1
|
Heerfordt IM, Windfeld-Mathiasen J, Dalhoff KP, Mogensen M, Andersen JT, Horwitz H. Cutaneous manifestations of misuse of androgenic anabolic steroids: A retrospective cohort study. J Am Acad Dermatol 2024; 90:1047-1048. [PMID: 38215797 DOI: 10.1016/j.jaad.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/12/2023] [Accepted: 01/06/2024] [Indexed: 01/14/2024]
Affiliation(s)
- Ida M Heerfordt
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - Josefine Windfeld-Mathiasen
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kim Peder Dalhoff
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Mogensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jon Trærup Andersen
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Horwitz
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Heerfordt IM, Windfeld-Mathiasen J, Dalhoff KP, Trærup Andersen J, Horwitz H. Excessive androgen exposure and risk of malignancies: A cohort study. Andrology 2024. [PMID: 38602128 DOI: 10.1111/andr.13648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND A link between androgen use and the risk of cancers, especially prostate and breast cancer, has been suggested. The knowledge about a possible association is limited. OBJECTIVE The study aimed to investigate cancer incidence rates, particularly those related to prostate and breast cancer, in male androgen users and compare them to a control group. METHODS We included male androgen users identified through a nationwide anti-doping testing program in Danish fitness centers from 2006 to 2018. We paired each case with 50 male controls of the same age, selected randomly. The cohort was followed from baseline and until 2023. The outcome was the incidence of prostate cancer, breast cancer, or any cancer excluding non-melanoma skin cancer. RESULTS The study included 1,189 androgen users and 59,450 controls, with a mean age of 27 years at enrolment. During the follow-up period with a mean length of 11 years, 13 androgen users, and 612 controls were diagnosed with cancer. This resulted in an incidence rate ratio of 1.05 (95% CI: 0.55-1.81). None of the androgen users were diagnosed with prostate or breast cancer. DISCUSSION AND CONCLUSION Male androgen users did not face an increased short-term risk of cancer, neither overall nor related to prostate or breast cancer. Our study indicates that the absolute risk of malignancies in androgen users is comparable to that in the background population. However, we cannot exclude androgens as a cancer risk factor due to the limited sample size, relatively short follow-up period, and subject age.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Kim Peder Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jon Trærup Andersen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Horwitz
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Windfeld-Mathiasen J, Heerfordt IM, Dalhoff KP, Andersen JT, Horwitz H. Mortality Among Users of Anabolic Steroids. JAMA 2024; 331:1229-1230. [PMID: 38483396 PMCID: PMC10941020 DOI: 10.1001/jama.2024.3180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
This cohort study investigates mortality and cause of death among a large cohort of androgenic anabolic steroid users, compared with a control group, in Denmark from January 3, 2006, to March 1, 2018.
Collapse
Affiliation(s)
| | - Ida M. Heerfordt
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kim Peder Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jon Trærup Andersen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Henrik Horwitz
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| |
Collapse
|
4
|
Giraldi L, Heerfordt IM, Windfeld-Mathiasen J, Dalhoff KP, Andersen JT, Horwitz H. Extensive androgen exposure and meningioma risk - A matched cohort study. Clin Neurol Neurosurg 2024; 239:108217. [PMID: 38452714 DOI: 10.1016/j.clineuro.2024.108217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Meningiomas frequently occur within the field of neuro-oncology, but it is unclear whether exogenous or imbalanced endogenous hormones are involved in the pathophysiology. A previous case-control study found an almost 20-fold increase in the risk of developing meningioma among users of androgenic anabolic steroids. We, therefore, investigated this hypothesis. METHODS We compared the incidence rate of meningioma in a cohort of males sanctioned for the use of androgenic anabolic steroids with age- and sex-matched controls with an identical enrollment date. RESULTS We followed 1189 males sanctioned for using androgenic anabolic steroids for a total of 13,305 person-years and found 0 cases of meningioma. The control cohort of 59,450 males was followed for a total of 654,938 person-years, and 16 were diagnosed with meningioma. Thus, the incidence rate ratio was 0 (95% CI: 0-12.8). CONCLUSION We did not find any evidence supporting the hypothesis of an increased risk of meningioma development with the use of androgenic anabolic steroids. Due to the limited sample size, we cannot exclude androgenic anabolic steroids as a potential risk factor for meningioma development, despite the lack of apparent evidence in this study.
Collapse
Affiliation(s)
- Laura Giraldi
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ida M Heerfordt
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | | | - Kim Peder Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jon Trærup Andersen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Horwitz
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Heerfordt IM, Philipsen PA, Andersen JD, Langhans L, Schmidt G, Morling N, Wulf HC. RNA analysis of tape strips to rule out melanoma in lesions clinically assessed as cutaneous malignant melanoma: A diagnostic study. J Am Acad Dermatol 2023; 89:537-543. [PMID: 37224970 DOI: 10.1016/j.jaad.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Distinguishing cutaneous malignant melanoma (CMM) from nevi can be clinically challenging. Suspicious lesions are therefore excised, resulting in many benign lesions being removed surgically to find 1 CMM. It has been proposed to use tape strip derived ribonucleic acid (RNA) to distinguish CMM from nevi. OBJECTIVE To develop this technique further and validate if RNA profiles can rule out CMM in clinically suspicious lesions with 100% sensitivity. METHODS Before surgical excision, 200 lesions clinically assessed as CMM were tape stripped. Expression levels of 11 genes on the tapes were investigated by RNA measurement and used in a rule-out test. RESULTS Histopathology showed that 73 CMMs and 127 non-CMMs were included. Our test correctly identified all CMMs (100% sensitivity) based on the expression levels of 2 oncogenes, PRAME and KIT, relative to a housekeeping gene. Patient age and sample storage time were also significant. Simultaneously, our test correctly excluded CMM in 32% of non-CMM lesions (32% specificity). LIMITATIONS Our sample contained a very high proportion of CMMs, perhaps due to inclusion during COVID-19 shutdown. Validation in a separate trial must be performed. CONCLUSION Our results demonstrate that the technique can reduce removal of benign lesions by one-third without overlooking any CMMs.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - Peter A Philipsen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jeppe D Andersen
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Linnea Langhans
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Grethe Schmidt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Niels Morling
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
6
|
Heerfordt IM. Artificial intelligence-assisted publishing in 5 prominent dermatology journals: A quantitative study of recent publications. Clin Exp Dermatol 2023:llad250. [PMID: 37493214 DOI: 10.1093/ced/llad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 9, 2400 Copenhagen, Denmark
| |
Collapse
|
7
|
Heerfordt IM, Philipsen PA, Lerche CM, Wulf HC. Phototesting in erythropoietic protoporphyria trials: A systematic review. Exp Dermatol 2023. [PMID: 37052136 DOI: 10.1111/exd.14809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Abstract
Severe skin pain when exposed to long wave ultraviolet radiation or visible light is the main symptom of erythropoietic protoporphyria (EPP). Treatment options for EPP are inadequate and new treatments are needed but hampered by the lack of valid efficacy outcomes. Phototesting with well-defined illumination of the skin can be performed reliably. We aimed to provide an overview of phototest procedures used to evaluate EPP treatments. Systematic searches of Embase, MEDLINE and the Cochrane Library were performed. Searches identified 11 studies using photosensitivity as efficacy outcome. The studies used eight different phototest protocols. Illuminations were performed with a filtered high-pressure mercury arc, or a xenon arc lamp equipped with monochromator or filters. Some used broadband, others narrowband illumination. In all protocols phototests were performed on the hands or the back. Endpoints were minimal dose required to induce either first symptom of discomfort, erythema, urticaria or intolerable pain. Other endpoints were change in erythema intensity or diameter of any type of flare after exposure compared to before. In conclusion, protocols displayed extensive variability in illumination set-up and evaluation of phototest reactions. Implementation of a standardized phototest method will allow more consistent and reliable outcome evaluation in future therapeutic research of protoporphyric photosensitivity.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Catharina M Lerche
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
8
|
Thomsen IMN, Heerfordt IM, Karmisholt KE, Mogensen M. Detection of cutaneous malignant melanoma by tape stripping of pigmented skin lesions - A systematic review. Skin Res Technol 2023; 29:e13286. [PMID: 36973976 PMCID: PMC10155806 DOI: 10.1111/srt.13286] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/13/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Cutaneous malignant melanoma (MM) is potentially aggressive, and numerous clinically suspicious pigmented skin lesions are excised, causing unnecessary mutilation for patients at high healthcare costs, but without histopathological evidence of MM. The high number of excisions may be lowered by using more accurate diagnostics. Tape stripping (TS) of clinically suspicious lesions is a non-invasive diagnostic test of MM that can potentially lower the number needed to biopsy/excise. MATERIALS AND METHODS The aim is to determine the diagnostic accuracy of TS in detecting MM in clinically suspicious pigmented skin lesions. This systematic review following PRISMA guidelines searched PubMed, Web of Science, and Embase (September 2022) using melanoma combined with tape stripping, adhesive patch(es), pigmented lesion assay, or epidermal genetic information retrieval. RESULTS Ten studies were included. Sensitivity ranged from 68.8% (95% confidence interval [CI] 51.5, 82.1) to 100% (95% CI 91.0, 100). Specificity ranged from 69.1% (95% CI 63.8, 74.0) to 100% (95% CI 78.5, 100). A pooled analysis of five studies testing the RNA markers LINC00518 and PRAME found a sensitivity of 86.9% (95% CI 81.7, 90.8) and a specificity of 82.4% (95% CI 80.8, 83.9). CONCLUSION Overall quality of studies was low, and the reliability of sensitivity and specificity is questionable. However, TS may supplement well-established diagnostic methods as pooled analysis of five studies indicates a moderate sensitivity. Future studies are needed to obtain more reliable data as independent studies with no conflict of interest.
Collapse
Affiliation(s)
| | - Ida M. Heerfordt
- Department of DermatologyCopenhagen University Hospital – BispebjergCopenhagenDenmark
| | - Katrine Elisabeth Karmisholt
- Department of DermatologyCopenhagen University Hospital – BispebjergCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Mette Mogensen
- Department of DermatologyCopenhagen University Hospital – BispebjergCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
9
|
Heerfordt IM, Philipsen PA, Lerche CM, Wulf HC. Protection against visible light by dihydroxyacetone in erythropoietic protoporphyria. Photodiagnosis Photodyn Ther 2023; 41:103302. [PMID: 36690194 DOI: 10.1016/j.pdpdt.2023.103302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients with erythropoietic protoporphyria (EPP) are hypersensitive to long wave ultraviolet (UVA) radiation and visible light and they experience severe skin pain by light exposure. The patients have very limited treatment options. Sunless skin tanning with dihydroxyacetone (DHA) is now being investigated as a possible treatment modality of skin photosensitivity in EPP. METHODS We simulated the theoretical light protection factor provided by DHA application. In addition, we present 19 cases with EPP who were treated at our department with DHA weekly during spring and summer from 2018 to 2021 inclusive. RESULTS The protection factor against UVA and visible light was estimated to approximately two. Out of the 19 patients with EPP who were treated with DHA in 2018, 11 patients experienced a sustained good effect and continued to use the treatment on a weekly basis in the spring and summer of 2019, 2020, and 2021. CONCLUSION AND PERSPECTIVES Both the theoretical estimates and the uncontrolled study suggest that sunless tanning with DHA reduces photosensitivity in patients with EPP. Our hypothesis is that skin treated with DHA can tolerate twice the daylight dose compared to untreated skin before onset of skin symptoms. To validate this conclusion, we plan a randomized clinical trial to determine the effect of DHA application to reduce photosensitivity in patients with EPP under controlled clinical conditions. The study protocol for this trial is presented in the paper.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark.
| | - Peter A Philipsen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark
| | - Catharina M Lerche
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark; Department of Pharmacy, University of Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark
| |
Collapse
|
10
|
Wulf HC, Heerfordt IM. Counteracting Side-effects of Photodynamic Therapy for Actinic Keratoses. Anticancer Res 2022; 42:5017-5020. [PMID: 36192011 DOI: 10.21873/anticanres.16009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/02/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Actinic keratoses (AKs) are precursors of squamous cell carcinomas and early intervention is important. Photodynamic therapy (PDT) is often first-choice treatment for widespread AKs. Classic PDT consists of: Superficial curettage, application of 5-aminolevulinic acid or methyl aminolevulinate, incubation and protoporphyrin IX (PpIX) accumulation under occlusion for 3 hours, followed by illumination with red light-emitting diode light (37 J/cm2). Classic PDT is effective in treating AKs, but side-effects include unpleasant pretreatment, severe pain during illumination, inflammation after treatment, and long waiting time in the clinic. MATERIALS AND METHODS This targeted mini review describes efforts to counteract side-effects and simplify the procedure considering the clinic capacity. Changes are only acceptable if treatment effect is maintained. RESULTS We introduce the following procedure changes: (i) reducing pre-treatment pain, bleeding, and oozing by omitting curettage; (ii) long-term illumination for 2 hours during PpIX formation (already in use as daylight PDT) and shortening of incubation time from 3 hours to 30 minutes to minimize pain and inflammation risk. In addition, options of timing, incubation, and illumination indoors and outdoors are discussed, focusing on advantages and disadvantages for patients and clinics. CONCLUSION We report several options to counteract side-effects of classic PDT.
Collapse
Affiliation(s)
- Hans Christian Wulf
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ida M Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
11
|
Heerfordt IM, Andersen JD, Philipsen PA, Langhans L, Tvedebrink T, Schmidt G, Poulsen T, Lerche CM, Morling N, Wulf HC. Detection of cutaneous malignant melanoma using RNA sampled by tape strips: A study protocol. PLoS One 2022; 17:e0274413. [PMID: 36129945 PMCID: PMC9491607 DOI: 10.1371/journal.pone.0274413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/30/2022] [Indexed: 12/12/2022] Open
Abstract
Background Cutaneous malignant melanoma (CMM) is curable if detected in its early stages. However, the clinical recognition of CMM is challenging. An American research group has shown promising results in detecting CMM based on RNA profiles sampled from suspicious lesions with tape strips. We aim to further develop this technique and validate if RNA profiles sampled with tape strips can detect CMM. Methods This prospective cohort study will include approximately 200 lesions clinically suspected of CMM requiring surgical removal. Tape stripping of the lesions will be performed just before surgical excision. Subsequently, RNA on the tape strips is analyzed using quantitative real-time polymerase chain reaction with TaqMan technology. The results are combined into a binary outcome where positive indicates CMM and negative indicates no CMM. The histopathological diagnosis of the lesions will be used as the gold standard. The main outcome is the results of the RNA test and the histopathological diagnosis, which, combined, provide the sensitivity and specificity of the test. Discussion The accuracy of the clinical examination in CMM diagnostics is limited. This clinical trial will explore the ability to use RNA analysis to improve the management of suspicious lesions by enhancing early diagnostic accuracy. Hopefully, it can reduce the number of benign lesions being surgically removed to rule out CMM and decrease patient morbidity. Trial registration The project was approved by The Committee on Health Research Ethics of the Capital Region of Denmark (H-15010559) and registered at the Danish Data Protection Agency (BFH-2015-065).
Collapse
Affiliation(s)
- Ida M. Heerfordt
- Department of Dermatology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- * E-mail:
| | - Jeppe D. Andersen
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter A. Philipsen
- Department of Dermatology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Linnea Langhans
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Torben Tvedebrink
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Mathematical Sciences, Aalborg University, Aalborg, Denmark
| | - Grethe Schmidt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Thomas Poulsen
- Department of Pathology, Hospital of Southern Jutland, Soenderborg, Denmark
| | - Catharina M. Lerche
- Department of Dermatology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Niels Morling
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
12
|
Heerfordt IM, Lerche CM, Wulf HC. Cimetidine for erythropoietic protoporphyria. Photodiagnosis Photodyn Ther 2022; 38:102793. [PMID: 35245673 DOI: 10.1016/j.pdpdt.2022.102793] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Erythropoietic protoporphyria (EPP) is caused by deficiency of the enzyme converting protoporphyrin IX (PpIX) into heme resulting in accumulation of PpIX leading to photosensitivity and liver toxicity. Cimetidine might inhibit δ-aminolevulinic acid synthase influencing the heme biosynthesis. We present cases with EPP treated with cimetidine at our department, and a literature review. METHODS Systematic searches were performed to identify literature describing EPP patients treated with cimetidine. On that ground we treated EPP patients with cimetidine through spring and summer in 2020 and 2021 at our department. Their erythrocyte PpIX level and standard blood and liver parameters were collected before and during 4 months of treatment. Using a questionnaire, patients were asked about change in photosensitivity, side effects, and whether they would like to resume treatment in the spring of 2022. RESULTS Literature searches identified 9 patients treated with cimetidine. Four were outpatients reporting decreased photosensitivity. At our department 18 outpatients started treatment. Fifteen used oral cimetidine daily for 4 months or more providing a significant decrease in erythrocyte PpIX with a median of 20% (range: -18% to 53%) after 4 months. Eleven of the 15 patients reported a decrease in photosensitivity during treatment, 3 patients were unsure, and 1 patient experienced unchanged photosensitivity. Only mild side effects were reported. Fourteen patients requested to resume treatment in the spring of 2022. CONCLUSIONS These cases suggest that cimetidine can lower erythrocyte PpIX in patients with EPP.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark.
| | - Catharina M Lerche
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark; Department of Pharmacy, University of Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark
| |
Collapse
|
13
|
Affiliation(s)
- Ida M Heerfordt
- Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark
| |
Collapse
|
14
|
Heerfordt IM, Fontenete S, Lerche CM, Wulf HC. Distribution of protoporphyrin IX in erythrocytes in a case of acquired erythropoietic protoporphyria. Photodiagnosis Photodyn Ther 2021; 37:102629. [PMID: 34798346 DOI: 10.1016/j.pdpdt.2021.102629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Erythropoietic protoporphyria (EPP) is a rare genetic photodermatosis caused by loss-of-function mutations in the gene for ferrochelatase leading to accumulation of the fluorescent protoporphyrin IX (PpIX) in erythrocytes. The mutations are most often inherited mutations present in all cells causing inherited EPP. In very rare cases EPP are acquired in association with myelodysplastic syndromes or myeloproliferative neoplasms, conditions with genetic instability. CASE REPORT We report a case of acquired EPP in association with hematological disease. We followed erythrocyte PpIX concentration over a year and measured PpIX fluorescence in individual erythrocytes in a blood sample from the case using flow cytometry. The major proportion of erythrocytes did not fluoresce (84%), whereas 13% contained low PpIX fluorescence, 1% contained medium fluorescence, and 2% contained high fluorescence. DISCUSSION Our observation of the very skewed PpIX distribution in erythrocytes supports the description that acquired EPP is caused by a somatic mutation affecting a clone of hematopoietic cells.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark
| | | | - Catharina M Lerche
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark; Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark
| |
Collapse
|
15
|
Heerfordt IM, Lerche CM, Philipsen PA, Wulf HC. The effect of vitamin D recommendations on serum 25-hydroxyvitamin D level in patients with erythropoietic protoporphyria. Nutrition 2021; 93:111477. [PMID: 34763310 DOI: 10.1016/j.nut.2021.111477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Patients with erythropoietic protoporphyria (EPP) avoid sun exposure owing to photosensitivity. For decades, sun-avoiding Danes have been recommended daily vitamin D supplements all year. We offered our EPP patients serum 25-hydroxyvitamin D (25(OH)D) monitoring, and counseling if their level was low. We aimed to investigate the effect of the general recommendation and counseling on 25(OH)D status in patients attending our clinic. Additionally, the 25(OH)D status of our EPP patients was compared to that of British patients with EPP not taking vitamin D supplements and with that of the general Danish population. METHODS Forty-six Danish patients with EPP had 25(OH)D measured in 721 blood samples collected between 2003 and 2021. Dates of individual counseling were noted. Data on British patients with EPP and the general Danish population were extracted from previous publications. RESULTS Our patients had higher 25(OH)D levels than British patients with EPP not taking vitamin D supplements, but the recommendations did not elevate their 25(OH)D levels to that of the general Danish population. Overall, 17.5% of the 25(OH)D measurements in our EPP patients were below 30 nmol/L (deficiency) and 29.4% were between 30 and 50 nmol/L (insufficiency). Patients were monitored for a median of 11 y. Thirty-one patients had a total of 74 vitamin D counseling sessions, providing an increase in 25(OH)D of about 18 nmol/L the year after. However, many patients repeatedly developed insufficiency. CONCLUSIONS This study documents the positive effect of vitamin D recommendations on serum 25(OH)D in patients with EPP. Follow-up on vitamin D status and recommendations is essential to increase 25(OH)D levels.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Denmark.
| | - Catharina M Lerche
- Department of Dermatology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Denmark
| |
Collapse
|
16
|
Wulf HC, Heerfordt IM. Treatment of AIDS-related Kaposi's Sarcoma With Low-dose Radiotherapy - Follow-up on 2,305 Tumours. Anticancer Res 2021; 41:3871-3874. [PMID: 34281848 DOI: 10.21873/anticanres.15181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We aimed to report our experience obtained by treating AIDS-related Kaposi's sarcoma (KS) with radiotherapy before the era of antiretroviral therapy. PATIENTS AND METHODS This investigation was performed as a quality control of KS patients treated with low-dose radiotherapy at our department. KS patients referred to our section from 1983 up until 1990, were treated three times with radiotherapy (29-50 kV, 2-4 Gy), once every second week. RESULTS Initially, 74 skin KSs were treated three times with 2 Gy, of which 70% were treated successfully. Hereafter, other 2,066 KSs on the skin were treated three times with 4 Gy with a very high success rate of 93%. Additional 165 mucous KSs were treated three times with 4 Gy, of which 91% were treated successfully. CONCLUSION Low-dose radiotherapy is effective for the treatment of many AIDS-related KS patients.
Collapse
Affiliation(s)
- Hans Christian Wulf
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ida M Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
17
|
Heerfordt IM. Decreased public awareness of skin cancer during the coronavirus pandemic. Int J Dermatol 2021; 60:e334-e335. [PMID: 33982801 PMCID: PMC8239598 DOI: 10.1111/ijd.15659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
18
|
Heerfordt IM, Poulsen T, Wulf HC. Actinic keratoses contiguous with squamous cell carcinomas are mostly non-hyperkeratotic and with severe dysplasia. J Clin Pathol 2021; 75:560-563. [PMID: 33863749 DOI: 10.1136/jclinpath-2021-207497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 11/03/2022]
Abstract
AIMS Actinic keratosis (AK) is a precursor of cutaneous squamous cell carcinoma (SCC). No validated parameters can predict which AKs will progress into SCCs, but especially thick AKs are under suspicion. The clinical and histopathological thickness of AKs is strongly correlated. This study aimed to investigate the thicknesses and degree of dysplasia of AKs contiguous with SCCs assuming these AKs represent the AKs that have undergone malignant transformation. METHODS Files of the Pathology Department, Hospital of Southern Jutland, Denmark, were reviewed. 111 cases met the inclusion criteria: a skin biopsy containing an invasive SCC. All SCCs merged with an AK at the edge. Degree of dysplasia, epidermal thickness and stratum corneum thicknesses of AKs were measured. RESULTS All AKs showed severe dysplasia. Most AKs had a stratum corneum thickness under 0.1 mm and an epidermal thickness under 0.5 mm, corresponding to clinically thin and non-hyperkeratotic AKs. CONCLUSIONS Our result suggests malignant progression potential of AKs regardless of thickness.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Thomas Poulsen
- Department of Pathology, Hospital of Southern Jutland, Soenderborg, Denmark
| | | |
Collapse
|
19
|
Heerfordt IM, Heydenreich J, Philipsen PA, Lerche CM, Wulf HC. Light-provoked skin symptoms on the hands of erythropoietic protoporphyria patients related to personal dosimeter measurements, skin symptoms, light protection and priming. J Photochem Photobiol B 2020; 213:112054. [PMID: 33075648 DOI: 10.1016/j.jphotobiol.2020.112054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/08/2020] [Indexed: 12/29/2022]
Abstract
Erythropoietic protoporphyria (EPP) is characterised by accumulation of protoporphyrin IX (PpIX) in erythrocytes. Upon illumination PpIX is released to the skin. Activation of the photoactive substance PpIX causes painful skin symptoms. This study aimed to objectively quantify individual light exposure of EPP patients in their everyday lives through spring and summer. We further aimed to establish the associations between daily symptoms and light exposure dose to photoprimed and non-photoprimed skin, use of gloves, and erythrocyte PpIX concentration. 14 Danish EPP patients participated from April through June, the period when symptoms are most frequent. Light exposure was measured using personal electronic dosimeters with sensor sensitivity comparable to the absorption spectrum of PpIX, measuring the biological effect of the light in this disease. Concurrently participants reported symptoms and use of protective gloves in a diary. Patients had a blood sample analysed for erythrocyte PpIX. The median patient was exposed to an average daily PpIX-weighted light dose of 3.8 J/cm2 corresponding to approximately 15 min in the midday sun during summer in Denmark. The median patient reported symptoms on 29% and wore gloves on 11% of study days. There was a significant positive correlation between erythrocyte PpIX concentration and percentage of days wearing gloves (r = 0.65, p = 0.011), and a significant negative correlation between erythrocyte PpIX concentration and mean daily light dose on days not wearing gloves (r = -0.53, p = 0.049). Photosensitivity was strongly dependent on photopriming.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Jakob Heydenreich
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Catharina M Lerche
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
20
|
Abstract
BACKGROUND The rule of thumb "Fill up a handful of sunscreen and spread it all over your body" has been used in several sun safety campaigns. The intention was to increase the applied sunscreen to obtain a quantity of 2 mg/cm2 to all accessible skin. The present study is the first to investigate how this advice works in practice, evaluated by quantity of sunscreen applied and amount of covered skin. METHODS Seventeen volunteers wearing swimwear were asked to "Fill up a handful and spread it all over your body." Before and after sunscreen application, the volunteers were photographed in black light. As sunscreen absorbs black light, the darkness of the skin increases with increasing amounts of applied sunscreen, making it possible to identify skin left without coverage. The sunscreen container was weighed before and after to quantify the amount of sunscreen applied. RESULTS A median of 21% of the accessible skin was left completely without coverage. The 79% covered area was covered with a median of 1.12 mg/cm2, not the expected 2 mg/cm2. CONCLUSION In practice, the advice "Fill up a handful of sunscreen and spread it all over your body" led to a better but still modest protection, compared to the intended effect.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark.
| | - Peter A Philipsen
- Department of Dermatology Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - Hans Christian Wulf
- Department of Dermatology Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| |
Collapse
|
21
|
Heerfordt IM, Lerche CM, Wulf HC. Trends in erythrocyte protoporphyrin IX concentration by age, sex and season among patients with erythropoietic protoporphyria-20 years of follow-up. Photodiagnosis Photodyn Ther 2020; 32:101928. [PMID: 32717453 DOI: 10.1016/j.pdpdt.2020.101928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Erythropoietic protoporphyria (EPP) is an inherited disorder leading to an increased concentration of the photoactive protoporphyrin IX (PpIX) in erythrocytes. Upon photoactivation in the dermal blood vessels and release to the skin, it causes painful skin symptoms when illuminated, depending on PpIX concentration. The present study aimed to investigate if erythrocyte PpIX concentration changes with age in patients with EPP. In addition, we tested gender differences and seasonal variation in erythrocyte PpIX concentration. METHODS 53 EPP patients aged 0-90 years were included in this retrospective observational study. A total of 751 blood samples were routinely analyzed for erythrocyte PpIX between 2000 and 2020. Trends in erythrocyte protoporphyrin IX concentration depending on age, sex and season were investigated. RESULTS Erythrocyte PpIX levels increased during childhood and youth (median annual increase of 2.7 μmol/L) to reach a stable level in adults though, with a decrease in concentration of about 8% in summer. On average the PpIX level was higher in men (mean of 56 μmol/L, range: 6-139) than women (mean of 38 μmol/L, range: 6-82). CONCLUSION We hope that our results can contribute to finding a physiological explanation for the changes in erythrocyte PpIX observed throughout the lives of patients with EPP.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark.
| | - Catharina M Lerche
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
| |
Collapse
|
22
|
Heerfordt C, Heerfordt IM. Has there been an increased interest in smoking cessation during the first months of the COVID-19 pandemic? A Google Trends study. Public Health 2020; 183:6-7. [PMID: 32388011 PMCID: PMC7167577 DOI: 10.1016/j.puhe.2020.04.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 01/06/2023]
Affiliation(s)
- C Heerfordt
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - I M Heerfordt
- Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark.
| |
Collapse
|
23
|
Heerfordt IM. Sunscreen use at Danish beaches and how to improve coverage. Dan Med J 2018; 65:B5476. [PMID: 29619938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Exposure to ultraviolet radiation (UVR) from the sun is the main risk factor for development of skin cancer. The incidence of skin cancer in Denmark and worldwide is high and increasing. The overall aim was to achieve basic knowledge about sun protection with sunscreen among beachgoers in Denmark. Other aims were to establish a method to investigate sunscreen distribution on the body and to test two approaches to optimize the used amount and body distribution of sunscreen. Furthermore, time and duration of a beach visit and use of protective clothes among beachgoers were determined to investigate the risk the beachgoers expose themselves to.
Of the counted number of beachgoers 46% were at the beach between noon and 3 p.m. where the UVR is strongest and a mean beach visit lasted 142 minutes. In the middle of the day 90% of the beachgoers wore swimwear and sunscreen application was their only possible sun protection. More beachgoers wore protective clothes in the morning and late afternoon.
Seventy-eight percent of women wearing swimwear reported sunscreen use at the beach and 49% of men reported sunscreen use. They used a sunscreen with a median sun protection factor (SPF) of 20 (interquartile range: 15-30). The effective SPF probably decreases exponentially with decreasing quantity of sunscreen applied. Users at the beach applied a mean quantity of 0.57 mg/cm2 (standard deviation 0.31 mg/cm2) to their sun accessible skin, i.e. skin not covered by swimwear or scalp hair, providing a mean effective SPF of 2.3. Both SPF chosen and quantity applied were independent of sex.
Two approaches to increase sunscreen use was tested; the rule of thumb: "Fill up a handful of sunscreen and spread it all over your body", and a recommendation to apply sunscreen two consecutive times. Both strategies increased the total amount of sunscreen significantly. The instruction: "Fill up a handful of sunscreen and spread it all over your body" increased the median quantity of sunscreen to 0.87 mg/cm2 whereas double application increased the quantity to 1.10 mg/cm2. Sunscreen with a label SPF of 20 applied in a quantity of 0.87 mg/cm2 provided an effective SPF of 3.7. Applied in a quantity of 1.10 mg/cm2 provided an effective SPF of 5.2.
A method based on a link between darkness of skin in black light illumination and the quantity of sunscreen applied was established and made it possible to investigate the distribution of sunscreen on the body. Sunscreen was very unevenly applied both after application of a handful and after double application. The face and the front of the trunk were generally well covered whereas the back of the trunk was poorly covered. After a single application, either as at the beach or with the use of a handful of sunscreen, about one fifth of the total accessible skin was left without sunscreen. After double application only about a 9% of the accessible skin was left uncovered. As especially missed areas are at risk of getting sunburned double application seems to be the better of the two tested strategies to improve coverage.
Collapse
|
24
|
Abstract
Sunscreen users are often inadequately protected and become sunburned. This study aimed to investigate how much two consecutive sunscreen applications increased the quantity of sunscreen applied and decreased the skin area left without sunscreen (missed area) compared to a single application. Thirty-one healthy volunteers wearing swimwear were included and applied sunscreen two consecutive times in a laboratory environment. Participants had pictures taken in black light before and after each application. As sunscreens absorb black light, the darkness of the skin increased with increasing amounts of sunscreen applied. We conducted a standard curve establishing a link between change in picture darkness and quantity of sunscreen. The quantity of sunscreen at selected skin sites as well as the percentage of missed area was determined after each application. Participants had missed a median of 20% of their available body surface after a single application. After double application they had missed 9%. The decrease in missed areas was significant for the whole body surface and for each of the body regions separately. The median participant had applied between 13% and 100% more sunscreen at the selected skin sites after double application than after single application. We recommend double application, especially before intense sun exposure.
Collapse
Affiliation(s)
- Ida M. Heerfordt
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, NV Copenhagen, Denmark
- * E-mail:
| | - Linnea R. Torsnes
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, NV Copenhagen, Denmark
| | - Peter A. Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, NV Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, NV Copenhagen, Denmark
| |
Collapse
|
25
|
Heerfordt IM, Bieliauskiene G, Wulf HC. Protoporphyrin IX formation after application of methyl aminolevulinate on the face and scalp with and without prior curettage. Photodiagnosis Photodyn Ther 2018; 22:155-157. [PMID: 29601904 DOI: 10.1016/j.pdpdt.2018.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/23/2018] [Accepted: 03/26/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Pulse photodynamic therapy (PDT) is carried out as classical PDT except that methyl aminolaevulinate (MAL) is removed after 30 min. Protoporphyrin IX (PpIX) accumulation becomes lower after 3 h in pulse-PDT than in classical PDT, but pulse-PDT still has full treatment effect on actinic keratosis (AK). The present study aimed to investigate when PpIX formation in classical PDT without curettage reaches the PpIX level in pulse-PDT with curettage in the skin of the face and scalp. METHODS Fourteen patients with AKs in the face and scalp were included in this pilot study. Each patient had two fields randomly allocated to two different regimes: (i) continuing MAL incubation without prior curettage (-Cur) and (ii) 30 min MAL incubation after curettage (+Cur). The PpIX level in each field was measured with a hand-held fluorescence photometer every 30 min for 6 h after MAL application. No illumination was performed. RESULTS The median PpIX level in the +Cur field after 3 h was 22 arbitrary units (AU), which represents the amount of PpIX that could have been photobleached after pulse-PDT with maximal treatment effect. After 3 h the median PpIX level in the -Cur field was 20 AU, which was not significantly different from the level in the +Cur field (p = 0.9). CONCLUSIONS We propose PDT without curettage as follows: 3 h of MAL incubation and subsequently sufficient illumination. The treatment effect of this regime should be tested to verify if curettage of the face and scalp area may be omitted in PDT.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark.
| | - Giedre Bieliauskiene
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
| |
Collapse
|
26
|
Heerfordt IM, Torsnes LR, Philipsen PA, Wulf HC. Photoprotection by sunscreen depends on time spent on application. Photodermatol Photoimmunol Photomed 2017; 34:117-121. [DOI: 10.1111/phpp.12373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ida M. Heerfordt
- Department of Dermatology; Bispbjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Linnea R. Torsnes
- Department of Dermatology; Bispbjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Peter A. Philipsen
- Department of Dermatology; Bispbjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Hans Christian Wulf
- Department of Dermatology; Bispbjerg Hospital; University of Copenhagen; Copenhagen Denmark
| |
Collapse
|
27
|
Abstract
This observational study examined the trend from the 1990s to 2016 of sunscreen use, sun protection factor (SPF) and quantity of sunscreen applied amongst beachgoers in Denmark. In 1997, 1998, 1999 and 2016, a total of 1,306 beachgoers were asked if they had used sunscreen on that day and, if so, which SPF. In 1992 and 2016 another 143 beachgoers had their sunscreen bottles weighed before and after application. The frequency of sunscreen use among women increased from 45% in 1997 to 78% in 2016, while the frequency of use among men increased from 39% to 49%. For both sexes the median SPF increased, on average, by one unit per year, from SPF 5 in 1997 to SPF 20 in 2016. The quantity of sunscreen applied increased from 0.48 mg/cm2 in 1992 to 0.57 mg/cm2 in 2016. Thus, the frequency of sunscreen use, the SPF, and the quantity of sunscreen applied have increased in the recent decades.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology D92, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
| | | | | | | |
Collapse
|
28
|
Lerche CM, Heerfordt IM, Serup J, Poulsen T, Wulf HC. Red tattoos, ultraviolet radiation and skin cancer in mice. Exp Dermatol 2017; 26:1091-1096. [DOI: 10.1111/exd.13383] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Catharina M. Lerche
- Department of Dermatology; Copenhagen University Hospital; Copenhagen Denmark
| | - Ida M. Heerfordt
- Department of Dermatology; Copenhagen University Hospital; Copenhagen Denmark
| | - Jørgen Serup
- Department of Dermatology; Copenhagen University Hospital; Copenhagen Denmark
| | - Thomas Poulsen
- Department of Pathology; Hospital of Southern Jutland; Soenderborg Denmark
| | - Hans Christian Wulf
- Department of Dermatology; Copenhagen University Hospital; Copenhagen Denmark
| |
Collapse
|
29
|
Heerfordt IM, Wulf HC. Patients with erythropoietic protoporphyria have reduced erythrocyte protoporphyrin IX from early in pregnancy. Br J Dermatol 2016; 177:e38-e40. [PMID: 27943252 DOI: 10.1111/bjd.15228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- I M Heerfordt
- Department of Dermatology D92, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark
| | - H C Wulf
- Department of Dermatology D92, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark
| |
Collapse
|
30
|
Heerfordt IM, Nissen CV, Poulsen T, Philipsen PA, Wulf HC. Thickness of Actinic Keratosis Does Not Predict Dysplasia Severity or P53 Expression. Sci Rep 2016; 6:33952. [PMID: 27670104 PMCID: PMC5037398 DOI: 10.1038/srep33952] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/05/2016] [Indexed: 01/10/2023] Open
Abstract
The severity of dysplasia and expression of p53 in actinic keratosis (AK) is of importance for the transformation to squamous cell carcinoma. It is assumed that it is most important to treat thick AKs as they are believed to be more dysplastic than thin AKs. However, a relation between AK thickness and dysplasia or the expression of p53 has never been demonstrated. The aim of this study was to investigate this possible relation. Sixty-six AKs were included for clinical and histological examination. Prior to performing a punch biopsy, the clinical thickness of each AK was measured objectively using two scale bars with a thickness of 0.5 mm and 1 mm. Subsequently, the thickness of the epidermis, the severity of dysplasia and the expression of p53 were assessed histologically. We found a strong and significant positive correlation between measured clinical thickness of the AKs and the histological thickness of epidermis (p < 0.0001). However, the clinical thickness did not correlate with either the severity of dysplasia (p = 0.7) or the expression of p53 (p = 0.5). In conclusion, thin AKs show the same severity of dysplasia and expression of p53 as thicker AK lesions. Consequently, clinical thickness cannot predict aggressiveness.
Collapse
Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, DK-2400 NV Copenhagen, Denmark
| | - Christoffer V Nissen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, DK-2400 NV Copenhagen, Denmark
| | - Thomas Poulsen
- Department of Pathology, Hospital of Southern Jutland, DK-6400 Soenderborg, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, DK-2400 NV Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, DK-2400 NV Copenhagen, Denmark
| |
Collapse
|
31
|
Weischer M, Heerfordt IM, Bojesen SE, Eigentler T, Garbe C, Röcken M, Hölmich LR, Schmidt H, Klyver H, Bastholt L, Nordestgaard BG. CHEK2*1100delC and Risk of Malignant Melanoma: Danish and German Studies and Meta-Analysis. J Invest Dermatol 2012; 132:299-303. [DOI: 10.1038/jid.2011.303] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|