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Götzinger F, Hohl M, Lauder L, Millenaar D, Kunz M, Meyer MR, Ukena C, Lerche CM, Philipsen PA, Reichrath J, Böhm M, Mahfoud F. A randomized, placebo-controlled, trial to assess the photosensitizing, phototoxic and carcinogenic potential of hydrochlorothiazide in healthy volunteers. J Hypertens 2023; 41:1853-1862. [PMID: 37702559 DOI: 10.1097/hjh.0000000000003558] [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] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND AND AIMS Pharmacovigilance reports, associating hydrochlorothiazide (HCT) with skin cancer, resulted in a significant decrease of HCT prescriptions for hypertension and heart failure. Whether HCT exhibits phototoxic properties thereby causing skin cancer remains unknown. This study aimed to examine the photosensitizing, phototoxic and carcinogenic potential of HCT in a randomized, placebo-controlled, double-blind trial in vivo and also in vitro . METHODS The trial assigned 30 healthy, normotensive adult volunteers in a 2:1 ratio to either HCT 25 mg/day or placebo for 15 days. Photosensitivity of the skin with and without the effect of HCT treatment were assessed. Following whole-body ultraviolet A (UVA) and B (UVB, 311 nm) irradiation, phototoxic and carcinogenic reactions by measuring urinary excretion of pyrimidine dimers were evaluated. For the in-vitro studies, human keratinocytes (HaCaT) were incubated with HCT, irradiated with UVB, and analysed for markers of inflammation, apoptosis and carcinogenesis. RESULTS Skin photosensitivity following exposure to UVA and UVB remained unchanged from baseline to 15-day follow-up in both groups (UVA change HCT 0.0 J/cm 2 vs. placebo 0.0 J/cm 2 ; P = 0.99; UVB change HCT 0.0 J/cm 2 vs. placebo -0.2 J/cm 2 ; P = 0.06). Pyrimidine dimers were not detected in either group. In vitro , combination of HCT and UVB irradiation did not induce the expression of oxidative stress marker proteins, inflammatory proteins, apoptotic proteins or activation of oncoproteins. CONCLUSION HCT did not increase photosensitivity for UVA or UVB in healthy volunteers compared with placebo, and was not associated with phototoxic or carcinogenic reactions. In vitro , HCT was also not associated with phototoxicity or carcinogenesis (NCT04654312).
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Affiliation(s)
- Felix Götzinger
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital
| | - Mathias Hohl
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital
| | - Lucas Lauder
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital
| | - Dominic Millenaar
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital
| | - Michael Kunz
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital
| | - Markus R Meyer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Homburg, Germany
| | - Christian Ukena
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital
| | - Catharina M Lerche
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg
| | - Jörg Reichrath
- Department of Adult and Pediatric Dermatology, Venereology, Allergology, Saarland University Hospital, Homburg, Germany
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital
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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.
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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
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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.
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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
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4
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Wenande E, Togsverd-Bo K, Hastrup A, Lei U, Philipsen PA, Haedersdal M. Skin cancer development is strongly associated with actinic keratosis in solid organ transplant recipients: a Danish cohort study. Dermatology 2023:000529369. [PMID: 36731451 DOI: 10.1159/000529369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/22/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Solid organ transplant recipients (SOTRs) are at increased risk of skin cancer and suffer from greater disease-specific morbidity and mortality. To risk stratify the expanding SOTR population for more targeted skin cancer screening, a detailed understanding of risk factors is needed. Using combined clinical and pathological data to capture prevalence of actinic keratosis (AK) and skin cancer, this study aimed to identify risk factors of skin cancer development in a Danish SOTR cohort. METHODS The trial comprised a retrospective cohort study of patients attending organ transplant clinics at the dermatological departments of Bispebjerg and Gentofte Hospitals in Copenhagen, Denmark between 2009-2021. In addition to pathology records, AK prevalence was determined by review of electronic medical records (EMR) of SOTR visits which specifically included descriptions of clinical AK. Prevalence of skin cancer, here defined as basal cell carcinoma (BCC), squamous cell carcinoma (SCC) (invasive or in situ), or melanoma (invasive or in situ), was determined by EMR and pathology code review. Additional data extracted from EMRs included age, sex, Fitzpatrick skin type, and transplantation date, -type and immunosuppressive therapy. The effect of risk factors on skin cancer was calculated by Cox proportional hazards regression. RESULTS A total of 822 SOTRs were included with a mean follow-up duration of 10.8 years (SD 2.4 years). A skin dysplasia diagnosis was identified in 30% (n=250) of the population, consisting of either AK (22%; n=177), skin cancer (23% n=186), or both (14%; n=113). An AK diagnosis predicted both SCC (OR: 31.5 (95% CI 9.8-100.6), p<0.0001) and BCC development (OR: 2.3 (95% CI 1.6-3.3), p<0.0001), with AKs diagnosed an average 3.1 years before the first SCC (p<0.0001). Correspondingly while the risk of SCC in SOTRs without AK was 1.4% 25 years after transplantation, SOTRs with AKs had a 23% SCC risk only 10 years post-transplant. Other identified risk factors included Fitzpatrick skin type I (BCC: OR: 2.4 (95% CI 1.2-5.0), p=0.018; SCC: 3.2 (95% CI 1.2-8.2), p=0.016) and transplantation duration >15 years (BCC: OR 1.8 (95% CI 1.2 - 2.7), p=0.007). No significant association between skin cancer development and sex or immunosuppressive regimen was shown. CONCLUSION Keratinocyte carcinoma is strongly associated with an AK diagnosis in SOTRS and should prompt intensified skin cancer screening in affected individuals.
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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.
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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
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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).
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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
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Ortner VK, Mandel VD, Bertugno S, Philipsen PA, Haedersdal M. Imaging of the Nail Unit in Psoriatic Patients - a Systematic Scoping Review of Techniques and Terminology. Exp Dermatol 2022; 31:828-840. [PMID: 35353919 PMCID: PMC9323418 DOI: 10.1111/exd.14572] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/14/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
Background The growing interest in the visualization of psoriatic nail unit changes has led to the discovery of an abundance of image characteristics across various modalities. Objective To identify techniques for non‐invasive imaging of nail unit structures in psoriatic patients and review extracted image features to unify the diverse terminology. Methods For this systematic scoping review, we included studies available on PubMed and Embase, independently extracted image characteristics, and semantically grouped the identified features to suggest a preferred terminology for each technique. Results After screening 753 studies, 67 articles on the visualization of clinical and subclinical psoriatic changes in the nail plate, matrix, bed, folds and hyponychium were included. We identified 4 optical and 3 radiological imaging techniques for the assessment of surface (dermoscopy [n = 16], capillaroscopy [n = 12]), sub‐surface (ultrasound imaging [n = 36], optical coherence tomography [n = 4], fluorescence optical imaging [n = 3]), and deep‐seated psoriatic changes (magnetic resonance imaging [n = 2], positron emission tomography‐computed tomography [n = 1]). By condensing 244 image feature descriptions into a glossary of 82 terms, overall redundancy was cut by 66.4% (37.5%–77.1%). More than 75% of these image features provide additional disease‐relevant information that is not captured using conventional clinical assessment scales. Conclusions This review has identified, unified, and contextualized image features and related terminology for non‐invasive imaging of the nail unit in patients with psoriatic conditions. The suggested glossary could facilitate the integrative use of non‐invasive imaging techniques for the detailed examination of psoriatic nail unit structures in research and clinical practice.
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Affiliation(s)
- V K Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - V D Mandel
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Porphyria and Rare Diseases Unit, San Gallicano Dermatological Institute - IRCCS, Rome, Italy
| | - S Bertugno
- Radiology Unit, Bernardino Ramazzini Hospital, Carpi, Italy
| | - P A Philipsen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - M Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
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Erlendsson AM, Rosenberg LK, Lerche CM, Togsverd-Bo K, Wiegell SR, Karmisholt K, Philipsen PA, Hansen ACN, Janfelt C, Holmes J, Rossi A, Haedersdal M. A one-time pneumatic jet-injection of 5-fluorouracil and triamcinolone acetonide for treatment of hypertrophic scars-A blinded randomized controlled trial. Lasers Surg Med 2022; 54:663-671. [PMID: 35266202 DOI: 10.1002/lsm.23529] [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: 11/11/2021] [Revised: 01/05/2022] [Accepted: 02/06/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with hypertrophic scars (HTS) risk reduced quality of life due to itching, pain, poor cosmesis, and restriction of movement. Despite good clinical efficacy, patients are often reluctant to undergo repeated needle injections due to pain or needle phobia. OBJECTIVES To evaluate the applicability of needle-free pneumatic jet injection (PJI) and assess changes in hypertrophic scars following a single PJI treatment with 5-fluorouracil (5-FU) and triamcinolone acetonide (TAC). METHODS Twenty patients completed this blinded, randomized, controlled, split-scar trial. The intervention side of the HTS received a one-time treatment with PJIs containing a mixture of TAC + 5-FU injected at 5 mm intervals (mean 7 PJI per HTS); the control side received no treatment. Assessments were made at baseline and 4 weeks posttreatment. Outcome measures included change in (1) Vancouver Scar Scale (VSS) total score and subscores, (2) scar volume and surface area assessed by three-dimensional imaging, (3) skin microarchitecture measured by optical-coherence tomography (OCT), (4) photo-assessed scar cosmesis (0-100), (5) patient-reported pain and satisfaction (0-10), and (6) depiction of drug biodistribution after PJI. RESULTS PJI with TAC + 5-FU significantly decreased both HTS height (-1 VSS; p = 0.01) and pliability (-1 VSS; p < 0.01) with a nonstatistically significant reduction of -1 in total VSS score (0 in control; p = 0.09). On 3D imaging, a 33% decrease in scar volume (p = 0.016) and a 37% decrease in surface area (p = 0.008) was observed. OCT indicated trends towards smoother scar surface (Ra 11.1-10.3; p = 0.61), normalized dermal microarchitecture (attenuation coefficient: 1.52-1.68; p = 0.44), and a reduction in blood flow between 9% and 17% (p = 0.50-0.79). Despite advances in VSS subscores and OCT, no improved photo-assessed cosmesis was found (-3.2 treatment vs. -1.4 control; p = 0.265). Patient-reported pain was low (2/10) and 90% of the patients that had previously received needle injections preferred PJI to needle injection. Depositions of TAC + FU were imaged reaching deep into the scar at levels corresponding to the reticular dermis. CONCLUSION A single PJI injection containing 5-FU and TAC can significantly improve the height and pliability of HTS. PJI is favored by the patients and may serve as a complement to conventional needle injections, especially for patients with needle phobia.
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Affiliation(s)
- Andrés M Erlendsson
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.,Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lukas K Rosenberg
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Catharina M Lerche
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.,Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Togsverd-Bo
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Stine R Wiegell
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Katrine Karmisholt
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Anders C N Hansen
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Christian Janfelt
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | | | - Anthony Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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Skiveren JG, Ryborg MF, Nilausen B, Bermark S, Philipsen PA. Adverse skin reactions among health care workers using face personal protective equipment during the coronavirus disease 2019 pandemic: A cross-sectional survey of six hospitals in Denmark. Contact Dermatitis 2021; 86:266-275. [PMID: 34865243 PMCID: PMC9302995 DOI: 10.1111/cod.14022] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Health care workers (HCWs) report frequent adverse skin reactions (ASRs) due to face personal protective equipment (F-PPE) use during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES To describe self-reported ASRs among HCWs using F-PPE; investigate background factors, such as chronic skin diseases and skin types (dry, oily, combination, sensitive), and determine whether HCWs took preventive methods against ASRs. METHODS An online questionnaire was distributed to 22 993 HCWs at hospitals. RESULTS The prevalence of ASRs was 61.9% based on 10 287 responders. Different types of F-PPE caused different reactions. The most common ASRs from surgical masks were spots and pimples (37.2%) and from FFP3 masks was red and irritated skin (27.3%). A significantly higher proportion of HCWs with chronic skin diseases had ASRs (71.6%) than those without chronic skin diseases (59.7%) (P < .001). Some skin types were more prone to ASRs (sensitive skin [78.8%] vs dry skin [54.3%]; P = .001). HCWs using F-PPE for >6 hours versus <3 hours per day had a four times higher ASR risk (P = <.001). Nearly all HCWs used preventive and/or counteractive methods (94.2%). CONCLUSIONS It is important to consider background factors, such as chronic skin diseases and skin types, to prevent and counteract ASRs due to F-PPE use. HIGHLIGHTS Daily long-term use of face protective equipment increased the risk of adverse skin reaction by four times. Health care workers (HCWs) with chronic skin diseases had significantly more skin reactions than those without. Sensitive skin types were more prone to skin reactions. The skin reactions were higher in HCWs in intensive care units than HCWs in in-patient clinics.
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Affiliation(s)
- Jette G Skiveren
- Department of Dermatology and Copenhagen Wound Healing Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Malene F Ryborg
- Department of Dermatology and Copenhagen Wound Healing Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Britt Nilausen
- Department of Dermatology and Copenhagen Wound Healing Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Susan Bermark
- Department of Dermatology and Copenhagen Wound Healing Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Peter A Philipsen
- Department of Dermatology and Copenhagen Wound Healing Centre, Bispebjerg University Hospital, Copenhagen, Denmark
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10
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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.
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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
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Fuchs CSK, Ortner VK, Hansen FS, Philipsen PA, Haedersdal M. Subclinical effects of adapalene-benzoyl peroxide: a prospective in vivo imaging study on acne micromorphology and transfollicular delivery. J Eur Acad Dermatol Venereol 2021; 35:1377-1385. [PMID: 33508886 DOI: 10.1111/jdv.17140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/14/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adapalene-benzoyl peroxide (A-BPO) is a first-line topical treatment for acne vulgaris. In vivo reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) detect micromorphological changes over time and visualize transfollicular delivery. OBJECTIVES To visualize temporal, subclinical effects of A-BPO on acne micromorphology using RCM and OCT, and evaluate their impact on transfollicular delivery of microparticulate carrier systems. METHODS Fifteen patients with mild to moderate acne received a 6-week course of A-BPO. Micromorphological changes were evaluated at time 0, 3 and 6 weeks with RCM (n = 1190 images) and OCT (n = 210 scans). Transfollicular delivery of microparticles was assessed at baseline and week 6. RESULTS In vivo imaging visualized steady normalization of skin micromorphology in response to A-BPO over 6 weeks, including decreased hyperkeratinization of follicular borders (RCM median decrease -71.2%, P < 0.05), reduced intrafollicular keratinous content (RCM median decrease -47.7%, P < 0.05) and increased epidermal thickness (OCT median increase of 25.25%, P < 0.05). Imaging visualized microparticles in the follicular unit. Despite a visible reduction in keratin and sebum, transfollicular microparticle delivery appeared unaffected. CONCLUSIONS Reflectance confocal microscopy and OCT detect A-BPO-induced changes in micromorphology and visualize transfollicular microparticle delivery. Keratolysis and sebolysis did not have a measurable effect on transfollicular delivery of microparticles.
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Affiliation(s)
- C S K Fuchs
- Department of Dermatology, University of Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - V K Ortner
- Department of Dermatology, University of Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - F S Hansen
- Department of Dermatology, University of Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - P A Philipsen
- Department of Dermatology, University of Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - M Haedersdal
- Department of Dermatology, University of Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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12
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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.
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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.
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13
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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.
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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
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Ortner VK, Holmes J, Haedersdal M, Philipsen PA. Morphometric Optical Imaging of Microporated Nail Tissue: An Investigation of Intermethod Agreement, Reliability, and Technical Limitations. Lasers Surg Med 2020; 53:838-848. [PMID: 32770696 DOI: 10.1002/lsm.23304] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/17/2020] [Accepted: 07/20/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES While optical imaging is a useful technique to quantitate morphological differences and treatment effects, comparative investigations of the various techniques are lacking. This study aimed at evaluating intermethod agreement, reliability, and technical limitations of wide-field microscopy (WFM), reflectance confocal microscopy (RCM), and optical coherence tomography (OCT) for morphometry by assessing fractionally ablated nail tissue. STUDY DESIGN/MATERIALS AND METHODS Fifty healthy nail clippings were processed with a fractionated CO2 -laser (20 mJ/microbeam, density 15%), measured with calipers, and imaged using WFM, OCT, and RCM. Images were assessed for nail plate thickness, micropore dimensions, degree of poration, and artifacts. Repeated measurements (2-5) were taken to evaluate method repeatability using Cronbach's α and coefficients of variation (CoV), and estimate the intermethod correlation through linear correlation assessment (Pearson correlation coefficient [PCC]), ranked correlation (Kendall's tau; tau-c), and intraclass correlation (Shrout-Fleiss reliability coefficient; ICC). RESULTS The repeatability varied substantially between methods and target measurements. The level of intermethod agreement for thickness measurements performed with calipers, WFM, and OCT was high (tau-c ≥ 0.7; ICC ≥ 0.8; PCC ≥ 0.9). RCM could only image 28 out of 50 samples due to its limited penetration depth. OCT demonstrated the highest repeatability of all imaging techniques (CoV 4-7%) and nail thickness showed the highest measurement reliability (α = 0.92). Micropore dimensions correlated strongest between OCT and RCM (tau-c/ICC/PCC ≥ 0.5). All modalities were prone to artifacts, which may have adversely affected measurement variation and intermethod agreement. CONCLUSION Intermethod agreement and reliability appear to be highly dependent on the specific modality and target measurement. To reap the benefits of each technique while mitigating their limitations, an integrated approach to optical imaging is recommended. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Vinzent K Ortner
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Nordvest, 2400, Denmark
| | - Jon Holmes
- Michelson Diagnostics Ltd., Eclipse House, Eclipse Park, Maidstone, Kent, ME14 3EN, UK
| | - Merete Haedersdal
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Nordvest, 2400, Denmark
| | - Peter A Philipsen
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Nordvest, 2400, Denmark
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15
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Young AR, Morgan KA, Ho TW, Ojimba N, Harrison GI, Lawrence KP, Jakharia-Shah N, Wulf HC, Cruickshank JK, Philipsen PA. Melanin has a Small Inhibitory Effect on Cutaneous Vitamin D Synthesis: A Comparison of Extreme Phenotypes. J Invest Dermatol 2019; 140:1418-1426.e1. [PMID: 31883961 DOI: 10.1016/j.jid.2019.11.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- Antony R Young
- St John's Institute of Dermatology, King's College London, London, United Kingdom.
| | - Kylie A Morgan
- St John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Tak-Wai Ho
- Department of Nutritional Science, Division of Life-Course Sciences, King's College London, London, United Kingdom
| | - Ngozi Ojimba
- Department of Nutritional Science, Division of Life-Course Sciences, King's College London, London, United Kingdom; Dietetics Department, Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - Graham I Harrison
- St John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Karl P Lawrence
- St John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Nihull Jakharia-Shah
- St John's Institute of Dermatology, King's College London, London, United Kingdom
| | | | - J Kennedy Cruickshank
- Department of Nutritional Science, Division of Life-Course Sciences, King's College London, London, United Kingdom
| | - Peter A Philipsen
- Department of Dermatology D92, Bispebjerg Hospital, Copenhagen, Denmark
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16
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Bieliauskiene G, Holm-Schou ASS, Philipsen PA, Murphy GM, Sboukis D, Schwarz T, Young AR, Wulf HC. Measurements of sun sensitivity in five European countries confirm the relative nature of Fitzpatrick skin phototype scale. Photodermatol Photoimmunol Photomed 2019; 36:179-184. [PMID: 31785041 DOI: 10.1111/phpp.12529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/13/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Giedre Bieliauskiene
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Thomas Schwarz
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Antony R Young
- St John's Institute of Dermatology, King's College London, London, UK
| | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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17
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Young AR, Narbutt J, Harrison GI, Lawrence KP, Bell M, O'Connor C, Olsen P, Grys K, Baczynska KA, Rogowski-Tylman M, Wulf HC, Lesiak A, Philipsen PA. Optimal sunscreen use, during a sun holiday with a very high ultraviolet index, allows vitamin D synthesis without sunburn. Br J Dermatol 2019; 181:1052-1062. [PMID: 31069787 PMCID: PMC6899952 DOI: 10.1111/bjd.17888] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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] [Accepted: 03/14/2019] [Indexed: 12/17/2022]
Abstract
Background Sunlight contains ultraviolet (UV)A and UVB radiation. UVB is essential for vitamin D synthesis but is the main cause of sunburn and skin cancer. Sunscreen use is advocated to reduce the sun's adverse effects but may compromise vitamin D status. Objectives To assess the ability of two intervention sunscreens to inhibit vitamin D synthesis during a week‐long sun holiday. Methods The impact of sunscreens on vitamin D status was studied during a 1‐week sun holiday in Tenerife (28° N). Comparisons were made between two formulations, each with a sun protection factor (SPF) of 15. The UVA‐protection factor (PF) was low in one case and high in the other. Healthy Polish volunteers (n = 20 per group) were given the sunscreens and advised on the correct application. Comparisons were also made with discretionary sunscreen use (n = 22) and nonholiday groups (51·8° N, n = 17). Sunscreen use in the intervention groups was measured. Behaviour, UV radiation exposure, clothing cover and sunburn were monitored. Serum 25‐hydroxyvitamin D3 [25(OH)D3] was assessed by high‐performance liquid chromatography–tandem mass spectrometry. Results Use of intervention sunscreens was the same (P = 0·60), and both equally inhibited sunburn, which was present in the discretionary use group. There was an increase (P < 0·001) in mean ± SD 25(OH)D3 (28·0 ± 16·5 nmol L−1) in the discretionary use group. The high and low UVA‐PF sunscreen groups showed statistically significant increases (P < 0·001) of 19·0 ± 14·2 and 13·0 ± 11·4 nmol L−1 25(OH)D3, respectively with P = 0·022 for difference between the intervention sunscreens. The nonholiday group showed a fall (P = 0·08) of 2·5 ± 5·6 nmol L−1 25(OH)D3. Conclusions Sunscreens may be used to prevent sunburn yet allow vitamin D synthesis. A high UVA‐PF sunscreen enables significantly higher vitamin D synthesis than a low UVA‐PF sunscreen because the former, by default, transmits more UVB than the latter. What's already known about this topic? Action spectra (wavelength dependence) for erythema and the cutaneous formation of vitamin D overlap considerably in the ultraviolet (UV)B region. Theoretically, sunscreens that inhibit erythema should also inhibit vitamin D synthesis. To date, studies on the inhibitory effects of sunscreens on vitamin D synthesis have given conflicting results, possibly, in part, because people typically apply sunscreen suboptimally. Many studies have design flaws.
What does this study add? Sunscreens (sun protection factor, SPF 15) applied at sufficient thickness to inhibit sunburn during a week‐long holiday with a very high UV index still allow a highly significant improvement of serum 25‐hydroxyvitamin D3 concentration. An SPF 15 formulation with high UVA protection enables better vitamin D synthesis than a low UVA protection product. The former allows more UVB transmission.
Linked Editorial: https://doi.org/10.1111/bjd.18273. https://doi.org/10.1111/bjd.18492 available online https://www.bjdonline.com/article/optimal-sunscreen-use-during-a-sun-holiday-with-a-very-high-ultraviolet-index-allows-vitamin-d-synthesis-without-sunburn/
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Affiliation(s)
- A R Young
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - J Narbutt
- Medical University of Łódź, Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Łódź, 90-647, Poland
| | - G I Harrison
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - K P Lawrence
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - M Bell
- Walgreens Boots Alliance Inc., Nottingham, NG90 5EF, U.K
| | - C O'Connor
- Walgreens Boots Alliance Inc., Nottingham, NG90 5EF, U.K
| | - P Olsen
- Bispebjerg Hospital, Department of Dermatological Research, Copenhagen, 2400, Denmark
| | - K Grys
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - K A Baczynska
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxfordshire, OX11 0RQ, U.K
| | | | - H C Wulf
- Bispebjerg Hospital, Department of Dermatological Research, Copenhagen, 2400, Denmark
| | - A Lesiak
- Medical University of Łódź, Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Łódź, 90-647, Poland
| | - P A Philipsen
- Bispebjerg Hospital, Department of Dermatological Research, Copenhagen, 2400, Denmark
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Bieliauskiene G, Philipsen PA, Ørsted-Jordy L, Køster B, Wulf HC. Visual scales are superior to questionnaires in skin phototype self-assessment by children. Photodermatol Photoimmunol Photomed 2019; 35:238-245. [PMID: 30809865 DOI: 10.1111/phpp.12458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/25/2019] [Accepted: 02/25/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND/PURPOSE There are no suitable methods for skin phototype self-assessment by children. Our study investigated several skin phototype self-assessment methods in children to identify the best correlation to objectively measure skin phototype. METHODS Danish schoolchildren (ages 6-19) participated in a nation-wide study that assessed skin, eye, hair colour and sun behaviour. Skin phototype self-assessment was performed by children using two visual colour scales (cartoon faces and colour cards), question-based colour scale and questions about tendency to burn and ability to tan. For objective skin phototype measurements, 483 children from all age groups were selected and their pigment protection factor (PPF) was measured at three skin sites using a skin reflectance spectrophotometer. RESULTS Cartoon faces (r2 = 0.654) and colour cards (r2 = 0.659) were better at predicting PPF on the inner forearm than the question-based colour method (r2 = 0.520). PPF prediction from questions on skin reaction to sun exposure was markedly inferior (r2 ≤ 0.142) to both visual colour scales and question-based colour method. CONCLUSION Both visual colour scales proved to be superior to question-based skin phototype self-assessment in schoolchildren. In contrast, questions on skin reaction to sun exposure were shown to be an unsuitable tool for self-assessment of skin phototype in children.
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Affiliation(s)
- Giedre Bieliauskiene
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Thieden E, Holm-Schou ASS, Philipsen PA, Heydenreich J, Wulf HC. Adult UVR exposure changes with life stage - a 14-year follow-up study using personal electronic UVR dosimeters. Photochem Photobiol Sci 2019; 18:467-476. [PMID: 30511738 DOI: 10.1039/c8pp00365c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Over a period spanning 14 years (1999-2001, 2006 and 2012), 31 volunteers participated in sun behaviour studies with the same protocol wearing a personal, electronic wrist-borne UVR dosimeter and completed sun exposure diaries resulting in a total of 15 946 measurements days (126 days per person per year). The participants individually maintained their UVR dose level and behaviour over the years. No statistically significant differences were seen from year to year in the "estimated annual UVR dose", the "mean UVR dose per day", the "mean percentage of ambient UVR", "days sunbathing to get a tan", "days with intermittent exposure" or in "sunburn episodes". The 20 participants still active in the labour market used sunscreen on more days in 2012 than in 1999 (p = 0.019) and with a significantly higher SPF (sun protecting factor (p < 0.001)) resulting in significantly fewer days with risk behaviour without sunscreen applied in 2012 than in 2006 (p < 0.001) and 1999 (p < 0.003). This was in contrast to the 11 participants who retired during the study period. The retired group received a non-significant 45% higher UV dose in 2012 than in 1999 (p = 0.054). In an additional study, nine 30-year-old indoor workers (high school students in the 1999 study) had changed their sun exposure pattern and had fewer days sunbathing (p = 0.008) and fewer risk behaviour days without sunscreen applied in 2012 than in 1999 (p = 0.002). Conclusion: The participants still active in the labour market maintained their sun exposure behaviour over a 14-year period. The retirees had a higher UVR dose and riskier exposure behaviour after retirement, while the high school students had changed to less risky sun behaviour on becoming indoor workers.
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Affiliation(s)
- Elisabeth Thieden
- Department of Dermatology, Frederiksberg and Bispebjerg Hospitals, University of Copenhagen, Copenhagen, Denmark.
| | - Ann-Sofie Sonne Holm-Schou
- Department of Dermatology, Frederiksberg and Bispebjerg Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Frederiksberg and Bispebjerg Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Heydenreich
- Department of Dermatology, Frederiksberg and Bispebjerg Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Frederiksberg and Bispebjerg Hospitals, University of Copenhagen, Copenhagen, Denmark
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Banzhaf CA, Ortner VK, Philipsen PA, Haedersdal M. The ablative fractional coagulation zone influences skin fluorescence intensities of topically applied test molecules-An in vitro study with fluorescence microscopy and fluorescence confocal microscopy. Lasers Surg Med 2018; 51:68-78. [DOI: 10.1002/lsm.23034] [Citation(s) in RCA: 12] [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: 10/18/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Christina A. Banzhaf
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital 2400 Copenhagen NV Denmark
| | - Vinzent K. Ortner
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital 2400 Copenhagen NV Denmark
| | - Peter A. Philipsen
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital 2400 Copenhagen NV Denmark
| | - Merete Haedersdal
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital 2400 Copenhagen NV Denmark
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21
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Narbutt J, Philipsen PA, Harrison GI, Morgan KA, Lawrence KP, Baczynska KA, Grys K, Rogowski-Tylman M, Olejniczak-Staruch I, Tewari A, Bell M, O'Connor C, Wulf HC, Lesiak A, Young AR. Sunscreen applied at ≥ 2 mg cm -2 during a sunny holiday prevents erythema, a biomarker of ultraviolet radiation-induced DNA damage and suppression of acquired immunity. Br J Dermatol 2018; 180:604-614. [PMID: 30307614 DOI: 10.1111/bjd.17277] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Sun protection factor (SPF) is assessed with sunscreen applied at 2 mg cm-2 . People typically apply around 0·8 mg cm-2 and use sunscreen daily for holidays. Such use results in erythema, which is a risk factor for skin cancer. OBJECTIVES To determine (i) whether typical sunscreen use resulted in erythema, epidermal DNA damage and photoimmunosuppression during a sunny holiday, (ii) whether optimal sunscreen use inhibited erythema and (iii) whether erythema is a biomarker for photoimmunosuppression in a laboratory study. METHODS Holidaymakers (n = 22) spent a week in Tenerife (very high ultraviolet index) using their own sunscreens without instruction (typical sunscreen use). Others (n = 40) were given SPF 15 sunscreens with instructions on how to achieve the labelled SPF (sunscreen intervention). Personal ultraviolet radiation (UVR) exposure was monitored electronically as the standard erythemal dose (SED) and erythema was quantified. Epidermal cyclobutane pyrimidine dimers (CPDs) were determined by immunostaining, and immunosuppression was assessed by contact hypersensitivity (CHS) response. RESULTS There was no difference between personal UVR exposure in the typical sunscreen use and sunscreen intervention groups (P = 0·08). The former had daily erythema on five UVR-exposed body sites, increased CPDs (P < 0·001) and complete CHS suppression (20 of 22). In comparison, erythema was virtually absent (P < 0·001) when sunscreens were used at ≥ 2 mg cm-2 . A laboratory study showed that 3 SED from three very different spectra suppressed CHS by around ~50%. CONCLUSIONS Optimal sunscreen use prevents erythema during a sunny holiday. Erythema predicts suppression of CHS (implying a shared action spectrum). Given that erythema and CPDs share action spectra, the data strongly suggest that optimal sunscreen use will also reduce CPD formation and UVR-induced immunosuppression.
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Affiliation(s)
- J Narbutt
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Łódź, 90-647, Łódź, Poland
| | - P A Philipsen
- University of Copenhagen, Bispebjerg Hospital, Department of Dermatological Research, Copenhagen, 2400, Denmark
| | - G I Harrison
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - K A Morgan
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - K P Lawrence
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - K A Baczynska
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, OX11 0RQ, U.K
| | - K Grys
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | | | - I Olejniczak-Staruch
- Dermoklinika Centrum Medyczne, Łódź, 90-436, Poland.,Department of Dermatology and Venereology, Medical University of Łódź, 90-647, Łódź, Poland
| | - A Tewari
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - M Bell
- Walgreens Boots Alliance Inc., Nottingham, NG90 5EF, U.K
| | - C O'Connor
- Walgreens Boots Alliance Inc., Nottingham, NG90 5EF, U.K
| | - H C Wulf
- University of Copenhagen, Bispebjerg Hospital, Department of Dermatological Research, Copenhagen, 2400, Denmark
| | - A Lesiak
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Łódź, 90-647, Łódź, Poland
| | - A R Young
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
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22
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Narbutt J, Philipsen PA, Lesiak A, Sandberg Liljendahl T, Segerbäck D, Heydenreich J, Chlebna-Sokol D, Olsen P, Harrison GI, Pearson A, Baczynska K, Rogowski-Tylman M, Wulf HC, Young AR. Children sustain high levels of skin DNA photodamage, with a modest increase of serum 25-hydroxyvitamin D 3 , after a summer holiday in Northern Europe. Br J Dermatol 2018; 179:940-950. [PMID: 29691848 DOI: 10.1111/bjd.16668] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Childhood solar ultraviolet radiation (UVR) exposure increases the risk of skin cancer in adulthood, which is associated with mutations caused by UVR-induced cyclobutane pyrimidine dimers (CPD). Solar UVR is also the main source of vitamin D, essential for healthy bone development in children. OBJECTIVES To assess the impact of a 12-day Baltic Sea (54° N) beach holiday on serum 25-hydroxyvitamin D3 [25(OH)D3 ] and CPD in 32 healthy Polish children (skin types I-IV). METHODS Blood and urine were collected before and after the holiday and assessed for 25(OH)D3 and excreted CPD, respectively, and personal UVR exposure was measured. Diaries were used to record sunbathing, sunburn and sunscreen use. Before- and after-holiday skin redness and pigmentation were measured by reflectance spectroscopy. RESULTS The average ± SD daily exposure UVR dose was 2·4 ± 1·5 standard erythema doses (SEDs), which is borderline erythemal. The mean concentration of 25(OH)D3 increased (× 1·24 ± 0·19) from 64·7 ± 13·3 to 79·3 ± 18·7 nmol L-1 (P < 0·001). Mean CPD increased 12·6 ± 10·0-fold from 26·9 ± 17·9 to 248·9 ± 113·4 fmol μmol-1 creatinine (P < 0·001). Increased 25(OH)D3 was accompanied by a very much greater increase in DNA damage associated with carcinogenic potential. Overall, skin type had no significant effects on behavioural, clinical or analytical outcomes, but skin types I/II had more CPD (unadjusted P = 0·0496) than skin types III/IV at the end of the holiday. CONCLUSIONS Careful consideration must be given to the health outcomes of childhood solar exposure, and a much better understanding of the risk-benefit relationships of such exposure is required. Rigorous photoprotection is necessary for children, even in Northern Europe.
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Affiliation(s)
- J Narbutt
- Department of Dermatology, Paediatric Dermatology and Dermatological Oncology, Medical University of Łódź, 90-419, Łódź, Poland
| | - P A Philipsen
- Bispebjerg Hospital, Department of Dermatology D92, Bispebjerg Hospital, DK-2400, Copenhagen, NV, Denmark
| | - A Lesiak
- Department of Dermatology, Paediatric Dermatology and Dermatological Oncology, Medical University of Łódź, 90-419, Łódź, Poland
| | - T Sandberg Liljendahl
- Karolinska Institute, Department of Biosciences and Nutrition, S-141 83, Huddinge, Sweden
| | - D Segerbäck
- Karolinska Institute, Department of Biosciences and Nutrition, S-141 83, Huddinge, Sweden
| | - J Heydenreich
- Bispebjerg Hospital, Department of Dermatology D92, Bispebjerg Hospital, DK-2400, Copenhagen, NV, Denmark
| | - D Chlebna-Sokol
- Department of Paediatric Propedeutics and Bone Metabolic Diseases, Medical University of Łódź, 90-419, Łódź, Poland
| | - P Olsen
- Bispebjerg Hospital, Department of Dermatology D92, Bispebjerg Hospital, DK-2400, Copenhagen, NV, Denmark
| | - G I Harrison
- St John's Institute of Dermatology, King's College London, London, SE1 9RT, U.K
| | - A Pearson
- Public Health England, Laser and Optical Radiation Dosimetry Group, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxon, OX11 ORQ, U.K
| | - K Baczynska
- Public Health England, Laser and Optical Radiation Dosimetry Group, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxon, OX11 ORQ, U.K
| | | | - H C Wulf
- Bispebjerg Hospital, Department of Dermatology D92, Bispebjerg Hospital, DK-2400, Copenhagen, NV, Denmark
| | - A R Young
- St John's Institute of Dermatology, King's College London, London, SE1 9RT, U.K
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23
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Fuchs CSK, Andersen AJB, Ardigo M, Philipsen PA, Haedersdal M, Mogensen M. Acne vulgaris severity graded by in vivo reflectance confocal microscopy and optical coherence tomography. Lasers Surg Med 2018; 51:104-113. [DOI: 10.1002/lsm.23008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Christine S. K. Fuchs
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Amanda J. B. Andersen
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Marco Ardigo
- Clinical Dermatology; IFO-San Gallicano Dermatological Institute-IRCCS; Rome Italy
| | - Peter A. Philipsen
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Merete Haedersdal
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Mette Mogensen
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
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24
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Bieliauskiene G, Philipsen PA, Wulf HC. Phototype reproducibility and relation to objectively measured skin sensitivity is best when burn and tan reactivity to sun are answered separately. Photodermatol Photoimmunol Photomed 2018; 34:366-373. [DOI: 10.1111/phpp.12399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Giedre Bieliauskiene
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
- The Heart Center; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Peter A. Philipsen
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Hans Christian Wulf
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
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Abstract
Exposure to ultraviolet radiation (UVR) has important and significant consequences on human health. Recently, there has been renewed interest in the beneficial effects of UVR. This perspective gives an introduction to the solar spectrum, UV lamps, UV dosimetry, skin pigment and vitamin D. The health benefits of UVR exposure through vitamin D production or non-vitamin D pathways will be discussed in this themed issue in the following articles.
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Affiliation(s)
- C M Lerche
- Department of Dermatology, D92, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - P A Philipsen
- Department of Dermatology, D92, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - H C Wulf
- Department of Dermatology, D92, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
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26
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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.
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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
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27
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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
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28
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Lerche CM, Togsverd-Bo K, Philipsen PA, Wulf HC. Impact of UVR Exposure Pattern on Squamous Cell Carcinoma-A Dose-Delivery and Dose-Response Study in Pigmented Hairless Mice. Int J Mol Sci 2017; 18:ijms18122738. [PMID: 29258202 PMCID: PMC5751339 DOI: 10.3390/ijms18122738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 01/05/2023] Open
Abstract
Cumulative lifetime ultraviolet radiation (UVR) is an important factor in the development of squamous cell carcinoma. This study examines the impact of UVR exposure pattern on tumor development. Hairless C3.Cg/TifBomTac immunocompetent pigmented mice (n = 351) were irradiated with 12 standard erythema doses (SED)/week, given as 2 SED ×6, 3 SED ×4, 4 SED ×3, or 6 SED ×2 (dose-delivery study) or 0, 0.6, 1.2, 2, 3 or 4 SED ×3/week (dose-response study). All mice were irradiated until development of 3 tumors of 4 mm each. Pigmentation was measured once monthly. In the dose-delivery study, the median time until tumor development was independent of dose fractions. In the dose-response study, higher UVR doses resulted in faster tumor appearance. When the weekly UVR dose was decreased from 12 to 6 SED, the cumulative UVR dose needed for tumor development was reduced by 40%. In conclusion, delivery schedules of a fixed weekly UVR dose did not affect tumor development. When using different weekly UVR doses, longer time to tumor development was observed using lower UVR doses. Lower weekly UVR doses however resulted in lower cumulative UVR doses to induce tumors in hairless pigmented mice.
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Affiliation(s)
- Catharina M Lerche
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
| | - Katrine Togsverd-Bo
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
| | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
| | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
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29
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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.
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Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology D92, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
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30
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Karmisholt KE, Wenande E, Thaysen-Petersen D, Philipsen PA, Paasch U, Haedersdal M. Early intervention with non-ablative fractional laser to improve cutaneous scarring-A randomized controlled trial on the impact of intervention time and fluence levels. Lasers Surg Med 2017; 50:28-36. [DOI: 10.1002/lsm.22707] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2017] [Indexed: 11/06/2022]
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31
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Bieliauskiene G, Philipsen PA, Wulf HC. Can constitutive pigmentation be measured on upper inner arm? Correlation between arm and buttocks pigmentation. Photodermatol Photoimmunol Photomed 2017; 33:233-236. [PMID: 28500768 DOI: 10.1111/phpp.12314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Giedre Bieliauskiene
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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32
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Datta P, Philipsen PA, Olsen P, Bogh MK, Johansen P, Schmedes AV, Morling N, Wulf HC. The half-life of 25(OH)D after UVB exposure depends on gender and vitamin D receptor polymorphism but mainly on the start level. Photochem Photobiol Sci 2017; 16:985-995. [DOI: 10.1039/c6pp00258g] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The 25(OH)D decrease over time in a group (N= 22) with high 25(OH)D start levels was exponential. The half-life (T1/2) was 89 days and prolonged in materials with lower 25(OH)D start levels.
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Affiliation(s)
- Pameli Datta
- Department of Dermatology
- Copenhagen University Hospital
- Bispebjerg Hospital
- 2400 Copenhagen NV
- Denmark
| | - Peter A. Philipsen
- Department of Dermatology
- Copenhagen University Hospital
- Bispebjerg Hospital
- 2400 Copenhagen NV
- Denmark
| | - Peter Olsen
- Department of Dermatology
- Copenhagen University Hospital
- Bispebjerg Hospital
- 2400 Copenhagen NV
- Denmark
| | - Morten K. Bogh
- Department of Dermatology
- Copenhagen University Hospital
- Bispebjerg Hospital
- 2400 Copenhagen NV
- Denmark
| | - Peter Johansen
- Section of Forensic Genetics
- Department of Forensic Medicine
- Faculty of Health and Medical Sciences
- University of Copenhagen
- 2100 Copenhagen
| | - Anne V. Schmedes
- Department of Clinical Immunology and Biochemistry
- Lillebaelt Hospital
- 7100 Vejle
- Denmark
| | - Niels Morling
- Section of Forensic Genetics
- Department of Forensic Medicine
- Faculty of Health and Medical Sciences
- University of Copenhagen
- 2100 Copenhagen
| | - Hans C. Wulf
- Department of Dermatology
- Copenhagen University Hospital
- Bispebjerg Hospital
- 2400 Copenhagen NV
- Denmark
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33
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Banzhaf CA, Thaysen-Petersen D, Bay C, Philipsen PA, Mogensen M, Prow T, Haedersdal M. Fractional laser-assisted drug uptake: Impact of time-related topical application to achieve enhanced delivery. Lasers Surg Med 2016; 49:348-354. [DOI: 10.1002/lsm.22610] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Christina A. Banzhaf
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital; Copenhagen Denmark
- Dermatology Research Centre; The University of Queensland; Brisbane Australia
| | - Daniel Thaysen-Petersen
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital; Copenhagen Denmark
| | - Christiane Bay
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital; Copenhagen Denmark
| | - Peter A. Philipsen
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital; Copenhagen Denmark
| | - Mette Mogensen
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital; Copenhagen Denmark
| | - Tarl Prow
- Dermatology Research Centre; The University of Queensland; Brisbane Australia
| | - Merete Haedersdal
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital; Copenhagen Denmark
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34
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Karmisholt KE, Taudorf EH, Wulff CB, Wenande E, Philipsen PA, Haedersdal M. Fractional CO 2 laser treatment of caesarean section scars-A randomized controlled split-scar trial with long term follow-up assessment. Lasers Surg Med 2016; 49:189-197. [PMID: 27862066 DOI: 10.1002/lsm.22606] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Caesarean section (c-section) scars can be pose functional and cosmetic challenges and ablative fractional laser (AFXL) treatment may offer benefit to patients. We evaluated textural and color changes over time in AFXL-treated versus untreated control scars. MATERIALS AND METHODS A randomized, controlled, intra-individual split-scar trial with three sessions of AFXL-treatments for mature c-section scars. Settings of AFXL were adjusted to each individual scar. End-points were blinded on-site clinical evaluations at 1, 3, and 6 months follow-up (Patient and Observer Scar Assessment Scale [POSAS] and Vancouver Scar Scale [VSS]), blinded photo-evaluations, reflectance measurements, tissue histology, and patients satisfaction. RESULTS Eleven of 12 patients completed the study. At 1 month follow-up, AFXL-treated scars were significantly improved in pliability (POSAS P = 0.01 VSS P = 0.02) and smoother in surface relief (POSAS P = 0.03) compared to control scars. At 1-3 months, overall scar appearance was dominated by transient erythema and hyperpigmentation, confirmed by reflectance measurements (erythema% and pigmentation% peaked at 1 and 3 month follow-up, respectively). At 6 months follow-up, AFXL-treated scars improved on POSAS-total score though not significantly (P = 0.06). Correspondingly, blinded photo-evaluation found AFXL-treated scars significantly improved compared to controls (VAS P = 0.02). Histology indicated new dermal collagen and elastic fibers on AFXL-treated scars. At 6 months follow-up, a majority of patients (64%) favored subsequent AFXL-treatment of their untreated control scar tissue. CONCLUSIONS Scar remodeling is initiated 1 month after AFXL treatment, but overall scar improvement is concealed until laser-induced color changes resolve. At 6 months follow-up, the benefit of AFXL treatment on c-section scars emerges. Lasers Surg. Med. 49:189-197, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Katrine E Karmisholt
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth H Taudorf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Camilla B Wulff
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Emily Wenande
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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35
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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.
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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
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Abstract
BACKGROUND Cutaneous malignant melanoma (CMM) has been associated with "intermittent UVR exposure", which in previous studies has mainly been assessed by retrospective questionnaire data. Further, there is no uniform definition of the term "intermittent UVR exposure". OBJECTIVES We aimed to define and quantify "intermittent UVR exposure" by an objective measure. METHODS A broad study population of adults and children had data collected during a summer period. Data were personal UVR dosimetry measurements, from which the number of "intermittent days" was derived, sun behaviour diaries and retrospective questionnaires. Two definitions of intermittent UVR exposure were tested: (1) days when UVR dose exceeded 3 times individual average daily UVR dose, and (2) days when UVR dose exceeded individual constitutive skin type. Measures of nevi and lentigines were used as surrogates for CMM. RESULTS Using the first definition based solely on UVR dosimetry data we found 1241 "intermittent days" out of a total of 17 277 days (7.2%) among 148 participants. The numbers for nevi and lentigo density were significantly predicted by the number of intermittent days (R(2) = 0.15 and R(2) = 0.40, p < 0.001). The corresponding numbers for prediction of nevi and lentigo density by retrospective questionnaire data was lower (R(2) = 0.11, R(2) = 0.26, p < 0.001). CONCLUSIONS We introduce a well-defined objective measure of intermittent UVR exposure. This measure may provide a better prediction of solar skin damage and CMM than retrospective questionnaire data.
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Affiliation(s)
- M Bodekær
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
| | - P A Philipsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
| | - B Petersen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
| | - J Heydenreich
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
| | - H C Wulf
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
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Thaysen-Petersen D, Erlendsson AM, Nash JF, Beerwerth F, Philipsen PA, Wulf HC, Paasch U, Haedersdal M. Side effects from intense pulsed light: Importance of skin pigmentation, fluence level and ultraviolet radiation-A randomized controlled trial. Lasers Surg Med 2016; 49:88-96. [PMID: 27474536 DOI: 10.1002/lsm.22566] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVE Intense pulsed light (IPL) is a mainstream treatment for hair removal. Side effects after IPL are known, but risk factors remain to be investigated. The objective of this study was to assess the contribution of skin pigmentation, fluence level, and ultraviolet radiation (UVR) on IPL-induced side effects. METHODS The study was a blinded, randomized intra-individual controlled trial including 16 healthy subjects with Fitzpatrick Skin Types (FST) II-V. Three test areas were each divided into four sites, randomized to a single IPL exposure of 22, 34, 46 J/cm2 or triple stacking of 46 J/cm2 . Areas were subsequently randomized to no UVR or single solar-simulated UVR exposure of 3 Standard Erythema Dose at 30 minutes or 24 hours after IPL. Each area had a corresponding control, resulting in 15 treatment sites. Follow-up visits were scheduled up to 4 weeks after IPL. Outcome measures were: (i) blinded clinical skin reactions; (ii) objectively measured erythema and pigmentation; (iii) pain measured by visual analog scale (VAS); (iv) histology (H&E, Fontana-Masson); and (v) mRNA-expression of p53. RESULTS Fifteen subjects with FST II-IV completed the protocol. IPL induced a wide range of skin reactions, including erythema (87% of subjects), purpura (27%), blisters (20%), edema (13%), crusting (13%), hyper- (60%), and hypopigmentation (20%). Darker skin pigmentation and increasing IPL fluence were determinants for IPL-induced side effects (P ≤ 0.002), while a single exposure of UVR did not exacerbate side effects (P ≥ 0.180). Clinical findings were confirmed objectively by reflectance spectrometry and qualitatively by histological changes in skin architecture, inflammatory infiltration, and pigmentation. Marker of cellular DNA damage, that is, p53, did not increase after IPL (P ≥ 0.24). CONCLUSIONS Skin pigmentation and IPL fluence are major determinants of side effects after IPL exposure, while a single exposure to three SED of UVR at 30 minutes or 24 hours after IPL, does not amplify such side effects. Lasers Surg. Med. 49:88-96, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Daniel Thaysen-Petersen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, Nordvest, Denmark
| | - Andres M Erlendsson
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, Nordvest, Denmark
| | - J F Nash
- The Procter & Gamble Company, Cincinnati, Ohio, 45202
| | | | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, Nordvest, Denmark
| | - Hans C Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, Nordvest, Denmark
| | - Uwe Paasch
- Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, Nordvest, Denmark
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Taudorf EH, Lerche CM, Erlendsson AM, Philipsen PA, Hansen SH, Janfelt C, Paasch U, Anderson RR, Haedersdal M. Fractional laser-assisted drug delivery: Laser channel depth influences biodistribution and skin deposition of methotrexate. Lasers Surg Med 2016; 48:519-29. [PMID: 26846733 DOI: 10.1002/lsm.22484] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Ablative fractional laser (AFXL) facilitates delivery of topical methotrexate (MTX). This study investigates impact of laser-channel depth on topical MTX-delivery. MATERIALS AND METHODS MTX (1% [w/v]) diffused for 21 hours through AFXL-exposed porcine skin in in vitro Franz Cells (n = 120). A 2,940 nm AFXL generated microscopic ablation zones (MAZs) into epidermis (11 mJ/channel, MAZ-E), superficial-dermis (26 mJ/channel, MAZ-DS), and mid-dermis (256 mJ/channel, MAZ-DM). High performance liquid chromatography (HPLC) was used to quantify MTX deposition in full-thickness skin, biodistribution profiles at specific skin levels, and transdermal permeation. Fluorescence microscopy was used to visualize UVC-activated MTX-fluorescence (254 nm) and semi-quantify MTX distribution in skin. RESULTS AFXL increased topical MTX-delivery (P < 0.001). Without laser exposure, MTX-concentration in full-thickness skin was 0.07 mg/cm(2) , increasing sixfold (MAZ-E), ninefold (MAZ-DS), and 11-fold (MAZ-DM) after AFXL (P < 0.001). Deeper MAZs increased MTX-concentrations in all skin layers (P < 0.038) and favored maximum accumulation in deeper skin layers (MAZ-E: 1.85 mg/cm(3) at 500 μm skin-level vs. MAZ-DM 3.75 mg/cm(3) at 800 μm, P = 0.002). Ratio of skin deposition versus transdermal permeation remained constant, regardless of MAZ depth (P = 0.172). Fluorescence intensities confirmed MTX biodistribution through coagulation zones and into surrounding skin, regardless of thickness of coagulation zones (6-47 μm, P ≥ 0.438). CONCLUSION AFXL greatly increases topical MTX-delivery. Deeper MAZs deliver higher MTX-concentrations than superficial MAZs, which indicates that laser channel depth may be important for topical delivery of hydrophilic molecules. Lasers Surg. Med. 48:519-529, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- E H Taudorf
- Department of Dermatology, Bispebjerg University Hospital, University of Copenhagen, Denmark
| | - C M Lerche
- Department of Dermatology, Bispebjerg University Hospital, University of Copenhagen, Denmark
| | - A M Erlendsson
- Department of Dermatology, Bispebjerg University Hospital, University of Copenhagen, Denmark
| | - P A Philipsen
- Department of Dermatology, Bispebjerg University Hospital, University of Copenhagen, Denmark
| | - S H Hansen
- Faculty of Health and Medical Sciences, Department of Pharmacy, University of Copenhagen, Denmark
| | - C Janfelt
- Faculty of Health and Medical Sciences, Department of Pharmacy, University of Copenhagen, Denmark
| | - U Paasch
- Division of Dermatopathology, Aesthetics and Laserdermatology, Departments of Dermatology, University of Leipzig, Germany
| | - R R Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - M Haedersdal
- Department of Dermatology, Bispebjerg University Hospital, University of Copenhagen, Denmark.,Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Datta P, Philipsen PA, Olsen P, Petersen B, Johansen P, Morling N, Wulf HC. Major inter-personal variation in the increase and maximal level of 25-hydroxy vitamin D induced by UVB. Photochem Photobiol Sci 2016; 15:536-45. [DOI: 10.1039/c5pp00462d] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Individual differences in vitamin D formation and metabolism after long-term UVB exposure were at least 131 nmol l−1, even after eliminating most of the known external and behavioural sources of variation.
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Affiliation(s)
- Pameli Datta
- Department of Dermatology
- Copenhagen University Hospital
- Bispebjerg Hospital
- 2400 Copenhagen NV
- Denmark
| | - Peter A. Philipsen
- Department of Dermatology
- Copenhagen University Hospital
- Bispebjerg Hospital
- 2400 Copenhagen NV
- Denmark
| | - Peter Olsen
- Department of Dermatology
- Copenhagen University Hospital
- Bispebjerg Hospital
- 2400 Copenhagen NV
- Denmark
| | - Bibi Petersen
- Department of Dermatology
- Copenhagen University Hospital
- Bispebjerg Hospital
- 2400 Copenhagen NV
- Denmark
| | - Peter Johansen
- Section of Forensic Genetics
- Department of Forensic Medicine
- Faculty of Health and Medical Sciences
- University of Copenhagen
- 2100 Copenhagen
| | - Niels Morling
- Section of Forensic Genetics
- Department of Forensic Medicine
- Faculty of Health and Medical Sciences
- University of Copenhagen
- 2100 Copenhagen
| | - Hans C. Wulf
- Department of Dermatology
- Copenhagen University Hospital
- Bispebjerg Hospital
- 2400 Copenhagen NV
- Denmark
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Thaysen-Petersen D, Erlendsson AM, Nash JF, Beerwerth F, Philipsen PA, Wulf HC, Haedersdal M. Ultraviolet radiation after exposure to a low-fluence IPL home-use device: a randomized clinical trial. Lasers Med Sci 2015; 30:2171-7. [PMID: 26296296 DOI: 10.1007/s10103-015-1796-4] [Citation(s) in RCA: 3] [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: 03/30/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022]
Abstract
The prevailing advice is to avoid sun exposure after intense pulsed light (IPL) hair removal. However, no systematic evaluation of ultraviolet radiation (UVR) after IPL hair removal exits. Therefore, we investigated the occurrence of side effects in subjects receiving solar-simulated UVR after a low-fluence IPL treatment with a home-use device. Sixteen subjects with Fitzpatrick skin types (FST) II-V were enrolled. Three constitutive buttock blocks (4.4 × 6.4 cm) were each subdivided into four sites, randomized to one IPL exposure of 0, 7, 8, or 10 J/cm2 (spectral output 530-1100 nm). Blocks were randomized to no UVR or three standard erythema doses (SEDs) UVR either 30 min or 24 h after IPL. Follow-up visits were 48 h, 1 week, and 4 weeks after IPL. Outcome measures were (i) clinical skin reactions, (ii) reflectance measurements of erythema and pigmentation, and (iii) pain. Subjects with FST II-IV experienced no skin reactions up to 4 weeks after IPL, neither erythema, edema, blisters, crusting, textual, nor pigment changes. Reflectance confirmed no change in erythema and pigmentation (p ≥ 0.090). UVR exposure induced erythema and increased pigmentation. The combination of IPL and UVR induced skin reactions not different to responses from UVR (IPL-UVR vs. UVR, p ≥ 0.164). Pain was generally low (median 1, range 0-4) and correlated positively with fluence and pigmentation (Spearman's rho ≥ 0.394, p < 0.001). One subject with FST V experienced perifollicular hyperpigmentation after IPL and slightly more intense when exposed to UVR. A single UVR exposure of three SEDs either shortly or 1 day after low-fluence IPL causes no amplification of skin responses in constitutive skin of individuals with FST II-IV.
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Affiliation(s)
- Daniel Thaysen-Petersen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark.
| | - Andres M Erlendsson
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark
| | - J F Nash
- The Procter & Gamble Company, Cincinnati, Ohio, 45202, USA
| | | | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark
| | - Hans C Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark
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Nissen CV, Philipsen PA, Wulf HC. Protoporphyrin IX formation after topical application of methyl aminolaevulinate and BF-200 aminolaevulinic acid declines with age. Br J Dermatol 2015; 173:760-6. [PMID: 25997508 DOI: 10.1111/bjd.13923] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) is a popular treatment modality in dermatology. The effect of PDT in epidermal cells depends on formation of protoporphyrin IX (PpIX) from 5-aminolevulinic acid (ALA). A variety of physiological changes in epidermal function occur with increasing age, but no studies have investigated whether PpIX formation is age-related. OBJECTIVES To investigate a possible relationship between age and PpIX formation. METHODS Methyl aminolaevulinate cream (MAL) and 5-ALA gel (BF-200 ALA) were applied to two identical fields on the forearm of 30 healthy volunteers for 24 h. The volunteers were divided into two age groups: a young group under 55 years (range 18-54) and an older group over 55 years (range 65-85). PpIX formation was measured noninvasively every hour from 1-5 h, and after 18, 21 and 24 h. Skin phototype, stratum corneum hydration and ultraviolet (UV) damage were also assessed. Treatment efficacy in relation to age was evaluated in 100 basal cell carcinomas (BCCs) treated with MAL-PDT. RESULTS Both photosensitizers induced significantly more PpIX formation in the younger group. Linear regression revealed a significant age-related decline in PpIX formation after the standard application time of 3 h (P < 0.001 for both treatments). Skin phototype, stratum corneum hydration and UV damage were not associated with PpIX formation. The treatment efficacy of BCCs 3 months after MAL-PDT was higher in young patients (P = 0.012). CONCLUSIONS PpIX formation in human skin declines with age. No explanation could be attributed to skin phototype, stratum corneum hydration or UV damage. The consequence might be reduced efficacy of PDT in the elderly.
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Affiliation(s)
- C V Nissen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark
| | - P A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark
| | - H C Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark
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Erlendsson AM, Egekvist H, Lorentzen HF, Philipsen PA, Stausbøl-Grøn B, Stender IM, Haedersdal M. Actinic keratosis: a cross-sectional study of disease characteristics and treatment patterns in Danish dermatology clinics. Int J Dermatol 2015; 55:309-16. [PMID: 26276415 DOI: 10.1111/ijd.12874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/11/2014] [Accepted: 09/25/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The incidence of actinic keratosis (AK) is increasing, and several treatment options are available. The aim of this study was to describe clinical characteristics and treatment patterns in patients with AK treated by Danish dermatologists. METHODS A multicenter, non-interventional, cross-sectional study was conducted. Three dermatology hospital departments and seven private dermatology clinics enrolled eligible AK patients consecutively during one week. RESULTS A total of 312 patients were included. Non-melanoma skin cancer (NMSC) was previously reported in 51.0% of patients and currently suspected in 9.4% of AK-affected anatomical regions. Lesions of AK were located primarily on the face (38.6%), scalp (12.8%), and hands (11.2%). Actinic keratosis commonly presented with multiple AK lesions (38.6%) and field cancerization (38.5%). The treatments used most frequently were cryotherapy (57.7%) and photodynamic therapy (PDT) with methyl aminolevulinate (17.1%) and imiquimod (11.2%). The likelihood of receiving cryotherapy was higher for men (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.10-2.47) and increased with age (2.2% per year, 0.4-4.0%). PDT represented the most frequently applied treatment for severe actinic damage and was more likely to be prescribed to women (OR 4.08, 95% CI 2.22-7.47) and young patients (OR 0.97 per year, 95% CI 0.95-0.99). The prevalence of severe actinic damage (17.3% versus 9.6%) and intake of immunosuppressive medication (29.0 versus 2.0) were higher among hospital patients compared with those treated in private practices (P < 0.0001). CONCLUSIONS The majority of AK patients in Danish dermatology clinics have a history of skin cancer, and NMSC is suspected in almost 10% of AK-affected regions. Cryotherapy is the most frequently used treatment overall, except in instances of severe actinic damage, in which PDT is the first-choice treatment.
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Affiliation(s)
- Andrés M Erlendsson
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Bodekær M, Petersen B, Thieden E, Philipsen PA, Heydenreich J, Olsen P, Wulf HC. UVR exposure and vitamin D in a rural population. A study of outdoor working farmers, their spouses and children. Photochem Photobiol Sci 2015; 13:1598-606. [PMID: 25248029 DOI: 10.1039/c4pp00188e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Living and working in the countryside may result in excessive UVR exposure, with increased risk of skin cancer. Some sun exposure is, however, recommended, since vitamin D production is UVB-dependent. OBJECTIVES To examine UVR exposure and vitamin D levels in a rural population of outdoor working male farmers, their indoor working spouses and their children, expected to receive high UVR exposure. METHODS Prospective, cohort study. During the summer 2009 daily, personal UVR exposure and sun behaviour were recorded by dosimetry and diaries (17 403 days). Vitamin D was measured at the end of summer and the following winter. RESULTS Risk behaviour (= exposure of shoulders/upper body to the sun), beach days, sunscreen use and sunburns were infrequent. Farmers and boys had the highest daily UVR exposure (both 1.5 SED per day), likewise on work days. On non-work days the UVR exposure was even higher (up to 2.0 SED per day). Farmers, girls and boys had a higher chronic UVR exposure than the spouses, who had more intermittent high UVR exposure. Vitamin D levels did not differ between family members. At the end of summer 16% of the participants were vitamin D insufficient, the following winter, 61%. Some UVR exposure variables correlated positively, but weakly, with vitamin D levels. CONCLUSIONS UVR exposure was generally high among this study population, however, vitamin D levels still dropped below the recommended level during winter for most participants. Differences in UVR exposure between the groups did not result in differences in vitamin D levels.
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Affiliation(s)
- M Bodekær
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
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Lerche CM, Fabricius S, Philipsen PA, Wulf HC. Correlation between treatment time, photobleaching, inflammation and pain after photodynamic therapy with methyl aminolevulinate on tape-stripped skin in healthy volunteers. Photochem Photobiol Sci 2015; 14:875-82. [DOI: 10.1039/c5pp00069f] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A shorter incubation time with methyl aminolevulinate in healthy volunteers results in decreased photobleaching and also less inflammation and pain.
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Affiliation(s)
| | - Susanne Fabricius
- Department of Dermatology
- Copenhagen University Hospital
- Copenhagen
- Denmark
| | - Peter A. Philipsen
- Department of Dermatology
- Copenhagen University Hospital
- Copenhagen
- Denmark
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45
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Thaysen-Petersen D, Barbet-Pfeilsticker M, Beerwerth F, Nash JF, Philipsen PA, Staubach P, Haedersdal M. Quantitative assessment of growing hair counts, thickness and colour during and after treatments with a low-fluence, home-device laser: a randomized controlled trial. Br J Dermatol 2014; 172:151-9. [PMID: 25039260 DOI: 10.1111/bjd.13254] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND At-home laser and intense pulsed-light hair removal continues to grow in popularity and availability. A relatively limited body of evidence is available on the course of hair growth during and after low-fluence laser usage. OBJECTIVES To assess growing hair counts, thickness and colour quantitatively during and after cessation of low-fluence laser treatment. METHODS Thirty-six women with skin phototypes I-IV and light to dark-brown axillary hairs were included. Entire axillary regions were randomized to zero or eight self-administered weekly treatments with an 810-nm home-use laser at 5·0-6·4 J cm(-2). Standardized clinical photographs were taken before each treatment and up to 3 months after the final treatment for computer-aided quantification of growing hair counts, thickness and colour. RESULTS Thirty-two women completed the study protocol. During sustained treatment, there was a reduction in growing hair that reached a plateau of up to 59%, while remaining hairs became up to 38% thinner and 5% lighter (P < 0·001). The majority of subjects (77%) reported 'moderately' to 'much less hair' in treated than untreated axilla, and assessed remaining hairs as thinner and lighter (≥ 60%). After treatment cessation, hair growth gradually returned to baseline levels, and 3 months after the final treatment the count and thickness of actively growing hair exceeded pretreatment values by 29% and 7%, respectively (P ≤ 0·04). CONCLUSIONS Sustained usage of low-fluence laser induced a stable reduction of growing hair counts, thickness and colour. The reduction was reversible and hairs regrew beyond baseline values after cessation of usage. Computer-aided image analysis was qualified for quantification of hair counts, thickness and colour after laser epilation.
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Affiliation(s)
- D Thaysen-Petersen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark
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Togsverd-Bo K, Lerche CM, Philipsen PA, Hædersdal M, Wulf HC. Artificial daylight photodynamic therapy with "non-inflammatory" doses of hexyl aminolevulinate only marginally delays SCC development in UV-exposed hairless mice. Photochem Photobiol Sci 2014; 12:2130-6. [PMID: 24064675 DOI: 10.1039/c3pp50152c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Photodynamic therapy (PDT) is effective for actinic keratoses, but is associated with pain and post-treatment inflammation. Daylight-mediated PDT and PpIX-precursors at low concentrations reduce pain and inflammation intensity. The objective was to evaluate the effect of repeated low-concentration PDT combined with artificial daylight on SCC development. Mice (n = 265) were exposed to simulated solar UV-irradiation (UVR) 3 times weekly mimicking "summer-dose"-exposure (3 SED). Selected groups of mice received a "winter-dose"-exposure (0.6 SED) for the first 90 days. PDT was delivered with 0.1%, 0.05% and 0.02% hexyl aminolevulinate (HAL) cream and artificial daylight for 2.5 hours (6 J cm(-2)) in different treatment regimes (1-3 times weekly, 45-days intervals, days 1-180 and from day 180 onwards). The primary end-point was the time to first SCC (1 mm diameter). 0.1% HAL-PDT given 3 times weekly slightly delayed SCC development and induced minimal inflammation. In winter- and summer UVR-treatment regimes, 0.1% HAL PDT delayed the time to first SCC compared to control UVR and placebo-PDT when mice were PDT-treated on days 1-180 (median 213 vs. 199 days, p = 0.011) and from day 180 onwards (median 218 vs. 199 days, p = 0.006). PDT with 0.05% and 0.02% HAL did not influence SCC development (medians 206 days, p = ns). In summer UVR-exposed mice, 0.1% HAL-PDT marginally postponed the time to first SCC compared to control UVR (median 160 days) when treatments were given 3 times weekly for 180 days (median 166, p = 0.01), but not for 90 days (median 161, p = 0.112). In conclusion, repeated low-concentration HAL-PDT combined with artificial daylight is well-tolerated, but only marginally delays SCC development in mice.
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Petersen B, Wulf HC, Triguero-Mas M, Philipsen PA, Thieden E, Olsen P, Heydenreich J, Dadvand P, Basagaña X, Liljendahl TS, Harrison GI, Segerbäck D, Schmalwieser AW, Young AR, Nieuwenhuijsen MJ. Sun and ski holidays improve vitamin D status, but are associated with high levels of DNA damage. J Invest Dermatol 2014; 134:2806-2813. [PMID: 24844860 DOI: 10.1038/jid.2014.223] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 04/18/2014] [Accepted: 04/22/2014] [Indexed: 01/10/2023]
Abstract
Skin cancer is caused by solar UVR, which is also essential for vitamin D production. DNA damage (thymine dimers: T-T dimers) and vitamin D (25(OH)D) synthesis are both initiated by solar UVB. We aimed to investigate the simultaneous adverse and beneficial effects of solar UVB exposure in holidaymakers. Sun-seekers and skiers (n=71) were observed over 6 days through on-site monitoring, personal diary entries, and recording of personal UVB exposure doses with electronic dosimeters. Urine and blood samples were analyzed for T-T dimers and 25(OH)D, respectively. The volunteers had a statistically significant increase in vitamin D. There were strong associations between UVB exposure and post-holiday levels of T-T dimers and vitamin D, as well as between post-holiday T-T dimers and vitamin D. We conclude that UVB-induced vitamin D synthesis is associated with considerable DNA damage in the skin. These data, on two major health predictors, provide a basis for further field studies that may result in better understanding of the risks and benefits of "real life" solar exposure. However, vitamin D status can be improved more safely through the use of vitamin D dietary supplements.
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Affiliation(s)
- Bibi Petersen
- Department of Dermatological Research, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark.
| | - Hans C Wulf
- Department of Dermatological Research, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
| | - Margarita Triguero-Mas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Peter A Philipsen
- Department of Dermatological Research, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
| | - Elisabeth Thieden
- Department of Dermatological Research, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
| | - Peter Olsen
- Department of Dermatological Research, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jakob Heydenreich
- Department of Dermatological Research, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
| | - Payam Dadvand
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Xavier Basagaña
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Tove S Liljendahl
- Department of Biosciences and Nutrition, Karolinska Institute, Novum, Huddinge, Sweden
| | - Graham I Harrison
- St John's Institute of Dermatology, Guy's Hospital, King's College London, London, UK
| | - Dan Segerbäck
- Department of Biosciences and Nutrition, Karolinska Institute, Novum, Huddinge, Sweden
| | - Alois W Schmalwieser
- Unit of Molecular Physiology and Biophysics, University of Veterinary Medicine, Vienna, Austria
| | - Antony R Young
- St John's Institute of Dermatology, Guy's Hospital, King's College London, London, UK
| | - Mark J Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Taudorf EH, Haak CS, Erlendsson AM, Philipsen PA, Anderson RR, Paasch U, Haedersdal M. Fractional ablative erbium YAG laser: Histological characterization of relationships between laser settings and micropore dimensions. Lasers Surg Med 2014; 46:281-9. [DOI: 10.1002/lsm.22228] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Elisabeth H. Taudorf
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Christina S. Haak
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
- Wellman Center for Photomedicine; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | - Andrés M. Erlendsson
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Peter A. Philipsen
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - R. Rox Anderson
- Wellman Center for Photomedicine; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | - Uwe Paasch
- Departments of Dermatology; Venereology and Allergology; University of Leipzig; Leipzig Germany
| | - Merete Haedersdal
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
- Wellman Center for Photomedicine; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
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49
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Petersen B, Thieden E, Philipsen PA, Heydenreich J, Wulf HC, Young AR. Determinants of personal ultraviolet-radiation exposure doses on a sun holiday. Br J Dermatol 2013; 168:1073-9. [PMID: 23301517 DOI: 10.1111/bjd.12211] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A great number of journeys to sunny destinations are sold to the Danish population every year. We suspect that this travel considerably increases personal annual ultraviolet-radiation (UVR) exposure doses. This is important because such exposure is the main cause of skin cancer, and studies have shown a correlation between intermittent solar UVR exposure and malignant melanoma. OBJECTIVES To prospectively monitor the behaviour of a group of sun seekers during a winter sun holiday and to study the impact of behaviour on personal UVR exposure doses. METHODS In this observational study 25 Danish sun seekers were closely monitored by on-site investigators for 6 days during a winter sun holiday in the Canary Islands, thus avoiding the possible recall bias of retrospective studies with questionnaires. The volunteers recorded their location, clothing and sunscreen use in diaries, and their UVR doses were measured by personal UVR dosimeters worn on the wrist. This resulted in 3450 half-hour registrations during 150 participation days. RESULTS On average, each volunteer received a total UVR dose of 57 standard erythema doses over 6 days, which is 43% of the annual UVR dose of a Danish indoor worker. Their exposed body area, sunscreen use and percentage of body with sunscreen application were positively correlated with their personal UVR doses, and there was also a strong relationship between location and UVR doses received. CONCLUSIONS The behaviour of the volunteers had a major impact on their personal UVR doses. Our results emphasize the importance of changing the behaviour of sun seekers with protanning attitudes to reduce their personal annual UVR exposure doses, and possibly their risk of skin cancer.
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Affiliation(s)
- B Petersen
- Department of Dermatological Research, University of Copenhagen, Bispebjerg Hospital, DK-2400, Copenhagen, Denmark.
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Thaysen-Petersen D, Lin JY, Nash J, Beerwerth F, Wulf HC, Philipsen PA, Haedersdal M. The role of natural and UV-induced skin pigmentation on low-fluence IPL-induced side effects: a randomized controlled trial. Lasers Surg Med 2013; 46:104-11. [PMID: 24037900 DOI: 10.1002/lsm.22167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES The risk of adverse skin effects following light-based hair removal is greater in pigmented skin based on the theory of selective photothermolysis. Thus sunlight-induced pigment i.e., facultative pigmentation, increases the risk of adverse skin effects, perhaps disproportionately. The aim of this study was to evaluate the influence of constitutive and facultative skin pigmentation on low-fluence intense pulsed light (IPL)-induced adverse skin effects. STUDY DESIGN/MATERIALS AND METHODS Twenty-one subjects with Fitzpatrick skin type II-IV were enrolled. Two buttock blocks were randomized to receive 0 or 8 solar simulated ultraviolet radiation (UVR) exposures of consecutively increasing Standard Erythema Doses (2-4 SED). Each block was subdivided into four sites, randomized to receive IPL of 0, 7, 8, or 10 J/cm(2) , once a week for 3 weeks. Biopsies were taken 16-24 hours after the first IPL exposure and subjects were seen 1 and 4 weeks after the last IPL exposure. Outcome measures were: (i) skin reactions, (ii) pain, (iii) mRNA expression of pigment-markers microphthalmia-associated transcription factor (MITF) and pro-opiomelanocortin (POMC), and (iv) clinical appearance of biopsy wounds. RESULTS Skin pigmentation increased after UVR (baseline median 13.8%, after UVR 28.1%, P = 0.0001) in all skin types. Subjects reported low pain intensities (median 1.5, scale 0-10) and experienced transient erythema immediately after IPL exposure. No persistent erythema, blisters, crusting, textual, or pigment changes were observed. The risk of erythema and pain intensities increased with IPL dose and skin pigmentation (P < 0.03). There was no difference in pain or skin reactions in skin with similar degree of natural and facultative pigmentation (P ≥ 0.104). Expression of cellular pigment-markers was not influenced by IPL exposure, neither in constitutive nor in facultative pigmented skin. Clinical appearance of biopsy wounds was unaffected by IPL exposure. CONCLUSION The prevalence and intensity of low-fluence IPL-induced adverse skin effects depended on IPL dose and skin pigmentation regardless of the origin, i.e., constitutive versus UV induced.
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Affiliation(s)
- Daniel Thaysen-Petersen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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