Starenje kože lica

Skin aging is a multisystem degenerative process that involves the skin and skin support system. Young faces tend to be convex with full lips, sweeping jaw line with full temples and cheeks. Aged face tends to be concave with flat lips, sunken temples and cheeks, scalloped mandible and more shadows. Aging caused by the genes we inherit and depending on the passage of time per se is called chronological or intrinsic aging. Intrinsic akin aging is characterized by atrophy of the skin with loss of elasticity and slowed metabolic activity. The signs of intrinsic aging are fine wrinkles, thin and transparent skin, loss of underlying fat, facial bone loss, dry skin, inability to sweat sufficiently to cool the skin, hair loss and unwanted hair. The other type of aging is known as extrinsic aging and is caused by environmental factors. Among harmful environmental factors that contribute to extrinsic aging, long-term effects of repeated exposure to ultraviolet light are most significant and are referred to as photoaging. It is a cumulative process and depends primarily on the degree of sun exposure and skin pigment. UV irradiation invokes a complex sequence of specific molecular responses that cause damage to the skin connective tissue. Photoaging affects the sun-exposed areas and is characterized clinically by fine and coarse wrinkling, roughness, dryness, laxity, telangiectasias, loss of tensile strength and pigmentary changes. There is also an increase in development of benign and malignant neoplasms on photoaged skin.Starenje kože je degenerativni proces koji uz kožu zahvaća i potporne strukture kože. Mlado lice je konveksno s punim usnama i obrazima, a linija mandibule je uzdignuta prema obrazima. Lice koje pokazuje znakove starenja obilježavaju tanke usne, nejednolikosti pigmentacije, opušteni obrazi i čelo, opuštena mandibula i cijelo lice se doima konkavnim. Starenje uzrokovano genskim nasljeđem i koje ovisi o prolasku vremena zovemo kronološkim starenjem ili intrinzičnim starenjem. Ono je obilježeno atrofijom kože, gubitkom elastičnosti i usporenjem metaboličnih aktivnosti. Znakovi kronološkog starenja su sitne bore, tanka i transparentna koža, gubitak podložećeg masnog tkiva i koštane strukture lica, suhoća kože, nemogućnost žlijezda znojnica da dostatno hlade kožu, gubitak kose i pojava neželjene dlakavosti. Drugi tip starenja naziva se ekstrinzično starenje i uzrokovano je utjecajem vanjskih čimbenika. Između brojnih štetnih utjecaja okoline koji sudjeluju u starenju dugotrajno i opetovano izlaganje ultravioletnim zrakama je najznačajnije te uzrokuje fotostarenje kože. To je kumulativni proces koji prvenstveno ovisi o stupnju izloženosti sunčevim zrakama i pigmentu kože. UV zračenje uzrokuje složene procese na specifičnim molekulama odgovor kojih uzrokuje oštećenja vezivnog tkiva kože. Foto-starenje se očituje pojavom naboranosti, crvenilom kože, suhoćom, gubitkom elastičnosti, pojavom telangiektazija te pigmentnim promjenama. Izloženost UV zračenju povećava pojavu dobroćudnih i zloćudnih novotvorina kože na fotoeksponiranim dijelovima

PREDICTORS OF QUALITY OF LIFE IN PATIENTS WITH DERMATOLOGICAL DISEASES VISIBLE ON FACE

Lice ima veliki značaj u svakom aspektu ljudskog života. Kao glavni alat ljudske neverbalne komunikacije, lice ima utjecaj na naše društvene odnose. Psihosocijalni aspekti dermatološke bolesti utječu na pacijentovo opće zdravlje i mogu dovesti do osjećaja izolacije i usamljenosti. Cilj istraživanja bio je ispitati različite prediktore kvalitete života u bolesnika s bolestima kože koje su vidljive na licu. Ispitivanje je provedeno u Klinici za kožne i spolne bolesti KBC-a Sestre milosrdnice, čije Etičko povjerenstvo je odobrilo provođenje studije. U istraživanju je sudjelovalo 182 ispitanika, pacijenata oboljelih od dermatoloških bolesti: rozaceje, acne vulgaris i seboroičnog dermatitisa koji su liječeni u Poliklinici Klinike za kožne i spolne bolesti KBC Sestre milosrdnice u Zagrebu. Od toga je njih 60 imalo dijagnozu rozaceje, 70 dijagnozu acne vulgaris , a 52 sudionika su imala dijagnozu seboroičnog dermatitisa. Ispitanici su ispunili upitnik indeksa osobne kvalitete života, upitnik dermatološkog indeksa kvalitete života i upitnik percepcije stresa. U rezultatima istraživanja nađena je značajna pozitivna povezanost između kliničke procjene težine bolesti i utjecaja dermatološke bolesti na kvalitetu života u skupini oboljelih od seboroičnog dermatitisa, dok kod drugih oboljenja razlika nije pronađena. Oboljeli od rozaceje postižu značajno nižu ukupnu kvalitetu života u odnosu na oboljele od akne, ali nije pronađena razlika u kvaliteti života između oboljelih od rozaceje i oboljelih od seboroičnog dermatitisa. Oboljeli od akni postižu značajno nižu kvalitetu života u područjima materijalnog standarda, zdravlja i sigurnosti u budućnost u odnosu na oboljele od rozaceje i seboroičnog dermatitisa, između kojih nema razlike. Dermatološka kvaliteta života pokazala se značajnim prediktorom opće kvalitete života. Utvrđena je visoka razina stresa kod oboljelih od dermatoloških bolesti, no nema razlike u razini stresa između oboljelih od rozaceje, acne vulgaris ili seboroičnog dermatitisa. Dermatološka kvaliteta života i stres pokazali su se značajnim prediktorima opće ukupne kvalitete života Zbog ponavljajućeg karaktera bolesti, često nezadovoljavajućih rezultata liječenja i kozmetskih problema, promjene na koži mogu negativno utjecati na psihosocijalno funkcioniranje bolesnika. Rezultati istraživanja kvalitete života predstavljaju važan pokazatelj kojim liječnici i pacijenti mogu bolje procijeniti učinke liječenja.Introduction. The face has a major significance in every aspect of human life. As a major tool of human nonverbal communication it has an impact on our social relations. The psychosocial aspects of dermatological disease usually impact the patient’s general health and can lead to feeling of isolation and loneliness. Physicians have focused on treatments and minimizing side effects. However, a broad spectrum of patient needs are also factors in treatment success. The aim of the study is to examine different predictors of the quality of life in patients with dermatological disease visible on face. Methods. The study included one hundred and eighty two patients with acne vulgaris, rosacea and dermatitis seborrhoica which were treated in an outpatient treatment at the Department of Dermatovenerology, Sestre milosrdnice University Hospital Center in Zagreb. Participants were divided into three groups. In the first group of patients, sixty were those with rosacea. In the second group there were seventy patients with acne vulgaris and in third group fifty-two patients with dermatitis seborrhoica. Consenting participants completed the following standardizes psychological questionnaires: Dermatology Life Quality Index, Personal Wellbeing Index and Perceived Stress Scale. Results. The results of the study showed a significant positive correlation between the clinical assessment of the severity of the disease and the influence of dermatological disease on the quality of life in the group of seborrheic dermatitis patients, whereas in other diseases the difference was not found. Rosacea sufferers achieve significantly lower overall quality of life compared with acne vulgaris sufferers, but no difference in the quality of life between those with rosacea and those suffering from seborrheic dermatitis was found. Acne vulgaris sufferers achieve significantly lower quality of life in areas of material standard, health and safety in the future compared with those suffering from rosacea and seborrheic dermatitis, with no difference. Conclusion. Dermatological quality of life has proved to be a significant predictor of the overall quality of life. High levels of stress have been identified in patients with dermatological diseases, but there is no difference in the level of stress between those with rosacea, acne vulgaris or seborrheic dermatitis. Dermatological quality of life and stress proved to be significant predictors of overall quality of life Because of its recurrent character, frequent unsatisfying results of treatment and a cosmetic problem, skin lesions can cause negative patients' psychosocial functioning. Quality of life outcomes represent an important approach by which physicians and patients can better assess the effects of treatments

Photorejuvenation – Topical Photodynamic Therapy as Therapeutic Opportunity for Skin Rejuvenation

The intrinsic aging process of the skin in unavoidable and depends on the passage of time per se. Among harmful environmental factors that contribute to extrinsic aging, long-term effects of repeated exposure to ultraviolet radiation are the most signifi cant and are referred to as photoaging. Photoaging is directly correlated to the quantity of UV rays received during the course of a lifetime. Topical photodynamic therapy is well-established procedure for the treatment of actinic keratoses, Bowen disease and basal cell carcinomas. Clinical experience has demonstrated that extensive treatment of actinic keratoses on sun-damaged skin also produces as a positive side effects signifi cant improvement of the signs of skin aging. An improvement of lentigines, skin roughness, fi ne lines, increases in skin smoothness and improvement of actinic elastosis, skin colour and reduction of hyperpigmentation were seen. The reversible side effects of photodynamic therapy include pain, erythema, oedema, scaling and crusting, and sometimes in darker skin types post-infl ammatory hyperpigmentation. Photodynamic therapy is promising approach for treatment of photoinduced skin aging and takes place between ablative and non-ablative methods for skin rejuvenation. Effective improvement of photoaged skin, the possibility of repeated treatments and imitated side effects makes photodynamic therapy a promising procedure for skin rejuvenation

PREDICTORS OF QUALITY OF LIFE IN PATIENTS WITH DERMATOLOGICAL DISEASES VISIBLE ON FACE

Lice ima veliki značaj u svakom aspektu ljudskog života. Kao glavni alat ljudske neverbalne komunikacije, lice ima utjecaj na naše društvene odnose. Psihosocijalni aspekti dermatološke bolesti utječu na pacijentovo opće zdravlje i mogu dovesti do osjećaja izolacije i usamljenosti. Cilj istraživanja bio je ispitati različite prediktore kvalitete života u bolesnika s bolestima kože koje su vidljive na licu. Ispitivanje je provedeno u Klinici za kožne i spolne bolesti KBC-a Sestre milosrdnice, čije Etičko povjerenstvo je odobrilo provođenje studije. U istraživanju je sudjelovalo 182 ispitanika, pacijenata oboljelih od dermatoloških bolesti: rozaceje, acne vulgaris i seboroičnog dermatitisa koji su liječeni u Poliklinici Klinike za kožne i spolne bolesti KBC Sestre milosrdnice u Zagrebu. Od toga je njih 60 imalo dijagnozu rozaceje, 70 dijagnozu acne vulgaris , a 52 sudionika su imala dijagnozu seboroičnog dermatitisa. Ispitanici su ispunili upitnik indeksa osobne kvalitete života, upitnik dermatološkog indeksa kvalitete života i upitnik percepcije stresa. U rezultatima istraživanja nađena je značajna pozitivna povezanost između kliničke procjene težine bolesti i utjecaja dermatološke bolesti na kvalitetu života u skupini oboljelih od seboroičnog dermatitisa, dok kod drugih oboljenja razlika nije pronađena. Oboljeli od rozaceje postižu značajno nižu ukupnu kvalitetu života u odnosu na oboljele od akne, ali nije pronađena razlika u kvaliteti života između oboljelih od rozaceje i oboljelih od seboroičnog dermatitisa. Oboljeli od akni postižu značajno nižu kvalitetu života u područjima materijalnog standarda, zdravlja i sigurnosti u budućnost u odnosu na oboljele od rozaceje i seboroičnog dermatitisa, između kojih nema razlike. Dermatološka kvaliteta života pokazala se značajnim prediktorom opće kvalitete života. Utvrđena je visoka razina stresa kod oboljelih od dermatoloških bolesti, no nema razlike u razini stresa između oboljelih od rozaceje, acne vulgaris ili seboroičnog dermatitisa. Dermatološka kvaliteta života i stres pokazali su se značajnim prediktorima opće ukupne kvalitete života Zbog ponavljajućeg karaktera bolesti, često nezadovoljavajućih rezultata liječenja i kozmetskih problema, promjene na koži mogu negativno utjecati na psihosocijalno funkcioniranje bolesnika. Rezultati istraživanja kvalitete života predstavljaju važan pokazatelj kojim liječnici i pacijenti mogu bolje procijeniti učinke liječenja.Introduction. The face has a major significance in every aspect of human life. As a major tool of human nonverbal communication it has an impact on our social relations. The psychosocial aspects of dermatological disease usually impact the patient’s general health and can lead to feeling of isolation and loneliness. Physicians have focused on treatments and minimizing side effects. However, a broad spectrum of patient needs are also factors in treatment success. The aim of the study is to examine different predictors of the quality of life in patients with dermatological disease visible on face. Methods. The study included one hundred and eighty two patients with acne vulgaris, rosacea and dermatitis seborrhoica which were treated in an outpatient treatment at the Department of Dermatovenerology, Sestre milosrdnice University Hospital Center in Zagreb. Participants were divided into three groups. In the first group of patients, sixty were those with rosacea. In the second group there were seventy patients with acne vulgaris and in third group fifty-two patients with dermatitis seborrhoica. Consenting participants completed the following standardizes psychological questionnaires: Dermatology Life Quality Index, Personal Wellbeing Index and Perceived Stress Scale. Results. The results of the study showed a significant positive correlation between the clinical assessment of the severity of the disease and the influence of dermatological disease on the quality of life in the group of seborrheic dermatitis patients, whereas in other diseases the difference was not found. Rosacea sufferers achieve significantly lower overall quality of life compared with acne vulgaris sufferers, but no difference in the quality of life between those with rosacea and those suffering from seborrheic dermatitis was found. Acne vulgaris sufferers achieve significantly lower quality of life in areas of material standard, health and safety in the future compared with those suffering from rosacea and seborrheic dermatitis, with no difference. Conclusion. Dermatological quality of life has proved to be a significant predictor of the overall quality of life. High levels of stress have been identified in patients with dermatological diseases, but there is no difference in the level of stress between those with rosacea, acne vulgaris or seborrheic dermatitis. Dermatological quality of life and stress proved to be significant predictors of overall quality of life Because of its recurrent character, frequent unsatisfying results of treatment and a cosmetic problem, skin lesions can cause negative patients' psychosocial functioning. Quality of life outcomes represent an important approach by which physicians and patients can better assess the effects of treatments

Photoaging

Among harmful environmental factors that contribute to extrinsic aging, long-term effects of repeated exposure to ultraviolet light are the most significant and are referred to as photoaging. Photoaging is a multisystem degenerative process that involves the skin and skin support system. It is a cumulative process and depends primarily on the degree of sun exposure and skin pigment. The epidermis and dermis are both affected by UVB, but the dermis is also affected to a significant extent by UVA. It has long been thought that the majority of human photo-lesions due to UVB rays, now it is believed that UVA play a substantial role in photoaging. Photoaging affects the sun-exposed areas and is characterized clinically by fine and coarse wrinkling, roughness, dryness, laxity, teleangiectasia, loss of tensile strength and pigmentary changes. There is also an increase in development of benign and malignant neoplasms on photoaged skin. During the years the progress has been made in understanding the photoaging in human skin. UV irradiation invokes a complex sequence of specific molecular responses that damage skin connective tissue. Restriction of UV irradiation and the use of high-protection, broad-spectrum sunscreens may slow progression of photoaging

Perifolliculitis Capitis Abscedens et Suffodiens Treated with Anti-tumor Necrosis Factor-alpha – Possible New Treatment Option

The case of a 26-year-old male patient with perifolliculitis capitis abscedens et suffodiens (PCAS) who later developed hidradenitis suppurativa (HS) and exacerbation of acne is presented. The patient did not respond well to conventional treatment including isotretinoin and oral antibiotics. Quality of life was significantly impaired. After introduction of anti-tumor necrosis factor-alpha (TNF-α) treatment, the patient’s clinical picture improved dramatically and quality of life increased. The treatment has been well tolerated by the patient for 15 months at time of writing this report. </p

UV Radiation: What We Know and Do We Protect Ourselves Adequately?

Chronic sun exposure causes degenerative changes in the skin that are recognized as photoaging, immunosuppression and photocarcinogenesis. Sun is necessary for life, so total sun avoidance is impossible. Sun exposure during the first 15 years of life and blistering sunburns before age 20 have been linked to an increased risk of melanoma. Individuals who have outdoor lifestyles, live in sunny climates, and are lightly pigmented will experience the greatest degree of photoaging. In our study, performed four years ago, we have shown the knowledge of more than 4000 people about the effects of UV rays on the skin. The results show us that sun exposure is still exaggerated and uncontrolled due to the lack of knowledge about this topic. Encouraging photoprotection and improving the awareness of the general public about the harmful effects of too much sun exposure must be the leading preventative health strategy

Vitamin D – The True and the False about Vitamin D

Vitamin D has a positive impact on our overall health. Also there are a few conditions with strong evidence for a protective effect of vitamin D, such as bone diseases, internal cancers, multiple sclerosis, hypertension and DM type 1. Skin is the major source of vitamin D through the action of UVB light on keratinocytes, although the biologically active form of vitamin D is not exclusively produced in the kidney, but also in prostate, colon, skin and osteoblast where it acts as an autocrine or paracrine hormone. In the past decade raising incidence of skin cancers, especially melanoma and its connection with sun exposure lead to a sun protection policies and practices as part of the public health campaigns. The question is how much solar UV exposure is adequate to maintain the balance between the risk and the benefit. We as dermatologists have to raise public awareness of the potential health effects from excessive exposure to UV radiation but also we have to be aware that adequate blood level of vitamin D is necessary for optimal health. So future recommendation on sun protection have to balance between the risk and benefits of sun exposure, as well as to promote vitamin D supplementation as a safe alternatives in high risk population

Phototoxic and Photoallergic Skin Reactions

Indirect action of sun together with different exogenous agents (systemic medications and topically applied compounds) sometimes may result in phototoxicic and photoallergic reactions. Drug-induced photosensitivity reactions refer to the development of cutaneous disease as a result of the combined effects of a drug and light (mostly spectrum within the UVA and visible light range or UVB range). The aim of the review was to show the prominent features of phototoxic and photoallergic reactions, which occur in sun-exposed areas, including face, neck, hands and forearms. Phototoxic reactions are significantly more common than photoallergic reactions and mosty resemble to exaggerated sunburn. Photoallergic reactions appear only in a minority of individuals and resemble allergic contact dermatitis on sun-exposed areas, although sometimes may extend into covered areas. Generally, the physical examination and a positive patient’s history of photosensitivity reactions on substances are of great importance for the diagnostics. The treatment of these reactions includes identification and avoidance of offending agent and application of anti-inflammatory dressings, ointments and corticosteroids