What you need to know about common skin problems in older adults.

Skin ageing is a multifaceted process impacted by both intrinsic and extrinsic factors. Drier and less elastic skin with declining sebum levels in older age makes ageing skin more vulnerable to various skin conditions, including infections, inflammatory dermatoses, and cancers. Skin problems are common among older adults due to the effects of ageing, polypharmacy and multimorbidity impacting not only physical health but wellbeing and quality of life. In the UK, older adults in geriatric medicine wards may present with various skin conditions. Hospitalised older individuals may have undiagnosed skin problems unrelated to their admission, making hospitalisation an opportunity to manage unmet needs. Asteatotic eczema, incontinence associated dermatitis, seborrhoeic dermatitis, chronic venous insufficiency, and cellulitis are common disorders clinicians encounter in the geriatric medicine wards. This article outlines the importance of performing comprehensive skin assessments to help diagnose and commence management for these common conditions.

Efficacy and Safety of Precision Cryotherapy to Treat Seborrheic Dermatitis of the Scalp.

BACKGROUND: Recently, a new cryotherapy device that precisely controls skin temperature was developed. Precision cryotherapy (PC) can be a safe and alternative treatment modality for immune-related skin diseases that are difficult to treat by conventional cryotherapy because of serious adverse events. OBJECTIVE: To evaluate the efficacy and safety of PC in scalp seborrheic dermatitis (SD). METHODS: A single-arm, prospective trial was designed. Twenty-four patients with SD underwent 3 PC interventions 2 weeks apart. At the baseline, Week 6, and Week 8, overall improvements in Physician Global Assessment (PGA) and clinical severity scores were assessed. At each visit, the erythema index (EI) and transepidermal water loss were evaluated. The patients scored 9 subjective symptoms using a visual analog scale (VAS). RESULTS: The itch VAS score decreased by 50.4% at Week 8. Blinded investigators reported improvement of PGA scores from 2.86 ± 0.62 to 1.66 ± 0.61 and clinical severity scores from 4.55 ± 1.30 to 2.45 ± 1.37. The average EI decreased by 19.6% at Week 8 ( p < .05). CONCLUSION: This study not only demonstrated the efficacy and safety of PC in scalp SD but it also revealed insights for PC being a promising treatment modality in immune-related skin diseases.

Oily sensitive skin: A review of management options.

BACKGROUND: Due to the ever-increasing demands for the personalized care, people seek for the tailored management according to the accurate identification of their skin type. The Baumann Skin Type Indicator, which was proposed by Leslie Baumann, is composed of four parameters: oily or dry, resistant or sensitive, pigmented or nonpigmented, and wrinkled or tight. Among these, oily sensitive skin experiences significant discomfort and resists ordinary treatment. AIMS: In this article, we will review the clinical manifestations, underlying pathogenesis and recommendations on treatment options that may be utilized to help patients with oily sensitive skin. PATIENTS/METHODS: Literature search was conducted using PubMed. The literature concerning Baumann Skin Type Indicator and oily sensitive skin type were considered. RESULTS: Oily sensitive (OS)-type skin is a complex of oily and sensitive skin that causes significant discomfort and undergoes stubborn resistance to treatments. Sebum dysfunction and hypersensitivity may play a key role in the development of sensitive skin. Considering the pathogenesis of OS-type skin, treatment should focus on both seborrhea and hypersensitivity. CONCLUSION: Clinicians can effectively treat the oily sensitive skin by understanding underlying pathogenesis of it. Further investigations are necessary to reach a consensus on the basic pathophysiology and optimal management guidelines for oily sensitive skin.

Novel device-based acne treatments: comparison of a 1450-nm diode laser and microneedling radiofrequency on mild-to-moderate acne vulgaris and seborrhoea in Korean patients through a 20-week prospective, randomized, split-face study.

BACKGROUND: While device-based acne treatments are widely applied for patients not tolerating conventional medications, related controlled studies have been still limited. Recently, non-ablative 1450-nm diode laser (DL) and fractional microneedling radiofrequency (FMR) have been effectively used for acne, in addition to well-recognized dermal remodelling effects. OBJECTIVE: To compare the clinical course of acne treatment between DL and FMR. METHODS: Twenty-five Korean patients with mild-to-moderate facial acne completed treatments with DL and FMR through a 20-week, randomized split-face study. One randomly assigned half side of each patient's face received DL and the other side by FMR. Treatments were scheduled to receive three consecutive sessions at 4-week intervals. Objective assessments including revised Leeds grades, lesion counts, sebum output measurements, and patients' subjective satisfaction were investigated. RESULTS: Both DL and FMR demonstrated steady improvement of acne and seborrhoea during treatment sessions. While results between two devices were similar during treatment sessions, FMR was superior to DL in the 12-week follow-up. Patients' subjective assessments for seborrhoea improvement were similar between two devices, while those for acne, skin texture, and acne scars were more satisfactory for FMR. For safety profile, no significant difference was observed between two regimens, while mild postinflammatory hyperpigmentation was observed only in DL side. CONCLUSION: Both DL and FMR demonstrated efficacies for acne and seborrhoea, with reasonable safety profile. FMR was more effective than DL for the long-term maintenance, and subjective assessments for texture and scar improvements. Therefore, a few sessions of these devices would be a viable option for acne treatments.

Scalp hyperkeratosis in children with skin of color: diagnostic and therapeutic considerations.

Scalp hyperkeratosis is common in childhood and adolescence. Diagnosis is affected by age, race, and history of infectious exposure, and associated symptoms including atopic features, alopecia, inflammatory nodules, presence and type of cutaneous lesions outside of the scalp, and nuchal lymphadenopathy. Tinea capitis is common in children with skin of color, especially black and Hispanic children. In adolescents, seborrheic dermatitis predominates as the cause of scalp hyperkeratosis, but tinea is still of concern. This article aims to help the practitioner comfortably diagnose and treat scalp hyperkeratosis in children with skin of color.

Dermatite seborreica / Seborrheic dermatitis

A dermatite seborreica é uma doença eritêmato-escamativa de caráter crônico-recidivante que acomete entre 1 e 3 por cento da população geral dos Estados Unidos. Possui dois picos de incidência - o primeiro, durante os três primeiros meses de vida, e o segundo, a partir da puberdade, atingindo seu ápice entre os 40 e 60 anos de idade. Os indivíduos HIV positivos têm maior prevalência da doença, que apresenta maior intensidade e tendência à refratariedade ao tratamento. Doenças neurológicas e outras doenças crônicas também estão associadas ao desenvolvimento da dermatite seborreica. Como mecanismo fisiopatogênico, reconhece-se que o fungo Malassezia sp., presente na pele de indivíduos suscetíveis, leve a uma irritação não-imunogênica a partir da produção de metabólitos à base de ácidos graxos insaturados deixados na superfície cutânea. Este artigo faz uma revisão da literatura sobre dermatite seborreica, com ênfase nos aspectos imunogenéticos, formas clínicas e tratamento.

Seborrheic dermatitis is a chronic relapsing erythematous scaly skin disease, the prevalence of which is around 1 to 3 percent of the general population in the United States. It has two incidence peaks, the first in the first three months of life and the second beginning at puberty and reaching its apex at 40 to 60 years of age. The prevalence of seborrheic dermatitis is higher in HIV-positive individuals and the condition tends to be more intense and refractory to treatment in these patients. Neurological disorders and other chronic diseases are also associated with the onset of seborrheic dermatitis. The currently accepted theory on the pathogenesis of this disease advocates that yeast of Malassezia spp., present on the skin surface of susceptible individuals, leads to a non-immunogenic irritation due to the production of unsaturated fatty acids deposited on the skin surface. This article provides a review of the literature on seborrheic dermatitis, focusing on immunogenetics, the clinical forms of the disease and its treatment.

Dermatosis del adolescente / Skin disease in teenagers

Durante la adolescencia se producen cambios importantes en la piel que son motivo de consulta frecuente al especialista. Estos son producidos por múltiples factores, dentro de los cuales están los hormonales, inmunológicos, psicológicos y los psicosociales. Las dermatosis más frecuentes son: el acné, en sus distintas formas clínicas, que afecta a más del 90 por ciento de los adolescentes en distintos grados de severidad; la dermatitis seborreica; las alopecias no cicatriciales; hiperhidrosis y dishidrosis. Además, este grupo etáreo está presentando con mayor frecuencia complicaciones cutáneas por realizar arte corporal (perforaciones, tatuajes, entre otros). Estas dermatosis deben ser conocidas por los médicos generales y especialistas, porque los adolescentes son una población muy vulnerable psicológicamente y muchas de estas enfermedades van en detrimento de su calidad de vida. Las enfermedades cutáneas infecciosas (virales, bacterianas y parasitarias) que también comprometen a los adolescentes se analizarán en el capítulo sobre Infecciones Cutáneas.

Adolescent skin undergoes significant changes that may lead to frequent specialized consultation. These changes can be due to a number of factors such as physiological, hormonal and psychosocial changes. The most common skin diseases are acne in its various clinical forms which is suffered by over 90 per cent of teenagers at different levels of severity, seborreic dermatitis, non scarring alopecia, hyperhydrosis and dishydrosis and the skin complications originated by Body Art (tattooing, piercing, scarring andbranding), that are on the increase in this age group. General practitioners and specialist should be aware ofthese skin conditions since teenagers are psychologically vulnerable and many of these diseases have a negative effect on their lives. The infectious skin diseases (viral, bacterial an parasitic) which also affect adolescent will be reviewed in the Chapter related to skin infections.

Papulosquamous disorders: atopic dermatitis, psoriasis, seborrheic dermatitis, and nickel contact dermatitis.

This article has addressed some of the recent discoveries in pathogenesis and treatment options of 4 papulosquamous disorders: atopic dermatitis, psoriasis, seborrheic dermatitis, and nickel contact dermatitis.

Efectividad del ketoconazol oral en el tratamiento de la dermatitis seborreica moderada a grave / Effectiveness of oral ketoconazole in the treatment of moderate to severe seborrheic dermatitis

Introducción: La dermatitis seborreica es una enfermedad inflamatoria crónica de difícil manejo, que puede afectar diferentes zonas anatómicas. Su tratamiento con derivados imidazólicos, como el ketoconazol, produce resultados variables que dependen tanto de la seriedad y extensión de las lesiones como de la vía de administración del medicamento. El ketoconazol oral ha sido el tratamiento de elección en el manejo de la dermatitis seborreica moderada a grave en el Centro Dermatológico Federico Lleras Acosta; sin embargo, no existen estudios clínicos en Colombia que hayan evaluado su efectividad. El objetivo del presente estudio fue establecer la efectividad del ketoconazol oral en casos de dermatitis seborreica moderada a grave, comparando el compromiso clínico antes del tratamiento y después de él. Materiales y métodos: Se llevó a cabo un estudio clínico seudoexperimental para evaluar la efectividad de un ciclo de tratamiento con 200 mg diarios de ketoconazol durante treinta días. Se incluyeron 96 pacientes con diagnóstico de dermatitis seborreica moderada a grave, que aceptaron participar en el estudio siguiendo los principios de buenas prácticas clínicas. Para establecer el grado de compromiso, se utilizó la escala de gravedad de dermatitis seborreica de la guía de práctica clínica del Centro Dermatológico Federico Lleras Acosta. Esta escala incluye el grado de descamación, la presencia de prurito y eritema, y la localización anatómica. Los valores se establecen en un rango de 0 a 100, donde 100 es el nivel de compromiso máximo. Se incluyeron pacientes con puntuaciones iguales o superiores a 50, punto de corte para establecer el compromiso moderado. Se consideraron casos graves los que obtuvieron valores superiores a 75 puntos. El porcentaje de mejoría obtenido se calculó a partir de la diferencia entre el grado de compromiso inicial y el compromiso al final del ciclo. Un tratamiento fue considerado efectivo cuando la mejoría obtenida al final del tratamiento fue igual al 70% o mayor. Resultados: Ochenta y seis sujetos finalizaron el estudio, con un porcentaje de pérdidas en el seguimiento de 11%. La media de compromiso al ingreso fue de 67 puntos y al terminar el ciclo de tratamiento, de 33 puntos. Se establecieron diferencias significativas en las medias antes del tratamiento y después de él (p=0,001). El 48% (IC95 %: 37-58) de los sujetos alcanzaron un porcentaje de mejoría clínica igual al 70% o mayor. Se presentaron efectos secundarios en 11 pacientes (12,8%; IC95 %: 6,5-21,7), definidos como leves y de resolución espontánea. Conclusiones: El ketoconazol oral es una alternativa terapéutica en el tratamiento de pacientes con dermatitis seborreica moderada a grave, con un perfil de seguridad adecuado a las dosis utilizadas y durante el tiempo establecido en este estudio.

[Dermatology, cosmetic and well-being]. / Dermatologie, cosmétique et bien-être.

BACKGROUND: To the extent that they help improve our appearance, cosmetics can affect how we relate to ourselves and to others, and as such can improve quality of life. Such benefits may be objectively demonstrated using validated methods and quality-of-life scales. GOAL: The aim of this review is to assess the effects of cosmetics on well-being in various situations based on studies using objective measurement methods. METHOD: Literature review. RESULTS: In pathological settings, the use of cosmetics can significantly improve the quality of life and well-being of patients, resulting in better acceptance of their disease and better therapeutic compliance. The use of cosmetics has also been shown to exert positive effects on self-esteem and social relations. A growing body of studies also demonstrates the beneficial effects of cosmetics on well-being under normal physiological conditions. DISCUSSION: Today, the effects and benefits of cosmetics can be measured objectively using quality-of-life scales, allowing initiation of actions for the rediscovery of well-being and self-esteem.

Dermatite seborreica da face / Facial seborrheic dermatitis

Dermatite seborreica (DS) é uma afecção comum da pele, caracterizada por lesões eritêmato-descamativas que afetam principalmente o couro cabeludo e a face. Sua prevalência em populações sadias varia de 2% a 5%, segundo diferentes estudos. Acomete ambos os sexos, sendo mais comum em homens. As lesões se desenvolvem em áreas ricas em glândulas sebáceas, como couro cabeludo, face, pavilhão auricular, flexuras e tórax.A dermatite seborreica da face acomete sobrancelhas, base dos cílios, pregas nasolabiais e o canal auditivo externo e pode ser tratada com corticoide tópico, metronidazol e antifúngicos tópicos, sendo o cetoconazol o principal.

Alternative therapies for common dermatologic disorders, part 1.

The exact pathophysiology and curative treatment of many common dermatologic conditions remain unclear. Often conventional treatments are only partially effective, leading patients to look for alternative treatments. Rosacea may be helped by azelaic acid. Seborrheic dermatitis may be helped by tea tree oil. Chronic urticaria may be helped by a focused dietary history and elimination of food additives and salicylates. Although various alternative treatments have been touted as useful in herpes simplex, few have proved efficacious.

Selective electrothermolysis of the sebaceous glands: treatment of facial seborrhea.

BACKGROUND: There are few publications on facial seborrhea treatment. A focused therapy is needed. OBJECTIVE: Our aim was to evaluate the efficacy of electrothermolysis of the sebaceous glands. METHODS: In the preliminary studies, histologic changes in the cheek skin by electrothermolysis were examined by light microscopy. In the clinical studies, 15 adult women subjects with facial seborrhea were treated four times by the same procedure. A 1.50-mm-long needle with a 0.45-mm base insulation was inserted into pores in the forehead and cheeks, and a high-frequency electrical current was applied for 0.25 to 0.50 seconds with an output of 40 W. Each treatment took 60 to 90 minutes. The subjects returned for 6-months follow-up after their fourth treatment. RESULTS: Histology 1 and 6 months later showed fewer sebaceous glands and the development of fibrosis. All 12 subjects who completed the 6-month follow-up gave a subjective assessment of continuous reduction of facial seborrhea. On a scale of 0.0 to 3.0, the mean improvement score was 1.67+/-0.75. The mean reduction rate of skin surface lipids was 31.5% by sebumeter (p< .01). CONCLUSIONS: Even though this is a pilot, uncontrolled clinical assessment study, electrothermolysis of sebaceous glands may be an effective and safe approach for facial seborrhea treatment.

Seborrheic dermatitis: an overview.

Seborrheic dermatitis affects the scalp, central face, and anterior chest. In adolescents and adults, it often presents as scalp scaling (dandruff). Seborrheic dermatitis also may cause mild to marked erythema of the nasolabial fold, often with scaling. Stress can cause flare-ups. The scales are greasy, not dry, as commonly thought. An uncommon generalized form in infants may be linked to immunodeficiencies. Topical therapy primarily consists of antifungal agents and low-potency steroids. New topical calcineurin inhibitors (immunomodulators) sometimes are administered.