Do oral carotenoids protect human skin against ultraviolet erythema, psoralen phototoxicity, and ultraviolet-induced DNA damage?

Role of ingestible carotenoids in skin protection: A review of clinical evidence

Carotenoids, a class of phytonutrients, have been well established to boost skin's innate resistance against ultraviolet (UV) B-induced erythema (sunburn). Many of the published clinical studies thus far have focused on the measurement of erythema as the primary clinical indicator of skin protection against UVB radiation. More recent studies have shown that carotenoid supplementation provides even more skin protection than previously shown as new clinical and molecular endpoints beyond UVB-induced erythema have been reported. These recent studies have demonstrated that carotenoids also provide photoprotection against UVA-induced pigmentation and inhibit molecular markers of oxidative stress such as intercellular adhesion molecule 1, heme oxygenase-1, and matrix metalloproteinases 1 and 9. This article provides a comprehensive review of the published clinical evidence on skin benefits of carotenoids in the last five decades and indicates new perspectives on the role of ingestible carotenoids in skin protection.

Carotenoids in human skin

The skin is shielding our organism from exogenous threats including solar radiation. Carotenoids which are ingested with the diet accumulate in the skin with the highest levels occurring in skin of the forehead and in the palms of the hands. Blood and skin levels of carotenoids increase during supplementation and due to their antioxidant properties and UV-absorbing effects carotenoids are used as photoprotective agents. Systemic photoprotection with carotenoids after supplementation or ingestion of a carotenoid rich diet has been demonstrated in several human intervention studies. Although protection is only moderate it may contribute to UV protection in combination with other measures. Beyond photoprotection, ingestion of carotenoids has been postulated to be of additional benefit for cutaneous tissue and influences moisture and texture or elasticity of the skin. However, only a limited number of studies is available yet to substantiate such a claim.

Sunlight damage to cellular DNA: Focus on oxidatively generated lesions

The routine and often unavoidable exposure to solar ultraviolet (UV) radiation makes it one of the most significant environmental DNA-damaging agents to which humans are exposed. Sunlight, specifically UVB and UVA, triggers various types of DNA damage. Although sunlight, mainly UVB, is necessary for the production of vitamin D, which is necessary for human health, DNA damage may have several deleterious consequences, such as cell death, mutagenesis, photoaging and cancer. UVA and UVB photons can be directly absorbed not only by DNA, which results in lesions, but also by the chromophores that are present in skin cells. This process leads to the formation of reactive oxygen species, which may indirectly cause DNA damage. Despite many decades of investigation, the discrimination among the consequences of these different types of lesions is not clear. However, human cells have complex systems to avoid the deleterious effects of the reactive species produced by sunlight. These systems include antioxidants, that protect DNA, and mechanisms of DNA damage repair and tolerance. Genetic defects in these mechanisms that have clear harmful effects in the exposed skin are found in several human syndromes. The best known of these is xeroderma pigmentosum (XP), whose patients are defective in the nucleotide excision repair (NER) and translesion synthesis (TLS) pathways. These patients are mainly affected due to UV-induced pyrimidine dimers, but there is growing evidence that XP cells are also defective in the protection against other types of lesions, including oxidized DNA bases. This raises a question regarding the relative roles of the various forms of sunlight-induced DNA damage on skin carcinogenesis and photoaging. Therefore, knowledge of what occurs in XP patients may still bring important contributions to the understanding of the biological impact of sunlight-induced deleterious effects on the skin cells.

Oral Polypodium leucomotos increases the anti-inflammatory and melanogenic responses of the skin to different modalities of sun exposures: a pilot study

BACKGROUND

The effects on the inflammatory and tanning responses of sunlight/UVR of several oral antioxidants are still unknown.

OBJECTIVE

Assess intensity, time course of the inflammatory, and tanning responses to increasing dosages of solar-simulated radiation (SSR) at baseline and after oral supplementation of an extract of Polypodium leucotomos (PLE).

METHODS

Ten healthy subjects underwent phototesting with SSR with a visual and spectrophotometrical assessment of the responses with or without daily oral supplementation of two tablets containing 240 mg of PLE for a total of 15 days.

RESULTS

Polypodium leucotomos supplementation induced a significant increase of the minimal erythema dose (MED), a faster recovery of the inflammation following the delivery of super-erythemal doses, and no significant changes of the minimal melanogenic dose (MMD). Spectrophotometric assessment of the Δa* in test areas exposed to equally doses of SSR did not show differences.

CONCLUSIONS

Polypodium leucotomos supplementation increased the MED and induced a faster recovery of the inflammation and a stronger tanning response with no changes in the melanogenic threshold.

Brazilian consensus on photoprotection

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection.

The protective role of antioxidants in the defence against ROS/RNS-mediated environmental pollution

Overproduction of reactive oxygen and nitrogen species can result from exposure to environmental pollutants, such as ionising and nonionising radiation, ultraviolet radiation, elevated concentrations of ozone, nitrogen oxides, sulphur dioxide, cigarette smoke, asbestos, particulate matter, pesticides, dioxins and furans, polycyclic aromatic hydrocarbons, and many other compounds present in the environment. It appears that increased oxidative/nitrosative stress is often neglected mechanism by which environmental pollutants affect human health. Oxidation of and oxidative damage to cellular components and biomolecules have been suggested to be involved in the aetiology of several chronic diseases, including cancer, cardiovascular disease, cataracts, age-related macular degeneration, and aging. Several studies have demonstrated that the human body can alleviate oxidative stress using exogenous antioxidants. However, not all dietary antioxidant supplements display protective effects, for example, β-carotene for lung cancer prevention in smokers or tocopherols for photooxidative stress. In this review, we explore the increases in oxidative stress caused by exposure to environmental pollutants and the protective effects of antioxidants.

Skin photoaging and the role of antioxidants in its prevention

Photoaging of the skin depends primarily on the degree of ultraviolet radiation (UVR) and on an amount of melanin in the skin (skin phototype). In addition to direct or indirect DNA damage, UVR activates cell surface receptors of keratinocytes and fibroblasts in the skin, which leads to a breakdown of collagen in the extracellular matrix and a shutdown of new collagen synthesis. It is hypothesized that dermal collagen breakdown is followed by imperfect repair that yields a deficit in the structural integrity of the skin, formation of a solar scar, and ultimately clinically visible skin atrophy and wrinkles. Many studies confirmed that acute exposure of human skin to UVR leads to oxidation of cellular biomolecules that could be prevented by prior antioxidant treatment and to depletion of endogenous antioxidants. Skin has a network of all major endogenous enzymatic and nonenzymatic protective antioxidants, but their role in protecting cells against oxidative damage generated by UV radiation has not been elucidated. It seems that skin's antioxidative defence is also influenced by vitamins and nutritive factors and that combination of different antioxidants simultaneously provides synergistic effect.

β-Carotene and other carotenoids in protection from sunlight

Protection against skin damage from sunlight by nutritional means has been examined. Likewise, there has been work on the topical application of phytochemicals to the skin. This review focuses on the nutritional aspect of phytochemicals in humans-ie, the provision of carotenoid micronutrients by dietary means to the skin and their role in protection. Human intervention studies have documented protective effects for β-carotene or for lycopene provided either by a carotenoid-rich diet or by supplementation. In exposed tissues, light induces primary and secondary photooxidative processes. Scavenging of reactive oxygen species is considered to be a mechanism of action underlying the protective activity of carotenoids. However, food comprises a complex mixture of numerous constituents, so that other components may also contribute to the observed activity. Molecules with suitable structures absorb UV light and prevent direct damage of cellular targets. Phytoene and phytofluene are precursor molecules of higher unsaturated carotenoids and occur in various fruit and vegetables. Their absorption spectra cover the UVB and UVA range, respectively, thus potentially contributing to photoprotective effects of carotenoid-rich food. Because of the physiologic turnover time of skin, several weeks are required for protective effects to appear. Photoprotection through individual dietary components such as β-carotene or lycopene in terms of sun protection factor is considerably lower than that achieved by using topical sunscreens. However, an optimal supply of antioxidant micronutrients in the skin increases basal dermal defense against UV irradiation, supports longer-term protection, and contributes to maintenance of skin health and appearance.

Discovering the link between nutrition and skin aging

Skin has been reported to reflect the general inner-health status and aging. Nutrition and its reflection on skin has always been an interesting topic for scientists and physicians throughout the centuries worldwide. Vitamins, carotenoids, tocopherols, flavonoids and a variety of plant extracts have been reported to possess potent anti-oxidant properties and have been widely used in the skin care industry either as topically applied agents or oral supplements in an attempt to prolong youthful skin appearance. This review will provide an overview of the current literature "linking" nutrition with skin aging.

Photoprotection by dietary carotenoids: concept, mechanisms, evidence and future development

Carotenoids are micronutrients present mainly in fruits and vegetables, and they are ingested from these sources with the diet. They exhibit specific antioxidant activity but also influence signaling and gene expression at the cellular level. β-Carotene and lycopene, the colorants of carrots and tomatoes, respectively, are among the most prominent members of this group of lipids, and they are usually the dominating carotenoids in human blood and tissues. Both compounds modulate skin properties when ingested as supplements or as dietary products. There is evidence that they protect the skin against sunburn (solar erythema) by increasing the basal defense against UV light-mediated damage. Their photoprotective efficacy, however, is not comparable to the use of a sunscreen. In vitro data show that also other carotenoids are efficient photoprotectors. Among them are lutein and structurally unusual phenolic polyenes like 3,3'-dihydroxyisorenieratene.

Interactions of dietary carotenoids with activated (singlet) oxygen and free radicals: potential effects for human health

Molecular mechanisms associated with the anti-/pro-oxidative properties of carotenoids (CARs) are described in organic solvents, micro-heterogeneous environments and model lipid membranes and in cellular suspensions. Singlet oxygen is important in the skin and eye and CARs are efficient singlet oxygen (SO) quenchers with corresponding rate constants near diffusion controlled (typically app. 10¹⁰ M⁻¹ s⁻¹) with lycopene (LYC) exhibiting the most efficient quenching in organic solvents. However, in membrane environments there is little or no difference in the quenching efficiency between the dietary CARs. Furthermore, aggregation of CARs, particularly those in the macula (lutein and zeaxanthin), markedly reduces SO quenching efficiency. Free radical interactions with CARs leads to at least three processes, electron and hydrogen atom transfer and adduct formation. The most studied is electron transfer where the CAR loses an electron to become a radical cation. The reactivity/lifetime of such CAR radicals may lead to a switch from anti- to pro-oxidant behaviour of CARs. These reactions are related to CAR redox potentials with LYC being the lowest (most easily oxidised) allowing LYC to reduce/repair all other CAR radical cations and LYC 'sacrificed' where mixtures of CARs are present in oxidative environments. Such redox-controlled reactions may lead to deleterious as well as beneficial health effects.

Beta-carotene is an important vitamin A source for humans

Experts in the field of carotenoids met at the Hohenheim consensus conference in July 2009 to elucidate the current status of β-carotene research and to summarize the current knowledge with respect to the chemical properties, physiological function, and intake of β-carotene. The experts discussed 17 questions and reached an agreement formulated in a consensus answer in each case. These consensus answers are based on published valid data, which were carefully reviewed by the individual experts and are justified here by background statements. Ascertaining the impact of β-carotene on the total dietary intake of vitamin A is complicated, because the efficiency of conversion of β-carotene to retinol is not a single ratio and different conversion factors have been used in various surveys and following governmental recommendations within different countries. However, a role of β-carotene in fulfilling the recommended intake for vitamin A is apparent from a variety of studies. Thus, besides elucidating the various functions, distribution, and uptake of β-carotene, the consensus conference placed special emphasis on the provitamin A function of β-carotene and the role of β-carotene in the realization of the required/recommended total vitamin A intake in both developed and developing countries. There was consensus that β-carotene is a safe source of vitamin A and that the provitamin A function of β-carotene contributes to vitamin A intake.

[Systemic photoprotection through carotenoids]

Nutritional supplements are increasingly used to protect human skin against environmentally-induced damage, most importantly as a consequence of ultraviolet radiation exposure. beta-carotene is a major constituent of comercially available products administered for systemic photoprotection. Studies on the systemic use of beta-carotene provide evidence that 15-30 mg/d over a period of about 10-12 wk produces a protective effect against UV-induced erythema. Similar effects have been attributed to mixtures of carotenoids or after long-term intake of dietary products rich in carotenoids. Supplementation with carotenoids contributes to basal protection of the skin but is not sufficent to obtain complete protection against severe UV irradiation.

New strategies of photoprotection

Adequate photoprotection is essential to control UV-related disorders, including sunburn, photoaging and photocarcinogenisis. Sun avoidance, protection of skin with clothing, and sunscreens are presently the best way of photoprotection, assuming that they are used properly. However, new strategies, which are based on or make use of the endogenous protective response to UV light, may further improve currently used photoprotective means. The addition of repair enzymes and/or antioxidants has a positive effect on skin's recovery from UV-induced DNA-damage. Several botanical agents, mainly vitamins and polyphenols, have shown to influence signal transduction pathways leading to photoprotective effects. Also stimulation of endogenous UV-response pathways via irradiation with a low UV dose or via simulation of UV-induced DNA-damage results in photoprotective effects. Future research in this field and combination of different photoprotective strategies will hopefully lead to improved photoprotection.

Influence of oral antioxidants on ultraviolet radiation-induced skin damage in humans

Ultraviolet radiation (UVR) causes a range of acute and chronic adverse cutaneous effects, in addition to some beneficial effects. In present times, the skin is generally exposed to higher levels of UVR, such that inherent defence mechanisms become overwhelmed. Complications, notably skin malignancies, show a serious rise in incidence. Since many effects of UVR are mediated through generation of reactive oxygen species, antioxidant supplementation provides a strategy to combat their excess generation, and hence reduce the clinical consequences. Human supplementation studies examining the potential of a range of oral agents to protect against UVR-induced skin effects show mixed results; further studies should examine whether certain subgroups of the population may show augmented benefit.

Oral Polypodium leucotomos extract decreases ultraviolet-induced damage of human skin

BACKGROUND

UV radiation induces damage to human skin. Protection of skin by an oral photoprotective agent would have substantial benefits. Objective We investigated the photoprotective effect of oral administration of an extract of the natural antioxidant Polypodium leucotomos (PL).

METHODS

A total of 9 healthy participants of skin types II to III were exposed to varying doses of artificial UV radiation without and after oral administration of PL (7.5 mg/kg). At 24 hours after exposure the erythema reaction was assessed and paired biopsy specimens were obtained from PL-treated and untreated skin.

RESULTS

A significant decrease in erythema was found in PL-treated skin (P < .01). Histologically, PL-treated biopsy specimens showed less sunburn cells (P < .05), cyclobutane pyrimidine dimers (P < .001), proliferating epidermal cells (P < .001), and dermal mast cell infiltration (P < .05). A trend toward Langerhans cell preservation was seen.

CONCLUSION

Oral administration of PL is an effective systemic chemophotoprotective agent leading to significant protection of skin against UV radiation.

Effects of oral vitamin E and beta-carotene supplementation on ultraviolet radiation-induced oxidative stress in human skin

BACKGROUND

Ultraviolet radiation (UVR) generates reactive oxygen species in skin that can play a role in skin damage, but reports about the photoprotective properties of oral antioxidant supplements are conflicting.

OBJECTIVE

We examined the ability of 2 lipid-soluble antioxidants, vitamin E and beta-carotene, to reduce markers of oxidative stress and erythema in human skin exposed to UVR.

DESIGN

Sixteen healthy subjects took either alpha-tocopherol (n = 8; 400 IU/d) or beta-carotene (n = 8; 15 mg/d) for 8 wk. Biopsy samples before and after supplementation were taken from unexposed skin and skin 6 h after 120 mJ/cm(2) UVR. The effects of supplements on markers of oxidative stress in skin and the minimal erythema dose to UVR were assessed.

RESULTS

Supplementary vitamin E was bioavailable, the plasma concentration increased from 14.0 +/- 0.66 (x +/- SEM) to 18.2 +/- 0.64 mug/mL (P < 0.01), and the skin concentration increased from 0.55 +/- 0.09 to 1.6 +/- 0.19 ng/mg protein (P < 0.01). Supplementary beta-carotene increased plasma concentrations from 1 +/- 0.3 to 2.25 +/- 0.3 mug/mL (P < 0.05), but skin concentrations were undetectable. Before vitamin E supplementation, UVR increased the skin malondialdehyde concentration from 0.42 +/- 0.07 to 1.24 +/- 0.16 nmol/mg protein (P < 0.01), whereas oxidized or total glutathione increased from 9.98 +/- 0.4% to 12.0 +/- 1.0% (P < 0.05). Vitamin E supplementation significantly decreased the skin malondialdehyde concentration, but neither vitamin E nor beta-carotene significantly influenced other measures of oxidation in basal or UVR-exposed skin.

CONCLUSIONS

Vitamin E or beta-carotene supplementation had no effect on skin sensitivity to UVR. Although vitamin E supplements significantly reduced the skin malondialdehyde concentration, neither supplement affected other measures of UVR-induced oxidative stress in human skin, which suggested no photoprotection of supplementation.

Nutritional protection against skin damage from sunlight

The concept of systemic photoprotection by dietary means is gaining momentum. Skin is continuously exposed to ultraviolet (UV) radiation, the major cause of skin disorders such as sunburn, photodamage, and nonmelanoma skin cancer. Most of the erythemal annual UV dose is encountered under nonvacation conditions, when no sunscreen is applied. In the absence of topically added compounds, skin protection depends solely on endogenous defense. Micronutrients can act as UV absorbers, as antioxidants, or can modulate signaling pathways elicited upon UV exposure. UV-induced erythema is a suitable parameter to assess photoprotection. Dietary protection is provided by carotenoids, tocopherols, ascorbate, flavonoids, or n-3 fatty acids, contributing to maintenance resistance as part of lifelong protection.

Determinants of skin sensitivity to solar irradiation

BACKGROUND

Acute effects of UV irradiation include UV-induced erythema. Sunlight plays an important role in the development of skin cancer. Several predictive factors of UV-induced erythema could also be predictive for skin cancer.

OBJECTIVE

Our objective was to quantitatively assess phenotypical and nutritional determinants of sensitivity to UV irradiation, as assessed by the minimal erythema dose (MED).

DESIGN

We conducted a cross-sectional study among 335 volunteers. Sensitivity to UV irradiation was established through assessment of the MED. Phenotypical determinants, including skin melanin content, hair color and iris color were determined by skin reflectance spectrometry, a subjective questionnaire and an objective classification system, respectively. Furthermore, dietary exposure was measured by carotenoids, vitamin C, retinol and alpha-tocopherol in serum.

RESULTS

Male subjects were found to be more sensitive to UV irradiation; that is, the MED was significantly lower compared to female subjects. Skin melanin content, which was positively associated with iris color in both sexes and with hair color in men, was the main phenotypical determinant of sensitivity to UV irradiation. No associations were found between serum carotenoids and MED in the total study group. Vitamin C was inversely associated with MED. However, associations between carotenoids concentrations and MED showed a positive trend in subjects with melanin values above and a negative trend in subjects below the median after adjustment for gender and total cholesterol.

CONCLUSIONS

Skin melanin content and gender are important determinants of sensitivity to UV irradiation. No relation was found between serum carotenoids and MED in the total study group. The inverse association between vitamin C and MED was against our hypothesis. For the modifying effect of melanin on the association between carotenoids and MED, we do not have a clear biological explanation.

Systemic photoprotection with alpha-tocopherol (vitamin E) and beta-carotene

Cutaneous photodamage is partly mediated via oxidative pathways and there is evidence to suggest that antioxidants within the skin may have a photoprotective effect. Antioxidant activity is provided by a number of naturally occurring substances including alpha-tocopherol (vitamin E) and beta-carotene, whose effects are mediated by their capacity to quench singlet oxygen, scavenge free radicals and prevent the formation of free radicals. Beta-carotene has been used as treatment for various photosensitivity disorders for more than 30 years. The main indication for its use is in the treatment of the photosensitivity associated with erythropoietic protoporphyria. A role for beta-carotene in the prevention of non-melanoma skin cancer has yet to be demonstrated despite clinical research activity in this area. The role for alpha-tocopherol as a photoprotective agent is less clear-cut and it has yet to be established as treatment either for conditions characterized by photosensitivity or as an agent for preventing chronic photodamage or cutaneous malignancy.

UV light, beta-carotene and human skin--beneficial and potentially harmful effects

Solar radiation is one of the most important environmental stress agents for human skin, causing sunburn, premature skin aging, and skin cancer. Beta-carotene is discussed to protect against photooxidative stress and thus prevent skin damage. Though beta-carotene has been successfully used against photosensitivity in patients with erythropoietic protoporphyria, its beneficial potential in normal skin is still uncertain. A number of experimental studies indicate protective effects of beta-carotene against acute and chronic manifestations of skin photodamage. However, most clinical studies have failed to convincingly demonstrate its beneficial effects so far. Nevertheless, intake of oral beta-carotene supplements before sun exposure has been recommended on a population-wide basis. Recent studies on skin cells in culture have revealed that beta-carotene acts not only as an antioxidant but also has unexpected prooxidant properties. At present, there is an ongoing debate on the protective or potentially harmful role of beta-carotene in human skin.

Nutritional skin care: health effects of micronutrients and fatty acids

Human skin is continuously exposed to internal and external influences that may alter its condition and functioning. As a consequence, the skin may undergo alterations leading to photoaging, inflammation, immune dysfunction, imbalanced epidermal homeostasis, or other skin disorders. Modern nutritional science is developing new insights into the relation between food intake and health, and effects of food ingredients may prove to be biologically relevant for optimal skin condition. The objective of this review was to evaluate the present knowledge about the interrelation of nutrients and skin, particularly the photoprotective effects of nutrients, the influences of nutrients on cutaneous immune responses, and therapeutic actions of nutrients in skin disorders. The nutrients of focus were vitamins, carotenoids, and polyunsaturated fatty acids. Supplementation with these nutrients was shown to provide protection against ultraviolet light, although the sun-protection factor was relatively small compared with that of topical sunscreens. An increase in delayed-type hypersensitivity skin responses after supplementation with nutrients has proven beneficial, especially in elderly people, and may boost cell-mediated immunity. Dietary consumption of certain plants or fish oil is known to modulate the balance of lipid inflammatory mediators and, therefore, is valuable in the treatment of inflammatory skin disorders. It was concluded that nutritional factors exert promising actions on the skin, but information on the effects of low-to-moderate doses of nutrients consumed long term by healthy individuals is obviously lacking, as are data on direct effects on basal skin properties, including hydration, sebum production, and elasticity.

Carotenoid supplementation reduces erythema in human skin after simulated solar radiation exposure

Excessive exposure to solar radiation, especially ultraviolet A (UVA: 320-400 nm) and ultraviolet B (UVB: 290-320 nm) radiation, may induce UV-carcinogenesis and erythema in the skin. Although the protective effects of carotenoids against skin lesions are still unclear, beta-carotene has been proposed as an oral sun protectant. The purpose of this study was to determine the magnitude of the protective effects of oral alpha- and beta-carotene supplementation for 24 weeks on UVA- and UVB-induced erythema in humans. While being exposed to UVA and UVB radiation, 22 subjects (11 men and 11 women) were supplemented with natural carotenoids for 24 weeks. Each day for the first 8 weeks, subjects were given 30 mg of natural carotenoids containing 29.4 mg of beta-carotene, 0.36 mg of alpha-carotene, and traces of other carotenoids in vegetable oil. The natural carotenoid dose was progressively raised by 30-mg increments, at every 8 weeks, from 30 mg to 90 mg. Small areas (1 cm2) of the skin were exposed to increasing doses of UV light (16-42 mJ/cm2) to determine the minimal erythema dose (MED). MED was defined as a uniform pink color with well-defined borders. MED readings were obtained by visual inspection 24 hr postirradiation. Blood samples taken during supplementation were used to determine alpha- and beta-carotene serum levels and for a lipid peroxidation analysis. During natural carotenoid supplementation, the MED of solar simulator radiation increased significantly (P<0.05). After 24 weeks of supplementation, serum beta-carotene levels were increased from 0.22 microg/ml (95% CI; 0.16-0.27) to 1.72 microg/ml (95% CI;1.61-1.83). Similarly, alpha-carotene serum levels increased from 0.07 microg/ml (95% CI;0.048-0.092) to 0.36 microg/ml (95% CI; 0.32-0.40). Serum lipid peroxidation was significantly (P<0.05) inhibited in a dose-dependent manner during natural carotenoid supplementation. The present data suggest that supplementation with natural carotenoids may partially protect human skin from UVA- and UVB-induced erythema, although the magnitude of the protective effect is modest.

Enhancement of the UVA induction of haem oxygenase-1 expression by beta-carotene in human skin fibroblasts

beta-Carotene has often been discussed as a means to reduce the risk of skin photodamage. We studied the antioxidative potential of beta-carotene in human skin fibroblasts exposed to ultraviolet A light. Surprisingly, we found a pro-oxidative effect of beta-carotene. Using the induction of haem oxygenase-1 as a marker for oxidative stress, we found a strong enhancement of gene expression by beta-carotene in ultraviolet A-irradiated cells. This effect was clearly suppressed by concomitant addition of vitamin E but only moderately by vitamin C. The results show that beta-carotene has pro-oxidative properties in human skin fibroblasts exposed to ultraviolet-A light.

Drug treatment of photoaged skin

Although the prevention of skin aging is a holy grail of the cosmetic and pharmaceutical industries, this venture may be misplaced. The predominant clinical and biochemical features of aged skin are mostly attributable to photoaging rather than chronology. For instance chronic sun exposure is the major determinant of age spots (actinic lentigines) and wrinkles. Surgical approaches to the treatment of photoaging include face-lift, dermabrasion, chemical peeling, collagen and botulinum toxin injections, and laser re-surfacing. These approaches all have benefit and improve the clinical features of facial photoaging. Drug or pharmaceutical prevention and treatment of photoaged skin is still in its infancy. The main pharmaceutical approach to prevention of photoaging lies in the assiduous use of sunscreens. Recent evidence points to the importance of ultraviolet A (UVA) radiation as well as ultraviolet B (UVB) radiation in the aetiology of photoaging and thus the need for sunscreens that block both UVB and UVA. Drug treatment of photoaged skin can be categorised as antioxidants, alpha-hydroxy acids and topical retinoids. Of these 3 approaches only topical retinoids, particularly tretinoin (all-trans retinoic acid), have a well documented ability to repair photoaged skin at the clinical, histological and molecular level. Furthermore, the use of topical retinoids may actually prevent photoaging. The current interest in pharmaceutical modulation of the photoaging process has attracted considerable research into the mechanisms of photoaging and cutaneous aging. It is likely that treatment for, or prevention of, the chronological aging process may result from such research.

Potentials and limitations of the natural antioxidants RRR-alpha-tocopherol, L-ascorbic acid and beta-carotene in cutaneous photoprotection

Sun exposure has been linked to several types of skin damage including sun burn, photoimmunosuppression, photoaging and photocarcinogenesis. In view of the increasing awareness of the potentially detrimental long term side effects of chronic solar irradiation there is a general need for safe and effective photoprotectants. One likely hypothesis for the genesis of skin pathologies due to solar radiation is the increased formation of reactive oxidants and impairment of the cutaneous antioxidant system. Consequently, oral antioxidants that scavenge reactive oxidants and modulate the cellular redox status may be useful; systemic photoprotection overcomes some of the problems associated with the topical use of sunscreens. Preclinical studies amply illustrate the photoprotective properties of supplemented antioxidants, particularly RRR-alpha-tocopherol, L-ascorbate and beta-carotene. However, clinical evidence that these antioxidants prevent, retard or slow down solar skin damage is not yet convincing. The purpose of this review is to provide the reader with current information on cutaneous pathophysiology of photoxidative stress, to review the literature on antioxidant photoprotection and to discuss the caveats of the photo-oxidative stress hypothesis.

Uses of vitamins A, C, and E and related compounds in dermatology: a review

Vitamins have been increasingly used as prophylactic and therapeutic agents in the management of skin disorders. The current literature is replete with studies that promote the potential benefits of these compounds and attempt to elucidate their mechanisms of action. We review the literature and discuss the roles, safety, and efficacy of vitamins A, C, and E and related compounds in cutaneous health and disease.

The use of endogenous antioxidants to improve photoprotection

The skin possesses an elaborate antioxidant defence system to deal with UV-induced oxidative stress. However, excessive exposure to UV can overwhelm the cutaneous antioxidant capacity, leading to oxidative damage and ultimately to skin cancer, immunosuppression and premature skin aging. Therefore, an interesting strategy for photoprotection is the support of the endogenous antioxidant system. This can be accomplished by induction or transdermal delivery of the various antioxidant enzymes, such as glutathione peroxidase, catalase, or superoxide dismutase. Supplementation of non-enzymatic antioxidants such as glutathione, alpha-tocopherol, ascorbate and beta-carotene was also found to be very effective in photoprotection. Although treatments with single components of the antioxidant system were successful against a wide variety of photodamage, the balance between the different antioxidants in the skin is very important. In some studies, it was found that too much of a single component could even have deleterious effects. The most promising results were obtained in studies combining several compounds, often resulting in synergism of the protective effects.

Comparative studies on the tolerance to photoinduced cutaneous inflammatory reactions by psoralen and rose bengal

The photochemotherapeutic value of topical 8-methoxypsoralen (8-MOP) plus UVA irradiation has been well recognized. The phototoxicity associated with psoralen plus UVA (PUVA) therapy is hallmarked by an increase in vascular permeability (iVP), the accumulation of polymorphonuclear leukocytes (aPMN) and erythema formation in situ. Rose bengal (RB) plus UVA-VIS light (320-700 nm) produces a similar acute inflammatory response, but without immediate or delayed erythema and perceptible edema. This study describes some of the parameters involved in inflammatory reactions evoked by PUVA and the results are compared with RB-induced phototoxic reactions. The rates of iVP and aPMN with a 3 h pulse were quantified using 125I-albumin and 51Cr-labelled PMNs respectively. The erythemal response was graded visually. 8-MOP cream was applied topically, while RB was injected intradermally in rabbit skin before UVA-VIS (9.4 J cm-2) irradiation. The data show that there is no significant difference in the rates of iVP, aPMN and erythema formation between normal skin sites and mast cell-depleted skin sites when challenged with 8-MOP plus light. These results suggest that in situ mast cells do not play a significant role in 8-MOP-photoinduced acute cutaneous inflammatory reactions, in contrast with RB-photoinduced reactions. The iVP and aPMN responses are minimal or absent in sites subjected to repeated exposure to 8-MOP plus light for three or more consecutive days, suggesting the establishment of a desensitized/unresponsive state. Moreover, 8-MOP-photo-desensitized sites do not produce iVP and aPMN of the same magnitude as the normal (naive) skin sites when challenged with RB plus light. Similarly, RB-photo-desensitized sites do not produce iVP and aPMN of the same magnitude as the native skin sites when challenged with 8-MOP plus light. The desensitization and cross-desensitization of skin sites to 8-MOP- or RB-photoinduced reactions suggest that there is either direct attack on the target cell(s), thereby removing the ability to express adhesion molecules, such as endothelial leukocyte adhesion molecule 1 (ELAM-1) or intercellular adhesion molecule 1 (ICAM-1), involved in the accumulation of inflammatory cells, or downregulation of the secretion/release of putative agent(s), such as interleukin 1 (IL-1) and tumor necrosis factor alpha (TNF-alpha), responsible for the initiation and progression of cutaneous inflammations.

Effect of beta-carotene supplementation on the human sunburn reaction

Beta-carotene, a quencher of excited species such as singlet oxygen and free radicals, has been reported to protect against cutaneous photodamage, including sunburn acutely and photocarcinogenesis chronically. The present double blind placebo-controlled study examines the effect of beta-carotene supplementation on the human sunburn response and specifically on the induction of sunburn cells at the time of peak reaction intensity (24 h) after a single solar simulated light exposure 3 times the individually determined minimal erythema dose (MED). Administered orally either as a single 120 mg dose to dietarily restricted subjects or for 23 d as a daily 90 mg supplement to subjects on standard diets, beta-carotene increased plasma and skin levels of beta-carotene compared to both pretreatment levels and placebo-treated controls, but provided no clinically or histologically detectable protection against a 3 MED sunburn reaction. Thus, these data suggest that oral beta-carotene supplementation is unlikely to modify the severity of cutaneous photodamage in normal individuals to a clinically meaningful degree.

Protection by beta-carotene and related compounds against oxygen-mediated cytotoxicity and genotoxicity: implications for carcinogenesis and anticarcinogenesis

beta-Carotene protects against photooxidative dermatitis in porphyric humans and mice by quenching of photoactivated species. Other actions of beta-carotene in vivo are explained on the basis of its ability to scavenge free radicals in vitro. For example, in guinea pigs treated with CCl4, beta-carotene decreases pentane and ethane production. Epidemiological studies link low serum beta-carotene levels to elevated risk of lung and other cancers, and in intervention trials, beta-carotene diminishes preneoplastic lesions. However, the dose/response relationships are not well established, and antineoplastic mechanisms await clarification. Given a radical quenching mechanism, beta-carotene should block tumor promotion, but more typically the site of action is progression and an even later role in invasion has not been ruled out. Some antineoplastic actions of carotenoids (such as increased rejection of fibrosarcomas in mice) are attributed to immunoenhancement; others may reflect conversion to retinoids and subsequent gene regulation. Carotenoids other than beta-carotene may act at an earlier stage of carcinogenesis or be more effective as anticarcinogens at certain target sites. As scavengers of hydroxyl radicals, canthaxanthin and astaxanthin are more effective than beta-carotene. Canthaxanthin is sometimes more effective than beta-carotene in chemoprevention, but it is sometimes completely ineffective. Lycopene quenches singlet oxygen more than twice as effectively as beta-carotene. However, the antineoplastic actions of lycopene or astaxanthin remain untested. Explorations of the interactions of carotenoids with other nutrients are just beginning. Dietary fat increases absorption of carotene but decreases antineoplastic effectiveness. Research is hampered by technical problems, including the unavailability of rigorous controls, the instability of carotenoids, and the heterogeneous phase structure induced by hydrophobic compounds in aqueous media. Areas of current controversy and promising approaches for future research are identified.

Photoinduced cutaneous inflammatory response by psoralens

Our studies describe the inflammatory response in rabbit skin induced by topical application of 8-methoxypsoralen (8-MOP) and UVA-visible irradiation (320-700 nm). Increase in vascular permeability (iVP) and accumulation of polymorphonuclear leucocytes (aPMN) at the test sites were quantitated using 125I-albumin and 51Cr-labelled PMNs respectively. Erythema was graded visually. 8-MOP cream was applied topically and irradiated. The erythemal response, aPMN and iVP at the test sites were quantitated at 6, 24, 48 and 72 h post-irradiation. The iVP and aPMN were maximal at 24 h; the erythemal response was the same at 24-48 h. The responses were dependent on 8-MOP concentration and irradiation dose. Topical application of 200 micrograms 8-MOP cream followed by irradiation for 2 h (9.4 J cm-2) produced 3-7 times iVP, 2-4 times aPMN and intense erythema at the test sites after 24 h. Neither aPMN nor iVP was detected before 6 h and erythemal response was not observable up to 16 h after irradiation. The aPMN and iVP gradually subsided in 72 h, although the erythemal response was still present. The repeated exposure of 8-MOP-treated sites for three consecutive days 24 h apart did not produce appreciable iVP or aPMN at 72 h or 24 h after the last exposure; however, erythema persisted. The 8-MOP-treated sites previously exposed for three consecutive days on reapplication of 8-MOP cream plus irradiation showed significantly less response compared with non-pretreated sites. Our results suggest that the erythemal response is not directly related to either iVP or aPMN.

Free radicals as carcinogens and their quenchers as anticarcinogens

An oxygen dependent signal was detected, late in the 1950s by electron spin resonance (ESR) in a saline solution of hematoporphyrin (Hp) excited by light. This signal expressed a free radical consisting of 'some kind of an association between Hp and oxygen', that Smaller et al. called 'oxyradical' (HpOO.). It soon opened a new level of understanding in carcinogenesis triggered by photodynamic substances, including Hp itself, polycyclic hydrocarbons (PCHs), as well as any carcinogen involving molecular species activated by radiation and/or metabolic reaction. Early in the 1960s, this prompted the discovery of benzo(a)pyrene (BP) photocarcinogenic enhancement (BP-PCE) in mice, probably due to an increase in free oxygen radical generation following correct light exposure. This assumption was confirmed in 1980 by the fact that mice orally loaded with antioxidants and radical quenchers, such as beta-carotene (BC) and cantaxanthin (CX), were protected against BP-PCE at 100% and against total BP carcinogenicity at more than 60%. These achievements were presented as the bases of the current explosion of interest in biology and medicine in building up the new field of chemoprevention against cancer and other chronic diseases by supplementation with antioxidant vitamins, retinoids and especially carotenoids and their synergistic association. The relevant findings of this research obtained in the last decade in in vitro and in vivo experiments as well as human interventions are reported and discussed with personal contributions.

Mechanisms of photodynamic effects of furocoumarins

The photosensitizing action of furocoumarins on biological systems occurs by both an oxygen-independent pathway, which involves the photoaddition of the sensitizer to nucleic acids, proteins and lipids, and an oxygen-dependent pathway, which includes furocoumarins in the category of photodynamic sensitizers. The photodynamic action of furocoumarins, as studied using isolated biomolecules, human erythrocytes and human skin, appears to involve both activated oxygen species (singlet oxygen, superoxide anion, and hydroxyl radicals) and radical species formed by electron transfer from or to photoexcited furocoumarins. Another oxygen-dependent process involves the formation of photo-oxidized furocoumarin derivatives, which can react in the dark with several substrates (in particular, membrane components), causing an irreversible damage of cells. The latter type of process is temperature dependent. The relative importance of the different photosensitization mechanisms under various experimental conditions is discussed.

Physiological changes in ageing skin

The principal functions of the skin include protection, excretion, secretion, absorption, thermoregulation, pigmentogenesis, accumulation, sensory perception and regulation of immunological processes. These functions are all affected by the structural changes in the skin with ageing and, after middle age, most functions are reduced, some by as much as 50-60%. The physiological changes associated with these reductions include impairment of the barrier function, decreased turnover of epidermal cells, reduced numbers of keratinocytes and fibroblasts, and a reduced vascular network particularly around hair bulbs and glands. These changes result in fibrosis and atrophy, and decreases in hair and nail growth, vitamin D synthesis and the density of Langerhans cells. Production of epidermal thymocyte-activating factor, which enhances the T-cell response, is reduced leading to a decrease in the immune response; there is also a decreased functioning of Meissner's and Pacinian corpuscles. An increased generation of free radicals is observed. Certain environmental factors, particularly exposure to sun, accelerate the ageing of skin and are important in cutaneous carcinogenesis.