The analysis of the ultraviolet radiation doses required to produce erythemal responses in normal skin

Damage to skin extracellular matrix induced by UV exposure

SIGNIFICANCE

Chronic exposure to environmental ultraviolet radiation (UVR) plays a key role in both photocarcinogenesis and induction of accelerated skin aging. Although the spatiotemporal consequences of UVR exposure for the composition and architecture of the dermal extracellular matrix (ECM) are well characterized, the pathogenesis of photoaging remains poorly defined. Given the compelling evidence for the role of reactive oxygen species (ROS) as mediators of photoaging, UVR-exposed human skin may be an accessible model system in which to characterize the role of oxidative damage in both internal and external tissues.

RECENT ADVANCES

Although the cell-mediated degradation of dermal components via UVR-induced expression of ECM proteases has long been identified as an integral part of the photoaging pathway, the relative importance and identity of cellular and extracellular photosensitizers (direct hit and bystanders models, respectively) in initiating this enzymatic activity is unclear. Recently, both age-related protein glycation and relative amino-acid composition have been identified as potential risk factors for photo-ionization and/or photo-sensitization. Here, we propose a selective multi-hit model of photoaging.

CRITICAL ISSUES

Bioinformatic analyses can be employed to identify candidate UVR targets/photosensitizers, but the action of UVR on protein structure and/or ROS production should be verified experimentally. Crucially, in the case of biochemically active ECM components such as fibronectin and fibrillin, the downstream effects of photo-degradation on tissue homeostasis remain to be confirmed.

FUTURE DIRECTIONS

Both topical antioxidants and inhibitors of detrimental cell signaling may be effective in abrogating the effects of specific UVR-mediated protein degradation in the dermis.

Stem cell factor rescues tyrosinase expression and pigmentation in discreet anatomic locations in albino mice

The K14-SCF transgenic murine model of variant pigmentation is based on epidermal expression of stem cell factor (SCF) on the C57BL/6J background. In this system, constitutive expression of SCF by epidermal keratinocytes results in retention of melanocytes in the interfollicular basal layer and pigmentation of the epidermis itself. Here, we extend this animal model by developing a compound mutant transgenic amelanotic animal defective at both the melanocortin 1 receptor (Mc1r) and tyrosinase (Tyr) loci. In the presence of K14-Scf, tyrosinase-mutant animals (previously thought incapable of synthesizing melanin) exhibited progressive robust epidermal pigmentation with age in the ears and tails. Furthermore, K14-SCF Tyr(c2j/c2j) animals demonstrated tyrosinase expression and enzymatic activity, suggesting that the c2j Tyr defect can be rescued in part by SCF in the ears and tail. Lastly, UV sensitivity of K14-Scf congenic animals depended mainly on the amount of eumelanin present in the skin. These findings suggest that c-kit signaling can overcome the c2j Tyr mutation in the ears and tails of aging animals and that UV resistance depends on accumulation of epidermal eumelanin.

Reference Limits for Erythema-effective UV Doses

Diagnostic phototesting, including the determination of the minimal erythema dose (MED), is a useful procedure to detect abnormal sensitivity to UV radiation. We aimed to estimate the reference limits (RLs) of the MED in a reasonably large reference sample of white individuals. Skin phototypes and MED values for broadband UVB and for UVA were determined in 461 white subjects. When appropriate, the 95% reference intervals, including the 0.025 fractile and 0.975 fractile, were computed for the MED-UVB reference values (by means of parametric methods) and the MED-UVA reference values (by means of nonparametric methods). MED data were also converted to standard erythema doses (SEDs). As described elsewhere we observed a considerable overlap of MED values for all skin phototypes and confirmed that age and sex do not substantially influence the MED. The lower RLs observed for MED-UVB were 33 mJ cm(-2) (0.5 SEDs) and for MED-UVA 12.6 mJ cm(-2) (1.2 SEDs). The MED and SED findings from this investigation may serve as reference data for white individuals and give support to the clinician in differentiating between normal and pathologically abnormal photosensitivity. Although the MED data given here are limited to the phototest device used in the present study, the SED results establish comparability between our data and phototest results obtained from laboratories using different UV sources.

Human melanocytes and keratinocytes exposed to UVB or UVA in vivo show comparable levels of thymine dimers

Epidemiology shows a relationship between solar exposure and all types of skin cancer. Understanding the mechanisms of skin cancer requires knowledge of the photomolecular events that occur within the relevant epidermal cell types in vivo. Studies to date have focused on UVR-induced DNA lesions in keratinocytes, the majority epidermal cell population which gives rise to most skin cancers. Malignant melanoma, arising from melanocytes (5%-10% of epidermal cells), accounts for most skin cancer deaths. We report on new techniques to detect DNA photolesions in human epidermal melanocytes in situ. Previously nonexposed buttock skin of volunteers of skin types I/II was exposed to clinically relevant doses of narrow bandwidth UVB (300 nm) and UVA (320 nm, 340 nm, 360 nm) radiation. Biopsies were taken immediately afterwards and processed for routine histology. Microscope sections were prepared and double-stained with fluorescent-tagged monoclonal antibodies for thymine dimers and melanocytes. UVR dose-response curves for dimer levels within melanocyte nuclei were determined by image analysis and compared with dimer levels in adjacent basal cell keratinocytes. Our data show that UVB and UVA readily induce thymine dimers in melanocytes at levels that are comparable with those found in adjacent keratinocytes. This new technique will enable melanocyte specific studies, such as DNA repair kinetics, to be done in vivo.

The similarity of action spectra for thymine dimers in human epidermis and erythema suggests that DNA is the chromophore for erythema

The location of DNA photodamage within the epidermis is crucial as basal layer cells are the most likely to have carcinogenic potential. We have determined the action spectra for DNA photodamage in different human epidermal layers in situ. Previously unexposed buttock skin was irradiated with 0.5, 1, 2, and 3 minimal erythema doses of monochromatic UVR at 280, 290, 300, 310, 320, 340, and 360 nm. Punch biopsies were taken immediately after exposure and paraffin sections were prepared for immunoperoxidase staining with a monoclonal antibody against thymine dimers that were quantitated by image analysis. Dimers were measured at two basal layer regions, the mid and the upper living epidermis. The slopes of dose-response curves were used to generate four action spectra, all of which had maxima at 300 nm. Dimer action spectra between 300 and 360 nm were independent of epidermal layer, indicating comparable epidermal transmission at these wavelengths. Furthermore, we observed 300 nm-induced dimers in dermal nuclei; however, there was a marked effect of epidermal layer between 280 and 300 nm, showing relatively poor transmission of 280 and 290 nm to the basal layer. These data indicate that solar UVB (approximately 295-320 nm) is more damaging to basal cells than predicted from transmission data obtained from human epidermis ex vivo. The epidermal dimer action spectra were compared with erythema action spectra determined from the same volunteers and ultraviolet radiation sources. Overall, these spectral comparisons suggest that DNA is a major chromophore for erythema in the 280-340 nm region.

Erythema and melanogenesis action spectra in heavily pigmented individuals as compared to fair-skinned Caucasians

The protective role of epidermal melanin pigmentation against chronic exposure to ultraviolet radiation is widely accepted, although its photoprotective effect against acute exposure is less certain. In this study, the action spectra of erythema and melanogenesis in heavily pigmented individuals (skin type V) were determined at 295, 305, 315, and 365 nm, and compared with those of skin types I and II. When the erythema and melanogenesis action spectra for skin type V were normalized to 295 nm, they were identical to the corresponding action spectra for fair-skinned individuals, indicating that the photoprotection of epidermal melanin pigmentation is essentially independent of wavelength. The ratio of values for the minimum erythema dose (MED) between skin type V and skin types I and II was 2.29, which is close to the ratio of pigment in these skin types, as measured by diffuse reflectance spectroscopy in the visible range. The minimum immediate pigment darkening dose (IPD) and the minimum melanogenic dose (MMD) at 365 nm, and the MED and MMD at 315 nm were the same for all skin types, while the variation of MED for every skin type was maximum at 305 and 365 nm. The results provide circumstantial evidence that erythema and melanogenesis have the same mechanism at short-wavelength UVB (295 and 305 nm), and different mechanisms in UVA (365 nm). Furthermore, the 24 h MED at 305 nm appears to be a sensitive indicator of skin type.

Observed and predicted minimal erythema doses: a comparative study

This study compared how well minimal erythema doses predicted using the reference action spectrum for UV erythema proposed by the International Commission on Illumination (CIE) in 1987 agreed with those observed in phototesting a large number of subjects with normal responses to sunlight to six different wavelengths of UV radiation (UVR) between 300 and 400 nm. It was found that, within the limits of experimental error, the hypothesis that the CIE reference action spectrum is a valid predictor of the erythemal effectiveness of different wavelengths of UVR could not be dismissed. There is no strong reason, therefore, why the CIE action spectrum should not continue to be used as a reference to compare the erythemal effectiveness of different broadband sources. However, close examination of the residuals from the regression analysis suggested that the erythemal sensitivity of skin at longer UV wavelengths (> 350 nm) in the population studied here is greater than predicted from the CIE reference action spectrum.

Assessment of sun sensitivity by questionnaire: validity of items and formulation of a prediction rule

Sun sensitivity is a major risk factor for melanoma, basal cell carcinoma, and squamous cell carcinoma of the skin. Several variables have been used in epidemiologic studies to measure sun sensitivity. The present study assesses their validity and combines them to form a prediction rule for an objective measure of sun sensitivity, the minimal erythema dose of ultraviolet B radiation required to produce visibility reddened skin (MED). Participants were 116 patients with psoriasis presenting for phototherapy who completed a sun sensitivity questionnaire. Of the 14 questionnaire items evaluated, 10 were associated with the MED beyond expectation based on chance. The closest association was with the skin type (of Fitzpatrick), a 4-point scale based on historical ability to tan and susceptibility to sunburn. Color of untanned skin and hair were also independent predictors, and were included in the final prediction rule, which correlated 0.55 with MED. Combining items yields a more accurate predictor of sun sensitivity than any one or two individual response variables, and hence may be preferable for epidemiologic studies.

The relationship between chronological age and the erythemal response to ultraviolet B radiation

To investigate whether erythemal responses to ultraviolet radiation alter with age, we have reviewed the results of monochromator phototesting in adults and children, and have measured the dose-response curves for UVB erythema in a further 38 subjects. There was no significant difference between adults and children in minimal erythema dose (MED) at 300 nm; the median MED in 254 adults was 34 mJ/cm2 (range 14-80 mJ/cm2) and in 24 children aged less than 15 years was 30 mJ/cm2 (range 10-80 mJ/cm2). Objective measurements of UVB-induced erythema were performed in 15 subjects aged below 25 years and 23 subjects aged above 60 years. A dose-response curve for UVB erythema was constructed for each subject and the slope of the steepest part of each curve calculated by logit regression; the values in the young subjects were greater than in the older group (P less than 0.02). However, there was no difference between the two groups in either the visually assessed MED or the calculated UVB dose required to produce a constant degree of mild erythema.

The normal range in diagnostic phototesting

The minimal erythema doses (MED) to UVB and UVA radiation were measured in 254 normal subjects. Bivariate correlation analysis applied to the data showed a strong positive correlation between the UVB and UVA MEDs. By calculating the probability that a given combination of UVB and UVA MEDs is likely to occur in normal subjects, it was shown that, in some instances, both the UVB MED and UVA MED observed in a given subject may be within their respective normal ranges, but that the particular combination is more in keeping with abnormal photosensitivity.

Skin type, hair color, and freckles are predictors of decreased minimal erythema ultraviolet radiation dose

In a group of 190 white healthy subjects the skin type classification method was found valuable for differentiating subgroups with various degrees of sun sensitivity (except for 33% with borderline or unclassifiable skin type). Sun-sensitive skin types I and II were significantly more common among persons with light hair color or freckles, or both (p less than 0.001). In each skin type category the proportion of subjects with a minimal erythema dose (MED) lower than the median MED of the entire group (%LMED) decreased significantly with increasing skin type number, and distinguished between skin types I through III better than did their mean MED values. Independent predictors of %LMED were skin type and hair color. The contribution of freckles to %LMED was skin type dependent. Age, sex, or eye color had no independent effect on %LMED. The association of skin types I and II, red or blond hair, and freckles with decreased MED may reflect genetically controlled predominance of pheomelanin (a photosensitizing molecule) in the skin of subjects with these phenotypes.

A comparison of dosimeters used for solar ultraviolet radiometry

Radiometric measurements of terrestrial sunlight using three different types of broad-band dosimeters were compared with equivalent integrated quantities obtained from simultaneous spectroradiometric measurements. Measurements were made at Durham, UK (55 degrees N) during one day in mid-summer and one day in the autumn. By this means it was possible to encompass a wide range of ultraviolet irradiances. There was close agreement between UV-A irradiance measured using a broad-band radiometer and determined spectroradiometrically over the whole range of irradiances when allowance was made for the spectral sensitivity of the UV-A radiometer. The agreement between erythemally-effective irradiance determined spectroradiometrically and the response of a Robertson-Berger meter showed some non-linearity due to the mismatch between the erythema action spectrum and spectral response of the sensor. There was a similar disparity in agreement between erythemally-effective dose determined spectroradiometrically and the response of polysulphone film for similar reasons. Nevertheless it is concluded that if these latter two dosimeters are calibrated using sunlight, or a solar simulator, as the source, they can yield data which are sufficiently reliable for many applications.

A quantitative study of the effect of terfenadine on cutaneous erythema induced by UVB and UVC radiation

Terfenadine, given in sufficient dose to cause maximum H1 receptor blockade, had no effect on the intensity of UVB or UVC erythema measured with a reflectance instrument at 4, 8, and 24 h after irradiation. Histamine, acting on the H1 receptor, is not a significant mediator of UVB or UVC erythema.

A preliminary study on photoaddition and erythema due to UVB radiation

The spectral irradiance of narrow band and broad spectrum radiation sources have been measured and the erythemally effective irradiance calculated by weighting the spectral irradiance of each source by an erythema action spectrum for human skin and integrating over the range of wavelengths in each spectrum. The ratio of the erythemally effective irradiances determined in this manner have been compared with the ratio of exposure times necessary to produce a delayed minimal perceptible erythema on the trunk skin of fair-skinned subjects irradiated with the two different sources. There was close agreement between the two ratios, supporting the notion of photoaddition applied to erythema elicited by UVB radiation.

The establishment and clinical value of a dermatological photobiology service in a district general hospital

The availability of a local dermatological photobiology facility has proved to be of great value in the management of patients with photodermatoses, especially those with chronic actinic dermatitis. It is our belief that clinically useful results can only be achieved if careful attention is paid to technical factors such as radiation measurement.