The link between cutaneous inflammation and cognitive impairment Wen, S.; Elias, P.M.; Wakefield, J.S. ...
JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology,
October 2022, Volume:
36, Issue:
10
Journal Article
Peer reviewed
Open access
Cognitive impairment is a symptom of neurological disorders, including dementia and Alzheimer's disease; and mild cognitive impairment can be a precursor of both disorders. Aged humans and animal ...models with other systemic disorders, such as cardiovascular diseases and diabetes, display a higher incidence of cognitive decline. Epidemiological studies have shown that the incidence of cognitive impairment also is higher in subjects with certain inflammatory skin disorders, including psoriasis and chronic eczematous dermatitis. Chronologically aged individuals exhibit increased cutaneous inflammation and elevated circulating cytokine levels, linked to alterations in epidermal function, which itself can induce cutaneous inflammation. Conversely, strategies that improve epidermal function can lower cytokine levels in both the skin and circulation. Thus, it seems likely that epidermal dysfunction could contribute, at least in part, to the development of chronic low‐grade inflammation, also termed ‘inflammaging’, in the elderly. The evidence of cognitive impairment in patients with inflammatory dermatoses suggests a link between cutaneous inflammation and cognitive impairment. Because of the pathogenic role of epidermal dysfunction in ageing‐associated cutaneous inflammation, improvements in epidermal function could be an alternative approach for mitigation of the ageing‐associated decline in cognitive function.
Summary
While therapeutic approaches for psoriasis are widely available, preventive regimens are lacking. We aimed to determine whether improvements in epidermal function could prevent psoriasis ...relapse. Two self‐controlled cohort studies were designed, enrolling two cohorts of patients with psoriasis (n = 30 and n = 60) to be treated topically with an in‐house‐prepared emollient or ATOPALM® cream applied twice daily to one forearm for 20 and 30 days, respectively, while the same sites on the contralateral arm served as the untreated control. Epidermal function on both arms was assessed prior to and at the end of the trials. Delayed relapse on the treated arm was seen in 54.5% and 71% of patients in the first and second cohort, respectively. The time of psoriatic relapse correlated with the extent of abnormalities in baseline epidermal function. These results suggest that improvements in epidermal function with topical emollients can prevent/attenuate the development of psoriasis.
Background
Measurements of transepidermal water loss (TEWL) and stratum corneum (SC) hydration are important for assessing epidermal functions. However, the availability of reliable and user‐friendly ...devices, which can simultaneously measure both TEWL and SC hydration and can allow health providers to remotely access data in time, is limited.
Materials and Methods
GPSkin Barrier® was compared with MPA5 system in the measurements of TEWL and SC hydration on the cheek, the dorsal hand, and the forearm in 200 normal volunteers, including 126 females and 74 males, aged 1‐78 years with an average age of 45.24 ± 1.04 years. Correlation of data measured with MPA5 system and GPSkin Barrier® was determined.
Results
Levels of both TEWL and SC hydration measured with the Barrie GPSkin Barrier® were lower than that with MPA5 system on all 3 body sites except for hydration on the cheek. The levels of both TEWL and SC hydration measured with GpSkin Barrier® were correlated well with that measured with MPA5 system on all 3 body sites
Conclusions
GPSkin Barrier® is a reliable, affordable, and versatile device for assessing epidermal permeability barrier function and SC hydration.
Background
Lactic acid sting test (LAST) is a classical method to identify sensitive skin. However, some subjects with self‐perceived sensitive skin are negative for LAST.
Objective
To determine ...whether LAST scores are associated with specific phenotype of sensitive skin.
Methods
A total of 292 subjects with self‐perceived sensitive skin were enrolled in this study. The Sensitive Scale was used to evaluate the severity of burning, stinging, itching, tautness, erythema and scaling based on 0–10 scale scores. In addition to the assessment of LAST scores, epidermal biophysical properties were measured using an MPA system.
Results
The Sensitive Scale scores of stinging, itching, tautness and scaling were significantly different between the LAST‐positive and ‐negative groups. However, burning and erythema scores did not differ between the LAST‐positive and ‐negative groups. LAST scores were positively correlated with the Sensitive Scale scores for stinging, itching, tautness and scaling, but not for burning and erythema scores. Moreover, LAST scores negatively correlated with stratum corneum hydration, but positively with transepidermal water loss (TEWL) rates.
Conclusions
Lactic acid sting test scores positively correlated with TEWL rates. LAST scores could be used to identify subjects with sensitive skin characterized mainly by stinging and itching, but not those mainly by burning and erythema.
Résumé
Contexte
Le test de la piqûre d'acide lactique (LAST) est une méthode classique pour identifier les peaux sensibles. Cependant, certaines personnes s’évaluant ayant une peau sensible sont négatifs au test LAST.
Objectif
Déterminer si le score du LAST est associé à un phénotype spécifique de peau sensible.
Méthodes
Au total, 292 personnes s’évaluant ayant une peau sensible ont été inclus dans cette étude. L’échelle de sensibilité a été utilisée pour évaluer la sévérité de la brûlure, du picotements, de la démangeaison, de la tension, de l’érythème et des desquamations basée sur une échelle de 0‐10. En plus de l’évaluation du score LAST, les propriétés biophysiques épidermiques ont été mesurées à l'aide d'un système MPA.
Résultats
Les scores de l’échelle de sensibilité pour le picotement, les démangeaisons, la tension et la desquamation étaient significativement différents entre la groupe LAST positif et celle du LAST négatif. Cependant, les scores de la brûlure et de l’érythème n’étaient pas différents entre les deux groupes. Le score LAST était positivement corrélé avec les scores de l’échelle de sensibilité du picotement, des démangeaisons, de la tension et des desquamations, mais pas pour la brûlure et l’érythème. En plus, les scores LAST étaient négativement corrélés avec l'hydratation du stratum corneum, mais positivement corrélés avec le taux de perte en eau transépidermique (TEWL).
Conclusions
Les scores LAST étaient corrélés positivement avec le taux de perte en eau transépidermique. Les scores LAST pourraient être utilisés pour identifier les personnes avec la peau sensible caractérisée principalement le picotement et les démangeaisons, mais pas la brûlure et l’érythème.
The coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of patients infected worldwide and indirectly affecting even more individuals through disruption of daily living. Long-term ...adverse outcomes have been reported with similar diseases from other coronaviruses, namely Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Emerging evidence suggests that COVID-19 adversely affects different systems in the human body. This review summarizes the current evidence on the short-term adverse health outcomes and assesses the risk of potential long-term adverse outcomes of COVID-19. Major adverse outcomes were found to affect different body systems: immune system (including but not limited to Guillain-Barré syndrome and paediatric inflammatory multisystem syndrome), respiratory system (lung fibrosis and pulmonary thromboembolism), cardiovascular system (cardiomyopathy and coagulopathy), neurological system (sensory dysfunction and stroke), as well as cutaneous and gastrointestinal manifestations, impaired hepatic and renal function. Mental health in patients with COVID-19 was also found to be adversely affected. The burden of caring for COVID-19 survivors is likely to be huge. Therefore, it is important for policy makers to develop comprehensive strategies in providing resources and capacity in the healthcare system. Future epidemiological studies are needed to further investigate the long-term impact on COVID-19 survivors.
Background
While increased levels of circulating inflammatory cytokines in chronologically aged humans have been linked to the development of ageing‐associated chronic disorders (e.g., cardiovascular ...disease, type II diabetes, osteoporosis and Alzheimer's disease), approaches that reduce circulating cytokines are not yet available. In chronologically aged mice, we recently demonstrated that epidermal dysfunction largely accounts for age‐associated elevations in circulating cytokine levels, and that improving epidermal function reduced circulating cytokine levels.
Objective
We performed a pilot study to determine whether improving epidermal function reduces circulating pro‐inflammatory cytokine levels in aged humans.
Methods
Thirty‐three aged humans were topically treated twice‐daily for 30 days, with ≈ 3 mL of an emollient, previously shown to improve epidermal function, while untreated, aged humans and a cohort of young volunteers served as controls. Changes in epidermal function and levels of three key, age‐related, plasma cytokines (IL‐1β, IL‐6 and TNFα) were measured at baseline and after treatment, using Luminex 200™ system.
Results
We also found significantly higher baseline levels of IL‐1β, IL‐6 and TNFα in aged vs. young humans (P < 0.001), as previously reported. Topical applications of the barrier repair emollient significantly enhanced epidermal permeability barrier function (P < 0.01) and stratum corneum hydration (P < 0.05). In parallel, circulating levels of IL‐1β and IL‐6 normalized, while TNFα levels declined substantially.
Conclusion
The results of this preliminary study suggest that a larger clinical trial should be performed to confirm whether improving epidermal function also can reduce circulating pro‐inflammatory cytokine levels in aged humans, while also possibly attenuating the downstream development of chronic inflammatory disorders in the aged humans.
Background
Cognitive impairment is common in the elderly. Prior studies suggest a link between chronic inflammation and cognitive dysfunction, while aging‐associated epidermal dysfunction has been ...connected to elevations in circulating cytokines.
Objective
We assessed here whether improvements in epidermal function can mitigate the progression of cognitive impairment.
Methods
This randomized, open‐label pilot trial was carried out in two cities in northern China. A total of 200 participants aged ≥65 years were randomly assigned to the emollient‐treated and untreated groups at 1:1 ratio. Participants in the treated group were treated topically with Atopalm cream® twice‐daily from November to the following May each year for three consecutive years, while the untreated subjects served as controls. The Global Deterioration Scale (GDS) was used to assess the severity of cognitive impairment, while epidermal biophysical properties were measured on the forearms and the shins in parallel.
Results
Over the three‐year trial, GDS significantly increased from baseline (P < 0.0001) in the controls, while in the treated group, GDS stabilized. While stratum corneum hydration on the forearms did not change significantly in the controls, transepidermal water loss rates (TEWL), significantly increased by the end of the trial compared to baselines in the controls (P < 0.0001). On the forearms of the treated group, stratum corneum hydration increased (P < 0.0001) while skin surface pH decreased from baseline (P < 0.0001).
Conclusions
These results suggest that improvements in epidermal function with topical emollient can mitigate the progression of cognitive impairment. However, the sample size was relatively small, and trials in a larger cohort are needed to validate the present results.
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