Rachel Gimenes Albuquerque

Could adult female acne be associated with modern life

In recent years, the prevalence of adult female acne has increased, but the reason for this increase remains unclear. Acne is one of the most common skin disorders. It can be triggered or worsened by endogenous and exogenous factors, including genetic predisposition, hormone concentrations, diet, smoke and stress; although the interaction with this last factor is not well understood. Modern life presents many stresses including urban noises, socioeconomic pressures and light stimuli. Women are especially affected by stress during daily routine. The recent insertion in the labor market is added to the duties of the mother and wife. Women also have a higher risk of developing psychiatric disorders such as depression and anxiety. Sleep restriction is added to these factors, with several negative consequences on health, including on hormonal secretion and the immune system. This is further complicated by the natural variation in sleep architecture across the menstrual cycle. Recent studies have brought new data about the mechanisms and possible factors involved. This review aims to establish a connection between stress, sleep deprivation and adult female acne.

The bidirectional interactions between psoriasis and obstructive sleep apnea

Psoriasis is a chronic inflammatory skin disorder which can impair general routine activities and has been closely related to poor quality of life. Pruritus and scratching are frequently observed, occurring mainly during sleep and precipitating nighttime arousals. Indeed, sleep quality has been shown to be negatively affected in psoriatic patients, in a close relationship with stress exposure and immune response. Although psoriasis is known to impair sleep, leading to insomnia, its association with obstructive sleep apnea (OSA) is controversial. Similarly, OSA is considered a multifactorial inflammatory disease, characterized by intermittent hypoxia, sleep fragmentation and autonomic dysfunction, with important outcomes on the cardiovascular and metabolic systems. Importantly, immunological activities and pro‐inflammatory cytokines play a prominent role in both OSA and psoriasis. Currently it is not clear whether OSA is a risk factor for psoriasis development or if psoriasis is a possible predictor of OSA. Thus, our main purpose is to provide an overview of this intriguing relationship and show the current link between psoriasis and OSA in a bidirectional relationship.

The relationship between sleep apnea, metabolic dysfunction and inflammation: The gender influence

Obstructive sleep apnea (OSA) has been associated with increased risk of cardiovascular morbidity and mortality. Although inflammatory markers may mediate this association, it is unknown the influence of gender in this mechanism. Thus, we aimed to evaluate the interaction effects between OSA and gender on metabolic and inflammatory profile in a population sample. This study is part of EPISONO cohort, in which 1042 participants underwent polysomnography, answered questionnaires, and had their blood collected for analysis of fasting glucose, total cholesterol and fractions, leptin, ghrelin, liver transaminases, tumor necrosis factor (TNF)-α, interleukin (IL)-6, and C-reactive protein. The results showed that men with OSA had higher leptin levels, shorter sleep latency and lower N3 sleep stage compared to men control (CTRL). They also presented higher apnea index and number of central apneas compared to both CTRL men and OSA women. In women, OSA was related to longer REM sleep latency, higher apnea-hypopnea index (AHI) during REM sleep and increased TNF-α levels compared to CTRL women. A multivariate model showed that male gender, ghrelin and total cholesterol were negatively associated with TNF-α, while IL-6, triglycerides and hypopnea index were positively associated (R2=0.21). Additionally, gender (men), body mass index, ghrelin, apnea index and smoking were positive predictors of leptin levels (R2=0.55). Of note, postmenopause was associated with changes observed in both TNF-α and AHI during REM sleep in women with OSA. Taken together, our study suggests that OSA consequences may differ between genders and this could indicate a need for different OSA management in women according to their reproductive lifes stage.

The importance of quality of sleep in menopause

We read the article ‘ Prevalence of menopausal symptoms in Australian women at midlife: a systematic review ’ by Gartoulla and colleagues 1 with great interest. The review found over 6000 studies from different databases focusing on menopause symptoms of women in Australia. Ten were selected for analysis according to the authors ’ criteria, which are described in the article. We would like to make some additional points about these data analyses. Menopause, as well described by the authors, is characterized by the loss of ovarian reproductive function and of cyclic production of ovarian sex steroids 1 . It is associated with different symptoms, some of which are mentioned in the article such as vasomotor, sexual, psychological and physical symptoms. We would like to highlight the fact that menopause is also characterized by alterations in sleep architecture, which can affect quality of life 2 . Women present 41% more chance of developing insomnia than men 3 . Moreover, 25% of women aged between 50 and 64 years report sleep complaints and 15% of them present sleep disturbances 3 . Sleep disturbances related to menopause result from changes in ovarian hormone secretion, which results in the well-known hot fl ushes and sweats. In addition, psychological factors such as stress and mood disturbances are also associated with sleep disruption 4 . Women in the perimenopausal period are more likely to report diffi culty sleeping than premenopausal women and night sweats are more frequent among women in consecutive stages of the menopausal transition 5 . Mood symptoms, especially depression and anxiety, which can occur in this life stage of women, are strongly related with sleep disturbances 5 . Another study demonstrated that sleep complaints increased from the early to late menopausal transition, with hot fl ushes being an important factor 6 . In view of the physiological alterations resulting from menopause, we suggest that sleep would be an interesting aspect to be further investigated and included in additional studies involving women in different age ranges. Sleep is very important for body homeostasis in general and especially in this long stage of women ’ s life.

Sleep, Hansen’s disease and the immune system – A not so harmonic triad

Hansens disease is one of the oldest skin diseases in the world characterized by a spectrum of clinical manifestations that are associated with stigmatization and poor quality of life. It is also considered a model disease for investigating the human immune system because of its association with immune reactions, which are thought to be a reflection of the hosts immunological response, promoting intense cellular activity or humoral secretion. This relationship between the cellular and microbial components of skin and their regulation by local immune responses may be modulated by a currently neglected behavior: sleep. Recent studies have demonstrated that sleep deprivation may aggravate the progression of chronic dermatological diseases, which in turn can lead to a non-restorative sleep pattern. Indeed, sleep is essential for immune and skin integrity. Thus, we propose here a hypothesis linking Hansens disease, sleep and immunity in a bidirectional relationship. Hansens disease patients may demonstrate a worse sleep quality than the general population through the modulation of immunological environment; and sleep restriction, a hallmark of modern society, being a possible predictor of the disease progression.

Sleep assessment for better understanding skin composition.

http://dx.doi.org/10.1016/j.bbi.2015.07.028 0889-1591/ 2015 Published by Elsevier Inc. Comments of the article ‘‘Stress-related changes to immune cells in the skin wounding may impair subsequent healing’’. To the editor, We read the article entitled ‘‘Stress-related changes to immune cells in the skin prior to wounding may impair subsequent healing’’ (Koschwanez et al., 2015) with great interest. This short communication seems to be a proof of concept about the relationship between skin, stress and the immune system. The authors compared two clinical populations of extreme levels of self-perceived stress (SPS) by quantifying components of cellular immunity in skin tissue as well as immune cell activation and skin healing speed. The results showed that subjects with higher SPS had fewer skin macrophages than those with lower SPS, which in turn showed higher skin immune cell activation and faster healing compared to those with higher SPS. In addition, a direct association between faster healing, increased number of Langerhans cells and greater immune cell activation was also observed. Considering these preliminary results from Koschwanez’s group, we would like to add the following comments. Besides the SPS assessment, we believe that an evaluation of the chronotype and sleep would provide very relevant data in this study. Societies around the world have a very established routine to which everyone must submit. However, sometimes our biological time does not adapt to this social time, causing the called social jetlag. This is more frequent among subjects with an evening chronotype, who are individuals who prefer go to bed late and wake up late (Wittmann et al., 2006). A study demonstrated that evening-type individuals display lower subjective sleep quality and longer sleep latency in comparison to morning-type people, who prefer earlier bed and wake times (Roeser et al., 2012). In addition, Roeser and colleagues demonstrated that evening-type individuals present an elevated stress response after a mental arithmetic task in comparison to morning-type individuals. Interestingly, sleep quality mediates the relationship between the chronotype and the SPS (Roeser et al., 2012). There are no studies involving chronotype and skin to date. However, Oyetakin-White and colleagues (2015) demonstrated that sleep quality and duration may be involved in skin integrity maintenance. This study demonstrated that women who were classified as good sleepers according to the Pittsburgh Sleep Quality Index questionnaire presented fewer signs of intrinsic skin ageing, a greater rate of recovery from erythema after