Sunscreen photoprotection and vitamin D status Passeron, T.; Bouillon, R.; Callender, V. ...
British journal of dermatology (1951),
November 2019, 2019-11-00, 20191101, Letnik:
181, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Summary
Background
Global concern about vitamin D deficiency has fuelled debates on photoprotection and the importance of solar exposure to meet vitamin D requirements.
Objectives
To review the ...published evidence to reach a consensus on the influence of photoprotection by sunscreens on vitamin D status, considering other relevant factors.
Methods
An international panel of 13 experts in endocrinology, dermatology, photobiology, epidemiology and biological anthropology reviewed the literature prior to a 1‐day meeting in June 2017, during which the evidence was discussed. Methods of assessment and determining factors of vitamin D status, and public health perspectives were examined and consequences of sun exposure and the effects of photoprotection were assessed.
Results
A serum level of ≥ 50 nmol L−1 25(OH)D is a target for all individuals. Broad‐spectrum sunscreens that prevent erythema are unlikely to compromise vitamin D status in healthy populations. Vitamin D screening should be restricted to those at risk of hypovitaminosis, such as patients with photosensitivity disorders, who require rigorous photoprotection. Screening and supplementation are advised for this group.
Conclusions
Sunscreen use for daily and recreational photoprotection does not compromise vitamin D synthesis, even when applied under optimal conditions.
What's already known about this topic?
Knowledge of the relationship between solar exposure behaviour, sunscreen use and vitamin D is important for public health but there is confusion about optimal vitamin D status and the safest way to achieve this.
Practical recommendations on the potential impact of daily and/or recreational sunscreens on vitamin D status are lacking for healthy people.
What does this study add?
Judicious use of daily broad‐spectrum sunscreens with high ultraviolet (UV) A protection will not compromise vitamin D status in healthy people.
However, photoprotection strategies for patients with photosensitivity disorders that include high sun‐protection factor sunscreens with high UVA protection, along with protective clothing and shade‐seeking behaviour are likely to compromise vitamin D status.
Screening for vitamin D status and supplementation are recommended in patients with photosensitivity disorders.
Linked Comment: Bikle. Br J Dermatol 2019; 181:884.
Plain language summary available online
It has been generally believed that the four main causes of melasma are pregnancy, hormonal contraception, family history and sun exposure; however, there are few published comprehensive studies that ...confirm these assertions. The Pigmentary Disorders Academy - an international group of experts in pigmentary disorders - designed and conducted a global survey of women to investigate the effect of these factors on onset and chronicity of melasma and the course of the disease in order to gain a better understanding of the causative factors associated with this disorder, with a particular focus on hormonal factors and UV exposure in females.
A 40-item largely self-administered questionnaire was completed by 324 women being treated for melasma in nine clinics worldwide.
The mean age at onset of melasma was 34 years, and 48% of subjects questioned had a family history of melasma (97% in a first-degree relative). Subjects with family history of melasma tended to have darker skin (90% types III-VI) compared to those without (77% types III-VI). The most common time of onset was after pregnancy (42%), often years after the last pregnancy, with 29% appearing pre-pregnancy and 26% during pregnancy. Onset was related to darker skin type post-pregnancy (P = 0.002). Risk of onset during pregnancy was associated with having spent more time outdoors (an extra 10 h per week spent working outside increases the odds of onset of melasma during pregnancy by approximately 27%) and an increased maternal age at pregnancy (increased by approximately 8% for each year of age at first pregnancy; P = 0.02). The odds of melasma occurring for the first time during a pregnancy were also increased with multiple pregnancies (twice the odds if 2 vs. 1 pregnancies, three times higher if 3 or more vs. 1 pregnancy). Of the women, 25% who had used hormonal contraception claimed that melasma appeared for the first time after its use, the rate being higher for those without vs. with a family history.
The results suggest that, whilst accepted causes do affect onset of melasma, a combination of these factors often triggers this disorder. These factors may provide further insights into how physicians can manage individual melasma cases, support recommendation of preventative measures and even anticipate treatment results and recurrence.
Ozone therapy is a modestly invasive procedure based on the regeneration capabilities of low ozone concentrations and used in medicine as an alternative/adjuvant treatment for different diseases. ...However, the cellular mechanisms accounting for the positive effects of mild ozonization are still largely unexplored. To this aim, in the present study the effects of low ozone concentrations (1 to 20 µg O3/mL O2) on structural and functional cell features have been investigated in vitro by using morphological, morphometrical, cytochemical and immunocytochemical techniques at bright field, fluorescence and transmission electron microscopy. Cells exposed to pure O2 or air served as controls. The results demonstrated that the effects of ozoneadministration are dependent on gas concentration, and the cytoskeletal organization, mitochondrial activity and nuclear transcription may be differently affected. This suggests that, to ensure effective and permanent metabolic cell activation, ozone treatments should take into account the cytological and cytokinetic features of the different tissues.
Skin manifestations of obesity: a comparative study Boza, J.C.; Trindade, E.N.; Peruzzo, J. ...
Journal of the European Academy of Dermatology and Venereology,
10/2012, Letnik:
26, Številka:
10
Journal Article
Recenzirano
Background Obesity is one of the world’s biggest health problems nowadays. Little research has been done on the skin diseases that affect obese patients.
Objective To study the prevalence of skin ...manifestations in obese patients compared with a control group of normal‐weight patients.
Methods A total of 76 obese patients body mass index (BMI) ≥30 kg/m2 and 73 with normal‐weight volunteers (BMI 18.5–24.9 kg/m2) were included in the study and had their complete medical history and skin examination evaluated by the same examiner. All patients were investigated for the presence of metabolic syndrome.
Results The dermatoses that showed a statistically significant relationship with obesity, compared with the control group were: striae (P < 0.001), plantar hyperkeratosis (P < 0.001), acrochordons (P = 0.007), intertrigo (P < 0.001), pseudoacanthosis nigricans (P < 0.001), keratosis pilaris (P = 0.006), lymphedema (P = 0.002) and bacterial infections (P = 0.05). The presence of striae, pseudoacanthosis nigricans and bacterial infections were also found to be correlated with the degree of obesity.
Conclusions Obesity is strongly related to several skin alterations that could be considered as markers of excessive weight. Skin care of obese patients deserves particular attention, not only because of the high prevalence of cutaneous alteration but mainly because many of these disorders are preventable and could be treated, improving patient’s quality of life.
Objectives
This study compares the osseointegration of machined‐zirconia implants containing yttria (M‐Y‐TZP) with machined (M‐Ti) and resorbable blast media (RBM‐Ti) titanium implants.
Material and ...Methods
M‐Y‐TZP, M‐Ti and RBM‐Ti implants were randomly placed in rabbit tibiae. Fluorochrome bone labels (tetracycline, alizarin and calcein) were administered at different time periods. After 8 weeks, osseointegration was evaluated in terms of bone‐to‐implant contact (BIC), new bone area (nBA), remaining cortical bone area (rBA) and temporal quantification of fluorochromes, using micro‐CT and histomorphometric analyses.
Results
RBM‐Ti implants showed higher resorption of the remaining cortical bone and bone formation (rBA = 36.9% and nBA = 38.8%) than M‐Y‐TZP implants (rBA = 48% and nBA = 26.5%). The BIC values showed no differences among the groups in the cortical region (mean = 52.2%) but in the medullary region, they were 0.45‐fold higher in the RBM‐Ti group (51.2%) than in the M‐Y‐TZP group (35.2%). In all groups, high incorporation of tetracycline was observed (2nd to 4th weeks), followed by alizarin (4th to 6th weeks) and calcein (6th to 8th weeks). In the cortical region, incorporation of tetracycline was similar between RBM‐Ti (49.8%) and M‐Y‐TZP (35.9%) implants, but higher than M‐Ti (28.2%) implants. Subsequently, alizarin and calcein were 1.1‐fold higher in RBM‐Ti implants than in the other implants. In the medullary region, no significant differences were observed for all fluorochromes.
Conclusion
All implants favored bone formation and consequently promoted primary stability. Bone formation around the threads was faster in RBM‐Ti and M‐Y‐TZP implants than in M‐Ti implants, but limited bone remodeling with M‐Y‐TZP implants over time can have significant effects on secondary stability, suggesting caution for its use as an alternative substitute for titanium implants.
Summary
Background Pigmentation disorders, such as melasma, greatly influence the quality of life (QoL) of affected individuals who usually consider the disorder to be more severe than the objective ...clinical scores. Several instruments have been successfully developed to evaluate QoL. However, they must be adapted to the target population in terms of language and cultural diversity. The first, specific QoL questionnaire for melasma (MelasQoL) was developed for English speaking patients.
Objectives To validate the Brazilian Portuguese version of the MelasQoL evaluation questionnaire for patients with melasma (MelasQoL‐BP) and to assess the impact of treatment with a triple combination cream (hydroquinone, fluocinolone acetonide and tretinoin) on the QoL of patients with moderate‐to‐severe melasma.
Methods and Results Three hundred individuals from the five Brazilian geographic regions took part in this multicentre study. Their mean age was 42 years and skin phototype distribution was: type II 7·0% of patients, III 23·7%, IV 42·7% and V 22·7%. Melasma Area and Severity Index (MASI), MelasQoL‐BP and the short version of the QoL assessment instrument from the World Health Organization (WHOQOL‐BREF) were used to assess melasma severity and QoL at baseline. MelasQoL‐BP was previously translated and culturally adapted from the English version, with participation of the authors and according to the standards of the World Health Organization (WHO). From the original sample, we randomized150 volunteers to treat melasma and repeated the evaluation after 8 weeks. The analysis of the MelasQoL‐BP baseline answers demonstrated an important impact of the disease on skin appearance (65% of patients were bothered all the time or most of the time), frustration (55%), embarrassment (57%) and influence of the disease on interpersonal relationships (42%). Forty‐three per cent of patients felt not attractive or even dirty due to their skin condition. MelasQoL‐BP results showed significant internal consistency (Cronbach's alpha coefficient 0·919; P < 0·001) and good correlation with MASI scores. After treatment, the global assessment showed good or excellent results in 91·4% of the patients. The clinical outcome was not associated with the initial MASI score (P = 0·814; chi‐square), skin colour (P = 0·449; probability ratio) or skin pigmentation (P = 0·814; chi‐square). There was also a significant reduction on MelasQoL‐BP scores (Wilcoxon test; P < 0·001) after treatment, with the mean ± SD results shifting from 44·4 ± 14·9 at baseline to 24·3 ± 15·5 after treatment. The analysis of the MelasQoL‐BP before and after treatment showed an important effect of the impact of treatment on a number of QoL measures. Of note, skin appearance (69·8 vs. 10·1% of patients were bothered all the time or most of the time, respectively), frustration (59·7% vs. 12·2%, respectively), embarrassment (56% vs. 9·3%, respectively) and influence of the disease on interpersonal relationships (35·3% vs. 5·8%, respectively) were greatly improved.
Conclusions This study demonstrates that MelasQoL‐BP is a valid instrument and can be used to evaluate the quality of life and response to melasma treatment in Brazilian patients. The triple combination treatment produced significant results, regarding both clinical severity and quality of life.
Summary
Background
Systemic sclerosis (SSc) is characterized by target‐organ fibrosis and microvascular dysfunction, which can be assessed using nailfold capillaroscopy. Dermoscopy is a useful and ...easily performed method for diagnosing skin lesions.
Aim
To compare conventional capillaroscopy, using the gold‐standard method (conventional stereomicroscope nailfold capillaroscopy; SNFC), with polarized light noncontact dermoscopy (PNCD) and nonpolarized light contact dermoscopy (NPCD), and to evaluate their accuracy in diagnosing characteristic SSc‐related alterations.
Methods
The study enrolled 45 patients with SSc. Capillaroscopy images and photographs were taken with three devices, SNFC, NPCD and PNCD, and these images were randomly analysed by a blinded observer.
Results
The scleroderma pattern was found in 83% of patients. PNCD and NPCD were highly sensitive in identifying the presence of focal capillary loss (96.4% and 100%, respectively), haemorrhage (96.2% and 92%, respectively), and scleroderma (91.9%, 94.6%), and showed high specificity for haemorrhage and enlarged loops. The intra‐observer kappa values for detection of the scleroderma pattern by SNFC images, NPCD and PNCD were moderate to good: (κ = 0.71 (95% CI 0.44–0.95), κ = 0.60 (95% CI 0.35–0.83) and κ = 0.60 (95% CI 0.32–0.86), respectively. Evaluation of haemorrhage presence gave high kappa values for all methods: κ = 0.77 (95% CI 0.57–0.95), κ = 0.90 (95% CI 0.76–1.00) and κ = 0.95 (95% CI 0.85–1.00), respectively.
Conclusions
Both polarized and nonpolarized dermoscopy are reliable methods for valuation of nailfold capillaroscopy in patients with SSc. They are easy to perform, with good rates of accuracy and results that are comparable with traditional capillaroscopy.
Introduction Atopic dermatitis places a large burden on patients and their families, with greater risk of emotional disorders and behavioural problems. Preliminary evidence suggests that support ...groups and educational programs are helpful in reducing stress, disease and pruritus severity and improves quality of life (QoL).
Objectives To evaluate the intensity of pruritus and the QoL in children with atopic dermatitis and their families after joining support groups.
Material and methods Subjects were randomly assigned to intervention or control group and completed the Children's Dermatology Life Quality Index (CDLQI) and Family Dermatitis Impact (FDI). Pruritus was evaluated by the Yosipovitch's questionnaire for pruritus. Each patient/family unit was considered as one ‘patient’. Participants were divided into two different groups: one with children under 16 years and the second with patients’ relatives. Each unit was accompanied during 6 months.
Results Thirty‐two patients and their relatives completed the questionnaires satisfactorily. After intervention, pruritus intensity was similar (P = 0.42), but the pattern of pruritus improved in the intervention group. Overall QoL for CDLQI instruments improved significantly (P < 0.01) and, when specific domains were analysed, personal relationships (P = 0.02) and leisure (P = 0.04) showed marked enhancement. FDI scores failed to demonstrate differences in the QoL of patients’ relatives after treatment.
Conclusion The improvement on pruritus and QoL showed that atopic dermatitis patients had benefits with the attendance to support groups. We consider that these non‐pharmacological approaches can be a very effective accessory tools in the management of recalcitrant forms of the disease.
Background Melasma can cause a significant effect on individual emotional well‐being. Melasma Quality of Life Scale (MELASQoL) is a specific questionnaire elaborated to assess the burden of melasma ...on patient's quality of life.
Objective To evaluate the clinical aspects, severity and the influence of melasma on daily living of a sample of Brazilian women.
Methods Cross‐sectional study that enrolled 85 women with melasma older than 15 years of age. Trained investigators asked 55 questions to collect epidemiological and clinical data. The disease severity was clinically assessed using Melasma Area and Severity Index (MASI). Patients answered the Portuguese version of 10‐item MELASQoL scale without coaching.
Results The mean ± SD age was 41.1 ± 6.8 years, and the mean ± SD of MELASQoL score was 37.5 ± 15.2 (median, 35). Patients with previous psychiatric diagnosis had significantly higher MELASQoL scores (mean, 42.8; SD, 13.6) than patients without this antecedent (mean, 35.4; SD, 15.4; P < 0.05). Patients with less than 8 years of school attendance also had significantly higher MELASQoL score (mean, 44; SD, 16.9) than more graduated ones (mean, 34.4; SD, 13.5; P < 0.05). The mean ± SD MASI was 10.6 ± 6.6 (median, 10.2). There was no correlation between MASI and MELASQoL.
Conclusions This study confirms that MELASQoL‐BP is easy to administer, adds important information about the impact of melasma on South American women's life and, finally, contributes to building evidence on the validity, reliability and cultural adaptation of the Portuguese language MELASQoL version.
Background Extra‐facial melasma is a prevalent dermatosis in some populations with special characteristics in relation to its clinical aspects and probable etiopathogenic factors. Few studies have ...attempted to address this alteration of pigmentation, which has become a challenge in clinical Dermatology.
Objective To assess the clinical histopathological and immunohistochemical characteristics of extra‐facial melasma, comparing affected, and unaffected sites.
Methods Case‐control study with 45 patients in each group (melasma and disease‐free volunteers), assessing their clinical characteristics. In 36 patients, biopsies were performed on the lesion and the normal perilesional skin. Specimens were stained with HE and Fontana‐Masson, and melanocytes analysed by immunohistochemistry. Objective measurements were accomplished by a specifically designed image analysis software.
Results The melasma group had a mean age ± SD of 56.67 ± 8 years, the majority of them were women (86.7%) and 82.1% of the female cases had reached menopause. There were no significant differences between groups in terms of presence of comorbidities, use of medications or hormone therapies. For extra‐facial melasma patients, family history of this dermatose and of previous facial melasma was significantly higher than in the control group (P < 0.05). The HE staining showed increased rectification and basal hyperpigmentation, solar elastosis, and collagen degeneration in the pigmented area (P < 0.05). There was a significant increase in melanin density in melasma biopsies, but the immunohistochemical tests did not detect a difference between the groups in terms of number of melanocytes.
Conclusion Extra‐facial melasma appears to be related to menopause, family history, and personal history of facial melasma, in the studied population. Histopathology revealed a pattern similar to what has been described for facial melasma, with signs of solar degeneration, and a similar number of melanocytes, when comparing patients, and controls, suggesting that the hyperpigmentation is most likely the result of abnormal melanin production or distribution.
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