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Das A, Sil A, Kumar P, Khan I. Blue light and skin: what is the intriguing link? Clin Exp Dermatol 2023; 48:968-977. [PMID: 37097168 DOI: 10.1093/ced/llad150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023]
Abstract
Blue light has garnered attention because of its ability to penetrate more deeply into the skin layers, and induce cellular dysfunction and DNA damage. Photoageing, hyperpigmentation and melasma are some of the cutaneous changes that develop on exposure to blue light. To date, the therapeutic roles of blue light have been evaluated in dermatological conditions like psoriasis, eczema, acne vulgaris, actinic keratosis and cutaneous malignancies, among others. In this review, we have attempted to present an evidence-based compilation of the effects of blue light on the skin.
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Affiliation(s)
- Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Abheek Sil
- Department of Dermatology, Venereology and Leprosy, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Piyush Kumar
- Department of Dermatology, Madhubani Medical College & Hospital, Madhubani, Bihar, India
| | - Ismat Khan
- Department of Dermatology, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
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2
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Hussain Z, Qi Q, Zhu J, Anderson KE, Ma X. Protoporphyrin IX-induced phototoxicity: Mechanisms and therapeutics. Pharmacol Ther 2023; 248:108487. [PMID: 37392940 PMCID: PMC10529234 DOI: 10.1016/j.pharmthera.2023.108487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
Protoporphyrin IX (PPIX) is an intermediate in the heme biosynthesis pathway. Abnormal accumulation of PPIX due to certain pathological conditions such as erythropoietic protoporphyria and X-linked protoporphyria causes painful phototoxic reactions of the skin, which can significantly impact daily life. Endothelial cells in the skin have been proposed as the primary target for PPIX-induced phototoxicity through light-triggered generation of reactive oxygen species. Current approaches for the management of PPIX-induced phototoxicity include opaque clothing, sunscreens, phototherapy, blood therapy, antioxidants, bone marrow transplantation, and drugs that increase skin pigmentation. In this review, we discuss the present understanding of PPIX-induced phototoxicity including PPIX production and disposition, conditions that lead to PPIX accumulation, symptoms and individual differences, mechanisms, and therapeutics.
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Affiliation(s)
- Zahir Hussain
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Qian Qi
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Junjie Zhu
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Karl E Anderson
- Porphyria Laboratory and Center, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Xiaochao Ma
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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3
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Eadie E, Josso M, Touti R, Renoux P, Dawe RS, Ibbotson SH. Commercial visible-light protecting sunscreens for photosensitive individuals. Br J Dermatol 2023; 188:445-447. [PMID: 36680336 DOI: 10.1093/bjd/ljac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/26/2022] [Indexed: 01/22/2023]
Abstract
Visible light sensitivity can have a severe adverse impact on quality of life leading to withdrawal from social activity during daylight hours. Treatment options are limited and expensive. Commercially available sunscreens that provide visible light protection is of immediate practical importance, particularly for patients with Erythropoietic Protoporphyria (EPP) and Solar Urticaria as they experience intense symptoms of pain, burning, itch and urticarial rash or phototoxic erythema within seconds to minutes of even minor VL exposure.
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Affiliation(s)
- Ewan Eadie
- Scottish Photobiology Service, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Martin Josso
- L'Oréal Research and Innovation, Chevilly-Larue, Paris, France
| | - Rita Touti
- L'Oréal Research and Innovation, Chevilly-Larue, Paris, France
| | - Pascale Renoux
- L'Oréal Research and Innovation, Chevilly-Larue, Paris, France
| | - Robert S Dawe
- Scottish Photobiology Service, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Sally H Ibbotson
- Scottish Photobiology Service, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.,Photobiology Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Sernicola A, Cama E, Pelizzo MG, Tessarolo E, Nicolli A, Viero G, Alaibac M. In vitro Assessment of Solar Filters for Erythropoietic Protoporphyria in the Action Spectrum of Protoporphyrin IX. Front Med (Lausanne) 2021; 8:796884. [PMID: 34988101 PMCID: PMC8720878 DOI: 10.3389/fmed.2021.796884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Subjects with erythropoietic protoporphyria rely on broad-spectrum sunscreens with high sun protection factor, which is not informative on efficacy in the absorption spectrum of protoporphyrin IX, spanning visible radiation and peaking around 408 nm. Photoactivation of protoporphyrin IX is responsible for painful skin photosensitivity in erythropoietic protoporphyria. The authors assessed the protective efficacy of six sunscreens in vitro in the absorption spectrum of protoporphyrin IX. Method: Transmittance measurements were performed in the 300-850 nm wavelengths on samples of six photoprotective products applied to polymethyl methacrylate plates. Porphyrin protection factor was calculated in the 300-700 nm region to provide a measurement for the efficacy of each product based on the action spectrum of protoporphyrin IX. Results: Product A showed the highest porphyrin protection factor among tested products with a median value of 4.22. Product A is a sunscreen containing organic filters, titanium dioxide and synthetic iron oxides, pigmentary grade active ingredients that absorb visible radiation. Other products showed inefficient protection in the visible, with transmittance between 75 and 95% at 500 nm. The low porphyrin protection factor of inorganic filter product B was attributed to particle micronization, as declared by the manufacturer. Conclusion: Adding porphyrin protection factor to sunscreen labeling could help patients with erythropoietic protoporphyria and other photosensitivity disorders identify products tailored on their specific needs. The development of sunscreens providing protection from visible radiation and excellent cosmetical tolerability could improve the lifestyle of patients with erythropoietic protoporphyria.
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Affiliation(s)
- Alvise Sernicola
- Dermatology Unit, Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - Elena Cama
- Dermatology Unit, Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - Maria Guglielmina Pelizzo
- Department of Information Engineering, University of Padova, Padua, Italy
- Institute for Photonics and Nanotechnologies, National Research Council of Italy, Padua, Italy
| | - Enrico Tessarolo
- Institute for Photonics and Nanotechnologies, National Research Council of Italy, Padua, Italy
| | - Annamaria Nicolli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health (DCTV), University of Padova, Padua, Italy
| | - Giulia Viero
- Dermatology Unit, Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine (DIMED), University of Padova, Padua, Italy
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Lim HW, Kohli I, Granger C, Trullàs C, Piquero-Casals J, Narda M, Masson P, Krutmann J, Passeron T. Photoprotection of the Skin from Visible Light‒Induced Pigmentation: Current Testing Methods and Proposed Harmonization. J Invest Dermatol 2021; 141:2569-2576. [PMID: 34112516 DOI: 10.1016/j.jid.2021.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022]
Abstract
Visible light (VL) can induce pigmentary alterations, especially in dark-skinned individuals, and exacerbate photodermatoses and pigmentary disorders. Currently, there is no standardized method for assessing sunscreen protection against VL. On the basis of a critical review of published in vitro and in vivo methods, a VL photoprotection assessment method based on pigmentation is proposed.
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Affiliation(s)
- Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA.
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA; Department of Physics and Astronomy, College of Liberal Arts and Sciences, Wayne State University, Detroit, Michigan, USA
| | | | | | | | | | | | - Jean Krutmann
- IUF - Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany; Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
| | - Thierry Passeron
- Department of Dermatology, Centre Hospitalaire Universitaire de Nice, University Côte d'Azur, Nice, France; C3M, INSERM U1065, University Côte d'Azur, Nice, France
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Coats JG, Maktabi B, Abou-Dahech MS, Baki G. Blue light protection, part II-Ingredients and performance testing methods. J Cosmet Dermatol 2020; 20:718-723. [PMID: 33340223 DOI: 10.1111/jocd.13854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are numerous cosmetic ingredients that have been identified to have blue light protection benefits. The urge to learn more about blue light protection claims has led to several substantiation test methods that can be utilized by companies to prove product efficacy. AIMS Part II of this article provides up-to-date information on cosmetic ingredients that can provide protection from blue light, and methods companies can use to substantiate blue light protection claims. METHODS An Internet search was completed using the Google Scholar database and a cosmetic ingredient supplier database (UL Prospector) for ingredients and relevant literature. RESULTS Multiple ingredient categories, for example, algae-derived ingredients, UV filters, botanical extracts, antioxidants, and vitamins, are available on the market to fight against blue light-induced skin damage. There is not a formal standardized method to test for blue light protection; however, spectrophotometers, imaging devices, measuring oxidative stress, and visual evaluations are some of the methods being used today. CONCLUSIONS The number of ingredients launched for blue light protection and new methods developed to test products for blue light protection claims is expected to increase in the near future as we are learning more about the mechanism of damage that occurs in the skin upon blue light exposure.
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Affiliation(s)
- Jahnna G Coats
- Department of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH, USA
| | - Briana Maktabi
- Department of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH, USA
| | - Mariam S Abou-Dahech
- Department of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH, USA
| | - Gabriella Baki
- Department of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH, USA
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Heerfordt IM, Heydenreich J, Philipsen PA, Lerche CM, Wulf HC. Light-provoked skin symptoms on the hands of erythropoietic protoporphyria patients related to personal dosimeter measurements, skin symptoms, light protection and priming. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 213:112054. [PMID: 33075648 DOI: 10.1016/j.jphotobiol.2020.112054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/08/2020] [Indexed: 12/29/2022]
Abstract
Erythropoietic protoporphyria (EPP) is characterised by accumulation of protoporphyrin IX (PpIX) in erythrocytes. Upon illumination PpIX is released to the skin. Activation of the photoactive substance PpIX causes painful skin symptoms. This study aimed to objectively quantify individual light exposure of EPP patients in their everyday lives through spring and summer. We further aimed to establish the associations between daily symptoms and light exposure dose to photoprimed and non-photoprimed skin, use of gloves, and erythrocyte PpIX concentration. 14 Danish EPP patients participated from April through June, the period when symptoms are most frequent. Light exposure was measured using personal electronic dosimeters with sensor sensitivity comparable to the absorption spectrum of PpIX, measuring the biological effect of the light in this disease. Concurrently participants reported symptoms and use of protective gloves in a diary. Patients had a blood sample analysed for erythrocyte PpIX. The median patient was exposed to an average daily PpIX-weighted light dose of 3.8 J/cm2 corresponding to approximately 15 min in the midday sun during summer in Denmark. The median patient reported symptoms on 29% and wore gloves on 11% of study days. There was a significant positive correlation between erythrocyte PpIX concentration and percentage of days wearing gloves (r = 0.65, p = 0.011), and a significant negative correlation between erythrocyte PpIX concentration and mean daily light dose on days not wearing gloves (r = -0.53, p = 0.049). Photosensitivity was strongly dependent on photopriming.
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Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Jakob Heydenreich
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Catharina M Lerche
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
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8
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Teramura T, Mizuno M, Asano H, Naru E, Kawara S, Kamide R, Kawada A. Prevention of photosensitivity with action spectrum adjusted protection for erythropoietic protoporphyria. J Dermatol 2018; 45:145-149. [PMID: 29266358 PMCID: PMC5814858 DOI: 10.1111/1346-8138.14175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/08/2017] [Indexed: 12/24/2022]
Abstract
Erythropoietic protoporphyria is a genetic disease characterized by sensitivity to sunlight caused by the accumulation of protoporphyrin IX. Photoprotection against ultraviolet A and visible light is necessary for erythropoietic porphyria patients because the absorption spectrum of protoporphyrin IX lies in both ultraviolet A and visible light region. We developed a novel index, in vitro porphyrin protection factor, based on the protoporphyrin IX absorbance spectrum. We also selected appropriate photoprotective products designed according to protoporphyrin IX absorbance. The porphyrin protection factors of a combination of make-up base with a powder as well as with a liquid foundation were significantly higher than those of a conventional sunscreen product, even at a small application dose. An in-use test carried out for 6 months showed that the efficacy of these products was 78.3%, and no adverse reactions were observed. Male subjects preferred liquid foundation, whereas all female subjects used powder foundation. The preference of the subjects could lead to the long-term use of the tested products. In conclusion, this study provided a new approach to improve photoprotection in erythropoietic protoporphyria patients.
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Affiliation(s)
| | - Makoto Mizuno
- Fundamental Research LaboratoriesKOSÉ CorporationTokyoJapan
| | - Hajime Asano
- Fundamental Research LaboratoriesKOSÉ CorporationTokyoJapan
| | - Eiji Naru
- Fundamental Research LaboratoriesKOSÉ CorporationTokyoJapan
| | - Shigeru Kawara
- Department of DermatologyJapanese Red Cross Kanazawa HospitalIshikawaJapan
| | - Ryoichi Kamide
- Hihuno Clinic NingyochoTokyoJapan
- Department of DermatologyDaisan HospitalThe Jikei University School of MedicineTokyoJapan
| | - Akira Kawada
- Department of DermatologyKindai University Faculty of MedicineOsakaJapan
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Zaid AN, Jaradat N, Darwish S, Nairat S, Shamlawi R, Hamad Y, Hussein F, Issa L. Assessment of the general quality of sunscreen products available in Palestine and method verification of the sun protection factor using Food and Drug Administration guidelines. J Cosmet Dermatol 2018; 17:1122-1129. [PMID: 29377413 DOI: 10.1111/jocd.12496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sunlight exposure affects all skin types causing skin tanning, burns or even skin cancer. Sunscreens were invented to prevent these outcomes by scattering or absorbing the UV light. AIMS This study aimed to verify the effectiveness of Mansur method in SPF measurement and to find out how much reliable the labeled sun protection factor (SPF) value for the products that are imported to Palestine knowing that they are considered as cosmetics and they don't undergo tests by the Ministry Of Health (MOH). MATERIALS In this research, sun protection factor (SPF) was determined for 16 commercially available sunscreen products using Mansur equation which was also validated; moreover sunscreen classification, product phase determination and pH measurement were also done. RESULTS Sun protection factor values were mostly 50, 43.75% of the analyzed samples were close to the labeled SPF, 31.25% were under the labeled value, and 25% SPF value above the labeled value. All samples exhibited a pH close to skin pH. 62% of them were found to be O/W. Cosmetic companies and importers should focus on pediatric sunscreens, since only 12.5% are pediatric sunscreens. CONCLUSIONS Ministry Of Health should ask prove about the quality of an SPF value of sunscreens for final registration of these products. More instructions should be available on the label regarding the proper use especially, if they are not water proof.
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Affiliation(s)
- Abdel Naser Zaid
- Department of Pharmacy, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
| | - Nidal Jaradat
- Department of Pharmacy, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
| | - Saja Darwish
- Department of Pharmacy, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sura Nairat
- Department of Pharmacy, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
| | - Rawan Shamlawi
- Department of Pharmacy, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
| | - Yasmeen Hamad
- Department of Pharmacy, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
| | - Fatema Hussein
- Department of Pharmacy, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
| | - Linda Issa
- Department of Pharmacy, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
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Abstract
This is an overview of the cutaneous porphyrias. It is a narrative review based on the published literature and my personal experience; it is not based on a formal systematic search of the literature. The cutaneous porphyrias are a diverse group of conditions due to inherited or acquired enzyme defects in the porphyrin-haem biosynthetic pathway. All the cutaneous porphyrias can have (either as a consequence of the porphyria or as part of the cause of the porphyria) involvement of other organs as well as the skin. The single commonest cutaneous porphyria in most parts of the world is acquired porphyria cutanea tarda, which is usually due to chronic liver disease and liver iron overload. The next most common cutaneous porphyria, erythropoietic protoporphyria, is an inherited disorder in which the accumulation of bile-excreted protoporphyrin can cause gallstones and, rarely, liver disease. Some of the porphyrias that cause blistering (usually bullae) and fragility (clinically and histologically identical to porphyria cutanea tarda) can also be associated with acute neurovisceral porphyria attacks, particularly variegate porphyria and hereditary coproporphyria. Management of porphyria cutanea tarda mainly consists of visible-light photoprotection measures while awaiting the effects of treating the underlying liver disease (if possible) and treatments to reduce serum iron and porphyrin levels. In erythropoietic protoporphyria, the underlying cause can be resolved only with a bone marrow transplant (which is rarely justifiable in this condition), so management consists particularly of visible-light photoprotection and, in some countries, narrowband ultraviolet B phototherapy. Afamelanotide is a promising and newly available treatment for erythropoietic protoporphyria and has been approved in Europe since 2014.
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Affiliation(s)
- Robert Dawe
- Scottish Cutaneous Porphyria Service, Scottish Photodiagnostic Unit, Department of Dermatology, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
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Bora NS, Mazumder B, Chattopadhyay P. Prospects of topical protection from ultraviolet radiation exposure: a critical review on the juxtaposition of the benefits and risks involved with the use of chemoprotective agents. J DERMATOL TREAT 2017; 29:256-268. [DOI: 10.1080/09546634.2017.1364691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nilutpal Sharma Bora
- Division of Pharmaceutical Technology, Defence Research Laboratory, Tezpur, Assam, India
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, Assam, India
| | - Bhaskar Mazumder
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, Assam, India
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12
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Assessing the current market of sunscreen: a cross-sectional study of sunscreen availability in three metropolitan counties in the United States. J Skin Cancer 2014; 2014:285357. [PMID: 24955250 PMCID: PMC4052569 DOI: 10.1155/2014/285357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/28/2014] [Indexed: 11/17/2022] Open
Abstract
Sunscreen use is recommended for the prevention of sunburn and skin cancer. Little is known regarding sunscreen availability in high versus low income communities. We analyzed sunscreen availability in three large metropolitan counties to determine the relationship between availability and community demographics. We included sun care products in all pharmacies and supermarkets open as of July 2013 in representative high and low income zip codes in Cook County, Illinois, Miami-Dade County, Florida, and San Diego County, California. We recorded the percentage of tanning oil, sunscreens with a sun protection factor (SPF) < 15, SPF > 15, physical sunscreens, spray sunscreens, mean price per ounce (PPO), and mean SPF. Of the total products assessed, 11.0% were tanning oils, with physical sunscreens accounting for only 3.4% of the available sunscreens and 46.2% of sunscreens being spray-on. A comparison between higher and lower income zip codes demonstrated a significantly increased percentage of sunscreens with SPF < 15 in high income zip codes. Lower income zip codes had higher percentages of sunscreens with SPF > 15 and higher PPO, even when taking into account SPF. Further studies of sunscreen usage patterns in different populations must take into account sunscreen availability and price, as these significantly differ based on the community demographic.
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13
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Sambandan DR, Ratner D. Sunscreens: An overview and update. J Am Acad Dermatol 2011; 64:748-58. [DOI: 10.1016/j.jaad.2010.01.005] [Citation(s) in RCA: 220] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 12/28/2009] [Accepted: 01/03/2010] [Indexed: 11/25/2022]
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Wahlin S, Floderus Y, Stål P, Harper P. Erythropoietic protoporphyria in Sweden: demographic, clinical, biochemical and genetic characteristics. J Intern Med 2011; 269:278-88. [PMID: 20412370 DOI: 10.1111/j.1365-2796.2010.02236.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the demographic, clinical, biochemical and genotypic features of patients with erythropoietic protoporphyria (EPP) in a Swedish cohort. DESIGN Cross-sectional questionnaire, biochemical and genetic study. SETTING Sweden. SUBJECTS Fifty-one Swedish individuals known in 2008 to have EPP confirmed by molecular diagnosis. There were no exclusion criteria; all patients were included in the demographic and genetic study. A total of 92% participants completed the questionnaire study and 82% the biochemical study. RESULTS The prevalence of EPP was 1 : 180,000. Nine novel ferrochelatase gene mutations were found. The most commonly reported age at onset of symptoms was the first year of life and the mean age at diagnosis was 22 years. Painful photosensitivity was the main symptom. Exogenous factors other than sunlight were frequently reported to cause cutaneous symptoms. One in five patients reported a positive effect of beta-carotene therapy. A marked impact of EPP on quality of life was reported. Women had a significantly lower mean erythrocyte protoporphyrin concentration than men. Of all participants, 84% had insufficient vitamin D concentrations, 44% had below normal serum ferritin or transferrin saturation levels and red cell abnormalities were common. CONCLUSIONS The notably delayed diagnosis suggests the need for an increased awareness of EPP. Disturbed erythropoiesis, biochemical signs of iron deficiency and low vitamin D levels are frequent findings in this disease. New and better treatments are needed as current treatment options for symptom amelioration are limited. Vitamin D supplementation should be considered.
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Affiliation(s)
- S Wahlin
- Department of Gastroenterology and Hepatology, Porphyria Centre Sweden, Karolinska Institutet, Karolinska UniversityHospital, Stockholm, Sweden.
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Protection Afforded by Sunscreens Containing Inorganic Sunscreening Agents Against Blue Light Sensitivity Induced by Aminolevulinic Acid. Dermatol Surg 2008. [DOI: 10.1097/00042728-200811000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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BISSONNETTE ROBERT, NIGEN SIMON, BOLDUC CHANTAL, MÉRY SOPHIE, NOCERA THÉRÈSE. Protection Afforded by Sunscreens Containing Inorganic Sunscreening Agents Against Blue Light Sensitivity Induced by Aminolevulinic Acid. Dermatol Surg 2008; 34:1469-76. [DOI: 10.1111/j.1524-4725.2008.34311.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Sarkany RPE. Making sense of the porphyrias. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2008; 24:102-8. [PMID: 18353093 DOI: 10.1111/j.1600-0781.2008.00336.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with cutaneous porphyrias can be worrying for dermatologists. The diseases are rare enough to be unfamiliar, are associated with internal diseases, can have genetic implications, and are associated with incomprehensible biochemical pathways. In this review, I will try to explain why porphyrias occur, why they present as they do in the clinic, and provide a checklist for treating patients with porphyria.
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Genotoxicity of visible light (400–800nm) and photoprotection assessment of ectoin, l-ergothioneine and mannitol and four sunscreens. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2008; 91:24-34. [DOI: 10.1016/j.jphotobiol.2008.01.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 11/30/2007] [Accepted: 01/22/2008] [Indexed: 11/22/2022]
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Abstract
Sun exposure is the main cause of photocarcinogenesis, photoageing, and photosensitivity; thus, photoprotection is an important issue. In a skin cancer prevention strategy, behavioural measures--eg, wearing sun protective clothes and a hat and reducing sun exposure to a minimum--should be preferred to sunscreens. Often this solution is deemed to be unacceptable in our global, outdoor society, and sunscreens could become the predominant mode of sun protection for various societal reasons (eg, healthiness of a tan, relaxation in the sun). The application of a liberal quantity of sunscreen has been shown to be by far the most important factor for effectiveness of the sunscreen, followed by the uniformity of application and the specific absorption spectrum of the agent used. The sunscreen market--crowded by numerous products--shows various differences worldwide. Nevertheless, sunscreens should not be abused in an attempt to increase time in the sun to a maximum. Controversies about safety of sunscreens and clinical recommendations are discussed.
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Holme SA, Anstey AV, Finlay AY, Elder GH, Badminton MN. Erythropoietic protoporphyria in the U.K.: clinical features and effect on quality of life. Br J Dermatol 2006; 155:574-81. [PMID: 16911284 DOI: 10.1111/j.1365-2133.2006.07472.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Erythropoietic protoporphyria (EPP) is a rare inherited photodermatosis that causes lifelong painful photosensitivity. Neither its full clinical spectrum nor its impact on quality of life (QoL) has been investigated in a large cohort of patients. OBJECTIVES To document the clinical features of EPP and its impact on QoL in a high proportion of all patients with EPP resident in the U.K. METHODS Patients with EPP were identified from U.K. clinical databases and assessed by the same clinical investigator over a 7-month period using a standardized proforma and validated adult (Dermatology Life Quality Index, DLQI) and children's (Children's Dermatology Life Quality Index, CDLQI) QoL questionnaires. RESULTS Three hundred and eighty-nine living patients with EPP were identified, of whom 223 [114 females, 109 males; median age 34 years (range: 5-87), from 193 families] were investigated. Total erythrocyte porphyrin (TEP) was higher in males (median: 25.3 micromol L1) than females (median: 19.3 micromol L1). The median ages at onset and diagnosis were 1 and 12 years, respectively. Median times for onset of symptoms after sun exposure, onset of signs (oedema, erythema) and resolution of symptoms were 20 min, 6 h and 3 days, respectively. Most patients reported absence of protection by glass (92%), priming (85%), exacerbation by wind (68%), no family history of photosensitivity (56%), no symptoms during winter (56%) and had chronic skin lesions (79%). Symptoms changed little with age but improved during pregnancy in 47% of gravid women. Most patients used protective clothing and a sunscreen; 28% were taking beta-carotene and a further 56% had taken it; 29% were not under regular medical care. Two patients (1%) had liver failure and 8% reported gallstone disease. QoL was markedly impaired, with scores similar to those in severe dermatological disease (mean DLQI score 14.0, n = 176; mean CDLQI score 12.8, n = 44), indicating a large effect on patients' lives. DLQI scores correlated weakly with TEP (rs = 0.228; P = 0.002) and time to onset of symptoms (rs = -0.233; P = 0.002) but not with age at onset. CONCLUSIONS EPP is a persistent, severely painful, socially disabling disease with a marked impact on QoL. Its diagnosis is often overlooked. None of TEP, age at onset nor time to onset of symptoms is a useful predictor of impaired QoL in individual patients.
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Affiliation(s)
- S A Holme
- Department of Dermatology, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
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Abstract
Chronic actinic dermatitis is a condition involving abnormal cutaneous photosensitivity to UV and, often, visible wavelengths. It is rare, but more common in the elderly than in younger populations, with an estimated prevalence of one in 2000 in the > or = 75-year-old population in Tayside, Dundee, Scotland. It usually presents as a dermatitis that maximally, but not exclusively, affects photo-exposed skin. Investigation to confirm the diagnosis and guide management includes phototesting and patch testing. The mainstay of treatment is education about the condition and advice on sunlight and allergen avoidance. Topical corticosteroids and emollients are always required, at least intermittently, and it is sometimes necessary to resort to systemic immunosuppression, usually with corticosteroids or azathioprine.
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Affiliation(s)
- Robert S Dawe
- Photobiology Unit, Department of Dermatology, Ninewells Hospital and Medical School, Dundee, Scotland.
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Abstract
UNLABELLED Many agents affect the transmission of ultraviolet light to human skin. These include naturally occurring photoprotective agents (ozone, pollutants, clouds, and fog), naturally occurring biologic agents (epidermal chromophores), physical photoprotective agents (clothing, hats, make-ups, sunglasses, and window glass), and ultraviolet light filters (sunscreen ingredients and sunless tanning agents). In addition, there are agents that can modulate the effects of ultraviolet light on the skin (antioxidants and others). All of the above are reviewed in this article. LEARNING OBJECTIVE At the conclusion of this learning activity, participants should be able to provide an overview of all aspects of photoprotection.
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Abstract
Chronic actinic dermatitis, synonymous with the photosensitivity dermatitis and actinic reticuloid syndrome, presents as a dermatitis and/or a pseudolymphomatous eruption. Abnormal photosensitivity to ultraviolet (UV) and often visible radiation is a feature. Many patients also have multiple contact allergens. Histopathologic features vary, with a spectrum from mild dermatitis to pseudolymphomatous (reticuloid) features. The essential tests to make the diagnosis and to guide advice on avoidance of the responsible wavelengths and any contact allergens are phototesting and patch testing. Chronic actinic dermatitis can be regarded as a disorder of increased susceptibility, for reasons that remain uncertain, to develop delayed-type allergic responses to both endogenous photoallergens and exogenous allergens. Treatment consists of detailed advice on sunlight and allergen avoidance (guided by the results of investigations), topical corticosteroids, and emollients. When these measures are insufficient alone, systemic immunosuppressives may be considered: systemic prednisolone for acute exacerbations or azathioprine if systemic treatment is required for more than a few weeks.
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Affiliation(s)
- Robert S Dawe
- Photobiology Unit, Department of Dermatology, Ninewells Hospital and Medical School, Dundee, Scotland.
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Abstract
The idiopathic photodermatoses are the most common cause of photosensitivity and the commonest of these are polymorphic light eruption, actinic prurigo, chronic actinic dermatitis and solar urticaria. The clinical presentation, investigation and treatment of these four disorders are presented. Spontaneous improvement does occur.
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Affiliation(s)
- James Ferguson
- Consultant Dermatologist, Photobiology Unit, Ninewells Hospital and Medical School, Dundee, Scotland.
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Kontos AP, Ozog D, Bichakjian C, Lim HW. Congenital erythropoietic porphyria associated with myelodysplasia presenting in a 72-year-old man: report of a case and review of the literature. Br J Dermatol 2003; 148:160-4. [PMID: 12534613 DOI: 10.1046/j.1365-2133.2003.05040.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Congenital erythropoietic porphyria (CEP) is a rare autosomal recessive disease owing to the deficient activity of uroporphyrinogen III synthase, the fourth enzyme in the porphyrin-haem synthetic pathway. Of the porphyrias, it is the most mutilating type, usually presenting early in life. To date, 12 documented cases of adult onset CEP have been reported. We report the second oldest documented patient with late onset CEP with incidental findings of thrombocytopenia and myelodysplasia with bone-marrow sideroblasts. We further discuss several current and future treatment options for this therapeutically challenging disease.
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Affiliation(s)
- A P Kontos
- Department of Dermatology, Henry Ford Health System, Detroit, MI 48202, USA
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Gilaberte Y, Coscojuela C, Sáenz de Santamaría MC, González S. Fotoprotección. ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)76688-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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