Anna L. Chien

Background/Objectives: Oxidative stress plays a pivotal role in skin aging and carcinogenesis. Phytochemicals such as sulforaphane (SF, from broccoli sprouts or seeds) or curcumin (CUR, from turmeric) can be highly protective against this stress. They each induce a suite of cytoprotective and antioxidant enzymes that are coordinately transcribed via the Keap1-Nrf2-ARE pathway in mammals, such as the prototypical cytoprotective enzyme NAD(P)H dehydrogenase 1 (NQO1). Methods: Eighteen healthy human volunteers (9 males, 9 females, aged 18–69. were randomized to receive daily glucoraphanin (GR), which is converted to SF upon ingestion (450 mg; 1 mmol), CUR (1000 mg; 2.7 mmol), or both (450 mg GR + 1000 mg CUR), as oral supplements. After 8 days of a diet low in both compounds, blood and urine were collected for compliance and biomarker measurements. Randomized spots on the buttock’s skin were exposed to 2 x M.E.D. of UVB, and punch biopsies were obtained 1 and 3 days later for biomarker and histological measurement. Erythema was measured with a chromameter daily for 3 consecutive days following UVB. The process was repeated after receiving oral supplements, both with and without UVB exposure. Results: Compared to baseline, each treatment (n = 6 for each) induced NQO1 mRNA levels in skin biopsies: 3.1-fold with GR, 3.3-fold with CUR, and 3.6-fold with the combination of GR and CUR. Across all treatments (n = 18), expression of the pro-inflammatory cytokines IL-1β and TNF-α were reduced, as were IL-6, IL-17, STING, and CYR61, though less robustly. Modulation of these biomarkers persisted, but was less pronounced, in biopsies taken following UV exposure. The presence of SF and its metabolites in the skin post-treatment was confirmed by examining 6 of 12 subjects who ingested GR. Supplement effects on erythema following UV exposure were not significant, and no significant changes were measured in the same biomarkers in blood cells (PBMC), or by counting dyskeratotic keratinocytes. Supplements were well tolerated and compliance was excellent. Conclusions: Oral GR and CUR are well tolerated and have for the first time been shown to result in increased expression of cytoprotective genes and reduced expression of inflammatory cytokine genes in human skin in vivo. This mechanism-based clinical study suggests that an antioxidant, anti-inflammatory, and cytoprotective benefit from these oral supplements is delivered to the skin in humans.

Photoaging is the consequence of chronic exposure to solar irradiation, encompassing ultraviolet (UV), visible, and infrared wavelengths. Over time, this exposure causes cumulative damage, leading to both aesthetic changes and structural degradation of the skin. These effects manifest as rhytids, dyschromia, textural changes, elastosis, volume loss, telangiectasias, and hyperkeratosis, collectively contributing to a prematurely aged appearance that exceeds the skin’s chronological age. The hallmarks of photoaging vary significantly by skin phototype. Skin of color tends to exhibit dyschromia and features associated with “intrinsic” aging, such as volume loss, while white skin is more prone to “extrinsic” aging characteristics, including rhytids and elastosis. Moreover, susceptibility to different wavelengths within the electromagnetic spectrum also differs by skin phototype, influencing the clinical presentation of photoaging, as well as prevention and treatment strategies. Fortunately, photoaging—and its associated adverse effects—is largely preventable and, to some extent, reversible. However, effective prevention and treatment strategies require careful tailoring to an individual’s skin type. In this review, we summarize molecular mechanisms underlying photoaging, examine its clinical manifestations, outline risk factors and prevention strategies, and highlight recent advancements in its treatment.

Rosacea is a chronic inflammatory skin condition that is often more severe in older patients. The main clinical features are erythema, telangiectasia, and inflammatory lesions of the face. The pathogenesis of this condition is not fully understood but certainly multifaceted. Immune and inflammatory dysregulation, genetics, neurogenic dysregulation, microbiome dysbiosis, and systemic disease have all been implicated in rosacea pathogenesis. As we better understand the various pathways that lead to rosacea, we acknowledge that the different symptoms may have unique underlying triggers and mechanisms. Aging also impacts rosacea diagnosis and treatment. Older adults have more severe rosacea symptoms while also having more sensitive and fragile skin than younger patients; therefore, rosacea treatments for older patients require a balance between delivering adequate potency while also minimizing skin irritation and other adverse effects. Until recently, rosacea diagnoses were based on concrete subtypes that did not necessarily capture each patient’s manifestation of rosacea. There is now an emphasis on more personalized phenotype-based diagnoses and treatments, which allows for more emphasis on treating individual symptoms and accounting for the unique characteristics of older patients. Centrofacial erythema is best treated with brimonidine and oxymetazoline, while phymatous change and telangiectasia are best treated with surgery and laser ablation. Treatment for rosacea papules and pustules ranges from topicals, such as azelaic acid, ivermectin, metronidazole, minocycline, and encapsulated benzoyl peroxide, to systemics, such as doxycycline and isotretinoin. It is important to understand these treatments in relation to adverse effects and drug interactions that may specifically arise in older populations to provide optimal care. As we advance in understanding rosacea's pathogenesis and adopt personalized phenotype-based approaches, optimizing care for older patients becomes crucial. Continued research into novel treatments is essential to address their unique needs.

Skin of color (SOC) is characterized by increased tendency for tanning and decreased likelihood of sunburns due to the attenuation of sunlight by epidermal melanin. Although this contributes to the decreased incidence of skin cancer among SOC populations, individuals with SOC remain susceptible to various health consequences associated with sun exposure, including non-melanoma skin cancer, photoaging, pigmentary disorders, and photodermatoses — many of which not only present differently, but also disproportionately affect SOC. Prior epidemiological studies have found lower prevalence of sun protection behaviors among individuals with SOC, particularly in sunscreen use, signifying an unmet area for improvement in the prevention of sun-induced dermatologic conditions in these populations. The objective of this narrative review was to summarize the biology and health consequences of sun exposure in SOC, as well as cognitive and behavioral factors that affect the practice of photoprotection behaviors in SOC populations. We also review prior interventions that have been used to enhance photoprotection knowledge and behaviors among individuals with SOC, either in racially and ethnically diverse communities or within specific SOC populations.

Rosacea is a chronic inflammatory skin disorder that causes visible blood vessels and redness on the nose, chin, cheeks, and forehead. However, visual assessment, the current standard method used to identify rosacea, is often subjective among clinicians and results in high variation. Recent advances in artificial intelligence have allowed for the effective detection of various skin diseases with high accuracy and consistency. In this study, we develop a new methodology, coined “five accurate CNNs-based evaluation system (FACES)”, to identify and classify rosacea more efficiently. First, 19 CNN-based models that have been widely used for image classification were trained and tested via training and validation data sets. Next, the five best performing models were selected based on accuracy, which served as a weight value for FACES. At the same time, we also applied a majority rule to five selected models to detect rosacea. The results exhibited that the performance of FACES was superior to that of the five individual CNN-based models and the majority rule in terms of accuracy, sensitivity, specificity, and precision. In particular, the accuracy and sensitivity of FACES were the highest, and the specificity and precision were higher than most of the individual models. To improve the performance of our system, future studies must consider patient details, such as age, gender, and race, and perform comparison tests between our model system and clinicians.

Photoageing describes complex cutaneous changes that occur over time due to chronic exposure to solar radiation. All-trans retinoic acid (RA) is | POSTER

Background: Visible light (VL) is known to induce pigmentation in dark‐skinned individuals and immediate erythema in light‐skinned individuals. However, the effects of accumulated low‐dose VL exposure across skin types are not well established.Methods: Thirty‐one healthy subjects with light (Fitzpatrick skin types [FST] I‐II, n = 13) and dark (FST V‐VI, n = 18) skin types were enrolled. Subjects' buttocks were exposed daily to VL, wavelength 400–700 nm, with a dose of 120 J/cm² at 50 mW/cm², for four consecutive days. Microarray using Affymetrix GeneChip (49,395 genes) was performed followed by qRT‐PCR on skin samples.Results: Repeated low‐dose VL irradiation induced immediate pigment darkening and delayed tanning in dark‐skinned individuals while no discernable pigmentation and erythema were observed in light‐skinned individuals. Top ten upregulated genes by repeated VL exposure in microarray included melanogenic genes such as tyrosinase (TYR), tyrosinase‐related protein‐1 (TYRP1), dopachrome tautomerase (DCT), premelanosome protein (PMEL), melan‐A (MLANA), and solute carrier family 24, member 5 (SLC24A5) and genes involved in inflammation/matrix remodeling/cell signaling including chemokine (C‐C motif) ligand 18 (CCL18), BCL2‐related protein A1 (BCL2A1), and cartilage oligomeric matrix protein (COMP). In qRT‐PCR CCL18 was upregulated in light skin with a greater extent (mean fold change ± SD; 4.03 ± 3.28, p = .04) than in dark‐skinned individuals (1.91 ± 1.32, p = .07) while TYR was not significantly upregulated in both skin types.Conclusion: This study highlights the genes upregulated by cumulative VL exposure involved in pigmentation, immune response, oxidation/reduction, and matrix remodeling across skin types providing relevant information on daily solar exposure.

Retinoids are broadly accepted as the criterion standard for topical management of photodamage—improving the fine wrinkles and dyspigmentation characteristic of photoaged skin.^1-4 One of the major deterrents to their topical use, however, is the associated local skin irritation, such as erythema, pruritus, stinging, burning, and scaling.^5,6 In light of these toxic effects, efforts have been made to study the efficacy and tolerability of alternative forms of topical retinoids, particularly natural precursors of tretinoin, the bioactive metabolite of vitamin A. One such precursor is retinol, which generates tretinoin through sequential oxidation. Retinol can also be esterified with fatty acids and subsequently stored as retinyl esters like retinyl acetate and retinyl palmitate.⁷ Cosmeceutical products containing retinol and retinyl esters are widely available over the counter and may provide comparable efficacy as prescription-grade tretinoin.^8,9