RESUMEN
Aging is associated with significant changes to skin structure and function which lead to distinct clinical needs in geriatric dermatology patients. By understanding the relationship between altered skin function with aging and the clinical implications for geriatric dermatology patients, dermatologists can guide patients in developing a preventive regimen and managing age-related skin pathology. The second article of this 2-part continuing medical education series reviews the most common conditions affecting geriatric dermatology patients and specific treatment considerations with a focus on the impact of age-related skin barrier dysfunction.
RESUMEN
Aging is associated with significant changes to skin structure and function. As the United States population ages, dermatologists are increasingly presented with the clinical consequences of these changes. Understanding the biology of aging skin allows dermatologists to best guide patients towards proactive treatment of age-related skin disease. The first article of this 2-part continuing medical education series reviews the structural, molecular and functional changes associated with skin aging.
RESUMEN
Subungual melanoma is a rarer form of melanoma encountered in clinical practice that often has a poor prognosis because it presents with advanced disease. We report a case of a 46-year-old male with a circumferential osteoinvasive melanoma that invaded the superior and lateral aspects of the periosteum of the distal phalanx. We discuss pathologic findings and common physical exam findings to facilitate earlier diagnosis of subungual melanoma.
RESUMEN
The lower urinary tract (LUT) may be activated by spinal cord stimulation, but the physiological mapping characteristics of LUT activation with noninvasive transcutaneous spinal cord stimulation (TSCS) are not known. The effects of aging on the contractile properties of the detrusor are also not well understood. Therefore, TSCS was applied over the T10/T11 to L6/L7 spinous processes in adult ( n = 6) and aged ( n = 9) female rhesus macaques. A combination of urodynamic studies and electromyography recordings of the external urethral sphincter (EUS), external anal sphincter (EAS), and pelvic floor muscles was performed. Distinct functional maps were demonstrated for TSCS-evoked detrusor and urethral pressures and for the activation of the EUS, EAS, and pelvic floor muscles. The magnitude of responses for each peripheral target organ was dependent on TSCS location and strength. The strongest detrusor contraction was observed with TSCS at the L1/L2 site in adults and the L3/L4 site in aged subjects. TSCS-evoked bladder pressure at the L1/L2 site was significantly higher for the adults compared with the aged subjects ( P < 0.05). Cumulative normalized TSCS-evoked pressures, calculated for five consecutive sites between the T11/T12 and L3/L4 levels, were significantly lower for aged compared with adult subjects ( P < 0.05). The aged animals also showed a caudal shift for the TSCS site that generated the strongest detrusor contraction. We conclude that natural aging in rhesus macaques is associated with decreased detrusor contractility, a finding of significant translational research relevance as detrusor underactivity is a common occurrence with aging in humans. NEW & NOTEWORTHY Transcutaneous spinal cord stimulation (TSCS) was used to map lower urinary tract function in adult and aged rhesus macaques. Aging was associated with decreased peak pressure responses to TSCS, reduced cumulative normalized evoked bladder pressure responses, and a caudal shift for the site generating the strongest TSCS-induced detrusor contraction. We demonstrate the utility of TSCS as a new diagnostic tool for detrusor contractility assessments and conclude that aging is associated with decreased detrusor contractility in primates.