Analysis of compact fluorescent lights for use by patients with photosensitive conditions

Cutaneous Manifestations of "Lupus": Systemic Lupus Erythematosus and Beyond

Lupus, Latin for "wolf," is a term used to describe many dermatologic conditions, some of which are related to underlying systemic lupus erythematosus, while others are distinct disease processes. Cutaneous lupus erythematosus includes a wide array of visible skin manifestations and can progress to systemic lupus erythematosus in some cases. Cutaneous lupus can be subdivided into three main categories: acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus. Physical exam, laboratory studies, and histopathology enable differentiation of cutaneous lupus subtypes. This differentiation is paramount as the subtype of cutaneous lupus informs upon treatment, disease monitoring, and prognostication. This review outlines the different cutaneous manifestations of lupus erythematosus and provides an update on both topical and systemic treatment options for these patients. Other conditions that utilize the term "lupus" but are not cutaneous lupus erythematosus are also discussed.

Protective effect of curcumin on fertility of rats after exposure to compact fluorescent lamps: An experimental study

BACKGROUND

Testicular function is modified by maturational gonadostatic control highly susceptible to negative physiologic niche-altering factors like UV-rays.

OBJECTIVE

This study was performed in order to uncover new aspects of Compact Florescent Lamps (CFLs) induced damages on the testicular tissue of rats and evaluating the effect of curcumin on testis of rats after exposure to compact florescent Lamps.

MATERIALS AND METHODS

Twenty-four adult male Albino rats were randomly divided into three groups: control group (ethyl oleate 0.2 ml, IP, for 45 days, without CFLs exposure), fluorescent group (ethyl oleate 0.2 ml, IP, daily and treated with 12 hr CFLs exposure for 45 days) and curcumin group (curcumin 20 µ M, IP along with 12 hr CFLs exposure for 45 days). The rats were anesthetized at the end of the experiment. Gonadotropin hormones and prolactin levels were measured; Histopathological and histomorphometrical analysis of the testis was carried out.

RESULTS

Results of this study showed that CFLs significantly decreased serum levels of follicle stimulating hormone, prolactin, testicular weight, sperm motility, TDI, and SPI. Furthermore, CFLs had no effect on serum levels of luteinizing hormone and sperm count and also, increased abnormal sperm shapes. Our results also showed that curcumin supplementation following CFLs reversed these alterations.

CONCLUSION

These results strongly suggest that CFLs severely impairs testis while curcumin as an antioxidant had protective effects on undesirable effects in testis induced by CFLs.

Comparative Analysis of Lighting Characteristics and Ultraviolet Emissions from Commercial Compact Fluorescent and Incandescent Lamps

BACKGROUND

Some characteristics of lighting sources such as color properties and ultraviolet emissions have important roles on visual and non-visual health effects of lighting. This study aimed to investigate the light emissions of some compact fluorescent lamps (CFLs) and incandescent lamps commercially available to the Iranian consumers.

METHODS

Sixty lamps included 48 single envelope CFLs, and 12 incandescent lamps available in the electrical devices markets (in the west of Iran) were randomly selected from famous manufacturers between 2014 and 2015. Lighting characteristics and ultraviolet (UV) emissions were measured using spectroradiometer and calibrated radiometer, respectively. Data analysis was performed using SPSS16 software.

RESULTS

Color-rendering indexes of the studied lamps were above 80, which showed good color properties. The daylight CFLs had more desirable and natural color temperature (near to 5000 0k) compared with the other types of the studied lamps. Occupational exposures for periods up 8 h to UVB from the studied lamps at distances up to 0.25 m were more than the recommended limits. Moreover, public exposures for periods up 16 h to UVB from the studied lamps at any distances up to 2 m were more than the recommended limits.

CONCLUSIONS

Warm white lamps are suitable for homes usage, while daylight lamps can be used for offices rooms. Occupational exposure to single envelope CFLs near the body at distances of less than 25 cm can result in overexposure to actinic UV. Moreover, CFLs must be used at distances greater than 200 cm for public exposure.

Cutaneous Lupus Erythematosus: An Update on Pathogenesis, Diagnosis and Treatment

Cutaneous lupus erythematosus (CLE) includes a broad range of dermatologic manifestations, which may or may not be associated with systemic disease. Recent studies in this area continue to shape our understanding of this disease and treatment options. Epidemiologic studies have found an incidence of CLE of 4.30 per 100,000, which approaches similar analysis for systemic lupus erythematosus (SLE). Although there have been extensive efforts to define SLE, the classification of CLE and its subgroups remains a challenge. Currently, diagnosis relies on clinical and laboratory findings as well as skin histology. The Cutaneous Lupus Area and Severity Index™ (CLASI™) is a validated measure of disease activity and damage. CLE pathogenesis is multifactorial and includes genetic contributions as well as effects of ultraviolet (UV) light. Immune dysregulation and aberrant cell signaling pathways through cytokine cascades are also implicated. Patient education and avoidance of triggers are key to disease prevention. Antimalarials and topical steroids continue to be the standard of care; however, immunosuppressants, thalidomide analogs and monoclonal antibodies are possible systemic therapies for the treatment of recalcitrant disease.

The Photobiology of Lutein and Zeaxanthin in the Eye

Lutein and zeaxanthin are antioxidants found in the human retina and macula. Recent clinical trials have determined that age- and diet-related loss of lutein and zeaxanthin enhances phototoxic damage to the human eye and that supplementation of these carotenoids has a protective effect against photoinduced damage to the lens and the retina. Two of the major mechanisms of protection offered by lutein and zeaxanthin against age-related blue light damage are the quenching of singlet oxygen and other reactive oxygen species and the absorption of blue light. Determining the specific reactive intermediate(s) produced by a particular phototoxic ocular chromophore not only defines the mechanism of toxicity but can also later be used as a tool to prevent damage.

Lupus erythematosus revisited

Lupus erythematosus (LE) is a multifactorial autoimmune disease with clinical manifestations of differing severity. The exact pathomechanisms and interactions resulting in the inflammatory and immunological processes of this heterogeneous disease remain elusive. Approaches in the understanding of the pathomechanisms revealed that the clinical expression of LE is predisposed by susceptibility genes and that various environmental factors are responsible for an abnormal immune response. Several studies demonstrated that ultraviolet (UV) light is one of the major factors in the pathogenesis of the disease. Standardized photoprovocation in patients with LE has been shown to be a safe and efficient model for evaluating the underlying pathomechanisms which lead to the production of autoantibodies and immune complexes. In particular, interferons were defined as important players in the early activation of the immune system and were observed to play a specific role in the immunological interface between the innate and the adaptive immune system. Abnormalities or disturbances in the different processes of cell death, such as apoptosis or necrosis, have also been recognized as crucial in the pathogenesis of LE. Although each process is different and characterized by unique features, the processes are interrelated and result in a complex disease.

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.

Photosensitivity, apoptosis, and cytokines in the pathogenesis of lupus erythematosus: a critical review

The underlying pathomechanisms of lupus erythematosus (LE), a multifactorial autoimmune disease, remain elusive. Due to the clinical evidence demonstrating a clear relationship between ultraviolet (UV) light exposure and skin lesions of LE, photosensitivity has been proven to be an important factor in the pathogenesis of the disease. Standardised photoprovocation with UVA and UVB irradiation has been shown to be a reliable model for evaluating photosensitivity in patients with cutaneous LE (CLE) and analysing the underlying medical conditions of the disease. In this respect, UV irradiation can cause aberrant induction of apoptosis in keratinocytes and contribute to the appearance of excessive apoptotic cells in the skin of CLE patients. Moreover, apoptotic cells that cannot be cleared by phagocytes may undergo secondary necrosis and release proinflammatory compounds and potential autoantigens, which may contribute to the inflammatory micromilieu that leads to formation of skin lesions in the disease. In addition to UV-mediated induction of apoptosis, the molecular and cellular factors that may cause the abnormal long-lasting photoreactivity in CLE include mediators of inflammation, such as cytokines and chemokines. In particular, interferons (IFNs) are important players in the early activation of the immune system and have a specific role in the immunological interface between the innate and the adaptive immune system. The fact that treatment with recombinant type I IFNs (α and β) can induce not only systemic organ manifestations but also LE-like skin lesions provides additional evidence for a pathogenetic role of these IFNs in the disease.

Compact fluorescent lamps and risk of skin cancer

BACKGROUND

Previously considered safe for typical use, concerns have recently been expressed regarding the potential effect of compact fluorescent lamps (CFLs) on human skin and, in particular, on skin cancer risk.

OBJECTIVE

We sought to address this concern by reviewing the current literature on CFLs, ultraviolet (UV) radiation, and photocarcinogenic exposure.

RESULTS

On average, the UV radiation from CFLs and subsequent carcinogenic exposure is lower than that from incandescent bulbs. However, defective bulbs can emit higher levels of UV radiation, which may cause significant damage.

CONCLUSION

Our review calls for further investigation to determine how frequently these bulbs are sufficiently defective to lead to adverse effects.

Cutaneous lupus erythematosus: diagnosis and treatment

Cutaneous lupus erythematosus (CLE) encompasses a wide range of dermatologic manifestations, which may or may not be associated with the development of systemic disease. Cutaneous lupus is divided into several sub-types, including acute CLE (ACLE), sub-acute CLE (SCLE) and chronic CLE (CCLE). CCLE includes discoid lupus erythematosus (DLE), LE profundus (LEP), chilblain cutaneous lupus and lupus tumidus. The diagnosis of these diseases requires proper classification of the sub-type, through a combination of physical examination, laboratory studies, histology, antibody serology and occasionally direct immunofluorescence, while ensuring to exclude systemic disease. The treatment of cutaneous lupus consists of patient education on proper sun protection along with appropriate topical and systemic agents. Systemic agents are indicated in cases of widespread, scarring or treatment-refractory disease. In this chapter, we discuss issues in classification and diagnosis of the various sub-types of CLE, as well as provide an update on therapeutic management.

Ocular aldehyde dehydrogenases: protection against ultraviolet damage and maintenance of transparency for vision

Aldehyde dehydrogenase (ALDH) enzymes catalyze the NAD(P)(+)-dependent oxidation of a wide variety of endogenous and exogenous aldehydes to their corresponding acids. Some members of the ALDH superfamily of enzymes are abundantly expressed in the mammalian cornea and lens in a taxon-specific manner. Considered to be corneal and lens crystallins, they confer protective and transparent properties upon these ocular tissues. ALDH3A1 is highly expressed in the cornea of most mammals, with the exception of rabbit that expresses exclusively ALDH1A1 in the cornea. ALDH1A1 is present in both the cornea and lens of several animal species. As a result of their catalytic and non-catalytic functions, ALDH3A1 and ALDH1A1 proteins protect inner ocular tissues from ultraviolet radiation and reactive oxygen-induced damage. In addition, these corneal crystallins contribute to cellular transparency in corneal stromal keratocytes, supporting a structural role of these ALDH proteins. A putative regulatory function of ALDH3A1 on corneal cell proliferation has also been proposed. Finally, the three retinaldehyde dehydrogenases cooperatively mediate retinoic acid signaling during the eye development.

Retinal photodamage by endogenous and xenobiotic agents

The human eye is constantly exposed to sunlight and artificial lighting. Light transmission through the eye is fundamental to its unique biological functions of directing vision and circadian rhythm and therefore light absorbed by the eye must be benign. However, exposure to the very intense ambient radiation can pose a hazard particularly if the recipient is over 40 years of age. There are age-related changes in the endogenous (natural) chromophores (lipofuscin, A2E and all-trans-retinal derivatives) in the human retina that makes it more susceptible to visible light damage. Intense visible light sources that do not filter short blue visible light (400-440 nm) used for phototherapy of circadian imbalance (i.e. seasonal affective disorder) increase the risk for age-related light damage to the retina. Moreover, many drugs, dietary supplements, nanoparticles and diagnostic dyes (xenobiotics) absorb ocular light and have the potential to induce photodamage to the retina, leading to transient or permanent blinding disorders. This article will review the underlying reasons why visible light in general and short blue visible light in particular dramatically raises the risk of photodamage to the human retina.

Analysis of energy saving lamps for use by photosensitive individuals

Due to European legislation, the British government has begun the phase out of incandescent bulbs, to be replaced by energy-saving alternatives. The alternatives that are available on the market are Compact Fluorescent Lamps (CFL), Energy-Efficient Halogens (EEH) and Light Emitting Diodes (LED). Whilst previous research has shown that CFLs emit UVC, UVB and UVA, there is conflicting data available on whether double enveloped CFLs are a safer alternative to single enveloped CFLs for individuals suffering from photosensitivity. The emission spectra of 106 single enveloped CFLs and 65 double enveloped CFLs were measured. There were 17 different models of single enveloped CFLs, including lamps from 6 different manufacturers (ranging from 8-20 W) and 9 models of double enveloped CFLs from 6 different manufacturers (7-15 W). In addition, the emission spectra of 53 LEDs and 56 EEHs were also analysed. The LEDs consisted of 8 different models, from 3 manufacturers, spanning between 2.5 and 12 W. There were 11 models of EEH from 6 different manufacturers with wattages ranging from 28-70 W. In order to reduce sample bias, some bulbs were provided by the lighting industry federation and others were purchased randomly from local retailers. The results validate previous research in that considerable variation exists in the UV emitted from CFLs. This variation in UV levels is true, not only within different makes and models but also, surprisingly, within a box of 8 seemingly identical bulbs supplied by a single manufacturer. It was concluded that double enveloped CFLs do reduce the levels of UVC and UVB and therefore are a safer alternative for photosensitive individuals. However, as some double enveloped CFLs and EEHs do emit UVA at levels that provoke a reaction in the skin of UVA sensitive individuals, newly emerging LEDs that have minimal UV levels may provide a safer alternative.

Ultraviolet radiation as a risk factor for cataract and macular degeneration

The human eye is constantly exposed to sunlight and artificial lighting. Light transmission through the eye is fundamental to its unique biological functions of directing vision and circadian rhythm, and therefore, light absorbed by the eye must be benign. However, exposure to the intense ambient radiation can pose a hazard particularly if the recipient is over 40 years of age. This radiation exposure can lead to impaired vision and transient or permanent blindness.Both ultraviolet-A (UV-A) and UV-B induce cataract formation and are not necessary for sight. Ultraviolet radiation is also a risk factor for damage to the retinas of children. The removal of these wavelengths from ocular exposure will greatly reduce the risk of early cataract and retinal damage. One way this may be easily done is by wearing sunglasses that block wavelengths below 400 nm (marked 400 on the glasses). However, because of the geometry of the eye, these glasses must be wraparound sunglasses to prevent reflective UV radiation from reaching the eye. Additional protection may be offered by contact lenses that absorb significant amounts of UV radiation.In addition to UV radiation, short blue visible light (400-440 nm) is a risk factor for the adult human retina. This wavelength of light is not essential for sight and not necessary for a circadian rhythm response. For those over 50 years old, it would be of value to remove these wavelengths of light with specially designed sunglasses or contact lenses to reduce the risk of age-related macular degeneration.

Treatment of cutaneous lupus

Cutaneous lupus erythematosus (CLE) is an autoimmune inflammatory skin disease seen in patients with or without systemic lupus erythematosus. The management of CLE includes treatment and prevention of lesions as well as routine assessment for systemic disease. Treatment options include topical and systemic therapies. Topical therapies include corticosteroids and calcineurin inhibitors. Systemic therapies generally fall under one of three categories: antimalarials, immunomodulators (eg, dapsone and thalidomide), and immunosuppressives (eg, methotrexate and mycophenolate). Evidence for the treatment of CLE has been limited by few prospective studies and the lack of a validated outcome measure (until recently). There is good evidence to support the use of topical steroids and calcineurin inhibitors, although most of these trials have not used placebo or vehicle controls. There have been no randomized, placebo-controlled trials evaluating systemic therapies in the treatment of CLE.

Cutaneous lupus erythematosus: update of therapeutic options part I

In patients with cutaneous lupus erythematosus (CLE), it is important to provide instructions concerning methods of protection from sunlight and artificial sources of ultraviolet radiation. Topical corticosteroids are the mainstay of treatment for patients with CLE; however, they are of limited value because of their well-known side effects. Recently, calcineurin inhibitors have been shown to be efficient as topical therapy in various CLE subtypes. The first-line treatment for severe and widespread skin manifestations is antimalarials; hydroxychloroquine or chloroquine can each be combined with quinacrine in refractory CLE. Systemic steroids can be used additionally in exacerbations of the disease. In the first part of this review, recent information on topical and first-line systemic treatment is described in detail while providing the reader with up-to-date information on efficacy, side effects, and dosage for the various agents. In the second part, additional systemic agents for the treatment of CLE will be discussed.

Photosensitivity, phototesting, and photoprotection in cutaneous lupus erythematosus

Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune disease involving well-defined skin lesions that can be categorized as acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), or intermittent CLE (ICLE). It is commonly accepted that ultraviolet (UV) exposure can induce and exacerbate skin lesions in patients with certain subtypes of CLE. Phototesting with UVA and UVB irradiation using a standardized protocol has proven to be a reliable model to study photosensitivity in CLE and to analyse the underlying pathomechanisms of the disease. In addition to UV-mediated induction of apoptosis, the molecular and cellular factors that may underlie the abnormal long-lasting photoreactivity in CLE include mediators of inflammation such as cytokines and chemokines, inducible nitric oxide (NO) synthase (iNOS), and cellular adhesion molecules. The photosensitivity associated with CLE requires education of the patient about avoidance of excessive sun exposure, continuous photoprotection through physical measures such as protective clothing, and daily application of broad-spectrum sunscreens. Novel approaches to UV-protection, such as alpha-MSH or thymidine dinucleotides, might also have an impact on photosensitivity in patients with CLE. In this review, we summarize the current knowledge about photosensitivity in patients with CLE, including an overview of standardized phototesting procedures, possible molecular pathomechanisms, and photoprotection. Lupus (2010) 19, 1036—1046.

Rheumatic manifestations of skin disease

PURPOSE OF REVIEW

There is an increasing interest in improving the understanding of pathophysiology, outcome measures, and therapies of rheumatic skin disease. Increasingly, studies are using the skin as a primary endpoint for evaluating therapies. This will review the current state of the art for the most common rheumatic skin diseases.

RECENT FINDINGS

A number of medications, including biologics such as tumor necrosis factor alpha and interferon, have been associated with onset of cutaneous lupus. The cutaneous lupus erythematosus area and severity index has been further validated and utilized in a number of studies. Smoking continues to be associated both with presence and refractoriness of cutaneous lupus erythematosus to therapy. There are several tools now available for evaluating the skin disease of dermatomyositis, but there is a need for new effective therapies. Measurement of skin disease in scleroderma continues to be a challenge, and there is a need for more effective therapies. Several studies show efficacy of intravenous iloprost for severe Raynaud's and skin ulcers, and of bosentan for digital ulcers.

SUMMARY

The present review covers new outcome measures, treatments, and unusual manifestations of cutaneous lupus, dermatomyositis, scleroderma, and rheumatoid arthritis. There have been a number of new studies related to validation of disease activity measures, as well as their use in evaluation of new therapies for these conditions. Validated outcome measures are required to perform meaningful studies, and will facilitate organized epidemiologic, quality of life, and therapeutic studies.