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.     

Clinical,microbiological, immunological and imaging characteristics of tunnels and fistulas in hidradenitis suppurativa and Crohn’s disease

Hidradenitis suppurativa (HS) tunnels and Crohn's disease (CD) fistulas are a challenge to treat. Although pathogenic similarities have been described between HS and CD, recent studies indicate that clinical, microbiological, immunological and imaging characteristics differ between these diseases. This review highlights the differences between HS tunnels and CD fistulas. Next-generation sequencing studies demonstrate a microbiome in HS tunnels dominated by Porphyromonas spp., Prevotella spp. whereas no specific bacteria have been associated with cutaneous CD. Immunologically, TNF has been found upregulated in HS tunnels along with various interleukins (IL-8, IL-16, IL-1α and IL-1β). In CD fistulas, Th1, Th17, IL-17, IFN-ɤ, TNF and IL-23 are increased. US imaging is an important tool in HS. US of HS tunnels depict hypoechoic band-like structure across skin layers in the dermis and/or hypodermis connected to the base of a widened hair follicle. In CD, MR imaging of simple perianal fistulas illustrates a linear, non-branching inflammatory tract relating to an internal opening in the anus or low rectum and an external opening to the skin surface. An increased awareness of the immediate potential differences between HS tunnels and CD fistulas may optimize treatment regimens of these intractable skin manifestations.     

Concanavalin-A binding sites,pemphigus antigens,and β2microglobulin in epidermal hyperproliferation,premalignant and malignant lesions

Summary Three cell surface parameters of epidermal cells have been studied by immunofluorescence, pemphigus antigens, concanavalin-A binding sugars, and ₂ microglobulin microglobulin. Biopsy specimens were taken from a total of 59 patients with psoriasis, seborrheic and solar keratosis, squamous cell carcinoma, and basal cell epithelioma.We found a loss of demonstrability of all parameters in dedifferentiated tumors or tumor areas in squamous cell carcinoma, premonitory changes in solar keratosis, and no changes in seborrheic keratosis. In the psoriatic epidermis a granular redistribution of the cell surface parameters was occasionally observed in cirumscribed areas of the epidermis. A selective loss of the demonstrability of ₂ microglobulin was the prominent feature in basal cell epithelioma.Our findings demonstrate that the alterations of the cell surface differ in malignant and premalignant skin tumors, in basal cell epithelioma, and in benign psoriatic hyperplasia.Supported by the Deutsche Forschungsgemeinschaft (Ma 674) and the Paul G. Unna-StiftungThe results of this study were part of H. Patyk's doctoral thesis, Göttingen 1981     

Clinical and histological characteristics,and management of melanoma in French Guiana, 2007–2018

There are few studies available on melanoma in Afro-Caribbean and Amerindian populations of South America. French Guiana deserves a study due to its specific health system and diversity of phototypes. The objectives of this study were to evaluate the incidence, histological and clinical characteristics of melanoma in French Guiana. A retrospective study was conducted from October 2007 to January 2018 on all primary melanomas observed at the Cayenne Hospital Centre. Thirty-nine patients were included. The incidence rate (1.61/10⁶ inhabitants/year) was low compared with mainland France. Median age was 58, and gender ratio 1 : 16. Clear phototype (I/II) patients were the most frequent (38.5%), but a significant amount of melanoma also occurred in darker skin. Median Breslow was higher in dark phototypes than in fair-skinned patients. Superficial spreading melanoma (SSM) was the most common histological type (33.3%), particularly in patients with clear phototype (61.5%). Acral lentiginous melanoma was found only in darker-skinned patients (29.1%). The trunk was involved in 66.6% in the clearest group whereas foot was the most common location in the darkest group (60% in V/VI phototypes). Surgery was the most frequently used treatment (79.5%). At the end of the study period, 53.8% had been lost to follow-up. In conclusion, the incidence of melanoma in French Guiana is lower than in mainland France but remains a public health concern, as dark-skinned populations often present with advanced diseases. Awareness and prevention in these communities must be improved.     

Levels of matrix metalloproteinase-2, −9 and −8 in the skin,serum and saliva of smokers and non-smokers

Smoking induces skin ageing, affects wound healing and inflammatory responses in skin and mucous membranes but the mechanisms behind these adverse effects of smoking are not clear. The objective was to elucidate the mechanisms of smoking-related tissue damage, by comparing the levels of matrix metalloproteinases (MMPs) −2, −9, and −8 in the skin, serum and saliva of smokers and non-smokers. The study population consisted of 47 current smokers and 51 non-smokers, all males of Finnish origin. Skin samples from the upper inner arm were frozen in liquid nitrogen. Levels of MMP-2 and MMP-9 protein in the skin were assessed by zymography and MMP-8 isoforms were determined by Western blotting. From the serum samples, MMP-2 and MMP-9 were assessed by zymography and MMP-8 levels by time-resolved immunofluorometric assay (IFMA). From the salivary samples, MMP-8 levels were analysed by IFMA and MMP-9 levels by capture activity assay. In skin tissue, lower levels of both the pro and active forms of MMP-9 and of the active forms of MMP-8 were found in the smokers compared to the non-smokers. In serum, higher levels of proMMP-2 and proMMP-9 were found in the smokers compared to the non-smokers (P=0.001 and P<0.001, respectively), whereas MMP-8 levels did not differ significantly between the groups. Active forms of MMP-9 and MMP-2 could not be found in serum. In saliva, the amount of total MMP-9 was significantly lower in the smokers (156.0 U/ml) compared to the non-smokers (223.9 U/ml, P=0.032), whereas the levels of MMP-8 or active MMP-9 did not differ significantly between the groups. We conclude that smoking alters the levels of matrix metalloproteinases in skin tissue, serum and saliva, which may affect the turnover of extracellular matrix of skin even though the clinical impact of our findings is not clear.     

Common Ground?: Tetracyclines,Matrix Metalloproteinases,Pustular Dermatoses,and Loxoscelism

The fear of spiders is ancient and common throughout much of the world. Skin ulceration and necrosis due to Loxosceles spider envenomation ("bites") is among the best known sequelae of a usually accidental encounter. Therapies for Loxosceles envenomations either are not well documented or have adverse side effects that limit their use by generalists. Based on in vitro and in vivo studies in rabbits injected with purified or recombinant sphingomyelinase D2, Paix?o-Cavalcante et al. (2007) propose in this issue that topical tetracyclines could become safe, efficacious therapy for cutaneous loxoscelism.     

Podoplanin expression in wound and hyperproliferative psoriatic epidermis: regulation by TGF-β and STAT-3 activating cytokines, IFN-γ, IL-6, and IL-22

Background

Podoplanin (PDPN)/T1α/aggrus/PA2.26 antigen, a transmembranous glycoprotein, is a well-known lymphatic endothelial marker. Recent evidence indicates that PDPN is also expressed in keratinocytes especially of sebaceous glands.

Objective

To verify expression-pattern and the regulatory mechanism of PDPN in human epidermal keratinocytes.

Methods

PDPN-expression pattern was analyzed in normal and psoriatic epidermis by immunostaining. The regulatory mechanism of PDPN-expression of keratinocytes by cytokines was analyzed using specific inhibitors, siRNA, and adenoviral shRNA of signaling pathways.

Results

In normal skin, PDPN was expressed on the basal cell layer of sebaceous glands and on the outer root sheath of hair follicles. While no expression was detected in the normal interfollicular epidermis, PDPN was detected in the basal cell layer of wound and hyperproliferative psoriatic epidermis, where the granular layer is lacking. TGF-β1 and IFN-γ independently upregulated PDPN-expression of keratinocytes via TGF-β receptor-Smad pathway and JAK-STAT pathway, respectively. IL-6 and IL-22 also stimulated PDPN-expression of keratinocytes accompanied by STAT-3 phosphorylation. siRNA of STAT-1, inhibitors of STAT-3 signaling, AG490, STAT-3 inhibitor VI, and si/shRNA of STAT-3 inhibited the PDPN-expression of keratinocytes induced by IFN-γ, IL-6 and IL-22 but not by TGF-β1.

Conclusion

These results indicate that TGF-β1, IFN-γ, IL-6, and IL-22 induce PDPN-expression of keratinocytes, which might be significantly involved in the wound healing process as well as in the pathomechanism of hyperproliferative psoriatic epidermis.     

What's eating you? Bees, part 1: characteristics, reactions, and management

Bee stings are common in the United States. We review the characteristics of bumblebees, honeybees, and Africanized honeybees; the types and pathophysiology of sting reactions; and the medical management and prevention of bee stings. In part 2 of this series, we will discuss the use of venom immunotherapy, the diagnosis of systemic mastocytosis that initially presents as anaphylaxis, and the efficacy of immunotherapy in patients with mastocytosis.     

Measuring wound length, width, and area: which technique?

PURPOSE: To provide practitioners with evidence-based recommendations for measuring wound size. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in wound care. OBJECTIVES: After reading this article and taking this test, the reader should be able to: 1. Describe different methods of measuring wound size and their advantages and disadvantages. 2. Discuss a research study conducted to determine the most accurate ruler technique for measuring wounds. 3. Identify evidence-based wound measurement data and recommendations for clinical practice.     

RXRα ablation in epidermal keratinocytes enhances UVR-induced DNA damage, apoptosis, and proliferation of keratinocytes and melanocytes

We show here that keratinocytic nuclear receptor retinoid X receptor-α (RXRα) regulates mouse keratinocyte and melanocyte homeostasis following acute UVR. Keratinocytic RXRα has a protective role in UVR-induced keratinocyte and melanocyte proliferation/differentiation, oxidative stress-mediated DNA damage, and cellular apoptosis. We discovered that keratinocytic RXRα, in a cell-autonomous manner, regulates mitogenic growth responses in skin epidermis through secretion of heparin-binding EGF-like growth factor, GM-CSF, IL-1α, and cyclooxygenase-2 and activation of mitogen-activated protein kinase pathways. We identified altered expression of several keratinocyte-derived mitogenic paracrine growth factors such as endothelin 1, hepatocyte growth factor, α-melanocyte stimulating hormone, stem cell factor, and fibroblast growth factor-2 in skin of mice lacking RXRα in epidermal keratinocytes (RXRα(ep-/-) mice), which in a non-cell-autonomous manner modulated melanocyte proliferation and activation after UVR. RXRα(ep-/-) mice represent a unique animal model in which UVR induces melanocyte proliferation/activation in both epidermis and dermis. Considered together, the results of our study suggest that RXR antagonists, together with inhibitors of cell proliferation, can be effective in preventing solar UVR-induced photocarcinogenesis.     

IL-17: Important for Host Defense,Autoimmunity, and Allergy?

In this issue, Milovanovic and colleagues present evidence that IL-17a enhances IgE production, although the precise mechanism remains unclear. Their initial finding was that higher numbers of IL-17a-producing CD4(+) T cells were observed after polyclonal stimulation in a largely airway allergic population. These data add to the evidence that atopic disorders such as asthma and, possibly, atopic dermatitis (AD) may have distinct immunologic phenotypes. The hope is that by characterizing the immunologic basis of these common diseases we will be able to understand the heterogeneity observed in natural history, response to treatments, susceptibility to infections, genetic risk factors, and associations with other atopic disorders.