[Practical problems with the use of topicals in geriatric dermatology]

Changes related to aging affect all layers of the skin and are influenced by both intrinsic conditions and extrinsic factors. The extent of the senescent changes can vary enormeously in seniors, so that an individual assessment is useful and often necessary. Of particular clinical importance are changes in the epidermis, which entail a complex reduction of the barrier function and a reduction in the compensatory capacity with regard to exogenous noxae. This results in increased susceptibility, especially toward infection and cancer. Against this background, a prophylactic strategy for the substitution of the physicochemical and thus also the microbiological barrier in the context of basic care is very important. In order to be able to implement these consistently, recommendations for preparations explicitly designed for aging skin as well as practical instructions for use are highly meaningful. The latter should take into account limitations regarding mobility as well as possible cognitive deficits of seniors. For this purpose, creams and suitable preparations in terms of viscosity and composition should be recommended. In order to facilitate implementation, written or pictorial recommendations for application as well as digital assistance systems can be used. Due to demographic developments in Germany and Europe, the clinical relevance of geriatric dermatology will significantly increase in the future.

2,4-Dihydroxyphenyl-benzo[d]thiazole (MHY553), a synthetic PPARα agonist, decreases age-associated inflammatory responses through PPARα activation and RS scavenging in the skin

We previously reported that 2,4-dihydroxyphenyl-benzo[d]thiazole (MHY553) is a PPARα agonist, which has been shown to inhibit tyrosinase activity in murine melanocyte and alleviate hepatic steatosis in aged rats. This study investigated the effects of MHY553 on the age-related occurrence of inflammatory responses via the molecular modulation of the nuclear factor-κB (NF-κB) signaling pathway in the skin of aged rats and skin fibroblast cells. Moreover, we investigated the antioxidant effect of MHY553 via in vitro assays of reactive oxygen species (ROS) and peroxynitrite (ONOO^-) scavenging activities. We also scrutinized the ability of MHY553 as a PPARα activator in aged rat skin and H₂O₂-induced Hs27 fibroblast cells. In vivo experiments were performed in young, aged, and MHY553-fed aged rats (3 mg or 5 mg∙kg ^-1∙day ^-1 for 4 weeks). MHY553 dose-dependently scavenged ROS and ONOO^-. Furthermore, we found that MHY553 suppressed the NF-κB transcription factor and downregulated mitogen-activated protein kinase (MAPK)/activator protein-1 (AP-1) signaling. MHY553 also inhibited the expression of pro-inflammatory cytokines including COX-2, iNOS, IL-1β, and IL-6. Our findings indicate the MHY553 scavenges ROS/reactive nitrogen species and inhibits inflammatory cytokines through PPARα activation in the skin. Thus, these results suggest that MHY553 may be of therapeutic interest for protecting skin from oxidative stress-induced damage and intrinsic aging.

Skin tears: prevention and management

Skin tears commonly occur at the extremes of age and are associated with skin changes in ageing skin. They are considered to be acute wounds caused by mechanical forces, such as blunt trauma. While the true prevalence and incidence of skin tears is unknown, the available evidence suggests that these wounds occur in all healthcare settings. Importantly, skin tears are preventable with the implementation of a risk-reduction programme, which includes twice-daily skin moisturisation. Where these injuries do occur, it is important to categorise the extent of damage as well as to choose the most appropriate dressing to avoid adding any risks for further trauma.

Measurement of morphological and physiological skin properties in aged care residents: a test-retest reliability pilot study

This test-retest pilot study investigated the intra-rater reliability and reproducibility of non-invasive technologies to objectively quantify morphological (colour, thickness and elasticity) and physiological (transepidermal water loss (TEWL), hydration, sebum and pH) skin properties in an aged care population. Three consecutive measurements were taken from five anatomical skin sites, with the mean of each measurement calculated. The intra-class correlation coefficient (ICC) and the standard error of measurement (SEM) were used to examine the intra-rater reliability and reproducibility of measurements. Non-invasive technologies in this study showed almost perfect reliability for ultrasound measurements of the subepidermal low echogenicity band (SLEB) (ρ = 0·95-0·99) and skin thickness (ρ = 0·95-0·99) across all sites. The ICC was substantial to almost perfect for pH (ρ = 0·76-0·88) and viscoelasticity (ρ = 0·67-0·91) across all sites. Hydration (ρ = 0·53-0·85) and skin retraction (ρ = 0·57-0·99) measurements ranged from moderate to almost perfect across all sites. TEWL and elasticity were substantial to almost perfect across four sites. Casual sebum levels and most colour parameters showed poor ICC. The use of non-invasive technologies in this study provided an objective and reliable means for quantifying ageing skin and may offer future studies a valuable option for assessing skin tear risk.

Development and validation of the Patient Benefit Index for the dermatocosmetic treatment of aged skin

This study aimed to develop and validate an instrument for the assessment of patient-relevant benefit in dermatocosmetic treatment, i.e., skin care, of aged skin. Based on an open item collection with 33 elderly persons, items on patient-relevant treatment goals were collected. An expert panel selected 20 items to be most relevant and feasible for the questionnaire named Patient Benefit Index for Aged Skin (PBI-AS). The instrument, which assesses goal importance and achievement, was tested in a cognitive debriefing and validated in a longitudinal study (n = 80) along with the Dry Skin Area and Severity Index (DASI) and the Dermatology Quality of Life Index (DLQI) as convergent validation criteria. The cognitive debriefing showed the good practicability and feasibility of the instrument. Significant correlation with change in DASI (r = -0.527; p < 0.001) supports convergent validity of the PBI-AS. By contrast, correlation with DLQI was poor, indicating the different constructs. The PBI-AS is a valid and feasible tool for the patient-centered assessment of dermatocosmetic treatment benefit in aged skin.