Impact of Sleep on Skin Aging and other Dermatologic Conditions

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1 Impact of Sleep on Skin Aging and other Dermatologic Conditions Elma (Chat) D. Baron, MD Professor, Dermatology UPMASA Annual Convention July 2017 Albany, New York 1

2 Disclosures Research contracts Novartis Soligenix Coty Scientific Advisory Board Biofrontera

3 The skin reveals signs of aging most visibly

4 Factors that contribute to skin aging Genetics Ethnicity Neuro-endocrine Exposure to UV, cigarette smoking, pollution/other stressors

5 Exogenous factors (UV, smoking) cause aging via oxidative stress-mediated processes. Question: Does sleep or lack of sleep affect skin aging as well?

6 N= 60 women Poor Quality Sleepers: Less than five hours of poor quality sleep for at least one month prior to study commencement PSQI of 5 or greater Good Quality Sleepers: More than seven hours of good quality sleep for at least one month prior to study commencement PSQI less than 5 PSQI = Pittsburgh Sleep Quality Index Oyetakin, Suggs, Matsui, Yarosh, Baron. Clin Exp Dermatol 2015

7 Subject Characteristics Age range Average age: Good sleepers: Mean=38 (30-48) Poor sleepers: Mean=40 (31-49) Skin Phototypes: I-III Caucasian

8 Results: Subject Body Weight 35% of poor sleepers vs. 21% of good sleepers were classified as obese BMI 8 No Normal Overweight Obese Good sleeper Poor sleeper

9 Results: Scinexa INTRINSIC Age Score Scinexa measures clinical signs of aging both intrinsic and extrinsic Poor sleepers have significantly higher intrinsic age scores compared to good sleepers (68% difference) Poor sleepers show more signs of intrinsic aging uneven pigmentation fine wrinkling skin laxity loss of subcutaneous fat benign skin growths

10 Study Results SIGNS OF INTRINSIC AGING 5 Good Sleepers Poor Sleepers Scinexa Aging Score Uneven Skin Tone Fine Lines Elasticity Total Score Scinexa Measures

11 Sleep quality and perceived age poor sleeper good sleeper

12 Sleep Quality and Perceived Age Perceived Age compared to chronological age Perceived Older by 4 yrs Perceived Younger by 8 yrs

13 Skin Barrier function Known to diminish with aging Barrier function is experimentally measured by Transepidermal Water Loss (TEWL) Barrier was disrupted with tape stripping up to a uniform level of TEWL Poor sleepers were worse at repairing barrier function

14 Study Results EVALUATION OF SKIN BARRIER FUNCTION Transepidermal Water Loss Good Sleepers Poor Sleepers 30% Hours After Tape Stripping

15 Erythema from UV

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17 Conclusions from this study Poor sleep quality is associated with: Increased signs of skin aging Slower repair of the skin barrier Slower recovery from UV erythema

18 Potential players in the relationship of sleep and skin changes Glucocorticoids Melatonin Inflammation Oxidative Stress (ROS) DNA damage

19 The skin is an effective barrier against exogenous agents An increase in the permeability of the skin barrier is observed with aging.

20 Sleep and Glucocorticoids* Decreased barrier function Decreased adhesion of corneocytes Decreased wound healing Depressed innate immunity in epidermis *Mirescu et al, PNAS 2006 Kahan V et al, Med Hypothesis 2010

21 Sleep and Melatonin Reduced antioxidant activity Decreased protection against UV damage Esrefoglu et al J Pineal Res 2005 Kleszczynski et al Dermatoendocrinology 2012

22 Sleep and Inflammation Elevated IL6 and TNFalpha in sleep deprivation Cytokines linked to loss of facial subcutaneous fat through inhibition of preadipocyte differentiation Leads to wrinkling/sagging of skin Li et al. J Dermatol Sci 2013 Pessa et al. Aesthetic Surgery J 2014

23 Sleep and Oxidative Stress ROS cause dermal matrix degradation leading to skin wrinkling ROS increase destruction of or impairment of melanocytes leading to dyspigmentaion ROS cause unwarranted apoptosis and cellular dysfunction

24 Sleep and DNA damage Murine models showed increased DNA damage with sleep deprivation Both skin cancer and aging are closely linked with DNA damage and inhibition of DNA repair Hadshiew et al. Am J Contact Derm 2000

25 Day Night

26 Applications in Skin Research Phototherapy timing for diseases such as psoriasis Testing of sun protection agents Enforcement of sun protection recommendations Development of products (beyond sunscreens)in response to circadian variation

27 The Skin Studies Center

28 Thank you!