Abstracts
Aging Skin
Aging Skin
The majority of changes associated with "aging", such as wrinkles and solar lentigines (""liver" spots"), are due to photoaging and reflect cumulative sun exposure as well as "skin" pigmentation.
Classically, chronologic aging includes those cutaneous changes that occur in non-sun-exposed areas, such as the buttocks, and are observed in both men and women. The influence of androgens on "age"-related changes in keratinocyte and fibroblast function remains speculative.
Bolognia-JL: Aging skin. Am-J-Med. 1995 Jan 16; 98(1A): 99S-103S.
Diet
Diet
A dietary intervention trial has shown a significant reduction in occurrence of actinic keratosis and nonmelanoma skin cancer in skin cancer patients who adopt diets in which the percentage of calories from fat is markedly lowered.
Dietary intervention was effective in reducing the percentage of calories from fat to 21% by Month 4 and maintaining that level for the remainder of the two-year study. Practical dietary advice with respect to reduction of percentage of calories from fat, along with an increase in the intake of grains, fruits, and vegetables, could make an important contribution to the management and prevention of skin cancer.
Jaax S et al., General guidelines for a low-fat diet effective in the management and prevention of nonmelanoma skin cancer. Nutr Cancer, 1997, 27:2, 150-6.
Hemodialysis & Age Spots
Hemodialysis
Although hemodialysis has been associated with lesions of cutaneous aging, no controlled studies have been done in patients with chronic renal failure under periodic hemodialysis.
To determine the prevalence of several clinical parameters of cutaneous aging and their relationship with hemodialysis.
Skin cancer was diagnosed in 3 patients (2.6%), actinic keratoses in 12 (10.5%), senile lentigo in 22 (20%), senile purpura in 15 (13%), and Favre-Racouchot disease in 6 (5%).
There was no association with skin types or facial wrinkles with any other of the skin-aging features studied.
Facial wrinkles and the decrease in stratum corneum hydration (capacitance) correlated significantly with the length of time on hemodialysis.
Favre-Racouchot disease and actinic keratoses became increasingly frequent with the duration of chronic hemodialysis. These data show a high prevalence of cutaneous aging lesions in patients on chronic hemodialysis. Acceleration of cutaneous aging is associated with time on hemodialysis.
Tercedor J et al., Multivariate analysis of cutaneous markers of aging in chronic hemodialyzed patients. Int J Dermatol, 1995 Aug, 34:8, 546-50.
Liver Spots
Liver Spots
Solar lentigines ("liver spots") commonly occur on sun-damaged skin in the "elderly" population. Although they are benign, it is difficult in practice to distinguish solar lentigines and junctional nevi from melanoma in situ. Case report of a patient who developed melanoma on the same site as a previously diagnosed solar lentigo. Also review the histopathological criteria for differentiating benign "lesions" from potentially malignant ones.
Torres-JE: Melanoma in situ on facial skin damaged by sunlight. Am-J-Dermatopathol. 1994 Apr; 16(2): 171-4.
Melasma & Age Spots
Melasma
Melasma is a common disorder of cutaneous hyperpigmentation predominantly affecting the faces of women. Investigated topical "tretinoin" which is known to be of benefit in other forms of hyperpigmentation, for example liver spots.
Griffiths-CE et al: Topical tretinoin (retinoic acid) improves melasma. A vehicle-controlled, clinical trial. Br-J-Dermatol. 1993 Oct; 129(4): 415-21.
Midlife
Midlife
Intrinsic skin changes with advancing years include dryness, decreasing elasticity, increasing skin fragility, and more prominent vasculature.
Extrinsic skin aging, caused primarily by cigarette smoking and exposure to sunlight, includes mottled pigmentation and yellow discoloration, rough leathery textural changes, and wrinkling.
Major premalignant and malignant neoplasms in photodamaged skin are actinic keratosis, basal cell carcinoma, squamous cell carcinoma, and melanoma. Nonmalignant lesions include solar lentigines and seborrheic keratoses.
The A, B, C, D criteria can assist in the evaluation of pigmented nevi. Physicians play an important role in educating patients about the health risks associated with excessive sun exposure and about sun protection to prevent further skin damage.
Gordon ML & Hecker MS: Care of the skin at midlife: diagnosis of pigmented lesions. Geriatrics, 1997 Aug, 52:8, 56-8, 67-8; quiz 69.
The Older Woman
The Older Woman
The cutaneous signs of aging including wrinkles, solar lentigines ("liver spots"), and telangiectasias are primarily the result of repeated exposures to ultraviolet light (photoaging).
Chronologic aging, and in women, estrogen withdrawal also exert an effect on the structure and function of the epidermis and dermis. The relative roles of these three factors are discussed, as are the most common skin lesions found in the older woman. Lastly, the therapeutic options are outlined.
Bolognia-JL: Dermatologic and cosmetic concerns of the older woman. Clin-Geriatr-Med. 1993 Feb; 9(1): 209-29.
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