration, transepidermal water loss (TEWL), L(*), a(*), b(*) values, melanin index (MI), erythema index (EI), skin elasticity and skin thickness were examined by a blinded investigator. The function and volume of thyroid were also measured.

RESULTS

After red-light-PDT, IPL-PDT and IPL treatment, the appearance of photoaging lesion was improved. The SC hydration, L(*) value, elasticity and thickness increased, whereas the TEWL and MI value decreased. These changes in red-light-PDT and IPL-PDT group were more obvious than IPL group. The a(*) and EI value increased in red-light-PDT group. No significant change was noticed in red-light group. Partial irradiation of the thyroid did not affect the function and volume of the thyroid.

CONCLUSION

IPL-PDT and red-light-PDT showed better rejuvenation effect than IPL or red light alone on the neck skin.

Anti-aging effect of adipose-derived stem cells in a mouse model of skin aging induced by D-galactose

Introduction

Glycation products accumulate during aging of slowly renewing tissue, including skin, and are suggested as an important mechanism underlying the skin aging process. Adipose-derived cells are widely used in the clinic to treat ischemic diseases and enhance wound healing. Interestingly, adipose-derived stem cells (ASCs) are also effective in anti-aging therapy, although the mechanism underlying their effects remains unknown. The purpose of the present study was to examine the anti-aging effect of ASCs in a D-galactose-induced aging animal model and to clarify the underlying mechanism.

Materials and Methods

Six-week-old nude mice were subcutaneously injected with D-gal daily for 8 weeks. Two weeks after completion of treatment, mice were randomized to receive subcutaneous injections of 10⁶ green fluorescent protein (GFP)-expressing ASCs, aminoguanidine (AG) or phosphate-buffered saline (PBS). Control mice received no treatment. We examined tissue histology and determined the activity of senescence-associated molecular markers such as superoxide dismutase (SOD) and malondialdehyde (MDA).

Results

Transplanted ASCs were detectable for 14 days and their GFP signal disappeared at day 28 after injection. ASCs inhibited advanced glycation end product (AGE) levels in our animal model as well as increased the SOD level and decreased the MDA level, all of which act to reverse the aging phenotype in a similar way to AG, an inhibitor of AGE formation. Furthermore, ASCs released angiogenic factors in vivo such as vascular endothelial growth factor, suggesting a skin trophic effect.

Conclusions

These results demonstrate that ASCs may contribute to the regeneration of skin during aging. In addition, the data shows that ASCs provide a functional benefit by glycation suppression, antioxidation, and trophic effects in a mouse model of aging.

Visualization and treatment of subclinical actinic keratoses with topical imiquimod 5% cream: an observational study

BACKGROUND

Imiquimod 5% is licensed for the treatment of external genital warts, superficial basal cell carcinoma, and actinic keratosis (AK) and is being used experimentally in various other dermato-oncological conditions.

OBJECTIVE

This observational study shall show that nonmelanoma skin cancer can be detected at its earliest subclinical stage by its reaction with imiquimod and can be cleared by finishing the course of treatment.

MATERIAL AND METHODS

In this single arm trial 15 patients with chronically sun-exposed skin who had no clinical evidence of AK were treated with 5% imiquimod cream on the face or scalp for 4 weeks three times per week.

RESULTS

During treatment, all patients developed multiple areas with mild to moderate inflammatory skin reactions, such as erythema, induration, and scaling. Biopsies obtained from 12 patients prior to treatment revealed no malignancies. However, in cases with more pronounced inflammation during treatment, targeted biopsies indicated very early malignant alterations.

CONCLUSION

Topical imiquimod treatment of chronically sun-exposed skin without overt clinical signs of AK is able to detect subclinical actinic keratoses (SAK) and to completely clear the lesions, even before they can be clinically diagnosed as AK. In such patients, imiquimod might be able to prevent the evolution of SCC.

Comparison of 5-aminolevulinic acid photodynamic therapy and red light for treatment of photoaging

OBJECTIVE

The aim of this pilot study was to compare the efficacy of ALA-PDT and red light alone in the treatment of photoaging.

METHODS

A total of 14 adults with photoaging skin were recruited. ALA-PDT or red light alone was applied to the forearm extensor. Before and after treatment, the treated sites were examined by dermoscopy, the changes in straum corneum (SC) hydration, transepidermal water loss (TEWL), and the L*a*b* values were measured, and microscopic examination of collagens and elastins was performed.

RESULTS

After ALA-PDT or red light illumination, the appearance of photoaging lesions improved, SC hydration increased and TEWL decreased. These changes in the ALA-PDT group were more obvious than those in the red light group. No significant change was noticed in the L*a*b* values in both groups. The signs of typical solar elastosis damage were improved in both groups.

CONCLUSIONS

ALA-PDT showed better skin rejuvenation effect than red light alone.

Effects of topicals on the aging skin process

This article summarizes the antiaging properties of retinoids, glycolic acid, ascorbic acid, and peptide topicals. The supporting evidence is taken from the literature and the primary author's research, consisting of previously published data and new results from ongoing projects.

Histamine and allergen skin reactivity in the elderly population: results from the Korean Longitudinal Study on Health and Aging

BACKGROUND

The allergen skin prick test is the most representative diagnostic test for atopy, but its use has been limited because of the belief that skin reactivity decreases with aging.

OBJECTIVE

To investigate skin reactivity and influencing factors in the elderly population.

METHODS

This cross-sectional analysis included 854 subjects (aged ≥65 years) who participated in the Korean Longitudinal Study on Health and Aging cohort (September 2005 to August 2006) and underwent allergen skin prick tests. Skin prick tests were performed with 1 mg/mL of histamine and a panel of 12 aeroallergens that are common in Korea. The wheal diameters were measured and compared to identify the factors associated with skin reactivity.

RESULTS

Older age and female sex were associated with reduced histamine skin reactivity in elderly subjects. This age-related decrease was apparent only among women, the reasons for which were not identified. In contrast to histamine, wheal response size induced by 2 major allergens, Dermatophagoides pteronyssinus and Dermatophagoides farinae, did not show sex differences and did not decrease with age among the subjects showing allergen-induced wheal size greater than 0 mm.

CONCLUSIONS

This analysis demonstrates that age and sex can independently influence histamine skin reactivity among the elderly population. The allergen-induced wheal sizes did not decrease with age. The discrepancy between histamine and allergen skin reactivity may warrant further evaluation to redefine the cutoff value for the determination of a positive skin test result in elderly subjects.

The impact of age on prevalence of positive skin prick tests and specific IgE tests

Aging is associated with modifications of the immune system, defined as immunosenescence. This could contribute to a reduced prevalence of allergic disease in the elderly population. In this regard, atopy has rarely been considered in the clinical assessment of the geriatric respiratory patient. This article is a review of the available literature assessing the impact of age on atopy. In the majority of papers, we found a lower prevalence of atopy in the most advanced ages, both in healthy subjects and in individuals affected by allergic respiratory diseases. Unfortunately, no large, longitudinal studies performed in the general population have been conducted to further explore this observation. Although available data seem to favor the decline of allergen sensitization with age, the prevalence of allergic sensitizations in the elderly population with respiratory symptoms is substantial enough to warrant evaluation of the atopic condition. From a clinical perspective, allergic reactions in older adults can have the same or even worse manifestations compared to young people. For this reasons, the evaluation of the atopic condition also in the geriatric patient is recommended. Thus, the role of atopy as it pertains to the diagnosis, therapy (adoption of preventive measure such as removal of environmental allergen or immunotherapy), and prognosis (influence on morbidity and mortality) of chronic respiratory illnesses in the elderly is addressed.

Nonablative skin rejuvenation devices and the role of heat shock protein 70: results of a human skin explant model

Nonablative thermal laser therapy with a 1,540-nm laser induces controlled, spatially determined thermal damage, allowing subsequent collagen remodeling while preserving the epidermis. A photorejuvenation effect using nonthermal nonablative stimulation of cells with low energy and narrow band light has been termed photomodulation. Light emitting diodes (LEDs) are narrow band emitters that lead to photomodulation via stimulation of mitochondrial cell organelles. In a previous study, we demonstrated in a human skin explant model that heat shock protein 70 (HSP70) plays a pivotal role in the initiation of skin remodeling after ablative fractional photothermolysis. To test its importance in nonablative laser therapy and photomodulation, the spatio-temporal expression of HSP70 is investigated in response to a 1540-nm laser treatment and six different LED therapies. An Er:glass laser is used with a 1-Hz repetition rate, 30-J/cm(2) fluence, and a hand piece with a 2-mm spot size. Nonthermal nonablative treatment is performed using two LED (LEDA SCR red light: 635 nm, 40 to 120 W/cm(2), 40 to 120 J/cm(2); LEDA SCR yellow light: 585 nm, 16 to 35 W/cm(2), 20 to 100 J/cm(2); spot size 16 x 10 cm). Immediate responses as well as responses 1, 3, or 7 days postprocedure are studied; untreated skin explants serve as control. Immunohistochemical investigation (HSP70) is performed in all native, nontreated, and Er:glass laser- or LED-treated samples (n=175). Nonablative laser therapy leads to a clear time-dependent induction of epidermally expressed HSP70, peaking between one to three days post-treatment. In contrast, none of the various LED treatments up-regulated the HSP70 expression in our skin explant model. HSP70 is up-regulated by nonablative but thermal laser devices, but does not seem to play a significant role in the induction of skin remodeling induced by photomodulation. The maximum of HSP70 expression is reached later after Er:glass laser intervention compared to ablative fractional (AFP) treatment.

Intrinsic and extrinsic factors in skin ageing: a review

As the proportion of the ageing population in industrialized countries continues to increase, the dermatological concerns of the aged grow in medical importance. Intrinsic structural changes occur as a natural consequence of ageing and are genetically determined. The rate of ageing is significantly different among different populations, as well as among different anatomical sites even within a single individual. The intrinsic rate of skin ageing in any individual can also be dramatically influenced by personal and environmental factors, particularly the amount of exposure to ultraviolet light. Photodamage, which considerably accelerates the visible ageing of skin, also greatly increases the risk of cutaneous neoplasms. As the population ages, dermatological focus must shift from ameliorating the cosmetic consequences of skin ageing to decreasing the genuine morbidity associated with problems of the ageing skin. A better understanding of both the intrinsic and extrinsic influences on the ageing of the skin, as well as distinguishing the retractable aspects of cutaneous ageing (primarily hormonal and lifestyle influences) from the irretractable (primarily intrinsic ageing), is crucial to this endeavour.

Use of oral isotretinoin in photoaging therapy

BACKGROUND

Many drugs are being used for prevention and treatment of photoaging, especially topical retinoids. The use of systemic retinoids, more specifically, isotretinoin, for this purpose has not been properly addressed to date. Our study was designed to assess the systemic use of isotretinoin used alone for the therapy of cutaneous photoaging.

OBJECTIVE

To demonstrate that isotretinoin is converted into retinoid and improves the appearance of the photoaged skin.

METHODS

Fifty women aged 40 to 60 years, phototype I, II, or III according Fitzpatrick, were selected to receive 20 mg of isotretinoin orally 3 times a week for a 3-month period. Patients underwent clinical and laboratory evaluation. Two biopsies and photographic control were performed. Patients were requested to use only topical photoprotecting agents during the treatment. Improvement in photoaging clinical parameters were evaluated through pictures taken and also through an evaluation form. Anatomopathologic parameters were obtained by comparing collagen degeneration and skin trophism. Results. Thirty patients fully complied with study requirements and were adequately analyzed. From the anatomopathologic data, an improvement of photoaging in 20 patients was observed.

CONCLUSIONS

Isotretinoin improves photoaging with few adverse events because of the low dose used and to the short treatment duration.

Aesthetic Analysis of Asian Skin

Attention to restoring healthy and more youthful facial skin complements facial plastic surgery, optimizing cosmetic results. Asian skin has structural and physiologic differences from white skin. These distinctions account for variations in response to ultraviolet light exposure and alternate clinical manifestations of photoaging. The response to cosmetic treatment modalities also differs in patients of darker skin pigmentation, and this needs to be recognized by the cosmetic and laser surgeon. This article reviews the biology of Asian skin and discusses a clinical approach to aesthetic analysis of Asian skin.

A clinical comparison and long-term follow-up of topical 5-fluorouracil versus laser resurfacing in the treatment of widespread actinic keratoses

BACKGROUND AND OBJECTIVES

Many treatment modalities exist for actinic keratoses (AK). Topical 5-fluorouracil (5-FU) has been one of the standard treatments. Laser resurfacing is a more recent treatment option. In the literature prospective randomized studies comparing these treatments are lacking.

STUDY DESIGN/PATIENTS AND METHODS

Prospective randomized study to compare topical 5-FU with Er:YAG laser resurfacing. Fifty-five patients with multiple AK on the scalp and or the face were included. Clinical and histopathological evaluation took place at 3, 6, and 12 months after treatment.

RESULTS

At 3, 6, and 12 months after treatment, there were significantly less recurrences in the laser group compared to the group of patients treated with 5-FU. Side effects did occur more frequently in the laser group, especially erythema and hypopigmentation.

CONCLUSIONS

Compared to treatment with topical 5-FU, Er:YAG laser resurfacing is more effective regarding recurrence rates. Although significantly more side effects occur, laser resurfacing is a useful therapeutic option especially in patients with widespread AK.

A new wrinkle: skin manifestations of aging may relate to autonomic dysfunction

Various mechanisms have been argued for skin wrinkling, one of the hallmarks of aging. We hypothesize that chronic sympathetic bias is a previously unrecognized mechanism for wrinkling. In the acute setting of water immersion, reversible skin wrinkling is a well-known reflex mediated by the autonomic nervous system. We postulate that skin wrinkling results as a local maladaptive manifestation of a global chronic sympathetic bias that emerges during aging. The persistence of such changes may induce additional compensatory remodeling to cause permanent alteration of the skin. Sympatholytic agents may prove beneficial for arresting or ameliorating the development of wrinkles. Conditions that amplify sympathetic bias such as stress, smoking, amphetamine abuse, HIV, heart failure, and transplantation may accelerate wrinkling. Other common diseases of the skin may also arise as particular manifestations of aberrant autonomic activity through induction of vascular and immune dysfunctions. The temporal and spatial distribution of these dermatologic conditions may reflect variation of autonomic balance, which also regulates T helper immune balance. For all of these dermatologic conditions, local and systemic administration of drugs and medical devices that pharmacologically or electrically modulate autonomic nervous system activity may yield benefits as well.

Physiological shift of facial skin and its influence on the change in precision of computer-assisted surgery

Methods of recording landmarks on the facial skin without the use of markers have become increasingly accepted in image-guided surgery. However, position or muscular activity may change the skin's geometry and generate a lack of agreement between the facial contours recorded before and those recorded during the operation. In the present study, we measured this physiological shift of facial skin and evaluated its influence on the accuracy of stereotactic recording. We made laser-scans of the skin of 20 conscious patients while they were sitting and lying, both at rest and when smiling. The laser-scans were referenced to the corresponding computed tomographic dataset, and the accuracy of the recording was calculated. Gravitational or muscular shifts of the skin reduced the mean (S.D.) accuracy of recording to 1.7 (0.3)mm. The loss of accuracy was significantly correlated with the dynamic and gravitational wrinkling of the facial skin and with the body mass index of each patient.

Non-surgical treatment modalities of facial photodamage: practical knowledge for the oral and maxillofacial professional

With the increasing interest in cosmetic procedures, oral and maxillofacial surgeons are being asked not only to improve oral health and aesthetics but to extend their expertise to provide advice on improving the overall appearance of the face. For the discerning patient, improving overall facial skin appearance is becoming an integral part of the process of surgical cosmetic procedures. Here, some of the non-surgical options available for the treatment of photodamaged skin are reviewed and an overview of the specific treatments in this category provided. Sun avoidance and protection from harmful rays with appropriate sunscreens are primary to maintaining healthy skin and appearance. Among treatment options, topical treatments with preparations such as retinoids, alpha-hydroxy acids and antioxidants have been shown to provide some benefit and are relatively easy to use albeit with appropriate precautions and professional guidance. As a second-level option, facial rejuvenation procedures such as botulinum toxin injection, soft tissue augmentation with collagen or hyaluronic acid gel, skin resurfacing, use of chemical peels, dermabrasion and laser resurfacing procedures can be used but require administration by qualified practitioners. Overall, these treatments may be used to complement rehabilitative, reconstructive, or cosmetic oral and maxillofacial surgery to further improve and complement surgical results.

Allergen prick-puncture skin testing in the elderly

Many older patients present with rhinitis, conjunctivitis, asthma or itching that the patient attributes to allergies. Yet physicians often dismiss allergy in the elderly as irrelevant. Testing elderly patients for allergies is sometimes challenging as changes in the skin may cause difficulty in applying skin tests, and the response of the skin may be difficult to measure. The prick puncture skin test is the preferred method of immediate-type allergy testing, but careful examination of the skin prior to skin testing is important. If the area of skin where allergen skin tests are routinely placed is either atrophic or severely sun damaged, a sun-protected area should be sought. If no suitable area of skin can be identified, in vitro allergen testing should be considered. Skin-test results must be interpreted with care in the elderly. Positive skin tests to an allergen must correlate with a history of exacerbation to the allergen. By identifying specific allergens to which the elderly patient is sensitive, avoidance measures or specific allergen vaccination can be recommended, improving the quality of life and decreasing the need for medications.