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Kahremany S, Hofmann L, Gruzman A, Dinkova-Kostova AT, Cohen G. NRF2 in dermatological disorders: Pharmacological activation for protection against cutaneous photodamage and photodermatosis. Free Radic Biol Med 2022; 188:262-276. [PMID: 35753587 PMCID: PMC9350913 DOI: 10.1016/j.freeradbiomed.2022.06.238] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 01/27/2023]
Abstract
The skin barrier and its endogenous protective mechanisms cope daily with exogenous stressors, of which ultraviolet radiation (UVR) poses an imminent danger. Although the skin is able to reduce the potential damage, there is a need for comprehensive strategies for protection. This is particularly important when developing pharmacological approaches to protect against photocarcinogenesis. Activation of NRF2 has the potential to provide comprehensive and long-lasting protection due to the upregulation of numerous cytoprotective downstream effector proteins that can counteract the damaging effects of UVR. This is also applicable to photodermatosis conditions that exacerbate the damage caused by UVR. This review describes the alterations caused by UVR in normal skin and photosensitive disorders, and provides evidence to support the development of NRF2 activators as pharmacological treatments. Key natural and synthetic activators with photoprotective properties are summarized. Lastly, the gap in knowledge in research associated with photodermatosis conditions is highlighted.
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Affiliation(s)
- Shirin Kahremany
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, Ramat-Gan, 5290002, Israel; The Skin Research Institute, The Dead Sea and Arava Science Center, Masada, 86910, Israel
| | - Lukas Hofmann
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, Ramat-Gan, 5290002, Israel
| | - Arie Gruzman
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, Ramat-Gan, 5290002, Israel
| | - Albena T Dinkova-Kostova
- Jacqui Wood Cancer Centre, Division of Cellular Medicine, School of Medicine, University of Dundee, Dundee, UK; Department of Pharmacology and Molecular Sciences and Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Guy Cohen
- The Skin Research Institute, The Dead Sea and Arava Science Center, Masada, 86910, Israel; Ben-Gurion University of the Negev, Eilat Campus, Eilat, 8855630, Israel.
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Mesquita KDC, Igreja ACDSM, Costa IMC. Ultraviolet index: a light in atopic dermatitis and vitamin D research? An Bras Dermatol 2016; 91:34-9. [PMID: 26982776 PMCID: PMC4782644 DOI: 10.1590/abd1806-4841.20164337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 03/15/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The role played by vitamin D in atopic dermatitis is controversial and has been the focus of many studies. The ultraviolet index has not been considered in this type of research. OBJECTIVES The objectives of the study were to assess 25-hydroxy vitamin D [25(OH)D] serum level in atopic dermatitis patients and control group, to investigate the association between atopic dermatitis clinical severity (using the SCORing Atopic Dermatitis index - SCORAD) and 25(OH)D serum levels, and to evaluate the independent predictors, including Ultraviolet index, SCORAD and 25(OH)D. METHODS We conducted a cross-sectional study of 106 atopic dermatitis patients. A control group was matched with a subsample of 54 participants with atopic dermatitis. SCORAD index, laboratory tests, and local Ultraviolet index were assessed. RESULTS The atopic dermatitis patients had serum 25(OH)D levels and mean UVI significantly higher than the control group. Immunoglobulin E and Ultraviolet index were associated with the SCORAD index. Skin type, age and Ultraviolet index were independent predictors of 25(OH)D. CONCLUSIONS Although statistically significant, the different levels of 25(OH)D between the paired groups may be attributed to the higher mean Ultraviolet index in atopic dermatitis patients. Since Ultraviolet index is an independent predictor of SCORAD index and of 25(OH)D level, it may work as a confounding factor in studies involving atopic dermatitis and 25(OH)D and must be considered in this kind of research.
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Kudish A, Marsakova A, Jahn I, Gkalpakiotis S, Arenberger P, Harari M. Dead Sea ultraviolet climatotherapy for children with atopic dermatitis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 32:254-261. [DOI: 10.1111/phpp.12250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Avraham Kudish
- Blaustein Institutes for Desert Research; Ben-Gurion University of the Negev; Beer Sheva Israel
- Arava & Dead Sea Science Center; Neve Zohar Israel
| | - Anna Marsakova
- Department of Dermatovenereology; Third Faculty of Medicine; Charles University; Prague Czech Republic
| | - Irmgard Jahn
- DMZ Medical Center; Lot Spa Hotel, Dead Sea; Ein Bokek Israel
| | - Spyridon Gkalpakiotis
- Department of Dermatovenereology; Third Faculty of Medicine; Charles University; Prague Czech Republic
| | - Peter Arenberger
- Department of Dermatovenereology; Third Faculty of Medicine; Charles University; Prague Czech Republic
| | - Marco Harari
- Arava & Dead Sea Science Center; Neve Zohar Israel
- DMZ Medical Center; Lot Spa Hotel, Dead Sea; Ein Bokek Israel
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Potential role of reduced environmental UV exposure as a driver of the current epidemic of atopic dermatitis. J Allergy Clin Immunol 2015; 136:1163-9. [DOI: 10.1016/j.jaci.2015.06.042] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/04/2015] [Accepted: 06/12/2015] [Indexed: 11/23/2022]
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Engebretsen K, Johansen J, Kezic S, Linneberg A, Thyssen J. The effect of environmental humidity and temperature on skin barrier function and dermatitis. J Eur Acad Dermatol Venereol 2015; 30:223-49. [DOI: 10.1111/jdv.13301] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/01/2015] [Indexed: 01/06/2023]
Affiliation(s)
- K.A. Engebretsen
- National Allergy Research Centre; Department of Dermato-Allergology; Gentofte University Hospital; University of Copenhagen; Hellerup Denmark
| | - J.D. Johansen
- National Allergy Research Centre; Department of Dermato-Allergology; Gentofte University Hospital; University of Copenhagen; Hellerup Denmark
| | - S. Kezic
- Coronel Institute of Occupational Health; Academic Medical Centre; 1105 AZ Amsterdam The Netherlands
| | - A. Linneberg
- Research Centre for Prevention and Health; Glostrup The Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Experimental Research; Glostrup University Hospital; Glostrup Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - J.P. Thyssen
- National Allergy Research Centre; Department of Dermato-Allergology; Gentofte University Hospital; University of Copenhagen; Hellerup Denmark
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Permatasari F, Zhou B, Luo D. Epidermal barrier: Adverse and beneficial changes induced by ultraviolet B irradiation depending on the exposure dose and time (Review). Exp Ther Med 2013; 6:287-292. [PMID: 24137176 PMCID: PMC3786920 DOI: 10.3892/etm.2013.1175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/17/2013] [Indexed: 01/06/2023] Open
Abstract
Exposure of the skin to ultraviolet (UV) radiation induces various harmful effects in the tissues, particularly disruption of the epidermal barrier. However, ultraviolet B (UVB) irradiation has been applied in the treatment of atopic dermatitis, a skin disease in which the epidermal barrier is defective. We reviewed the homeostasis of the epidermal barrier and several studies investigating the adverse and beneficial effects caused by different doses of UVB irradiation in the epidermal barrier. It may be concluded that, despite the harmful effects of UVB irradiation on the skin, UVB irradiation is able to exert beneficial effects in the epidermal barrier when administered in suberythemal doses and over a relatively short period of time, with no clinically evident inflammation or barrier disruption. This may be a useful therapeutic strategy for the use of UVB irradiation in the treatment of skin diseases with a disrupted epidermal barrier, such as atopic dermatitis, while reducing or avoiding the side-effects.
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Affiliation(s)
- Felicia Permatasari
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Joo HM, Nam SY, Yang KH, Kim CS, Jin YW, Kim JY. The effects of low-dose ionizing radiation in the activated rat basophilic leukemia (RBL-2H3) mast cells. J Biol Chem 2012; 287:27789-95. [PMID: 22700973 DOI: 10.1074/jbc.m112.378497] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mast cells play important roles in many biological responses, such as those during allergic diseases and inflammatory disorders. Although laser and UV irradiation have immunosuppressive effects on inflammatory diseases by suppressing mast cells, little is known about the effects of γ-ionizing radiation on mast cells. In this study, we investigated the effects of γ-ionizing radiation on RBL-2H3 cells, a convenient model system for studying regulated secretion by mast cells. Low-dose radiation (<0.1 gray (Gy)) did not induce cell death, but high-dose radiation (>0.5 Gy) induced apoptosis. Low-dose ionizing radiation significantly suppressed the release of mediators (histamine, β-hexosaminidase, IL-4, and tumor necrosis factor-α) from immunoglobulin E (IgE)-sensitized RBL-2H3 cells. To determine the mechanism of mediator release inhibition by ionizing radiation, we examined the activation of intracellular signaling molecules such as Lyn, Syk, phospholipase Cγ, PKCs, and MAPK, and intracellular free calcium concentrations ([Ca(2+)](i)). The phosphorylation of signaling molecules following stimulation of high-affinity IgE receptor I (FcεRI) was specifically inhibited by low-dose ionizing radiation (0.01 Gy). These results were due to the suppression of FcεRI expression by the low-dose ionizing radiation. Therefore, low-dose ionizing radiation (0.01 Gy) may function as a novel inhibitor of mast cell activation.
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Affiliation(s)
- Hae Mi Joo
- Radiation Effect Research Team, Radiation Health Research Institute, Korea Hydro and Nuclear Power Co., Ltd., Seoul 132-703, Korea
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Biopositive effects of low-dose UVB on epidermis: coordinate upregulation of antimicrobial peptides and permeability barrier reinforcement. J Invest Dermatol 2008; 128:2880-7. [PMID: 18580964 DOI: 10.1038/jid.2008.169] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Whereas high-dose ultraviolet B (UVB) is detrimental to the epidermal permeability barrier, suberythemal doses of UVB are used to treat atopic dermatitis (AD), which is characterized by defective permeability barrier and antimicrobial function. As epidermal permeability barrier and antimicrobial peptide (AMP) expression are coregulated and interdependent functions, we hypothesized that suberythemal doses of UVB exposure could regulate AMP expression in parallel with permeability barrier function. Hairless mice were exposed to 40 mJ cm(-2) UVB (about 1/2 minimal erythema dose) daily for 1 or 3 days. Twenty-four hours after the last exposure, epidermal barrier function was assessed and skin specimens were taken for western blotting, immunohistochemistry, and quantitative reverse transcription-PCR for mouse beta-defensin (mBD)-2, mBD3 and cathelin-related antimicrobial peptide (CRAMP). mRNA levels of the vitamin D receptor (VDR), 1alpha-hydroxylase and key epidermal lipid synthetic enzymes were also quantified. After 3 days of UVB exposure, acceleration of barrier recovery and augmentation in expression of epidermal differentiation markers (for example, involucrin and filaggrin) occurred in parallel with increased mBD2, mBD3, and CRAMP expression at both the mRNA and protein level. VDR, 1alpha-hydroxylase, and the major epidermal lipid synthetic enzymes were also upregulated. When an inhibitor of 1alpha, 25 dihydroxyvitamin D(3) formation, ketoconazole, was applied immediately after UVB exposure, the cutaneous vitamin D system was inhibited, which in turn blocked epidermal lipid synthesis, AMP expression, and permeability barrier homeostasis, suggesting that the beneficial effect of low-dose UVB depends, at least in part, on activation of the cutaneous vitamin D system. Our results provide new insights into the mechanisms whereby low-dose UVB comprises effective therapy for AD.
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Selvaag E, Caspersen L, Bech-Thomsen N, Wulf HC. Optimized UVB Treatment of Atopic Dermatitis Using Skin Reflectance Measurements. A Controlled, Left–Right Comparison Trial. Acta Derm Venereol 2005; 85:144-6. [PMID: 15823909 DOI: 10.1080/00015550410024085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In a randomized, open, left-right comparison study, 20 patients with atopic dermatitis were treated with UVB. One side of the body received UVB in a conventional regimen with fixed dosage increments, the other side was given UVB dosages according to skin reflectance measurements of skin pigmentation and erythema. Clinical outcome was assessed by SCORAD. The initial, final and cumulative UVB dosages, time to 50% reduction in SCORAD, and side effects were compared. The initial UVB dosage was somewhat higher in the skin reflectance-guided treatment than in the conventional UVB regimen, although not significantly. There was no difference in the reduction of SCORAD comparing the two treatment options; however, the final UVB dosage and the cumulative UVB dosages were significantly lower in the optimized regimen. This new technique offers the same therapeutic advantage and security as a dose regimen guided by minimal erythema dose testing. However, measurement of skin pigmentation by skin reflectance is a rapid method, which can easily be operated by nurses.
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Affiliation(s)
- Edgar Selvaag
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen, Denmark
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Ibbotson SH, Bilsland D, Cox NH, Dawe RS, Diffey B, Edwards C, Farr PM, Ferguson J, Hart G, Hawk J, Lloyd J, Martin C, Moseley H, McKenna K, Rhodes LE, Taylor DK. An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop Report. Br J Dermatol 2004; 151:283-97. [PMID: 15327535 DOI: 10.1111/j.1365-2133.2004.06128.x] [Citation(s) in RCA: 199] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Summary These guidelines for use of narrowband (TL-01) ultraviolet B have been prepared for dermatologists by the British Photodermatology Group on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment of patients with a variety of dermatoses and photodermatoses, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of background photobiology.
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Affiliation(s)
- S H Ibbotson
- Pathobiology Unit, Ninewells Hospital and Medical School, Dundee, UK.
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Hsu MML, Yang CC. Uraemic pruritus responsive to broadband ultraviolet (UV) B therapy does not readily respond to narrowband UVB therapy. Br J Dermatol 2003; 149:888-9. [PMID: 14616389 DOI: 10.1046/j.1365-2133.2003.05590.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- Noah S Scheinfeld
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York 10025, USA.
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Abstract
UNLABELLED Atopic dermatitis (AD) is today the most common, chronic inflammatory skin disease among children in developed countries. Its cumulative prevalence varies from 20% in northern Europe and the USA to approximately 5% in Mediterranean countries. As a chronic disease it puts a special demand on treatment. There is no curative therapy, but competent guidance on treatment principles can control the disease in most, if not all children. This article summarizes the evidence-based knowledge that relates to the treatment of atopic eczema. It also gives advice and opinions on prophylactic measures as these are the focus of interest from most parents. LEARNING OBJECTIVE This article should enable you to give advice and guidance to parents of children with AD, including what is necessary for diagnosis, what is of value and importance considering allergies and allergological investigations, allergen exposure, prophylactic measures, diets and indoor environment. Finally, you should be able to explain the diversity of treatment principles for parents.
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Affiliation(s)
- K Thestrup-Pedersen
- Department of Dermatology, University of Aarhus, Marselisborg Hospital, Denmark.
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Selvaag E, Caspersen L, Bech-Thomsen N, de Fine Olivarius F, Wulf HC. Optimized UVB treatment of psoriasis: a controlled, left-right comparison trial. J Eur Acad Dermatol Venereol 2000; 14:19-21. [PMID: 10877248 DOI: 10.1046/j.1468-3083.2000.00012.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a randomized, controlled, left-right comparison study, 20 patients with chronic plaque psoriasis were treated with UVB. One side of the body received UVB in a conventional regimen with fixed dose increments, the other side was given UVB doses according to measurements of skin pigmentation. Skin pigmentation was quantified by the skin reflectance technique. The relationship between skin pigmentation and sensitivity to UV radiation was used to optimize and individualize the initial UVB exposure dose. Clinical outcome, initial, final and cumulative UVB doses, time to 50% reduction in PASI score, and side-effects were compared. The consequence of the optimization of the UVB doses with a skin reflectance meter was that the initial UVB dose was significantly higher than in the conventional UVB regimen. PASI scoring demonstrated a more rapid improvement during the first 2 weeks of treatment on the half body receiving the optimized treatment compared to the other side (P < 0.05). This new technique offers the same therapeutical advantages and security as a dose regimen guided by minimal erythema dose testing. However, measurement of skin pigmentation by skin reflectance is a quick method which can be operated easily by nurses.
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Affiliation(s)
- E Selvaag
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Denmark
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