Carina Trojahn

Relation between skin micro-topography, roughness, and skin age.

The topography of the skin surface consists of lines, wrinkles, and scales. Primary and secondary lines form a network like structure that may be identified as polygons. Skin surface roughness measurements are widely applied in dermatological research and practice but the relation between roughness parameters and their anatomical equivalents are unclear. This study aimed to investigate whether the number of closed polygons (NCP) per measurement field can be used as a reliable parameter to measure skin surface topography. For this purpose, we analysed the relation between skin surface roughness parameters and NCP in different age groups.

Measuring skin aging using optical coherence tomography in vivo: a validation study

Abstract. Dermal and epidermal structures in human skin change during intrinsic and extrinsic aging. Epidermal thickness is one of the most often reported parameters for the assessment of skin aging in cross-sectional images captured by optical coherence tomography (OCT). We aimed to identify further parameters for the noninvasive measurement of skin aging of sun-exposed and sun-protected areas utilizing OCT. Based on a literature review, seven parameters were inductively developed. Three independent raters assessed these parameters using four-point scales on images of female subjects of two age groups. All items could be detected and quantified in our sample. Interrater agreement ranged between 25.0% and 83.3%. The item scores “stratum corneum reflectivity,” “upper dermal reflectivity,” and “dermoepidermal contrast” showed significant differences between age groups on the volar and dorsal forearm indicating that they were best able to measure changes during skin aging. “Surface unevenness” was associated with the skin roughness parameters, Rz and Rmax, on the inner upper arm and volar forearm supporting the criterion validity of this parameter on sun-protected skin areas. Based on the interrater agreement and the ability to differentiate between age groups, these four parameters are being considered as the best candidates for measuring skin aging in OCT images.

Reliability and validity of two in vivo measurements for skin surface topography in aged adults.

The non‐contact optical methods phaseshift rapid in vivo measurement of skin (PRIMOS) and surface evaluation of living skin (SELS) are widely applied for measuring skin surface topography. The aims of the present study were to evaluate reliability and validity of these methods and to compare skin roughness intraindividually.

A multi-center prevalence study and randomized controlled parallel-group pragmatic trial to compare the effectiveness of standardized skin care regimens on skin health in nursing home residents: A study protocol

BACKGROUND Aged long-term residents suffer from a wide range of skin problems. Dry skin associated with severe pruritus, scratching and inflammation is the most prevalent, but exact figures are lacking. Maintaining skin and tissue health as well as enhancing the quality of life are major goals in institutional long-term care. Using mild and moisturizing skin care products is considered to improve the skin barrier and to reduce adverse events. However, the available evidence supporting particular skin care approaches is limited. OBJECTIVE This study aims at answering two general questions: (1) What is the prevalence of skin conditions and skin diseases in aged nursing home residents and how are they associated with general person and health related characteristics? (2) Does a structured skin care regimen improve the skin health of aged nursing home residents? DESIGN AND METHODS Using a random sample of all nursing homes of the state of Berlin, residents of seven institutions will undergo nursing, medical, and dermatological assessments. Biophysical skin parameters like transepidermal water loss or skin surface pH will be measured. Residents with dry skin will be included in a three arm randomized pragmatic trial investigating the effectiveness of two standardized skin care regimens compared to usual care. The primary outcome will be the Overall Dry Skin score. The follow-up period will be two months. SETTINGS Institutional long-term care facilities in Berlin, Germany. PARTICIPANTS Long-term care residents being 65+ years who gave their informed consent. SAMPLE SIZE AND STATISTICAL METHODS Due to the explorative nature of this study a formal sample size analysis is not possible. The expected sample size in the first part of the study is considered sufficiently large (n=280) to obtain precise point estimates. It is planned to allocate n=50 eligible nursing home residents in a 1:1:1 ratio per group in the intervention part. The detectable mean difference using these group sizes would be 0.32 between groups. Depending on the level of measurement variables will be described using absolute and relative frequencies, means, medians, and associated spread estimates. Possible bi- and multivariable associations will be analyzed. The primary outcome of dry skin will be described by mean differences and one-way ANOVA analysis with post-hoc pairwise two-sample t-tests. RESULTS The study started in September 2014. The results are expected in July 2015. TRIAL REGISTRATION The study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.

Characterizing facial skin ageing in humans: disentangling extrinsic from intrinsic biological phenomena.

Facial skin ageing is caused by intrinsic and extrinsic mechanisms. Intrinsic ageing is highly related to chronological age. Age related skin changes can be measured using clinical and biophysical methods. The aim of this study was to evaluate whether and how clinical characteristics and biophysical parameters are associated with each other with and without adjustment for chronological age. Twenty-four female subjects of three age groups were enrolled. Clinical assessments (global facial skin ageing, wrinkling, and sagging), and biophysical measurements (roughness, colour, skin elasticity, and barrier function) were conducted at both upper cheeks. Pearsons correlations and linear regression models adjusted for age were calculated. Most of the measured parameters were correlated with chronological age (e.g., association with wrinkle score, r = 0.901) and with each other (e.g., residual skin deformation and wrinkle score, r = 0.606). After statistical adjustment for age, only few associations remained (e.g., mean roughness (R z) and luminance (L *),  β = −0.507, R 2 = 0.377). Chronological age as surrogate marker for intrinsic ageing has the most important influence on most facial skin ageing signs. Changes in skin elasticity, wrinkling, sagging, and yellowness seem to be caused by additional extrinsic ageing.

The effectiveness of standardized skin care regimens on skin dryness in nursing home residents: A randomized controlled parallel-group pragmatic trial

BACKGROUND Aged residents of institutional long-term care facilities are at high risk for developing skin and tissue diseases. Besides various common skin problems, dry skin (xerosis cutis) is one of the most frequent skin conditions in this setting. OBJECTIVES To investigate the effectiveness of two structured skin care regimens in comparison to routine skin care on xerosis cutis in nursing home residents. DESIGN A multi-center, pragmatic, randomized, controlled, investigator blinded study with three parallel groups. SETTINGS The study was conducted in a random sample of ten out of 291 institutional long-term care facilities of the federal state of Berlin, Germany. PARTICIPANTS Long-term care residents being 65+ years affected by dry skin were included. METHODS The residents were allocated into one of three study groups. Two interventional groups used standardized skin care regimens, consisting of a body wash and twice daily applications of leave-on products for eight weeks. The third control group performed skin care as usual. All participating residents were examined at baseline and after 4 and 8 weeks. Xerosis cutis was measured with the Overall Dry Skin score. Instrumental skin barrier measurements were performed at baseline and after 8 weeks. Diaries were used to document washing and skin care frequencies. RESULTS In total, 133 residents were included and allocated to one of the three groups. Mean age was 83.8 (SD 8.3) years, 65.4% were female and most residents had care levels I (42.9%) or II (42.9%) according to the German Social Code Book XI. Mean Barthel score was 46.8 (SD 24.2) and mean Braden score was 17.6 (SD 3.7). Leg skin areas were drier compared to arms and trunk areas. At the end of the study the Overall Dry Skin scores in the intervention groups were lower compared to the control group. There were statistically significant improvements of skin dryness in both intervention groups compared to the control group over time. CONCLUSIONS The results of this pragmatic trial indicate that structured skin care regimens are effective in reducing skin dryness in aged nursing home residents within eight weeks. TRIAL REGISTRATION The study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.

Prevalence and associated factors of skin diseases in aged nursing home residents: a multicentre prevalence study

Objectives The aim of this study was to measure the prevalence of skin diseases in aged nursing home residents and to explore possible associations with demographic and medical characteristics. Design Descriptive multicentre prevalence study. Setting and participants The study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n=223 residents were included. Results In total, 60 dermatological diseases were diagnosed. The most frequently diagnosed skin disease was xerosis cutis (99.1%, 95% CI 97.7% to 100.0%) followed by tinea ungium (62.3%, 95% CI 56.0% to 69.1%) and seborrheic keratosis (56.5%, 95% CI 50.2% to 63.0%). Only few bivariate associations have been detected between skin diseases and demographic and medical characteristics. Conclusion Study results indicate that almost every resident living in residential care has at least one dermatological diagnosis. Dermatological findings range from highly prevalent xerosis and cutaneous infection up to skin cancer. Not all conditions require immediate dermatological treatment and can be managed by targeted skin care interventions. Caregivers need knowledge and diagnostic skills to make appropriate clinical decisions. It is unlikely that specialised dermatological care will be delivered widely in the growing long-term care sector. Trial registration number This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.

Reduction of Inflammatory and Noninflammatory Lesions with Topical Tyrothricin 0.1% in the Treatment of Mild to Severe Acne Papulopustulosa: A Randomized Controlled Clinical Trial.

Background/Aims: Antibiotic-induced drug resistance requires new approaches in topical acne treatment. Tyrothricin is known to produce no resistance. In this study, it was tested for the first time in topical acne treatment. The efficacy and tolerability of topical tyrothricin 0.1% was evaluated. Methods: A randomized, active comparator-controlled, exploratory, observer-blind clinical study was conducted in 24 patients with acne papulopustulosa. Randomization on a split-face was either tyrothricin versus clindamycin + benzoyl peroxide (BPO) (n = 12) or tyrothricin versus BPO 5% (n = 12). The main outcome was change in inflammatory and noninflammatory lesion counts. Results: The mean differences in inflammatory lesion counts from baseline were -12.3 (95% CI: -20.5 to -4.1) in clindamycin + BPO, -10.2 (95% CI: -15.3 to -5.0) in BPO 5%, and -7.7 (95% CI: -11.7 to -3.7) in tyrothricin. Tyrothricin reduced noninflammatory lesions (mean difference: -6.5 (95% CI: -11.6 to -1.4) and caused less product-related adverse events (n = 31) compared to BPO (n = 37) and clindamycin + BPO (n = 20). Conclusion: The results indicate that tyrothricin might be a candidate for treating acne and it seems to be more tolerable than both comparator treatments.

Quantifying dyspigmentation in facial skin ageing: an explorative study

The skin melanin system is affected by ageing, resulting in dyspigmentation with associated clinical and psychosocial consequences. In dark skinned phenotypes, broad evidence is available, whereas little is known about pigmentary changes in fair‐skinned Caucasians. The objective of this study was to investigate age‐related changes in facial pigmentation and dyspigmentation in subjects of skin phototypes II–III and to develop and test parameters for quantifying dyspigmentation.

Sensitivity to change of the Dermatology Life Quality Index in adult females with facial acne vulgaris: a validation study.

The postadolescent form of acne papulopustulosa, also referred to as ‘acne tarda’ can have substantial negative impact on Quality of Life, especially in adult female patients.