Chronologic aging alters the response to ultraviolet-induced inflammation in human skin

High salt diet accelerates skin aging in wistar rats: an 8-week investigation of cell cycle inhibitors, SASP markers, and oxidative stress

Background

Recent studies have shown that the high salt diet (HSD) is linked to increased dermal pro-inflammatory status and reduced extracellular matrix (ECM) expression in inflamed skin of mice. Decreased ECM content is a known aging phenotype of the skin, and alterations in ECM composition and organization significantly contribute to skin aging. This study aimed to determine whether a high salt diet accelerates skin aging and to identify the time point at which this effect becomes apparent.

Methods

Wistar rats were randomly divided into normal diet and high salt diet groups and fed continuously for 8 weeks. Skin samples were collected at weeks 7 and week 8. Skin pathological sections were evaluated and levels of cell cycle inhibitors, senescence-associated secretory phenotype (SASP), oxidative stress and vascular regulatory factors (VRFs) were examined. Correlation analyses were performed to reveal the effect of a high salt diet as an extrinsic factor on skin aging and to analyse the correlation between a high salt diet and intrinsic aging and blood flow status.

Results

At week 8, HSD rats exhibited thickened epidermis, thinned dermis, and atrophied hair follicles. The expression of cell cycle inhibitors and oxidative stress levels were significantly elevated in the skin of HSD rats at both week 7 and week 8. At week 7, some SASPs, including TGF-β and PAI-1, were elevated, but others (IL-1, IL-6, IL-8, NO) were not significantly changed. By week 8, inflammatory molecules (IL-1, IL-6, TGF-β), chemokines (IL-8), proteases (PAI-1), and non-protein molecules (NO) were significantly increased. Notably, despite elevated PAI-1 levels suggesting possible blood hypercoagulation, the ET-1/NO ratio was reduced in the HSD group at week 8.

Conclusion

The data suggest that a high salt diet causes skin aging by week 8. The effect of a high salt diet on skin aging is related to the level of oxidative stress and the expression of cell cycle inhibitors. Additionally, a potential protective mechanism may be at play, as evidenced by the reduced ET-1/NO ratio, which could help counteract the hypercoagulable state and support nutrient delivery to aging skin.

Aged and young mice differentially respond to tape-stripping in epidermal gene expression

Disruption of epidermal permeability barrier induces an increase in proinflammatory cytokine expression and release, stimulation of epidermal lipid and DNA synthesis, and expression of antimicrobial peptides. Although alterations in epidermal function in the aged skin are known, whether the epidermal transcriptomic responses to barrier disruption differ between aged and young mice remains unknown. Here, we performed RNA sequencing of the epidermis in 2-month- vs. 20-month-old mice following barrier disruption with repeated tape-stripping. At baseline condition, the epidermis of 20-month-old mice displayed an upregulation of inflammation-associated genes and down-regulation of epidermal structure- and development-related genes in comparison to 2-month-old mice. Barrier disruption upregulated expression levels of 327 genes and downregulated 209 genes in 2-month-old mice. In 20-month-old mice, the numbers of upregulated and down-regulated genes were 537 and 299, respectively. In comparison to young mice, the prominently upregulated genes in the 20-month-old mice were associated with the IL-17 signalling pathway, while downregulated genes were mainly involved in the cytokine-cytokine receptor interaction pathway. These results indicate that inflammation-associated signalling pathways are upregulated, while epidermal structure- and development-related genes are downregulated in the epidermis of aged mice, with further aggravation following barrier disruption, suggesting the importance of improving epidermal function in the elderly.

Royal jelly regulates the proliferation of human dermal microvascular endothelial cells through the down-regulation of a photoaging-related microRNA

Although royal jelly is believed to prevent skin aging, the underlying mechanism is not known in detail. In the present study, we investigated the plausibility of the involvement of microRNAs in the manifestation of this effect of royal jelly. The expression of microRNAs was determined by PCR array analysis and real-time PCR and the number of cells was counted with a cell counter. Using PCR array, we identified four microRNAs that were downregulated by royal jelly in cultured human dermal microvascular endothelial cells (HDMEC). Upon comparison of the expression of the four microRNAs between young and senescent facial skin, miR-129-5p was found to be significantly upregulated in senescent skin. Consistently, the expression of miR-129-5p in HDMEC was significantly increased by UVB radiation, suggesting that this microRNA is related to photoaging. The royal jelly treatment increased the number of HDMEC. Furthermore, forced overexpression of miR-129-5p resulted in significant decrease in the number of HDMEC, and its forced downregulation increased the number of cells. The number and density of vessels is reported to be decreased in aged skin. Our results indicate that miR-129-5p is induced in damaged endothelial cells upon exposure to UV radiation, which decreases the cell number. Furthermore, administration of royal jelly downregulated the expression of miR-129-5p in endothelial cells, and might prevent skin aging by maintaining the number of cells. The present study elucidates the mechanism of vessel aging caused by UV exposure and the anti-aging effects of royal jelly through the involvement of microRNA.

Scarless wound healing: From development to senescence

An essential element of tissue homeostasis is the response to injuries, cutaneous wound healing being the most studied example. In the adults, wound healing aims at quickly restoring the barrier function of the skin, leading however to scar, a dysfunctional fibrotic tissue. On the other hand, in fetuses a scarless tissue regeneration takes place. During ageing, the wound healing capacity declines; however, in the absence of comorbidities a higher quality in tissue repair is observed. Senescent cells have been found to accumulate in chronic unhealed wounds, but more recent reports indicate that their transient presence may be beneficial for tissue repair. In this review data on skin wound healing and scarring are presented, covering the whole spectrum from early embryonic development to adulthood, and furthermore until ageing of the organism.

Actin cytoskeleton assembly regulates collagen production via TGF-β type II receptor in human skin fibroblasts

The dermal compartment of skin is primarily composed of collagen-rich extracellular matrix (ECM), which is produced by dermal fibroblasts. In Young skin, fibroblasts attach to the ECM through integrins. During ageing, fragmentation of the dermal ECM limits fibroblast attachment. This reduced attachment is associated with decreased collagen production, a major cause of skin thinning and fragility, in the elderly. Fibroblast attachment promotes assembly of the cellular actin cytoskeleton, which generates mechanical forces needed for structural support. The mechanism(s) linking reduced assembly of the actin cytoskeleton to decreased collagen production remains unclear. Here, we report that disassembly of the actin cytoskeleton results in impairment of TGF-β pathway, which controls collagen production, in dermal fibroblasts. Cytoskeleton disassembly rapidly down-regulates TGF-β type II receptor (TβRII) levels. This down-regulation leads to reduced activation of downstream effectors Smad2/Smad3 and CCN2, resulting in decreased collagen production. These responses are fully reversible; restoration of actin cytoskeleton assembly up-regulates TβRII, Smad2/Smad3, CCN2 and collagen expression. Finally, actin cytoskeleton-dependent reduction of TβRII is mediated by induction of microRNA 21, a potent inhibitor of TβRII protein expression. Our findings reveal a novel mechanism that links actin cytoskeleton assembly and collagen expression in dermal fibroblasts. This mechanism likely contributes to loss of TβRII and collagen production, which are observed in aged human skin.

Age-related reduction of dermal fibroblast size upregulates multiple matrix metalloproteinases as observed in aged human skin in vivo

BACKGROUND

Fragmentation of collagen fibrils, the major structure protein in skin, is a hallmark of dermal ageing. Matrix metalloproteinases (MMPs) are largely responsible for the fragmentation of collagen fibrils.

OBJECTIVES

To quantify gene expression of all 23 known mammalian MMPs in sun-protected young and aged human skin in vivo and to investigate the potential mechanism underlying age-related alteration of multiple MMPs.

METHODS

MMP mRNA expression levels and MMP activity in sun-protected young and aged human skin in vivo were determined by real-time reverse transcription polymerase chain reaction (RT-PCR) and in situ zymography, respectively. The relative contributions to elevated MMPs in epidermis and dermis were quantified by laser capture microdissection coupled real-time RT-PCR. Dermal fibroblast morphology and collagen fibril fragmentation in human skin in vivo were assessed by second-harmonic generation microscopy and atomic force microscopy, respectively. In vitro cell morphology was assessed by CellTracker® fluorescent dye (Molecular Probes, Eugene, OR, U.S.A.) and phalloidin staining. Protein levels were determined by ProteinSimple capillary electrophoresis immunoassay (ProteinSimple, Santa Clare, CA, U.S.A.).

RESULTS

Multiple MMPs are elevated in aged human skin dermis. Increased MMP activity and collagen fibril fragmentation were observed in aged skin dermis. As dermal fibroblasts are the major MMP-producing cells in the dermis, reduction of dermal fibroblast size, which is observed in aged human skin, contributes to the elevation of age-related multiple MMPs. Reduction of fibroblast size upregulates c-Jun/c-Fos and activates AP-1.

CONCLUSIONS

Combined actions of the wide variety of MMPs that are constitutively elevated in aged dermis may be involved in the progressive degradation of dermal collagen fibrils. Age-related elevations of multiple MMPs are likely to be a result of the reduction of fibroblast size via activation of AP-1.

Introduction to skin aging

Cutaneous science has seen considerable development in the last 25 years, in part due to the Omics revolution, and the appreciation that this organ is hardwired into the body's key neuro-immuno-endocrine axes. Moreover, there is greater appreciation of how stratification of skin disorders will permit more targeted and more effective treatments. Against this has been how the remarkable extension in the average human life-span, though in the West at least, this parallels worrying increases in lifestyle-associated conditions like diabetes, skin cancer etc. These demographic trends bring greater urgency to finding clinical solutions for numerous age-related deficits in skin function caused by extrinsic and intrinsic factors. Mechanisms for aging skin include the actions of reactive oxygen species (ROS), mtDNA mutations, and telomere shortening, as well as hormonal changes. We have also significantly improved our understanding of how to harness the skin's considerable regenerative capacity e.g., via its remarkable investment of stem cell subpopulations. In this way we hope to develop new strategies to selectively target the skin's capacity to undergo optimal wound repair and regeneration. Here, the unsung hero of the skin regenerative power may be the humble hair follicle, replete with its compliment of epithelial, mesenchymal, neural and other stem cells. This review introduces the topic of human skin aging, with a focus on how maintenance of function in this complex multi-cell type organ is key for retaining quality of life into old age.

Peripheral microcirculatory hemodynamic changes in patients with myocardial ischemia

BACKGROUND

Patients with coronary heart disease demonstrate changes in skin microcirculation and a decrease in cutaneous blood mass.

OBJECTIVE

The goal of this study was to assess the feasibility of diagnosing myocardial ischemia based on peripheral microcirculatory variables.

METHODS

The skin microcirculatory measurements were monitored using an LPT system comprising a Laser Doppler Flowmeter (LDF), a photoplethysmograph (PPG) and a transcutaneous oxygen tension device (tc-PO2). Concurrently, heart rate and blood pressure were monitored. Measurements were performed before and after exercise stress test. Subjects were divided into ischemic (20) and nonischemic (27) patients based on myocardial perfusion imaging (MPI).

RESULTS

The results indicate differences in LPT variables between ischemic and nonischemic patients following exercise, while no differences in the central variable values were observed between the two groups.

CONCLUSIONS

Peripheral microcirculatory variables may be useful for non-invasive assessment of myocardial ischemia. The system has clinical potential for sensitive and noninvasive monitoring of vital variables during medical procedures in clinics, as well as in home care for patients who suffer from ischemic cardiac diseases.

Age-related changes in angiogenesis in human dermis

Present research is aimed to examine the number of dermal blood vessels, vascular endothelial growth factor (VEGF), delta-like ligand 4(Dll4) and Jagged-1 (Jag-1) in dermal blood vessels of human from 20weeks of pregnancy to 85years old. Numbers and proliferative activity of dermal fibroblast-like cells were also examined. Blood vessels were viewed with immunohistochemical staining for von Willebrand factor or CD31. VEGF, Dll4, Jag-1, and proliferating cell nuclear antigen (PCNA) were detected immunohistochemically. Results showed that the numbers of fibroblast-like cells, PCNA positive fibroblast-like cells, von Willebrand factor positive or CD31 positive blood vessels in dermis are dramatically decreased with age. The intensity of immunohistochemical staining for VEGF or Jag-1 in blood vessels of dermis is increased from antenatal to deep old period. The degree of immunohistochemical staining of dermal blood vessels for Dll4 has gone up from 20-40weeks of pregnancy to early life period (0-20years), and further decreased below antenatal values. Age-related decrease in the number of dermal blood vessels is suggested to be due to an impairment of VEGF signaling and to be mediated by Dll4 and Jag-1. It may be supposed that diminishing in blood supply of dermis occurring with age is a cause of a decrease in the number and proliferative pool of dermal fibroblasts.

Sensitive skin: an overview

Sensitive skin is a condition of subjective cutaneous hyper-reactivity to environmental factors. Subjects experiencing this condition report exaggerated reactions when their skin is in contact with cosmetics, soaps and sun screens, and they often report worsening after exposure to dry and cold climate. Although no sign of irritation is commonly detected, itching, burning, stinging and a tight sensation are constantly present. Generally substances that are not commonly considered irritants are involved in this abnormal response.Sensitive skin and subjective irritation are widespread but still far from being completely defined and understood. A correlation between sensitive skin and constitutional anomalies and/or other triggering factors such as occupational skin diseases or chronic exposure to irritants has been hypothesized. Recent findings suggest that higher sensitivity can be due to different mechanisms. Hyper-reactors may have a thinner stratum corneum with a reduced corneocyte area causing a higher transcutaneous penetration of water-soluble chemicals. Alterations in vanilloid receptors and changes in neuronal transmission have been described. Monitoring skin parameters such as barrier function, proclivity to irritation, corneocyte size and sensorial transmission can also be useful to identify regional differences in skin sensitivity.

The role of estrogen deficiency in skin ageing and wound healing

The links between hormonal signalling and lifespan have been well documented in a range of model organisms. For example, in C. elegans or D. melanogaster, lifespan can be modulated by ablating germline cells, or manipulating reproductive history or pregnenolone signalling. In mammalian systems, however, hormonal contribution to longevity is less well understood. With increasing age human steroid hormone profiles change substantially, particularly following menopause in women. This article reviews recent links between steroid sex hormones and ageing, with special emphasis on the skin and wound repair. Estrogen, which substantially decreases with advancing age in both males and females, protects against multiple aspects of cellular ageing in rodent models, including oxidative damage, telomere shortening and cellular senescence. Estrogen's effects are particularly pronounced in the skin where cutaneous changes post-menopause are well documented, and can be partially reversed by classical Hormone Replacement Therapy (HRT). Our research shows that while chronological ageing has clear effects on skin wound healing, falling estrogen levels are the principle mediator of these effects. Thus, both HRT and topical estrogen replacement substantially accelerate healing in elderly humans, but are associated with unwanted deleterious effects, particularly cancer promotion. In fact, much current research effort is being invested in exploring the therapeutic potential of estrogen signalling manipulation to reverse age-associated pathology in peripheral tissues. In the case of the skin the differential targeting of estrogen receptors to promote healing in aged subjects is a real therapeutic possibility.

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.

Age-related changes in proliferation, the numbers of mast cells, eosinophils, and cd45-positive cells in human dermis

Skin aging is an extremely important medical and social problem in the modern world. Therefore, a goal of the present work was to estimate changes in the numbers of fibroblast-like cells, proliferating cells nuclear antigen-positive cells, CD45-positive cells, mast cells, and eosinophils in human dermis at different ages. Skin specimens from human fetuses that died antenatally from 20 to 40 weeks of pregnancy and humans who died from different causes from 1 day to 85 years of life were used for the study. Results showed a decrease in a total number and the number of proliferating cells nuclear antigen-positive fibroblast-like cells in dermis with progression of age. The numbers of CD45-positive cells and mast cells are gradually increased with aging. Eosinophils are almost absent in dermis independently on age. Mast cells are probably a main factor that potentially can be involved in tissue damage and aging changes in skin. Mast cells should be regarded as an important target for anti-aging therapy.

Laser ablation of unwanted hand veins

BACKGROUND

Many patients express dissatisfaction with prominent and bulging hand veins. Abolishing these veins with sclerotherapy requires higher concentrations of sclerosing agents than are used for leg veins and often results in a tender, phlebitic cord. Phlebectomy is another treatment option. Endovenous occlusion and shrinkage techniques have been used successfully to treat varicose veins of the lower extremities. The authors demonstrate a new and unique endovenous laser technique to abolish unwanted hand veins.

METHODS

Fifty-four hands (28 patients) with prominent hand veins were treated using a 600-microm laser fiber. The Dornier MedTech 940-nm diode laser system was used. The laser fiber was introduced through a 4-French sheath, which tracked as a coaxial system over an 0.018-inch guidewire. Initial entry into the treated vein was accomplished with a 20-gauge angiocatheter percutaneously. On average, four veins were treated in each hand. Tumescent anesthesia was infiltrated around the laser fiber/sheath unit before activating the laser, and all procedures were performed in an office setting. A compressive dressing was used postoperatively.

RESULTS

All but one of the unwanted hand veins were cannulated successfully. The uncannulated vein was treated with sclerotherapy and eventually required phlebectomy. Hand swelling occurred in all treated hands and lasted 2 weeks or less. There was one skin burn of approximately 3 mm at a laser exit site. All 28 patients were satisfied with their results during follow-up, which ranged from 2 weeks to 31 months.

CONCLUSIONS

This is the first report of endovenous treatment of unwanted hand veins. Laser ablation of unwanted hand veins can be performed in an office setting. These cosmetically conscious patients were satisfied with their results.

Skin ageing and its treatment

The effects of chronic sun exposure on skin are readily apparent when skin not typically exposed to the sun and skin regularly exposed to the sun are compared. While the sun is not the only aetiological factor in the dynamic process of skin ageing, it is the primary exogenous cause among several internal and environmental elements. Thus, photo-ageing, the main focus of this article, is a subset of extrinsic skin ageing. The influence of the sun in extrinsic skin ageing, as well as its role in potentially altering the normal course of intrinsic (also known as natural or cellular) ageing, is discussed. Telomeres, the specialized structures found at the ends of chromosomes, are believed to be integral to cellular ageing as well as in the development of cancer. The ageing process, both intrinsic and extrinsic, is also believed to be influenced by the formation of free radicals, also known as reactive oxygen species. The loss of collagen is considered the characteristic histological finding in aged skin. Wrinkling and pigmentary changes are directly associated with photo-ageing and are considered its most salient cutaneous manifestations. Such photodamage represents the cutaneous signs of premature ageing. In addition, deleterious consequences of chronic sun exposure, specifically various forms of photo-induced skin cancer, are also linked to acute and chronic sun exposure. The only known strategies aimed at preventing photo-ageing include sun avoidance, using sunscreens to block or reduce skin exposure to UV radiation, using retinoids to inhibit collagenase synthesis and to promote collagen production, and using anti-oxidants, particularly in combination, to reduce and neutralize free radicals.

Angiogenesis in skin aging and photoaging

Angiogenesis, the process of generating new blood vessels, is affected by various physiological and pathological conditions of skin. The skin aging process can be divided into intrinsic aging and photoaging. With aging, cutaneous blood vessels undergo pronounced alterations. A reduction of the cutaneous microvasculature has been observed in the skin of elderly individuals. Human skin is exposed daily to solar ultraviolet (UV) radiation, infrared rays and heat, and these stimuli are known to induce skin angiogenesis. Interestingly, although acute UV irradiation stimulates skin angiogenesis, cutaneous blood vessels are decreased in chronically photodamaged skin. The reason for the differential effects of acute and chronic UV exposure on skin angiogenesis remains to be elucidated. This review discusses the vascularization changes in intrinsically aged and photoaged human skin, the effects of UV irradiation, infrared rays and heat on skin angiogenesis, and the effects of topical retinoic acid treatment on UV-induced angiogenesis and cutaneous vascularity in aged and photoaged human skin. An understanding of the molecular mechanisms of aging- and photoaging-dependent changes of skin angiogenesis may provide us with new insights to prevent and treat the skin aging process.

Different inflammatory mediators induce inflammation and pain after application of liquid nitrogen to the skin

The application of liquid nitrogen to the skin induces inflammation and pain. However, there is little data on the role of inflammatory mediators in the production of these symptoms. We have developed an experimental model to study some aspects of the inflammatory response and its mediators following the application of cold. We have applied liquid nitrogen jets to subcutaneous air pouches in the dorsal skin of rats to study the kinetics of the migration of inflammatory cells; also to the ear for histopathological analysis and on the paws for edema and pain. Inflammatory mediators were identified by pharmacological means. The results showed that the cellular inflammatory response was characterized by persistent cell migration, mainly of granulocytes. Histopathology of the ears confirmed these findings. Histamine and sympathomimetic mediators were mainly responsible for the resultant swelling. However, the hypernociception that resulted involved other mediators including IL-1 and eicosanoids. These data suggest that interference with the release of inflammatory mediators might reduce the side effects of cryosurgery and prevent hyperalgesia and inflammation at the site of application of cold.

Reference Limits for Erythema-effective UV Doses

Diagnostic phototesting, including the determination of the minimal erythema dose (MED), is a useful procedure to detect abnormal sensitivity to UV radiation. We aimed to estimate the reference limits (RLs) of the MED in a reasonably large reference sample of white individuals. Skin phototypes and MED values for broadband UVB and for UVA were determined in 461 white subjects. When appropriate, the 95% reference intervals, including the 0.025 fractile and 0.975 fractile, were computed for the MED-UVB reference values (by means of parametric methods) and the MED-UVA reference values (by means of nonparametric methods). MED data were also converted to standard erythema doses (SEDs). As described elsewhere we observed a considerable overlap of MED values for all skin phototypes and confirmed that age and sex do not substantially influence the MED. The lower RLs observed for MED-UVB were 33 mJ cm(-2) (0.5 SEDs) and for MED-UVA 12.6 mJ cm(-2) (1.2 SEDs). The MED and SED findings from this investigation may serve as reference data for white individuals and give support to the clinician in differentiating between normal and pathologically abnormal photosensitivity. Although the MED data given here are limited to the phototest device used in the present study, the SED results establish comparability between our data and phototest results obtained from laboratories using different UV sources.

Changes in responses of UVB irradiated skin of brownish guinea pigs with aging

It is known that skin often shows irregular pigmentation during aging, which is frequently associated with hyperpigmentation. Many studies have utilized brownish A1 guinea pigs to investigate the pathogenesis of ultraviolet B (UVB)-induced skin pigmentation, however, responses associated with aging following UVB irradiation have not been elucidated. To characterize those responses, dorsal skin of A1 guinea pigs from 14-weeks to 5-yr old were investigated. The minimal erythema dose was found to increase with aging. Further, in pigmentation induced by UVB radiation, skin brightness (DeltaL*-value) decreased equally in both the 14-week old (young) group and in the 3-yr old (old) group of guinea pigs. The DeltaL*-value recovered in the young group from 21 d after UVB irradiation, whereas no such recovery was seen in the old group. In addition, the amount of melanin and the number of melanocytes returned near pre-irradiation levels in the young group, while they remained high in the old group. Our results therefore demonstrate for the first time that skin responses following UVB irradiation change with aging in A1 guinea pigs.

Ultraviolet and laser radiation safety

Both ultraviolet radiation and laser radiation occupy pmt of the Spectrum designated "optical radiation". Thus, measurement techniques are similar and the same organs (eyes and skin) are at risk from accidental exposure. However, the equipment used to produce ultraviolet and laser radiation differs substantially and the harm caused by each type of radiation is also different. Another significant difference arises from the fact that ultraviolet radiation is natural with associated general population exposure. Consequently, the present article reviews the current status of both ultraviolet and laser radiation with the material divided into two sections where each hazard is considered separately.

Investigation of photosensitive disorders

Investigation of photodermatosis is based primarily on the history and clinical findings, histological, immunological and biochemical findings are variably helpful depending on the clinical picture. Formal testing for photosensitivity may be the only definitive test proving photosensitivity on occasion. This article delineates the important features which allow classification of patients which then enables appropriate treatment.

Replicative senescence enhances apoptosis induced by pemphigus autoimmune antibodies in human keratinocytes

We have recently shown that skin lesions of the autoimmune disease pemphigus vulgaris are associated with Fas-mediated apoptosis. Here, we describe the induction of the Fas-dependent apoptosis pathway in cultured keratinocytes by pemphigus vulgaris autoantibodies (PV-IgG), as seen from a variety of cellular, morphological and biochemical parameters. All apoptotic characters appear stronger and faster in aged cultures than in young, showing increased susceptibility of senescent keratinocytes to PV-IgG-mediated apoptotic death and culture lesions. Together with immunosenescence, this phenomenon may explain the late onset of pemphigus disease.

The effects of age-related skin changes on wound healing rates

The evidence that wound healing is adversely affected by age-related changes is inconclusive. Some studies report that ageing skin loses its ability to regenerate, whereas others have found that ageing processes can have beneficial effects.

The ageing of the blood supply and the lymphatic drainage of the skin

The anatomy and functions of the blood and lymph vessels of human skin are described. Variation in these due to site, ageing and events during life consequent to exposure to a threatening environment are emphasised. Gradual atrophy and greater heterogeneity are features of ageing. Responses to injury and repair are complex and the interaction of mechanical signals distorting skin cells with numerous chemical signals are referred to. The lymphatics are part of an immunosurveillance system to monitor skin barrier penetration. The review attempts to draw attention to key recent advances in our understanding of the cytokine and growth factor production of the skin in the context of previous mainly physiological reviews especially influenced by 50 years of clinical practice as a dermatologist with an eye on both the skin and the fields of microcirculation and lymphology.

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.

Photoaging in Asians

The aging process of the skin can be divided into intrinsic and photoaging. Clinically, naturally aged skin is smooth, pale and finely wrinkled. In contrast, photoaged skin is coarsely wrinkled and associated with dyspigmentation and telangiectasia. Although the population of Asia is more than half the population of the Earth, no well-designed study has been undertaken to investigate the characteristics of cutaneous photodamage in Asian skin. As Asian skin is more pigmented, the acute and chronic cutaneous responses to UV irradiation seen in brown skin differ from those in white skin. The clinical characteristics of photoaging in Asian skin, such as pigmentary changes and wrinkle patterns, differ from those of Caucasian skin. This review provides an outline of the characteristic features of photoaging on the brown skin of Asians.

Effects of UV irradiation on the sebaceous gland and sebum secretion in hamsters

BACKGROUND

Although an understanding of the photobiology of the skin has been extensively advanced recently, the effect of ultraviolet (UV) radiation on sebaceous glands is not well known.

OBJECTIVE

In this study, we examined the direct effect of UV radiation on cultured sebocytes from hamsters in vitro experimental system. Moreover, we examined whether UV-induced peroxidation of skin surface lipids may affect barrier function of horney layer.

METHODS

We irradiated cultured sebocytes from hamsters, which have similar biological characteristics to the human sebocytes, with UV radiation. Moreover, transepidermal water loss (TEWL) was examined after topical application of cholesterol or triglyceride (TG) and UV exposures on the back of hamsters.

RESULTS

The number of sebocytes were increased significantly (120-140%) after 4 days as compared with the non-irradiated controls. Lipid production in sebocytes was also increased on day 7 in an irradiation-dependent manner up to 4.1 times of the pre-irradiated level. When UVB was irradiated to TG- or cholesterol-applied skin at the minimum ear-swelling dose, TEWL increased twice or more as compared with UVB irradiation to unapplied sites. When in vitro-irradiated TG, in vitro-irradiated cholesterol, TG-peroxide (TG-OOH), and cholesterol-peroxide (CHO-OOH) were applied to the skin, TEWL increased significantly.

CONCLUSION

These results suggest that UVB may directly activate the functions of the sebaceous gland in vivo to produce increased amounts of sebum, which may undergo peroxidation by UV light and damage the barrier functions of the skin.

Delayed distribution of active vasodilation and altered vascular conductance in aged skin

Reflex vasodilation is attenuated in aged skin during hyperthermia. We used laser-Doppler imaging (LDI) to test the hypothesis that the magnitude of conductance and the spatial distribution of vasodilation are altered with aging. LDI of forearm skin was compared in 12 young (19- to 29-yr-old) and 12 older (64- to 75-yr-old) men during supine passive heating. Additionally, iontophoresis of bretylium tosylate was performed in a subset of subjects to explore the involvement of sympathetic vasoconstriction in limiting skin blood flow. Passive heating with water-perfused suits clamped mean skin temperature at 41.0 +/- 0.5 degrees C, causing a ramp increase in esophageal temperature (T(es)) to </=38.5 degrees C. LDI scans were performed at baseline and at every 0.2 degrees C increase in T(es). LDI at bretylium and control sites was identical, suggesting no influence of noradrenergic vasoconstriction. Forearm vascular conductance (venous occlusion plethysmography) was reduced in the older men (P </= 0.001) at every elevated T(es). Mean cutaneous vascular conductance (CVC) of the scanned area was reduced in the older men at 0.2 degrees C </= DeltaT(es) </= 0.8 degrees C. Early in heating (0.2 degrees C </= DeltaT(es) </= 0.6 degrees C), older men also responded with a reduced vasodilated area (P </= 0.05), implying a slower recruitment or filling of skin microvessels. The results indicate that the area of vasodilation and CVC within the vasodilated area are reduced in aged skin during early passive heating, but only CVC is reduced at DeltaT(es) = 0.8 degrees C.

Fifty years of skin aging

In developed countries, interest in cutaneous aging is in large part the result of a progressive, dramatic rise over the past century in the absolute number and the proportion of the population who are elderly (Smith et al, 2001). The psychosocial as well as physiologic effects of skin aging on older individuals have created a demand for better understanding of the process and particularly for effective interventions. Skin aging is a complex process determined by the genetic endowment of the individual as well as by environmental factors. The appearance of old skin and the clinical consequences of skin aging have been well known for centuries, but only in the past 50 y have mechanisms and mediators been systematically pursued. Still, within this relatively short time there has been tremendous progress, a progress greatly enhanced by basic gerontologic research employing immunologic, biochemical, and particularly molecular biologic approaches (Figs 1, 2).

The IL1A genotype associates with atopy in nonasthmatic adults

BACKGROUND

The skin prick test is used to examine specific IgE-mediated allergic responses. Generally, results accord well with anamnestic information on atopy. Several genetic factors probably affect the strength of allergen-mediated skin test reactions.

OBJECTIVE

We sought to investigate skin test findings in a population-based sample of adult asthmatic patients and control subjects and to establish whether the IL1A genotype affects allergy testing.

METHODS

We analyzed the single G-to-T base exchange polymorphism in exon 5 at +4845 of the gene encoding IL-1alpha (IL1A) in adult asthmatic patients (n = 245) and nonasthmatic control subjects (n = 405). The data were assessed for correlation with data on the skin test responses of these subjects to 22 common allergens.

RESULTS

The IL1A genotype distribution and allele frequencies proved similar in patients and control subjects. Surprisingly, the IL1A genotype distribution was markedly different in control subjects with positive (ie, >/=1 positive reaction) and negative skin test responses (P =.006). This difference was caused by an increase in the frequency of the rarer allele 2 in control subjects with negative skin test responses (P =.004).

CONCLUSION

Our study demonstrates that the IL1 gene complex is involved in the regulation of IgE-mediated atopic reactions. The results suggest that skin test responses to specific allergens are differently regulated in nonasthmatic and asthmatic subjects. Because of the potential role of the IL1A genotype as a confounding factor in skin prick testing, these results require special attention and should be further evaluated in other clinical settings.

Age dependence of ultraviolet light-induced erythema following narrow-band UVB exposure

BACKGROUND/PURPOSE

A report in the literature suggests longer duration and greater intensity of late phase UVB erythema in older people. The aim of this study was to identify differences in minimum erythema dose (MED) and intensity of UV-induced erythema after narrow band UVB exposure between older and younger individuals in the late phase of UVB erythema.

METHODS

Using the UVA/TL 01 UV skin tester (Waldmann Medizintechnik, Villingen-Schwenningen, Germany), MED was determined for narrow-band UVB exposure in 20 young subjects aging from 20-40, and 20 elderly subjects over 70 years of age. The intensity of UV-induced erythema was measured by chromametry (a*-value and L-value) and laser Doppler 48 h after irradiation. Minimum erythema dose (MED) was additionally assessed visually.

RESULTS

Elderly subjects showed no statistical different MED compared to younger subjects. However, the erythema intensity 48 h after narrow-band UVB exposure was significantly greater in the elderly.

CONCLUSIONS

Narrow-band UVB therapy may, in case of over dosage, produce more intense erythema in the late phase of UVB erythema in old people than in younger individuals.

Ultraviolet B radiation induces a transient appearance of IL-4+ neutrophils, which support the development of Th2 responses

UVB irradiation can cause considerable changes in the composition of cells in the skin and in cutaneous cytokine levels. We found that a single exposure of normal human skin to UVB induced an infiltration of numerous IL-4(+) cells. This recruitment was detectable in the papillary dermis already 5 h after irradiation, reaching a peak at 24 h and declining gradually thereafter. The IL-4(+) cells appeared in the epidermis at 24 h postradiation and reached a plateau at days 2 and 3. The number of IL-4(+) cells was markedly decreased in both dermis and epidermis at day 4, and at later time points, the IL-4 expression was absent. The IL-4(+) cells did not coexpress CD3 (T cells), tryptase (mast cells), CD56 (NK cells), and CD36 (macrophages). They did coexpress CD15 and CD11b, showed a clear association with elastase, and had a multilobed nucleus, indicating that UVB-induced infiltrating IL-4(+) cells are neutrophils. Blister fluid from irradiated skin, but not from control skin, contained IL-4 protein as well as increased levels of IL-6, IL-8, and TNF-alpha. In contrast to control cultures derived from nonirradiated skin, a predominant type 2 T cell response was detected in T cells present in primary dermal cell cultures derived from UVB-exposed skin. This type 2 shift was abolished when CD15(+) cells (i.e., neutrophils) were depleted from the dermal cell suspension before culturing, suggesting that neutrophils favor type 2 T cell responses in UVB-exposed skin.

Age-related changes in wound healing

Evidence for age-related effects on wound healing have been derived for the most part from empirical observations without adjustment for confounders other than age. Age-related changes in the structure and function of the skin do occur. Some of these changes result from chronic solar radiation exposure rather than chronological age per se. The tensile strength of wounds, accumulation of wound healing factors and rate of wound closure have all been examined in relation to chronological aging. However, the clinical impact of these changes in acute wound healing appears to be small. Poor healing in chronic wounds is more often related to comorbid conditions rather than age alone. Since the majority of these chronic wounds occur in elderly populations, this has contributed to the conclusion that aging itself may influence healing. Progress in understanding the role that growth factors play in wound healing and the ability to synthesise adequate quantities of these factors for clinical use has led to clinical trials evaluating their use in wound healing. The results of these studies, with the possible exception of those in diabetic wounds, have been disappointing. Insight into the wound healing process indicates that growth factors interact during wound healing in a sequential and orderly process. Improved wound healing may require different clinical designs or the use of these factors in a precisely timed sequential administration.

The aged epidermal permeability barrier: basis for functional abnormalities

Aged epidermis develops an abnormality in permeability barrier homeostasis, which is accentuated further in photoaged skin. The biochemical basis is a global reduction in stratum corneum lipids and profound abnormality in cholesterol synthesis. Various cytokine/growth factor signaling pathways are abnormal in aged skin, particularly in the interleukin-1 family. Barrier repair therapy can be effective in restoring normal function if a cholesterol-dominant mixture of the three key physiologic lipids, including ceramides and free fatty acids, is emphasized.

Skin temperature measurements during intense pulsed light emission

BACKGROUND

Although lasers and intense pulsed light sources have improved the capability of injuring veins without affecting the overlying skin, work is needed to improve the procedure.

OBJECTIVE

To create a method for predicting skin reaction to pulsed light.

METHODS

Twenty patients were divided into four groups according to skin type (I-IV). An industrial thermometer equipped with a laser-aiming system was adapted to the intense pulsed light source handpiece. Patients received shots of increasing intensity while the skin temperature was measured.

RESULTS

Fluence and temperature data were analyzed by logistic regression to evaluate possible injury. The stepwise method selected skin type and temperature variation as predictors of skin injury. Logistic curves indicated the maximum temperature variation tolerable for each skin type. More pigmented skin types tolerated less temperature increase.

CONCLUSION

Skin type can predict cutaneous reaction to intense pulsed light through measurements of temperature variation. This method may help achieve successful selective photothermolysis.

Effect of daily versus intermittent sunscreen application on solar simulated UV radiation-induced skin response in humans

BACKGROUND

Acute and chronic skin damage occurs as a consequence of solar UV radiation exposure. To diminish such skin damage, the dermatologic community advocates the daily use of sunscreens as part of a sun avoidance strategy.

OBJECTIVE

We determined the effectiveness of a sunscreen product with a sunscreen protection factor (SPF) of 15 applied daily in preventing UV-induced histologic damage in human skin compared with the protection afforded by sunscreens with equal or higher SPF applied intermittently.

METHODS

Twenty-four subjects were exposed to 2 minimal erythema doses of solar-simulated UV on 4 consecutive days. Three sunscreen products were applied to the buttock of each subject. One SPF 15 product was applied daily before exposure to UV and, to simulate intermittent product use, an SPF 15 or SPF 29 product was applied on 3 of 4 days, with one missed application on days 2, 3, or 4. Skin biopsy specimens were taken and processed for routine and immunohistochemical staining. Changes in number of sunburn cells and Langerhans cells as well as degree of inflammatory infiltrate and lysozyme immunostaining were determined.

RESULTS

There was a statistically significant increase in the number of sunburn cells, degree of inflammation, and intensity of lysozyme staining, and there was a decrease in the number of Langerhans cells at sites where sunscreen application was missed as compared with unirradiated control and daily SPF 15 sunscreen-treated sites.

CONCLUSION

Our data suggest that daily use of a sunscreen reduces the skin damage produced by UV exposure compared with intermittent use of equal or higher SPF products. The daily application of sunscreens in appropriate quantities reduces the harmful effects of solar UV radiation on skin. Compliance is essential for maximal benefit of sunscreens.