The link between psychological stress and aging is intuitive although the underlying mechanisms are not well defined. Evidence suggests that chronic psychological stress stimulates the autonomic nervous system, renin-angiotensin system, and the hypothalamic-pituitary-adrenal axis when the body attempts to resolve perceived threats to homeostasis. Prolonged activation of these pathways can result in chronic immune dysfunction, increased production of reactive oxygen species, and DNA damage, which are known to contribute to the again of skin and other tissues.

Despite the lack of conclusive evidence directly linking psychological stress to skin aging, mechanisms by which stress leads to immune dysfunction, oxidative radicals, and ultimately DNA damage via neuronal, endocrine, and immune modulation may present a possible intervention for skin aging. In addition to the wide array of anti-oxidant therapies being developed to combat aging, the topical use of beta-blockers such as timolol, angiotensin receptor blockers such as valsartan, glucocorticoid blockers such as mifepristone, and cholinergic modulators including botulinum toxin, might be potential therapeutic strategies to prevent skin aging. Given the current understanding of these pathways, it would be premature to utilize such modalities for prevention of skin aging at this time, but future research into this type of topical pharmacologic anti-aging intervention may be promising.

The Physician Quality Reporting System (PQRS) was established in 2006 by the Centers for Medicare and Medicaid Services (CMS) as part of an incentive process to improve healthcare preventive practices.  As of 2011, there were 235 PQRS measures but only three specific to skin diseases, specifically melanoma. To measure current usage of the PQRS among dermatologists in Colorado, a survey was distributed at the 2011 Colorado Dermatological Society Meeting.  Of the 120 physician attendees, 60 responded, yielding a response rate of 50%.

Compared with responses from a similar 2010 survey, a significantly higher number of physicians are using PQRS, as well as E-prescribing and EHR systems.  This is likely owing to the fact that CMS will require mandatory reporting of these measures in 2015. Respondents from the current survey commented that a major hurdle to PQRS reporting is the inability to submit data through existing EHR or billing systems.  Currently, CMS requires PQRS reporting through a designated registry such as that provided by the AAD. Some practices have opted to report metrics such as tobacco and alcohol screening, since these can be reported through their billing systems. The results suggest structural improvements in the PQRS reporting system could improve compliance.