Clinical implications of aging skin: cutaneous disorders in the elderly

Comparative Analysis of Efficacy of Lactic Acid 30% with Ferulic Peel 12% (Combination Peel) Versus TCA 10% with Ferulic Peel 12% (Combination Peel) for Photoageing Skin

OBJECTIVES

Chemical peels are used to treat photoageing, pigmentation, improve complexion and dull skin, fine lines and scars. The objective of this study is to do comparative analysis of Lactic Acid 30% with Ferulic peel 12% (combination peel) versus TCA 10% with Ferulic peel 12% (combination peel) for Photoageing Skin.

MATERIALS AND METHODS

This is a retrospective study from September 2021 to 2022 with total 50 female patients aged between 25 and 40 years were treated. Randomisation of patients was done (simple randomisation using lottery method) for both groups with 25 patients enrolled in each group. The first group (Group A-25 patients) were treated with lactic acid 30% with Ferulic peel 12% (combination peel). The second group (Group B-25 patients) were treated with TCA 10% with Ferulic peel 12% (combination peel). Inclusion and exclusion criteria have been defined for the study. Two scales have been used for assessing the results: Allergan Skin Roughness Scale (ASRS) and Allergan Fine Line Scale (AFLS). ASRS and AFLS scores were assessed at pre-treatment (pre) and post treatment (post-1 month after last peel session). Data were summarised in Mean ± SD (standard deviation). Pre and post groups were compared by paired t test. The pre to post change in outcome measures between two independent groups were compared by independent Student's t test. Discrete (categorical) groups were compared by Chi-square (χ2) test. A two-tailed (α=2) P < 0.05 was considered statistically significant. Analyses were performed on SPSS software (Windows version 22.0). Patients were followed up for 6 months post treatment.

RESULTS

In Group A, comparing the pre and post ASRS score, paired t test showed significant (P < 0.001) decrease or improvement of 56.1%. In Group B, comparing the pre and post ASRS score, paired t test showed significant (P < 0.001) decrease or improvement of 52.8%. Comparing the pre to post mean decrease or improvement in ASRS score of two groups, Student's t test showed similar (P > 0.05) improvement between the two groups though it was 2.5% higher in Group B as compared to Group A. In Group A, comparing the pre and post AFLS score, paired t test showed significant (P < 0.001) decrease or improvement of 63.2% at post as compared to pre. In Group B, comparing the pre and post AFLS score, paired t test showed significant (P < 0.001) decrease or improvement of 58.8% at post as compared to pre. Further, comparing the pre to post mean decrease or improvement in AFLS score of two groups, Student's t test showed similar (P > 0.05) improvement between the two groups though it was 16.7% higher in Group A as compared to Group B.

CONCLUSION

Study found both the treatments equally effective in the management of ageing skin after 6 months of treatment. However, study needs further validation on larger sample size, varied age groups and male gender.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Biomaterials-Based Strategies to Enhance Angiogenesis in Diabetic Wound Healing

Amidst the present healthcare issues, diabetes is unique as an emerging class of affliction with chronicity in a majority of the population. To check and control its effects, there have been huge turnover and constant development of management strategies, and though a bigger part of the health care area is involved in achieving its control and the related issues such as the effect of diabetes on wound healing and care and many of the works have reached certain successful outcomes, still there is a huge lack in managing it, with maximum effect yet to be attained. Studying pathophysiology and involvement of various treatment options, such as tissue engineering, application of hydrogels, drug delivery methods, and enhancing angiogenesis, are at constantly developing stages either direct or indirect. In this review, we have gathered a wide field of information and different new therapeutic methods and targets for the scientific community, paving the way toward more settled ideas and research advances to cure diabetic wounds and manage their outcomes.

Knowledge, Attitude, Reception, and Preventive Practices Towards Skin Photoaging Among the General Population in Jazan, Saudi Arabia

Introduction Skin photoaging is caused by prolonged exposure to sunlight, particularly ultraviolet rays (UV). High cumulative levels of UV radiation may cause burning, photoallergic or phototoxic reactions, pigmentary changes, photoaging, and even immunosuppression and skin cancers. Therefore, this study aims to assess knowledge, attitude, reception, and preventive practices towards skin photoaging among the Jazan general population in Saudi Arabia and its determinants. Methods A descriptive cross-sectional study was conducted among the general population of Jazan, Saudi Arabia, who were aged 18 years and above and agreed to participate in the study. The calculated minimum sample size was 385. An online, semi-structured, self-administered questionnaire was distributed conveniently in Google Forms through social media platforms. It included four sections: The first section was about sociodemographic characteristics. The second section assessed the smoking, exercise, and healthy diet behavior of participants and the use of sunscreen. The third section assessed the knowledge regarding the photoaging process and its preventive measures utilization using three-point Likert scale questions. The fourth section assessed attitudes towards the photoaging process and its preventive measures through three-point Likert scales. Results The study included 452, of which 243 (53.76%) were aged 18-30 years, 258 (57.08%) were females, and 272 (60.18%) had white skin color. Approximately 417 (92.26%) were nonsmokers. Sixty-eight percent (372) spent 1-3 hours in the sun. Social media was the primary source of information on photoaging 81 (17.92%). Around 234 (51.77%) defined photoaging correctly. Regarding sunscreen usage, 58 (12.83%) always use sunscreen, and 177 (39.16%) never use it. However, 191 (42.26%) recognized the correct sunscreen application. Approximately 233 (51.5%) and 240 (53.1%) of respondents had fair knowledge and a positive attitude regarding photoaging and sunscreen use. Being female, pursuing university and postgraduate education, and taking information on photoaging from a physician were linked to a higher knowledge of photoaging (p<0.05). Participants who never use sunscreen had lower knowledge than those who always use it (p<0.001). None of the demographic factors was associated with the attitude towards sunscreen use (p>0.05). Conclusion There is a substantial gap in knowledge and preventive practices related to skin photoaging among the Jazan general population in Saudi Arabia. Gender, education level, and information sources influence knowledge levels. Targeted educational interventions are needed to enhance awareness and promote healthier practices, particularly sun exposure and photoaging prevention.

Effects of Siegesbeckia herba extract against particulate matter 10 (PM10 ) in skin barrier-disrupted mouse models

OBJECTIVES

Skin barrier disruption is a significant problem of the older population in an aging society. It is characterized by increased transepidermal water loss and decreased skin water content, and particulate matter (PM) is a social issue that can contribute to the exacerbation of skin inflammation. Thus, addressing this problem is urgent.

METHODS

Skin barrier-disrupted mouse models were induced by two methods using acetone application or tape-stripping. This study investigated the antioxidative and anti-inflammatory properties of the Siegesbeckia herba extract (SHE) on PM-induced changes in skin barrier-disrupted mouse models. To examine changes in skin water content, inflammatory cytokines, and keratinocyte differentiation markers, mouse models were treated with vehicle 100 μL, PM10 100 μL (100 μg/mL), SHE 100 μL, or PM10 100 μL (100 μg/mL) plus SHE 100 μL.

RESULTS

SHE preserved skin hydration in the skin barrier-disrupted mouse models regardless of the presence of PM10 . SHE also inhibited the upregulation of inflammatory cytokines such as interleukin (IL)-1β, IL-4, IL-6, IL-8, and tumor necrosis factor-α and normalized the downregulation of keratinocyte differentiation markers against PM10 in skin barrier-disrupted mouse models.

CONCLUSIONS

This study elucidated the therapeutic effects of SHE against PM10 in skin barrier-disrupted mouse models.

Acantholytic Dyskeratosis Consistent With Grover's Disease After Letrozole Therapy

We present a rare case of Grover's disease (GD) associated with letrozole therapy in a 66-year-old female with stage IV breast cancer. GD is a dermatological condition characterized by papulovesicular lesions typically found on the chest and trunk. While GD is linked to chemotherapeutic agents, its association with letrozole is not well documented. The patient presented with a pruritic rash on her neck, right arm, and trunk, initially misdiagnosed as contact dermatitis. Despite treatment with triamcinolone acetonide, the rash persisted. A subsequent punch biopsy confirmed acantholytic dyskeratosis consistent with GD. Discontinuation of letrozole and treatment with augmented betamethasone dipropionate resulted in significant improvement within four weeks. This case underscores the importance of considering drug-induced dermatological conditions in patients undergoing chemotherapy. While hypersensitivity drug eruptions typically present as morbilliform-patterned cutaneous eruptions, GD should be considered, especially in older patients with multiple medications. The incidence of GD following letrozole therapy is not well studied, making this case a valuable addition to the limited literature. In summary, recognizing and managing drug-induced skin conditions in cancer patients are crucial. This report contributes to our understanding of the potential association between letrozole and GD, emphasizing the need for further research in this area.

Diagnosis and Management of Bullous Disease

Bullous diseases are a group of dermatoses primarily characterized by the presence of vesicles (0.1-0.9 cm) or bullae (>1 cm). There are various categories of bullous disease: allergic, autoimmune, infectious, mechanical, and metabolic. These diseases affect individuals in all decades of life, but older adults, age 65 and older, are particularly susceptible to bullous diseases of all etiologies. The incidence of these disorders is expected to increase given the advancing age of the general population. In this comprehensive review, we will outline the common bullous diseases affecting older individuals and provide an approach to evaluation and management.

Development of an epigenetic clock to predict visual age progression of human skin

Aging is a complex process characterized by the gradual decline of physiological functions, leading to increased vulnerability to age-related diseases and reduced quality of life. Alterations in DNA methylation (DNAm) patterns have emerged as a fundamental characteristic of aged human skin, closely linked to the development of the well-known skin aging phenotype. These changes have been correlated with dysregulated gene expression and impaired tissue functionality. In particular, the skin, with its visible manifestations of aging, provides a unique model to study the aging process. Despite the importance of epigenetic age clocks in estimating biological age based on the correlation between methylation patterns and chronological age, a second-generation epigenetic age clock, which correlates DNAm patterns with a particular phenotype, specifically tailored to skin tissue is still lacking. In light of this gap, we aimed to develop a novel second-generation epigenetic age clock explicitly designed for skin tissue to facilitate a deeper understanding of the factors contributing to individual variations in age progression. To achieve this, we used methylation patterns from more than 370 female volunteers and developed the first skin-specific second-generation epigenetic age clock that accurately predicts the skin aging phenotype represented by wrinkle grade, visual facial age, and visual age progression, respectively. We then validated the performance of our clocks on independent datasets and demonstrated their broad applicability. In addition, we integrated gene expression and methylation data from independent studies to identify potential pathways contributing to skin age progression. Our results demonstrate that our epigenetic age clock, VisAgeX, specifically predicting visual age progression, not only captures known biological pathways associated with skin aging, but also adds novel pathways associated with skin aging.

Skin Disease Profile in Geriatric Inpatients at a Tertiary Referral Hospital

Background

Elderly people are susceptible to various skin diseases. To monitor disease trends in the geriatric population, epidemiologic data on skin diseases are essential. However, studies on skin diseases in geriatric patients in Indonesia, particularly those who are hospitalised, are limited. Therefore, this retrospective study aims to determine the skin disease profile in geriatric patients at a tertiary referral hospital in Indonesia.

Methods

The subjects were all geriatric inpatients who were consulted at the Department of Dermatology and Venereology, Dr. Cipto Mangunkusumo National General Hospital between 2017 and 2019. The patients were analysed according to sex, age and comorbidities. They were divided into 15 groups according to the diseases. Chi-square test or Fisher's exact test was used to compare categorical variables.

Results

The most common skin diseases were infections (35.8%), dermatitis (21.8%), ulcers (12.8%), age-related skin changes (8.4%) and vascular diseases (5.3%). Dermatitis was significantly more common in males (P < 0.05), whereas infections were significantly more common in females (P < 0.05).

Conclusion

Consistent with previous studies, our inpatient data showed that infections were significantly more common in females, whereas dermatitis was significantly more common in males. The data collected may contribute to epidemiologic data on skin diseases in the geriatric population.

Adherence to dermatologic treatment: A retrospective cross-sectional study on geriatric patients

OBJECTIVE

With the prolongation of the average life expectancy worldwide, diseases including dermatological disorders of the elderly are gaining importance. The presence of comorbidities in this age group may affect the treatment strategies; compliance with follow-up and adherence to medication can be poor. The aim of this study is to evaluate the dermatological disorders of patients aged 65 and over and determine their adherence to dermatologic treatment.

METHODS

A retrospective and cross-sectional study was conducted on patients aged 65 and over applied to a single tertiary dermatology clinic between April 2021 and April 2022. Diagnoses were that clinical and diagnostic tests were performed when only necessary.

RESULTS

A total of 207 admissions to the dermatology clinic by 135 patients were evaluated. Eczema (23.05%) and infections (25.2%) were the most common dermatological diagnoses. The percentage of patients with precancerous and cancerous lesions was 11.9%. Among 123 patients who need at least a follow-up visit, only 37 patients (30.1%) applied for follow-up as advised, and medicines were taken regularly by 23 of these patients (62.2%). Compliance with follow-up was lower among men (OR 0.365, 95% CI 0.160-0.834, and p=0.02) and patients who were treated only with local therapy agents (OR 0.345, 95% CI 0.138-0.863, and p=0.20).

CONCLUSION

Eczema and infections were the most common dermatological diagnoses among geriatric patients in the present study. The majority of geriatric patients with skin conditions were not applying for follow-up visits. Women and patients treated with systemic therapy agents were more compliant. The prevalence of basal cell carcinoma was not low, and this emphasizes the importance of a careful dermatological examination regardless of primary complaint in this age group.

A novel hydrogel-based moisturizing cream composed of hyaluronic acid for patients with xerosis: An intraindividual comparative analysis

BACKGROUND

Hyaluronic acid (HA) is mainly used to treat xerosis. It also exerts wound-healing, moisturizing, and antiaging effects. Although HA is considered an effective and safe ingredient in cosmetics, there is a constant demand for a more money-saving and effective formulation. This study aimed to evaluate the safety and efficacy of a novel hydrogel-based moisturizer containing HA cross-linked with silicone polymers, produced solely through irradiation without the use of cross-linking agents.

MATERIALS AND METHODS

A safety study enrolled 30 participants with healthy skin to perform patch and photopatch tests while recording adverse events. For the efficacy study, 30 participants with xerosis were compared before and after using the novel hydrogel, evaluating the cutaneous barrier function, xerosis severity scale (XSS) score, participant's satisfaction, and Investigator's Global Assessment (IGA). Furthermore, the efficacy of the novel hydrogel-based moisturizer was evaluated by comparing it with a conventional moisturizer, Physiogel, in another 30 participants with xerosis.

RESULTS

In the safety study, no serious adverse events were observed. In the efficacy study before and after use, skin hydration and skin surface lipid increased (p < 0.05) whereas the XSS scores decreased (p < 0.05) with time. In the comparative efficacy study with Physiogel, skin hydration increased whereas the XSS scores decreased (p < 0.05) over time in both groups. Furthermore, IGA improved in 100% of participants in both groups. Also, 100% and 93% of participants were satisfied with the novel hydrogel-based moisturizer and Physiogel, respectively.

CONCLUSIONS

The novel hydrogel-based moisturizer proved to be safe and effective for xerosis, showing comparable results to the conventional moisturizer.

The prevalence and interventions of xerosis cutis among older adults: A systematic review and meta-analysis

BACKGROUND

Xerosis cutis in older adults is a geriatric public health issue that severely affects healthy aging, associated with adverse outcomes and increased nursing burden. Skin care plays a significant role in the management of xerosis cutis.

AIM

To assess the pooled prevalence and interventions of xerosis cutis among older adults.

METHODS

We searched ten databases systematically from inception to August 29, 2023. We estimated pooled prevalence of xerosis cutis using Stata 15.0.

RESULTS

28 articles were included in this review. The pooled prevalence of xerosis cutis was 53 %(95 %CI:36-69 %). We found the prevalence of xerosis cutis was highest in nursing homes and developed countries. The prevalence of xerosis cutis was similar in males and females. The prevalence of mild xerosis cutis and xerosis cutis at lower limbs was relatively high. Regular use of humectant-containing leave-on skin care products and structured skin care regimens were helpful in alleviating xerosis cutis.

CONCLUSION

Older adults are at high risk for xerosis cutis. The research provides health professionals with a basic framework for the prevention and management of xerosis cutis.

Bifidobacterium longum 68S mediated gut-skin axis homeostasis improved skin barrier damage in aging mice

BACKGROUND

Bifidobacterium as probiotics, play important roles in skin status, while the potential mechanisms interaction remains unknown. The study further explored the potential mechanism of B. longum 68S in ameliorating skin barrier damage from the perspective of the gut-skin axis in aging mice.

METHODS

B. longum 68S supplied natural aging mouse model and fecal microbiota transplantation (FMT) experiment proves the key role of intestinal microbiota in B. longum 68S up-regulating the production of ceramide synthesis key enzyme (SPT1) and ceramide level and improving skin barrier damage. Moreover, B. longum 68S supplied SPT1 gene deletion mouse model to investigate the mechanism of B. longum 68S on improving skin barrier damage.

RESULTS

Transcriptome analysis and 16S rRNA high-throughput pyrosequencing demonstrated that aging mice exhibited skin barrier dysfunction and intestinal dysbiosis. Meanwhile, aging mice exhibited an up-regulation in the trans epidermal water loss (TEWL) and a down-regulation in the level of SPT1, ceramide and skin barrier-related proteins (Loricrin, Keratin 10 and Desmoglein 1). Similarity, the FMT from aging mice to normal mice and SPT1 gene deletion mice could rebuild skin barrier damage and B. longum 68S supplementation exerted a positive effect on it. Further, B. longum 68S-mediated SPT1-derived ceramide production prevented impaired ceramide synthesis-induced endoplasmic reticulum stress and apoptotic response, ultimately improving skin barrier damage in vitro.

CONCLUSION

Emerging anti-aging therapies are necessary given the poor safety profiles of current pharmaceutical drugs. B. longum 68S may be better alternatives, considering the association between the gut microbiota and healthy aging. The findings suggested that B. longum 68S-mediated gut-skin axis homeostasis, thereby exhibiting an anti-aging effect and facilitate a better understanding of the mechanisms governing the various beneficial effects of B. longum 68S.

Skin Cancer Microenvironment: What We Can Learn from Skin Aging?

Aging is a natural intrinsic process associated with the loss of fibrous tissue, a slower cell turnover, and a reduction in immune system competence. In the skin, the continuous exposition of environmental factors superimposes extrinsic damage, mainly due to ultraviolet radiation causing photoaging. Although not usually considered a pathogenic event, photoaging affects cutaneous biology, increasing the risk of skin carcinogenesis. At the cellular level, aging is typified by the rise of senescence cells a condition characterized by reduced or absent capacity to proliferate and aberrant hyper-secretory activity. Senescence has a double-edged sword in cancer biology given that senescence prevents the uncontrolled proliferation of damaged cells and favors their clearance by paracrine secretion. Nevertheless, the cumulative insults and the poor clearance of injured cells in the elderly increase cancer incidence. However, there are not conclusive data proving that aged skin represents a permissive milieu for tumor onset. On the other hand, tumor cells are capable of activating resident fibroblasts onto a pro-tumorigenic phenotype resembling those of senescent fibroblasts suggesting that aged fibroblasts might facilitate cancer progression. This review discusses changes that occur during aging that can prime neoplasm or increase the aggressiveness of melanoma and non-melanoma skin cancer.

Clusters of medical specialties around patients with multimorbidity - employing fuzzy c-means clustering to explore multidisciplinary collaboration

BACKGROUND

Hospital care organization, structured around medical specialties and focused on the separate treatment of individual organ systems, is challenged by the increasing prevalence of multimorbidity. To support the hospitals' realization of multidisciplinary care, we hypothesized that using machine learning on clinical data helps to identify groups of medical specialties who are simultaneously involved in hospital care for patients with multimorbidity.

METHODS

We conducted a cross-sectional study of patients in a Dutch general hospital and used a fuzzy c-means clustering algorithm for the analysis. We explored the patients' membership degrees in each cluster to identify subgroups of medical specialties that provide care to the same patients with multimorbidity. We used retrospectively collected electronic health record data from 2017. We extracted data from 22,133 patients aged ≥18 years who had received outpatient clinical care for two or more chronic and/ or oncological diagnoses.

RESULTS

We found six clusters of medical specialties and identified 22 subgroups. The clusters were labeled based on the specialties that most characterized them: 1. dermatology/ plastic surgery, 2. six specialties (gynecology/ rheumatology/ orthopedic surgery/ urology/ gastroenterology/ otorhinolaryngology), 3. pulmonology, 4. internal medicine/ cardiology/ geriatrics, 5. neurology/ physiatry (rehabilitation)/ anesthesiology, and 6. internal medicine. Most patients had a full or dominant membership to one of these clusters of medical specialties (11 subgroups), whereas fewer patients had a membership to two clusters. The prevalence of specific diagnosis groups, patient characteristics, and healthcare utilization differed between subgroups.

CONCLUSION

Our study shows that clusters and subgroups of medical specialties simultaneously involved in hospital care for patients with multimorbidity can be identified with fuzzy c-means cluster analysis using clinical data. Clusters and subgroups differed regarding the involved medical specialties, diagnoses, patient characteristics, and healthcare utilization. With this strategy, hospitals and medical specialists can further analyze which subgroups are target populations that might benefit from improved multidisciplinary collaboration.

Knowledge, Attitude, and Practice of Skin Care Among Elderly Patients in Riyadh, Saudi Arabia

As people age, the likelihood that they will experience maladies of the skin increases. It is therefore important that older individuals possess the necessary knowledge and proper attitudes and practices regarding their skincare. The purpose of this study was to examine such knowledge, attitudes, and practices among older members of the Saudi Arabian population. The results of the study showed that among the majority of the participants, skincare practices could be considered insufficient and, surprisingly, elderly men undertake better skincare practices than women of this age category. It is recommended that more should be done to educate those within the older Saudi population regarding skin care practices.

Associations of self-reported skin symptoms with age, sex, and living with a partner: Findings from a representative survey in view of the biomedical and the biopsychosocial model

Introduction

Social and demographic characteristics are crucial determinants of health. The objective of this contribution is to study the associations of skin symptoms and sociodemographic variables in the general population, and to discuss these findings in view of the biomedical and the biopsychosocial models of skin diseases.

Methods

A national face-to-face household survey with a representative sample of the German general population assessed 19 self-reported skin symptoms (N = 2,487). Associations with age, sex, and living situation (alone vs. with partner) were analyzed using logistic regression analyses.

Results

The frequencies of pimples and biting of the nails decreased by approximately 30% per age decade, and oily skin, the feeling of disfigurement, excoriations, and sun damages decreased by 8%-15% per age decade. Dryness of the skin increased by 7% per decade. Sensitive skin and dryness were approx. twice as likely in females as in males. Dryness of the skin, itch, and excoriations were 23%-32% more frequent in participants living without a partner.

Discussion

The biomedical model explains some of the findings well (e.g., reduction of pimples with age). The interpretation of other results is facilitated by the biopsychosocial model (e.g., association of living without a partner and itch). This suggests a stronger integration of psychological and social factors into the understanding and treatment of symptoms of the skin.

Efficacy and safety of oral palmitoleic acid supplementation for skin barrier improvement: A 12-week, randomized, double-blinded, placebo-controlled study

Background

Palmitoleic acid (omega-7) has been reported to be effective primarily for metabolic disorders. Recently, it has been reported to help improve quality of life (QoL) by improving skin symptoms.

Objective

The aim of this randomized, double-blinded, placebo-controlled clinical study is to evaluate the efficacy and safety of oral palmitoleic acid in improving skin barrier, elasticity, and wrinkle formation in adult women.

Methods

In this randomized, double-blind, placebo-controlled clinical study, 90 healthy participants were enrolled and received 500 mg/day palmitoleic acid (intervention) or corn oil without palmitoleic acid (control) for 12 weeks. Skin hydration and transepidermal water loss and skin elasticity, surface roughness, eye wrinkle volume, and wrinkle severity were measured at 6-week intervals to assess the skin barrier function and efficacy in wrinkle improvement, respectively.

Results

After 12 weeks, skin hydration and transepidermal water loss significantly improved in the intervention group compared to the control group. Skin elasticity, surface roughness, eye wrinkle volume, wrinkle severity, and participant-assessed clinical improvement score did not significantly improve compared with the control group.

Conclusion

Oral palmitoleic acid effectively improves the skin barrier function improvement, which may enhance QoL in aging adults.

Skin aging associated with chromium among rural housewives in northern China

Previous studies have found associations between chromium exposure and skin damage. However, few studies have focused on both chromium and skin aging. This study aimed to assess the degree of skin aging symptoms and estimate the relationship between hair chromium and skin aging among rural housewives. We recruited 405 subjects in Shanxi Province of northern China and analyzed 397 eligible hair samples with inductively coupled plasma-mass spectrometry (ICP-MS). The subjects' skin aging symptoms were assessed with SCINEXA™ (SCore of INtrinsic and EXtrinsic skin Aging). After adjusting for age and other important covariates, the regression results showed more severe skin aging symptoms in women with a higher level of hair chromium and presented an increasing linear trend. Vegetables, fruits, and beans might be a source of chromium exposure. We concluded that skin aging might be positively associated with hair chromium. It is necessary to take measures to reduce chromium exposure to prevent skin aging.

Cross-setting Comparison of Risk Factors for Pressure Injuries Acquired in Post-Acute Care

GENERAL PURPOSE

To provide information on the association between risk factors and the development of new or worsened stage 2 to 4 pressure injuries (PIs) in patients in long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), and skilled nursing facilities (SNFs).

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:1. Compare the unadjusted PI incidence in SNF, IRF, and LTCH populations.2. Explain the extent to which the clinical risk factors of functional limitation (bed mobility), bowel incontinence, diabetes/peripheral vascular disease/peripheral arterial disease, and low body mass index are associated with new or worsened stage 2 to 4 PIs across the SNF, IRF, and LTCH populations.3. Compare the incidence of new or worsened stage 2 to 4 PI development in SNF, IRF, and LTCH populations associated with high body mass index, urinary incontinence, dual urinary and bowel incontinence, and advanced age.

The multiscale characterization and constitutive modeling of healthy and type 2 diabetes mellitus Sprague Dawley rat skin

In type 2 diabetes mellitus (T2DM), elevated glucose level impairs the biochemistry of the skin which may result in alteration of its mechanical and structural properties. The several aspects of structural and mechanical changes in skin due to T2DM remain poorly understood. To fill these research gaps, we developed a non-obese T2DM rat (Sprague Dawley (SD)) model for investigating the effect of T2DM on the in vivo strain stress state, mechanical and structural properties of skin. In vivo strain and mechanical anisotropy of healthy and T2DM skin were measured using the digital imaging correlation (DIC) technique and DIC coupled bulge experiment, respectively. Fluorescence microscopy and histology were used to assess the collagen and elastin fibers microstructure whereas nanoscale structure was captured through atomic force microscopy (AFM). Based on the microstructural observations, skin was modeled as a multilayer membrane where in and out of plane distribution of collagen fibers and planar distribution of elastin fibers were cast in constitutive model. Further, the state of in vivo stresses of healthy and T2DM were measured using model parameters and in vivo strain in the constitutive model. The results showed that T2DM causes significant loss in in vivo stresses (p < 0.01) and increase in anisotropy (p < 0.001) of skin. These changes were found in good correlation with T2DM associated alteration in skin microstructure. Statistical analysis emphasized that increase in blood glucose concentration (HbA1c) was the main cause of impaired biomechanical properties of skin. The presented data in this study can help to understand the skin pathology and to simulate the skin related clinical procedures. STATEMENT OF SIGNIFICANCE: Our study is significant as it presents findings related to the effect of T2DM on the physiologic stress strain, structural and mechanical response of SD rat skin. In this study, we developed a non-obese T2DM SD rat model which mimics the phenotype of Asian type 2 diabetics (non-obese). Several structural and mechanical characterization techniques were explored for multiscale characterization of healthy and T2DM skin. Further, based on microstructural information, we presented the constitutive models that incorporate the real microstructure of skin. The presented results can be helpful to simulate the realistic mechanical response of skin during various clinical trials.

The Role of Anti-Factor Xa Activity in the Management of Ecchymosis in Patients Receiving Rivaroxaban after Total Knee Arthroplasty

This study aims to evaluate the efficacy of anti-factor Xa activity (aFXa) in predicting ecchymosis after total knee arthroplasty (TKA). One hundred and two unilateral primary TKA patients were recruited consecutively in this prospective observational study. Participants received rivaroxaban (10 mg p.o. qd) from postoperative day 1 (POD1) to POD35 and were divided into a non-ecchymosis group (group A) and an ecchymosis group (group B). AFXa was assessed as the primary outcome on POD1 and POD3. Prothrombin time (PT), activated partial thromboplastin time (APTT) and thromboelastography (TEG) were recorded both preoperatively and postoperatively (on POD1 and POD3). Other outcomes, including venous thromboembolism (VTE), blood loss and wound complications were also collected and compared. As a result, 27.5% of the participants (n = 28) were allocated into group B. Demographic data were comparable between the two groups. The aFXa levels in group B were significantly higher than those in group A on POD1 and POD3, and the aFXa level was assessed as an independent risk factor for ecchymosis. The cut-off value of aFXa was determined to be 121.38 ng/mL at maximal Youden index, associated with area under the receiver operating characteristics curve of 0.67. Group B experienced significantly more blood loss and wound complications than group A. No statistical difference was detected regarding PT, APTT and TEG parameters. AFXa is a promising parameter to predict ecchymosis after TKA. Patients with aFXa > 121.38 ng/mL should be considered as high-risk population for postoperative ecchymosis and may require intense monitoring or dosage modification of anticoagulants.

Risk of skin tears associated with nursing interventions: A systematic review

BACKGROUND

Skin tears are a significant problem for patients and healthcare professionals. They can cause pain, impact quality of life, and become chronic and infected. The risk of skin tears is associated with dependence in daily life activities and with nursing interventions.

OBJECTIVES

To examine which nursing interventions increase the risk of skin tears.

DESIGN

Systematic review.

DATA SOURCES

The MEDLINE, CINAHL, Scopus, and Cochrane Library databases were searched in March 2022.

PUBLICATION YEARS

Publications included were from 2012 to 2022.

RESULTS

Seventeen articles were included in the final analysis reporting nursing interventions associated with the risk of skin tears. Hygiene with cold water and soap, not applying leave-on products to moisten/protect dehydrated skin, and wearing short sleeves were found to be associated with skin tears. Transferring patients into and out of bed in a rough manner and wearing jewelry or long nails can increase the risk of skin tears. Removal of adhesive dressings or bandages can also cause skin tears.

CONCLUSION

Nursing staff need to know which interventions put their patients at risk of skin tears and which interventions are recommended to prevent skin tears. Nursing care can affect the health of the patient's skin.

Rete ridges: Morphogenesis, function, regulation, and reconstruction

Rete ridges (RRs) are distinct undulating microstructures at the junction of the dermis and epidermis in the skin of humans and certain animals. This structure is essential for enhancing the mechanical characteristics of skin and preserving homeostasis. With the development of tissue engineering and regenerative medicine, artificial skin grafts have made great progress in the field of skin healing. However, the restoration of RRs has been often disregarded or absent in artificial skin grafts, which potentially compromise the efficacy of tissue repair and regeneration. Therefore, this review collates recent research advances in understanding the structural features, function, morphogenesis, influencing factors, and reconstruction strategies pertaining to RRs. In addition, the preparation methods and limitations of tissue-engineered skin with RRs are discussed. STATEMENT OF SIGNIFICANCE: The technology for the development of tissue-engineered skin (TES) is widely studied and reported; however, the preparation of TES containing rete ridges (RRs) is often ignored, with no literature reviews on the structural reconstruction of RRs. This review focuses on the progress pertaining to RRs and focuses on the reconstruction methods for RRs. In addition, it discusses the limitations of existing reconstruction methods. Therefore, this review could be a valuable reference for transferring TES with RR structure from the laboratory to clinical applications in skin repair.

Safety and efficacy of a new hydrogel based on hyaluronic acid as cosmeceutical for xerosis

BACKGROUND

Hyaluronic acid (HA) is among the most effective and safe ingredients frequently used in cosmetics. However, a more economical and efficient formulation is still required.

OBJECTIVE

We sought to assess the safety and efficacy of a novel hydrogel manufactured only by irradiation containing cross-linked HA and polyethylene glycol polymers with addition of polysiloxane.

METHODS

The study included 30 people with normal skin and 30 patients with xerosis. In the normal skin group, to evaluate the safety, a patch test and a photopatch test were performed, and patients' discomfort was investigated. In those with xerosis, to assess the efficacy, a skin barrier function test was performed at baseline and at 2, 4, and 8 weeks after the application of the novel hydrogel. Additionally, the xerosis severity scale (XSS), patient satisfaction, Investigator's Global Assessment (IGA), and adverse responses were evaluated.

RESULTS

In the safety study, there was no significant discomfort in the experimental group compared with the control group. In the efficacy study, at 2, 4, and 8 weeks after the application of the novel hydrogel, the mean value of skin hydration and sebum content increased and the mean value of XSS decreased with time in the experimental group, and a difference was observed when compared with the control group. IGA showed improvement in 97%, 77%, and 80% at each visit and the proportions of satisfied patients were 90%, 87%, and 90%, respectively.

CONCLUSIONS

The novel HA-based hydrogel tested herein could be a safe and effective therapeutic remedy for xerosis.

Development of a Noninvasive Blood Glucose Monitoring System Prototype: Pilot Study

Background

Diabetes mellitus is a severe disease characterized by high blood glucose levels resulting from dysregulation of the hormone insulin. Diabetes is managed through physical activity and dietary modification and requires careful monitoring of blood glucose concentration. Blood glucose concentration is typically monitored throughout the day by analyzing a sample of blood drawn from a finger prick using a commercially available glucometer. However, this process is invasive and painful, and leads to a risk of infection. Therefore, there is an urgent need for noninvasive, inexpensive, novel platforms for continuous blood sugar monitoring.

Objective

Our study aimed to describe a pilot test to test the accuracy of a noninvasive glucose monitoring prototype that uses laser technology based on near-infrared spectroscopy.

Methods

Our system is based on Raspberry Pi, a portable camera (Raspberry Pi camera), and a visible light laser. The Raspberry Pi camera captures a set of images when a visible light laser passes through skin tissue. The glucose concentration is estimated by an artificial neural network model using the absorption and scattering of light in the skin tissue. This prototype was developed using TensorFlow, Keras, and Python code. A pilot study was run with 8 volunteers that used the prototype on their fingers and ears. Blood glucose values obtained by the prototype were compared with commercially available glucometers to estimate accuracy.

Results

When using images from the finger, the accuracy of the prototype is 79%. Taken from the ear, the accuracy is attenuated to 62%. Though the current data set is limited, these results are encouraging. However, three main limitations need to be addressed in future studies of the prototype: (1) increase the size of the database to improve the robustness of the artificial neural network model; (2) analyze the impact of external factors such as skin color, skin thickness, and ambient temperature in the current prototype; and (3) improve the prototype enclosure to make it suitable for easy finger and ear placement.

Conclusions

Our pilot study demonstrates that blood glucose concentration can be estimated using a small hardware prototype that uses infrared images of human tissue. Although more studies need to be conducted to overcome limitations, this pilot study shows that an affordable device can be used to avoid the use of blood and multiple finger pricks for blood glucose monitoring in the diabetic population.

Contact Allergy in the Elderly: A Study of 600 Patients

The proportion of elderly in the general population is increasing. Ageing of the skin and immune system can modify the features of contact hypersensitivity (CH). The number of epidemiological studies according to the age-related features of CH is very limited. We aimed to analyse the clinical characteristics of CH in an elderly patient population. A total of 600 patients (patient age > 60 years old) were patch tested with the European Environmental Baseline Series (EEBS) and 440 of them with the Complementary Fragrance Series (CFS) at the same time according to the actual international methodological standards in the Allergy Outpatient Unit of Department of Dermatology, Venereology and Dermato-Oncology of Semmelweis University between 2015−2019. Out of 600 tested patients, 54.8% had at least one allergen positivity. Female predominance was observed (78.7%). The most common diagnosis was contact dermatitis (63.7%), followed by psoriasis (6.2%). Most of the cases (58.0%) were found in the age group of 60−69. The five most common contact allergens were benzoic acid, methylisothiazolinone (MI), wood tar, nickel, and balsam of Peru. Allergic skin symptoms are present in all ages and also in the elderly. According to our data, the most common contact allergens are preservatives, followed by balsam of Peru among men and nickel among women. In case of contact dermatitis, stasis dermatitis, rosacea, and atopic dermatitis are worth patch testing to verify CH even in those above 60 years old.

Focus on the Contribution of Oxidative Stress in Skin Aging

Skin aging is one of the most evident signs of human aging. Modification of the skin during the life span is characterized by fine lines and wrinkling, loss of elasticity and volume, laxity, rough-textured appearance, and pallor. In contrast, photoaged skin is associated with uneven pigmentation (age spot) and is markedly wrinkled. At the cellular and molecular level, it consists of multiple interconnected processes based on biochemical reactions, genetic programs, and occurrence of external stimulation. The principal cellular perturbation in the skin driving senescence is the alteration of oxidative balance. In chronological aging, reactive oxygen species (ROS) are produced mainly through cellular oxidative metabolism during adenosine triphosphate (ATP) generation from glucose and mitochondrial dysfunction, whereas in extrinsic aging, loss of redox equilibrium is caused by environmental factors, such as ultraviolet radiation, pollution, cigarette smoking, and inadequate nutrition. During the aging process, oxidative stress is attributed to both augmented ROS production and reduced levels of enzymatic and non-enzymatic protectors. Apart from the evident appearance of structural change, throughout aging, the skin gradually loses its natural functional characteristics and regenerative potential. With aging, the skin immune system also undergoes functional senescence manifested as a reduced ability to counteract infections and augmented frequency of autoimmune and neoplastic diseases. This review proposes an update on the role of oxidative stress in the appearance of the clinical manifestation of skin aging, as well as of the molecular mechanisms that underline this natural phenomenon sometimes accelerated by external factors.

Matrikines as mediators of tissue remodelling

Extracellular matrix (ECM) proteins confer biomechanical properties, maintain cell phenotype and mediate tissue repair (via release of sequestered cytokines and proteases). In contrast to intracellular proteomes, where proteins are monitored and replaced over short time periods, many ECM proteins function for years (decades in humans) without replacement. The longevity of abundant ECM proteins, such as collagen I and elastin, leaves them vulnerable to damage accumulation and their host organs prone to chronic, age-related diseases. However, ECM protein fragmentation can potentially produce peptide cytokines (matrikines) which may exacerbate and/or ameliorate age- and disease-related ECM remodelling. In this review, we discuss ECM composition, function and degradation and highlight examples of endogenous matrikines. We then critically and comprehensively analyse published studies of matrix-derived peptides used as topical skin treatments, before considering the potential for improvements in the discovery and delivery of novel matrix-derived peptides to skin and internal organs. From this, we conclude that while the translational impact of matrix-derived peptide therapeutics is evident, the mechanisms of action of these peptides are poorly defined. Further, well-designed, multimodal studies are required.

Usage Patterns and Self-Esteem of Female Consumers of Antiaging Cosmetic Products

Aging is an irreversible process of the human body, resulting from a progressive decrease in the biological functions of the organs, including the skin. This study analyzed the relationship between usage patterns of different types of anti-aging cosmetic products, sociodemographic variables, appearance schemes, psychological morbidity, perfectionism, and aging perception of aging with self-esteem. This cross-sectional study included a sample of 260 women, aged between 25 and 64 years, who are users of anti-aging cosmetics and/or aesthetic treatments. Participants were assessed on psychological morbidity (Hospital Anxiety and Depression Scale), appearance schemes (Appearance Schemas Inventory—Revised), perfectionism (Frost Multidimensional Perfectionism Scale), aging perceptions (Brief Aging Perceptions Questionnaire), and self-esteem (Rosenberg Self-Esteem Scale). The use of facial-firming cosmetics positively correlated with self-esteem. The results of regression analysis revealed that psychological morbidity and perfectionism contribute negatively to self-esteem, while marital status, professional status, and aging perceptions (positive consequences) contribute positively. According to the results, intervention programs to promote women’s self-esteem should focus on the reduction in psychological morbidity and the promotion of adaptive patterns of perfectionism and address aging perceptions. Longitudinal studies might help explain the complex relationship between the use of anti-aging cosmetic products and psychological variables, particularly self-esteem in women.

Prevalence and burden of skin diseases among the elderly in Singapore: A 15-year clinical cohort study

BACKGROUND

Populations around the world are rapidly ageing. The profile of skin diseases in the elderly is likely to present unique demands on the healthcare system.

OBJECTIVES

To provide current data on the burden of skin diseases in Singaporean patients and identify differences in the pattern of skin diseases between elderly patients and the rest of the population.

METHODS

This was a retrospective cohort study of 858,117 patients who attended the National Skin Centre between 2004 to 2018. Prevalence was calculated by grouping International Classification of Diseases codes into different categories of skin conditions based on Global Burden of Disease and American Academy of Dermatology classifications. Years lost to disability (YLD) and disability-adjusted life years (DALY) were calculated to report the morbidity and mortality of skin diseases. Differences of each skin condition between age groups were compared.

RESULTS

The three most prevalent dermatoses across all age groups were dermatitis (33.3%), acne vulgaris (8.3%) and viral skin diseases (7.5%). The top three most common skin conditions among the elderly were dermatitis (37.7%), viral skin diseases (6.2%), and fungal skin diseases (4.3%). Decubitus ulcers, keratinocyte carcinomas and scabies represented a significant proportion of YLD per 100,000 in the elderly (p <0.001). Malignant melanomas, keratinocyte carcinomas, cellulitis, pyoderma, and decubitus ulcers contributed to high DALY in patients aged 70 - 80 years old.

CONCLUSION

Aligning health systems with specific healthcare needs will reduce the disproportionately high burden of skin disease observed in the elderly.

Anti-skin Aging Activities of Sideritis scardica and 3 Flavonoids With an Uncommon 8-Hydroxyl Moiety

The skin plays various crucial biological functions and gradually degenerates due to the process of skin aging. Hence, the development of new ingredients for delaying or even reversing skin aging is an essential subject that needs to be addressed. Our screening effort for anti-skin aging ingredients has led to the discovery that Sideritis scardica extract (SSE) possesses collagenase inhibition, advanced glycation end product (AGE) formation inhibition, antioxidative, and antiallergic activities, as well as ultraviolet B (UVB)-induced matrix metalloproteinase-1 (MMP-1) expression inhibition activity. However, the effect of S. scardica, commonly known as a mountain herb, on skin aging is unknown and needs additional study. Further studies on SSE have led to the isolation of 3 flavonoids with an uncommon 8-hydroxyl moiety, isoscutellarein (1), 4′- O-methylhypolaetin (2), and 4′- O-methylisoscutellarein (3). Biological evaluations also revealed that 1-3 possess SSE collagenase inhibition, AGE formation inhibition, antioxidative, and antiallergic activities, while 3 was identified to possess SSE UVB-induced MMP-1 expression inhibition activity. Moreover, the AGE formation inhibition activity and antiallergic activity of 1-3 were speculated to be derived from their antioxidative activity, while direct inhibition of the collagenase enzyme led to their observed collagenase inhibition activity. Regarding the inhibition activity of 1-3 on UVB-induced MMP-1 expression, further studies are necessary to reveal their possible mechanism of action. Collectively, the biological activities of SSE and the isolated flavonoids 1-3 highlight the potential of S. scardica to be further developed as an agent to delay or reverse skin aging.

Feet/Footwear-Related Fall Risk Screening Tool for Older Adults: Development and Content Validation

Background and Purpose

Screening for feet- and footwear-related influences on fall risk is an important component of multifactorial fall risk screenings, yet few evidence-based tools are available for this purpose. We developed the Screening Tool for Feet/Footwear-Related Influences on Fall Risk to support interprofessional health care providers in their efforts to screen for feet/footwear-related influences on fall risk among community-dwelling older adults identified at risk for falling.

Materials and Methods

The study consisted of two phases. During Phase 1, results of a systematic review of lower-limb factors associated with balance and falls informed tool development. The tool's initial draft was evaluated by an external group of nine interprofessional content experts. After incorporating changes recommended by Phase 1 participants, Phase 2 was initiated. During Phase 2, eight new interprofessional experts (19.3 average years of experience) completed the three rounds of a modified Delphi study.

Results

Phase 1 experts recommended modifying eight items and rated the tool's clarity, appeal and clinical feasibility as 81.2/100, 79.1/100, and 76.1/100, respectively. Phase 2 participants suggested combining items with similar recommended actions, adding a question about orthoses, and increasing the specificity of nine items. The refinements resulted in a 20-item screening tool. Each item was approved by the Phase 2 participants with > 80% agreement after two rounds of consensus voting, reflecting the tool's high face and content validity.

Conclusion

The new screening tool has high face and content validity and supports identification of feet- and footwear-related influences on fall risk among community-dwelling older adults. The tool can be used by interprofessional healthcare providers completing a multifactorial fall risk screening on community-dwelling adults identified as being at risk for falling.

A Correlation of the Glogau Scale With VISIA-CR Complexion Analysis Measurements in Assessing Facial Photoaging for Clinical Research

BACKGROUND

Historically, common evaluations for photoaging have been subjective analysis; however, recently, investigators have turned to non-invasive devices for more objective evaluation of facial aging.

OBJECTIVES

This study aimed to establish a clinical correlation between the Glogau Photoaging Scale and VISIA-CR Complexion Analysis System. In doing so, decreasing intra- and inter-observer variability when assessing photodamage.

METHODS

One-hundred seventeen subjects between ages 18 and 89 were included. 2D facial photographs were analyzed by three independent reviewers and were assigned Glogau scores. Images were also captured and analyzed using VISIA software. Data was grouped by median Glogau score and compared between groups.

RESULTS

All groups were statistically different (p < 0.05) for Spots, Wrinkles and Remasked Wrinkles, except for Glogau 1 and 2 for Spots and Remasked Wrinkles. Wrinkles scores were plotted against age, and an exponential regression model was noted to be a better fit (R 2 = 0.5) compared to a linear model (R 2 = 0.47). The same was true for Spots with an exponential (R 2 = 0.36) compared to linear model (R 2 = 0.33). Scores were also evaluated based on sun exposure history, of which there were no significant differences.

CONCLUSIONS

The results illustrate that an imaging system can be used to reliably determine objective scores correlating to Glogau photoaging evaluations. Results also supported that aging more closely resembles an exponential process. Collectively, these findings will prove useful to those hoping to further investigate facial aging and therapeutic options available for facial skin rejuvenation and objectively assessing their outcomes.

Changes in Thromboelastography to Predict Ecchymosis After Knee Arthroplasty: A Promising Guide for the Use of Anticoagulants

Background

Ecchymosis is one of the worrisome complications after total knee arthroplasty (TKA) and interferes with functional rehabilitation. Current clinical guidelines do not provide individualized approaches for patients with ecchymoses.

Methods

In this study, we used thromboelastography (TEG) to determine the coagulation state after TKA and to then explore markers that predict the occurrence of ecchymosis events after TKA. In our cohort, patients were divided into ecchymosis (n = 55) and non-ecchymosis (n = 137) groups according to whether ecchymosis events occurred after TKA. Rivaroxaban 10 mg/d was taken orally for thromboprophylaxis after surgery. All patients completed TEG testing. Correlation analysis was used to determine the risk factors for ecchymosis after TKA, and receiver operating characteristic (ROC) curves for variables with significant correlation were plotted.

Results

In all, 55 of the 192 patients (28.65%) developed ecchymosis surrounding the surgical site. Multivariate analysis showed that hidden blood loss (OR = 1.003 and p = 0.005) and changes in the coagulation index (ΔCI) values (OR = 0.351 and p = 0.001) were risk factors for ecchymosis after TKA. Using the Youden index, 0.1805 was determined as the optimal threshold value of ΔCI for predicting the occurrence of ecchymosis, with a sensitivity of 74.55% and specificity of 72.99%. ΔCI is a promising marker as an alarm for the occurrence of ecchymosis after TKA.

Trial Registration

The study was registered in the Chinese Clinical Trial Registry (ChiCTR1800017245). Registered name: The role of thrombelastography in monitoring the changes of coagulation function during perioperative period of arthroplasty. Registered 19 July 2018. http://www.chictr.org.cn/showproj.aspx?proj=29220

Prevalence and potential risk factors of chronic pruritus among community middle-aged and older population in Beijing, China

BACKGROUND

Chronic pruritus is a common problem among older adults, with a significant impact on their quality of life. However, it is under-studied epidemiologically, especially among Chinese older adults.

OBJECTIVE

To identify the prevalence and explore the risk factors of chronic pruritus among the middle-aged and older adults in Beijing, China.

METHODS

A total of 929 participants aged ≥35 years from six communities in Beijing, China, were interviewed. The survey collected the demographic characteristics, the experience of chronic pruritus (>6 weeks), chronic disease history, the level of physical activities, and sleep quality. A population-based case-control study was conducted, including 178 chronic pruritus cases and 697 controls. A multivariate logistic regression model was performed to explore the risk factors of chronic pruritus. Additionally, a random forest algorithm was used to rank the importance of potential risk factors and analyze the overall interpretation of risk factors.

RESULTS

The prevalence of chronic pruritus was 19.48% (181/929) among the Beijing middle-aged and elderly population. The findings indicated that older adults aged 65 years old or above, male, with college or higher degree, alcohol drinking, hypertension, hyperlipidemia, chronic lung disease, cardiovascular disease, digestive system disease and osteoarthritis/rheumatism, middle or low sleep quality were associated with the increased risk of chronic pruritus, respectively. Physical activity level (≥3000 Met) was associated with a decreased risk of chronic pruritus. The rank according to the most contribution of chronic pruritus risk was sleep quality, education, physical activity level, osteoarthritis/rheumatism, age, and gender.

CONCLUSION

Prevalence of chronic pruritus was high among the Chinese middle-aged and elderly population. Age, gender, high education, alcohol drinking, hypertension, hyperlipidemia, chronic lung disease, cardiovascular disease, digestive system disease, osteoarthritis /rheumatism, poor sleep quality may serve as risk factors of chronic pruritus. Moderate and high physical activity levels may serve as protective factors of chronic pruritus risk.

Skin Immunosenescence and Type 2 Inflammation: A Mini-Review With an Inflammaging Perspective

Skin-resident stromal cells, including keratinocytes, fibroblasts, adipocytes, and immune cells including Langerhans cells, dendritic cells, T cells, and innate lymphoid cells, and their functional products work in concert to ensure the realization of skin barrier immunity. However, aging-induced immunosenescence predisposes the elderly to pruritic dermatoses, including type 2 inflammation-mediated. Inflammaging, characterized by chronic low level of pro-inflammatory cytokines released from senescent cells with the senescence-associated secretory phenotype (SASP), may drive immunosenescence and tangle with type 2 inflammatory dermatoses. The present mini-review summarizes current evidence on immunosenescence and type 2 inflammation in the skin and further focuses on future needs from an inflammaging perspective to clarify their complexity.

The effect of hyperbaric oxygen therapy on the pathophysiology of skin aging: a prospective clinical trial

INTRODUCTION

Skin biopsies can be used to evaluate physiological effects of aging targeted intervention at the tissue/cellular levels. Recent clinical trials have shown that hyperbaric oxygen therapy (HBOT) can target aging hallmarks, including telomere shortening, senescent cells clearance and angiogenesis. The aim of this study was to evaluate the effects of HBOT on the skin of a normal, non-pathological, aging population.

METHODS

The study was performed as a prospective clinical trial. After signing informed consent and undergoing baseline evaluations, the subjects were assigned to a three-month control period followed by three months of HBOT daily sessions. Skin biopsies were taken at baseline, after three months of no intervention (control) and 1-2 weeks following the last HBOT session. Trichrome, Orecin, lipofuscin and CD31 staining were used to evaluate collagen fibers, elastic fibers, senescent cells and blood vessels, respectively.

RESULTS

Out of the cohort of 70 participants in the normal aging population study, thirteen male patients (age 68.07±2.5y) gave consent for repeated skin biopsies. Following HBOT, there was a significant increase in collagen density (p<0.001, effect size(es)=1.10), elastic fiber length (p<0.0001, es=2.71) and the number of blood vessels (p=0.02, es=1.00). There was a significant decrease in fiber fragmentation (p=0.012) and in tissue senescent cells (p=0.03, es=0.84) post-HBOT. No changes were noted in elastic fiber density or thickness.

CONCLUSIONS

The study indicates, for the first time in humans, that HBOT can significantly modulate the pathophysiology of the skin aging in a healthy aging population. The demonstrated mechanisms include angiogenesis and senescent cell clearance.

An Analysis of Spontaneously Reported Data of Vesicular and Bullous Cutaneous Eruptions Occurring Following Vaccination with the Adjuvanted Recombinant Zoster Vaccine

Introduction

With the approval of the adjuvanted recombinant zoster vaccine (RZV; Shingrix, GSK) in October 2017, GSK established enhanced safety surveillance measures to allow prompt identification of potential safety signals not observed during clinical development. In Germany, cases of vesicular and bullous cutaneous eruptions following RZV vaccination were reported.

Objective

Our objective was to search and analyse 2.5 years of worldwide spontaneously reported post-marketing data for vesicular and bullous cutaneous eruptions, represented by adverse events suggestive of (1) herpes zoster (HZ) and (2) non-HZ vesicular and bullous cutaneous eruptions, that occurred following RZV vaccination.

Methods

We conducted a descriptive analysis of all identified reports of HZ and non-HZ vesicular and bullous cutaneous eruptions following RZV vaccination and an observed versus expected (O/E) analysis of reports of HZ that met criteria of varicella zoster virus (VZV) reactivations following RZV vaccination (i.e., time to onset [TTO] of the event < 30 days or missing after any dose).

Results

Until the data lock point, 32,597,779 RZV doses had been distributed globally. There were 2423 reports of HZ (including complications) identified, of which 645 met the criteria of possible vaccination failure (i.e., TTO of the event ≥ 30 days or missing following a complete RZV vaccination schedule). The O/E analysis of 1928 reports assessed as possible VZV reactivations indicated that the observed number of cases was lower than that expected in the general population. Additionally, 810 reports of non-HZ vesicular and bullous cutaneous eruptions were identified, including injection site rashes attributed to the vaccine’s reactogenicity.

Conclusion

This review of spontaneously reported post-marketing data did not raise safety concerns regarding the occurrence of vesicular and bullous cutaneous eruptions following vaccination with RZV.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40264-021-01118-3.

Shingles is a disease caused by reactivation of the chickenpox virus. It mostly affects adults aged 50 years and older and patients of all ages who have an impaired immune system. Diagnosis of shingles is often based only on the presence of symptoms such as a typical rash and pain. However, rashes can have various other causes (e.g., allergies, autoimmune diseases, and infections). Consequently, rashes with other causes may be misdiagnosed as shingles. Adults at increased risk of shingles and/or aged 50 years and older may be vaccinated with Shingrix (GSK, Belgium) to protect them from shingles and its complications. Since Shingrix became available in Germany, blister-like skin rashes have been reported that occurred shortly after vaccination. We searched the GSK safety database for reports of blister-like skin rashes that occurred following vaccination with Shingrix and that were spontaneously reported from countries where Shingrix was first marketed. To analyse these reports of rashes, we described the reports that we retrieved, we performed a statistical analysis to quantify whether the number of events assessed as reactivations of the chickenpox virus following Shingrix vaccination was higher than the number of reactivations that would be expected in the general population, and we described possible explanations for the observed rashes and underlying disease mechanisms. Our analyses did not raise safety concerns related to the onset of these rashes after vaccination with Shingrix. This paper raises awareness about the varying causes of rashes since a shingles-like rash that onsets shortly after vaccination with Shingrix is not necessarily caused by vaccination. In conclusion, this analysis shows that caution is needed when evaluating rashes in older adults and that all potential contributing factors (e.g., pre-existing diseases, medication, vaccination) should be considered.

Casper's sign in the elderly

Casper's sign refers to the absence of external signs of trauma despite severe and often lethal internal injuries. It occurs because the elasticity and resilience of the skin results in it deforming and moving rather than sustaining injuries from being tethered and relatively immobile. Given the known increase in skin and soft-tissue fragility in the elderly with a greater vulnerability for bruising and skin tears, a study was undertaken to determine whether Casper's sign may be present or not in older populations. A review of autopsy files at Forensic Science SA over a 20-year period from January 2000 to December 2019 was performed in individuals ≥80 years of age where death involved blunt chest trauma, blunt abdominal trauma or multiple blunt-force injuries. Four cases were identified. All of the decedents were males aged 82-89 years (Mage=86 years) with deaths associated with a fall (n=1) and vehicle impacts (n=3). Despite significant and often lethal internal chest/abdominal injuries, none of the cases had external injuries to their torsos. Thus, as Casper's sign may be present at all ages, the absence of external injury in the elderly may be no reflection of the force of the impact or the degree of resultant skeletal and/or internal organ disruption. This may be pertinent in cases of elder abuse.

Trichloroacetic Acid Peeling for Treating Photoaging: A Systematic Review

Photoaging can significantly contribute to lower quality of life. Medium-deep peeling using trichloroacetic acid allows controlled keratocoagulation through the dermis and into the dermal papillary layer that is effective for skin rejuvenation. The purpose of this article is to give updates regarding the efficacy, possible adverse events, and patient satisfaction of trichloroacetic acid (TCA) peeling for skin rejuvenation by assessing various photoaging parameters. A systematic review of prospective trial articles collected from PubMed, MEDLINE, EMBASE, Cochrane, and Scopus databases was conducted on November 2, 2020. Treatment efficacy was assessed based on the photoaging parameters used by each study. Adverse events and patient satisfaction as the secondary outcome were assessed based on patients-perceived improvements. Five studies included three randomized comparison studies and two prospective cohort studies. These studies show that TCA peeling significantly improve the cosmesis of photoaged facial skin. Low concentration is effective for superficial sun damage. Medium-depth peels using a higher concentration of TCA or as combination therapy are effective as skin resurfacing agents to reduce wrinkles. Some adverse effects may occur but usually resolve within weeks. Overall patients were satisfied with the treatment result. An equivalent basic skin preparation such as topical retinoic acid skin priming prior to intervention is necessary for more objective comparison. Further research studies with a larger sample size and longer follow-up period are required. This evidence suggests that TCA peeling is effective in photoaging treatment, either as monotherapy or as combination therapy with other modalities.

Integra as Firstline Treatment for Scalp Reconstruction in Elderly Patients

PURPOSE

Large scalp defects pose a reconstructive problem especially in elderly patients. The purpose of the study is to describe our experience of oncologic scalp reconstruction using a dermal matrix (Integra).

MATERIAL AND METHODS

We conducted a retrospective cohort study (January 2007 to March 2021) of patients who had undergone scalp tumor excision and reconstruction using Integra and a split-thickness skin graft (STSG). The primary end point was Integra and STSG success (defined by ≥75% percent take) and the secondary end point was postoperative complications. Both end points were assessed by the surgeon during follow-up. Demographic data, tumor characteristics, average defect size, time between stages and full-thickness scalp defects were characterized using descriptive statistics. Univariate and multivariate logistic regression models were used to evaluate the association between variables and end points.

RESULTS

The sample included 70 patients with a mean (SD) age of 83.3 (7.0) years, 75.7% men and 92.9% with comorbidities. Mean (SD) defect area was 23 (17.0) cm² and the mean (SD) first-to-second phase interval was 30.6 (8.4) days. Sixty-four patients (91.4%) underwent outpatient surgery. Integra and STSG success rates were 87.1% (95% CI: 77.69 to 93.74%) and 100%, respectively. The complications rate was 18.6% (95% CI: 9 to 28%). Mean (SD) follow-up was 18 (16.7) months. Univariate and multivariate logistic regression analysis showed no association between variables and the primary and secondary end points.

CONCLUSIONS

Reconstruction of oncologic scalp defects using Integra can be performed under sedation and local anesthesia. Integra should be considered as firstline treatment for the reconstruction of scalp defects in elderly patients with comorbidities, given the low postoperative major complications rate and Integra and STSG take success.

Safety of Endoscopic Sinus Surgery in the Elderly-Are Octogenarian Patients at a Higher Risk?

BACKGROUND

Surgeons are often faced with concerns regarding the risks versus benefits of endoscopic sinus surgery (ESS) in elderly patients.

OBJECTIVE

To analyze the risk for complications of ESS in the elderly (age ≥70 years) compared to younger patients, with emphasis on octogenarians.

METHODS

Retrospective review of medical charts of adult patients who underwent ESS at a tertiary referral center during the years 2014 to 2018.

RESULTS

We compared 128 elderly patients with 276 matched younger patients. In the elderly group mean age was 76 years (range, 70-91 years ). Thirty-one elderly patients were 80 years or older. Surgical complications in the elderly patients were 3.9%. Minor complications were 2.3% and major complications were 1.7%. The surgical complications rate was similar in the younger group (8%, P value: .127). Medical complications were observed in 2.3% comparing to 0.7% in younger patients. Interestingly, age, revision surgery, extent and duration of surgery, and modality of anesthesia were not identified as risk factors. Only ischemic heart disease (IHD) was identified as a risk factor for complications in a multivariate analysis in elderly patients. Comparison of elderly patients younger than 80 years with octogenarians revealed no difference in complication rate between these groups.

CONCLUSIONS

Overall, ESS was found to be a safe procedure in elderly patients compared to younger patients. Octogenarian patients should not be denied upfront surgery. IHD is a risk factor for complications in elderly patients.

Eczematous Drug Eruptions

Eczematous drug eruptions are a heterogenous group of skin reactions that resemble eczema both clinically and histologically. We reviewed the literature and cataloged the systemically administered medications that cause these eruptions, along with their characteristic clinical presentations. We identified three primary pathophysiologic etiologies: (1) cutaneous immunomodulation, (2) skin dehydration, and (3) delayed hypersensitivity. Notably, eczematous eruptions caused by altered immunity in the skin may be increasing in incidence as some responsible drugs, in particular biologic therapies (such as tumor necrosis factor-α and interleukin-17 inhibitors) and targeted cancer treatments (including immune checkpoint inhibitors and epidermal growth factor receptor inhibitors), become more commonly employed in clinical practice. Other notable causes of eczematous eruptions include antiviral agents for hepatitis C virus and cardiovascular medications in elderly individuals, and notable subtypes of eczematous reactions include systemic contact dermatitis and photoallergic reactions, which are also discussed. The diagnostic gold standard is drug rechallenge and most reactions may be treated effectively with emollients, topical corticosteroids, and oral antihistamines.

Applications of Mesenchymal Stem Cells in Skin Regeneration and Rejuvenation

Mesenchymal stem cells (MSCs) are multipotent stem cells derived from adult stem cells. Primary MSCs can be obtained from diverse sources, including bone marrow, adipose tissue, and umbilical cord blood. Recently, MSCs have been recognized as therapeutic agents for skin regeneration and rejuvenation. The skin can be damaged by wounds, caused by cutting or breaking of the tissue, and burns. Moreover, skin aging is a process that occurs naturally but can be worsened by environmental pollution, exposure to ultraviolet radiation, alcohol consumption, tobacco use, and undernourishment. MSCs have healing capacities that can be applied in damaged and aged skin. In skin regeneration, MSCs increase cell proliferation and neovascularization, and decrease inflammation in skin injury lesions. In skin rejuvenation, MSCs lead to production of collagen and elastic fibers, inhibition of metalloproteinase activation, and promote protection from ultraviolet radiation-induced senescence. In this review, we focus on how MSCs and MSC-derived molecules improve diseased and aged skin. Additionally, we emphasize that induced pluripotent stem cell (iPSC)-derived MSCs are potentially advanced MSCs, which are suitable for cell therapy.

Pathophysiology and Treatment of Pruritus in Elderly

Pruritus is a relatively common symptom that anyone can experience at any point in their life and is more common in the elderly. Pruritus in elderly can be defined as chronic pruritus in a person over 65 years old. The pathophysiology of pruritus in elderly is still unclear, and the quality of life is reduced. Generally, itch can be clinically classified into six types: Itch caused by systemic diseases, itch caused by skin diseases, neuropathic pruritus, psychogenic pruritus, pruritus with multiple factors, and from unknown causes. Senile pruritus can be defined as a chronic pruritus of unknown origin in elderly people. Various neuronal mediators, signaling mechanisms at neuronal terminals, central and peripheral neurotransmission pathways, and neuronal sensitizations are included in the processes causing itch. A variety of therapies are used and several novel drugs are being developed to relieve itch, including systemic and topical treatments.

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.

Anthocyanins, Vibrant Color Pigments, and Their Role in Skin Cancer Prevention

Until today, numerous studies evaluated the topic of anthocyanins and various types of cancer, regarding the anthocyanins' preventative and inhibitory effects, underlying molecular mechanisms, and such. However, there is no targeted review available regarding the anticarcinogenic effects of dietary anthocyanins on skin cancers. If diagnosed at the early stages, the survival rate of skin cancer is quite high. Nevertheless, the metastatic form has a short prognosis. In fact, the incidence of melanoma skin cancer, the type with high mortality, has increased exponentially over the last 30 years, causing the majority of skin cancer deaths. Malignant melanoma is considered a highly destructive type of skin cancer due to its particular capacity to grow and spread faster than any other type of cancers. Plants, in general, have been used in disease treatment for a long time, and medicinal plants are commonly a part of anticancer drugs on the market. Accordingly, this work primarily aims to emphasize the most recent improvements on the anticarcinogenic effects of anthocyanins from different plant sources, with an in-depth emphasis on melanoma skin cancer. We also briefly summarized the anthocyanin chemistry, their rich dietary sources in flowers, fruits, and vegetables, as well as their associated potential health benefits. Additionally, the importance of anthocyanins in topical applications such as their use in cosmetics is also given.