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Actinic cheilitis is a premalignant condition that can progress to squamous cell carcinoma with a higher propensity for metastasis than cutaneous squamous cell carcinoma. Optimal treatment for actinic cheilitis has not been established, and evidence-based estimates of clinical cure in the dermatology literature are limited. Here, we review and synthesize outcome data published for patients with actinic cheilitis after treatment with various modalities. A systematic review was conducted in MEDLINE, Embase and the Cochrane library for English, French and German-language studies and references of included articles from inception to 20 January 2020. Studies were included if they reported on at least six patients with biopsy-proven actinic cheilitis. After quality appraisal, results of studies with the strongest methodology criteria were synthesized. 18 studies of 411 patients (published 1985 to 2016) were included. The majority of the studies were case series. Carbon dioxide laser ablation and vermilionectomy were associated with the most favourable outcomes with fewest recurrences. Chemical peel and photodynamic therapy were associated with higher recurrence. Adverse effects generally resolved in the weeks following treatment and cosmetic outcomes were favourable overall. In conclusion, there is a lack of high-quality comparative studies evaluating different treatment options for actinic cheilitis. The included publications used various outcome measures; however, the majority reported on the recently defined core outcome sets. These results suggest that both carbon dioxide laser ablation and vermilionectomy are effective treatments for actinic cheilitis. Prospective head-to-head studies are needed to compare these treatment modalities and to assess patient preferences.

Un des enjeux majeurs de ce XXIesiècle est la lutte contre le vieillissement, défini comme un ensemble de mécanismes physiologiques altérant les capacités physiques et intellectuelles de l’organisme. Le vieillissement de la peau n’est qu’un trait visible de ce processus. Il est associé à des défauts de cicatrisation majeurs liés à l’altération des propriétés biomécaniques des cellules cutanées, essentiellement des fibroblastes dermiques. Le système immunitaire, autre composante clé du maintien de l’homéostasie cutanée et du bon déroulement de la cicatrisation des plaies, subit aussi les effets du temps : l’immunosénescence cutanée consécutive limiterait la réponse anti-infectieuse et vaccinale, tout en favorisant un environnement pro-tumoral. Les principales atteintes cutanées dues au vieillissement, que celui-ci soit intrinsèque ou extrinsèque, seront détaillées avant d’énumérer les stratégies anti-âges efficaces pour lutter contre les stigmates dermiques et épidermiques liées à l’âge.

Cutaneous T-cell lymphomas (CTCL) are a heterogenous group of rare diseases. Many studies have reported on local epidemiology or geographic clustering, however we lack information from a global perspective. A systematic review and meta-analysis was conducted in Medline and the Cochrane Library based on a previously registered protocol and according to the preferred reporting of items for systematic reviews and meta-analyses (PRISMA). We selected publications that enrolled at least 100 patients with primary cutaneous lymphomas according to the current classifications. The relative frequencies (proportions) of subtypes were compared between studies and geographic regions in a meta-analysis. In total, 26 studies met our inclusion criteria, reporting on altogether 16,953 patients. Within primary cutaneous lymphomas, CTCL appeared to be 15% more frequent in Asian populations. Mycosis fungoides (MF) accounted for 62% of CTCL, with an important heterogeneity in frequencies between studies and continents. The proportion of S&eacute, zary syndrome (SS) was 3%, stable worldwide. Rare CTCL, such as NK/T-cell lymphoma or subcutaneous panniculitis-like lymphoma, were more frequent in Asian studies. This global meta-analysis of CTCL confirmed the predominance of CTCL among primary cutaneous lymphomas (83% on average) in the three analyzed continents, most of which were MF cases. It revealed the same proportions of SS across continents, and the heterogeneity of MF frequencies, suggesting the possible role of environmental factors in the pathophysiology of the latter. Registration number: CRD42020148295 (PROSPERO).

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Background: Despite increasing availability of therapeutic agents, Sezary syndrome (SS) remains associated with a generally poor prognosis. Typically, patients endure multi-line treatment, frequently with disappointingly short durations of clinical benefit. Time to next treatment (TTNT) measures the interval from the date of commencement of one therapy to the date of initiation of the next line of therapy, and provides a simple and reliable surrogate for duration of clinical benefit outside of clinical trials [ 1 ]. In this multi-centre collaborative study, we review the clinical outcomes of patients with SS/ mycosis fungoides (MF) with B1-2 blood involvement, and compare the treatment efficacy of the currently available systemic therapies using TTNT. Methods: In this retrospective analysis, eligible patients were identified from University Hospital Birmingham, Birmingham, Peter MacCallum Cancer Centre, Melbourne, and Hopital Saint Louis, Paris. Strict eligibility required biopsy-proven MF/SS, with B1-2 blood involvement, newly diagnosed during 1/1/2012 to 31/12/2020. Studied treatment groups include monotherapy and combination therapies of interferon, methotrexate, ECP, HDAC inhibitors, retinoids, monoclonal antibodies, biologicals, chemotherapy, allogeneic stem cell transplant, and best supportive care. The primary endpoint was TTNT, with the aim to compare the efficacy of these systemic therapies. Results: 178 patients were eligible. 77 (43%) were female, median age was 66 (17–94) years. At diagnosis, 35 (20%) patients had Stage IIIB, 131 (74%) Stage IVA and 12 (7%) Stage IVB MF/SS. Large cell transformation was present in 35 (20%) patients at time of diagnosis. A total of 802 treatment lines were delivered, of which 711 were systemic therapies and were included for analysis. Of the 178 patients, 168 received systemic therapy first-line: the most commonly delivered first-line systemic treatments were ECP-containing regimens in 42 (25%) patients (ECP-monotherapy, 17, ECP-based combination therapy, 25), retinoid monotherapy in 34 (19%), interferon monotherapy in 25 (14%) and methotrexate monotherapy in 25 (14%) patients. TTNT and overall survival data will be presented. Conclusions: As a surrogate for duration of clinical benefit, TTNT is a useful endpoint to retrospectively compare the treatment efficacy of currently available systemic therapies for SS/MF with B1-2 blood involvement. Long-term disease control with durable clinical benefit remains the ultimate goal for patients with SS/MF with blood involvement.

Introduction: Cancer-associated fibroblasts (CAFs), a component of tumor microenvironment, play a key role in oncogenesis and promote growth, invasion, metastasis and chemo-resistance of tumor cells. Our previous RNAseq results brought evidence of the contribution of dermal fibroblasts obtained from cutaneous T-cell lymphoma (CTCL) lesions to support tumor growth. Here, we further go on by analyzing the alteration of protein production by dermal fibroblasts obtained from CTCL lesions versus control fibroblasts. Materials and methods: Secretome and proteome was performed on fibroblast primary cultures skin biopsies of 6 cutaneous T-cell lymphoma (CTCL[GD1]) versus fibroblasts from healthy mammary skin controls (age-paired). The fibroblasts of the two groups were studied at the 3rd passage, after stimulation or not with 5 ng/ml TGF-β for 24 h. The supernatants and lysates collected underwent enzymatic digestion with trypsin before peptide analysis by HLPC/Mass spectrometry Results: The comparison of the secretomes from the CTCL groups (± TGF-s) and the control donors showed a global significant differential expression (fold >2, p-value 2, p-value Conclusion: The present data demonstrate the potent proteomic alteration of CTCL-associated dermal fibroblasts, confirming the involvement of mesenchymal cells on the behavior of CTCL.

Background Aged residents of institutional long-term care facilities are at high risk for developing skin and tissue diseases. Besides various common skin problems, dry skin (xerosis cutis) is one of the most frequent skin conditions in this setting. Objectives To investigate the effectiveness of two structured skin care regimens in comparison to routine skin care on xerosis cutis in nursing home residents. Design A multi-center, pragmatic, randomized, controlled, investigator blinded study with three parallel groups. Settings The study was conducted in a random sample of ten out of 291 institutional long-term care facilities of the federal state of Berlin, Germany. Participants Long-term care residents being 65+ years affected by dry skin were included. Methods The residents were allocated into one of three study groups. Two interventional groups used standardized skin care regimens, consisting of a body wash and twice daily applications of leave-on products for eight weeks. The third control group performed skin care as usual. All participating residents were examined at baseline and after 4 and 8 weeks. Xerosis cutis was measured with the Overall Dry Skin score. Instrumental skin barrier measurements were performed at baseline and after 8 weeks. Diaries were used to document washing and skin care frequencies. Results In total, 133 residents were included and allocated to one of the three groups. Mean age was 83.8 (SD 8.3) years, 65.4% were female and most residents had care levels I (42.9%) or II (42.9%) according to the German Social Code Book XI. Mean Barthel score was 46.8 (SD 24.2) and mean Braden score was 17.6 (SD 3.7). Leg skin areas were drier compared to arms and trunk areas. At the end of the study the Overall Dry Skin scores in the intervention groups were lower compared to the control group. There were statistically significant improvements of skin dryness in both intervention groups compared to the control group over time. Conclusions The results of this pragmatic trial indicate that structured skin care regimens are effective in reducing skin dryness in aged nursing home residents within eight weeks. Trial registration The study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.

Background Primary cutaneous lymphomas (PCLs) are a heterogeneous group of T-cell (CTCL) and B-cell (CBCL) malignancies. Little is known about their epidemiology at initial presentation in Europe and about potential changes over time. Objectives The aim of this retrospective study was to analyse the frequency of PCLs in the French Cutaneous Lymphoma Registry (GFELC) and to describe the demography of patients. Methods Patients with a centrally validated diagnosis of primary PCL, diagnosed between 2005 and 2019, were included. Results The calculated incidence was unprecedently high at 1·06 per 100 000 person-years. The number of included patients increased yearly. Most PCL subtypes were more frequent in male patients, diagnosed at a median age of 60 years. The relative frequency of rare CTCL remained stable, the proportion of classical mycosis fungoides (MF) decreased, and the frequency of its variants (e.g. folliculotropic MF) increased. Similar patterns were observed for CBCL; for example, the proportion of marginal-zone CBCL increased over time. Conclusions Changes in PCL frequencies may be explained by the emergence of new diagnostic criteria and better description of the entities in the most recent PCL classification. Moreover, we propose that an algorithm should be developed to confirm the diagnosis of PCL by central validation of the cases.

Background Dry skin (xerosis cutis) is increasingly recognized as a relevant health problem in daily life and in health and nursing care. The use of bath additives such as oils is common to reduce dry skin, but empirical evidence supporting this practice is limited. Objectives The aim of this study was to investigate the effectiveness of using a bath oil additive in improving skin barrier function and ameliorating dry skin in comparison to non-oil containing skin cleansers for bathing or showering. Design Single centre randomized observer blind pragmatic parallel group trial. Settings Outpatient/community care. Participants Volunteers showing clinically mild to moderate dry skin recruited from the city of Berlin. Methods Healthy children and adults were randomly assigned to use either a commercially available bath oil or to continue using their regular non-oil containing skin cleansers every other day over a study period of 28days. Skin barrier parameters and the severity of dry skin were assessed at baseline and at two follow-up visits at the study centre. Transepidermal water loss was the primary outcome. Results All sixty participants randomized completed the trial. Median age was 32.5 (IQR 8.3 to 69) years. At the end of study the mean transepidermal water loss in the intervention group was statistically significant lower compared to the control group (mean difference −1.9 (95% CI −3.1 to −0.8) g/m 2 /h). Stratum corneum hydration was statistically significantly higher in the intervention group at the end of the study. Skin surface pH and roughness were comparable in both groups and remained unchanged, while both groups showed a trend to improvement in dry skin symptoms Conclusions This pragmatic trial provides empirical evidence that the regular use of the investigated bath oil is effective in improving the skin barrier function in children and adults with mild dry skin when used in routine skin care and supports its use as a basic element for the management of a broad spectrum of dry skin conditions. Trial registration ClinicalTrials.gov Identifier NCT02557698.

Background The postadolescent form of acne papulopustulosa, also referred to as ‘acne tarda’ can have substantial negative impact on Quality of Life, especially in adult female patients. Objective Although the Dermatology Life Quality Index (DLQI) is widely used, empirical evidence about its performance in adult female acne patients is lacking. Methods In this prospective cohort study, we have investigated the sensitivity to change of the DLQI in 53 female adult acne patients with mild to moderate facial acne treated with azelaic acid (AzA) 15% gel twice daily over 24 weeks. Results Mean Investigator Static Global Assessment (ISGA) score was 2.3 (SD 0.5) at baseline and ranged from 0.9 (SD 0.3) to 2.1 (SD 0.4) at the end of the study in the ‘Highly Improved’ and ‘Unchanged’ responder groups respectively. The mean baseline DLQI score was 5.1 (SD 4.2). The Effect Size in the responder group ‘Highly Improved’ was 0.66; in group ‘Improved’ 0.62 and 0.23 in group ‘Unchanged’. At the end of study, the mean DLQI score ranged from 1.1 (SD 1.5) in the ‘Highly Improved’ group to 3.7 (SD 6.0) in the ‘Unchanged’ group. Conclusion The results support the sensitivity to change of the DLQI in this population.

Clinical scales are widely used in anti-ageing research and practice. More than 100 skin ageing scales exist, which makes it difficult to choose outcome measures and to compare study results. The objectives were to assess and evaluate the quality of measurement properties of available clinical skin ageing scales. A systematic review was conducted. Electronic databases including Medline (1970 to June 2013) and EMBASE (1974 to June 2013) were searched via Ovid SP. To enhance the sensitivity forward searches were conducted in Scopus and Web of Science. We identified 111 scales in 52 included publications. Thirty studies had good methodology for at least one measurement property. Forty-two scales were evaluated for their test-retest or interrater reliability. Nineteen showed high reliability coefficients. A further 15 instruments were partly supported by content and/or structural and/or criterion validity and/or hypotheses-testing evidence. The majority of existing clinical skin ageing scales were developed for evaluating facial characteristics. Many scales quantify similar constructs. In contrast to the high number of available scales there is limited evidence supporting their measurement properties. Recommendations for the use of specific skin ageing scales for clinical studies must be made with caution because of the high number of studies with poor methodology. Development of new instruments should be justified, and existing ones investigated for scale behaviour using appropriate methods. Future research should aim to select and/or adapt existing scales to identify the 'best' to improve clinical research and practice.

Background Associations between daily amounts of drinking water and skin hydration and skin physiology receive increasingly attention in the daily life and in clinical practice. However, there is a lack of evidence of dermatological benefits from drinking increased amounts of water. Materials and methods Pubmed and Web of Science were searched without any restrictions of publication dates. References of included papers and related reviews were checked. Eligibility criteria were primary intervention and observational studies investigating the effects of fluid intake on skin properties in English, German, Spanish or Portuguese language, including subjects being healthy and 18+ years. Results Searches resulted in 216 records, 23 articles were read in full text, and six were included. The mean age of the samples ranged from 24 to 56 years. Overall the evidence is weak in terms of quantity and methodological quality. Disregarding the methodological limitations a slight increase in stratum corneum and "deep" skin hydration was observed after additional water intake, particularly in individuals with lower prior water consumption. Reductions of clinical signs of dryness and roughness were observed. The extensibility and elasticity of the skin increased slightly. Unclear associations were shown between water intake and transepidermal water loss, sebum content, and skin surface pH. Conclusions Additional dietary water intake may increase stratum corneum hydration. The underlying biological mechanism for this possible relationship is unknown. Whether this association also exists in aged subjects is unclear. Research is needed to answer the question whether increased fluid intake decreases signs of dry skin.

The report concerns a 61-year-old woman suffering from a chronic pain syndrome of peripheral arterial vascular disease. Despite level III-WHO medication she was not able to walk a distance of more than 100 m without pain. The patient received sonographically guided procaine injections into both femoral arteries. Directly after the injection the patient was free of pain for 4 weeks and for 6 months after a repeat injection.

Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80% Caucasian men and 42% of women. Patients afflicted with androgenetic alopecia may undergo significant impairment of quality of life. The European Dermatology Forum (EDF) initiated a project to develop evidence-based guidelines for the treatment of androgenetic alopecia. Based on a systematic literature research the efficacy of the currently available therapeutic options was assessed and therapeutic recommendations were passed in a consensus conference. The purpose of the guideline is to provide dermatologists with an evidence-based tool for choosing an efficacious and safe therapy for patients with androgenetic alopecia.

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ObjectivesThe aim of this study was to measure the prevalence of skin diseases in aged nursing home residents and to explore possible associations with demographic and medical characteristics.DesignDescriptive multicentre prevalence study.Setting and participantsThe study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n=223 residents were included.ResultsIn total, 60 dermatological diseases were diagnosed. The most frequently diagnosed skin disease was xerosis cutis (99.1%, 95% CI 97.7% to 100.0%) followed by tinea ungium (62.3%, 95% CI 56.0% to 69.1%) and seborrheic keratosis (56.5%, 95% CI 50.2% to 63.0%). Only few bivariate associations have been detected between skin diseases and demographic and medical characteristics.ConclusionStudy results indicate that almost every resident living in residential care has at least one dermatological diagnosis. Dermatological findings range from highly prevalent xerosis and cutaneous infection up to skin cancer. Not all conditions require immediate dermatological treatment and can be managed by targeted skin care interventions. Caregivers need knowledge and diagnostic skills to make appropriate clinical decisions. It is unlikely that specialised dermatological care will be delivered widely in the growing long-term care sector.Trial registration numberThis study is registered athttps://clinicaltrials.gov/ct2/show/NCT02216526.

Background Pressure Ulcers (PUs) are a severe form of skin and soft tissue lesions, caused by sustained deformation. PU development is complex and depends on different factors. Skin structure and function change during prolonged loading on PU predilection sites and surfaces being in direct contact with skin are likely to have an impact as well. Little is known about the influence of fabrics on skin function under pressure conditions. Objectives To investigate skin responses to sustained loading in a sitting position and possible differences between two fabrics. Methods Under controlled conditions 6 healthy females (median age 65.0 (61.0–67.8) years) followed a standardized immobilization protocol of a sitting position for 45 min on a spacer and on a cotton fabric. Before and after the loading period skin surface temperature, stratum corneum hydration, transepidermal water loss (TEWL), erythema, skin elasticity and 'relative elastic recovery‘ were measured at the gluteal areas. Results A 45 min sitting period caused increases of skin surface temperature and erythema independent of the fabric. Loading on spacer fabric showed a two times higher increase of TEWL compared to cotton. Stratum corneum hydration showed slight changes after loading, skin elasticity and 'relative elastic recovery' remained stable. Conclusions Sitting on a hard surface causes skin barrier changes at the gluteal skin in terms of stratum corneum hydration and TEWL. These changes are influenced by the fabric which is in direct contact to the skin. There seems to be a dynamic interaction between skin and fabric properties especially in terms of temperature and humidity accumulation and transport.

The German acupuncture trials ART and GERAC have shown that acupuncture and sham or minimal acupuncture were equally effective in the reduction of chronic pain symptoms. These results have prompted an ongoing discussion as to whether acupuncture exerts its effects through a placebo response. Increasing knowledge about the neurobiology of pain and its intrinsic control suggests a combination of acupuncture-specific neurophysiologic effects combined with effects that match those of expectation-induced placebo analgesia.

The introduction of a new crop requires adapted genotypes as well as optimum crop management practices. This study was conducted to determine the optimum crop density of adapted grain amaranth genotypes in the Pannonian region of Eastern Austria. The genotypes Neuer Typ (A. hypochondriacus), Mittlerer Typ (A. hypochondriacus) and Amar (A. cruentus) were established at plant densities of 8, 17 and 35 plants/m 2 in 2002 and 2003. Average hand-harvested yields ranged from 2200 to 3000 kg/ha without significant genotypic differences. Genotypes differed in thousand seed weight (0.55–1.04 g), time from sowing to harvest (97–130 days), grain water content at harvest (24–38%), microbial infestation of air-dried grain (0.2–118.6 cfu × 10 6 /g), germination (29–79%) and grain composition. Grain contents fell within the following ranges: crude protein 15.2–18.6%, crude fat 5.4–8.6%, crude fibre 3.5–4.2%, ash 2.7–3.2%, and carbohydrates 66.7–72.7%. High grain water contents involved stronger microbial infestation and reduced germination. Crop density affected neither grain yield nor grain quality.

Background Porphyrins are native fluorophores in the follicle openings, visible under ultraviolet-A light. Acne severity might be associated with increased Propionibacterium acnes colonization and porphyrin production. Aim of this study was to investigate whether the parameter fluorescence quantity can be used to measure acne severity. Methods A validation study was conducted in 24 patients with acne using split-face design. Acne severity was measured using Investigator Static Global Assessment scores and lesion counts. Reliability, construct validity and sensitivity to change in fluorescence quantity were investigated. Results Mean baseline Investigator Static Global Assessment score was 2.7 (SD 0.1). Mean baseline fluorescence quantities were 24.8 (SD 4.0) on the cheek and 20.3 (SD 4.6) on the chin. On day 25, values ranged from 6.0 (SD 6.0) to 18.1 (SD 18.4) on the cheek and from 2.6 (SD 4.4) to 14.7 (SD 16.2) on the chin. The intraclass correlation coefficients of fluorescence quantity ranged from 0.513 to 0.987. Effect sizes for fluorescence measurements were highest on the chin and cheek ranging from 0.24 to 0.77 and 0.32 to 0.75, respectively. Conclusion Fluorescence quantity indicates acne severity, especially on the inner cheek and chin areas. Fluorescence quantity is reliable but is not as sensitive as manual lesion counting.

Background/Aims: Antibiotic-induced drug resistance requires new approaches in topical acne treatment. Tyrothricin is known to produce no resistance. In this study, it was tested for the first time in topical acne treatment. The efficacy and tolerability of topical tyrothricin 0.1% was evaluated. Methods: A randomized, active comparator-controlled, exploratory, observer-blind clinical study was conducted in 24 patients with acne papulopustulosa. Randomization on a split-face was either tyrothricin versus clindamycin + benzoyl peroxide (BPO) (n = 12) or tyrothricin versus BPO 5% (n = 12). The main outcome was change in inflammatory and noninflammatory lesion counts. Results: The mean differences in inflammatory lesion counts from baseline were -12.3 (95% CI: -20.5 to -4.1) in clindamycin + BPO, -10.2 (95% CI: -15.3 to -5.0) in BPO 5%, and -7.7 (95% CI: -11.7 to -3.7) in tyrothricin. Tyrothricin reduced noninflammatory lesions (mean difference: -6.5 (95% CI: -11.6 to -1.4) and caused less product-related adverse events (n = 31) compared to BPO (n = 37) and clindamycin + BPO (n = 20). Conclusion: The results indicate that tyrothricin might be a candidate for treating acne and it seems to be more tolerable than both comparator treatments.

Objectives.—To evaluate the effect of repetitive somatosensory stimulation (acupuncture) on cerebrovascular response in migraineurs by functional transcranial Doppler. Methods.—Changes of cerebral blood flow velocity in the right posterior and left middle cerebral arteries were measured by functional transcranial Doppler during visual stimulation (flickering light over 57 seconds) in 10 migraineurs before and after 10 acupuncture sessions. The same stimulation paradigm was performed in 10 control subjects. Cerebral blood flow velocity data were analyzed with a previously validated technique based on automated stimulus-related averaging. To evaluate the clinical effect of the treatment, a headache diary monitored the frequency and intensity of the migraine attacks. A positive treatment effect was defined as a reduction of at least 50% in the attack frequency or the mean headache intensity (or both). Results.—Before treatment, migraineurs showed overshooting cerebral blood flow velocity changes at the beginning and at the end of the stimulation and a delayed decline to baseline compared with control subjects. After treatment, this response pattern was significantly diminished (P≤ .05) in those who benefited from treatment (n = 6). Those who did not benefit from treatment (n = 4) showed a significantly (P≤ .05) more marked alteration of the cerebral blood flow velocity pattern. Conclusions.—Data indicate that repetitive somatosensory stimulation (acupuncture) might positively influence the abnormal cerebrovascular response in migraineurs. In a subgroup of migraineurs, however, the dysfunction of the cerebrovascular system might deteriorate under the treatment.

Dermal and epidermal structures in human skin change during intrinsic and extrinsic aging. Epidermal thickness is one of the most often reported parameters for the assessment of skin aging in cross-sectional images captured by optical coherence tomography (OCT). We aimed to identify further parameters for the noninvasive measurement of skin aging of sun-exposed and sun-protected areas utilizing OCT. Based on a literature review, seven parameters were inductively developed. Three independent raters assessed these parameters using four-point scales on images of female subjects of two age groups. All items could be detected and quantified in our sample. Interrater agreement ranged between 25.0% and 83.3%. The item scores “stratum corneum reflectivity,” “upper dermal reflectivity,” and “dermoepidermal contrast” showed significant differences between age groups on the volar and dorsal forearm indicating that they were best able to measure changes during skin aging. “Surface unevenness” was associated with the skin roughness parameters, Rz and Rmax, on the inner upper arm and volar forearm supporting the criterion validity of this parameter on sun-protected skin areas. Based on the interrater agreement and the ability to differentiate between age groups, these four parameters are being considered as the best candidates for measuring skin aging in OCT images.

Facial skin ageing is caused by intrinsic and extrinsic mechanisms. Intrinsic ageing is highly related to chronological age. Age related skin changes can be measured using clinical and biophysical methods. The aim of this study was to evaluate whether and how clinical characteristics and biophysical parameters are associated with each other with and without adjustment for chronological age. Twenty-four female subjects of three age groups were enrolled. Clinical assessments (global facial skin ageing, wrinkling, and sagging), and biophysical measurements (roughness, colour, skin elasticity, and barrier function) were conducted at both upper cheeks. Pearson’s correlations and linear regression models adjusted for age were calculated. Most of the measured parameters were correlated with chronological age (e.g., association with wrinkle score,r=0.901) and with each other (e.g., residual skin deformation and wrinkle score,r=0.606). After statistical adjustment for age, only few associations remained (e.g., mean roughness (Rz) and luminance (L*), β=-0.507,R2=0.377). Chronological age as surrogate marker for intrinsic ageing has the most important influence on most facial skin ageing signs. Changes in skin elasticity, wrinkling, sagging, and yellowness seem to be caused by additional extrinsic ageing.

Background Aged long-term residents suffer from a wide range of skin problems. Dry skin associated with severe pruritus, scratching and inflammation is the most prevalent, but exact figures are lacking. Maintaining skin and tissue health as well as enhancing the quality of life are major goals in institutional long-term care. Using mild and moisturizing skin care products is considered to improve the skin barrier and to reduce adverse events. However, the available evidence supporting particular skin care approaches is limited. Objective This study aims at answering two general questions: (1) What is the prevalence of skin conditions and skin diseases in aged nursing home residents and how are they associated with general person and health related characteristics? (2) Does a structured skin care regimen improve the skin health of aged nursing home residents? Design and methods Using a random sample of all nursing homes of the state of Berlin, residents of seven institutions will undergo nursing, medical, and dermatological assessments. Biophysical skin parameters like transepidermal water loss or skin surface pH will be measured. Residents with dry skin will be included in a three arm randomized pragmatic trial investigating the effectiveness of two standardized skin care regimens compared to usual care. The primary outcome will be the Overall Dry Skin score. The follow-up period will be two months. Settings Institutional long-term care facilities in Berlin, Germany. Participants Long-term care residents being 65+ years who gave their informed consent. Sample size and statistical methods Due to the explorative nature of this study a formal sample size analysis is not possible. The expected sample size in the first part of the study is considered sufficiently large ( n =280) to obtain precise point estimates. It is planned to allocate n =50 eligible nursing home residents in a 1:1:1 ratio per group in the intervention part. The detectable mean difference using these group sizes would be 0.32 between groups. Depending on the level of measurement variables will be described using absolute and relative frequencies, means, medians, and associated spread estimates. Possible bi- and multivariable associations will be analyzed. The primary outcome of dry skin will be described by mean differences and one-way ANOVA analysis with post-hoc pairwise two-sample t -tests. Results The study started in September 2014. The results are expected in July 2015. Trial registration The study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.

Synopsis Objective The skin melanin system is affected by ageing, resulting in dyspigmentation with associated clinical and psychosocial consequences. In dark skinned phenotypes, broad evidence is available, whereas little is known about pigmentary changes in fair-skinned Caucasians. The objective of this study was to investigate age-related changes in facial pigmentation and dyspigmentation in subjects of skin phototypes II–III and to develop and test parameters for quantifying dyspigmentation. Methods Twenty-four skin healthy female subjects were recruited in three distinct age groups (30–40, 50–60, 70–80 years). Skin colour was measured by Mexameter and Chromameter. Skin dyspigmentation was measured by clinical evaluation and newly developed image-processing parameters on the cheeks and the forehead. The reliability of the clinical evaluation was investigated by intraclass correlation coefficients between three raters, and the validity of the dyspigmentation parameters was analysed by bivariate correlations with related measures. Results Skin lightness decreased with increasing age. Clinical dyspigmentation scores showed positive associations with chronological age ranging between 0.452 and 0.606. RBX®-Brown transformation-based hyperpigmentation and hypopigmentation indices increased with age, whereas the overall pigmentation intensity decreased with age at the cheeks. The image analysis-based parameters showed strong associations with the clinical scores and related measurements. Conclusion We demonstrated age-related changes in the facial colour and dyspigmentation of fair-skinned Caucasian females. An increase in dyspigmentation was found by clinical scoring and the RBX®-Brown transformation-based pigmentation indices. The validity of hyper- and hypopigmentation indices and overall pigmentation intensity was supported. The RBX® transformation-based pigmentation indices might be applied in future studies to complement or substitute clinical evaluation. Resume Objectif Le systeme de melanine de la peau est affecte par le vieillissement qui entraine une depigmentation avec des consequences cliniques et psychosociales associees. Dans les phenotypes a peau foncee de nombreuses preuves en sont disponibles alors que peu est connu sur les changements pigmentaires chez les Caucasiens a peau claire. L'objectif de l'etude etait d'etudier les changements lies a l'âge dans la pigmentation et la depigmentation de la peau du visage chez les sujets phototypes II–III et de developper et de tester des parametres d'essai pour la quantification de depigmentation. Methodes Vingt-quatre sujets a peau saine de sexe feminin ont ete recrutes dans trois groupes distincts d'âge (30–40, 50–60, 70–80 ans). La couleur de la peau a ete mesuree par Mexameter et Chromametre. La depigmentation de la peau a ete mesuree par une evaluation clinique et par les parametres de traitement d'image nouvellement elabore au niveau des joues et du front. La reliabilitee de l'evaluation clinique a ete etudiee par des coefficients de correlation intra-classe entre trois evaluateurs et la validite des parametres de depigmentation a ete analysee par des correlations bivariees avec les mesures connexes. Resultats La clarte de la peau diminue avec l'âge. Les scores de depigmentation cliniques ont montre des associations positives avec l'âge chronologique comprise entre 0.452 et 0.606. Les indices d'hyperpigmentation et d'hypopigmentation bases sur la transformation RBX®-Brown augmentent avec l'âge, tandis que l'intensite globale de la pigmentation diminue avec l'âge au niveau des joues. Les parametres bases sur l'analyse d'images ont montre de fortes associations avec les scores cliniques et des mesures connexes. Conclusion Nous avons demontre des changements dans la couleur du visage et la depigmentation des femmes de race blanche a peau claire liees a l'âge. Une augmentation de la depigmentation a ete trouvee par la notation clinique et par les indices de pigmentation bases sur la transformation RBX®-Brown. La validite des indices d'hyper- et d'hypo-pigmentation et de l'intensite globale de la pigmentation a ete confirmee. Les indices de la pigmentation a base de transformation de RBX® pourraient etre appliques dans de futures etudes afin de completer l'evaluation clinique ou de la substituer.

Purpose Pressure ulcers are localized injuries to the skin or underlying tissues over a bony prominence, as a result of pressure, or pressure in combination with shear. Ultrasound imaging techniques are widely applied to detect and to investigate pressure ulcer pathogenesis and healing, but due to missing structural alterations, very early signs of tissue alterations are not detectable. Ultrasound elastography was proposed as a new method to measure very early signs of pressure ulcer development but this was not investigated in humans so far. The aim of this study was to investigate for the first time whether US elastography is able to measure potential changes in dermal and subcutaneous tissue stiffness during prolonged loading. Materials and methods An exploratory study including nine healthy volunteers (mean age 70.1 (SD 4.8) years) was conducted. Study participants were requested to follow a standardized lying protocol, consisting of two loading phases of 90 and 150 min in supine position on a standard hospital mattress. Three pressure ulcer predilection sites (lateral heel over the calcaneus, sacral, and upper back area) were measured using B-mode and elastographic ultrasound system at baseline – immediately, after 90 min, and after 150 min loading. Results Mean baseline shear wave velocities were highest in the heel skin (2.7 m/s) and lowest in the upper back skin (1.9 m/s) indicating that heel skin was stiffest. Also the subcutaneous soft tissue stiffness was highest for the heel (2.7 m/s) and lowest for the upper back region (1.3 m/s). After 90 and 150 min loading there was a mean stiffness increase of the skin layers and a pronounced stiffness decrease of subcutaneous heel and sacral tissues. Conclusions Continuous loading of skin and underlying subcutaneous soft tissues leads to dynamic changes of tissue stiffness which are considered to play key roles in pressure ulcer development. Superficial skin and deep tissues seem to react differently. Elastography is able to quantify the dynamic of skin and subcutaneous soft tissue stiffness changes non-invasively in vivo . Shear wave velocity might serve as a new parameter for quantifying pressure ulcer damage risk in superficial and deeper tissues prone to pressure ulcer development.

Background Severe illness, disability and immobility increase the risk of pressure ulcer development. Pressure ulcers are localized injuries to the skin and/or underlying tissue as a result of long enduring pressure and shear. Little is known about the role of the stratum corneum and the upper skin layers in superficial pressure ulcer development. Objectives To investigate possible effects of long enduring loading on the skin barrier function under clinical conditions at two pressure ulcer predilection sites. Methods Under controlled conditions 20 healthy females (mean age 69.9 (3.4) years) followed a standardized immobilization protocol of 90 and 150 min in supine position wearing hospital nightshirts on a standard hospital mattress. Before and immediately after the loading periods skin surface temperature, stratum corneum hydration, transepidermal water loss and erythema were measured at the sacral and heel skin. Results Prolonged loading caused increases of skin surface temperature and erythema at the sacral and heel skin. Stratum corneum hydration remained stable. Transepidermal water loss increased substantially after loading at the heel but not at the sacral skin. Conclusions Skin functions change during prolonged loading at the sacral and heel skin in aged individuals. Accumulation of heat and hyperaemia seem to be primarily responsible for increasing skin temperature and erythema which are associated with pressure ulcer development. Increased transepidermal water loss at the heels indicate subclinical damages of the stratum corneum at the heel but not at the sacral skin during loading indicating distinct pathways of pressure ulcer development at both skin areas.

Background The non-contact optical methods phaseshift rapid in vivo measurement of skin (PRIMOS) and surface evaluation of living skin (SELS) are widely applied for measuring skin surface topography. The aims of the present study were to evaluate reliability and validity of these methods and to compare skin roughness intraindividually. Methods SELS and PRIMOS measurements were performed on four skin areas of the left and right volar forearms in 12 healthy elderly subjects. Reliability and correlations were analyzed for Visioscan® and PRIMOS roughness parameters. Student's t-tests for estimating differences between contralateral volar forearm sites were applied. Results ICC coefficients of the Visioscan® roughness estimates ranged between 0.50 and 0.95 and of the PRIMOS measurements between 0.01 and 1.00. The Visioscan® parameters SEr, SEsm, Rmax, and Rz, and the PRIMOS parameters Ra, Rz, Smax, Wt, and Sz showed most significant correlations with each other and to additional roughness parameters. Mean roughness differences between contralateral forearm skin areas ranged between 0.0 (SEsc) and 6.7 (Rmax). Conclusions The Visioscan® parameters SEr, Rmax, and Rz showed most reliable and valid values and were largely comparable on contralateral forearm skin sites in elderly subjects. Rmax, Rz, and Ra should be preferred for measuring skin surface topography with PRIMOS.

Measurements of complement split products by enzyme-linked immunosorbent assays (ELISA) are well established for the assessment of in vivo complement activation. We have combined two monoclonal antibodies (mAb) with specificities for C3b/iC3b/C3dg (mAb I3/15) and C4/C4b/C4d (mAb M4d2), respectively, in a sandwich ELISA to quantitate C4-C3 complexes as an indicator of complement activation. Serum incubated with heat aggregated IgG (HAG) was used as a standard and the C4-C3 levels expressed as microgram equivalent HAG/ml (microgram HAG-equ/ml). Normal values of C4-C3 complexes in plasma (EDTA) of healthy probands (n = 11) were 6.3 micrograms HAG-equ/ml +/- 1.5 (mean +/- 1 standard deviation (SD), with a range from 3.6 to 9.1). In patients with systemic lupus erythematosus (SLE, n = 23) C4-C3 values were clearly elevated (48.8 micrograms HAG-equ/ml +/- 52.9, range 7.5-184.7) as compared to samples from patients with idiopathic hypertension (IDH, n = 10) (6.5 micrograms HAG-equ/ml +/- 1.7, range 4.1-9.4). For SLE patients C4-C3 levels significantly correlated with values for C3b/iC3b/C3d (r = 0.69, p0.001) and C3 containing immune complexes (r = 0.68, p0.001), but not with the C4d fragment (r = 0.26). C4-C3 levels of 96% of the studied SLE patients were increased more than 2 SD above the normal mean as compared to 74% of C4d and activated C3 values, respectively. Serum treated with zymosan as an activator of the alternative pathway of complement did not exhibit higher C4-C3 values. These results demonstrate that the quantitation of in vivo generated C4-C3 complexes by ELISA provide a novel, sensitive parameter for classical pathway of complement activation.

Photoaging is associated with increasing pigmentary heterogeneity and darkening of skin color. However, little is known about age-related changes in skin pigmentation on sun-protected areas. The aim of this explorative study was to measure skin color and dyspigmentation using image processing and to evaluate the reliability of these parameters. Twenty-four volunteers of three age-groups were included in this explorative study. Measurements were conducted at sun-exposed and sun-protected areas. Overall skin-color estimates were similar among age groups. The hyper- and hypopigmentation indices differed significantly by age groups and their correlations with age ranged between 0.61 and 0.74. Dorsal forearm skin differed from the other investigational areas (p