Neoplastic Skin Lesions in the Elderly Patient. As the proportion of the aged in the US population increases, so does the burden of cutaneous disease [1]. Cutaneous diseases of the elderly represent significant morbidity, with many patients having multiple conditions [2]. Hyperproliferative disorders of the skin are strongly associated with exposure to solar radiation and are commonly present in older adults [3]. Although nonmalignant growths are far more common than malignant ones, skin cancers represent about 6% of all dermatology visits [4]. The prevalence of cutaneous malignancies increases with age [5] (Table. Clinical Review: Topical Retinoids. apply a moisturizing sunscreen of SPF. A Randomised Controlled Trial; A Prospective Randomized Study of Clinical.Gout News and Research Archive. But they couldn't have possibly looked at the trial results. in order to bypass the aging process and add shelf life. Evidence-based information on healthy skin from hundreds of trustworthy sources for health and social care. Make better, quicker, evidence based decisions. Evidence. The present invention relates to the use of deuterium oxide (D2O) for prevention and/or treatment of virus-based diseases of the skin, in particular herpes virus. A randomized controlled trial to assess sunscreen. to daily sunscreen use in a skin cancer prevention. normal part of aging but. Cosmeceuticals. Introduction. Cosmeceuticals represent a marriage between cosmetics and pharmaceuticals. Like cosmetics, cosmeceuticals are topically applied, but they contain ingredients that influence the biological function of the skin. Cosmeceuticals improve appearance, but they do so by delivering nutrients necessary for healthy skin. Cosmeceuticals typically claim to improve skin tone, texture, and radiance, while reducing wrinkling. 124 Skin barrier & drug delivery. 01 Stratum corneum. 02 Epid lipid metabolism. 03 Transdermal strategies. 04 Metabolic strategies. 05 Transdermal principles. Subject index. Subject index. retreatment and 60-week open-label extension phases of a randomized phase II trial. may accelerate skin aging. The treatment of recurrent aphthous stomatitis (RAS) still remains nonspecific and is based primarily on empirical data. The goals of therapy include the management. Cosmeceuticals are the fastest- growing segment of the natural personal care industry.[1] Consumers are always interested in maintaining a youthful appearance, and as the global population's median age increases, this market is increasingly expanding. Cosmeceuticals are not subject to review by the Food and Drug Administration (FDA), and the term cosmeceutical is not recognized by the Federal Food, Drug, and Cosmetic Act. Although cosmetics and cosmeceuticals are tested for safety, testing to determine whether beneficial ingredients actually live up to a manufacturer's claims is not mandatory. In general, vitamins, herbs, various oils, and botanical extracts may be used in cosmeceuticals, but the manufacturer may not claim that these products penetrate beyond the skin's surface layers or that they have druglike or therapeutic effects. For cosmetic labels, no division between active ingredients and other ingredients is required; they are all listed together. The most important botanicals pertaining to dermatologic uses, such as cosmeceuticals, include teas, soy, pomegranate, date, grape seed, pycnogenol, horse chestnut, German chamomile, curcumin, comfrey, allantoin, and aloe; only green and black tea, soy, pomegranate, and date have been studied to the extent that clinical trials for the treatment of parameters of extrinsic aging have been published.[2] Few botanical- based cosmeceuticals have uses that are supported by evidence- based science. Top antiaging creams currently on the market were evaluated. These included Rosmarinus officinalis, Vitis vinifera (grape seed extract), citronellol, Limonene, Oenothera biennis (evening primrose), Glycyrrhiza glabra (licorice extract), Aframomum angustifolium seed extract, diosgenin (wild yam), N6 furfuryladenine (kinetin), and ergothioneine.[3] Randomized controlled trials are still needed, although some ingredients may have a scientific basis for their use. Chemoprevention by oral or topical use of dietary or pharmacologic agents to inhibit or reverse the development of cancer is a possibility.[4] Potential cosmeceutical agents in this category include green tea, grape seed extract, vitamin E, and beta- carotene. Some ingredients, like peppermint oil, are used in cosmeceuticals, personal hygiene products, foods, and pharmaceutical products for both flavoring and fragrance properties; these may produce an allergic contact dermatitis.[5] The convergence of cosmetics and foods, so- called nutricosmetics, refers to oral supplementation of nutrients, marketed mainly for antiaging effects, ie, reducing wrinkles by fighting free radicals generated by solar radiation. Nutricosmetics include antioxidants such as carotenoids (beta- carotene, lycopene, lutein, zeaxanthin, and astaxanthin) and polyphenols (anthocyanidins, catechins, flavonoids, tannins, and procyanidins).[6] Men have special skin care influenced by facial shaving and attendant irritation.[7] Maintaining hair softness and facial hydration postshaving may require moisurizers containing glycerine and be improved by ingredients such as niacinamide. Also see Cosmetics. Moisturizers. The cutaneous permeability barrier is localized in the stratum corneum interstices and is mediated by the lamellar bilayers enriched in cholesterol, free fatty acids, and ceramides. Formulations containing skin- identical lipids have been suggested to facilitate a cascade of physiologic events in keratinocytes, normalizing damaged skin. When applied to the skin for an extended period, water can cause the excretion of cytokines. These proinflammatory molecules induce edema, vasodilation, and frank inflammation; therefore, water alone may alter both the structure and the function of the skin under some conditions. By the same token, moisturizers that make the stratum corneum softer and more pliant by increasing its hydration could be considered cosmeceuticals. Intact protein- rich corneocytes, surrounded by the lamellar intercellular lipids, provide waterproof barrier protection for the body, damage to which can be treated by a variety of externally applied substances, such as ceramides, hyaluronic acid, licorice extracts, dimethicone, petrolatum, and paraffin wax.[8] Orange roughy (Hoplostetbus atlanticus) oil may be comparable to petrolatum in those with dry skin.[9] A multilamellar vesicular emulsion ceramide – containing liquid cleanser and moisturizing cream plus fluocinonide cream 0. Retinoids. Retinoids are possibly the most prevalent cosmeceuticals in the market. Retinoids are vitamin A derivatives present in all living organisms either as preformed vitamin A or as carotenoids. Vitamin A (retinol) is the prototype of all other retinoids and is necessary for proper growth, bone development, and integrity of mucosal and epithelial surfaces. In vitamin A deficiency, the eyes and the skin are severely affected. The conjunctiva and the cornea develop metaplasia and keratinization, leading to night blindness. The skin develops follicular hyperkeratosis or phrynoderma. The hyperkeratotic follicular papules are usually clustered around bony prominences, such as the elbows and the knees, but in severe deficiency, the papules can be found throughout the entire skin surface. Early civilizations recognized the benefits of vitamin A in treating and healing night blindness with diets rich in liver. In the 1. 93. 0s, the clinical manifestations of vitamin A deficiency were recognized, and the idea to use vitamin A in the treatment of skin diseases was initiated. The advent of synthetic analogs of vitamin A in the 1. Since then, vitamin A and its derivatives have been useful in the treatment of many skin disorders, including ichthyosis, acne, and psoriasis. A great amount of research has concentrated on its use as an antiaging compound as well as its use for other cutaneous disorders; therefore, today, vitamin A is recognized as comprising a magnitude of biological effects far beyond those on the cornea. Vitamin A and its derivatives have 2 main functions: they act as antioxidants, and they activate specific genes and proteins. As antioxidants, they protect cells from oxidative damage by 3 different mechanisms: (1) scavenging peroxyl radicals, (2) quenching singlet oxygen, and (3) triplet- state sensitizers. Vitamin A also exerts a hormone- like effect on the skin, activating specific genes through nuclear receptors. The receptors bind to target sequences called hormone response elements on DNA and activate gene transcription. Retinoic acid receptors (RARs) bind all- trans retinoic acid, and retinoic X receptors (RXRs) bind 9- cis retinoic acid. Vitamin A and its derivatives inhibit lipid peroxidation; increase levels of alpha- tocopherol (vitamin E); and activate growth factors, oncogenes, keratins, and transglutaminases. Histologically, vitamin A and its derivatives induce epidermal thickening, increase mitoses, differentiate keratinocytes, and reduce the number of sebocytes. The dermis shows increased amounts of glycosaminoglycans (GAGs) and anchoring fibrils. Structural changes underlying the cosmetic benefits include correction of epidermal atrophy, deposition of new collagen, generation of new vessels, and enhancement of mitogenesis. This enhanced mitogenesis promotes the shedding of melanin- laden keratinocytes, resulting in bleaching and subsequent depigmentation.
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