Ethanol consumption synergistically increases ultraviolet radiation induced skin damage and immune dysfunction.

BACKGROUND: Excessive UV radiation disrupts skin homeostasis by multiple mechanisms that extend beyond the simple erythema associated with sunburns including reduction of antioxidants, increased DNA damage, and impairment of skin immune responses. Recreational UV exposure frequently occurs concurrently with excessive ethanol (EtOH). Epidemiological studies suggest a harmful, dose-dependent impact of EtOH in the setting of high UV exposure, leading to increased severity of sunburns relative to those generated in the absence of EtOH. Furthermore, EtOH consumption and UV radiation have multiple overlapping effects on the skin that could account for the epidemiological association. OBJECTIVE: To elucidate the relationship between excessive EtOH ingestion and UV exposures on early skin damage and downstream immune dysfunction. METHODS: We examined the impact of UVB on local skin damage, including inflammation, sunburned cells, apoptotic cells, melanin and antioxidant levels, DNA damage and immune dysfunction in the presence or absence of EtOH ingestion by combining standard mouse models of EtOH consumption and UVB exposure models. To confirm that the observed changes in mouse skin were relevant to human skin, we investigated the effects of EtOH on UV-induced skin damage with human skin explants. RESULTS: We demonstrated that EtOH consumption and UV exposure act synergistically to increase the severity of local skin damage resulting in impaired melanin responses, reduced antioxidants, greater DNA damage, and immune dysfunction as measured by reduced contact hypersensitivity. CONCLUSIONS: The results support incorporation of the risks of combined UV exposure and excessive alcohol consumption into public health campaigns.

Trends in emergency department visits due to sunburn and factors associated with severe sunburns in the United States.

Little is known regarding the burden of sunburns leading to emergency department (ED) visits in the United States (US). The objectives of this research were to characterize the burden of sunburn ED visits, investigate predictors of severe sunburns, and evaluate risk factors for increased cost of care in patients presenting to the ED for sunburn. In this nationally representative cross-sectional study of the National Emergency Department Sample (NEDS, 2013-2015), multivariable models were created to evaluate adjusted odds for sunburn ED visits, seasonal/regional variation in sunburn ED visits, adjusted odds for second and third degree sunburns, and risk factors for increased ED expenditure. 82,048 sunburn ED visits were included in this study. On average, the cost of care for a sunburn ED visit was $1132.25 (± $28.69). The prevalence and cost of ED visits due to sunburn increased during the summer months. Controlling for sociodemographic factors, comorbidities, and hospital characteristics, patients presenting to the ED for all sunburns (and for severe sunburns) were most likely to be lower income young adult men. Older, higher income patients in metropolitan hospitals had more expensive ED visits. This research provides nationally representative estimates of visits to the ED due to sunburn in the US, as well as evaluates determinants for severe sunburns and more expensive sunburn ED visits. Ultimately, characterizing the national burden of ED visits due to sunburn is critical in the development of interventions to reduce the impact of sunburn ED visits on the US healthcare system.

Effects of oligomeric proanthocyanidins (OPCs) of red wine to improve skin whitening and moisturizing in healthy women - a placebo-controlled randomized double-blind parallel group comparative study.

OBJECTIVE: This study was undertaken to evaluate the effects of red wine from grapes oligomeric procyanidins (OPCs) intake on skin color and skin moisture in Japanese healthy women. The purpose of this study was to improve skin condition, with the primary endpoint set to improve sunburn by ultraviolet (UV) and the secondary endpoint set to improve dryness. PATIENTS AND METHODS: A randomized, placebo-controlled, double-blind, parallel-group study was conducted on 100 subjects (30 to 59 years of age). They were administered a test beverage, including 200 mg of the red wine OPCs (the test beverage group) or a placebo beverage (the control beverage group) once a day for 12 weeks. The properties of facial skin were measured at 0 (start value), 4th, 8th, and 12th week of the test period. RESULTS: After 12 weeks of administration, the pigmentation scores and melanin index values of the OPC group were significantly reduced from the start value and were lower than the control group (p<0.05). In addition, the OPC group showed a significant increase in water content of the stratum corneum compared to the start value, while that of the control group significantly decreased. CONCLUSIONS: The red wine OPCs showed the effects of skin whitening and moisturizing, and it is suggested that OPCs may improve the skin condition of healthy women.

Primary Language in Relation to Knowledge of Diagnosis and Sun-Related Behaviors in Adults with Sun-Exacerbated Dermatoses.

OBJECTIVE: To evaluate how patients' primary spoken language influences the understanding of their disorder and their subsequent sun-related behaviors. METHODS: This was a cross-sectional study conducted between February 2015 and July 2016 in two outpatient dermatology clinics among 419 adults with a sun-exacerbated dermatosis. The primary outcome was a successful match between the patient-reported diagnosis on a survey and the dermatologist-determined diagnosis. RESULTS: Of participants, 42% were native English speakers, and 68% did not know their diagnosis. Fewer non-native English speakers identified one risk factor for their condition (46% versus 54%, p < 0.01). A greater number of non-native English speakers were less familiar with medical terminology. Native English speakers were 2.5 times more likely to know their diagnosis compared to non-native speakers (adjusted odds (aOR) 2.5, 95% confidence interval, 1.32 to 4.5; p = 0.005). Additional factors associated with higher odds of knowing the diagnosis included: Higher education, sunscreen use, female gender, symptoms for 1-5 years, and diagnosis of melasma and postinflammatory hyperpigmentation (PIH). CONCLUSIONS: Knowledge of the diagnosis and understanding of factors that may influence skin disease may promote conscious sun behavior. Patients who knew that their diagnosis was sun-exacerbated had higher odds of wearing sunscreen.

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.

Assessment of Predictors of Sun Sensitivity as Defined by Fitzpatrick Skin Phototype in an Ecuadorian Population and Its Correlation with Skin Damage.

BACKGROUND: The Fitzpatrick skin phototype scale (FSPTS) is a widely used instrument to assess skin type. METHODS: A cross-sectional survey collected responses from 254 subjects from Quito regarding self-reported FSPTS, gender, age, education, and tobacco and alcohol consumption. Univariate and multivariate logistic regression analyses were performed to determine if ethnicity, hair color, and eye color significantly predict FSPTS. In addition, we studied the correlation between FSPTS and the SCINEXA scale with Pearson's correlation coefficient. RESULTS: Ethnicity, eye color, and hair color are significant independent predictors of FSPTS (p < 0.0001). CONCLUSIONS: Patient self-reported race and pigmentary phenotypes are inaccurate predictors of sun sensitivity as defined by Fitzpatrick skin phototype. Our study does not fully represent the population of the country. There are limitations to using patient-reported race and appearance in predicting individual sunburn risk.

Future reduction of cutaneous malignant melanoma due to improved sun protection habits and decreased common melanocytic nevi density among Swedish children?: A follow-up from 2002 to 2012.

We have previously demonstrated significant improvements in sun protection regimens and significantly fewer common melanocytic nevi (CMN) among 7-year-old children in southern Sweden when comparing year 2007 with 2002. The aim of this study was to investigate whether the observed decreasing trend also can be observed at age 10 and, in addition, to compare the CMN density change between 7 and 10 years of age during two periods of time. Two open cohorts were used, cohort I with schoolchildren investigated in 2002 at age 7 and in 2005 at age 10 and cohort II with schoolchildren investigated in 2009 at age 7 and in 2012 at age 10. A significant decrease in CMN density (number/m2 BSA) at age 10 from 2005 to 2012 was observed: 15.9 (14.7-17.2) and 11.4 (10.1-12.7), respectively. The density growth rate from 7 to 10 years was 2.8 (2.1-3.5) between 2002 and 2005 and decreased significantly to 0.9 (0.2-1.5) between 2009 and 2012. Significant increases were observed for 'often use of sunscreen', 'often staying in shade' and 'often staying indoors' from cohort I to cohort II: 65 vs 80%, 7.6 vs 13% and 7.3 vs 19%, respectively. The decrease in number of CMN among 10-year-old children confirms a current trend in Sweden. If this persists, a future reduction of cutaneous malignant melanoma incidence in Sweden might be anticipated. The results also indicate that CMN count could be used as an indicator of ultraviolet exposure.

Treatment and Prevention of Pediatric Sunburn.

Skin cancer is the most common cancer in the United States, and risk for melanoma is greatly increased with a serious sunburn in childhood or adolescence. Skin cancer also is one of the most preventable cancers, as sun exposure is an almost entirely modifiable risk factor. Proper skin protection should start early in life when infants begin to be exposed to the outdoors. [Pediatr Ann. 2019;48(6):e213-e214.].

UV damage of the anterior ocular surface - microstructural evidence by in vivo confocal microscopy.

PURPOSE: To evaluate and describe the microstructural changes at the ocular surface in response to habitual ocular sun exposure, correlate them with the UV protection habits and follow their dynamics using in vivo confocal microscopy(ICM). METHODS: For a period of minimum 4 months 200 subjects (400 eyes), aged 28 ±â€¯7.3 years, were recruited with the agreement that they will spend their summer exclusively in the region of the Black Sea coast at 43 °N latitude and will be examined before and after the summer. All subjects filled in a questionnaire about habitual UV protection and were examined clinically and by ICM. RESULTS: Questionnaire results demonstrated that 83.5% (167 participants) of the subjects considered the sun dangerous for their eyes, but 78% (156 subjects) believed that there is danger exclusively during the summer period. Although no clinical changes were detected, microstructural analysis of the cornea demonstrated statistically significant (p = 0.021) decrease of the basal epithelial density - from 6167 ±â€¯151 cells/mm2 before to 5829 ±â€¯168 cells/mm2 after the summer period. Microstructural assessment of the conjunctiva demonstrated characteristic cystic lesions with dark centres and bright borders encountered in only 25 eyes(6%) before, and affecting 118 eyes(29.5%) after the summer. The total area of the cysts after the summer increased fivefold. Spearman analysis proved negative correlation between sun protection habits and number of cysts. CONCLUSION: Summer sun exposure for one season leads to clinically undetectable, microstructural changes affecting the cornea, bulbar and palpebral conjunctiva with transient, but possibly cumulative nature.

Psoriasis y quemaduras solares: a propósito de un caso / Psoriasis and sunburns: a case report

Caso clínico en el que se presenta un paciente con una quemadura solar en una pierna. El paciente presenta psoriasis en placas y está recibiendo tratamiento con corticoide tópico combinado con análogo de la vit D

In this case, a situation arises in which, in the presence of a skin pathology such as psoriasis, it may appear another health problem associated to the use of medication for the psoriasis treatment without the necessary care to minimise the sun effects

From UV Protection to Protection in the Whole Spectral Range of the Solar Radiation: New Aspects of Sunscreen Development.

Sunscreens have been constantly improving in the past few years. Today, they provide an efficient protection not only in the UVB but also in the UVA spectral region of the solar radiation. Recently it could be demonstrated that 50% of all free radicals induced in the skin due to solar radiation are formed in the visible and infrared spectral region. The good protective efficacy of sunscreens in the UV region prompts people to stay much longer in the sun than if they had left their skin unprotected. However, as no protection in the visible and infrared spectral region is provided, high amounts of free radicals are induced here that could easily exceed the critical radical concentration. This chapter describes how the effect of sunscreens can be extended to cover also the visible and infrared spectral region of the solar radiation by adding pigments and antioxidants with high radical protection factors to the sunscreen formulations.

Long-term Trend in Sunscreen Use among Beachgoers in Denmark.

This observational study examined the trend from the 1990s to 2016 of sunscreen use, sun protection factor (SPF) and quantity of sunscreen applied amongst beachgoers in Denmark. In 1997, 1998, 1999 and 2016, a total of 1,306 beachgoers were asked if they had used sunscreen on that day and, if so, which SPF. In 1992 and 2016 another 143 beachgoers had their sunscreen bottles weighed before and after application. The frequency of sunscreen use among women increased from 45% in 1997 to 78% in 2016, while the frequency of use among men increased from 39% to 49%. For both sexes the median SPF increased, on average, by one unit per year, from SPF 5 in 1997 to SPF 20 in 2016. The quantity of sunscreen applied increased from 0.48 mg/cm2 in 1992 to 0.57 mg/cm2 in 2016. Thus, the frequency of sunscreen use, the SPF, and the quantity of sunscreen applied have increased in the recent decades.

Oral Vitamin D Rapidly Attenuates Inflammation from Sunburn: An Interventional Study.

The diverse immunomodulatory effects of vitamin D are increasingly being recognized. However, the ability of oral vitamin D to modulate acute inflammation in vivo has not been established in humans. In a double-blinded, placebo-controlled interventional trial, 20 healthy adults were randomized to receive either placebo or a high dose of vitamin D3 (cholecalciferol) one hour after experimental sunburn induced by an erythemogenic dose of UVR. Compared with placebo, participants receiving vitamin D3 (200,000 international units) demonstrated reduced expression of proinflammatory mediators tumor necrosis factor-α (P = 0.04) and inducible nitric oxide synthase (P = 0.02) in skin biopsy specimens 48 hours after experimental sunburn. A blinded, unsupervised hierarchical clustering of participants based on global gene expression profiles revealed that participants with significantly higher serum vitamin D3 levels after treatment (P = 0.007) demonstrated increased skin expression of the anti-inflammatory mediator arginase-1 (P = 0.005), and a sustained reduction in skin redness (P = 0.02), correlating with significant expression of genes related to skin barrier repair. In contrast, participants with lower serum vitamin D3 levels had significant expression of proinflammatory genes. Together the data may have broad implications for the immunotherapeutic properties of vitamin D in skin homeostasis, and implicate arginase-1 upregulation as a previously unreported mechanism by which vitamin D exerts anti-inflammatory effects in humans.

UV adaptation: Pigmentation and protection against overexposure.

The skin is known to adapt to UV exposures, that is become less sensitive to sunburn. Reported decreases in sensitivity vary widely from well over 10-fold down to a negligible 10%. This appears to depend importantly on the UV irradiation spectrum to which the skin adapts and on the UV irradiation spectrum that is used to test the sensitivity. The sensitivity is conventionally and generally assessed by the reciprocal of the minimal erythema dose (MED): the UV dose causing a just perceptible reddening of the skin after 8-24 hours. However, MED is much too subtle for everyday life: people will not notice a minimal reddening and commonly consider themselves sunburnt at considerably higher UV doses causing an intense reddening. Levels of adaptation of a well-tanned skin may be substantially higher at these more intense levels of reddening than MED levels. This expectation is based on the fact that people with a constitutively coloured skin may show moderate differences in MED compared with fair-skinned people but far less steep increases in reddening with overexposures to solar-simulated radiation (SSR). UVA exposure is known to enhance pigmentation and may thus be important in protection against overexposure to SSR.

Sun Protection by Beach Umbrella vs Sunscreen With a High Sun Protection Factor: A Randomized Clinical Trial.

Importance: Sun-protective behavior affects skin cancer prevention. Shade works by physically shielding skin from direct harmful UV rays; however, skin may still remain exposed to reflected and indirect UV rays. There is no current standard metric to evaluate shade for its effectiveness in sun protection, and there is insufficient clinical evidence that a beach umbrella alone can provide adequate sun protection. Objective: To directly measure sunburn protection offered by a standard beach umbrella compared with that provided by sunscreen with a high sun protection factor under actual use conditions. Design, Setting, and Participants: A single-center, evaluator-blinded, randomized clinical study was conducted from August 13 to 15, 2014, in Lake Lewisville, Texas (elevation, 159 m above sea level), among 81 participants with Fitzpatrick skin types I (n = 1), II (n = 42), and III (n = 38). Participants were randomly assigned to 2 groups: 1 using only a beach umbrella, and the other using only sunscreen with a sun protection factor of 100. All participants remained at a sunny beach for 3½ hours at midday. Clinical sunburn evaluation of each individual for all exposed body sites was conducted 22 to 24 hours after sun exposure. Interventions: The shade provided by a beach umbrella or protection provided by sunscreen with a sun protection factor of 100. Main Outcomes and Measures: Sunburn on all exposed body sites 22 to 24 hours after sun exposure. Results: Among the 81 participants (25 male and 56 female; mean [SD] age, 41 [16] years) for all body sites evaluated (face, back of neck, upper chest, arms, and legs), the umbrella group showed a statistically significant increase in clinical sunburn scores compared with baseline and had higher postexposure global scores than the sunscreen group (0.75 vs 0.05; P < .001). There was a total of 142 sunburn incidences in the umbrella group vs 17 in the sunscreen group. Thirty-two of the 41 participants (78%) in the umbrella group showed erythema in 1 or more sites vs 10 of the 40 participants (25%) in the sunscreen group (P < .001). Neither umbrella nor sunscreen alone completely prevented sunburn. Conclusions and Relevance: A beach umbrella alone may not provide sufficient protection for extended UV exposure. It is important to educate the public that combining multiple sun protection measures may be needed to achieve optimal protection. Trial Registration: isrctn.org Identifier: ISRCTN19177299.

Identifying people at higher risk of melanoma across the U.K.: a primary-care-based electronic survey.

BACKGROUND: Melanoma incidence is rising rapidly worldwide among white populations. Defining higher-risk populations using risk prediction models may help targeted screening and early detection approaches. OBJECTIVES: To assess the feasibility of identifying people at higher risk of melanoma using the Williams self-assessed clinical risk estimation model in U.K. primary care. METHODS: We recruited participants from the waiting rooms of 22 general practices covering a total population of > 240 000 in three U.K. regions: Eastern England, North East Scotland and North Wales. Participants completed an electronic questionnaire using tablet computers. The main outcome was the mean melanoma risk score using the Williams melanoma risk model. RESULTS: Of 9004 people approached, 7742 (86%) completed the electronic questionnaire. The mean melanoma risk score for the 7566 eligible participants was 17·15 ± 8·51, with small regional differences [lower in England compared with Scotland (P = 0·001) and Wales (P < 0·001), mainly due to greater freckling and childhood sunburn among Scottish and Welsh participants]. After weighting to the age and sex distribution, different potential cut-offs would allow between 4% and 20% of the population to be identified as higher risk, and those groups would contain 30% and 60%, respectively of those likely to develop melanoma. CONCLUSIONS: Collecting data on the melanoma risk profile of the general population in U.K. primary care is both feasible and acceptable for patients in a general practice setting, and provides opportunities for new methods of real-time risk assessment and risk stratified cancer interventions.

Retinopatía solar bilateral. Autofluorescencia y tomografía de coherencia óptica / Bilateral solar retinopathy. Autofluorescence and optical coherence tomography

CASO CLÍNICO: Varón de 33 años, que refiere disminución de agudeza visual bilateral desde hace 5 años. No presenta antecedentes de interés. Militar de profesión y probable exposición ocular solar previa. Se aprecian en el fondo de ojo lesiones pigmentadas focales maculares, con alteración de la capa de los fotorreceptores a nivel foveal, evidenciada por tomografía de coherencia óptica (OCT) en varios sectores de la fóvea. DISCUSIÓN: La retinopatía solar está asociada a profesiones con exposición solar de riesgo. El diagnóstico está basado en la autofluorescencia y OCT macular que nos va a aportar datos fundamentales para establecer la causa

CASE REPORT: A 33-year-old man referred decreased bilateral visual acuity for five years, with no history of interest. Military profession and probably previous sun exposure. Focal pigmented lesions in the macular area of the fundus were observed, with impairment of the photoreceptor layer in the fovea, observed by optical coherence tomography (OCT), in various sectors of the fovea. DISCUSSION: Solar retinopathy is associated with professions at risk of sun exposure. The diagnosis is based on autofluorescence and macular OCT, that later will provide key data to establish the cause