Beyond photoaging: additional factors involved in the process of skin aging

Knowledge, Attitude, Reception, and Preventive Practices Towards Skin Photoaging Among the General Population in Jazan, Saudi Arabia

Introduction Skin photoaging is caused by prolonged exposure to sunlight, particularly ultraviolet rays (UV). High cumulative levels of UV radiation may cause burning, photoallergic or phototoxic reactions, pigmentary changes, photoaging, and even immunosuppression and skin cancers. Therefore, this study aims to assess knowledge, attitude, reception, and preventive practices towards skin photoaging among the Jazan general population in Saudi Arabia and its determinants. Methods A descriptive cross-sectional study was conducted among the general population of Jazan, Saudi Arabia, who were aged 18 years and above and agreed to participate in the study. The calculated minimum sample size was 385. An online, semi-structured, self-administered questionnaire was distributed conveniently in Google Forms through social media platforms. It included four sections: The first section was about sociodemographic characteristics. The second section assessed the smoking, exercise, and healthy diet behavior of participants and the use of sunscreen. The third section assessed the knowledge regarding the photoaging process and its preventive measures utilization using three-point Likert scale questions. The fourth section assessed attitudes towards the photoaging process and its preventive measures through three-point Likert scales. Results The study included 452, of which 243 (53.76%) were aged 18-30 years, 258 (57.08%) were females, and 272 (60.18%) had white skin color. Approximately 417 (92.26%) were nonsmokers. Sixty-eight percent (372) spent 1-3 hours in the sun. Social media was the primary source of information on photoaging 81 (17.92%). Around 234 (51.77%) defined photoaging correctly. Regarding sunscreen usage, 58 (12.83%) always use sunscreen, and 177 (39.16%) never use it. However, 191 (42.26%) recognized the correct sunscreen application. Approximately 233 (51.5%) and 240 (53.1%) of respondents had fair knowledge and a positive attitude regarding photoaging and sunscreen use. Being female, pursuing university and postgraduate education, and taking information on photoaging from a physician were linked to a higher knowledge of photoaging (p<0.05). Participants who never use sunscreen had lower knowledge than those who always use it (p<0.001). None of the demographic factors was associated with the attitude towards sunscreen use (p>0.05). Conclusion There is a substantial gap in knowledge and preventive practices related to skin photoaging among the Jazan general population in Saudi Arabia. Gender, education level, and information sources influence knowledge levels. Targeted educational interventions are needed to enhance awareness and promote healthier practices, particularly sun exposure and photoaging prevention.

Role of autophagy in skin photoaging: A narrative review

As the largest organ of the human body, the skin serves as the primary barrier against external damage. The continuous increase in human activities and environmental pollution has resulted in the ongoing depletion of the ozone layer. Excessive exposure to ultraviolet (UV) radiation enhances the impact of external factors on the skin, leading to photoaging. Photoaging causes physical and psychological damage to the human body. The prevention and management of photoaging have attracted increased attention in recent years. Despite significant progress in understanding and mitigating UV-induced photoaging, the precise mechanisms through which autophagy contributes to the prevention of photoaging remain unclear. Given the important role of autophagy in repairing UV-induced DNA damage and scavenging oxidized lipids, autophagy is considered a novel strategy for preventing the occurrence of photoaging and other UV light-induced skin diseases. This review aims to elucidate the biochemical and clinical features of photoaging, the relationship of skin photoaging and chronological aging, the mechanisms underlying skin photoaging and autophagy, and the role of autophagy in skin photoaging.

The Effectiveness of Injectable Hyaluronic Acid in the Improvement of the Facial Skin Quality: A Systematic Review

Background

Several studies have evaluated the role of various injectable formulations of hyaluronic acid (HA) in the improvement of the quality of facial skin. It is important to systematically summarize the available evidence in this regard.

Methods

Relevant databases were searched for clinical studies that evaluated the therapeutic role of any injectable formulation of HA in improving the quality of facial skin in adult humans until 31 December 2022. The available studies were critically analyzed and the data were extracted.

Results

A total of 2996 articles were screened and 13 studies were finally included. Eight studies evaluated the effect of various formulations of HA alone, while five evaluated the effect of various formulations of HA along with other active ingredients (cocktails) on the quality of facial skin. All types of HA formulations cause a significant improvement in facial skin quality, in terms of hydration, firmness, skin-tiring effect/fatigue, brightness, texture, radiance, and elasticity. The effect of HA monotherapy was more pronounced than that of the cocktail ingredients. HA treatment was quite safe and the patient satisfaction level was high.

Conclusion

The clinical evidence on the use of injectable HA alone in the improvement of the quality of facial skin, in terms of hydration, firmness, skin-tiring effect/fatigue, brightness, texture, radiance, and elasticity, is quite promising. Large randomized controlled trials are required in this regard.

3D Printed Hollow Microneedles for Treating Skin Wrinkles Using Different Anti-Wrinkle Agents: A Possible Futuristic Approach

Skin wrinkles are an inevitable phenomenon that is brought about by aging due to the degradation of scleroprotein fibers and significant collagen reduction, which is the fundamental basis of anti-wrinkle technology in use today. Conventional treatments such as lasering and Botulinum toxin have some drawbacks including allergic skin reactions, cumbersome treatment procedures, and inefficient penetration of the anti-wrinkle products into the skin due to the high resistance of stratum corneum. Bearing this in mind, the cosmetic industry has exploited the patient-compliant technology of microneedles (MNs) to treat skin wrinkles, developing several products based on solid and dissolvable MNs incorporated with antiwrinkle formulations. However, drug administration via these MNs is limited by the high molecular weight of the drugs. Hollow MNs (HMNs) can deliver a wider array of active agents, but that is a relatively unexplored area in the context of antiwrinkle technology. To address this gap, we discuss the possibility of bioinspired 3D printed HMNs in treating skin wrinkles in this paper. We compare the previous and current anti-wrinkling treatment options, as well as the techniques and challenges involved with its manufacture and commercialization.

Benefits of topical hyaluronic acid for skin quality and signs of skin aging: From literature review to clinical evidence

Skin aging goes beyond a chronological process and also results from extrinsic factors referred to as the exposome. Hyaluronic acid (HA) is an important component of the extracellular matrix, with loss starting at 25 years old. While many studies of HA concern topical use, few literature reviews only address the use of topical HA in dermatology. This review describes the different characteristics of HA-containing cosmeceuticals, with a focus on skin aging and the impact of exposome factors on HA synthesis and degradation. A review was performed using the terms HA, hyaluronan, topical, dermatology, cosmetic, aging treatment, exposome, and cosmeceuticals. Results are also presented from a recent randomized controlled trial (RCT), which investigated the additional benefit of using a HA epidermic filler (HA-filler serum) combined with Botulinum toxin type A (BoNTA) to treat signs of skin aging. Subjects were randomized to two groups: HA-filler serum starting 24 h after the BoNTA injection then twice daily for 24 weeks, or the control group, which received BoNTA. HA is a key ingredient used in cosmeceuticals for its hydration/antiaging properties (hygroscopic, rheological, and viscoelastic). Several clinical studies indicate that HA is both well tolerated and effective, adjuvant to both post-surgical and facial rejuvenation procedures. In the RCT, one of few studies to combine BoNTA and HA with a 6-month follow-up, the HA-filler serum lengthened the duration of BoNTA's effect in reducing wrinkles. Numerous studies support HA-based cosmeceuticals as a noninvasive, effective solution for improving skin hydration and rejuvenation.

Photolyase Production and Current Applications: A Review

The photolyase family consists of flavoproteins with enzyme activity able to repair ultraviolet light radiation damage by photoreactivation. DNA damage by the formation of a cyclobutane pyrimidine dimer (CPD) and a pyrimidine-pyrimidone (6-4) photoproduct can lead to multiple affections such as cellular apoptosis and mutagenesis that can evolve into skin cancer. The development of integrated applications to prevent the negative effects of prolonged sunlight exposure, usually during outdoor activities, is imperative. This study presents the functions, characteristics, and types of photolyases, their therapeutic and cosmetic applications, and additionally explores some photolyase-producing microorganisms and drug delivery systems.

Factors Influencing Skin Aging and the Important Role of Estrogens and Selective Estrogen Receptor Modulators (SERMs)

The narrative for this overview focuses on updating the factors that influence skin aging and the important role estrogens and selective estrogen receptor modulators (SERMs) play in this process (mainly utilizing journal reports and reviews from the last four years). Estrogens have been known and studied for over a century. For many years, it has been recognized that estrogens are important in the maintenance of human skin. Women seek cosmetic and medical treatments to improve dermal health and physical characteristics to enhance their self-perception and inhibit skin aging, particularly in highly visible body areas. The goal: to retain estrogen’s positive benefits while aging and especially at/after menopause where estrogen-deficient skin contributes to the dramatic decline in skin health. In this overview, both background information and recent novel findings are included that cover aging (general mechanisms), skin aging, and factors that influence skin aging (intrinsic, extrinsic, skin microbiome and gut microbiome.) Plus, estrogen’s general role in maintaining skin health is presented through the classical estrogen receptors alpha (α) and beta (β) and non-classical (or non-genomic) estrogen receptor (G protein-coupled seven transmembrane receptor). More importantly, the various benefits of 17β-estradiol in skin health are examined (ie, skin collagen and elastin profiles that follow 17β-estradiol levels during aging and at/after menopause). Finally, a revision of information for estrogenic skin topical applications involving isoflavonoid compounds that act as SERMs, but are classified as endocrine disruptors, and a topical estrogen analog are explored to update the known and unknown characteristics of these treatments. Further study is warranted to understand the biological and molecular mechanisms by which estrogens support and enhance dermal health and wellbeing.

Estrogen Action and Gut Microbiome Metabolism in Dermal Health

Emerging scientific advances in microbial research linking estrogens and the gut-skin microbiome in reference to dermal health are featured in this narrative review of journal reports and reviews from January 2018 through February 2022. Background information on advances in microbial research along with defining the microbiota and microbiome is presented in brief. The development of and factors that influence the gut microbiome in health and disease as well as the intrinsic and extrinsic factors influencing the skin microbiome and skin aging are summarized. New information on the development and changes of organ microbiomes have exposed similarities between skin and gut structure/function, microbial components/diversity/taxonomy and how they impact the immune response for combating disease and enhancing wellness. Estrogens promote health and support homeostasis in general and directly impact dermal health. Moreover, the gut, based upon the level of the microbial enzyme β-glucuronidase, which regulates estrogen’s enterohepatic recirculation, constitutes a gut-skin microbial axis. This axis revolves around the systemically available estrogen to support immune function, counteract inflammation and oxidative stress, and decrease the risk of hormone-dependent skin cancers. These data support the direct effect of estrogens on skin health and the interaction of diet on dermal health via effects on the gut microflora. Finally, the potential for bioactive botanicals containing phytoestrogens or selective estrogen receptor modulators (SERMs) to evade the effects of gut β-glucuronidase expressing flora is proposed that may have a positive impact on skin.

The effect of a restricted diet on the results of fractional microneedle radiofrequency therapy: A comparison of vegan and omnivorous participants in terms of the antiaging effect of radiofrequency therapy

OBJECTIVES

The aim of the present study was to compare the results of fractional microneedle radiofrequency (FMR) therapy in vegan and omnivorous participants.

METHODS

A total of 30 vegan and 30 omnivorous women who were treated with FMR therapy for combating aging were included in the study. The clinical results were examined in Months 3 and 6 based on the Fitzpatrick Wrinkle Scale (FWS). Individual satisfaction was investigated in Month 6 using the Patient's Global Impression of Change (PGIC).

RESULTS

At the onset of the treatment, there was no significant difference with regard to the FWS scores in both groups. The decrease in the FWS score was significantly lower in vegans after 3 months (p = 0.01). Vegans had worsened clinical outcomes by Month 6 (p = 0.01). The PGIC scores were significantly lower in vegans (p = 0.01).

CONCLUSION

A vegan diet adversely affects the outcome of FMR therapy.

Galangin Reverses H2O2-Induced Dermal Fibroblast Senescence via SIRT1-PGC-1α/Nrf2 Signaling

UV radiation and H₂O₂ are the primary factors that cause skin aging. Both trigger oxidative stress and cellular aging. It has been reported that deacetylase silent information regulator 1 (SIRT1), a longevity gene, enhances activation of NF-E2-related factor-2 (Nrf2), as well as its downstream key antioxidant gene hemeoxygenase-1 (HO-1), to protect cells against oxidative damage by deacetylating the transcription coactivator PPARγ coactivator-1α (PGC-1α). Galangin, a flavonoid, possesses anti-oxidative and anti-inflammatory potential. In the present study, we applied Ultraviolet B/H₂O₂-induced human dermal fibroblast damage as an in vitro model and UVB-induced photoaging of C57BL/6J nude mice as an in vivo model to investigate the underlying dermo-protective mechanisms of galangin. Our results indicated that galangin treatment attenuates H₂O₂/UVB-induced cell viability reduction, dermal aging, and SIRT1/PGC-1α/Nrf2 signaling activation. Furthermore, galangin treatment enhanced Nrf2 activation and nuclear accumulation, in addition to inhibiting Nrf2 degradation. Interestingly, upregulation of antioxidant response element luciferase activity following galangin treatment indicated the transcriptional activation of Nrf2. However, knockdown of SIRT1, PGC-1α, or Nrf2 by siRNA reversed the antioxidant and anti-aging effects of galangin. In vivo evidence further showed that galangin treatment, at doses of 12 and 24 mg/kg on the dorsal skin cells of nude mice resulted in considerably reduced UVB-induced epidermal hyperplasia and skin senescence, and promoted SIRT1/PGC-1α/Nrf2 signaling. Furthermore, enhanced nuclear localization of Nrf2 was observed in galangin-treated mice following UVB irradiation. In conclusion, our data indicated that galangin exerts anti-photoaging and antioxidant effects by promoting SIRT1/PGC-1α/Nrf2 signaling. Therefore, galangin is a potentially promising agent for cosmetic skin care products against UV-induced skin aging.

Critical thinking and diagnostic reasoning when advanced practitioners assess and treat skin conditions

Advanced clinical practitioner (ACP) roles require a broad range of knowledge of both medical and surgical medicine and the ability to work autonomously in a variety of settings. Despite around half of the UK adult population presenting with a skin condition requiring attention, this is something many ACPs feel unprepared to be consulted on. However, due to the complexity and large number of potential diagnoses, it is imperative that ACPs develop their confidence and knowledge to diagnosis, request investigations and initiate treatment for a patient with a skin complaint. In the first part of this clinical review the authors presented the key elements of history taking, consultation and assessment of the skin. This second clinical review discusses the main differential diagnoses, mimics, common investigations and treatments. This article is designed to support novice ACPs from acute hospital settings to primary care to develop a foundation of understanding in the main diagnosis and treatment options that should be considered following a clinical assessment of patients' skin outside the dermatology setting.

Detection of genomic structure variants associated with wrinkled skin in Xiang pig by next generation sequencing

Wrinkling is prominent manifestation of aging skin. A mutant phenotype characterized by systemic wrinkles and thickened skin was discovered in Xiang pig populations with incidence about 1-3%. The feature in histological structure was epidermal hyperplasia and thickening, collagen fibers disorder. To uncover genetic mechanisms for the mutant phenotype of Xiang pigs with systemic wrinkle (WXP), a genome-wide of structural variations (SVs) in WXP was described by next generation resequencing, taking Xiang pigs (XP) and European pigs (EUP) as compares. Total of 32,308 SVs were detected from three pig groups and 965 SVs were identified specifically from WXP, involving 481 protein-coding genes. These genes were mainly enriched in nuclear structure, ECM components and immunomodulatory pathways. According to gene function and enrichment analysis, we found that 65 candidate SVs in 59 protein genes were probably related with the systemic wrinkle of WXP. Of these, several genes are reported to be associate with aging, such as EIF4G2, NOLC1, XYLT1, FUT8, MDM2 and so on. The insertion/deletion and duplication variations of SVs in these genes resulted in the loss of stop-codon or frameshift mutation, and aberrant alternative splicing of transcripts. These genes are involved in cell lamin filament, intermediate filament cytoskeleton, supramolecular complex, cell differentiation and regulation of macromolecule metabolic process etc. Our study suggested that the loss of function or aberrant expression of these genes lead to structural disorder of nuclear and the extracellular matrix (ECM) in skin cells, which probably was the genetic mechanisms for the mutant phenotype of systemic skin wrinkle of Xiang pig.

Single Treatment, Single Depth Superficial Microfocused Ultrasound with Visualization for Rhytid Improvement

Background

Standard lifting and tightening protocols with microfocused ultrasound with visualization (MFU-V, Ultherapy) comprise the use of multiple transducer depths. We developed a shortened, single depth treatment protocol for patients seeking skin rejuvenation.

Methods

Single-center, prospective case series. Subjects with static periorbital wrinkles, perioral wrinkles, or accordion lines had a single MFU-V treatment comprising up to 340 lines (periorbital 120, perioral 100, and accordion 120) with the superficial depth transducer (10.0 MHz/1.5 mm). Efficacy was assessed using established rating scales as well as clinician- and subject-reported Global Aesthetic Improvement Scales at baseline, 90, and 180 days, and each subject served as their own control. Adverse events were documented.

Results

Nine subjects, women aged 38-64, received treatment. At 180 days, post treatment clinicians reported visible improvements in periorbital lines (6/6 cases), accordion lines (5/6 cases), and perioral lines (3/6 cases). Subjects' self-assessments mirrored those of the clinicians, reporting improvements in accordion lines (5/6 cases improved, 1/6 cases much improved), periorbital lines (3/6 cases improved, 3/6 cases much improved) and perioral lines (2/6 cases improved, 2/6 cases much improved). Subject-rated satisfaction was high (accordion lines 6/6 cases, periorbital lines 4/6 cases and perioral lines 4/6 cases). All subjects experienced mild, transient erythema; in one subject, wheals persisted for 24 hours, resolving on application of mild topical corticosteroid.

Conclusions

Shortened protocol, single depth MFU-V treatment was well-tolerated. It provided aesthetic improvements in periorbital and accordion lines, and to a lesser extent in perioral lines. Its utility as a noninvasive therapy for superficial skin rejuvenation warrants further investigation.

Anti-inflammatory and antiaging properties of chlorogenic acid on UV-induced fibroblast cell

Background

Skin aging is the most common dermatological problem caused by intrinsic and extrinsic factor, such as exposure to (ultraviolet) UV rays. Chlorogenic acid (CA) is a phenolic compound which is known for its antioxidant properties against oxidative stress.

Objective

This study investigates the antiaging and anti-inflammatory properties of CA on UV-induced skin fibroblast cells.

Methods

Anti-inflammatory properties of CA were assessed by measuring inflammatory-related proteins IL-1β and TNF-α, while antiaging properties of CA were assessed by measuring reactive oxygen species (ROS), apoptosis, live and necrotic cells, and COL-3 gene expression level.

Results

Treating UV-induced skin fibroblast cells with CA decreased the level of ROS, IL-1β, TNF-α, apoptotic cells, and necrotic cells and increased live cells and COL-3 gene expression.

Conclusion

CA has the potential as the protective compound against inflammation and aging by decreasing the level ROS, pro-inflammatory cytokines IL-1β and TNF-α, apoptotic cells, and necrotic cells and by increasing live cells and COL-3 gene expression.

Ultrapulsed CO2 Resurfacing of Photodamaged Facial Skin in Vegan and Omnivore Patients: A Multicentric Study

BACKGROUND AND OBJECTIVES

Skin photoaging is related to extrinsic environmental exposures, mainly represented by ultraviolet radiation. One of the treatment options is laser resurfacing. As nutritional status is involved in cutaneous photodamage, we evaluated whether dietary patterns can also influence the response to facial resurfacing. Our prospective multicentric study involves three dermatologic centers specialized in laser therapy in northern Italy. The study aims to compare the outcome of a CO₂ ablative laser therapy between omnivore and vegan patients.

STUDY DESIGN/MATERIALS AND METHODS

Fifty-three omnivore and fifty-three vegan women undergoing ultrapulsed CO₂ resurfacing for photodamaged facial skin were enrolled in this study. Clinical improvement was evaluated 3 and 6 months after the treatment using the modified Dover score.

RESULTS

After laser treatment, vegans showed slower complete re-epithelialization (P < 0.001*) and disappearance of the erythema (P < 0.001*). After 3 and 6 months, vegans showed worse outcomes in terms of fine lines (P < 0.001* and P < 0.001*, respectively) and tactile roughness (P = 0.003* and ​​​​P = 0.002*, respectively) compared with omnivores, while they did not differ in mottled pigmentation.

CONCLUSIONS

The present study suggests that diet influences the clinical outcome of fractioned CO₂ laser treatment. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.

Biologically Active Compounds in Stizolophus balsamita Inflorescences: Isolation, Phytochemical Characterization and Effects on the Skin Biophysical Parameters

Three germacranolides, as well as five flavonoids, natural steroid and simple phenolic compounds, were isolated from the inflorescence of Stizolophus balsamita growing in Iran. The paper presents active compounds found for the first time in the inflorescence of this species. The flavonoids, simple phenolic compounds and natural steroids have been isolated for the first time in the genus Stizolophus. The MTT assay was employed to study in vitro cytotoxic effects of the taxifolin against human fibroblasts. We also evaluate the possible biological properties/cosmetic effects of Stizolophus balsamita extract and taxifolin on the human skin. Sixty healthy Caucasian adult females with no dermatological diseases were investigated. We evaluate the effects of S. balsamita extract and taxifolin on skin hydration and transepidermal water loss (TEWL). It was revealed that S. balsamita extract might decrease TEWL level and fixed the barrier function of the epidermis. The presence of bioactive phytochemical constituents in S. balsamita inflorescences makes them a valuable and safe source for creating new cosmetics and medicines.

Counteracting the Ramifications of UVB Irradiation and Photoaging with Swietenia macrophylla King Seed

In this day and age, the expectation of cosmetic products to effectively slow down skin photoaging is constantly increasing. However, the detrimental effects of UVB on the skin are not easy to tackle as UVB dysregulates a wide range of molecular changes on the cellular level. In our research, irradiated keratinocyte cells not only experienced a compromise in their redox system, but processes from RNA translation to protein synthesis and folding were also affected. Aside from this, proteins involved in various other processes like DNA repair and maintenance, glycolysis, cell growth, proliferation, and migration were affected while the cells approached imminent cell death. Additionally, the collagen degradation pathway was also activated by UVB irradiation through the upregulation of inflammatory and collagen degrading markers. Nevertheless, with the treatment of Swietenia macrophylla (S. macrophylla) seed extract and fractions, the dysregulation of many genes and proteins by UVB was reversed. The reversal effects were particularly promising with the S. macrophylla hexane fraction (SMHF) and S. macrophylla ethyl acetate fraction (SMEAF). SMHF was able to oppose the detrimental effects of UVB in several different processes such as the redox system, DNA repair and maintenance, RNA transcription to translation, protein maintenance and synthesis, cell growth, migration and proliferation, and cell glycolysis, while SMEAF successfully suppressed markers related to skin inflammation, collagen degradation, and cell apoptosis. Thus, in summary, our research not only provided a deeper insight into the molecular changes within irradiated keratinocytes, but also serves as a model platform for future cosmetic research to build upon. Subsequently, both SMHF and SMEAF also displayed potential photoprotective properties that warrant further fractionation and in vivo clinical trials to investigate and obtain potential novel bioactive compounds against photoaging.

Comparison of microfocused ultrasound with visualization for skin laxity among vegan and omnivore patients

BACKGROUND

The aging of facial structures depends on genetic, anatomic, chronologic, and environmental factors that affect the skin and underlying tissues. Microfocused ultrasound with visualization (MFU-V) has emerged as a safe and effective treatment for skin laxity. As the nutritional status may contribute to skin aging, it would be interesting to evaluate whether different dietary patterns can also influence the response to MFU-V treatment for skin laxity.

AIMS

The aim of this study is to compare the outcome of MFU-V therapy between omnivore and vegan patients.

METHODS

Twenty-seven vegan and twenty-seven omnivorous women who underwent MFU-V treatment for laxity of lower face and neck were enrolled. The clinical outcome was evaluated using the FLR (Facial Laxity Rating) scale after 3 and 6 months from treatment.

RESULTS

At baseline, no significant differences were found in terms of FLR scale in both treated sites. After 3 months, reduction in FLR scale was significantly lower for vegans both on face (P = .04) and neck (P = .004). At 6 months, vegan patients had a worse clinical outcome on lower face (P = .001) and neck (P < .001).

CONCLUSION

The present study suggests that a vegan diet may negatively influence the outcome of a MFU-V treatment.

The effectiveness and safety of Chinese herbal formulas on skin photoaging: A protocol for systematic review and meta-analysis

BACKGROUND

Skin photoaging (SP) is a complex and complicated process of skin characteristic changes caused by excessive sunlight. Wrinkles, looseness, coarseness, and increase or loss of pigment are the main clinical manifestations of the disease. The pathogenesis of SP mainly involving oxidative stress, inflammatory reaction, immune dysregulation and DNA damage, and so on. In recent years, traditional Chinese medicine, as an significant form of complementary and alternative medicine, has attracted the more and more attention within the field of health care and indicated a desirable effect on SP. Chinese herbal formula (CHF) is an essential part of traditional Chinese medicine interventions, and the number of clinical trails on SP treated by CHFs have shown a growing trend. Therefore, we developed this systematic review and meta-analysis protocol to assess the effectiveness and safety of CHFs in the therapy of SP, so as to provide reliable evidence-based evidence for clinical decision-making.

METHODS

A overall literature retrieval will be carried out in 9 electronic journal database. We will include randomized controlled trials (RCTs) on CHFs alone or combined with routine western medicine measures in the treatment of SP. The outcomes we focused on are consists of symptom score (skin relaxation, telangiectasia, pore coarseness, pigmentation, etc), total effective rate, and adverse reactions. Meta-analysis will be performed using Stata 13.0 software. Literature retrieval and screening, data extraction, risk of bias assessment of RCTs, evidence confidence rating by grading of recommendations assessment, development, and evaluation method and methodological quality assessment of systematic review by assessment of multiple systematic reviews-2 will be conducted independently by 2 reviewers, and disagreements will be resolved through discussion or judged by a third senior reviewer.

RESULTS

This systematic review and meta-analysis will pool the proof of RCTs on SP treated by CHFs alone or combined with conventional western medicine treatments. The findings of this study will be presented at relevant conferences and submitted to peer-reviewed journals for publication.

CONCLUSION

We expect that the results of this systematic review will provide comprehensive and reliable evidence for clinicians and policy makers.

REGISTRATION NUMBER

INPLASY 2020120005.

Global Gene Expression of Cultured Human Dermal Fibroblasts: Focus on Cell Cycle and Proliferation Status in Improving the Condition of Face Skin

Chronological skin ageing is an inevitable physiological process that results in thin and sagging skin, fine wrinkles, and gradual dermal atrophy. The main therapeutic approaches to soft tissue augmentation involve using dermal fillers, where natural fillers, such as autologous fibroblasts, are involved in generating dermal matrix proteins. The aim of this study was to determine the global transcriptome profile of three passages of dermal autologous fibroblasts from a male volunteer, focusing on the processes of the cell cycle and cell proliferation status to estimate the optimal passage of the tested cells with respect to their reimplantation. We performed K-means clustering and validation of the expression of the selected mRNA by qRT-PCR. Ten genes were selected (ANLN, BUB1, CDC20, CCNA2, DLGAP5, MKI67, PLK1, PRC1, SPAG5, and TPX2) from the top five processes annotated to cluster 5. Detailed microarray analysis of the fibroblast genes indicated that the cell population of the third passage exhibited the highest number of upregulated genes involved in the cell cycle and cell proliferation. In all cases, the results of qRT-PCR confirmed the differences in expression of the selected mRNAs between fibroblasts from the primary culture (C0) and from the first (C1), second (C2), and third (C3) cell passage. Our results thus suggest that these cells might be useful for increasing fibroblast numbers after reimplantation into a recipient's skin, and the method used in this study seems to be an excellent tool for autologous transplantation allowing the rejuvenation of aging skin.

Skin protective and regenerative effects of RM191A, a novel superoxide dismutase mimetic

Superoxide dismutase (SOD) is known to be protective against oxidative stress-mediated skin dysfunction. Here we explore the potential therapeutic activities of RM191A, a novel SOD mimetic, on skin. RM191A is a water-soluble dimeric copper (Cu²⁺-Cu³⁺)-centred polyglycine coordination complex. It displays 10-fold higher superoxide quenching activity compared to SOD as well as significant antioxidant, anti-inflammatory and immunomodulatory activities through beneficial modulation of several significant inflammatory cytokines in vitro and in vivo.

We tested the therapeutic potential of RM191A in a topical gel using a human skin explant model and observed that it significantly inhibits UV-induced DNA damage in the epidermis and dermis, including cyclobutane pyrimidine dimers (CPD), 8-oxo-guanine (8-oxoG) and 8-nitroguanine (8NGO). RM191A topical gel is found to be non-toxic, non-teratogenic and readily distributed in the body of mice. Moreover, it significantly accelerates excisional wound healing, reduces 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced inflammation and attenuates age-associated oxidative stress in skin, demonstrating both skin regenerative and geroprotective properties of RM191A.

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RM191A is a Cu³⁺ containing coordination complex with 10-fold higher superoxide quenching activity compared to superoxide dismutase.

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RM191A exhibits potent antioxidant, anti-inflammatory and immunomodulatory properties in vitro and in vivo.

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RM191A protects human skin explants against UV-induced oxidative stress and DNA damage.

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RM191A is non-toxic, non-teratogenic and readily bioavailable in mice.

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RM191A promotes wound healing, and attenuates TPA-induced inflammation as well as age-associated oxidative stress in mouse skin.

Low molecular weight heparan sulfate containing facial skin care for reducing inflammation and restoring aged-skin homeostasis

BACKGROUND

Chronic exposure of the skin to environmental factors, including solar radiation and air pollution, promotes skin aging by inducing inflammation which damages the skin. Heparan sulfate (HS) is one of the glycosaminoglycans, which has a central role in modulating skin repair. In its appearance in the skin, HS is large and highly polar and therefore unable to penetrate the skin. As a component in a topical formulation, the modified to a low molecular weight heparan sulfate analog (LMW-HS) showed biological modulation activity.

AIMS

This review discusses the potential role of topical formulations containing LMW-HS in restoring aged-skin homeostasis and skin health.

METHODS

An expert panel of dermatologists who regularly treat clinical signs of facial photoaging explored the role of LMW-HS containing formulations for reducing inflammation and facial-aging signs. For this purpose, evidence from the conducted literature searches was used together with expert opinion and experience of the panel.

RESULTS

Extrinsic factors contribute to skin aging through oxidative stress, stimulating inflammation involved in extracellular matrix degradation. Evidence showed that chemokines require heparan sulfate for their full range of functional activities during innate immunity. Studies showed the LMW-HS containing topical formulation to penetrate the skin within 48 hours of once-daily application. LMW-HS used in the periorbital area improved discoloration and wrinkles at Week 2 with continuous improvement up to Week 12.

CONCLUSION

The LMW-HS containing formulation showed improvements in skin condition when applied on photo-damaged skin, indicating its therapeutic potential.

Topical application of a commercially available formulation of vitamin C stabilized by vitamin E and ferulic acid reduces tissue viability and protein synthesis in ex vivo human normal skin

BACKGROUND

Aqueous formulations of vitamin C stabilized by vitamin E and ferulic acid at low pH effectively protect skin against reactive oxygen species-induced damage. However, the effects of these formulations on human skin have not clearly been described. The aim of this study was to investigate whether topical application of two commercially available formulations of vitamin C alter human skin using an ex vivo model.

METHODS

Human skin explants were topically treated on alternate days with commercially available formulation 1 (15% vitamin C) at 100% (without dilution), 50%, or 10% diluted in saline or formulation 2 (20% vitamin C) at 100% (without dilution), 50%, or 10% diluted in saline. Only saline was applied to control skin explants.

RESULTS

Topical formulation 1 at 100%, 50%, or 10%, but not formulation 2 at 100%, 50%, or 10%, reduced the viability of ex vivo human skin compared to the control after 7, 10, and 13 days. In addition, compared to the control, ex vivo human skin treated with formulation 1 at 50%, but not formulation 2 at 50%, also decreased mRNA levels of actin and ribosomal protein L10 and gene expression of extracellular matrix components after 10 days. Furthermore, after 10 days, topical application of formulation 1 at 50%, but not formulation 2 at 50%, decreased the protein expression of proliferating cellular nuclear antigen, lysyl oxidase, β-actin, and glyceraldehyde-3-phosphate dehydrogenase compared to the control.

CONCLUSIONS

Topical formulation 1, but not formulation 2, may reduce the viability of and protein synthesis in ex vivo human skin. Those effects might be due to action of vehicle of formulation 1 on ex vivo human skin.

Current state of methods of correction of involutional changes of skin and the place of photodynamic therapy among them

This work is a review of modern scientific data on the process of aging, as well as the prospect of using photodynamic therapy for correction of involutional skin changes in the age cohorts, cohorts with a burdened medical history, including cancerous and precancerous skin neoplasms. The data on the predicted increase in life expectancy and, as a consequence, the potential risk of pathologies, including those with skin localization, progression of malignancy processes, as well as the formation of de novo elements, is presented. The increase in life expectancy also demonstrates the socialization of the elderly population, along with the increasing need for correction of involutional skin changes. However, considering the risks associated with the chronic diseases and increased malignancy in this cohort, methods have to be carefully selected. One such technique is photodynamic therapy (PDT). PDT is actively used in oncology, and recently has been increasingly showing its aesthetic effectiveness. It can be predictably used not only on cancer patients, but also in an age cohort.

Effects of autologous platelet-rich plasma injections on facial skin rejuvenation

Autologous serum platelet-rich plasma (PRP) has been used to rejuvenate wrinkled and aged skin for years; however, the molecular mechanism for the positive effects of PRP on the skin remains unclear. The present study aimed to clarify the potential molecular mechanisms for the role of PRP in wrinkled and aged skin rejuvenation, and provide evidence for future clinical applications. A total of 30 healthy females were recruited for PRP treatment and signed informed consent was obtained. A total of 3 autologous PRP injections were administered to each patient with 15-day intervals between injections. The effects of PRP injections were evaluated using the VISIA^® Complexion Analysis System and skin computed tomography. A human organotypic skin model was established and treated with PBS or PRP before ultraviolet (UV)-B light (10 mJ/cm²) irradiation. The distribution of the epidermal structure and dermal fibers were analyzed by hematoxylin and eosin and Masson's trichome staining. Expression of matrix metalloproteinase-1 (MMP-1), tyrosinase, fibrillin and tropoelastin was detected by reverse transcription-quantitative PCR, western blotting and immunofluorescence. The present results showed that PRP treatment improved skin quality in the participants. In addition, the VISIA^® results showed that wrinkles, texture and pores were decreased in the PRP groups compared with the PBS treatment. The in vitro study demonstrated that PRP treatment ameliorated photoaging by inhibiting UV-B-induced MMP-1 and tyrosinase upregulation, and by inducing fibrillin and tropoelastin expression that was downregulated by UV-B. Collectively, it was demonstrated that PRP treatment ameliorated skin photoaging through regulation of MMP-1, tyrosinase, fibrillin and tropoelastin expression.

Non-Traditional and Non-Invasive Approaches in Facial Rejuvenation: A Brief Review

While injectables, lasers, and surgical interventions have traditionally been used to reverse the changes associated with facial aging, other alternative therapies such as facial acupuncture and facial exercises are now being studied for facial rejuvenation. In this paper, we both summarize the concepts of facial acupuncture and facial exercises, and review seven studies that evaluate the efficacy of these modalities. Data from these studies suggest that both facial acupuncture and facial exercises have the potential to improve the skin laxity, wrinkle length, muscle thickness, and pigmentary changes associated with aging. Patients frequently reported improvement and experienced very few side effects. However, further research is necessary before these modalities are widely accepted as effective by the medical community, though the results of these studies may ultimately make providers less hesitant when patients seek out these services.

Tranexamic Acid Cream Protects Ultraviolet B-induced Photoaging in Balb/c Mice Skin by Increasing Mitochondrial Markers: Changes Lead to Improvement of Histological Appearance

Tranexamic acid (TSA) is widely used as an antiaging treatment for reducing melasma and wrinkles. There are various mechanisms for wrinkle formation, and one of them is due to damage of the mitochondria. Research on mitochondria in the skin is very limited, so we are interested to see the changes that occur after application of TSA cream. We explored the effect of TSA on mitochondrial protein levels (PGC1α, Tom20, COX IV), which had affected to skin histological structure. Thirty male, 6-week-old, Balb/C mice were divided into five groups (negative control, positive control, TSA 3%, TSA 4% and TSA 5%). After 10 days of acclimatization, four groups of mice were exposed to UVB light, of which three groups were given TSA cream for 10 weeks. The skin tissue was excised for protein and histological studies. H&E staining was performed for evaluating histological changes in epidermal thickness and dermal elastosis. TSA treatment on the mice skin increased mitochondrial marker levels and epidermal thickness while decreasing dermal elastosis for all the treatment groups. Topical application of TSA significantly increased mitochondrial biogenesis which may cause alteration in epidermal thickness and reduced dermal elastosis in the histology of mice skin.

A novel water-based anti-aging suncare formulation provides multifaceted protection and repair against environmental aggressors: evidence from in vitro, ex vivo, and clinical studies

Background

Ultraviolet (UV) radiation is an established cause of skin aging, and the role of pollution is increasingly acknowledged. In this study, we evaluated the efficacy of an antipollution and anti-aging suncare product in in vitro, ex vivo, and clinical studies.

Methods

We assessed 1) sunburn cell (SBC) and cyclobutane pyrimidine dimer (CPD) formation and gene expression profile in reconstructed human epidermis following solar irradiation, 2) malondialdehyde (MDA) level, Nrf2 immunostaining, and genetic expression in skin explants exposed to pollution, 3) carbon particle adhesion to healthy forearm skin in a clinical study, and 4) skin firmness, elasticity, and pigmentation spots in healthy women following 56 days of application.

Results

1) The product fully protected against CPD formation, and provided a high protection against SBC formation, with levels close to non-irradiated samples. Expression of genes encoding pro-inflammatory and oxidative stress response markers was lower in product-treated than untreated skin. 2) Compared with pollution-exposed untreated controls, product-treated skin had 23% lower MDA levels (P<0.01), weaker Nrf2 immunostaining, and attenuated upregulation of CYP1A1. 3) The product significantly decreased adhesion of carbon particles to the skin (15.2% less than control; P<0.01). 4) Clinically, product use led to a decrease in brown spots, with a relative reduction in the count of −1.9% (NS), and in area, −5.0% (P<0.01), and decrease in UV spots, with a relative reduction of −6.9% (P<0.01) and −9.3% (P=0.02) for count and area, respectively. Firmness increased significantly by 14.1% (P<0.01). Participants reported skin was more even in tone (80%), more moisturized (93%), and firmer (74%).

Conclusion

This water-based anti-aging SPF50 suncare formulation containing photolyase encapsulated in liposome, active biopeptides, antioxidants, and hyaluronic acid provides multifaceted protection and repair action against pollution and UV-induced skin aging, ideal for everyday use.

Understanding rates of genital-anal injury: Role of skin color and skin biomechanics

PURPOSE

A series of studies suggest that non-Hispanic White women have significantly more injuries than non-Hispanic Black women after sexual assault and consensual sexual intercourse. One explanation for this difference is that the degree of skin protection may vary as skin mechanics and skin pigmentation vary. The aim of the study was to determine the association among genital-anal injury, skin color, skin viscoelasticity and skin hydration in women following consensual sexual intercourse when controlling for age, smoking history, body mass index (BMI), sun exposure, and health status.

PROCEDURES

We employed a prospective cohort study design to enroll women 21 years of age or older at two study sites. They underwent two data collection sessions, baseline and follow-up after consensual sexual intercourse. Baseline genital-anal injury identification occurred with a standard forensic examination (direct visualization, nuclear staining with toluidine blue contrast, and colposcopy examination) and measurements of other variables (skin color, skin viscoelasticity, skin hydration, age, smoking history, body mass index [BMI], sun exposure, and health status). Participants were then asked to have consensual sexual intercourse with a male partner of their choice and to return for a second forensic examination for injury detection. Genital-anal injury was regressed on skin color, skin viscoelasticity, skin hydration, age, smoking history, BMI, sun exposure, and health status.

FINDINGS

We enrolled 341 participants, 88 non-Hispanic White (25.8%), 54 non-Hispanic Black (15.8%), 190 Hispanic/Latina (55.7), and 9 Other Identities (2.6%). At baseline the genital-anal injury prevalence was 57.77% and at follow-up after consensual sexual intercourse, injury prevalence was 72.73%. External genital injury prevalence was associated with increased L* (lightness) values (Adjusted Odds Ratio [AOR] = 1.98, 95% Confidence Interval [CI] = 1.03, 4.04) and decreased skin elasticity (AOR = 0.96, 95% CI = 0.93, 0.99) at baseline. Increased skin hydration was associated with a significantly higher frequency of external, internal, anal, and total genital-anal injuries (Adjusted Rate Ratio [ARR] > 1.27) at follow-up. Also at the follow-up examination, Hispanic/Latina participants had significantly lower external genital and total genital-anal injury prevalence and frequency as compared to non-Hispanic White participants (AOR < 0.40).

CONCLUSIONS

Our findings provide qualified support for the importance of skin color during the forensic examination. Women with lighter skin tones may have skin that is more easily injured than women with darker tones. In contrast, external genital injuries may be more easily identified in women with light as compared to dark skin, a situation that is important in both the health care and criminal justice systems. Additionally, women with decreased viscoelasticity and increased hydration may be more easily injured. These findings support the need to develop forensic procedures that are effective in people across the range of skin colors and to interpret forensic findings considering the innate properties of the skin.

The effects of Astragalus Membranaceus Active Extracts on Autophagy-related Diseases

Autophagy is an evolutionarily conserved 'self-eating' process that maintains cellular, tissue, and organismal homeostasis. New studies on autophagy, mediated by subsets of autophagy proteins, are emerging in many physiological and pathological processes. Astragalus membranaceus (AM), also named Huangqi, is one of the fundamental herbs in traditional Chinese medicine and its extracts have been proved to possess many biological activities related to autophagy, including anti-oxidation, anti-inflammation, anticancer, anti-photoaging, and improvement of cardiomyocyte function. Evidence suggests that AM extracts can have therapeutic potential in autophagy dysregulation-associated diseases because of their biological positive effects. Here we will review the literature concerning the effects of AM extracts on autophagy dysregulation-associated diseases.

Topical effects of SCA® (Cryptomphalus aspersa secretion) associated with regenerative and antioxidant ingredients on aged skin: evaluation by confocal and clinical microscopy

Purpose

This was an open-label, single-center clinical study to evaluate a topical association of SCA^® (Cryptomphalus aspersa secretion) with regenerative and antioxidant ingredients, according to the type and area of the face, on the improvement of signs of skin aging.

Patients and methods

One hundred and twenty female participants aged between 40 and 65 years, with facial aging complaints (presence of static, dynamics wrinkles, loss of elasticity, and skin firmness) were randomized into two groups according to the type of skin: normal–oily and normal–dry, and 40 participants were randomized for evaluation of the periocular area (with the presence of wrinkles, expression lines, and dark circles) with both types of skin. The groups received serum for normal–oily skin, a cream for normal–dry skin, and a cream for periocular and eyelid skin (eye area). All the participants were evaluated by a dermatologist and submitted to hydration evaluation by corneometry, elasticity and firmness measures complementarily, and images were collected in confocal reflectance microscopy.

Results

Topical skin treatment with the association of SCA with antioxidant ingredients (green coffee oil, olive oil, ectoine, hyaluronic acid, and peptides) was able to promote significant clinical and subjective improvement of all signs of skin aging. This improvement was presented at the epidermal level, with improved hydration levels measured by corneometry and epidermal thickness, and at the dermal level, with improvement of the firmness and elasticity parameters, measured by cutometry, from 45 days of use.

Conclusion

All the evaluated topical formulations seemed to be an effective alternative for the progressive treatment of signs of skin aging, since they demonstrate a real improvement of dermal–epidermal structure and function with high safety margin for long-term use.