Behaviorally segmented audiences for managing sunscreen chemical pollution risk in protected coastal natural resource areas.

This audience segmentation of visitors at coastal parks in Hawaii and North Carolina addresses an emergent natural resource management concern and risk to aquatic ecosystems: sunscreen chemical pollution. Four audiences were identified that correspond to different behavioral profiles: sunscreen protection tourists, multimodal sun protection tourists, in-state frequent park visitors, and frequent beachgoers who skip sunscreen. The second-largest audience, sunscreen protection tourists, represents 29% of visitors at Cape Lookout National Seashore and 25% at Kaloko-Honokohau National Historical Park. This group ranks of most concern for chemical pollution because they use sunscreen, but not typically mineral formulations or other methods such as protective clothing, and they have lower levels of sunscreen chemical issue awareness. The identification of similar audience segments across regions with differing cultural characteristics and sunscreen regulation status suggests the robustness of the model and its indicator variables, with implications for both environmental protection and public health. Further, coastal visitors' interest in enacting pro-environmental sun protection behaviors during their next park or beach visit indicates the potential for natural resource managers to holistically address risks in both domains through targeted interventions with audiences of most concern.

A systematic review on traditional, ayurvedic, and herbal approaches to treat solar erythema.

Solar erythema is a kind of radiation burn that strikes living tissue, such as skin, that arises from overexposure to UV radiation often from the sun. Ordinary symptoms of solar erythema include reddish skin, specifically warm to touch, overall tiredness, hurting, and mild whirl. Sunscreen contains SPF value, which measures how much ultraviolet radiation is needed to cause sunburn on sunscreen-applied skin, which is proportional to the quantity of solar energy needed to cause sunburn on unprotected skin. Between 30 and 50 SPF value is sufficient to protect from sunburn, especially for the people who are more sensitive to sunburn. Sunscreen also protects from sun damage including dark spots and discoloration and helps to keep skin smooth, spotless, and more even. Chemical-based sunscreen is widely used because it effectively protects the skin from sun damage, but it clogs pores and can be problematic for sensitive skin as it can cause itching or stinging of the skin and pus in the hair follicles. On the other hand, herbal sunscreen absorbs light preferentially over the range of 280-320 mm without causing any harm to the skin and eyes. Ayurveda rejuvenates dull skin by regaining the skin's natural glow and radiance. This review concludes the damaging and harmful effects of UV rays, along with various traditional, ayurvedic, and herbal approaches to treat solar erythema naturally.

Perspectives of topical formulations for melasma.

Melasma is acquired hyperpigmentation that mainly affects the face, can cause negative changes in self-esteem, and mostly affects women. Treatment is difficult, and different drugs can be used in mono or combination therapy. In this article, we present a brief overview of melasma, how to evaluate it, and a synthesis of the most commonly used topical therapies and their indications, including sunscreens, pharmacological agents, and plant extracts. Hydroquinone (4%) in monotherapy or combined with corticosteroids (dexamethasone and fluocinolone acetonide) and retinoids (tretinoin); arbutin (1%); methimazole (5%); kojic (2%), azelaic (20%), and tranexamic (5%) acids are the pharmacological agents that stand out. Correct application of these substances determines a variable improvement in melasma but often causes adverse reactions such as erythema, itching, and burning at the application site. Vitamin C can contribute to the reduction of melasma and have little or no adverse effects while sunscreens are normally used as coadjuvant therapies. In conclusion, we have compiled specific topical therapies for treating melasma and discussed those that are the most used currently. We consider it important that prescribers and researchers evaluate the best cost-benefit ratio of topical therapeutic options and develop new formulations, enabling efficacy in the treatment with safety and comfort during application, through the reduction of adverse effects.

Experimental and approved treatments for skin photosensitivity in individuals with erythropoietic protoporphyria or X-linked protoporphyria: A systematic review.

Erythropoietic protoporphyria (EPP) and X-linked protoporphyria (XLP) are characterized by skin photosensitivity caused by accumulation of protoporphyrin IX. We aimed to review the clinical evidence of efficacy and safety of skin photosensitivity treatments in individuals with EPP or XLP. We systematically searched MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov. A total of 40 studies with data on 18 treatment modalities were included. Comprehensive treatment safety data were obtained from the European Medicines Agency and the United States Food and Drug Administration. The studies used different outcome measures to evaluate the sensitivity without a generally accepted method to assess treatment effect on skin photosensitivity. Of the included studies, 13 were controlled trials. Gathered, the trials showed moderate positive effect of inorganic sunscreen application and subcutaneous implant of afamelanotide and no effect of organic sunscreen application, or oral treatment with beta-carotene, cysteine, N-acetylcysteine, vitamin C, or warfarin. Studies without control groups suggested treatment effect of foundation cream, dihydroxyacetone/lawsone cream, narrow-band ultraviolet B phototherapy, erythrocyte transfusion, extracorporeal erythrocyte photodynamic therapy, or oral treatment with zinc sulphate, terfenadine, cimetidine, or canthaxanthin, but the real effect is uncertain. Assessment of treatment effect on photosensitivity in patients with EPP or XLP carries a high risk of bias since experienced photosensitivity varies with both weather conditions, exposure pattern, and pigmentation. Controlled trials of promising treatment options are important although challenging in this small patient population.

Natural products and extracts from plants as natural UV filters for sunscreens: A review.

Although solar exposure is necessary for human health, phototoxicology induced by excessive UVB and UVA radiation, which involves sunburns, skin aging and even tumorigenesis, has been widely researched. Sunscreen is one of the most important ways to protect skin from UV phototoxic damage. As well as inorganic and organic UV filters, some natural products or plant extracts with aromatic rings in their structures, such as flavonoids or polyphenols, can absorb UV to reduce sunburn, acting as a natural UV filter; they also show antioxidant or/and anti-inflammatory activity. This could explain why, although there are no officially approval natural commercial sun-filters, more and more commercial sunscreen products containing plant extracts are available on the market. Here we summarize articles focusing on natural UV filters from plant published in the last 6 years, selecting the most significant data in order to better understand the photoprotective activity of natural products and extracts from plants, including their major constituents and main biological effects, methods for evaluating UV radiation resistance, anti-UV radiation experimental models and anti-UV radiation mechanisms.

Clinical study of Asian skin changes after application of a sunscreen formulation containing grape seed extract.

BACKGROUND: Asian skin undergoing chronological aging, accumulates signs of photoaging mediated by prolonged exposure to ultraviolet (UV) radiation. Although sunscreens are effective in preventing signs of photoaging, polyphenol-rich extracts, for example, grape seed extract (GSE) can provide additional protection through the broad spectrum of biological activities. AIMS: To access the effectiveness of a sunscreen formulation containing GSE as an important cosmetic ingredient for the improvement of age-related changes in Asian skin using noninvasive evaluation techniques. METHODS: Noninvasive methods were used to assess changes in the biophysical properties corresponding to aging signs including melanin and erythema indices, color parameters of the CIE L*a*b* system, elasticity, and hydration of the forearm skin before and after applying the sunscreen with GSE. In addition, to confirm the effectiveness of the tested product, we compared it with benchmark sunscreen, and a cream base containing either GSE or UV filters. RESULTS: Twice-daily application of sunscreen containing 3% GSE significantly reduced the level of melanin and erythema and improved overall skin tone. The hydration was drastically increased after 3 h of wearing formulation and was maintained relatively high for 5 h. Skin elasticity parameters, including Young's modulus, retraction time, and viscoelasticity, improved in participants of all age categories (35-59 years). Moreover, sunscreen with GSE, as acclaimed by participants, improved overall skin appearance. CONCLUSIONS: The balancing potential of GSE on the skin, combined with the photoprotective properties of UV filters demonstrated an added value as an anti-aging agent and proved efficacy for both photo- and chronologically-aged Asian skin.

Photoprotection for all: Current gaps and opportunities.

The effects of solar radiation on human skin differ based on the skin phototype, presence or absence of photodermatoses, biologic capacity to repair DNA damage, wavelength, intensity of sun exposure, geographic latitude, and other factors, underscoring the need for a more tailored approach to photoprotection. To date, the focus of photoprotection guidelines has been to prevent sunburn and DNA damage induced by UV radiation, both UVB and UVA; however, several recent studies have shown that visible light also generates reactive oxygen and nitrogen species that can contribute to skin damage and pigmentation on the skin, particularly in people with skin of color. Therefore, individuals with dark skin, while naturally better protected against UVB radiation by virtue of the high eumelanin content in melanocytes, may need additional protection from visible light-induced skin damage. The current options for photoprotection products need to expand, and potential strategies against visible light include the addition of iron oxide, titanium dioxide, and biologically relevant antioxidants to sunscreen formulations as well as supplementation with orally active antioxidants.

Prevalence of vitamin D deficiency and its associated risk factors among rural population of the northern part of the Persian Gulf.

BACKGROUND: Accumulating evidence indicates that vitamin D deficiency has been increased globally over the last two decades. However, the majority of these studies are concerned with cities and there is scant information regarding the prevalence of vitamin D in rural areas. The main aim of this study was to investigate the prevalence of vitamin D deficiency and its associated risk factors among the rural population in Bushehr province which shares the longest border with the Persian Gulf. METHODS: The rural inhabitants of more than 25 years old from three mountainous, plain, and seashore areas of Bushehr province were selected through a stratified multi-cluster random sampling method. After obtaining the participants' demographic and anthropometric data and their past medical history, serum 25-hydroxyvitamin D [25(OH)D] was measured using ELISA. RESULTS: A total of 1806 (means ±SD, 46± 14years old) rural subjects (35 % males and 65 % females) participated in this study. The prevalence of vitamin D deficiency, insufficiency, and sufficiency were 28 %, 50 %, and 22 %, respectively. The deficiency of vitamin D in women was higher than in men (OR=1.27, 95 % CI: 1.05 to 1.54, P=0.04). There was a positive significant correlation between age and serum vitamin D levels. Men with vitamin D deficiency had higher BMI (P=0.008); this association was not observed among women (P=0.7). There was no significant difference between the food item's consumption frequencies, and vitamin D status (P>0.05). The mountainous, and plain areas had the highest and lowest vitamin D levels, respectively. CONCLUSIONS: Although, Bushehr province is located in a sunny part of Iran, the prevalence of vitamin D deficiency was high among its rural population. The shift of their lifestyle patterns and rapid industrialization in these rural areas may be responsible. Therefore, the enrichment of dietary sources with vitamin D and the use of vitamin D supplements are recommended to tackle the high prevalence of vitamin D deficiency in the rural population of the northern part of the Persian Gulf.

Immunopathogenesis and management of polymorphic light eruption.

Polymorphic light eruption (PLE) is the most common immunologically mediated photodermatosis, demonstrating many abnormalities caused by critical failure of ultraviolet (UV)-induced immunosuppression. The unique expression of antimicrobial peptides in PLE, which is most likely determined by alteration of microbiome components upon UV exposure, implicates their possible triggering role and pathogenic significance in the eruption. The review aims to clarify current knowledge regarding the immunological disturbances correlated with PLE that serve a base for better understanding of molecular pathogenesis of the disease and the development of new therapeutic strategies. Preventive treatment with broad-spectrum suncreens and sunscreens containing DNA repair enzymes, as well as natural photohardening with graduate exposure to sunlight in early spring could be sufficient in milder cases. Antioxidants and topical calcipotriol are promising approach for adjuvant prevention. Phototherapy, mainly with narrow band UVB rays, is more appropriate method in severe cases of the disease. The established treatment options for PLE include local and systemic glucocorticoids, systemic nonsedative antihistamines for itch relief, and rarely, immunosuppressive drugs in the refractory cases. Like medical photohardening, afamelanotide has the potential of photoprotection by inducing a melanization of the skin. Afamelanotide is believed to be a possible new treatment option for very severe and refractory cases of PLE. Targeting the main pruritogenic cytokine, IL-31, opens a new road for the development of novel therapeutic approaches to combat moderate and severe itching in cases of PLE with intense pruritus.

From Sea to Skin: Is There a Future for Natural Photoprotectants?

In the last few decades, the thinning of the ozone layer due to increased atmospheric pollution has exacerbated the negative effects of excessive exposure to solar ultraviolet radiation (UVR), and skin cancer has become a major public health concern. In order to prevent skin damage, public health advice mainly focuses on the use of sunscreens, along with wearing protective clothing and avoiding sun exposure during peak hours. Sunscreens present on the market are topical formulations that contain a number of different synthetic, organic, and inorganic UVR filters with different absorbance profiles, which, when combined, provide broad UVR spectrum protection. However, increased evidence suggests that some of these compounds cause subtle damage to marine ecosystems. One alternative may be the use of natural products that are produced in a wide range of marine species and are mainly thought to act as a defense against UVR-mediated damage. However, their potential for human photoprotection is largely under-investigated. In this review, attention has been placed on the molecular strategies adopted by marine organisms to counteract UVR-induced negative effects and we provide a broad portrayal of the recent literature concerning marine-derived natural products having potential as natural sunscreens/photoprotectants for human skin. Their chemical structure, UVR absorption properties, and their pleiotropic role as bioactive molecules are discussed. Most studies strongly suggest that these natural products could be promising for use in biocompatible sunscreens and may represent an alternative eco-friendly approach to protect humans against UV-induced skin damage.

MMP-9 and IL-1ß as Targets for Diatoxanthin and Related Microalgal Pigments: Potential Chemopreventive and Photoprotective Agents.

Photochemoprevention can be a valuable approach to counteract the damaging effects of environmental stressors (e.g., UV radiations) on the skin. Pigments are bioactive molecules, greatly attractive for biotechnological purposes, and with promising applications for human health. In this context, marine microalgae are a valuable alternative and eco-sustainable source of pigments that still need to be taken advantage of. In this study, a comparative in vitro photochemopreventive effects of twenty marine pigments on carcinogenic melanoma model cell B16F0 from UV-induced injury was setup. Pigment modulation of the intracellular reactive oxygen species (ROS) concentration and extracellular release of nitric oxide (NO) was investigated. At the cell signaling level, interleukin 1-ß (IL-1ß) and matrix metallopeptidase 9 protein (MMP-9) protein expression was examined. These processes are known to be involved in the signaling pathway, from UV stress to cancer induction. Diatoxanthin resulted the best performing pigment in lowering MMP-9 levels and was able to strongly lower IL-1ß. This study highlights the pronounced bioactivity of the exclusively aquatic carotenoid diatoxanthin, among the others. It is suggested increasing research efforts on this molecule, emphasizing that a deeper integration of plant ecophysiological studies into a biotechnological context could improve the exploration and exploitation of bioactive natural products.

Children of the Sun: a historical look at how pediatric light therapy shaped attitudes and behaviors toward sunbathing.

Today, parents are warned to protect their children from the sun's ultraviolet (UV) rays, the most preventable and leading cause of skin cancer. Yet, during the first half of the 20th century, the medical community widely extolled the health benefits of daily sunbaths for babies and children. What initially had begun as evidence-based medical therapies to prevent pediatric diseases, specifically tuberculosis and rickets, soon took on a life of its own as physicians, public health experts, and the general public embraced sunbathing and tanning as a means to ensure health and wellbeing for children and families. Here, we trace how specific medical therapies entered mainstream pediatric medicine and, converging with societal and cultural forces, shaped attitudes and behaviors towards sunbathing that still exist today. Understanding our complex history with the sun may shed light on the current peak of skin cancer incidence and future disease development. Moreover, it may help improve how we educate parents and children about sun safety by taking into account the current social and cultural context of medical practice and health communication.

Safe, mild ultraviolet-B exposure: An essential human requirement for vitamin D and other vital bodily parameter adequacy: A review.

The enigma of skin sunburning, skin ageing and skin cancer and essential vitamin D production both resulting from solar ultraviolet-B (280-315 nm) (UVB) exposure has long puzzled photobiologists. Advice to patients by non-photobiological clinicians is now often to sunbathe to acquire vitamin D adequacy. However, modern work shows only mild UVB exposure is needed to maintain satisfactory levels, which have been demonstrated as very similar in summer and winter from about 25° to 70° north. Even very careful high protection factor 15 sunscreen use does not prevent adequate production, although it is slightly reduced, such that obsessive use of very protective screens of 50 + might. Dark skin pigmentation too usually at most minimally impairs production. However, confinement indoors and widespread clothing cover can, but oral supplementation overcomes any such deficiency. Thus, vitamin D adequacy needs just mild regular UVB skin exposure well under sunburning levels, unlikely to cause significant skin damage. This suggests mild UVB exposure may also be needed for other bodily requirements, which is indeed so. Thus, it also prevents the development of contact dermatitis and polymorphic light eruption through suppressing adaptive immunity. It also prevents the occurrence of multiple skin infections resulting from this suppression through stimulating innate immunity and cutaneous bacterial defensin production. Finally, blood pressure is reduced through low-dose UVB-induced production of the vasodilator nitric oxide (though UVA, 315-400 nm, is more efficient). Thus, mild UVB exposure is important for several aspects of internal health, whereas high-dose exposure is extremely detrimental to cutaneous health.

Efficacy of 577 nm pro-yellow laser in the treatment of melasma: a prospective split-face study.

We aimed to study the effectiveness of 577 nm pro-yellow laser in the treatment of melasma. A total of 82 patients with melasma were included in this comparative study. A detailed medical history, examination, and calculation of Melasma Area and Severity Index were done for all patients. All participants were treated with topical sunscreen and hydroquinone 4% cream on both sides of the face. In addition, the left side of the face was subjected to a single pass of 577-nm pro-yellow laser at a monthly interval for three sessions. Follow up was done by comparing the Melasma area and severity index at 0, 3 and 6 months. At baseline, there is no significant difference in the Melasma area and severity index score between both sides of the face. At 3 months, MASI score was statistically significantly decreased on both sides of the face compared to pretreatment (P < .05). At 6 months, the mean MASI score at the laser-treated side was statistically significantly decreased compared to the non-laser-treated side (P < .05). we concluded that the addition of 577 nm pro-yellow laser in the treatment of melasma leads to maintain the improvement and reduction of the recurrence rate.

The effects of UVB irradiance on vitiligo phototherapy and UVB-induced photocarcinogenesis.

Phototherapy is the most commonly used modality for repigmenting vitiligo. Currently, UVB emitting devices, including narrow-band UVB (NBUVB) and excimer laser/light, are considered as the treatment of choice. While emitting wavelengths at close proximity, excimer lights emit higher irradiance (HI; W/m2 ) compared to NBUVB. Clinical reports have shown that excimer light is more efficacious in treating vitiligo compared to NBUVB, and we demonstrated that irradiance plays a critical role in promoting melanoblasts differentiation. UVB radiation from the sun is closely associated with photocarcinogenesis of the skin. Sunscreens were used to protect the skin by reducing UVB irradiance (low irradiance (LI) UVB). Sunscreen use was associated with skin cancer reduction in clinical trials. Paradoxically, sunscreen use was associated with increased sunburn episodes in the real-world settings. It was shown that UVB-induced sunburn depends on fluence (J/m2 ) but not irradiance of UVB radiation. We investigated the significance of irradiance in the context of UVB-induced carcinogenesis of the skin. For mice receiving equivalent fluence of UVB exposure, the LIUVB-treated mice showed earlier tumor development, larger tumor burden, and more epidermal keratinocytes harboring mutant p53 as compared to their HIUVB-treated counterparts. These results suggested that at equivalent fluence, LIUVB radiation has more photocarcinogenic potential on the skin compared to its HI counterpart. Since development of sunburn with or without sunscreen use indicates that certain threshold of UVB fluence has been received by the skin at LI and HI, respectively, sunburn episodes with sunscreen use (LIUVB) are more damaging to the skin compared to that without sunscreen (HIUVB) application. In summary, since irradiance plays an important role determining the biological effects of UVB radiation on the skin, future related studies should take this critical parameter into consideration.

Relationship between sun safety behaviours and modifiable lifestyle cancer risk factors and vitamin D levels.

BACKGROUND: Sun exposure is the most important environmental risk factor for causing skin cancer. PURPOSE: This study examines the relationship between sun protection behaviours and modifiable lifestyle risk factors for other cancers as well as vitamin D levels. METHODS: Cross-sectional data were analysed from two large national health surveys (n = 31, 445 and n = 5604). Sun exposure and protection were characterized by the presence of sunburn, duration of sun exposure, frequency of seeking shade, frequency of wearing a hat and frequency of wearing sunscreen. Using Statistical Analysis System (SAS) software 9.3.1, multivariate logistic regression models were compiled. RESULTS: Unhealthy behaviour practices were associated with sunburns or infrequent sun protection behaviour, such as cigarette consumption (either current or former smokers), second-hand smoke exposure, not having a regular doctor, higher level of alcohol consumption, street drug usage and low levels of fruit/vegetable consumption. Approximately one-quarter of individuals had less than the recommended value of serum vitamin D levels (<50 nmol/L), despite 39.2% of these individuals reporting ≥1 hour of sun exposure. CONCLUSION: Modifiable lifestyle risk factors for other cancers are correlated with infrequently practicing sun protection behaviours for skin cancer prevention. Therefore, cancer prevention campaigns can aim to target all these risk factors associated with different cancers. Sun exposure is not a reliable source to obtain recommended vitamin D levels and that other sources (eg. fish, egg yolk, fortified drinks and supplements) are a safer and more reliable option.

What's New in Melanoma.

Melanoma is rapidly evolving because of advances in noninvasive diagnosis, targeted therapies, and improved prognostic methods. This article discusses what is new in melanoma risk factors, prevention, clinical management, and targeted treatment. The incidence continues to increase worldwide, whereas mortality is steadily improving. This trend reinforces the importance of dermatologists comprehensively understanding all aspects of melanoma. Further research is needed to continue making a material impact on outcomes for patients.

What's New in Pigmentary Disorders.

Pigmentary disorders are common and can be very distressing to patients. There is a need for better, standardized therapies. The authors review the most recent data for topical, systemic, light, and laser treatments for vitiligo, melasma, and postinflammatory hyperpigmentation. There is a paucity of large-scale, well-designed, randomized, controlled trials for these treatments. Treatment options are often drawn from smaller trials and case series. The treatments described in this article are promising candidates for larger follow-up studies.

Skin cancer prevention: a review of current topical options complementary to sunscreens.

The incidence of non-melanoma skin cancer (NMSC) is dramatically increasing worldwide, despite the increased use of improved sunscreens. In 2014, the Surgeon General estimated that 2.2-5.0 million people were treated annually for NMSC. As the number of newly diagnosed skin cancers continues to rise, there is a need for additional preventative measures beyond sunscreens. Several newer topical products that focus on boosting DNA repair, modulating DNA transcription, decreasing inflammation and selectively targeting precancerous cells may play an important role in future skin cancer prevention.