Sunscreening agent intolerance: contact and photocontact sensitization and contact urticaria

Environmental fate of organic UV filters: Global occurrence, transformation, and mitigation via advanced oxidation processes

Organic UV filters are used in personal care products, plastics, paints, and textiles to protect against UV radiation. Despite regulatory limits, these compounds still enter the environment through direct wash-off during swimming, evaporation, leaching from products, and incomplete removal in wastewater treatment plants. They have been detected in various environmental matrices worldwide. Once in the environment, organic UV filters can undergo phototransformation and biotransformation, forming transformation products that, together with parent substances, pose health risks to humans and wildlife and harm marine ecosystems, especially coral reefs. The increasing concern over water scarcity and the environmental impact of pollutants underscores the importance of eliminating these contaminants from aquatic environments. This review primarily focuses on organic UV filters approved for use in sunscreens, many of which are also utilized in other materials, with a few exceptions including UV stabilizer UV-328. It includes an in-depth analysis of 155 peer-reviewed articles published from 2015 to 2024, assessing the concentrations of these filters in various environmental matrices, including water and solid matrices, air and biota. Moreover, this review explores the environmental transformation of these chemicals and assesses the effectiveness of advanced oxidation processes (AOPs) in removing these pollutants. The findings highlight the pervasive presence of organic UV filters in the environment and the promising potential of AOPs to mitigate the associated environmental challenges.

The Effect of α-Arbutin on UVB-Induced Damage and Its Underlying Mechanism

Ultraviolet radiation can heighten tyrosinase activity, stimulate melanocyte production, impede the metabolism of numerous melanocytes, and result in the accumulation of plaques on the skin surface. α-Arbutin, a bioactive substance extracted from the arbutin plant, has been widely used for skin whitening. In this study, the whitening effect of α-arbutin by inhibiting tyrosinase activity and alleviating the photoaging effect induced by UVB are investigated. The results indicate that α-arbutin can inhibit skin inflammation, and its effectiveness is positively correlated with concentration. Moreover, α-arbutin can reduce the skin epidermal thickness, decrease the number of inflammatory cells, and down-regulate the expression levels of IL-1β, IL-6 and TNF-α, which are inflammatory factors. It also promotes the expression of COL-1 collagen, thus playing an important role in anti-inflammatory action. Network pharmacology, metabolomics and transcriptomics further confirm that α-arbutin is related to the L-tyrosine metabolic pathway and may interfere with various signaling pathways related to melanin and other photoaging by regulating metabolic changes. Therefore, α-arbutin has a potential inhibitory effect on UVB-induced photoaging and possesses a whitening effect as a cosmetic compound.

Preclinical evaluation from in-silico to in-vivo study of polyherbal microsponge sunscreen gel

BACKGROUND

Electromagnetic spectrum of the UV region predominantly becomes the reason for skin's detrimental effects that give the genesis of innumerable skin ailments; because of this reason, the sunscreen products are required before condition in day to day lifestyle; products such as moisturizers, lotions, creams, shampoos, and other hair and skin preparations are accessible and accompanied by sunscreen properties, but they do not provide extended effect, also causes side effects due to harsh chemicals.

AIM

The present study focuses on the effects of polyherbal extracts containing Microsponge gel for the protection of skin from ultraviolet rays.

MATERIALS AND METHODS

In the present research, already prepared Microsponge gel through quasi-emulsion solvent diffusion (QESD) technique was used for the HPLC, in-silico, in-vitro antioxidant activity, and in-vivo study. AdmetSAR software tool was utilized for the in-silico study, whereas for the in-vivo study, UV radiations are given on Albino rats using solarimeter.

RESULTS

Results shown the active constituents are non-carcinogenic and non-toxic; IC50 values show good antioxidant activity and minimal effect of UV radiations after application of the gel formulation on animal skin.

DISCUSSION

The results manifest prominent effects on animal skin further test for presence of ascorbic acid level and total protein in blood further verify the efficacy of the formulation.

CONCLUSION

The study consequently established a strong ground for further extensive clinical studies.

Removal of Aqueous Para-Aminobenzoic Acid Using a Compartmental Electro-Peroxone Process

The presence of emerging contaminant para-aminobenzoic acid (PABA) in the aquatic environment or drinking water has the potential to harm the aquatic ecosystem and human health. In this work, the removal of aqueous PABA by a compartmental electro-peroxone (E-peroxone) process was systematically investigated from the kinetic and mechanism viewpoints. The results suggest that single electrolysis or ozonation was inefficient in PABA elimination, and the combined E-peroxone yielded synergistic target pollutant degradation. Compared to the conventional E-peroxone oxidation, the sequential cathodic reactions, followed by anodic oxidations, improved the PABA removal efficiency from ~63.6% to ~89.5% at a 10-min treatment, and the corresponding pseudo first-order kinetic reaction rate constant increased from ~1.6 × 10−3 to ~3.6 × 10−3 s−1. Moreover, the response surface methodology (RSM) analysis indicated that the appropriate increase of inlet ozone concentration, applied current density, initial solution pH value, and solution temperature could accelerate the PABA degradation, while the excess of these operational parameters would have a negative effect on the treatment efficiency. The comparation tests revealed that the coupling of electrolysis and ozonation could synergistically produce hydroxyl radicals (HO•) and the separation of cathodic reactions and anodic oxidations further promoted the HO• generation, which was responsible for the enhancement of PABA elimination in the compartmental E-peroxone process. These observations imply that the compartmental E-peroxone process has the potential for aqueous micropollutants elimination, and the reaction conditions that favor the reactive oxygen species generation are critical for the treatment efficiency.

Ultraviolet blocking and antioxidant polyvinyl alcohol films incorporated with baicalin extraction from Scutellaria baicalensis Georgi

Baicalin, an active flavonoid ingredient of Scutellaria baicalensis Georgi, was extracted by heat reflux extraction and showed the same significance UV absorption property with standard baicalin. Active films were prepared from polyvinyl alcohol (PVA) containing baicalin extract by casting method. The effect of baicalin extracts on the UV-blocking, optical, antioxidant property, water vapor permeability, swelling and mechanical properties of the films were studied. UV–vis transmittance spectra showed that PVA films incorporated with baicalin extract blocked ultraviolet light range from 280–400 nm even with low concentration of baicalin (0.5 wt%) and maintain the high transparency in visible spectrum. The outstanding UV-blocking properties of PVA films incorporated with baicalin extract were also confirmed by Rhodamine B degradation. Baicalin conferred antioxidant properties to PVA films as determined by DPPH radical scavenging activity. Due to the interaction between hydroxy groups of baicalin and PVA molecule, water vapor permeability, swelling and elongation at break of the films were decreased accompanied with the increasing in tensile strength and Young’s modulus. FTIR reveal that the interaction between PVA molecules was significant changed by the introduction of baicalin. These results suggest that PVA film incorporated with baicalin extract can be used for the development of functional protective film.

Photopatch Testing Among Members of the American Contact Dermatitis Society

BACKGROUND

Photopatch testing is an important diagnostic tool in evaluating patients with suspected photoallergic contact dermatitis. Although protocols for photopatch testing have been described, there are no consensus recommendations by the American Contact Dermatitis Society (ACDS).

OBJECTIVES

The aims of this study were to examine the common practices of photopatch testing among ACDS members and to review and compare commonly used photoallergen series.

METHODS

We conducted a questionnaire-based survey among ACDS members via e-mail to inquire about their photopatch test methods. We compared the results with the European consensus methodology and reviewed photoallergen series reported by the respondents.

RESULTS

Of the 791 members contacted, 112 members (14%) responded to the survey. Among these, 50 respondents (45%) perform photopatch testing, approximately half of whom (48%) determine minimal erythema dose before the test using UVA with or without UVB irradiation. Respondents use a total of 13 photoallergen series, alone or in any combination, as well as customized series.

CONCLUSIONS

These results have potential to aid clinicians in identifying photoallergen series best suited for their patients and suggest a need for consensus recommendations by the ACDS.

Mycosporine-Like Amino Acids: Potential Health and Beauty Ingredients

Human skin is constantly exposed to damaging ultraviolet radiation (UVR), which induces a number of acute and chronic disorders. To reduce the risk of UV-induced skin injury, people apply an additional external protection in the form of cosmetic products containing sunscreens. Nowadays, because of the use of some chemical filters raises a lot of controversies, research focuses on exploring novel, fully safe and highly efficient natural UV-absorbing compounds that could be used as active ingredients in sun care products. A promising alternative is the application of multifunctional mycosporine-like amino acids (MAAs), which can effectively compete with commercially available filters. Here, we outline a complete characterization of these compounds and discuss their enormous biotechnological potential with special emphasis on their use as sunscreens, activators of cells proliferation, anti-cancer agents, anti-photoaging molecules, stimulators of skin renewal, and functional ingredients of UV-protective biomaterials.

Natural products as photoprotection

The rise in solar ultraviolet radiation on the earth's surface has led to a depletion of stratospheric ozone over recent decades, thus accelerating the need to protect human skin against the harmful effects of UV radiation such as erythema, edema, hyperpigmentation, photoaging, and skin cancer. There are many different ways to protect skin against UV radiation's harmful effects. The most popular way to reduce the amount of UV radiation penetrating the skin is topical application of sunscreen products that contain UV absorbing or reflecting active molecules. Based on their protection mechanism, the active molecules in sunscreens are broadly divided into inorganic and organic agents. Inorganic sunscreens reflect and scatter UV and visible radiation, while organic sunscreens absorb UV radiation and then re-emit energy as heat or light. These synthetic molecules have limited concentration according to regulation concern. Several natural compounds with UV absorption property have been used to substitute for or to reduce the quantity of synthetic sunscreen agents. In addition to UV absorption property, most natural compounds were found to act as antioxidants, anti-inflammatory, and immunomodulatory agents, which provide further protection against the damaging effects of UV radiation exposure. Compounds derived from natural sources have gained considerable attention for use in sunscreen products and have bolstered the market trend toward natural cosmetics. This adds to the importance of there being a wide selection of active molecules in sunscreen formulations. This paper summarizes a number of natural products derived from propolis, plants, algae, and lichens that have shown potential photoprotection properties against UV radiation exposure-induced skin damage.

Photoprotective characteristics of natural antioxidant polyphenols

Fourteen natural polyphenols belonging to the classes of stilbenes, flavonoids and hydroxycinnamic acid derivatives, have been investigated in order to verify the combination of their photoprotective characteristics with their antioxidant properties. To this purpose, sun protection factor (SPF), UVA/UVB ratio and critical wavelengths (λc), have been considered to evaluate photoprotection capacity, while inhibition of lipid peroxidation has been adopted as a reliable measure of the antioxidant properties. The results obtained indicate that a large number of these natural phenol derivatives show both antioxidant activity and photoprotective characteristics and, as a consequence, they could be interesting components for pharma-photoprotection formulations. In fact, these compounds associate to a preventive function, linked to UV filtering properties, an effective action, correlated to antioxidant capacity of contrast towards UV-induced ROS injury.

Aquatic photodegradation of sunscreen agent p-aminobenzoic acid in the presence of dissolved organic matter

Dissolved organic matter (DOM) is an important photosensitizer for the phototransformation of organic contaminants in sunlit natural waters. This article focuses on the photolysis kinetics and mechanism of sunscreen agent p-aminobenzoic acid (PABA) in the presence of four kinds of DOM; Suwannee River fulvic acid (SRFA), Suwannee River humic acid (SRHA), Nordic Lake fulvic acid (NOFA) and Nordic Lake humic acid (NOHA). It is evident that direct photolysis of PABA is highly pH-dependent because different species of PABA have different electrical densities on the ring system. The presence of four kinds of DOM inhibits the photolysis of PABA primarily due to their light screening effect. Meanwhile, a complex interaction involving energy transfer, triplet carbonyl group induced electron transfer, and amino acid induced proton abstraction between PABA and DOM is verified by competition kinetics experiments and density functional theory (DFT) computation. In addition, DOM-induced singlet oxygen ((1)O(2)) and hydroxyl radical (OH) are determined to play an insignificant role in PABA photolysis by competition dynamics method. Photoproducts identification using solid phase extraction-liquid chromatography-mass spectrometry (SPE-LC-MS) techniques reveals that the distribution of the photoproducts could not be affected by the addition of DOM. Two photodegradation pathways of PABA are temporarily proposed, in which the di(tri)-polymerization of intermediates are the dominant pathway whereas the oxidation of amino group to nitryl followed by hydroxylation is a minor process. Our findings reveal that direct photolysis is the dominant transformation pathway of PABA in natural sunlit waters, while the presence of DOM could evidently influence such process by light screening effect, energy transfer, electron transfer and proton abstraction mechanism. The findings in this study provide useful information for understanding of interaction between DOM and organic contaminants.

Photoprotective effects of methoxycinnamidopropyl polysilsesquioxane

A new sunscreen ingredient, methoxycinnamidopropyl polysilsesquioxane (MCP-PSQ), which contains an UV-absorbing p-methoxycinnamoyl group, has been developed synthetically and evaluated using in vitro and in vivo approaches. Previous studies revealed that MCP-PSQ has a raising or boosting effect on the sun protection factor (SPF) of other sunscreen agents. In this study, we demonstrated that MCP-PSQ, an organic/inorganic hybrid compound, has photoprotective effects for human fibroblasts, and for hairless mouse and human skin. MCP-PSQ increases cell viability and suppresses the expression of p53 protein in fibroblasts after UV exposure. In addition, the numbers of sunburn cells and mast cells are reduced by topical application of MCP-PSQ on hairless mouse skin after UV irradiation. A 10% MCP-PSQ cream has higher and similar effects on SPF values for human skin compared to 5% titanium dioxide (TiO(2)) and 5% ethylhexyl methoxycinnamate (EHMC), respectively. The SPF value obtained using the MCP-PSQ cream did not drop after UV irradiation of the cream itself. However, higher dose of UV irradiation is required to guarantee the stability or photostability of the formulation. Further, there were no side effects such as erythema, edema, itch or tingling, suggesting that MCP-PSQ is a good sunscreen agent.

Drug-cyclodextrin-vesicles dual carrier approach for skin targeting of anti-acne agent

In the present study attempt was made for preparation of isotretinoin-hydroxypropyl beta cyclodextrin (HP-beta-CD) inclusion complex and encapsulate this complex in elastic liposomes to study the effect of dual carrier approach on skin targeting of isotretinoin. The isotretinoin HP-beta-CD complex was prepared by freeze-drying method and characterized by IR spectroscopy. The drug and drug-CD complex loaded elastic liposomal formulation were prepared and characterized in vitro, ex-vivo and in vivo for shape, size, entrapment efficiency, no. of vesicles per cubic mm, in vitro skin permeation and deposition study, photodegradation and skin toxicity assay. The transdermal flux for different vesicular formulations was observed between 10.5 +/- 0.5 to 13.9 +/- 1.6 microg/cm(2)/h. This is about 15-21 folds higher than that obtained from drug solution (0.7 +/- 0.1 microg/cm(2)/h) and 4-5 folds higher than obtained with drug-CD complex solution (2.7 +/- 0.1 microg/cm(2)/h). The amount of drug deposit was found to increase significantly (p < 0.05) by cyclodextrin complexation (30.1 +/- 0.1 microg). The encapsulation of this complex in elastic liposomal formulation further increases its skin deposition (262.2 +/- 21 microg). The results of skin irritation study using Draize test also showed the significant reduction in skin irritation potential of isotretinoin elastic liposomal formulation in comparison to free drug. The results of the present study demonstrated that isotretinoin elastic liposomal formulation possesses great potential for skin targeting, prolonging drug release, reduction of photodegradation, reducing skin irritation and improving topical delivery of isotretinoin.

Identification of the Biotransformation Products of 2-Ethylhexyl 4-(N,N-Dimethylamino)benzoate

Nowadays, 2-ethylhexyl 4-(N,N-dimethylamino)benzoate (EDP) is one of the most widely used UV filters in sunscreen cosmetics and other cosmetic products. However, undesirable processes such as percutaneous absorption and biological activity have been attributed to this compound. The in vitro metabolism of EDP was elucidated in the present work. First of all, the phase I biotransformation was studied in rat liver microsomes and two metabolites, N,N-dimethyl-p-aminobenzoic acid (DMP) and N-monomethyl-p-aminobenzoic acid (MMP), were identified by GC-MS analysis. Secondly, the phase II metabolism was investigated by means of LC-MS. The investigated reactions were acetylation and glucuronidation working with rat liver cytosol and with both human and rat liver microsomes, respectively. Analogue studies with p-aminobenzoic acid (PABA) were carried out in order to compare the well established metabolic pathway of PABA with the unknown biotransformation of EDP. In addition, a method for the determination of EDP and its two phase I metabolites in human urine was developed. The methodology requires a solid-phase extraction prior to LC-MS analysis. The method is based on standard addition quantification and has been fully validated. The repeatability of the method, expressed as relative standard deviation, was in the range 3.4-7.4% and the limit of detection for all quantified analytes was in the low ng mL(-1) range.

Sunscreen Allergy: A Review of Epidemiology, Clinical Characteristics, and Responsible Allergens

Although allergy to sunscreen represents a small proportion (< 1%) of allergic contact dermatitis reactions in North America, it is one of the most common causes of photoallergy. The epidemiology and clinical characteristics of sunscreen allergy are summarized in this review. In addition, a detailed discussion of specific chemical sunscreen allergens is provided.

Anionic clays for sunscreen agent safe use: Photoprotection, photostability and prevention of their skin penetration

The use of sunscreen preparations is recently growing and their efficacy and safety must be taken into account since they are applied on the skin frequently and for many hours. Exposition to sunlight, in fact, can cause sunscreen photodegradation and determine their decrease in UV protection often with the occurrence of allergic and/or toxic degradation products. A high photostability is hence very important for their effectiveness and safety. The aim of this work is to obtain new sunscreen formulations stabilized by intercalating PABA, within the lamellar structures of two kinds of hydrotalcite. PABA was chosen as model sunscreen because of its high photoinstability and photosensitizing properties that nowadays bar its utilization. Both intercalated products showed an increased protection range and, in one case, an improved sunscreen photostability. Sunscreen release from creams containing intercalated or free PABA was evaluated as well. The very low or negligible sunscreen release, obtained from the intercalated product loaded formulations, resulted in a lack of a close contact between skin and filter with the consequence that cutaneous reactions and allergy problems are eliminated. The use of these materials resulted in a good strategic technological approach in order to increase efficacy and safety of solar products.

An overview of ultraviolet radiation, sunscreens, and photo-induced dermatoses

The incidence of sunlight-induced skin aging and skin cancers, particularly melanoma skin cancer, has been increasing in many parts of the world. Authorities are recommending primary prevention programs to reduce cutaneous photodamage and skin carcinogenesis. An integral component of these programs is the use of protective clothing and effective sunscreens. Most modern sunscreens have highly efficient absorption or reflecting capabilities throughout ultraviolet B, partly ultraviolet A, and in some instances infrared wavelengths. Over the last several years, more efficient sunscreening ingredients have been developed for improved skin protection. More recently, direct evidence has demonstrated the effectiveness of sunscreens in their ability to reduce the incidence of solar keratoses. This article reviews the protectiveness of sunscreens and assays that predict their levels of protection.

Protecting the Protectors: Reducing the Biological Toxicity of UV Sunscreens by Zeolite Encapsulation

The phototoxic and photoallergic effects of the once popular UV sunscreen p-aminobanzoic acid are related, in part, to its ability to sensitize the formation of singlet oxygen as well as other reactive oxygen species. In this work we demonstrate that the sunscreen-photoinduced inactivation of a model protein, horseradish peroxidase, is reduced by approximately a factor of three when the sunscreen is encaspsulated in zeolite sodium Y. These results provide evidence that using the technology of zeolite encapsulation to prepare a supramolecular sunscreen that minimizes the skin contact of active ingredients may reduce the adverse effects of "naked" sunscreens on biological systems. These radiation-induced effects, unfortunately, frequently accompany the desirable UV-screening role of these products. These results provide an important benchmark for the use of zeolite encapsulation as a means of improving the safety of UV sunscreens for topical application.

Human Safety and Efficacy of Ultraviolet Filters and Sunscreen Products

Ultraviolet (UV) filters are the active ingredients in sunscreens. The concentration and combination of UV filters determine the efficacy of sunscreens as measured by sun protection factor. The safety of individual UV filters, and, more generally, sunscreen products, is a matter of a few related components: objective toxicologic evaluation, phototoxicologic potential, and human health consequences of using products that may reduce some but not all of the solar UV. Of 16 UV filters approved by the US Food and Drug Administration, 9 are used in different combinations in the most currently marketed sunscreens. Most of these compounds are considered safe and effective alone or in combination with other UV filters based on extensive toxicologic/phototoxicologic evaluations and market history. The benefits from proper use of sunscreens outweigh real or perceived human health concerns, establishing a favorable benefit-to-risk ratio. Future UV filters will require complete human safety evaluations alone and in combination with select benchmark ingredients.

Comparative studies of the influence of cyclodextrins on the stability of the sunscreen agent, 2-ethylhexyl-p-methoxycinnamate

The effects of beta-cyclodextrin (beta-CD) and hydroxypropyl-beta-cyclodextrin (HP-beta-CD) on the base-catalyzed degradation and light-induced decomposition of the sunscreen agent, trans-2-ethylhexyl-p-methoxycinnamate (trans-EHMC) were investigated. Reversed-phase liquid chromatography was used to study the interaction between natural and modified cyclodextrins, added to the mobile phase, and the sunscreen. Among the available cyclodextrins (beta-CD, HP-beta-CD, hydroxypropyl-alpha-cyclodextrin and hydroxypropyl-gamma-cyclodextrin), only HP-beta-CD and beta-CD produced a significant decrease in the chromatographic retention of trans-EHMC. The complexation of the sunscreen agent with HP-beta-CD and beta-CD was confirmed by thermal analysis and nuclear magnetic resonance spectroscopy. beta-CD depressed the decomposition of trans-EHMC in alkaline solutions more effectively than HP-beta-CD. Moreover, the irradiation-induced degradation of the sunscreen agent in emulsion vehicles was reduced by complexation with beta-CD (the extent of degradation was 26.1% for the complex compared to 35.8% for free trans-EHMC) whereas HP-beta-CD had no significant effect. Therefore, the complex of beta-CD with trans-EHMC enhances the chemical- and photo-stability of the sunscreen agent. Moreover, it limits adverse interactions of the UV filter with other formulation ingredients.

Effect of nanoparticle encapsulation on the photostability of the sunscreen agent, 2-ethylhexyl-p-methoxycinnamate

The aim of this study was to investigate the influence of nanoparticle-based systems on the light-induced decomposition of the sunscreen agent, trans-2-ethylhexyl-p-methoxycinnamate (trans-EHMC). Ethylcellulose (EC) and poly-D,L-lactide-co-glycolide (PLGA) were used as biocompatible polymers for the preparation of the particulate systems. The "salting out" method was used for nanoparticle preparation and several variables were evaluated in order to optimize product characteristics. The photodegradation of the sunscreen agent in emulsion vehicles was reduced by encapsulation into the PLGA nanoparticles (the extent of degradation was 35.3% for the sunscreen-loaded nanoparticles compared to 52.3% for free trans-EHMC) whereas the EC nanoparticle system had no significant effect. Therefore, PLGA nanoparticles loaded with trans-EHMC improve the photostability of the sunscreen agent.

Results of photopatch testing in Rotterdam during a 10-year period

BACKGROUND

Photoallergic contact dermatitis is of importance in a proportion of photodermatoses and can be evaluated through photopatch testing.

OBJECTIVES

To conduct a retrospective evaluation of photopatch tests performed in patients with suspected photodermatoses at the clinic at the University Hospital Rotterdam during a 10-year period.

METHODS

During the first 5(1/2) years 44 patients were tested with a standard set of 14 allergens, and during the next 4(1/2) years 55 patients were tested with a standard set of 23 allergens.

RESULTS

Photocontact reactions were found in 9% and 27% of patients in the two periods, respectively. In the second period, positive reactions were mostly produced by sunscreens. The difference in the percentage of positive photopatch tests was probably caused by the difference in composition of the standard set of allergens (more sunscreens in the second period), this being the only alteration in the test procedure.

CONCLUSIONS

The standard set of photoallergens has to be updated periodically. Standardization of the test procedure is needed to compare the test results of different institutions.

Photoallergic contact dermatitis is uncommon

BACKGROUND

Despite the enormous increase in sunscreen use, allergic contact (AC) and photoallergic (PA) reactions to ultraviolet (UV) filters are considered rare.

OBJECTIVES

To analyse the data from 2715 patients who underwent photopatch testing at St John's Institute of Dermatology during the period 1983-98.

METHODS

A retrospective analysis of all positive photopatch test episodes was undertaken with the results retrieved from the environmental dermatology database and further verified with the original archived patch test documentation for each individual patient.

RESULTS

In 111 patients with positive reactions (4.1%), there were 155 AC or PA reactions to allergens in the photopatch test series. Eighty PA reactions were observed in 62 (2.3%) patients (32 men and 30 women, age range 28-75 years), with UV filters accounting for 52 positive reactions (65%), drugs 16 (20%), musk ambrette 11 (14%) and the antiseptic trichlorocarbanilide one (1%). The most common UV filter photoallergen was benzophenone-3 with 14 positive results, followed by benzophenone-10 (n = 9), isopropyl dibenzoylmethane (n = 6), p-aminobenzoic acid (PABA) (n = 5), octyl dimethyl PABA (n = 5), butyl methoxydibenzoylmethane (n = 4), isoamyl methoxycinnamate (n = 2), ethyl methoxycinnamate (n = 2), octyl methoxycinnamate (n = 2), amyl dimethyl PABA (n = 2) and phenylbenzimidazole sulphonic acid (n = 1). A similar number of AC reactions to UV filters was detected in this study. Thus 49 patients (1.8%) had a total of 75 reactions: 51 due to UV filters and 24 as a result of exposure to fragrances and therapeutic agents. Benzophenone-10 accounted for 13 AC reactions and benzophenone-3 for eight reactions. Twenty-two patients had a PA reaction alone, whereas 19 patients had chronic actinic dermatitis and 15 patients polymorphic light eruption (PLE) in addition. Thus, 34 of the 62 patients (55%) had a preceding underlying photodermatosis.

CONCLUSIONS

These results show a low yield of positive photopatch tests. Thus, despite the large increase in the use of UV filters over the last decade, the development of PA reactions remains rare. Furthermore, most of the common UV filter photoallergens identified in this study, including PABA, amyl dimethyl PABA and benzophenone-10, are now rarely used in sunscreen manufacture, while isopropyl dibenzoylmethane was voluntarily removed from the market in 1993. Currently, benzophenone-3 is the commonest contact photoallergen still in widespread use. In contrast, the UVB filter octyl methoxycinnamate, used in a number of sunscreens, produced only two positive PA reactions in 12 years of testing. Nevertheless, although these reactions are extremely rare, patients with photodermatoses such as PLE and chronic actinic dermatitis do represent a group of patients at increased risk of developing photoallergy. Further photopatch test series should be regularly reviewed and updated, as the relevance of individual photoallergens changes over time. Currently, there is no evidence that PA reactions represent a common clinical problem.

Modern approaches to photoprotection

UV light reacts with skin to produce undesirable changes, including photoaging and skin cancer. Sunscreen strategies are useful for protection against UV-B and short-wave UV-A, but complete protection against long-wave UV-A has not been achieved. Because UV-A is especially efficient at generating reactive oxygen species, it is being recognized increasingly as an important cause of photoaging and skin cancer.

Inclusion complexation of the sunscreen agent 2-ethylhexyl-p-dimethylaminobenzoate with hydroxypropyl-beta-cyclodextrin: effect on photostability

The interaction between the UV filter, 2-ethylhexyl-p-dimethylaminobenzoate, and unmodified and modified alpha-, beta- or gamma-cyclodextrins was studied in water by phase-solubility analysis. Of the cyclodextrins available, only hydroxypropyl-beta-cyclodextrin caused a marked increase in the aqueous solubility of 2-ethylhexyl-p-dimethylaminobenzoate. The data from the solubility study indicated the formation of a 1:1 (sunscreen-cyclodextrin) complex. The inclusion of the sunscreen agent into the hydroxypropyl-beta-cyclodextrin cavity was confirmed by thermal analysis and by nuclear magnetic resonance spectroscopy. Irradiation-induced degradation of 2-ethylhexyl-p-dimethylaminobenzoate was reduced by complexation with hydroxypropyl-beta-cyclodextrin, this effect being more pronounced in solution (the extent of degradation was 25.5% for the complex compared with 54.6% for free 2-ethylhexyl-p-dimethylaminobenzoate) than in the emulsion vehicle (the extent of degradation was 25.1% for the complex compared with 33.4% for free 2-ethylhexyl-p-dimethylaminobenzoate). Although photodegradation of the sunscreen agent is significantly reduced by formation of the inclusion complex it is important to design a suitable vehicle. Inclusion of 2-ethylhexyl-p-dimethylaminobenzoate-DMAB into the hydroxypropyl-beta-cyclodextrin cavity limits interaction of the UV filter with the skin reducing the side-effects of the formulation.

Skin problems in the traveler

Skin lesions are common in travelers and include a mix of mundane dermatologic problems and rare diseases acquired only in remote or tropical regions. The morphology, distribution, and progression of the lesions are useful in assessing possible causes. Early in the evaluation it is important to determine whether the patient might have a process that is rapidly progressive, treatable, or transmissible. In addition to routine laboratory studies, biopsy and serologic tests are often necessary to confirm a specific diagnosis.

Contact and photocontact sensitivity to sunscreens. Review of a 15-year experience and of the literature

This review summarizes published and unpublished data of our 15-year experience with sunscreen allergy and photoallergy. From 1981-1996, 402 patients with suspected clinical photosensitivity were patch and photopatch tested with the commercial sunscreens and facial cosmetics that they had used and with chemical UV absorbers, fragrance materials, preservatives, and emollients. 80 patients (20%) (28 men, 52 women) demonstrated allergic and/or photoallergic contact dermatitis to 1 or more UV absorber(s). In 47 patients with photodermatoses or photo-aggravated dermatoses and in 33 subjects with normal photosensitivity, 91 allergic and 84 photoallergic reactions to UV filters were observed. Over the years sunscreens were added to the test series, which since 1989 comprised the following 10 UV absorbers and which induced allergic (a) and photoallergic (pa) reactions (number, type of reaction): 4 UVA absorbers--isopropyldibenzoylmethane (30a/32pa); butyl methoxydibenzoyl-methane (15a/13pa); benzophenone-3 (3a/9pa); benzophenone-4 (0a/0pa); and 6 UVB absorbers--PABA (2a/2pa); octyl dimethyl PABA (1a/2pa); methylbenzylidene camphor (32a/5pa); octyl methoxycinnamate (3a/4pa); isoamyl p-methoxycinnamate (4a/10pa); and phenylbenzimidazole sulfonic acid (1a/7pa). The frequent (photo)sensitization to isopropyldibenzoylmethane was the reason that its production was discontinued in 1993. 47 patients reacted to fragrance materials, 11 to preservatives and 2 to lanolin alcohol. These constituents were contained in the commercial sunscreens and cosmetics that they had used. Continuous revision of the UV absorber photopatch test series was necessary to be closer to the real frequency of exposure and of reported (photo)allergy to newer sunscreens. Clinicians should consider contact and photocontact allergy, especially in patients with photodermatoses and photo-aggravated dermatoses, and they should perform photopatch testing. Once the culprit has been identified, its INCI (International Nomenclature Cosmetic Ingredients) designation should be given to the patient, who must be warned to avoid products containing the (photo)allergen.