Summary of Findings

• The results of this study indicated that the degradation of collagen fiber led to thinner and more wrinkled skin. The results further indicated that in general, the elasticity of the dermal layer tends to decline with age, which in turn leads to the degradation of collagen and thus the formation of wrinkles.
• According to this study, smoking and alcohol use increase the appearance of facial aging among women.
•  Another study found that the more a person was exposed to high concentrations of tropospheric ozone, the higher their chances of developing coarse wrinkles in the face. The study demonstrated that ozone quickly oxidizes lipids and proteins in the skin and triggers oxidative stress.

Research Strategy

Introduction

Selected Findings

• According to this study, significant exposure to UV rays damages the skin and reduces its elasticity.
• The findings of this study suggest that intrinsic aging is a major cause of lost skin elasticity and firmness.
• This study explores the negative impact of chronic smoking on the elastic fiber network of the skin (both elastin and fibrillin-rich microfibrils.)

Research Strategy

Introduction

Selected Findings

Article 1: Factors influencing Face Aging. Literature Review

• The article was published by Stomatologija, Baltic Dental, and Maxillofacial Journal.
• The article lists ultraviolet light, gravity, habits, and teeth loss as some factors that can affect facial appearance during aging.
• The article breaks down the morphological effects of aging on the face into upper third, middle third, and lower third including the neck.
•  Gravity, soft-tissue maturation, skeletal remodeling, muscular facial activity, solar changes, and changes in stomatognatic system were identified as the major factors that are responsible for the aging of the face.
• Furthermore, the report noted that the factors that influence aging can be classified into internal factors (natural) and external factors. 
•  Natural or internal factors include the slowing down of collagen production, a reduction in the production of elastin, the disappearance of fat cells, the inability of the skin to retain moisture, the appearance of frown lines, and others. On the other hand, external factors such as exposure to UV and others can be controlled.

Research Strategy

Introduction

Selected Findings

• The findings of this study suggest that pigmented demodicidosis should be recognized as one of the causes of facial hyperpigmentation.
• The findings of this report suggest that clinicians should consider vitamin B12 deficiency as a probable cause in cases of acral hyperpigmentation.
•  This study analyzes how the misuse of hydroquinone (treatment cream for hyperpigmentation) can lead to a more severe hyperpigmentation condition like exogenous ochronosis. A picture showing the exogenous ochronosis condition in a woman has been presented below.

 

Source

 

•  The article highlights how sunscreen plays an important role in therapy for improving and stabilizing hyperpigmentation disorders, such as postinflammatory hyperpigmentation (PIH) and melasma. The article emphasizes the use of sunscreen in patients with skin of color.
• There are additional causes of hyperpigmentation that have not been covered by the presented articles. Other causes of hyperpigmentation include the imbalance of estrogen and progesterone (catamenial hyperpigmentation), post-inflammatory changes, drug reactions, and mosaic genetic alterations.

Research Strategy

Introduction

Summary of Findings

• The researchers in this study concluded that while there may be various factors that lead to the development of melasma, a person's genetics, gender, and family history largely influence its development.
•  This study concluded that although the exact cause of melasma is unknown, genetic or hormonal factors in conjunction with UV radiation lead to the development of the condition. Particularly, the researchers concluded that sun exposure, pregnancy, and the use of oral contraceptive pills are factors that can potentially precipitate or exacerbate melasma. Additionally, some patients develop melasma as a result of the presence of autoimmune disease, especially thyroid dysfunction, in their genetic makeup.
•  This study found that individuals affected by melasma require protection from the sun irrespective of the treatment they are currently using. The researchers, through their secondary analysis, indicated that melasma patients should use a broad spectrum UVA/UVB sunscreen with at least SPF30 daily, preferably with a physical blocking agent such as zinc oxide or titanium dioxide if they want to prevent the condition from worsening.

Research Strategy

Introduction

The Causes of Rosacea and What Worsens Them

• A research study by the American Journal of Clinical Dermatology published by Springer Link on March 23, 2021, covers the new classification and phenotype-based diagnosis reflecting the pathophysiology of rosacea. According to this study, rosacea is caused by the dysregulation of innate and adaptive immune that is triggered by bacteria such as Staphylococcus epidermidis and bacillus oleronius.

• Another study published by the National Center for Biotechnology Information (NCBI) discusses the association of Demodex mites to rosacea. These bacteria are the Demodex brevis and Demodex folliculorum, which "controls" the host's immune system and induces proliferation. Over proliferation of these bacteria will then cause dry skin, pruritus, hypersensitive skin, burning sensation, and irregular or rough skin.

• A study published by Wiley Online Library on February 24, 2021, described the factors that trigger or worsen rosacea, focusing on the role of UV radiation. Patients who already have rosacea have higher levels of reactive oxygen species (ROS) which can further increase their inflammatory response.

• This study assessed the prevalence of contact sensitization to allergens in rosacea patients. The result of this study indicated that rosacea patients were more likely to have positive results in patch tests using a cosmetic series and 49 allergens.

Research Strategy:

• In Greece, 14 patients of mean age 66.93 years exhibited papulosquamous rash that was later diagnosed as psoriasis.
• Studies have shown that HIV-positive people record higher incidences of skin disorders, particularly, psoriasis.
• Researchers have increasingly revealed the association between obesity and psoriasis.

Introduction

Selected Findings

Article 1: A Study of Skin Sensitivity to Various Allergens by Skin Prick Test in Patients of Nasobronchial Allergy

• The article was published by the National Center for Biotechnology Information, U.S. National Library of Medicine.
• The article is a study of skin sensitivity to various allergens in patients with nasobronchial allergy. It was done on 2,880 skin prick tests with 60 allergens on 48 patients with nasobronchial allergy.
• "The antigens included 32 types of pollens, 14 types of fungi, 6 types of insects, 4 types of dusts, and 4 types of dander. Drop of each allergen was placed 2cm apart and then pricked with 26 gauge needle."
• The result established that the "most common offending allergens were insects (21.2%), followed by dusts (12.0%), pollens (7.8%), animal dander (3.1%), and fungi (1.3%). The common insect antigen were locust female (33.3%) followed by locust male (25%), grasshopper (20.8%), cricket (16.7%), cockroach female (16.7%) and cockroach male (14.6%). Common dust allergens were house dust, wheat dust, cotton mill and paper dust. Among pollens, Amaranthus spinosus, Argemone mexicana, Adhatoda vasica, Ailanthus and Cannabis were found to be common allergens. In animal danders common offending allergens were cow dander and dog dander. Among fungi Aspergillus fumigatus, Aspergillus flavus, Alternaria teneis and Fusarium sodani were common allergens."

Research Strategy

Summary

• The findings of the NutriNet-Sante Prospective Cohort study showed that the dietary habits of adults are directly associated with current acne.
• According to the above study, the "consumption of fatty and sugary products, sugary beverages, and milk was associated with current acne in adults."
• Another Indian study on the prevalence of acne in adults found that people aged between 25-35 years are the most likely to suffer from acne with a female preponderance.
• In the United States, around $9 billion is spent on cosmetics per year. However, a wrong choice of cosmetic products for adults that have acne can result in flareups and worse acne.

Introduction

Summary of Findings

• The results of this study indicated that acne occurs because of an increase in the production of the hormone androgen when an individual reaches puberty, which in turn causes skin pores to become clogged and trap bacteria.
• The researchers in this study found that summer and high temperatures make acne worse because high temperatures affect how sebum is secreted, which in turn exacerbates the problem. The authors also noted that chocolate, dairy products, and hyperglycemic food products such as flour can also exacerbate the condition.
• Based on the results of this study, diet and stress are aggravating factors for acne, and the authors noted that changes in lifestyle, sensitive skin, and using a full-coverage foundation tend to increase the severity of acne vulgaris.

Research Strategy

Introduction

Selected Findings

• The current overview of atopic dermatitis (AD) suggests that factors such as genetics, barrier function, immunity, irritants, cutaneous infections, and environmental determinants can aid the development of the disease.

• The causes and aggravators in the development of AD are not entirely understood. However, some factors, including defects in skin barrier function, environmental and infectious agents, and immune dysregulation, are primarily responsible for the disease.

• The top factors that exacerbate eczema are sweating, physicochemical stimuli, specific foods, and psychological stresses. Specific foods are known aggravators in children with AD, while psychological stress worsens AD in adults.

• Patients are likely to develop eczematous lesions and itching when exposed to irritants such as neutral-to-alkaline soaps, shampoos, synthetic fabrics, and wool. Aeroallergens, such as house dust mites (HDM), animal dander, and pollen, are known to aggravate AD lesions and hypersensitivity and cause enormous allergic reactions.

Research Strategy

•  Hyaluronic acid (HA) alone, or combined with agents such as lidocaine, exhibited promising efficacy in facial rejuvenation, skin elasticity and tightness, wrinkle reduction, improved aesthetic scores, and rejuvenation of tear trough.
•  Smoking and alcohol consumption were associated with increased wrinkling.
• Daily intake of fermented soymilk may reduce facial wrinkles in healthy postmenopausal women.

Selected Findings

• Myrrh is used extensively in cases of chapped, irritated, and aging skin and it improves firmness and skin elasticity. Pomegranate essential oil is a rich source of vitamin C which helps to boost the production of collagen and improve skin elasticity.
• Bel-Even® is a new product manufactured by DSM for skincare applications to rebalance the levels of cortisol in the skin, enhancing skin elasticity, barrier, and density.
• Frequent exposure to sunlight leads to reduced skin elasticity and wrinkle formation. The use of sunscreens with high SPF prevent sunburns, wrinkles, and loss of elasticity. Sunscreens should not be used as the only protection against UV radiation from the sun. It is also important to wear protective clothing, sunglasses, hat and drink water.
• Hot yoga leads to an increase in the moisture content of the stratum corneum, improved elasticity, skin moisture content, and skin texture.
• Daily supplementation with a liquid nutraceutical which contains hydrolyzed fish collagen, vitamins, antioxidants and other active ingredients can result in the improvement of skin texture and elasticity.
• The nutraceutical ELASTEN® contains 2.5 g of collagen peptides, acerola fruit extract, vitamin C, zinc, biotin, and a native vitamin E complex. It leads to the significant improvement of skin hydration, elasticity, roughness, and density.

Research Strategy

Selected Findings

• A novel two-product combination system consisting of a serum and cream with hyaluronic acid and multiple strong antioxidants was assessed in this research study to determine their effectiveness and safety in rejuvenating the neck. The results showed that the serum and cream caused the improvement of wrinkles, laxity, pigmentation, erythema, dryness, and skin texture.
• This research study evaluated the effectiveness and safety of a non-cross-linked hyaluronic acid filler combined with L-carnosine in the treatment of horizontal neck wrinkles. The results showed a positive on the treatment of neck wrinkles.
• This literature study investigated the role and effectiveness of using micro-focused ultrasound (MFU) therapy in male and female participants aged 35 to 65 years. Many patients are seeking effective and safe alternative body, neck, and facial aesthetic surgical procedures. The literature review revealed that the use of the MFU treatment plan leads to significant overall improvements in the aesthetics of sagging of the mid and lower areas of the face.
• The objective of this research was to create the first practice guidelines for the rejuvenation treatment of the face and the neck using combinations of a polycaprolactone (PCL)-based collagen stimulator, a poly-L-lactic acid (PLLA)- and a poly-glycolic acid (PLGA)-based resorbable suspension suture with a 3D-cone technology, and a cross-linked hyaluronic acid (HA), whether or not they are associated with other commonly used MIPs such as botulinum neurotoxins or energy-based devices (EBDs). The new guidelines provided general support for optimal treatment strategies.
• This pilot study was conducted to investigate whether the consumption of one avocado per day for eight weeks can reduce skin aging in healthy overweight women while assessing the physical characteristics of the skin and resistance to UVB radiation. The face, along with the neck and forearm, has different aging-related features compared with other parts of the body since it undergoes photoaging as a result of much more exposure to sunlight than other parts. The findings suggest that daily consumption of avocado may lead to improved elasticity and firmness of the facial skin of healthy women.
• This research conducted a double-blind clinical trial where the effect of drinking 1.5 to 2 liters of hydrogen-rich water every day for 12 days was investigated. The results indicated that the consumption of hydrogen-rich water has a positive impact on neck skin aging.

Research Strategy

Introduction

Findings

• This research paper states that the first-line treatment for hyperpigmentation includes topical formulations of conventional agents such as hydroquinone, kojic acid, and glycolic acid, followed by oral formulations of therapeutic agents such as tranexamic acid, melatonin, and cysteamine hydrochloride. Hydroquinone remains the current gold standard for hyperpigmentation treatment
•  Natural ingredients such as azelaic acid, aloesin, mulberry, licorice extracts, lignin peroxidase, kojic acid, niacinamide, ellagic acid, arbutin, green tea, turmeric, soy, and ascorbic acid have been shown to be effective in the treatment of hyperpigmentation.

•  This paper notes that once the inflammation is controlled, the mainstays of treatment for Postinflammatory hyperpigmentation (PIH) are time and sun protection. Sunscreen and avoiding sunlight and wind are critical to decreasing the incidence of hyperpigmentation. In addition, irritants that can worsen hyperpigmentation should be avoided. Exposure to UV, medications such as minocycline, infectious agents, and cutaneous injury can all aggravate this condition.
• Sunscreen with both UV + VL protection is an important adjuvant therapy to prevent the worsening of hyperpigmentation and to improve the appearance of these conditions. The study findings show that sunscreen use can improve outcomes in PIH and that higher SPF sunscreens may be more effective.

• According to this research, vitamin B12 deficiency is one of the most underdiagnosed causes of hyperpigmentation. Patients with B12 levels below 200 pg/ml are considered deficient. The prevalence of B12 deficiency varies from 3-5% in the general population and 5- 20% among people older than 65 years.  
• This review shows that Hyperpigmentation is an early and reversible sign of vitamin B12 deficiency, which must be promptly recognized and corrected.

Introduction

Findings

• According to research, although concerns relating to its side effects remain, Hydroquinone alone or in combination remains the most effective treatment for Melasma. The most recommended formula among triple combination creams is the Kligman and Willis formula (5% HQ, 0.1% dexamethasone, and 0.1% tretinoin). Other agents that have shown good results include niacinamide, azelaic acid, glycolic acid ,corticosteroid, tretinoin, kojid acid, and vitamin C.
• From a historical perspective, commonly used agents for the treatment of melasma include hydroquinone, azelaic acid, kojic acid, glycolic acid, salicylic acid, and tretinoin. Out of these, hydroquinone remains the gold standard. Hydroquinone inhibits tyrosinase, which is the rate-limiting enzyme for pigment production.

• The current recommendation is that patients use a broad-spectrum UVA/UVB sunscreen with at least SPF30 daily, preferably with a physical blocking agent such as zinc oxide or titani um dioxide. Other behavioral changes include wearing wide-brimmed hats and avoiding peak sunlight hours.
• Sunbathing is to be strictly avoided, as a few minutes of sunbathing can reverse the benefits of months of therapy. Sunscreens must be applied daily, during and after the treatment, throughout the sunny months of the year for an indefinite period. It is mandatory to use of mineral sunscreens containing titanium dioxide or zinc oxide, with a sun protection factor (SPF) of 30 or higher.

• This study shows that the novel oral nutritional dietary supplement containing Pinus pinaster bark extract, Grape seed extract, vitamins and minerals is an effective treatment option for mild to moderate facial melasma in combination with high SPF sunscreen.
• According to Iranian traditional medicine, the consumption of foods such as water peas, grape juice, rice milk, almond porridge, lamb meat as well as soda-extracting herbal medicines such as Curainia Sophia, Fumitory, Polypodium vulgare, Aftimon, and Terminalia Chebula can reduce Melasma. In addition, avoiding soda-producing food including eggplant, over-consumption of dates, cow’s meat, salted food, and fast food can help to reduce Melasma and lighten the skin as well as cure hyperpigmented areas.

RESEARCH STRATEGY

Selected Findings

• A scientific article that gave insights on the skincare ingredients that benefit this issue is "Evidence of Barrier Deficiency in Rosacea and the Importance of Integrating OTC Skincare Products into Treatment Regimens."
• A scientific article that gave insights on the other lifestyle changes that should improve this issue is "Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee"
• A scientific article that gave insights on the dietary or nutritional changes that should improve this issue is "Rosacea and Diet: What is New in 2021?"

Research Strategy

Selected Findings

Skincare Ingredients For Psoriasis

• According to the study, skincare ingredients such as aloe vera, vitamin D3, vitamin A, vitamin E, vitamin C, and vitamin B5 can aid in the treatment of psoriasis. Because synthesized Vitamin D3 suppresses the immune system, it can be used in the topical treatment of psoriasis to inhibit cell proliferation, according to the study.
• Vitamin A and retinoic acid influence the proliferation and differentiation of epithelia keratin, as well as the regulation of its disturbances in autoimmune diseases like psoriasis. Vitamin B5 is necessary for carbohydrate, fat, and protein metabolism and can aid in the treatment of wounds and psoriasis lesions.
• Vitamin E is an antioxidant that can prevent tissue destruction caused by free radicals, making it useful in the treatment of psoriasis. Vitamin C is an antioxidant that aids in the renewal of vitamin E. The gel from aloe vera plant was also found to help reduce the redness and scaling associated with psoriasis, according to the study.

Research Strategy

Introduction

Some Findings

• Researchers in a global study concluded that fatigue, female hormonal status, food, and sleep disorders are associated with sensitive skin. This suggests that making changes that will help decrease fatigue, improve sleep disorder, better nutritional choices, among others, may help improve skin sensitivity.
• Chinese researchers determined in a study that "having a combination of oily skin type, living in the municipalities, being under heavy stress, and applying several cosmetic products will increase skin stress and contribute to the occurrence of sensitive skin."
• A study found that pimecrolimus may quickly inhibit or ameliorate burning or itch sensation in patients with sensitive skin. Pimecrolimus therapeutic effect is based on "the mechanisms that activate or sensitize transient receptor potential vanilloid 1 (TRPV1) and desensitizes TRPV1 in the skin sensory afferents."

Research Strategy

Selected Findings

• A scientific article that gave insights on the skincare ingredients that benefit this issue is "Clinical study to assess efficacy and safety of Purifying Neem Face Wash in prevention and reduction of acne in healthy adults."
• A scientific article that gave insights on the other lifestyle changes that should improve this issue is "Acne and its association with modifiable factors amongst young adults of Islamabad- A cross-sectional study."
• A scientific article that gave insights on the dietary or nutritional changes that should improve this issue is "Effects of Diet on Acne and Its Response to Treatment."

Research Strategy

Introduction

Selected Findings

• Salicylic acid was found to be a safe and effective treatment for acne in a wide variety of skin types, per a study in the Clinical, Cosmetic and Investigational Dermatology.
• Teenagers can benefit from improving their sleep habits, exercising, or taking up a hobby, per a recent study from India.
• Dietary changes that reduce the intake of simple and refined carbohydrates are recommended, per the same study from India.

Key Takeaways

• Skincare ingredients that benefit eczema include colloidal oatmeal and hydrocortisone.
• Emollient use prevents eczema development by 50%.
• Poor sleep in children contributes to poor skin barrier recovery and worse a eczema outcome.

Introduction

Findings

• Eczema can be prevented in infants living in a community by using an emollient from birth.
• Emollient use prevents eczema development by 50%.
• Moisturizers are alleviating measures for the dry skin associated with eczema. Skincare ingredients that benefit eczema include colloidal oatmeal and hydrocortisone.
•  Dairy diet elimination can improve eczema symptoms and outcome.
• Taking GLA diet supplements serve as an additional treatment for less severe forms of eczema.

Research Strategy

Selected Findings

Effects of Weather Change

• Title: "Changes in filaggrin degradation products and corneocyte surface texture by season".
• The effect of season on NMF levels and corneocyte surface texture in healthy adults' cheek and hand skin is the subject of this study. The participants in this study were 80 healthy volunteers, 40 men and 40 women, half of whom were between the ages of 18 and 40 and the other half between the ages of 70 and 80.
• In both the winter and summer, researchers taped volunteers' cheek and dorsal hand skin to examine natural moisturizing factors (NMF) and corneocyte surface texture (Dermal Texture Index, DTI). They then noticed, under high magnification, that skin cells shrank in the winter, changing the surface texture and raising DTI levels. The results also revealed that during the winter, NMF levels in cheek skin samples were lower. NMF levels were higher in older participants than in younger participants.
• NMF levels were higher in the winter than in the summer in the hand skin samples, with female participants experiencing higher levels overall than their male counterparts. Seasonal effects on NMF and DTI on the cheeks and hands suggest a biochemical and ultrastructural influence of climatic factors.

Lifestyle Factors

• Title: "Lifestyle Factors and Visible Skin Aging in a Population of Japanese Elders"
• The objective of this study was to see if there was a link between lifestyle factors and visible skin aging. The participants in the study were 802 community-dwelling Japanese men and women aged 65 and up who lived in Kurabuchi. A standardized facial imaging system and subsequent computer image analysis were used to assess the subjects' facial skin condition quantitatively.
• A structured questionnaire was used to gather information about people's lifestyles. Multivariable regression analysis was used to investigate the relationship between skin condition and lifestyle factors. The study found that the mean values for facial texture, hyperpigmentation, and pores among women were found to be lower than those of age-matched men.
• The study also discovered that as women got older, their skin conditions deteriorated. Smoking status and use of topical sun protection were both linked to signs of visible skin aging. The findings of this study suggest that changes in modifiable lifestyle factors like smoking and sunscreen use can help to maintain good skin condition to some extent.

Research Strategy

Introduction

Select Findings

How Changes in Seasons Affect Skin Elasticity

Article Title: Seasonal variations in the skin parameters of Caucasian women from Central Europe

• This study was conducted to understand the impact of seasonal changes, environmental, relative and absolute humidity on the skin parameters of Caucasian women from the Czech Republic.
• The study included reviewing existing literature, measuring key skin parameters in different seasons, and discussing the possible factors behind the changes.
• The study authors "measured stratum corneum (SC) hydration, transepidermal water loss (TEWL), sebum level, erythema index, and elasticity parameters R2 and R7 on the forehead and the cheek of Caucasian women from the Czech Republic throughout the year."
• They found out that during winter, the skin had SC hydration and sebum production. During spring, they "found the lowest TEWL (on the forehead) and the highest SC hydration but also the highest erythema index and the lowest elasticity presumably indicating skin photodamage."
• The authors concluded that seasonal changes in the skin parameters still show considerable inconsistencies, and there was a need for further studies to better understand how skin parameters change throughout the year.

Article Title: Effect of seasonal change on the biomechanical and physical properties of the human skin

• In this study, researchers conducted an in vivo investigation on how the transition of seasons from winter to summer affects the mechanical and physical properties of the human skin.
• The study participants were healthy volunteers aged between 22 and 42 years. 
• The study found that trans-epidermal water loss (TEWL) decreased by 22.15%, and average epidermal roughness (AER) decreased by 34.29% with the seasonal transition from winter to summer. In addition, there was a 25.48% increase in average epidermal hydration (AEH), a 22.59% increase in skin thickness, a 38.64% rise in melanin, a 21.92% increase in redness, "an 8.25% rise in its firmness and 23.14% increase in elasticity when strained with uniaxial deformations."
• The skin firmness was observed to be directly proportional to TWEL and inversely proportional to skin hydration, "where these relationships were stronger in summer than in winter." The study also found that the "winter season displayed lower skin firmness and elasticity of 0.37 mm and 0.04 mm compared to 0.40 mm and 0.06 mm in summer accordingly."

Research Strategy

Introduction

Some Findings

• A study to evaluate the safety and efficacy of "a novel two product combination system composed of a serum and cream with hyaluronic acid and multiple strong antioxidants" in the rejuvenation of the neck skin found that "both active and placebo cream and serum showed improvement of wrinkles, laxity, pigmentation, erythema, dryness, and texture of the skin, and high patient satisfaction scores."
• A study found that "consumption of hydrogen-rich water has a positive effect on neck skin aging."
• A research paper identifies chloracnegens as an environmental pollutant that affects the neck, causing chloracne. Chloracne "is a systemic toxic disease caused by exposure to chloracnegens (halogenated aromatic hydrocarbons). It is characterized by acneiform skin lesions such as comedones and cysts mainly on the face (outer sides of the eye and behind the ears) and neck."

Research Strategy

Selected Findings

• The Role of Sunscreen in Melasma and Postinflammatory Hyperpigmentation. 
•  Chloracne and Hyperpigmentation Caused by Exposure to Hazardous Aryl Hydrocarbon Receptor Ligands.
• Oxidative stress in the skin: Impact and related protection.

Research Strategy

Selected Findings

• A scientific article that gave insights on how changes in seasons or the weather affect melasma is "Epidemiological Profile of Patients with Skin Diseases in a Tertiary Hospital in Kathmandu, Nepal: A Cross-Sectional Retrospective Study."
• A scientific article that gave insights on how other lifestyle factors affect melasma is "Melasma show up in contraceptive pills acceptors."
• A scientific paper that gave insights on how environmental factors affect melasma includes "Chinese women with melasma exhibit a low minimal erythema dose to both UVA and UVB."

Research Strategy

Selected Findings

Lifestyle Effects

• Title: "Diet and rosacea: the role of dietary change in the management of rosacea"

• The research looked at the impact of dietary changes on rosacea. The findings also point to a link between gut-skin and rosacea. Certain foods and beverages were mentioned by patients to as rosacea triggers.
• The four types of rosacea triggers reported by the patients in this study are heat, alcohol, capsaicin, and cinnamaldehyde. One possible pathogenic mechanism is the activation of transient receptor potential cation channels, which results in neurogenic vasodilation.
• Diet may also affect rosacea via a gut-skin connection, according to the study, but more research is needed to fully establish this link. Patients with rosacea have a higher prevalence of gastrointestinal disease according to epidemiological studies.
• One study found that rosacea improved after successful treatment of small intestinal bacterial overgrowth. While more research is being conducted on this topic, patients are advised to take steps to support a healthy gut microbiome, such as eating a fiber-rich diet.

Environmental Effects

• Title: "Impact of ultraviolet radiation and exposome on rosacea: Key role of photoprotection in optimizing treatment"

• The role of UV radiation and exposome in rosacea initiation is the focus of this research. The study also discusses the importance of non-pharmacologic photoprotection strategies. UV radiation and the exposome both play a role in the development of rosacea, according to the study.
•  Environmental factors like various microorganisms, air pollution, and psychological stress have also been shown to trigger or worsen rosacea. UV exposure has been linked to pro-inflammatory, pro-angiogenic, and pro-fibrotic responses. The single most important environmental variable is lifetime UV radiation exposure, which has been shown to be significantly associated with the presence of rosacea.
•  The use of sunscreens with emollient, anti-inflammatory, and/or vasoregulatory properties has been shown to improve symptomatology significantly. In addition to providing the required level of photoprotection, properly formulated sunscreens may also help to mitigate barrier dysfunction, neutralize facial redness (tinted sunscreens), and reduce inflammation and vascular dysfunction.

Research Strategy

Selected Findings

• A scientific article that gave insights on how changes in seasons or the weather affect psoriasis is "Psoriasis and seasonal variation: A systematic review on reports from Northern and Central Europe—Little overall variation but distinctive subsets with improvement in summer or wintertime."
• A scientific article that gave insights on how other lifestyle factors affect psoriasis is "Increased Skin Clearance and Quality of Life Improvement with Brodalumab Compared with Ustekinumab in Psoriasis Patients with Aggravating Lifestyle Factors."
• A scientific article that gave insights on how environmental factors affect psoriasis includes "Environmental risk factors and epigenetic alternations in psoriasis."

Research Strategy

Introduction

Selected Findings

• The following study on how seasons affect skin sensitivity was published on PubMed.
• The researchers interviewed more than 1000 people aged 15 years or older. These interviews revolved around how their skins are influenced during different seasons.
• The findings revealed that people with sensitive skins were more numerous in summer than in winter. The female population experienced more sensitivity than their male counterparts.

Research Strategy

Key Takeaways

• Adult acne is prevalent among women.
• Adult acne is more aggravated in the summer (36.4%) and least in the winter (1.4%).
• Certain foods such as milk, sugary, and fatty foods are consistent with adult acne.

Introduction

• The requested publications and summaries for adult acne are provided in rows 43-46 and columns M-R of the attached spreadsheet. Some brief findings are provided below.

Findings

• Adult acne is more aggravated in the summer (36.4%) and least in the winter (1.4%). This data confirms that seasonal changes affect acne, worsening in the summer.
• Ambient exposure to nitrogen dioxide at high levels is responsible for inflammatory acne in Lebanese adults.
• Adult acne is prevalent among women.
• Sunlight is often beneficial to acne. However, specific therapies like psoralen and ultraviolet A could make it worse
• Certain foods such as milk, sugary, and fatty foods are consistent with adult acne.

Research Strategy

Introduction

Selected Findings

• The research paper titled "Evaluation of acne severity and its impact on young adults" has discussed how hot weather has led to the worsening of acne lesions among students aged 18-22 years in Malaysia.
• The research paper titled "The association between short-term air pollution exposure and post-adolescent acne: the evidence from a time series analysis in Xi’an, China" has discussed how air pollution, especially the increased SO2, NO2, and PM10 concentration, has resulted in increased post-adolescent acne outpatient visits in Xi’an, China.
• In a study titled "Adolescents’ beliefs and perceptions of acne vulgaris: a cross-sectional study in Montenegrin schoolchildren," school students in Montenegro said that improper lifestyle choices like inadequate face washing, consumption of sweets and greasy food, stress, and makeup use can lead to the aggravation of acne.

Research Strategy

Introduction

Selected Findings

• Articles on how changes in seasons or the weather affect eczema include "Children with atopic eczema experiencing increased disease severity in the pollen season more often have hay fever at a young age and a dark skin type" and "Impact of Absolute Humidity and Temperature on Eczema."
• Articles on how other environmental factors affect eczema include "Atopic eczema is an environmental disease" and "NO2 exposure increases eczema outpatient visits in Guangzhou, China: an indication for hospital management."

Research Strategy

Introduction

Selected Findings

• Name of article: "Dietary water affects human skin hydration and biomechanics"
• Extended summary:

• Past studies have proven that high cutaneous water content plays a role in different skin functions. However, a direct relationship with dietary water has never been established. Study investigators maintained that the consumption of dietary water benefits the skin. Therefore, they set out to establish a connection between skin health and consumption of dietary water.

• They conducted a survey in which they measured the total water intake in a sample of 49 healthy females using a validated Food Frequency Questionnaire (FFQ). The properties examined included the water produced by regular metabolism, the water they drink, and the water content of their dietary nutrients.

• In this way, a deeper look could be made into the impact of dietary water on normal skin physiology. The study concluded that a high-water intake among individuals with low daily consumption is advisable to improve their normal skin physiology.

Research Strategy

Introduction

Selected Findings

• The human skin does not adapt quickly to new climate conditions and it often requires an adjustment period. When moving to geographic zones with cold temperatures, oils and serums are recommended to keep the skin supple and dewy. In hot weather conditions, face wash can help keep acne away.
• Airline travelers are more prone to skin tightness and itchiness. These observations stem from dehydration of the stratum corneum as skin capacitance decreases rapidly on the face and forearms when on a flight.
• According to a report by Cancer.Org, passengers cannot get sunburnt on commercial airline flights. However, pilots and cabin crew members have twice the rate of Melanoma compared to the general population. The development of Melanoma and other skin cancers is fueled by excessive exposure to UV radiation.
• Research has proven that factors including emotional stress, psychological stress, and intense anger tend to aggravate the severity of acne. However, contradictory studies state that stress is not directly linked to acne. Rather, the tolerance level for stress and coping mechanisms are the causes of acne.
• Blue light destroys the collagen in the skin through oxidative stress. This damage happens when Elvin in the skin absorbs blue light, and unstable oxygen molecules are produced. These molecules can damage the skin, poking holes in the collagen.

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Summary of Findings

Row 64: Smoking and skin disease.

• Tobacco smoking is seen as a preventable and serious health hazard that can increase diseases and shorten life expectancy. However, smoking's role as an etiologic factor in the development of skin diseases is not widely known. Even though epidemiological evidence is rare, the findings suggest that tobacco smoking contributes to "systemic lupus erythematosus, psoriasis, palmoplantar pustulosis, cutaneous squamous cell carcinoma, hidradenitis suppurativa, and genital warts."
• On the other hand, smoking can conder protective effects and prevent other diseases such as "pemphigus vulgaris, pyoderma gangrenosum, aphthous ulcers, and Behçet's disease." Several degenerative dermatologic conditions are affected by smoking, like dysregulated wound healing and skin wrinkling. This can lead to post-surgical complications and arrested or delayed healing of chronic wounds. Most likely, the alteration of extracellular matrix turnover and inflammatory cell function as a result of smoking-induced oxidative stress are part of the pathophysiologic mechanisms.

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Key Findings

• This study found that (1) Compounds from beauty products last on the skin for weeks after their first use despite daily showering. (2) Beauty products alter molecular and bacterial diversity as well as the dynamic and structure of molecules and bacteria on the skin. (3) Molecular and bacterial temporal variability is product, site, and person-specific, and changes are observed starting the first week of beauty product use.
•  Beauty products used for cosmetic purposes can have adverse effects to human health due to the fact that they contain lead, a highly toxic metal.
•  The health risk associated with the use of cosmetics ranges from a simple mild hypersensitivity reaction to an anaphylactic process or even a lethal intoxication. There is also the risk of cancer.
• The skin, especially the face, is highly sensitive, and the incidence of adverse reactions to cosmetics and toiletries is high. The symptoms can be visible irritations such as erythema and desquamation and also be subjective discomforts such as tingling, burning, itching, and tightness.
• The study showed that there were significant differences in skin chromophores between Chinese women living in two cities with different levels of pollution.
• Although human skin acts as a biological shield against pro-oxidative chemicals and physical air pollutants, prolonged or repetitive exposure to high levels of these pollutants may have profound negative effects on the skin. Exposure to ultraviolet radiation has been associated with extrinsic skin aging and skin cancers.
• The household environment is a wide source of indoor air pollutants. The concentration of VOCs and SVOCs – emanating from household products and combustion of fuel used for cooking, heating and lighting has been found to be higher indoors than outdoors.
•  Acne, hyper-pigmentation, atopic dermatitis, and psoriasis have been shown to be influenced by air pollution.
•  Particulate matter (PM) was shown to induce a skin barrier dysfunction and provoke the formation of reactive oxygen species through direct and indirect mechanisms, leading to oxidative stress and induced activation of the inflammatory cascade in human skin. Moreover, a positive correlation was reported between extrinsic aging and atopic eczema relative risk with increasing particulate matter exposure.
•  Major air pollutants with effects on the skin include the solar UVR (ultraviolet radiation), PAHs (polycyclic aromatic hydrocarbons), VOCs (volatile organic compounds), NOx, PM (particulate matter), O3 (ozone), and cigarette smoke.
•  A review of evidence around major climate conditions on skin integrity and function found that under dry conditions, surface roughness increases, while conductance decreases, indicating increased skin dryness.
•   The thermal neutral temperature predicted by the PMV (predictive mean vote) method is 2.7°C lower than that predicted by the TSV (thermal sensation vote) method, indicating thermal comfort range recommended by the popular HVAC design standards should be updated to fit older people's needs.
• Low humidity and low temperatures lead to a general decrease in skin barrier function and increased susceptible towards mechanical stress.
•  The study has concluded that both temperature and humidity have a contributing role in pathogenesis of acne.
• Results of the study showed that there was a drastic decrease in the environmental humidity reduced the total free amino acid generation and consequently induced skin surface dryness in the stratum corneum.

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Row 101: Solar UV radiation reduces the barrier function of human skin

• The article acknowledges that the presence of solar UV radiation in human life is crucial for vitamin D production. However, it also leads to damage, photoaging, and malignancies. The authors state that the effects of UV on the mechanical barrier function of the outermost layer of the epidermis, the stratum corneum (SC), are not fully understood. Altering SC's mechanical properties can create severe macroscopic skin damage like cracking, chapping, infection, and scarring.

• The study shows that UV exposure has serious impacts on mechanical integrity and cell cohesion related to its effects on the stratum corneum's intercellular components, including the corneodesmosomes and intercellular lipids.
• The study finds that even though the keratin-controlled stiffness stayed constant with UV exposure, the intercellular cohesion, strain, and strength decreased significantly. It also shows that solar UV radiation creates a double threat to the skin. This happens by increasing the biomechanical driving force for damage while at the same time, decreasing the skin's natural ability to resist UV rays, affecting the critical barrier role of the skin.

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Research Strategy:

Introduction

Summary of Findings

Row 130: Altitude Increases Sunburn Risk

• The article states that altitude increases sunburn risk. A researcher from the Department of Dermatology at the New York University School of Medicine found that the direct UV-B levels at 8,500 feet in Vail, Colorado were 60% higher than at sea level in New York.
• The direct UV-B levels in Vail were also similar to those in Orlando, a site 775 miles closer to the equator. This intensity of UV-B exposure shows that a person with an "average complexion and unprotected skin would burn after six minutes of sun exposure on a clear day at noon in Vail, Colorado at 11,000 feet above sea level."
• The same person would also get sunburned after 25 minutes of exposure at noon in New York or 14 minutes of unprotected exposure in Orlando. With the rising exposure to UV-B, the expected yearly non-melanoma skin cancer rate for year-round residents at 8,500 feet is approximately 155% more than those living at sea level at the same latitude. Melanoma rates are also higher at increasing altitudes. The conclusion of the article is that everyone in high-altitude areas should wear protective clothing, wear sunscreen daily, and avoid the strongest mid-day sun as per the American Academy of Dermatology.

Research Strategy