Factors associated with dermatoporosis in a sample of geriatric patients in Mexico.

INTRODUCTION: Dermatoporosis is a chronic cutaneous fragility syndrome, characterized by skin atrophy, purpura and pseudo-cicatrices. OBJECTIVE: To determine factors associated with dermatoporosis in a sample of subjects aged ≥ 60 years. METHODS: Observational, cross-sectional, descriptive, analytical study of subjects aged ≥ 60 years who underwent history taking, physical examination and application of a self-administered dermatoporosis diagnostic questionnaire. To determine the associated factors, a multivariate logistic regression analysis was used. RESULTS: In 315 evaluated subjects, the prevalence of dermatoporosis was 29%; 70% were females. Associated risk factors were age > 75 years (p = 0.001), prolonged sun exposure (p = 0.002), use of anticoagulants/antiplatelet medications (p = 0.004), oral steroids (p = 0.03) and chronic kidney disease (p = 0.03), as well as maternal age > 40 years at last pregnancy (p = 0.02), breastfeeding for > 7 months per pregnancy and > 18 cumulative months (p = 0.01). Age < 20 years at first pregnancy and menopause after 45 years were related to dermatoporosis absence. The correlation between self-assessment and clinical diagnosis was considerably high (0.95, p < 0.001). CONCLUSIONS: The risk factors associated with dermatoporosis were similar to those previously reported.

INTRODUCCIÓN: La dermatoporosis es un síndrome crónico de fragilidad cutánea, caracterizado por atrofia, púrpura y pseudocicatrices en piel. OBJETIVO: Determinar los factores asociados a dermatoporosis en una muestra de sujetos ≥ 60 años. MÉTODOS: Estudio observacional, transversal, descriptivo y analítico de sujetos ≥ 60 años a quienes se realizó historia clínica, exploración física y aplicación de un autocuestionario diagnóstico de dermatoporosis. Para determinar los factores asociados se realizó análisis de regresión logística multivariado. RESULTADOS: En 315 sujetos, la prevalencia de dermatoporosis fue de 29 %; 70 % fue del sexo femenino. Los factores asociados fueron edad > 75 años (p = 0.001), exposición solar prolongada (p = 0.002), ingesta de anticoagulantes/antiplaquetarios (p = 0.004), esteroides orales (p = 0.03) y enfermedad renal crónica (p = 0.03); así como, edad materna > 40 años en el último parto (p = 0.02), lactancia > 7 meses por embarazo y lactancia acumulada > 18 meses (p = 0.01). Se relacionaron con su ausencia, edad < 20 años en el primer embarazo y menopausia después de los 45 años. La correlación entre la autovaloración y el diagnóstico clínico fue muy alta (0.95, p < 0.001). ­. CONCLUSIONES: Los factores de riesgo asociados a dermatoporosis fueron similares a los previamente reportados.

Objective and automatic grading system of facial signs from selfie pictures of South African women: Characterization of changes with age and sun-exposures.

OBJECTIVE: To evaluate the capacity of the automatic detection system to accurately grade, from smartphones' selfie pictures, the severity of fifteen facial signs in South African women and their changes related to age and sun-exposure habits. METHODS: A two-steps approach was conducted based on self-taken selfie images. At first, to assess on 306 South African women (20-69 years) enrolled in Pretoria area (25.74°S, 28.22°E), age changes on fifteen facial signs measured by an artificial intelligence (AI)-based automatic grading system previously validated by experts/dermatologists. Second, as these South African panelists were recruited according to their usual behavior toward sun-exposure, that is, nonsun-phobic (NSP, N = 151) and sun-phobic (SP, N = 155) and through their regular and early use of a photo-protective product, to characterize the facial photo-damages. RESULTS: (1) The automatic scores showed significant changes with age, by decade, of sagging and wrinkles/texture (p < 0.05) after 20 and 30 years, respectively. Pigmentation cluster scores presented no significant changes with age whereas cheek skin pores enlarged at a low extent with two plateaus at thirties and fifties. (2) After 60 years, a significantly increased severity of wrinkles/texture and sagging was observed in NSP versus SP women (p < 0.05). A trend of an increased pigmentation of the eye contour (p = 0.06) was observed after 50 years. CONCLUSION: This work illustrates specific impacts of aging and sun-exposures on facial signs of South African women, when compared to previous experiments conducted in Europe or East Asia. Results significantly confirm the importance of sun-avoidance coupled with photo-protective measures to avoid long-term skin damages. In inclusive epidemiological studies that aim at investigating large human panels in very different contexts, the AI-based system offers a fast, affordable and confidential approach in the detection and quantification of facial signs and their dependency with ages, environments, and lifestyles.

Areca nut procyanidins prevent ultraviolet light B-induced photoaging via suppression of cyclooxygenase-2 and matrix metalloproteinases in mouse skin.

Chronic exposure to solar ultraviolet (UV) light induces photoaging in human skin. Our previous results have shown that areca nut procyanidins (ANPs) have antioxidant capacity and possess potential anti-inflammatory effects. Here, we aimed to investigate the effect of ANPs on UVB-induced photoaging. In the present study, dorsal skin of CD-1 mice was exposed to UVB at a minimal erythema dose (130 mJ/cm2) throughout a 3-week period. The effects of ANPs and epigallocatechin-3-gallate (EGCG), a polyphenolic constituent of green tea, on UVB-induced photoaging were compared. The results show that oral administration of ANP prevented UVB-induced photoaging, indicated by epidermal thickness and collagen disorientation, and inhibited UVB-induced expression of cyclooxygenase-2 and matrix metalloproteinases (MMPs), such as MMP-2, MMP-9, and TIMP1. The protective potential of ANP on UVB-induced photodamage was comparable to that of EGCG. These data suggest that ANP could be useful as a dietary supplement to attenuate solar UVB-induced premature skin aging.

Japanese experiment of a complete and objective automatic grading system of facial signs from selfie pictures: Validation with dermatologists and characterization of changes due to age and sun exposures.

OBJECTIVE: To evaluate the capacity of the automatic detection system to accurately grade, from smartphones' selfie pictures, the severity of ten facial signs in Japanese women and their changes due to age and sun exposures. METHODS: A three-step approach was conducted, based on self-taken selfie images. At first, to check on 310 Japanese women (18-69 years) enrolled in the northerner Hokkaido area (latitude 43.2°N), how, on ten facial signs, the A.I-based automatic grading system may correlate with dermatological assessments, taken as reference. Second, to assess and compare age changes in 310 Japanese and 112 Korean women. Third, as these Japanese panelists were recruited according to their usual behavior toward sun exposure, that is, non-sun-phobic (NSP, N = 114) and sun-phobic (SP, N = 196), and through their regular and early use of a photo-protective product, to characterize the facial photo-damages. RESULTS: (a) On the ten facial signs, detected automatically, nine were found significantly (P < .0001) highly correlated with the evaluations made by three Japanese dermatologists (Wrinkles: r = .75; Sagging: r = .80; Pigmentation: r = .75). (b) The automatic scores showed significant changes with age, by decade, of Wrinkles/Texture, Pigmentation, and Ptosis/Sagging (P < .05). (c) After 45 years, a significantly increased severity of Wrinkles/Texture and Pigmentation was observed in NSP vs. SP women (P < .05). A trend of an increased Ptosis/Sagging (P = .09) was observed. CONCLUSION: This work illustrates, for the first time through investigations conducted at home, some impacts of aging and sun exposures on facial signs of Japanese women. Results significantly confirm the importance of sun avoidance coupled with photo-protective measures. In epidemiological studies, the AI-based system offers a fast, affordable, and confidential approach in detection and quantification of facial signs and their dependence with ages, environments and lifestyles.

A Clinical Perspective on the Automated Analysis of Reflectance Confocal Microscopy in Dermatology.

BACKGROUND AND OBJECTIVES: Non-invasive optical imaging has the potential to provide a diagnosis without the need for biopsy. One such technology is reflectance confocal microscopy (RCM), which uses low power, near-infrared laser light to enable real-time in vivo visualization of superficial human skin from the epidermis down to the papillary dermis. Although RCM has great potential as a diagnostic tool, there is a need for the development of reliable image analysis programs, as acquired grayscale images can be difficult and time-consuming to visually assess. The purpose of this review is to provide a clinical perspective on the current state of artificial intelligence (AI) for the analysis and diagnostic utility of RCM imaging. STUDY DESIGN/MATERIALS AND METHODS: A systematic PubMed search was conducted with additional relevant literature obtained from reference lists. RESULTS: Algorithms used for skin stratification, classification of pigmented lesions, and the quantification of photoaging were reviewed. Image segmentation, statistical methods, and machine learning techniques are among the most common methods used to analyze RCM image stacks. The poor visual contrast within RCM images and difficulty navigating image stacks were mediated by machine learning algorithms, which allowed the identification of specific skin layers. CONCLUSIONS: AI analysis of RCM images has the potential to increase the clinical utility of this emerging technology. A number of different techniques have been utilized but further refinements are necessary to allow consistent accurate assessments for diagnosis. The automated detection of skin cancers requires more development, but future applications are truly boundless, and it is compelling to envision the role that AI will have in the practice of dermatology. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Riboflavin Plays a Pivotal Role in the UVA-Induced Cytotoxicity of Fibroblasts as a Key Molecule in the Production of H2O2 by UVA Radiation in Collaboration with Amino Acids and Vitamins.

To investigate environmental factors that contribute to ultraviolet A (UVA)-induced oxidative stress, which accelerates the senescence and toxicity of skin cells, we irradiated human fibroblasts cultured in commonly used essential media with UVA and evaluated their viability and production of reactive oxygen species. The viability of fibroblasts exposed to a single dose of 3.6 J/cm2 UVA was not reduced when cultured in Hanks balanced salt solution, but it was significantly decreased when cultured in Dulbecco's modified Eagle's medium (DMEM), which contains various amino acids and vitamins. Furthermore, cell viability was not reduced when fibroblasts were cultured in DMEM and treated with a hydrogen peroxide (H2O2) scavenger such as glutathione or catalase added after UVA irradiation. In addition, we confirmed that the production of H2O2 was dramatically increased by UVA photosensitization when riboflavin (R) coexisted with amino acids such as tryptophan (T), and found that R with folic acid (F) produced high levels of H2O2 after UVA irradiation. Furthermore, we noticed that R and F or R and T have different photosensitization mechanisms since NaN3, which is a singlet oxygen quencher, suppressed only R and T photosensitization. Lastly, we examined the effects of antioxidants (L-ascorbic acid, trolox, L-cysteine, and L-histidine), which are singlet oxygen or superoxide or H2O2 scavengers, on R and F or on R and T photosensitization, and found that 1 mM ascorbic acid, Trolox, and L-histidine were strongly photosensitized with R, and produced significant levels of H2O2 during UVA exposure. However, 1 mM L-cysteine dramatically suppressed H2O2 production by UVA photosensitization. These data suggest that a low concentration of R-derived photosensitization is elicited by different mechanisms depending on the coexisting vitamins and amino acids, and regulates cellular oxidative stress by producing H2O2 during UVA exposure.

Protective Effect of L-Hexaguluroic Acid Hexasodium Salt on UVA-Induced Photo-Aging in HaCaT Cells.

This study aimed to show the α-L-Hexaguluroic acid hexasodium salt (G6) protective effect against UVA-induced photoaging of human keratinocyte cells. We found that G6 localized to the mitochondria and improved mitochondrial functions. G6 increased respiratory chain complex activities, which led to increased cellular ATP content and NAD+/NADH ratio. Thus, G6 alleviated the oxidative stress state in UVA-irradiated cells. Moreover, G6 can regulate the SIRT1/pGC-1α pathway, which enhanced the cells' viability and mitochondria energy metabolism. Notably, the anti-photoaging potential of G6 was directly associated with the increased level of MMP and SIRT1, which was followed by the upregulation of pGC-1α, D-LOOP, and Mt-TFA, and with the transcriptional activation of NRF1/NRF2. Taking all of the results together, we conclude that G6 could protect HaCaT cells from UVA-induced photo-aging via the regulation of mitochondria energy metabolism and its downstream signaling pathways.

Comparative Evaluation of the Biodegradability and Wrinkle Reduction Efficacy of Human-Derived Collagen Filler and Hyaluronic Acid Filler.

BACKGROUND: The development of fillers for wrinkle prevention is growing to meet rising demands to reduce the aging of skin. OBJECTIVE: In this experiment, we confirmed the effects of human collagen and hyaluronic acid filler biodegradation for wrinkle reduction using a photo-aging mouse model. MATERIALS AND METHODS: A total of 10 hairless mice (SKH1-Hrhr) were randomly divided into two groups and injected with hyaluronic acid and human-derived collagen filler. At 0, 2, 4, 8, and 12 weeks, PRIMOSlite®, folliscope, and MRI were used to evaluate the biodegradability of the fillers after the injections. We also studied the photo-aging mouse model for skin roughness and histological evaluation and confirmed that the filler injection had excellent anti-wrinkle effects. RESULTS: Human-derived collagen fillers had excellent biodegradability compared to that of hyaluronic acid fillers. The skin surface roughness in the photo-aging mouse models was significantly reduced after injections of human-derived collagen filler. CONCLUSION: Our results showed that the human-derived collagen filler had excellent biodegradability and effectively reduced wrinkle formation in a photo-aging mouse model. NO LEVEL ASSIGNED: 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 .

Inhibition of UVB-induced pro-inflammatory cytokines and MMP expression by Zanthoxylum rhetsa bark extract and its active constituent hesperidin.

The antiphoto aging property of Zanthoxylum rhetsa obtained from Pangkor Island, Malaysia, was evaluated. Solvent fractions of different polarity obtained from the methanolic extract of the bark material were initially tested for anticollagenase and antielastase activities. The ethyl acetate fraction showed bioactivity against the protease enzymes. Hence, it was subjected to further purification via column chromatography, to yield a major constituent, hesperidin. Subsequently, the ethyl acetate fraction and hesperidin were tested for their effects against UVB-induced cytotoxicity and expressions of inflammatory cytokines (IL-6, IL-1ß, and TNF-α), NF-κB, and MMPs (MMP1, 3, and 9) in human dermal fibroblasts (HDF). Both fraction and pure compound prevented UVB-induced cytotoxicity in HDF cells, in a dose dependent manner. Moreover, the ethyl acetate fraction inhibited the increase of pro-inflammatory cytokines induced by UVB to a level similar to the control (without UV treatment). Additionally, the fraction significantly inhibited the expressions of NF-κB, MMP 1, MMP 3, and MMP 9 in HDF cells treated with UVB. Similar effects were observed with hesperidin. The results obtained suggested that the ethyl acetate fraction of Z. rhetsa and its bioactive constituent, hesperidin, have the potential to be used as active ingredients in sunscreen and antiphoto aging formulations.

Facial skin photo-aging and development of hyperpigmented spots from children to middle-aged Japanese woman.

BACKGROUND/PURPOSE: Facial skin hyperpigmention caused by chronic sun exposure is a major skin complaint, however, its characteristics and influential factors are still limitedly known. METHODS: A cross-sectional survey in healthy Japanese women aged from 6 to 62 years (n=169) was conducted using a facial image analyzer VISIA™ for knowing onset age of hyperpigmented spot formation, its chronological changes, and influence of environmental factors. RESULTS: UV Pigmented Spot (PS) Score was positively correlated with age (R=.487, P=.000). Hyperpigmented spots appeared first around 18 years old in most subjects, and PS score remarkably increased at 20s then gradually increased by ages. The subjects with Skin Type I, one of the three grades of Japanese Skin Type (JST), whose melanin formation is genetically lower, showed higher PS score. A woman aged 31 years was subjected a weekly VISIA measurement for 2 years, and found no changes in the number, place, size and intensity of the pigment spots in this duration. CONCLUSION: Hyperpigmented spots developed in women over 20 years of age due to chronic sun exposure without sun protection during childhood and adolescent and it was stable afterwards, whose intensity was influenced by age and skin type.