Effects of ageing on dermal echogenicity

Background/aims: Changes in the dermis associated with ageing can be detected by high-frequency skin ultrasonography. In photoaged skin, this technique shows a subepidermal low echogenic band (SLEB) that is probably an ultrasound manifestation of elastosis and oedema in the papillary dermis. Since some authors found an association between age and SLEB thickness or its echogenicity on exposed sites, it has been proposed to use these parameters to quantify skin photoageing.
Methods: To determine whether SLEB can be used as a quantitative marker of ageing, its prevalence was determined on forearm skin in a group of 55 individuals (age 18–57 years). The size of SLEB has been measured by quantifying the number of low echogenic pixels in the subepidermal area, which is an accurate method for assessing SLEB severity.
Results: The prevalence of SLEB increased with age, but SLEB was also present in young subjects. The echogenicity of the subepidermal area did not show any age dependence. However, when a ratio of echogenicity between upper and lower dermis was calculated, a linear dependence on age was found.
Conclusions: This study indicates that skin echogenicity measured as a ratio between the upper and lower dermis may be used to objectively estimate photoageing.     

Dermal fluid translocation is an important determinant of the diurnal variation in human skin thickness

BACKGROUND: Ultrasonography has been used as a non-invasive approach to measure skin thickness. To date there have been no studies on diurnal variations in skin thickness. OBJECTIVES: To evaluate diurnal variations in skin thickness and to compare these with corresponding echogenicity and skin elasticity. METHODS: Measurements by ultrasonography B-mode and by Cutometer SEM 575 were carried out in the morning and in the afternoon on 20 men and 20 women (mean age 30 years) on three areas of the face (forehead, corner of the eye and cheek), the forearm and the upper arm, and the flank, thigh and calf. RESULTS: From the morning to the afternoon, the skin thickness in both sexes significantly decreased on three areas of the face, the forearm and the upper arm, but significantly increased on the thigh and calf. In parallel, the echogenicity significantly increased from the morning to the afternoon on the three areas of the face, the forearm and the upper arm, but decreased significantly on the thigh and calf. Measurements of mechanical properties at four sites demonstrated that from the morning to the afternoon, the major parameters of skin elasticity Ue* and Uf* increased significantly in both sexes on two areas of the face and slightly on the forearm, but decreased significantly on the calf. CONCLUSIONS: The diurnal profiles of skin thickness and skin elasticity in the upper half of the body are the reverse of those in the lower half of the body. These findings suggest that shifts of dermal fluid from the face to the leg by gravity during the day cause the diurnal variation in skin thickness.     

Variations in facial skin thickness and echogenicity with site and age.

The characteristic pattern of reflectivity of facial skin, as evaluated by ultrasound, has not previously been described quantitatively. The aim of this study was to evaluate site- and age-dependent variations in skin thickness and echogenicity of facial skin. A total of 40 women, in different age groups, were studied at 12 different facial skin sites. Echographic images were recorded with a 20 MHz B-Scanner and processed by dedicated software. Skin thickness measurements showed significantly higher values on the lower part of the face, whereas skin echogenicity was higher on the upper part of the face. In elderly subjects, an increase in facial skin thickness and overall echogenicity was observed compared with the younger subjects at all assessed skin areas, except the infraorbital regions. Moreover, modifications of skin echogenicity according to age, consisting in the appearance of a subepidermal band and an enhancement of the lower dermis' reflectivity, were observable at most facial skin sites.     

Ultrasound biomicroscopy in the diagnosis of skin diseases

Ultrasound scanning is becoming an important diagnostic tool in dermatology. The major advantages of this technique are its non invasive non-ionizing nature and its relatively low cost. We aimed to evaluate the accuracy of ultrasound biomicroscopy (UBM) in the diagnosis of eight skin disorders namely, morphea, keloid, lichen planus, chronic eczema, psoriasis, port wine stain, seborrheic keratosis, and photo-aged skin, through correlation of its findings with clinical and pathological assessment. Fifty seven patients with the above diseases were examined by ultrasound biomicroscopy (UBM). Two areas, one of normal skin and the other from lesional skin, were examined for each patient. Skin biopsies were taken from the same lesion examined by UBM. In morphea, the dermal echogenicity was increased and the thickness of morphea plaques correlated significantly with disease severity. Keloids appeared as low echogenic images. In lichen planus and chronic eczema the dermis appeared as sound shadow. In psoriasis, an intermediate zone between the epidermis and dermis (B zone) was detected. Its thickness correlated significantly with the PASI score. Port wine stain lesions appeared hypoechoic. Seborrheic keratosis appeared as a sound shadow. In photo-aged skin a subepidermal low echogenic band (SLEB) was detected. We conclude that UBM is a non-invasive diagnostic tool in dermatology which can be used to give valuable information about disease progress and the effectiveness of therapy.     

Assessment of dermal water by high-frequency ultrasound: comparative studies with nuclear magnetic resonance

Summary Although a principal constituent of human skin, cutaneous water is difficull to sttidy. and litlle is known about water behaviour in physiological and pathological conditions of Ihe skin. It has heen proposed recently that changes in dermal echogenicity measured hy high-frequency ultrasonography reflect changes in dermal water content. To validate skin ultrasonography for assessment of dermal water changes we have studied the relationship hetween dermal echogenicity and skin water content determined hy nuclear magnetic resonance technique. Twenty MHz ultrasovmd scanning of the dorsal and ventral forearm skin was performed in 59 healthy volunteers (age 18–65) and dermal echogenicity was determined by counting low echogenic pixels (LEPs) in skin images, ¹H magnetic resonance spectra were obtained from the same regions and the ratio of areas under the water- and fat-specific peaks (W/F) were calculated to measure a relative water content. Acute dermal oedemn (histamine weal) was studied in the same way in 40 individuals. Baseline dermal echogenicily correlated significantly with W/F. both in the ventral (r=0.47l and dorsal (r = O.57) forearm, lntradennal application of histamine caused a development of intradermal oedema which could be visualized by nuclear magnetic resonance imaging. In a corresponding ultrasound image oedema was seen as a low-echogenic area. The proportional increases in LBPs and W/F after histamine application were correlated, but the elevation in LEPs was 25–48% (95% contidence intervals) higher than that for W/F. These results suggest that high-frequency ultrasonography is a sensitive method for assessment of changes in dermal hydration. This technique may find important applications in comparative and non-invasive evaluations of dermal water in physiological conditions and in skin pathologies associated with oedema formation.     

Relationship between the echogenicity of subcutaneous tissue and the depth of forehead wrinkles

Background/purpose: Subcutaneous tissue is rarely studied in research on wrinkles. We used diagnostic ultrasonography to produce images of subcutaneous tissue of the forehead, one of the areas where age‐related wrinkles form. We quantified the resulting echogenicity and investigated its relationship with wrinkle depth. Methods: One hundred and seventy‐three Japanese subjects were divided into four age groups (21–28 years, 35–41 years, 47–59 years, 65–75 years). Maximum wrinkle depth (R_max) was measured in the forehead. On an ultrasound image, which was captured by scanning perpendicular to the deepest wrinkle, we set a 12.5‐mm‐wide region of interest by aligning the deepest point of the wrinkle at its center and then obtained the ratio of the area exceeding this threshold to the total area as the echogenicity. Results: R _max increased and the echogenicity decreased with age. A negative correlation was found in the oldest group but was not found in other groups, presumably due to individual differences in the echogenicity among younger subjects. Conclusion: This study suggests that the internal structure of subcutaneous tissue, as observed by ultrasonography, is related to wrinkle depth. The relationship between wrinkle depth and echogenicity of subcutaneous tissue is particularly pronounced in the elderly.     

Thickness and echogenicity of the skin in children as assessed by 20-MHz ultrasound

BACKGROUND: Skin anatomy and physiology undergo modifications throughout the whole lifespan. In children the skin appears with structural characteristics, as evaluated by histology, which differ from those of adults, especially in the first years of life. OBJECTIVE: The aim of our study was to evaluate skin thickness and echogenicity at different sites in children by 20-MHz ultrasound. METHODS: Eight skin sites of 42 children and 30 young adults were studied with a 20-MHz B scanner. Skin thickness and mean echogenicity were evaluated. The echographic images were processed and segmented by a dedicated program: the 0-30 amplitude interval, which marks the hypoechogenic parts of the tissue, and the 201-255 range, highlighting the hyperreflecting areas, have been selected. RESULTS AND CONCLUSION: Whereas skin thickness shows a gradual increase from birth to adulthood, maturation of the skin leads to variations in the intensity of its echogenicity, depending on the different skin areas. Whereas on the face and the trunk it appears lower in adults with respect to children, a gradual increase can be observed on the limbs with growing age. The distribution of skin reflectivity also greatly varies in different phases of life.     

Perception,understanding, and association between psychological stress and skin aging: Quantitative surveys of Asian women aged 18–34 years,dermatologists, and psychologists in China and Japan

Background

Skin aging involves a variety of structural and functional changes, under the influence of various factors. Preaging skin is a relatively new concept describing self-perceived signs of skin aging that appear in the early 20s–30s and may be triggered by psychological stress. However, it is unclear how young women and healthcare professionals (HCP) understand the association between stress and skin aging.

Aims

We sought to explore the perceptions of stress-related skin aging among young women and HCPs.

Methods

We performed online surveys of 403 young women (18–34 years), 60 dermatologists, and 60 psychologists residing in major cities in China and Japan. Questions covered skin signs, understanding/perceptions of stress–aging connection, and demographics. Young women also completed DASS-21 to assess their stress level, which was dichotomized as normal or mild–extremely severe.

Results

The stress level was normal in 52.6% or mild–extremely severe in 47.4% of young women. Greater proportions of women in the mild–extremely severe stress group reported skin manifestations associated with preaging, the top three being “rough skin” (39.3% vs. 24.1%), “slow metabolic rate” (28.8% vs. 14.2%), and “dull skin” (43.5% vs. 29.2%). The top three skin manifestations showing the strongest perceived associations with stress were: “dark eye circles,” “slow metabolic rate,” and “dull skin” (among young women); “acne,” “dry skin,” and “skin rash” (among HCPs).

Conclusions

Young women frequently report high levels of psychological stress and signs of skin aging. Perceptions of stress–skin aging association differ between young women and HCPs.     

Age and skin structure and function, a quantitative approach (I): blood flow, pH, thickness, and ultrasound echogenicity

BACKGROUND/PURPOSE: The aging process has been studied with fervor recently, given our shifting demographics. Since age's effects are so manifest in skin's appearance, structure, mechanics, and barrier function, it is not surprising that much effort has been placed in research to better understand them. Quantitative measurements permitted by bioengineering have allowed us to objectively and precisely study aging skin. These overviews piece together the immense amounts of information that have emerged from recent technological advances in dermatological research in order to develop a unified understanding of the quantitative effects of age on the skin. METHODS: We performed a literature on age-related changes in blood flow, pH, skin thickness, and ultrasound imaging data, searching Pub-med, Em-Base, Science Citation Index, and the UCSF dermatological library's collection of books on the topic of aging skin. RESULTS: Despite the many tools and techniques available for quantitative analysis of skin, age studies are often conflicting, especially in the areas of blood flow and skin thickness. Trends indicate that blood flow may decrease with age, especially in sites exposed to the environment. pH apparently varies little until the age of 70, after which it declines. Skin thickness data are difficult to interpret; while the stratum corneum is generally accepted to maintain its thickness during aging, dermal, epidermal, and whole skin thickness changes are controversial. Ultrasound reveals the appearance of a subepidermal low echogenic band that thickens with age, especially in environmentally exposed areas. Some studies also indicate the presence of an echogenic band in the lower dermis which thins with increased age. However, the whole dermis appears to become more echogenic in elderly people. CONCLUSION: Much remains to be done if we are to reach consensus on the effects of age on skin structure and function. Future studies would be benefited by increased standardization of skin sites tested, methodology, and increased sample size.     

Quantitative evaluation of chronological ageing and photoageing in vivo: studies on skin echogenicity and thickness

Skin ageing is divided into chronological ageing and photoageing due to the cumulative effects of solar ultraviolet radiation. It is, however, difficult to measure the degree of photoageing and chronological ageing in humans in vivo . Here, we have evaluated the usefulness of ultrasonography for measurement of chronological ageing and photoageing in vivo . Twenty megahertz ultrasonography was performed in 90 individuals (29 men, 61 women, age 18–94) to describe age-related changes in sun-exposed regions with different levels of sun exposure (dorsal and ventral forearm, forehead, ankle) and non-exposed buttock skin. Skin thickness and skin echogenicity in different layers of the dermis were measured in ultrasound images. Additionally, cutaneous photodamage was scored clinically. Age-related changes were dependent on body site as well as layer of the dermis. A progressive, age-related decrease in echogenicity of the upper dermis was found in sun-exposed regions (dorsal forearm, forehead), but not in moderately exposed regions (ventral forearm, ankle). In the buttock an increase in echogenicity was observed. The echogenicity of the lower dermis increased in all examined sites. Skin thickness increased with age in the forehead and buttock, but decreased in the extremity skin. Our findings show that photoageing causes a decrease in echogenicity in the upper dermis. In contrast, chronological ageing is associated with an increase in echogenicity in the lower dermis. Although both increases and decreases in skin thickness were observed in different anatomical regions, there was no general relationship between skin thickness and age. Dermal echogenicity was deemed valuable for in vivo study of chronological ageing and photoageing.     

Treatment of advanced dermatofibrosarcoma protuberans with imatinib mesylate with or without surgical resection

Background Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma of the skin characterized by the presence of specific COL1A1–PDGFB fusion protein, which appears as a consequence of the t(17;22) (q22;q13) translocation. Objective The aim of the study was to perform an analysis of patients with advanced DFSP treated with imatinib, with or without surgery, in clinical practice outside trials. Patients and Methods We analysed the data of 15 patients (6 male, 9 female; median age 56 years) with locally advanced/initially inoperable and/or metastatic DFSP treated with imatinib 400–800 mg daily between 12/2004 and 06/2009. All diagnoses were ascertained cytogenetically (fluorescent in situ hybridization). Median follow‐up time was 16 months (range: 4–81). Results Metastases were present in six cases (two lungs, two soft tissue, two lymph nodes). Fibrosarcomatous transformation (FS‐DFSP) was confirmed in seven patients (47%). A 2‐year progression‐free survival (PFS) rate was 60%, and a 2‐year overall survival (OS) rate was 78% (median time for PFS/OS was not reached). The best overall responses were: 10 partial responses (67%, including 5 FS‐DFSP – 1 progressed during the follow‐up), 2 stable diseases (13%) and 3 progressive diseases (20%). Seven patients (47%) underwent resection of residual disease and remained free of disease. Conclusions We have confirmed the profound anti‐tumour effect of imatinib in DFSP harbouring t(17;22) with long‐term responses. Imatinib therapy may in some cases lead to tumour resectability of lesser disfiguration.     

High frequency, high resolution B-scan ultrasound in the assessment of skin tumours

Sixteen skin tumours and one BCG vaccination granuloma were examined by 20-MHz B-scan ultrasound. Images were compared with closely matched histological sections of excised lesions. The correlation between histology and ultrasound was excellent for maximum tumour depth measurements (r=0.96, P<0.0001), but less good for maximum width (r=0.84, P<0.0001) because of the elastic contraction of tissue at excision. Architectural detail of lesions on histological sections corresponded well with that on ultrasound images. There was a good correlation for heterogeneity (collagen distribution vs. echo pattern (r=0.86, P<0.0001)), and between collagen content and echogenicity of lesions (r=0.69, P<0.003), Strong correlations were also obtained for echogenicity vs. spacing of collagen bundles (r=?0.65, P<0.005), echogenicity vs. collagen bundle size (r=0.58, P<0.02), and echogenicity vs. cellularity (r=?0.68, P<0.003). Results for dermatofibroma were atypical, due to paradoxical low internal echogenicity and increased echo absorption. B-scanning is a reliable non-invasive method for assessing tumour dimensions, and has potential for the study of tumour characteristics for diagnostic purposes.     

The effect of mechanical forces (vibration or external compression) on the dermal water content of the upper dermis and epidermis, assessed by high frequency ultrasound

An ultrasound scanner, is used to detect changes in water content of the upper dermis. This has previously been found to vary with age and to show diurnal variation. Furthermore, oedema due to venous disease can be shown, using this technique, to respond to elevation. In this study, the water content of the upper dermis and epidermis of the leg in 16 subjects is increased following vibration for 10 minutes using a passive exercise system. A study of pressure applied to the skin of the heel for 10 minutes in 14 volunteers also showed an increase in water content of epidermis and dermis in young persons, but less so in the elderly. It is postulated that the anatomical structure of the vascular bed of the upper dermis predisposes to transsudation when pressure to the skin is applied, thereby maintaining the resilience of the skin in the young, but less so in the elderly.     

Reliability of B-mode ultrasound and shear wave elastography in evaluating sacral bone and soft tissue characteristics in young adults with clinical feasibility in elderly

BackgroundPhysiologic aging is associated with loss of mobility, sarcopenia, skin atrophy and loss of elasticity. These factors contribute, in the elderly, to the occurrence of a pressure ulcer (PU). Brightness mode ultrasound (US) and shear wave elastography (SWE) have been proposed as a patient-specific, bedside, and predictive tool for PU. However, reliability and clinical feasibility in application to the sacral region have not been clearly established.MethodThe current study aimed to propose a simple bedside protocol combining US and SWE. The protocol was first tested on a group of 19 healthy young subjects by two operators. The measurements were repeated three times. Eight parameters were evaluated at the medial sacral crest. Intraclass Correlation Coefficient (ICC) was used for reliability assessment and the modified Bland Altman plot analysis for agreement assessment. The protocol was then evaluated for clinical feasibility on a healthy older group of 11 subjects with a mean age of 65 ± 2.4 yrs.FindingsICC showed poor to good reliability except for skin SWE and hypodermis thickness with an ICC (reported as: mean (95%CI)) of 0.78 (0.50–0.91) and 0.98 (0.95–0.99) respectively. No significant differences were observed between the young and older group except for the muscle Shear Wave Speed (SWS) (respectively 2.11 ± 0.27 m/s vs 1.70 ± 0.17 m/s).InterpretationThis is the first protocol combining US and SWE that can be proposed on a large scale in nursing homes. Reliability, however, was unsatisfactory for most parameters despite efforts to standardize the protocol and measurement definitions. Further studies are needed to improve reliability.     

Dermal echogenicity: a biological indicator of individual cumulative UVR exposure?

Dermal alterations due to chronic UVR exposure may influence dermal ultrasound echogenicity, and a subepidermal low-echogenic band has been proposed as a marker of photoaging. The aim of this study was to determine whether dermal echogenicity could be used as a biological UVR dosimeter. We included 201 subjects (138 healthy volunteers, 31 patients with basal cell carcinoma, and 32 patients with cutaneous malignant melanoma). The number of low-echogenic pixels in the upper dermis relative to the lower dermis (LEP_u/l) was determined in sun-exposed and sun-protected skin. Individual UVR exposure data were collected retrospectively and prospectively using a questionnaire and electronic personal UVR dosimeters. Age, but not sex, skin type, constitutive pigmentation or smoking, correlated significantly with LEP_u/l at all body sites. Different measures of individual UVR exposure were significantly positively correlated with LEP_u/l (together r²=0.39, dorsal forearm), but separately the correlations were poor (r²=0.04–0.19). LEP_u/l was higher in the dorsal forearm in a group with high UVR exposure compared to a low-exposure group (P=0.007). Skin cancer patients in general had a lower LEP_u/l than healthy subjects. The results indicate that the age-related increase in LEP_u/l might be attributed mainly to UVR exposure, and that the methods used to obtain the UVR exposure data might not be sufficiently sensitive or specific. Genetic factors might also influence LEP_u/l. We consider LEP_u/l to be a sensitive and specific marker for UVR exposure at the dorsal aspect of the forearm in healthy subjects.Abbreviations BCC basal cell carcinoma - LEP_u/l number of low echogenic pixels in the upper dermis relative to the lower dermis - MED minimal erythema dose - MM cutaneous malignant melanoma - PPF pigment protection factor - SED standard erythema dose - UVR ultraviolet radiation     

The effectiveness of anticellulite treatment using tripolar radiofrequency monitored by classic and high‐frequency ultrasound

Background Cellulite affects nearly 85% of the female population. Given the size of the phenomenon, we are continuously looking for effective ways to reduce cellulite. Reliable monitoring of anticellulite treatment remains a problem. Objective The main aim of the study was to evaluate the effectiveness of anticellulite treatment carried out using radiofrequency (RF), which was monitored by classical and high‐frequency ultrasound. Methods Twenty‐eight women underwent anticellulite treatment using RF, 17 women were in the placebo group. The therapy was monitored by classical and high‐frequency ultrasound. The examinations evaluated the thickness of the epidermal echo, dermis thickness, dermis echogenicity, the length of the subcutaneous tissue bands growing into the dermis, the presence or absence of oedema, the thickness of subcutaneous tissue as well as thigh circumference and the stage of cellulite (according to the Nürnberger–Müller scale). Results Cellulite was reduced in 89.286% of the women who underwent RF treatment. After the therapy, the following observations were made: a decrease in the thickness of the dermis and subcutaneous tissue, an increase in echogenicity reflecting on the increase in the number of collagen fibres, decreased subcutaneous tissue growing into bands in the dermis, and the reduction of oedema. In the placebo group, no statistically significant changes of the above parameters were observed. Conclusion Radiofrequency enables cellulite reduction. A crucial aspect is proper monitoring of the progress of such therapy, which ultrasound allows.     

Assessment of disease severity and outcome in the gravitational syndrome using pulsed A-scan ultrasound to measure skin thickness

In order to investigate the prognostic significance of skin thickening in the gravitational syndrome, 54 patients and 10 normal control subjects were studied. Patients were investigated using a standard questionnaire, as well as recording the results of clinical history and a physical examination. To quantify the severity of the syndrome, an index of disease severity was devised on the basis of the clinical findings. Skin thickness was measured using pulsed A-scan ultrasound on standardized sites on the lower leg in patients and controls. The results indicated that skin thickness determined non-invasively by pulsed A-scan ultrasound can be used to provide prognostic information in the gravitational syndrome.     

Bioestimulación cutánea con plasma rico en plaquetas autólogo. Estudio controlado con ecografía

Introduction

It is well known that, due to the presence of growth factors, platelet-rich plasma (PRP), is able to produce histological changes in the dermis that reproduce the process of biological tissue repair without previous damage. Biostimulation with PRP has been used clinically for skin rejuvenation of the face and neck. Skin ultrasound can be helpful to evaluate several aspects of skin aging. This study was designed to perform an objective evaluation of the beneficial effects of this treatment on skin aging.

Material and methods

Autologus PRP was injected by mesotherapy in 10 women, aged between 45 and 60 years, in the face, neck and cleavage. Three-monthly sessions were carried out and the final results were measured 1 month after the final treatment. Pictures were taken and skin ultrasound was performed of the same area of the face before and after the treatment.

Results

All patients noted an improvement in their skin quality: the skin was brighter, more hydrated, more compact and plumper. An increase of dermal thickness and a decrease in subepidermic low echogenic band (SLEB) was observed on skin ultrasound. However, this improvement was not statistically significant, probably due to the small number of patients.

Conclusions

Biotestimulation with autologous PRP improved skin quality and reversed ultrasound signs of skin aging. More studies are required to confirm these results.     

Hydration of human stratum corneum studied in vivo by optothermal infrared spectrometry, electrical capacitance measurement, and evaporimetry

Optothermal infrared spectrometry (OTIS) is a recently introduced method for specific measurement, in vivo, of water in the skin. In the present study the method proved well suited to register the increase in water content in stratum corneum following application of emollients. The results were compared with those obtained with a commercial instrument, the Corneometer, and the two methods were found to match very closely. Neither method indicated any difference in hydration of normal skin between young and elderly women. Evaporimetry was used to detect any influence on the water barrier function of the skin following application of emollients; even though the water content of the skin was significantly higher after emollient treatment, the transepidermal water loss remained unchanged.