Sun Protection Outreach Teaching by Students (SPOTS)-Evaluating the Efficacy of Skin Cancer Prevention Education for Adolescents

BACKGROUND

The Sun Protection Outreach Teaching by Students (SPOTS) program addresses an unmet need by training medical students to teach adolescents about skin cancer prevention and early detection.

OBJECTIVE

To measure (1) changes in adolescents' knowledge, attitudes, and behaviors regarding sun protection and (2) the impact on medical students' confidence in skin cancer preventive counseling.

METHODS

Pre-SPOTS and 1-month post-SPOTS program surveys were completed by adolescent participants and medical student instructors.

RESULTS

Amongst adolescent students, analysis of 1,142 pre-program surveys and 618 post-program surveys revealed statistically significant improvements in knowledge, attitudes, and behaviors. Among the favorable results, 26%, 41%, and 20% improvements over baseline were observed in SPF knowledge, preference for natural untanned skin, and intent to wear sunscreen, respectively (p < .001). One-third of adolescents reported having tried to increase sunscreen use. Amongst medical students, analysis of 78 pre-teaching and 74 post-teaching surveys revealed an increase in feeling "very confident" in counseling patients, from 23% pre-teaching to 82% post-teaching (p < .001).

CONCLUSION

SPOTS demonstrated a dual benefit to adolescents and medical students. The program is available for dermatologists to implement in their communities.

Sunlight-induced Painful Skin (Sun Pain): A New Differential Diagnosis in Photodermatology

Photodermatoses are characterized by the development of skin eruptions following exposure to ultraviolet radiation or visible light. We report here the clinical findings and results of laboratory investigations and phototesting of 6 patients who experience debilitating and excruciating pain after sun exposure ("sun pain") in the absence of any skin eruption. Phototesting with sub-erythemal doses of ultraviolet A radiation triggered localized pain in 4 patients. At follow-up, 3 female patients were found to have developed fibromyalgia, 2 male patients experienced a major depressive disorder, and another male patient had a conversion disorder. One patient also developed allodynia to tactile stimuli and one developed allodynia to thermal and tactile stimuli. Psychiatric conditions should be taken into consideration in patients presenting with excruciating and debilitating pain on exposure to ultraviolet radiation, but with absence of skin eruption. Further research is needed to evaluate whether it represents a type of allodynia triggered by exposure to ultraviolet radiation.

Solar retinopathy and associated optical coherence tomography findings

Solar retinopathy is a rare but well-recognised clinical entity of macular damage, caused by viewing a solar eclipse or direct sun-gazing. Visual deterioration from solar retinopathy typically ranges from 6/9 to 6/60 and in most cases the visual loss is reversible. We present a case of solar retinopathy following direct sun-gazing and illustrate the damage within the retinal structure with optical coherence tomographic (OCT) findings. The visual prognosis of solar retinopathy is usually favourable but prevention remains the mainstay of treatment. The optometrist may play an important role in patient education and reassurance, as well as differentiating solar retinopathy from other likely macular abnormalities.

The effect of age on the acquisition and selection of cancer driver mutations in sun-exposed normal skin

BACKGROUND

The accumulation of somatic mutations contributes to ageing and cancer. Sunlight is the principal aetiological factor associated with skin cancer development. However, genetic and phenotypic factors also contribute to skin cancer risk. This study aimed at exploring the role of photoaging, as well as other well-known epidemiological risk factors, in the accumulation of somatic mutations in cancer-free human epidermis.

MATERIAL AND METHODS

We deeply sequenced 46 genes in normal skin biopsies from 123 healthy donors, from which phenotypic data (including age, pigmentation-related genotype and phenotype) and sun exposure habits were collected. We determined the somatic mutational burden, mutational signatures, clonal selection and frequency of driver mutations in all samples.

RESULTS

Our results reveal an exponential accumulation of UV-related somatic mutations with age, matching skin cancer incidence. The increase of mutational burden is in turn modified by an individual's skin phototype. Somatic mutations preferentially accumulated in cutaneous squamous cell carcinoma cancer genes and clonally expanded with age, with distinct mutational processes underpinning different age groups. Our results suggest a loss of fidelity in transcription-coupled repair later in life.

CONCLUSION

Our findings reveal that ageing is not only associated with an exponential increase in the number of somatic mutations accumulated in normal epidermis, but also with selection and expansion of cancer-associated mutations. Aged, sun-exposed normal skin is thus an extended mosaic of multiple clones with driver mutations, poised for the acquisition of transforming events.

Sun exposure as a strategy for acquiring vitamin D in developing countries of tropical region: Challenges & way forward

Adopting sun exposure as a low-cost sustainable strategy in tropical countries needs critical analysis for its feasibility and inclusion in national policy. This review explores the opportunities and challenges associated with sun exposure in tropical countries and discusses potential strategies that may be adopted for promoting sun exposure. For this, two strands of evidence were reviewed; trials on sun exposure, analysed for risk of bias and, the environmental factors that influence acquisition of vitamin D from sun exposure in the context of on-going ecological and nutritional transition. Compilation of data from available databases in terms of deficiency, per cent rural population, status of fortification, air pollution, ultraviolet index, skin reflectance and skin cancer prevalence were done. In the context of environmental and lifestyle-related challenges, opportunities go hand-in-hand in terms of built environment, variability in air pollution and personal factors such as skin pigmentation, precursor availability and general nutritional status. Contextual policy decisions should consider urban and rural development planning, control of air pollution, targeted guidelines for indigenous and immigrant population and use of space technology in educating general population for balanced sun exposure as essential components for a sustainable strategy. Important opportunities exist for tropical countries to develop sun exposure as a strategy for acquiring vitamin D and these need to be explored.

Visible light. Part II: Photoprotection against visible and ultraviolet light

Cutaneous photobiology studies have focused primarily on the ultraviolet portion of the solar spectrum. Visible light (VL), which comprises 50% of the electromagnetic radiation that reaches the Earth's surface and, as discussed in Part I of this CME, has cutaneous biologic effects, such as pigment darkening and erythema. Photoprotection against VL includes avoiding the sun, seeking shade, and using photoprotective clothing. The organic and inorganic ultraviolet filters used in sunscreens do not protect against VL, only tinted sunscreens do. In the United States, these filters are regulated by the Food and Drug Administration as an over-the-counter drug and are subject to more stringent regulations than in Europe, Asia, and Australia. There are no established guidelines regarding VL photoprotection. Alternative measures to confer VL photoprotection are being explored. These novel methods include topical, oral, and subcutaneous agents. Further development should focus on better protection in the ultraviolet A1 (340-400 nm) and VL ranges while enhancing the cosmesis of the final products.

Priority of Risk (But Not Perceived Magnitude of Risk) Predicts Improved Sun-Protection Behavior Following Genetic Counseling for Familial Melanoma

BACKGROUND

Understanding multiple components of risk perceptions is important because perceived risk predicts engagement in prevention behaviors.

PURPOSE

To examine how multiple components of risk perceptions (perceived magnitude of and worry about risk, prioritization of the management of one's risk) changed following genetic counseling with or without test reporting, and to examine which of these components prospectively predicted improvements in sun-protection behavior 1 year later.

METHODS

A prospective, nonrandomized study design was used. Participants were 114 unaffected members of melanoma-prone families who (i) underwent genetic testing for a CDKN2A/p16 mutation (n = 69) or (ii) were at comparably elevated risk based on family history and underwent genetic counseling but not testing (no-test controls, n = 45). Participants reported risk perception components and sun-protection behavior at baseline, immediately following counseling, and 1 month and 1 year after counseling.

RESULTS

Factor analysis indicated three risk components. Carriers reported increased perceived magnitude and priority of risk, but not cancer worry. No-test controls showed no changes in any risk perception. Among noncarriers, priority of risk remained high at all assessments, whereas magnitude of risk and cancer worry decreased. Of the three risk components, greater priority of risk uniquely predicted improved self-reported sun protection 1 year post-counseling.

CONCLUSIONS

Priority of risk (i) seems to be a component of risk perceptions distinguishable from magnitude of risk and cancer worry, (ii) may be an important predictor of daily prevention behavior, and (iii) remained elevated 1 year following genetic counseling only for participants who received a positive melanoma genetic test result.

Vitamin K2 Awareness in Sun-Protected Patients Supplementing With Vitamin D

Dermatologists often recommend vitamin D for sun-protected patients. Most patients are not aware of the key role vitamin K2 plays in vitamin D metabolism and do not receive sufficient dietary vitamin K2. A survey of 50 sun-protecting patients shows 4/50 understood the role of vitamin K2 and 1/50 was supplementing vitamin K2. Therefore, counseling on vitamin K2 supplementation may be of benefit to sun-protected dermatology patients. J Drugs Dermatol. 2021;20(2):228-229. doi:10.36849/JDD.5829.

What Sun Protection Practices Should Be Adopted by Trainee Teachers to Reduce the Risk of Skin Cancer and Other Adverse Outcomes?

Excessive sun exposure and insufficient protection are the main risk factors for the onset of melanoma and non-melanoma skin cancer (the most common types of cancer suffered by fair-skinned populations) and other adverse effects on the skin and eyes. Epidemiological data highlight the scant awareness of this risk among young people and the high rates of sunburn often recorded among this population. The main aim of the present study is to examine sun exposure and protection behavior by university students. A cross-sectional questionnaire-based study was undertaken to investigate sun exposure and protection practices among students of education sciences at a university in southern Spain. The data obtained were used to perform a descriptive, comparative analysis, by groups and by gender, of photoprotection and skin self-examination practices. The reliability and validity of the questionnaire were both tested. Of the 315 students who completed the questionnaire, 74.6% had suffered at least one sunburn during the previous year. Few made frequent use of sunscreen or protective clothing and 89.5% did not self-examine their skin. The metric properties of the questionnaire revealed its excellent reliability and validity. Among the Spanish university students considered, there was little awareness of the risk of excessive sun exposure, self-protection was insufficient, the potential exposure to dangerous levels of ultraviolet radiation was high, and most had suffered one or more sunburns in the last year. Intervention strategies should be implemented to highlight the risks involved and the need for more appropriate sun protection practices. Information campaigns should be conducted in this respect so that, when these students become teachers, they will have adequate knowledge of the risks involved and of the benefits of addressing this problem effectively, and will ultimately transfer these health education competences to their own students.

Photosensitive Self-Induced Seizures Since Childhood

A 15-year-old girl was admitted to the emergency room because of a bilateral tonic-clonic seizure. The family reported that the episode began with rapid hand movements in front of the patient's eyes while staring at the sun. The patient has a history of multiple admissions in the emergency department due to similar events since the age of eight. Most occurrences were associated with episodes of frustration. The review of the literature has shown that this type of phenomenon, designated in some studies by sunflower syndrome, may be overlooked in patients with photosensitive epilepsy. Despite the unknown etiology, there are several reasons why patients experience this type of behavior, and thus a multidisciplinary approach is needed.

Effect of Photoperiod with Sunlight at Thermal Stress and Sperm Parameters in Guinea Pigs

&lt;b&gt;Background and Objective:&lt;/b&gt; Photoperiod can regulate reproductive physiological processes in mammals, in which improvements in testosterone concentration, testicular volume and seminal quality have been reported. The aim was to evaluate the influence of photoperiod treatments on guinea pigs' spermatic parameters. &lt;b&gt;Materials and Methods:&lt;/b&gt; Thirty guinea pigs, between males and females, were distributed in two rooms with the photoperiodic treatment of 10 hrs light and 14 hrs dark (PT&lt;sub&gt;1&lt;/sub&gt; with artificial photoperiod and PT&lt;sub&gt;2&lt;/sub&gt; photoperiod with sunlight by opening windows from 08:00-18:00) and one without any direct light stimulus (PT&lt;sub&gt;0&lt;/sub&gt;) for 78 days. The temperature and humidity were recorded and the TH index was calculated for each room. The sperms were recovered in Tris base medium from the epididymis of 16 males to determine sperm concentration, motility, kinetic parameters, vitality, HOST, acrosomal integrity and DNA fragmentation. &lt;b&gt;Results:&lt;/b&gt; Sperm values in PT&lt;sub&gt;1&lt;/sub&gt; and PT&lt;sub&gt;0&lt;/sub&gt; were similar but PT&lt;sub&gt;2&lt;/sub&gt; obtained values lower in sperm concentration, non-progressive motility, total motility, VCL, ALH, vitality, HOST+, acrosomal integrity, sperm with non-fragmented DNA and no pregnancies were reported (0/5). A 100% pregnancy was observed in PT&lt;sub&gt;0&lt;/sub&gt; (4/4) and 50% in PT&lt;sub&gt;1&lt;/sub&gt; (2/4). However, precocity was evidenced in PT&lt;sub&gt;1&lt;/sub&gt; compared to PT&lt;sub&gt;0&lt;/sub&gt;. PT&lt;sub&gt;2&lt;/sub&gt; recorded higher peaks in temperature (33.8°C, THI 81, considered as thermal stress) compared to PT&lt;sub&gt;0&lt;/sub&gt; (32.65°C, THI 81.8) and PT&lt;sub&gt;1&lt;/sub&gt; (32.75°C, THI 81.6). &lt;b&gt;Conclusion:&lt;/b&gt; An artificial photoperiod can improve sperm characteristics and reproductive precociousness of guinea pigs, unlike the photoperiod with sunlight, which generated low spermiogram values and absence of pregnancy due to thermal stress.

[Sun-damaged skin (photoaging): what is new?]

Skin aging results from the interaction of genetic and nongenetic so-called exposomal, factors. Among the exposomal factors, chronic, life-long exposure to sunlight is of eminent importance for the development of skin aging characteristics. Importantly, photoaging of human skin is not only caused by ultraviolet (UV) B and A radiation, but is also the consequence of exposure to wavelengths beyond the UV spectrum. These include visible, i.e. blue light (400-440 nm) as well as the short part of infrared radiation, i.e. IRA (760-1200 nm). Here we summarize the scientific evidence supporting these conclusions and emphasize the resulting consequences for daily photoprotection of human skin. We also explain the clinical significance of the concept that is offered by the skin aging exposome, which e.g. takes into account the fact that sunlight interacts with other exposomal factors and that this interaction is important for photoaging of the skin.

Clinical Evaluation of a Nature-Based Bakuchiol Anti-Aging Moisturizer for Sensitive Skin

BACKGROUND

Patients with sensitive skin find topical retinoid use for anti-aging purposes challenging due to irritation. Bakuchiol, a meroterpene from the Psoralea corylifolia seed, has retinol functionality through retinol-like regulation of gene expression.

OBJECTIVE

This research examined the tolerability, efficacy, and barrier effects of a nature-based bakuchiol-containing cleanser and moisturizer in subjects with sensitive skin.

METHODS

60 female subjects Fitzpatrick skin types I&ndash;V age 40&ndash;65 years with sensitive mild to moderate photodamaged skin were enrolled in this 4 week study. A sensitive skin panel was constructed: 1/3 eczema/atopic dermatitis, 1/3 rosacea, 1/3 cosmetic intolerance syndrome. Subjects used a nature-based cleanser and moisturizer twice daily and underwent transepidermal water loss (TEWL), corneometry, tolerability assessments, and efficacy assessments at baseline, 5&ndash;10 minutes post-application, and week 4.

RESULTS

The skin care products were well tolerated and efficacious (P&lt;0.001) in terms of investigator assessed improvement in visual smoothness, tactile smoothness, clarity, radiance, overall appearance, and global anti-aging. Cheek corneometry measurements demonstrated a statistically significant 16% increase in skin moisture content (P&lt;0.001).

CONCLUSION

A bakuchiol nature-based anti-aging moisturizer is well tolerated and effective in individuals with sensitive skin.J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.5522.

Oxytocin Levels Inversely Correlate With Skin Age Score and Solar Damage

BACKGROUND

Studies have shown oxytocin (OT) and its carrier protein neurophysin 1 are found in the epidermis. The oxytocin receptor, which is found on human fibroblasts has been shown, when activated by oxytocin, to inhibit senescence-associated secretory phenotype (SASP). SASP activation induces the release of proinflammatory cytokines which contribute to skin aging. Therefore, its inhibition by oxytocin would constitute a protective mechanism. This pilot study was designed to explore clinical evidence of oxytocin levels correlating to the skin&rsquo;s appearance in subjects.

METHODS

Oxytocin levels, facial photographs, and lifetime sun exposure questionnaires from six female subjects aged 48&ndash;61 years old were analyzed. A skin age score (SAS) was determined for each subject and was compared to the expected average SAS for each subject based on their age to determine a percentage in change, if any. A reduction in SAS would indicate more youthful appearing skin than the average person of that age.

RESULTS

All subjects had at least some reduction in SAS score as compared to their expected score. An almost linear relationship of SAS reduction as related to OT levels was found, showing a correlation of more youthful appearing skin with higher OT levels.

CONCLUSIONS

This study links previously published evidence of oxytocin&rsquo;s protective role against inflammatory cytokine release in the skin with clinical evidence of OT levels correlating with SAS scores. Furthermore, it shows OT is likely inducing a protective function in the epidermis in the case of sun exposure and possibly with intrinsic aging. J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.5063.

Exposure to solar ultraviolet radiation and breast cancer risk: A dose-response meta-analysis

The relationship between solar ultraviolet radiation and the risk of breast cancer is conflicting. The purpose of our study was to quantitatively assess the relationship between solar ultraviolet radiation and breast cancer risk and to analyze related factors such as age and sunscreen use.Articles indexed in PubMed and Embase and published between January 2005 and March 2020 were searched for relevant keywords. The relative risk was calculated using random-effect or fixed-effect models in the meta-analysis and dose-response meta-analysis, which were conducted according to the Meta-Analyses of Observational Studies in Epidemiology reporting guidelines. Sensitivity analyses for heterogeneity and publication bias were evaluated.Six studies were eligible for inclusion in the meta-analysis, and three of these were included in the dose-response analysis. We found a correlation between exposure to solar ultraviolet radiation and breast cancer risk (relative risk: 0.70, 95% confidence interval: 0.65, 0.75). We also found a linear dose-response relationship between the exposure and breast cancer risk (relative risk: 0.86, 95% confidence interval: 0.81, 0.91) in women over 40. Not tanning and covering the limbs were associated with breast cancer risk, but sunscreen use was not.Exposure to solar ultraviolet radiation is negatively correlated with breast cancer risk, and the association is linear in women over 40. This is the first dose-response meta-analysis on the topic, and the influence of factors such as estrogen receptor status, occupational exposure, and ethnicity requires in-depth study.

Sequential Treatment of Actinic Keratosis and Photoaging by Daylight PDT and Injectable NASHA Gel as Skin Booster

INTRODUCTION

Actinic keratosis (AK) is a common intraepithelial atypical proliferation of keratinocytes that might progress into invasive squamous cell carcinoma.

METHOD

We have tested the treatment using sequential sessions of photodynamic therapy in daylight and injectable non-animal hyaluronic acid gel skin boosters (NSBs) on 4 patients with AK on head and neck. Two further sessions of NSBs were scheduled, 30 and 60 days after the first injection, to improve the overall skin quality.

RESULTS

All patients showed a clinically significant improvement of the overall face skin quality, photoaging signs, and fine wrinkles; all patients were satisfied of the treatment outcome. None of the patients reported any side effect related to the treatment.

DISCUSSION

The combination of two minimally invasive treatments showed to be effective giving the almost complete resolution of AK and a clear improvement of skin texture, with noticeable reduction of the clinical signs of skin photoaging, meeting patient&rsquo;s expectations. J Drugs Dermatol. 2020;19(11): doi:10.36849/JDD.2020.2229.

Focus on UV-Induced DNA Damage and Repair-Disease Relevance and Protective Strategies

The protective ozone layer is continually depleting due to the release of deteriorating environmental pollutants. The diminished ozone layer contributes to excessive exposure of cells to ultraviolet (UV) radiation. This leads to various cellular responses utilized to restore the homeostasis of exposed cells. DNA is the primary chromophore of the cells that absorbs sunlight energy. Exposure of genomic DNA to UV light leads to the formation of multitude of types of damage (depending on wavelength and exposure time) that are removed by effectively working repair pathways. The aim of this review is to summarize current knowledge considering cellular response to UV radiation with special focus on DNA damage and repair and to give a comprehensive insight for new researchers in this field. We also highlight most important future prospects considering application of the progressing knowledge of UV response for the clinical control of diverse pathologies.

'More extraordinary than mundane … ' A phenomenological analysis of the experiences of individuals living with CLE and their taking care in the sun

Introduction

CLE is a chronic inflammatory autoimmune condition of which photosensitivity is a major symptom. Individuals living with CLE are advised to practice photoprotection. Despite the benefits for disease control, many individuals living with CLE do not practice optimal photoprotection. The aim of this study was to gain a deep insight into the lived experiences of individuals with CLE and their photoprotective practices.

Methods

A qualitative study approach was conducted, using Hermeneutic phenomenology. Individuals living with CLE were recruited and interviewed. Rich pictures were used to enrich the interviews. Interviews were transcribed and analysed using Template Analysis.

Results

Analysis revealed four themes: ‘Much more than just a photosensitive skin condition’, ‘The impact of sun on CLE and social dynamics’, ‘Drifting to the sun: personal transitions and social norms’ and ‘Taking care in the sun: easier said than done’.

Discussion and conclusion

This study provides a nuanced insight into the lived experiences of individuals with CLE and their photoprotective practices. Taking care in the sun is not a simplistic process. Beyond the biomedical model of illness, the social impact that CLE has on individuals has a dominant influence on their photoprotective behaviours. Such insights could help healthcare professionals tailor photoprotective advice.

The Shadow Rule, the UV Index, and the 5S Steps in the Tropics

Solar ultraviolet radiation (UVR) induces the production of vitamin D (VD), but it also causes erythema and skin cancer among other diseases. The amount of UVR to get benefit and avoid harm is unknown. Some principles were proposed to provide accessible information on how to avoid overexposure to the Sun. They are (1) the Shadow Rule (SR); (2) the UV Index (UVI); and (3) the Slip, Slop, Slap, Seek, Slide (5S) steps. This work discusses these principles in the tropics, considering measurements of solar UVR, total ozone column, and cloudiness. Indeed, the SR leads to overexposures. The UVI is adequate for cloudless skies, but it does not consider radiation enhancement events by clouds. "Seek shade" in the 5S steps should be more emphasized as it is both the most efficient step in terms of avoiding direct sun and the friendliest step toward the environment. Therefore, photoprotection attitudes in the tropics should focus on the UVI and the 5S steps in addition to considering both VD sufficiency and environmental outcomes. The SR is clearly inaccurate.

Validation of SEPI in German-A German Translation of the Sun Exposure and Protection Index

The Sun Exposure and Protection Index (SEPI) is a brief instrument for scoring of sun exposure habits and propensity to increase sun protection, previously validated in English and in Swedish, as well as in two different outdoor sun intensity environments (Australia and Northern Europe). The aim of the present study was to study reliability and validity of a German translated version of the SEPI to be used in German-speaking populations. Data was collected at University of Flensburg and at Hamburg University of Applied Sciences from November 2018 to April 2019. Participants (n = 205) filled out the SEPI and also a selection of corresponding questions from the Austrian Vienna UV Questionnaire in German. After three weeks, the participants filled out the SEPI once again in order to assess test–retest stability. Of the 205 participants completing the baseline questionnaire, 135 participants completed it once again after three weeks. Internal consistency, by Cronbach’s alpha, for the baseline responses was 0.70 (95% C.I: 0.63–0.76) for SEPI part 1 (sun exposure habits) and 0.72 (95% C.I: 0.66–0.78) for part 2 (propensity to increase sun protection). Test–retest stability was high, with weighted Kappa >0.6 for all items but one, and the instrument correlated well with the previously validated German-language UV Skin Risk Survey Questionnaire. In conclusion, the German version of SEPI can reliably be used for mapping of individual sun exposure patterns.