Cutaneous hypothalamic-pituitary-adrenal axis homolog: regulation by ultraviolet radiation.

The hypothalamic-pituitary-adrenal (HPA) axis maintains basal and stress-related homeostasis in vertebrates. Skin expresses all elements of the HPA axis including corticotropin-releasing hormone (CRH), proopiomelanocortin (POMC), ACTH, ß-endorphin (ß-END) with corresponding receptors, the glucocorticoidogenic pathway, and the glucocorticoid receptor (GR). To test the hypothesis that cutaneous responses to environmental stressors follow the organizational structure of the central response to stress, the activity of the "cutaneous HPA" axis homolog was investigated after exposure to ultraviolet radiation (UVR) wavelengths of UVA (320-400 nm), UVB (280-320 nm), and UVC (100-280 nm) in human skin organ culture and in co-cultured keratinocytes/melanocytes. The level of stimulation of CRH, POMC, MC1R, MC2R, CYP11A1, and CYP11B1 genes was dependent on UV wavelengths and doses, with the highest effects observed for highly energetic UVC and UVB. ELISA and Western assays showed significant production of CRH, POMC, ACTH, and CYP11A1 proteins and of cortisol, with a decrease in GR expression only after UVB and UVC. However, ß-END expression was also stimulated by UVA. Immunocytochemistry localized the deposition of the aforesaid antigens predominantly to the epidermis with additional accumulation of CRH, ß-END, and ACTH in the dermis. UVR-stimulated CYP11A1 expression was seen in the basal layer of the epidermis and cells of adjacent dermis. Thus, the capacity to activate or change the spatial distribution of the cutaneous HPA axis elements is dependent on highly energetic wavelengths (UVC and UVB), implying a dependence of a local stress response on their noxious activity with overlapping or alternative mechanisms activated by UVA.

Comparative effectiveness of clinically used light sources for cutaneous protoporphyrin IX-based photodynamic therapy.

This report documents the optical characteristics of a number of photodynamic therapy (PDT) light sources of varied types, measured and indexed relative to estimated effectiveness for activation of the PDT chromaphore protoporphyrin IX (PpIX). PDT sources in use at several clinics, including intense pulsed light (IPL) sources, lasers, and continuous wave (CW) light sources, were spectroradiometrically measured and indexed relative to their overlap to an absorption spectrum of PpIX. The sources were highly disparate, varying in power from irradiance in the mW/cm(2) range for the CW sources up to ∼30 J/cm(2) per flash for the IPL sources. Our PpIX Index ranged by a factor of nearly 100 (0.008-0.630) in estimated PpIX PDT effectiveness following the distinct spectral characteristics of the light sources surveyed. Application of this PpIX Index, tempered with an understanding of the biology of the lesion being treated and effective spectrum of the light source reaching the lesion requiring therapy, provides a rational algorithm to approximate equivalent light doses prior to clinical protocols to establish equivalent patient outcomes employing alternative PDT light sources.

The FDA proposed solar simulator versus sunlight.

The US Food and Drug Administration is in the process of formulating final rules for sunscreen labeling and testing. They have adopted a version of the solar simulator standard proposed by COLIPA, a European cosmetic products trade association. From our files we have selected spectral data on several solar simulators that comply with the proposed rules and have compared these sources both one to another and to several standard solar spectra of Air Mass 1.0, 1.5, and 2.0. In doing so we have used additional spectral analysis procedures including examining the goodness of fit between each solar simulator spectrum and an Air Mass 1.0 (0 degrees zenith angle) solar spectrum. The index of goodness of fit ranges from approximately 78% to just over 90% compared to solar spectra representing other Air Masses of 1.5 and 2.0, the goodness of fit is lower. Unfortunately, one may not assume that complying with a standard assures that other solar simulators also complying will produce identical results. In fact, by our analysis, none of the solar simulators we examined would be expected to produce the same SPF as sunlight.

In vitro sunscreen transmittance measurement with concomitant evaluation of photostability: evolution of a method.

The recent paper by Miura et al. (Photochem. Photobiol. 84[6], 1569-1575) offers a re-examination of extant in vitro methods for dynamically measuring sunscreen photodegradation under continuous irradiation in situ. We commend the authors' efforts toward developing an improved system for accurate in vitro sunscreen assessment. This work describes an alternate derivative apparatus incorporating an improved detector which may prove an exceptionally valuable contribution toward that goal. Unfortunately their report suffers from insufficient detail in instrumentation description and lacks requisite calibration procedures. Their utilization of a solar simulator filtered for conventional in vivo sun protection factor (SPF) testing poses transmittance measurement limitations at short wavelengths that are not adequately addressed and is also deficient, relative to sunlight, in longer UVA wavelengths shown to contribute to sunscreen photoinstability. We concur that the in vitro sunscreen testing should utilize continuous or multiple irradiation doses and should ideally use the same 2 mg cm(-2) product application amount as does the human SPF test. We encourage their proposal that methodology, which simultaneously measures sunscreen spectral transmittance and photodegradation under continuous irradiation to an accumulated erythemic endpoint, as we previously described, be developed into a consensus test standard.

Analysis of compact fluorescent lights for use by patients with photosensitive conditions.

Ultraviolet radiation (UVR) is hazardous to patients with photosensitive skin disorders, such as lupus erythematosus, xeroderma pigmentosum and skin cancer. As such, these patients are advised to minimize their exposure to UVR. Classically, this is accomplished through careful avoidance of sun exposure and artificial tanning booths. Indoor light bulbs, however, are generally not considered to pose significant UVR hazard. We sought to test this notion by measuring the UV emissions of 19 different compact fluorescent light bulbs. The ability to induce skin damage was assessed with the CIE erythema action spectrum, ANSI S(lambda) generalized UV hazard spectrum and the CIE photocarcinogenesis action spectrum. The results indicate that there is a great deal of variation amongst different bulbs, even within the same class. Although the irradiance of any given bulb is low, the possible daily exposure time is rather lengthy. This results in potential daily UVR doses ranging from 0.1 to 625 mJ cm(-2), including a daily UVB (290-320 nm) dose of 0.01 to 15 mJ cm(-2). Because patients are exposed continually over long time frames, this could lead to significant cumulative damage. It would therefore be prudent for patients to use bulbs with the lowest UV irradiance.

Indoor tanning injuries: an evaluation of FDA adverse event reporting data.

BACKGROUND/AIMS: In 1979 the Food and Drug Administration (FDA) designated indoor tanning units would be regulated medical devices and that each must have an exposure timer. In 1985 FDA added a scheduled series of doses designed to allow tanning with little risk of concomitant sunburn. Subsequently FDA/CDRH maintained databases in which medical device associated injuries were reported. The databases, MAUDE and its predecessor MDR, are available online. While these records, in part, are not intended for evaluation of adverse event rates, analysis provides insight into the etiology of UV-related tanning injuries. METHODS/RESULTS: We compiled 142 records reported for 1985-2006 including 22% noninjury malfunctions. Of the reported injuries approximately 50% resulted from UV exposure, an average of <1/year resulted in hospitalization. At least 36% of the UV-related injuries were attributable to various (user/operator) noncompliance with FDA sunlamp guidance policies. During 1985-1995 there were six times more UV injuries than 1996-2006, presumably reflecting cessation of much mandatory reporting in 1996. Injury reports declined steady from 1997 to 2006. CONCLUSIONS: FDA guidance appears most efficacious in injury prevention and we encourage its incorporation into the enforceable performance standard. We also advise that tanning industry professional training programs seek standardization/accreditation of their personnel certifications through recognized accreditation bodies such as ANSI or ISO/IEC.

25-Hydroxyvitamin D, cholesterol, and ultraviolet irradiation.

Vitamin D deficiency may have implications for cardiovascular health. The purpose of this study was to determine the relationship of 25-hydroxyvitamin D (25[OH]D) to cholesterol and lipoprotein particles and to determine whether increasing 25(OH)D through ultraviolet (UV) irradiation impacted on these parameters in healthy young men and women. This was a randomized trial of 51 adults exposed to suberythemal doses of whole-body irradiation using UV lamps that emitted UV-A and UV-B radiation, compared with a control group, twice weekly for 12 weeks. 25-Hydroxyvitamin D, cholesterol, and lipoprotein subfractions were measured at baseline and after 12 weeks. There was a significant (P < .03) positive association between 25(OH)D and apolipoprotein A-I (Apo A-I) and lipoprotein A-I (Lp A-I). The ratio of low-density lipoprotein to high-density lipoprotein was significantly (P < or = .044) negatively correlated with 25(OH)D levels. The levels of 25(OH)D increased significantly in the treated compared with control group (P < .05). Overall, there were no significant differences between the treated and control groups in any lipoproteins or apolipoproteins after administration of UV irradiation. Subgroup analysis for Apo A-II confined to those with 25(OH)D insufficiency (25[OH]D <75 nmol/L [30 ng/mL]) revealed decreases in Apo A-II in the treated group and increases in the control group that were statistically significantly different between the groups (P = .026). We found a significant positive correlation between 25(OH)D and Apo A-I and Lp A-I and a significant negative correlation between 25(OH)D and the ratio of low-density lipoprotein to high-density lipoprotein. In those with vitamin D insufficiency, we found small decreases in Apo A-II in the treated relative to the control group. Overall, though, twice weekly exposure to UV radiation resulting in an increase in serum 25(OH)D had no significant impact on lipoprotein composition.

Commentary on 'UVB-SPF': the SPF labels of sunscreen products convey more than just UVB protection.

The FDA recently published a proposed amendment of the Final Monograph for OTC Sunscreen Products. Among the proposals, FDA revised solar simulator performance specifications and additional labeling for sunscreen products. The maximum allowable labeled sun protection factor (SPF) was increased to SPF 50 while simultaneously requiring it to be called 'UVB-SPF'. UVB accounts for 80-91% of the erythemic effectiveness of the UV solar simulator specified in the amendment. Analysis of the specified solar simulator spectrum used to determine SPF indicates that if 100% of the UVB is blocked, it is mathematically impossible to achieve an SPF in excess of approximately 11 without also blocking at least some UVA. Consequently significant UVA protection must be provided for sunscreen products to achieve SPFs of 15 and higher. At the maximum allowed SPF 50, where only 2% or less of the effective UV risk remains, the minimum reduction of UVA erythemal effectiveness must by definition be 78-90%. While mandating UVA protection criteria is doubtless important, especially as it relates to sunscreen photostability, there is no utility in, or basis for, the proposed 'UVB-SPF' descriptor as existing high SPF labeling indicates both UVB and UVA protection.

The increase in melanoma: are dietary furocoumarins responsible?

According to most cancer registries the incidence of cutaneous melanoma (CM) has been increasing for several decades. Unlike other skin cancers, CM does not clearly correlate with exposure to ultraviolet radiation. The strongest etiological evidence for CM in man is genetic predisposition, evidenced by very high risks in primary relatives of melanoma patients, and photochemotherapy with 8-methoxy psoralen in combination with ultraviolet-A radiation (PUVA) to treat psoriasis and vitiligo. Retrospective studies of PUVA patients show significantly increased incidence of CM. Psoralens, and other furocoumarins, are phototoxic and photocarcinogenic, intercalate DNA and photochemically induce mutations. Furocoumarins are botanical phytoalexins found to varying extents in a variety of vegetables and fruits, notably citrus fruits. The levels of furocoumarins present in our diets, while normally well below that causing evident acute phototoxicity, do cause pharmacologically relevant drug interactions. For the past approximately 50 years CM has increased at similar rates as the increased availability and consumption of citrus products. Recently in a large study of nurses, only orange juice drinking, indicative of dietary preference for citrus, was positively associated with significantly increased risk of developing CM. We hypothesize that the increases in cutaneous melanoma incidence may be in part related to concomitant increases in dietary photocarcinogenic furocoumarins.

Darkness at noon: sunscreens and vitamin D3.

We are assured by responsible scientific and governmental organizations that sunscreens should be routinely worn to reduce skin cancer risk. We are also advised that wearing sunscreens will not hinder our ability to produce sufficient previtamin D3 (preD3) from casual sunlight exposure. We report the examination of a series of 166 solar spectra, obtained on different days throughout a year, evaluated for erythemic and preD3 effectiveness and the relative effects of recommended Sun protection factor (SPF) 15 sunscreen. The results show that the sunscreen is much more effective in blocking the formation of preD3, than its labeled SPF for preventing sunburn. In fact with sunscreen applied only miniscule amounts of preD3 are predicted to be made outdoors even with extensive exposure. This raises important questions regarding the safest way to use sunlight exposure to promote healthy vitamin D3 levels and suggests the need to modify the public safety "Safe Sun" messages.

Unexpected photolysis of the sunscreen octinoxate in the presence of the sunscreen avobenzone.

A major concern raised about photostability studies of sunscreen products is that the photodegradation of sunscreens does not readily translate into changes in product performance. This study examines the correlation between photochemical degradation of sunscreen agents and changes in protection provided by sunscreen films. Films of a commercial sunscreen product containing avobenzone, oxybenzone and octinoxate were irradiated using a fluorescent UV-A phototherapy lamp with additional UV-B blocking filter. Periodically, during irradiation the transmittances of the films were measured and samples collected for chemical analysis of the sunscreen agents using high-performance liquid chromatography techniques. The results show that UV-induced changes in UV transmittance of sunscreen films correlate with changes in concentration of sunscreen agents. In a parallel experiment, we also irradiated a thin film of the same product in the cavity of an electron spin resonance (ESR) spectrometer. We report the concomitant photolysis of avobenzone and octinoxate that predominates over expected E/Z photoisomerization and that irradiation of a film of this product produced free radicals detected by ESR spectroscopy that persisted even after exposure had ended.

Sunscreen ingredients inhibit inducible nitric oxide synthase (iNOS): a possible biochemical explanation for the sunscreen melanoma controversy.

Sunscreen products are rated upon their ability to inhibit visible redness of the skin 24 h after measured doses of ultraviolet (UV) exposure (Sun Protection Factor, SPF). Although sunscreens prevent UV-induced redness, their ability to protect against melanoma or the development of moles is less clear. UV-induced redness occurs in part by the action of nitric oxide (NO), synthesized in the skin. NO is also an important immunoregulatory molecule in the induction of the cell-mediated tumour immune response. In this study, various sunscreen ingredients were tested for their ability to inhibit the production of NO. Four of the five sunscreens tested directly inhibited the conversion of arginine to citrulline by inducible nitric oxide synthase (iNOS) in vitro. These findings suggest that sunscreens may prevent redness partly by UV absorption and partly by inhibition of the skin's inflammatory response. As such, sunscreens might promote instead of protect against melanoma.

Novel non-calcemic secosteroids that are produced by human epidermal keratinocytes protect against solar radiation.

CYP11A1 hydroxylates the side chain of vitamin D3 (D3) in a sequential fashion [D3→20S(OH)D3→20,23(OH)2D3→17,20,23(OH)3D3], in an alternative to the classical pathway of activation [D3→25(OH)D3→1,25(OH)2D3]. The products/intermediates of the pathway can be further modified by the action of CYP27B1. The CYP11A1-derived products are biologically active with functions determined by the lineage of the target cells. This pathway can operate in epidermal keratinocytes. To further define the role of these novel secosteroids we tested them for protective effects against UVB-induced damage in human epidermal keratinocytes, melanocytes and HaCaT keratinocytes, cultured in vitro. The secosteroids attenuated ROS, H2O2 and NO production by UVB-irradiated keratinocytes and melanocytes, with an efficacy similar to 1,25(OH)2D3, while 25(OH)D3 had lower efficacy. These attenuations were also seen to some extent for the 20(OH)D3 precursor, 20S-hydroxy-7-dehydrocholesterol. These effects were accompanied by upregulation of genes encoding enzymes responsible for defense against oxidative stress. Using immunofluorescent staining we observed that the secosteroids reduced the generation cyclobutane pyrimidine dimers in response to UVB and enhanced expression of p53 phosphorylated at Ser-15, but not at Ser-46. Additional evidence for protection against DNA damage in cells exposed to UVB and treated with secosteroids was provided by the Comet assay where DNA fragmentation was markedly reduced by 20(OH)D3 and 20,23(OH)2D3. In conclusion, novel secosteroids that can be produced by the action of CYP11A1 in epidermal keratinocytes have protective effects against UVB radiation. This article is part of a special issue entitled '17th Vitamin D Workshop'.

Dermatological risk of indoor ultraviolet exposure from contemporary lighting sources.

Discussions of risks and implications of cutaneous exposure to indoor lighting, including hypothetical contribution to causality of melanoma, have mainly concentrated on ultraviolet (UV) A and B (UVA, UVB) spectral emissions from fluorescent bulbs. Only studies of quartz halogen lamps have suggested that users might sustain UVC-induced injury. Examination of light sources in the home and school of a child with xeroderma pigmentosum revealed that several different types emitted surprising levels of UV. Our purpose was to assess the extent of UV emissions from a variety of commonly used light sources to identify potential dermatological risks. UV and visible spectral emissions of commercially obtained lamps of several types were measured using a calibrated spectral radiometer traceable to the National Institute of Standards and Technology. Indoor light sources including fluorescent, quartz halogen and even tungsten filament incandescent lamps provided UVA, UVB and sometimes UVC emissions. Intensities of some emissions were of similar magnitude to those in sunlight. Chronic exposure to indoor lighting may deliver unexpected cumulative UV exposure to the skin and eyes. Patients with UV-exacerbated dermatoses should be cautioned about potential adverse reactions from indoor lighting.

Photobiological safety evaluation of UV nail lamps.

We evaluated six UV nail lamps representative of major US manufacturers to evaluate radiant hazards as defined in ANSI/IESNA RP-27 Recommended Practice for Photobiological Safety. Lamps were evaluated at three positions, 1 cm above the inner surface approximating exposure to the hand and the 20 cm RP-27 non-general light source distance, oriented normal and 45° to the opening. Hazard to skin at intended use distance classified these devices into Risk Group 1 or 2 (Low to Moderate) with S(λ) weighted Actinic UV ranging 1.2-1.7 µW cm(-2) and 29.8-276.25 min permissible daily exposure. At 20 cm on center and 45° UV risk to skin and eyes were all within Exempt classification. Actinic UV ranged 0.001-0.078 µW cm(-2) and unweighted near UV (320-400 nm) ranged 0.001-0.483 mW cm(-2). Likewise the retinal photochemical blue light hazard and retinal thermal and cornea/lens IR were also Exempt. One device had aphakic eye hazard slightly rising into Risk Group 1 (Low). There were no other photobiological risks to normal individuals. Total exposure following programmed times and steps accumulate to only a small fraction of RP-27 permissible daily occupational exposure. These risks are further mitigated in realistic nonoccupational use scenarios as it is unlikely to be a daily occurrence.

FDA-sunlamp recommended Maximum Timer Interval And Exposure Schedule: consensus ISO/CIE dose equivalence.

The authors compared calculations of sunlamp maximum exposure times following current USFDA Guidance Policy on the Maximum Timer Interval and Exposure Schedule, with USFDA/CDRH proposals revising these to equivalent erythemal exposures of ISO/CIE Standard Erythema Dose (SED). In 2003, [USFDA/CDRH proposed replacing their unique CDRH/Lytle] erythema action spectrum with the ISO/CIE erythema action spectrum and revising the sunlamp maximum exposure timer to 600 J m(-2) ISO/CIE effective dose, presented as being biologically equivalent. Preliminary analysis failed to confirm said equivalence, indicating instead ∼38% increased exposure when applying these proposed revisions. To confirm and refine this finding, a collaboration of tanning bed and UV lamp manufacturers compiled 89 UV spectra representing a broad sampling of U.S. indoor tanning equipment. USFDA maximum recommended exposure time (Te) per current sunlamp guidance and CIE erythemal effectiveness per ISO/CIE standard were calculated. The CIE effective dose delivered per Te averaged 456 J(CIE) m(-2) (SD = 0.17) or ∼4.5 SED. The authors found that CDRH's proposed 600 J(CIE) m(-2) recommended maximum sunlamp exposure exceeds current Te erythemal dose by ∼33%. The current USFDA 0.75 MED initial exposure was ∼0.9 SED, consistent with 1.0 SED initial dose in existing international sunlamp standards. As no sunlamps analyzed exceeded 5 SED, a revised maximum exposure of 500 J(CIE) m(-2) (∼80% of CDRH's proposal) should be compatible with existing tanning equipment. A tanning acclimatization schedule is proposed beginning at 1 SED thrice-weekly, increasing uniformly stepwise over 4 wk to a 5 SED maximum exposure in conjunction with a tan maintenance schedule of twice-weekly 5 SED sessions, as biologically equivalent to current USFDA sunlamp policy.

Examination of solar simulators used for the determination of sunscreen UVA efficacy.

The U.S. FDA recently proposed both in vivo and in vitro UVA efficacy tests for sunscreen products with the lower result used to establish the sunscreen's labeled UVA protection claim. The FDA stated their rationale for dual tests was concern that the in vivo test method overemphasizes UVA-2 (320-340 nm) photoprotection. We attribute FDA's observation to the relative lack, compared to sunlight, of UVA-1 (340-400 nm) radiation in the current JCIA UVA solar simulator specification, allowing the method to generate higher UVA protection factors than sunscreens will provide in sunlight. Our work is based upon comparisons of Air Mass 1.0 sunlight to variously filtered UVA solar simulators. Sources near the JCIA UVA-2/UVA limits (8-20%) had a goodness of fit to solar UVA of only 67-79%. We propose that instead of using ratios of UVA-2 to UVA the standard should be a goodness of fit to the UVA region of an Air Mass 1 solar reference spectrum. As the spectral distribution of solar UVA varies much less than UVB, sunlight of reasonable zenith angles of < or = 60 degrees will have similar spectral shapes and approximate risk spectrum. Goodness of fit to this spectrum will produce UVA protection values predictive to those actually achieved in sunlight of different zenith angles.