The impact of skin colour on human photobiological responses

Evaluation of the awareness of Western Australian SunSmart campaigns between 2008 and 2022

ISSUE ADDRESSED

It is unknown whether SunSmart health promotion campaigns in Western Australia are still effectively reaching their target audience of young people (under 45 years). This study examined trends over time in awareness, relevancy and believability of SunSmart advertisements and identified socio-demographic characteristics and risk factors associated with campaign awareness.

METHOD

Linear regression and log-binomial modelling were undertaken using data from the annual SunSmart post-campaign evaluation surveys between 2008/2009 and 2021/2022. SunSmart campaigns were analysed and categorised into the following themes: (1) personal real-life stories; (2) daily activities/sun exposure leads to skin cancer; or (3) cartoon/animated.

RESULTS

Between 2008 and 2022, there were declines in total awareness (74.2% to 20.4%), unprompted awareness (33.7% to 4.9%) and relevancy (89.5% to 54.8%) of SunSmart advertisements (representing annual percent decreases of 3.6%, 3.1% and 1.8%, respectively). However, believability remained high over time (>94% in each annual survey). Trends were inconsistent between the awareness of campaign themes and socio-demographic characteristics and risk factors. Several campaigns had greater awareness in their subsequent years, compared with the first campaign year.

CONCLUSION

In more recent years, SunSmart advertisements and campaigns may not have reached their target audience. In addition to socio-demographic characteristics, particularly age, advertisement factors may also affect the awareness of specific campaigns. SO WHAT?: Given the changing advertising landscape and its rising costs, ongoing funding is pertinent to increase the reach of future SunSmart campaigns. Increasing advertisements on alternative platforms and designing campaigns which separately target adolescents and adults need to be considered.

Assessing and documenting dark skin tones in stoma care

The stoma care nurse (SCN) assesses peristomal skin during each patient intervention. Living in a diverse multicultural society, the SCN needs to consider dark skin tones and how these are documented. This article looks at how the literature on peristomal skin assessment and available tools discuss skin colour, and compare this with the tissue viability literature. Stoma care and peristomal skin literature features very little about skin colour. Registered nurses are often unaware of the differences when assessing light skin tones versus dark skin tones. The article discusses how to assess for, identify and document problems around peristomal skin with patients who have dark skin tones. The differences in skin breakdown between light skin tones and dark skin tones are highlighted. There needs to be further research and development of tools to assist clinicians in identification and documentation relating to skin tone, thus providing consistency in assessment.

Distinct cAMP Signaling Microdomains Differentially Regulate Melanosomal pH and Pigmentation

cAMP signaling is a well-established regulator of melanin synthesis. Two distinct cAMP signaling pathways-the transmembrane adenylyl cyclase pathway, activated primarily by the MC1R, and the soluble adenylyl cyclase (sAC) pathway-affect melanin synthesis. The sAC pathway affects melanin synthesis by regulating melanosomal pH, and the MC1R pathway affects melanin synthesis by regulating gene expression and post-translational modifications. However, whether MC1R genotype affects melanosomal pH is poorly understood. We now report that loss of function MC1R does not affect melanosomal pH. Thus, sAC signaling appears to be the only cAMP signaling pathway that regulates melanosomal pH. We also addressed whether MC1R genotype affects sAC-dependent regulation of melanin synthesis. Although sAC loss of function in wild-type human melanocytes stimulates melanin synthesis, sAC loss of function has no effect on melanin synthesis in MC1R nonfunctional human and mouse melanocytes or skin and hair melanin in e/e mice. Interestingly, activation of transmembrane adenylyl cyclases, which increases epidermal eumelanin synthesis in e/e mice, leads to enhanced production of eumelanin in sAC-knockout mice relative to that in sAC wild-type mice. Thus, MC1R- and sAC-dependent cAMP signaling pathways define distinct mechanisms that regulate melanosomal pH and pigmentation.

Enzyme-treated caviar extract ameliorates melanogenesis in UVB-induced SKH-1 hairless mice

This study investigated anti-melanogenesis effects of enzyme-treated caviar extract (CV) in murine melanoma B16F10 cells and SKH-1 hairless mice. To induce melanin production in vitro and in vivo studies, B16F10 cells were treated with 3-Isobutyl-1-methylxanthine (IBMX), and SKH-1 hairless mice were irradiated with UVB, respectively. The expression of melnogenesis-related factors and signaling molecules were analyzed by ELISA and western blotting. 50, 100 and 200 μg/mL of CV significantly decreased the melanin contents and the activities of tyrosinase, nitric oxide, glutathione, and cAMP, melanogenesis factor, in B16F10 cells treated IBMX. In addition, CV significantly suppressed the expression of melanogenesis proteins such as pPKA, pCREB, MITF, TRP-1and TRP-2. Similarly, results of oral administration of CV (20, 50 and 100 mg/kg) for 8 weeks in UVB-Induced SKH-1 hairless mice, the expression of melanogenesis-related factor tyrosinase, nitric oxide, and cAMP and protein expression of pPKA, pCREBa, MITF, TRP-1and TRP-2 was significantly reduced. In particular, 100 mg/kg of CV exhibited an excellent effect similar to control group. Therefore, we suggest the possibility of developing CV as a food supplement having skin whitening effects by ameliorating melanogenesis.

Far-UVC- and UVB-induced DNA damage depending on skin type

Far-UVC radiation sources of wavelengths 222 nm and 233 nm represent an interesting potential alternative for the antiseptic treatment of the skin due to their high skin compatibility. Nevertheless, no studies on far-UVC-induced DNA damage in different skin types have been published to date, which this study aims for. After irradiating the skin with far-UVC of the wavelengths 222 and 233 nm as well as broadband UVB, the tissue was screened for cyclobutane pyrimidine dimer-positive (CPD+ ) cells using immunohistochemistry. The epidermal DNA damage was lower in dark skin types than in fair skin types after irradiation at 233 nm. Contrary to this, irradiation at 222 nm caused no skin type-dependent differences, which can be attributed to the decreased penetration depth of radiation. UVB showed the relatively strongest differences between light and dark skin types when using a suberythemal dose of 3 mJ/cm2 . As melanin is known for its photoprotective effect, we evaluated the ratio of melanin content in the stratum basale and stratum granulosum in samples of different skin types using two-photon excited fluorescence lifetime imaging (TPE-FLIM) finding a higher ratio up to skin type IV-V. As far-UVC is known to penetrate only into the upper layers of the viable skin, the aforementioned melanin ratio could explain the less pronounced differences between skin types after irradiation with far-UVC compared to UVB.

Melanoma in skin of color: Part II. Racial disparities, role of UV, and interventions for earlier detection

Despite a higher incidence of melanoma among White individuals, melanoma-specific survival is worse among individuals with skin of color. Racial disparities in survival are multifactorial. Decreased skin cancer education focused on people with skin of color, lower rates of screening, increased socioeconomic barriers, higher proportions of more aggressive subtypes, and underrepresentation in research and professional education contribute to delays in diagnosis and treatment. Although high, intermittent UV exposure during childhood has been established as a significant modifiable risk factor for melanoma in individuals with lighter skin phototypes, there are limited data on UV exposure and melanoma risk in people with darker skin phototypes. The second article of this continuing medical education series will examine factors contributing to racial disparities in melanoma-specific survival, discuss the role of UV radiation, and address the need for further research and targeted educational interventions for melanoma in individuals with skin of color.

Simultaneous detection of ultraviolet irradiation and vitamin C using an all-carbon-based integrated wearable system powering by a micro-supercapacitor

Ultraviolet (UV) radiation is a harmful exogenous factor for human skin. Wearable UV photodetectors can monitor UV exposure in the surroundings, and wearable vitamin C (V_C) sensors tracking the levels in the human body present the potential ability to defend the UV radiation. Herein, we reported on the fabrication of an all-in-one wearable system with a UV photodetector and V_C sensor powered by a micro-supercapacitor. Based on direct laser writing carbonization of polyimide sheets, the patterned electrodes and interconnects of the circuit were fabricated by a facile one-step operation, obtaining an all-carbon-based integrated system. Such a system exhibited outstanding energy storage ability (56.2 μWh cm^-2 at 4.17 mW cm^-2), high areal capacitance (1.06 mF cm^-2 at 5 mV s^-1), satisfying capacitive stability, and good mechanical flexibility. The UV photodetector and the V_C sensor were powered to obtain a linear range of UV intensity from 11 to 44 μW cm^-2 (equivalent to Ultraviolet Index 4.4 to 17.6), and V_C levels of 1.0-200 μM with a low limit of detection of 0.83 μM. Furthermore, the integrated system was successfully applied to the determination of V_C in commercial beverage and human sweat samples. This work provided a simple and promising method to fabricate integrated wearable systems for on-site providing information on the UV intensity of the external environment and the V_C level of the human body simultaneously.

Clinical and molecular change induced by repeated low-dose visible light exposure in both light-skinned and dark-skinned individuals

BACKGROUND

Visible light (VL) is known to induce pigmentation in dark-skinned individuals and immediate erythema in light-skinned individuals. However, the effects of accumulated low-dose VL exposure across skin types are not well established.

METHODS

Thirty-one healthy subjects with light (Fitzpatrick skin types [FST] I-II, n = 13) and dark (FST V-VI, n = 18) skin types were enrolled. Subjects' buttocks were exposed daily to VL, wavelength 400-700 nm, with a dose of 120 J/cm2 at 50 mW/cm2 , for four consecutive days. Microarray using Affymetrix GeneChip (49,395 genes) was performed followed by qRT-PCR on skin samples.

RESULTS

Repeated low-dose VL irradiation induced immediate pigment darkening and delayed tanning in dark-skinned individuals while no discernable pigmentation and erythema were observed in light-skinned individuals. Top ten upregulated genes by repeated VL exposure in microarray included melanogenic genes such as tyrosinase (TYR), tyrosinase-related protein-1 (TYRP1), dopachrome tautomerase (DCT), premelanosome protein (PMEL), melan-A (MLANA), and solute carrier family 24, member 5 (SLC24A5) and genes involved in inflammation/matrix remodeling/cell signaling including chemokine (C-C motif) ligand 18 (CCL18), BCL2-related protein A1 (BCL2A1), and cartilage oligomeric matrix protein (COMP). In qRT-PCR CCL18 was upregulated in light skin with a greater extent (mean fold change ± SD; 4.03 ± 3.28, p = .04) than in dark-skinned individuals (1.91 ± 1.32, p = .07) while TYR was not significantly upregulated in both skin types.

CONCLUSION

This study highlights the genes upregulated by cumulative VL exposure involved in pigmentation, immune response, oxidation/reduction, and matrix remodeling across skin types providing relevant information on daily solar exposure.

Fermented Aronia melanocarpa Inhibits Melanogenesis through Dual Mechanisms of the PI3K/AKT/GSK-3β and PKA/CREB Pathways

UV light causes excessive oxidative stress and abnormal melanin synthesis, which results in skin hyperpigmentation disorders such as freckles, sunspots, and age spots. Much research has been carried out to discover natural plants for ameliorating these disorders. Aronia melanocarpa contains various polyphenolic compounds with antioxidative activities, but its effects on melanogenesis have not been fully elucidated. In this study, we investigated the inhibitory effect of fermented Aronia melanocarpa (FA) fermented with Monascus purpureus on melanogenesis and its underlying mechanism in the B16F10 melanoma cell line. Our results indicate that FA inhibited tyrosinase activity and melanogenesis in alpha-melanocyte-stimulating hormone (α-MSH)-induced B16F10 cells. FA significantly downregulated the PKA/CREB pathway, resulting in decreased protein levels of tyrosinase, TRP-1, and MITF. FA also inhibited the transcription of MITF by increasing the phosphorylation levels of both GSK3β and AKT. Interestingly, we demonstrated that these results were owing to the significant increase in gallic acid, a phenolic compound of Aronia melanocarpa produced after the fermentation of Monascus purpureus. Taken together, our research suggests that Aronia melanocarpa fermented with Monascus purpureus acts as a melanin inhibitor and can be used as a potential cosmetic or therapeutic for improving hyperpigmentation disorders.

Consumer Behavior, Skin Phototype, Sunscreens, and Tools for Photoprotection: A Review

Sunscreens and photoprotection tools along with consumer habits and behaviors, can mitigate the skin damage caused by excessive solar radiation. For example, protecting oneself in the shade, avoiding inadequate sun exposure at times of higher incidence of UVB radiation (between 10:00 a.m. and 4:00 p.m.), wearing clothes with sun protection factors, applying sunscreens at the correct amounts and intervals, and wearing glasses with anti-UVA and UVB lenses are effective measures for protecting an individual. Therefore, the objective of this review was to highlight the importance of photoprotection for all skin phototypes, as skin cancer is a worldwide public health problem. In this review of the scientific literature on the Scopus platform between 2015 and 2022, we addressed the most common behaviors among different individuals and their phototypes, the importance of clarifying population habits against solar radiation, and the use of sunscreens and photoprotection tools to provide advice on healthy and safe sun exposure.

Recent Advances and Progress on Melanin: From Source to Application

Melanin is a biological pigment formed by indoles and phenolic compounds. It is widely found in living organisms and has a variety of unique properties. Due to its diverse characteristics and good biocompatibility, melanin has become the focus in the fields of biomedicine, agriculture, the food industry, etc. However, due to the wide range of melanin sources, complex polymerization properties, and low solubility of specific solvents, the specific macromolecular structure and polymerization mechanism of melanin remain unclear, which significantly limits the further study and application of melanin. Its synthesis and degradation pathways are also controversial. In addition, new properties and applications of melanin are constantly being discovered. In this review, we focus on the recent advances in the research of melanin in all aspects. Firstly, the classification, source, and degradation of melanin are summarized. Secondly, a detailed description of the structure, characterization, and properties of melanin is followed. The novel biological activity of melanin and its application is described at the end.

Skin lightness affects ultraviolet A-induced oxidative stress: Evaluation using ultraweak photon emission measurement

The human skin is usually exposed to ultraviolet A (UVA) in the sunlight and experiences oxidative stress associated with skin disorders and aging. Although oxidative stress caused by UVA exposure is assumed to be dependent on skin colour, few studies have demonstrated this dependency. We investigated the effects of skin colour on UVA-induced oxidative stress using ultraweak photon emission (UPE) generated from the skin during oxidation processes. The UPE intensities of skin samples were detected using a photomultiplier tube every second without any labelling. We irradiated skin tissue of different colours with UVA and measured UPE over time. UVA-induced UPE could be detected from immediately after irradiation to 2 h after irradiation, indicating persistent oxidative stress. Skin lightness (L*) positively correlates with UPE intensity. Lighter-coloured skin exhibited more UVA-induced UPE, indicating higher oxidative stress. Additionally, oxidative stress persisted significantly more in lighter skin compared with darker skin. Skin tissues exhibited pigment darkening after UVA irradiation. Our results suggest that skin lightness affects oxidative stress induced by UV irradiation. Our study demonstrated the relationship between skin lightness and UVA-induced oxidative stress for the first time and offers new photodermatological insights into the human skin.

Skin cancer risk factors among Black South Africans-The Johannesburg Cancer Study, 1995-2016

BACKGROUND

The Black population has lower skin cancer incidence compared to White, Indian/Asian, and Mixed-race populations in South Africa; however, skin cancer still exists in the Black population. The aim of this study is to identify risk factors associated with skin cancer among Black South Africans.

MATERIALS AND METHODS

A case-control study was conducted. Cases were patients with keratinocyte cancers (KCs) and/or melanoma skin cancers (MSCs) and controls were cardiovascular patients. Sociodemographic exposures, environmental health variables, smoking, and HIV status were assessed. Stepwise logistic regression was used to identify risk factors associated with KCs and MSCs.

RESULTS

The KCs histological subtypes showed that there were more squamous cell carcinomas (SCCs) (78/160 in females, and 72/160 in males) than basal cell carcinomas (BCCs). The SCC lesions were mostly found on the skin of the head and neck in males (51%, 38/72) and on the trunk in females (46%, 36/78). MSC was shown to affect the skin of the lower limbs in both males (68%, 27/40) and females (59%, 36/61). Using females as a reference group, when age, current place of residency, type of cooking fuel used, smoking, and HIV status were adjusted for, males had an odds ratio (OR) of 2.04 for developing KCs (confidence interval [CI]: 1.08-3.84, p = .028). Similarly, when age, current place of residency, and place of cooking (indoors or outdoors) were adjusted for, males had an OR of 2.26 for developing MSC (CI: 1.19-4.29, p = .012).

CONCLUSIONS

Differences in the anatomical distribution of KCs by sex suggest different risk factors between sexes. There is a positive association between being male, smoking, rural dwelling, and a positive HIV status with KCs and being male and rural dwelling with MSC. The rural dwelling was a newly found association with skin cancer and warrants further investigation.

A Correlation of the Glogau Scale With VISIA-CR Complexion Analysis Measurements in Assessing Facial Photoaging for Clinical Research

BACKGROUND

Historically, common evaluations for photoaging have been subjective analysis; however, recently, investigators have turned to non-invasive devices for more objective evaluation of facial aging.

OBJECTIVES

This study aimed to establish a clinical correlation between the Glogau Photoaging Scale and VISIA-CR Complexion Analysis System. In doing so, decreasing intra- and inter-observer variability when assessing photodamage.

METHODS

One-hundred seventeen subjects between ages 18 and 89 were included. 2D facial photographs were analyzed by three independent reviewers and were assigned Glogau scores. Images were also captured and analyzed using VISIA software. Data was grouped by median Glogau score and compared between groups.

RESULTS

All groups were statistically different (p < 0.05) for Spots, Wrinkles and Remasked Wrinkles, except for Glogau 1 and 2 for Spots and Remasked Wrinkles. Wrinkles scores were plotted against age, and an exponential regression model was noted to be a better fit (R 2 = 0.5) compared to a linear model (R 2 = 0.47). The same was true for Spots with an exponential (R 2 = 0.36) compared to linear model (R 2 = 0.33). Scores were also evaluated based on sun exposure history, of which there were no significant differences.

CONCLUSIONS

The results illustrate that an imaging system can be used to reliably determine objective scores correlating to Glogau photoaging evaluations. Results also supported that aging more closely resembles an exponential process. Collectively, these findings will prove useful to those hoping to further investigate facial aging and therapeutic options available for facial skin rejuvenation and objectively assessing their outcomes.

A new visible light absorbing organic filter offers superior protection against pigmentation by wavelengths at the UVR-visible boundary region

Skin pigmentation by solar ultraviolet radiation (UVR; ~295-400 nm) is well established. More recently, visible light (VL; 400-740 nm) has been shown to induce rapid pigmentation. Such pigmentation is thought to be caused by oxidative stress, which has associations with skin cancer and photoageing. However, the UVR-VL boundary region has been less well studied. The lower back of healthy Fitzpatrick skin type II-IV individuals was irradiated with increasing doses of narrow-band 385 nm and 405 nm radiation. Pigmentation change was measured immediately, 6 h and 24 h post-irradiation using two reflectance spectroscopy devices and visual grading. Pigmentation was dose-dependently increased in all skin types and time points for both spectra. Two sunscreens, both labelled SPF 15 and UVA protective in the EU and USA (but with different Boots star rating in the UK, 2* vs 5*) were compared. Their formulations were the same apart from the addition of a new organic filter bis-(diethylaminohydroxybenzoyl benzoyl) piperazine (BDBP) that absorbs between 350 and 425 nm. The product that lacked BDBP provided minimal protection against pigmentation, but its addition provided almost complete protection. This demonstrates the needs to improve photoprotection at the UVR-visible border and for sunscreens to act as neutral density filters.

Low vitamin D in dark-skinned immigrants is mainly due to clothing habits and low UVR exposure: a Danish observational study

Low 25-hydroxyvitamin D₃ (25(OH)D) among dark-pigmented persons has been observed. To elucidate the reason for this we examined sun behaviour, sun-exposed body area, solar UVR exposure and 25(OH)D levels in immigrants with dark pigmented skin and Danes with light pigmented skin. Clothing, sun behaviour, and diet were recorded daily during a Danish summer season (93 analysed days). Erythema-weighted UVR doses were measured by personal electronic UVR dosimeters (with erythema response, measurement every 5th second) and 25(OH)D was measured in 72 participants (33 dark-skinned and 39 light-skinned). The immigrants exposed 28% less skin area, received 70% less UVR dose, and had 71% less 25(OH)D increase during the summer. The UVR reactivity (Δ25(OH)D per joule accumulated UVR dose) was similar (P = 0.62) among the immigrants (0.53 nmol l^-1 J^-1) and the Danes (0.63 nmol l^-1 J^-1). In the groups combined, 25(OH)D levels after summer were mainly influenced by UVR dose to exposed skin (28.8%) and 25(OH)D start level (27.9%). Height and measured constitutive skin pigmentation were of minor influence: 3.5% and 3.2%, respectively. Sun exposure and clothing habits were the main reasons for lower 25(OH)D level after summer in the darker immigrants, as both groups had similar UVR reactivity.

A revised action spectrum for vitamin D synthesis by suberythemal UV radiation exposure in humans in vivo

Solar UV radiation (UVR) causes sunburn but initiates the first step of vitamin D synthesis, which is the formation of previtamin D₃ (pre-D₃) in skin. The gold standard for assessing vitamin D is serum 25-hydroxyvitamin D₃ [25(OH)D₃]. Public health advice for optimal solar exposure requires UVR wavelength-dependence (action spectrum) data on risks and benefits. An action spectrum for pre-D₃ in human ex vivo skin was established over 30 y ago, but its validity has been questioned. We tested this action spectrum in healthy volunteers using serum 25(OH)D₃ as the endpoint. Our analysis shows that the pre-D₃ action spectrum can be improved with a systematic correction. This will result in better risk–benefit calculations for public health advice on solar exposure.

Action spectra are important biological weighting functions for risk/benefit analyses of ultraviolet (UV) radiation (UVR) exposure. One important human benefit of exposure to terrestrial solar UVB radiation (∼295 to 315 nm) is the cutaneous synthesis of vitamin D₃ that is initiated by the photoconversion of 7-dehydrocholesterol to previtamin D₃. An action spectrum for this process that is followed by other nonphotochemical steps to achieve biologically active vitamin D₃ has been established from ex vivo data and is widely used, although its validity has been questioned. We tested this action spectrum in vivo by full- or partial-body suberythemal irradiation of 75 healthy young volunteers with five different polychromatic UVR spectra on five serial occasions. Serum 25-hydroxyvitamin D₃ [25(OH)D₃] levels, as the most accurate measure of vitamin D₃ status, were assessed before, during, and after the exposures. These were then used to generate linear dose–response curves that were different for each UVR spectrum. It was established that the previtamin D₃ action spectrum was not valid when related to the serum 25(OH)D₃ levels, as weighting the UVR doses with this action spectrum did not result in a common regression line unless it was adjusted by a blue shift, with 5 nm giving the best fit. Such a blue shift is in accord with the published in vitro action spectra for vitamin D₃ synthesis. Thus, calculations regarding the risk (typically erythema) versus the benefit of exposure to solar UVR based on the ex vivo previtamin D₃ action spectrum require revision.

Study of the characteristics of facial skin tone status in 1092 young Chinese females according to the ITA°

BACKGROUND

The ITA° is the gold standard for skin tone classification. Different skin tones are often associated with different skin characteristics and issues. Different skin types are often associated with different skin characteristics and issues in China.

AIMS

To study the population's skin color distribution and accompanying skin problems according to the ITA° classification standard.

METHODS

A total of 1092 women aged 22-42 years were recruited in 7 cities in China. All biophysical parameter measurements (SM, CM, TWEL, pH, R2, GLOSS_DSCT, MEXA, ERYTH, ITA°; 9 indexes total) were quantified with noninvasive instruments. All volunteers provided consent before enrollment.

RESULT

The main skin color categories were light (II), very light (I), intermediate (III), and tan (IV). The results demonstrated that the characteristics of the facial skin based on the ITA° were significantly different among cities and age groups and were associated with different skin issues.

CONCLUSIONS

Lighter skin was associated with worse skin elasticity; intermediate skin was associated with worse skin hydration content and was most prone to being oily; and darker skin was associated with poor barrier function. Established principal component regression (PCR) indicated that pH, gloss GLOSS_DSC, MEXA, ERYTH, TEWL, and SM had significant effects on the ITA°.

UV Photochromism in Transition Metal Oxides and Hybrid Materials

Limited levels of UV exposure can be beneficial to the human body. However, the UV radiation present in the atmosphere can be damaging if levels of exposure exceed safe limits which depend on the individual the skin color. Hence, UV photochromic materials that respond to UV light by changing their color are powerful tools to sense radiation safety limits. Photochromic materials comprise either organic materials, inorganic transition metal oxides, or a hybrid combination of both. The photochromic behavior largely relies on charge transfer mechanisms and electronic band structures. These factors can be influenced by the structure and morphology, fabrication, composition, hybridization, and preparation of the photochromic materials, among others. Significant challenges are involved in realizing rapid photochromic change, which is repeatable, reversible with low fatigue, and behaving according to the desired application requirements. These challenges also relate to finding the right synergy between the photochromic materials used, the environment it is being used for, and the objectives that need to be achieved. In this review, the principles and applications of photochromic processes for transition metal oxides and hybrid materials, photocatalytic applications, and the outlook in the context of commercialized sensors in this field are presented.

Personal Solar Ultraviolet Radiation Exposure of Farmworkers: Seasonal and Anatomical Differences Suggest Prevention Measures Are Required

INTRODUCTION

Farmworkers are at risk of excess exposure to solar ultraviolet radiation (UVR) during their work activities, especially if they work in geographical areas with high ambient solar UVR levels such as in South Africa. Excess exposure to solar UVR may lead to several negative health effects such as certain cataracts and skin cancer. This study evaluated personal solar UVR exposure of a group of farmworkers to determine if they were at risk of health-related problems due to excess solar UVR exposure.

METHODS

Polysulphone film (PSF) badges were placed on the shoulder, arm, and top of the head of outdoor and indoor farmworkers on a macadamia nut and avocado farm in the Limpopo province for the duration of their daily work shift to evaluate their total daily solar UVR exposure. Sixteen days were assessed for each of the three, high solar UVR seasons, i.e. autumn, spring, and summer.

RESULTS

During autumn, farmworkers' arms received the highest solar UVR exposures (geometric mean (GM) = 7.8 SED, where 1 standard erythemal dose (SED) = 100 J/m2, 95% CI 6.1-9.8 SED) while the highest exposures were on the top of the head during spring (GM = 11.6 SED, 95% CI 7.3-17.4 SED) and summer (GM = 13.9, 95% CI 10.4-17.9 SED). Statistically significant differences in solar UVR exposure were found between the body sites during spring and summer but not autumn.

CONCLUSIONS

The relatively high daily solar UVR exposure levels of farmworkers suggest this occupational group is at risk of excess solar UVR exposure and preventive measures with awareness information to safeguard health is necessary for employers and employees.

Stratum corneum biomarkers after in vivo repeated exposure to sub-erythemal dosages of ultraviolet radiation in unprotected and sunscreen (SPF 50+) protected skin

BACKGROUND

There is a need for non-invasive biomarkers to assess in vivo efficacy of protective measures aiming at reducing ultraviolet radiation (UVR) exposure. Stratum corneum (SC) biomarkers showed to be promising markers for internal UVR dose and immune response.

PURPOSE

To establish a dose-response relationship for SC biomarkers and explore their suitability for in vivo assessment of the blocking effect of two sunscreens with a high sun protection factor (SPF) (50+).

METHODS

Twelve volunteers were exposed to a broad-spectrum UVB (280-320 nm), five times a week, during one week. Unprotected back skin was irradiated with 0.24, 0.48, 0.72 and 1.44 standard erythema dose (SED) and sunscreen-protected skin with 3.6 SED. SC samples for determination of the relative amount of cis-urocanic acid (cUCA) and thirteen immunological makers including cytokines and matrix metalloproteinases (MMP) were collected after each irradiation.

RESULTS

cUCA sharply increased after the first irradiation in a dose-dependent fashion. However, it levelled-off after subsequent exposures and reached a plateau for the highest UV-dose after the third irradiation. None of the immunological markers showed dose-dependency. However, MMP-9, IL-1β and CCL27 increased gradually from baseline during repetitive exposures to the highest UV-dose. Assessed from cUCA, both sunscreens blocked >98% of the applied UV-dose.

CONCLUSIONS

cUCA is a sensitive, non-invasive marker of the internal UVR dose enabling in vivo assessment of the blocking effect of high SPF sunscreens in the UVB-region. Immunological SC markers show low sensitivity in detecting immune response at sub-erythemal UVR dosages, suggesting they might be suitable only at higher and/or repetitive UVR exposure.

The evolution of human skin pigmentation involved the interactions of genetic, environmental, and cultural variables

The primary biological role of human skin pigmentation is as a mediator of penetration of ultraviolet radiation (UVR) into the deep layers of skin and the cutaneous circulation. Since the origin of Homo sapiens, dark, protective constitutive pigmentation and strong tanning abilities have been favored under conditions of high UVR and represent the baseline condition for modern humans. The evolution of partly depigmented skin and variable tanning abilities has occurred multiple times in prehistory, as populations have dispersed into environments with lower and more seasonal UVR regimes, with unique complements of genes and cultural practices. The evolution of extremes of dark pigmentation and depigmentation has been rare and occurred only under conditions of extremely high or low environmental UVR, promoted by positive selection on variant pigmentation genes followed by limited gene flow. Over time, the evolution of human skin pigmentation has been influenced by the nature and course of human dispersals and modifications of cultural practices, which have modified the nature and actions of skin pigmentation genes. Throughout most of prehistory and history, the evolution of human skin pigmentation has been a contingent and non-deterministic process.

UVB damage response of dermal stem cells as melanocyte precursors compared to keratinocytes, melanocytes, and fibroblasts from human foreskin

Ultraviolet B (UVB) radiation induces mutagenic DNA photolesions in skin cells especially in form of cyclobutane pyrimidine dimers (CPDs). Protection mechanisms as DNA repair and apoptosis are of great importance in order to prevent skin carcinogenesis. In human skin, neural crest-derived precursors of melanocytes, the dermal stem cells (DSCs), are discussed to be at the origin of melanoma. Although they are constantly exposed to solar UV radiation, it is still not investigated how DSCs cope with UV-induced DNA damage. Here, we report a comparative study of the DNA damage response after irradiation with a physiological relevant UVB dose in DSCs in comparison to fibroblasts, melanocytes and keratinocytes isolated from human foreskin. Within our experimental settings, DSCs were able to repair DNA photolesions as efficient as the other skin cell types with solely keratinocytes repairing significantly faster. Interestingly, only fibroblasts showed significant alterations in cell cycle distribution in terms of a transient S phase arrest following irradiation. Moreover, with the applied UVB dose none of the examined cell types was prone to UVB-induced apoptosis. This may cause persistent genomic alterations and in case of DSCs it may have severe consequences for their daughter cells, the differentiated melanocytes. Altogether, this is the first study demonstrating a similar UV response in dermal stem cells compared to differentiated skin cells.

Clinical and biological impact of the exposome on the skin

The skin exposome is defined as the totality of environmental exposures over the life course that can induce or modify various skin conditions. Here, we review the impact on the skin of solar exposure, air pollution, hormones, nutrition and psychological factors. Photoageing, photocarcinogenesis and pigmentary changes are well-established consequences of chronic exposure of the skin to solar radiation. Exposure to traffic-related air pollution contributes to skin ageing. Particulate matter and nitrogen dioxide cause skin pigmentation/lentigines, while ozone causes wrinkles and has an impact on atopic eczema. Human skin is a major target of hormones, and they exhibit a wide range of biological activities on the skin. Hormones decline with advancing age influencing skin ageing. Nutrition has an impact on numerous biochemical processes, including oxidation, inflammation and glycation, which may result in clinical effects, including modification of the course of skin ageing and photoageing. Stress and lack of sleep are known to contribute to a pro-inflammatory state, which, in turn, affects the integrity of extracellular matrix proteins, in particular collagen. Hormone dysregulation, malnutrition and stress may contribute to inflammatory skin disorders, such as atopic dermatitis, psoriasis, acne and rosacea.

An Immunometabolic Shift Modulates Cytotoxic Lymphocyte Activation During Melanoma Progression in TRPA1 Channel Null Mice

Melanoma skin cancer is extremely aggressive with increasing incidence and mortality. Among the emerging therapeutic targets in the treatment of cancer, the family of transient receptor potential channels (TRPs) has been reported as a possible pharmacological target. Specifically, the ankyrin subfamily, representing TRPA1 channels, can act as a pro-inflammatory hub. These channels have already been implicated in the control of intracellular metabolism in several cell models, but little is known about their role in immune cells, and how it could affect tumor progression in a process known as immune surveillance. Here, we investigated the participation of the TRPA1 channel in the immune response against melanoma tumor progression in a mouse model. Using Trpa1 ^+/+ and Trpa1 ^-/- animals, we evaluated tumor progression using murine B16-F10 cells and assessed isolated CD8+ T cells for respiratory and cytotoxic functions. Tumor growth was significantly reduced in Trpa1 ^-/- animals. We observed an increase in the frequency of circulating lymphocytes. Using a dataset of CD8+ T cells isolated from metastatic melanoma patients, we found that TRPA1 reduction correlates with several immunological pathways. Naïve CD8+ T cells from Trpa1 ^+/+ and Trpa1 ^-/- animals showed different mitochondrial respiration and glycolysis profiles. However, under CD3/CD28 costimulatory conditions, the absence of TRPA1 led to an even more extensive metabolic shift, probably linked to a greater in vitro killling ability of Trpa1 ^-/- CD8+ T cells. Therefore, these data demonstrate an unprecedented role of TRPA1 channel in the metabolism control of the immune system cells during carcinogenesis.

Pharmacologic manipulation of skin pigmentation

Skin complexion is among the most recognizable phenotypes between individuals and is mainly determined by the amount and type of melanin pigment deposited in the epidermis. Persons with dark skin complexion have more of a brown/black pigment known as eumelanin in their epidermis whereas those with fair skin complexions have less. Epidermal eumelanin acts as a natural sunblock by preventing incoming UV photons from penetrating into the skin and therefore protects against UV mutagenesis. By understanding the signaling pathways and regulation of pigmentation, strategies can be developed to manipulate skin pigmentation to improve UV resistance and to diminish skin cancer risk.

Physical Determinants of Vitamin D Photosynthesis: A Review

Vitamin D synthesis by exposure of skin to solar ultraviolet radiation (UVR) provides the majority of this hormone that is essential for bone development and maintenance but may be important for many other health outcomes. This process, which is the only well-established benefit of solar UVR exposure, depends on many factors including genetics, age, health, and behavior. However, the most important factor is the quantity and quality of UVR reaching the skin. Vitamin D synthesis specifically requires ultraviolet B (UVB) radiation that is the minority component (<5%) of solar UVR. This waveband is also the most important for the adverse effects of solar exposure. The most obvious of which is sunburn (erythema), but UVB is also the main cause of DNA damage to the skin that is a prerequisite for most skin cancers. UVB at the Earth's surface depends on many physical and temporal factors such as latitude, altitude, season, and weather. Personal, cultural, and behavioral factors are also important. These include skin melanin, clothing, body surface area exposed, holiday habits, and sunscreen use. There is considerable disagreement in the literature about the role of some of these factors, possibly because some studies have been done by researchers with little understanding of photobiology. It can be argued that vitamin D supplementation obviates the need for solar exposure, but many studies have shown little benefit from this approach for a wide range of health outcomes. There is also increasing evidence that such exposure offers health benefits independently of vitamin D: the most important of which is blood-pressure reduction. In any case, public health advice must optimize risk versus benefit for solar exposure. It is fortunate that the individual UVB doses necessary for maintaining optimal vitamin D status are lower than those for sunburn, irrespective of skin melanin. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

Vitamin D Update

Purpose

The goal of this review is to provide an update in the field of vitamin D, in particular, the role of vitamin D in non-skeletal health, the complexity of providing patient guidance regarding obtaining sufficient vitamin D, and the possible involvement of vitamin D in morbidity and mortality due to SARS-CoV-2 (COVID-19).

Recent Findings

In addition to bone health, vitamin D may play a role in innate immunity, cardiovascular disease, and asthma. Although rickets is often regarded as an historical disease of the early twentieth century, it appears to be making a comeback worldwide, including “first-world” countries. Broad-spectrum sunscreens (with high UVA filters) that prevent erythema are unlikely to compromise vitamin D status in healthy populations.

Summary

New attention is now focused on the role of vitamin D in a variety of diseases, and more individualized patient recommendation schemes are being considered that take into account more realistic and achievable goals for achieving sufficient vitamin D through diet, supplements, and sun behavior.

Materials Science Challenges in Skin UV Protection: A Review

UV radiation is one of the critical environmental stress factors for human skin, which can trigger various problems such as pruritus, burning, erythema, premature skin aging and skin cancer. Hence, UV protection has become an indispensable daily routine and the use of topical sunscreen products is rapidly increasing. However, there are emerging concerns over the efficiency and safety of existing chemical and physical UV filters used in consumer products. Furthermore, there is no universally approved method for assessing sun protection efficiency regardless of the immediate end user need to develop safer sunscreen products that afford broad-spectrum photoprotection. It is evident that the current organic and inorganic UV filters have significant unfavorable impacts on human, environmental, and marine safety. Therefore, effective alternative UV filters should be established. This article comprehensively reviews the properties, safety, health and ecological concerns of various UV filters including TiO₂ and ZnO nanoparticles as well as the limitations of the testing protocols and guidelines provided by major regulatory bodies. The photoreactivity of UV filters used in sunscreen remains a major challenge, and it is crucial to develop new sunscreen ingredients, which not only protect the consumer, but also the environment.

A Randomized Study to Determine the Sun Protection Factor of Natural Pterostilbene from Pterocarpus Marsupium

Ultraviolet (UV) rays and its harmful effects have always been a concern to skin health. Sunscreen and sunblock prevent the harmful effects of UV radiation on the skin. Sun Protection Factor (SPF) is an indication of the sun-protective capacity of an ingredient. There is an ever increasing interest in the cosmetic industry for developing novel functional ingredients from natural sources. The purpose of this study was to determine in-vitro and in vivo SPF of natural 90% pterostilbene extracted from the dried heartwood of Pterocarpus marsupium (Indian Kino). The SPF of purified pterostilbene and a formulation containing 0.4% pterostilbene was determined In Vitro using a UV spectrophotometer. Pterostilbene had an SPF of 21.73 ± 0.06, while the cream formulation had an SPF of 8.84 ± 0.01. The in vivo SPF of the 0.4% pterostilbene cream in humans was found to be 6.2 ± 1.30. Primary skin irritation tests in human subjects showed the formulation was safe and had no irritation potential. Pterostilbene was also found to have significant antioxidant activity as determined by free radical scavenging assays in vitro. These results suggest that natural pterostilbene is an antioxidant and shows SPF value both in-vitro and in the human clinical study and thus could be used as an ingredient in topical sun-protective formulations.

Melanin has a Small Inhibitory Effect on Cutaneous Vitamin D Synthesis: A Comparison of Extreme Phenotypes

Epidemiology suggests that melanin inhibits cutaneous vitamin D₃ synthesis by UVR. Laboratory investigations assessing the impact of melanin on vitamin D production have produced contradictory results. We determined the effect of melanin on vitamin D₃ photosynthesis in healthy young volunteers (n = 102) of Fitzpatrick skin types II-VI (white to black). Participants, irrespective of skin type, were exposed to the same suberythemal UVR dose, to 85% body surface area, using solar simulated UVR or narrowband UVB (311 nm). This was repeated five times with intervals of 3-4 days between UVR exposures. Blood was taken before, during, and after the irradiation and assessed for serum 25-hydroxyvitamin D₃ (25[OH]D₃) as a marker of vitamin D₃ status. Linear UVR dose-dependent increases in 25(OH)D₃ were highly significant (P ≤ 7.7 x 10^-11). The ratios of regression slopes of the different skin type groups were compared, and only skin type II was significantly steeper than the other groups. Comparisons between extreme skin types II and VI showed melanin inhibition factors of approximately 1.3-1.4, depending on the UVR source. We conclude that the inhibitory effect of melanin on vitamin D₃ synthesis is small, compared with erythema, but that this difference may be sufficient to explain the epidemiological data.

Sun exposure and health safety practices of high school students in an urban population of Iran

Background

Skin cancer attributed to sunlight exposure has an increasing trend worldwide, resulting in increased problems for healthcare services. This study aimed to evaluate the health safety practices of high school students in Saveh, Iran according to a sun protection guideline produced locally for Iran.

Method

This cross-sectional study was done in 31 government and private high schools of Saveh, a central city of Iran. A sun protection questionnaire was designed in accordance with Iran sun protection guideline which has been developed based on the World Health Organization and US Environmental Protection Agency guidelines. The questionnaire consists of four sections of demographic information, knowledge, attitude, and protection behavior. A total of 504 students were selected by simple random sampling method. Pearson correlation coefficient and multiple linear regression analysis were used to assess the correlation between knowledge, attitude and behavior of the participants.

Results

The mean score of the students’ knowledge, attitude, and behavior regarding harmfulness of ultraviolet radiation was 50.79 ± 14.64, 60.41 ± 15.04, and 45 ± 11.59, respectively. A significant association was observed between attitude and knowledge, behavior and knowledge as well as attitude. There was a significant correlation between sex and protective behaviors, sex and knowledge (p ≤ 0.001), and education level and knowledge (p = 0.002).

Conclusion

students who protected themselves from sunlight less than others believed that their protection level was adequate. Health concerns related to sun exposure suggest the need for increasing the student’s awareness in sun protection area. As behavior is influenced by cultural aspects, implementation of the current guideline can be effective in reducing the health effects of sun exposure.

Measurements of sun sensitivity in five European countries confirm the relative nature of Fitzpatrick skin phototype scale

BACKGROUND/PURPOSE

Skin colour and sun sensitivity are highly related to the distance to the equator: people in southern latitudes are usually darker and less sensitive to sun than in northern latitudes. Whether differences in sun sensitivity can be found in a relatively homogenous European population is unclear. We aimed to objectively measure sun sensitivity (assessed as pigment protection factor (PPF)) in five European countries, relate it to self-assessed Fitzpatrick skin phototype (FST) and to determine whether PPF levels in the different FST categories are dependent on the investigated countries.

METHODS

Volunteers (n = 569) were recruited in Copenhagen (Denmark), Dublin (Ireland), London (England), Münster (Germany) and Ioannina (Greece). Skin phototype was self-assessed using the FST scale. PPF was measured at both sun-protected buttocks and five sun-exposed skin sites by a skin reflectance spectrophotometer.

RESULTS

Overall, there were statistically significant differences in PPF of the buttocks, inner arm, outer arm, forehead, chest and back between the five countries (P ≤ .031). Generally, PPF level was lower in northern than in southern latitudes. PPF of the buttocks was similar in all countries for those who identified as FST I (P = .723). However, it was statistically significantly different (P ≤ 2.913*10^-4 ) and country-dependent for those who identified as FST II-IV.

CONCLUSION

Objectively measured sun sensitivity is higher (lower PPF) in northern compared with southern latitudes. The choice of self-identified FST category is influenced by a person's immediate environment. Therefore, we confirmed the relative nature of the FST scale and the need to standardise the skin phototype assessment procedure.

Melanism protects alpine zooplankton from DNA damage caused by ultraviolet radiation

Melanism is widely observed among animals, and is adaptive in various contexts for its thermoregulatory, camouflaging, mate-attraction or photoprotective properties. Many organisms exposed to ultraviolet radiation show increased fitness resulting from melanin pigmentation; this has been assumed to result in part from reduced UV-induced damage to DNA. However, to effectively test the hypothesis that melanin pigmentation reduces UV-induced DNA damage requires quantification of UV-specific DNA damage lesions following UV exposure under controlled conditions using individuals that vary in pigmentation intensity. We accomplished this using alpine genotypes of the freshwater microcrustacean Daphnia melanica, for which we quantified cyclobutane pyrimide dimers in DNA, a damage structure that can only be generated by UV exposure. For genotypes with carapace melanin pigmentation, we found that individuals with greater melanin content sustained lower levels of UV-induced DNA damage. Individuals with more melanin were also more likely to survive exposure to ecologically relevant levels of UV-B radiation. Parallel experiments with conspecific genotypes that lack carapace melanin pigmentation provide additional support for our conclusion that melanism protects individuals from UV-induced DNA damage. Finally, within-genotype comparisons with asexually produced clonal siblings demonstrate that melanin content influences DNA damage even among genetically identical individuals raised in the same environment.

No effect of Turkish bath (Hammam) on sunburn after exposure to natural ultraviolet radiation: A randomized controlled blinded trial

BACKGROUND

Scrubbing of the skin during Hammam, a Turkish spa treatment, removes cells from the ultraviolet radiation absorbing stratum corneum.

AIM

The aim of this study was to assess if skin is more susceptible to sunburn after a Hammam treatment.

METHODS

In this randomized controlled trial with a paired design, healthy adult participants with skin types 1-3 were randomized to receive Hammam treatment on one side of the back while the other side was used as control. Participants had 30 minutes of sun exposure on their backs. Erythema and pain were assessed before and 1, 4, 8, and 24 hours after sun exposure. Erythema was assessed by a visual scale and by using chromatography on high-resolution photos. Pain was assessed with the Visual Analogue Scale (VAS). The primary outcome was the difference in chromatography-assessed erythema from baseline to the 24-hour assessment, compared between the Hammam- and the control side. Secondary outcomes were differences in pain and visually assessed erythema.

RESULTS

Twelve participants were included with complete follow-up. Eight participants had type-3 skin and four had type-2 skin. There was no difference between the Hammam and the control side for any of the outcomes. Even though erythema assessed by chromatography was slightly higher for the Hammam side, the difference was insignificant.

CONCLUSION

Hammam treatment did not increase sunburn, measured by UV-induced skin erythema and pain, compared with untreated skin following 30 minutes of sun exposure.

The molecular clock in the skin, its functionality, and how it is disrupted in cutaneous melanoma: a new pharmacological target?

The skin is the interface between the organism and the external environment, acting as its first barrier. Thus, this organ is constantly challenged by physical stimuli such as UV and infrared radiation, visible light, and temperature as well as chemicals and pathogens. To counteract the deleterious effects of the above-mentioned stimuli, the skin has complex defense mechanisms such as: immune and neuroendocrine systems; shedding of epidermal squamous layers and apoptosis of damaged cells; DNA repair; and pigmentary system. Here we have reviewed the current knowledge regarding which stimuli affect the molecular clock of the skin, the consequences to skin-related biological processes and, based on such knowledge, we suggest some therapeutic targets. We also explored the recent advances regarding the molecular clock disruption in melanoma, its impact on the carcinogenic process, and its therapeutic value in melanoma treatment.

The color of skin: red diseases of the skin, nails, and mucosa

Red color is pervasive in local and systemic skin conditions. It is a color that often reflects variations of dermal blood flow and extends beyond the rubor and calor of inflammation. The pathophysiology of red skin involves remote and local chemical mediators that dilate arteriolar smooth muscle and increase blood flow to superficial vessels and capillary beds. Incident light hits hemoglobin, which preferentially absorbs light of shorter wavelengths, such as blue, and reflects warmer colors. Due to its pervasiveness and consistency, red color is a useful descriptive factor in helping narrow a differential diagnosis. Red skin disorders include a variety of conditions involving endocrine mediators, cardiovascular responses, and the disruption of the skin barrier. An understanding of the blood's role in these disorders equips clinicians to generate differential diagnoses through the lens of pathophysiology. Dermatologists can improve management by considering red skin as part of systemic disease rather than as an isolated incident.

A Prospective Cohort Study of Vitamin D Supplementation in AD Soldiers: Preliminary Findings

PURPOSE

To explore response to vitamin D supplementation in active duty (AD) warfighters and translate findings into evidence-based health policy.

BACKGROUND

Soldiers are at risk for musculoskeletal injuries and metabolic dysfunction that impact physical performance and military readiness; the link with low vitamin D status is unclear.

METHODS

This prospective trial enrolled 152 soldiers; baseline 25 hydroxyvitamin (OH) D level determined assignment to a no-treatment control (CG) or treatment group (TG) receiving a vitamin D3 supplement for 90 days. Symptoms, diet, sun exposure, and blood biomarkers obtained at baseline (T1) and 3 months (T2).

RESULTS

Cohort was predominantly white (58%) with a significant difference in racial distribution for vitamin D status. Mean (SD) 25(OH)D levels were 37.8 (5.6) ng/mL, 22.2 (5.0) ng/mL, and 22.9 (4.7) ng/mL for the CG, low dose TG, and high-dose TG at T1, respectively. Following three months of treatment, one-way ANOVA indicated a statistically significant difference between groups (F5,246 = 44.37; p < 0.0001). Vitamin D intake was 44% of Recommended Dietary Allowance throughout the first phase of the trial. Patient-Reported Outcomes Measurement Information System scores improved in TG for fatigue and sleep, p < 0.01.

CONCLUSIONS

Vitamin D deficiency is widespread in AD soldiers. Clinicians must intervene early in preventable health conditions impacting warfighter performance and readiness and recommend appropriate self-care strategies.

Comorbidities in multiple sclerosis-a plea for interdisciplinary collaboration to improve the quality of life of MS patients

The negative influence of comorbidities on the quality of life of people with multiple sclerosis is evident and the problem is increasingly acknowledged by numerous international studies in long-term care. One therapeutic option would be an add-on therapy with vitamin D (VD), with the aim of achieving a therapeutically effective dose. The individually required VD dose must be tested, since the response to a certain dose is subject to variations between individuals. A possible toxicity with increased 1.25(OH)D3 (active VD metabolite) is largely prevented by increased activity of 24-hydroxylase (CYP24A1). Monitoring of serum VD levels as well as serum calcium and phosphate levels (optional Ca excretion in 24-hour urine, Ca creatinine ratio in urine) provides safety and is necessary because possible mutations on the (catabolic) CYP24A1 gene can lead to a partial or total loss of 24-hydroxylase activity and provoke hypercalcemia/hyperphosphatemia. The main therapeutic objective is to maintain functional and social independence by using drugs with a high safety profile. The prevention and optimal management of comorbidities can influence the quality of life of patients with MS (PwMS) when included in patient care. Adequate measures can reduce the burden of MS only if the risk of comorbidity is reduced through targeted monitoring, early detection and diagnosis. Such a strategy will contribute to influencing the premature mortality of patients with MS. If VD is recognized as a "multipurpose steroid hormone", it could also be used to maintain cognitive function and prevent premature possible dementia, especially as there is evidence that VD deficiency correlates with brain atrophy (hippocampus). At present, MS therapy is still a balancing act between therapeutically efficient action and the management of unexpected side effects, with VD add-on therapy being almost unproblematic and most likely to be accepted by PwMS.

Targeted photosensitizer delivery: A prospective approach to vitiligo photochemotherapy

Aim. In this work, the authors set out to develop an effective method for the intrafollicular delivery of “Ammi majus fructuum furocumarines” photosensitizer (AMFF) followed by UVA irradiation (λ = 320–400 nm). Materials and methods. The proposed delivery method consists in using calcium carbonate particles acting as AMFF carriers. In vivo monitoring of hair follicle filling was carried out via optical coherence tomography, as well as by means of analyzing epilated hair using confocal laser scanning microscopy. Following the administration of free and encapsulated AMFF to three healthy volunteers, the character of UVA-induced skin pigmentation was registered under dermatoscopic examination. Results. The obtained results demonstrate a profuse filling of hair follicles with calcium carbonate particles, thus confirming the possibility of intrafollicular photosensitizer delivery. It was established that exposure to UVA irradiation causes intense pigment accumulation in the area of AMFF carrier administration. Conclusion. The proposed method of the targeted photosensitizer delivery allows photochemical therapy to be improved.