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Shahin TB, Sreekantaswamy SA, Hawkes JE, Butler DC. Treatment Strategies for Chronic Pruritus and Eczema/Dermatitis in Older Adults Under the Category of Chronic Eczematous Eruptions of Aging (CEEA). Am J Clin Dermatol 2023; 24:405-418. [PMID: 36920748 DOI: 10.1007/s40257-023-00767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
Chronic eczematous eruptions of aging (CEEA) refers to a heterogenous group of longstanding, pruritic eczematous dermatoses with an unidentified etiology, or those which do not meet strict disease criteria. The literature has not yet established a single ubiquitous disease or term for these eruptions in adults over the age of 65 years. Instead, CEEA is attributed various names, including immunologic eruption of aging, and eruption of immunosenescence. Atopic dermatitis in the elderly, eczema in the elderly, and late- or adult-onset atopic dermatitis or eczema likely also fall under the umbrella of CEEA, given that older patients often do not meet strict criteria for atopic dermatitis. As a reflection of such terminological heterogeneity, CEEA does not have a standardized workup algorithm. This lack of uniformity can obscure the ability to study and understand appropriate treatments for this condition. Yet, as providers become increasingly aware of CEEA and more comfortable in making this diagnosis in older adults, it is necessary that dermatologists understand the safety and efficacy of common CEEA treatments in this population. Here, we discuss special considerations, challenges, and recommendations for treating older adults with CEEA with topical and systemic therapeutics. We provide an overview of therapeutic strategies and potential barriers to treatment and discuss the essential role of shared decision making when caring for this patient population.
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Affiliation(s)
- Tala B Shahin
- University of Arizona, College of Medicine, 1501 N Campbell Ave, Tuscon, AZ, 85724, USA
| | - Shreya A Sreekantaswamy
- University of Arizona, College of Medicine, 1501 N Campbell Ave, Tuscon, AZ, 85724, USA.,University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Jason E Hawkes
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Daniel C Butler
- University of Arizona, College of Medicine, 1501 N Campbell Ave, Tuscon, AZ, 85724, USA.
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Liu H, Wang J, Hu J, Wang L, Guo Z, Fan W, Xu Y, Liu D, Zhang Y, Xie M, Tang J, Huang W, Zhang Q, Zhou Z, Hou S. Genome-wide association analysis reveal the genetic reasons affect melanin spot accumulation in beak skin of ducks. BMC Genomics 2022; 23:236. [PMID: 35346029 PMCID: PMC8962612 DOI: 10.1186/s12864-022-08444-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/25/2022] [Indexed: 12/18/2022] Open
Abstract
Abstract
Background
Skin pigmentation is a broadly appearing phenomenon of most animals and humans in nature. Here we used a bird model to investigate why melanin spot deposits on the skin.
Results
Our result showed that growth age and the sunlight might induce melanin deposition in bird beak skin which was determined by genetic factors. GWAS helped us to identify two major loci affecting melanin deposition, located on chromosomes 13 and 25, respectively. The fine mapping works narrowed the candidate regions to 0.98 Mb and 1.0 Mb on chromosomes 13 and 25. The MITF and POU2F3 may be the causative genes and synergistically affect melanin deposition during duck beak skin. Furthermore, our data strongly demonstrated that the pathway of melanin metabolism contributes to melanin deposition on the skin.
Conclusions
We demonstrated that age and sunlight induce melanin deposition in bird beak skin, while heredity is fundamental. The MITF and POU2F3 likely played a synergistic effect on the regulation of melanin synthesis, and their mutations contribute to phenotypic differences in beak melanin deposition among individuals. It is pointed out that melanin deposition in the skin is related to the pathway of melanin metabolism, which provided insights into the molecular regulatory mechanisms and the genetic improvement of the melanin deposition in duck beak.
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Worrede A, Douglass SM, Weeraratna AT. The dark side of daylight: photoaging and the tumor microenvironment in melanoma progression. J Clin Invest 2021; 131:143763. [PMID: 33720046 DOI: 10.1172/jci143763] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Continued thinning of the atmospheric ozone, which protects the earth from damaging ultraviolet radiation (UVR), will result in elevated levels of UVR reaching the earth's surface, leading to a drastic increase in the incidence of skin cancer. In addition to promoting carcinogenesis in skin cells, UVR is a potent extrinsic driver of age-related changes in the skin known as "photoaging." We are in the preliminary stages of understanding of the role of intrinsic aging in melanoma, and the tumor-permissive effects of photoaging on the skin microenvironment remain largely unexplored. In this Review, we provide an overview of the impact of UVR on the skin microenvironment, addressing changes that converge or diverge with those observed in intrinsic aging. Intrinsic and extrinsic aging promote phenotypic changes to skin cell populations that alter fundamental processes such as melanogenesis, extracellular matrix deposition, inflammation, and immune response. Given the relevance of these processes in cancer, we discuss how photoaging might render the skin microenvironment permissive to melanoma progression.
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Affiliation(s)
- Asurayya Worrede
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephen M Douglass
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ashani T Weeraratna
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Sidney Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Di Lernia V, Goldust M. An overview of the efficacy and safety of systemic treatments for psoriasis in the elderly. Expert Opin Biol Ther 2018; 18:897-903. [DOI: 10.1080/14712598.2018.1504016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Mohamad Goldust
- Department of Dermatology, Mazandaran University of Medical Sciences, Sari, Iran
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Sheu SL, Wang KC. Pruritus and Dermatitis in the Elderly. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0189-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Taleban S, Elquza E, Gower-Rousseau C, Peyrin-Biroulet L. Cancer and inflammatory bowel disease in the elderly. Dig Liver Dis 2016; 48:1105-11. [PMID: 27289334 DOI: 10.1016/j.dld.2016.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/11/2022]
Abstract
Cancer may be a complication of inflammatory bowel disease (IBD) or its treatments. In older Crohn's disease and ulcerative colitis patients, the risk of malignancy is of particular concern. IBD diagnosis at an advanced age is associated with earlier development of colitis-associated colorectal cancer. Thiopurine use in older IBD patients is tied to an increased risk of non-Hodgkin's lymphoma, nonmelanoma skin cancer, and urinary tract cancers. Additionally, older age is accompanied by multimorbidity, an increased risk of malnutrition, and decreased life expectancy, factors that complicate the management of cancer in the elderly. The optimal approach to the increased risk of malignancy in older age IBD is appropriate cancer screening and medical treatment. This may include age-specific colorectal cancer screening and limiting UV radiation exposure. With a growing number of older IBD patients, further studies are necessary to delineate the risk of cancer in this population.
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Affiliation(s)
- Sasha Taleban
- Division of Gastroenterology, University of Arizona College of Medicine, Tucson, AZ, United States; University of Arizona Center of Aging, Department of Medicine, Tucson, AZ, United States.
| | - Emad Elquza
- Hematology/Oncology, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Health Economics, EPIMAD Registery, Regional House of Clinical Research, Regional University Hospital, Lille Cedex, France; Lille Inflammation Research International Center, LIRIC-UMR 995 Inserm, Lille University 2, Lille University Hospital, Lille University, France
| | - Laurent Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Lorraine University, Vandœuvre-lès-Nancy, France
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Powell JB, Gach JE. Phototherapy in the elderly. Clin Exp Dermatol 2015; 40:605-10. [PMID: 25809797 DOI: 10.1111/ced.12626] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- J. B. Powell
- Department of Dermatology; Worcestershire Royal Hospital; Worcester UK
| | - J. E. Gach
- Department of Dermatology; University Hospitals Coventry and Warwickshire; Coventry West Midlands UK
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Abstract
With worldwide expansion of the aging population, research on age-related pathologies is receiving growing interest. In this review, we discuss current knowledge regarding the decline of skin structure and function induced by the passage of time (chronological aging) and chronic exposure to solar UV irradiation (photoaging). Nearly every aspect of skin biology is affected by aging. The self-renewing capability of the epidermis, which provides vital barrier function, is diminished with age. Vital thermoregulation function of eccrine sweat glands is also altered with age. The dermal collagenous extracellular matrix, which comprises the bulk of skin and confers strength and resiliency, undergoes gradual fragmentation, which deleteriously impacts skin mechanical properties and dermal cell functions. Aging also affects wound repair, pigmentation, innervation, immunity, vasculature, and subcutaneous fat homeostasis. Altogether, age-related alterations of skin lead to age-related skin fragility and diseases.
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Abstract
Chronic actinic dermatitis is a condition involving abnormal cutaneous photosensitivity to UV and, often, visible wavelengths. It is rare, but more common in the elderly than in younger populations, with an estimated prevalence of one in 2000 in the > or = 75-year-old population in Tayside, Dundee, Scotland. It usually presents as a dermatitis that maximally, but not exclusively, affects photo-exposed skin. Investigation to confirm the diagnosis and guide management includes phototesting and patch testing. The mainstay of treatment is education about the condition and advice on sunlight and allergen avoidance. Topical corticosteroids and emollients are always required, at least intermittently, and it is sometimes necessary to resort to systemic immunosuppression, usually with corticosteroids or azathioprine.
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Affiliation(s)
- Robert S Dawe
- Photobiology Unit, Department of Dermatology, Ninewells Hospital and Medical School, Dundee, Scotland.
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Abstract
Allergic skin disorders in the elderly may arise from contact with or ingestion of offending allergens. Itching associated with skin allergy must be distinguished from other causes of itching in the elderly such as xerosis, itching due to systemic disease and bullous disease. Although elderly people have somewhat decreased cell-mediated immunity and may be harder to sensitise under experimental conditions, they have had many years to acquire allergic responses, and therefore develop contact dermatitis frequently. Patch testing is a valuable tool to diagnose contact allergy and should be used often in the elderly, particularly in patients at high risk of contact dermatitis, such as those with chronic lower extremity dermatitis or ulcers due to venous stasis. When prescribing topical medications to high risk patients, a knowledge of the common sensitisers is important. In addition to allergy to medicaments and dressings used to treat stasis ulcers, contact allergy to dental prostheses and medications used to treat ocular disease are common in the elderly as a result of increased usage and exposure. Rash caused by ingested allergens is much more commonly due to medications than to food in the elderly. Allergic noneczematous dermatoses in the elderly are commonly drug-induced. Urticarial skin reactions are often associated with the administration of antibacterials, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants or opioids. Morbilliform rashes are a common sign of systemic reaction to anticonvulsants, gold, allopurinol or diuretics. Phototoxic reactions may be associated with the administration of tetracyclines, diuretics, NSAIDs and antihyperglycaemic agents. Patient-specific variables such as HLA type and concomitant medication may affect the likelihood of an allergic response to medication. Many elderly patients take multiple medications, which can make diagnosis of drug allergy difficult because diagnosis is most commonly accomplished by observing clinical response once the medication is withdrawn. In the case of lichenoid cutaneous reactions, clinical improvement may take several months after withdrawal of the offending drug. Laboratory tests to detect drug-induced allergic skin disorders may be available in the future.
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Affiliation(s)
- S T Nedorost
- Department of Dermatology, Case Western Reserve University and University Hospitals of Cleveland, Ohio, USA
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McCoy JM, Hudson J. EXCEPTIONAL AND ACQUIRED WOUND-HEALING COMPLICATIONS. Oral Maxillofac Surg Clin North Am 1996. [DOI: 10.1016/s1042-3699(20)30923-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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