What's New in Photoprotection: A Review of New Concepts and Controversies

Unveiling the potential of Pseudococcomyxa simplex: a stepwise extraction for cosmetic applications

Microalgae are gaining attention as they are considered green fabrics able to synthesize many bioactive metabolites, with unique biological activities. However, their use at an industrial scale is still a challenge because of the high costs related to upstream and downstream processes. Here, a biorefinery approach was proposed, starting from the biomass of the green microalga Pseudococcomyxa simplex for the extraction of two classes of molecules with a potential use in the cosmetic industry. Carotenoids were extracted first by an ultrasound-assisted extraction, and then, from the residual biomass, lipids were obtained by a conventional extraction. The chemical characterization of the ethanol extract indicated lutein, a biosynthetic derivative of α-carotene, as the most abundant carotenoid. The extract was found to be fully biocompatible on a cell-based model, active as antioxidant and with an in vitro anti-aging property. In particular, the lutein-enriched fraction was able to activate Nrf2 pathway, which plays a key role also in aging process. Finally, lipids were isolated from the residual biomass and the isolated fatty acids fraction was composed by palmitic and stearic acids. These molecules, fully biocompatible, can find application as emulsifiers and softener agents in cosmetic formulations. Thus, an untapped microalgal species can represent a sustainable source for cosmeceutical formulations. KEY POINTS: • Pseudococcomyxa simplex has been explored in a cascade approach. • Lutein is the main extracted carotenoid and has antioxidant and anti-aging activity. • Fatty acids are mainly composed of palmitic and stearic acids.

Exposure to UV-B filter octylmethoxycinnamate and human health effects: Focus on endocrine disruptor actions

Human skin is the first line of photoprotection against UV radiation. However, despite having its defence mechanisms, the photoprotection that the skin exerts is not enough. To protect human skin, the inclusion of UV filters in the cosmetic industry has grown significantly as a photoprotection strategy. Octylmethoxycinnamate, also designated by octinoxate, or 2-ethylhexyl-4-methoxycinnamate (CAS number: 5466-77-3) is one of the most widely used UV-B filter in the cosmetic industry. The toxic effects of OMC have alarmed the public, but there is still no consensus in the scientific community about its use. This article aims to provide an overview of the UV filters' photoprotection, emphasizing the OMC and the possible negative effects it may have on the public health. Moreover, the current legislation will be addressed. In summary, the recommendations should be rethought to assess their risk-benefit, since the existing literature warns us to endocrine-disrupting effects of OMC. Further studies should be focus on the toxicity of OMC alone, in mixture and should consider its degradation products, to improve the knowledge of its risk assessment as EDC.

Unveiling the mechanisms for the development of rosehip-based dermatological products: an updated review

Rosa spp., commonly known as rosehips, are wild plants that have traditionally been employed as herbal remedies for the treatment of a wide range of disorders. Rosehip is a storehouse of vitamins, including A, B complex, C, and E. Among phytonutrients, vitamin C is found in the highest amount. As rosehips contain significant levels of vitamin C, they are perfect candidates for the development of skincare formulations that can be effectively used in the treatment of different skin disorders (i.e., scarring, anti-aging, hyperpigmentation, wrinkles, melasma, and atopic dermatitis). This research focuses on the vitamin C content of several Rosa sp. by their botanical and geographic origins, which according to research studies are in the following order: R. rugosa > R. montana > R. canina > R. dumalis, with lower levels in R. villosa and R. arvensis, respectively. Among rosehip species, R. canina is the most extensively studied species which also displays significant amounts of bioactive compounds, but also antioxidant, and antimicrobial activities (e.g., against Propionibacterium acnes, Staphylococcus aureus, S, epidermis, and S. haemolyticus). The investigation also highlights the use of rosehip extracts and oils to minimise the harmful effects of acne, which primarily affects teenagers in terms of their physical appearance (e.g., scarring, hyperpigmentation, imperfections), as well as their moral character (e.g., low self-confidence, bullying). Additionally, for higher vitamin C content from various rosehip species, the traditional (i.e., infusion, maceration, Soxhlet extraction) and contemporary extraction methods (i.e., supercritical fluid extraction, microwave-assisted, ultrasonic-assisted, and enzyme-assisted extractions) are highlighted, finally choosing the best extraction method for increased bioactive compounds, with emphasis on vitamin C content. Consequently, the current research focuses on assessing the potential of rosehip extracts as medicinal agents against various skin conditions, and the use of rosehip concentrations in skincare formulations (such as toner, serum, lotion, and sunscreen). Up-to-date studies have revealed that rosehip extracts are perfect candidates as topical application products in the form of nanoemulsions. Extensive in vivo studies have revealed that rosehip extracts also exhibit specific activities against multiple skin disorders (i.e., wound healing, collagen synthesis, atopic dermatitis, melasma, and anti-aging effects). Overall, with multiple dermatological actions and efficacies, rosehip extracts and oils are promising agents that require a thorough investigation of their functioning processes to enable their safe use in the skincare industry.

Effects associated with exposure to the emerging contaminant octyl-methoxycinnamate (a UV-B filter) in the aquatic environment: a review

Given the increasing concern surrounding ultraviolet (UV) radiation-induced skin damage, there has been a rise in demand for UV filters. Currently, UV-filters are considered emerging contaminants. The extensive production and use of UV filters have led to their widespread release into the aquatic environment. Thus, there is growing concern that UV filters may bioaccumulate and exhibit persistent properties within the environment, raising several safety health concerns. Octyl-methoxycinnamate (OMC) is extensively employed as a UV-B filter in the cosmetic industry. While initially designed to mitigate the adverse photobiological effects attributed to UV radiation, the safety of OMC has been questioned with some studies reporting toxic effects on environment. The aim of this review to provide an overview of the scientific information regarding the most widely used organic UV-filter (OMC), and its effects on biodiversity and aquatic environment.

Dithiothreitol reduces oxidative stress and necrosis caused by ultraviolet A radiation in L929 fibroblasts

Ultraviolet A (UVA) radiation, present in sunlight, can induce cell redox imbalance leading to cellular damage and even cell death, compromising skin health. Here, we evaluated the in vitro antioxidant and photochemoprotective effect of dithiothreitol (DTT). DTT neutralized the free radicals 2,2-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS·+), 2,2-diphenyl-1-picrylhydrazyl (DPPH·), and superoxide anion (O2·-) in in vitro assays, as well as the ferric ion (Fe3+) in the ferric reducing antioxidant power (FRAP) assay. We also evaluated the effect of DTT pre-treatment in L929 dermal fibroblasts and DTT (50 and 100 µM) led to greater cell viability following UVA-irradiation compared to cells that were untreated. Furthermore, the pre-treatment of cells with DTT prevented the increase of intracellular reactive oxygen species (ROS) production, including hydrogen peroxide (H2O2), lipid peroxidation, and DNA condensation, as well as the decrease in mitochondrial membrane potential (Δψm), that occurred following irradiation in untreated cells. The endogenous antioxidant system of cells was also improved in irradiated cells that were DTT pre-treated compared to the untreated cells, as the activity of the superoxide dismutase (SOD) and catalase (CAT) enzymes remained as high as non-irradiated cells, while the activity levels were depleted in the untreated irradiated cells. Furthermore, DTT reduced necrosis in UVA-irradiated fibroblasts. Together, these results showed that DTT may have promising use in the prevention of skin photoaging and photodamage induced by UVA, as it provided photochemoprotection against the harmful effects of this radiation, reducing oxidative stress and cell death, due mainly to its antioxidant capacity.

Structural Elucidation of Agrochemical Metabolic Transformation Products Based on Infrared Ion Spectroscopy to Improve In Silico Toxicity Assessment

Toxicological assessments of newly developed agrochemical agents consider chemical modifications and their metabolic and biotransformation products. To carry out an in silico hazard assessment, understanding the type of chemical modification and its location on the original compound can greatly enhance the reliability of the evaluation. Here, we present and apply a method based on liquid chromatography-mass spectrometry (LC-MS) enhanced with infrared ion spectroscopy (IRIS) to better delineate the molecular structures of transformation products before in silico toxicology evaluation. IRIS facilitates the recording of IR spectra directly in the mass spectrometer for features selected by retention time and mass-to-charge ratio. By utilizing quantum-chemically predicted IR spectra for candidate molecular structures, one can either derive the actual structure or significantly reduce the number of (isomeric) candidate structures. This approach can assist in making informed decisions. We apply this method to a plant growth stimulant, digeraniol sinapoyl malate (DGSM), that is currently under development. Incubation of the compound in Caco-2 and HepaRG cell lines in multiwell plates and analysis by LC-MS reveals oxidation, glucuronidation, and sulfonation metabolic products, whose structures were elucidated by IRIS and used as input for an in silico toxicology assessment. The toxicity of isomeric metabolites predicted by in silico tools was also assessed, which revealed that assigning the right metabolite structure is an important step in the overall toxicity assessment of the agrochemical. We believe this identification approach can be advantageous when specific isomers are significantly more hazardous than others and can help better understand metabolic pathways.

New developments in sunscreens

Topical sunscreen application is one of the most important photoprotection tool to prevent sun damaging effects in human skin at the short and long term. Although its efficacy and cosmeticity have significantly improved in recent years, a better understanding of the biological and clinical effects of longer wavelength radiation, such as long ultraviolet A (UVA I) and blue light, has driven scientists and companies to search for effective and safe filters and substances to protect against these newly identified forms of radiation. New technologies have sought to imbue sunscreen with novel properties, such as the reduction of calorific radiation. Cutaneous penetration by sunscreens can also be reduced using hydrogels or nanocrystals that envelop the filters, or by binding filters to nanocarriers such as alginate microparticles, cyclodextrins, and methacrylate polymers. Finally, researchers have looked to nature as a source of healthier products, such as plant products (e.g., mycosporines, scytonemin, and various flavonoids) and even fungal and bacterial melanin, which could potentially be used as substitutes or enhancers of current filters.

Current practice and beliefs of parents toward sunscreen use for their children: A cross-sectional study

Parents are generally influencing the sun protection behaviors of their children, including sunscreen use. In Saudi Arabia, sunscreen use was estimated in adults but not children. The objective was to estimate the prevalence and predictors of sunscreen use among parents and their children. An observational cross-sectional study was conducted in April 2022. Parents who were visiting outpatient clinics at a university hospital in Al-Kharj city, Saudi Arabia, were invited to complete an online questionnaire. A total of 266 participants were included in the final analysis. The mean age of parents was 39.0 ± 8.9 years, and the mean age of children was 8.2 ± 3.2 years. The prevalence of sunscreen use was 38.7% in parents and 24.1% in their children. Females had higher sunscreen use than males in both parents (49.7% versus 7.2%, p < 0.001) and in children (31.9% versus 18.3%, p = 0.011). The most frequent sunburn protection measures practiced by children were wearing long-sleeved clothes (77.0%), sitting in the shade (70.6%), and wearing hats (39.2%). In multivariable analysis, predictors of sunscreen use in parents included female sex, history of sunburn, and sunscreen use by children. Independent predictors of sunscreen use in children included a history of sunburn, wearing hats, and practicing other sunburn protection measures on risky occasions, and sunscreen use in parents. Sunscreen use in parents and children in Saudi Arabia is still inadequate or limited. This calls for community/school intervention programs using educational activities and multimedia promotion. Further studies are needed.

Clinical Applications of Polypodium leucotomos (Fernblock®): An Update

Exposure to sun radiation leads to higher risk of sunburn, pigmentation, immunosuppression, photoaging and skin cancer. In addition to ultraviolet radiation (UVR), recent research indicates that infrared radiation (IR) and visible light (VIS) can play an important role in the pathogenesis of some of these processes. Detrimental effects associated with sun exposure are well known, but new studies have shown that DNA damage continues to occur long after exposure to solar radiation has ended. Regarding photoprotection strategies, natural substances are emerging for topical and oral photoprotection. In this sense, Fernblock^®, a standardized aqueous extract of the fern Polypodium Leucotomos (PLE), has been widely administered both topically and orally with a strong safety profile. Thus, this extract has been used extensively in clinical practice, including as a complement to photodynamic therapy (PDT) for treating actinic keratoses (AKs) and field cancerization. It has also been used to treat skin diseases such as photodermatoses, photoaggravated inflammatory conditions and pigmentary disorders. This review examines the most recent developments in the clinical application of Fernblock^® and assesses how newly investigated action mechanisms may influence its clinical use.

Biopigments of Microbial Origin and Their Application in the Cosmetic Industry

Along with serving as a source of color, many microbial pigments have gained attention as interesting bioactive molecules with potential health advantages. These pigments have several applications in the food, agrochemical, medicine, and cosmetic industries. They have attracted the attention of these industries due to their high production value, low cost, stability, and biodegradability. Recently, many consumers worldwide have noted the impact of synthetic dyes; thus, natural pigments are more in demand than synthetic colors. On the other hand, the cosmetic industry has been moving toward greener manufacturing, from the formulation to the packaging material. Microbial pigments have several applications in the field of cosmetics due to their photoprotection, antioxidant, and antiaging properties, including inhibiting melanogenesis and acting as natural colorants for cosmetics, as some microorganisms are rich in pigments. More investigations are required to estimate the safety and efficacy of employing microbial pigments in cosmetic products. Furthermore, it is necessary to obtain information about DNA sequencing, metabolic pathways, and genetic engineering. In addition, unique habitats should be explored for novel pigments and new producing strains. Thus, new microbial pigments could be of consideration to the cosmetic industry, as they are ideal for future cosmetics with positive health effects.

Characterization of Solar Radiation-Induced Degradation Products of the Plant Sunscreen Sinapoyl Malate

Agricultural activities at lower temperatures lead to lower yields due to reduced plant growth. Applying photomolecular heater agrochemicals could boost yields under these conditions, but UV-induced degradation of these compounds needs to be assessed. In this study, we employ liquid chromatography-mass spectrometry (LC-MS) coupled with infrared ion spectroscopy (IRIS) to detect and identify the degradation products generated upon simulated solar irradiation of sinapoyl malate, a proposed photomolecular heater/UV filter compound. All major irradiation-induced degradation products are identified in terms of their full molecular structure by comparing the IRIS spectra obtained after LC fractionation and mass isolation with reference IR spectra obtained from quantum-chemical calculations. In cases where physical standards are available, a direct experimental-to-experimental comparison is possible for definitive structure identification. We find that the major degradation products originate from trans-to-cis isomerization, ester cleavage, and esterification reactions of sinapoyl malate. Preliminary in silico toxicity investigations using the VEGAHUB platform suggest no significant concerns for these degradation products' human and environmental safety. The identification workflow presented here can analogously be applied to break down products from other agrochemical compounds. As the method records IR spectra with the sensitivity of LC-MS, application to agricultural samples, e.g., from field trials, is foreseen.

Process Optimization of Phytoantioxidant and Photoprotective Compounds from Carob Pods (Ceratonia siliqua L.) Using Ultrasonic Assisted Extraction Method

The current study first describes the extraction of phytoantioxidant polyphenols from Carob byproducts (pods) using maceration and heating-assisted extraction as traditional methods and ultrasonic-assisted extraction (UAE) as an innovative method to determine the most efficient extraction process in terms of four targeted responses: total phenolic content (TPC), antioxidant activities (TAC and DPPH), and photoprotective properties as measured by the sun protection factor (SPF). Second, we used response surface methodology (RSM) with a central composite rotatable design (CCDR) approach to investigate the influence of process variables (extraction time, extraction temperature, and solvent concentration) on UAE, which was found to be the most effective extraction technique in our study. Carob byproduct extracts had a TPC ranging from 6.21 to 21.92 mg GAE/g dw, a TAC ranging from 22.00 to 49.30 mg AAE/g dw, DPPH scavenging activity ranging from 56.35 to 90.50%, and SPF values ranging from 8.62 to 22.37. The optimal UAE conditions for maximum TPC, TAC, DPPH, and SPF responses were determined to be 38.90% ethanol, 53.90 °C, and 50.92 min. Using Carob as a source for sustainable and bioactive products in conjunction with optimized UAE is a promising contribution to the cosmetic industry that will help to strengthen the concept of environmentally-friendly "green chemistry". Given that Carob pulp or seeds are considered food byproducts, the research presented here encourages the use of these agri-food waste materials in cosmetics.

Self-Emulsifying Phospholipid Preconcentrates for the Enhanced Photoprotection of Luteolin

Exposure to ultraviolet B (UVB) leads to the overproduction of reactive oxygen species (ROS), causing higher risks of skin disorders. Luteolin (Lut) is a naturally occurring antioxidant that can absorb a broad range of ultraviolet light, but its water solubility and skin permeability are limited and insufficient. The aim of the current study was to develop a Lut-loaded self-emulsifying phospholipid preconcentrate (LSEPP) for enhancing the solubility, permeability, and photoprotective activity of Lut. The designed formulations were firstly examined for their droplet size, zeta potential, dispersity, and in vitro corneum permeability after dispensing the preconcentrate to form an emulsion; the optimized formulation was further characterized for its emulsified morphology, compatibility with excipients, stability in the preconcentrate form, and photoprotective activity by the HaCaT cell model under the emulsified status. The optimized LSEPP formulation attained a smaller droplet size (140.6 ± 24.2 nm) with the addition of 1,8-cineole and increased the permeability of Lut by 7-fold. As evidenced in the cell model studies, the optimized LSEPP formulation can efficiently deliver Lut into HaCaT cells after emulsification and result in a 115% better cell viability as well as a 203% stronger ROS scavenging capability, compared with those of unformulated Lut after UVB irradiation. To sum up, we have successfully developed an LSEPP formulation, which is a safe and promising topical delivery system for enhancing the photoprotective effects of Lut.

What are parents reading about the sunscreen controversy?

The benefits of sunscreen use have been well-established. However, discussion of its risks remains on the internet. Given this point of controversy, a web search of 50 websites on children's sun safety was performed and indicated that the information online is variable and incomplete when informing parents on the benefits and risks of sunscreen use.

Flower Extracts from Ornamental Plants as Sources of Sunscreen Ingredients: Determination by In Vitro Methods of Photoprotective Efficacy, Antigenotoxicity and Safety

Plants are sources of sunscreen ingredients that prevent cellular mutations involved in skin cancer and aging. This study investigated the sunscreen properties of the extracts from some ornamental plants growing in Colombia. The UV filter capability of the flower extracts obtained from Rosa centifolia L., Posoqueria latifolia (Rudge) Schult, and Ipomoea horsfalliae Hook. was examined. Photoprotection efficacies were evaluated using in vitro indices such as sun protection factor and critical wavelength. UVB antigenotoxicity estimates measured with the SOS Chromotest were also obtained. Extract cytotoxicity and genotoxicity were studied in human fibroblasts using the trypan blue exclusion and Comet assays, respectively. Major compounds of the promising flower extracts were identified by UHPLC–ESI+–Orbitrap–MS. The studied extracts showed high photoprotection efficacy and antigenotoxicity against UVB radiation, but only the P. latifolia extract showed broad-spectrum photoprotection at non-cytotoxic concentrations. The P. latifolia extract appeared to be safer for human fibroblast cells and the R. centifolia extract was shown to be moderately cytotoxic and genotoxic at the highest assayed concentrations. The I. horsfalliae extract was unequivocally cytotoxic and genotoxic. The major constituents of the promising extracts were as follows: chlorogenic acid, ecdysterone 20E, rhamnetin-rutinoside, cis-resveratrol-diglucoside, trans-resveratrol-diglucoside in P. latifolia; quercetin, quercetin-glucoside, quercetin-3-rhamnoside, kaempferol, kaempferol-3-glucoside, and kaempferol-rhamnoside in R. centifolia. The potential of the ornamental plants as sources of sunscreen ingredients was discussed.

Formulation of a new broad-spectrum UVB + UVA and blue light SPF50+ sunscreen containing Phenylene Bis-Diphenyltriazine (TriAsorB), an innovative sun filter with unique optical properties

Accumulating evidence from numerous comprehensive studies has demonstrated that blue light, in particular high-energy visible light, can exert a range of harmful effects on skin cells. These forms of radiation are now known to be able to trigger oxidation reactions, DNA damage, erythema and pigmentary changes, and may also be associated with photoaging. Sunscreens protecting the skin from only ultraviolet (UV)-B and UVA rays can therefore no longer be regarded as sufficient to help prevent skin damage from sunlight, and products containing filters that can provide broad-spectrum photoprotection are required. To meet this need, a new sunscreen formulation that provides photoprotection against solar radiation with wavelengths ranging from UV to visible light has been developed, using an innovative organic sun filter with unique optical properties: phenylene bis diphenyltriazine (TriAsorB™). This article outlines the development and characteristics of this innovative filter and describes new key results from studies performed to assess the effectiveness and safety of the filter and the new sunscreen product. The studies conducted so far demonstrate that the filter has a good human and environmental safety profile. In addition, the sunscreen, which contains TriAsorB in combination with three other UV filters to offer broad-spectrum sun protection with a high sun protection factor (SPF50⁺ ), appears to effectively prevent multiple forms of cellular photodamage, in particular blue light-induced oxidatively generated DNA lesions. Overall, the available data indicate that regular use of the TriAsorB-containing sunscreen could help prevent solar radiation-induced skin damage and the development of signs of premature skin aging, as well as photodermatoses caused or exacerbated by visible light.

Long-acting microneedle patch loaded with adipose collagen fragment for preventing the skin photoaging in mice

Skin photoaging is one of the most serious public health problems in the 21st century that may lead to thin, saggy, and structurally weakened skin. Adipokine therapy toward skin photoaging is always associated with poor permeability, biologic stability and the short in vivo release duration. Our laboratory previously extracted an extracellular matrix component of adipose tissue by purely physical methods, namely "adipose collagen fragment (ACF)", which holds promise for preventing skin photoaging. However, the injection treatment of ACF requires repeated preparation processes and injection procedures, which may be time-consuming and painful. Therefore, we describe the fabrication and assessment of a detachable ACF-microneedle (ACF-MN) patch that creates minimally invasive dermal microtrauma upon application. And we evaluated the morphology characterization, mechanical properties and puncture performance in vitro. The delivery efficiency of ACF from the patches was estimated in vitro and vivo. Then, the therapeutic efficacy was identified through applying ACF-MN patches into the dermis of UVA-induced photoaging mice and the related detection of skin photoaging was estimated. Our results demonstrated that ACF-MN exhibited well skin puncture performance and could release ACF component slowly. Meanwhile, this microneedle device loaded with ACF exhibited the treatment efficiency on skin photoaging in a mouse model. Therefore, implantation of the microtrauma-mediated, long-acting ACF-MN system can be utilized as a potential candidate for preventing skin photoaging in the clinic.

Expert Recommendations on the Evaluation of Sunscreen Efficacy and the Beneficial Role of Non-filtering Ingredients

A variety of non-filtering agents have been introduced to enhance sunscreen photoprotection. Most of those agents have only weak erythema protective properties but may be valuable and beneficial in supporting protection against other effects of UV radiation, such as photoimmunosuppression, skin aging, and carcinogenesis, as well as photodermatoses. The question arises how to measure and evaluate this efficacy since standard SPF testing is not appropriate. In this perspective, we aim to provide a position statement regarding the actual value of SPF and UVA-PF to measure photoprotection. We argue whether new or additional parameters and scales can be used to better indicate the protection conferred by these products against the detrimental effects of natural/artificial, UV/visible light beyond sunburn, including DNA damage, photoimmunosuppression and pigmentation, and the potential benefits of the addition of other ingredients beyond traditional inorganic and organic filters to existing sunscreens. Also, we debate the overall usefulness of adding novel parameters that measure photoprotection to reach two tiers of users, that is, the general public and the medical community; and how this can be communicated to convey the presence of additional beneficial effects deriving from non-filtering agents, e.g., biological extracts. Finally, we provide a perspective on new challenges stemming from environmental factors, focusing on the role of the skin microbiome and the role of air pollutants and resulting needs for photoprotection.

Sunscreen lotions in the dermatological prescription: review of concepts and controversies

The skin is regularly exposed to several environmental aggressions, including solar radiation, whose biological effects can induce sunburn, dyschromia, skin aging and cancer. Among the photoprotection measures, sunscreens comprise a relevant part of the strategy aimed to prevent solar radiation damage and, for effective action, the patient must adhere to the product use and the latter, in turn, must follow technical parameters to promote adequate protection. This review article brings together the most current and relevant concepts about photoprotection for dermatological use, including the challenges for their formulation, the risks of certain photoprotective active substances for individual and environmental safety and the importance of stringency in determining the product efficacy, considering the regulatory aspects, highlighting relevant differences between Brazil and other countries. Thus, when assessing a sunscreen, not only the visual aspects and sensory perception will be immediately evaluated, but also the quality and suitability of the vehicle, the chemical composition of the formulation, the environmental risks, the photostability of the screening system, and the measurement of its protection spectrum. Technical knowledge of sunscreens can help dermatologists in this important role of educating patients about the best photoprotective strategies in each situation.

PHOTOPROTECTION FOR ALL: CURRENT GAPS AND OPPORTUNITIES

The effects of solar radiation on human skin differ based on skin phototype, the presence or absence of photodermatoses, biological capacity to repair DNA damage, wavelength, intensity of sun exposure, geographic latitude, and other factors, underscoring the need for a more tailored approach to photoprotection. To date, the focus of photoprotection guidelines has been to prevent sunburn and DNA damage induced by ultraviolet (UV) radiation, both UVB and UVA; however, several recent studies have shown that visible light (VL) also generates reactive oxygen and nitrogen species that can contribute to skin damage and pigmentation on the skin, particularly in people of color. Therefore, dark-skinned individuals, while naturally better protected against UVB radiation by virtue of high eumelanin content in melanocytes, may need additional protection from VL-induced skin damage. The current options for photoprotection products need to expand, and potential strategies against VL include the addition of iron oxide, titanium dioxide, and biologically relevant antioxidants to sunscreen formulations, as well as supplementation with orally active antioxidants.

Wavelength, dose, skin type and skin model related radical formation in skin

The exposure to sun radiation is indispensable to our health; however, a long-term and high exposure could lead to cell damage, erythema, premature skin aging, and promotion of skin tumors. An underlying pathomechanism is the formation of free radicals which may induce oxidative stress at elevated concentrations. Different skin models, such as porcine-, murine-, human- ex vivo skin, reconstructed human skin (RHS) and human skin in vivo, were investigated during and after irradiation using X- and L-band EPR spectroscopy within different spectral regions (UVC to NIR). The amount of radical formation was quantified with the spin probe PCA and the radical types were measured ex vivo with the spin trap DMPO. The radiation dose influences the types of radicals formed in the skin. While reactive oxygen species (ROS) are always pronounced at low doses, there is an increase in lipid oxygen species (LOS) at high doses. Furthermore, the radical types arise independent from the irradiation wavelength, whereas the general amount of radical formation differs with the irradiation wavelength. Heat pre-stressed porcine skin already starts with higher LOS values. Thus, the radical type ratio might be an indicator of stress and the reversal of ROS/LOS constitutes the point where positive stress turns into negative stress.Compared to light skin types, darker types produce less radicals in the ultraviolet, similar amounts in the visible and higher ones in the infrared spectral region, rendering skin type-specific sun protection a necessity.

Vitamin D: Skin, sunshine, and beyond

Vitamin D is a steroid hormone of importance to the field of dermatology. Skin is unique in that it is the site of vitamin D synthesis upon sun exposure and a target organ for its activity. We explore the physiology and metabolic mechanism of action of vitamin D, as well as its effects on the skin. We also discuss the current evidence of the efficacy and safety of oral and topical vitamin D analogues on skin conditions such as psoriasis, atopic dermatitis, vitiligo, sunburn, actinic keratosis, and fibrosing skin disorders. Based on currently available scientific evidence, the National Academy of Medicine's recommended dietary allowance for vitamin D ranges from 400 IU to 800 IU daily based on age categories.

Sunscreens and Photoaging: A Review of Current Literature

Sunscreens have been on the market for many decades as a means of protection against ultraviolet-induced erythema. Over the years, evidence has also shown their efficacy in the prevention of photoaging, dyspigmentation, DNA damage, and photocarcinogenesis. In the USA, most broad-spectrum sunscreens provide protection against ultraviolet B (UVB) radiation and short-wavelength ultraviolet A (UVA) radiation. Evidence suggests that visible light and infrared light may play a role in photoaging and should be considered when choosing a sunscreen. Currently, there is a paucity of US FDA-approved filters that provide protection against long UVA (> 370 nm) and none against visible light. Additionally, various sunscreen additives such as antioxidants and photolyases have also been reported to protect against and possibly reverse signs of photoaging. This literature review evaluates the utility of sunscreen in protecting against photoaging and further explores the requirements for an ideal sunscreen.

UV Radiation in DNA Damage and Repair Involving DNA-Photolyases and Cryptochromes

Prolonged exposure to ultraviolet radiation on human skin can lead to mutations in DNA, photoaging, suppression of the immune system, and other damage up to skin cancer (melanoma, basal cell, and squamous cell carcinoma). We reviewed the state of knowledge of the damaging action of UVB and UVA on DNA, and also the mechanisms of DNA repair with the participation of the DNA-photolyase enzyme or of the nucleotide excision repair (NER) system. In the course of evolution, most mammals lost the possibility of DNA photoreparation due to the disappearance of DNA photolyase genes, but they retained closely related cryptochromes that regulate the transcription of the NER system enzymes. We analyze the published relationships between DNA photolyases/cryptochromes and carcinogenesis, as well as their possible role in the prevention and treatment of diseases caused by UV radiation.

An Adipose-Derived Injectable Sustained-Release Collagen Scaffold of Adipokines Prepared Through a Fast Mechanical Processing Technique for Preventing Skin Photoaging in Mice

Ultraviolet A (UVA) radiation is the major contributor to skin photoaging, associated with increased collagen degradation and reactive oxygen species (ROS) expression. Adipokines have been proven as promising therapeutic agents for skin photoaging. However, adipokine therapy is generally limited by the short in vivo release duration and biological instability. Therefore, developing a treatment that provides a sustained release of adipokines and enhanced therapeutic effects is desirable. In this study, we developed a novel mechanical processing technique to extract adipose tissue-derived ECM components, named the “adipose collagen fragment” (ACF). The physical characterization, injectability, collagen components, residual DNA/RNA and adipokine release pattern of ACF were identified in vitro. L929 cells were treated with ACF or phosphate-buffered saline for 24 h after UVA irradiation in vitro. The expression of senescence-associated xβ-galactosidase (SA-β-gal), ROS and antioxidase were investigated. Then, we evaluated its therapeutic efficacy by injecting ACF and phosphate-buffered saline, as a control, into the dermis of photoaging nude mice and harvesting skin samples at weeks 1, 2, and 4 after treatment for assessment. The content of adipokines released from ACF was identified in vivo. The collagen synthesis and collagen degradation in ACF implants were evaluated by immune staining. Dermal thickness, fibroblast expression, collagen synthesis, ROS level, antioxidase expression, capillary density, and apoptotic cell number were evaluated by histological assessment, immune staining, and polymerase chain reaction in the skin samples. We demonstrated that ACF is the concentrated adipose extracellular matrix collagen fragment without viable cells and can be injected through fine needles. The lower expression of SA-β-gal, ROS and higher expression of antioxidase were observed in the ACF-treated group. ACF undergoes collagen degradation and promotes neocollagen synthesis in ACF implants. Meanwhile, ACF serves as a sustained-release system of adipokines and exhibits a significantly higher therapeutic effect on mouse skin photoaging by enhancing angiogenesis, antioxidant abilities, antiapoptotic activities, and collagen synthesis through sustainedly releasing adipokines. To sum up, ACF is an adipokines-enriched, sustained-release extracellular matrix collagen scaffold that can prevent UVA-induced skin photoaging in mice. ACF may serve as a novel autologous skin filler for skin rejuvenation applications in the clinic.

Medical Advice for Travelers

BACKGROUND

In 2019, 1.5 billion international tourist trips were counted worldwide. Germany, with 70.8 million vacations lasting ≥ 5 days, was one of the populations most willing to travel. These days, even elderly and multimorbid persons regularly travel long-distance, which can be associated with significant health risks. By advising travelers and implementing preventive measures, the risk of illness can be reduced significantly.

METHODS

A selective survey of PubMed was performed to identify publications on medical advice for travelers between 2000 and 2020. We included guidelines, studies, and recommendations that mainly deal with the preventive aspects of travel medicine and have a high level of practical relevance and the highest possible level of evidence. Previously published guidelines (based on the GRADE criteria) were adopted, and recommendations not based on the results of scientific studies were characterized as Good Clinical Practice (GCP).

RESULTS

Many medical recommendations for travelers still rely on individualized, experience-based, or consensus-based assessments. Apart from a review of medical history and vaccination status, a risk analysis is performed, travel fitness is evaluated individually, and a prevention plan is designed. Particular attention is devoted to malaria prophylaxis, vector protection, and traveler's diarrhea. Medical advice before travel is especially important for the elderly, children, pregnant women, the chronically ill, long-term and adventure travelers as well as migrants from malaria-endemic areas who are returning home.

CONCLUSION

The health risks associated with travel can be minimized by specialist medical advice. Many recommendations are empirical in nature and require further research.

Prodigiosin Production and Photoprotective/Antigenotoxic Properties in Serratia marcescens Indigenous Strains from Eastern Cordillera of Colombia

Serratia marcescens is a bacterial species that produces an antibacterial pigment (Prodigiosin) showing a wide adaptive response to environmental stresses. The study aimed to investigate Prodigiosin production in S. marcescens wild-type strains, as well as its relation to photoprotection and antigenotoxicity against UVB. Prodigiosin yield was spectrophotometrically assayed in extracts of bacterial strains grown in different culture media. In vitro photoprotection efficacy was evaluated using the in vitro indices sun protection factor (SPF_in vitro ) and critical wavelength (λc). The percentage of UVB antigenotoxicity estimates (%GI) in the SOS Chromotest was also evaluated. Correlation analysis was used to examine the relationship between Prodigiosin yield, SPF_in vitro , %GI estimates and environmental traits (altitude, temperature, rainfall and solar irradiance). Prodigiosin yield in S. marcescens strains varied depending on culture media used for its growth, and it was correlated with environmental variables such as temperature and solar irradiance. SPF_in vitro estimates were well correlated with Prodigiosin concentration and %GI values in the bacterial strains being studied. UVB photoprotective efficacy of the extracts obtained from S. marcescens strains depends on the strain's Prodigiosin yield and its antigenotoxic potential. The extracts with Prodigiosin yield higher than ˜17 μg mL^-1 could be used as sources of sunscreen ingredients.

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.

Menopause, Ultraviolet Exposure, and Low Water Intake Potentially Interact with the Genetic Variants Related to Collagen Metabolism Involved in Skin Wrinkle Risk in Middle-Aged Women

Genetic and environmental factors influence wrinkle development. We evaluated the polygenetic risk score (PRS) by pooling the selected single nucleotide polymorphisms (SNPs) from a genome-wide association study (GWAS) for wrinkles and the interaction of PRS with lifestyle factors in middle-aged women. Under the supervision of a dermatologist, the skin status of 128 women aged over 40 years old was evaluated with Mark-Vu, a skin diagnosis system. PRS was generated from the selected SNPs for wrinkle risk from the genome-wide association study. Lifestyle interactions with PRS were also evaluated for wrinkle risk. Participants in the wrinkled group were more likely to be post-menopausal, eat less fruit, take fewer vitamin supplements, exercise less, and be more tired after awakening in the morning than those in the less-wrinkled group. The PRS included EGFR_rs1861003, MMP16_rs6469206, and COL17A1_rs805698. Subjects with high PRS had a wrinkle risk 15.39-fold higher than those with low PRS after adjusting for covariates, and they had a 10.64-fold higher risk of a large skin pore size. Menopause, UV exposure, and water intake interacted with PRS for wrinkle risk: the participants with high PRS had a much higher incidence of wrinkle risk than those with low PRS, only among post-menopausal women and those with UV exposure. Only with low water intake did the participants with medium PRS have increased wrinkle risk. In conclusion, women aged >40 years with high PRS-related collagen metabolism may possibly avoid wrinkle risk by avoiding UV exposure by applying sunscreen, maintaining sufficient water intake, and managing estrogen deficiency.

Effect of a Face-Aging Mobile App-Based Intervention on Skin Cancer Protection Behavior in Secondary Schools in Brazil: A Cluster-Randomized Clinical Trial

Question

Can a face-aging mobile app improve the skin cancer protection behavior of secondary school students?

Findings

In this cluster-randomized clinical trial of 52 school classes with 1573 Brazilian pupils, meaningful improvements were observed in sunscreen use, tanning behavior, and skin self-examinations 3 to 6 months after an intervention using a face-aging app compared with the nonintervention group.

Meaning

Face-aging apps may be useful tools to increase skin cancer protection in adolescents and thereby decrease skin cancer risk.

Importance

Because exposure to UV radiation early in life is an important risk factor for melanoma development, reducing UV exposure in children and adolescents is of paramount importance. New interventions are urgently required.

Objective

To determine the effect of the free face-aging mobile app Sunface on the skin cancer protection behavior of adolescents.

Design, Setting, and Participants

This cluster-randomized clinical trial included a single intervention and a 6-month follow-up from February 1 to November 30, 2018. Randomization was performed on the class level in 52 school classes within 8 public secondary schools (grades 9-12) in Itauna, Southeast Brazil. Data were analyzed from May 1 to October 10, 2019.

Interventions

In a classroom seminar delivered by medical students, adolescents’ selfies were altered by the app to show UV effects on their future faces and were shown in front of their class, accompanied by information about UV protection. Information about relevant parameters was collected via anonymous questionnaires before and 3 and 6 months after the intervention.

Main Outcomes and Measures

The primary end point of the study was the difference in daily sunscreen use at 6 months of follow-up. Secondary end points included the difference in daily sunscreen use at 3 months of follow-up, at least 1 skin self-examination within 6 months, and at least 1 tanning session in the preceding 30 days. All analyses were predefined and based on intention to treat. Cluster effects were taken into account.

Results

Participants included 1573 pupils (812 girls [51.6%] and 761 boys [48.4%]; mean [SD] age, 15.9 [1.3] years) from 52 school classes. Daily sunscreen use increased from 110 of 734 pupils (15.0%) to 139 of 607 (22.9%; P < .001) at the 6-month follow-up in the intervention group. The proportion of pupils performing at least 1 skin self-examination in the intervention group rose from 184 of 734 (25.1%) to 300 of 607 (49.4%; P < .001). Use of tanning decreased from 138 of 734 pupils (18.8%) to 92 of 607 (15.2%; P = .04). No significant changes were observed in the control group. The intervention was more effective for female students (number needed to treat for the primary end point: 8 for girls and 31 for boys).

Conclusions and Relevance

These findings suggest that interventions based on face-aging apps may increase skin cancer protection behavior in Brazilian adolescents. Further studies are required to maximize the effect and to investigate the generalizability of the effects.

Trial Registration

ClinicalTrials.gov Identifier: NCT03178240

UVA-Triggered Drug Release and Photo-Protection of Skin

Light has attracted special attention as a stimulus for triggered drug delivery systems (DDS) due to its intrinsic features of being spatially and temporally tunable. Ultraviolet A (UVA) radiation has recently been used as a source of external light stimuli to control the release of drugs using a "switch on- switch off" procedure. This review discusses the promising potential of UVA radiation as the light source of choice for photo-controlled drug release from a range of photo-responsive and photolabile nanostructures via photo-isomerization, photo-cleavage, photo-crosslinking, and photo-induced rearrangement. In addition to its clinical use, we will also provide here an overview of the recent UVA-responsive drug release approaches that are developed for phototherapy and skin photoprotection.

Fair-y Tales: An analysis of children's books about sun safety

INTRODUCTION

Skin cancer prevention should ideally begin with healthy sun protection habits during childhood. Children's books can be effective tools to introduce healthy habits early in life and should be targeted toward all children regardless of skin tone. This study examined sun protection guidelines and the representation of skin tones in commercial children's books.

METHODS

We performed internet searches for children's books about sun protection. We compared content from these books to current sun protection guidelines from the American Academy of Dermatology (AAD). We assessed books for reading level, author profession, and skin tone representation.

RESULTS

Seventeen books met study criteria. Of 19 factors surrounding sun protection provided by the AAD, the median number of factors mentioned within children's books was nine (range 3-13). Of the 13 books with color illustrations of people, one (7.6%) book depicted people with dark skin tones on the cover, and three (23.1%) books depicted people with dark skin tones within the story.

CONCLUSION

Commercial children's books about sun protection incorporate some, but not all, of the AAD guidelines, and there is an inadequate representation of darker skin tones within and on the cover of these books.

Melatonin protects against oxybenzone-induced deterioration of mouse oocytes during maturation

Oxybenzone (OBZ), an ultraviolet light filter that is widely used in sunscreens and cosmetics, is an emerging contaminant found in humans and the environment. Recent studies have shown that OBZ has been detected in women's plasma, urine, and breast milk. However, the effects of OBZ exposure on oocyte meiosis have not been addressed. In this study, we investigated the detrimental effects of OBZ on oocyte maturation and the protective roles of melatonin (MT) in OBZ-exposed mouse models. Our in vitro and in vivo results showed that OBZ suppressed oocyte maturation, while MT attenuated the meiotic defects induced by OBZ. In addition, OBZ facilitated H3K4 demethylation by increasing the expression of the Kdm5 family of genes, elevating ROS levels, decreasing GSH, impairing mitochondrial quality, and disrupting spindle configuration in oocytes. However, MT treatment resulted in significant protection against OBZ-induced damage during oocyte maturation and improved oocyte quality. The mechanisms underlying the beneficial roles of MT involved reduction of oxidative stress, inhibition of apoptosis, restoration of abnormal spindle assembly and up-regulation of H3K4me3. Collectively, our results suggest that MT protects against defects induced by OBZ during mouse oocyte maturation in vitro and in vivo.

(Bio)Technological aspects of microalgae pigments for cosmetics

Photosynthetic microorganisms convert carbon dioxide and solar radiation into interesting bioactive compounds not yet entirely explored. Several species of microalgae are known to be rich in colored high-valuable components that, although remarkable, are poorly explored as natural sources of pigments for cosmetics. Pigments associated to photosynthetic activity include chlorophyll, β-carotene, astaxanthin, xanthophylls, and phycobiliproteins, many of which have shown high potential as cosmetic actives due to their antioxidant, immune-enhancing, and anti-inflammatory properties. In the last decade, concern with a young and beautiful appearance has emerged, encouraging many consumers to use anti-aging cosmetics daily. As a result, the cosmetic market has been growing and evolving rapidly to meet consumer expectations. However, due to regular use and the sensitive nature of facial skin, local adverse reactions may often occur, such as irritation, sensitization, or photoreactions, and safety evaluation is mandatory prior to marketing. It is, therefore, understandable that new actives from natural sources, such as microalgae, are perceived as attractive alternatives for consumers who seek ingredients without allergenic potential. Thus, the cosmetic industry has recently started to explore the inclusion of compounds extracted from microalgae and cyanobacteria in innovative formulations. Herein, we revised nontraditional microalgae species for pigment production with cosmetic applications, indicating those that could also be considered potential ingredients for innovative cosmetics. KEY POINTS: • Extraction methods for pigments from photosynthetic microorganisms were compiled. • Innovative cosmeceuticals could be developed with natural pigments. • Safety features of such natural pigments were also described.

In vivo SPF from multifunctional sunscreen systems developed with natural compounds-A review

BACKGROUND

The use of sunscreens is mandatory, especially in countries with high ultraviolet (UV) incidence. In consequence, there has been a growing interest in using compounds from natural sources to develop new multifunctional products that protect human skin from the consequences of UV exposition. Even though there are in vitro methods to determine anti-UV efficacy, it is still required to test photoprotection activity on human skin to validate product performance.

AIM AND METHODS

In this review, we summarized all reported clinical studies about sun protection factor (SPF) measurements of sunscreens with natural compounds. We also discussed the probable action mechanism of those actives.

RESULTS

Herein, we provided an overview on recent studies concerning photoprotection activity of compounds from natural sources, for example, rutin, ferulic acid, caffeine, shea butter, and plant extracts, mainly presented in sunscreen systems with efficacy clinically established by SPF.

CONCLUSION

Our review suggested that even when the in vivo SPF evaluation has inherent difficulties, it is essential to assure the real efficacy of sunscreens. Furthermore, the incorporation of natural compounds could enhance the in vivo SPF values of such sunscreens by different mechanisms. Finally, some compounds derived from natural resources with skin benefits could be used as "green"/natural UV filters that provide broad-spectrum sunscreens with further upgrading of the multifunctional dermocosmetic formulation to enhance aesthetics and even skin health.

Extracellular vesicles from adipose-derived stem cells ameliorate ultraviolet B-induced skin photoaging by attenuating reactive oxygen species production and inflammation

BACKGROUND

Large numbers of adipose-derived stem cells (ADSCs) are easily obtained and have been demonstrated to protect against ultraviolet B (UVB)-induced skin photoaging. Extracellular vesicles (EVs) exhibit some of the same effects as the cells from which they originate and have many advantages over stem cells. In particular, their application circumvents many safety concerns associated with cell therapy. Thus, as a cell-free agent, adipose-derived stem cell extracellular vesicles (ADSC-EVs) have anti-photoaging potential. However, the protective effects of ADSC-EVs in skin photoaging remain uncertain.

METHODS

To investigate the effect of ADSC-EVs on mice with UVB-induced photoaging, 150 μg and 300 μg ADSC-EVs were subcutaneously injected weekly into photoaging mice for 8  weeks. The protective effect was evaluated by gross assessment and hematoxylin and eosin, Masson's trichrome, and β-galactosidase staining. Proliferating cell nuclear antigen, CD68, and dihydroethidium staining were performed to evaluate cell proliferation, inflammation infiltration, and reactive oxygen species (ROS) production, respectively. In vitro, 100 μg/mL and 200 μg/mL ADSC-EVs were used to treat photoaging fibroblasts (FBs). β-galactosidase staining and collagen 1 and matrix metalloproteinase 3 (MMP-3) expression were analyzed to evaluate FB senescence. To explain the protective mechanism of ADSC-EVs, their role in regulating ROS production, antioxidant enzyme expression, cell cycle arrest, and inflammation was evaluated.

RESULTS

In vivo, we showed that ADSC-EVs decreased skin wrinkles in mice with UVB-induced photoaging, while promoting epidermal cell proliferation and attenuating macrophage infiltration and ROS production. In vitro, we showed that ADSC-EVs increased FB activity and protected FBs from UVB-induced senescence, attenuated raw 264.7 cell differentiation from M0 to M1 macrophages, reduced intracellular ROS production, promoted antioxidant enzyme expression, and rescued FBs from cell cycle arrest.

CONCLUSION

The anti-photoaging effect of ADSC-EVs was attributed to their ability to attenuate ROS production and the inflammatory response, which are key factors in MMP activation and collagen degradation.

[Effects of solar radiation and an update on photoprotection]

Sunburn, immunodepression, photoaging, and photocarcinogenesis, are some of the most significant adverse effects of solar radiation in humans. Children are population group of special vulnerability, due to the fact that exposure to the sun has more pronounced biological effects compared to adults. Furthermore, childhood is a critical period for promoting the development of photo damage and photocarcinogenesis in the later stages of life if adequate measures at not put into place. This is because it is estimated that between 18 and 20 years of age is when 40% to 50% of the accumulative exposure to ultraviolet radiation up to 60 years of age is received. The most important strategy for the photoprotection of children is changes in behaviour and habits associated with exposure to the sun at all levels (school, society, family, etc.). Resorting to the shade, reduction in overall time of exposure to the sun, and physical protection (clothes, hats, and sunglasses) are the best and least costly photoprotection strategies. The photoprotectors must be incorporated into the daily routine of children in the same way as adults, and must complete a series of requirements in order to make them effective, safe, and in line with the environment.

Photoprotection beyond ultraviolet radiation: A review of tinted sunscreens

Ultraviolet radiation and visible light both have biologic effects on the skin. Visible light can induce erythema in light-skinned individuals and pigmentation in dark-skinned individuals. Broad-spectrum sunscreens protect against ultraviolet radiation but do not adequately protect against visible light. For a sunscreen to protect against visible light, it must be visible on the skin. Inorganic filters (also known as mineral filters), namely, zinc oxide and titanium dioxide, are used in the form of nanoparticles in sunscreens to minimize the chalky and white appearance on the skin; as such, they do not protect against visible light. Tinted sunscreens use different formulations and concentrations of iron oxides and pigmentary titanium dioxide to provide protection against visible light. Many shades of tinted sunscreens are available by combining different amounts of iron oxides and pigmentary titanium dioxide to cater to all skin phototypes. Therefore, tinted sunscreens are beneficial for patients with visible light-induced photodermatoses and those with hyperpigmentation disorders such as melasma and postinflammatory hyperpigmentation.

Sunscreen: FDA regulation, and environmental and health impact

Despite the concern for potential environmental and health effects, the FDA still considers organic UVR filters safe for use. For those who are concerned, inorganic UVR filter (namely, zinc oxide and titanium dioxide)-based sunscreens can be used.

Rosacea: a wholistic review and update from pathogenesis to diagnosis and therapy

Rosacea is a chronic inflammatory disorder of the central face with multiple overlapping presentations. Recent advancements are reshaping our understanding of rosacea from both a pathophysiologic perspective and clinical approach to therapy, introducing novel agents that have improved patient outcomes and reduced morbidity. In this article, we aim to outline the advancements in understanding, diagnosing, and managing rosacea and to familiarize physicians with the literature, thereby allowing us to better practice safe and effective medicine.