Skin Age Research Articles

Use and sources of medicines: a population-based study in Campinas, São Paulo State, Brazil

The use of medicines is influenced by different factors. This study aimed to analyze the use of medicines and identify the sources for obtaining them and associated factors, using a population-based cross-sectional design with two-stage cluster sampling in Campinas, São Paulo State, Brazil, in 2008. Prevalence of use of at least one drug in the 3 previous days was 57.2% and prevalence of obtaining the drug from the Brazilian Unified National Health System (SUS) was 30%. 47.8% of individuals with no health insurance had to pay out-of-pocket for their medication, and 10.9% of individuals with insurance nevertheless obtained their medication from the SUS. Use of medicines obtained from the SUS was associated with older age, widowhood, black or brown skin color, lower schooling and income, and lack of insurance. Only 2.1% reported not being able to obtain the prescribed medication, and the main reasons were lack of availability in the public system and lack of money for out-of-pocket purchases. The study identified the subgroups that obtained most of their medicines in the SUS and showed that these were the subgroups with the lowest use of medicines in the system.

Instrument-related Skin Disorders in Musicians.

Among artists, musicians may suffer from occupational skin problems; notwithstanding, these conditions have been rarely reviewed. The characteristics of individual performer and the type of instrument will determine the kind of disease. Moreover, the hours that the musician spent to advance artistic skill may influence the severity. The frequency and risk factors of instrument-related skin disorders in musicians from southern Italy were analyzed. An observational study was conducted in 628 musicians. A questionnaire including questions related to age, sex, instrument played, musical activity, previous or current skin disorders, and impact of skin symptoms on music making was submitted. Of 628 musicians, 199 (31.7%) reported suffering from at least 1 skin disease. Cutaneous diseases likely directly correlated with the use of the musical instrument were found in 129 (20.5%) of the 628 subjects. In particular, different patterns of irritant contact dermatitis were found. Skin conditions may be a significant problem in professional instrumentalists. They are mainly related to musical activity. Preventive measures should be established.

Use of the Brazilian People's Pharmacy Program by older adults.

ABSTRACTOBJECTIVE To assess the prevalence and factors associated with the use of the expanded Brazilian People’s Pharmacy Program among older adults and the reasons for not using it.METHODS In this population-based cross-sectional study conducted in the urban area of Pelotas, RS, Southern Brazil, we evaluated 1,305 older adults (aged 60 years or over) who had used medication in the last 15 days. Independent variables were socioeconomic factors, economic status, household income in minimum wages, educational attainment in years of schooling and occupational status. Demographic variables were sex, age, marital status, and self-reported skin color/race. Poisson regression was employed to analyze the factors associated with the use of the program.RESULTS The prevalence of use was 57.0% whilst the prevalence of knowledge of the program was 87.0%. In individuals aged 80 years or over, use of the program was 41.0%. As to the origin of the prescriptions used by older adults, 46.0% were from the Brazilian Unified Health System. The main reasons for not using the program were: difficulty in getting prescriptions, medication shortage, and ignorance about the medications offered and about the program. Higher age, lower income, presence of chronic diseases, and use of four or more medications were associated with use of the program.CONCLUSIONS It is necessary to expand the knowledge and use of the Brazilian People’s Pharmacy Program, especially among older adults, and to improve the dissemination of its list of medications to users and physicians. Thus it will be possible to reduce spending on long-term medications, which are especially important for this population.

A Comparative Study on Skin and Plasma Advanced Glycation End Products and Their Associations with Arterial Stiffness

Background: We compared skin and plasma measurements of advanced glycation end products (AGEs), with particular focus on their levels in the presence of hypertension or diabetes and prediabetes and their associations with arterial stiffness in outpatients with suspected or diagnosed hypertension. Methods: Skin AGE accumulation was measured as autofluorescence on the left forearm using the skin autofluorescence Reader and expressed in arbitrary units in the range from 0 to 25. Plasma AGE concentration was measured by the enzyme-linked immunosorbent assay method and logarithmically transformed for statistical analysis. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV) using the SphygmoCor system (Sydney, Australia). Results: The 218 participants (96 [44.0%] men, mean age 51.9 years) had a mean skin autofluorescence of 1.89 arbitrary units, plasma AGE concentration of 4.47 μg/ml, and cfPWV of 8.0 m/s. Skin autofluorescence was significantly correlated with plasma AGEs in diabetic or prediabetic patients (n = 31, r = 0.37, p = 0.04) but not in subjects with normoglycemia (n = 187, r = -0.05, p = 0.48). Nonetheless, both measurements were significantly (p ≤ 0.001) higher in men (2.00 arbitrary units and 6.73 μg/ml, respectively) than women (1.81 arbitrary units and 3.60 μg/ml, respectively) and in diabetic or prediabetic (2.03 arbitrary units and 6.61 μg/ml, respectively) than normoglycemia subjects (1.87 arbitrary units and 4.17 μg/ml, respectively), but similar in hypertensive (n = 105) and normotensive subjects (n = 113, p ≥ 0.35). In adjusted multiple regression analyses, plasma AGE concentration, but not skin autofluorescence (p ≥ 0.37), was significantly associated with cfPWV in all subjects (β 0.44 m/s for each 10-fold increase; p = 0.04) and in subgroups of men and diabetes and prediabetes (β 0.12-0.55 m/s for each 10-fold increase; p ≤ 0.02). Conclusions: Although skin and plasma AGEs were similarly associated with gender and diabetes or prediabetes, they might measure something different and have different clinical relevance, such as for arterial stiffness.

Advanced Glycation End Products Evolution after Pancreas-Kidney Transplantation: Plasmatic and Cutaneous Assessments.

Diabetes mellitus leads to increased Advanced Glycation End Products (AGE) production, which has been associated with secondary diabetic complications. Type 1 diabetic patients undergoing pancreas-kidney transplantation (SPKT) can restore normoglycemia and renal function, eventually decreasing AGE accumulation. We aimed to prospectively study AGE evolution after SPKT. Circulating AGE were assessed in 20 patients, at time 0 (T0), 3 months (T3), 6 months (T6), and 12 months (T12) after successful SPKT. Global AGE and carboxymethyllysine (CML) were analyzed, as well as advanced oxidation protein products (AOPP). Skin biopsies were obtained at T0 and T12. Immunohistochemistry with anti-AGE antibody evaluated skin AGE deposition. AGE mean values were 16.8 ± 6.4 μg/mL at T0; 17.1 ± 3.8 μg/mL at T3; 17.5 ± 5.6 μg/mL at T6; and 16.0 ± 5.2 μg/mL at T12. CML mean values were 0.94 ± 0.36 ng/mL at T0; 1.11 ± 0.48 ng/mL at T3; 0.99 ± 0.42 ng/mL at T6; and 0.78 ± 0.38 ng/mL at T12. AOPP mean values were 130.1 ± 76.8 μMol/L at T0; 137.3 ± 110.6 μMol/L at T3; 116.4 ± 51.2 μMol/L at T6; and 106.4 ± 57.9 μMol/L at T12. CML variation was significant (P = 0.022); AOPP variation was nearly significant (P = 0.076). Skin biopsies evolved mostly from a cytoplasmic diffuse to a peripheral interkeratinocytic immunoreaction pattern; in 7 cases, a reduction in AGE immunoreaction intensity was evident at T12. In conclusion, glycoxidation markers decrease, plasmatic and on tissues, may start early after SPKT. Studies with prolonged follow-up may confirm these data.

한국 여성의 피부 부위 및 연령에 따른 피부 측정 인자와 생물 인자 연구

The skin is one of the largest organs in our body and participates in many of the human organism`s physiological and pathological events. Skin function were known for self-maintenance and self-repair, mechanical and chemical stress protection, protection against UV and environmental pathogenic micro-organisms, production of vitamin D, and social and psychological function through the physical aspect. The aim of this study was to evaluate the variation of biophysical parameters and to find relation with skin biomarkers in different anatomical site and age in Korean women. About 70 healthy volunteers in age range 20 to 49 were participated in this test. Test areas were the forearms and the cheek. Investigation to determine biophysical parameters on human skin, was carried out using various non-invasive methods. For analysis to skin biomarkers, we studied to examine various biomarkers for the quantitative determination of cortisol, fibronectin, keratin-1, 10, and 11, involucrin, and keratin-6 in human face and forearm. And we measured to skin biophysical parameters for skin anatomical site and age difference with non-invasive methods. As results of measuring site, some parameters were have following significant difference, stratum corneum hydration, trans epidermal water loss and skin color (L and a value). As results of age difference, skin colors were had only significant difference with age. For cortisol, keratin-6, fibronectin, keratin-1, 10, 11 contents, there were no significant difference in age and site. However, involucrin level in the cheeks were the highest for age group 30 ~ 39 compared to other age groups. These results suggest that in individual skin condition may explain detailed skin state variation.

Genetic vs Environmental Factors That Correlate With Rosacea: A Cohort-Based Survey of Twins.

To our knowledge, this is the first study on rosacea to formally define genetic and environmental contributions. To study a cohort of identical and fraternal twins to determine whether genetic factors contribute to rosacea development and, if genetic factors are present, quantitatively estimate the genetic contribution, as well as to identify environmental factors that correlate with rosacea by controlling for genetic susceptibility. Identical and fraternal twins were surveyed regarding risk factors implicated in rosacea. Faculty dermatologists determined a rosacea score for each twin participant according to the National Rosacea Society (NRS) grading system. Data were collected at the annual Twins Days Festival in Twinsburg, Ohio, on August 4-5, 2012, and August 2-3, 2013. Analysis was conducted for several months after each meeting. A cohort of 550 twin individuals, with most from Ohio, Pennsylvania, and the northeastern United States, participated. The NRS score and rosacea subtype were assessed using the NRS grading system and physical examination by board-certified dermatologists. Among the 275 twin pairs (550 individuals), there were 233 identical twin pairs with a mean rosacea score of 2.46 and 42 fraternal twin pairs with a mean rosacea score of 0.75. We observed a higher association of NRS scores between identical vs fraternal twins (r = 0.69 vs r = 0.46; P = .04), demonstrating a genetic contribution. Using the ACE model (proportion of variance in a trait heritable secondary to additive genetics [A] vs the proportions due to a common environment [C] and unique environment [E]), we calculated this genetic contribution to be 46%. A higher NRS score was also significantly associated with the following factors: age (r = 0.38; P < .001) and lifetime UV radiation exposure (r = 0.26; P < .001). These associations remained after use of propensity score matching to adjust for multicollinearity. Other correlated variables included body mass index (r = 0.21; P < .001), smoking (r = 0.10; P < .02), alcohol consumption (r = 0.11; P = .01), cardiovascular comorbidity (r = 0.17; P < .001), and skin cancer comorbidity (r = 0.19; P < .001). The study of twins allows us to separate genetic susceptibility and the influence of environmental factors affecting rosacea. We found that approximately half of the contribution to the NRS score could be accounted for by genetics and the other half by environment. We identified correlations between rosacea and UV radiation exposure, alcohol, smoking, skin cancer history, cardiac comorbidity, and age. These findings may help improve current management and expectations of individuals affected by rosacea.

Body mass index, chronological age and hormonal status are better predictors of biological skin age than arm skin autofluorescence in healthy women who have never smoked.

As life expectancy is increasing and healthy ageing becomes more and more important, skin ageing is a growing topic of interest from both a medical and a commercial point of view. The urgency to unravel the causes of skin ageing is rising. However, there is a lack of objective, simple, noninvasive methods to assess biological skin age - a term introduced to describe how old someone looks, covering both the appearance and function of the skin. A rapid, noninvasive assessment of biological skin age would greatly facilitate the execution of the studies required to find the causes of skin ageing. To find an objective, easy-to-apply method to assess biological skin age. Skin age score (SAS) was compared with skin autofluorescence, a measure of advanced glycation end products in the skin, and several subject characteristics in 32 healthy, white women with little sun-exposed skin and no history of smoking. A moderate, positive correlation (R(2) = 0·32, P = 0·001) between SAS and skin autofluorescence-based biological skin age was found. However, the variation in biological skin age according to SAS could be explained better by body mass index, chronological age and hormonal status (R(2) = 0·86, P < 0·001). In the current setting skin autofluorescence did not contribute better to the prediction of biological skin age than chronological age. Biological skin age was best predicted by body mass index, chronological age and hormonal status, and this approach provides a considerable simplification of the application of biological skin age.

A Single Center's Experience with Donation of Facial Allografts for Transplantation

Face transplantation offers superior functional and aesthetic outcomes when compared with conventional reconstruction. Optimizing criteria to match donors and recipients will improve outcomes. However, there is limited available literature regarding donor procurement and matching. The Brigham and Women's Hospital describes its experience with facial allograft donation for 7 face transplants performed between 2009 and 2014. Important considerations include donors' type of death, allograft ischemia time, demographics, immunologic compatibility, serology, and donor facial restoration. Brain-dead, heart-beating donors were preferred because their hemodynamic stability facilitated procurement logistics. The maximum allograft ischemia time allowed by our team was 4 hours. Donor and recipient should be matched in appearance by having the same gender, similar age, and comparable skin tone/texture. Immunologic compatibility requires ABO compatibility, suitable HLA typing, and negative crossmatch. Donor serology for infectious diseases, especially cytomegalovirus (CMV) and Epstein-Barr virus (EBV), is important because of implications of post-transplant immunosuppression. High-risk CMV and EBV matches (donor-positive/recipient-negative) should be avoided when possible. Facial restoration with a prosthetic mask was performed to preserve the donor's dignity. Although every face transplant recipient has unique needs, we hope this report will help identify important donor characteristics that can be incorporated in a national donor registry.

Skin autofluorescence: a risk marker for chronic kidney disease

Advanced glycation end product (AGE) accumulation results from hyperglycaemia, oxidative stress, diet and reduced renal excretion. Skin autofluorescence (SAF) is closely correlated with skin AGE levels and the measurement of SAF has been identified as a non-invasive, simple marker of AGE accumulation. Catherine Johnson and Maarten Taal discuss the relevance of SAF to the renal community.

Phototherapy plus concurrent exercise on improvement of metabolic syndrome biomarkers and body composition in obese women

the effects combination of light at different wavelengths in the treatment of wrinkles and acne. The treatment was performed in 10 sessions using the commercial equipment called Venus®, once a week during one hour and thirty minutes in the all face. The treatment evaluations were done by visual analysis of images using digital clinical photography. In all patients was observed a decrease in expression lines, wrinkles and acne lesions. It was also observed improvement in skin tonus and color homogeneity decreasing the perception of skin age.

Use of low-level laser (light) therapy to improve muscle performance in soccer players

the effects combination of light at different wavelengths in the treatment of wrinkles and acne. The treatment was performed in 10 sessions using the commercial equipment called Venus®, once a week during one hour and thirty minutes in the all face. The treatment evaluations were done by visual analysis of images using digital clinical photography. In all patients was observed a decrease in expression lines, wrinkles and acne lesions. It was also observed improvement in skin tonus and color homogeneity decreasing the perception of skin age.

Dermoscopic changes in melanocytic nevi in patients receiving immunosuppressive and biologic treatments: Results of a prospective case-control study

The immune system restrains benign melanocytic lesions, however the relationship between immunosuppression and changes in nevi is not known. We sought to investigate the development of new nevi in patients using immunosuppressive agents, to evaluate any size or dermoscopic changes in existent nevi, and to evaluate any risk of developing melanoma. There were 266 melanocytic lesions in 103 patients undergoing immunosuppressive therapy and 180 melanocytic lesions matched for age, sex, race, and Fitzpatrick skin type in 60 healthy control subjects. Nevus counts increased from baseline in the treatment group (P<.001) as did nevus size (P=.046) but the increase compared with the control group only remained statistically significant for nevus numbers (P=.001). There was a statistically significant appearance of dermoscopic changes in the nevi of immunosuppressed patients compared with healthy control subjects (P<.001). Ten lesions were excised including 6 because of significant dermoscopic change during treatment and all were benign. Follow-up duration was short and the number of patients was small. Immunosuppressive therapy was associated with increased nevus counts and changed dermoscopic appearance but as none of the changed and subsequently excised nevi were malignant, continued monitoring for invasive features is a reasonable alternative to excision.

Psychosocial stress and hypertension in nursing staff

Objective: To describe the prevalence of systemic arterial hypertension (SAH) and verify the association between psychosocial stress and systemic arterial hypertension in nursing staff. Methods: A cross-sectional study conducted in an emergency care hospital in Southern Brazil. An instrument with sociodemographic, labor, clinical data and questions of Job Stress Scale was used. Descriptive and multivariate statistics analysis was performed. Results: The prevalence of SAH was 32%. An association was shown between SAH and being considered overweight/obese, having a larger waist circumference, age and self-reported skin color. No association was found between psychosocial stress (Demand Control Model quadrants) and systemic arterial hypertension, as well as with the different levels of blood pressure. Conclusions: High prevalence of hypertension was found among nursing staff although psychosocial stress was not associate with its occurrence. Follow-up studies are needed to elucidate more clearly the influence of the workplace environment on the health-illness process of the workers.

The thermal impact of phototherapy with concurrent super-pulsed lasers and red and infrared LEDs on human skin.

From the very first reports describing the method of action of phototherapy, the effects have been considered to be the result of photochemical and photophysical interactions between the absorbed photons and tissue and not related to secondary changes in tissue or skin temperature. However, thermal effects have been recently reported in dark pigmented skin when irradiated with single wavelengths of 810 and 904nm of low-level laser therapy (LLLT) devices even with doses that do not exceed those recommended by the World Association of Laser Therapy (WALT). The aim of this study was to evaluate the thermal impact during the concurrent use of pulsed red and infrared LEDs and super-pulsed lasers when applied to light, medium, and dark pigmented human skin with doses typically seen in clinical practice. The study evaluated the skin temperature of 42 healthy volunteers (males and females 18years or older, who presented different pigmentations, stratified according to Von Luschan's chromatic scale) via the use of a thermographic camera. Active irradiation was performed with using the multi-diode phototherapy cluster containing four 905-nm super-pulsed laser diodes (frequency set to 250Hz), four 875-nm infrared-emitting diodes, and four 640-nm LEDs (manufactured by Multi Radiance Medical™, Solon, OH, USA). Each of the four doses were tested on each subject: placebo, 0J (60s); 10J (76s); 30J (228s); and 50J (380s). Data were collected during the last 5s of each dose of irradiation and continued for 1min after the end of each irradiation. No significant skin temperature increases were observed among the different skin color groups (p > 0.05), age groups (p > 0.05), or gender groups (p > 0.05). Our results indicate that the concurrent use of super-pulsed lasers and pulsed red and infrared LEDs can be utilized in patients with all types of skin pigmentation without concern over safety or excessive tissue heating. Additionally, the doses and device utilized in present study have demonstrated positive outcomes in prior clinical trials. Therefore, it can be concluded that the effects seen by the concurrent use of multiple wavelengths and light sources were the result of desirable photobiomodulation effect and not related to thermal influence.

On the benefits of alternative color spaces for noncontact heart rate measurements using standard red-green-blue cameras.

Existing video plethysmography methods use standard red-green-blue (sRGB) video recordings of the facial region to estimate heart pulse rate without making contact with the person being monitored. Methods achieving high estimation accuracy require considerable signal-processing power and result in significant processing latency. High processing power and latency are limiting factors when real-time pulse rate estimation is required or when the sensing platform has no access to high processing power. We investigate the use of alternative color spaces derived from sRGB video recordings as a fast light-weight alternative to pulse rate estimation. We consider seven color spaces and compare their performance with state-of-the-art algorithms that use independent component analysis. The comparison is performed over a dataset of 41 video recordings from subjects of varying skin tone and age. Results indicate that the hue channel provides better estimation accuracy using extremely low computation power and with practically no latency.

YouTube Videos Related to Skin Cancer: A Missed Opportunity for Cancer Prevention and Control.

BackgroundEarly detection and treatment influence the mortality risk of skin cancer.ObjectiveThe objective of this study was to analyze the content of the most viewed professional and consumer videos uploaded to YouTube related to skin cancer.MethodsA total of 140 professional and consumer videos uploaded between 2007 and 2014 were identified and coded. Coding involved identifying and sorting followed by gathering descriptive information, including length of the video, number of views, and year uploaded. A dichotomous coding scheme (ie, yes or no) was used in coding specific aspects of video content, including provision of information, type of skin cancer, age group, family history, risk reduction, risk factors, fear, and home remedies for skin cancer treatment.ResultsThe majority of videos provided information related to screening. Many consumer videos conveyed information related to the use of a black salve as a home remedy for skin cancer, despite the fact that there is no evidence that it is an effective treatment.ConclusionsResearch is needed to identify characteristics of videos that are most likely to be viewed to inform the development of credible communications.

Exclusive Development of a Single Type of Keratinocyte Skin Cancer: Evidence from an Australian Population–Based Cohort Study

Whether susceptible people develop both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) or one type exclusively during life is unknown. We investigated this in an Australian community cohort of 1,191 adults aged 25-75 years by recording all new BCCs and SCCs for 16 years in people with no previous keratinocyte cancer. Among those who developed multiple skin cancers, age- and sex-specific incidence rates per 100,000 were calculated for those who developed BCC exclusively, SCC exclusively, or BCC and SCC. Corresponding relative risks (and 95% confidence intervals) were estimated by Poisson regression. During follow-up, 116 people developed multiple keratinocyte cancers: 65 (56%) developed BCC exclusively (range 2-8 per person); 18 (16%) developed SCC exclusively (2-5 per person); and 28% developed both types. Of the 116, 88 had a BCC first, of whom 74% subsequently developed only BCCs, and 28 had SCC first, of whom 64% subsequently developed only SCCs. Incidence rates did not differ by sex in the BCC-only, SCC-only, or mixed groups, but they increased significantly with age especially in the SCC-only group. These findings suggest that the majority of people are prone to develop one type rather than a mix of keratinocyte cancers.

Rythmologie

Photoplethysmography (PPG) in wearable sensors potentially plays an important role in accessible heart rhythm monitoring. We investigated the accuracy of a state-of-the-art bracelet (Corsano 287) for heartbeat detection in cardiac patients and evaluated the efficacy of a signal qualifier in identifying medically useful signals.Patients from an outpatient cardiology clinic underwent a simultaneous resting ECG and PPG recording, which we compared to determine accuracy of the PPG sensor for detecting heartbeats within 100 and 50 ms of the ECG-detected heart beats and correlation and Limits of Agreement for heartrate (HR) and RR-intervals. We defined subgroups for skin type, hair density, age, BMI and gender and applied a previously described signal qualifier.In 180 patients 7914 ECG-, and 7880 (99%) PPG-heartbeats were recorded. The PPG-accuracy within 100 ms was 94.6% (95% CI 94.1–95.1) and 89.2% (95% CI 88.5–89.9) within 50 ms. Correlation was high for HR (R = 0.991 (95% CI 0.988–0.993), n = 180) and RR-intervals (R = 0.891 (95% CI 0.886–0.895), n = 7880). The 95% Limits of Agreement (LoA) were −3.89 to 3.77 (mean bias 0.06) beats per minute for HR and −173 to 171 (mean bias −1) for RR-intervals. Results were comparable across all subgroups. The signal qualifier led to a higher accuracy in a 100 ms range (98.2% (95% CI 97.9–98.5)) (n = 143).We showed that the Corsano 287 Bracelet with PPG-technology can determine HR and RR-intervals with high accuracy in cardiovascular at-risk patient population among different subgroups, especially with a signal quality indicator.

Determinants of Central Nervous System Involvement in Herpes Zoster

Background: Herpes zoster is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. Central nervous system(CNS) involvements are uncommon complications of herpes zoster. The exact mechanism and risk factors are still unknown. Methods: We retrospectively reviewed the clinical data of patients who was admitted at our hospital due to herpes zoster from 2003 to 2013. The patients under age 15, herpes zoster infection without skin lesions, and cases not confirmed by a dermatologist were excluded. CNS involvements are defined as meningitis, encephalitis, single or multiple cranial neuropathies and all cases were evaluated with brain magnetic resonance imaging, spinal tapping, serological tests and confirmed by a neurologist. We compared the herpes zoster patients with CNS involvement to those without CNS involvement. Age, sex, body mass index, associated chronic medical illnesses, site and extent of skin lesion and development of post herpetic neuralgia were compared between two groups. Results: Total 1,131 subjects (male 460, female 671) were recruited. A group with CNS involvement was 91(8.04%). Sex, body mass index, associated chronic medical illnesses, extent of skin lesion were not different between two groups. A group with CNS involvement showed younger age(p<0.01), more facial and cervical skin lesions(p<0.01), lesser development of post herpetic neuralgia(p=0.048). Conclusions: CNS involvement is not a rare complication of herpes zoster and more frequent in patients with younger age and faciocervical zoster. J Korean Neurol Assoc 33(1):13-17, 2015