Age-Associated Skin Conditions and Diseases: Current Perspectives and Future Options

Agarose-collagen composite microsphere implants: A biocompatible and robust approach for skin tissue regeneration

Photoaged skin, a consequence of UV radiation-induced collagen degradation, presents a significant challenge for skin rejuvenation. Synthetic polymer microspheres, while offering collagen regeneration potential, carry risks like granulomas. To overcome this, we developed a novel agarose-collagen composite microsphere implant for skin tissue regeneration. Fabricated using an emulsification-crosslinking method, these microspheres exhibited excellent uniformity and sphericity (with a diameter of ~38.5 μm), as well as attractive injectability. In vitro studies demonstrated their superior biocompatibility, promoting cell proliferation, adhesion, and migration. Further assessments revealed favorable biosafety and blood compatibility. In vivo experiments in photoaged mice showed that implantation of these microspheres effectively reduced wrinkles, increased skin density, and improved elasticity by stimulating fibroblast encapsulation and collagen regeneration. These findings highlight the potential of agarose-collagen microspheres in dermatological and tissue engineering applications, offering a safer alternative for skin rejuvenation.

Strategies to make human skin models based on cellular senescence for ageing research

Human skin ageing is closely related to the ageing of the whole organism, and it's a continuous multisided process that is influenced not only by genetic and physiological factors but also by the cumulative impact of environmental factors. Currently, there is a scientific community need for developing skin models representing ageing processes to (i) enhance understanding on the mechanisms of ageing, (ii) discover new drugs for the treatment of age-related diseases, and (iii) develop effective dermo-cosmetics. Bioengineers worldwide are trying to reproduce skin ageing in the laboratory aiming to better comprehend and mitigate the senescence process. This review provides details on the main ageing molecular mechanisms and procedures to obtain in vitro aged skin models.

Real-Life Data on Wound Healing Speed and Duration to Wound Closure by Different Aetiology in a Primary Care Centre in the Netherlands

Correct classification of wounds is of paramount importance for diagnostic and therapeutic pathways. The aim of this study was to provide insight in the incidence of different aetiology of wounds and the healing time in a primary care setting. All patients with a wound presented in Primary Care (PC) practice from January 2017 through 2020 were included. A retrospective analysis related to age, sex, duration of wound healing, healing-rates, aetiology and comorbidity of the patients was performed. The prevalence of wounds in primary care was is 3.9 per 1000. In more than 90% of the wounds heal within 37 days. The wound healing speed and duration to closure differ significantly (P = .002) between aetiology. This study shows that 90% of wounds that enter a Dutch GP practice heal within 37 days. This study provides unique data on wound healing rates differentiated by etiology.

Inhibition of transglutaminase 2 inhibits ionizing radiation-induced cellular senescence in skin keratinocytes in vitro

Senescent cells are typically characterized by a stable proliferation arrested in dividing cells accompanied with a senescence-associated secretory phenotype (SASP). Skin cellular senescence is the primary cause of skin aging, whereas the lack of identified skin senescence markers limits our understanding of the mechanisms involved in skin aging. Recent studies have revealed that intracellular calcium signaling has emerged as a key player in regulating cellular senescence and aging. However, the implication and roles of calcium signaling in skin keratinocyte senescence remain only partially understood. In this study, we developed a model for skin keratinocyte senescence using ionizing radiation (I/R) stimulation and found that the calcium-associated gene transglutaminase 2 (TGM2) was significantly induced compared with normal control. Interestingly, inhibition of TGM2 was found to delay skin keratinocyte senescence by suppressing I/R-promoted intracellular calcium signaling, accumulation of reactive oxygen species (ROS), DNA damage, as well as NF-κB-mediated SASP secretion. Taken together, our findings demonstrate that inhibition of TGM2 contributes to bypassing I/R-induced skin keratinocyte senescence and sheds light on novel strategies against skin stresses caused by I/R.

Prevalence of dermatoses in geriatric singaporeans in the community - a cross-sectional study

BACKGROUND

Little is known about the prevalence of dermatoses in "skin-well" geriatric Singaporeans. We aim to identify the prevalence of dermatoses and their associations within the geriatric population in Singapore, and to understand the distribution of dermatological encounters presenting to primary care physicians, and the resultant referral behaviour.

METHODS

A joint quantitative-qualitative study was performed across 8 months. Patients aged 65 years and above who visited a local polyclinic for management of non-dermatological chronic diseases were recruited. They were administered questionnaires, and underwent full skin examinations. Online surveys were disseminated to polyclinic physicians under the same healthcare cluster.

RESULTS

201 patients and 53 physicians were recruited. The most common dermatoses identified in patients were benign tumours and cysts (97.5%), and asteatosis (81.6%). For every 1-year increase in age, the odds of having asteatosis increased by 13.5% (95% CI 3.4-24.7%, p = 0.008), and urticarial disorders by 14.6% (95% CI 0.3-30.9%, p = 0.045). Patients who used any form of topical preparations on a daily basis had higher odds of having eczema and inflammatory dermatoses (OR 2.51, 95% CI 1.38 to 4.56, p = 0.003). Physicians reported dermatological conditions involving 20% of all clinical encounters. Eczema represented the most commonly reported dermatosis within the first visit. 50% of dermatology referrals were done solely at the patient's own request.

CONCLUSION

The prevalence of dermatoses in the elderly in Singapore is high, especially asteatosis. Prompt recognition by the primary healthcare provider potentially prevents future morbidity. Outreach education for both primary care physicians and the general public will be key.

ETHICS APPROVAL

National Healthcare group (NHG) Domain Specific Review Board (DSRB), Singapore, under Trial Registration Number 2020/00239, dated 11 August 2020.

Elimination of damaged mitochondria during UVB-induced senescence is orchestrated by NIX-dependent mitophagy

Skin aging is the result of two types of aging, "intrinsic aging" an inevitable consequence of physiologic and genetically determined changes and "extrinsic aging," which is dependent on external factors such as exposure to sunlight, smoking, and dietary habits. UVB causes skin injury through the generation of free radicals and other oxidative byproducts, also contributing to DNA damage. Appearance and accumulation of senescent cells in the skin are considered one of the hallmarks of aging in this tissue. Mitochondria play an important role for the development of cellular senescence, in particular stress-induced senescence of human cells. However, many aspects of mitochondrial physiology relevant to cellular senescence and extrinsic skin aging remain to be unraveled. Here, we demonstrate that mitochondria damaged by UVB irradiation of human dermal fibroblasts (HDF) are eliminated by NIX-dependent mitophagy and that this process is important for cell survival under these conditions. Additionally, UVB-irradiation of human dermal fibroblasts (HDF) induces the shedding of extracellular vesicles (EVs), and this process is significantly enhanced in UVB-irradiated NIX-depleted cells. Our findings establish NIX as the main mitophagy receptor in the process of UVB-induced senescence and suggest the release of EVs as an alternative mechanism of mitochondrial quality control in HDF.

Photoprotective activities of Capsosiphon fulvescens in UVB-induced SKH-1 mice and human keratinocytes

Capsosiphon fulvescens (CF) is a green alga widely consumed in East Asian countries, particularly in Korea. It has a rich composition of vitamins, minerals, dietary fibers, and bioactive compounds, which contribute to its multiple therapeutic properties. Its application ranges from acting as an antioxidant and anti-inflammatory agent to supporting the skin system. Despite these benefits of CF, the effects and mechanisms of action related to photoaging of the skin have not yet been elucidated. To investigate the photoprotective effects of CF against photoaging, both animal (SKH-1 mouse) and cell models (HaCaT cell line) were used in this study. As a result, administering the CF extract over a period of 10 weeks, which included times of Ultraviolet B (UVB) exposure, significantly reduced erythema and various UVB-induced skin changes, such as wrinkle formation, and the thickening of the epidermis and dermis, as well as alterations in the length and depth of wrinkles. Furthermore, our investigation into CF extract's antiwrinkle properties revealed its efficacy in enhancing skin hydration and collagen content, counteracting the collagen depletion and moisture loss induced by UVB radiation. Also, the fact that the levels of p-ERK, p-p38, and p-JNK proteins went down shows that the CF extract might have a controlling effect on the MAPK signaling pathways. Our findings suggest that CF holds significant potential for preventing photoaging, providing a foundation for the development of functional foods or botanical drugs targeting skin aging and related skin disorders. PRACTICAL APPLICATION: This research proved that Capsosiphon fulvescen, a green alga widely consumed in East Asian countries, provides photoprotective activities against UV-induced skin aging. Therefore, Capsosiphon fulvescen can be utilized as functional foods or botanical drugs targeting skin aging and related skin disorders.

Prevalence and incidence of skin tear in older adults：A systematic review and meta-analysis

BACKGROUND

Skin tear (ST) is a public health problem in older adults; they substantially increase the risk of complications and cause serious adverse consequences and health care burden.

AIM

To estimate the pooled prevalence and incidence of ST among older adults.

METHODS

Ten databases were systematically searched from their inception to July 27, 2023. Two researchers performed a systematic review independently according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All inconsistencies were resolved by a principal researcher. The pooled prevalence and incidence of ST were estimated in R 4.3.1 program.

RESULTS

Thirteen studies were included in this review. The pooled prevalence of ST was 6.0 % (95 % confidence interval (CI): 3.0%-11.0 %, I2 = 98 %), and the pooled incidence was 11.0 % (95 % CI: 5.0%-19.0 %, I2 = 94 %). The prevalence of ST was 11.0 % (95 % CI: 5.0%-19.0 %, I2 = 95 %) in long-term care facilities, 5.0 % (95 % CI: 3.0%-9.0 %, I2 = 86 %) in Europe, and 7.0 % (95 % CI: 1.0%-16.0 %, I2 = 82 %) in the Skin Tear Audit Research classification system (STAR). It has stabilized at 6.0 % since 2021. The incidence of ST was 15.0 % (95 % CI: 11.0%-20.0 %, I2 = 66 %) in long-term care facilities in Japan and 4.0 % (95 % CI: 2.0%-6.0 %) in Canada.

CONCLUSIONS

Older adults are at a high risk for ST. Our findings emphasize the importance of epidemiologic studies and further exploring assessment tools for ST. Healthcare professionals should pay attention to ST, identify high-risk individuals and associated factors, and implement targeted prevention strategies for older adults.

Skin microbiome profiling reveals the crucial role of microbial metabolites in anti-photoaging

BACKGROUND

Skin microbiota is essential for health maintenance. Photoaging is the primary environmental factor that affects skin homeostasis, but whether it influences the skin microbiota remains unclear.

OBJECTIVE

The objective of this study is to investigate the relationship between photoaging and skin microbiome.

METHODS

A cohort of senior bus drivers was considered as a long-term unilateral ultraviolet (UV) irradiated population. 16S rRNA amplicon sequencing was conducted to assess skin microbial composition variations on different sides of their faces. The microbiome characteristics of the photoaged population were further examined by photoaging guinea pig models, and the correlations between microbial metabolites and aging-related cytokines were analyzed by high-throughput sequencing and reverse transcription polymerase chain reaction.

RESULTS

Photoaging decreased the relative abundance of microorganisms including Georgenia and Thermobifida in human skin and downregulated the generation of skin microbe-derived antioxidative metabolites such as ectoin. In animal models, Lactobacillus and Streptobacillus abundance in both the epidermis and dermis dropped after UV irradiation, resulting in low levels of skin antioxidative molecules and leading to elevated expressions of the collagen degradation factors matrix metalloproteinase (MMP)-1 and MMP-2 and inflammatory factors such as interleukin (IL)-1β and IL-6.

CONCLUSIONS

Skin microbial characteristics have an impact in photoaging and the loss of microbe-derived antioxidative metabolites impairs skin cells and accelerates the aging process. Therefore, microbiome-based therapeutics may have potential in delaying skin aging.

Piperlongumine regulates genes involved in the skin barrier in epidermal keratinocyte HaCaT cells

Given that the skin is the largest tissue in the human body, performing external barrier functions with innate and adaptive immunity and undergoing substantial changes during aging, it is under investigation as a major target of various bioactive molecules. In the present study, we examined the biological activity of the senolytic piperlongumine by analyzing alterations in mRNA expression of notable skin genes using transformed aneuploid immortal epidermal keratinocytes, HaCaT cells. We observed that piperlongumine increased the mRNA expression of genes playing critical roles in skin barrier function. In addition, piperlongumine increased expression enzymes involved in the synthesis of ceramide, a major component of intercellular lipids. Furthermore, we measured the protein levels of various cytokines secreted by epidermal keratinocytes and found changes in the release of GRO-αβγ, CCL5, and MCP1. Additionally, we observed that piperlongumine treatment modulated the expression of keratinocyte-specific aging markers and influenced telomerase activity. Based on these findings, piperlongumine could regulate the physiological activity of epidermal keratinocytes to induce beneficial effects in human skin by regulating important skin-related genes.

Exogenous Nucleotides Improve the Skin Aging of SAMP8 Mice by Modulating Autophagy through MAPKs and AMPK Pathways

The skin, serving as the body's primary defense against external elements, plays a crucial role in protecting the body from infections and injuries, as well as maintaining overall homeostasis. Skin aging, a common manifestation of the aging process, involves the gradual deterioration of its normal structure and repair mechanisms. Addressing the issue of skin aging is increasingly imperative. Multiple pieces of evidence indicate the potential anti-aging effects of exogenous nucleotides (NTs) through their ability to inhibit oxidative stress and inflammation. This study aims to investigate whether exogenous NTs can slow down skin aging and elucidate the underlying mechanisms. To achieve this objective, senescence-accelerated mouse prone-8 (SAMP8) mice were utilized and randomly allocated into Aging, NTs-low, NTs-middle, and NTs-high groups, while senescence-accelerated mouse resistant 1 (SAMR1) mice were employed as the control group. After 9 months of NT intervention, dorsal skin samples were collected to analyze the pathology and assess the presence and expression of substances related to the aging process. The findings indicated that a high-dose NT treatment led to a significant increase in the thickness of the epithelium and dermal layers, as well as Hyp content (p < 0.05). Additionally, it was observed that low-dose NT intervention resulted in improved aging, as evidenced by a significant decrease in p16 expression (p < 0.05). Importantly, the administration of high doses of NTs could improve, in some ways, mitochondrial function, which is known to reduce oxidative stress and promote ATP and NAD+ production significantly. These observed effects may be linked to NT-induced autophagy, as evidenced by the decreased expression of p62 and increased expression of LC3BI/II in the intervention groups. Furthermore, NTs were found to upregulate pAMPK and PGC-1α expression while inhibiting the phosphorylation of p38MAPK, JNK, and ERK, suggesting that autophagy may be regulated through the AMPK and MAPK pathways. Therefore, the potential induction of autophagy by NTs may offer benefits in addressing skin aging through the activation of the AMPK pathway and the inhibition of the MAPK pathway.

Liquid collagen from freshwater fish skin ameliorates hydration, roughness and elasticity in photo-aged skin: a randomized, controlled, clinical study

BACKGROUND/OBJECTIVES

Collagen is commonly used in diverse forms as a functional component in skincare products. On the other hand, the effects of collagen on human skin are controversial. Dietary collagen hydrolysates from freshwater Pangasius hypophthalmus fish skin ameliorated photo-aged skin of hairless mice. This study conducted a randomized, double-blind, placebo-controlled clinical trial to determine if liquid fish collagen (Collagen-Tripep20™, Tripep20) as a drink strengthens skin health and quality.

SUBJECTS/METHODS

In this clinical trial, 85 subjects aged 35-60 yrs were diagnosed with photo-aged skin. Eighty-five subjects were randomized to receive either Tripep20 (n = 44) or placebo (n = 41). Seventy-eight subjects fully participating for a 12-week period consumed 1,000 mg of Tripep20 (n = 41) or placebo (n = 37) in a 50-mL bottle as a daily drink. The intend-to-treat and per-protocol populations were 85 and 78, respectively. Skin hydration, wrinkles, and elasticity were assessed at 0 (baseline), 6, and 12 weeks during the study period.

RESULTS

Skin hydration in the Tripep20 group was significantly higher from 6 weeks (P < 0.001) than the baseline. After 12 weeks, the Crow's-feet visual score and skin roughness (Ra, Rq, and Rmax) were significantly improved in the Tripep20 group than in the placebo group (P < 0.05). Consuming liquid collagen Tripep20 greatly enhanced skin elasticity (Gross R2, Net R5, and Biological elasticity R7) in 6 weeks compared to the placebo group. The Tripep20 group showed a significant increase in skin elasticity from the baseline after 6 and 12 weeks (P < 0.001). Neither abnormal symptoms nor adverse events were encountered during the study period in subjects ingesting Tripep20 or placebo. The changes in parameters related to hematology and clinical chemistry were within the normal ranges.

CONCLUSION

Oral consumption of liquid collagen Tripep20 was safe and well-tolerated. The results of this study show that freshwater fish-derived liquid collagen Tripep20 can be used as a healthy functional food ingredient to improve skin moisturizing, anti-wrinkling, and elasticity in an aging population.

Skin health of community-living older people: a scoping review

The population of older people is steadily increasing and the majority live at home. Although the home and community are the largest care settings worldwide, most of the evidence on dermatological care relates to secondary and tertiary care. The overall aims were to map the available evidence regarding the epidemiology and burden of the most frequent skin conditions and regarding effects of screening, risk assessment, diagnosis, prevention and treatment of the most frequent skin conditions in older people living in the community. A scoping review was conducted. MEDLINE, Embase and Epistemonikos were systematically searched for clinical practice guidelines, reviews and primary studies, as well as Grey Matters and EASY for grey literature published between January 2010 and March 2023. Records were screened and data of included studies extracted by two reviewers, independently. Results were summarised descriptively. In total, 97 publications were included. The vast majority described prevalence or incidence estimates. Ranges of age groups varied widely and unclear reporting was frequent. Sun-exposure and age-related skin conditions such as actinic keratoses, xerosis cutis, neoplasms and inflammatory diseases were the most frequent dermatoses identified, although melanoma and/or non-melanoma skin cancer were the skin conditions investigated most frequently. Evidence regarding the burden of skin conditions included self-reported skin symptoms and concerns, mortality, burden on the health system, and impact on quality of life. A minority of articles reported effects of screening, risk assessment, diagnosis, prevention and treatment, mainly regarding skin cancer. A high number of skin conditions and diseases affect older people living at home and in the community but evidence about the burden and effective prevention and treatment strategies is weak. Best practices of how to improve dermatological care in older people remain to be determined and there is a particular need for interventional studies to support and to improve skin health at home.

Collagen peptides affect collagen synthesis and the expression of collagen, elastin, and versican genes in cultured human dermal fibroblasts

Background

Collagen is one of the major proteins of the skin and it is particularly important for its strength and resilience. Skin aging is a natural process that is characterized by the decrease and fragmentation of collagen in the dermis. Oral supplementation with collagen peptides has been clinically shown to have a positive effect on the skin condition. However, the mechanisms of aging-related changes synthesized by cells exposed to collagen are currently not well understood. Therefore, in this in vitro study, the mechanisms associated with collagen, elastin, and versican in human dermal fibroblasts were investigated after exposure to collagen peptides.

Methods

The effects of different concentrations of collagen peptides on cell viability and metabolism were analyzed. For gene expression analysis, human dermal fibroblasts were treated with collagen peptides. This was then followed by RNA extraction and DNA synthesis. Gene expressions of collagen type 1 (COL1A1), elastin (ELN), and versican (VCAN) were quantified by quantitative reverse transcription polymerase chain reaction (RT-qPCR). In addition, collagen levels were analyzed by confocal scanning laser microscopy using immunostaining.

Results

Collagen peptides tested in the study increased the expression of the relevant COL1A1, ELN, and VCAN genes in human dermal fibroblasts (p < 0.005). Furthermore, confocal microscopy showed increased collagen expression in the dermal fibroblast culture after treatment with the collagen peptides (p < 0.005).

Conclusion

These data provide cell-based evidence for the beneficial effects of exposure to collagen peptides on the skin's collagen content and on the molecules that provide firmness and elasticity. This may support the hypothesis that collagen peptides are important for maintaining extracellular matrix (ECM) structure and skin regeneration.

Cell Senescence-Independent Changes of Human Skin Fibroblasts with Age

Skin ageing is defined, in part, by collagen depletion and fragmentation that leads to a loss of mechanical tension. This is currently believed to reflect, in part, the accumulation of senescent cells. We compared the expression of genes and proteins for components of the extracellular matrix (ECM) as well as their regulators and found that in vitro senescent cells produced more matrix metalloproteinases (MMPs) than proliferating cells from adult and neonatal donors. This was consistent with previous reports of senescent cells contributing to increased matrix degradation with age; however, cells from adult donors proved significantly less capable of producing new collagen than neonatal or senescent cells, and they showed significantly lower myofibroblast activation as determined by the marker α-SMA. Functionally, adult cells also showed slower migration than neonatal cells. We concluded that the increased collagen degradation of aged fibroblasts might reflect senescence, the reduced collagen production likely reflects senescence-independent processes.

The roles of gut microbiome and metabolites associated with skin photoaging in mice by intestinal flora sequencing and metabolomics

Photoaging of skin, a chronic disease, can produce the appearance changes and cancer lesions of skin. Therefore, it is of great significance to investigate the mechanisms and explore effective methods to treat the disorder. Gut microbiota and intestinal metabolisms have critical roles in a variety of diseases. However, their roles on photoaging of skin were not well tested. In the present work, the results showed that compared with control group, the levels of MDA, SOD and CAT associated with oxidative stress, the levels of COL I, CER, and HA associated with skin function, and the mRNA levels of IL-1β, IL-6, TNF-α associated with inflammation after long-term exposure to ultraviolet radiation in mice were significantly changed. Skin pathological tissue was also seriously damaged. The protein levels of AQP3 and FLG were significantly decreased. Ultraviolet exposure also promoted skin photoaging by activating TNFR1/TRAF2-mediated MAPK pathway, in which the protein levels of P38/P-P38, c-FOS/P-c-FOS, MMP1, TNFR1 and TRAF2 were significantly increased in model mice compared with control group. In fecal microbiota transplantation (FMT) experiment, we found that the intestinal microbiome of control mice alleviated skin photoaging via adjusting the protein levels of P38/P-P38, c-FOS/P-c-FOS, MMP1, TNFR1 and TRAF2. 16S rRNA sequencing found that 1639 intestinal bacteria were found, in which 15 bacteria including norank_f_Ruminococcaceae, Lachnospirac -eae_NK4A136_group, Lachnoclostridium, etc., were significantly different at the genus level. Untargeted GC-TOF/MS and UHPLC-MS/MS metabolomics showed 72 and 188 metabolites including taurine, ornithine, L-arginine, L-histidine, sucrose with significant differences compared with control group. Then, amino acid targeting assay showed 10 amino acids including L-ornithine, L-arginine and L-citrulline with higher levels in control group compared with model group. In addition, we also found that the variation of Lachnoclostridium abundance may regulate L-arginine metabolism to affect skin photoaging. Some intestinal bacteria and metabolites including amino acids may be closely related to skin photoaging, which should provide new methods to treat skin photoaging in the future.

The Promising Role of Polyphenols in Skin Disorders

The biochemical characteristics of polyphenols contribute to their numerous advantageous impacts on human health. The existing research suggests that plant phenolics, whether consumed orally or applied directly to the skin, can be beneficial in alleviating symptoms and avoiding the development of many skin disorders. Phenolic compounds, which are both harmless and naturally present, exhibit significant potential in terms of counteracting the effects of skin damage, aging, diseases, wounds, and burns. Moreover, polyphenols play a preventive role and possess the ability to delay the progression of several skin disorders, ranging from small and discomforting to severe and potentially life-threatening ones. This article provides a concise overview of recent research on the potential therapeutic application of polyphenols for skin conditions. It specifically highlights studies that have investigated clinical trials and the use of polyphenol-based nanoformulations for the treatment of different skin ailments.

Keystone Flap for Closure of Skin Cancer Defects on the Upper Extremity

Background: We sought to examine the efficacy of the Keystone Design Perforator Island Flap (KDPIF) for the reconstruction of skin cancer excision defects isolated to the upper extremity. In particular, to examine the size of defects repaired and the complications associated with the keystone flap procedure isolated to the upper extremity. Methods: This is a retrospective chart review including all patients older than 18 years of age who received a KDPIF procedure between February 2013 and February 2019 for the oncologic reconstruction of skin cancer defects isolated to the upper extremities by a single surgeon. All procedures were done according to the original description by Behan. Results: A total of 32 patients, 18 (56%) male and 14 (44%) female, received 35 keystone flaps between February 2013 and February 2019. The mean age of the males and females was 70.5 and 79.7 years of age, respectively. Thirty-five lesions suspicious for cancer were excised and 14 (40%) basal cell carcinoma (BCC), 11 (31%) squamous cell carcinoma (SCC), 9 (26%) melanoma, and 1 (3%) actinic keratoses diagnoses were histopathologically determined. Skin defect excisions varied from 3.53 cm2 to 31.42 cm2. No intraoperative or postoperative complications occurred. Conclusions: The keystone flap is a successful versatile flap procedure with a low or absent complication rate for the reconstruction of skin cancer excision defects of various locations (eg arm, hand, elbow, forearm, shoulder, and wrist), cancer pathologies, and sizes on the upper extremity. When needed, a Doppler may successfully identify adequate perforating blood vessels for the relatively larger flaps.

Clinically Actionable Topical Strategies for Addressing the Hallmarks of Skin Aging: A Primer for Aesthetic Medicine Practitioners

In this narrative review, we sought to provide a comprehensive overview of the mechanisms underlying cutaneous senescence, framed by the twelve traditional hallmarks of aging. These include genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, impaired macroautophagy, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, altered intercellular communication, chronic inflammation, and dysbiosis. We also examined how topical interventions targeting these hallmarks can be integrated with conventional aesthetic medicine techniques to enhance skin rejuvenation. The potential of combining targeted topical therapies against the aging hallmarks with minimally invasive procedures represents a significant advancement in aesthetic medicine, offering personalized and effective strategies to combat skin aging. The reviewed evidence paves the way for future advancements and underscores the transformative potential of integrating scientifically validated interventions targeted against aging hallmarks into traditional aesthetic practices.

Analysis of Treatment Efficacy of Intense Pulsed Light (M22) for Meibomian Gland Dysfunction with Demodex Mites

Objective

To investigate the effectiveness of intense pulsed light (M22) in treating patients with meibomian gland dysfunction (MGD) caused by demodex mites.

Methods

A total of 100 patients (100 eyes) diagnosed with demodex mites through microscopic examination at Shanxi Bethune Eye Clinic between June 2021 and May 2023 were selected using convenience sampling. The patients were randomly divided into two groups: an experimental group (n=50) and a control group (n=50). The control group received comprehensive treatment consisting of artificial tears, warm compress, anti-inflammatory eye ointment, hypochlorous acid cleansing, okra cotton pad, and meibomian gland massage. In addition to the comprehensive treatment, the experimental group received intense pulsed light (M22) therapy. After 8 weeks of treatment, the mite clearance rate and cure rate of dry eye were measured for both groups. The recurrence rate of dry eye was also observed 4 weeks after discontinuing M22 treatment.

Results

The experimental group achieved a mite clearance rate of 88.0%, while the control group had a rate of 58.0%, with a statistically significant difference (χ2 = 5.43, P = 0.017). Regarding the cure rate of dry eye, the experimental group showed a rate of 92.0%, while the control group had a rate of 82.0%, with a statistically significant difference (χ2 = 3.61, P = 0.021). In terms of the recurrence rate of dry eye, the experimental group exhibited a rate of 13.04%, while the control group had a rate of 26.83%, with a statistically significant difference (χ2 = 4.18, P = 0.016).

Conclusion

Intense pulsed light (M22) demonstrated superior efficacy in eradicating demodex mites, treating dry eye, and maintaining the treatment's effectiveness compared to comprehensive treatment with medication in patients suffering from meibomian gland dysfunction with demodex mites.

Chitosan-coated miconazole as an effective anti-inflammatory agent for the treatment of postoperative infections in obstetrics and vaginal yeast infection control on in vitro evaluations

People with immune deficiency are at risk of developing infections caused by several bacterial and fungal species. In this work, chitosan-coated miconazole was developed by a simple sol-gel method. Miconazole is considered an effective drug to treat vaginal infection-causing bacteria and fungi. The coating of chitosan with miconazole nitrate showed the highest drug loading efficiency (62.43%) and mean particle size (2 μm). FTIR spectroscopic analysis confirmed the entrapment of miconazole nitrate into chitosan polymer. The antifungal result demonstrated that MN@CS microgel possessed notable anti-Aspergillus fumigatus and Candida albicans activity in lower doses. Antibacterial activity results revealed excellent bacterial growth inhibition of MN@CS microgel towards human skin infectious pathogens Escherichia coli and Staphylococcus aureus. The biocompatibility studies of In vitro cell viability and Artemia salina lethality assay suggested that MN@CS microgel is more biosafe and suitable for human external applications. In the future, it will be an efficient anti-inflammatory agent for the treatment of vaginal infections.

Poria cocos Lanostane Triterpenoids Extract Promotes Collagen and Hyaluronic Acid Production in D-Galactose-Induced Aging Rats

The global aging population is expanding at an increasingly rapid pace, with approximately one-fourth of the world's population expected to be composed of elderly individuals by 2050. Aging skin is one of the major characteristics expressed in the elderly. The study comprehensively utilizes both cell and animal experiments to confirm the skin anti-aging effects of Poria cocos (P. cocos), which is one of the most important traditional Chinese medicines classified as tonic Chinese medicine, commonly used to treat physical weakness and aging-associated diseases. We demonstrate in this study that P. cocos lanostane triterpenoids extract (Lipucan®) ameliorates aging skin and promotes collagen accumulation and hyaluronic acid production in galactose-induced aging rats. Purified lanostane triterpenoids were initially identified as active components in P. cocos, which significantly increased collagen and hyaluronic acid levels in cultured human skin cells.

Basal cell carcinosarcoma: a systematic review and reappraisal of its challenges and the role of Mohs surgery

Basal cell carcinosarcoma (BCCS) is a rare malignant biphasic tumor of the skin, composed of epithelial and mesenchymal components, and may be underdiagnosed. We sought to summarize the current understanding of BCCS including its reported history, clinical presentation, diagnosis, and treatment. We also reappraise and present our recommendations of histological interpretation for its diagnosis and treatment. A systematic review of PubMed and EMBASE, from inception of databases to December 1, 2022, identified all reported cases of basal cell carcinosarcoma. A total of 34 reports containing 54 patients with basal cell carcinosarcoma were included. The neoplasm was most commonly associated in areas of sun-exposed skin and primarily affected the elderly. Diagnosis was made on histology specimens using H&E. To address underdiagnosis, additional immunohistochemical markers have been proposed due to unreliable phenotypic appearance in this poorly differentiated neoplasm. Treatment consists of excision of the tumor, typically with Mohs surgery, and is curative in most cases. There are limited treatment options for metastatic disease. There were limitations to this study as various immunohistochemical stains used on suspected BCCS without providing an explanation as to why certain markers were included and others were excluded. Continued efforts in characterizing this complex neoplasm are critical in establishing reliable and accurate diagnostic tests and accompanying treatment options, especially in cases of metastatic disease.

[Practical problems with the use of topicals in geriatric dermatology]

Changes related to aging affect all layers of the skin and are influenced by both intrinsic conditions and extrinsic factors. The extent of the senescent changes can vary enormeously in seniors, so that an individual assessment is useful and often necessary. Of particular clinical importance are changes in the epidermis, which entail a complex reduction of the barrier function and a reduction in the compensatory capacity with regard to exogenous noxae. This results in increased susceptibility, especially toward infection and cancer. Against this background, a prophylactic strategy for the substitution of the physicochemical and thus also the microbiological barrier in the context of basic care is very important. In order to be able to implement these consistently, recommendations for preparations explicitly designed for aging skin as well as practical instructions for use are highly meaningful. The latter should take into account limitations regarding mobility as well as possible cognitive deficits of seniors. For this purpose, creams and suitable preparations in terms of viscosity and composition should be recommended. In order to facilitate implementation, written or pictorial recommendations for application as well as digital assistance systems can be used. Due to demographic developments in Germany and Europe, the clinical relevance of geriatric dermatology will significantly increase in the future.

The theory and practice of pressure ulcer/injury risk assessment: a critical discussion

Pressure ulcer/injury (PU) risk assessment is widely considered an essential component in clinical practice. It is a complex and broad concept that includes different approaches, such as clinical judgement, using standardised risk assessment instruments, skin assessments, or using devices to measure skin or tissue properties. A distinction between PU risk assessment and early detection is important. PU risk measures the individual's susceptibility to developing a PU under a specific exposure (primary prevention), and early detection includes the assessment of early (sub)clinical signs and symptoms to prevent progression and to support healing (secondary prevention). PU risk is measured using prognostic/risk factors or prognostic models. Every risk estimate is a probability statement containing varying degrees of uncertainty. It therefore follows that every clinical decision based on risk estimates also contains uncertainty. PU risk assessment and prevention is a complex intervention, where delivery contains several interacting components. There is a huge body of evidence indicating that risk assessment and its outcomes, the selection of preventive interventions and PU incidence are not well connected. Methods for prognostic model development and testing in PU risk research must be improved and follow state-of-the-art methodological standards. Despite these challenges, we do have substantial knowledge about PU risk factors that helps us to make better clinical decisions. An important next step in the development of PU risk prediction might be the combination of clinical and other predictors for more individualised care. Any prognostic test or procedure must lead to better prevention at an acceptable cost.

Rural-urban and socio-demographic differentials in perceived health state among aging population in Ghana

BACKGROUND

The variations in health between rural and urban population have become an increasingly significant public health concern in developing countries including Ghana where urbanization is occurring. Whereas urbanization results in improved access to healthcare services, the concomitant negative consequences of urbanization coupled with unfavorable compositional and contextual attributes can affect the health of populations. The study sought to examine the effect of rural-urban residence and selected socio-demographic factors on perceived health state among aging population by employing a nationally representative data collected by the WHO from 2014 to 2015.

METHODS

The data were derived from the WHO Study on Aging wave 2 released in 2019. A total of 4511 individuals, made up of 1018 adults between 18 and 49 years and 3493 respondents within the ages of 50 years and above, were involved in this study. The study examined the Spearman's rho correlations between perceived health, rural-urban residence, age, sex, marital status, ever schooled, current work state, religion, and regional location. Subsequently, the study employed a multivariable ordinal logistic regression model to test the effect of the selected biosocial and contextual variables on perceived health state.

RESULTS

The selected socio-demographic variables significantly correlated with health state, except for rural-urban residence. However, the predictive ability of rural-urban residence and the socio-demographic variables on perceived health state were strongly ascertained. It was observed that age, sex, rural-urban residence, and current state of work among aging populations were significant predictors of perceived health state as demonstrated by odds ratios and significant p values. The contextual factor of regional location was the most significant variable that increases the perceived health state of respondents in the study.

CONCLUSIONS

Continues engagement in work-related activities, an individual's age within the aging continuum and regional location coupled with its environmental and ecological attributes, may significantly influence the development of positive perception toward health state, which forms a vital constituent of an individual health seeking behavior.

Nacre Extract from Pearl Oyster Shell Prevents D-Galactose-Induced Brain and Skin Aging

Pearl oyster shells comprise two layers, a prismatic and nacreous layer, of calcium carbonate. The nacreous layer has been used in Chinese medicine since ancient times. In this study, we investigated the effects of the extract from the nacreous layer of pearl oysters (nacre extract) on D-galactose-induced brain and skin aging. Treatment with nacre extract led to the recovery of D-galactose-induced memory impairment, as examined using the Barnes maze, novel object recognition, and Y-maze tests. A histological study showed that nacre extract suppressed D-galactose-induced neuronal cell death and the expression of B cell lymphoma 2 (Bcl-2)-associated X protein (Bax), which causes apoptosis in the hippocampus. In addition, the expression levels of brain-derived neurotrophic factor, which counteracts age-related brain dysfunction, and nicotinamide adenine dinucleotide-dependent deacetylase (sirtuin 1), which delays aging and extends lifespan, increased after nacre extract treatment. Moreover, the nacre extract showed anti-aging effects against D-galactose-induced skin aging; it suppressed D-galactose-induced wrinkle formation, decreased skin moisture, decreased epidermal thickness, and destroyed collagen arrangement associated with aging. Furthermore, the nacre extract suppressed oxidative stress associated with aging in the brain and skin by upregulating the expression of catalase and superoxide dismutase. The expression level of the cellular senescence marker p16, which is induced by oxidative stress, was elevated in the hippocampus and skin epidermal layer of D-galactose-treated mice, and it was suppressed by the administration of nacre extract. These results show that the nacre extract can suppress D-galactose-induced aging by enhancing anti-oxidant activity and suppressing p16 expression. Thus, the nacre extract may be an effective anti-aging agent.

K-means cluster analysis of characteristic patterns of allergen in different ages: Real life study

BACKGROUND

Atopy varies in people of different ages owing to different physical conditions and exposure to allergens. We aimed to cluster ages based on atopic severity using K-means cluster analysis and identify atopic incidence, severity, as well as the association among peripheral eosinophils, IgE and sensitisation.

METHODS

Consecutive patients (n = 7654) with allergic symptoms and undergoing allergen-specific IgE tests were included from 2013 to 2017. Age, sex, specific-IgE, peripheral eosinophil counts and total-IgE were collected.

RESULTS

Five age categories were identified: 1-17, 18-36, 37-52, 53-69 and 70-100 years. The incidences of atopy and poly-sensitisation decreased with increasing age. Similar trend was observed for aeroallergens, egg and milk but not for peanuts, soy or seafood. Dust mites remain the crucial factor bothering patients with allergic symptoms, especially for children and adolescents. In patients aged <52 years, sensitisation to aeroallergens was more prevalent than food. In group 37-52 years, incidence of females' atopy was higher than that of males. The overlap of atopy, high eosinophils, and high total-IgE was found in only 19.18% of patients. The trend of allergen-test positivity is not parallel to total IgE and peripheral eosinophil counts.

CONCLUSION

Age-grouping based on cluster analysis helps to find the changes in atopic status and distribution of sensitised allergens with age. Allergen tests are still necessary in the clinical diagnosis and treatment. An innovative exploration of the influence of age and allergens on total-IgE and eosinophil counts is helpful for the development of bio-targeted precision therapy.

CLINICAL TRIAL REGISTRATION

ChiCTR2300067700.

Disease-related biomarkers as experimental endpoints in 3D skin culture models

The success of in vitro 3D models in either recapitulating the normal tissue physiology or altered physiology or disease condition depends upon the identification and/or quantification of relevant biomarkers that confirm the functionality of these models. Various skin disorders, such as psoriasis, photoaging, vitiligo, etc., and cancers like squamous cell carcinoma and melanoma, etc. have been replicated via organotypic models. The disease biomarkers expressed by such cell cultures are quantified and compared with the biomarkers expressed in cultures depicting the normal tissue physiology, to identify the most prominent variations in their expression. This may also indicate the stage or reversal of these conditions upon treatment with relevant therapeutics. This review article presents an overview of the important biomarkers that have been identified in in-vitro 3D models of skin diseases as endpoints for validating the functionality of these models.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10616-023-00574-2.

Improving skin health of community-dwelling older people: a scoping review protocol

INTRODUCTION

Ageing is accompanied by an age-related decrease in mobility or cognitive and sensory functions; in addition, physiological changes in the skin occur with age. Therefore, the skin requires appropriate care and observation in order to prevent or manage a variety of dermatological diseases and conditions, and to prevent or minimise effects on the quality of life.Globally, most older people live at home, and the need to establish sustainable structures and processes to support and to care for people at home for as long as possible has been emphasised. The body of evidence supporting screening, diagnosis and management of skin conditions in older people living at home has not been collated and summarised to date. The aim of this scoping review is to describe and summarise the extent and nature of the available body of evidence in this regard.

METHODS AND ANALYSIS

This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Eligibility criteria were developed using the Population, Concept and Context framework, and the search will focus on systematic and scoping reviews as well as clinical practice guidelines. Two reviewers will conduct systematic searches, screen and select identified evidence as well as extract and chart data, independently. Finally, data will be systematically analysed and summarised descriptively to map existing evidence and identify gaps.

ETHICS AND DISSEMINATION

Due to the nature of research, not involving humans or unpublished secondary data, approval of an ethics committee is not required. The dissemination of findings is planned via professional networks and publication in scientific open access journals.

Biomarkers of aging

Aging biomarkers are a combination of biological parameters to (i) assess age-related changes, (ii) track the physiological aging process, and (iii) predict the transition into a pathological status. Although a broad spectrum of aging biomarkers has been developed, their potential uses and limitations remain poorly characterized. An immediate goal of biomarkers is to help us answer the following three fundamental questions in aging research: How old are we? Why do we get old? And how can we age slower? This review aims to address this need. Here, we summarize our current knowledge of biomarkers developed for cellular, organ, and organismal levels of aging, comprising six pillars: physiological characteristics, medical imaging, histological features, cellular alterations, molecular changes, and secretory factors. To fulfill all these requisites, we propose that aging biomarkers should qualify for being specific, systemic, and clinically relevant.

A retrospective study on the incidence, management and risk factors of skin rash in patients with advanced prostate cancer in Japan

BACKGROUND

Worldwide, prostate cancer (PC) is the second most diagnosed cancer and the fifth leading cause of cancer death in men. Hormonal therapies, commonly used for PC, are associated with a range of treatment-emergent adverse events (TEAEs). The population from Japan seems to be at higher risk of developing TEAEs of skin rash compared to the overall global population. This study was conducted to get a better insight into the incidence, management, and risk factors for skin rash during active treatment for advanced PC in Japan.

METHODS

A retrospective cohort of PC patients was identified and subsequently categorized, into non-metastatic and metastatic castration-resistant prostate cancer patients (nmCRPC and mCRPC), and metastatic castration-naïve prostate cancer patients (mCNPC). The analysis was based on a dataset from the Medical Data Vision (MDV) database. Descriptive statistics were determined, and a multivariate Cox proportional hazards model was used to the associated risk factors for the onset of rash.

RESULTS

Overall, 1,738 nmCRPC patients, 630 mCRPC patients, and 454 mCNPC patients were included in this analysis. The median age was 78 years old and similar across the three cohorts. The skin rash incidence was 19.97% for nmCRPC cohort, 28.89% for mCRPC cohort, and 28.85% for mCNPC cohort. The median duration of skin rash ranged from 29 to 42 days. Statistically significant risk factors for developing skin rash included a history of allergy or hypersensitivity (all cohorts), increased age (nmCRPC and mCRPC), a body mass index (BMI) of < 18.5 (nmCRPC and mCRPC), and a PSA level higher than the median (nmCRPC). Skin rash was commonly managed with systemic and topical corticosteroids which ranged from 41.76% to 67.03% for all cohorts. Antihistamines were infrequently used.

CONCLUSION

This study provides a better understanding of the real-world incidence, onset, duration, management and risk factors of skin rash in patients on active PC treatment in Japan. It was observed that approximately 20-30% of PC patients experience skin rash. Development of skin rash was associated with previous allergy or hypersensitivity, BMI of < 18.5, increased age and higher PSA levels, and was usually treated with corticosteroids.

The Melatonin-Mitochondrial Axis: Engaging the Repercussions of Ultraviolet Radiation Photoaging on the Skin's Circadian Rhythm

Sunlight is a vital element in modulating the central circadian rhythm, such as the regulation of the host's sleep-awake state. Sunlight is also considered to have a significant influence on the circadian rhythm of the skin. Over-exposure or prolonged exposure to sunlight can lead to skin photodamage, including hyperpigmentation, collagen degradation, fibrosis, and even skin cancer. Thus, this review will focus on the adverse effects of sunlight on the skin, not only in terms of photoaging but also its effect on the skin's circadian rhythm. Mitochondrial melatonin, regarded as a beneficial anti-aging substance for the skin, follows a circadian rhythm and exhibits a powerful anti-oxidative capacity, which has been shown to be associated with skin function. Thus, the review will focus on the influence of sunlight on skin status, not only in terms of ultraviolet radiation (UVR)-induced oxidative stress but also its mediation of circadian rhythms regulating skin homeostasis. In addition, this article will address issues regarding how best to unleash the biological potential of melatonin. These findings about the circadian rhythms of the skin have broadened the horizon of a whole new dimension in our comprehension of the molecular mechanisms of the skin and are likely to help pharmaceutical companies to develop more effective products that not only inhibit photoaging but keep valid and relevant throughout the day in future.

Food Peptides for the Nutricosmetic Industry

In recent years, numerous reports have described bioactive peptides (biopeptides)/hydrolysates produced from various food sources. Biopeptides are considered interesting for industrial application since they show numerous functional properties (e.g., anti-aging, antioxidant, anti-inflammatory, and antimicrobial properties) and technological properties (e.g., solubility, emulsifying, and foaming). Moreover, they have fewer side effects than synthetic drugs. Nevertheless, some challenges must be overcome before their administration via the oral route. The gastric, pancreatic, and small intestinal enzymes and acidic stomach conditions can affect their bioavailability and the levels that can reach the site of action. Some delivery systems have been studied to avoid these problems (e.g., microemulsions, liposomes, solid lipid particles). This paper summarizes the results of studies conducted on biopeptides isolated from plants, marine organisms, animals, and biowaste by-products, discusses their potential application in the nutricosmetic industry, and considers potential delivery systems that could maintain their bioactivity. Our results show that food peptides are environmentally sustainable products that can be used as antioxidant, antimicrobial, anti-aging, and anti-inflammatory agents in nutricosmetic formulations. Biopeptide production from biowaste requires expertise in analytical procedures and good manufacturing practice. It is hoped that new analytical procedures can be developed to simplify large-scale production and that the authorities adopt and regulate use of appropriate testing standards to guarantee the population's safety.

An epidemiological study on skin tumors of the elderly in a community in Shanghai, China

The morbidity of skin tumors (ST) in China is a great concern as the population ages. No epidemiological survey on ST in elderly communities in China has been reported. A questionnaire survey was conducted among the residents over 60 years old in a community in Shanghai, China from May 1, 2011 to November 30, 2011. The prevalence of cutaneous tumors and associated factors were analyzed. Among 2038 valid cases, a total of 78 (3.8%, 95% CI 3.0-4.7) skin cancers (SC) were confirmed. According to the final multivariate regression analysis, age, gender and previous occupation were the significantly influential factors for SC. Actinic keratosis (AK) accounted for the largest proportion (63, 3.1%) in SC. The head and neck was the physiological site with the highest incidence of SC (64, 82.1%), and AK was the most common (55, 87.3%) in head and neck SC. The common concomitant diseases of SC were hypertension (26, 33.3%) and diabetes mellitus (9, 11.5%). Seborrheic keratosis (SK) was the most common benign skin tumor with a prevalence of 100%. Men and women developed SK in significantly different parts of the body (P < 0.0001). The incidence of ST in the elderly population in Shanghai community increased with age. ST preferred to occur in the head and neck, which might be attributed to excessive ultraviolet (UV) exposure in these areas. Therefore, early diagnosis and sun-protection education are essential interventions for ST in the elderly.

Evaluation of Fermented Turmeric Milk by Lactic Acid Bacteria to Prevent UV-Induced Oxidative Stress in Human Fibroblast Cells

The nutrition enhancement of turmeric using lactic acid bacteria (LAB) was studied. Among the 23 different LAB strains, Levilactobacillus brevis BCRC12247 was chosen due to its robustness. The fermentation of a turmeric drink from L. brevis significantly improved DPPH antioxidant activity (from 71.57% to 75.87%) and total reducing capacity (2.94 ± 0.03 mM Trolox/g dw) compared to the unfermented product. The fermented turmeric samples were subjected to liquid–liquid partition, producing four different fractions. An in vitro study was conducted by treating the fractions on human fibroblast cells (Hs68). The results indicated that hexane (Hex) and water residual (WA) samples could significantly attenuate UVA (15 J/cm2)-induced reactive oxygen species (ROS), reducing the oxidative damage from 16.99 ± 3.86 to 3.42 ± 2.53 and 3.72 ± 1.76 times, respectively. Real-time polymerase chain reaction (qPCR) results showed that Hex and WA inhibited the expression of c-jun and c-fos and lowered the mmp-1 value compared to the negative control group (by 2.72 and 2.58 times, respectively). Moreover, the expressions of Nrf2 and downstream antioxidant-related genes were significantly elevated in the Hex fraction. Therefore, fermentation using L. brevis can be an effective method to elevate the nutritional values of turmeric, protecting fibroblast cells from UVA-induced photoaging and oxidative stress.

Prevalence and associations of xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo in aged nursing home residents: A representative prevalence study

BACKGROUND

The number of elderly and care-dependent people is increasing, leading to increased risks of adverse skin conditions. Skin care, including prevention and treatment of vulnerable skin, is an essential part of daily nursing practice in long-term residential settings. For many years, the research focus has been on individual skin problems including xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo, although people may be affected by several at the same time.

OBJECTIVES

Aim of the present study was to describe the prevalence and associations of skin conditions relevant to nursing practice in aged nursing home residents.

DESIGN

Analysis of baseline data of a cluster-RCT in long-term residential settings.

SETTING

The study was conducted in a representative sample of n = 17 nursing homes in the federal state of Berlin, Germany.

PARTICIPANTS

Care dependent nursing home residents being 65+ years.

METHODS

A random sample of all eligible nursing homes was drawn. Demographic and health characteristics were collected and head-to-toe skin examinations conducted by dermatologists. Prevalence estimates and intracluster correlation coefficients were calculated, and group comparisons conducted.

RESULTS

Three hundred fourteen residents with a mean age of 85.4 (SD 7.1) years were included. The majority was affected by xerosis cutis (95.9%, 95% CI 93.6 to 97.8), followed by intertrigo 35.0% (95% CI 30.0 to 40.1), incontinence-associated dermatitis 21.0% (95% CI 15.6 to 26.3), skin tears 10.5% (95% CI 7.3 to 13.8), and pressure ulcers 8.0% (95% CI 5.1 to 10.8). In total, more than half of the nursing home residents were affected by two or more skin conditions at the same time. Several associations between skin conditions and mobility, care dependency, or cognitive impairment were observed. There were no associations between xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers or intertrigo.

CONCLUSIONS

The adverse skin and tissue conditions xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo are very common in long-term residential settings, placing a high burden on this population. Although care receivers share similar risk factors and may be affected by several skin conditions at the same time, there are no associations indicating separate aetiological pathways.

REGISTRATION

This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).

Possible Mechanisms of Oxidative Stress-Induced Skin Cellular Senescence, Inflammation, and Cancer and the Therapeutic Potential of Plant Polyphenols

As the greatest defense organ of the body, the skin is exposed to endogenous and external stressors that produce reactive oxygen species (ROS). When the antioxidant system of the body fails to eliminate ROS, oxidative stress is initiated, which results in skin cellular senescence, inflammation, and cancer. Two main possible mechanisms underlie oxidative stress-induced skin cellular senescence, inflammation, and cancer. One mechanism is that ROS directly degrade biological macromolecules, including proteins, DNA, and lipids, that are essential for cell metabolism, survival, and genetics. Another one is that ROS mediate signaling pathways, such as MAPK, JAK/STAT, PI3K/AKT/mTOR, NF-κB, Nrf2, and SIRT1/FOXO, affecting cytokine release and enzyme expression. As natural antioxidants, plant polyphenols are safe and exhibit a therapeutic potential. We here discuss in detail the therapeutic potential of selected polyphenolic compounds and outline relevant molecular targets. Polyphenols selected here for study according to their structural classification include curcumin, catechins, resveratrol, quercetin, ellagic acid, and procyanidins. Finally, the latest delivery of plant polyphenols to the skin (taking curcumin as an example) and the current status of clinical research are summarized, providing a theoretical foundation for future clinical research and the generation of new pharmaceuticals and cosmetics.

Hesperidin, Hesperetin, Rutinose, and Rhamnose Act as Skin Anti-Aging Agents

Aging is a complex physiological process that can be accelerated by chemical (high blood glucose levels) or physical (solar exposure) factors. It is accompanied by the accumulation of altered molecules in the human body. The accumulation of oxidatively modified and glycated proteins is associated with inflammation and the progression of chronic diseases (aging). The use of antiglycating agents is one of the recent approaches in the preventive strategy of aging and natural compounds seem to be promising candidates. Our study focused on the anti-aging effect of the flavonoid hesperetin, its glycoside hesperidin and its carbohydrate moieties rutinose and rhamnose on young and physiologically aged normal human dermal fibroblasts (NHDFs). The anti-aging activity of the test compounds was evaluated by measuring matrix metalloproteinases (MMPs) and inflammatory interleukins by ELISA. The modulation of elastase, hyaluronidase, and collagenase activity by the tested substances was evaluated spectrophotometrically by tube tests. Rutinose and rhamnose inhibited the activity of pure elastase, hyaluronidase, and collagenase. Hesperidin and hesperetin inhibited elastase and hyaluronidase activity. In skin aging models, MMP-1 and MMP-2 levels were reduced after application of all tested substances. Collagen I production was increased after the application of rhamnose and rutinose.

The Characteristics of the Skin Physiological Parameters and Facial Microbiome of "Ideal Skin" in Shanghai Women

Purpose

Everyone pursues perfect skin, but there exist significant differences between cultures, and no commonly accepted standards have been established. Therefore, our study attempted to define the "ideal skin" of oriental women and analyze the relationship between different skin physiological parameters and microbiomes.

Patients and Methods

Based on our customized grading standard, the VISIA CR photos of 111 young women aged from 18 to 25 in Shanghai were collected and scored by the severity of pores, acne, spots, and wrinkles. The volunteers were then divided into "ideal skin" (W1), "normal skin" (W2), and "undesirable skin" (W3) groups. The physiological parameters of facial skin were measured by non-invasive instrumental methods, and the skin microbiome was analyzed by 16S rRNA and ITS high-throughput sequencing.

Results

From "ideal skin" to "undesirable skin", the skin physiological parameters, α-diversity, and composition of the facial microbiome showed noticeable regular changes. Compared with the "normal skin" (W2) and "undesirable skin" (W3), the "ideal skin" (W1) group had lower sebum content, TEWL, melanin, hemoglobin, and roughness but higher hydration content and skin pH value. Furthermore, the Shannon index of skin bacteria was significantly increased in W1 (P = 0.004), suggesting that the ideal skin had higher species diversity. From W1 to W3, the species composition was changed significantly. The abundance of Actinobacteria was increased, while Proteobacteria and Bacteroidetes were decreased. Correspondingly, the abundances of lipophilic Propionibacterium and Malassezia were increased, while the abundances of Stenotrophomonas, Pseudomonas, Ralstonia, and Streptococcus, were significantly decreased. Additionally, Spearman correlation analysis revealed strong correlations between the physiological parameters and the microbiota. Notably, the Shannon index of skin bacteria was significantly positively correlated with skin hydration (P = 0.03) but negatively correlated with the abundance of Cutibacterium (P = 0.000), hemoglobin content (P = 0.025), and sebum content (P = 0.5). Therefore, the skin hydration content and the abundance of Cutibacterium played an important role in maintaining the α-diversity and skin homeostasis.

Conclusion

Ideal skin had better water-oil balance and barrier function, higher microbial diversity, and more reasonable species distribution. Therefore, daily skincare needs to control skin oil and maintain skin microecological balance to achieve ideal skin conditions for young women aged 18-25 years old.

Benefits of skin application of piceatannol-A minireview

The skin is the largest organ of the human body and has several functions such as barrier against external agents, the maintenance of temperature and homeostatic functions. Skin ageing is a natural process that can be influenced by environmental factors, intrinsic skin factors and lifestyle. UV light plays an important role in skin ageing and can cause spots, requiring the use of depigmenting agents. Nowadays, there is a great demand for ingredients that prevent skin ageing, with natural agents occupying a promising position. Among the natural agents, polyphenols, such as resveratrol and piceatannol, found in grapes, passion fruits and other fruits, have a huge relevance. Great benefits of piceatannol have been reported, so thus, this work focuses specifically on a review of the literature regarding the application of this polyphenol in skin care products. This polyphenol can be used in a wound-healing, or as anti-ageing, antioxidant, anti-acne and skin whitening, among other effects.

Impact of skin care on body image of aging people: A quasi-randomized pilot trial

Aim

Support for various activities of daily living is essential for maintaining the health of residents in nursing homes. Although aging people who move to nursing homes often change their skin care habits, how these changes impact aging adults' social and mental well-being remains unclear. This study aimed to evaluate the effects of facial skin care on aging residents' self-body image, self-esteem, well-being, depressive symptoms and social cognitive function by a quasi-randomized controlled pilot trial in Japanese nursing homes.

Method

Thirty-seven older adult women living in nursing homes took part in this quasi-randomized controlled pilot trial. Eighteen participants applied a skincare gel-cream to the face twice a day for three months, while 19 participants used no skincare products. Self-body image and psychological measures such as the Cutaneous Body Image Scale (CBIS), the Rosenberg Self-esteem Scale (RSES), Philadelphia Geriatric Center Morale Scale (PGCMS) and Geriatric Depression Scale (GDS) were used in each nursing home to evaluate the pre- and post-treatment scores. In addition, cognitive items of the Functional Independence Measure (FIM) were evaluated as social cognitive function at pre- and post-treatment.

Results

There was a significant different change of the Cutaneous Body Image Scale scores (p = 0.045, r = 0.34) after three months between skin care group and control group. Although there were no clear significant differences in other psychological assessments, there was a higher number of them with positive changes in the skin care group compared to the control group.

Conclusion

Skin care may help improve cutaneous self-body image and positive emotion in aging female residents of Japanese nursing homes.

Development on potential skin anti-aging agents of Cosmos caudatus Kunth via inhibition of collagenase, MMP-1 and MMP-3 activities

BACKGROUND

Skin aging is associated with degradation of collagen by matrix metalloproteinases (MMPs), which leads to loss of skin elasticity and formation of wrinkles. Cosmos caudatus Kunth (CC) has been traditionally claimed as an anti-aging agent in Malaysia. Despite its well-known antioxidant activity, the anti-aging properties of CC was not validated.

PURPOSE

This study aimed to investigate the anti-aging potential of CC extracts and fractions, particularly their inhibition of collagenase, MMP-1 and MMP-3 activities in human dermal fibroblasts CCD-966SK, followed by isolation, identification and analysis of their bioactive constituents.

STUDY DESIGN AND METHODS

DPPH assay was firstly used to evaluate the antioxidant activity throughout the bioactivity-guided fractionation. Cell viability was determined using MTS assay. Collagenase activity was examined, while MMP-1 and MMP-3 expression were measured using qRT-PCR and western blotting. Then, chemical identification of pure compounds isolated from CC fractions was done by using ESIMS, ¹H and ¹³C NMR spectroscopies. HPLC analyses were carried out for bioactive fractions to quantify the major components.

RESULTS

Throughout the antioxidant activity-guided fractionation, fractions CC-E2 and CC-E3 with antioxidant activity and no toxicity towards CCD-966SK cells were obtained from CC 75% ethanol partitioned layer (CC-E). Both fractions inhibited collagenase activity, MMP-1 and MMP-3 mRNA and protein expression, as well as NF-κB activation induced by TNF-α in CCD-966SK cells. 14 compounds, which mainly consists of flavonoids and their glycosides, were isolated. Quercitrin (14.79% w/w) and quercetin (11.20% w/w) were major compounds in CC-E2 and CC-E3, respectively, as quantified by HPLC. Interestingly, both fractions also inhibited the MMP-3 protein expression synergistically, compared with treatment alone.

CONCLUSION

The quantified CC fractions rich in flavonoid glycosides exhibited skin anti-aging effects via the inhibition of collagenase, MMP-1 and MMP-3 activities, probably through NF-κB pathway. This is the first study reported on MMP-1 and MMP-3 inhibitory activity of CC with its chemical profile, which revealed its potential to be developed as anti-aging products in the future.

A comprehensive comparison of facial skin hydration based on capacitance and conductance measurements in Chinese women

OBJECTIVES

The aim of this study was to compare the data of conductance and capacitance measurements of facial skin hydration and to evaluate and discuss the advantages and disadvantages of the different approaches.

METHODS

We measured skin capacitance (Corneometer® CM 825) and skin conductance (Skicon-200EX®) on 30 pre-defined facial sites of 125 Chinese women, resulting in 3750 readings per device. The data were analysed and compared, and continuous colour maps were generated on a 3D avatar for capacitance, conductance, relative difference (Δ%) and correlation (R-value) by interpolating between the individual readings and converting the values to colours. This visualization allows a better interpretation of the results.

RESULTS

The complexity of facial skin hydration is revealed by this approach. The similarities and discrepancies in the facial hydration maps are clearly apparent. Due to the superiority of the Skicon in measuring high hydration levels, differences in skin hydration were evident on the forehead compared with the Corneometer maps, which may be related to the more superficial measurement of the Skicon within the stratum corneum. Conversely, a greater understanding of the complexity of facial skin hydration in the nasolabial fold was obvious when using the Corneometer. The best congruence between the instruments was found at two specific but separated facial areas, one around the inner eye region and the other one on a line between the nasolabial sulcus and the oblique, lateral jaw. Interestingly, the data were not normally distributed for both instruments and they had opposite skews. All facial clusters were statistically different from each other (p < 0.001), except the cheek and jaw for the Skicon. Larger than expected percentage coefficients of variance were found for the Corneometer on some facial sites that might be explainable by differences in stratum corneum physiology and biochemistry. Corneometer values of 48 AU and Skicon values of 132 μS were taken as the cutoff for normally hydrated facial skin.

CONCLUSIONS

Both devices have their advantages and disadvantages suggesting that bio-instrumental measurement of skin hydration is actually more complicated than commonly thought and that the different facial zones and the use of multiple instrumentation have not been adequately considered.

Delivery of superoxide dismutase by TAT and abalone peptides for the protection of skin cells against oxidative stress

Trichoderma reesei superoxide dismutase (TrSOD) is a well-characterized enzyme being stable between 30 and 90°C for 1 h with activity at pH between 2.6 and 9.0. This work aimed to clone, express, purify, and evaluate the protective effect antioxidant of this enzyme on skin cells when fused to transactivator of transcription (TAT) protein transduction domain of HIV-1 and abalone (Ab) peptides to allow cell penetration. TrSOD, TAT-TrSOD-Yfp (fused to yellow fluorescent protein), and Ab-TrSOD were expressed in E. coli and purified as soluble proteins. The cytotoxicity of the enzymes, at the concentrations of 1, 3, and 6 μmol/L, was evaluated for a period of 24 and 48 h of incubation, with no cytotoxic effect on 3T3 fibroblasts. The 3T3 cells were exposed to the oxidant agent tert-butyl hydroperoxide and evaluated for reactive oxygen species (ROS) generation, in the presence or not of the recombinant enzymes. TAT-TrSOD-Yfp was able to decrease the generation of ROS by 15% when used in the concentrations of 3 and 6 μmol/L in comparison to the control, but there was no difference in relation to the effect of TrSOD. Ab-TrSOD, when compared to TrSOD, promoted a decrease in the formation of ROS of 19% and 14% at the concentrations of 1 and 6 μmol/L, respectively, indicating that this recombinant form was more effective in reducing oxidative stress compared to SOD without the cell-penetrating peptide (CPP). Together, these results indicate that the fusion of SOD with these CPP increased the antioxidant capacity of fibroblasts, identified by the reduction in the generation of ROS. In addition, such molecules, in the concentrations initially used, were not toxic to the cells, opening perspectives for the development of products for antioxidant protection of the skin that may have therapeutic and cosmetic application.

Purification and Identification of Antioxidant Peptides from Rice Fermentation of Lactobacillus plantarum and Their Protective Effects on UVA-Induced Oxidative Stress in Skin

Oxidative stress is an important factor on both aging and disease. Among foods endowed with beneficial healthy properties, rice is a very useful material, not only because it has a good amino acid ratio and produces antioxidant peptides through microbial fermentation, but also for its inexpensive availability. In this study, rice was treated with Lactobacillus plantarum, and the resulting mixture of small peptides with less than 11 amino acids (RFP) was extracted and purified from the fermentation broth. Subsequently, the antioxidant activity of RFP was assessed using the chemical model, cell biology, and animal model methods. RFP enhanced the expression of the antioxidant enzyme genes downstream of the KEAP1-NRF2/ARE pathway by promoting nuclear factor-erythroid 2-related factor 2 (NRF2) nuclear translocation while simultaneously removing lipid oxidation products and excess free radicals. These results suggest that RFP is a potential substance for resisting aging and disease caused by oxidative stress.

Organotypic cultures as aging associated disease models

Aging remains a primary risk factor for a host of diseases, including leading causes of death. Aging and associated diseases are inherently multifactorial, with numerous contributing factors and phenotypes at the molecular, cellular, tissue, and organismal scales. Despite the complexity of aging phenomena, models currently used in aging research possess limitations. Frequently used in vivo models often have important physiological differences, age at different rates, or are genetically engineered to match late disease phenotypes rather than early causes. Conversely, routinely used in vitro models lack the complex tissue-scale and systemic cues that are disrupted in aging. To fill in gaps between in vivo and traditional in vitro models, researchers have increasingly been turning to organotypic models, which provide increased physiological relevance with the accessibility and control of in vitro context. While powerful tools, the development of these models is a field of its own, and many aging researchers may be unaware of recent progress in organotypic models, or hesitant to include these models in their own work. In this review, we describe recent progress in tissue engineering applied to organotypic models, highlighting examples explicitly linked to aging and associated disease, as well as examples of models that are relevant to aging. We specifically highlight progress made in skin, gut, and skeletal muscle, and describe how recently demonstrated models have been used for aging studies or similar phenotypes. Throughout, this review emphasizes the accessibility of these models and aims to provide a resource for researchers seeking to leverage these powerful tools.

Ageing decreases the healing of wounds in the skin of alcohol-preferring rats

OBJECTIVE

Alcohol consumption combined with ageing alters the healing process of the skin. We evaluated whether ageing decreases the healing of incisional wounds in the skin of Wistar rats of Universidade de Chile of variety B (UChB).

METHOD

A total of 20 adult rats and 20 older UChB rats, divided into two groups which underwent surgical aggression in the anterior region of the abdomen, were used: G1, adult rats (100 days old, control) with water and 10% ethanol; G2, aged rats (540 days old, experimental) with water and 10% ethanol; evaluated at 4, 7, 14 and 21 days after surgery.

RESULTS

Ageing did not alter the rupture force and collagen elasticity and resistance. There were increases in telomerase with the implementation of cellular senescence, in interleukin 1-alpha (IL-1α) at 14 days of healing, in epidermal growth factor (EGF) at 14 and 21 days of healing with delayed growth and development of keratinocytes, also an increase of IL-β at 4 days, and decrease in tumour necrosis factor (TNFα) at 7 days, associated with chronic scarring. There was an increase in vascular endothelial growth factor (VEGF) at 4 and 7 days, responsible for the early vessels re-establishment. There was a decrease in transforming growth factor 2-beta (TGFβ2) and β3 at 4 and 7 days of healing respectively, and estradiol at 4 days.

CONCLUSION

Ageing decreases the skin healing in incisional wounds in alcohol-preferring rats.

Barriers and facilitators to delivering everyday personal hygiene care in residential settings: A systematic review

INTRODUCTION

Globally, the population is ageing, and more people live in residential care. Best practice in personal hygiene care may reduce distressing and debilitating skin and oral problems and improve resident outcomes. Although there is guidance on personal hygiene care, implementation may be a challenge.

AIM

To identify barriers and facilitators to delivering personal hygiene care for older persons in residential care settings.

METHODS

Systematic review reported according to PRISMA 2020 guidance. Databases MEDLINE, CIHAHL and PsychINFO were systematically searched using terms and synonyms 'barriers', 'facilitators', 'hygiene', 'older adults' and 'residential care'. Only empirical studies, reporting everyday skin and oral care, in English, peer reviewed and published from 2000 to 2021 were included. Due to methodological heterogeneity, a narrative synthesis was conducted.

RESULTS

Sixteen papers yielded nine categories of barrier or facilitator. Five related to skin and oral care: (i) knowledge, (ii) skills relating to hygiene care, (iii) skills relating to supporting 'uncooperative' behaviours, (iv) lack of resources and (v) time, workload and staffing levels. The remainder related only to oral care: (vi) resident, family or carer motivation, (vii) dislike of hygiene care, (viii) carer attitudes and beliefs and (ix) social influences and communication. Six papers reported interventions to optimise care.

CONCLUSION

This review highlights the persistent dearth of research into everyday personal hygiene practices, in particular skin hygiene in residential care. Existing literature identifies a range of barriers; however, there is a mismatch between these and reported interventions to improve practice.

RELEVANCE TO CLINICAL PRACTICE

Advances in implementation science to support optimal care have yet to be applied to interventions to support hygiene practices in care homes and it is imperative this is addressed. Future interventions should involve: (i) systematically and theoretically assessing barriers, (ii) application of tailored behaviour change techniques (iii) using these co-design pragmatic, locally acceptable strategies.

Molecular Mechanisms of Changes in Homeostasis of the Dermal Extracellular Matrix: Both Involutional and Mediated by Ultraviolet Radiation

Skin aging is a multi-factorial process that affects nearly every aspect of skin biology and function. With age, an impairment of structures, quality characteristics, and functions of the dermal extracellular matrix (ECM) occurs in the skin, which leads to disrupted functioning of dermal fibroblasts (DFs), the main cells supporting morphofunctional organization of the skin. The DF functioning directly depends on the state of the surrounding collagen matrix (CM). The intact collagen matrix ensures proper adhesion and mechanical tension in DFs, which allows these cells to maintain collagen homeostasis while ECM correctly regulates cellular processes. When the integrity of CM is destroyed, mechanotransduction is disrupted, which is accompanied by impairment of DF functioning and destruction of collagen homeostasis, thereby contributing to the progression of aging processes in skin tissues. This article considers in detail the processes of skin aging and associated changes in the skin layers, as well as the mechanisms of these processes at the molecular level.