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Harvey VM, Alexis A, Okeke CAV, McKinley-Grant L, Taylor SC, Desai SR, Jaleel T, Heath CR, Kang S, Vashi N, Lester J, Vasquez R, Rodrigues M, Elbuluk N, Hamzavi I, Kwatra SG, Sundaram H, Cobb C, Brown SG, Kohli I, Callender VD. Integrating skin color assessments into clinical practice and research: A review of current approaches. J Am Acad Dermatol 2024:S0190-9622(24)00215-9. [PMID: 38342247 DOI: 10.1016/j.jaad.2024.01.067] [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: 06/20/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/13/2024]
Abstract
Skin color classification can have importance in skin health, pigmentary disorders, and oncologic condition assessments. It is also critical for evaluating disease course and response to a variety of therapeutic interventions and aids in accurate classification of participants in clinical research studies. A panel of dermatologists conducted a literature review to assess the strengths and limitations of existing classification scales, as well as to compare their preferences and utilities. We identified 17 skin classification systems utilized in dermatologic settings. These systems include a range of parameters such as UV light reactivity, race, ethnicity, and degree of pigmentation. The Fitzpatrick skin type classification is most widely used and validated. However it has numerous limitations including its conflation with race, ethnicity, and skin color. There is a lack of validation data available for the remaining scales. There are significant deficiencies in current skin classification instruments. Consensus-based initiatives to drive the development of validated and reliable tools are critically needed.
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Affiliation(s)
- Valerie M Harvey
- Director, Hampton Roads Center for Dermatology, Newport News, Virginia; President, Skin of Color Society, Newport News, Virginia.
| | - Andrew Alexis
- Clinical Dermatology, Weill Cornell Medical College, New York, New York
| | - Chidubem A V Okeke
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Lynn McKinley-Grant
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Seemal R Desai
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Innovative Dermatology, Dallas, Texas
| | - Tarannum Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Candrice R Heath
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Neelam Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Jenna Lester
- Department of Dermatology, School of Medicine, University of California, San Francisco, California
| | | | - Michelle Rodrigues
- Department of Dermatology, Royal Children's Hospital, Victoria, Australia
| | - Nada Elbuluk
- Department of Dermatology, Keck Medicine, University of Southern California, Los Angeles, California
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hema Sundaram
- Private Practice, Rockville, Maryland; Private Practice, Fairfax, Virginia; Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Caryn Cobb
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Stafford G Brown
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia
| | - Indermeet Kohli
- The Henry W Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; Department of Physics and Astronomy, Wayne State University, Detroit, Michigan
| | - Valerie D Callender
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
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Mineroff J, Maghfour J, Ozog DM, Lim HW, Kohli I, Jagdeo J. Photobiomodulation CME part II: Clinical applications in dermatology. J Am Acad Dermatol 2024:S0190-9622(24)00187-7. [PMID: 38307144 DOI: 10.1016/j.jaad.2023.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/07/2023] [Accepted: 10/08/2023] [Indexed: 02/04/2024]
Abstract
Photobiomodulation (PBM) is an emerging treatment modality in dermatology with increasing office and home-based use. PBM is the use of various light sources in the red light (620-700 nm) and near-infrared (700-1440 nm) spectrum as a form of light therapy. PBM is often administered through low-level lasers or light-emitting diodes. Studies show that PBM can be used effectively to treat conditions secondary to cancer therapies, alopecia, ulcers, herpes simplex virus, acne, skin rejuvenation, wounds, and scars. PBM offers patients many benefits compared to other treatments. It is noninvasive, cost-effective, convenient for patients, and offers a favorable safety profile. PBM can be used as an alternative or adjuvant to other treatment modalities including pharmacotherapy. It is important for dermatologists to gain a better clinical understanding of PBM for in-office administration and to counsel patients on proper application for home-use devices to best manage safety and expectations as this technology develops. PBM wavelengths can induce varied biological effects in diverse skin types, races, and ethnicities; therefore, it is also important for dermatologists to properly counsel their skin of color patients who undergo PBM treatments. Future clinical trials are necessary to produce standardized recommendations across conditions and skin types.
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Affiliation(s)
- Jessica Mineroff
- Department of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, New York
| | - Jalal Maghfour
- The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan
| | - David M Ozog
- The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Henry W Lim
- The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Indermeet Kohli
- The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; Department of Physics and Astronomy, Wayne State University, Detroit, Michigan
| | - Jared Jagdeo
- Department of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, New York.
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Maghfour J, Ozog DM, Mineroff J, Jagdeo J, Kohli I, Lim HW. Photobiomodulation CME Part I: Overview and Mechanism of Action. J Am Acad Dermatol 2024:S0190-9622(24)00186-5. [PMID: 38309304 DOI: 10.1016/j.jaad.2023.10.073] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 02/05/2024]
Abstract
Photobiomodulation (PBM), previously known as low-level laser light therapy, represents a non-invasive form of phototherapy that utilizes wavelengths in the red light (RL, 620-700 nm) portion of the visible light (VL, 400-700 nm) spectrum and the near-infrared (NIR, 700-1440 nm) spectrum. PBM is a promising and increasingly used therapy for the treatment of various dermatologic and non-dermatologic conditions. Photons from RL and NIR are absorbed by endogenous photoreceptors including mitochondrial cytochrome C oxidase (COX). Activation of COX leads to the following changes: modulation of mitochondrial adenosine triphosphate (ATP), generation of reactive oxygen species (ROS), and alterations in intracellular calcium levels. The associated modulation of ATP, ROS and calcium levels promotes the activation of various signaling pathways (e.g., insulin-like growth factors, phosphoinositide 3-kinase pathways), which contribute to downstream effects on cellular proliferation, migration and differentiation. Effective PBM therapy is dependent on treatment parameters (e.g., fluence, treatment duration and output power). PBM is generally well-tolerated and safe with erythema being the most common and self-limiting adverse cutaneous effect.
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Affiliation(s)
- Jalal Maghfour
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - David M Ozog
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA; The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, MI, USA; College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.
| | - Jessica Mineroff
- Department of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jared Jagdeo
- Department of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Indermeet Kohli
- College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA; The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, MI, USA; College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
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Grant GJ, Kohli I, Mohammad TF. A narrative review of the impact of ultraviolet radiation and sunscreen on the skin microbiome. Photodermatol Photoimmunol Photomed 2024; 40:e12943. [PMID: 38288770 DOI: 10.1111/phpp.12943] [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] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/18/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND The human skin microbiome is a dynamic ecosystem that plays an important role in skin health. The skin microbiome has been implicated in numerous diseases, and our knowledge surrounding it continues to evolve. A better understanding of the interactions between the environment and the skin microbiome will lead to improvements in skin health. METHODS This article reviews the published literature surrounding the impact of ultraviolet radiation (UVR) and sunscreen on the skin microbiome. RESULTS Skin microbes are differentially impacted by UVR, and alterations in the microbiome can be detected following UVR exposure. These changes are related to direct bactericidal effects, alterations in the cutaneous metabolome, and changes in the cutaneous immune system. UV filters used in sunscreen have been shown to have bactericidal effects, and many compounds used in sunscreen emulsions can also negatively impact cutaneous microbes. CONCLUSION A healthy microbiome has been shown to produce compounds that help protect the skin from UVR, and sunscreen has the potential to reduce the diversity of the skin microbiome. This indicates that designing sunscreen products that both provide protection against UVR and preserve the skin microbiome may offer additional benefits to skin health when compared with traditional sunscreen products.
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Affiliation(s)
- Garett J Grant
- Department of Internal Medicine, Transitional Year Residency Program, Henry Ford Hospital, Detroit, Michigan, USA
| | - Indermeet Kohli
- The Henry W Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan, USA
| | - Tasneem F Mohammad
- The Henry W Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
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Ezekwe N, Pourang A, Lyons AB, Narla S, Atyam A, Zia S, Friedman BJ, Hamzavi IH, Lim HW, Kohli I. Evaluation of the protection of sunscreen products against long wavelength ultraviolet A1 and visible light-induced biological effects. Photodermatol Photoimmunol Photomed 2024; 40:e12937. [PMID: 38069506 DOI: 10.1111/phpp.12937] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Long wavelength ultraviolet-A1 in combination with visible light induces hyperpigmentation, particularly in dark-skin phototypes. This study evaluated the efficacy of four sunscreen formulations in protecting against VL + UVA1 (370-700 nm). METHODS The test products (A-D) were applied to the back of 12 volunteers, then irradiated with 320 J/cm2 VL + UVA1 (3.5% UVA1 [370-400 nm]). Immediately after irradiation, and at Days 1, 7, and 14, erythema and pigmentation were assessed by investigator global assessment (IGA), colorimetry (Δa* and ΔITA) and diffuse reflectance spectroscopy (DRS)-measured relative dyschromia (area under the curve AUC). Control areas were irradiated without sunscreen. RESULTS Product D, containing titanium dioxide 11%, iron oxides 1%, and antioxidants, provided the highest and most consistent protection. Compared with unprotected irradiated control, it had statistically significantly less erythema on IGA, DRS (Δoxyhemoglobin), and colorimetry (Δa*) at Day 0; less pigmentation on IGA at all time points, on DRS (relative dyschromia) at Days 7 and 14, and on colorimetry (ΔITA) at Day 0. Product B, containing zinc oxide 12% plus organic UV filters, iron oxides 4%, and antioxidants, also showed some efficacy. CONCLUSION Of the sunscreens tested, the tinted products provided better protection against VL + UVA1 than the non-tinted products. Since the product with 1% iron oxides was superior to the product with 4% iron oxides, further studies are needed to evaluate whether iron oxide content correlates with better protection.
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Affiliation(s)
- Nneamaka Ezekwe
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health, Detroit, Michigan, USA
| | - Aunna Pourang
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health, Detroit, Michigan, USA
| | - Alexis B Lyons
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health, Detroit, Michigan, USA
| | - Shanthi Narla
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health, Detroit, Michigan, USA
| | - Amruth Atyam
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health, Detroit, Michigan, USA
| | - Shereen Zia
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health, Detroit, Michigan, USA
| | - Ben J Friedman
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health, Detroit, Michigan, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health, Detroit, Michigan, USA
| | - Henry W Lim
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health, Detroit, Michigan, USA
| | - Indermeet Kohli
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health, Detroit, Michigan, USA
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan, USA
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Kohli I, Ceresnie MS, Teklehaimanot F, Lane BN, Huggins RH, Hamzavi IH, Lim HW, Mohammad TF. Objective assessment of color match for a universal tinted sunscreen on individuals with skin of color: A pilot study. Photodermatol Photoimmunol Photomed 2024; 40:e12941. [PMID: 38288774 DOI: 10.1111/phpp.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/28/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Indermeet Kohli
- The Henry W. Lim MD Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Marissa S Ceresnie
- The Henry W. Lim MD Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Fayven Teklehaimanot
- Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA
| | - Brittany N Lane
- The Henry W. Lim MD Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Richard H Huggins
- The Henry W. Lim MD Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Iltefat H Hamzavi
- The Henry W. Lim MD Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Henry W Lim
- The Henry W. Lim MD Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Tasneem F Mohammad
- The Henry W. Lim MD Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
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Lim SS, Mohammad TF, Kohli I, Hamzavi I, Rodrigues M. Optimisation of skin phototype classification. Pigment Cell Melanoma Res 2023; 36:468-471. [PMID: 37550876 DOI: 10.1111/pcmr.13110] [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: 09/26/2022] [Revised: 04/17/2023] [Accepted: 06/20/2023] [Indexed: 08/09/2023]
Abstract
Understanding individuals' skin pigmentation and photosensitivity is important in judging risk of skin cancer and response to certain treatment modalities. However, individuals with darkly pigmented skin are poorly represented in the widely used Fitzpatrick skin phototype (FST) system. Moreover, the FST system is prone to misuse, as it relies on subjective patient and clinician assessment of skin type, and does not clearly differentiate pigmentation from photosensitivity. By evaluating the key literature surrounding the FST system, its criticisms and proposed alternatives, this review serves to understand how skin phototype classification can be optimised.
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Affiliation(s)
| | - Tasneem F Mohammad
- The Henry W Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Indermeet Kohli
- The Henry W Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
- Chroma Dermatology, Pigment and Skin of Colour Centre, Melbourne, Victoria, Australia
| | - Iltefat Hamzavi
- The Henry W Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Michelle Rodrigues
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan, USA
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Kumar N, Pourang A, Ezekwe N, Parks-Miller A, Mohammad TF, Huggins RH, Deal LS, Lukic T, Zhang F, Lim HW, Hamzavi I, Kohli I. A method for assessing rater reliability in applying the Vitiligo Area Scoring Index. Br J Dermatol 2023; 189:645-647. [PMID: 37555429 DOI: 10.1093/bjd/ljad285] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/10/2023]
Abstract
The Vitiligo Area Scoring Index (VASI) is a tool for measuring repigmentation after patients undergo vitiligo treatment, offering a standardized, quantitative scale without the need for specialized equipment. For large multicentre trials that require multiple raters, VASI must be consistently applied to generate interpretable data; therefore, a method for assessing rater reliability would improve data integrity for large clinical studies of vitiligo. This study aimed to assess a method for determining the reliability of VASI raters by evaluating raters of different levels of experience relative to a gold standard.
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Affiliation(s)
- Nishant Kumar
- The Multicultural Dermatology Center and The Henry W Lim, MD, Division of Photobiology and Photomedicine Unit, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Aunna Pourang
- The Multicultural Dermatology Center and The Henry W Lim, MD, Division of Photobiology and Photomedicine Unit, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Nneamaka Ezekwe
- The Multicultural Dermatology Center and The Henry W Lim, MD, Division of Photobiology and Photomedicine Unit, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- University of Colorado, Aurora, CO, USA
| | - Angela Parks-Miller
- The Multicultural Dermatology Center and The Henry W Lim, MD, Division of Photobiology and Photomedicine Unit, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Tasneem F Mohammad
- The Multicultural Dermatology Center and The Henry W Lim, MD, Division of Photobiology and Photomedicine Unit, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Richard H Huggins
- The Multicultural Dermatology Center and The Henry W Lim, MD, Division of Photobiology and Photomedicine Unit, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | | | | | | | - Henry W Lim
- The Multicultural Dermatology Center and The Henry W Lim, MD, Division of Photobiology and Photomedicine Unit, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Iltefat Hamzavi
- The Multicultural Dermatology Center and The Henry W Lim, MD, Division of Photobiology and Photomedicine Unit, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Indermeet Kohli
- The Multicultural Dermatology Center and The Henry W Lim, MD, Division of Photobiology and Photomedicine Unit, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Department of Physics and Astronomy, Wayne State University, Detroit, MI, USA
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9
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Cohen L, Brodsky MA, Zubair R, Kohli I, Hamzavi IH, Sadeghpour M. Cutaneous interaction with visible light: What do we know? J Am Acad Dermatol 2023; 89:560-568. [PMID: 32289393 DOI: 10.1016/j.jaad.2020.03.115] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
Visible light has been used therapeutically in dermatology for years for a variety of cosmetic and medical indications, including skin rejuvenation and the treatment of inflammatory and neoplastic conditions, among others. Until recently, visible light was thought to be relatively inert compared to its spectral neighbors, ultraviolet and infrared radiation. However, recent literature has described the ability of visible light to cause erythema in light skin and pigmentary changes in individuals with darker skin types. Concern surrounding its potentially damaging cutaneous effects has been raised in both the medical community and social media outlets. In this article, we provide an evidenced-based review describing what is currently known about visible light, focusing on its role in dermatologic diseases including disorders of hyperpigmentation such as melasma and postinflammatory hyperpigmentation.
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Affiliation(s)
- Leah Cohen
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Raheel Zubair
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
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10
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Ceresnie MS, Patel J, Tvedten EJ, Kohli I, Mohammad TF. Blue light and the skin on social media: An analysis of posts on exposure and photoprotection strategies. Photodermatol Photoimmunol Photomed 2023; 39:543-545. [PMID: 37386800 DOI: 10.1111/phpp.12896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/01/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Marissa S Ceresnie
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Jay Patel
- Western Michigan University College of Medicine, Kalamazoo, Michigan, USA
| | - Erika J Tvedten
- Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Tasneem F Mohammad
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
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11
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Ceresnie MS, Patel J, Lim HW, Kohli I. The cutaneous effects of blue light from electronic devices: a systematic review with health hazard identification. Photochem Photobiol Sci 2023; 22:457-464. [PMID: 36245016 DOI: 10.1007/s43630-022-00318-9] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/03/2022] [Indexed: 10/17/2022]
Abstract
The biologic effects of visible light, particularly blue light, on the skin at doses and irradiances representative of sunlight have been established. Recent research studies investigated the effects of blue light (BL) from electronic screen devices; however, it is unclear if the evidence can be generalized to real life. The aim of this systematic review was to evaluate available evidence regarding clinical effects of BL emitted from electronic devices on human skin using the framework established by the Office of Health Assessment and Translation (OHAT). A systematic literature search was conducted by two librarians in Ovid MEDLINE, Embase.com, and Web of Science for relevant articles published from 1946 to March 2022. In vitro and in vivo studies that investigated the effects of BL from electronic devices on skin were included. From the 87 articles gathered from database searches and 1 article identified from citation search, only 9 met the inclusion criteria (6 in vitro and 3 in vivo studies). Human and animal literature with the highest level of evidence ratings were considered with mechanistic data to form one of five human hazard identifications for each outcome category using the OHAT protocol: (1) known, (2) presumed, (3) suspected, (4) not classifiable, or (5) not identified to be a hazard to humans. Literature-based evidence integration did not identify exposure to BL from electronic devices as a hazard to skin pigmentation, redness, yellowness, or melasma exacerbation. Exposure to BL from electronic devices was not classified as a skin photoaging hazard. Low confidence in representative exposure characterization drove high OHAT risk-of-bias ratings for the majority of included studies. While these conclusions hold true for the limited existing data, a larger number of future studies with high-confidence evidence are needed to verify and strengthen hazard identification conclusions.
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Affiliation(s)
- Marissa S Ceresnie
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health, 3031 W. Grand Blvd, Suite 700, Detroit, MI, 48202, USA
| | - Jay Patel
- Western Michigan University College of Medicine, Kalamazoo, MI, USA
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health, 3031 W. Grand Blvd, Suite 700, Detroit, MI, 48202, USA
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health, 3031 W. Grand Blvd, Suite 700, Detroit, MI, 48202, USA. .,Wayne State University, Detroit, MI, USA.
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12
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Parashar K, Torres AE, Boothby-Shoemaker W, Kohli I, Veenstra J, Neel V, Ozog DM. Imaging technologies for presurgical margin assessment of basal cell carcinoma. J Am Acad Dermatol 2023; 88:144-151. [PMID: 34793927 DOI: 10.1016/j.jaad.2021.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/20/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022]
Abstract
Basal cell carcinoma is the most common cancer worldwide, necessitating the development of techniques to decrease treatment costs through efficiency and efficacy. Mohs micrographic surgery, a specialized surgical technique involving staged resection of the tumor with complete histologic evaluation of the peripheral margins, is highly utilized. Reducing stages by even 5% to 10% would result in significant improvement in care and economic benefits. Noninvasive imaging could aid in both establishing the diagnosis of suspicious skin lesions and streamlining the surgical management of skin cancers by improving presurgical estimates of tumor sizes. Herein, we review the current state of imaging techniques in dermatology and their applications for diagnosis and tumor margin assessment of basal cell carcinoma prior to Mohs micrographic surgery.
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Affiliation(s)
| | | | - Wyatt Boothby-Shoemaker
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; Department of Physics and Astronomy, Wayne State University, Detroit, Michigan
| | - Jesse Veenstra
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Victor Neel
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan.
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13
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Ceresnie MS, Kohli I, Friedman BJ, Lim HW, Hamzavi IH. 32329 Assessing the utility of Fontana-Masson and MART-1 stains in evaluating skin pigmentary changes induced by ultraviolet radiation and visible light. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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14
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Ceresnie M, Maghfour J, El Dairi K, Mokhtari M, Hamzavi I, Lim H, Kohli I. 617 The impact of the spectral composition of long-wavelength ultraviolet A1 and visible light on cutaneous biologic effects. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Kohli I. 623 Variations in in vivo visible light phototesting methodologies. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Karaman-Jurukovska N, Hamzavi I, Kohli I, Nicholson C, Mohammad T, Nahhas A, Braunberger T, Matsui M, Mammone T. 633 Comparison of soluble proteins from skin sections of acne and TCA induced postinflammatory hyperpigmentation and erythema. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Ruvolo E, Boothby-Shoemaker W, Kumar N, Hamzavi IH, Lim HW, Kohli I. Evaluation of efficacy of antioxidant-enriched sunscreen prodcuts against long wavelength ultraviolet A1 and visible light. Int J Cosmet Sci 2022; 44:394-402. [PMID: 35587114 DOI: 10.1111/ics.12785] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/11/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The synergistic effects of VL and long wavelength UVA1 (VL+UVA1, 370-700 nm) on inducing pigmentation and erythema in skin have been demonstrated and linked to exacerbation of dermatologic conditions including melasma and post-inflammatory hyperpigmentation. This study aims to compare the photoprotection of organic sunscreens enriched with antioxidant (AO) combinations against VL+UVA1 induced biologic effects. The efficacy was compared to that offered by a commercially available tinted sunscreen. METHODS Ten healthy adult subjects with Fitzpatrick skin phototypes IV-VI were enrolled (nine completed). VL+UVA1 dose of 380 J/cm2 was utilized. Assessment methods were polarized photography, investigator global scoring, and diffuse reflectance spectroscopy (DRS). Measurements were obtained at baseline and immediately, 24 hours, and 7 days after irradiation. RESULTS Sites treated with tinted sunscreen product had significantly less pigmentation compared with untreated but irradiated skin at all time points. However, DRS results demonstrated that the 5-AO sunscreen performed comparably or better than all sunscreens tested with relatively lower dyschromia, delayed erythema and pigmentation. CONCLUSION These results highlight the potential of AO enriched sunscreens to be photoprotective against VL+UVA1. The combination of efficacy and the cosmetic appearance of this product may provide wider acceptability which is crucial considering the limited available means of protection against this waveband.
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Affiliation(s)
| | - Wyatt Boothby-Shoemaker
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA.,Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Nishant Kumar
- College of Literature, Science and Arts, University of Michigan, Ann Arbor, Michigan, USA
| | - Iltefat H Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Physics and Astronomy, Wayne State University, Detroit, Michigan, USA
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18
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Pourang A, Tisack A, Ezekwe N, Torres AE, Kohli I, Hamzavi IH, Lim HW. Effects of visible light on mechanisms of skin photoaging. Photodermatol Photoimmunol Photomed 2022; 38:191-196. [PMID: 34585779 DOI: 10.1111/phpp.12736] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/05/2021] [Accepted: 09/26/2021] [Indexed: 01/21/2023]
Abstract
Human skin is not only affected by ultraviolet radiation but also by visible light wavelengths emitted by sunlight, electronic devices, and light emitting diodes. Similar to the ultraviolet radiation, visible light has been implicated in photoaging. In this review, the effects of blue light, yellow light, red light, and broad visible light are discussed in relation with photoaging. Different visible light wavelengths likely contribute beneficial and deleterious effects on photoaging by way of interaction with specific photoreceptors, ROS production, and other photon-mediated reactions. Further in vivo studies are needed to determine the mechanism and action spectrum of photoaging in humans, as well as optimal photoprotection with coverage against visible light wavelengths.
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Affiliation(s)
- Aunna Pourang
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Aaron Tisack
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nneamaka Ezekwe
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Angeli E Torres
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA.,Department of Physics and Astronomy, Wayne State University, Detroit, Michigan, USA
| | - Iltefat H Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
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19
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Affiliation(s)
- Nneamaka Ezekwe
- Department of Dermatology University of Colorado Aurora CO USA
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital Detroit MI
| | - Jalal Maghfour
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital Detroit MI
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital Detroit MI
- Department of Physics and Astronomy Wayne State University Detroit MI
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20
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Lyons A, Narla S, Kohli I, Zubair R, Jacobsen G, Ceresnie M, Parks-Miller A, Hamzavi I. Safety and Efficacy of Intense Pulsed Light With Radiofrequency in United States Hidradenitis Suppurativa Patients. J Drugs Dermatol 2022; 21:430-432. [PMID: 35389583 DOI: 10.36849/jdd.6562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Copy: The combination of intense pulsed light and radiofrequency has been described in German populations to be a noninvasive therapy option for patients with hidradenitis suppurativa, demonstrating significant improvements in the quality of life and reduction in number of inflammatory lesions. OBJECTIVE To evaluate the efficacy and safety of combination intense pulsed light and radiofrequency therapy in patients with hidradenitis suppurativa in the United States. METHODS A prospective split body was conducted in the United States on patients with bilateral hidradenitis suppurativa. Subjects received 3 passes of intense pulsed light and radiofrequency per treatment session to a single involved body region on a randomized side of the body at least 2 weeks apart over 9 to 10 treatment sessions. RESULTS When measured from baseline to final visit, the overall mean difference in Dermatology Life Quality Index was found to be statistically significant (-2.8, P=0.043, n = 9). Patients reported mild discomfort during therapy and no adverse events occurred during or after treatment sessions. CONCLUSIONS Although statistically significant, the mean difference in Dermatology Life Quality Index in treated patients found in this study did not reach the minimal clinically important difference for inflammatory skin disease. J Drugs Dermatol. 2022;21(4):430-432. .doi:10.36849/JDD.6562.
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21
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Vickers C, Maghfour J, Kohli I, Lim HW, Hamzavi IH. Validation of a dermatologic surface area smartphone application: EZBSA. Skin Res Technol 2021; 28:368-370. [PMID: 34923672 PMCID: PMC9907622 DOI: 10.1111/srt.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Conor Vickers
- Department of Dermatology, Lewis Katz School of Medicine, Temple University Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jalal Maghfour
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
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22
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Osto M, Hamzavi IH, Lim HW, Kohli I. Individual Typology Angle and Fitzpatrick Skin Phototypes are Not Equivalent in Photodermatology. Photochem Photobiol 2021; 98:127-129. [PMID: 34796498 DOI: 10.1111/php.13562] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/14/2021] [Indexed: 11/27/2022]
Abstract
Individual typology angle (ITA) measures constitutive pigmentation while skin phototypes (SPT) categories are based on sun reactiveness. However, the association between the two, ITA and SPT, is yet to be established. Since both systems provide six categories, recent studies have used ITA classifications as synonymous to SPT. The results of this study indicate that these cannot be utilized interchangeably. In conclusion, poor correlation between the six objective individual typology angle categories and the subjective Fitzpatrick skin phototype categories was established along with highlighting ITAs potential in photobiologic studies and objective standardization of skin type classifications.
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Affiliation(s)
- Muhammad Osto
- Wayne State University School of Medicine, Detroit, MI
| | - Iltefat H Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI.,Department of Physics and Astronomy, Wayne State University, Detroit, MI
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23
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Vellaichamy G, Kohli I, Zubair R, Yin C, Braunberger T, Nahhas AF, Nicholson C, Mohammad TF, Isedeh P, Lyons AB, Nartker N, Al-Jamal M, Matsui M, Karaman-Jurukovska N, Zhou L, Lim HW, Mi QS, Hamzavi IH. An in vivo model of postinflammatory hyperpigmentation and erythema: clinical, colorimetric and molecular characteristics. Br J Dermatol 2021; 186:508-519. [PMID: 34625951 DOI: 10.1111/bjd.20804] [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] [Accepted: 09/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postinflammatory hyperpigmentation (PIH) is a common, acquired pigmentary disorder of the skin associated with significant quality-of-life impairment, especially in individuals with skin of colour. Current treatment for PIH is limited, largely due to a poor understanding of disease pathogenesis and the lack of a representative disease model. OBJECTIVES This study is intended to further develop, update and validate our previously designed in vivo model of acne-induced PIH/postinflammatory erythema (PIE) using different concentrations of trichloroacetic acid (TCA), a medium-depth chemical peel. METHODS Twenty-nine patients with skin types II-VI and clinician-confirmed presence of two or more truncal acne pustules and PIH/PIE were included. On the basis of Investigator's Global Assessment (IGA), clinical polarized photography (CPP), colorimetry and Skindex, we experimentally determined an optimum TCA concentration and assessed our model's ability to exhibit a dose-response relationship between degree of inciting insult and severity of resulting pigmentation. We also performed differential microRNA profiling and pathway analysis to explore the potential of microRNAs as molecular adjuncts to our model. RESULTS Application of TCA 30% produced lesions indistinguishable from acne-induced PIH and PIE lesions on the basis of colorimetry data without causing epidermal necrosis. Application of progressively increasing TCA doses from 20% to 30% resulted in concentration-dependent increases in CPP, IGA and colorimetry scores at all timepoints during the study. miRNA-31 and miRNA-23b may play a role in PIH pathogenesis, although further validation is required. CONCLUSIONS Our TCA-based in vivo model, using TCA concentrations between 20% and 30% with an optimum of 30%, enables the quantitative assessment of the pigmentary response to varying degrees of cutaneous inflammation in a fashion that mirrors natural acne-induced PIH and PIE.
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Affiliation(s)
- G Vellaichamy
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - I Kohli
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - R Zubair
- Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - C Yin
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - T Braunberger
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - A F Nahhas
- Department of Dermatology, Beaumont Hospital, Farmington Hills, MI, USA
| | - C Nicholson
- Department of Dermatology, Wayne State University, Dearborn, MI, USA
| | - T F Mohammad
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - P Isedeh
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - A B Lyons
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - N Nartker
- Department of Dermatology, Wayne State University, Dearborn, MI, USA
| | - M Al-Jamal
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - M Matsui
- Department of Dermatology and Division of Environmental Sciences, School of Public Health, Columbia University, New York, NY, USA
| | | | - L Zhou
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - H W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Q-S Mi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - I H Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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24
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Lyons AB, Zubair R, Kohli I, Nahhas AF, Braunberger TL, Mokhtari M, Ruvolo E, Lim HW, Hamzavi IH. Mitigating Visible Light and Long Wavelength UVA1-induced Effects with Topical Antioxidants. Photochem Photobiol 2021; 98:455-460. [PMID: 34549819 DOI: 10.1111/php.13525] [Citation(s) in RCA: 4] [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] [Received: 07/19/2021] [Accepted: 09/19/2021] [Indexed: 12/19/2022]
Abstract
The role of topical antioxidants (AOs) on visible light plus ultraviolet A1 (VL+UVA1)-induced skin changes were evaluated. Twenty subjects with skin phototypes (SPTs) I-VI had placebo and concentrations of an AO blend applied to their back (AO 0.5%, 1.0% and 2.0%). Treated and control sites were irradiated with VL+UVA1. Colorimetric and diffuse reflectance spectroscopy (DRS) assessments were performed immediately, 24 h and 7 days after irradiation. Subjects with SPT I-III had erythema that faded within 24 h, while SPT IV-VI had persistent pigmentation. SPT I-III demonstrated significantly less erythema at the 2% AO site while SPT IV-VI demonstrated significantly less immediate pigmentation at 2% AO site and less pigmentation (approaching significance, P = 0.07) on day 7 compared with control. Immunohistochemistry from biopsies of 2% AO and placebo at 24 h did not demonstrate a significant change in COX-2 or MART-1 for any SPT. There was a decrease in cyclin D1 for SPT IV-VI which was approaching significance (P = 0.06) but not for SPT I-III. The results indicate that topical AO inhibits erythema in SPT I-III and reduces pigmentation in SPT IV-VI caused by VL+UVA1. AO may help prevent worsening of pigmentary disorders and should be incorporated into photoprotection.
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Affiliation(s)
- Alexis B Lyons
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI
| | - Raheel Zubair
- Graduate Medical Education, Broward Health Medical Center, Fort Lauderdale, FL
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI.,Department of Physics and Astronomy, Wayne State University, Detroit, MI
| | - Amanda F Nahhas
- Department of Dermatology, Beaumont-Farmington Hills, Farmington Hills, MI
| | - Taylor L Braunberger
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI
| | | | | | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI
| | - Iltefat H Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI
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25
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Ko D, Lyons AB, Kohli I, Narla S, Torres AE, Miller A, Ozog D, Hamzavi I, Lim HW. The value of photomedicine in a global health crisis: Utilizing ultraviolet C to decontaminate N95 respirators during the COVID-19 pandemic. Photodermatol Photoimmunol Photomed 2021; 38:95-98. [PMID: 34467568 PMCID: PMC8661793 DOI: 10.1111/phpp.12729] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/11/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
One early problem during the height of the COVID‐19 global pandemic, caused by severe acute respiratory syndrome 2 (SARS‐CoV‐2), was the shortage of personal protective equipment donned by healthcare workers, particularly N95 respirators. Given the known virucidal, bactericidal, and fungicidal properties of ultraviolet irradiation, in particular ultraviolet C (UVC) radiation, our photomedicine and photobiology unit explored the role of ultraviolet germicidal irradiation (UVGI) using UVC in effectively decontaminating N95 respirators. The review highlights the important role of photobiology and photomedicine in this pandemic. Namely, the goals of this review were to highlight: UVGI as a method of respirator disinfection—specifically against SARS‐CoV‐2, adverse reactions to UVC and precautions to protect against exposure, other methods of decontamination of respirators, and the importance of respirator fit testing.
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Affiliation(s)
- Dayoung Ko
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Alexis B Lyons
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Department of Physics and Astronomy, Wayne State University, Detroit, MI, USA
| | - Shanthi Narla
- Department of Dermatology, St. Luke's University Health Network, Easton, PA, USA
| | | | - Angela Miller
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - David Ozog
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Iltefat Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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26
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Pourang A, Dourra M, Ezekwe N, Kohli I, Hamzavi I, Lim HW. The potential effect of Polypodium leucotomos extract on ultraviolet- and visible light-induced photoaging. Photochem Photobiol Sci 2021; 20:1229-1238. [PMID: 34449075 DOI: 10.1007/s43630-021-00087-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/15/2021] [Accepted: 07/14/2021] [Indexed: 11/24/2022]
Abstract
Photoaging induced by both ultraviolet and visible light has been shown to lead to increased inflammation and dysregulation of the extracellular matrix. Standardized extract of the Polypodium leucotomos fern, PLE, possesses anti-inflammatory and antioxidant properties, and has been shown to potentially mitigate photoaging through various mechanisms. This comprehensive review presents the data available on the effects of P. leucotomos extract on UV and VL-induced photoaging in vitro as well as in vivo in murine and human models.
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Affiliation(s)
- Aunna Pourang
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, 3031 W. Grand Blvd, Suite 800, Detroit, MI, 48202, USA
| | - Mohsen Dourra
- College of Medicine, Michigan State University, East Lansing, MI, USA
| | - Nneamaka Ezekwe
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, 3031 W. Grand Blvd, Suite 800, Detroit, MI, 48202, USA
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, 3031 W. Grand Blvd, Suite 800, Detroit, MI, 48202, USA
| | - Iltefat Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, 3031 W. Grand Blvd, Suite 800, Detroit, MI, 48202, USA
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, 3031 W. Grand Blvd, Suite 800, Detroit, MI, 48202, USA.
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27
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Lyons AB, Narla S, Kohli I, Zubair R, Nahhas AF, Braunberger TL, Joseph MK, Nicholson CL, Jacobsen G, Hamzavi IH. Assessment of Inter-rater Reliability of Clinical Hidradenitis Suppurativa Outcome Measures Using Ultrasonography. Clin Exp Dermatol 2021; 47:319-324. [PMID: 34388853 DOI: 10.1111/ced.14889] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) staging and severity is typically based upon physical examination findings which can result in misclassification of severity based on subclinical disease activity and significant variation between healthcare providers. Ultrasound (US) is an objective tool to help evaluate subclinical disease and more accurately classify severity of disease. The objective of this study was to evaluate inter-rater reliability in HS disease severity assessment using clinical and US techniques. METHODS Twenty subjects underwent clinical evaluation of HS using clinical outcome measures including Hurley, Sartorius, HS Physician Global Assessment (HS-PGA), and Hidradenitis Suppurativa Clinical Response (HiSCR) independently by two physicians. US was subsequently performed, and clinical assessments were repeated. Intra-class correlation coefficients (ICC) were obtained to evaluate inter-rater agreement of each outcome measure before and after US. RESULTS Pre- to post-US improvement in ICC was seen with the Sartorius, HiSCR nodule and abscess count, and HiSCR draining fistula count. The scores went from having "good" rater agreement for Sartorius and HiSCR nodule and abscess count and "poor" rater agreement for HiSCR draining fistula count to "excellent" rater agreement amongst these scores. CONCLUSIONS US improved inter-rater agreement and should be used in conjunction with physical examination findings to evaluate disease severity to ensure uniform staging.
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Affiliation(s)
- A B Lyons
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - S Narla
- Department of Dermatology, St. Lukes Hospital, Easton, PA, USA
| | - I Kohli
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Department of Physics & Astronomy, Wayne State University, Detroit, MI, USA
| | - R Zubair
- Department of Dermatology, Broward Hospital, Ft. Lauderdale, FL, USA
| | - A F Nahhas
- Department of Dermatology, Beaumont Health-Farmington Hills, Farmington Hills, MI, USA
| | - T L Braunberger
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - M K Joseph
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - C L Nicholson
- Department of Dermatology, Wayne State University, Detroit, MI, USA
| | - G Jacobsen
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | - I H Hamzavi
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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Tisack A, Pourang A, Kohli I, Lim HW, Hamzavi IH. Recommendations for Reporting Methods in Phototesting Studies. Photochem Photobiol 2021; 98:130-131. [PMID: 34312877 DOI: 10.1111/php.13493] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/24/2021] [Indexed: 01/17/2023]
Abstract
The figure presented here illuminates the large number of variables that are necessary to adequately describe phototesting protocols. Each of these characteristics can be critical in understanding results presented in the photomedicine community as well as the broader photobiology and photochemistry communities. The inclusion of all of these variables within each phototesting publication will aid in discourse and further scientific discovery within our field.
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Affiliation(s)
- Aaron Tisack
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Aunna Pourang
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Department of Physics and Astronomy, Wayne State University, Detroit, MI, USA
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Iltefat H Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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29
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Lim HW, Kohli I, Granger C, Trullàs C, Piquero-Casals J, Narda M, Masson P, Krutmann J, Passeron T. Photoprotection of the Skin from Visible Light‒Induced Pigmentation: Current Testing Methods and Proposed Harmonization. J Invest Dermatol 2021; 141:2569-2576. [PMID: 34112516 DOI: 10.1016/j.jid.2021.03.012] [Citation(s) in RCA: 11] [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] [Received: 12/10/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022]
Abstract
Visible light (VL) can induce pigmentary alterations, especially in dark-skinned individuals, and exacerbate photodermatoses and pigmentary disorders. Currently, there is no standardized method for assessing sunscreen protection against VL. On the basis of a critical review of published in vitro and in vivo methods, a VL photoprotection assessment method based on pigmentation is proposed.
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Affiliation(s)
- Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA.
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA; Department of Physics and Astronomy, College of Liberal Arts and Sciences, Wayne State University, Detroit, Michigan, USA
| | | | | | | | | | | | - Jean Krutmann
- IUF - Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany; Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
| | - Thierry Passeron
- Department of Dermatology, Centre Hospitalaire Universitaire de Nice, University Côte d'Azur, Nice, France; C3M, INSERM U1065, University Côte d'Azur, Nice, France
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30
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Boothby-Shoemaker W, Lim HW, Kohli I, Ozog DM. Changes in Google search for "sunburn" during the COVID-19 pandemic. Photodermatol Photoimmunol Photomed 2021; 37:474-475. [PMID: 33830570 PMCID: PMC8250935 DOI: 10.1111/phpp.12684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/18/2021] [Accepted: 04/04/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Wyatt Boothby-Shoemaker
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Department of Physics and Astronomy, Wayne State University, Detroit, MI, USA
| | - David M Ozog
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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31
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Austin E, Geisler AN, Nguyen J, Kohli I, Hamzavi I, Lim HW, Jagdeo J. Visible light. Part I: Properties and cutaneous effects of visible light. J Am Acad Dermatol 2021; 84:1219-1231. [PMID: 33640508 DOI: 10.1016/j.jaad.2021.02.048] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [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: 09/17/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/22/2022]
Abstract
Approximately 50% of the sunlight reaching the Earth's surface is visible light (400-700 nm). Other sources of visible light include lasers, light-emitting diodes, and flash lamps. Photons from visible light are absorbed by photoreceptive chromophores (e.g., melanin, heme, and opsins), altering skin function by activating and imparting energy to chromophores. Additionally, visible light can penetrate the full thickness of the skin and induce pigmentation and erythema. Clinically, lasers and light devices are used to treat skin conditions by utilizing specific wavelengths and treatment parameters. Red and blue light from light-emitting diodes and intense pulsed light have been studied as antimicrobial and anti-inflammatory treatments for acne. Pulsed dye lasers are used to treat vascular lesions in adults and infants. Further research is necessary to determine the functional significance of visible light on skin health without confounding the influence of ultraviolet and infrared wavelengths.
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Affiliation(s)
- Evan Austin
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York; Dermatology Service, VA New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York
| | | | - Julie Nguyen
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York; Dermatology Service, VA New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York
| | - Indermeet Kohli
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan
| | - Iltefat Hamzavi
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan
| | - Henry W Lim
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan
| | - Jared Jagdeo
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York; Dermatology Service, VA New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York.
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32
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Lyons AB, Narla S, Torres AE, Parks-Miller A, Kohli I, Ozog DM, Lim HW, Hamzavi IH. Skin and eye protection against ultraviolet C from ultraviolet germicidal irradiation devices during the COVID-19 pandemic. Int J Dermatol 2020; 60:391-393. [PMID: 33259055 PMCID: PMC7753667 DOI: 10.1111/ijd.15255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
With the COVID-19 pandemic depleting personal protective equipment worldwide, various methods including ultraviolet C (UVC) germicidal irradiation (UVGI) have been implemented to decontaminate N95 filtering facepiece respirators. These devices pose a risk for UVC exposure to the operator with reported adverse effects generally limited to the eyes and skin. Our hospitals are currently using UVC devices for N95 decontamination with a few reported cases of face and neck erythema from exposure. Because sunscreens are designed and tested for UVA and UVB protection only, their effects on blocking UVC are largely unknown. Therefore, our objective was to determine if various sunscreens, UV goggles, and surgical mask face shields minimize UVC exposure from UVGI devices. Our study clearly demonstrated that healthcare workers responsible for the disinfection of PPE using UVGI devices should always at least utilize clear face shields or UV goggles and sunscreen to protect against side effects of UVC exposure.
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Affiliation(s)
- Alexis B Lyons
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Shanthi Narla
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Angeli E Torres
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | | | - Indermeet Kohli
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Department of Physics and Astronomy, Wayne State University, Detroit, MI, USA
| | - David M Ozog
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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33
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Kohli I, Lyons AB, Golding B, Narla S, Torres AE, Parks-Miller A, Ozog D, Lim HW, Hamzavi IH. UVC Germicidal Units: Determination of Dose Received and Parameters to be Considered for N95 Respirator Decontamination and Reuse. Photochem Photobiol 2020; 96:1083-1087. [PMID: 32767758 PMCID: PMC7436593 DOI: 10.1111/php.13322] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Received: 05/05/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic has resulted in an international shortage of personal protective equipment including N95 filtering facepiece respirators (FFRs), resulting in many institutions using ultraviolet germicidal irradiation (UVGI) technology for N95 FFR decontamination. To ensure proper decontamination, it is crucial to determine the dose received by various parts of the FFR in this process. Recently, our group customized a UVGI unit for N95 decontamination. With experimental and theoretical approach, this manuscript discusses the minimum dose received by various parts of the N95 respirator after one complete decontamination cycle with this UVGI unit. The results demonstrate that all parts of the N95 FFR received at least 1 J cm-2 after one complete decontamination cycle with this unit. As there are a variety of UVGI devices and different types of FFRs, this study provides a model by which UVC dose received by different areas of the FFRs can be accurately assessed to ensure proper decontamination for the safety of healthcare providers.
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Affiliation(s)
- Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI.,Department of Physics and Astronomy, Wayne State University, Detroit, MI
| | - Alexis B Lyons
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI
| | | | - Shanthi Narla
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI
| | - Angeli E Torres
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI
| | - Angela Parks-Miller
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI
| | - David Ozog
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI
| | - Iltefat H Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI
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34
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Ozog D, Parks-Miller A, Kohli I, Lyons AB, Narla S, Torres AE, Levesque M, Lim HW, Hamzavi IH. The importance of fit testing in decontamination of N95 respirators: A cautionary note. J Am Acad Dermatol 2020; 83:672-674. [PMID: 32389714 PMCID: PMC7205728 DOI: 10.1016/j.jaad.2020.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/07/2023]
Affiliation(s)
- David Ozog
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan,Correspondence to: David Ozog, MD, Department of Dermatology, Henry Ford Medical Center New Center One, 3031 W Grand Blvd, Ste 800, Detroit, MI 48202
| | - Angela Parks-Miller
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan,Department of Physics & Astronomy, Wayne State University, Detroit, Michigan
| | - Alexis B. Lyons
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Shanthi Narla
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Angeli E. Torres
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Martin Levesque
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Henry W. Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Iltefat H. Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
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35
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Torres AE, Lyons AB, Narla S, Kohli I, Parks-Miller A, Ozog D, Hamzavi IH, Lim HW. Ultraviolet-C and other methods of decontamination of filtering facepiece N-95 respirators during the COVID-19 pandemic. Photochem Photobiol Sci 2020; 19:746-751. [PMID: 33856682 PMCID: PMC8047514 DOI: 10.1039/d0pp00131g] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/23/2020] [Indexed: 01/14/2023]
Abstract
During global health emergencies such as the current COVID-19 pandemic, the decontamination of single-use personal protective equipment (PPE) becomes a necessary means to keep up with the growing demand from healthcare workers and patients alike. Many unverified methods are being considered, which can pose the risk of incomplete decontamination and lead to catastrophic results. Several factors come into play when determining the suitability of such methods including the quality of the decontamination technique, the targeted pathogen, cost, ease of installation and use, rate of sterilization, and the surface or material to be sterilized. The germicidal properties of ultraviolet-C are well known. This review will cover the most commonly described methods for the sterilization of N95 respirators, namely, ultraviolet germicidal irradiation, hydrogen peroxide vaporization, microwave-generated steaming, and dry heating. These techniques have been tested previously and have demonstrated efficacy in reducing or inactivating viral and bacterial pathogens, although testing against SARS-CoV-2 specifically has not been done. Moreover, it must be emphasized that proper disposal after a single use is still ideal under normal circumstances.
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Affiliation(s)
- Angeli Eloise Torres
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Alexis B Lyons
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Shanthi Narla
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
- Department of Physics and Astronomy, Wayne State University, Detroit, MI, USA
| | - Angela Parks-Miller
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - David Ozog
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Iltefat H Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.
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36
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Narla S, Lyons AB, Kohli I, Torres AE, Parks-Miller A, Ozog DM, Hamzavi IH, Lim HW. The importance of the minimum dosage necessary for UVC decontamination of N95 respirators during the COVID-19 pandemic. Photodermatol Photoimmunol Photomed 2020; 36:324-325. [PMID: 32291807 PMCID: PMC7262176 DOI: 10.1111/phpp.12562] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Shanthi Narla
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Alexis B Lyons
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA.,Department of Physics & Astronomy, Wayne State University, Detroit, MI, USA
| | - Angeli E Torres
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Angela Parks-Miller
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - David M Ozog
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Iltefat H Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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37
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Lyons AB, Trullas C, Kohli I, Hamzavi IH, Lim HW. Photoprotection beyond ultraviolet radiation: A review of tinted sunscreens. J Am Acad Dermatol 2020; 84:1393-1397. [PMID: 32335182 DOI: 10.1016/j.jaad.2020.04.079] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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: 02/17/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/26/2023]
Abstract
Ultraviolet radiation and visible light both have biologic effects on the skin. Visible light can induce erythema in light-skinned individuals and pigmentation in dark-skinned individuals. Broad-spectrum sunscreens protect against ultraviolet radiation but do not adequately protect against visible light. For a sunscreen to protect against visible light, it must be visible on the skin. Inorganic filters (also known as mineral filters), namely, zinc oxide and titanium dioxide, are used in the form of nanoparticles in sunscreens to minimize the chalky and white appearance on the skin; as such, they do not protect against visible light. Tinted sunscreens use different formulations and concentrations of iron oxides and pigmentary titanium dioxide to provide protection against visible light. Many shades of tinted sunscreens are available by combining different amounts of iron oxides and pigmentary titanium dioxide to cater to all skin phototypes. Therefore, tinted sunscreens are beneficial for patients with visible light-induced photodermatoses and those with hyperpigmentation disorders such as melasma and postinflammatory hyperpigmentation.
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Affiliation(s)
- Alexis B Lyons
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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38
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Kohli I, Kastner S, Thomas M, Nahhas AF, Braunberger TL, Mohammad TF, Nicholson CL, Canfield D, Kollias N, Lim HW, Hamzavi IH, Patwardhan SV. Quantitative measurement of skin surface oiliness and shine using differential polarized images. Arch Dermatol Res 2020; 313:71-77. [PMID: 32270323 DOI: 10.1007/s00403-020-02070-5] [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: 12/12/2019] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
Excess amounts of skin surface oil can lead to adverse psychological consequences. Grease-spot photometry-based techniques measure sebum production rate. However, besides being tedious, these measurements are influenced by contact area, applied pressure, and time of application. Image analysis of polarized images has the potential to provide objective, quantitative information of skin oiliness. This study was designed to set up an imaging device for capturing and enhancing the changes in skin surface oiliness and to clinically and quantitatively, (via image analysis), evaluate varying levels of skin surface oiliness. Mineral oil was used to simulate skin surface oil. 40.5 µL of the mineral oil was applied within a two inch square area of interest on facial skin in twelve steps, from 1 to 40.5 µL, at 40% increments. The results indicate a strong correlation between the quantitative skin surface oiliness measurements and the clinical assessments. This sensitive technique has the potential to be utilized in future studies to evaluate product efficacies in reducing skin oiliness.
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Affiliation(s)
- Indermeet Kohli
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | | | - Mani Thomas
- Canfield Scientific Inc., Parsippany, NJ, USA
| | - Amanda F Nahhas
- Department of Dermatology, Beaumont-Farmington Hills, Farmington Hills, MI, USA
| | | | | | | | | | | | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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39
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Lyons AB, Kohli I, Nahhas AF, Braunberger TL, Mohammad TF, Nicholson CL, Nartker NT, Modi K, Matsui MS, Lim HW, Hamzavi IH. Trichloroacetic acid model to accurately capture the efficacy of treatments for postinflammatory hyperpigmentation. Arch Dermatol Res 2020; 312:725-730. [DOI: 10.1007/s00403-020-02071-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/27/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
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40
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Hamzavi IH, Lyons AB, Kohli I, Narla S, Parks-Miller A, Gelfand JM, Lim HW, Ozog DM. Ultraviolet germicidal irradiation: Possible method for respirator disinfection to facilitate reuse during the COVID-19 pandemic. J Am Acad Dermatol 2020; 82:1511-1512. [PMID: 32246972 PMCID: PMC7214862 DOI: 10.1016/j.jaad.2020.03.085] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Alexis B Lyons
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; Department of Physics & Astronomy, Wayne State University, Detroit, Michigan
| | - Shanthi Narla
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
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41
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Abstract
Until recently, visible light (VL) had been regarded to be without significant photobiologic effect on the skin. Updated research suggests that this is not the case and the measurable effect of visible light on the skin is being documented in all skin types. Recent studies have demonstrated that in dark-skinned individuals, visible light can induce more intense and longer lasting pigmentation of the skin compared to UVA1. This effect was potentiated when VL was combined with a small percentage of ultraviolet A1 radiation (UVA1). Further, the combination of VL + UVA1 was also able to induce erythema in light-skinned individuals, a novel finding since the erythemogenic spectrum of sunlight had primarily been attributed to ultraviolet B (UVB) and short wavelength UVA (320-340 nm). Based on these findings, VL and UVA1 may also potentially play a role in conditions aggravated by sun exposure such as phototoxicity in light-skinned patients and post-inflammatory hyperpigmentation and melasma, especially in dark-skinned individuals. Currently available organic (chemical) UV filters are not sufficient to protect the skin from the effect of VL. VL is emerging as a key player in photodermatology and additional research is needed on the cutaneous effects of VL, as well as the development of filters and other means of photoprotection against the harmful effects of the VL spectrum. The aim of this manuscript is to review the literature on the cutaneous effects of VL as well as to highlight areas of dermatology where VL may play an important role.
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Affiliation(s)
- Shanthi Narla
- Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA.
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
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Horton L, Torres AE, Narla S, Lyons AB, Kohli I, Gelfand JM, Ozog DM, Hamzavi IH, Lim HW. Spectrum of virucidal activity from ultraviolet to infrared radiation. Photochem Photobiol Sci 2020; 19:1262-1270. [PMID: 32812619 PMCID: PMC8047562 DOI: 10.1039/d0pp00221f] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The COVID-19 pandemic has sparked a demand for safe and highly effective decontamination techniques for both personal protective equipment (PPE) and hospital and operating rooms. The gradual lifting of lockdown restrictions warrants the expansion of these measures into the outpatient arena. Ultraviolet C (UVC) radiation has well-known germicidal properties and is among the most frequently reported decontamination techniques used today. However, there is evidence that wavelengths beyond the traditional 254 nm UVC - namely far UVC (222 nm), ultraviolet B, ultraviolet A, visible light, and infrared radiation - have germicidal properties as well. This review will cover current literature regarding the germicidal effects of wavelengths ranging from UVC through the infrared waveband with an emphasis on their activity against viruses, and their potential applicability in the healthcare setting for general decontamination during an infectious outbreak.
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Affiliation(s)
- Luke Horton
- Wayne State University School of Medicine, Detroit, MI USA
| | - Angeli Eloise Torres
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI USA
| | - Shanthi Narla
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI USA
| | - Alexis B. Lyons
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI USA
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI USA ,Department of Physics and Astronomy, Wayne State University, Detroit, MI USA
| | - Joel M. Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - David M. Ozog
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI USA
| | - Iltefat H. Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI USA
| | - Henry W. Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI USA
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Abstract
Photosensitive conditions such as melasma and postinflammatory hyperpigmentation (PIH) are exacerbated by exposure to ultraviolet (UV) rays and visible light making sunscreen use an essential component of treatment. This is especially true in skin of color patients who are less likely to use photoprotection, even if diagnosed with these photoexacerbated conditions. We aimed to evaluate the body of literature to provide evidence for the use of sunscreen in the treatment of melasma and PIH. We reviewed English articles from PubMed, Journals@Ovid Full Text, and Embase using the search terms “sunscreen” and either “melasma” “PIH,” or “post-inflammatory hyperpigmentation.” Nine relevant publications provide evidence that a broad spectrum of protection, including UVA, UVB, and visible light within sunscreens can play an adjuvant role in therapy for melasma and PIH by stabilizing and improving these pigmentary disorders in skin of color patients. This review illustrates the advantages and limitations of sunscreen use, as well as practice gaps in photoprotection in the skin of color patients with melasma and PIH.
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Affiliation(s)
- Sakeena Fatima
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | | | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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Mohammad TF, Kohli I, Nicholson CL, Treyger G, Chaowattanapanit S, Nahhas AF, Braunberger TL, Lim HW, Hamzavi IH. Oral Polypodium Leucotomos Extract and Its Impact on Visible Light-Induced Pigmentation in Human Subjects. J Drugs Dermatol 2019; 18:1198-1203. [PMID: 31859468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND: Visible light (VL) has multiple effects on the skin that currently available sunscreens do not protect against. Polypodium leucotomos extract (PLE) has properties that may offer protection against VL. OBJECTIVES: To determine the effectiveness of PLE in preventing VL-induced effects. METHODS: Twenty-two subjects with Fitzpatrick skin phototype IV-VI were enrolled. On day 0, subjects were irradiated with VL. Clinical Investigator’s Global Assessment (IGA) scoring and spectroscopic evaluations were performed immediately, 24 hours, and 7 days after irradiation. Subjects then received a 28-day supply of PLE (480 mg daily). Irradiation and evaluation were repeated. Three 4-mm punch biopsies were obtained for immunohistochemistry analysis: one from normal unirradiated skin and the other two twenty-four hours after irradiation, pre- and post-PLE, from sites irradiated with highest dose of VL. RESULTS: All subjects had immediate pigment darkening, persistent pigment darkening, and delayed tanning both pre- and post-PLE. For the highest VL dose (480 J/cm²) spectroscopic assessments demonstrated a statistically significant decrease in persistent pigment darkening and delayed tanning post-PLE. In addition, there was a significant decrease in cyclooxygenase-2, and a trend towards decreases in the markers for cellular damage post-PLE. While there was a trend towards lower IGA scores post-PLE, statistical significance was not reached possibly due to lack of sensitivity of the visual IGA scoring system in detecting small changes. CONCLUSIONS: Spectroscopic data and immunohistochemistry indicate an effect of PLE on visible light induced effects. As such, PLE may be used as an adjuvant to traditional means of photoprotection to protect against the effects of VL. Clinical trial registration number: NCT02904798. J Drugs Dermatol. 2019;18(12):1198-1203.
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van Geel N, Hamzavi I, Kohli I, Wolkerstorfer A, Lim HW, Bae JM, Lui H, Harris JE, Pandya AG, Thng Tien Guan S, Abdallah M, Esmat S, Seneschal J, Speeckaert R, Grine L, Kang HY, Raboobee N, Xiang LF, Bekkenk M, Picardo M, Taieb A. Standardizing serial photography for assessing and monitoring vitiligo: A core set of international recommendations for essential clinical and technical specifications. J Am Acad Dermatol 2019; 83:1639-1646. [PMID: 31678332 DOI: 10.1016/j.jaad.2019.10.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/15/2019] [Revised: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Clinical photography is an important component of the initial assessment and follow-up of patients with vitiligo in clinical practice and research settings. Standardization of this photographic process is essential to achieve useful, high-quality, and comparable photographs over time. OBJECTIVE The aim is to develop an international consensus for a core set of recommendations for standardized vitiligo clinical photography. METHODS Based an international meeting of vitiligo experts, a standard operating procedure was developed for vitiligo photography in daily practice and research settings. This protocol was subsequently reviewed by 20 vitiligo experts until agreement was reached. RESULTS The resulting protocol includes a set of 10 and 15 photographs for clinical practice and research purposes, respectively. The photographic series are based on anatomic units included in the Vitiligo Extent Score. Furthermore, graphic representations of standardized positioning and suggestions for guidelines to standardize the process (background color, lighting, position marking, scales, materials, instruments) for both color and ultraviolet photographs are described. CONCLUSIONS This consensus-based protocol for vitiligo photography will harmonize imaging for both clinical practice, translational research, and clinical trials. It can improve outcome assessment, foster multicenter collaboration, and promote better communication with patients regarding outcomes of treatment.
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Affiliation(s)
- Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Albert Wolkerstorfer
- Department of dermatology, institute for pigment disorders and Infection & Immunity Institute Amsterdam UMC, Amsterdam, The Netherlands
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Harvey Lui
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada; Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - John E Harris
- Department of Dermatology, The University of Massachusetts Medical School, Worcester, Massachusetts
| | - Amit G Pandya
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Marwa Abdallah
- Dermatology, Andrology, and Venereology Department, Ain Shams University, Cairo, Egypt
| | - Samia Esmat
- Department of Dermatology, Faculty Of Medicine Cairo University, Cairo, Egypt
| | - Julien Seneschal
- INSERM U 1035, University of Bordeaux; Department of Dermatology, Bordeaux University Hospitals, Bordeaux, France
| | | | - Lynda Grine
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Noufal Raboobee
- Department of Dermatology, Westville Hospital, Westville, South Africa
| | - Leihong Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Marcel Bekkenk
- Department of dermatology, institute for pigment disorders and Infection & Immunity Institute Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Alain Taieb
- INSERM U 1035, University of Bordeaux; Department of Dermatology, Bordeaux University Hospitals, Bordeaux, France
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Kohli I, Braunberger TL, Nahhas AF, Mirza FN, Mokhtari M, Lyons AB, Kollias N, Ruvolo E, Lim HW, Hamzavi IH. Long-wavelength Ultraviolet A1 and Visible Light Photoprotection: A Multimodality Assessment of Dose and Response. Photochem Photobiol 2019; 96:208-214. [PMID: 31464341 DOI: 10.1111/php.13157] [Citation(s) in RCA: 13] [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] [Received: 05/21/2019] [Accepted: 08/20/2019] [Indexed: 01/02/2023]
Abstract
Human skin is exposed to visible light (VL; 400-700 nm) and long-wavelength ultraviolet A1 (UVA1) radiation (370-400 nm) after the application of organic broad-spectrum sunscreens. The biologic effects of these wavelengths have been demonstrated; however, a dose-response has not been investigated. Ten subjects with Fitzpatrick skin phototype IV-VI were enrolled. Subjects were irradiated with 2 light sources (80-480 J cm-2 ): one comprising VL with less than 0.5% UVA1 (VL+UVA1) and the other pure VL. Skin responses were evaluated for 2 weeks using clinical and spectroscopic assessments. 4-mm punch biopsies were obtained from nonirradiated skin and sites irradiated with 480 J cm-2 of VL+UVA1 and pure VL 24 h after irradiation. Clinical and spectroscopic assessments demonstrated a robust response at VL+UVA1 sites compared with pure VL. Histology findings demonstrated a statistically significant increase in the marker of inflammation (P < 0.05) and proliferation (P < 0.05) at the irradiated sites compared with nonirradiated control. Threshold doses of VL+UVA1 resulting in biologic responses were calculated. Results indicate that approximately 2 h of sun exposure, which equates to VL+UVA1 dose (~400 J cm-2 ), is capable of inducing inflammation, immediate erythema and delayed tanning. These findings reinforce the need of photoprotection beyond the UV range.
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Affiliation(s)
| | | | - Amanda F Nahhas
- Department of Dermatology, Henry Ford Hospital, Detroit, MI.,Department of Dermatology, Beaumont Hospital-Farmington Hills, Farmington Hills, MI
| | | | | | - Alexis B Lyons
- Department of Dermatology, Henry Ford Hospital, Detroit, MI
| | | | | | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, MI
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Kohli I, Nicholson CL, Williams JD, Lyons AB, Seo I, Maitra P, Tian X, Atillasoy E, Lim HW, Hamzavi IH. Greater efficacy of SPF 100+ sunscreen compared with SPF 50+ in sunburn prevention during 5 consecutive days of sunlight exposure: A randomized, double-blind clinical trial. J Am Acad Dermatol 2019; 82:869-877. [PMID: 31542406 DOI: 10.1016/j.jaad.2019.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 06/25/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Beach vacations are high-risk settings for overexposure to ultraviolet radiation. OBJECTIVE To compare the sunburn protective efficacy of SPF 50+ and SPF 100+ sunscreens under actual use at the beach. METHODS A prospective, randomized, double-blind, single-center, split-body/face study of 55 healthy individuals. Each participant applied both sunscreens to randomized sides of the face/body for up to 5 consecutive days. Blinded clinical evaluation of erythema by a single grader and objective instrumental assessments, colorimetry, and diffuse reflectance spectroscopy were performed the morning after each sun exposure. RESULTS After 5 days, 31 (56%) participants had more sunburn on the SPF 50+ side compared to 4 (7%) on the SPF 100+ side. Overall, mean erythema intensity showed statistically significantly less erythema on the SPF 100+ side compared with the SPF 50+ side. The first observation of sunburn exclusively on the SPF 50+ side occurred after 1 day of sun exposure, whereas that for SPF 100+ occurred after 3 days of sun exposure. LIMITATIONS Only initial sunscreen application was monitored, only 1 participant with skin phototype I was recruited, and participants were recruited from a local beach area. CONCLUSION SPF 100+ was significantly more effective in protecting against ultraviolet radiation-induced erythema and sunburn than SPF 50+ in actual use in a beach vacation setting.
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Affiliation(s)
- Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Cynthia L Nicholson
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; Department of Dermatology, Wayne State University, Detroit, Michigan
| | | | - Alexis B Lyons
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - InSeok Seo
- Johnson & Johnson Consumer Inc, Skillman, New Jersey
| | | | - Xiaoyan Tian
- Johnson & Johnson Consumer Inc, Skillman, New Jersey
| | | | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
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48
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Kohli I, Zubair R, Lyons AB, Nahhas AF, Braunberger TL, Mokhtari M, Ruvolo E, Lim HW, Hamzavi IH. Impact of Long‐Wavelength Ultraviolet A1 and Visible Light on Light‐Skinned Individuals. Photochem Photobiol 2019; 95:1285-1287. [DOI: 10.1111/php.13143] [Citation(s) in RCA: 18] [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] [Received: 04/23/2019] [Accepted: 07/05/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Indermeet Kohli
- Department of Dermatology Henry Ford Hospital Detroit MI USA
| | - Raheel Zubair
- Department of Dermatology Henry Ford Hospital Detroit MI USA
| | - Alexis B. Lyons
- Department of Dermatology Henry Ford Hospital Detroit MI USA
| | - Amanda F. Nahhas
- Department of Dermatology Beaumont‐Farmington Hills Farmington Hills MI USA
| | | | | | | | - Henry W. Lim
- Department of Dermatology Henry Ford Hospital Detroit MI USA
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49
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Kohli I, Sakamaki T, Dong Tian W, Moyal D, Hamzavi IH, Kollias N. The dynamics of pigment reactions of human skin to ultraviolet A radiation. Photodermatol Photoimmunol Photomed 2019; 35:387-392. [PMID: 31206816 DOI: 10.1111/phpp.12497] [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: 02/13/2019] [Revised: 05/30/2019] [Accepted: 06/13/2019] [Indexed: 11/27/2022]
Abstract
The pigment responses of human skin to broadband UVA radiation (320-400 nm) occur in three distinct phases. The first phase includes immediate pigment darkening (IPD), the pigment that appears immediately after irradiation. The second phase involves an intermediate step, termed persistent pigment darkening (PPD), which leads to the third phase of neomelanogenesis or delayed tanning (DT). Since DT results from synthesis of new melanin, it persists beyond 5-7 days. We conducted studies on human subjects to investigate the dynamic responses of the IPD and PPD reactions to broadband UVA radiation at threshold and superthreshold doses. The threshold doses for IPD, PPD, and DT were found to be approximately 1, 11, and 18 J/cm2 , respectively. The colorimetry ΔL* value corresponding to minimal clinically perceptible pigmentation was found to be 0.8 ± 0.1. IPD appeared immediately and had an associated decay constant of approximately 1.4 minutes. At doses greater than PPD threshold, IPD reaction decayed while PPD developed indicating toward IPD being used as a substrate in the formation of PPD.
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Affiliation(s)
| | - Takeshi Sakamaki
- Wellman Center of Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wei Dong Tian
- Wellman Center of Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Nikiforos Kollias
- Henry Ford Hospital, Detroit, Michigan.,Wellman Center of Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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50
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Kohli I, Nahhas AF, Braunberger TL, Chaowattanapanit S, Mohammad TF, Nicholson CL, Kollias N, Lim HW, Hamzavi IH. Spectral characteristics of visible light‐induced pigmentation and visible light protection factor. Photodermatol Photoimmunol Photomed 2019; 35:393-399. [DOI: 10.1111/phpp.12490] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/13/2019] [Accepted: 05/26/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Indermeet Kohli
- Department of Dermatology Henry Ford Hospital Detroit Michigan
| | - Amanda F. Nahhas
- Department of Dermatology Beaumont Hospital-Farmington Hills Farmington Hills Michigan
| | | | - Suteeraporn Chaowattanapanit
- Division of Dermatology, Department of Medicine Srinagarind Hospital Medical School, Khon Kaen University Khon Kaen Thailand
| | | | | | | | - Henry W. Lim
- Department of Dermatology Henry Ford Hospital Detroit Michigan
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