Visible light and human skin pigmentation: The importance of skin phototype.

Melanin is synthesised within melanocytes and transferred to keratinocytes in human skin, thereby regulating skin colour and protecting skin cells against UVR-induced damage. We commonly divide human skin into six phototypes (SPT)-I to -VI (Fitzpatrick scale) according to the skin's tanning response to UVR. In this pilot study, we investigated the impact of UVR (maximum 311nm), blue (peak 450nm) and green visible light (peak 530nm) on melanin production and type in healthy human skin histocultures (SPT-I, -II and -III). UVR, blue and green light stimulated a surface tanning response in SPT-II and -III, but not SPT-I. Using the Warthin-Starry stain for sensitive melanin detection, all three light treatments induced melanogenesis in SPT-II and -III skin. Surprisingly, blue and green light (but not UVR) stimulated melanin synthesis in SPT-I skin. Moreover, melanin synthesis induced by blue and green visible light in SPT-I, SPT-II, and SPT-III skin was not associated with a detectable increase in DNA damage or cell apoptosis. By contrast, both responses were detected after UVR. These data suggest that blue and green visible light can stimulate melanin production in fair-skinned individuals without, at least some of, the harmful consequences of UVR-induced pigmentation. We are currently examining the molecular basis of UVR-independent melanogenesis in fair skin.

Photoreactivity of Hair Melanin from Different Skin Phototypes-Contribution of Melanin Subunits to the Pigments Photoreactive Properties.

Photoreactivity of melanin has become a major focus of research due to the postulated involvement of the pigment in UVA-induced melanoma. However, most of the hitherto studies were carried out using synthetic melanin models. Thus, photoreactivity of natural melanins is yet to be systematically analyzed. Here, we examined the photoreactive properties of natural melanins isolated from hair samples obtained from donors of different skin phototypes (I, II, III, and V). X-band and W-band electron paramagnetic resonance (EPR) spectroscopy was used to examine the paramagnetic properties of the pigments. Alkaline hydrogen peroxide degradation and hydroiodic acid hydrolysis were used to determine the chemical composition of the melanins. EPR oximetry and spin trapping were used to examine the oxygen photoconsumption and photo-induced formation of superoxide anion, and time-resolved near infrared phosphorescence was employed to determine the singlet oxygen photogeneration by the melanins. The efficiency of superoxide and singlet oxygen photogeneration was related to the chemical composition of the studied melanins. Melanins from blond and chestnut hair (phototypes II and III) exhibited highest photoreactivity of all examined pigments. Moreover, melanins of these phototypes showed highest quantum efficiency of singlet oxygen photogeneration at 332 nm and 365 nm supporting the postulate of the pigment contribution in UVA-induced melanoma.

Effectiveness of water as the neutralising agent for glycolic acid peels in skin phototypes IV-V.

The aim of the study is to evaluate the effectiveness of water as a substitute for sodium bicarbonate plus solution in the neutralisation process of chemical peeling using a 35% glycolic acid solution. This randomised, double-blind, split-face, controlled trial was conducted in an outpatient setting. A total of 126 healthy patients with skin phototypes IV-V aged between 18 and 60 years old were recruited. Chemical peeling was performed with 35% glycolic acid solution. One side of the face was neutralised with water, and the other side of the face was neutralised with a sodium bicarbonate plus solution. The main outcome of this study was measured by the degree of erythema, pruritus and pain scores. Significant difference in the pain score immediately after the neutralisation process of the chemical peeling with glycolic acid was seen. However, there were no significant differences in the degree of erythema or the pruritus score. These results indicate that water can be used as a substitute for sodium bicarbonate plus solution in the neutralisation process of chemical peeling with 35% glycolic acid in patients with skin phototypes IV-V.

Skin Phototype Could Be a Risk Factor for Multiple Sclerosis.

Environmental and genetic factors are assumed to be necessary for the development of multiple sclerosis (MS), however its interactions are still unclear. For this reason here, we have not only analyzed the impact on increased risk of MS of the best known factors (HLA-DRB1*15:01 allele, sun exposure, vitamin D levels, smoking habit), but we have included another factor (skin phototype) that has not been analyzed in depth until now. This study included 149 MS patients and 147 controls. A multivariate logistic regression (LR) model was carried out to determine the impact of each of the factors on the increased risk of MS. Receiver Operating Characteristics (ROC) analysis was performed to evaluate predictive value of the models. Our multifactorial LR model of susceptibility showed that females with light brown skin (LBS), smokers and who had HLA-DRB1*15:01 allele had a higher MS risk (LBS: OR = 5.90, IC95% = 2.39-15.45; smoker: OR = 4.52, IC95% = 2.69-7.72; presence of HLA-DRB1*15:01: OR = 2.39, IC95% = 1.30-4.50; female: OR = 1.88, IC95% = 1.08-3.30). This model had an acceptable discriminant value with an Area Under a Curve AUC of 0.76 (0.69-0.82). Our study indicates that MS risk is determined by complex interactions between sex, environmental factors, and genotype where the milieu could provide the enabling proinflammatory environment that drives an autoimmune attack against myelin by self-reactive lymphocytes.

Dermatosis Papulosa Nigra: A Quality of Life Survey Study.

Background: Dermatosis papulosa nigra (DPN) is a skin condition characterized by pigmented sessile and pedunculated papules on the body, particularly on the face and other sun-exposed areas, that can cause cosmetic disfigurement and varying degrees of distress and psychosocial concern among patients. Objective: We sought to evaluate the effect of DPN on quality of life (QoL). Methods: A 39-item questionnaire was administered to 50 African-American (AA) adults, 48 women and two men, with an average age of 51.7 years and visible DPN lesions at a dermatology clinic. We collected demographic information, family history, prior treatment, as well as type(s), frequency, duration of lesions, and attitudes about lesions. Dermatologic QoL (DLQI) survey scores were used to quantify the effect that DPN had on QoL. RESULTS: Most subjects reported lesions on the face (86%); 49 percent reported between 10 to 30 lesions on the body. The average age of diagnosis was 44.7 years (±15.51 years). Further, 84 percent of subjects reported having a firstdegree relative with DPN. Most patients reported little to no symptoms from their DPN (82%), while 36 percent had previously visited a physician due to their DPN. Electrocautery and cryosurgery were the most common methods of DPN removal. All subjects who had their DPN lesions removed reported improvement in the appearance of their skin. The average (standard deviation) DLQI score was six points (±5.42 points), which indicates that DPN has a moderate effect on QoL. Conclusion: Our study results reveal the high likelihood of a family history of DPN in subjects with the condition. Overall, most subjects reported few symptoms of DPN and their QoL was only moderately affected by DPN. Still, patients might benefit from the removal of DPN lesions.

Are the Fitzpatrick Skin Phototypes Valid for Cancer Risk Assessment in a Racially and Ethnically Diverse Sample of Women?

The Fitzpatrick Skin Phototypes (FSP) were developed to classify skin color and response to ultraviolet radiation. FSP are used clinically to assess risk for sunburn and skin cancer. Our aim was to determine the criterion-related validity of self-reported FSP when compared with skin color and sunburn history, controlling for age, race/ethnicity, and seasonality/geography. We performed a secondary analysis of data (N=466) from an observational study. The racial/ethnic composition of the sample was 45% White/White Hispanic (WWH), 40% Black/Black Hispanic (BBH), and 15% Other Identities. Outcome measures were self-reported FSP and sunburn history, as well as physiological measures of skin color (L* lightness/darkness, a* redness/greenness, b* yellowness/blueness). Correlation between FSP and L* was -.77 (95% CI -.81, -.73; P<.001). Although 60% of the variance in FSP was accounted for by L* values for the entire sample, only 5% of the variance was accounted for among BBH participants (r=-.23), and up to 30% for WWH/Other Identity participants (r=-.48 and -.52). Multiple regression analysis indicated L* and b* values, sunburn history, and race/ethnicity, but not geography/seasonality or a* values significantly and collectively accounted for 72% of the variance in FSP. While the criterion validity of FSP was established by the strong relationship between L* values and FSP for the entire sample, when examined at the level of individual racial/ethnic subgroups, criterion validity of FSP was not demonstrated. When self-reported FSP are used for clinical skin assessment and sun cancer screening, they provide a restricted range of options for people with darker skin that does not capture variations in their skin color. Inaccuracy of clinical data may lead to unequal treatment or inadequate cancer risk assessment.

The effect of pre-phototest sun exposure on minimal erythema dose and minimal melanogenic dose among skin phototypes III, IV and V.

BACKGROUND: Ethnicity, skin phototype and colour influenced minimal erythema dose (MED). Sun exposure has been postulated to increase MED. We determined immediate pigment darkening dose to UVA (IPDDA), MED and minimal melanogenic dose (MMD) for UVB and UVA, and investigated factors affecting these doses. METHODS: Skin phototype was determined using Fitzpatrick phototype quiz, DSMII ColorMeter measured skin colours, sun exposure quantified using an index (SEI) and phototest performed with MEDlight-Multitester. RESULTS: A total of 167 healthy volunteers participated. There were 110 (66%) females and 56 (34%) males; 124 (74.7%) were Malay, 27 (16.3%) Chinese and 14 (8.4%) Indians. One hundred and nine (65.7%) skin phototype IV, 30 (18.1%) phototype III and 27 (16.3%) phototype V. IPDDA ranges from 6 ± 1.5-5.7 ± 1.4 J/cm2 . MED-UVB were 96.9 ± 17.6, 124 ± 29.3 and 118.6 ± 27.4 mJ/cm2 for phototype III, IV and V, respectively. All MED-UVA were outside the tested dose range of 3.6-11 J/cm2 . MMD-UVB were 106 ± 18.2, 134 ± 25.6 and 136 ± 31.1 mJ/cm2 while MMD-UVA were 4.1 ± 4.1, 4.9 ± 3.8 and 5.7 ± 3.7 J/cm2 respectively for phototypes III, IV and V. MED-UVB, MMD-UVB and MMD-UVA did not depend on skin phototype. Facultative skin whiteness (L*), erythema (E) and melanin content (M) correlated significantly with MED-UVB while constitutive skin colours were significant for L*, yellowness (b*), E and M. Sun exposure did not significantly correlate with MED-UVB and MMDs, however, an inverse relationship with MED-UVB was demonstrated. CONCLUSION: Minimal erythema doses in our cohort were slightly different from other regional countries. Constitutive and facultative skin whiteness, erythema and melanin content correlated with MED. There was no association between skin phototype and sun exposure with MED or MMD.

Postinflammatory hyperpigmentation: A comprehensive overview: Epidemiology, pathogenesis, clinical presentation, and noninvasive assessment technique.

Postinflammatory hyperpigmentation (PIH) commonly occurs after various endogenous and exogenous stimuli, especially in dark-skinned individuals. PIH is one of the most common complications of procedures performed using laser and other light sources. The severity of PIH is determined by the inherent skin color, degree and depth of inflammation, degree of dermoepidermal junction disruption, inflammatory conditions, and the stability of melanocytes, leading to epidermal and dermal melanin pigment deposition. The depth of melanin pigment is the key factor to predict prognosis and treatment outcome. Epidermal hyperpigmentation fades more rapidly than dermal hyperpigmentation. Various inflammatory disorders can eventually result in PIH. The evaluation of pigmentation using noninvasive tools helps define the level of pigmentation in the skin, pigmentation intensity, and guides therapeutic approaches. This first article in this 2-part series discusses the epidemiology, pathogenesis, etiology, clinical presentation, differential diagnoses, and investigation using noninvasive assessment techniques that objectively determine the details of pigmentation.

Clinical and Histopathological Findings of Frontal Fibrosing Alopecia-Associated Lichen Planus Pigmentosus.

BACKGROUND: Frontal fibrosing alopecia (FFA) is a primary lymphocytic scarring alopecia occurring mainly in postmenopausal women. A range of facial lesions have been described in FFA, such as lichen planus (LP) pigmentosus, red dots, facial papules, and perifollicular and diffuse erythema. These lesions can be the first sign of FFA. LP pigmentosus is a rare variant of LP. The first description of LP pigmentosus associated with FFA (in 2012) reported 22 cases of LP pigmentosus among 44 cases of FFA affecting South African patients. METHODS: We reviewed 16 FFA patients with LP pigmentosus and the histopathological findings of the biopsy of LP pigmentosus in 9 patients. RESULTS: Most patients had intermediate skin phototypes (III-IV; n = 10; 62%). The age at onset of LP pigmentosus ranged from 30 to 60 years. The most common histopathological findings were epidermal atrophy, basal cell degeneration, interfollicular inflammatory infiltrate and melanophages, and perifollicular changes. Other findings not previously described in LP pigmentosus were inflammation and interface changes on sweat duct epithelia (acrosyringium and superior dermal duct), and lichenoid perisebaceitis. CONCLUSIONS: Histology of our cases confirmed previous findings and showed a high incidence of perifollicular involvement with occasional changes affecting sebaceous and sweat glands.

Protección solar en niños / Sun protection in children

Introducción: Los niños pertenecen al grupo poblacional en el que más debe extremarse la fotoprotección. Son más sensibles a los efectos negativos derivados de una exposición solar excesiva, y no son conscientes de este riesgo. La radiación ultravioleta y las quemaduras durante la infancia son un factor de riesgo fundamental para el desarrollo de cáncer cutáneo en la edad adulta. Objetivo: caracterizar el fototipo cutáneo, el nivel de información y los hábitos de protección solar en niños. Materiales y métodos: se realizó un estudio descriptivo, transversal, de enero a abril de 2015, en 70 niños de 9 años de la escuela “13 de Marzo”, de Santa Clara. Las variables estudiadas fueron: sexo, fototipos cutáneos, nivel de información y hábitos de protección solar. Se utilizó el análisis de estadística descriptiva. El proyecto de investigación fue aprobado por el Comité de Ética en la Investigación. Resultados: el 38,6 % presentaron fototipo cutáneo tipo III; el 52,9 % fueron del sexo femenino. El nivel de información sobre los horarios menos aconsejables para tomar el sol fue inadecuado en el 81,4 %. Conclusión: La generalidad conoce que el sol causa daños a la piel. Los hábitos de protección solar, como el uso de protector, gorras, sombrillas, así como la selección de lugares de juego y deportes, son incorrectos en la mayoría de los niños.

Background: children belong to the population group where photo protection should be extreme. They are more sensible to the negative effects of an excessive sun exposition, and they are not conscious of this risk. Ultraviolet radiation and sunburns during childhood are important risk factors for developing skin cancer at adult age. Aims: characterizing skin phototype, the information level and sun protection habits in children. Materials and methods: a cross-sectional, descriptive study was carried out from January to April 2015, in 70 children aged 9 years assisting the school “13 de Marzo”, of Santa Clara. The studied variables were: gender, skin phototypes, information level and sun protection habits. It was used the analysis of descriptive statistic. The research project was approved by the Research Ethic Committee. Outcomes: 38.6 % had Type III skin phototype; 52.9 % were female ones. The information level on the less advisable time for taking the sun was inadequate in 81.4 %. Conclusion: most of them know that sun damages the skin. Sun protection habits, like the use of protector, hats, umbrellas, and the choice of play ground and sport places are erroneous in most of the children.

Voriconazole-associated phototoxic dermatoses and skin cancer.

Voriconazole's antifungal spectrum, oral bioavailability, and proven efficacy in treatment of invasive mycoses have led to its widespread off-label use for antifungal prophylaxis. There is an increasing recognition that long-term voriconazole use is associated with accelerated sun-induced skin changes that include acute phototoxicity reactions, photoaging, actinic keratosis and esp. among immunocompromised patients, skin cancers. The mechanisms underlying these dermatologic adverse events are not clearly understood. Population-risks of long-term voriconazole use need to be prospectively investigated. This review aims to provide an in-depth assessment of published literature and highlight salient findings from retrospective studies and case series. A broad practical guideline for assessment and management of these patients is provided.

Morphological changes in skin of different phototypes under the action of topical corticosteroid therapy and tacrolimus.

BACKGROUND/PURPOSE: The present study aimed to investigate the influence of topical corticosteroid therapy and tacrolimus on morphological indices of different skin phototypes and to optimize topical therapy using the OCT technique. METHODS: Twenty healthy volunteers aging from 20 to 30 (14 men and 6 women) took part in the study: 10 persons with skin phototype I, II and 10 persons with skin phototype V, VI. Morphological state of the skin was assessed before and during application of topical steroids of different strength and calciumneurin inhibitors for 49 days. Morphological state was studied in vivo using the optical coherence tomograph. RESULTS: Morphological manifestations of skin atrophy with the use of clobetasol propionate appear earlier than with the use of hydrocortisone 17-butyrate; this process was faster in representatives of groups V, VI. Epidermal thinning in the zone of tacrolimus application was not recorded in any phototype. CONCLUSION: Recording of early preclinical signs of epidermis thinning in the course of OCT follow-up may be an indication for changing the corticosteroid therapy by calciumneurin inhibitors, which will permit to individualize the therapy, to increase its efficacy, and to minimize the possibility of complications in each particular case.

Dermatosis provocadas por la luz solar e influencia en la calidad de vida / Skin lesions caused by sunlight and their influence on quality of life

En los últimos años ha existido un incremento de lesiones dermatológicas en las zonas expuestas al sol como resultado del deterioro de la capa de ozono, lo que se ha comportado según los distintos tipos de piel, ello ha determinado que los sujetos vean afectada su calidad de vida. Objetivos: determinar las afectaciones por daño solar según fototipo cutáneo y su relación con la calidad de vida en sujetos que trabajan en el mar. Métodos: estudio descriptivo en 204 sujetos trabajadores del mar mediante el examen clínico-dermatológico y una medición de su calidad de vida a través del Cuestionario General de Calidad de Vida, el que definió la afectación o no de esta. Resultados: predominaron los fototipos IV, V y III. La mayoría de los sujetos presentaron daño solar y afectaciones de la calidad de vida. Hubo relación significativa entre el fototipo cutáneo, el daño solar, la calidad de vida y el número de lesiones actínicas. Los diagnósticos más frecuentes fueron los léntigos y fotoenvejecimiento. Las dimensiones más afectadas fueron la salud física y la salud psicológica. Conclusiones: se encontró relación entre el fototipo cutáneo de los sujetos, daño solar y la calidad de vida...

"Recent years have witnessed an increase in the number of dermatological lesions on skin areas exposed to sunlight, as a result of the depletion of the ozone layer. Sun damage varies with skin type, and affects the subjects' quality of life. Objectives: determine sun-related skin damage by skin phototype and its relationship to quality of life in sea workers. Methods: descriptive study of 204 sea workers. All underwent clinical and dermatological examination as well as measurement of their quality of life through the General Quality of Life Questionnaire. Results: most subjects had sun-related skin damage and deterioration of their quality of life. Phototypes IV, V and III were predominant, and the most common diagnoses were lentigos and photoaging. The most affected areas were physical health and psychological health. Conclusions: sea workers show damage to their physical health due to their lengthy exposure to sunlight, which in turn affects their psychological health, particularly their self-esteem and mood. The combination of these factors negatively affects their quality of life and should be taken into account in the work strategies designed by their managers...