Senile Lentigo Research Articles

Beneficial Effect of Low Fluence 1,064 nm Q-Switched Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Senile Lentigo.

BackgroundLow fluence 1,064 nm Q-switched (QS) Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser treatment, also known as laser toning, is widely used for pigmentary disorders. There has been no reliable evaluation of the effect of low fluence 1,064 nm QS Nd:YAG laser for senile lentigo.ObjectiveTo investigate the beneficial effect of low fluence 1,064 nm QS Nd:YAG laser in the treatment of senile lentigo on the face.MethodsA retrospective review was conducted on patients treated only with repetitive low fluence 1,064 nm QS Nd:YAG laser. Among them, 12 patients with multiple senile lentigines before treatment were included. All side effects were recorded to assess the safety of the modality.ResultsMean age was 56.1±7.8 years old and male-to-female ratio was 1:11. Mean treatment fluence was 1.62±0.16 J/cm2 and mean total treatment session was 8.8±2.6. Mean interval period between each session was 28.0±11.4 days and mean treatment session to reach marked and near total improvement was 8.7±2.8. At the final visit, seven of 12 (58.3%) patients reached marked and near total improvement, and three of 12 (25.0%) reached moderate improvement. No side effects occurred.ConclusionRepetitive low fluence 1,064 nm QS Nd:YAG laser treatment may be an effective and safe optional modality for senile lentigo.

Exposure to fine particulate matter associated with senile lentigo in Chinese women: a cross-sectional study.

BackgroundSkin ageing especially senile lentigo directly affects self‐esteem. For decades, senile lentigo has been associated with chronic exposure to solar radiation. However, a study conducted recently in Caucasian subjects suggested that exposure to air pollution was significantly correlated with extrinsic skin ageing, in particular senile lentigines.ObjectiveTo investigate the association between fine particulate matter (PM 2.5) and skin ageing, particularly senile lentigo and seborrheic keratosis.MethodsThe study enrolled 400 Chinese women aged 40–90 years including 210 from the Yanqing county in Beijing (low PM 2.5 exposure group) and 190 from the Xuanwumen in Beijing (high PM 2.5 exposure group). Skin ageing symptoms, particularly senile lentigines and seborrheic keratoses, were clinically assessed using scores of intrinsic and extrinsic skin ageing. An ordinal logistic regression model was used to analyse the effect of PM 2.5 on skin ageing adjusted for factors underlying skin ageing.ResultsIn the study population of Xuanwumen, we found that senile lentigo on cheeks and back of hands was 1.48 times and 2.8 times higher, respectively, compared with those from Yanqing county. However, no association was found between PM 2.5 and seborrheic keratosis. We found that other variables such as smoking, second‐hand smoking, contact with fossil fuels and skin types were significantly associated with skin ageing.ConclusionThese results indicate that PM 2.5 was another extrinsic factor promoting skin ageing.

Clinical study of a retinoic acid-loaded microneedle patch for seborrheic keratosis or senile lentigo

AimsPigmented lesions such as of seborrheic keratosis and senile lentigo, which are commonly seen on skin of people>50years of age, are considered unattractive and disfiguring because of their negative psychological impact. Drug therapy using all-trans retinoic acid (ATRA) is an attractive option for self-treatment at home. We have developed an ATRA-loaded microneedle patch (ATRA-MN) and confirmed the pharmacological effects of ATRA-MN application in mice. Here, we describe a clinical study to evaluate the safety and efficacy of ATRA-MN in subjects with seborrheic keratosis or senile lentigo. Main methodsATRA-MN was applied to the lesion site of each subject for 6h once per week for 4weeks. The skin irritation reaction was scored to assess adverse reactions and blood tests were performed to evaluate the presence of systemic adverse reactions. To assess the treatment effect using ATRA-MN, the desquamation and whitening ability of the investigational skin was observed. Key findingsDesquamation of the stratum corneum was observed following four ATRA-MN applications at 1-week intervals, but ATRA-MN applications did not induce severe local or systemic adverse effects. SignificanceThese results showed that ATRA-MN treatment is promising as a safe and effective therapy for seborrheic keratosis and senile lentigo.

Application of Cell Extracts from Skin, Placenta, Mesenchyme with Collagen and Elastin in Aesthetic Dermatology and Skin Revitalization: Evaluation of Outcomes in Cohort Study

Aging–related changes of the skin are characterized by reduction of the elasticity, moistness and thickness, appearance of wrinkles, pigmented spots, lentigos, and keratosis. Histological changes include thinning of epidermis, flattening of epidermal-dermal interface, reduction of production and disorganization of collagen and elastin, slowdown of cell turnover, reduction of melanocytes and their erratic activity and the phenomenon of solar elastosis. The objectives of the study were to evaluate the efficacy of mesotherapy with a cocktail containing combination of cell extracts from skin, placenta and mesenchyme with addition of collagen and elastin proteins in rejuvenation and revitalization of the facial skin. The cohort comprised of 26 women in the age 40-65 y.o. (mean age 56 ± 2.5) with Fitzpatrick skin types III and IV and Glogau score II-III. Treatment consisted of mesotherapy applied on the forehead, cheeks, periorbital and perioral areas, chin and neck. The injected formulation was MF+ Mito Organelles™ SPMCE – peptide-extracts from skin, placenta, mesenchyme, with collagen and elastin. Treatment sessions were performed across 12 weeks at weekly intervals. Final results were assessed 1 and 3 months after the last mesotherapy session using photographic comparison and patient’s subjective view and external dermatologist-expert’s opinion, clinical and instrumental evaluation, and histopathology report. Clinical and histochemical data obtained from the study confirms the anti-aging properties of the used product. Analysis of dermal elastic filaments has proven the reduction of skins roughness and determined the bio-revitalizing and rejuvenating effect of the used product. Study has demonstrated MF+ MO™ SPMCE capacity to promote biosynthesis of new collagen and elastic fibers. The improvements in skin hydration and dramatic reduction of senile lentigo and uneven pigmentation were noted. Obtained data allow to conclude that application of MF+ MO™ SPMCE cellular extracts/peptides in mesotherapy can be considered as safe and effective method of facial rejuvenation.

Efficacy and safety of a topical carbon suspension photoenhancer adjunctive to intense pulsed light treatment for pigmented lesions in Japanese patients: A pilot study.

Pigmented lesions, e.g., senile lentigo and seborrheic keratosis are commonly seen in photodamaged skin in the Japanese general population. The use of the laser to treat such lesions is often painful, and intense pulsed light (IPL) systems have become widely used. Clearly demarcated pigmented lesions may be identified easily and treated with IPL. Less well demarcated lesions, however, which are very difficult to identify or thick melanogesic lesions like seborrheic keratosis represent one of the most challenging conditions to be treated using IPL. This pilot study evaluated carbon suspension-assisted IPL treatment of such lesions. Three female Japanese patients, Fitzpatrick skin type III-IV, comprised the subjects, aged 58, 78 and 85, with indistinct senile lentigines or thick seborrheic keratoses. The lesions were painted or demarcated with a carbon-based ink from a commercially-available Japanese writing instrument (Fude-pen™, Pentel, Japan) consisting of a brush-like pen nib with a refillable or replaceable ink reservoir, and then treated with a broadband (560 - 1200 nm) IPL system. The poorly-demarcated lesions were quickly and easily marked with the pen, and the IPL treatments were well-tolerated. All patients had good improvement in their painted pigmented lesions based on the overall evaluation, compared with unpainted ones. Side effects after treatment, such as hyperpigmentation, persistent erythema, and scarring, were minimal. Topical carbon suspension-assisted IPL treatment could be a good option for patients with indistinct pigmented or thick melanogenesic lesions. Adverse reactions to this treatment were minimal and the results acceptable, though appropriate lesions need to be chosen carefully.

Identification and Management of Malignant Skin Lesions Among Older Adults

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

The Effect of Mesobotox Together with Intense Pulsed Light on Facial Wrinkles and Erythema

Facial ageing is a gradual process which could be due to intrinsic and extrinsic causes, it ultimately results in the appearance of gravity-induced tissue ptosis, wrinkles, epidermal and dermal atrophy, dryness, senile lentigo, flushing, telangiectasia, and enlarged pores. Mesobotox treatment is a technique of microinjections of diluted Botulinum toxin type A (BTX) to preserve the facial mobility in order to preserve the natural beauty. BTX treatment enhances the aesthetic improvements attained with IPL. Ten patients of age ranging between 40 - 60 years old ( mean 45±10.3 years) with skin type ranging between (III - V) were treated using BTX and Intense Pulsed Light (IPL) using cutoff filter 550 nm with a fluence of 25 J/cm2 together as a combination therapy. All patients received standard IPL treatment and were assigned to receive eight 0.1 mL intradermal injections of BTX in each cheek (8 U total dose). Vertical lines within the forehead also received five 0.1 mL intradermal injections of BTX. Small wrinkles and fine lines, erythema, apparent pore size, skin texture, and overall appearance were evaluated after one week. A significantly higher proportion of patients showed improvement in small wrinkles and erythema with IPL plus BTX compared with the baseline demonstrated by computerized image analysis. In conclusion, A combined therapy of mesobotx and IPL is an effective and safe treatment for fine wrinkles, telangiectasia, flushing.

Hypopigmenting Activity of Bisabolangelone Isolated fromAngelica koreanaMaxim. inα-Melanocyte Stimulating Hormone-Activated B16 or Melan-a Cells

Tyrosinase is a key enzyme in the biosynthetic pathway of melanin pigments. Abnormal accumulation of melanin pigments causes melasma, freckles, and senile lentigo, which can be substantially ameliorated by treatment with arbutin or other tyrosinase inhibitors. In this study, roots of Angelica koreana Maxim. (Umbelliferae) inhibited melanin production in α-melanocyte stimulating hormone ( α-MSH)-activated B16 melanoma cells or melan-a melanocytes. To elucidate the hypopigmenting principle of A. koreana, the plant extracts were subjected to bioassay-guided phytochemical analysis, resulting in the identification of bisabolangelone. Bisabolangelone dose-dependently inhibited α-MSH-induced melanin production in B16 or melan-a cells with IC(15) values of 9-17 µM. The positive control arbutin also inhibited melanin production in B16 cells with an IC(50) value of 317 µM. Bisabolangelone suppressed α-MSH-inducible protein levels of tyrosinase in B16 cells but could not significantly inhibit the catalytic activity of cell-free tyrosinase. Taken together, this study indicates that bisabolangelone is the primary hypopigmenting principle of A. koreana and may have pharmacological potential in the melanin-associated hyperpigmentation disorders.

Extracts from Amazonian plants have inhibitory activity against tyrosinase: an in vitro evaluation

Dermatological disorders related to pigmentation result in tenuous hyper or hypopigmentation Cosmetic and pharmaceutical products containing depigmenting substances are used in the treatment of patients who have high pigmentation disorders, such as melasma or chloasma, post-inflammatory hyperpigmentation, senile lentigo and ephelides. Skin lightening agents are not yet totally effective or safe and therefore intensive research for the discovery of new agents is continuous. Enzyme inhibitors involved in melanogenesis, such as tyrosinase, have been discovered in Asian countries, including those isolated from plant extracts. The Brazilian flora has the highest species diversity in the world, and the chemical, pharmacological and cosmetic potential for the discovery of new skin whitening agents is in proportion with this biodiversity. For these reasons, 25 aqueous and 24 organic extracts obtained from 19 plants native to the Amazon rain forest and to the Atlantic forest, belonging to 11 different families, were evaluated as tyrosinase inhibitors. Nine out of 49 extracts showed inhibitory activity in the screening process. The 50% inhibitory activity (IA50) was calculated, revealing that the most active extracts were the organic extracts from the leaves and stem of Ruprechtia sp. (IA50 33.76 mg.mL-1) and the organic extract from the aerial organs of Rapanea parviflora (IA50 64.19 mg.mL-1).

Treatment of 153 Japanese patients with Q-switched alexandrite laser

We have recently used Q-switched alexandrite laser for the treatment of various kinds of pigmented skin lesions. We retrospectively compared therapeutic outcomes of 153 Japanese patients who consulted our department. This approach was not very efficient for nevus spilus/café-au-lait spots, which seemed laser-resistant, especially when the pigmentation had appeared after 1 year of age, was treated after 5 years of age, was located on the face, was oval with a smooth border, and the patient was male. This approach was equally effective for senile lentigo, nevus of Ota, and Mongolian spots, but less effective for acquired bilateral nevus of Ota-like macules. Some patients with sacral Mongolian spots or those with light-colored, senile lentigo developed severe post-inflammatory hyperpigmentation after treatment. As a whole, good therapeutic outcome was achieved after multiple treatment sessions. However, the use of other lasers or other treatment modalities should be considered to treat nevus spilus/café-au-lait spots.

Interaction between stem cell factor and endothelin-1: effects on melanogenesis in human skin xenografts

The two paracrine melanogenic cytokines, stem cell factor (SCF) and endothelin-1 (ET-1), have been demonstrated to play pivotal roles in skin pigmentation including UVB-induced pigmentation and senile lentigo. However, little is known regarding their interactive effect on skin pigmentation. In order to investigate their roles in vivo, facultative pigmentation of human skin xenografts on severe combined immunodeficient (SCID) mice was assessed. After 1 week of acclimation in a pathogen-free barrier, dermatomed fresh cadaveric skin was surgically grafted onto the back of the mice and allowed to heal for 5–6 weeks prior to cytokine administration. Intradermal injections of SCF at 0.7 or 2.0 μg significantly increased skin pigmentation when compared to vehicle control. Despite the lack of a dose-dependent pigmentation response following ET-1 administration, the combination of 0.2 μg SCF and 0.1 μg ET-1 demonstrated a statistically significant increase in tyrosinase gene expression substantiated by the enhancement of melanin content and skin pigmentation compared to treatment with SCF alone or ET-1 alone. These findings establish an in vivo interaction between SCF and ET-1 with regard to their capacity to effect an increase in skin pigmentation.

Skin Ultrastructure in Senile Lentigo

Senile lentigo is a common component of photoaged skin. It is characterized by hyperpigmented macules which affect chronically irradiated skin mostly after the age of 50. This study was undertaken to assess the morphology of senile lentigo on the dorsum of the hands. A systematic comparison between lesional and perilesional skin using histology and transmission electron microscopy was done to determine whether melanocytes or keratinocytes are affected in the evolution of lesions and which tissue structure is modified. The histology study showed that lesional skin is characterized by a hyperpigmented basal layer and an elongation of the rete ridges, which seem to drive deeply into the dermis. The epidermis contained clusters of keratinocytes, which retained and accumulated the melanin pigment. Electron microscopy studies showed important modifications in the lesional skin ultrastructure in comparison with perilesional skin. In melanocytes from perilesional and lesional skin, we observed normal size melanosomes at all stages of maturation in the cytoplasm and in migration within dendrites. No pigment accumulation was observed. However, the morphology of melanocytes in lesional skin revealed an activated status with numerous mitochondria and a well-developed endoplasmic reticulum, which could reflect intense protein synthesis. In basal keratinocytes from lesional skin, we observed numerous melanosome complexes called polymelanosomes, which formed massive caps on the nuclei. Observations in colored semi-thin sections also revealed perturbed structures in the basal layer region, which could explain the skin perturbation. Indeed, we observed keratinocytes that presented important microinvaginations and pendulum melanocytes, which sank into the dermis, beneath the basal layer of keratinocytes. These cell modifications seemed to be due to a perturbation of the dermal-epidermal junction, which appeared disorganized and disrupted and could directly disturb the basal support of the cells.

Alterations in the epidermal-dermal melanin axis and factor XIIIa melanophages in senile lentigo and ageing skin

Senile lentigo (SL) is a pigmentation disorder that occurs predominantly on the dorsa of the hands, the forearms and the face; its incidence increases with age. Histological hallmarks of SL lesions are hyperpigmentation of the epidermis and elongation of the epidermal rete ridges. Various factors such as alpha-melanocyte-stimulating hormone, endothelin-1 or stem cell factor are involved in the onset and maintenance of the increased pigmentation. Alterations of the dermal compartment have not yet been analysed in detail in SL. To study the occurrence and distribution of melanin in the dermis from SL and aged skin, biopsies from 12 subjects were morphologically analysed by light and electron microscopy in comparison with unaffected skin. Punch biopsies of SL and adjacent skin from 12 male or female volunteers aged 52-81 years were prepared for light and electron microscopy and samples were analysed by morphological, morphometric, histochemical and immunohistochemical methods. The epidermis from SL revealed morphological features such as hyperpigmentation of basal keratinocytes and the formation of elongated rete ridges. S100+ melanocytes in the stratum basale were not markedly increased, indicating that the hyperpigmentation is predominantly due to changes in melanin synthesis, distribution or turnover. Quantification of epidermal cells expressing the proliferation marker Ki67 did not show an increase of this parameter in SL, indicating that at least in the established lesion cell proliferation is not enhanced. We further focused on the dermal compartment and observed granulated cells which were more abundant in SL. Electron microscopic and histochemical analysis revealed that the granulation of these cells is based on melanosomes, mostly present in large melanosomal complexes. Immunohistochemistry using antibodies to CD68 and factor XIIIa (FXIIIa) showed these melanophages to be predominantly FXIIIa+ dermal dendrocytes, which were about six times more abundant than CD68+ macrophages. In SL an increased number of melanophages was found compared with unaffected skin from the same subject. These melanophages were identified as FXIIIa+ dermal dendrocytes. Possible functional consequences of the massive melanin uptake by dermal dendrocytes are discussed.

Epidermal dermal junction and spots in human skin

Epidermal dermal junction and spots in human skin

Pigments in aging: an overview.

Although during the normal aging process there are numerous pigmentary changes, the best recognized are those of melanin and lipofuscin. Melanin may increase (e.g., age spots, senile lentigo, or melanosis coli) or decrease (e.g., graying of hair or ocular melanin) with age, while lipofuscin (also called age pigment) always increases with age. In fact, the time-dependent accumulation of lipofuscin in lysosomes of postmitotic cells and some stable cells is the most consistent and phylogenetically constant morphologic change of aging. This pigment displays a typical autofluorescence (Ex: approximately 440; Em: approximately 600 nm), sudanophilia, argyrophilia, PAS positiveness, and acid fastness. Advances on its biogenesis, composition, evolution, and lysosomal degradation have been hampered by the persistent confusion between lipofuscin and the large family of ceroid pigments found in a variety of pathological conditions, as evidenced by the frequent use of the hybrid term lipofuscin/ceroid by investigators mainly working with in vitro systems of disputable relevance to in vivo lipofuscinogenesis. While lipofuscin and ceroid pigments may share some of their physicochemical properties at one moment or another in their evolutions, these pigments have different tissue distribution, rates of accumulation, origin of their precursors, and lectin binding affinities. Although it is widely believed that lipofuscin is a marker of oxidative stress, and that it can be, therefore, modified by antioxidants and prooxidants, these assumptions are mainly based on in vitro experiments and are not generally supported by in vivo studies. Another common misconception is the belief that lipofuscin can be extracted from tissues by lipid solvents and measured spectrofluorometrically. These and other disturbing problems are reviewed and discussed in this presentation.

Use of Er:YAG laser for benign skin disorders.

The Er:YAG laser is of special interest in dermatology and cosmetic surgery since it ablates and cuts tissue with surgical precision with minimal collateral thermal damage due to the wavelength of the Er:YAG radiation (2,940 nm), which is strongly absorbed by liquid water in tissue. The study was designed to establish optimal laser parameters for treating various skin disorders. Sixty-four patients were treated for benign skin disorders: seborrhoic warts, plane warts, milia, xanthelasma palpebrarum, hidradenoma, chloasma, senile lentigo, epidermal naevi, actinic keratosis, fibroepithelial papillomata, scars. The lesions were irradiated with single pulse laser energies 100-1,000 mJ, repetition rates 2-10 Hz, and spot diameters 2-8 mm. Epidermis was effectively removed on a layer-by-layer basis. For the ablation, energy densities higher than 2.5 J/cm2 were required. If bleeding appeared, the hemostatic effect was achieved by irradiating the bleeding surface with few Er:YAG laser pulses of lower power density (0.5-1.5 J/cm2). Healing was excellent and without apparent scarring. It was established that Er:YAG laser with properly selected parameters offers a tool for tissue ablation and/or coagulation. The Er:YAG laser was found to be a perfect option for effective treatment of benign skin disorders.

Chemical peeling: How, when, why?

AbstractGeneral description Chemical peeling is a procedure frequently used lo treat unaesthetic cutaneous alterations such as photoageing, actinic keratosis, chloasma, senile lentigo, and post‐acneic scars as well those of a non‐strictly aesthetic nature such as seborrhoeic keratosis and flat warts. Several chemical agents are used depending on the depth of peeling to be obtained. The most commonly used agents are: alpha‐hydroxy‐acids, resorcinol, Jessner's solution, and trichloroacetic acid. In the present study the characteristics of the individual substances, technical procedure, and applications are taken into consideration. Finally, the main risks and side‐effects, depending on the depth of peeling, are considered.Learning objective The reader will have learned what a chemical peeling is, what chemical agents are available, and how to perform chemical peeling in the office. The mechanism of action of different chemical agents, expectations from this procedure, potential risks and complications are also reviewed with insight into criteria for selecting patients.

Chemical peeling: How, when, why?

General description Chemical peeling is a procedure frequently used to treat unaesthetic cutaneous alterations such as photoageing, actinic keratosis, chloasma, senile lentigo, and post-acneic scars as well those of a non-strictly aesthetic nature such as seborrhoeic keratosis and flat warts. Several chemical agents are used depending on the depth of peeling to be obtained. The most commonly used agents are: alpha-hydroxy-acids, resorcinol, Jessner's solution, and trichloroacetic acid. In the present study the characteristics of the individual substances, technical procedure, and applications are taken into consideration. Finally, the main risks and side-effects, depending on the depth of peeling, are considered.Learning objective The reader will have learned what a chemical peeling is, what chemical agents are available, and how to perform chemical peeling in the office. The mechanism of action of different chemical agents, expectations from this procedure, potential risks and complications are also reviewed with insight into criteria for selecting patients.

Immunopathological analysis of mucosal melanocyte distribution in the human lower lip of the elderly.

Mucosal melanocyte distribution in the human lower lip was analyzed immunopathologically using a wide selection of 195 surgical specimens. An age-related increase of mucosal melanocyte distribution was observed in the human lower lip by Fontana-Masson argentaffin stain and S-100 protein immunoreactivity. The mean number of mucosal melanocytes increased gradually with advancing age. A large number of them was found at or beyond the seventh decade of life in both sexes, which was statistically significant compared with those in all other decades (p < 0.01 or < 0.05). In addition, the sex difference in mucosal melanocyte density was statistically significant (p < 0.001) in each decade (men > women). These results suggest that physiological changes in mucosal melanocyte distribution are dependent upon aging and sex difference, and may play an important role in development of melanocytic lesions such as senile lentigo, pigmented nevi, and also intraepithelial malignant melanomas.

Multivariate analysis of cutaneous markers of aging in chronic hemodialyzed patients.

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. Our purpose was to determine the prevalence of several clinical parameters of cutaneous aging and their relationship with hemodialysis. One hundred fourteen patients on chronic hemodialysis were investigated for the presence of several cutaneous aging markers in a cross-sectional study, using multivariate analysis to minimize the confounding effect of age. 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. Multivariate analysis, controlling for age as a confounding variable, indicated that the degree of facial wrinkles and the decrease in stratum corneum hydration (capacitance) correlated significantly with the length of time on hemodialysis (P = 0.012 and P = 0.012, respectively). Favre-Racouchot disease (Odds Ratio [OR] = 1.23, P = 0.055, 95% confidence interval [CI] 0.99-1.52) and actinic keratoses (OR = 1.15, P = 0.076, CI 0.98-1.34) 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.