Age-associated changes in the skin

Modulating embryonic signaling pathways paves the way for regeneration in wound healing

Epithelial tissues, including the skin, are highly proliferative tissues with the capability to constant renewal and regeneration, a feature that is essential for survival as the skin forms a protective barrier against external insults and water loss. In adult mammalian skin, every injury will lead to a scar. The scar tissue that is produced to seal the wound efficiently is usually rigid and lacks elasticity and the skin's original resilience to external impacts, but also secondary appendages such as hair follicles and sebaceous glands. While it was long thought that hair follicles develop solely during embryogenesis, it is becoming increasingly clear that hair follicles can also regenerate within a wound. The ability of the skin to induce hair neogenesis following injury however declines with age. As fetal and neonatal skin have the remarkable capacity to heal without scarring, the recapitulation of a neonatal state has been a primary target of recent regenerative research. In this review we highlight how modulating dermal signaling or the abundance of specific fibroblast subsets could be utilized to induce de novo hair follicles within the wound bed, and thus to shift wound repair with a scar to scarless regeneration.

Effects of Milk Amazake on Skin Elasticity, Hydration, and Transepidermal Water Loss: An 8-Week Double-Blind, Randomized, Controlled Trial

Amazakes made from rice and koji mold are rich in nutrients, such as groups of vitamin B, minerals, essential amino acids, and oligosaccharides, and can improve skin moisturization. However, there are few reports on milk amazake, made from milk and koji mold. Therefore, in this double-blind, randomized controlled trial, we investigate the effect of milk amazake on skin function. Healthy women and men (n = 40) were randomly allocated to the milk amazake or placebo group. The test beverage was consumed once daily for 8 weeks. Skin elasticity, hydration, and transepidermal water loss (TEWL) were measured at baseline and at weeks 4 and 8, and all subjects completed the trial. Skin elasticity (R2 and R5) at 8 weeks was significantly increased in the milk amazake group compared with baseline. In addition, changes in R5 in the milk amazake group were significantly higher than those in the placebo group. Conversely, TEWL, an evaluation item of skin moisturizing function at 8 weeks, was significantly decreased in the active group compared with baseline. In conclusion, milk amazake may be useful as a functional food for improving skin function.

The CSIESA: A Novel Score for the Assessment of Intrinsic and Extrinsic Skin Aging Based on Reflectance Confocal Microscopy Imaging

Skin aging is an intricate physiological process governed by intrinsic and extrinsic factors. Increasing life expectancy has turned skin aging into a growing concern for the general population. Clinical examination of the skin does not fully describe the skin aging process. This study aims to evaluate the healthy skin of five different age groups in order to develop an easy-to-use confocal score for quantifying signs of skin aging and test the correlation between this new score and the already described clinical score, SCINEXA (score of intrinsic and extrinsic skin aging). Thirty-five subjects split into five age groups: <35; 36−45; 46−55; 56−65, and >65 years old were enrolled. Clinical signs were quantified using the SCINEXA score, and known confocal variables of skin aging were evaluated. Three different semi-quantitative scores were calculated: epidermal disarrangement score (EDS), epidermal hyperplasia score (EHS), and dermal score (DS). The EDS showed a stable trend up to the age of 65 and a dramatic increase in older subjects. EHS was characterized by an ascending trend from younger subjects to middle-aged ones. The DS was progressive with age, with a different proportion of distinct collagen types. The confocal CSIESA (confocal score for the assessment of intrinsic and extrinsic skin aging) score correlated well with the SCINEXA score. Reflectance confocal microscopy is a powerful, non-invasive technique for microscopically quantifying aging signs.

Clinical features of eczema and dermatitis in the elderly: A cross-sectional study in mainland China

Purpose: The clinical features of eczema and dermatitis in the elderly have not been fully studied. To investigate the proportion and clinical features of geriatric eczema patients in mainland China.

Patients and methods: A multicenter cross-sectional study conducted in outpatients with eczema from 39 tertiary hospitals in 15 provinces.

Results: 1128 elderly patients (12.88%) had eczema and dermatitis. The mean age of those was 68.2 ± 6.8 years (range, 60–90 years) with a median course of 5.5 ± 8.9 years, which is much longer than that of non-geriatric patients (2.6 ± 4.1 years, p < 0.001). Compared to non-geriatric patients, more patients involved in extremities (76.2% vs 61.5%, p < 0.001) and trunk (37.2% vs 26.4%, p < 0.001), but less in head and neck (18.3% vs 30.4%, p < 0.001; 25.3% vs 20.6%, p < 0.001). 13.4% of eczema and dermatitis in the elderly was widespread, which is much higher than that of 8% in non-geriatric group (13.4% vs 8%, p < 0.001). 22.9% of geriatric eczema patients reported severe itching, which is much higher than that of 14% in counterparts (22.9% vs 14%, p < 0.001). A positive correlation was observed between age and severe itching (Spearman’s rank correlation test, p < 0.001). More geriatric patients had xerosis (39.6% vs 30.4%, p < 0.001) and more lichenification was found (25.6% vs 13.3%, p < 0.001).

Conclusion: More than 10% of eczema occurs in the elderly patients. Longer disease duration, more severe itching, more extremities and trunk involvement, and prone to widespread, xerosis, and lichenification make it a special entity which should be studied further.

The efficacy and safety of an antiaging topical serum containing hesperetin and sodium cyclic lysophosphatidic acid: A single-center clinical trial

BACKGROUND

Skin aging is characterized by dehydration and degradation of the structural components in the dermis. It has been demonstrated that hesperetin possesses collagen synthesis and antioxidant properties and sodium cyclic lysophosphatidic acid (NcPA) increases skin moisture through upregulating the synthesis of hyaluronic acid.

AIMS

To evaluate the efficacy and safety of a serum containing hesperetin 0.1% and NcPA 0.1% for photoaged skin.

PATIENTS/METHODS

The trial consisted of a 12-week topical application of the test product twice daily. A total of 35 female subjects were enrolled. The primary outcome was the change of skin hydration and elasticity, which were determined by Corneometer and Cutometer measurements. Skin biopsy for histological evaluations and subject's self-assessment were conducted.

RESULTS

At week 12, a significant improvement of stratum corneum hydration (p = 0.015) and skin elasticity (p < 0.001) was detected comparing to baseline. The skin biopsy showed significantly improved scores of hyaluronic acid levels (p = 0.034) and elastic fiber structure (p = 0.023). Moreover, the test product resulted in a significant subject-reported overall satisfaction rate 94.3% after 12-week application (p = 0.005).

CONCLUSION

Skin care product containing hesperetin and NcPA showed significant antiaging effects on skin hydration and elasticity.

Age, gender, and racial/ethnic differences in the association of triclocarban with adulthood obesity using NHANES 2013-2016

This study examined the association between triclocarban and obesity among US adults and compared the pattern of this association across age, gender, and racial/ethnic groups. Study found triclocarban to be associated with obesity (OR: OR:1.123 95% CI: 1.046, 1.205) and this association remained among women (OR:1.14 95% CI: 1.031, 1.261). Study participants aged 60 years and older were more likely to be overweight (OR:1.131 95% CI: 1.022 1.251) and obese (OR:1.192 95% CI: 1.079, 1.317) when compared to other age groups. Likewise, non-Hispanic whites (OR:1.126 95% CI: 1.003, 1.263) and "other race including multi-racial" (OR:1.431 95% CI: 1.219, 1.679) were more likely to be obese when compared to other racial/ethnic groups. In conclusion, triclocarban is associated with obesity among US adults and there is evidence of gender, age, and racial/ethnicity differences in the association.

The Human Epidermal Basement Membrane: A Shaped and Cell Instructive Platform That Aging Slowly Alters

One of the most important functions of skin is to act as a protective barrier. To fulfill this role, the structural integrity of the skin depends on the dermal-epidermal junction—a complex network of extracellular matrix macromolecules that connect the outer epidermal layer to the underlying dermis. This junction provides both a structural support to keratinocytes and a specific niche that mediates signals influencing their behavior. It displays a distinctive microarchitecture characterized by an undulating pattern, strengthening dermal-epidermal connectivity and crosstalk. The optimal stiffness arising from the overall molecular organization, together with characteristic anchoring complexes, keeps the dermis and epidermis layers extremely well connected and capable of proper epidermal renewal and regeneration. Due to intrinsic and extrinsic factors, a large number of structural and biological changes accompany skin aging. These changes progressively weaken the dermal–epidermal junction substructure and affect its functions, contributing to the gradual decline in overall skin physiology. Most changes involve reduced turnover or altered enzymatic or non-enzymatic post-translational modifications, compromising the mechanical properties of matrix components and cells. This review combines recent and older data on organization of the dermal-epidermal junction, its mechanical properties and role in mechanotransduction, its involvement in regeneration, and its fate during the aging process.

Age- and Gender-Related Variability in Nasal Tip Support

BACKGROUND

The age at which nasal tip support changes start to occur is unknown. Evaluation of nasal tip support is difficult, especially as the ideal nasal tip support pressure remains elusive. The aim of this study is to determine the nasal tip support pressure alterations relative to age and sex.

OBJECTIVES

The aim of this study is to determine the changers in resistance of the nasal tip support in relation to age and sex.

METHODS

This prospective clinical study was conducted between January and April 2019 at a tertiary health facility. Nasal tip resistances were measured in four different age-groups (20-29, 30-39, 40-64, and > 65 years) with a digital Newton meter. A total of 159 patients with a minimum of 36 patients per group were included in the study. Nasal tip resistance measurements were compared among nasal tip displacement distances of 2, 3, and 4 mm, focusing on age and sex.

RESULTS

The nasal tip resistance of the 20-29 age-group was significantly higher at 2, 3, and 4 mm nasal tip displacement distances, when compared with the 30-39 and 40-64 age-groups, whereas compared to the > 65 years group, it was significantly higher at 3 and 4 mm nasal tip displacement distances (p < 0.005). Nasal tip resistance of males was found to be significantly higher than that of females, at 3 and 4 mm nasal tip displacement distances (p < 0.001).

CONCLUSIONS

Nasal tip resistance is higher in males and universally decreases significantly after 30 years of age while remaining constant at later ages. Therefore, surgeons should prefer nasal tip resistance increasing techniques in the rhinoplasty operations that are performed on patients even from early years of age, in order to maintain and strengthen the nasal tip resistance.

LEVEL OF EVIDENCE IV

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Distribution of heparan sulfate correlated with the expression of heparanase-1 and matrix metalloproteinase-9 in an ovariectomized rats skin

There are few studies on heparan sulfate (HS) in the skin, during aging, when estrogen is suppressed. The enzyme heparanase-1 (HPSE-1), has its 17β-estrogen-regulated expression in pathological conditions such as cancer and chronic inflammatory diseases. HPSE-1 is correlated with the matrix metalloproteinase-9 (MMP-9), an endopeptidase that also undergoes estrogen action. We investigated the distribution of HS, expression HPSE-1 and MMP-9 in the skin of adult rats at different ages and in the age-matched ovariectomized rats to evaluate the influence of low estrogen on the distribution of HS. Thirty female Wistar rats were used. Rats underwent to a sham surgery (ctr, n = 15) or to a bilateral ovariectomy (ovx, n = 15) and were euthanized after 45, 75, and 90 days after ovariectomy. Morphological, morphometric, biochemical, and reverse transcriptase polymerase chain reaction (RT-PCR) methodologies were used. A significant decrease (P < 0.001) in total skin thickness was observed in the ctr and ovx animals, being higher in the older animals. The thickness of the epidermis and dermis decreased; however, the proportion in the total skin remained similar comparing ctr and ovx. An increase of HS with increasing age and ovariectomy was observed. The expression of the HPSE-1 and MMP-9 enzymes decreased, being higher in old animals. A correlation between the increase of HS and the decrease of the HPSE-1 was demonstrated in both groups. Overall, these data suggested that estrogen acts in the regulation of the expression of the HPSE-1, not only in pathological states, as already established, but also in aging.

The permanence of friction ridge skin and persistence of friction ridge skin and impressions: A comprehensive review and new results

This study addresses the permanence and persistence of friction ridges and the persistence of impressions made from these friction ridges over months and years. Permanence is the unchanging presence and appearance of friction ridge arrangements and their attributes between recurring observations of the skin. Permanence was evaluated from direct photographs of fingers collected over a period of 30-45 days (covering one or more skin regeneration cycles) as well as after 8 or more years had elapsed. Persistence embodies the operational concept of whether or not a pair of images displays sufficient similarity upon which to base an informed decision that they were made by the same finger, while acknowledging certain dissimilarities or distortions due to friction ridge physiology, image capture, matrix, substrate, and applied pressure. Persistence applies to both friction ridge skin and impressions made from these friction ridges. Permanence and persistence of skin were assessed from direct photographs of fingers taken two months apart and from finger photographs separated by an interval of at least 8 years. Permanence and persistence were also assessed from impressions taken over 4 months, as well as those separated by 8-53 years. Variability due to capture method was assessed by using four image capture methods over a four month period: direct photography of fingers, impressions captured by ink, holographic imaging, and live scan. Qualified latent fingerprint examiners assessed all changes observed over time, as well as any limitations imposed by capture method. The practice of comparison and identification of fingerprint impressions was upheld, as was the prevailing use of the word persistence to describe stability of friction ridges. All photographs and impressions of the same finger were identifiable as originating from the same source. Within all the periods of observation, level 1 detail was permanent and persistent. Persistence, but not permanence, was supported for level 2 detail. Notably, the small changes observed were only in appearance; there were no changes in the presence of new, or absence of existing, minutiae. Level 3 details of ridge edge shape and pore presence were neither permanent nor persistent. Ridge width was permanent and persistent. Incipient ridges were neither permanent nor persistent.

Upregulation of Skin-Aging Biomarkers in Aged NHDF Cells by a Sucrose Ester Extract from the Agroindustrial Waste of Physalis peruviana Calyces

As part of a search for new sustainable plant sources of valuable compounds, the EtOAc extract of the discarded calyces of Physalis peruviana fruit was selected for its significant antiaging activity. Eight new sucrose esters (SEs), named peruvioses F-M (1-8), along with three known SEs, peruvioses A (9), peruviose B (10), and nicandrose D (11), were isolated. Their structures were elucidated by comprehensive analyses of their NMR and MS data. A global fragmentation pattern of these SEs was established from their MS data. The SE extract (SEE) at a concentration of 0.5 mg L^-1 upregulated multiple skin-aging biomarkers, namely, collagen I, elastin, and fibrillin-1, in aged normal human dermal fibroblast cells. A 36% increase in collagen I was observed. The elastin and fibrillin-1 contents were fully recovered, and an increase of at least 10% in the production of elastin was observed.

Beyond photoaging: additional factors involved in the process of skin aging

Studies assessing the impact of extrinsic factors on skin aging have increased during the last with the increase in life expectancy. Although most of the studies are about the sun radiation impact, many factors should be considered in elderly people, beyond environmental conditions. Lifestyle factors, like diet, sleeping, smoking, should be analyzed carefully, as common age-related conditions (menopause, diabetes, pulmonary diseases, etc.). All these factors could accelerate the natural decline of skin structure and functions, possibly affecting the responses to treatments and drugs. This review demonstrates that growing evidence regarding environmental factors that are associated with lifestyle and comorbidities deserve greater attention from researchers and dermatologists and may require new approaches in the management of skin aging.

Nutraceuticals for Skin Care: A Comprehensive Review of Human Clinical Studies

The skin is the body’s largest organ, it participates in sensitivity and offers protection against microorganisms, chemicals and ultraviolet (UV) radiation. Consequently, the skin may suffer alterations such as photo-ageing, immune dysfunction and inflammation which may significantly affect human health. Nutraceuticals represent a promising strategy for preventing, delaying, or minimising premature ageing of the skin and also to alleviate certain skin disorders. Among them, bioactive peptides and oligosaccharides, plant polyphenols, carotenoids, vitamins and polyunsaturated fatty acids are the most widely used ingredients. Supplementation with these products has shown evidence of having an effect on the signs of ageing and protection against UV radiation ageing in several human trials. In this review, the most relevant human studies on skin nutraceuticals are evaluated and the statistical resolution, biological relevance of their results, and, the trial protocols are discussed. In conclusion, quality and rigorousness of the trials must be improved to build credible scientific evidence for skin nutraceuticals and to establish a cause-effect relationship between the ingredients the beneficial effects for the skin.

Skin tears and risk factors assessment: a systematic review on evidence-based medicine

Skin tears represent a common condition of traumatic wounds, which may be encountered in some categories of individuals at the extremes of age, such as infants and the elderly. Despite the high prevalence and cost of these lesions, there has been little investigation into the risk factors that lead to this condition. The aim of this review was to systematically evaluate the main risk factors involved in development of skin tears. We planned to include all the studies dealing with risk factors related to skin tears. Only publications in English were considered. We excluded all the studies that did not properly fit our research question and those with insufficient data. Of the 166 records found, 24 matched our inclusion criteria. After reading the full-text articles, we decided to exclude seven articles because of the following reasons: (1) not responding properly to our research questions and (2) insufficient data; the final set included 17 articles. From a literature search, we found the following main issues related to risk factors, which have been described in detail in this section: age-related skin changes, dehydration, malnutrition, sensory changes, mobility impairment, pharmacological therapies and mechanical factors related to skin care practices. Our findings clearly show that in frail populations (especially infant and elderly), the stratification risk, as a primary prevention strategy, is an effective tool in avoiding the development of chronic wounds. The development and the implementation of prevention strategies based on appropriate knowledge of the risk factors involved and the adoption of correct techniques during skin care practices could reduce or even avoid the onset of skin tears.

Dental Videographic Analysis using Digital Age Media

Aims and objectives

This study was to evaluate a new method of smile analysis using videographic and photographic softwares (as in this study Photoshop Elements X, Windows Movie Maker 2012) as primary assessment tools and to develop an index for malocclusion and treatment plan that could be used in assessing severity of maloc-clussion.

How to cite this article

Agarwal A, Seth K, Parmar S, Jhawar R. Dental Videographic Analysis using Digital Age Media. Int J Clin Pediatr Dent 2016;9(4):355-363.

Skin Excision as an Adjunctive Technique to Rhinoplasty in Middle-Aged and Elderly Patients

Supplemental Digital Content is available in the text.

Rhinoplasty in middle-aged and elderly patients comes with its own set of challenges. There is relative lengthening of the nose with drooping of the nasal tip. With aging, the skin loses its elasticity, and the combination of nasal skeletal reduction along with overlying inelastic skin provides a setup for skin redundancy and poor postoperative outcome. We describe a surgical technique involving lenticular skin excision as a part of rhinoplasty in 12 patients older than 50 years to improve the aesthetic outcome. Skin width up to 1.6 cm was excised. Included is a literature review of skin excision in rhinoplasty. In elderly patients with thin, inelastic skin and long nose with a drooping tip, a reduction rhinoplasty technique might result in skin redundancy. Lenticular skin excision along the radix of the nose in these 12 patients improved the aesthetic outcome by decreasing the redundancy and preventing nasal tip ptosis. The wound from the skin resection healed in all the patients with minimal scar, and no complication was noted after at least 1 year of follow-up for each patient.

Epidermal growth factor improves the migration and contractility of aged fibroblasts cultured on 3D collagen matrices

Epidermal growth factor (EGF) plays a critical role in fibroblasts by stimulating the production of collagen and supports cell renewal through the interaction between keratinocytes and fibroblasts. It is well known that the contractile activity of fibroblasts is required for the remodeling of the extracellular matrix (ECM), which contributes to skin elasticity. However, the role of EGF in the contraction of aged fibroblasts under 3-dimensional (3D) culture conditions is not yet fully understood. In the present study, we demonstrated that young fibroblasts spread and proliferated more rapidly than aged fibroblasts under 2-dimensional (2D) culture conditions. Cell migration assay using a nested collagen matrix revealed that the migration of young fibroblasts was also greater than that of aged fibroblasts under 3D culture conditions. However, the addition of recombinant human EGF (rhEGF) resulted in the enhanced migration of aged fibroblasts; the migration rate was similar to that of the young fibroblasts. The aged fibroblasts showed decreased cluster formation compared with the young fibroblasts on the collagen matrix, which was improved by the addition of rhEGF. Furthermore, cell contraction assay revealed that the basal contractility of the aged fibroblasts was lower than that of the young fibroblasts; however, following treatment with rhEGF, the contractility was restored to levels similar or even higher to those of the young fibroblasts. Taken together, our results suggest that rhEGF is a potential renewal agent that acts to improve the migration and contraction of aged fibroblasts more efficiently than young fibroblasts under 3D culture conditions; thus, EGF may have valuable regenerative effects on aged skin.

Quantitative analysis of intrinsic skin aging in dermal papillae by in vivo harmonic generation microscopy

Chronological skin aging is associated with flattening of the dermal-epidermal junction (DEJ), but to date no quantitative analysis focusing on the aging changes in the dermal papillae (DP) has been performed. The aim of the study is to determine the architectural changes and the collagen density related to chronological aging in the dermal papilla zone (DPZ) by in vivo harmonic generation microscopy (HGM) with a sub-femtoliter spatial resolution. We recruited 48 Asian subjects and obtained in vivo images on the sun-protected volar forearm. Six parameters were defined to quantify 3D morphological changes of the DPZ, which we analyzed both manually and computationally to study their correlation with age. The depth of DPZ, the average height of isolated DP, and the 3D interdigitation index decreased with age, while DP number density, DP volume, and the collagen density in DP remained constant over time. In vivo high-resolution HGM technology has uncovered chronological aging-related variations in DP, and sheds light on real-time quantitative skin fragility assessment and disease diagnostics based on collagen density and morphology.

Solar ultraviolet irradiation induces decorin degradation in human skin likely via neutrophil elastase

Exposure of human skin to solar ultraviolet (UV) irradiation induces matrix metalloproteinase-1 (MMP-1) activity, which degrades type I collagen fibrils. Type I collagen is the most abundant protein in skin and constitutes the majority of skin connective tissue (dermis). Degradation of collagen fibrils impairs the structure and function of skin that characterize skin aging. Decorin is the predominant proteoglycan in human dermis. In model systems, decorin binds to and protects type I collagen fibrils from proteolytic degradation by enzymes such as MMP-1. Little is known regarding alterations of decorin in response to UV irradiation. We found that solar-simulated UV irradiation of human skin in vivo stimulated substantial decorin degradation, with kinetics similar to infiltration of polymorphonuclear (PMN) cells. Proteases that were released from isolated PMN cells degraded decorin in vitro. A highly selective inhibitor of neutrophil elastase blocked decorin breakdown by proteases released from PMN cells. Furthermore, purified neutrophil elastase cleaved decorin in vitro and generated fragments with similar molecular weights as those resulting from protease activity released from PMN cells, and as observed in UV-irradiated human skin. Cleavage of decorin by neutrophil elastase significantly augmented fragmentation of type I collagen fibrils by MMP-1. Taken together, these data indicate that PMN cell proteases, especially neutrophil elastase, degrade decorin, and this degradation renders collagen fibrils more susceptible to MMP-1 cleavage. These data identify decorin degradation and neutrophil elastase as potential therapeutic targets for mitigating sun exposure-induced collagen fibril degradation in human skin.

Skin tears: achieving positive clinical and financial outcomes

Skin tears are one of the most common wounds found among frail, older individuals, and are considered to be largely preventable. Skin tears occur frequently in those with fragile skin, in neonates and the elderly; particularly those with comorbidities affecting their balance, e.g. postural hypotension, motor neurone disease, diabetes and cerebral vascular accident (CVA). Those taking oral medications including steroids and anticoagulants are also at risk of developing skin tears. The increase in the population of older people is likely to produce a concurrent rise in the number of skin tears. Health professionals and health care assistants have a significant role to play in skin tear prevention, assessment and management.

In the shadow of the wrinkle: theories

As time passes, wrinkles typically appear. These skin depressions that become deeper and deeper draw more and more coarser lines on almost all the visible parts of aging individual's skin. They are indeed the most obvious and maybe disliked signs of skin aging, and thus, preventing and treating them are a major topic for dermo-cosmetic laboratories. However, the cause and occurrence mechanism of these simplistic looking lines are not yet fully understood. Wrinkling is thought to be a complex biophysical process resulting from repeated strains on a progressively, structurally and biochemistry altered aging skin with impaired mechanical properties. Focus is made on the specific histological features of the wrinkle compared to the surrounding aging skin. The numerous age-related changes in human skin that are supposed to be involved in wrinkling are briefly reviewed, and the current theories on wrinkle formation linked to these changes are also discussed.

Phenotype and functions of conventional dendritic cells are not compromised in aged mice

Aging has profound effects on the immune system, including thymic involution, reduced diversity of the T cell receptor repertoire, reduced effector T cell and B cell function and chronic increase of proinflammatory cytokine production by innate immune cells. The precise effects of aging on conventional dendritic cells (cDC), the main antigen presenting cells of the immune system, however, are not well understood. We found that in aged mice the number of cDC in the spleen and lymph nodes remained stable, whereas the number of cDC in the lungs increased with age. Whereas cDC in mice showed similar cycling kinetics in all organs tested, cDC reconstitution by aged bone marrow precursors was relatively higher than that of their young counterparts. With the exception of CD86, young and aged cDC did not differ in their expression of co-stimulatory molecules at steady state. Most toll-like receptor (TLR) ligands induced comparable upregulation of co-stimulatory molecules CD40, CD86 and B7H1 on young and aged cDC, whereas TLR2 and TLR5 stimulation resulted in reduced upregulation of CD80 and CD86 on aged cDC in vitro. In vivo, influenza infection-induced upregulation of CD86, but not other co-stimulatory molecules, was lower in aged DC. Young and aged DC were equally capable of direct and cross presentation of antigens in vitro. Transcriptome analysis did not reveal any significant difference between young and aged cDC. These data show that unlike T and B cells, the maintenance of cDC throughout the life of a healthy animal is relatively robust during the aging process.

Molecular mechanisms and in vivo mouse models of skin aging associated with dermal matrix alterations

Skin is the most superficial body organ and plays an important role in protecting the body from environmental damage and in forming social relations. With the increase of the aging population in our society, dermatological and cosmetic concerns of skin aging are rapidly increasing. Skin aging is a complex process combined with intrinsic and extrinsic factors. Intrinsic or chronological skin aging results from the passage of time and is influenced by genetic factors. Extrinsic skin aging is mainly determined by UV irradiation, also called photoaging. These two types of aging processes are superimposed on sun-exposed skin, and have a common feature of causing dermal matrix alterations that mostly contribute to the formation of wrinkles, laxity, and fragility of aged skin. The dermal matrix contains extracellular matrix proteins such as collagen, elastin, and proteoglycans that confer the strength and resiliency of skin. Skin aging associated with dermal matrix alterations and atrophy can be caused by cellular senescence of dermal cells like fibroblasts, and decreased synthesis and accelerated degradation of dermal matrix components, especially collagen fibers. Both intrinsic aging and photoaging exert influence during each step of dermal matrix alteration via different mechanisms. Mouse models of skin aging have been extensively developed to elucidate intrinsic aging and photoaging processes, to validate in vitro biochemical data, and to test the effects of pharmacological tools for retarding skin aging because they have the advantages of being genetically similar to humans and are easily available.

Influence of season on some skin properties: winter vs. summer, as experienced by 354 Shanghaiese women of various ages

The facial skin of 354 women, aged 18-80, living in Shanghai, was investigated over two successive 6-month periods, summer and winter. Results from clinical assessments indicate that aging signs, such as wrinkling and sagging, are unaffected over such period. However, physical measurements revealed alterations in some functional criteria of the skin, such as sebum output, skin colour, melanin content of pigmented spots, skin hydration, all being increased during summer. The relationships between all criteria, as well as technical or applied inferences/consequences from this study, are discussed.

Effect of estrogens on skin aging and the potential role of selective estrogen receptor modulators

Estrogens have a profound influence on skin. The relative hypoestrogenism that accompanies menopause exacerbates the deleterious effects of both intrinsic and environmental aging. Estrogens prevent skin aging. They increase skin thickness and improve skin moisture. Beneficial effects of hormone replacement therapy (HRT) on skin aging have been well documented, but HRT cannot obviously be recommended solely to treat skin aging in menopausal women. Topical estrogen application is highly effective and safe if used by a dermatologist with expertise in endocrinology. The question of whether estrogen alternatives such as phytoestrogens and selective estrogen receptor modulators are effective estrogens for the prevention of skin aging in postmenopausal women remains unanswered. However, preliminary data indicate that such treatment may be of benefit for skin aging treatment.

Changes in S100A8 expression in UV-irradiated and aged human skin in vivo

S100A8, a calcium-binding protein, is associated with keratinocyte differentiation, inflammation and wound healing. S100A8 is induced by various skin stresses and diseases, which suggests that S100A8 plays a role in those processes. However, it has not been reported how the expression of S100A8 is affected during skin aging or whether S100A8 plays a role in the skin aging process. In this study, we investigated the changes in S100A8 mRNA and protein following acute UV irradiation to human buttock skin and by intrinsic aging and photoaging in human sun-protected (upper-inner arm) and sun-exposed (forearm) skin of elderly subjects. Real-time PCR, western blot and immunohistochemical staining analyses of UV-irradiated young buttock skin revealed that S100A8 protein expression was increased at 24 h (3.0-fold) and 48 h (4.4-fold) after UV irradiation. S100A8 mRNA and protein were more highly expressed by 2.3- and 4.0-fold, respectively, in the sun-protected skin of elderly people than in that of young people. In addition, the sun-exposed skin of elderly expressed more S100A8 mRNA and protein than the sun-protected skin of the same individuals. In immunohistochemical staining, facial (photoaged) skin > or = 72 years showed higher epidermal expression of S100A8 than that of the other age groups. Based on the above results, our data suggest that the expression of S100A8 is affected by acute UV irradiation, intrinsic aging and photoaging processes.

Increased expression of TRPV1 channel in intrinsically aged and photoaged human skin in vivo

Transient receptor potential vanilloid type 1 (TRPV1) is activated by various stimuli including capsaicin, heat and acid. While TRPV1 has been localized in the epidermis, little is known about the physiological role of TRPV1 in the skin, especially in skin ageing. In this study, we investigated the effect of acute UV irradiation on TRPV1 expression in human skin and the changes in TRPV1 mRNA and protein in intrinsic ageing and photoageing using human sun-protected (upper inner arm) and sun-exposed (forearm) skin of young and elderly subjects. Western blot analysis of UV-irradiated young buttock skin revealed that the expression of TRPV1 protein was increased at 24 h (2.3-fold) and 48 h (2.4-fold) after UV irradiation. Real-time PCR analysis also showed that the mRNA level of TRPV1 was augmented by 2.4-fold at 4 h after UV irradiation. TRPV1 protein was expressed at higher levels by 2.6-fold in the sun-protected skin of the elderly subjects than in that of young people according to western blotting, real-time PCR analysis and immunohistochemical staining. In addition, the photoaged skin of elderly showed increased expression of TRPV1 mRNA and protein compared with that of the sun-protected skin of the same individuals. Also, we found increased expression of TRPV1 in nerve fibres of elderly persons using double staining of TRPV1 and nerve fibres. Based on the above results, our data suggest that the expression of TRPV1 is affected by both the intrinsic ageing and photoageing processes.

Cytokeratin-related loss of cellular integrity is not a major driving force of human intrinsic skin aging

The contribution of extracellular matrix components to intrinsic skin aging has been investigated thoroughly, however, there is little information as to the role of the cytoskeletal proteins in this process. Therefore, we compared the expression of the constituents of the cytoskeleton, keratins 1-23 (K1-K23) as well as junction-plakoglobin (JUP), alpha-tubulin (TUBA), and beta-actin (ACTB) in human foreskins of both young (mean 6.4 years) and aged (mean 54.3 years) individuals. By applying RNA expression analysis to intrinsically aged human skin, we demonstrated that the mRNA levels of the genes for K1, K3, K4, K9, K13, K15, K18, K19 and K20 are downregulated in aged skin, K5 and K14 are unchanged, and K2, K16 and K17 are upregulated in aged skin. The mRNA data were confirmed on the protein level. This diverse picture is in contrast to other cytoskeletal proteins including components of the desmosome (JUP), microtubuli (TUBA) and microfilaments (ACTB) - often regarded as house-keeping genes - that were all reduced in aged skin. These cytoskeletal features of intrinsic aging highlight the importance of the cellular compartment in this process and demonstrate that special attention has to be given to RNA as well as protein normalization in aging studies.

Photoprotective and anti-skin-aging effects of eicosapentaenoic acid in human skin in vivo

Skin aging can be attributed to photoaging (extrinsic) and chronological (intrinsic) aging. Photoaging and intrinsic aging are induced by damage to human skin attributable to repeated exposure to ultraviolet (UV) irradiation and to the passage of time, respectively. In our previous report, eicosapentaenoic acid (EPA) was found to inhibit UV-induced matrix metalloproteinase-1 (MMP-1) expression in human dermal fibroblasts. Therefore, we investigated the effects of EPA on UV-induced skin damage and intrinsic aging by applying EPA topically to young and aged human skin, respectively. By immunohistochemical analysis and Western blotting, we found that topical application of EPA reduced UV-induced epidermal thickening and inhibited collagen decrease induced by UV light. It was also found that EPA attenuated UV-induced MMP-1 and MMP-9 expression by inhibiting UV-induced c-Jun phosphorylation, which is closely related to UV-induced activator protein-1 activation, and by inhibiting JNK and p38 activation. EPA also inhibited UV-induced cyclooxygenase-2 (COX-2) expression without altering COX-1 expression. Moreover, it was found that EPA increased collagen and elastic fibers (tropoelastin and fibrillin-1) expression by increasing transformin growth factor-beta expression in aged human skin. Together, these results demonstrate that topical EPA has potential as an anti-skin-aging agent.

Rhinoplasty with advancing age

Rhinoplasty in the aging patient poses a unique set of challenges to the plastic surgeon. Aging patients usually have different expectations and motivations than their younger counterparts; therefore, open communication and frank discussions are paramount to define realistic goals. Anatomically, changes in skin quality, cartilage characteristics, underlying bony framework, and the nasal airways mandate special considerations to optimize the functional and aesthetic results. This review will present a practical approach to the management of the nose in the aging patient.

Augmentation rhinoplasty with a combination of triple cartilage grafts for secondary rhinoplasty in a middle-aged population

Because of physiologic changes with advancing age as well as previously traumatized and then healed tissues, secondary rhinoplasty for a middle-aged patient is a challenging procedure. Depending on both factors, changes in the midvault can cause a functional airway disorder, and the nose also may need a complete correction for cosmetic purposes. To achieve aesthetic and functional outcomes, augmentation rhinoplasty using a combination of triple cartilage grafts, namely, spreader, columellar, and dorsal onlays, was performed for 12 patients. Sufficient nasal airways with satisfactory appearance were achieved for 11 of 12 patients. Only one patient had improved but still insufficient nasal function with a good aesthetic result. Augmentation rhinoplasty using a combination of triple cartilage grafts for middle-aged patients could be considered an effective procedure for improving the patient's nasal airway and appearance.

Utility of Acellular Allograft Dermis in the Care of Elderly Burn Patients

BACKGROUND

Because skin thins with advancing age, traditional thickness skin grafts cannot always be obtained in very elderly burn patients without creating a new full-thickness wound at the skin graft donor site.

MATERIALS AND METHODS

In an attempt to circumvent this problem, acellular allograft dermis (Alloderm, Life Cell Corp., The Woodlands, TX) and thin autograft (depth 0.005 inches) was used in skin grafting 10 elderly burn patients (age 78 year +/- 2, TBSA burn 17% +/- 2; mean +/- SEM) over a 1-year period. The outcome of patients receiving Alloderm was compared retrospectively to a similar group of 18 elderly patients admitted over the prior year, eight of whom underwent operative wound excision and autografting (depth 0.014 inches) without Alloderm.

RESULTS

Length of hospital stay was significantly reduced in patients treated with Alloderm compared to the total group of elderly in whom selective use of operative debridement and skin grafting was used. Functional outcome was improved in those patients who underwent skin grafting regardless of operative technique. Donor site healing time was significantly reduced with Alloderm (12 days +/- 1 versus 18 days +/- 2), while graft take was similar to conventional autografting. Unfortunately, 3-month mortality remained poor regardless of operative skin grafting or technique used.

CONCLUSIONS

This initial experience suggests that use of Alloderm may allow more elderly burn patients to undergo operative wound closure, thus improving functional outcome and reducing hospitalization. Unfortunately, long-term survival for very elderly burn patients remains poor.

Increased expression of 14-3-3varepsilon protein in intrinsically aged and photoaged human skin in vivo

Skin aging is a complicated process associated with the passage of time and environmental exposure, especially to UV light. This aging phenomenon is related to alterations in various cellular mechanisms, such as changes in apoptosis, perturbations to cellular signaling, and an increased genetic instability. In this study, we investigated changes of proteins involved in intrinsic aging by the proteomic analysis of human sun-protected (upper inner arm) young and aged dermis. One of the proteins upregulated in aged dermis was identified as 14-3-3epsilon. This protein is an isoform of 14-3-3 protein, which is involved in cellular processes like signal transduction, cell cycle arrest, and apoptosis. 14-3-3epsilon is consistently found to be upregulated in the sun-protected dermis of aged skin, by Western blotting and immunohistochemical staining. In addition, we demonstrate that the expression of 14-3-3epsilon is further upregulated in the sun-exposed (photodamaged) dermis, and that the UV irradiation of young skin significantly upregulates 14-3-3epsilon in vivo. Our results suggest the possibility that the cellular processes related to 14-3-3epsilon protein play an important role in the photoaging and intrinsic aging of human skin.

[Conservative treatment of facial wrinkles in the hands of the plastic surgeon]

The conservative treatment of facial wrinkles is an integral part of the growing market for aesthetic surgery. Unfortunately, physicians of any specialty and even nonphysicians tried to occupy this lucrative field without providing serious information and knowledge about a holistic plastic surgical concept, which includes second- and third-step aesthetic surgical procedures when conservative treatment does not suffice. The following article outlines and critically evaluates the current state of knowledge.

Modulating diseased skin with tissue engineering: actinic purpura treated with Apligraf

BACKGROUND

Actinic purpura (AP) is an important medical issue and quality of life issue in the elderly. Current treatment of AP is limited to prevention of cutaneous aging.

OBJECTIVE

To assess the utility of tissue engineered skin (Apligraf, Organogenesis, Canton, MA) as a tissue modulator in diseased skin and as treatment for AP.

METHODS

A thin partial-thickness section of AP was removed from the forearm of an elderly gentleman and replaced with fenestrated Apligraf. Healing, durability and cosmetic outcome were assessed.

RESULTS

Apligraf-treated skin healed rapidly with good clinical "take." Lack of new skin tears and resultant erosions or ulcer formation suggests improved durability of the Apligraf-treated area occurred.

CONCLUSION

These results suggest that tissue engineered skin modulates aged dermal tissue to behave in a more sturdy fashion. Furthermore, in selected cases Apligraf may represent a treatment option for AP.

Molecular mechanisms of skin ageing

Cutaneous ageing is a complex biological phenomenon consisting of two components; intrinsic ageing, which is largely genetically determined and extrinsic ageing caused by environmental exposure, primarily UV light. In sun-exposed areas, these two processes are superimposed. The process of intrinsic skin ageing resembles that seen in most internal organs and is thought to involve decreased proliferative capacity leading to cellular senescence, and altered biosynthetic activity of skin derived cells. Extrinsic ageing, more commonly termed photoageing, also involves changes in cellular biosynthetic activity but leads to gross disorganisation of the dermal matrix. The molecular mechanisms underlying some of these changes are now beginning to be unravelled and are discussed. As these mechanisms are identified, further insights into the underlying processes of skin ageing should emerge and better strategies to prevent the undesirable effects of age on skin appearance should follow.

The effect of increasing vertical dimension of occlusion on facial aesthetics

AIM

To investigate the effect of increasing the vertical dimension of occlusion on facial aesthetics.

SETTING

General practice.

METHOD

Questionnaires were sent to 96 patients who had been treated in the practice during the period of July 1998 to December 2000, resulting in an overall 72% response rate. All these patients had had their occlusal vertical dimension increased. Photographs of patients were taken before, during and after treatment. The questionnaire asked their opinion on the effects of the treatment on their facial features. To obtain an objective view to substantiate the opinions of the patients, a panel of five judges reviewed the before and after photographs and filled in their own questionnaires.

RESULTS

Of the patients who responded to the questionnaire, 79.7% said they looked younger after the treatment. The panel thought 81.2% of the patients treated whose photographs they reviewed looked younger.

CONCLUSION

Increasing the vertical dimension of occlusion can have far reaching effects on facial aesthetics, not just on the peri-oral areas but on the whole face.