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Charoenchon N, Rhodes LE, Nicolaou A, Williamson G, Watson RE, Farrar MD. Ultraviolet radiation‐induced degradation of dermal extracellular matrix and protection by green tea catechins: a randomised controlled trial. Clin Exp Dermatol 2022; 47:1314-1323. [PMID: 35279873 PMCID: PMC9320810 DOI: 10.1111/ced.15179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/17/2022] [Accepted: 03/11/2022] [Indexed: 11/29/2022]
Abstract
Background Aim Methods Results Conclusions
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Affiliation(s)
- Nisamanee Charoenchon
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences School of Biological Sciences Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre Manchester UK
| | - Lesley E. Rhodes
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences School of Biological Sciences Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre Manchester UK
- Photobiology Unit, Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre Manchester UK
| | - Anna Nicolaou
- Laboratory for Lipidomics and Lipid Biology, Division of Pharmacy and Optometry School of Health Sciences Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre Manchester UK
| | - Gary Williamson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences Monash University Victoria Australia
| | - Rachel E.B. Watson
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences School of Biological Sciences Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre Manchester UK
| | - Mark D. Farrar
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences School of Biological Sciences Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre Manchester UK
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Borecka O, Farrar MD, Osman JE, Rhodes LE, Webb AR. Older Adults Who Spend More Time Outdoors in Summer and Have Higher Dietary Vitamin D Than Younger Adults Can Present at Least as High Vitamin D Status: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073364. [PMID: 33805086 PMCID: PMC8037349 DOI: 10.3390/ijerph18073364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 01/30/2023]
Abstract
Vitamin D3 can be produced by exposing skin to UVB radiation or sourced through dietary products. It is often stated that vitamin D status declines in older adults, yet little is known about differences in current-day lifestyle and dietary behaviours influencing vitamin D outcomes in younger (18–40 years old) and older adults (65–89 years old). Our objectives were to perform a pilot study to compare sun exposure behaviours, i.e., time spent outdoors, holiday behaviour and use of sunscreen/clothing, and dietary vitamin D intake, in young and older adults in the UK, together with assessment of their vitamin D status. A total of 13 young and 11 older volunteers completed a four-page questionnaire to assess sun exposure and photoprotective behaviour and an eleven-page one-week vitamin D diet diary, alongside their plasma 25(OH)D measurement. It was found that the older group tended to spend more time outdoors during the working week in summer, to take more summer and winter holidays each year, take longer winter holidays and have similar sunscreen use when compared to younger adults. Older adults had a significantly higher daily dietary intake of vitamin D (4.0 μg) than young adults (2.4 μg). Mean winter 25(OH)D concentration was higher in older (56.9 nmol/L) than in young adults (43.2 nmol/L), but there was no statistical difference between the groups. Contrary to common assumptions, in this study, older adults had sun exposure and dietary behaviours conferring a vitamin D status at least as good as that of younger adults.
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Affiliation(s)
- Oktawia Borecka
- Department of Earth and Environmental Sciences, Faculty of Science and Engineering, University of Manchester, Manchester M13 9PL, UK;
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Medicine Biology and Health, University of Manchester, Manchester M13 9PL, UK; (M.D.F.); (L.E.R.)
- Correspondence:
| | - Mark D. Farrar
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Medicine Biology and Health, University of Manchester, Manchester M13 9PL, UK; (M.D.F.); (L.E.R.)
| | - Joanne E. Osman
- Photobiology Unit, Dermatology Research Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M6 8HD, UK;
| | - Lesley E. Rhodes
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Medicine Biology and Health, University of Manchester, Manchester M13 9PL, UK; (M.D.F.); (L.E.R.)
- Photobiology Unit, Dermatology Research Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M6 8HD, UK;
| | - Ann R. Webb
- Department of Earth and Environmental Sciences, Faculty of Science and Engineering, University of Manchester, Manchester M13 9PL, UK;
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Hubbard G, Cherrie J, Gray J, Kyle RG, Nioi A, Wendelboe-Nelson C, Cowie H, Dombrowski S. Sun protection education for adolescents: a feasibility study of a wait-list controlled trial of an intervention involving a presentation, action planning, and SMS messages and using objective measurement of sun exposure. BMC Public Health 2020; 20:131. [PMID: 32000743 PMCID: PMC6990594 DOI: 10.1186/s12889-020-8265-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People increase their risk of melanoma unless they are protected from the harmful effects of sun exposure during childhood and adolescence. We aimed to assess the feasibility of a three-component sun protection intervention- presentation, action planning, and SMS messages - and trial parameters. METHODS This feasibility wait-list trial was conducted in the United Kingdom in 2018. Students aged 13-15 years were eligible. Feasibility outcomes were collected for recruitment rates; data availability rates for objective measurements of melanin and erythema using a Mexameter and self-reported sunburn occurrences, severity and body location, tanning, sun protection behaviours and Skin Self-Examination (SSE) collected before (baseline) and after the school summer holidays (follow-up); intervention reach, adherence, perceived impact and acceptability. Quantitative data were analysed using descriptive statistics; qualitative data were analysed thematically. RESULTS Five out of eight schools expressing an interest in participating with four allocated to act as intervention and one control. Four parents/carers opted their child out of the study. Four hundred and eighty-seven out of 724 students on the school register consented to the study at baseline (67%). Three hundred and eighty-five were in intervention group schools. Objective skin measurements were available for 255 (66%) of the intervention group at baseline and 237 (61%) of the group at follow up. Melanin increased; erythema decreased. Complete self-report data were available for 247 (64%) students in the intervention group. The number of students on the school register who attended the presentation and given the booklet was 379 (98%) and gave their mobile phone number was 155 (40%). No intervention component was perceived as more impactful on sun protection behaviours. Adolescents did not see the relevance of sun protection in the UK or for their age group. CONCLUSIONS This is the first study to use a Mexameter to measure skin colour in adolescents. Erythema (visible redness) lasts no more than three days and its measurement before and after a six week summer holiday may not yield relevant or meaningful data. A major challenge is that adolescents do not see the relevance of sun protection and SSE. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number ISRCTN11141528. Date registered 0/2/03/2018; last edited 31/05/2018. Retrospectively registered.
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Affiliation(s)
- Gill Hubbard
- Department of Nursing and Midwifery, University of the Highlands and Islands, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH UK
| | - John Cherrie
- Heriot-Watt University, Institute of Biological Chemistry, Biophysics and Bioengineering, Edinburgh, EH14 3AS UK
- Research Division, Institute of Occupational Medicine, Edinburgh, EH14 4AP UK
| | - Jonathan Gray
- Department of Nursing and Midwifery, University of the Highlands and Islands, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH UK
| | - Richard G. Kyle
- School of Health & Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN UK
| | - Amanda Nioi
- Heriot-Watt University, Institute of Biological Chemistry, Biophysics and Bioengineering, Edinburgh, EH14 3AS UK
| | - Charlotte Wendelboe-Nelson
- Heriot-Watt University, Institute of Biological Chemistry, Biophysics and Bioengineering, Edinburgh, EH14 3AS UK
| | - Hilary Cowie
- Research Division, Institute of Occupational Medicine, Edinburgh, EH14 4AP UK
| | - Stephan Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
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Schneiderbanger CK, Schuler G, Heinzerling L, Kirchberger MC. Characterization of tanning behavior assessed via online survey: Attitudes, habits, and preventive measures with focus on sunscreen use. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:268-274. [PMID: 30854722 DOI: 10.1111/phpp.12465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND/PURPOSE Incidence of melanoma is increasing globally. Exposure to ultraviolet radiation (UVR) as important risk factor for developing skin cancer can be influenced by tanning behavior. Only a few studies are available concerning sun tanning behavior and protective measures. METHODS An online survey was distributed via social media to assess tanning habits and examine associated demographic and behavioral factors. RESULTS In total, 403 questionnaires were distributed, and mean age of respondents was 32. Having a tanned skin, feeling warm and relaxed were the most common motivations for tanning. The use of sunscreen varied and seemed to depend on the occasion of UVR exposure, constantly applied during vacation and during tanning, less commonly applied in daily life and during work. Avoiding painful solar dermatitis was more important as motivation for the use of sunscreen than skin cancer prevention. Skin aging as reason for the use of sunscreen was especially important for females younger than 26 years. The most common applied sun protection factor was 16-49. The main reason opposing the use of sunscreen was a too laborious usage, which was significantly associated with male. Beauty was the only association related to tanned skin the majority (62%) agreed with. CONCLUSION The motivation for tanning and reasons for avoiding sunscreen strongly varies. Knowledge about these factors could be used for improving campaigns with respect to target groups. Clarifying the appropriate application of sunscreen, developing convenient sunscreen formulations and providing information about UVR-induced skin aging could lead to an increased usage of sunscreen and therefore to an improved UVR protection.
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Affiliation(s)
- Constanze K Schneiderbanger
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Gerold Schuler
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Lucie Heinzerling
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael C Kirchberger
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
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Hubbard G, Kyle RG, Neal RD, Marmara V, Wang Z, Dombrowski SU. Promoting sunscreen use and skin self-examination to improve early detection and prevent skin cancer: quasi-experimental trial of an adolescent psycho-educational intervention. BMC Public Health 2018; 18:666. [PMID: 29843654 PMCID: PMC5975556 DOI: 10.1186/s12889-018-5570-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/16/2018] [Indexed: 12/15/2022] Open
Abstract
Background Skin cancer rates are increasing. Interventions to increase adolescent sunscreen use and skin self-examination (SSE) are required. Methods Quasi-experimental design; 1 control and 4 intervention group schools in Scotland, UK. Participants were 15–16 year old students on the school register. The intervention was a theoretically-informed (Common-Sense Model and Health Action Process Approach) 50-min presentation, delivered by a skin cancer specialist nurse and young adult skin cancer survivor, to students in a classroom, supplemented by a home-based assignment. Outcome variables were sunscreen use intention, SSE intention/behaviour, planning, illness perceptions and skin cancer communication behaviour, measured 2 weeks pre- and 4 weeks post- intervention using self-completed pen and paper survey. School attendance records were used to record intervention up-take; students self-reported completion of the home-based assignment. Pearson’s chi-square test, analysis of variance, and non-parametric Wilcoxon Signed Ranks Test were used to measure outcomes and associations between variables. Focus groups elicited students’ (n = 29) views on the intervention. Qualitative data were analysed thematically. Results Five of 37 invited schools participated. 639 (81%) students in intervention schools received the intervention; 33.8% completed the home-based assignment. 627 (69.6%) of students on the school register in intervention and control schools completed a questionnaire at baseline; data for 455 (72.6%) students were available at baseline and follow-up. Focus groups identified four themes – personal experiences of skin cancer, distaste for sunscreen, relevance of SSE in adolescence, and skin cancer conversations. Statistically significant (p < 0.05) changes were observed for sunscreen use, SSE, planning, and talk about skin cancer in intervention schools but not the control. Significant associations were found between sunscreen use, planning and 2 illness perceptions (identity and consequence) and between SSE, planning and 3 illness perceptions (timeline, causes, control). Conclusions It is feasible to promote sunscreen use and SSE in the context of an adolescent school-based psychoeducation intention. Further research is required to improve study uptake, intervention adherence and effectiveness. Trial registration ISRCTN11141528 Electronic supplementary material The online version of this article (10.1186/s12889-018-5570-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gill Hubbard
- School of Health, Social Care and Life Sciences, Centre for Health Sciences, University of the Highlands and Islands (UHI), Old Perth Road, Inverness, IV2 3JH, Scotland.
| | - Richard G Kyle
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN, UK
| | - Richard D Neal
- Academic Unit of Primary Care, Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK
| | - Vincent Marmara
- Department of Management, Faculty of Economics, Management and Accountancy, University of Malta, Humanities B (FEMA), Msida, MSD, 2080, Malta
| | - Ziyan Wang
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, FK10 4LA, Stirling, Scotland
| | - Stephan U Dombrowski
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, FK10 4LA, Stirling, Scotland
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Markiewicz E, Idowu OC. Personalized skincare: from molecular basis to clinical and commercial applications. Clin Cosmet Investig Dermatol 2018; 11:161-171. [PMID: 29692619 PMCID: PMC5903487 DOI: 10.2147/ccid.s163799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Individual responses of human skin to the environmental stress are determined by differences in the anatomy and physiology that are closely linked to the genetic characteristics such as pigmentation. Ethnic skin phenotypes can be distinguished based on defined genotypic traits, structural organization and compartmentalized sensitivity to distinct extrinsic aging factors. These differences are not only responsible for the variation in skin performance after exposure to damaging conditions, but can also affect the mechanisms of drug absorption, sensitization and other longer term effects. The unique characteristics of the individual skin function and, particularly, of the ethnic skin type are currently considered to shape the future of clinical and pharmacologic interventions as a basis for personalized skincare. Individual approaches to skincare render a novel and actively growing area with a range of biomedical and commercial applications within cosmetics industry. In this review, we summarize the aspects of the molecular and clinical manifestations of the environmental stress on human skin and proposed protective mechanisms that are linked to ethnic differences and pathophysiology of extrinsic skin aging. We subsequently discuss the possible applications and translation of this knowledge into personalized skincare.
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Affiliation(s)
- Ewa Markiewicz
- Research & Development, Hexis Lab, Science Central, The Core, Bath Lane, Newcastle upon Tyne, UK
| | - Olusola Clement Idowu
- Research & Development, Hexis Lab, Science Central, The Core, Bath Lane, Newcastle upon Tyne, UK
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Babazadeh T, Nadrian H, Banayejeddi M, Rezapour B. Determinants of Skin Cancer Preventive Behaviors Among Rural Farmers in Iran: an Application of Protection Motivation Theory. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:604-612. [PMID: 26922176 DOI: 10.1007/s13187-016-1004-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Skin cancer is one of the most prevalent cancers, worldwide, which happens more among those with more sunlight exposure like farmers. The aim of this study was to explore the determinants of skin cancer preventive behaviors (SCPBs) among rural farmers using Protection Motivation Theory (PMT). In this cross-sectional study, multistage random sampling was employed to enroll 238 farmers referring to rural health houses (HH) in Chaldoran County, Iran. A valid and reliable instrument based on PMT variables was used. Significant correlations were found between all PMT variables with SCPBs (p < 0.05). Hierarchical multiple linear regressions were performed with Protection Motivation and SCPBs as outcome variables. Predictors for these two outcome variables were classified in two different blocks according to their natures. Demographic characteristics (p > 0.05) and PMT constructs (p < 0.001) explained 3 and 63.6 % of the observed variance in Protection Motivation, respectively. Also, no significant effect was found on SCPBs by demographic variables, in the first block (∆R 2 = 0.025); however, in the second block, Perceived Susceptibility (p = 0.000), Rewards (p = 0.022), Self-efficacy (p = 0.000), and Response Cost (p = 0.001) were significant predictors of SCPBs (∆R 2 = 0.432). Health care providers may consider PMT as a framework for developing educational interventions aiming at improving SCPBs among rural farmers.
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Affiliation(s)
- Towhid Babazadeh
- Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haidar Nadrian
- Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Morteza Banayejeddi
- Department of Disease Control and Prevention, Chalderan Health Care Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Baratali Rezapour
- Department of Public Health, Urmia University of Medical Sciences, Urmia, Iran
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Emmerson AJB, Dockery KE, Mughal MZ, Roberts SA, Tower CL, Berry JL. Vitamin D status of White pregnant women and infants at birth and 4 months in North West England: A cohort study. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28421711 DOI: 10.1111/mcn.12453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 11/29/2022]
Abstract
The prevalence of vitamin D deficiency in pregnant white-skinned women (WSW) and their infants has not been investigated at northern latitudes in a developed county. A 2-year observational cohort study was undertaken in the North West of England to determine 25-hydroxyvitamin D (25OHD) levels in WSW and their infants during pregnancy and 4 months postdelivery and to explore factors associated with these levels. Nutritional and lifestyle questionnaires were completed and 25OHD levels measured at 28 weeks and 4 months postdelivery. Twenty-seven percent and 7% of WSW had insufficient and deficient levels of 25OHD during pregnancy and 48% and 11% four months postdelivery. WSW with Fitzpatrick skin-type I (FST I) have significantly lower 25OHD than other skin types after controlling for time spent outside and vitamin D intake. Twenty-four percent and 13% of infants had insufficient and deficient 25OHD levels at 4 months. Unsupplemented breast-fed infants have the highest level of insufficiency (67%) compared with formula-fed infants (2%). Factors associated with infant serum 25OHD levels at 4 months included breast feeding, supplementation, and time outside. WSW have a high prevalence of insufficiency and deficiency during pregnancy which doubles 4 months after birth. Breast-fed infants of WSW are rarely considered at risk of vitamin D insufficiency but have high rates compared with formula-fed infants. This is the first study to show the finding that FST I WSW have significantly lower levels of 25OHD than those with FST II-IV (difference adjusted for diet and time outside 14 (95%CI 7-21) nmol/L).
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Affiliation(s)
- Anthoney J B Emmerson
- Departments of Newborn Intensive Care, and Obstetrics, St Mary's Hospital, & Manchester Health Sciences Centre, Central Manchester Foundation Trust, Manchester, UK
| | - Karen Elizabeth Dockery
- Departments of Newborn Intensive Care, and Obstetrics, St Mary's Hospital, & Manchester Health Sciences Centre, Central Manchester Foundation Trust, Manchester, UK
| | - M Z Mughal
- Vitamin D Research Group, University of Manchester, Manchester, UK
| | | | - Clare Louise Tower
- Departments of Newborn Intensive Care, and Obstetrics, St Mary's Hospital, & Manchester Health Sciences Centre, Central Manchester Foundation Trust, Manchester, UK
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Cestari T, Buster K. Photoprotection in specific populations: Children and people of color. J Am Acad Dermatol 2017; 76:S110-S121. [PMID: 28038884 DOI: 10.1016/j.jaad.2016.09.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/19/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
Improved education on appropriate photoprotection in children is vital. Photoprotection for these individuals should include seeking shade, the use of physical agents (clothing, hat, sunglasses), and application of sunscreens on exposed areas. Avoidance of the use of tanning beds is an important component of education for teenagers. Ultraviolet radiation exposure induces DNA damage and photoaging in all skin types, including people of color. The extent of such damage is inversely related to constitutive skin pigmentation. Therefore, personalized photoprotection recommendations concerning skin cancer risk factors, desired treatment outcomes, health needs (eg, vitamin D), and photoaging based on the needs and preferences of the patient are essential. It is clear that additional research is needed on optimal levels of protection against ultraviolet radiation for people of color.
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Affiliation(s)
- Tania Cestari
- Department of Dermatology, Federal University of Rio Grande do Sul, School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | - Kesha Buster
- Buster Dermatology, Tulsa, Oklahoma; University of Alabama at Birmingham, Birmingham, Alabama
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