RESUMO
BACKGROUND: Photodynamic therapy (PDT) has been described for photoageing treatment, but its mechanism of action is not clarified. Although PDT-induced matrix metalloproteinase (MMP) expression and collagen production have been studied in normal skin and in inflammatory disease, there is no report about the effect of PDT on the extracellular matrix in photodamaged skin. OBJECTIVES: To evaluate skin remodelling induced by methyl aminolaevulinate (MAL)-PDT in photodamaged skin by histological and immunohistochemical studies. METHODS: Fourteen patients were treated with two sessions of MAL-PDT. The light source was a light-emitting diode (635 nm, 37 J cm(-2)). Skin biopsies were performed in all patients before and at 3 and 6 months after treatment. Immunohistochemical studies evaluated collagen types I and III, MMP-1, MMP-3, MMP-7, MMP-9, MMP-12 and tissue inhibitor of metalloproteinases-1. RESULTS: Global improvement in photodamaged skin was observed. A significant increase in expression of MMP-9 in the dermis was detected at 3 months after treatment (P = 0.002). Significant increases in the expression of collagen type I at 3 months (P = 0.002) and at 6 months after treatment (P = 0.001) were also observed. CONCLUSIONS: Skin remodelling induced by MAL-PDT was demonstrated in photodamaged skin. Two sessions of MAL-PDT increases immunohistochemical expression of MMP-9 in the dermis at 3 months after treatment, and also of collagen type I.
Assuntos
Metaloproteinases da Matriz/biossíntese , Fotoquimioterapia , Envelhecimento da Pele , Pele/metabolismo , Ácido Aminolevulínico/análogos & derivados , Ácido Aminolevulínico/uso terapêutico , Colágeno Tipo I/metabolismo , Colágeno Tipo III/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Terapia com Luz de Baixa Intensidade , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Pele/efeitos dos fármacos , Envelhecimento da Pele/efeitos dos fármacos , Envelhecimento da Pele/patologia , Inibidor Tecidual de Metaloproteinase-1/metabolismoRESUMO
BACKGROUND: Despite evidences of the beneficial clinical effects of oral isotretinoin in the treatment of cutaneous photoaging, scientific evidences are still scarce, mainly supported by histopathological and morphometric studies. OBJECTIVES: To analyse possible clinical and morphological changes resulting from the treatment of photoaging with oral isotretinoin. METHODS: Thirty female patients, aged 40 to 55 years, phototypes II to IV, with moderate to severe photoaging were randomly assigned to two groups of 15 each. Group I (G I) patients were treated with 10 mg of isotretinoin and group II (G II) with 20 mg of oral isotretinoin thrice a week for 3 months. Skin biopsies were performed before and after the end of therapy, and the various sections were submitted to specific staining for collagen and elastic fibres. To analyse the changes, morphometric studies were performed, and the results obtained were analysed by Student's t-test (paired and non-paired). Clinical results of therapy regarding texture, colouring and aspect of the wrinkles were assessed by both physician and patient. RESULTS: The increase in the amount of collagen fibres was statistically significant with both dosage regimens (mean, 37.8%, increasing to 44.4%; P = 0.029 with the 10-mg dosage; and mean, 36.6%, increasing to 41.9%; P = 0.01 with the 20-mg dosage). A pattern pointing toward a decrease in the number of elastic fibres was found (mean, 15.3-12%; P = 0.014 with the 10-mg dosage; mean, 15.5-14%; P = 0.125 with the 20-mg dosage). Additionally, there was improvement in the general aspect of the skin, regarding texture, wrinkles depth and skin coloration. LIMITATIONS: Despite ethical considerations, a lack of a control group using placebo may render the results less accurate. CONCLUSION: Low dosages of oral isotretinoin seem to be an effective therapeutic option for cutaneous photoaging.
Assuntos
Isotretinoína/administração & dosagem , Envelhecimento da Pele/efeitos dos fármacos , Luz Solar/efeitos adversos , Administração Oral , Adulto , Colágeno/metabolismo , Método Duplo-Cego , Humanos , Isotretinoína/farmacologia , Pessoa de Meia-Idade , Pele/efeitos dos fármacos , Pele/metabolismoRESUMO
OBJECTIVE: This study aims to determine the relationship between smoking and cutaneous ageing. METHODS: A cross-sectional study was carried out on 301 subjects (191 women and 110 men, aged between 25 and 86 years), of which 165 were non-smokers and 136 were smokers and ex-smokers. The association between tabagism and cutaneous ageing was controlled for other variables (solar exposure, age, skin phototype, sex, sunscreen use, alcohol consumption, coffee consumption, sports participation, body mass index, and history of relatives with precocious ageing). RESULTS: Analysis revealed that age, chronic solar exposure, skin phototype and tobacco load significantly contributed to the formation of facial wrinkles. The larger the tobacco load, the larger was the amount of facial wrinkling, with an odds ratio of 3.92 in 'heavy' smokers (> 40 packs/year) in relation to non-smokers. CONCLUSION: The results of this study point to smoking as one of the main factors involved in facial wrinkling. The relationship between smoking and cutaneous ageing is an important element in educational campaigns against tabagism.
Assuntos
Envelhecimento da Pele , Fumar/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: A study on HIV/AIDS-related mucocutaneous manifestations has been carried out in three different ethnic and geographic areas, namely Brazil, Denmark, and Thailand. METHODS: The Brazil cohort comprised 110 patients, the Danish cohort 150, and the Thai cohort 206 patients. The majority of the Brazil and Thai cohort patients belonged to groups III and IV according to the CDC clinical staging system, whereas the patients in Denmark called their doctors earlier and only 8% were classified in groups III and IV. RESULTS: In all three areas the number of mucocutaneous diseases correlated well with the progression of the HIV disease. Ethnic differences were not identified, whereas geographic differences related to skin infections were marked. In the Asian cohort a generalized fungal infection was detected with characteristic mucocutaneous symptoms caused by Penicillium marneffei. CONCLUSIONS: Teaching efforts about mucocutaneous signs as markers of HIV infection may be of value, particularly in developing areas, to allow earlier diagnosis. In future guidelines for classification of HIV/AIDS-related mucocutaneous diseases geographic considerations should be included.