Aging-like skin changes induced by ultraviolet irradiation in an animal model of metabolic syndrome

Both physiological skin aging and pathologic photo-aging caused by ultraviolet (UV) irradiation are mediated by latent inflammation and oxidative stress. Although numerous animal skin-aging models have used UV irradiation, most require massive doses or long-term irradiation. To establish a more refined skin-aging model, we focused on an animal model of metabolic syndrome (MS) because MS involves damage to various organs via oxidative stress or inflammation, similar to the changes associated with aging. We hypothesized that MS skin might exhibit more aging-like changes after milder, shorter-term UV irradiation than would normal animal skin under similar conditions, thus providing a useful model for skin aging. The authors therefore examined the skin from Tsumura Suzuki obese diabetic (TSOD) mice (MS model) and control Tsumura Suzuki non-obese (TSNO) mice before and after UV irradiation. Skin from TSOD mice had a thinner epidermis and dermis, a thicker fatty layer, reduced density and convolution of the fragmented collagen fibers, and upregulated expression of tumor necrosis factor (TNF)-α, a dual marker for inflammation and aging, compared to the skin from TSNO mice. UV irradiation affected TSOD skin more severely than TSNO skin, resulting in various changes resembling those in aged human skin, including damage to the dermis and subcutaneous fatty tissue, infiltration of inflammatory cells, and further upregulation of TNF-α expression. These results suggest that UV-irradiated TSOD mice may provide a new model of skin aging and imply that skin from humans with MS is more susceptible to UV- or aging-related damage than normal human skin.     

Wound healing and the aged patient

The aged patient is more susceptible to wound healing problems because of the interactions of body systems, environmental stresses, and disease with an aging process that takes place over many years. The multifactorial nature of wound healing in the elderly makes it difficult to determine whether observed healing problems are attributable to results of aging or other factors. Healing is affected by multiple factors in addition to patient age, which itself is not a dependable indicator of physiologic health. Some of these factors are disease, nutrition, perfusion, skin quality, environment, and individual responses to life events. It is particularly difficult for the aged patient to sustain the motivation to participate in care required during the healing process when cascading problems are allowed to build on the decreasing functions and reserve capacities of aging body systems and deplete available energy levels. Assessment of each individual is required because of the wide variety of aging changes and healing responses seen in aged patients. Compared with a younger adult, the aged patient generally heals well, following the same healing process but at a slower rate. Wound healing for the aged can be optimized through techniques of energy conservation, correction of existing problems, and management of risks related to aging and the individual patient. Healing problems are usually the result of decreases in systemic and local perfusion, decreases in the ability to ward off infection, and fragility of aging skin. The aged patient requires the same care as younger patients. It is more critical that this care be meticulously delivered with particular attention to care of intact skin, effects of chronic disease and medications, motivation, social habits, and discharge planning. Nurses can promote improved healing through the care they provide and by studying the progression of healing in aged patients.     

The dark side of daylight: photoaging and the tumor microenvironment in melanoma progression

Continued thinning of the atmospheric ozone, which protects the earth from damaging ultraviolet radiation (UVR), will result in elevated levels of UVR reaching the earth’s surface, leading to a drastic increase in the incidence of skin cancer. In addition to promoting carcinogenesis in skin cells, UVR is a potent extrinsic driver of age-related changes in the skin known as “photoaging.” We are in the preliminary stages of understanding of the role of intrinsic aging in melanoma, and the tumor-permissive effects of photoaging on the skin microenvironment remain largely unexplored. In this Review, we provide an overview of the impact of UVR on the skin microenvironment, addressing changes that converge or diverge with those observed in intrinsic aging. Intrinsic and extrinsic aging promote phenotypic changes to skin cell populations that alter fundamental processes such as melanogenesis, extracellular matrix deposition, inflammation, and immune response. Given the relevance of these processes in cancer, we discuss how photoaging might render the skin microenvironment permissive to melanoma progression.     

Sun-induced skin changes

Chronic sun exposure is responsible for changes in skin texture, pigmentation, vascularity, maturation, and production of neoplasms. A 78% decrease in the lifetime incidence of basal and squamous cell carcinoma has been reported with regular use of SPF 15 sunscreen for the first 18 years of life. Actinic keratoses, sun-induced premalignant lesions of the skin, can be eliminated by mechanical and medication therapies. 5-fluorouracil therapy can be effective treatment for widespread actinic damage.     

The aging face. Why changes occur, how to correct them

Most changes that occur in the aging face are related to gravity working on skin that is becoming progressively thinner, drier, and less elastic. Exposure to sunlight hastens these changes, and protection from the sun is the only proved way to delay them. Dermabrasion, chemabrasion, and collagen implant (Zyderm) injection are safe and effective nonsurgical procedures that can improve the appearance of the aging face. Plastic surgical procedures to remove excess skin at the upper eyelids, raise the eyebrows, tighten the lower lids, and elevate the nasal tip can provide functional as well as cosmetic improvement.     

EXPERIMENTAL PRODUCTION OF HEMORRHAGE AND VASCULAR LESIONS IN LYMPH NODES: AN EXTENSION OF THE SHWARTZMAN PHENOMENON

Characteristic changes are produced in the lymph nodes of rabbits following the intravenous injection of certain bacterial filtrates administered 24 hours after either an intralymphatic or an intradermal injection of the same filtrate. These changes are limited to the nodes served by the lymphatic injected or to those furnishing the lymphatic drainage for the injected skin site. By either method the initial or preparatory injection of filtrate reaches the lymph nodes through one or more of its afferent lymphatics, and similar lesions are produced in the nodes. The lesions consist of hemorrhages recognizable by gross and microscopic examination. The capillaries and veins are congested and thrombosed. Their endothelial cells are swollen. Arterioles are generally little affected. Though hemorrhages and thromboses are usually seen together in the nodes, they have been observed occurring independently. They are both probably secondary to endothelial changes. The lesions are not dependent on the amount of preexisting inflammation in the nodes. Endothelial changes, hemorrhages and thromboses were usually noted in the regional nodes when positive Shwartzman reactions had been elicited in prepared skin by intravenous injection of the bacterial filtrate. However, these lesions in many instances were observed under similar conditions in these nodes even when the Shwartzman reaction in the skin was negative. It appears that lymph nodes are more susceptible to the production of the Shwartzman phenomenon than the skin sites which they drain. A single intralymphatic or intradermal injection of the bacterial filtrates used in this study, even in high concentrations, does not produce in adjacent lymph nodes the characteristic changes noted when this preparatory injection is followed by a subsequent intravenous injection of the filtrate. Single intravenous injections also are not productive of hemorrhage and thrombosis in lymph nodes.     

White matter atrophy and lesion formation explain the loss of structural integrity of white matter in aging

The importance of macrostructural white matter changes, including white matter lesions and atrophy, in intact brain functioning is increasingly being recognized. Diffusion tensor imaging (DTI) enables measurement of the microstructural integrity of white matter. Loss of white matter integrity in aging has been reported, but whether this is inherent to the aging process itself or results from specific white matter pathology is unknown. In 832 persons aged 60 years and older from the population-based Rotterdam Study, we measured fractional anisotropy (FA) and directional diffusivities in normal-appearing white matter using DTI. All subjects' DTI measures were projected onto a common white matter skeleton to enable robust voxelwise comparison. With increasing age, multiple regions showed significant decreases in FA or increases in axial or radial diffusivity in normal-appearing white matter. However, nearly all of these regional changes were explained by either white matter atrophy or by white matter lesions; each of which related to changes in distinct brain regions. These results indicate that loss of white matter integrity in aging is primarily explained by atrophy and lesion formation and not by the aging process itself. Furthermore, white matter atrophy and white matter lesion formation relate to loss of integrity in distinct brain regions, indicating the two processes are pathophysiologically different.     

正常人表皮细胞老化过程中的生物学特性

背景目前有关表皮细胞体外衰老的文献报道甚少,而表皮细胞是构建组织工程化皮肤所必需的种子细胞,文章拟对正常人表皮细胞老化过程中的生物学特性加以阐述,为组织工程化皮肤选择合适的种子细胞奠定基础.目的通过研究表皮细胞体外增殖与老化规律,为选择合适的组织工程化皮肤种子细胞提供依据.设计自身对照实验.单位潍坊医学院整形外科研究所,潍坊医学院附属医院普外科.材料实验于2000-09/2002-09在潍坊医学院整形外科研究所完成.实验样本来源于在潍坊医学院附属医院普外科行包皮环切术的6～8岁正常男性儿童20例切除的健康包皮组织,监护人获完全同意,将包皮标本用于表皮细胞增殖培养实验.方法取正常年轻人表皮细胞进行传代培养,以不同代龄细胞为实验对象,采用形态学观察、群体倍增时间、免疫细胞化学及β-半乳糖苷酶染色的方法,检测表皮细胞老化规律.主要观察指标①表皮细胞生长特性的改变.②表皮细胞形态学改变.③表皮细胞表型的改变.结果①表皮细胞生长特性的改变体外单层培养9代,P2的群体倍增时间最短,前5代增殖能力较强,P5以后群体倍增时间明显延长,P8细胞不再增殖.②表皮细胞形态学改变原代细胞接种3 d后开始增殖,4 d后细胞加速增殖,培养1周左右细胞接近融合.显微镜、免疫组化鉴定,符合表皮细胞的特点.③表皮细胞表型的改变随着细胞的连续传代培养,β-半乳糖苷酶组化表达呈现从弱(在年轻细胞中占9%)到强(在老化细胞中占65%)的趋势,β-半乳糖苷酶染色的阳性率和细胞代龄之间呈显著正相关(r=0.87,P＜0.01).结论①与年轻细胞相比,老化细胞具有衰老形态和酶细胞化学特征的增多;在细胞从年轻向老化发展的进程中,细胞群体倍增时间呈延长的趋势.②与年轻细胞相比,老化细胞中β-半乳糖苷酶的表达显著增强,且这种增强与细胞衰老表型的出现和细胞增殖能力的丧失相平行,反应细胞的老化程度.③本实验建立了体外培养正常人表皮细胞的衰老模型,第1～5代表皮细胞(供者年龄16～18岁)可作为构建组织工程化皮肤的种子细胞.     

Skin problems in advanced and terminal cancer patients

Disturbances caused by skin problems may compromise the quality of life of cancer patients. The main complications affecting the skin comprise the dermatologic toxicity of anticancer therapy, bedsores, malignant ulcers, sores due to nonmetastatic cancer, pruritus, and infections. Most of the information available about these entities has been acquired in the cancer patient without advanced disease. The little currently known about the epidemiology and physiopathology of such lesions in the advanced phase of cancer is presented, and approaches to management are suggested.     

HOMOLOGOUS DISEASE IN THE ADULT RAT, A MODEL FOR AUTOIMMUNE DISEASE : I. GENERAL FEATURES AND CUTANEOUS LESIONS

The cutaneous lesions of adult rats with homologous disease are described, and evidence is presented to indicate that they have an immunologic basis. The skin changes included erythema, purpura, edema, and a variety of inflammatory lesions. In the more active lesions, dermal infiltration, hydropic degeneration, acanthosis, and atrophy of the epidermis with hyperkeratosis and follicular plugging were present. In some cases, ulceration and sloughing were also observed. More chronic lesions were characterized by atrophy of the epidermis and collagenization of the dermis with disappearance of the skin appendages. Rejection of autografts was observed simultaneously with acceptance of homografts. The histologic appearance of autografts undergoing rejection was similar to that of the spontaneous skin lesions, suggesting that the latter, too, had an immunologic basis. In favor of this, also, was the specificity of the dermatitis for the skin of the host, with sparing of neighboring homograft tissue. There was a histologic similarity between the spontaneous skin lesions of homologous disease and those of lupus erythematosus on the one hand, and scleroderma on the other, thus supporting the possibility that the cutaneous lesions of these connective tissue diseases of man may also have an immunologic basis. It was concluded that the adult rat with homologous disease may furnish a model for human autoimmune disease.     

Identification and Management of Malignant Skin Lesions Among Older Adults

The incidence of malignant skin lesions is increasing among older adults. The elderly generally present with different symptoms than younger adults, and lesions tend to have a poorer prognosis. Benign skin lesions, such as senile lentigo and seborrheic keratosis, may confound the identification of malignancy. This article reviews the risk factors and age-related changes that affect the development of skin lesions. After differentiating actinic keratosis, basal cell and squamous cell carcinoma, and malignant melanoma, it discusses nonsurgical, topical, and surgical management options as appropriate for older adults with comorbidities.     

Aging and the skin

Several pathologic processes of the skin are seen more commonly in the elderly, so these patients need special attention. The skin undergoes physiologic and structural changes as it ages, and knowledge of these changes is essential to accurately interpret the physical signs and symptoms that may be present in the elderly patient. Since cutaneous inflammatory responses and subjective sensations may be diminished in aged skin, a higher degree of vigilance in physical examination is needed to reach a proper diagnosis. Prevention of many of the cutaneous signs of aging and of most skin cancers is dependent upon sun avoidance. Thus, the best advice physicians can offer patients of any age is to limit sun exposure by using a sunscreen with a high sun-protection factor, to avoid being in the sun during the peak tanning hours (between 10:00 AM and 2:00 PM), and to wear protective clothing when exposed to the sun.     

Sleep in the older adult: implications for nurses (CE)

Normal aging is accompanied by sleep pattern changes that may result in daytime sleepiness and affect the quality of life in older adults. These changes also can signal more serious sleep problems, which become more prevalent with aging. More than half of adults older than 65 living at home and about two-thirds of those in long-term care facilities have some difficulties with sleep. It is important for nurses to understand the normal changes in sleep that accompany aging and be able to differentiate them from the symptoms of serious sleep disorders to ensure holistic care for older adults.     

The aging eye. A family physician discusses some inevitable changes and suggests methods for dealing with them

The aging eye undergoes a variety of structural and physiologic changes that can impair vision and cause functional disability. Among the changes are backward displacement of the eye into the orbit, thickening and yellowing of the lens, decrease in pupil size, increase in laxity of the lids, and accumulation of waste products in the retina. The specific diseases of the eye that occur with aging include macular degeneration, cataracts, glaucoma, diabetic retinopathy, and sudden vision loss. Preventive care both in old age and earlier in life may help forestall ocular changes and the subsequent morbidity and mortality they cause. Environmental changes to accommodate visual change can be important in accident prevention and in improved functioning and quality of life.     

Research dissemination and utilization

Why does sun protection and skin cancer awareness need to be addressed? Skin cancer is the most common form of cancer. There has been a steady increase in the incidence of melanoma every year. Evidence shows that ultraviolet radiation from sun exposure during early life is associated with an increased risk of skin cancer in later life. The majority of skin cancer can be prevented by limiting sun exposure. Children and adolescents spend more time exposed to the sun than adults. What are the obstacles to skin cancer prevention? Public perception of tanning needs to be changed. The public associates well being with a tan. The public is uneducated on skin cancer prevention. Skin cancer awareness does not take precedence in our society. School health providers are not active in stressing the importance of avoiding sun exposure. How can nurses promote sun protection? Become educated in the identification of atypical lesions. Reinforce the benefits of sun protection. Recommend sun protection techniques to clients at every office visit. Partner with parents in stressing to children the importance of skin protection. For more information contact. The American Academy of Dermatology (www.aad.org). The American Medical Association. The Centers for Disease Control and Prevention.     

LCT (lipocolloid technology) in lesions of venous etiology

This article reports on a spanish study to evaluate the effectiveness of dressings using a Technology Lipido-Colloid to treat skin lesions with "Urgotul". Has been included 18 of this 60 lesions were leg ulcers. We have decided to focus our analysis in these difficult to treat chronic wounds. This study noted better results in relation to the evolution of these lesions and in the quality of life for these patients who suffered these lesions in terms of pain control, skin deterioration or lesions in the same spot related to changing dressings, and an improvement in the skin nearby the lesion.     

Congenital cutaneous candidiasis in a premature neonate: A case report

Congenital cutaneous candidiasis (CCC) is a rare and usually benign disorder that develops within the first week of life. It predominantly presents with diffuse maculopapular and papulopustular erythematous desquamating patches. We report a preterm neonate with respiratory distress syndrome and skin diffuse maculopapular lesions at birth. Candida albicans was isolated from skin and gastrointestinal fluid culture; she underwent medical treatment with topical and systemic antifungal with clinical improvement and skin lesions resolution.     

Spinal cord injury and aging: challenges and recommendations for future research

Population aging, caused by reductions in fertility and increasing longevity, varies by country and is anticipated to continue and to reach global proportions during the 21st century. Although the effects of population aging have been well documented for decades, the impact of aging on people with spinal cord injury (SCI) has not received similar attention. It is reasonable to expect that population aging features such as the increasing mean age of the population, share of the population in the oldest age groups, and life expectancy would be reflected in SCI population demographics. Although the mean age and share of the SCI population older than 65 yrs are increasing, data from the National Spinal Cord Injury Statistical Center suggest that life expectancy increases in the SCI population have not kept the same pace as those without SCI in the last 15 yrs. The reasons for this disparity are likely multifactorial and include the changing demographics of the SCI population with more older people being injured; susceptibility of people with SCI to numerous medical conditions that impart a health hazard; risky behaviors leading to a disproportionate percentage of deaths as a result of preventable causes, including septicemia; changes in the delivery of health services during the first year after injury when the greatest resources are available; and other unknown factors. The purposes of this paper are (1) to define and differentiate general population aging and aging in people with SCI, (2) to briefly present the state of the science on health conditions in those aging with SCI, and finally, (3) to present recommendations for future research in the area of aging with SCI.     

Thiazide Diuretics Induce Cutaneous Lupus-Like Adverse Reaction

Abstract

One of the side effects reported in patients taking thiazide diuretics is photosensitivity. We report two patients who developed lupus-like skin lesions while taking thiazide diuretics. One patient developed erythematous scaling papules, patches and plaques on the upper extremities and trunk resembling subacute cutaneous lupus erythematosus. Histopathology of a skin biopsy from the trunk showed basal cell layer liquefaction and lichenoid interface changes suggestive of lupus erythematosus. The skin lesions resolved completely within two months of discontinuing thiazide therapy. The second patient developed multiple flesh colored urticarial plaques on the trunk one year after beginning thiazide therapy. Slight lichenoid interface changes were noted on a skin biopsy, along with dense mucin deposition in the papillary and deep dermis, suggestive of tumid lupus erythematosus. The skin lesions persisted despite discontinuing thiazide therapy, necessitating systemic corticosteroid treatment. Both patients had circulating anti-SSA/Ro autoantibodies and antinuclear antibodies. These two patients illustrate that thiazide diuretics may induce a cutaneous lupus erythematos us-like adverse reaction and production of anti-SSA/Ro autoantibodies as demonstrated by immunodiffusion, immunoblot and immunoprecipitation testing.     

Normal aging eye

Aging is a normal occurrence in life. When one's eyes start to age, many aggravations seem to occur, and these may affect life satisfaction or independence. Nurses can help the aging client to accept life changes gracefully by offering an explanation and by making the necessary corrections when applicable.