Does using a high sun protection factor sunscreen on face, along with physical photoprotection advice, in patients with melasma, change serum vitamin D concentration in Indian conditions? A pragmatic pretest-posttest study.

BACKGROUND: Use of sunscreens on the face is becoming popular, and patients with melasma are prescribed sunscreen for use on the face. Results of a few Western studies on the effect of sunscreen use on serum vitamin D concentration are not applicable to Indian conditions. AIMS: To examine the effect of use of a high sun protection factor (SPF 50+, PA++++) sunscreen on face in patients with melasma on serum concentration of 25-hydroxyvitamin D. METHODS: Forty-five Indian patients (Fitzpatrick skin types III and IV) with melasma were advised to use a sunscreen with SPF 50 + for 3 months, 43 (33 female, 10 male; age 32.9 ± 8 years) completed the study. Patients staying outdoor for <4 hours applied sunscreen once daily after bath. Patients staying outdoors for >4 hours reapplied sunscreen 4 hours after first application. Patients were provided a container to measure the amount of sunscreen for use, which was approximately equal to recommended thickness. Compliance was tested by weighing the used tubes and tubes in use during monthly visits. Serum concentration of 25-hydroxyvitamin D was tested before and after the study period. RESULTS: Amount of sunscreen advised (100.5 ± 29.2 ml) and the actual amount used (96.6 ± 27.9 ml) were similar (P = 0.53, t-test). The difference between serum concentrations of 25-hydroxyvitamin D at the baseline (19.20 ± 9.06 ng/ml) and at 3 months (18.91 ± 8.39 ng/ml) was not significant (P = 0.87, paired t-test, 95% confidence interval of difference -3.33 to 3.92). No correlation was found between the amount of sunscreen used and the percentage change in serum 25-hydroxyvitamin D concentration at 3 months (rho = 0.099, P = 0.528, Spearman's rank correlation). LIMITATIONS: Longer duration of application and a larger sample size may detect minor differences in vitamin D concentration. CONCLUSION: Using a high SPF sunscreen on the face, along with physical photoprotection advice, in patients with melasma for 3 months does not influence serum 25-hydroxyvitamin D concentration in Indian conditions.

Histopathological comparison of lesional and perilesional skin in melasma: A cross-sectional analysis.

BACKGROUND: Melasma is a common acquired hyperpigmentary disorder of the sun exposed skin, especially the face. The pathogenesis is unclear but interplay between genetic factors, hormones and ultraviolet radiation is important. We have evaluated the histological characteristics of melasma and compared the findings with adjacent normal skin. METHODS: Skin biopsies were taken from both melasma and the surrounding perilesional normal skin in 50 Indian women. The sections were stained with hematoxylin and eosin, Fontana-Masson and Verhoeff-Van Gieson stains. RESULTS: Biopsy from melasma showed significant epidermal atrophy, basal cell hyperpigmentation and solar elastosis when compared with the perilesional skin. We found that the proportion of pendulous melanocytes was significantly higher in the lesional biopsy compared with the perilesional biopsy (76% vs 42%, P < 0.001). Similarly, pigmentary incontinence and features of solar elastosis were significantly higher in the lesional skin compared with the perilesional skin. CONCLUSION: The characteristic histopathological features such as epidermal atrophy, basal cell hyperpigmentation and solar elastosis suggest the role of chronic sun exposure in the pathogenesis of melasma. Presence of pendulous melanocytes is a characteristic feature of melasma. The presence of pendulous melanocytes may have prognostic implications in melasma.

Photosensitive spongiotic/lichenoid eruption of micropapules and plaques: a morphologically distinct entity.

BACKGROUND: A distinct morphological pattern of photodermatosis has been observed with shiny skin colored to hypopigmented tiny papules, discrete or coalescing to form plaques. AIMS: To study the clinico-pathological features of patients presenting with these lesions. METHODS: A total of 72 patients were recruited. Clinical examination and skin biopsy was carried out to evaluate the morphological patterns and the histopathological features. RESULTS: In all patients, tiny discrete to coalescent papules were observed on sun-exposed sites but usually sparing the face. The condition occurred more commonly in women. Three specific histopathological patterns were observed : spongiotic (43.7%), lichenoid (22.5%), psoriasiform (18.7%) and also perivascular pattern in 5%. CONCLUSION: Photosensitive lichenoid eruption is a morphologically distinct photodermatoses that is commonly seen in Indian patients with pathological features showing mostly spongiotic changes and in some cases lichenoid changes.

Photodermatoses in India.

Photodermatoses are a group of disorders resulting from abnormal cutaneous reactions to solar radiation. They include idiopathic photosensitive disorders, drug or chemical induced photosensitivity reactions, DNA repair-deficiency photodermatoses and photoaggravated dermatoses. The pathophysiology differs in these disorders but photoprotection is the most integral part of their management. Photoprotection includes wearing photoprotective clothing, applying broad spectrum sunscreens and avoiding photosensitizing drugs and chemicals.

Solar ultraviolet radiation induces biological alterations in human skin in vitro: relevance of a well-balanced UVA/UVB protection.

Cutaneous damages such as sunburn, pigmentation, and photoaging are known to be induced by acute as well as repetitive sun exposure. Not only for basic research, but also for the design of the most efficient photoprotection, it is crucial to understand and identify the early biological events occurring after ultraviolet (UV) exposure. Reconstructed human skin models provide excellent and reliable in vitro tools to study the UV-induced alterations of the different skin cell types, keratinocytes, fibroblasts, and melanocytes in a dose- and time-dependent manner. Using different in vitro human skin models, the effects of UV light (UVB and UVA) were investigated. UVB-induced damages are essentially epidermal, with the typical sunburn cells and DNA lesions, whereas UVA radiation-induced damages are mostly located within the dermal compartment. Pigmentation can also be obtained after solar simulated radiation exposure of pigmented reconstructed skin model. Those models are also highly adequate to assess the potential of sunscreens to protect the skin from UV-associated damage, sunburn reaction, photoaging, and pigmentation. The results showed that an effective photoprotection is provided by broad-spectrum sunscreens with a potent absorption in both UVB and UVA ranges.

The development of efficient sunscreens.

Skin exposure to acute or repetitive ultraviolet light induces risks which are now well identified. An efficient photoprotection is thus required for both UVB and UVA radiation. In particular, increasing evidence of the detrimental effects of UVA on skin has led to the development of a new generation of sunscreens that provide effective protection throughout the whole UV radiation spectrum. Many new UV filters have been introduced in the last decade, particularly UVA filters, with improved efficacy and safety. Sunscreen filters must be carefully combined to achieve esthetically pleasing products offering photostable and well-balanced photoprotection.

Photoprotection and vitamin D status: a study on awareness, knowledge and attitude towards sun protection in general population from Kuwait, and its relation with vitamin D levels.

BACKGROUND: The primary cause of skin cancers is exposure to ultraviolet (UV) radiation. And, for decades sun protection has been promoted in various public health education campaigns. Recently, however, vitamin D deficiency has been related to increased risk of skin cancers. And, skin being the primary site for the synthesis of active form of vitamin D, excessive sun protection could lead to vitamin D-deficient states. But, the results have so far been conflicting. AIMS: To study the level of awareness, knowledge and attitude of representative groups from the general population from Kuwait towards sun protection. And, also study the correlation of the level of sun protective measures used and vitamin D levels in these groups. METHODS: The study constituted of two main parts. First part comprised a questionnaire-based survey of representative group of people aged 18 and above to assess their knowledge, awareness and attitude towards sun protection. The second part consisted of measuring serum vitamin D levels in 150 volunteers amongst the responders of the questionnaire, who had been regularly using sunscreens for at least 2 years and compare to the levels seen in 150 age and sex-matched responders of similar skin phototypes, who had never used sunscreens. RESULTS: Out of the total of 1044 responders, 80% of them had adequate knowledge of the beneficial and harmful effects of sun exposure, and had been using sunscreens regularly, and adopting other sun protective measures in their daily life. The levels of vitamin D were found to be deficient in both sunscreen users and those who had never used sunscreens. The difference between the two groups was statistically insignificant (60.67% vs 54.67%; P value>0.001). CONCLUSION: Population at large seems to be adequately informed about the beneficial and deleterious effects of sun exposure. Vitamin D levels are deficient in majority of our people, and there is a need to do larger surveys covering all parts of the country and give supplemental doses of vitamin D to those found deficient.

A clinicoepidemiological study of polymorphic light eruption.

BACKGROUND AND AIMS: The prevalence of polymorphic light eruption (PLE) varies between 10-20% in different countries but no such data is available from India, where exposure to sunlight is high. METHODS: A clinico-epidemiological study of PLE was done in the skin outpatient department (OPD) of Institute of Medical Sciences Hospital from January to December. RESULTS: The ages of the patients varied from 5-70 years. Out of a total of 39,112 OPD cases, 220 cases of PLE (138 females and 82 males) were recorded, giving a prevalence of 0.56% in this study population. The skin type varied between IV and VI in 96% of the cases. Housewives were 81, students 67, office persons 39, farmers 22, businessmen 6 and unemployed 5. DISCUSSION: The manifestation of PLE was most common in housewives in areas exposed to the sun. Most of the PLE patients presented with mild symptoms and rash around the neck, forearms and arms which was aggravated on exposure to sunlight. PLE was more prevalent in the months of March and September and the disease was recurrent in 31.36% of the cases. CONCLUSIONS: The prevalence of PLE was 0.56%. It was mild in nature and only areas exposed to the sun were involved.

Comparative study of efficacy and safety of hydroxychloroquine and chloroquine in polymorphic light eruption: a randomized, double-blind, multicentric study.

BACKGROUND: Polymorphic light eruption is the most common photodermatosis characterized by nonscarring, pruritic, erythematous papules and plaques. AIM: To evaluate the efficacy and safety of hydroxychloroquine in comparison with chloroquine in patients suffering from polymorphic light eruption. METHODS: This was a randomized, double-blind, comparative, multicentric study conducted at two centers. This study enrolled 68 (58.1%) males, 49 (41.8%) females whose ages ranged from 18-73 years and average weight was 57.89 +/- 8.27 kg. A total of 117 patients were enrolled in the study. Out of 117 patients, 63 patients were randomized to receive hydroxychloroquine tablets 200 mg twice daily for the first month and 200 mg once daily for the next month. Similarly, 54 patients were randomized to receive chloroquine tablets 250 mg twice daily for the first month and 250 mg once daily for the next month. The total duration of therapy for both the study arms was two months. The severity and frequency of burning, itching, erythema and scaling were evaluated at predetermined intervals (at baseline, after four, eight and 12 weeks of therapy). RESULTS: A significant reduction in severity scores for burning, itching and erythema was observed in patients treated with hydroxychloroquine than with chloroquine (P P = 0.229). The good to excellent response was reported by 68.9% of the patients who received hydroxychloroquine and by 63% of the patients who received chloroquine. The adverse events reported were mild to moderate and none of the patients reported any serious adverse events or ocular toxicity in this study. CONCLUSION: Hydroxychloroquine was found to be significantly more effective than chloroquine in the treatment of polymorphic light eruption and can be used safely in the dosage studied in such patients with little risk of ocular toxicity.

Porfiria cutánea tarda: análisis de datos y criterios prospectivos para su manejo clínico / Porphyria cutanea tarda: data analysis and prospective criteria for the clinical manegement

Objetivo: realizar un análisis retrospectivo de los datos obtenidos en pacientes con porfiria cutánea tarda (PCT); establecer pautas de manejo diagnóstico y de seguimiento; evaluar enfermedades asociadas y/o vinculadas a PCT. Material y métodos: pacientes provenientes de la Sección Dermatología del Hospital J. B. Iturraspe de la ciudad de Santa Fe (1985-1997) y del Servicio de Gastroenterología del Sanatorio Allende de la ciudad de Córdoba (1997). Resultados: del total de 14 pacientes, 11 se diagnosticaron en Santa Fe y 3 en Córdoba; rango etario: 36-63; edad promedio 53,2; 11 hombres y 3 mujeres. Signos dermatológicos más frecuentes: lesiones ampollares, hiperpigmentación y fotosensibilidad. Signos oculares encontrados: fotofobias e inyección conjuntival. Factores precipitantes: tóxicos: etilismo (10), alcohol metílico (1), agroquímicos (1). Farmacológicos: estrógenos (1); psicofármacos (1). Enfermedades asociadas: lepra (2), carcinoma testicular y enfermedad de von Recklinghausen, psoriasis, diabetes, anemia hemolítica autoinmune. Determinación de marcadores virales: total de pacientes: 5; resultados: VIH (-) 3/3; VHB (-) 5/5; VHC (+) 4/5. Conclusión: se enfatiza la importancia de la asociación de PCT y hepatopatía crónica, en especial por virus C

Porfiria cutánea tarda: análisis de datos y criterios prospectivos para su manejo clínico / Porphyria cutanea tarda: data analysis and prospective criteria for the clinical manegement

Objetivo: realizar un análisis retrospectivo de los datos obtenidos en pacientes con porfiria cutánea tarda (PCT); establecer pautas de manejo diagnóstico y de seguimiento; evaluar enfermedades asociadas y/o vinculadas a PCT. Material y métodos: pacientes provenientes de la Sección Dermatología del Hospital J. B. Iturraspe de la ciudad de Santa Fe (1985-1997) y del Servicio de Gastroenterología del Sanatorio Allende de la ciudad de Córdoba (1997). Resultados: del total de 14 pacientes, 11 se diagnosticaron en Santa Fe y 3 en Córdoba; rango etario: 36-63; edad promedio 53,2; 11 hombres y 3 mujeres. Signos dermatológicos más frecuentes: lesiones ampollares, hiperpigmentación y fotosensibilidad. Signos oculares encontrados: fotofobias e inyección conjuntival. Factores precipitantes: tóxicos: etilismo (10), alcohol metílico (1), agroquímicos (1). Farmacológicos: estrógenos (1); psicofármacos (1). Enfermedades asociadas: lepra (2), carcinoma testicular y enfermedad de von Recklinghausen, psoriasis, diabetes, anemia hemolítica autoinmune. Determinación de marcadores virales: total de pacientes: 5; resultados: VIH (-) 3/3; VHB (-) 5/5; VHC (+) 4/5. Conclusión: se enfatiza la importancia de la asociación de PCT y hepatopatía crónica, en especial por virus C (AU)