Mending the Rift: DNA Repair and Aging

David A. Goukassian, MD, PhD, Department of Dermatology, Boston University School of Medicine, Boston, MA, USA.

One important goal in the field of DNA repair is to use current knowledge of DNA damage and repair mechanisms in normal young and adult cells and animal models in the chemoprevention and chemotherapeutics of DNA damage-related diseases. However, such a translation into a true in vivo setting can prove difficult. No doubt, the scope of human in vivo studies is currently restricted by the complexity of this setting and by the relatively limited availability of safe and effective in vivo chemopreventive and chemotherapeutic substances, as well as tremendous ethical responsibility. This article’s focus is on human and human skin organ-culture studies and outlines possible future directions for the field of photobiology in “translational” applications.
Key words: aging, DNA repair, UV, skin tumour, T-oligos.

Skin Manifestations of Internal Disease

D’Arcy Little, MD, CCFP, Lecturer, Department of Family and Community Medicine, University of Toronto, Toronto, ON.

The skin can be a window to certain internal diseases. Notable internal diseases with a prominent skin component include systemic lupus erythematosus, dermatomyositis, scleroderma, psoriasis, and sarcoidosis. This article will review some of the common skin manifestations of these diseases.

Key words: skin disease, internal disease, systemic lupus erythematosus, dermatomyositis, scleroderma, psoriasis, sarcoidosis.

Promoting Healing of Diabetic Foot Ulcers

Oksana Davidovich, BSc, DCh (Chiropodist), Private Practice: Davisville Foot Clinic; President of the Ontario Society of Chiropodists, Toronto, ON.

Diabetic neuropathic foot ulcers, often a precursor to amputation, occur in high-pressure areas on the sole of the foot. Ulcer healing can be achieved through a combination of wound management and a variety of offloading modalities. Total contact casts and removable cast walkers are effective methods for facilitating wound closure. Alternatively, a wide range of temporary, weight-relief shoes and healing sandals are also effective in resolving active ulcers. Once the wound has healed, prevention strategies typically include custom-made, modified, or premade orthopedic shoes used in conjunction with foot orthoses, as well as a regular podiatric examination to screen for potential complications.

Key words: diabetic foot, foot ulcer, cast, orthopedic footwear, foot orthoses.

Management of Diabetic Foot Ulcers

Madhuri Reddy, MD, MSc, FRCPC, Assistant Professor, Department of Medicine,
University of Toronto, Associate Editor, Geriatrics & Aging, Toronto, ON.

R. Gary Sibbald, BSc, MD, FRCPC (Med), FRCPC (Derm), MACP, DABD, Associate Professor and Director of Continuing Education, Department of Medicine, University of Toronto, Toronto, ON.

Prevention of diabetic foot wounds is of crucial importance. Diabetic foot wounds are basically pressure ulcers due to improper footwear, and therefore the most critical aspect of prevention is wearing proper shoes, checked regularly by a reputable orthotist. Once foot wounds have occurred in a person with diabetes, proper footwear continues to be
crucial. Also of importance are adequate vascular supply, treatment of infection, and surgical debridement, if necessary. All diabetic foot wounds should be probed in order to evaluate depth. If the wound probes to bone, osteomyelitis should be presumed unless proven otherwise.

Key words: diabetes, wounds, ulcers, vascular, infection.

Psoriasis in Older Adults: Issues and Treatment

Scott RA Walsh, MD, PhD, Division of Dermatology, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto Medical School, Toronto, ON.

Madhuri Reddy, MD, MSc, FRCPC, Divisions of Dermatology and Geriatric Medicine, Department of Medicine, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto Medical School, Toronto, ON.

Psoriasis is a chronic, recurring T-cell- mediated skin disease that causes significant morbidity. The disease is often life-long and thus prevalence is highest in older adults. Severe clinical variants are also more frequent. Complicating psoriasis presentation and treatment in older adults are issues related to polypharmacy, including a higher frequency of drug-induced or drug-exacerbated disease and potential drug interactions. Treatment should be tailored to the individual with his/her respective limitations and reflect disease severity. This review examines suitable treatment protocols, including patient education and topical and systemic medications in older populations coping with psoriasis.

Key words: psoriasis, older adults, complications, treatment, immunologic disease

Benign Pigmented Lesions in Older Adults: A Field Guide

Gordon E. Searles, OD, MD, MSc, FRCPC, FACP, Internal Medicine and Dermatology, Western Canada Dermatology Institute, Edmonton, AB.

Practitioners are commonly asked about issues of skin and skin disorders. While many skin lesions are benign, it is becoming increasingly important for clinicians to be able to distinguish benign lesions from premalignant or malignant lesions. The goal of this article is to describe the most common forms of benign lesions in older patients and suggest various treatment strategies.

Key words: melanoma, pigmentary, macules, keratosis, ephelides.