1
|
Dugast C, Bruneau L, Fianu A, Ferdynus C, Boussaid K, Vuichard J, Duloutre F, Dumez J, Sultan-Bichat N, Bertolotti A. PRESOLRE: study protocol for a primary school-based, cluster randomised controlled trial of three sun exposure risk prevention strategies on Reunion Island. BMJ Open 2024; 14:e082045. [PMID: 38754877 PMCID: PMC11097802 DOI: 10.1136/bmjopen-2023-082045] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Reunion Island, a French overseas department, is located in the southern hemisphere, close to the Capricorn tropic. This island has a multicultural and multiethnic population of 860 000 inhabitants, a quarter of whom are at high risk of developing skin cancer due to intense ultraviolet radiation. Melanoma is responsible for the majority of skin cancer deaths. The early prevention of melanoma is based on sun protection in childhood, but French regulations are not adapted to the environmental conditions of this tropical region.The main objective of our study is to evaluate the effectiveness of three sun protection programs conducted in Reunionese primary schools through a pupil knowledge questionnaire. METHODS AND ANALYSIS PRESOLRE is an interventional, open-label, cluster-randomised controlled trial, in four parallel arms, that is being conducted throughout 2022-2023 on Reunion Island. The trial design assumes an escalation interventional effect using: first, a control arm without proposed intervention (arm 1); second, an arm whose classes are encouraged to use the validated educational programme 'Living With the Sun' (LWS) (arm 2); third, an arm whose classes are encouraged to use both 'LWS' combined with 'Mission Soleil Réunion's sun protection awareness programme (arm 3); fourth, an arm benefiting from an intervention similar to arm 3, combined with the distribution of hats, sunglasses and sun creams (arm 4). In all, 1780 pupils from 18 classes of 20 pupils, on average, will be included. Randomisation applies to the classes of pupils (so defined as clusters). The primary outcome is based on the proportion of correct answers to the knowledge questions after the awareness programme, compared between the four arms using a linear mixed model with random intercept. ETHICS AND DISSEMINATION The study obtained ethics approval in 2022 (ID: 2022-A00350-43). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05367180.
Collapse
Affiliation(s)
- Charline Dugast
- Center for Clinical Investigation (CIC) 14 10 Clinical Epidemiology National Institute of Health and Medical Research (INSERM), Reunion University Hospital, Saint Pierre, Reunion Island, France
| | - Léa Bruneau
- Center for Clinical Investigation (CIC) 14 10 Clinical Epidemiology National Institute of Health and Medical Research (INSERM), Reunion University Hospital, Saint Pierre, Reunion Island, France
| | - Adrian Fianu
- Center for Clinical Investigation (CIC) 14 10 Clinical Epidemiology National Institute of Health and Medical Research (INSERM), Reunion University Hospital, Saint Pierre, Reunion Island, France
- Center for Epidemiology and Research in POPulation health (CERPOP) National Institute of Health and Medical Research (INSERM), Université Paul Sabatier (UPS) Toulouse, Toulouse, France
| | - Cyril Ferdynus
- Center for Clinical Investigation (CIC) 14 10 Clinical Epidemiology National Institute of Health and Medical Research (INSERM), Reunion University Hospital, Saint Pierre, Reunion Island, France
| | - Karim Boussaid
- Center for Clinical Investigation (CIC) 14 10 Clinical Epidemiology National Institute of Health and Medical Research (INSERM), Reunion University Hospital, Saint Pierre, Reunion Island, France
| | - Juliette Vuichard
- Center for Clinical Investigation (CIC) 14 10 Clinical Epidemiology National Institute of Health and Medical Research (INSERM), Reunion University Hospital, Saint Pierre, Reunion Island, France
| | - Floreana Duloutre
- Center for Clinical Investigation (CIC) 14 10 Clinical Epidemiology National Institute of Health and Medical Research (INSERM), Reunion University Hospital, Saint Pierre, Reunion Island, France
| | - Jessica Dumez
- Center for Clinical Investigation (CIC) 14 10 Clinical Epidemiology National Institute of Health and Medical Research (INSERM), Reunion University Hospital, Saint Pierre, Reunion Island, France
| | - Nathalie Sultan-Bichat
- Dermatology Department, West Reunion University Hospital, Saint Paul, Reunion Island, France
- MISOLRE Prevention Association, Saint-Paul, Reunion Island, France
| | - Antoine Bertolotti
- Center for Clinical Investigation (CIC) 14 10 Clinical Epidemiology National Institute of Health and Medical Research (INSERM), Reunion University Hospital, Saint Pierre, Reunion Island, France
- MISOLRE Prevention Association, Saint-Paul, Reunion Island, France
- Infectious Diseases-Dermatology Department, Reunion University Hospital, Saint Pierre, Reunion Island, France
| |
Collapse
|
2
|
Ross HE, Parkin D, Ayer J. Overexposure to ultraviolet radiation in solar urticaria. BMJ Case Rep 2024; 17:e258868. [PMID: 38724216 PMCID: PMC11085702 DOI: 10.1136/bcr-2023-258868] [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] [Indexed: 05/13/2024] Open
Abstract
A man in his 50s was diagnosed with solar urticaria following monochromated light testing that demonstrated exquisite photosensivity to ultraviolet (UV) A, UV B (UVB) and visible light.Treatment options for this photodermatosis are limited; UVB phototherapy is one modality that can be appropriate in some patients. This is administered at very low doses in a controlled environment to induce skin hardening.1 To self-treat his condition, the patient used a commercial sunbed on two occasions several days apart. He noted an immediate flare of solar urticaria after first use with associated dizziness. Following the second use, he felt generally unwell and was witnessed to lose consciousness and displayed jerky movements of his limbs while a passenger in a car. Investigations including a head MRI and an EEG were normal; an anoxic seizure caused by a flare of solar urticaria was later confirmed.Solar urticaria is a rare photodermatosis that is poorly understood and difficult to treat. The condition has a significant impact on the quality of life of patients. Severe cases can be associated with systemic symptoms that could be life-threatening.
Collapse
Affiliation(s)
- Hannah Elizabeth Ross
- Photobiology Unit, Department of Dermatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Donna Parkin
- Photobiology Unit, Department of Dermatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Jean Ayer
- Photobiology Unit, Department of Dermatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Division of Musculoskeletal & Dermatological Sciences, The University of Manchester School of Biological Sciences, Manchester, UK
| |
Collapse
|
3
|
Lin Y, Wang SJ, Fan ZP, Xie JB, Ding GY, Liu YL, Wang YF, Zhang LH. A causal analysis of the relationship between exposure to sunlight and colorectal cancer risk: A Mendelian randomization study. Medicine (Baltimore) 2024; 103:e37991. [PMID: 38701321 PMCID: PMC11062724 DOI: 10.1097/md.0000000000037991] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
Several observational studies have found that exposure to sunlight reduces the risk of colorectal cancer (CRC). However, sun exposure remains ambiguous in its relationship to CRC. We carried out a Mendelian randomization (MR) study to explore the potential associations between them. We examined the exposure to sunlight summary statistics of the UK Biobank Consortium using a 2-sample MR analysis. Using data from the FinnGen consortium, we derived summary statistics for CRC. We conducted our analysis with various methods, incorporating inverse variance weighted (IVW) along with 4 other approaches. A Cochran Q statistic was used to measure the heterogeneity of instrumental variables (IVs). We screened 133 single nucleotide polymorphisms (SNPs) (time spent outdoors in summer), 41 SNPs (time spent outdoors in winter), and 35 SNPs (frequency of solarium/sunlamp use) representing sunlight exposure for MR analysis. All selected SNPs had an F-statistic >20, indicating that IVs did not weakly bias the results. The summer outdoor activity trait exhibited significant heterogeneity (Cochran Q statistic = 183.795, P = .002 < 0.05), but we found no horizontal polymorphisms or significant heterogeneity for the other exposure traits. According to IVW estimates, no causal association exists between time spent outdoors in summer and CRC (Odds Ratio, OR = 0.735, 95% confidence interval, CI = 0.494-1.017, P = .128 > 0.017). No causal relationship existed between time spent outdoors in winter and CRC, as indicated by Bonferroni-corrected adjusted p-values. The OR was 0.877 with a 95% CI of 0.334-2.299, and the P value was .789, more significant than the significance threshold of 0.017. The solarium/sunlamp use frequency was not associated with CRC (OR = 1.567, 95%CI = 0.243-10.119, P = .637 > .017). Also, an IVW with random effects was applied to determine the causal relationship between summer outdoor time and CRC. No causal association between summer outdoor time and CRC was found (OR = 0.735, 95% CI = 0.494-1.017, P = .128 > .017). Additionally, 4 additional analyses yielded similar results. The findings of our study suggest that exposure to sunlight may reduce CRC risk, but the causal relationship remains unsolved. There is no evidence to suggest that exposure to sunlight prevents CRC. Randomized, controlled trials are needed to determine whether sunlight exposure protects against CRC.
Collapse
Affiliation(s)
- Yuan Lin
- Department of Gastroenterology, Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, China
| | - Shan-Juan Wang
- Department of Gastroenterology, Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, China
| | - Zhu-Ping Fan
- Department of Gastroenterology, Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, China
| | - Jin-Bi Xie
- Department of Gastroenterology, Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, China
| | - Gang-Yu Ding
- Department of Neurology, Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, China
| | - Yan-Li Liu
- Department of Gastroenterology, Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, China
| | - Yi-Fei Wang
- Department of Gastroenterology, Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, China
| | - Li-Hang Zhang
- Department of Gastroenterology, Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, China
| |
Collapse
|
4
|
Little MP, Mai JZ, Fang M, Chernyavskiy P, Kennerley V, Cahoon EK, Cockburn MG, Kendall GM, Kimlin MG. Solar ultraviolet radiation exposure, and incidence of childhood acute lymphocytic leukaemia and non-Hodgkin lymphoma in a US population-based dataset. Br J Cancer 2024; 130:1441-1452. [PMID: 38424165 PMCID: PMC11059281 DOI: 10.1038/s41416-024-02629-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Acute lymphocytic leukaemia (ALL) and non-Hodgkin lymphoma (NHL) are among the commonest types of childhood cancer. Some previous studies suggested that elevated ultraviolet radiation (UVR) exposures increase ALL risk; many more indicate NHL risk is reduced. METHODS We assessed age<20 ALL/NHL incidence in Surveillance, Epidemiology and End Results data using AVGLO-derived UVR irradiance/cumulative radiant exposure measures, using quasi-likelihood models accounting for underdispersion, adjusted for age, sex, racial/ethnic group and other county-level socioeconomic variables. RESULTS There were 30,349 cases of ALL and 8062 of NHL, with significant increasing trends of ALL with UVR irradiance (relative risk (RR) = 1.200/mW/cm2 (95% CI 1.060, 1.359, p = 0.0040)), but significant decreasing trends for NHL (RR = 0.646/mW/cm2 (95% CI 0.512, 0.816, p = 0.0002)). There was a borderline-significant increasing trend of ALL with UVR cumulative radiant exposure (RR = 1.444/MJ/cm2 (95% CI 0.949, 2.197, p = 0.0865)), and significant decreasing trends for NHL (RR = 0.284/MJ/cm2 (95% CI 0.166, 0.485, p < 0.0001)). ALL and NHL trend RR is substantially increased among those aged 0-3. All-age trend RRs are most extreme (increasing for ALL, decreasing for NHL) for Hispanics for both UVR measures. CONCLUSIONS Our more novel finding, of excess UVR-related ALL risk, is consistent with some previous studies, but is not clear-cut, and in need of replication.
Collapse
Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, 20892-9778, USA.
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK.
| | - Jim Z Mai
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, 20892-9778, USA
| | - Michelle Fang
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, 20892-9778, USA
| | - Pavel Chernyavskiy
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, 22908-0717, USA
| | - Victoria Kennerley
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, 20892-9778, USA
| | - Elizabeth K Cahoon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, 20892-9778, USA
| | - Myles G Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gerald M Kendall
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Michael G Kimlin
- Institute of Evidence Based Medicine, Bond University, Robina, Gold Coast, QLD, 4226, Australia
| |
Collapse
|
5
|
Rutter KJ, Peake M, Hawkshaw NJ, Scholey R, Bulfone-Paus S, Friedmann PS, Farrar MD, Rhodes LE. Solar urticaria involves rapid mast cell STAT3 activation and neutrophil recruitment, with FcεRI as an upstream regulator. J Allergy Clin Immunol 2024; 153:1369-1380.e15. [PMID: 38184075 DOI: 10.1016/j.jaci.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 12/01/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Solar urticaria is a rare photodermatosis characterized by rapid-onset sunlight-induced urticaria, but its pathophysiology is not well understood. OBJECTIVE We sought to define cutaneous cellular and molecular events in the evolution of solar urticaria following its initiation by solar-simulated UV radiation (SSR) and compare with healthy controls (HC). METHODS Cutaneous biopsy specimens were taken from unexposed skin and skin exposed to a single low (physiologic) dose of SSR at 30 minutes, 3 hours, and 24 hours after exposure in 6 patients with solar urticaria and 6 HC. Biopsy specimens were assessed by immunohistochemistry and bulk RNA-sequencing analysis. RESULTS In solar urticaria specimens, there was enrichment of several innate immune pathways, with striking early involvement of neutrophils, which was not observed in HC. Multiple proinflammatory cytokine and chemokine genes were upregulated (including IL20, IL6, and CXCL8) or identified as upstream regulators (including TNF, IL-1β, and IFN-γ). IgE and FcεRI were identified as upstream regulators, and phosphorylated signal transducer and activator of transcription 3 expression in mast cells was increased in solar urticaria at 30 minutes and 3 hours after SSR exposure, suggesting a mechanism of mast cell activation. Clinical resolution of solar urticaria by 24 hours mirrored resolution of inflammatory gene signature profiles. Comparison with available datasets of chronic spontaneous urticaria showed transcriptomic similarities relating to immune activation, but several transcripts were identified solely in solar urticaria, including CXCL8 and CSF2/3. CONCLUSIONS Solar urticaria is characterized by rapid signal transducer and activator of transcription 3 activation in mast cells and involvement of multiple chemotactic and innate inflammatory pathways, with FcεRI engagement indicated as an early event.
Collapse
Affiliation(s)
- Kirsty J Rutter
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom; Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, United Kingdom.
| | - Michael Peake
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Nathan J Hawkshaw
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Rachel Scholey
- Genomic Technologies Core Facility, University of Manchester, Manchester, United Kingdom
| | - Silvia Bulfone-Paus
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Peter S Friedmann
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Mark D Farrar
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom; Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, United Kingdom
| | - Lesley E Rhodes
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom; Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, United Kingdom
| |
Collapse
|
6
|
Hong SH, Choi N, Baek RM, Kim JH. Surgical correction of sunken upper eyelid with upper arcus marginalis release and precision fat distribution technique. J Cosmet Dermatol 2024; 23:1771-1776. [PMID: 38164125 DOI: 10.1111/jocd.16168] [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: 11/07/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Sunken upper eyelids, characterized by hollowing in the upper orbital region, can contribute to an aged or fatigued appearance. We aim to report on the surgical technique and its effects, involving the release of the arcus marginalis of the upper eyelid and the precise distribution of orbital fat. METHODS From December 2021 to March 2023, a total of 84 eyelids from 42 patients who underwent surgical correction for sunken upper eyelids, utilizing the upper arcus marginalis release and precision fat distribution technique, were included in this study. Preoperative and postoperative sunken depths were measured and statistically analyzed. Aesthetic satisfaction was assessed through patient questionnaires. RESULTS Preoperative and postoperative sunken depths measured 9.2 ± 2.2 mm and 5.9 ± 2.3 mm, respectively. The mean improvement was 3.3 mm, a change of statistical significance. Aesthetic outcomes and patient satisfaction yielded favorable results. No major complications were observed during the follow-up period. CONCLUSION The upper arcus marginalis release and orbital fat distribution technique demonstrated favorable outcomes in correcting sunken upper eyelids. This procedure ensures stable placement of orbital fat at the deepest sunken point, resulting in aesthetically pleasing and enduring results. This technique serves as a valuable alternative for patients with moderate to severe sunken eyelids.
Collapse
Affiliation(s)
| | - Nakwon Choi
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Rong-Min Baek
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Ho Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
7
|
Alves FFC, de Jesus LCB, Cristelli MP, Enokihara MMSES, Hirata SH, Facina ADS, Tomimori J. Metastasis of skin squamous cell carcinoma in kidney transplant recipients. Int J Dermatol 2024; 63:560-564. [PMID: 38263692 DOI: 10.1111/ijd.17029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/14/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the most common skin malignancy in kidney transplant recipients (KTRs) as a result of immunosuppression. A worldwide increase in kidney transplantation justifies the determination of prognostic biomarkers by collecting detailed patient data on metastasis development. This study aims to characterize the clinical, epidemiological, and histopathological profiles of KTRs who developed metastasis of cSCC. We conducted a retrospective single-center study on 18 KTRs and 21 immunocompetent patients (ICs) with metastatic cSCC, using data from 2004 to 2021. ICs were older (median age 70.5 years) than KTRs (median age: 59.5 years). Both groups were predominantly male with Fitzpatrick skin phototype I/II. The primary tumor appeared around 83.5 months post-transplant, usually in sun-exposed areas (61.1%), though some non-exposed areas in ICs (23.8%) contradicted literature findings. KTRs took longer to develop metastasis (median: 11.0 months) compared to ICs (median: 5.5 months). The mean size of the primary tumor was smaller in KTRs (2.50 cm2) compared to ICs (4.55 cm2). The main lymph node chain affected by metastasis was parotid lymph nodes in KTRs (27.8%) and cervical/axillar lymph nodes in ICs (both 19.0%). Both groups exhibited similar primary tumor grades and metastasis evolution, but KTRs had a higher prevalence of lymphovascular invasion. Metastasis of cSCC was more common in males with low skin phototype, in KTRs, particularly on the head and neck. The study suggests a possible link between lymphovascular invasion and metastasis development in KTRs.
Collapse
Affiliation(s)
| | - Laura C B de Jesus
- Department of Medicine, Post Graduate Program in Translational Medicine, São Paulo, Brazil
| | | | - Milvia M S E S Enokihara
- Department of Pathology - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sérgio H Hirata
- Department of Dermatology - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP) and Hospital São Paulo, São Paulo, Brazil
| | - Anamaria da Silva Facina
- Department of Dermatology - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP) and Hospital São Paulo, São Paulo, Brazil
| | - Jane Tomimori
- Department of Dermatology - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP) and Hospital São Paulo, São Paulo, Brazil
| |
Collapse
|
8
|
Redelmeier DA, Staples JA. Fatal Traffic Risks With a Total Solar Eclipse in the US. JAMA Intern Med 2024; 184:575-577. [PMID: 38526467 PMCID: PMC10964155 DOI: 10.1001/jamainternmed.2023.5234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/17/2023] [Indexed: 03/26/2024]
Abstract
This case-control study describes the incidence of fatal traffic crashes in the US during the 2017 total solar eclipse.
Collapse
Affiliation(s)
- Donald A. Redelmeier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Science Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Center for Leading Injury Prevention Practice Education & Research, Toronto, Ontario, Canada
| | - John A. Staples
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology & Evaluation, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
9
|
Rönsch H, Rocholl M, Ludewig M, Staudt A, Langner M, Steeb T, Wilke A, John SM, Berking C, Beissert S, Bauer A. Sun protection in outdoor workers - Development and validation of standardized questionnaires for behavior and knowledge. J Dtsch Dermatol Ges 2024; 22:665-673. [PMID: 38528320 DOI: 10.1111/ddg.15378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/11/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Outdoor workers are at increased risk of developing non-melanoma skin cancer. We aimed to address the lack of validated German-language measurement instruments for outdoor workers' sun safety behavior and knowledge by compiling and validating two questionnaires. PARTICIPANTS AND METHODS By expert consensus, items for the assessment of protective behavior (OccuSun) were compiled based on existing instruments. For knowledge, a translation of the Skin Cancer and Sun Knowledge (SCSK) scale was selected. After a pre-test, a validation study including 68 outdoor workers (62% female) was conducted in 2020. RESULTS The retest reliability was r = 0.93 (95% confidence interval: 0.86-0.96) for the protection score and rs = 0.78 (0.67-0.86) for the knowledge score. Protective behaviors were correlated with respective diary data (0.38 ≤ rs ≤ 0.74, p < 0.001) and skin pigmentation changes (-0.23 ≥ rs ≥ -0.42, 0.007 ≤ p ≤ 0.165) but not with self-reported sunburn frequency (0.21 ≥ rs ≥ -0.04). CONCLUSIONS Among German outdoor workers, two questionnaires for the assessment of sun protection behavior (OccuSun) and knowledge (SCSK) demonstrated good reliability. The OccuSun had generally good validity. Both instruments are fit for subsequent validation to determine their sensitivity to change.
Collapse
Affiliation(s)
- Henriette Rönsch
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marc Rocholl
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Michaela Ludewig
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Andreas Staudt
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Mathias Langner
- Institute for Clinical Chemistry und Laboratory Medicine (IKL), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Theresa Steeb
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Annika Wilke
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Swen Malte John
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
10
|
Twigg E, Roberts E, Sharp A, Iraba J, Chapa P, Freeland H, Mavura D. Daylight photodynamic therapy as a treatment for actinic field change in patients diagnosed with oculocutaneous albinism in sub-Saharan Africa. Clin Exp Dermatol 2024; 49:484-490. [PMID: 37995284 DOI: 10.1093/ced/llad406] [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: 08/28/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Oculocutaneous albinism (OCA) is a genetically inherited condition, whereby melanin is reduced or absent in the skin. A lack of melanin predisposes people to actinic damage and skin malignancies. In Tanzania, a resource-limited country, the treatment of choice for precancerous skin lesions is cryotherapy. OBJECTIVES To investigate whether daylight photodynamic therapy (dPDT) is a safe and well-tolerated treatment for actinic field change in the OCA population in Tanzania. METHODS Twelve participants with actinic damage were recruited from a Standing Voice skin surveillance clinic and treated with dPDT. Study participants completed tolerability and acceptability questionnaires at day 5 and 3 months after treatment. A dermatologist assessed their clinical response to dPDT at 3 months. RESULTS dPDT was well-tolerated and acceptable to the majority of patients. Actinic damage was reduced by 25-90%. No skin cancers developed during the treatment. CONCLUSIONS This pilot study suggests that dPDT is a safe and tolerable treatment for actinic damage in people with OCA in Tanzania. Further work is required to compare the efficacy of dPDT against other topical therapies for actinic field change.
Collapse
Affiliation(s)
- Emily Twigg
- Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Elizabeth Roberts
- Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andrew Sharp
- Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Peter Chapa
- Dodoma Regional Referral Hospital, Dodoma, Tanzania
| | | | | |
Collapse
|
11
|
Dona AC, Jewett PI, Henning-Smith C, Ahmed RL, Wei ML, Lazovich D, Vogel RI. Rural-Urban Differences in Sun Exposure and Protection Behaviors in the United States. Cancer Epidemiol Biomarkers Prev 2024; 33:608-615. [PMID: 38227023 PMCID: PMC10990774 DOI: 10.1158/1055-9965.epi-23-1264] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/13/2023] [Accepted: 01/11/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Evidence regarding whether rural residence is a risk factor for skin cancer is mixed. We compared sun exposure and protection behaviors between rural and urban residents by ethno-racial group in the United States. METHODS We analyzed data from three (2013-2018) National Health and Nutrition Examination Survey cycles. We compared self-reported sun exposure and protection measures (sunburn, time spent outside, sunscreen use, wearing long sleeves, staying in shade) by rural-urban residential status using survey-weighted logistic regression models stratified by ethno-racial group, adjusting for age, sex, income, education, body mass index, and smoking. RESULTS Hispanic rural versus urban residents more often reported sunburns in the past year [41.6% vs. 31.2%, adjusted OR (aOR): 1.46 (1.15-1.86)]. White rural versus urban residents more often spent 2+ hours outside on workdays [42.9% vs. 29.1%, aOR: 1.60 (1.27-2.01)] and non-workdays [72.2% vs. 64.8%, aOR: 1.45 (1.12-1.88)] and less often used sunscreen [26.0% vs. 35.1%, aOR: 0.74 (0.59-0.93)] and stayed in the shade [21.7% vs. 26.7%, aOR: 0.72 (0.57-0.89)]. Black rural versus urban residents stayed in the shade less often [31.6% vs. 43.9%, aOR: 0.60 (0.39-0.91)] but less often spent 2+ hours outside on non-workdays [47.6% vs. 56.8%, aOR: 0.67 (0.51-0.90)]. CONCLUSIONS Across all ethno-racial groups included, rural residents reported greater sun risk behaviors than urban residents, with some nuances by ethno-racial identity, suggesting rural residence is a potential risk factor for skin cancer. IMPACT Sun protection promotion programs should consider rural-urban settings while also accounting for ethno-racial identities.
Collapse
Affiliation(s)
- Allison C. Dona
- Medical School, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Patricia I. Jewett
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Carrie Henning-Smith
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rehana L. Ahmed
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Maria L. Wei
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA; Dermatology Service, San Francisco VA Health Care System, San Francisco, CA, USA
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Rachel I. Vogel
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
12
|
Futterknecht S, Steinemann-Inauen A, Rothenbühler S, Hasler PW, Camenzind-Zuche H. Solar Eclipse Maculopathy in an 11-Year-Old Boy. Klin Monbl Augenheilkd 2024; 241:496-497. [PMID: 38653310 DOI: 10.1055/a-2210-0833] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Stefan Futterknecht
- Department of Ophthalmology, University Hospital of Basel, Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | | | - Simon Rothenbühler
- Department of Ophthalmology, University Hospital of Basel, Basel, Switzerland
| | - Pascal W Hasler
- Department of Ophthalmology, University Hospital of Basel, Basel, Switzerland
| | | |
Collapse
|
13
|
Dona AC, Jewett P, Henning-Smith C, Ahmed RL, Lazovich D, Vogel RI. Rural-urban differences in meeting of physical activity recommendations by sun exposure and protection behaviors in the United States. Prev Med 2024; 181:107919. [PMID: 38408648 PMCID: PMC10947812 DOI: 10.1016/j.ypmed.2024.107919] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To examine associations between sun protection behaviors and physical activity (PA) by rural and urban residence in the United States. METHODS We analyzed data from the National Health and Nutrition Examination Survey (2013-2018), restricting to participants ages 20-59 with sun behavior data. Sunburns, sun exposure, and sun protection measures were dichotomized (yes/no): ≥1 sunburn in the past year, 2+ hour outside during workdays or non-workdays, and never/rarely/sometimes using sunscreen, wearing long sleeves, and staying in the shade. Meeting PA recommendations (yes/no) was defined as ≥150 min of vigorous/moderate or ≥ 75 min vigorous PA per week. Associations between sun behaviors and PA were analyzed using logistic regression models, which accounted for survey-weights and potential confounders, and stratified by rural-urban status. RESULTS Rural and urban individuals meeting PA recommendations had greater odds of spending 2+ hour outside during workdays (OR: 2.26 [1.88, 2.74] and 3.95 [2.72, 5.73]) and non-workdays (OR: 2.06 [1.78, 2.38] and 3.33 [2.47, 4.46]). Among urban residents, odds of staying in the shade were lower among those who met PA recommendations (OR: 0.78 [0.66, 0.92]). We did not observe differences in sunburns or other sun behaviors by PA status, regardless of rurality. CONCLUSIONS Meeting PA recommendations was associated with greater sun exposure in both rural and urban populations. Additional exercise location (indoors/outside) data is needed to inform PA and skin cancer prevention interventions to reduce unintended increases in sun exposure and reductions in PA, respectively, especially among rural populations.
Collapse
Affiliation(s)
- Allison C Dona
- Medical School, University of Minnesota, Minneapolis, MN, USA; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Patricia Jewett
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA; Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Carrie Henning-Smith
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Rehana L Ahmed
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Rachel I Vogel
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
| |
Collapse
|
14
|
Jeremian R, Malinowski A, Lytvyn Y, Georgakopoulos JR, Muntyanu A, Mufti A, Lefrançois P, Yeung J, Litvinov I. Skin photoageing following sun exposure is associated with decreased epigenetic and biologic age, and correlates with basal cell carcinoma phenotype. Br J Dermatol 2024; 190:590-592. [PMID: 38133632 PMCID: PMC10941323 DOI: 10.1093/bjd/ljad527] [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: 09/02/2023] [Revised: 12/11/2023] [Accepted: 01/13/2024] [Indexed: 12/23/2023]
Abstract
This study investigated epigenetic changes, specifically epigenetic ageing, in an adult cohort of healthy individuals using five validated epigenetic clock algorithms and a DNA methylation-based estimator of telomere length. Our study demonstrated significant biologic/epigenetic age dysregulation in sun-exposed vs. sun-protected dermal and epidermal skin, with a strong correlation to the validated Helfrich skin photoageing scale, occurring in patterns that overlap with those seen in basal cell carcinoma. This work highlights the power of novel epigenetic analyses in studying photoageing and skin cancer predisposition.
Collapse
Affiliation(s)
- Richie Jeremian
- Faculty of Medicine and Health Sciences
- Research Institute of the McGill University Health Centre, Montréal, QC
| | | | - Yuliya Lytvyn
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | | | - Anastasiya Muntyanu
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | - Philippe Lefrançois
- Division of Dermatology, Department of Medicine, McGill University, Montréal, QC
- Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON
| | - Ivan V Litvinov
- Research Institute of the McGill University Health Centre, Montréal, QC
- Division of Dermatology, Department of Medicine, McGill University, Montréal, QC
| |
Collapse
|
15
|
Slavinsky V, Helmy J, Vroman J, Valdebran M. Solar ultraviolet radiation exposure in workers with outdoor occupations: a systematic review and call to action. Int J Dermatol 2024; 63:288-297. [PMID: 37853576 DOI: 10.1111/ijd.16877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/20/2023] [Accepted: 09/28/2023] [Indexed: 10/20/2023]
Abstract
Chronic solar ultraviolet radiation (sUVR) exposure leads to an increased incidence of non-melanoma skin cancer (NMSC) development, particularly when accumulated over decades. Workers in certain industries, such as construction, agriculture, postal workers, and the military, are at higher risk due to cumulative sUVR exposure in their line of work. By assessing the relationship between sUVR exposure in outdoor workers and their skin cancer risk and defining methods of prevention, clinicians can offer focused sun protection counseling to this unique population. PubMed was used to perform a literature review to address the following research questions: 1. How is ultraviolet radiation measured? 2. What is the modern utility of the ultraviolet index in modifying sun protection behaviors in outdoor industry workers? 3. What is the risk of non-melanoma skin cancer development in individuals working in outdoor occupations? 4. What is the prevalence of skin cancer among outdoor workers? 5. Is the number of nevi and solar lentigines elevated among individuals employed in outdoor occupations? The literature suggests that individuals in outdoor occupations are exposed to UV levels that often surpass safety limits for occupational UVR exposure, increasing their risk of developing skin cancer and precursor and pigmented lesions. Individuals in high-risk occupations experience significantly higher levels of sUVR exposure than their indoor worker counterparts, increasing their risk of malignant cutaneous transformation. Accordingly, these individuals must be counseled on effective solar protection methods, and employers should advocate for actionable change.
Collapse
Affiliation(s)
| | - John Helmy
- Medical University of South Carolina, Charleston, SC, USA
| | - Jenna Vroman
- Medical University of South Carolina, Charleston, SC, USA
| | - Manuel Valdebran
- Division of Pediatric Dermatology, Department of Dermatology, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
16
|
Valbuena MC, Bravo C, Rolón-Cadena MC. Fixed Sunlight Eruption: A Series of 13 Cases in Bogotá, Columbia. Actas Dermosifiliogr 2024; 115:288-292. [PMID: 37244395 DOI: 10.1016/j.ad.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/09/2023] [Accepted: 04/02/2023] [Indexed: 05/29/2023] Open
Abstract
Few reports describing an association between UV radiation and fixed skin eruptions have been published since 1975. These reactions have received various names, including fixed sunlight eruption, fixed exanthema due to UV radiation, and broad-spectrum abnormal localized photosensitivity syndrome. We present a series of 13 patients (4 men [30.8%] and 9 women [69.2%]) aged between 28 and 56 years who were evaluated for fixed eruptions induced by UV radiation at a dermatology referral hospital in Bogotá, Colombia. The lesions were located on the inner thighs, buttocks, popliteal region, anterior and posterior axilla, and dorsum of the feet. Photoprovocation reproduced lesions in all the affected areas, and histopathology showed changes similar to those seen in fixed drug eruptions. While these UV-provoked reactions may be a type of fixed skin eruption, we cannot rule out that they may also be a distinct condition that simply shares a pathogenic mechanism with fixed eruptions.
Collapse
Affiliation(s)
- M C Valbuena
- Hospital Universitario, Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia.
| | - C Bravo
- Dermatología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | |
Collapse
|
17
|
Tod B, Whitaker D, Visser W, Isaacs T, Jacobs T, Wiid K, Dlova NC, Wright CY. Integrated sun protection advice for the South African population. Int J Dermatol 2024; 63:277-287. [PMID: 38124402 DOI: 10.1111/ijd.16980] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Exposure to solar ultraviolet radiation (UVR) is associated with several cutaneous adverse effects. However, to the best of our knowledge, in South Africa there are no formal guidelines on sun protection. A group of South African dermatologists and researchers convened over the course of 1 year to deliberate on integrated advice for sun protection among the multi-ethnic South African population. For people with light skin and those with genetic skin disorders (e.g., oculocutaneous albinism), sun protection was identified as critical to prevent sunburn, skin cancer, and photoaging. The evidence is less clear for people with medium and darker skin types, especially the latter, in whom melanin may confer a degree of protection against some parts of the solar spectrum. Recent studies have demonstrated that visible light can cause pigmentary changes in individuals with darker skin types in particular. Sun protection for people of all skin colors is beneficial to protect against photoaging and ocular damage. Herein sun protection advice is suggested for South Africans of all skin colors to reduce morbidity and mortality from sun exposure, particularly relating to skin cancer. Several knowledge gaps are identified as future research priorities.
Collapse
Affiliation(s)
- Bianca Tod
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Willie Visser
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Thuraya Isaacs
- Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Kim Wiid
- L'Oréal Dermatological Beauty, Johannesburg, South Africa
| | - Ncoza C Dlova
- Dermatology Department, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Caradee Y Wright
- Climate Change and Health Research Programme, Environment and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
18
|
Mitev S, Zheleva N, Ivanova A. Sunlight's Dark Side: A Case of Subtle Skin Lesions and Hyperpigmentation. Gastroenterology 2024; 166:376-378. [PMID: 37926131 DOI: 10.1053/j.gastro.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Stefan Mitev
- Gastroenterology Clinic, University Hospital Sveti Ivan Rilski, Sofia, Bulgaria.
| | - Nadezhda Zheleva
- Gastroenterology Clinic, University Hospital Sveti Ivan Rilski, Sofia, Bulgaria
| | - Aneta Ivanova
- Bulgarian Porphyria Center, University Hospital Sveti Ivan Rilski, Sofia, Bulgaria
| |
Collapse
|
19
|
Valbuena MC, Bravo C, Rolón-Cadena MC. [Translated article] Fixed Sunlight Eruption: A Series of 13 Cases in Bogotá, Colombia. Actas Dermosifiliogr 2024; 115:T288-T292. [PMID: 38219907 DOI: 10.1016/j.ad.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/02/2023] [Indexed: 01/16/2024] Open
Abstract
Few reports describing an association between UV radiation and fixed skin eruptions have been published since 1975. These reactions have received various names, including fixed sunlight eruption, fixed exanthema due to UV radiation, and broad-spectrum abnormal localized photosensitivity syndrome. We present a series of 13 patients (4 men [30.8%] and 9 women [69.2%]) aged between 28 and 56 years who were evaluated for fixed eruptions induced by UV radiation at a dermatology referral hospital in Bogotá, Colombia. The lesions were located on the inner thighs, buttocks, popliteal region, anterior and posterior axilla, and dorsum of the feet. Photoprovocation reproduced lesions in all the affected areas, and histopathology showed changes similar to those seen in fixed drug eruptions. While these UV-provoked reactions may be a type of fixed skin eruption, we cannot rule out that they may also be a distinct condition that simply shares a pathogenic mechanism with fixed eruptions.
Collapse
Affiliation(s)
- M C Valbuena
- Dermatologist, Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia.
| | - C Bravo
- Dermatology resident, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | |
Collapse
|
20
|
Calzavara-Pinton P, Tonon F, Calzavara-Pinton I. Sun pain and solar dysesthesia: A new challenge in clinical practice. Photodermatol Photoimmunol Photomed 2024; 40:e12955. [PMID: 38361492 DOI: 10.1111/phpp.12955] [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: 12/13/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND A few patients report intense pain and other unpleasant sensations, such as burning, dysesthesia and hyperalgesia, after even brief exposure to the sun and in the absence of any skin lesion. Sometimes they also develop systemic symptoms, such as mild fever, fatigue, faintness and fainting. As a result, these patients carefully avoid even short-term sun exposure with a consequent severe negative impact on their lives. METHODS We have reviewed the clinical findings and the results of photobiological investigations of 10 patients who presented this clinical picture. Six of these patients were previously described by our group with the diagnosis of sun pain. We have reviewed the similarities with other previously described disorders such as solar dysesthesia and PUVA pain and have evaluated possible pathogenetic mechanisms. RESULTS During phototesting our patients experienced intense pain in the exposed area and in the surrounding skin, without any visible lesion, even with very low sub-erythemal doses. At follow-up, five patients were diagnosed with fibromyalgia, three with a major depressive disorder, one with bipolar syndrome and one with a conversion disorder. The pathogenesis remains unclear, but the use of a psychopharmacological treatment with antidepressants improved both the neuropsychiatric symptoms and sensitivity to the sun in most subjects. CONCLUSION For patients with pain and other severe symptoms in the absence of skin lesions and clinical and laboratory manifestations of known photodermatoses, a neuropsychiatric evaluation should be suggested.
Collapse
Affiliation(s)
| | - Francesco Tonon
- Dermatology Unit, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Irene Calzavara-Pinton
- Department of Mental Health and Addictions, ASST Spedali Civili and University of Brescia, Brescia, Italy
| |
Collapse
|
21
|
Larnac E, Montoni A, Haydont V, Marrot L, Rochette PJ. Lipid Peroxidation as the Mechanism Underlying Polycyclic Aromatic Hydrocarbons and Sunlight Synergistic Toxicity in Dermal Fibroblasts. Int J Mol Sci 2024; 25:1905. [PMID: 38339182 PMCID: PMC10856043 DOI: 10.3390/ijms25031905] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Light and atmospheric pollution are both independently implicated in cancer induction and premature aging. Evidence has been growing more recently on the toxic synergy between light and pollutants. Polycyclic aromatic hydrocarbons (PAHs) originate from the incomplete combustion of organic matter. Some PAHs, such as the Benzo[a]pyrene (BaP), absorb ultraviolet A (UVA) wavelengths and can act as exogenous chromophores, leading to synergistic toxicity through DNA damage and cytotoxicity concomitant to ROS formation. In this study, we shed light on the mechanism underlying the toxic synergy between PAHs and UVA. Using dermal fibroblasts co-exposed to UVA and BaP, we have demonstrated that the photosensitization reaction causes mortality, which is most likely caused by ROS accumulation. We have shown that these ROS are concentrated in the lipids, which causes an important induction of lipid peroxidation and malondialdehyde, by-products of lipid peroxidation. We have also shown the accumulation of bulky DNA damage, most likely generated by these by-products of lipid peroxidation. To our knowledge, this study represents the first one depicting the molecular effects of photo-pollution on dermal skin.
Collapse
Affiliation(s)
- Eloïse Larnac
- Centre de Recherche du CHU de Québec, Université Laval, Axe Médecine Régénératrice, Hôpital du Saint-Sacrement, Québec, QC G1S 4L8, Canada; (E.L.); (A.M.)
- Centre de Recherche en Organogénèse Expérimentale, Université Laval/LOEX, Québec, QC G1V 0A6, Canada
| | - Alicia Montoni
- Centre de Recherche du CHU de Québec, Université Laval, Axe Médecine Régénératrice, Hôpital du Saint-Sacrement, Québec, QC G1S 4L8, Canada; (E.L.); (A.M.)
- Centre de Recherche en Organogénèse Expérimentale, Université Laval/LOEX, Québec, QC G1V 0A6, Canada
| | - Valérie Haydont
- Advanced Research, L’OREAL Research & Innovation, 93600 Aulnay-Sous-Bois, France; (V.H.); (L.M.)
| | - Laurent Marrot
- Advanced Research, L’OREAL Research & Innovation, 93600 Aulnay-Sous-Bois, France; (V.H.); (L.M.)
| | - Patrick J. Rochette
- Centre de Recherche du CHU de Québec, Université Laval, Axe Médecine Régénératrice, Hôpital du Saint-Sacrement, Québec, QC G1S 4L8, Canada; (E.L.); (A.M.)
- Centre de Recherche en Organogénèse Expérimentale, Université Laval/LOEX, Québec, QC G1V 0A6, Canada
- Département d’Ophtalmologie et ORL-Chirurgie Cervico-Faciale, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| |
Collapse
|
22
|
Neale RE, Beedle V, Ebeling PR, Elliott T, Francis D, Girgis CM, Gordon L, Janda M, Jones G, Lucas RM, Mason RS, Monnington PK, Morahan J, Paxton G, Sinclair C, Shumack S, Smith J, Webb AR, Whiteman DC. Balancing the risks and benefits of sun exposure: A revised position statement for Australian adults. Aust N Z J Public Health 2024; 48:100117. [PMID: 38350754 DOI: 10.1016/j.anzjph.2023.100117] [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: 09/03/2023] [Revised: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE To describe the development of a new position statement regarding balancing the risks and benefits of sun exposure for Australian adults. METHODS We conducted a Sun Exposure Summit in March 2021, with presentations from invited experts and a workshop including representation from academic, clinical, policy, and patient stakeholder organisations. The group considered advice about balancing the risks and benefits of sun exposure for Australian adults and developed a revised consensus position statement. RESULTS The balance of risks and benefits of sun exposure is not the same for everybody. For people at very high risk of skin cancer, the risks of exposure likely outweigh the benefits; sun protection is essential. Conversely, people with deeply pigmented skin are at low risk of skin cancer but at high risk of vitamin D deficiency; routine sun protection is not recommended. For those at intermediate risk of skin cancer, sun protection remains a priority, but individuals may obtain sufficient sun exposure to maintain adequate vitamin D status. CONCLUSIONS The new position statement provides sun exposure advice that explicitly recognises the differing needs of Australia's diverse population. IMPLICATIONS FOR PUBLIC HEALTH Mass communication campaigns should retain the focus on skin cancer prevention. The new position statement will support the delivery of personalised advice.
Collapse
Affiliation(s)
- Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia.
| | | | - Peter R Ebeling
- Monash University, Melbourne, Australia; Healthy Bones Australia, Australia
| | - Thomas Elliott
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Christian M Girgis
- University of Sydney, Sydney, Australia; Australa and New Zealand Bone and Mineral Society, Australia
| | - Louisa Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | | | - Graeme Jones
- Australa and New Zealand Bone and Mineral Society, Australia; University of Tasmania, Hobart, Australia
| | | | - Rebecca S Mason
- University of Sydney, Sydney, Australia; Healthy Bones Australia, Australia
| | | | | | | | | | | | - Jane Smith
- Royal Australian College of General Practitioners, Australia
| | - Ann R Webb
- University of Manchester, Manchester, United Kingdom
| | - David C Whiteman
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia
| |
Collapse
|
23
|
Rodriguez NG, Claici AO, Ramos-Castaneda JA, González-Zamora J, Bilbao-Malavé V, de la Puente M, Fernandez-Robredo P, Garzón-Parra SJ, Garza-Leon M, Recalde S. Conjunctival ultraviolet autofluorescence as a biomarker of outdoor exposure in myopia: a systematic review and meta-analysis. Sci Rep 2024; 14:1097. [PMID: 38212604 PMCID: PMC10784576 DOI: 10.1038/s41598-024-51417-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
Outdoor exposure is considered the primary modifiable risk factor in preventing the development of myopia. This effect is thought to be attributed to the light-induced synthesis and release of dopamine in the retina. However, until recent years, there was no objective quantifiable method available to measure the association between time spent outdoors and myopia. It is only recently that the conjunctival ultraviolet autofluorescence (CUVAF) area, serving as a biomarker for sun exposure, has begun to be utilized in numerous studies. To provide a comprehensive summary of the relevant evidence pertaining to the association between the CUVAF area and myopia across different geographic regions and age groups, a systematic review and meta-analysis were conducted. The search encompassed multiple databases, including MEDLINE, SCIENCE DIRECT, GOOGLE SCHOLAR, WEB OF SCIENCE, and SCOPUS, and utilized specific search terms such as "conjunctival ultraviolet autofluorescence", "CUVAF", "UVAF", "objective marker of ocular sun exposure", "myopia", "degenerative myopia", and "high myopia". The bibliographic research included papers published between the years 2006 and 2022. A total of 4051 records were initially identified, and after duplicates were removed, 49 articles underwent full-text review. Nine articles were included in the systematic review. These studies covered myopia and outdoor exposure across different regions (Australia, Europe and India) with a total population of 3615 individuals. They found that myopes generally had smaller CUVAF areas compared to non-myopes. The meta-analysis confirmed this, revealing statistically smaller CUVAF areas in myopic patients, with a mean difference of - 3.30 mm2 (95% CI - 5.53; - 1.06). Additionally, some studies showed a positive correlation between more outdoor exposure and larger CUVAF areas. In terms of outdoor exposure time, myopic patients reported less time outdoors than non-myopic individuals, with a mean difference of - 3.38 h/week (95% CI - 4.66; - 2.09). Overall, these findings highlight the connection between outdoor exposure, CUVAF area and myopia, with regional variations playing a significant role. The results of this meta-analysis validate CUVAF as a quantitative method to objectively measure outdoor exposure in relation with myopia development.
Collapse
Grants
- 01/0022-23 Doctoral fellowship funded by Miniciencias Bogotá, Colombia.
- PI20/00251 Instituto de Salud Carlos III through the project Co-funded by European Regional Development Fund "A way to make Europe"
- CUN 2019 Multiópticas
- (RD21/0017/0027) Redes de Investigación Cooperativa Orientadas al Resultado en Salud (RICORS) de Terapias avanzadas , Enfermedades Inflamatorias and Enfermedades vasculares cerebrales , Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III
- (RD21/0002/0010) Redes de Investigación Cooperativa Orientadas al Resultado en Salud (RICORS) de Terapias avanzadas , Enfermedades Inflamatorias and Enfermedades vasculares cerebrales , Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III
- (RD21/0006/0008) Redes de Investigación Cooperativa Orientadas al Resultado en Salud (RICORS) de Terapias avanzadas , Enfermedades Inflamatorias and Enfermedades vasculares cerebrales , Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III
- 01-20/21 Fundación Jesús Gangoiti Barrera
- Instituto de Salud Carlos III through the project Co-funded by European Regional Development Fund “A way to make Europe”
Collapse
Affiliation(s)
- Natali Gutierrez Rodriguez
- Grupo de Investigación en Optometría-Facultad de Optometría de la Universidad Antonio Nariño, Bogotá, Colombia
| | - Aura Ortega Claici
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Spain
- Faculty of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Jorge A Ramos-Castaneda
- Research Group Innovación y Cuidado, Faculty of Nursing, Universidad Antonio Nariño, Neiva, Colombia
| | - Jorge González-Zamora
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Spain
- Department of Ophthalmology, Clínica Universidad de Navarra, Madrid, Spain
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Valentina Bilbao-Malavé
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Spain
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Miriam de la Puente
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Spain
- Department of Ophthalmology, Clínica Universidad de Navarra, Madrid, Spain
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Patricia Fernandez-Robredo
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Spain
- Department of Ophthalmology, Clínica Universidad de Navarra, Madrid, Spain
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Sandra Johanna Garzón-Parra
- Grupo de Investigación en Optometría-Facultad de Optometría de la Universidad Antonio Nariño, Bogotá, Colombia
| | - Manuel Garza-Leon
- Clinical Science Department, Science of Health Division, University of Monterrey, San Pedro Garza García, Nuevo León, México
| | - Sergio Recalde
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Spain.
- Department of Ophthalmology, Clínica Universidad de Navarra, Madrid, Spain.
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain.
| |
Collapse
|
24
|
Odutola MK, van Leeuwen MT, Bruinsma F, Turner J, Hertzberg M, Seymour JF, Prince HM, Trotman J, Verner E, Roncolato F, Opat S, Lindeman R, Tiley C, Milliken ST, Underhill CR, Benke G, Giles GG, Vajdic CM. A Population-Based Family Case-Control Study of Sun Exposure and Follicular Lymphoma Risk. Cancer Epidemiol Biomarkers Prev 2024; 33:106-116. [PMID: 37831120 PMCID: PMC10774741 DOI: 10.1158/1055-9965.epi-23-0578] [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: 05/20/2023] [Revised: 08/08/2023] [Accepted: 10/11/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Epidemiologic evidence suggests an inverse association between sun exposure and follicular lymphoma risk. METHODS We conducted an Australian population-based family case-control study based on 666 cases and 459 controls (288 related, 171 unrelated). Participants completed a lifetime residence and work calendar and recalled outdoor hours on weekdays, weekends, and holidays in the warmer and cooler months at ages 10, 20, 30, and 40 years, and clothing types worn in the warmer months. We used a group-based trajectory modeling approach to identify outdoor hour trajectories over time and examined associations with follicular lymphoma risk using logistic regression. RESULTS We observed an inverse association between follicular lymphoma risk and several measures of high lifetime sun exposure, particularly intermittent exposure (weekends, holidays). Associations included reduced risk with increasing time outdoors on holidays in the warmer months [highest category OR = 0.56; 95% confidence interval (CI), 0.42-0.76; Ptrend < 0.01], high outdoor hours on weekends in the warmer months (highest category OR = 0.71; 95% CI, 0.52-0.96), and increasing time outdoors in the warmer and cooler months combined (highest category OR = 0.66; 95% CI, 0.50-0.91; Ptrend 0.01). Risk was reduced for high outdoor hour maintainers in the warmer months across the decade years (OR = 0.71; 95% CI, 0.53-0.96). CONCLUSIONS High total and intermittent sun exposure, particularly in the warmer months, may be protective against the development of follicular lymphoma. IMPACT Although sun exposure is not recommended as a cancer control policy, confirming this association may provide insights regarding the future control of this intractable malignancy.
Collapse
Affiliation(s)
- Michael K. Odutola
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Marina T. van Leeuwen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Bruinsma
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer Turner
- Anatomical Pathology, Douglass Hanly Moir Pathology, Macquarie Park, Sydney, Australia
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital and University of New South Wales, Sydney, New South Wales, Australia
| | - John F. Seymour
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - H. Miles Prince
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Judith Trotman
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Emma Verner
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Stephen Opat
- Clinical Haematology, Monash Health, Clayton, Victoria, Australia
| | - Robert Lindeman
- New South Wales Health Pathology, Sydney, New South Wales, Australia
| | | | | | - Craig R. Underhill
- Border Medical Oncology Research Unit, Albury, New South Wales, Australia
| | - Geza Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Graham G. Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Claire M. Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
25
|
Woźna J, Stępka J, Bałoniak A, Adamski Z. Evaluation of social knowledge on photoprotection and its relationship with education and age in a Polish seaside town during summer holidays. Photodermatol Photoimmunol Photomed 2024; 40:e12920. [PMID: 37927110 DOI: 10.1111/phpp.12920] [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: 09/08/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE This survey aimed to evaluate knowledge of photoprotection among individuals from a random group in a resort town in Poland, Kołobrzeg, and explore the correlation between their knowledge and demographics like age, gender, education, and residence. METHODS An anonymous survey was conducted among a diverse group. This population comprised individuals from various backgrounds: health spa patients undergoing treatments, therapies and medical appointments, guests visiting the resort for leisure, passersby, and staff working at the spa and recreational facilities. The survey was designed by authors, encompassed 16 questions about knowledge on photoprotection, sunscreen use and related topics, and gathered demographic data. Responses from 142 individuals were statistically analyzed using PQStat Software. RESULTS Only 7.7% use sunscreen all year-round. The majority apply sun protection factor (SPF) creams on sunny days or with prolonged sun exposure. Over half of the respondents (53.5%) are aware when to apply sunscreen but 43% reapply it less than every 4 h. 25.4% do not reapply at all. 38.7% think protection provided by higher SPF means longer sun exposure time. Over 50% believe SPF 30 offers double the protection of SPF 15. Almost half (46.8%) use extra sun protection, like sunglasses or hats. Significant correlations exist between education/age and certain survey responses. CONCLUSIONS The findings emphasize the urgency to improve photoprotection knowledge in the Polish population, particularly regarding the year-round harmful solar effects and the correct use of sun protection products.
Collapse
Affiliation(s)
- Julia Woźna
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jan Stępka
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Bałoniak
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
26
|
Nascimento NS, Torres-Obreque KM, Oliveira CA, Rabelo J, Baby AR, Long PF, Young AR, Rangel-Yagui CDO. Enzymes for dermatological use. Exp Dermatol 2024; 33:e15008. [PMID: 38284197 DOI: 10.1111/exd.15008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/18/2023] [Accepted: 12/15/2023] [Indexed: 01/30/2024]
Abstract
Skin is the ultimate barrier between body and environment and prevents water loss and penetration of pathogens and toxins. Internal and external stressors, such as ultraviolet radiation (UVR), can damage skin integrity and lead to disorders. Therefore, skin health and skin ageing are important concerns and increased research from cosmetic and pharmaceutical sectors aims to improve skin conditions and provide new anti-ageing treatments. Biomolecules, compared to low molecular weight drugs and cosmetic ingredients, can offer high levels of specificity. Topically applied enzymes have been investigated to treat the adverse effects of sunlight, pollution and other external agents. Enzymes, with a diverse range of targets, present potential for dermatological use such as antioxidant enzymes, proteases and repairing enzymes. In this review, we discuss enzymes for dermatological applications and the challenges associated in this growing field.
Collapse
Affiliation(s)
- Natália Santos Nascimento
- Department of Biochemical and Pharmaceutical Technology, School of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, Brazil
| | - Karin Mariana Torres-Obreque
- Department of Biochemical and Pharmaceutical Technology, School of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, Brazil
| | - Camila Areias Oliveira
- Laboratory of Analytical Validation and Development, Fundação Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Brazil
| | - Jheniffer Rabelo
- Department of Biochemical and Pharmaceutical Technology, School of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, Brazil
| | - André Rolim Baby
- Department of Pharmacy, School of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, Brazil
| | - Paul F Long
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Antony R Young
- St John's Institute of Dermatology, King's College London, London, UK
| | - Carlota de Oliveira Rangel-Yagui
- Department of Biochemical and Pharmaceutical Technology, School of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, Brazil
- Institute of Pharmaceutical Science, King's College London, London, UK
| |
Collapse
|
27
|
Granger C, Trullàs C, Sokeechand NB, Jourdan E, Krutmann J, Francois-Newton V, Hosenally M. Evaluating the factors influencing sun protection factors (SPF): Pooling data from multiple studies involving two reference ISO 24444:2019 sunscreen products (P2 and P8). Photodermatol Photoimmunol Photomed 2024; 40:e12942. [PMID: 38288771 DOI: 10.1111/phpp.12942] [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: 07/12/2023] [Revised: 11/27/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Standardized methods for sun protection factor (SPF) testing are still beset with endpoint and method-driven issues, and can be influenced by multiple factors. The purpose of this analysis is to explore the factors influencing the results of sun protection factor (SPF) testing in human subjects according to the ISO 24444:2019 standard. Intrinsic factors, such as baseline skin color, age and gender, the minimal erythemal dose on an unprotected area (MEDu), as well as environmental factors such as season/weather influences, are considered for analysis. METHODS Datasets generated for two reference products (P2 and P8) during the conduct of 50 such studies using the ISO standard 24444:2019 for the testing of SPF products, from a single testing center located in Bucharest, Romania between April 2021 and December 2022, were retrieved and compiled. Overall, the data for 334 subjects was available, with 276 observations for the reference P8, and 171 for P2. RESULTS No effects due to gender or age were detected. Seasonal changes, the individual typology angle (ITA°) and MEDu were found to have an influence on the outcome of the SPF values. CONCLUSIONS This study adds new original data about the impact of intrinsic and extrinsic factors on SPF variations pertaining to ISO reference sunscreen P8 (SPF 50+). The findings suggest that some factors will inevitably impact the results between two SPF experiments for the same product and SPF testing laboratory. The interconnections between the sources of this variation are discussed. The findings of this research help to identify and characterize factors that contribute to SPF testing variability.
Collapse
Affiliation(s)
| | | | | | - Eric Jourdan
- Innovation and Development, ISDIN, Barcelona, Spain
| | - Jean Krutmann
- IUF Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany
- Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
| | | | - Muzzammil Hosenally
- Centre International de Développement Pharmaceutique (CIDP), Phoenix, Mauritius
- Department of Economics and Statistics, University of Mauritius, Réduit, Mauritius
| |
Collapse
|
28
|
Goh CL, Kang HY, Morita A, Zhang C, Wu Y, Prakoeswa CRS, Sau NH, Kerob D, Flament F, Wei L. Awareness of sun exposure risks and photoprotection for preventing pigmentary disorders in Asian populations: Survey results from three Asian countries and expert panel recommendations. Photodermatol Photoimmunol Photomed 2024; 40:e12932. [PMID: 38059515 DOI: 10.1111/phpp.12932] [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: 07/13/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND In this article, we review and discuss the photoprotection behavior of Asians based on the literature, along with a subanalysis of an original online survey, and make recommendations to optimize photoprotection for Asian populations to prevent photoaging and pigmentary disorders. METHODS An international panel of eight dermatologists from Asia (China, Korea, Japan, Singapore, Indonesia, and Vietnam) met to discuss sunscreen photoprotection for Asian patients. Additionally, a subanalysis of an online survey by 3000 respondents from three Asian countries (China, Indonesia, and Japan) investigated general public awareness and attitudes to sun exposure. RESULTS A pre-meeting survey of the eight experts from Asia showed key concerns of Asian patients consulting dermatologists are pigmentary disorders, especially actinic/senile lentigo, post-inflammatory hyperpigmentation, melasma, vitiligo, and Hori's nevus. The survey subanalysis of participants from China, Indonesia, and Japan with predominantly Fitzpatrick skin types (FST) II to IV revealed that they are particularly concerned about sun exposure causing photoaging and pigmentary disorders. Most of the respondents indicated they have limited knowledge on sunlight radiation and appropriate sunscreen protection factors. Only 22%, 13%, and 3% for China, Indonesia, and Japan, respectively, systematically use multiple protective measures (using sunscreen, avoiding midday sun, staying in the shade, wearing a hat, protective clothing, and sunglasses) when exposed to the sun. CONCLUSIONS Further education is needed for Asian populations on the importance of comprehensive daily photoprotection, including broad-spectrum sunscreen, with high UVA and visible light protection, to reduce and prevent photoaging and pigmentary disorders.
Collapse
Affiliation(s)
| | - Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Wu
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - Cita Rosita Sigit Prakoeswa
- Department of Dermatology and Venerology, Faculty of Medicine, Universitas Airlangga - Dr Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Nguyen Huu Sau
- Hanoi Medical University and National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Delphine Kerob
- Laboratoire Dermatologique La Roche-Posay, Levallois-Perret, France
| | | | - Liu Wei
- Department of Dermatology, The General Hospital of Air Force PLA, Beijing, China
| |
Collapse
|
29
|
Mija LA, Salem Y, Bouadi N, Lefrançois P. Insufficient Primary Photoprotective Behaviours Assessment Among Outdoor Workers Calls for an Update in the Evaluation of Sun Safety Strategies in Industry, Maintenance, and Construction Professions: A Literature Review. J Cutan Med Surg 2024; 28:95-96. [PMID: 38263795 PMCID: PMC10908192 DOI: 10.1177/12034754231217235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
| | - Youssef Salem
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Naila Bouadi
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Philippe Lefrançois
- Division of Dermatology, Department of Medicine, McGill University, Montréal, QC, Canada
- Division of Dermatology, Department of Medicine, Jewish General Hospital, Montréal, QC, Canada
- Lady Davis Institute for Medical Research, Montréal, QC, Canada
| |
Collapse
|
30
|
Flament F, Mercurio DG, Muller B, Li J, Tricaud C, Bernerd F, Roudot A, Candau D, Passeron T. The impact of methoxypropylamino cyclohexenylidene ethoxyethylcyanoacetate (MCE) UVA1 filter on pigmentary and ageing signs: An outdoor prospective 8-week randomized, intra-individual comparative study in two populations of different genetic background. J Eur Acad Dermatol Venereol 2024; 38:214-222. [PMID: 37655436 DOI: 10.1111/jdv.19486] [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: 04/19/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Of all ultraviolet (UV) radiations reaching the earth, UVA1 rays have a higher potential of penetrating and producing clinically harmful consequences. While UV radiations up to 370 nm are well-blocked by current sunscreens, a photoprotection gap remains for the UVA1 wavelengths between 370 and 400 nm. OBJECTIVE This study was to assess under outdoor summer conditions the impact on pigmentation and skin ageing signs of a protection against UVA1 using methoxypropylamino cyclohexenylidene ethoxyethylcyanoacetate (MCE) filter added to a reference SPF50 sunscreen, in comparison with the same sunscreen without the MCE filter. MATERIALS AND METHODS This prospective randomized comparative intra-individual study was conducted in 113 women in Brazil and China. Subjects had their face and two forearms exposed twice-daily to a 1-h outdoor sunlight exposure over 8 weeks. Before exposure, the SPF50 sunscreen containing 3% MCE was applied on one half-face and one forearm and the same reference product without MCE on the other half-face and forearm. Primary study endpoint was skin colour changes (chromametry). Other endpoints included expert panel grading of pigmentation and facial skin ageing, and naïve panel assessment of facial skin radiance and homogeneity. RESULTS After 8 weeks, the skin was darker on both forearms but the increase in sun-induced pigmentation was smaller with the SPF50/MCE sunscreen. Expert panel evaluations showed no change in severity scores for pigmentation and a decreased severity scores for facial skin ageing in areas protected with the SPF50/MCE product: severity scores in areas protected with the SPF50 alone were either increased (pigmentation) or unchanged (skin ageing). Naïve panel evaluations of skin radiance and homogeneity showed statistically significant superiority of the SPF50/MCE product. CONCLUSION Overall, this study demonstrates that a protection with the SPF50/MCE sunscreen significantly reduces pigmentation and ageing signs compared to the same SPF50 sunscreen.
Collapse
Affiliation(s)
- F Flament
- L'Oréal Research and Innovation, Clichy, France
| | - D G Mercurio
- L'Oréal Research and Innovation, Rio de Janeiro, Brazil
| | - B Muller
- L'Oréal Research and Innovation, Clichy, France
| | - J Li
- L'Oréal Research and Innovation, Shanghai, China
| | - C Tricaud
- L'Oréal Research and Innovation, Clichy, France
| | - F Bernerd
- L'Oréal Research and Innovation, Aulnay-sous-Bois, France
| | - A Roudot
- L'Oréal Research and Innovation, Chevilly-Larue, France
| | - D Candau
- L'Oréal Research and Innovation, Chevilly-Larue, France
| | - T Passeron
- CHU Nice, Department of Dermatology, Université Côte d'Azur, Nice, France
- Université Côte d'Azur, INSERM, U1065, C3M, Nice, France
| |
Collapse
|
31
|
Sánchez Melús J, Refusta Ainaga P, Mata Crespo LD. [Crystalline miliaria in adult woman after solar exposition]. Aten Primaria 2024; 56:102781. [PMID: 37890348 PMCID: PMC10630589 DOI: 10.1016/j.aprim.2023.102781] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/29/2023] Open
Affiliation(s)
- Jorge Sánchez Melús
- Servicio de Urgencias Hospitalarias, Hospital Ernest Lluch Martín, Calatayud (Zaragoza), España.
| | - Paula Refusta Ainaga
- Atención Primaria, Centro de Salud Calatayud Norte, Calatayud (Zaragoza), España; Atención Primaria, Calatayud (Zaragoza), España
| | | |
Collapse
|
32
|
Gutiérrez-Manzanedo JV, González-Montesinos JL, Aguilera-Arjona J, Rodríguez-Martínez A, Vaz-Pardal C, España-Romero V, Rivas-Ruiz F, Blázquez-Sánchez N, De Gálvez-Aranda MV, De Troya-Martín M. Ultraviolet sun exposure and sun protection behaviors in outdoor rock climbers. Photochem Photobiol Sci 2023; 22:2817-2826. [PMID: 37847459 DOI: 10.1007/s43630-023-00488-0] [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: 06/03/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Overexposure to sunlight and sunburn are the main preventable causes of skin cancer. Outdoor sports are associated with significant levels of sunlight exposure. AIMS We sought to quantify the sun radiation exposure received by outdoor rock climbers and assess their sun exposure habits, sun protection behaviors, attitudes, and knowledge regarding skin cancer. METHODS From April to June 2021, outdoor rock climbers contacted via email completed an online validated self-reported questionnaire on sun related habits, behaviors, attitudes and knowledge. As a pilot trial, ten participants wore a personal dosimeter during two outdoor climbing weekends in May and November 2021. Ambient ultraviolet radiation (UVR) was also recorded. RESULTS A total of 217 outdoor rock climbers (103 women), mean age 36.8 ± 8.8 years (range 20-70 years) and median climbing practice per week of 8 h (IQR 7.5) were studied. Two in three (65.9%) participants reported at least one sunburn event during the previous rock climbing season. Of the survey respondents, 49.3% reported using sunscreen with SPF ≥ 15, 47% wore sunglasses, and 14.3% indicated they reapplied sunscreen every two hours. The median personal UVR dose measured during the two outdoor climbing weekends analyzed was 5.2 (IQR 1.8) and 8.8 (IQR 1.1) standard erythemal doses, respectively. CONCLUSIONS The high rates of sunburn, the elevated personal UVR measured and the clearly insufficient sun protection practices followed during rock climbing together with unsatisfactory attitudes towards tanning reveal the need to develop explicit sun protection campaigns and educational strategies to reduce the risk of skin cancer among the athletes studied.
Collapse
Affiliation(s)
- José V Gutiérrez-Manzanedo
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avda. República Saharaui s/n, Puerto Real, 11519, Cádiz, Spain.
| | - José Luis González-Montesinos
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avda. República Saharaui s/n, Puerto Real, 11519, Cádiz, Spain
| | - José Aguilera-Arjona
- Photobiological Dermatology Laboratory Medical Research Centre, Department of Dermatology and Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain
| | | | | | - Vanesa España-Romero
- MOVE-IT Research Group and Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
| | | | | | - María Victoria De Gálvez-Aranda
- Photobiological Dermatology Laboratory Medical Research Centre, Department of Dermatology and Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain
| | | |
Collapse
|
33
|
Passeron T, Lim HW, Goh CL, Kang HY, Ly F, Morita A, Ocampo-Candiani J, Puig S, Schalka S, Liu W, Demessant-Flavigny AL, Le Floc'h C, Kerob D, Dreno B, Krutmann J. Sun exposure behaviours as a compromise to paradoxical injunctions: Insight from a worldwide survey. J Eur Acad Dermatol Venereol 2023; 37:2481-2489. [PMID: 37590528 DOI: 10.1111/jdv.19421] [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: 01/31/2023] [Accepted: 07/12/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Behavioural interventions can improve attitudes towards sun protection but the impact remains inconsistent worldwide. OBJECTIVE To assess awareness of and attitudes towards the multiple facets of sun exposure and suggest ways to improve prevention from overexposure to the sun in all geographical zones and multiple skin types. METHODS Online survey was conducted from 28 September to 18 October 2021. Study population was selected from the Ipsos online Panel (3,540,000 panellists), aged ≥18 years, from 17 countries around the five continents. Demographics, sun-exposure habits and practices, understanding of risks and information on phototypes were documented and analysed using descriptive statistics. RESULTS Eighty-eight per cent of participants knew that sunlight can cause skin health problems (90% phototypes I-II, 82% phototypes V-VI, >90% in American and European countries, 72% in Asia and 85% in Africa). Eighty-five per cent used some form of protection against sunlight, predominantly: Seeking shade (77%), avoiding the midday sun (66%), facial application of sunscreen (60%) and wearing protective clothing (44%). The perception of sunlight itself is positive ('it gives energy' for 82%; 'tanned skin looks attractive' for 72%), although less in Asian countries and among individuals with dark skin phototypes. Eighty-three per cent reported having experienced sunburn, mainly in Australia, Canada, USA, Germany, France and Russia, and among individuals with dark skin phototypes. Only 12% systematically/often used all types of protection during exposure to the sun and 23% believed it is safe to go out in the sun with no protection when their skin is already tanned. From 13% (skin phototype I) to 26% (phototype VI) reported not using any form of protection against the sun. Knowledge and habits were significantly superior among people who are accustomed to seeing a dermatologist for a complete skin exam. CONCLUSIONS Dermatologists could play a crucial role in relaying novel prevention messages, more finely tailored to specific risks, populations and areas of the world.
Collapse
Affiliation(s)
- Thierry Passeron
- Department of Dermatology, Côte d'Azur University, Nice University Hospital Center, Nice, France
- INSERM U1065, C3M, Côte d'Azur University, Nice, France
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | | | - Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - Fatimata Ly
- Department of Dermatology, Cheikh Anta Diop Dakar University, EPS Institute of Social Hygiene, Dakar, Senegal
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Jorge Ocampo-Candiani
- Universidad Autonoma de Nuevo León, Facultad de Medicina, University Hospital "Dr. Jose E. González", Monterrey, Mexico
| | - Susana Puig
- Dermatology Department, Hospital Clinic de Barcelona, Barcelona University, Barcelona, Spain
| | - Sergio Schalka
- Medcin Skin Research Center and Biochemistry Department, Chemistry Institute of Sao Paulo University, Sao Paulo, Brazil
| | - Wei Liu
- Department of Dermatology, The General Hospital of Air Force PLA, Beijing, China
| | | | | | | | - Brigitte Dreno
- Nantes University, Univ Angers, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes, France
| | - Jean Krutmann
- IUF Leibniz Research Institute for Environmental Medicine, Duesseldorf, Germany
- Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| |
Collapse
|
34
|
Cheah S, English DR, Harrison SJ, Vajdic CM, Giles GG, Milne RL. Sunlight, vitamin D, vitamin D receptor polymorphisms, and risk of multiple myeloma: A systematic review. Cancer Epidemiol 2023; 87:102488. [PMID: 37976630 DOI: 10.1016/j.canep.2023.102488] [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: 08/02/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
This systematic review examines the relationship with multiple myeloma (MM) risk for sunlight and vitamin D related exposures, including vitamin D supplementation, circulating 25-hydroxyvitamin D concentration, personal ultraviolet B radiation exposure, ambient solar irradiance and vitamin D receptor (VDR) gene polymorphisms We conducted a search for terms related to multiple myeloma, vitamin D, vitamin D receptor, ultraviolet radiation, sunlight, and single nucleotide polymorphism (SNP) using Ovid MEDLINE, Ovid EMBASE, Web of Science and Cochrane CENTRAL. Studies were assessed for risk of bias and quality using the RoB 2.0, ROBINS-E or Q-Genie tools. We identified 13 eligible studies: one randomised controlled trial, two cohort studies, and ten case-control studies, including one nested case-control study and one meta-analysis of genome-wide association studies. We conducted a qualitative synthesis; quantitative synthesis was not appropriate due to study heterogeneity and the small number of studies identified. There was insufficient evidence to support an effect of any sunlight or vitamin D related exposure on MM risk. No polymorphisms in VDR were found to be strongly related to risk for people of European ancestry. Of the identified studies, many had high risk of bias or were of lower quality. Few studies have investigated the association between sunlight and vitamin D related exposures and multiple myeloma risk. The scarcity of high-quality studies makes it difficult to evaluate potential effects of these exposures on MM risk. Further research is necessary to investigate the influence of vitamin D related exposures on risk of multiple myeloma..
Collapse
Affiliation(s)
- Simon Cheah
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, Victoria 3010, Australia; Cancer Epidemiology Division, Cancer Council Victoria, 200 Victoria Parade, East Melbourne, Victoria 3002, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, Victoria 3010, Australia; Cancer Epidemiology Division, Cancer Council Victoria, 200 Victoria Parade, East Melbourne, Victoria 3002, Australia
| | - Simon J Harrison
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, 305 Grattan Street, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum Dept of Oncology, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Claire M Vajdic
- Kirby Institute, University of New South Wales, Sydney NSW 2052, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, Victoria 3010, Australia; Cancer Epidemiology Division, Cancer Council Victoria, 200 Victoria Parade, East Melbourne, Victoria 3002, Australia; Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria 3168, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, Victoria 3010, Australia; Cancer Epidemiology Division, Cancer Council Victoria, 200 Victoria Parade, East Melbourne, Victoria 3002, Australia; Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria 3168, Australia
| |
Collapse
|
35
|
Loesch AJ, Kleinerman R, Lau G. Multiple Halo Nevi Induced by Intense Sun Exposure. J Drugs Dermatol 2023; 22:e31-e32. [PMID: 38051850 DOI: 10.36849/jdd.6792] [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: 12/07/2023]
Abstract
We present the case of a 38-year-old male who reported to our practice with multiple newly developed halos around 26 existing nevi on his trunk. The halo nevi developed after the patient, who lived in the northeast, spent 2 months on a lake in Alabama, with intense heat and sun exposure. This case is remarkable in that it points to ultraviolet exposure as one instigating factor in the development of halo nevi, the development of which is incompletely understood. J Drugs Dermatol. 2023;22(12):e31-e32. doi:10.36849/JDD.6792e.
Collapse
|
36
|
Knipping S, Ter Haar E, Alkemade H, Bronkhorst E, Falk M, Hueskes K, Nij Bijvank C, Spillekom-van Koulil S, Lubeek S. Translation and Validation of the Dutch Version of the Sun Exposure and Protection Index. Dermatology 2023; 240:282-290. [PMID: 38011834 PMCID: PMC10997267 DOI: 10.1159/000535510] [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: 05/12/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Skin cancer is currently the most common cancer type worldwide, and numbers are rapidly increasing. To improve primary prevention, individualised prevention strategies may be of interest as this enhances the chance of long-term behavioural change. The Sun Exposure and Protection Index (SEPI), previously validated in multiple languages, is a tool that could help identify individuals with risky behaviour and tailor interventions to the person's propensity to change. The aim of the present study was to investigate the reliability and validity of a Dutch version of the SEPI for both usage in daily clinical practice and research. METHODS Patients were included at primary care settings and dermatology outpatient settings in a 1:1 ratio. Participants were asked to fill out the SEPI together with some baseline characteristics and the previously validated FACE-Q Skin Cancer - Sun Protection module. Construct validity was tested by comparing SEPI part I and the FACE-Q module using Spearman's Rho. Internal consistency was assessed with Cronbach's Alpha for both SEPI parts separately. To assess test-retest reliability, the SEPI was again filled out 3 weeks later, and scores were compared with Cohen's weighted Kappa. RESULTS Of the 171 participants completing the first questionnaire, 147 (86.0%) participants also completed the follow-up questionnaire. Comparison between the corresponding SEPI part I and FACE-Q module questions showed good correlations regarding sun exposure habits (correlation coefficients ranging from 0.61 to 0.85). Internal consistency of SEPI part I was 0.63 and SEPI part II was 0.65. The test-retest analysis indicated reproducibility over time (weighted Kappa ranging from 0.38 to 0.76). CONCLUSION In conclusion, the Dutch version of the SEPI is shown to be a valid and reliable tool for both usages in daily clinical practice and research to evaluate individual ultraviolet exposure and measure a person's propensity to limit it.
Collapse
Affiliation(s)
- Sofie Knipping
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands,
| | - Elke Ter Haar
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Alkemade
- Department of Dermatology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Ewald Bronkhorst
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Magnus Falk
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Kevin Hueskes
- General Practitioner's Office, Health Center Hazenkamp, Nijmegen, The Netherlands
| | - Carla Nij Bijvank
- General Practitioner's Office, Health Center De Vuursteen, Molenhoek, The Netherlands
| | | | - Satish Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
37
|
Mathias SD, Burke L, Colwell HH, Mensing G, Savage W, Naik H. Development and content validation of a sunlight exposure diary in patients with erythropoietic protoporphyria. J Patient Rep Outcomes 2023; 7:119. [PMID: 37982964 PMCID: PMC10660587 DOI: 10.1186/s41687-023-00655-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Erythropoietic protoporphyria is a rare, inherited disorder presenting in early childhood with severe, painful phototoxicity. EPP has significant impacts on health-related quality of life, though there is variable disease severity. Accurately capturing how much time individuals with EPP can spend outdoors before they develop symptoms is critical to understanding HRQoL and measuring therapeutic response. Therefore, the goal of this study was to develop a comprehensive and content valid sun exposure diary to assess the efficacy of new therapies in individuals with EPP. METHODS Qualitative interviews were conducted with adult and adolescent EPP participants, as well as five clinical experts, to obtain their input on the content of an existing sun exposure diary. Revisions to the diary were made based on evidence generated in cognitive debriefing interviews analyzed in eight consecutive groups of EPP participant. RESULTS Interviews were conducted with 17 adults and 6 adolescents with EPP. The average age of adults was 40 years and of adolescents was 14 years. Clinical experts thought the original diary needed clarification on the description of symptoms, how time outdoors was captured, and the distinction between direct vs. indirect sunlight. Participants with EPP also noted these items needed revision, and that the distinction between prodromal symptoms and full reaction symptoms should be clarified. In the final diary version, participants with EPP found most items to be clear and easy to complete/think about. Seventy-six percent of participants (13/17) asked thought the diary was easy to complete. The remainder thought the majority of the diary was easy to complete with the exception of select questions. CONCLUSIONS Evaluating a new treatment for EPP requires accurately capturing time in sunlight and symptoms in this unique disorder. The newly developed sun exposure diary is content valid and can be used to assess important aspects of symptoms and daily life and therefore evaluate clinically meaningful therapeutic response.
Collapse
Affiliation(s)
| | | | | | | | | | - Hetanshi Naik
- Department of Genetics, Stanford University School of Medicine, Palo Alto, CA, USA.
| |
Collapse
|
38
|
Li M, Mathura P, Hagtvedt R, Dytoc M. Sun Safety in Elementary School: Trialing Strategies for Keeping Children Protected. J Cutan Med Surg 2023; 27:657-658. [PMID: 37947200 DOI: 10.1177/12034754231211329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Miriam Li
- University of Alberta, Edmonton, Canada
| | - Pamela Mathura
- Department of Medicine, Quality Council, University of Alberta, Edmonton, Canada
| | - Reidar Hagtvedt
- University of Alberta Alberta School of Business, Edmonton, Canada
| | - Marlene Dytoc
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| |
Collapse
|
39
|
Lee SSY, Lingham G, Wang CA, Diaz Torres S, Pennell CE, Hysi PG, Hammond CJ, Gharahkhani P, Clark R, Guggenheim JA, Mackey DA. Changes in Refractive Error During Young Adulthood: The Effects of Longitudinal Screen Time, Ocular Sun Exposure, and Genetic Predisposition. Invest Ophthalmol Vis Sci 2023; 64:28. [PMID: 37982764 PMCID: PMC10668617 DOI: 10.1167/iovs.64.14.28] [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: 06/02/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023] Open
Abstract
Purpose Changes in refractive error during young adulthood is common yet risk factors at this age are largely unexplored. This study explored risk factors for these changes, including gene-environmental interactions. Methods Spherical equivalent refraction (SER) and axial length (AL) for 624 community-based adults were measured at 20 (baseline) and 28 years old. Participants were genotyped and their polygenic scores (PGS) for refractive error calculated. Self-reported screen time (computer, television, and mobile devices) from 20 to 28 years old were collected prospectively and longitudinal trajectories were generated. Past sun exposure was quantified using conjunctival ultraviolet autofluorescence (CUVAF) area. Results Median change in SER and AL were -0.023 diopters (D)/year (interquartile range [IQR] = -0.062 to -0.008) and +0.01 mm/year (IQR = 0.000 to 0.026), respectively. Sex, baseline myopia, parental myopia, screen time, CUVAF, and PGS were significantly associated with myopic shift. Collectively, these factors accounted for approximately 20% of the variance in refractive error change, with screen time, CUVAF, and PGS each explaining approximately 1% of the variance. Four trajectories for total screen time were found: "consistently low" (n = 148), "consistently high" (n = 250), "consistently very high" (n = 76), and "increasing" (n = 150). Myopic shift was faster in those with "consistently high" or "consistently very high" screen time compared to "consistently-low" (P ≤ 0.031). For each z-score increase in PGS, changes in SER and AL increased by -0.005 D/year and 0.002 mm/year (P ≤ 0.045). Of the three types of screen time, only computer time was associated with myopic shift (P ≤ 0.040). There was no two- or three-way interaction effect between PGS, CUVAF, or screen time (P ≥ 0.26). Conclusions Higher total or computer screen time, less sun exposure, and genetic predisposition are each independently associated with greater myopic shifts during young adulthood. Given that these factors explained only a small amount of the variance, there are likely other factors driving refractive error change during young adulthood.
Collapse
Affiliation(s)
- Samantha Sze-Yee Lee
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), the University of Western Australia, Perth, Western Australia, Australia
- https://orcid.org/0000-0001-6635-1098
| | - Gareth Lingham
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), the University of Western Australia, Perth, Western Australia, Australia
- Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
- https://orcid.org/0000-0002-8957-0733
| | - Carol A Wang
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- https://orcid.org/0000-0002-4301-3974
| | - Santiago Diaz Torres
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- https://orcid.org/0000-0002-5442-9211
| | - Craig E Pennell
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- John Hunter Hospital, Department of Obstetrics and Gynaecology, Newcastle, New South Wales, Australia
- https://orcid.org/0000-0002-0937-6165
| | - Pirro G Hysi
- King's College London, Section of Ophthalmology, School of Life Course Sciences, London, United Kingdom
- King's College London, Department of Twin Research and Genetic Epidemiology, London, United Kingdom
- https://orcid.org/0000-0001-5752-2510
| | - Christopher J Hammond
- King's College London, Section of Ophthalmology, School of Life Course Sciences, London, United Kingdom
- King's College London, Department of Twin Research and Genetic Epidemiology, London, United Kingdom
- https://orcid.org/0000-0002-3227-2620
| | - Puya Gharahkhani
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- https://orcid.org/0000-0002-4203-5952
| | - Rosie Clark
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, United Kingdom
- https://orcid.org/0000-0003-1247-4636
| | - Jeremy A Guggenheim
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, United Kingdom
- https://orcid.org/0000-0001-5164-340X
| | - David A Mackey
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), the University of Western Australia, Perth, Western Australia, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia
- School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
- https://orcid.org/0000-0001-7914-4709
| |
Collapse
|
40
|
Krejci M, Caruso G. Assessment of the Blue Light Ocular Hazard by Solar Measurements and the Impact of Selected Sunglasses Based upon the Limits of the International Commission on Non-Ionizing Radiation Protection Guideline. Health Phys 2023; 125:338-351. [PMID: 37584567 DOI: 10.1097/hp.0000000000001723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
ABSTRACT A quantitative assessment of the blue light hazard for the human eye related to direct solar irradiation is presented. For six radiation situations, missing eye protection was compared to protection by nine different commercial sunglasses with and without an optimized blue light filter. Measurements of the solar irradiance were performed on Earth's surface as well as at an elevation of 12 km in the cockpit of an airliner. An irradiation time limit was calculated from the measurement data, within which the maximum blue light dose of 100 J m -2 , recommended by the International Commission on Non-Ionizing Radiation Protection and mandatory for the safe operation of lamps according to the norm ICE 62471, is reached. The results suggest that the blue light dose limit is violated within less than 3 s when looking without eye protection directly into the sun. For Category 3 sunglasses without the optimized blue light filter, time limits of 10 to 25 s on Earth's surface and 7 to 8 s at 12 km altitude were observed. The investigated Category 3 sunglasses with optimized blue light protection and suited for traffic use allow a time limit of more than 40 s on Earth's surface and 18 to 95 s in the airliner's cockpit. The outcome of the study is that the eye protection against blue light hazard related to solar radiation can be quantified using existing limits and that the choice of sunglasses is relevant: Traffic-worthy sunglasses optimized for protection against blue light hazard offer a better protection than non-optimized sunglasses.
Collapse
Affiliation(s)
- Martin Krejci
- University of Applied Sciences and Arts of Switzerland
| | | |
Collapse
|
41
|
Grenier A, Morissette MC, Rochette PJ, Pouliot R. The combination of cigarette smoke and solar rays causes effects similar to skin aging in a bilayer skin model. Sci Rep 2023; 13:17969. [PMID: 37863977 PMCID: PMC10589246 DOI: 10.1038/s41598-023-44868-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023] Open
Abstract
Skin aging is a multifactorial process influenced by internal and external factors. The contribution of different environmental factors has been well established individually in the last few years. On the one hand, man is rarely exposed to a single factor, and on the other hand, there is very little knowledge about how these extrinsic factors may interact with each other or even how the skin may react to chronic exposure. This study aimed to evaluate the effect on skin aging of a chronic co-exposure of tissue-engineered skin substitutes to cigarette smoke extract (CSE) and solar simulator light (SSL). Skin substitutes were reconstructed according to the self-assembly method and then exposed to CSE followed by irradiation with SSL simultaneously transmitting UVA1, visible light and infrared. When skin substitutes were chronically exposed to CSE and SSL, a significant decrease in procollagen I synthesis and the inhibition of Smad2 phosphorylation of the TGF-β signaling pathway were observed. A 6.7-fold increase in MMP-1 activity was also observed when CSE was combined with SSL, resulting in a decrease in collagen III and collagen IV protein expression. The secretory profile resulting from the toxic synergy was investigated and several alterations were observed, notably an increase in the quantities of pro-inflammatory cytokines. The results also revealed the activation of the ERK1/2 (3.4-fold) and JNK (3.3-fold) pathways. Taken together, the results showed that a synergy between the two environmental factors could provoke premature skin aging.
Collapse
Affiliation(s)
- Alexe Grenier
- Centre de Recherche en Organogénèse Expérimentale de l'Université Laval/LOEX, Axe Médecine Régénératrice, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, QC, G1J 1Z4, Canada
- Faculté de Pharmacie, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Mathieu C Morissette
- Québec Heart and Lung Institute-Université Laval, Quebec City, QC, G1V 4G5, Canada
- Département de Médecine, Faculté de Médecine, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Patrick J Rochette
- Centre de Recherche en Organogénèse Expérimentale de l'Université Laval/LOEX, Axe Médecine Régénératrice, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, QC, G1J 1Z4, Canada
- Département d'Ophtalmologie et ORL-Chirurgie Cervico-Faciale, Faculté de Médecine, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Roxane Pouliot
- Centre de Recherche en Organogénèse Expérimentale de l'Université Laval/LOEX, Axe Médecine Régénératrice, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, QC, G1J 1Z4, Canada.
- Faculté de Pharmacie, Université Laval, Quebec City, QC, G1V 0A6, Canada.
| |
Collapse
|
42
|
Young AR. The adverse consequences of not using sunscreens. Int J Cosmet Sci 2023; 45 Suppl 1:11-19. [PMID: 37799076 DOI: 10.1111/ics.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/10/2023] [Indexed: 10/07/2023]
Abstract
The adverse effects of solar ultraviolet radiation (UVR) on normal skin are well established, especially in those with poorly melanized skin. Clinically, these effects may be classified as acute, such as erythema or chronic such as keratinocyte and melanocyte skin cancers. Apart from skin type genetics, clinical responses to solar UVR are dependent on geophysical (e.g., solar intensity) and behavioural factors. The latter are especially important because they may result in 'solar overload' with unwanted clinical consequences and ever greater burdens to healthcare systems. Correctly used, sunscreens can mitigate the acute and chronic effects of solar UVR exposure. Laboratory studies also show that sunscreens can inhibit the initial molecular and cellular events that are responsible for clinical outcomes. Despite public health campaigns, global trends continue to show increasing incidence of all types of skin cancer. Large-scale epidemiological studies have shown the benefits of sunscreen use in preventing skin cancer, though it is likely that sunscreen use has not been optimal in such studies. It is evident that without substantial changes in sun-seeking behaviour, sunscreen use is a very important part of the defence against the acute and chronic effects of solar exposure. Ideally, sunscreens should be able to provide the level of protection that reduces the risk of skin cancer in susceptible skin types to that observed in heavily melanized skin.
Collapse
Affiliation(s)
- Antony R Young
- St John's Institute of Dermatology, King's College London, London, UK
| |
Collapse
|
43
|
Rukhsar S, Masood S, Ghulam U, Hannan E. Prevalence Of Sunscreen Usage And Perception About Sun Exposure And Sunscreen: A Lower-Middle-Income Country's Perspective. J PAK MED ASSOC 2023; 73:2069-2072. [PMID: 37876073 DOI: 10.47391/jpma.7752] [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] [Indexed: 10/26/2023]
Abstract
Sunlight is required for vitamin D synthesis but is also responsible for various adverse effects on human skin, including photo aging, sunburn, and skin cancer. To avoid this, regular use of sunscreens is recommended. The aim of the study was to evaluate the knowledge of a subset of our local population about exposure to sun and assess the attitude about the importance of sunscreen usage. This prospective cross-sectional study was conducted at the dermatology outpatient clinic using a predesigned questionnaire filled by the participants. A total of 200 patients were selected, out of which 135 were females and 65 were males. Forty-nine percent of the participants claimed to use sunblock; however, the majority (54%) used it only occasionally. Fifty-one percent of the participants were not aware that exposure to sun can cause darkening of the skin but more than 100(50%) were aware that this exposure has multiple side effects on the skin. It was also observed that participants had good knowledge about the side effects of sunblock. The study results concluded that participants have good perception of the effectiveness and side effects of sunscreen, most of them used it occasionally. It necessitates the need for a health education programme.
Collapse
Affiliation(s)
- Shayana Rukhsar
- Department of Dermatology, Aga Khan University Hospital, Karachi, Pakistan
| | - Sadia Masood
- Department of Dermatology, Aga Khan University Hospital, Karachi, Pakistan
| | - Unzela Ghulam
- Department of Dermatology, Aga Khan University Hospital, Karachi, Pakistan
| | - Eisha Hannan
- 3rd Year MBBS Student, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
44
|
Navarro-Bielsa A, Gracia-Cazaña T, Almagro M, Fuente-Meira SDL, Florez Á, Yélamos O, Montero-Vilchez T, González-Cruz C, Diago A, Abadías-Granado I, Fuentelsaz V, Colmenero M, Bañuls J, Arias-Santiago S, Buendía-Eisman A, Almenara-Blasco M, Gil-Pallares P, Gilaberte Y. A multicenter case-control study comparing sun exposure habits and use of photoprotection measures in patients diagnosed with different types of skin cancer. Photodermatol Photoimmunol Photomed 2023; 39:457-465. [PMID: 37130164 DOI: 10.1111/phpp.12878] [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: 02/10/2023] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND While skin cancer awareness programs have significantly furthered public understanding about the harmful effects of the sun, there is a disparity between photoprotection knowledge and protection practices. OBJECTIVE To compare sun exposure habits and photoprotection measures in patients diagnosed with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma versus controls. METHODS Multicentre case-control observational study carried out by 13 Spanish dermatologists between April 2020 and August 2022. Patients diagnosed with BCC, SCC, or melanoma were considered cases. The control group consisted of individuals with no history of skin cancer. RESULTS Of the 254 cases (56.2% female; mean age, 62.67 ± 15.65), 119 (31.2%) had BCC, 62 (16.27%) SCC, and 73 (19.1%) melanoma. The control group consisted of 127 (33.33%) individuals. Avoiding sun exposure between 12:00 and 16:00 was the most commonly used photoprotection measure (habitually/always: 63.1%), followed by the use of sunscreen (habitually/always: 58.9%). Patients with melanoma were less likely to use clothing and shade to avoid sun exposure (p < .05), whereas those with BCC and SCC reported greater use of head coverings (p = .01). BCC and SCC groups reported greater sun exposure 15 years prior, whereas controls reported greater use of sunscreen. However, at the time of this study all groups reported using SPF ≥ 21, and the majority SPF > 50. No differences were observed in photoprotection measures between people with and without a previous history of skin cancer. CONCLUSIONS We describe differences in photoprotection measures and sun exposure patterns among patients diagnosed with different skin tumor types. Whether these differences may influence the type of tumor each developed will require further investigation.
Collapse
Affiliation(s)
- Alba Navarro-Bielsa
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Tamara Gracia-Cazaña
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Manuel Almagro
- Department of Dermatology, Complejo Hospitalario Universitario, A Coruña, Spain
| | | | - Ángeles Florez
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain
| | - Oriol Yélamos
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Carlos González-Cruz
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Adrián Diago
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | | | | | - María Colmenero
- Department of Dermatology, Hospital Costa del Sol, Marbella, Spain
| | - José Bañuls
- Departmment of Dermatology, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | | | | | - Manuel Almenara-Blasco
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Pedro Gil-Pallares
- Department of Dermatology, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Yolanda Gilaberte
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| |
Collapse
|
45
|
Arai N, Matsunami N, Yamamoto N, Li J. A case of a full-term newborn with severe craniotabes due to insufficient maternal sunlight exposure during the COVID-19 pandemic. Pediatr Neonatol 2023; 64:625-626. [PMID: 37221121 PMCID: PMC10175073 DOI: 10.1016/j.pedneo.2023.04.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Affiliation(s)
- Natsumu Arai
- Department of Neonatology, Izumiotsu Municipal Hospital, Izumiotsu, Japan; Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Naoyuki Matsunami
- Department of Neonatology, Izumiotsu Municipal Hospital, Izumiotsu, Japan
| | - Nagisa Yamamoto
- Department of Neonatology, Izumiotsu Municipal Hospital, Izumiotsu, Japan
| | - Jingang Li
- Department of Neonatology, Izumiotsu Municipal Hospital, Izumiotsu, Japan; Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
| |
Collapse
|
46
|
O'Sullivan DE, Hillier TWR, Brenner DR, Peters CE, King WD. Time spent in the sun and the risk of developing non-Hodgkin lymphoma: a Canadian cohort study. Cancer Causes Control 2023; 34:791-799. [PMID: 37264255 DOI: 10.1007/s10552-023-01719-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE The objective was to explore the relationship of sun behavior patterns with the risk of developing non-Hodgkin lymphoma (NHL). METHODS Sun behavior information from Alberta's Tomorrow Project, CARTaGENE, and Ontario Health Study were utilized. The relationship between time in the sun during summer months and risk of NHL was assessed using Cox proportional hazard models with age as the time scale and adjustment for confounders. Cohorts were analyzed separately and hazard ratios (HR) pooled with random effects meta-analysis. Joint effects of time in the sun and use of sun protection were examined. Patterns of exposure were explored via combinations of weekday and weekend time in the sun. RESULTS During an average follow-up of 7.6 years, 205 NHL cases occurred among study participants (n = 79,803). Compared to < 30 min daily in the sun, we observed HRs of 0.84 (95% CI 0.55-1.28) for 30-59 min, 0.63 (95% CI 0.40-0.98) for 1-2 h, and 0.91 (95% CI 0.61-1.36) for > 2 h. There was suggestive evidence that > 2 h was protective against NHL with use of sun protection, but not without it. Compared to < 30 min daily, moderate exposure (30 min to 2 h on weekdays or weekend) was associated with a lower risk of NHL (HR 0.63, 95% CI 0.43-0.92), while intermittent (< 30 min on weekdays and > 2 h on weekends) and chronic (> 2 h daily) were not. CONCLUSION This study provides evidence of a protective effect of moderate time spent in the sun on NHL risk.
Collapse
Affiliation(s)
- Dylan E O'Sullivan
- Department of Oncology, University of Calgary, Calgary, AB, Canada.
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada.
- Holy Cross Centre, Box ACB, 2210 2nd St SW, Calgary, AB, T2S 3C3, Canada.
| | | | - Darren R Brenner
- Department of Oncology, University of Calgary, Calgary, AB, Canada
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada
| | - Cheryl E Peters
- BC Centre for Disease Control & BC Cancer, Vancouver, BC, Canada
| | - Will D King
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| |
Collapse
|
47
|
Modenese A, Chou BR, Ádám B, Loney T, Silva Paulo M, Tenkate T, Gobba F. Occupational Exposure to Solar Radiation and the Eye: A Call to Implement Health Surveillance of Outdoor Workers. Med Lav 2023; 114:e2023032. [PMID: 37534422 PMCID: PMC10415847 DOI: 10.23749/mdl.v114i4.14657] [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] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/15/2023] [Indexed: 08/04/2023]
Abstract
Globally, hundreds of millions of outdoor workers are exposed to solar radiation (SR) for the majority of their working life. Such occupational exposure is known to induce various adverse health effects to the eyes, mainly related to its ultraviolet (UV) component. The present work is a call-to-action aimed at raising the awareness on the need of health surveillance for the prevention of the chronic ocular diseases in outdoor workers. Photo-chemical chronic damage can induce pterygium at the outer layer of the eye and cataract in the lens. Considering carcinogenic effects, rare squamous-cells tumors of the cornea and/or of the conjunctiva and the ocular melanomas are associated with UV radiation exposure. Solar UV-related eye diseases should be considered as "occupational diseases" when there is sufficient exposure in workers, but they are often not recognized, and/or frequently not reported to the national compensation authorities. Therefore, to prevent the burden of these work-related eye pathologies, an adequate risk assessment with identification of appropriate preventive measures, and a provision of periodic health surveillance to the exposed workers, in particular considering those at higher risk of exposure or with individual susceptibility, should be urgently implemented.
Collapse
Affiliation(s)
- Alberto Modenese
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena (Italy).
| | - B Ralph Chou
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada.
| | - Balázs Ádám
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
| | - Tom Loney
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, PO Box 505055, United Arab Emirates.
| | - Marilia Silva Paulo
- CHRC, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisboa (Portugal).
| | - Thomas Tenkate
- School of Occupational and Public Health, Toronto Metropolitan University, Ontario, Canada.
| | - Fabriziomaria Gobba
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena (Italy).
| |
Collapse
|
48
|
Barón DR, Sánchez NB, Ruiz FR, Martínez AR, Arjona JA, de Castro Maqueda G, Araujo IG, de Gálvez Aranda MV, Martínez AR, de Troya Martín M. Occupational Sun Exposure Among Physical Education Teachers in Primary and Secondary Schools in Andalusia, Spain. J Cancer Educ 2023; 38:1157-1162. [PMID: 36701024 DOI: 10.1007/s13187-022-02242-z] [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] [Accepted: 11/20/2022] [Indexed: 06/17/2023]
Abstract
Chronic sun exposure and sunburns are the main preventable causes of skin cancer. Due to the nature of their work, physical education teachers are at high risk for occupational skin cancer. This descriptive, cross-sectional study analyzes primary and secondary physical education teachers in Andalusia, Spain. All participants were invited to monitor their ultraviolet (UV) radiation exposure using individual biologic dosimeters and record their photoprotection practices over 3 workdays. The teachers spent an average of 2.7 h outdoors and the mean personal UV radiation exposure was 309.9 J/m2 per day, a value three times higher than international recommendations. Based on the photoprotection diary, it was determined that classes held outdoors were not scheduled outside the hours with the highest UV index and that the percentage of participants who followed the photoprotective practices of remaining in the shade or wearing a hat during outdoor lessons were less than 20% and 60%, respectively. The results on sun exposure and photoprotection practices show a need for organizational and educational intervention strategies to mitigate sun exposure and increase compliance with photoprotection measures to reduce skin cancer risk among these workers and promote early diagnosis of the disease.
Collapse
Affiliation(s)
| | - Nuria Blázquez Sánchez
- Department of Dermatology, Costa del Sol Hospital, Marbella, Spain.
- PAIDI Group: CTS-1081: Photoprotection and Prevention of Skin Cancer (PHOTOPROTECTION), Marbella, Spain.
| | | | | | - José Aguilera Arjona
- Photobiological Dermatology Laboratory, Medical Research Center, Department of Medicine and Dermatology, University of Málaga, Málaga, Spain
| | | | | | | | | | - Magdalena de Troya Martín
- Department of Dermatology, Costa del Sol Hospital, Marbella, Spain
- PAIDI Group: CTS-1081: Photoprotection and Prevention of Skin Cancer (PHOTOPROTECTION), Marbella, Spain
| |
Collapse
|
49
|
Lewandowska A, Lewandowski T, Rudzki G, Próchnicki M, Laskowska B, Pavlov S, Vlasenko O, Rudzki S, Wójcik W. The Risk of Melanoma due to Exposure to Sun and Solarium Use in Poland: A Large-Scale, Hospital Based Case - Control Study. Asian Pac J Cancer Prev 2023; 24:2259-2269. [PMID: 37505755 PMCID: PMC10676492 DOI: 10.31557/apjcp.2023.24.7.2259] [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: 11/08/2022] [Accepted: 07/02/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE The incidence of skin cancer is constantly growing, it is considered a serious problem of public health. Most cases of skin cancer are caused by a combination of non-modifiable genetic, and modifiable environmental risk factors. The study objective was to analyse the correlation between pigmentation traits, excessive sunlight exposure, solarium use and the risk of melanoma development. METHODS The study included 480 patients diagnosed with melanoma and 400 within the control group. Subjects diagnosed with the melanoma confirmed by histopathology were invited to take part in the study. The research was based on a clinical, direct, individual, structured, in-depth and focused interview. RESULTS The mean age of the study subjects was 44.3 ± 7.86, while in the control group 59.5 (7.93) Most frequently, melanoma was located on the upper extremities (64%). A family history of neoplastic diseases was found in 55% of the patients. The assessment of sunburns showed that only 15% of the respondents never experienced sunburn, 49% of the study subjects never used solarium. Among patients with multiple sunburns, the risk of developing skin cancer was 1.27 (AOR = 1,27; 95% CI, 1.07-1.55) compared with non-sunburns subjects. CONCLUSIONS Risky behaviours including excessive exposure to UV radiation, both natural and artificial, are of special significance in women with fair complexion and fair hair. Indoor tanning is a probable factor of increased skin cancer incidence in younger women, as compared to men.
Collapse
Affiliation(s)
- Anna Lewandowska
- Institute of Healthcare, State School of Technology and Economics in Jaroslaw, 37-500 Jaroslaw, Poland.
| | - Tomasz Lewandowski
- Institute of Technical Engineering, State School of Technology and Economics in Jaroslaw, 37-500 Jaroslaw, Poland.
| | - Grzegorz Rudzki
- Chair and Department of Endocrinology, Medical University of Lublin, 20-090, Poland.
| | - Michał Próchnicki
- Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, 20-439, Poland.
| | - Barbara Laskowska
- Institute of Healthcare, State School of Technology and Economics in Jaroslaw, 37-500 Jaroslaw, Poland.
| | - Sergii Pavlov
- Vinnytsia National Technical University, Biomedical Engineering Department, Scientific Laboratory of Biomedical Optics, Ukraina.
| | - Oleg Vlasenko
- Vinnytsia National Medical University, Normal Physiology Department, Ukraina.
| | - Sławomir Rudzki
- Chair and Department of General and Transplant Surgery and Nutritional, Medical University of Lublin, 20-090, Poland.
| | - Waldemar Wójcik
- Faculty of Electrical Engineering and Computer Science, Lublin University of Technology, 20-618, Lublin, Poland.
| |
Collapse
|
50
|
Puthran SV, Biswas S, Karthikeyan SK, Thomas J. Association of sunlight exposure with visual impairment in an Indian fishing community. Indian J Ophthalmol 2023; 71:2409-2415. [PMID: 37322650 PMCID: PMC10417968 DOI: 10.4103/ijo.ijo_2088_22] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/23/2023] [Accepted: 02/08/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Indian fishermen belong to a marginalized population and are continuously exposed to extreme occupational hazards and sunlight. A high prevalence of visual impairment (VI) is reported in the coastal fishing community. We aimed to investigate the association between VI and sunlight exposure measurement (SEM). Methods In this cross-sectional observational study, 270 eyes of 135 participants were enrolled from a coastal fishing village. Participants underwent a comprehensive ophthalmic examination, which included best-corrected visual acuity (BCVA), and anterior and posterior segment examination. Ocular Surface Disease Index (OSDI) and SEM questionnaire were administered to estimate the level of dry eye and ultraviolet-B (UV-B) exposure, respectively. VI was defined as presenting visual acuity worse than 6/12 (logarithm of the minimum angle of resolution [logMAR] > 0.3). Results The mean age and spherical equivalent were 50.56 ± 11.72 years (range: 18-80 years) and 0.36 ± 1.68 diopters (D) (range: -7.0 to +3.0 D), respectively. Age, SEM, OSDI, fishing as an occupation, and cataract were significantly associated with higher odds of VI in univariate analysis. Refraction, gender, education level, smoking status, amblyopia, systematic, and other ocular diseases were not significantly associated with VI. In the multivariate analysis, age, SEM, and presence of cataract remained significantly associated with a higher risk for VI. The area under the receiver operating characteristic curve values for age and SEM scores demonstrate a fair index of discrimination for the detection of VI. Conclusion SEM level is directly associated with a higher risk of VI among fishermen. The fishing community might benefit from regular eye examinations and awareness about the harmful effects of sunlight exposure and preventive measures.
Collapse
Affiliation(s)
- Shwetha V Puthran
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sayantan Biswas
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Siddharth K Karthikeyan
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jyothi Thomas
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|