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Factors Associated with Premature Skin Aging (Photoaging) before the Age of 55: A Population-Based Study
Abstract
Precise factors associated with premature skin aging, or photoaging, in the general population are unknown.
To examine the risk factors for photoaging in a Queensland community.
A cross-sectional study of 1,400 randomly selected residents aged 20-54 years, using casts of the back of the hand (surface microtopography) and dermatological assessment of photoaging.
83% of the participants had premature skin aging, worsening after the age of 30. Severe neck wrinkling was 3 times more likely in men and some 4 times more likely in fair-skinned people (odds ratio, OR=3.86, 95% confidence interval, CI=2.40-6.23). Red hair and mainly outdoor work or leisure raised the odds of microtopographic photoaging. Current smoking was strongly associated with facial comedones and telangiectasia, and among current smokers, the microtopography grade was significantly associated with moderate and heavy smoking measured by pack-years of exposure, with OR=3.18 (95% CI=1.38-7.35) in the heaviest (>20 pack-years) smoking category compared with 1-7 pack-years.
Premature skin aging is common in the subtropics, more severe in men and the fair-skinned. It is associated with high sun exposure during leisure or work, and moderate to heavy smoking, and therefore is preventable.
... Studies have demonstrated that the prevalence of melasma ranges from 5% to 46% [1][2][3] depending on the population examined. A population-based study involving 1400 residents revealed a 10% prevalence of plateau facial telangiectasia [4]. Meanwhile, the worldwide prevalence of vitiligo is estimated to range from 0.4% to 2% [5], with a reported prevalence of 0.56% in China [6]. ...
... Our findings reveal that the prevalence in Lhasa is 14.94% for melasma, 17.14% for plateau facial telangiectasia, and 0.38% for vitiligo. In contrast, previous research in plain areas indicated a melasma prevalence of 3.52% in Zibo [17], a facial telangiectasia prevalence of 10% in Queensland [4], and a vitiligo prevalence of 0.093% in Shaanxi Province [18]. These data underscore the heightened risk of melasma, facial telangiectasia, and vitiligo in high-altitude areas. ...
... Previous studies had shown variations in the prevalence of pigmented skin disorders in different regions of the world, with a prevalence of melasma of 13.14%-15.5% in 401 Arab-Americans [19] in 2007 and a prevalence of facial telangiectasia of 10% in 1400 Queensland community individuals [4] in 2011. The prevalence of vitiligo was 1.3% in 2022 among 35 694 participants from Europe, Japan, and the United States [20]. ...
Background
Previous studies showed the prevalence of melasma, plateau facial telangiectasia, and vitiligo varied in different regions but were absent in high‐altitude areas.
Aims
To investigate the prevalence of three common pigmented skin disorders (melasma, plateau facial telangiectasia, and vitiligo) among the general population in Lhasa, aiming to provide a scientific basis for their prevention and management in high‐altitude areas.
Methods
From May 2021 to October 2021, multistage stratified cluster random sampling was conducted in Lhasa to carry out a questionnaire and a second on‐site physical examination, and the results were statistically analyzed.
Results
The study included 4988 participants, revealing a prevalence of 14.94% for melasma, 17.14% for plateau facial telangiectasia, and 0.38% for vitiligo. Notably, the prevalence of melasma and plateau facial telangiectasia were significantly higher among women, particularly those aged 31–50 years, compared to men. Urban residents also showed a higher prevalence than their rural counterparts.
Conclusions
Our study concludes that the prevalence of the three pigmented skin disorders in Lhasa is notably higher than in lower‐altitude areas, with UV radiation being a significant risk factor. Our findings underscore the need for enhanced public health interventions, including screening, education, and prevention efforts, to mitigate the impact of these skin disorders in high‐altitude regions. Our research contributes valuable insights toward the understanding and management of pigmented skin disorders in such unique environments. It may also provide an easy‐to‐use epidemiological survey method for socioeconomically underdeveloped areas.
... A study of 1204 Indian women living in Chennai city, the fourth most populous urban area in India, found that living in a metropolitan area was a risk factor of skin aging [6]. Skin is vulnerable to work conditions, and outdoor work, even part-time, leads to skin aging [5,7]. ...
... According to our skin physiological parameters, being very low surface moisture at T-and U-zones and having a dry skin type were significantly related to skin aging. According to Green et al., every extra year of age after 30 up to 54 years significantly increased the odds of having a higher skin aging grade by 14%, and people frequently working outdoors had 60% higher odds [7]. These findings are similar to our study and other previous published study [12,18,19]. ...
... Nonetheless, being a current smoker increased the odds of skin aging by 30 percent. Several studies concluded that people with high BMI were significantly more likely to have higher skin aging grades, but not after adjusting for age and sex [7,18], consistent with our study. A clinical study of postmenopausal women concluded that women who slept for 5 hours per day had higher trans-epidermal water loss levels and decreased skin barrier recovery after UV-induced erythema [8]. ...
The world population is aging and no country is immune to the consequences. We are not aware of any country-specific skin aging risk factors data for the Mongolian people. Thus, we aimed to study the risk factors associated with skin aging in the Mongolian population. A population-based cross-sectional study of 2720 study participants 18 years of age and older was performed evaluating the severity of skin aging based on cutaneous microtopography. Questionnaire data and skin physiological measurements were obtained. The odds ratios for skin aging grades associated with risk factors were estimated using ordinal logistic regression. Study participant’s mean age was 45 years, ranging from 18 to 87. After adjustment for known risk factors, skin aging was associated with demographic risk factors such as increasing age (aOR = 1.19, 95% CI 1.18–1.20), living in an urban area (aOR = 1.31, 95% CI 1.12–1.55) and lifestyle factors including being a smoker (aOR = 1.32, 95% CI 1.09–1.61), having a higher body mass index (aOR = 1.04, 95% CI 1.02–1.06) and higher levels of sun exposure time (aOR = 1.03, 95% CI 1.00–1.06) were significantly associated with higher skin aging grades. Having dry (aOR = 1.94, 95% CI 1.45–2.59) and combination skin (aOR = 1.62, 95% CI 1.22–2.16) types were also independent risk factors associated with skin aging. Having very low skin surface moisture at the T-zone (aOR = 2.10, 95% CI 1.42–3.11) was significantly related to skin aging. Older age, urban living and toxic working conditions were independent demographic risk factors related to skin aging. Smoking, higher BMI, greater levels of sun exposure were significant lifestyle risk factors. Having a skin type other than normal was a physiologic risk factor for skin aging.
... Excessive sun exposure is the primary environmental risk factor for development of melanoma and other skin cancer. 1 Superimposed on innate skin aging, photoaging causes the majority of clinical and histopathologic changes in aged skin. 2 Community-based surveys in subtropical Queensland have shown that by age 50 most residents bear signs of moderate to severe skin photoaging, with 14% of those under 30 also showing detectable premature aging of sun-exposed skin. 3 When histopathologic changes were used to directly assess the degree of skin photodamage, premature skin aging was present in 83% of Queensland adults aged between 20 and 55. 4 In a study comparing self-reported facial aging in women, Australian's reported higher rates of change as well as reporting signs of moderate to severe damage 10-20 years earlier than those in the USA and UK 5 Since patterns of photodamage in Caucasian adults differ by climate and lifestyle factors 6 , we hypothesized that people living in a sunny climate such as subtropical Queensland, as opposed to cool climates where clothing cover is the norm 7 , would have extensive sundamage across body sites. ...
... Methods of measuring photodamage include clinical examination 8 , histopathology 4 , and photonumeric 9, 10 scales with majority of methods focusing on evaluating aging of the face 11 . ...
... 25,26 Our findings regarding associated factors are similar to those of earlier studies in Queensland in showing significant associations between severe photodamage and increasing age, sex, smoking, and previous skin cancer. 3,4 However, we did not see significant associations with overall outdoor occupational and recreational exposure since leaving high school, or tendency to burn as previously reported. 3,4 This could be due to participants' misclassification by self-report or our inability to detect these associations with our smaller sample size. ...
Background
Skin cancer is strongly associated with photodamaged skin but body sites are often referred to as ‘exposed’ or ‘unexposed’ to sun without recognizing extent of site‐specific variation.
Objectives
To assess whole‐body patterns of photodamage in an Australian population.
Methods
A random sample of adult residents of Queensland underwent imaging across 10 body sites. Photodamage was graded from images using an ordinal photo‐numeric scale. We used cluster analysis to identify whole‐body photodamage patterns and prevalence proportion ratios (PPRs) to assess associated factors.
Results
Of 190 adults (median age 52; 58% males), 58% showed severe or moderate‐to‐severe photodamage on most body sites. A higher proportion of woman had severe photodamage on the arms (upper: p=0.002, lower: p=0.034). A higher proportion of men had moderate or severe photodamage on the lower back (p=0.004). We identified four photodamage patterns: ‘severe general’ (n=24, 13%), ‘moderate‐severe general’ (n=86, 45%), ‘moderate‐severe head, neck, décolletage’ (n=40, 21%), and ‘mild‐moderate upper body’ (n=12, 6%). All participants with ‘severe‐general’ photodamage were > 50 years, and more likely to have past skin cancer (PPR: 2.54, 95% CI: 1.44‐4.49) than those with moderate‐severe head, neck, décolletage photodamage. Those with ‘moderate‐severe general’ photodamage showed similar associations, and were more likely female (PPR: 1.33, 95% CI: 1.04‐1.69). Past or current smoking was associated with having higher levels of photodamage, with no smokers in those with ‘mild‐moderate upper body’ photodamage.
Conclusions
Moderate to severe photodamage across much of the body is common in Queensland adults and associated with age, sex, past skin cancer and smoking. Assuming a universal pattern of site‐specific sun‐exposure could lead to spurious correlations, while accurate and objective assessment of site‐specific photodamage can add to understanding of the development of sun‐associated skin cancers, in particular site‐specific skin carcinogenesis. Additionally, degree of site‐specific photodamage has the potential to assist skin cancer screening.
... Severity of dermal elastosis is indicated by microtopographic grading of the skin surface on the back of the hand (Beagley and Gibson, 1980;Holman et al., 1984) and is valid up to age 70 years (Battistutta et al., 2006;Hughes et al., 2012). Associations with microtopography grade very closely resemble the associations with clinical signs of photoaging of the face and neck (Green et al., 2011). Biochemical changes involving advanced glycation end products (AGEs) and elastic fibers also occur (Jeanmaire et al., 2001;Mizutari et al., 1997) owing to UV-induced oxidative stress accelerating the formation of AGEs (Pageon et al., 2013) and a cascade of reactions altering skin morphology and function (Pandel et al., 2013). ...
... Supplement studies suggest that antioxidants are more effective in combination (Pandel et al., 2013), but the effects of antioxidants in food overall on photoaging have never been reported. We therefore investigated whether the total antioxidant capacity of foods consumed by adults aged <55 years influenced their subsequent skin photoaging, hypothesizing that results would differ by sex and between those aged 45 and >45 years because sex and age are strong independent determinants of photoaging (Green et al., 2011) and diet quality (Arabshahi et al., 2011). ...
... Linear trends were assessed by modeling the median values for each quartile group as continuous variables. Models were adjusted for age (centered on the mean), sex, baseline smoking status, sunscreen use before randomization (<50% of the time, >50% of the time), sun exposure up to the end of follow-up (average hours per day spent outdoors up to 2007; up to 3 hours, >3 hours per day), and trial sunscreen and beta carotene allocation and mean energy intake (centered), previously shown to be associated with diet quality and photoaging (Arabshahi et al., 2011;Green et al., 2011;Hughes et al., 2009Hughes et al., , 2006. A priori, we examined the potential of age and sex as effect modifiers (Arabshahi et al., 2011;Green et al., 2011) by including an interaction term between time, diet antioxidant capacity, and the above factors. ...
The long-term effect of diet on skin aging is largely unknown but evidence suggests antioxidants from foods may mitigate the main component of skin aging caused by sun exposure. We assessed the association between total antioxidant capacity of foods people eat and photoaging of their skin. In a community-based, prospective study among 777 Australian adults aged <55 years at baseline, we estimated the total dietary antioxidant capacity of participants’ diets in 1992, 1994 and 1996 and graded photoaging severity using microtopography in 1992, 1996 and 2007. We used ordinal logistic regression and applied generalized estimating equations to estimate change in degree of photoaging associated with increasing total antioxidant capacity compared with the group with the lowest antioxidant capacity, separately in younger (≤45 years) and older (>45) adults. In the15-year study period, overall prevalence of severe skin photoaging increased from 42% at baseline to 88%. Adults aged >45 years who consumed foods with high antioxidant capacity experienced approximately 10% less photoaging over 15 years than those ate foods with low antioxidant capacity. No association was found among adults aged ≤45. Foods rich in antioxidants as measured by antioxidant capacity may retard skin aging among healthy men and women aged >45 years.
... In one cross-sectional study of 1400 subjects (aged 20-54 years), telangiectasia was associated with increasing age, male sex, fair skin, smoking and mainly outdoor occupations. 7 Smoking has repeatedly been associated with telangiectasia, 8,9 but little is known about other lifestyle and physiological factors associated with red veins in the middle-aged to elderly. ...
... Pale skin colour type was associated with more telangiectasia, as previously reported. 7 Similar to smoking, the underlying mechanism is not yet elucidated, but we hypothesize that ultraviolet induced DNA damage will play a role, as in other types of skin ageing. Alternatively, telangiectasia might be more visible on lighter skin. ...
... Female sex was associated with more telangiectasia, which was opposite to what has been previously reported. 7 This could be explained in part by the higher average age in the RS population compared to the age of the participants in the previous report. Men tend to show signs of skin wrinkling earlier in life, with women showing similar wrinkling prevalence as men later on in life. ...
Background:
Telangiectasia or red veins are one of the prominent features of facial skin aging. To date there are few studies investigating the determinants of telangiectasia.
Objectives:
We investigated lifestyle and physiological factors associated with facial telangiectasia in a large prospective Dutch cohort study.
Methods:
Telangiectasia were quantified digitally from standardized facial photographs of 2,842 North-European participants (56.8% female, median age 66.9) from the Rotterdam Study, collected in 2010-2013. Effect estimates from multivariable linear regressions are presented as the percentage difference in the mean value of telangiectasia area per unit increase of a determinant (%Δ) with corresponding 95% CI.
Results:
Significant determinants were older age (1.7%Δ per year [95%CI 1.4, 2.0]), female sex (18.3%Δ [95%CI 13.2, 23.6]), smoking (current versus never 38.4%Δ [95%CI 30.3, 47.0]; former versus never 11.6%Δ [95%CI 6.6, 16.9]), a high susceptibility to sunburn (10.2%Δ [95%CI 5.4, 15.3]) and light skin color (pale versus white-to-olive 31.4%Δ [95%CI 19.7, 44.1]; white vs. white-to-olive 9.2%Δ [95%CI 2.8, 16.0]).
Conclusions:
In this large cohort study, we confirmed known and described new determinants of facial telangiectasia.
... 11 This loss of craniofacial skeletal support for the overlying midfacial soft tissue contributes significantly to the volume changes observed here. 12 Although studies have shown that photodamage is more prevalent in younger Australians than their age-matched counterparts in Europe, 13,14 data are limited on the differences in the extent and course of skin and volume-related facial ageing between women living in Australia and those living in the northern hemisphere. This sub-analysis of a large cross-sectional, multinational, internet-based study was conducted to compare the differences in the patterns of static facial wrinkles and volume loss reported by Australian and non-Australian women. ...
... Of 1400 participants aged 27-47 years, 83% had moderate to severe photoageing shown by skin microtopography, and every year of age after 30 years up to 54 years significantly increased the odds of photoaged skin. 13 Other community-based studies of Australian adults have also shown photoageing prevalence rates that are substantially higher than in European adults. 14 In a hospital-based study in The Netherlands, only 7% of 24-49-year olds had moderate to severe clinically assessed elastosis, compared with 35% of Australians in the same age group. ...
... Although the USA, Canada and the UK had higher proportions of Asian respondents and Asians experience skin wrinkling later than Caucasians 6,[17][18][19] , variability due to race was controlled for in the linear regressions. We also controlled for differences in smoking habits, as smoking is positively associated with skin ageing 13,20,21 . Of the survey respondents who were excluded because they had used cosmetic treatments to alter the effect of aging to their face, 43% were from the USA, 27% from Canada, 22% from Australia, and 8% from the UK. ...
Background/objectives:
Australians are more exposed to higher solar UV radiation levels that accelerate signs of facial ageing than individuals who live in temperate northern countries. The severity and course of self-reported facial ageing among fair-skinned Australian women were compared with those living in Canada, the UK and the USA.
Methods:
Women voluntarily recruited into a proprietary opt-in survey panel completed an internet-based questionnaire about their facial ageing. Participants aged 18-75 years compared their features against photonumeric rating scales depicting degrees of severity for forehead, crow's feet and glabellar lines, tear troughs, midface volume loss, nasolabial folds, oral commissures and perioral lines. Data from Caucasian and Asian women with Fitzpatrick skin types I-III were analysed by linear regression for the impact of country (Australia versus Canada, the UK and the USA) on ageing severity for each feature, after controlling for age and race.
Results:
Among 1472 women, Australians reported higher rates of change and significantly more severe facial lines (P ≤ 0.040) and volume-related features like tear troughs and nasolabial folds (P ≤ 0.03) than women from the other countries. More Australians also reported moderate to severe ageing for all features one to two decades earlier than US women.
Conclusions:
Australian women reported more severe signs of facial ageing sooner than other women and volume-related changes up to 20 years earlier than those in the USA, which may suggest that environmental factors also impact volume-related ageing. These findings have implications for managing their facial aesthetic concerns.
... In populations of European and North American adults with phototypes I, II, and III, photoaging is highly prevalent, affecting up to 80-90% of individuals [1]. Several risk factors contribute to this condition, including older age, male gender, light skin phototypes, extensive sun exposure, and residing in sun-exposed areas [2]. ...
... Air pollution, which includes indoor and outdoor pollutants, has been linked to skin aging, supported by epidemiological studies. Smoking is known to contribute to the development of "smoker's face", characterized by wrinkles and an uneven complexion, likely due to impaired collagen synthesis and degradation [2,8]. ...
This original article presents the findings of a comprehensive case series, shedding light on the efficacy of diverse treatment modalities for managing precancerous and cancerous skin lesions and their remarkable rejuvenation effects on the skin. A particular focus is placed on the promising outcomes achieved through the application of a combination treatment involving 5-Fluorouracil (5-FU) and salicylic acid, which demonstrates enduring and noteworthy results. Furthermore, alternative therapeutic approaches, including 5-FU monotherapy, Methyl aminolevulinate–photodynamic therapy (MAL-PDT), and the combination of Imiquimod therapy with MAL-PDT, exhibit substantial potential for patients seeking non-surgical solutions. These treatments manifest as valuable tools in improving skin texture and mitigating the effects of photodamage. Nevertheless, the intricate interplay between the chosen treatment, the extent of photodamage, and individual patient characteristics, with a particular emphasis on age, necessitates long-term follow-up to gauge treatment outcomes and the likelihood of lesion recurrence. Notably, these treatments are associated with a significant degree of inflammation, igniting curiosity regarding enhanced skin cellular turnover and the potential for a more youthful skin appearance. Our findings accentuate the promise of topical fluorouracil (5-FU) and photodynamic therapy (PDT) in combating photoaging among patients with actinic keratoses. However, a need for further in-depth research is evident to unravel the nuanced relationships between these treatments, the severity of photodamage, and the influence of patient-specific factors. Such comprehensive investigations are instrumental in optimizing patient care and outcomes, offering a holistic approach to managing photodamage within the context of actinic keratoses. This work, when combined with existing literature, provides valuable insights and serves as a catalyst for future research to fully unlock the potential of these treatments, ultimately enhancing the quality of patient care.
... [3][4][5] It is important to make a habit of avoiding UVR to prevent this damage and daily use of UV protective cosmetics, such as sunscreen, is a convenient and effective way to maintain skin beauty and health. [6][7][8][9] The SPF value is an index to prevent sunburn, but it can also be used as an index for preventing skin damage caused by chronic UV exposure. However, contrary to SPF, no practical method is available for evaluating the long-term effects of chronic UV exposure. ...
... 4,16,17,18 In addition, regarding the preventive effects of long-term clinical sunscreen on photoaging, a study using a sunscreen of SPF 16 showed its efficacy. 6,7 The Skin Cancer Foundation in the United States gives recommendation stickers to sunscreens that meet criteria such as SPF15 or higher. As the SPF value required to get the same protective effect as SPF 15 sunscreen at 2 mg/cm 2 was calculated to be 23.8 with the average application density of consumers in actual use, SPF 23 can be considered as a guide for preventing photoaging. ...
Background
Sun protection factor (SPF) and UVA protection factor (UVAPF) are performance indicators consumers recognize for UV protective cosmetics such as sunscreens. However, on-site application density affects actual UV protection, despite these indicators. To understand actual UV protection better, a more reliable manner is needed to verify application density for further discussion of photoprotection efficacy regarding public health.
Method
The subjects applied the SPF-labeled sunscreens as usual. We measured the application amount and area including any amount on their hands to calculate the average application density on the face. Also, sunscreens were applied at densities of 0.5, 1.0, and 2.0 mg/cm². The SPF values were measured at each application site to evaluate the effect of application density on photoprotection efficacy.
Result
We established a method of measuring application density utilizing three-dimensional photograph analysis. The median application density of the sunscreen applied in actual use was 1.33 mg/cm². The measured SPF values decreased in association with the decreased application density of sunscreens. Based on the estimate assuming the first-order correlation, the SPF value required to get the protective effect equivalent to a sunscreen with SPF 15, 30, or 50 at 2 mg/cm² was calculated to be 23.8, 47.5, and 79.2 respectively with the application density of 1.33 mg/cm².
Conclusion
We demonstrated a reasonable procedure for estimating the photoprotection efficacy of sunscreens on the face. A suggestion was made to consider the application density for further discussion of photoprotection among consumers, especially for the long term with respect to public health.
... Although we cannot entirely avoid sun exposure, exposure to other environmental factors, including those where personal choice plays a role, may influence cutaneous function. A number of studies have identified smoking as one such factor [2][3][4][5]; these epidemiological studies identify smoking as an independent risk factor for the occurrence of facial wrinkles. ...
... Smoking is regarded as an independent risk factor for skin ageing [2][3][4][5], the clinical presentation of which includes the premature appearance of coarse and fine wrinkles [39]. Here, we confirm the findings of previous studies that identify a significant remodelling of the elastic fibre network occurs in the photoprotected skin of smokers [27][28][29] and provide further evidence for alterations in both the macromolecular organisation and tensile strength of FRMs, fundamental components of elastic fibres in diverse tissue systems. ...
One of the major functions of human skin is to provide protection from the environment. Whilst we cannot entirely avoid, for example, sun‐exposure, it is likely that exposure to other environmental factors could impact cutaneous function. A number of studies have identified smoking as one such factor that leads to both facial wrinkle formation and a decline in skin function. In addition to the direct physical effects of tobacco smoke on skin, its inhalation has additional profound systemic effects for the smoker. The adverse effects on the respiratory and cardiovascular systems from smoking are well known. Central to the pathological changes associated with smoking is the elastic fibre, a key component of the extracellular matrices of lungs. In this study we examined the systemic effect of chronic smoking (>40 cigarettes/day; >5 years) on the histology of the cutaneous elastic fibre system, the nanostructure and mechanics of one of its key components, the fibrillin‐rich microfibril, and the micromechanical stiffness of the dermis and epidermis. We show that photoprotected skin of chronic smokers exhibits significant remodelling of the elastic fibre network (both elastin and fibrillin‐rich microfibrils) as compared to the skin of age‐ and sex‐matched non‐smokers. This remodelling is not associated with increased gelatinase activity (as identified by in situ zymography). Histological remodelling is accompanied by significant ultrastructural changes to extracted fibrillin‐rich microfibrils. Finally, using scanning acoustic microscopy, we demonstrated that chronic smoking significantly increases the stiffness of both the dermis and the epidermis. Taken together, these data suggest an unappreciated systemic effect of chronic inhalation of tobacco smoke on the cutaneous elastic fibre network. Such changes may in part underlie the skin wrinkling and loss of skin elasticity associated with smoking.
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... 7 Thus, UVR exposure increases the risk of developing actinic keratosis (AK) and melanocytic nevi (MN) [8][9][10] and is the main etiological cause of keratinocyte cancer (KC). 4,11,12 Other known risk factors include older age and fair skin type for AK and FW, [13][14][15] male sex and exposure to tar products, welding, poly-aromatic hydrocarbons (PAH), arsenic for AK [15][16][17] and smoking for FW. 18,19 Conversely, age is negatively associated with MN count. ...
... 7 Thus, UVR exposure increases the risk of developing actinic keratosis (AK) and melanocytic nevi (MN) [8][9][10] and is the main etiological cause of keratinocyte cancer (KC). 4,11,12 Other known risk factors include older age and fair skin type for AK and FW, [13][14][15] male sex and exposure to tar products, welding, poly-aromatic hydrocarbons (PAH), arsenic for AK [15][16][17] and smoking for FW. 18,19 Conversely, age is negatively associated with MN count. ...
Background
The risk of photoaging and actinic keratosis caused by work related solar ultraviolet radiation exposure has not previously been investigated in Nordic countries. The objectives of this study was to describe the occurrence of photoaging, actinic keratosis and keratinocyte cancer in a population of Danish outdoor and indoor workers, and investigate the association between these clinical findings and semi‐objective measures of work related solar ultraviolet radiation exposure in the same population.
Methods
A clinical cross‐sectional study of the occurrence of facial wrinkles, actinic keratosis, keratinocyte cancer and melanocytic nevi in a population of Danish outdoor and indoor workers and associations with semi‐objective measures of work related solar ultraviolet radiation exposure based on a combination of dosimetry and self‐report.
Results
Work related solar ultraviolet radiation exposure was significantly positively associated with occurrence of facial wrinkles (α=.05). Actinic keratosis was associated to status as outdoor worker (OR=4.272, CI [1.045 – 17.471]) and age (p<0.001, CI [1.077 – 1.262]) and twice as common in outdoor workers (10.3% CI [0.05, 0.15]) compared to indoor workers (5.1% CI [0.00, 0.10]). Only two cases of keratinocyte cancer were diagnosed (<1%). Older age was negatively associated with occurrence of melanocytic nevi.
Conclusion
Outdoor work in Denmark is associated with increased occurrence of facial wrinkles and actinic keratosis from solar ultraviolet radiation exposure, thus justifying sun safety at Danish workplaces from a clinical perspective.
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... It is well-recognized that regular sunscreen use can help prevent photoaging of skin in fair-skinned people. [1][2][3] Therefore, application of sunscreen is recommended for the prevention of photoaging as well as squamous cell carcinoma (SCC) or actinic keratosis (AK) in many countries. In the USA, sunscreen is available over-the-counter. ...
... Only younger participants under 55 years old were used for photoaging analysis in a huge clinical trial in Nambour. 2,3 The authors explained that the reason for this restriction is because skin aging under the age of 55 years is caused predominantly by photoaging, rather than by photoaging and aging. All the subjects in the study were over 60 years. ...
Since photoaging of skin is caused by chronic sun exposure, it is well-recognized that regular sunscreen use can help prevent photoaging of skin in fair-skinned people. Therefore, application of sunscreen is recommended for the prevention of photoaging in many countries. However, the relationship between UV exposure and photoaging has rarely been investigated in clinical studies in Japan. In addition, there have been almost no long-term interventional studies in Japanese people. We have previously conducted a study where Japanese actinic keratosis patients were instructed to continuously apply sunscreen. The results indicated that long-term application of sunscreen is effective in suppressing actinic keratosis progression and generation. In the present study, we investigated the effects of sunscreen on photoaged skin in 14 elderly Japanese people. Skin conditions such as water content, transepidermal water loss, the number of spots, wrinkles, and skin color tone uniformity were measured and compared before and after the study. A statistically significant difference was observed only in skin surface hydration. There were large inter-individual differences in amount of sunscreen used throughout the study. The changes in the number of spots and skin color tone uniformity during the 18 months showed good correlation with amount of sunscreen being used. These results suggest an increase in the number of spots and deterioration in skin color tone uniformity in the 18-month non-sunscreen application period, and that such skin conditions improved with increasing use of sunscreen. In this study, we suggested an inhibitory effect on photoaging symptoms such as spots and skin color tone non-uniformity, by application of the appropriate amount of sunscreen over a long period of time in Japanese people, similar to Caucasians.
... Skin aging is a complex process that is governed by key contributions from several factors (Farage et al., 2008). Gender, ethnicity, genetic variations, inherited genes, radiation exposure, diabetes, nutrition, environment and lifestyle habits contribute to the process of skin aging (Farage et al., 2017;Gunn et al., 2014;Makrantonaki et al., 2012;Green et al., 2011;Tobin, 2017;McDaniel et al., 2018;Argyropoulos et al., 2016;Panich et al., 2016). The process of aging is initiated at cellular level by loss of function and ability to replenish damaged keratinocytes. ...
Human skin plays an important role protecting the body from both extrinsic and intrinsic factors. Skin aging at cellular level, which is a consequence of accumulation of irreparable senescent keratinocytes is associated with chronological aging. However, cell senescence may occur independent of chronological aging and it may be accelerated by various pathological conditions. Recent studies have shown that oxidative stress driven keratinocyte senescence is linked to the rate limiting polyol pathway enzyme aldose reductase (AR). Here we investigated the role of three novel synthetic AR inhibitors (ARIs) AT-001, AT-003 and AT-007 in attenuating induced skin cell senescence, in primary normal human keratinocytes (NHK cells), using three different senescence inducing agents: high glucose (HG), hydrogen peroxide (H2O2) and mitomycin-c (MMC). To understand the efficacy of ARIs in reducing senescence, we have assessed markers of senescence, including SA-β-galactosidase activity, γ-H2AX foci, gene expression of CDKN1A, TP53 and SERPINE1, reactive oxygen species generation and senescence associated secretory phenotypes (SASP). Strikingly, all three ARIs significantly inhibited the assessed senescent markers, after senescence induction. Our data confirms the potential role of ARIs in reducing NHK cell senescence and paves the way for preclinical and clinical testing of these ARIs in attenuating cell aging and aging associated diseases.
... Vulnerability to sunlight, on the other hand, depends on the melanin content of the skin. As such, according to the Fitzpatrick scale, skin types I, II and III are more sensitive to photoaging than IV, V or VI [16,17]. ...
Background/Objectives: The skin is the largest organ of the human body and is exposed to the aging process (not only chronological aging, but also photoaging). One of the methods used to correct visible skin changes due to photoaging is lasers. The aim of this study was to objectively evaluate the effect of Q-switched laser treatments on visible changes in the photoaging process among women using specialized measuring devices—ultrasound and Courage & Khazaka. Methods: The study included 36 women with visible signs of photoaged skin. The women were given a series of three treatments with a Fotona QX MAX fractional head laser. Both before and after the treatment, the women were examined for selected skin parameters with the help of specialized measuring devices such as Courage & Khazaka and skin ultrasound. Skin firmness and elasticity, the degree of hydration, TEWL and HL TOTAL levels, and MEP and HEP skin echogenicity were taken into account. The obtained results were tabulated and statistically analyzed. Results: Statistically significant differences were noted for parameters representing skin elasticity R2 [p = 0.0210] and R7 [p = 0.0302], TEWL [p = 0.0152] and HL TOTAL [p = 0.0367] on the forehead, and HL TOTAL [p = 0.0450] on the cheek. In addition, statistically significant differences were observed in the MEP/TP parameter on the forehead and cheek [p = 0.0236, 0.0475, respectively] and HEP/TP in the forehead area [p = 0.0367]. Conclusions: Q-switched laser treatments have a positive effect on the condition of women’s skin. Therapy with this laser reduces the visible changes in the photoaging process in the face.
... progression of precancerous lesions [5,6]. The severity of the development of PA can be reflected in the appearance of premature aging even in 30-year-old individuals [7]. ...
Photoaging (PA) is considered a silent disease affecting millions of people globally and is defined as skin damage due to prolonged exposure to ultraviolet radiation (UVR) from the sun. Physiologically, the skin is in a state of renewal and synthesis of components of the extracellular matrix (ECM). However, exposure to UVR affects the production of the ECM, and the functioning and response of skin cells to UVR begins to change, thus expressing clinical and phenotypic characteristics of PA. The primary mechanisms involved in PA are direct damage to the DNA of skin cells, increases in oxidative stress, the activation of cell signaling pathways responsible for the loss of skin integrity, and cytotoxicity. The medical and scientific community has been researching new therapeutic tools that counteract PA, considering that the damage caused by UVR exceeds the antioxidant defense mechanisms of the skin. Thus, in recent years, certain nutraceuticals and phytochemicals have been found to exhibit potential antioxidant and photoprotective effects. Therefore, the main objective of this review is to elucidate the molecular bases of PA and the latest pharmaceutical industry findings on antioxidant treatment against the progression of PA.
... 2 A study conducted on subjects born in Australia and New Zealand showed that 1.400 of 2.095 subjects experienced photoaging, most of which (83%) experienced severe or very severe photoaging. 3 In Indonesia, specifically in Jakarta, a study involving 136 subjects showed that there are 78 subjects experiencing premature aging due to sun exposure. 4 Sun exposure, namely ultra violet B (UVB) photons that penetrate the epidermis, can induce sunburn. ...
Background: Photoaging is the aging of the skin characterized by the appearance of wrinkles, telangiectasis, solar elastosis, pigmentation and keratosis. Photoaging is usually caused by external factor, such as sun exposure. The radiation from the sun causes an increase of the reactive oxygen species (ROS). Cell damage, dry skin, photoaging, and skin cancer are all caused by the accumulation of ROS in the skin. Purpose: The goal of this study is to find out how sun exposure affects the severity of photoaging and skin hydration at dr. Zainoel Abidin Regional General Hospital Banda Aceh. Methods: This is an analytic observational study with an accidental sampling technique. Sun exposure was measured by a questionnaire, the severity of photoaging was assessed based on the doctor's diagnosis, and skin hydration was assessed through an examination using a corneometer and tewameter. Results: This study indicates that there is an effect of sun exposure and the severity of photoaging with p value of 0.016, while skin hydration shows a significant effect of sun exposure on hydration with a corneometer parameter with a p value of 0.031 Conclusion: There is a substantial correlation between sun exposure and the severity of photoaging. There is a substantial relationship between sun exposure and skin moisture, as measured by the corneometer parameter.
... In a study conducted by Green et al., it was found that individuals who had outdoor occupations had 60% raised odds of higher grades of photoaging. [11] is was not consistent with our study as housewives who do not have much photo exposure constituted a majority i.e. 26 (52%) of our patients. ...
Objectives
Red light-emitting diodes (LEDs) alter the extracellular matrix and increase fibroblast growth factor which increases the number of fibroblasts. Carotenoids have singlet oxygen quenching properties. The objective of this study was to evaluate combined effect of red light with oral beta-carotene in treating photo-damaged skin.
Material and Methods
Enrolled subjects were randomized into two groups, A and B. Group A received two sessions/week for 4 weeks of red light therapy and oral beta-carotene 30 mg/day for 12 weeks and Group B received two sessions/week for 4 weeks of red light therapy alone. Before and after clinical as well as dermoscopic photographs were evaluated. Dermoscopic photoaging scale (DPAS), Physician Global Assessment, and Patient Global Assessment was done at baseline, at end of therapy at 4 weeks and at 12 weeks.
Results
The mean DPAS of Group A before the treatment was 22.76 which decreased to 10.08 at the end of follow-up period (12 weeks) and was 19.80 in Group B before the treatment which decreased to 10.84. There was 28.25% reduction in DPAS in Group A at 4 weeks whereas it was 16.18% in Group B. Group A showed 56.12% reduction at week 12, while Group B showed 44.78% reduction. There was statistically significant difference in mean percentage reduction in DPAS between the two groups when compared ( P = 0.001).
Conclusion
Red LED therapy with oral beta-carotene is a better approach for treating photoaging than Red LED therapy alone.
... It is estimated that premature skin aging affects up to 83% of adults under the age of 55 [1,20]. Since having a young and attractive appearance may exert a positive influence on social behavior and mood, there is a growing interest in therapies that help to alleviate or reduce the effects of aging [2]. ...
Combined methods of applying chemical peels and antioxidants could be an option for skin rejuvenation with no down-time. The penetration of active substances can be enhanced by microneedle mesotherapy. The study was conducted on a group of 20 female volunteers, aged 40–65 years. All volunteers received a series of eight treatments performed every seven days. The whole face was first treated with azelaic acid; following this, the right side received a 40% solution of vitamin C and the left side 10% vitamin C with microneedling. Hydration and skin elasticity were markedly improved, with better results observed on the microneedling side. Melanin and erythema index decreased. No significant side effects were seen. The combination of active ingredients and delivery techniques have great potential to enhance the effectiveness of cosmetic preparations, probably by multidirectional ways of action. In our study, we demonstrated that both 20% azelaic acid + 40% vitamin C treatment and 20% azelaic acid + 10% vitamin C + microneedle mesotherapy efficiently improved the assessed parameters of aging skin. However, the use of microneedling mesotherapy as a means of direct delivery of active compound to the dermis enhanced the effectiveness of the studied preparation.
... Susceptibility of skin to the UV induced damage depends upon the content of melanin a particular skin type, of Fitzpatrick scale, contains. According to which, skin types I, II, and III are more susceptible to photoaging than type IV, V and VI [15,16] (see Table 1). ...
Skin areas exposed to ultraviolet radiation (UV) from sunlight are more prone to photoaging than unexposed areas evidenced by several signs which include skin dryness, irregular pigmentation, lentigines, hyperpigmentation, wrinkling, and decreased elasticity. Plant-based natural product ingredients with therapeutic potential against skin photoaging are gaining more attention. This article aims the reviewing the research work done in exploring the cellular and molecular mechanisms involved in UV-induced skin photoaging, followed by summarizing the mechanistic insights involved in its therapeutics by natural product-based ingredients. In the mechanistic section of the convoluted procedure of photoaging, we described the effect of UV radiation (UVR) on different cellular macromolecules (direct damage) and subsequently, the deleterious consequences of UVR-generated reactive oxygen species (indirect damage) and signaling pathways activated or inhibited by UV induced ROS generation in various cellular pathologies of skin photoaging like inflammation, extracellular matrix degradation, apoptosis, mitochondrial dysfunction, and immune suppression. We also discussed the effect of UV radiation on the adipose tissue, and transient receptor potential cation channel V of photoaging skin. In the past few decades, mechanistic studies performed in this area have deciphered various therapeutic targets, opening avenues for different available therapeutic options against this pathological condition. So the remaining portion of the review deals with various natural product-based therapeutic agents available against skin photodamage.
... These effects, that are a result of ultraviolet A and B (UVA and UVB), infrared (IR) radiations with formation of free radicals, and even visible light, include increased skin aging, loss of elasticity, dry skin, patchy discoloration or uneven skin tone, benign skin growths, and the much-dreaded skin cancer to name a few. [2][3][4] The concept of dermatoheliosis, a term related to damaged skin because of increased exposure to the sun, is the basis of the multi-billion-dollar cosmeceutical industry aimed at preventing sun-damaged skin or reversing the effects thereof. Photoprotective measures include the wearing of longsleeved shirts and wide brimmed hats, avoiding the sun, seeking shade in daytime, as well as adequate and appropriate sunscreen use with respect to quantity and frequency of application. ...
Introduction
Public health awareness on sun-protection practices especially sunscreen use is established in developed countries compared with some other tropical African countries. Open-market traders in Nigeria, who typically have black skin, spend up to 8 hours in daylight with unprotected sun exposure.
Aim
To determine prevalence of the knowledge of sunscreen use and to discover if adequate and appropriate sunscreen use is practiced by market traders.
Methods
Cross-sectional study on 307 consenting traders at Sandgrouse Market in Lagos, Nigeria. Demographic data and responses to questions on sun exposure and its effects, knowledge and use of sunscreen, source of knowledge, and frequency of application were documented with a predesigned study questionnaire. Data were analyzed with SPSS 22.
Results
More females (207; 67.4%) were observed and the mean age was 42.7 ± 12.8 years, though most were within the 35- to 39-year age range. One-third (102; 33.2%) were unaware that sun exposure could damage the skin and only 30 (9.8%) were aware of or knew what sunscreen meant. Commercials or advertisements were the most common source of knowledge and females were significantly more aware of sunscreens ( P = 0.018).
Conclusion
There is poor knowledge and awareness of the use of sunscreen among urban market traders in Nigeria who have prolonged unprotected exposure during their daily activities. Females were significantly more aware of sunscreens than males but there was no significant difference in the use pattern.
... oth intrinsic and extrinsic factors contribute to skin aging; smoking and UV radiation are well-known extrinsic risk factors. [1][2][3] Fine and coarse rhytids, xerosis, sallowness, roughness, loss of tone, and resiliency are all indications of photodamaged skin. 4 Atrophic or hyperplastic epidermis, flattened dermo-epidermal junction, decreased cell turnover, upregulated melanocytes, and inflammatory cells are phenotypical features. ...
Background:
Fractional radiofrequency (FRF) technology reduces skin laxity and treats aging-related skin disorders such as wrinkles. The objective of this study was to evaluate participant satisfaction of FRF for the treatment of facial wrinkles.
Methods:
A total of 25 male and female patients (average age 60.5 years) were enrolled in this prospective, single center study. Patients received 3 FRF treatments at 3- to 5-week intervals on both sides of the face, using 80-pin (up to 124 millijoule/pin) or the 160-pin tip (up to 62 millijoule/pin) applicator. Follow-up visits were conducted at 6 and 12 weeks after the last treatment. Participant satisfaction was evaluated by individual self-assessment of wrinkle reduction and a patient satisfaction questionnaire. Pain, tolerability, and safety were monitored throughout.
Results:
The individual satisfaction was high with participants giving an average satisfaction score of 2.8 ("satisfied") out of 4. Pain was rated "mild" with an average of 4.0 on a 10-point Visual Analog Scale (VAS). Tolerability was rated 3.3 out of 4.0, correlating to "very tolerable." Ninety percent (90%) of subjects reported a mild or moderate improvement in their treatment area at 12-week follow-up.
Conclusion:
This study demonstrates that under the FRF pre-sets used, patients are satisfied with results of FRF modality for improvement of their wrinkles. No unanticipated side effects were observed. Treatment was tolerable, and individuals had high levels of satisfaction and tolerability with the results at last follow-up. J Drugs Dermatol. 2022;21(11):1221-1227. doi:10.36849/JDD.6986.
... Intrinsic skin aging was attributed to non-modifiable risk factors such as chronological aging and genetic influences, while extrinsic aging was attributed to modifiable extrinsic factors, such as sun exposure and smoking. From the primary search, there were instances of the terms 'photoaging' being used in place of or equated to 'extrinsic aging' [22][23][24][25] , while others defined extrinsic aging as skin aging influenced by multiple extrinsic risk factors, including skin aging attributed to sun or ultraviolet (UV) exposure which 'photoaging' refers to, but not vice versa. This review considers photoaging as a proper subset of extrinsic aging. ...
Skin aging has been defined to encompass both intrinsic and extrinsic aging, with extrinsic aging effected by environmental influences and overlaying the effects of chronological aging. The risk factors of skin aging have been studied previously, using methods of quantifying skin aging. However, these studies have yet to be reviewed. To better understand skin aging risk factors and collate the available data, we aimed to conduct a systematic review and meta-analysis. We conducted our systematic review in compliance with Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines. Embase, PubMed and Web of Science databases were searched in October 2020 using specific search strategies. Where odds ratios were reported, meta-analyses were conducted using the random effects model. Otherwise, significant factors were reported in this review. We identified seven notable risk factors for various skin aging phenotypes: age, gender, ethnicity, air pollution, nutrition, smoking, sun exposure. This review’s results will guide future works, such as those aiming to examine the interaction between genetic and environmental influences.
... Premature skin ageing is estimated to affect as much as 83% of adults under the age of 55 [2]. ...
Skin ageing is a progressive but modifiable, multi-factorial disorder that involves all skin tissues. Pertaining to its wide range of physiological and psychosocial complications, skin ageing requires rigorous clinical attention. Topical retinoids and per-oral proteoglycans are promising, non-invasive, therapeutic modalities. To overcome the low bioavailability of conventional free retinoids, Nourella® cream with Retilex-A® (Pharma Medico, Aarhus, Denmark) was developed using a proprietary nano-encapsulation technology. The nano-encapsulation is a sophisticated ‘permeation/penetration enhancer’ that optimises topical drug delivery by increasing surface availability and net absorption ratio. Treatment adherence is also improved by minimising skin irritation. Interventional evidence supports the higher efficacy of Retilex-A® in improving skin thickness and elasticity compared with conventional free forms. It is also reported that the rejuvenating efficacy of Retilex-A® and tretinoin are comparable. Another skin anti-ageing approach is proteoglycan replacement therapy (PRT) with Vercilex®. Vercilex® in Nourella® tablet has the potential to ameliorate proteoglycan dysmetabolism in the aged skin by activating skin cells and improving collagen/elastin turnover. Replicated clinical trials evidenced that PRT can significantly enhance the density, elasticity and thickness of both intrinsically aged and photoaged skin. Evidently, Vercilex® and Retilex-A® share a range of bioactivities, which underlies their synergistic activity observed in a clinical trial. Dual therapy with Nourella® tablets and cream produced higher effect sizes on skin characteristics than monotherapy with each of the two treatments. In conclusion, Nourella® cream and tablets are safe and effective treatments for skin ageing; however, combining the two in a ‘dual skin rejuvenation system’ significantly improves treatment outcomes.
... [1][2][3] Skin is one of the main and most visible indicator of age in the human body. 1 Cumulative intrinsic and extrinsic factors causes progressive changes in the structure and physiology of all skin layers, which in return will change the external appearance of the skin, especially in areas with more sun exposure. 4,5 Ultraviolet (UV) B irradiation is one of the main external factors that influences extrinsic skin aging. 6 The connective tissues structure in dermis are mostly made of collagen fibers, and chronic UV exposure will induce oxidative stress that play a role in damaging this extracellular collagen matrix. ...
Background: Chronic Ultraviolet B (UVB) exposure causes oxidative stress that may induce damages to the collagen matrix and thus plays a role in the wrinkle formation. Lactobacillus reuteri is a probiotic that may exerts antioxidant effects, thus helping to reduce damages caused by UVB-induced oxidative stress in the skin.
Materials and Methods: Twenty-eight male Balb/c mice were divided equally into control group, UVB radiation only group, oral L. reuteri supplementation only group, and UVB radiation with oral L. reuteri supplementation group. UVB irradiation was given 3 times a week (100 seconds/exposure, within 3 cm distance) for 10 weeks, with a total dose of 166 mJ/cm2. Oral L. reuteri supplementation (0.2 mL, 108 CFU) was provided every morning after meal via orogastric feeding tube for 10 weeks. Wrinkle formation on the dorsal skin of the mice was evaluated in accordance with the Bissett method and type I procollagen levels was evaluated by western blotting.
Results: In comparison with the group receiving only UVB irradiation, the group receiving probiotic and UVB irradiation showed significantly lower wrinkle scores (Group 1 vs. Group 3, 2.50±0.55 vs. 1.00±0,00; p
... The most important intrinsic factors of aging include gender, ethnicity, and genetic variations [2]. A number studies on twins have shown a significant inherited component in skin aging [3][4][5]. Extrinsic factors can be divided into 3 main groups: (1) UV radiation and air pollution; (2) some diseases (e.g., diabetes); and (3) lifestyle choices, such as smoking, alcoholism and nutrition [6][7][8]. Solar radiation is the most crucial extrinsic factor capable of inducing premature skin aging and skin diseases in exposed areas of the body, e.g., the face and neck [9,10]. ...
Skin aging has been associated with a higher dietary intake of carbohydrates, particularly glucose and galactose. In fact, the carbohydrates are capable of damaging the skin’s vital components through nonenzymatic glycation, the covalent attachment of sugar to a protein, and subsequent production of advanced glycation end products (AGEs). This review is focused on the role of D-galactose in the development of skin aging and its relation to oxidative stress. The interest in this problem was dictated by recent findings that used in vitro and in vivo models. The review highlights the recent advances in the underlying molecular mechanisms of D-galactose-mediated cell senescence and cytotoxicity. We have also proposed the possible impact of galactosemia on skin aging and its clinical relevance. The understanding of molecular mechanisms of skin aging mediated by D-galactose can help dermatologists optimize methods for prevention and treatment of skin senescence and aging-related skin diseases.
... Photo aged skin has less elasticity, dilated superficial blood vessels, dry and rough texture, wrinkles and pigmentation. Changes at tissue level include thick epidermis, abnormal keratinocytes, less collagen in dermal layer and atypical elastin (dermal elastosis) (Green et al., 2011;Hughes et al., 2013). The major source of UV radiations is sun light. ...
Aging is the accumulation of detriment which may lead to decline in normal function on cellular, tissue and organ level that ultimately causes age-related diseases and death over time. Genetics, intrinsic (endogenous) and extrinsic (environmental) factors play potential role in complex process of aging. Aged skin shows abnormalities in angiogenesis, immune system, vitamin D synthesis, wound healing and sweat and lipid production causing benign and malignant cancers. The ongoing overview uncovers the relationship between intrinsic and extrinsic skin aging processes. The effect of shortening of telomeres during every cell division is also a factor to determine skin aging. Natural products have been the essential source of medicines since ages. The purpose of skin anti-aging is to slow, cease or reverses the process of aging just to expand the life span of skin of individual.
... [47][48][49][50] The cumulative effects of UV radiation on exposed skin surfaces have been shown to clinically manifest as elastotic skin changes, purpura, uneven skin pigmentation and melanoma and non-melanoma skin lesions. [51][52][53][54][55][56][57][58] Despite a broad range of individual attributes, skin characteristics, and skin properties being assessed, this study may not have identified all factors that could contribute to the risk of skin tears. Therefore, the results of this study may only be relevant to Australia, with further studies across different population groups and geographical locations needed to confirm these findings. ...
The objective of this study was to construct a predictive model to identify aged care residents at risk of future skin tears. Extensive data about individual characteristics, skin characteristics, and skin properties were gathered from 173 participants at baseline and at 6 months. A predictive model, developed using multivariable logistic regression, identified five variables that significantly predicted the risk of skin tear at 6 months. These included: a history of skin tears in the previous 12 months (OR 3.82 [1.64‐8.90], P = 0.002), purpura ≤20 mm in size (OR 3.64 [1.42‐9.35], P = 0.007), a history of falls in the previous 3 months (OR 3.37 [1.54‐7.41], P = 0.002), clinical manifestations of elastosis (OR 3.19 [1.38‐7.38], P = 0.007), and male gender (OR 3.08 [1.22‐7.77], P = 0.017). The predictive model yielded an area under the receiver operating characteristic curve of 0.854 with an 81.7% sensitivity and an 81.4% specificity. This predictive model could inform a simple but promising bedside tool for identifying older individuals at risk of skin tears.
... Skin aging was graded as 1 to 6 according to the Beagley-Gibson system, 15 which has been widely used to evaluate skin aging. 16,17 The higher the grade, the greater the degree of skin aging. Skin grades were assessed separately by 2 investigators, with the mean grade calculated from their results for each skin site in each individual. ...
Objectives
Some researchers have focused on the relationship between vitamin D and cognition, but the conclusions are inconsistent. We estimated cumulative UV exposure could be used to represent the individual's long‐term vitamin D status and investigated its association with global cognitive function in elderly Chinese.
Methods
A total of 641 participants aged 60 years and over were recruited in a rural area of Shenyang, China. All were interviewed to obtain data regarding sociodemographic characteristics and time spent outdoors. Cognitive function was evaluated using the Montreal Cognitive Assessment‐Beijing version (MoCA‐BJ). Images of skin from UV‐exposed (dorsal hand) and UV‐protected (inner forearm) sites from each individual were graded by the Beagley‐Gibson system. Differences in skin‐grade between the 2 sites were used to indicate cumulative UV exposure level. Subjects were grouped in tertiles based on skin‐grade differences (<1.75, 1.75–2.74, and ≥ 2.75), representing low, medium, and high UV exposure levels, respectively. The MoCA‐BJ score was classified in tertiles as low (<19), middle (19‐22), and high (≥23) levels of cognition. Associations between cognitive function and UV exposure were analyzed using ordinal regression.
Results
Skin‐grade differences were associated with self‐reported time spent outdoors. After adjustment for age, gender, education, BMI, whether living alone, income, diet, hypertension, and diabetes, a high UV exposure level was associated with better cognitive function (odds ratio = 0.643, 95% confidence interval = 0.427–0.969).
Conclusions
Greater cumulative UV exposure appears to be associated with better cognitive function in elderly adults.
... Both intrinsic and extrinsic factors (Guinot et al., 2002) contribute to skin aging; smoking and UV radiation are the most well-known extrinsic risk factors (Daniell, 1971;Green et al., 2011). High body mass index (BMI) accounts for less wrinkles (Ernster et al., 1995), most probably because facial fat has an expanding/filler effect on the skin. ...
Facial wrinkling is one of the most notable signs of skin aging. Men and women show different wrinkling patterns yet the lifestyle and physiological factors underlying these sex-specific patterns are relatively unknown. Here, we investigated sex-specific determinants for facial wrinkles. Wrinkle area was quantified digitally using facial photographs of 3,831 north-western Europeans (51-98 years, 58% female). Effect estimates from multivariable linear regressions are presented as the percentage difference in the mean value of wrinkle area per unit increase of a determinant (%Δ). Wrinkle area was higher in men (median 4.5%, [interquartile range (IQR):2.9-6.3]) than in women (3.6%, [IQR:2.2-5.6]). Age was the strongest determinant, and current smoking (men:15.5%Δ; women:30.9%Δ) and lower body mass index (men:1.7%Δ; women:1.8%Δ) were also statistically significantly associated with increased wrinkling. Pale skin color showed a protective effect (men: -21.0%Δ; women: -28.5%Δ) and, in men, sunburn tendency was associated with less wrinkling. In women, low educational levels and alcohol use were associated with more wrinkling, while female pattern hair loss and a higher free androgen index were associated with less wrinkling. In summary, we validated known and identified additional determinants for wrinkling. Skin aging reducing strategies should incorporate the sex differences found in this study.
... 5 The use of sunscreen affords a variety of benefits, including decreasing the number of nevi in children, 6,7 preventing the development of actinic keratosis, 8,9 squamous cell carcinoma, 10-12 melanoma, 13 and reducing the signs of photoaging. 14,15 Currently, the only numeric measure of sunscreen efficacy in the United States is sun protection factor (SPF), which is based on an in vivo test that measures protection against sunburn or erythema induced primarily by ultraviolet B light (UVB; 290-320 nm) and ultraviolet A2 light (UVA2; 320-340 nm). The SPF value offers little information regarding protection against UVA1 light (340-400 nm). ...
Background:
The importance of adequate ultraviolet A light (UVA) protection has become apparent in recent years. The United States and Europe have different standards for assessing UVA protection in sunscreen products.
Objective:
We sought to measure the in vitro critical wavelength (CW) and UVA protection factor (PF) of commercially available US sunscreen products and see if they meet standards set by the United States and the European Union.
Methods:
Twenty sunscreen products with sun protection factors ranging from 15 to 100+ were analyzed. Two in vitro UVA protection tests were conducted in accordance with the 2011 US Food and Drug Administration final rule and the 2012 International Organization for Standardization method for sunscreen effectiveness testing.
Results:
The CW of the tested sunscreens ranged from 367 to 382 nm, and the UVA PF of the products ranged from 6.1 to 32. Nineteen of 20 sunscreens (95%) met the US requirement of CW >370 nm. Eleven of 20 sunscreens (55%) met the EU desired ratio of UVA PF/SPF > 1:3.
Limitations:
The study only evaluated a small number of sunscreen products.
Conclusion:
The majority of tested sunscreens offered adequate UVA protection according to US Food and Drug Administration guidelines for broad-spectrum status, but almost half of the sunscreens tested did not pass standards set in the European Union.
... 9,10 Predictable changes in the skin surface occur with chronic sun exposure including progressive loosening of the basket weave pattern and overall skin laxity. 6,[11][12][13][14] Skin microtopography can be captured simply using silicon impressions, which viewed under a 10-power microscope and graded using a six-tiered system proposed by Beagley and Gibson. 15,16 This system has been validated in an Australian population-based cohort <70 years old. ...
Background:
Skin microtopography as a measure of photoaging is a non-invasive approach to measuring chronic ultraviolet radiation (UVR) exposure, and reflects the degree of dermal elastosis in populations of European descent in the subtropics. Less is known about the utility of this approach in populations at different latitudes, and whether it relates to skin cancer risk.
Methods:
A population-based case-control study of 342 SCC cases and 331 age- and gender-matched controls were evaluated for histologic evidence of solar damage and severity of photoaging based on microtopography on a six-grade scale. Odds ratios for SCC associated with degree of photoaging were estimated using logistic regression analysis adjusted for potentially confounding factors.
Results:
After adjustment for known risk factors, SCC was associated with increasing photoaging grade (OR = 1.7, 95% CI = 0.9-3.0 for severe photoaging; OR = 2.8, 95% CI = 1.6-5.0 for very severe photoaging). Associations remained among those with actinic keratosis (OR = 3.4, 95% CI = 0.9-12.4 for severe photoaging, OR = 5.7, 95% CI = 1.7-19.6 for very severe photoaging).
Limitations:
There was limited statistical power, particularly for subgroup analyses.
Conclusion:
Our findings provide further evidence of microtopography as an independent, objective indicator of risk of SCC. This article is protected by copyright. All rights reserved.
Skin aging is the result of physiological changes determined by genetically driven processes and intrinsic factors, and exacerbated by a combination of multiple environmental factors, the main one being sun exposure. The effects of photoaging are particularly apparent on the face, where the appearance of aging signs can have a significant impact on the emotions conveyed and well‐being. Photoprotection and facial skin care for managing photoaging signs are thus of particular importance for both physical and mental health. Countries, like Australia and Brazil, where the level of sun exposure is high and the populations have predominantly outdoor lifestyles, are particularly aware of the harms of photoaging and have implemented several measures to help reduce the risk of skin cancer in their populations. However, sun‐seeking behaviours are difficult to change, and it takes time before interventions provide perceptible results. Australia still has some of the highest skin cancer incidence and mortality rates in the world. Solutions that target individuals can also be used for minimizing the clinical signs of facial aging and for improving skin quality, with the ultimate aim being not only to improve the appearance of the skin but also to mitigate the occurrence of pre‐malignant and malignant lesions. This review summarizes the features of facial skin photoaging in photo‐exposed populations, based on evidence gained from studies of Australian individuals, and discusses the various available solutions for skin photoaging, in particular those that are most popular in Brazil, which is a country with many years of experience in managing photoaged skin.
Skin ageing is an inevitable phenomenon with several characteristic manifestations. The genetic, molecular, and cellular factors that contribute to aged skin are becoming increasingly understood. As our knowledge of how skin ages advances, the potential therapeutic opportunities for skin rejuvenation are similarly increased and improved. In this chapter, the process of skin ageing based on both intrinsic factors and extrinsic influences across the spectrum of skin types is discussed. The biological mechanisms that contribute to these phenomena are further discussed, as well as the progress and opportunities for therapeutic interventions.
As our society ages, questions concerning the relations between generations gain importance. The quality of human relations depends on the quality of emotion communication, which is a significant part of our daily interactions. Emotion expressions serve not only to communicate how the expresser feels, but also to communicate intentions (whether to approach or retreat) and personality traits (such as dominance, trustworthiness, or friendliness) that influence our decisions regarding whether and how to interact with a person. Emotion Communication by the Aging Face and Body delineates how aging affects emotion communication and person perception by bringing together research across multiple disciplines. Scholars and graduate students in the psychology of aging, affective science, and social gerontology will benefit from this over-view and theoretical framework.
Skin ageing results from both the passage of time and from extrinsic forces, predominantly solar ultraviolet irradiation. Intrinsic ageing is characterized by fine wrinkling and homogenous colour on sun‐protected sites whereas extrinsic ageing is characterized by fine and coarse wrinkling, erythema and dyspigmentation on sun‐exposed sites. Two distinct phenotypes of extrinsic ageing have emerged: atrophic and hypertrophic variants. Tools to measure and quantify skin ageing have been developed and offer therapeutic and research applications. Molecular mechanisms distinguishing intrinsic and extrinsic skin ageing are discussed. The implications of skin ageing are cosmetic, medical and social in nature.
INTRODUCTION: UV-B exposure to the skin may produce ROS, decreasing collagen density and increasing MMP-1 expression. Longan leaf extract cream contains antioxidant and is expected to prevent decrease in collagen density and MMP-1 expression increase.OBJECTIVE: The research aims at administering longan leaf extract cream to increase collagen density and decrease MMP-1 expression in BALB/c mice exposed to UV-B rays.METHODS: This experimental research employed a Post Test Only Controlled Group Design. The subjects were 24 BALB/c mice, which were randomly divided into 4 groups. The Control Group (Ctr-G)was only administered with basic cream and exposed to UV-B rays, while Groups DLS-3, DLS-6, and DLS-13were respectively administered with longan leaf extract cream at doses 3.25%, 6.5% and 13% and exposed to UV-B rays for 4 weeks at a dose of 1 MED. On day 29, a tissue excision biopsy was performed to determine the collagen density and MMP-1 expression. The collagen density preparations were made using Masson’s Trichome staining and MMP-1 preparations were made using immunohistochemical staining.RESULTS: Kruskalwallis analysis showedstatistically no significant differences in collagen density and MMP-1 expression between groups(p value> 0.05).CONCLUSION: Administration of longan leaf extract cream at doses of 3.25%, 6.5% and 13% had proven unable to increase collagen densitynor decrease the MMP-1 expression significantly after UVB exposure.
Studies have shown an association between cigarette smoking and premature aging. The objective is to compare severity of facial wrinkling in smokers and nonsmokers after rhytidectomy with concurrent procedures. Patients who underwent rhytidectomy at a single academic institution between 2009 and 2020 were identified. The main outcome measure was the Merz wrinkle scale for preoperative and postoperative photos at 3 and 12 months. Of the 155 patients included, 66 (43%) patients had a smoking history: 7 current and 59 former smokers. Average packs per day was 0.70 and pack-years was 16. All patients showed significant improvement in midface wrinkles postoperatively ( P < .001). At baseline and 3 months, smokers had significantly worse lip wrinkle scores ( P < .01). All patients who received CO 2 laser at time of rhytidectomy (with and without fat transfer) showed significantly greater improvement in lip wrinkle scores at both 3 and 12 months postop ( P < .02). Severity of facial wrinkling is greater in smokers, especially around the lips. Concurrent use of CO 2 laser significantly improved perioral wrinkling, and the greatest results were seen when combined with fat transfer.
Facial pigmented spots are one of the phenotypes of skin aging, but no quantitative analysis of spot features such as color intensity, size, anatomical position, and number on the cheek has yet been performed. In the current study, we conducted an epidemiological survey of 454 Japanese women in their 20s to 70s and analyzed age‐related changes and site differences of facial pigmented spots. Using image analysis of high‐resolution digital facial photographs, 4912 individual pigmented spots were quantified according to color, size, anatomical position, and total number on the cheek. As a result of color analysis, the color intensity of individual pigmented spots increased with aging, significantly so between ages 30s and 50s. The age‐related increase in melanin index of facial spots was confirmed in all sites but did not significantly differ between facial subregions. Regarding the size of pigmented spots, the frequency of large spots increased with age, and large spots were detected in all facial sites. The total number of pigmented spots on the entire cheek increased with aging, significantly so between the 20s and 40s. The number of pigmented spots tended to increase from the region near the canthi to the lower cheeks. The number of spots was markedly increased in the buccal regions compared with the infraorbital and zygomatic regions. The data and methodology presented in the current study can link the state of facial pigmentation with the various factors involved in the histological development of pigmented spots, opening new possibilities in the fields of skin pharmacology and dermatology.
Skin ageing is a progressive, but modifiable, multi-factorial disorder that involves all the skin’s tissues. Due to its wide range of physiological and psychosocial complications, skin ageing requires rigorous clinical attention. In this review, we aim to encourage clinicians to consider skin ageing as a disorder and suggest a novel, dual approach to its clinical treatment. Topical retinoids and per-oral proteoglycans are promising, non-invasive, therapeutic modalities. To overcome the low bioavailability of conventional free retinoids, Nourella® cream with Retilex-A® (Pharma Medico, Aarhus, Denmark) was developed using a proprietary nano-encapsulation technology. The nano-encapsulation is a sophisticated ‘permeation/penetration enhancer’ that optimises topical drug delivery by increasing the surface availability and net absorption ratio. Treatment adherence is also improved by minimising skin irritation. Interventional evidence suggests the greater efficacy of Retilex-A® in improving skin thickness and elasticity compared with conventional free forms. It is also reported that the rejuvenating efficacy of Retilex-A® and tretinoin are comparable. Another skin anti-ageing approach is proteoglycan replacement therapy (PRT) with Vercilex®. Vercilex® in Nourella® tablet form has the potential to ameliorate proteoglycan dysmetabolism in aged skin by activating skin cells and improving collagen/elastin turnover. Replicated clinical trials evidenced that PRT can significantly enhance the density, elasticity and thickness of both intrinsically aged and photoaged skin. Evidently, Vercilex® and Retilex-A® share a range of bioactivities that underlie their synergistic activity, as observed in a clinical trial. Dual therapy with Nourella® tablets and cream produced greater effects on skin characteristics than monotherapy with each of the two treatments. In conclusion, Nourella® cream and tablets are safe and effective treatments for skin ageing; however, combining the two in a ‘dual skin rejuvenation system’ significantly improves treatment outcomes.
The world population is aging and no country is immune to the consequences. We are not aware of any country-specific skin aging risk factors data for the Mongolian people. Thus, we aimed to study the risk factors associated with skin aging in the Mongolian population. A population-based cross-sectional study of 2720 study participants 18 years of age and older was performed evaluating the severity of skin aging based on cutaneous microtopography. Questionnaire data and skin physiological measurements were obtained. The odds ratios for skin aging grades associated with risk factors were estimated using ordinal logistic regression. Study participant's mean age was 45 years, ranging from 18 to 87. After adjustment for known risk factors, skin aging was associated with demographic risk factors such as increasing age (aOR=1.19, 95% CI 1.18-1.20), living in an urban area (aOR=1.31, 95% CI 1.12-1.55) and working outside (aOR=1.44, 95% CI 0.88-2.39) and lifestyle factors including non-usage of sunscreen cream (aOR=1.09 95% CI 0.87-1.37), being a smoker (aOR=1.32, 95% CI 1.09-1.61), having a higher body mass index (BMI) (aOR=1.04, 95% CI 1.02-1.06) and higher levels of sun exposure time (aOR=1.03, 95% CI 1.00-1.06 ) were significantly associated with higher skin aging grades. Having dry (aOR=1.94, 95% CI 1.45-2.59) and combination skin (aOR=1.62, 95% CI 1.22-2.16) types were also independent risk factors associated with skin aging. Having very low skin surface moisture at the T-zone (aOR=2.10, 95% CI 1.42-3.11) and U-zone (aOR=1.25, 95% CI 0.95-1.65) were significantly related to skin aging. Older age, urban living, harsh working conditions, living in a ger district were independent demographic risk factors related to skin aging. Not using sunscreen cream, smoking, higher BMI, greater levels of sun exposure were significant lifestyle risk factors. Having a skin type other than normal was a physiologic risk factor for skin aging.
Subbrow blepharoplasty is widely used in Asian patient populations to preserve the natural upper lid crease while addressing dermatochalasis with lateral hooding. The authors describe the first use of this technique in Caucasians with dermatochalasis and lateral hooding. This is a retrospective case series of Caucasian patients who underwent subbrow blepharoplasty for moderate to severe dermatochalasis with lateral hooding. Patients were included when the skin excess of the upper lid was noted predominantly as a lateral hooding over the lateral half of the upper lid. A modified subbrow blepharoplasty technique was used and will be described in detail. Fifty patients underwent the procedure from January of 2017 to June of 2018, 18 female and 32 male patients. The average age of the patients was 71.4 years (range, 59 to 84 years). Minimum patient follow-up was 3 months. An internal browpexy and a periosteal fixation were combined with subbrow blepharoplasty for 22 patients (14 men and eight women). Patient satisfaction with the result of the procedure and incision line were assessed. All 50 patients were satisfied with the surgical results. No patients noted any issues with the incision. No patients complained of incision problems, but the surgeon noted two patients with redness in the scar at 3 months that improved over a 12-month follow-up. Subbrow blepharoplasty may be an alternative to the classic upper lid blepharoplasty in older Caucasian patients, as it can address moderate to severe dermatochalasis with lateral hooding.
Clinical question/level of evidence:
Therapeutic, IV.
Background:
The severity of facial telangiectasia or red veins is associated with many lifestyle factors. However, the genetic predisposition remains unclear.
Objectives:
We performed a genome-wide association study (GWAS) on facial telangiectasia in the Rotterdam Study (RS) and tested for replication in two independent cohorts. Additionally, a candidate gene approach with known pigmentation genes was performed.
Methods:
Facial telangiectasia were extracted from standardized facial photographs (collected from 2010-2013) of 2842 northwestern European participants (median age 66.9, 56.8% female) from the RS. Our GWAS top hits (P-value <10-6 ) were tested for replication in 460 elderly women of the SALIA cohort and in 576 additional men and women of the RS. Associations of top single nucleotide polymorphisms (SNPs) with expression quantitative trait loci (eQTL) in various tissues were reviewed (GTEx database) alongside phenotype associations in the UK biobank database. SNP-based associations between known pigmentation genes and facial telangiectasia were tested. Conditional analysis on skin colour was additionally performed.
Results:
Our most significant GWAS signal was rs4417318 (P-value 5.38*10-7 ), an intergenic SNP on chromosome 12 mapping to the SLC16A7 gene. Other suggestive SNPs tagged genes ZNF211, ZSCAN4, ICOS and KCNN3; SNP eQTLs and phenotype associations tagged links to the vascular system. However, the top signals did not pass significance in the two replication cohorts. The pigmentation genes KIAA0930, SLCA45A2 and MC1R, were significantly associated with telangiectasia in a candidate gene approach but not independently of skin colour.
Conclusion:
In this GWAS on telangiectasia in a northwestern European population, no genome-wide significant SNPs were found, although suggestive signals indicate genes involved in the vascular system might be involved in telangiectasia. Significantly associated pigmentation genes underline the link between skin colour and telangiectasia.
Objective
With the application of 3D photography, our study aimed to quantify parameters of static nasolabial fold wrinkles and establish mathematic regression model between parameters of wrinkles and age, further to quantitatively evaluate the effect of rejuvenation treatment in terms of age.
Methods
From October 2016 to May 2018, 433 Chinese female volunteers, aged 25‐60 years old, were enrolled in this study. Antera 3D camera was used to collect four parameters of static nasolabial fold wrinkles on the left and right sides of the volunteers, including overall size, average depth (mm), average width (mm) and maximum depth (mm). For those presented a linear relationship with age, univariate linear regression fitting was performed, followed by residual analysis, goodness‐of‐fit test, and significance test.
Results
The results of univariate linear regression fitting showed there was a clear linear relationship between the maximum depth, average depth, overall size of nasolabial fold wrinkles and age, and the regression equations were established. The significance test of regression coefficients showed p values were less than 0.0001.
Conclusions
With application of the regression model between parameters of nasolabial fold wrinkles and age, the effect of rejuvenation treatment can be quantitatively evaluated in terms of age, which has certain reference and promotion value.
Aging is (so far) an inexorable and irreversible path in all species and organisms. In human beings, aging involving the skin has a special meaning because our appearance has become crucial for our social life in the modern world. Knowledge of the morphologic changes that happen during the aging process is crucial for understanding its pathogenesis, which in turn is necessary to approach it and even revert it. Skin aging happens because of 2 main sets of changes. Many -although not all-are the cause of exposure to external agents (extrinsic aging), of which the most important is solar exposure (also known as photoaging). In addition, skin also degenerates by mechanisms linked to genetically programed information (intrinsic aging). In this article, the histopathologic changes evident in exposed and nonexposed skin are examined.
Background:
Exposure to the sun causes premature skin aging, known as photoaging. Clinical features of photoaging vary widely among individuals. In one form, skin appears thin with telangiectasia, and in another form, skin appears thickened with coarse wrinkles. Etiologic, clinical, and therapeutic distinctions among different forms of photoaging remain largely unknown.
Objective:
To characterize the clinical, histologic, and molecular features of hypertrophic and atrophic photoaging.
Methods:
In total, 53 individuals were clinically classified as having primarily atrophic or hypertrophic photoaging or neither (controls). Participants' demographic and sun exposure-related lifestyle data were captured by questionnaire. Fifteen clinical features of participants were qualitatively or quantitively scored. Facial biopsies were analyzed for gene expression and histologic characteristics.
Results:
Actinic and seborrheic keratosis, telangiectasia, and prior incidence of skin cancers were statistically significantly greater and photoaging scale severity, coarse wrinkles, thickness, and sallowness were significantly reduced in atrophic versus hypertrophic groups. Histology also revealed significantly less elastotic material in atrophic photoaging. Gene expression of matrix metalloproteinases and collagens did not differ between the 2 forms of photoaging.
Limitations:
The study was not designed to identify other possible subtypes of photoaging.
Conclusion:
Systematic, categorical, and quantitative clinical and histologic assessments distinguish atrophic and hypertrophic photoaging.
Background: Photoaging is a complex biologic process that affects various layers of the skin with the major damage seen in the connective tissue of the dermis. Although rarely fatal, photoaging can significantly contribute to a loss of quality of life; therefore, it deserves attention. Researchers are continually searching for new compounds to develop rejuvenation therapies. Nowadays, the stem cell population has been discovered, and it shows capability to rejuvenate the skin.
Material and Methods: This was an analytic experimental research conducted on a total of 48 women who were randomised into two groups; 24 women received amniotic membrane stem cell-conditioned medium (AMSC-CM) and the other 24 women received normal saline (NS). We applied the drug for 3 times with an interval of 2 weeks. Microneedling was used to enhance epidermal penetration. We evaluated the progression of photoaging on weeks 0, 4 and 8, as well as the side effects.
Results: The improvement in photoaging after treatment showed significant better effects with the AMSC-CM than with NS (p <0.05). There were minimal transient side effects in either of the study groups.
Conclusion: AMSC-CM has the capability to improve clinical photoaging and is a promising option for rejuvenation therapy.
Introduction : Le système nerveux autonome (SNA) est le marqueur le plus puissant du vieillissement global de l'organisme, en particulier du vieillissement vasculaire cérébral et cardiaque. Bien que la peau soit richement innervée par les nerfs autonomes et le SNA contrôle de nombreuses fonctions cutanées, la relation entre le SNA et le vieillissement cutané n'a pas été étudiée. Méthodes : Nous avons évalué le vieillissement cutané chez 209 sujets âgés (105 femmes et 104 hommes, âge moyen 77,5 ans) appartenant à la cohorte stéphanoise PROOF (PROgnostic indicator OF cardiovascular and cerebrovascular events) qui explore la fonctionnalité du SNA. Le vieillissement cutané a été mesuré par le score clinique SCINEXA (SCore for INtrinsic and EXtrinsic skin Aging), par VISIA, vidéodermatoscopie et cutométrie. L’activité du SNA a été mesurée par la variabilité de la fréquence cardiaque sur enregistrement de l’électrocardiogramme de 24 heures. Résultats : Une relation entre SNA et SCINEXA n’a pas pu être démontrée. Cependant, une relation entre l'activité du SNA et certains items du SCINEXA et certains paramètres du VISIA, de la vidéodermatoscopie et de la cutométrie a été trouvée. En particulier, l'analyse des paramètres VISIA a mis en évidence une relation entre porphyrines élevées et baisse de l’activité sympathique du SNA. Discussion et Conclusion : Quoique nous n’ayons pas trouvé de relation entre le vieillissement cutané global et la fonction du SNA, il est possible que le SNA joue un rôle sur le vieillissement intrinsèque de la peau, mais d’une manière négligeable en comparaison des facteurs externes tels que l’exposition solaire, et que cette partie du vieillissement soit difficile à mettre en évidence. De plus ayant trouvé une relation entre certains paramètres du vieillissement cutané et le SNA, notre étude encourage les futures recherches sur l’influence du SNA sur les différents composants du vieillissement cutané
Background and purpose:
The Beagley-Gibson (BG) grading system utilizes microtopographical skin changes to generate an individualized, objective estimate of cumulative, lifetime ultraviolet radiation (UVR) exposure. However, predictors of BG grade are ill-defined, particularly in older populations. The aim of this cross-sectional study was to describe the factors associated with skin damage as measured by the BG method in 835 community-dwelling older adults.
Methods:
Study participants aged 53-83 years had silicone casts taken from the dorsum of both hands and graded by the BG method. Lifetime sun exposure, skin phenotypic traits and smoking status were assessed by questionnaire. 25-hydroxyvitamin D and melanin density were measured using radioimmunoassay and spectrophotometry, respectively. Ordered logistic regression was used to compute a single odds ratio (OR) by taking BG grade as the outcome variable.
Results:
Higher 25-hydroxyvitamin D was associated with increasing BG grade (OR = 1.39, P = 0.02) in adjusted analysis. Age (OR = 1.14, P < 0.001), occupational sun exposure (OR = 1.62, P < 0.001), ability to tan (OR = 1.40, P < 0.001), melanin density (OR=0.79, P = 0.001), lifetime leisure time sun exposure (OR = 1.21, P = 0.004), current smoking (OR = 1.82, P = 0.007), propensity to sunburn (OR = 1.18, P = 0.016), and waist-hip ratio (OR = 1.10, P = 0.02) were independent predictors of BG grade. Hair colour, number of sunburns, body mass index and gender were not independent predictors of BG grade.
Conclusions:
Beagley-Gibson skin cast grade is a biologically relevant marker of UVR exposure in older adults influenced by both intrinsic and extrinsic factors.
This chapter discusses in detail all the various factors that affect the process of skin aging. Skin aging depends upon a combination of intrinsic and extrinsic factors. Intrinsic factors include gender, ethnicity, and anatomical variations, which are genetically determined. Extrinsic factors such as lifestyle, nutrition, smoking, and sun exposure can also accelerate skin aging. Most intrinsic factors cannot be avoided, but extrinsic factors, such as sun exposure and smoking, can be reduced or eliminated, with substantial impact on the visible appearance of the skin. Lifestyle factors such as smoking or nutritional choices can modulate the effects of both genetic and environmental aging. Exposure to solar ultraviolet light initiates a flurry of molecular and cellular responses that promote rapid and dynamic changes in the skin. Greater understanding of the molecular processes which contribute to skin aging, as well as how lifestyle choices accelerate or impede those changes, may help improve both physical and psychological health for the increasing percentage of the population in the latter years of their lives.
Past sun exposure is linked to a wide range of disease outcomes but is difficult to measure accurately. Silicone skin casts measure skin damage, but some studies show that age rather than sun exposure is the most important determinant of cast score. We examined skin damage scores from silicone casts of the back of the hand in a large adult sample (n = 534) with a broad range of past cumulative UV radiation (UVR) doses. Participants were ages 18 to 61 years and resided in one of four locations down the eastern Australian seaboard, spanning 27-43 degrees S. Data were collected by questionnaire and during a nurse-led interview and examination. Silicone casts were graded from 1 to 6, where higher score represents greater damage. Higher skin damage score was associated with lighter skin pigmentation [adjusted odds ratio (AOR), 4.51; 95% confidence interval (95% CI), 2.33-8.75], fairer natural hair color, particularly red hair (AOR, 11.31; 95% CI, 4.08-31.36), and blue/gray eyes (AOR, 1.72; 95% CI, 1.14-2.59). Higher cumulative UVR dose, particularly before age 18 years, was associated with higher skin damage score (AOR, 2.06; 95% CI, 1.15-2.67 per 1,000 KJ/m(2)), as was number of sunburns, even after adjustment for cumulative UVR dose (AOR, 2.86; 95% CI, 1.50-5.43 for >10 sunburns ever compared with no sunburns ever). Silicone casts of the dorsum of the hand provide a measure of cumulative UVR dose and number of sunburns over the lifetime, which persists after adjustment for chronological age. They can be used as an objective measure of cumulative past sun exposure in epidemiologic studies, but other determinants of skin damage, such as skin pigmentation, should be concurrently evaluated.
The number of studies that use objective and quantitative methods to evaluate facial skin aging in elderly people is extremely limited, especially in Japan. Therefore, in this cross-sectional study we attempted to characterize the condition of facial skin (hyperpigmentation, pores, texture, and wrinkling) in Japanese adults aged 65 years or older by using objective and quantitative imaging methods. In addition, we aimed to identify lifestyle factors significantly associated with these visible signs of aging.
The study subjects were 802 community-dwelling Japanese men and women aged at least 65 years and living in the town of Kurabuchi (Takasaki City, Gunma Prefecture, Japan), a mountain community with a population of approximately 4800. The facial skin condition of subjects was assessed quantitatively using a standardized facial imaging system and subsequent computer image analysis. Lifestyle information was collected using a structured questionnaire. The association between skin condition and lifestyle factors was examined using multivariable regression analysis.
Among women, the mean values for facial texture, hyperpigmentation, and pores were generally lower than those among age-matched men. There was no significant difference between sexes in the severity of facial wrinkling. Older age was associated with worse skin condition among women only. After adjusting for age, smoking status and topical sun protection were significantly associated with skin condition among both men and women.
Our study revealed significant differences between sexes in the severity of hyperpigmentation, texture, and pores, but not wrinkling. Smoking status and topical sun protection were significantly associated with signs of visible skin aging in this study population.
Aging skin undergoes progressive degenerative change. Structural and physiologic changes that occur as a natural consequence of intrinsic aging combined with the effects of a lifetime of ongoing cumulative extrinsic damage and environment insult (e.g. overexposure to solar radiation) can produce a marked susceptibility to dermatologic disorders in the elderly. As skin ages, the vasculature progressively atrophies. The supporting dermis also deteriorates, with collagen and elastin fibers becoming sparse and increasingly disordered. These changes leave the elderly increasingly susceptible to both vascular disorders such as stasis dermatitis and skin injuries such as pressure ulcers and skin tears, with a steadily decreasing ability to effect skin repair.
A parallel erosion of normal immune function produces higher levels of autoimmune skin disorders such as bullous pemphigoid, benign mucous membrane pemphigoid, paraneoplastic pemphigoid, and pemphigus vulgaris. Lichen sclerosus, an autoimmune disorder often occurring in the genital area in older women, is not common but is an important development because of the potential for substantial discomfort as well as serious complications. The prevalence of polypharmacy in this population increases the risk for autoimmune drug reactions, and diagnosis should be undertaken with an awareness that polypharmacy in this population creates a greatly increased susceptibility to drug eruptions that can mimic other cutaneous disorders.
Immunologic senescence in the elderly also sets the stage for potential reactivation of the Varicella zoster virus, in which initial dermatologic involvement expands into the major sensory ganglia. Known as shingles, this disorder can be excruciatingly painful with the potential to cause blindness if the optic nerve becomes involved.
Dermatoses such as xerosis, pruritus, and eczema are also widespread in the elderly, create substantial suffering in those afflicted, and often prove recalcitrant to treatment. Individual susceptibility to specific types of contact dermatitis changes over the lifetime, and seborrheic dermatitis is substantially more prevalent in the elderly.
It is not uncommon for older patients to have multiple impairments, with the potential for cognitive dysfunction as well as impaired vision, hearing, or mobility. In addition, they may not have adequate housing or nutrition, or the financial resources necessary for adequate compliance. Physicians must take into consideration the patient’s physical ability to comply with the recommended therapy as well as socioeconomic factors that may impact on compliance. Simple topical regimens are preferable wherever possible in order to maximize compliance and, therefore, efficacy. Extra effort may be necessary to ensure that instructions are accurately followed and that ongoing compliance with the regimen prescribed is actually achieved.
Management of dermatologic disorders in the elderly is often less than optimal, due to the fact that the special needs and limitations of this population are not adequately considered. Treatments should consider the intrinsic differences between younger and older patients thatmay impact on diagnosis and therapy choice. The aged patient is often afflicted with numerous co-morbidities that can influence the choice of therapy. Skin integrity in the elderly is compromised, and safety concerns are increased with the long-term use of any medication prescribed. In addition, the prevalence of polypharmacy in the aged population substantially increases the risk of cutaneous drug reactions, which can profoundly complicate accurate diagnosis of dermatologic disorders. The aged population also needs to be more closely monitored because of increased fragility of the skin and the physical limitations that may hinder compliance with prescribed regimens.
This study examined the association of smoking status and pack-years of smoking with facial wrinkling in men and women.
We conducted a cross-sectional study of 299 never smokers, 551 former smokers and 286 current smokers, aged 30 through 69 years, drawn from a health maintenance organization. Smoking status, pack-years of smoking, and potential confounding variables were assessed by questionnaire. Facial wrinkle category, a dichotomous variable, and facial wrinkle score, a computed continuous variable, were assessed by blinded standardized visual assessment. Wrinkling was so uncommon among 30- through 39-year-old subjects that analyses were restricted to subjects aged 40 and over (227 never smokers, 456 former smokers, and 228 current smokers).
With age, average sun exposure, and body mass index controlled, the estimated relative risk of moderate/severe wrinkling for current smokers compared to never smokers was 2.3 (95% confidence interval [CI] = 1.2, 4.2) among men and 3.1 (95% CI = 1.6, 5.9) among women. Pack-years was positively associated with facial wrinkle score in women aged 40 through 69 years and in men aged 40 through 59 years. In both groups, the increased risk of wrinkling was equivalent to about 1.4 years of aging.
Our results support earlier findings that risk of facial wrinkling is greater in cigarette smokers than in never smokers.
The skin is increasingly exposed to ambient UV-irradiation thus increasing its risk for photooxidative damage with longterm detrimental effects like photoaging, which is characterized by wrinkles, loss of skin tone, and resilience. Photoaged skin displays prominent alterations in the cellular component and the extracellular matrix of the connective tissue with an accumulation of disorganized elastin and its microfibrillar component fibrillin in the deep dermis and a severe loss of interstitial collagens, the major structural proteins of the dermal connective tissue. The unifying pathogenic agents for these changes are UV-generated reactive oxygen species (ROS) that deplete and damage non-enzymatic and enzymatic antioxidant defense systems of the skin. As well as causing permanent genetic changes, ROS activate cytoplasmic signal transduction pathways in resident fibroblasts that are related to growth, differentiation, senescence, and connective tissue degradation. This review focuses on the role of UV-induced ROS in the photodamage of the skin resulting in biochemical and clinical characteristics of photoaging. In addition, the relationship of photoaging to intrinsic aging of the skin will be discussed. A decrease in the overall ROS load by efficient sunscreens or other protective agents may represent promising strategies to prevent or at least minimize ROS induced photoaging.
Risk factors for non‐melanoma skin cancer among populations with evidence of precursor damage are not well described. We examined and compared risk factors associated with the development of cutaneous basal‐cell (BCC) or squamous‐cell (SCC) carcinoma among a group of 918 adults with significant sun damage (≥10 clinically assessable actinic keratoses) but no prior history of skin cancer. These adults were participants in a 5‐year skin chemoprevention trial between 1985 and 1992, who had been randomized to the placebo group and followed for occurrence of skin cancer. During the study, a total of 129 first SCC and 164 first BCC lesions were diagnosed. The overall BCC and SCC incidence rates for this group of men and women, mean age 61 years, were 4,106 and 3,198 per 100,000 person‐years, respectively. Different constitutional and exposure factors were independently associated with BCC compared to SCC. Only increased age independently predicted BCC occurrence among this population. In contrast, older age along with male gender, natural red hair color and adult residence in Arizona for 10 or more years independently predicted SCC occurrence. The substantial incidence of skin cancer found among this population confirms the need for active dermatological monitoring among individuals with multiple visible actinic lesions. © 2001 Wiley‐Liss, Inc.
Despite an overall thinning of the epidermis and focal areas of cytologic atypia, there was no morphologic evidence that the protective function of this tissue was compromised by age. The characteristic morphologic markers associated with the keratinization process were not altered either in appearance or in amounts. A well-formed stratum corneum was present, suggestive that barrier ability is not compromised in senile skin. Whereas alterations in the aged epidermis are slight, the dermal-epidermal changes are marked and have greater physiologic consequences. The major change is a relatively flat dermal-epidermal junction because of retraction of the epidermal papillae as well as the microprojections of basal cells into the dermis. This flattening results in a more fragile tissue that is less resistant to shearing forces. Retraction of the epidermal downgrowths may also explain the loss in proliferative capacity associated with the aged epidermis. The major alterations in the aged dermis concern the architecture of the collagen and elastin networks. Both fibrous components appear more compact because of a decrease in the voids or spaces between the fibers; the spaces resulted from a loss of ground substance. Collagen bundles appear to unravel, and the individual elastic fibers show signs of elastolysis. The net effect of these fibrous rearrangements and alterations is a dermis that is less stretchable, less resilient, more lax, and prone to wrinkling.
Objective
To identify risk factors of non-melanoma skin cancer (NMSC) in US veterans patients.Background
There are an estimated one million new NMSC cases annually in the United States alone. While other studies with varying foci have evaluated risk factors in different subsets of the general populace, none have examined veterans as a group with potentially unique exposures and risks.Methods
An investigation of risk factors for skin cancer through questionnaire and physical examination on 145 veteran patients with skin cancer and 59 veteran patients without a history of skin cancer was conducted.ResultsParents' ethnicity, actinic keratosis on the face or other anatomic sites, solar elastosis of the neck, facial telangiectasias, age of first sunburn, and residency in Indiana were risk factors significantly associated with the development of skin cancer. Other possible risk factors included smoking and radiation therapy.Conclusions
We documented several risk factors which significantly increased the chance of developing skin cancer among veterans. These included ethnic background and solar damage of the skin among others. A review of the literature confirms these risks in the general population, but also further study is warranted to address risk factors like smoking and radiation, particularly in veterans populations. Identification of pertinent risk factors will help to identify high risk individuals, allow detection of new skin cancer at its earliest stage, and develop a profile of favorable lifestyle characteristics that reduce NMSC risk.
Risk factors for non-melanoma skin cancer among populations with evidence of precursor damage are not well described. We examined and compared risk factors associated with the development of cutaneous basal-cell (BCC) or squamous-cell (SCC) carcinoma among a group of 918 adults with significant sun damage (≥10 clinically assessable actinic keratoses) but no prior history of skin cancer. These adults were participants in a 5-year skin chemoprevention trial between 1985 and 1992, who had been randomized to the placebo group and followed for occurrence of skin cancer. During the study, a total of 129 first SCC and 164 first BCC lesions were diagnosed. The overall BCC and SCC incidence rates for this group of men and women, mean age 61 years, were 4,106 and 3,198 per 100,000 person-years, respectively. Different constitutional and exposure factors were independently associated with BCC compared to SCC. Only increased age independently predicted BCC occurrence among this population. In contrast, older age along with male gender, natural red hair color and adult residence in Arizona for 10 or more years independently predicted SCC occurrence. The substantial incidence of skin cancer found among this population confirms the need for active dermatological monitoring among individuals with multiple visible actinic lesions. © 2001 Wiley-Liss, Inc.
To identify environmental factors that correlate with skin photoaging, controlling for genetic susceptibility by using a questionnaire administered to twins.
The survey collected information about each participant's Fitzpatrick type, history of skin cancer, smoking and drinking habits, and weight from a cohort of twins. Clinicians then assigned a clinical photodamage score to each participant.
The annual Twins Days Festival in Twinsburg, Ohio.
A voluntary cohort of twins from the general community, mostly from Ohio, Pennsylvania, and the northeastern United States. The survey was completed on a voluntary basis by sets of monozygotic (MZ) and dizygotic (DZ) twins. A total of 130 surveys taken by 65 complete twin pairs were analyzed.
Skin aging was assessed using a validated photographic scale of photodamage, graded by such characteristics as wrinkling and pigmentation change.
Photodamage scores among twins of a pair, whether MZ or DZ, were highly correlated (P = .92). Factors found to predict higher photodamage include history of skin cancer (P < .001), zygosity status (MZ vs DZ) (P = .001), weight (P = .02), and cigarette smoking (P = .046). Alcohol consumption was significantly associated with lower photodamage scores (P = .003).
The study of twins provides a unique opportunity to control for genetic susceptibility in order to elucidate environmental influences on skin aging. The relationships found between smoking, weight, sunscreen use, skin cancer, and photodamage in these twin pairs may help to motivate the reduction of risky behaviors.
To investigate cutaneous aging patterns of residents in Hangzhou, Zhejiang, China, and their contributing factors.
Eight hundred and forty-eight Hangzhou residents received the survey between March 2004 and September 2004.
Facial wrinkling first occurred at 21 years of age and skin elasticity began to lose at 22 years of age. In middle-aged and old people, facial wrinkling and looseness escalated with the increase of ultraviolet (UV)-exposure time, indicating the accelerating effect of a higher accumulative dose of UV radiation on skin aging. Only Fitzpatrick types II, III and IV were found in the skin phototypes of residents in Hangzhou area, and Fitzpatrick type II seemed to be much more subject to severe wrinkling, elasticity destruction and skin tumors than types III and IV. The oily skin was more protected against wrinkling and facial looseness than dry skin. However, as to concomitant cutaneous diseases, no difference was found among different skin types.
Age, solar-exposure time, Fitzpatrick type and skin type are the associated forces in promoting skin aging, and emotional factor seems to be another independent risk factor. The age of 49 years and 2 h/d of solar-exposure time seem to be the turning points responsible for dramatic changes of cutaneous appearance in the process of skin aging in Southeast China.
The physical properties of the skin were measured by using noninvasive methods on 72 people displaying various levels of solar elastosis on the neck. The physical parameters measured were the skin extensibility, the elastic recovery, the skin colour, the skin thickness and the electrical conductance. The correlation between the above parameters, the clinical grades of elastosis and the chronological age of each subject were studied using two different statistical approaches. They both showed that elastotic skin is less elastic, dryer, darker, more erythematous and less yellowish than the nonexposed skin. The similarities and differences between the properties of elastotic skin and purely chronologically aged skin are discussed.
The use of non-invasive and invasive techniques for the assessment of human photodamaged skin is reviewed. Physical changes during photodamage and its treatment are best scored using a visual analogue scale rather than a short, non-equal interval scale. Epidermal thickness can be measured by histometric methods but dermal thickness can be measured non-invasively using pulsed A-scan and B-scan ultrasound techniques. These approaches are not effective in detecting any changes due to photodamage. Mechanical properties of the dermis can be determined using either a static or a dynamic test mode. The authors have used extensometry to provide a measure of the laxity of skin. Replicas of the crow's foot areas have been taken before and after tretinoin treatment, and the replicas have been inspected by optical profilometry. Reductions of blood flow in photodamaged skin have been established using laser Doppler measurements, the effect being reversed by topical tretinoin. Invasive biochemical techniques have the disadvantage that they generally require large amounts of tissue. Cytochemical techniques, however, have shown increased glucose-6-phosphate dehydrogenase activity in the granular cell layer of patients with non-melanoma skin cancer, premalignant epidermal lesions, sun-damaged epidermis and artificially irradiated skin. This technique may provide an important model for the study of photodamage. It is concluded that there is no single method available to quantify the degenerative changes associated with photodamage and the effects of tretinoin.
The distinction between intrinsic and extrinsic ageing can be made on both histological and clinical grounds. Clinical criteria associated with the diagnosis of extrinsic ageing are coarse wrinkles, actinic lentigines, elastotic conditions, purpura, telangiectasia and cutaneous neoplasms. These parameters are always superimposed on changes associated with intrinsic ageing: namely, fine wrinkles and benign growths. There is heightened interest in extrinsic ageing as a result of studies demonstrating the efficacy of topical tretinoin in improving this condition. As a consequence, systems for grading extrinsic ageing have been developed, including a photographic standard scale which removes some of the subjectivity inherent to current methodology.
Biopsies were taken from the upper and inner arm of 10 60-year-old male cigarette smokers and compared with 10 age-matched controls who were non-smokers. The mean relative area, number and thickness of the elastic fibres were significantly increased in the cigarette smokers compared to the controls. These results were confirmed using antibodies to elastin or the microfibrillar component of elastic tissue. In the smokers the broader and more fragmented elastic fibres in the skin were not as intensely stained as those of the non-smokers and the ultrastructural alterations of the elastic fibres were similar to those in solar elastosis.
To determine the prevalence of premature ageing of the skin and to assess its associations with skin cancer and related risk factors in a Queensland population.
Community-based prevalence survey of skin cancer and actinic skin damage.
Population of Nambour, Queensland, in December 1986.
Random sample of 1539 residents aged 20 to 55 years for whom skin texture measurements were obtained, and a subsample of 807 whose skin reflectance was measured.
Associations of premature ageing of exposed skin, assessed by silicone moulds of the dorsal skin of the hand, with present or past skin cancer, skin colour measured by reflectance and other related risk factors.
Skin texture changes consistent with moderate to severe ageing were observed in 72% of men and 47% of women under 30 years of age. Severity of skin ageing was significantly associated with increasing age, and independently, with the presence of solar keratoses (P less than 0.01) and skin cancer (P less than 0.05). Increased deterioration was also correlated with decreasing reflectance (darker colour) of sun-exposed skin in both men (P less than 0.01) and women (P less than 0.05), but not with reflectance from sun-protected skin, that is inherent skin colour. Photoageing among men was associated with outdoor occupations, outdoor leisure activities, a tendency to sunburn and previous skin cancer.
Marked premature ageing of exposed skin is common in residents of Queensland and is evident among adults in their twenties. Public education programs about the ill-effects of excessive sun exposure should emphasise not only the risk of skin cancer, but also the high risk of premature skin ageing.
To determine if cigarette smoking is a risk factor for the development of premature facial wrinkling.
Cross-sectional study.
Smoking cessation clinic and community.
Convenience sample of 132 adult smokers and non-smokers in 1988.
A questionnaire was administered to quantify cigarette smoking and to obtain information about possibly confounding factors such as skin pigmentation, sun exposure, age, and sex. Wrinkling was assessed using photographs of the temple region, and a severity score based on predetermined criteria was assigned. A logistic regression model, which controlled for confounding variables, was developed to assess the risk for premature wrinkling in response to pack-years of smoking.
The prevalence of premature wrinkling was independently associated with sun exposure and pack-years of smoking. After controlling for age, sex, and sun exposure, premature wrinkling increased with increased pack-years of smoking. Heavy cigarette smokers (greater than 50 pack-years) were 4.7 times more likely to be wrinkled than nonsmokers (95% CI, 1.0 to 22.6; P value for trend = 0.05). Sun exposure of more than 50,000 lifetime hours also increased the risk of being excessively wrinkled 3.1-fold (CI, 1.2 to 7.1). When excessive sun exposure and cigarette smoking occurred together, the risk for developing excessive wrinkling was multiplicative (prevalence ratio of 12.0; CI, 1.5 to 530).
Cigarette smoking is an independent risk factor for the development of premature wrinkling.
In the present study we have estimated the current prevalence of actinic skin disease in young and middle-aged adults in Queensland, Australia by surveying a representative community. It was found that 4.6% of persons aged 20 to 69 years had skin cancer, mostly basal cell carcinoma, and 40% had solar keratoses. The age distribution and site distribution of actinic lesions in this population were not as classically described; persons below age 40 years exhibited substantial sun-related skin damage, and a large proportion of actinic lesions occurred on sites other than the head, backs, of hands, or forearms. Allowing for age and sex, the strongest risk factors for skin cancer and solar keratoses were fair skin, as assessed by a dermatologist, and clinical signs of solar damage such as solar lentigines, facial telangiectasia, and actinic elastosis of the neck. Associations with self-reported tendencies toward sunburn, frequent painful sunburns, occupational sun exposure, and a previous history of skin cancer were confirmed.
Despite an overall thinning of the epidermis and focal areas of cytologic atypia, there was no morphologic evidence that the protective function of this tissue was compromised by age. The characteristic morphologic markers associated with the keratinization process were not altered either in appearance or in amounts. A well-formed stratum corneum was present, suggestive that barrier ability is not compromised in senile skin. Whereas alterations in the aged epidermis are slight, the dermal-epidermal changes are marked and have greater physiologic consequences. The major change is a relatively flat dermal-epidermal junction because of retraction of the epidermal papillae as well as the microprojections of basal cells into the dermis. This flattening results in a more fragile tissue less resistant to shearing forces. Retraction of the epidermal downgrowths may also explain the loss in proliferative capacity associated with the aged epidermis. The major alterations in the aged dermis concern the architecture of the collagen and elastin networks. Both fibrous components appear more compact because of a decrease in the voids or spaces between the fibers; the spaces resulted from a loss of ground substance. Collagen bundles appear to unravel, and the individual elastic fibers show signs of elastolysis. The net effect of these fibrous rearrangements and alterations is a dermis that is less stretchable, less resilient, more lax, and prone to wrinkling.
Two methods for the assessment of severity of actinic skin damage were evaluated in a population-based survey of 1216 subjects. After controlling for the effects of age, skin texture changes graded by cutaneous microtopography were found to be associated strongly with the presence of solar keratoses and a past history of non-melanotic skin cancer. Changes in skin condition graded by paraocular photography had a weaker relationship with the presence of keratoses and showed no association with non-melanotic skin cancer. These results, together with a higher level of agreement between observers in grading cutaneous microtopographs, support the use of cutaneous microtopography as an index of actinic skin damage in epidemiological research.
There is some evidence that hormone replacement therapy may produce significant improvements in fine wrinkling, while aging skin is more frequently found in smokers. However, studies of the combined effect of a protective factor, such as HRT, and a damaging factor, such as smoking, are rare.
To determine in postmenopausal women the relationship between smoking status and the average number of packets of cigarettes since the subject took up smoking (packs-years) on the one hand, and facial wrinkling on the other, and to evaluate the role of hormone replacement therapy in the prevention of wrinkles in smokers and non-smokers.
All subjects were recruited from our menopause clinic at Hospital Clínic i Provincial in Barcelona and were placed into one of three groups according to their smoking status: 215 life-long non-smokers, 306 former smokers and 209 current smokers. Smoking status, pack-years and hormone replacement were assessed by direct questioning. Facial wrinkle scores were estimated by standardized visual assessment.
The relative risk of moderate-severe wrinkling for current smokers compared to that for life-long non-smokers was 2.57 (confidence interval: 1.83-3.06; P < 0.0005). Pack-years was positively related to facial wrinkles. Life-long non-smokers receiving HRT had lower facial wrinkle scores than Life-long non-smokers who had never received HRT. HRT did not, in general, modify the facial wrinkle score in current smokers.
Our results suggest that the risk of facial wrinkles is greater in smokers and that HRT does not diminish this risk.
To identify risk factors of non-melanoma skin cancer (NMSC) in US veterans patients.
There are an estimated one million new NMSC cases annually in the United States alone. While other studies with varying foci have evaluated risk factors in different subsets of the general populace, none have examined veterans as a group with potentially unique exposures and risks.
An investigation of risk factors for skin cancer through questionnaire and physical examination on 145 veteran patients with skin cancer and 59 veteran patients without a history of skin cancer was conducted.
Parents' ethnicity, actinic keratosis on the face or other anatomic sites, solar elastosis of the neck, facial telangiectasias, age of first sunburn, and residency in Indiana were risk factors significantly associated with the development of skin cancer. Other possible risk factors included smoking and radiation therapy.
We documented several risk factors which significantly increased the chance of developing skin cancer among veterans. These included ethnic background and solar damage of the skin among others. A review of the literature confirms these risks in the general population, but also further study is warranted to address risk factors like smoking and radiation, particularly in veterans populations. Identification of pertinent risk factors will help to identify high risk individuals, allow detection of new skin cancer at its earliest stage, and develop a profile of favorable lifestyle characteristics that reduce NMSC risk.
Smoking and ultraviolet radiation are known to have a detrimental effect on human skin. Important characteristics of the aging skin are elastosis and telangiectasia. The purpose of the study was to assess the relative importance of age per se, and the detrimental effects caused by sun exposure and smoking on the development of cutaneous elastosis and telangiectasia in a well-defined group of individuals. We made use of 966 individuals who participated in a case-control study to investigate environmental and genetic risk factors for skin cancer. Exposure measurements for sunlight and smoking were collected and the amount of elastosis and telangiectasia in the face and neck was recorded according to a four-graded score varying from none to severe. Relative risks were estimated using exposure odds ratios from cross-tabulation and logistic regression. Multivariate logistic regression was used to adjust for potential confounders. Among both sexes a strong association was observed between increasing age, sun exposure, and amount of elastosis. The association between increasing age, sun exposure, and amount of telangiectasia was strong among men, but less apparent among women. Smoking was also associated with elastosis among both sexes, and with telangiectasia predominantly among men. Intrinsic differences between men and women (e.g., hormones) or behavior differences (e.g., more frequent use of creams and cosmetics among women) could account for this apparent difference in the occurrence of telangiectasia. In contrast to elastosis, telangiectasia may not be a good marker of the aging skin, specifically not in women.
The technique of grading the surface topography of sun-exposed skin using silicone impressions of the skin surface is a simple, non-invasive method for measuring skin damage because of sun exposure, but it has never been validated in a community setting.
To investigate the repeatability and validity of using standardly-graded skin impressions as a means of assessing skin photoaging.
A random sample of 195 adults aged 18-79 years and living in Nambour, Australia (latitude, 26 degrees South) had a silicone impression taken of the back of the left hand and a 2 mm punch biopsy of the skin at the same site. Silicone impressions were graded twice independently and histological photoaging was determined by two pathologists.
Grading of silicone impressions of skin surface topography was highly repeatable (weighted kappa > 0.8). Compared with those with low skin impression grades (least degeneration), people with high grades were three times more likely to show a high degree of dermal elastosis on skin histology (odds ratio 3.1, 95% confidence interval 1.6, 5.7) after adjusting for age, sex, skin colour, tanning ability, occupational exposure, smoking and height-adjusted weight. Other photoaging changes in the stratum corneum and dermis were also strongly correlated with high grades of damage on skin impressions.
Grading silicone impressions of skin surface topography is a highly reliable and a valid measure of photoaging and enables prediction of dermal elastosis in a population setting.
To develop a reproducible photonumeric scale to assess photoprotected skin aging and to determine whether health and lifestyle factors, such as smoking, affect skin aging in photoprotected sites.
Using standard photographs of participants' upper inner arms, we created a 9-point photonumeric scale. Three blinded reviewers used the scale to grade the photographs. Participants answered multiple lifestyle questions.
Academic outpatient dermatology clinic.
Eighty-two healthy men and women aged 22 to 91 years. Interventions A professional medical photographer took standardized photographs of each participant's upper inner arm. Participants answered standardized health and lifestyle questions.
(1) Interobserver agreement and reproducibility using the photonumeric scale and (2) health and lifestyle factors most predictive of the degree of aging in photoprotected skin.
There was good blinded interobserver agreement as measured by the maximum range of disagreement scores for each participant (mean, 0.91; 95% confidence interval, 0.76-1.06). Results were reproducible. We developed a multiple regression model showing that the best model for predicting the degree of aging in photoprotected skin includes 2 variables: age and packs of cigarettes smoked per day.
This photonumeric scale demonstrates good interobserver agreement and good reproducibility. Using this scale, the degree of aging in photoprotected skin was significantly correlated with patient age and a history of cigarette smoking. Additional studies are needed to continue garnering information regarding independent risk factors for aging of photoprotected skin.
Photoageing is the superposition of chronic ultraviolet (UV)-induced damage on intrinsic ageing and accounts for most age-associated changes in skin appearance. It is triggered by receptor-initiated signalling, mitochondrial damage, protein oxidation and telomere-based DNA damage responses. Photodamaged skin displays variable epidermal thickness, dermal elastosis, decreased/fragmented collagen, increased matrix-degrading metalloproteinases, inflammatory infiltrates and vessel ectasia. The development of cosmetically pleasing sunscreens that protect against both UVA and UVB irradiation as well as products such as tretinoin that antagonize the UV signalling pathways leading to photoageing are major steps forward in preventing and reversing photoageing. Improved understanding of the skin's innate UV protective mechanisms has also given rise to several novel treatment concepts that promise to revolutionize this field within the coming decade. Such advances should not only allow for the improved appearance of skin in middle age and beyond, but also greatly reduce the accompanying burden of skin cancer.
The incidence of sunlight-induced skin changes (photoaged skin, skin carcinogenesis) increases with increasing age and it is thought to be associated with an accumulation of mutations in skin cells. These mutations are mainly caused by UV exposure. The reactive oxygen species produced in UV-exposed skin can cause various kinds of DNA damages e.g., 8-oxoguanine, which are primarily repaired by the base excision repair (BER) system. In addition, UV can directly cause DNA damages; cyclobutane pyrimidine dimers (CPD) and pyrimidine-pyrimidone (6-4) photoproducts (6-4PP), both of which can be repaired by the nucleotide excision repair (NER) system. There have been several reports showing an age-related reduction in the DNA repair capacity in the NER, BER, and other repair systems, which contributes to the phenotypes of aging. To clarify the mechanism of skin aging, we examined the NER of skin fibroblasts from healthy donors of different ages. In a host cell reactivation assay, the cells from elderly donors exhibited a significant decline in the ability to restore transfected reporter DNA damaged by UV. In contrast, the ability to remove CPD and 6-4PP declined little with age, as assessed by an enzyme-linked immunosorbent assay. The mRNA expression of DNA repair synthesis-related genes was markedly decreased in the cells from elderly subjects as compared with those from young subjects. These results imply that the age-sensitive step took place after the damage excision in the NER, and that there is an impairment of the latter step of the NER in aging. Based on our data, as well as other reports, the reduced post-UV DNA repair capacity in aging resulting in an accumulation of UV-induced DNA damage is thus considered to be associated with the phenotypes of photoaged skin.
Solar elastosis with comedones studding the central face is often referred to as Favre-Racouchot disease. These open and cystically dilated comedones tend to appear in the periorbital region of the face. The clinical manifestations, pathogenesis and current treatment of this disorder are reviewed.
A large number of melanocytic nevi is the strongest known risk factor for melanoma in whites, but its relationship to sun exposure overseas among young white women living in temperate climates is unclear. A total of 754 white English women aged 18-46 years were recruited into a cross-sectional study in 1997-2000 to investigate the effect of ultraviolet exposures on numbers of nevi and atypical nevi, and on skin aging as measured by microtopography. Having ever holidayed in hotter countries was associated with a greater age- and phenotype-adjusted mean number of whole-body nevi (percent increase=74; 95% confidence interval: 24, 144; P=0.001), particularly for holidays taken at ages 18-29 years and for counts of the trunk and lower limbs. Having ever lived overseas was not associated with nevus counts, but was inversely associated with number of atypical nevi (P=0.02). Skin aging was not associated with residence or holidays abroad. The association of holidays overseas with an increased nevus count in young white women, which was stronger in the anatomical sites intermittently exposed to sunlight, supports the hypothesis that intermittent sun exposure is of relevance in the etiology of nevi and, hence, melanoma. The findings are of public health relevance given the growing popularity of foreign holidays.
Changes in Skin Condition in Relation to Degree of Exposure to Ultraviolet Light
- J Beagley
- I M Gibson
Beagley J, Gibson IM: Changes in Skin Condition in Relation to Degree of Exposure to
Ultraviolet Light. Perth, School of Biology,
Western Australia Institute of Technology,
1980.