Skin Signs Research Articles

Infectious Endocarditis with Major Cutaneous Expression: About A Case

Introduction: Infectious endocarditis is a transplant of microorganisms in healthy endocardium, in injured endocardium or intracardiac material. The modes of revelation can be multiple and varied, the skin manifestations of an infectious although classical endocarditis, are rare. Observation: This was a young 20-year-old patient, admitted in our cardiac unit for the exploration of a cardiac murmur in a context of long-term fever evolving for nearly 3 weeks associated with a skin rash. The examination found fever at 39°C and tachycardia at 115 beats/min. The cardiac auscultation revealed tachycardia with a systolic breath apexian mitral insufficiency. The skin examination revealed Osler’s nodules, an erythema of Janeway on the soles of the feet and on the palms of the hands. In biology, there was a non-specific biological inflammatory syndrome. Blood cultures from three series of samples did not isolate a germ. The transthoracic echography showed large vegetations in the anterior and posterior leaflets of mitral valve associated with severe mitral regurgitation. In this context, the diagnosis of mitral endocarditis is retained according to the Duke criteria. A double intravenous antibiotic therapy based on ceftriaxone and gentamycin was administrated. The evolution was favorable with stable apyrexia, disappearance of skin signs, regression of non-specific biological inflammatory syndrome. A replacement surgery of mitral valve was proposed. Conclusion: Infectious endocarditis is a disease with multiple and varied modes of revelation. Although skin manifestations are rare, they are still a determining factor in the diagnosis of infectious endocarditis.

How to prevent skin damage from air pollution part 2: Current treatment options.

In the first part of this review, we have summarized the methods used to examine skin exposure to air pollution and the fundamental concept of skin-exposome interactions. Part 2 of this review focuses on dermatoses, whose aggravation or initiation by air pollution has been confirmed in evidence based medicine manner. Based on the model of photodermatology and photodermatoses, we propose a new concept of "polludermatoses." A key feature of this concept is identifying patients at risk, which will reveal the noxious effects of air pollutants on skin health. Identifying clinical signs of pollution-damaged skin could be beneficial in categorizing conditions caused or exacerbated by exposure to air pollution. Finally, we discuss the current treatment options and the pathogenetic processes targeted by these therapeutics or the development of novel treatment modalities.

Skin Lesions, Skin Care, and Characteristics of Pruritus in Patients Undergoing Haemodialysis

Introduction: Pruritus has been shown to be a common and burdensome complaint in the general population. In some diseases, there is an even higher rate and intensity of pruritus such as in chronic kidney diseases. In particular, patients requiring dialysis commonly suffer from pruritus with proportions between 22.0 and 90.0%. Few data on the characteristics and burden of such pruritus have been published. Therefore, the aim of this study was to investigate the extent and profiles of pruritus in such patients related to skin lesions and care. Methods: A non-interventional cross-sectional study in 14 centres for haemodialysis across Germany was conducted. The survey explored the prevalence, severity, and resulting burden of pruritus and skin lesions. Results: In total, 302 patients with uraemia (56.5% male, mean age 66.0 ± 14.4 years, mean duration of dialysis 3.9 ± 4.8 years) were included. Skin lesions appeared since start of dialysis in 50.0% of patients, with xerosis (94.7%) and desquamation (25.8%) being the most frequent and disturbing findings. Pruritus was reported by 60.9% of patients undergoing dialysis with a current mean numerical rating scale of 5.1 ± 2.4 occurring most frequently in the back, legs, and arms. About 89.0% of patients with xerosis and 69.0% with desquamation reported self-medication. However, only 40.0% and 28.0% sought medical help, respectively, indicating a remarkable lack of healthcare. Discussion: The current data suggest a more intensive focus on the skin symptoms and signs related to uraemia in the patients with dialysis and thus underline claims from a previous German large-scale study. Recommendations for early treatment and prevention of skin lesions in dialysis patients should be developed. Further research should be conducted focusing on recognizing subgroups of patients of particular vulnerability to pruritus and skin lesions, which may facilitate identifying patients at risk in an early moment. Moreover, a more specific tool for screening of skin lesions as well as pruritus may be useful since the existing instruments lack such specificity.

Psychocutaneous Medicine Clinic: Wisconsin Experience.

Psychocutaneous medicine, also known as psychodermatology, is a subspecialty of dermatology and psychiatry that explores the interactions between the skin and the brain. For many patients, skin disease affects their quality of life and mental well-being. For others, psychiatric problems exhibit skin signs. Little data are available from psychocutaneous clinics worldwide. The aim of our review is to advance clinical knowledge about psychocutaneous medicine and help bridge the current gap between dermatology and psychiatry. A total of 808 cases referred to our psychocutaneous clinic from 2002 to 2018 were reviewed. A specific code in the electronic health records allowed us to identify these patients. All the patients referred to the clinic were included in the study. The primary variable of interest was the patient's final diagnosis, as made by the psychiatrist. Patient demographics (age, sex, marital status), number of visits, and treatments were collected. Our data showed a high prevalence of skin picking disorder followed by depressive and anxiety disorders. Serious mental health disorders such as major depressive disorder and generalized anxiety disorder were common in our patients. Three-fourth of our patients were women. Skin picking was more prevalent in women, and alcohol dependence was more prevalent in men. No other significant gender differences in final diagnoses were found. 44.2% of patients needed one visit and were able to return to referring physicians for follow up. This is the largest collection of patients from a psychocutaneous clinic in the literature to date. Previous studies show that psychocutaneous clinics save health care dollars by decreasing the number of patient visits and improving the quality of life of patients with dermatologic problems. Introducing the results of this clinic could inform future integration of psychocutaneous clinics in dermatology practices and identify areas of need in training dermatology and psychiatry residents.

Efeitos da administração oral do ácido hialurônico no envelhecimento cutâneo: uma revisão

Introdução: No corpo humano, o conteúdo total de ácido hialurônico (AH) encontrado é de aproximadamente 15g a cada 70kg e metade encontra-se na pele mais especificamente entre a derme e epiderme. Com o passar dos anos, observa-se um declínio da sua produção endógena alterando seu volume, hidratação, sustentação e elasticidade, deixando a pele com um aspecto mais envelhecido. Objetivo: Avaliar o impacto da suplementação oral do ácido hialurônico no envelhecimento cutâneo. Material e Método: Foi realizada uma revisão bibliográfica nas principais bases de dados em saúde MEDLINE, LILACS e SCIELO, utilizando os descritores em Ciências da Saúde (DeCS): ácido hialurônico, envelhecimento cutâneo e pele, nos idiomas português e inglês, considerando os últimos 5 anos. Resultado: Foram encontrados 51 estudos, 5 foram incluídos e 46 excluídos por não atenderem os critérios de elegibilidade. Os estudos observados sugerem que a ingestão de AH via oral aumenta a hidratação e diminui as linhas de expressão, sendo um possivel tratamento na prevenção do envelhecimento da pele. Sua utilização como suplemento oral também é relativamente nova em comparação com outros nutrientes usados ​​para a pele seca e o seu envelhecimento. Conclusão: O AH possibilitou melhora na hidratação e na elasticidade da pele. Nesta revisão, a suplementação oral de diferentes doses e pesos moleculares apresentaram benefícios na saúde da pele. Entretanto, são necessários estudos clínicos randomizados para confirmar seus efeitos e estabelecer o peso molecular ideal, bem como, a dose adequada para minimizar os sinais clínicos do envelhecimento cutâneo.

Anaesthetic Management of Patient with Distal Radius Fracture with Ipsilateral Arteriovenous Fistula

Introduction: Patient with upper limb fracture with ipsilateral limb AV fistula, anaesthetic options are still challenging. Case Report: A 40 year old male patient who is an K/C/O CKD on maintenance hemodialysis and hypertensive on medication.Patient had AV fistula on the same side of the fracture, Detailed examination of the fistula was done, 1. Thrill over the fistula palpated. 2. Bruit was auscultated on the fistula side. 3. Radial pulse was palpated for volume and rhythm. 4. Fistula hand was compared with other hand for colour , any cyanosis or pallor, temperature, ulcer, edema , pigmentation or peeling of the skin and Nicoladoni Branham sign was negative Under USG, plexus was identified. Using 23G spinal needle , Bupivacaine 0.5(H) 15ml[75mg] plexus . Post supraclavicular block , both sensory and motor blockade was checked. Without tourniquet surgery was proceeded , face mask with 5L/min of O2 was given to the patient. Intraoperatively patient was hemodynamically stable, maintenance fluid of 0.5ml/kg/hr. Post procedure examination of AV fistula was repeated to check the patency. Conclusion: Use of regional anaesthesia over general anaesthesia in distal end fracture with ipsilateral AV fistula has advantage in both in management and patency of the AV fistula.

27893 An advanced oil composition containing stabilized retinol with enhanced bioactivity using neocitrate

We have previously developed a proprietary retinol oil formulation that delivers improvements in facial wrinkles as early as 1 week, as well as sustained improvements in cutaneous skin parameters that address the needs of subjects with signs of skin aging and photodamage. The objective of this study was to demonstrate anti-aging performance of this enhanced formulation at a molecular level. Leveraging Neocitrate as a proven collagen-boosting peptide, we sought to demonstrate that (1) its combination with retinol oil was compatible with retinol’s mechanism of action by confirming retinol-induced stimulation of antiaging biomarkers and that, (2) the combination leads to an increased collagen production vs retinol alone.

Photo Skin Rejuvenation with IPL

Photo aging is becoming increasingly interesting, as it causes, among other alterations, the appearance of wrinkles, pigmentation disorders and loss of normal skin tone. Exposure to sunlight is responsible for 80 to 90% of facial aging. Signs of photoaged skin include changes in skin color, dyschromia’s, lentigos, gradual appearance of telangiectasias (dilation of small blood vessels), as well as changes in skin texture such as loss of smoothness, keratotic appearance, early development and deepening of wrinkles.The aging of our skin is not only the result of the passage of time. It is also strongly influenced by external factors, such as weather conditions. The skin is made up of three layers: the epidermis, or outer layer, the dermis, or middle layer, and the subcutaneous tissue, or deep layer. The dermis contains collagen, elastin, and other fibers that make up the skin’s structure. These elements give the skin a smooth and youthful appearance, and these are those damaged by Ultraviolet Radiation (UVR). UVRs are made up of two different types of waves, UVA and UVB. When UV rays hit the skin, the melanocytes struggle to produce melanin to deposit in the epidermis. This is the process that gives you a tan, which is actually a defense reaction against radiation so that it does not penetrate the skin. UVB rays are shorter than UVA rays and are the main cause of sunburn. UVA rays are responsible for much of the damage we associate with photoaging. UVA rays penetrate deep into the dermis, where damage to collagen fibers occurs. This damage causes an abnormal increase in elastin production.

Puppyhood diet as a factor in the development of owner-reported allergy/atopy skin signs in adult dogs in Finland.

BackgroundThe increased prevalence of atopic dermatitis (AD) in dogs necessitates research in its disease etiology.ObjectivesTo explore the association between puppyhood dietary exposures and prevalence of owner‐reported allergy/atopy skin signs (AASS) after the age of 1 year.AnimalsFour thousand and twenty‐two dogs were eligible, 1158 cases, and 2864 controls.MethodsThis cross‐sectional hypothesis‐driven observational study was extracted from the DogRisk food frequency questionnaire. Forty‐six food items and the ratio of 4 major diet types were tested for their association with AASS incidence later in life. Potential puppyhood dietary risk factors for AASS incidence were specified using binary multivariable logistic regression. The model was adjusted for age and sex.ResultsEating raw tripe (odds ratio, 95% confidence intervals OR, 95% CI = 0.36, 0.16‐0.79; P = .01), raw organ meats (OR, 95% CI = 0.23, 0.08‐0.67; P = .007), human meal leftovers, and fish oil supplements as well as eating more that 20% of the diet as raw and/or <80% of the diet as dry, in general, were associated with significantly lower AASS incidence in adulthood. In contrast, dogs fed fruits (OR, 95% CI = 2.01, 1.31‐3.07; P = .001), mixed‐oil supplements, dried animal parts, and dogs that drank from puddles showed significantly higher AASS incidence in adulthood.Conclusions and Clinical ImportancePuppyhood exposure to raw animal‐based foods might have a protective influence on AASS incidence in adulthood, while puppyhood exposure to mixed oils, heat processed foods and sugary fruits might be a potential risk factor of AASS incidence later. The study suggests a causal relationship but does not prove it.

Improvement of Biophysical Skin Parameters of Topically Applied Fermented Soybean Extract-Loaded Niosomes with No Systemic Toxicity in Ovariectomized Rats

Despite the known beneficial impacts of estrogen used as hormone replacement therapy to ameliorate signs of skin aging in postmenopausal women, its compliance rates are low. A significant amount of estrogen may be absorbed into the blood circulation and can lead to systemic actions. Soy isoflavone exhibits biological activities similar to synthetic estrogen because it is a heterocyclic phenolic compound. The disadvantage of most topical ingredients based on isoflavone is that they contain biologically inactive glycoside forms, which must be converted to a readily absorbed aglycone for the topical application. The purposes of this study were to develop niosomes-loaded Aspergillus oryzae-fermented soybean extract (FSE) to enhance skin absorption with proven systemic side effect compared to estrogen application. Skin hydration and viscoelasticity of 75 days post-ovariectomized (OVX) Wistar rats following 84-day topical treatment with various tested gel formulations containing fermented soybean extract (FSE) were evaluated. The tested formulations were gel + FSE nanoniosomes, gel + FSE microniosomes, gel + FSE (200 µg FSE/9 cm2/rat), gel + blank nanoniosomes (a negative control), and gel + 17β-estradiol (E2) nanoniosomes (a positive control, 20 µg E2/9 cm2/rat). Changes in vaginal cornifications and weights of uteri, livers, and kidneys in the OVX rats and signs of primary skin irritation in the rabbits were evaluated for their toxicities. Results showed that FSE-loaded nanoniosomes improved the skin hydration and viscoelasticity better than gel + FSE microniosomes and gel + FSE, respectively, but lower than those of gel + E2 nanoniosomes (p < 0.05). Unlike all gel + E2 nanoniosomes, the FSE formulations showed no changes in vaginal cells and weights of uteri, livers, and kidneys and no signs of skin irritation. In conclusion, The FSE niosome-based gels should be promising candidates for delivering phytoestrogens against signs of skin aging with no systemic toxicities.

Klebsiella Pneumoniae Necrotizing Fascitis of The Lower Extremity in A 7-Month-Old Male: A Case Report and Literature Review

Introduction: Klebsiella pneumoniae necrotizing fasciitis is an uncommon soft tissue infection characterized by rapidly progressing necrosis involving the skin, subcutaneous tissue, and fascia. This condition may result in gross morbidity and mortality if not treated in its early stages. In fact, the mortality rate of this condition is high, ranging from 25 to 35%. We present a case of 7-month-old male with K. pneumoniae necrotizing fasciitis of the lower extremity. Materials and Methods: A 7-month-old male presented with large areas over both left and right inferior side of the lower limbs to the emergency department of Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia. Physical examination revealed elevated heart rate of 136 times per minute and increased body temperature of 38oC. The large areas on both lower limbs were darkened, sloughed off, and very tender to palpation. A small area over the right hand was erythematous and sloughed off. Laboratory evaluation demonstrated decreased hemoglobin of 6.2 g/dL and elevated leukocyte of 28,850 g/dL. Blood cultures demonstrated that K. pneumoniae was present. Discussion: NF is usually hard to diagnose during the initial period. The findings of NF can overlap with other soft tissue infections including cellulitis, abscess or even compartment syndrome. However, pain out of proportion to the degree of skin involvement and signs of systemic shock should alert the clinical to the possibility of NF. The clinical manifestations of NF start around a week after the initiating event, with induration and edema, followed by 24 to 48 hours later by erythema or purple discoloration and increasing local fever In the next 48 to 72 hours, the skin turns smooth, bright, and serous, or hemorrhagic blisters develop. If unproperly treated, necrosis develops, and by the fifth or sixth day, the lesion turns black with a necrotic crust. Conclusions: K. pneumoniae necrotizing fasciitis is a rare but lifethreatening disease. A high index of suspicion is required for early diagnosis and treatment of this condition

Peeling with 25% trichloroacetic acid in the treatment of facial skin photoaging

Introduction: The chemical peel consists of the application of chemical exfoliants that eliminate the layers of the skin so that it can regenerate with an improved texture and pigmentation. It is currently a valuable therapy in dermatology, however, few studies objectively evaluate its efficacy. Objective: To evaluate the efficacy and safety of peeling with 25% trichloroacetic acid in the treatment of facial skin rejuvenation. Method: An observational, analytical and longitudinal study was carried out in 250 patients from two hospitals (Surgical Clinic: “Hermanos Ameijeiras” and General Teaching: “Enrique Cabrera”), in the period between January 2010 and January 2020. Treatment It was applied monthly for 6 months. The final evaluation was carried out 3 months after the end of the treatment. Results: 238 women and 12 men were treated with an average age of 30.5 (± 8.4) years. After treatment, there were significant changes in the Glogau Photo Damage Scale (P=0.012), in the Lemperle Wrinkle Assessment Scale (P=0.016) and in the Global Aesthetic Improvement Scale (P=0.021). The adverse events found were burning, inflammation and scaling. The degree of satisfaction reported by the patients was good (4.4%) and very good (95.6%) (P=0.011). Conclusion: The 25% trichloroacetic acid peel proved to be effective and safe to reduce the signs of facial skin aging, associated with a high degree of patient satisfaction.

Fox sign in a case of terminal stage pancreatic cancer and suggestions for diagnosis

Skin signs in acute pancreatitis are well-known and frequently discussed manifestations accompanied by unfavorable prognoses although they may rarely appear in clinical and forensic medicine. In 2018, the district attorney’s office ordered a forensic autopsy for a 74-year-old man with terminal stage pancreatic cancer. The autopsy was ordered based on accusations of the deceased’s widow regarding alleged medical malpractice and poor hospital care. The widow filed a grievance about multiple unsuccessful attempts to draw blood from her husband in addition to a diaper dermatitis at the right groin. An autopsy and additional histological examinations were performed. After considering all findings, the diaper dermatitis was eventually assumed to be a Fox sign caused by acute pancreatitis, and the allegations of medical malpractice were refuted. This case led us to identify another case with suspected cutaneous manifestations in pancreatic disease. We performed immunohistochemical staining on those two cases and six control cases to examine whether there was detectable presence of pancreatic lipase and trypsin in the skin discolorations and whether it could be used as a feasible method to verify skin signs associated with pancreatitis. Based on our findings, a minor disseminated lipase and trypsin staining should be considered regular and is therefore not conclusive of a skin sign associated with pancreatitis. Moreover, trypsin does not seem to be as suitable as lipase for this suggested immunohistochemical method. Nevertheless, this method might be a useful addition for determining the origin of skin discoloration and verifying skin signs associated with pancreatitis.

Efficacy and Safety of Autologous Platelets Concentrated in the Treatment of Perioral Skin Aging.

Introduction: The rejuvenation of the perioral region has a certain degree of difficulty. The search for painless and minimally invasive alternatives is a challenge in the field of aesthetic medicine. Objective: To evaluate the efficacy and safety of intradermal microinjection of autologous platelet concentrate (APC) in the treatment of perioral skin aging signs. Method: An observational, analytical and longitudinal study was carried out in 60 patients from the Hospital Clínico Quirúrgico: “Hermanos Ameijeiras”, in the period between March 1, 2017 and March 31, 2020. The treatment was applied monthly. For 1 year. The final evaluation was carried out 3 months after the end of the treatment. Results: 60 women with an average age of 45 ± 4.3 years were treated. After treatment, there were significant changes in the Glogau Photo Damage Scale (P = 0.028), in the Global Aesthetic Improvement Scale (P &lt;0.032) and in the Evaluative Scale of the severity range of the nasolabial fold (P = 0.031). The adverse events found were pain, inflammation and ecchymosis. The degree of satisfaction reported by the patients was good (16.7%) and very good (83.8%) (P &lt;0.038). Conclusions: The autologous platelet concentrate proved to be effective and safe to reduce the signs of perioral skin aging, associated with a high degree of patient satisfaction.

Native Spleen Preservation During Visceral Transplantation Inhibits Graft-Versus-Host-Disease Development: Clinical and Experimental Study.

We aimed to assess whether native spleen preservation during visceral transplantation (VT) affects graft-versus-host-disease (GVHD) incidence. GVHD is one of the most severe and frequently lethal hematological complications after VT procedures. Because there is no specific treatment for GVHD, it is imperative to develop a strategy to reduce donor lymphocyte engraftment and proliferation. Our study included both clinical and experimental data. A total of 108 patients were divided into 3 groups: a native spleen preservation group, a native spleen removal with no donor spleen group, and a donor spleen included (allogeneic spleen) group. We also used an allogeneic VT rat model, in which recipients were divided into 2 groups: a native spleen preservation (+SP) group and a native spleen removal (-S) group. Skin rash appearance, histopathological changes, chimerism, and spleen effects on circulating allogeneic T-cells were assessed. The patients with native spleen preservation showed a lower rate of GVHD ( P <.001) and better survival ( P <.05) than those in the other groups. Skin and histological signs of GVHD were lower in the rats in the +SP group ( P <.05). The donor T-cell frequency in the bloodstream and skin was also significantly reduced when the native spleen was preserved ( P <.01 and P <.0001, respectively). The clinical and experimental data indicate that recipient spleen preservation protects against GVHD after VT, and donor cell clearance from the bloodstream by spleen macrophages could be the underlying mechanism. Therefore, spleen preservation should be considered in VT procedures, whenever possible.

Skin signs in eating disorders: a literature review.

To summarize and describe the available knowledge on dermatological manifestation of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder and eating disorder not otherwise specified, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders IV-TR and 5th edition. We searched in PubMed, Scopus and Web of Science databases from January 1, 1980 through May 1, 2020 for papers in English language on the skin manifestation of eating disorders. Results were screened using the PRISMA tool. The study yielded 207 results. According with PRISMA guidelines, 26 papers were included in the review. More than 73% of screened papers (19/26) were case reports. Cross-sectional studies represented the 19.2% of screened papers (5/26). Each eligible study has been screened and analyzed. Huge heterogeneity of skin signs of eating disorders were identified. The number of controlled studies available is very limited, and most papers of interest are case reports or narrative review articles. Larger, more methodologically rigorous studies to evaluate the presence of dermatological issue in eating disorder patients are needed. Level IV. Evidence obtained from multiple time series analysis such as case studies.

The chameleon rash: a review of the polyphenotypic dermatoses of dermatomyositis

Dermatomyositis (DM) is an autoimmune connective tissue disease that is included in the idiopathic inflammatory myopathies. Cutaneous manifestations are a prominent part of the condition: some skin signs in DM are common to most patients, while other signs are encountered infrequently. A number of features are pathognomic for DM. The demonstration of myositis-specific antibodies (MSAs) in DM has extended the ability to define phenotypic subgroups. It appears that the presence of certain MSAs confers susceptibility to specific clinical features, an association which reveals a serotype-phenotype relationship. In this review article we have provided a detailed summary of common and under-recognized cutaneous manifestations of DM.

Peeling with 30% Salicylic acid in the treatment of facial skin photoaging

Introduction: Chemical peeling consists of the application of one or more chemical ablative agents to the surface of the skin to induce keratolysis or keratocoagulation, with subsequent regeneration, achieving improved texture and pigmentation. It is currently a popular tool in the dermatology therapeutic arsenal, however, few studies objectively evaluate its efficacy. Objective: To evaluate the efficacy and safety of the 30% salicylic acid peeling in the treatment of facial skin rejuvenation. Method: An observational, analytical and longitudinal study was carried out in 280 patients from two hospitals (Surgical Clinic: “Hermanos Ameijeiras” and General Teaching: “Enrique Cabrera”), in the period between January 2010 and January 2020. Treatment It was applied monthly for 6 months. The final evaluation was carried out 3 months after the end of the treatment. Results: 256 women and 24 men were treated with an average age of 34.2 (± 6.3) years. After treatment, there were significant changes in the Glogau Photo Damage Scale (P = 0.015), in the Global Aesthetic Improvement Scale (P = 0.023) and in the Lemperle Wrinkle Assessment Scale (P = 0.017). The adverse events found were burning, inflammation and scaling. The degree of satisfaction reported by the patients was good (6.4%) and very good (93.5%) (P = 0.001). Conclusions: The 30% salicylic acid peel proved to be effective and safe to reduce the signs of facial skin aging, associated with a high degree of patient satisfaction.

Efficacy of fractional laser, radiofrequency and IPL rejuvenation of periorbital region

The purpose of this study was to assess skin elasticity, the reduction in the number and the depth of wrinkles and changes in the other skin defects (bags under the eyes, dark circles under the eyes, skin hyperpigmentation in the ageing eye area following the use of non-ablative fractional laser, bipolar radiofrequency and intense pulsed light). Moreover, the study was also comparison which device brought better results than the others. This study included 71 patients (66 women, 5 men), aged 33–63 years (the average age was 45.81 years) with skin phototypes II and III. Twenty-four patients received five treatment sessions with a 1410-nm non-ablative fractional laser in 2-week intervals, 23 patients received five treatment sessions with a bipolar radiofrequency in 1-week intervals and 24 patients received five treatment sessions with an intense pulsed light in 2-week intervals. The treatment was applied on the skin in the eye area. The Cutometer (Courage + Khazaka electronic) reference test was used as an objective method for the assessment of skin elasticity. A questionnaire was used to compare baseline state with changes that occurred after the series of treatment sessions. The results of cutometric measurements of R2, R6 and R7 parameters and the results of questionnaires indicated that non-ablative fractional laser therapy, bipolar radiofrequency and intense pulsed light improved skin elasticity. Of the three treatments, the most significant percentage improvement in the R6 parameter was demonstrated by non-ablative fractional laser therapy which gave better final results than the other methods (p < 0.0001). No other statistically significant relationships were found between RF and IPL. In the (subjective) opinion of study participants (questionnaire), all used methods resulted in the reduction of the amount and the depth of wrinkles. However, they did not observe significant impact of individual treatment method on the signs of skin ageing, including discolorations within eye area, bags (fatty hernia), dark circles (vascular/pigmentary) and oedema (predisposition to water retention). Non-ablative fractional laser therapy, bipolar radiofrequency and intense pulsed light improved skin elasticity and the reduction of wrinkles. The most significant improvement of elasticity was demonstrated by laser therapy. It seems necessary to expand the group with the effect of individual treatments against bags and dark circles under the eyes.

Daily photoprotection to prevent photoaging

Extrinsic skin aging or photoaging was previously thought to be almost exclusively due to solar ultraviolet (UV) radiation. However, recent literature has described other contributing factors and clarification is thus required as to what extent and what type of daily photoprotection is needed to mitigate extrinsic skin aging. We reviewed the existing scientific evidence on daily photoprotection, and specific requirements at the product level, to prevent extrinsic skin aging. We critically reviewed the existing evidence on potential ecological and toxicological risks which might be associated with daily photoprotection. Evidence shows that broad protection against the entire solar range of UVB, UVA, UVA1, visible light, and short infrared (IRA) is required to prevent extrinsic aging. Other exposome factors, such as air pollution and smoking, also contribute to skin aging. Daily broad-spectrum sunscreen photoprotection should thus contain antioxidant ingredients for additional benefits against UV, IRA, and pollution-induced oxidative stress as well as anti-aging active ingredients to provide clinical benefits against skin aging signs, such as wrinkles and dark spots. Broad-spectrum sunscreen containing pigments, such as iron oxide, may be required for melasma prevention. There is no conclusive clinical evidence that daily sunscreen use is unsafe or that it compromises vitamin D synthesis. Daily use of broad-spectrum sunscreen containing antioxidant and anti-aging active ingredients can effectively reduce extrinsic aging.