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Arisi M, Rossi MT, Fusano M, Gualini A, Tomasi C, Moggio E, Caravello S, Calzavara-Pinton P, Venturini M. Clinical and Spectrophotometric Evaluation of Skin Photoadaptation in Vitiligo Patients after a Short Cycle of NB-UVB Phototherapy. Dermatology 2019; 235:509-515. [PMID: 31586997 DOI: 10.1159/000502853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 08/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The phenomenon of photoadaptation to narrow-band ultraviolet B (NB-UVB) radiation has been previously described in vitiligo and has usually been clinically measured by the assessment of the minimal erythema dose (MED) after phototesting. OBJECTIVES To assess the photoadaptive response in vitiligo and healthy skin after NB-UVB phototherapy not only clinically, but also by spectrophotometry. MATERIALS AND METHODS Fourteen patients affected by generalized vitiligo underwent NB-UVB phototherapy twice weekly for 12 weeks. Before and after phototherapy, a phototesting procedure was administered on vitiligo patches and adjacent healthy skin with a solar simulated radiation (SSR). Visual assessment of the MED took place after 24 h. A spectrophotometer was used to assess the a* value and the melanin index (MI*), as signs of skin erythema and pigmentation. The photoadaptation factor (MED-PF) and the a* photoadaptation factor (a*-PF) were calculated. RESULTS After NB-UVB phototherapy, both vitiligo and healthy skin showed an increase in MED and MI* values and a reduction of skin erythema compared to baseline (p < 0.05). MED-PF data showed a photoadaptation in 10 (71.4%) vitiligo lesions and in 12 (85.7%) healthy skin areas. The assessment of the a*-PF showed a negative mean percentage value in all affected and unaffected skin areas. CONCLUSIONS A short cycle of NB-UVB phototherapy can induce photoadaptation in vitiligo by increasing the MED and reducing skin erythema after stimulation with SSR. This is most likely due to the physical filter function induced by ultraviolet radiation.
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Affiliation(s)
- Mariachiara Arisi
- Dermatology Department, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy,
| | - Maria Teresa Rossi
- Dermatology Department, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Marta Fusano
- Dermatology Department, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alessandra Gualini
- Dermatology Department, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Cesare Tomasi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Occupational Health, University of Brescia, Brescia, Italy
| | - Erica Moggio
- Dermatology Department, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Simone Caravello
- Dermatology Department, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Marina Venturini
- Dermatology Department, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
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Conant L, Beck KM, Liao W. A Rapid and Cost-Effective Device for Testing Minimal Erythema Dose. Dermatol Ther (Heidelb) 2018; 8:483-489. [PMID: 30097899 PMCID: PMC6109034 DOI: 10.1007/s13555-018-0255-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION We describe a novel device for rapid and economical minimal erythema dose testing in patients undergoing ultraviolet (UV) light phototherapy for treatment of skin diseases. METHODS A minimal erythema testing device was designed and created using transparent plastic sheeting and printed patterns with increasing ink density, allowing for graded UV transmission of 100%, 80%, 60%, 40%, 20%, and 10% energy through six 10-mm square apertures. The plastic sheet was placed in a UV-impenetrable and Velcro-fitted adjustable sleeve, designed to fit easily onto a patient's arm. A pilot validation study was performed, comparing this device with a commercially available windowed device in which the dose is controlled by varying the UV exposure time through sequential opening of each window. The pilot was conducted on healthy skin of two human subjects with different Fitzpatrick skin types. RESULTS In our subjects, tested with one device on each forearm, the minimal erythema dose (MED), judged visually, was identical. However, the test device allowed MED testing in 3 min compared with 15 min for the traditional device. The test device is equally effective for use with ultraviolet-A (UVA), narrowband ultraviolet-B (NB-UVB) and broadband ultraviolet-B (BB-UVB) wavelengths. The test device is economical, with manufacturing cost of less than US $2. CONCLUSION We designed an MED testing device that is quick, accurate, cost-effective, and easy to use in the setting of a busy phototherapy practice. This device therefore has many advantages over existing MED testing approaches.
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Affiliation(s)
- Leah Conant
- UCSF School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kristen M Beck
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA.
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Kohli I, Shafi R, Isedeh P, Griffith JL, Al-Jamal MS, Silpa-Archa N, Jackson B, Athar M, Kollias N, Elmets CA, Lim HW, Hamzavi IH. The impact of oral Polypodium leucotomos extract on ultraviolet B response: A human clinical study. J Am Acad Dermatol 2017; 77:33-41.e1. [PMID: 28341348 DOI: 10.1016/j.jaad.2017.01.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is a rationale for adding systemic photoprotective agents to the current photoprotection regimen. OBJECTIVE This study was designed to objectively evaluate the molecular and photobiologic effects of oral administration of Polypodium leucotomos extract (PLE). METHODS In all, 22 subjects with Fitzpatrick skin phototype I to III were enrolled. On day 1, subjects were irradiated with visible light, ultraviolet (UV) A1, and UVB (using 308-nm excimer laser). Evaluation was done immediately and 24 hours after irradiation. On days 3 and 4, irradiation and evaluation process was repeated after ingestion of PLE. RESULTS Clinical assessments and colorimetry data showed a decrease in UVB-induced changes in 17 of 22 subjects post-PLE administration; histology findings demonstrated such a decrease in all 22 subjects. LIMITATIONS Only 2 doses of PLE were given. Furthermore, subjects with skin phototypes I to III only were studied. CONCLUSION The results suggest that PLE can potentially be used as an adjunctive agent to lessen the negative photobiologic effects of UVB.
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Affiliation(s)
- Indermeet Kohli
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Rubina Shafi
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Prescilia Isedeh
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - James L Griffith
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Mohammed S Al-Jamal
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Narumol Silpa-Archa
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Bradford Jackson
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mohammed Athar
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Craig A Elmets
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Henry W Lim
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Iltefat H Hamzavi
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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Eadie E, Valentine RM, Thompson G, Campbell K, Moseley H. Transmitted irradiance not as expected in enclosed handheld minimal erythema dose device. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 32:304-306. [PMID: 27552537 DOI: 10.1111/phpp.12267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Ewan Eadie
- NHS Tayside, Photobiology Unit, Ninewells Hospital and Medical School, Dundee, UK
| | - Ronan M Valentine
- Photobiology Unit, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Grace Thompson
- School of Physics & Astronomy, University of St Andrews, St Andrews, UK
| | - Kevin Campbell
- Photonet, NHS Scotland, Photobiology Unit, Ninewells Hospital and Medical School, Dundee, UK
| | - Harry Moseley
- Photobiology Unit, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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Attwa E. Review of narrowband ultraviolet B radiation in vitiligo. World J Dermatol 2016; 5:93-108. [DOI: 10.5314/wjd.v5.i2.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/16/2015] [Accepted: 04/11/2016] [Indexed: 02/06/2023] Open
Abstract
Vitiligo is a common, acquired pigmentary disorder of unknown etiology with great impact on patient’s appearance and quality of life. It presents a therapeutic challenge to many dermatologists. Photochemotherapy using psoralen and ultraviolet A (UVA) therapy, topical and oral immunosuppresants, as well as cosmetic camouflage are also commonly employed with varying clinical efficacy. Phototherapy is a popular treatment option, which includes both of the generalized ultraviolet B (UVB) therapies, broadband UVB and narrowband UVB (NB-UVB). It has been used favorably, both alone as well as in combination with other agents like topical calcineurin inhibitors, vitamin-D analogs. Combination therapies are useful and may provide quicker regimentation and treat vitiligo with an additive mechanism of action than UVB phototherapy. Advances in technology may lead to the continuing use of UVB phototherapy as a treatment for vitiligo through the development of sophisticated devices and delivery systems as well as innovative application methods. These will provide increased therapeutic options for all vitiligo patients, particularly those with refractory disease. In this article, I have reviewed the available data pertaining to efficacy and safety issues for NB-UVB as monotherapy, its comparison with psoralen plus UVA and other modes of phototherapy, combination regimens that have been tried and future prospects of NB-UVB in vitiligo.
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Moseley H, Allan D, Amatiello H, Coleman A, du Peloux Menagé H, Edwards C, Exton L, Ferguson J, Garibaldinos T, Martin C, Mohd Mustapa M, McHenry P, Griffiths M, Buckley D, Nasr I, Swale V, Duarte Williamson C, Leslie T, Mallon E, Towers K, Saunders C, Brain A. Guidelines on the measurement of ultraviolet radiation levels in ultraviolet phototherapy: report issued by the British Association of Dermatologists and British Photodermatology Group 2015. Br J Dermatol 2015; 173:333-50. [DOI: 10.1111/bjd.13937] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
Affiliation(s)
- H. Moseley
- The Photobiology Unit Ninewells Hospital and Medical School Dundee DD1 9SY U.K
| | - D. Allan
- The Christie NHS Foundation Trust and University of Manchester Manchester Academic Health Science Centre Wilmslow Road Manchester M20 4BX U.K
| | - H. Amatiello
- Radiation Physics and Protection Group Churchill Hospital Old Road Headington Oxford OX3 7LJ U.K
| | - A. Coleman
- Guy's and St Thomas' NHS Foundation Trust St Thomas' Hospital Westminster Bridge Road London SE1 7EH U.K
| | - H. du Peloux Menagé
- Guy's and St Thomas' NHS Foundation Trust St Thomas' Hospital Westminster Bridge Road London SE1 7EH U.K
- Lewisham and Greenwich NHS Trust High Street London SE13 6LH U.K
| | - C. Edwards
- Royal Gwent Hospital Cardiff Road Newport NP20 2UB U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - J. Ferguson
- The Photobiology Unit Ninewells Hospital and Medical School Dundee DD1 9SY U.K
| | - T. Garibaldinos
- Guy's and St Thomas' NHS Foundation Trust St Thomas' Hospital Westminster Bridge Road London SE1 7EH U.K
| | - C. Martin
- Department of Clinical Physics and Bio‐Engineering University of Glasgow Glasgow G12 8QQ U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
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Mogollon JA, Boivin C, Lemieux S, Blanchet C, Claveau J, Dodin S. Chocolate flavanols and skin photoprotection: a parallel, double-blind, randomized clinical trial. Nutr J 2014; 13:66. [PMID: 24970388 PMCID: PMC4082621 DOI: 10.1186/1475-2891-13-66] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 06/24/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Solar ultraviolet (UV) radiation has deleterious effects on the skin, including sunburn, photoaging and cancer. Chocolate flavanols are naturally-occurring antioxidant and anti-inflammatory molecules that could play a role in preventing cutaneous UV damage. We investigated the influence of 12-week high-flavanol chocolate (HFC) consumption on skin sensitivity to UV radiation, measured by minimal erythema dose (MED). We also evaluated skin elasticity and hydration. METHODS In this 2-group, parallel, double-blind, randomized controlled trial, 74 women aged 20-65 years and Fitzpatrick skin phototypes I or II were recruited from the general community in Quebec City, for randomization to either HFC (n = 33) or low-flavanol chocolate (LFC) (n = 41). A blocked randomisation (4), considering date of entry, skin type and age as factors, generated a sequentially-numbered allocation list. Study participants and research assistants were blinded. Totally, 30 g of chocolate were consumed daily for 12 weeks, followed by a 3-week washout period. MED was assessed at baseline and at 6, 9, 12 and 15 weeks. Main outcome was changes in MED at week 12. RESULTS 33 participants in the HFC group and 41 in the LFC group were analyzed with 15 weeks of follow-up. Both groups showed similarly-increased MED at 12 weeks (HFC: 0.0252 ± 0.1099 J/cm2 [mean ± standard deviation (SD)]; LFC: 0.0151 ± 0.1118; mean difference (MD): 0.0100 J/cm2; 95% confidence interval (CI): -0.0417 to 0.0618). However, after 3-week washout, the HFC group presented decreased MED (-0.0248 ± 0.1145) whereas no effect was seen in the LFC group (0.0168 ± 0.1698) (MD: -0.0417; 95% CI: -0.1106 to 0.0272). Net temple elasticity increased slightly but significantly by 0.09 ± 0.12 mm in the HFC group at 12 weeks compared to 0.02 ± 0.12 mm in the LFC group (MD: 0.06; 95% CI: 0.01 to 0.12 ). No significant adverse events were reported. CONCLUSION Our study failed to demonstrate a statistically-significant protective effect of HFC vs. LFC consumption on skin sensitivity to UV radiation as measured by MED. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01444625.
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Affiliation(s)
| | | | | | | | | | - Sylvie Dodin
- St, François d'Assise Hospital, Centre hospitalier universitaire de Québec (CHUQ), Quebec, QC, Canada.
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Turner D, Goulden V. Determination of the optimum operating point for a handheld minimal erythema dose device. Br J Dermatol 2014; 170:996-7. [DOI: 10.1111/bjd.12793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D. Turner
- Leeds Teaching Hospitals Trust; Leeds U.K
| | - V. Goulden
- Leeds Teaching Hospitals Trust; Leeds U.K
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Lynch M, Carroll F, Kavanagh A, Honari B, Collins P. Comparison of a semiautomated hand-held device to test minimal erythema dose before narrowband ultraviolet B phototherapy with the conventional method using matched doses. J Eur Acad Dermatol Venereol 2014; 28:1696-700. [PMID: 24456040 DOI: 10.1111/jdv.12371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND A semiautomated hand-held device has been introduced in some phototherapy centres to establish the minimal erythema dose (MED) before treatment with narrowband ultraviolet (NBUV) B. OBJECTIVES To compare the semiautomated hand-held device with the conventional method of MED testing (a UV-opaque template and a panel of UVB fluorescent tubes), using the same series of incremented doses. METHODS Twenty-four patients referred for treatment with NBUVB phototherapy were included. Each patient had MED testing with the conventional method and the semiautomated hand-held device at the same level of the left and right back. The results were read by four investigators each time. RESULTS The semiautomated hand-held device was a significant estimator of the MED using the conventional panel method (P < 0.001; r = 0.97). The average ratio of the hand-held MED to the conventional MED was 67%. The mean difference between the methods was 165 mJ/cm(2) . The interobserver test showed very high agreement for both methods of MED testing (Cronbach α coefficient 0.97 for the hand-held MED tester vs. 0.93 for the conventional method). CONCLUSIONS The semiautomated hand-held device MED results were lower than that of the conventional panel method and may prolong the treatment course by 2-3 treatments. The hand-held tester is a fast and reproducible method, and may allow more phototherapy units, limited by staff and time, to do MED testing.
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Affiliation(s)
- M Lynch
- The Charles Centre, Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
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Al-Ismail D, Edwards C, Al-Ofi O, Anstey A. Minimal phototoxic dose (MPD) measurements for topical photochemotherapy using a semiautomated MPD tester. Br J Dermatol 2013; 169:687-9. [DOI: 10.1111/bjd.12395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 12/01/2022]
Affiliation(s)
- D. Al-Ismail
- Department of Dermatology; Aneurin Bevan Health Board; St Woolos Hospital; Newport; U.K
| | - C. Edwards
- Department of Dermatology; Aneurin Bevan Health Board; St Woolos Hospital; Newport; U.K
| | - O. Al-Ofi
- Department of Dermatology; Aneurin Bevan Health Board; St Woolos Hospital; Newport; U.K
| | - A.V. Anstey
- Department of Dermatology; Aneurin Bevan Health Board; St Woolos Hospital; Newport; U.K
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Heckman CJ, Chandler R, Kloss JD, Benson A, Rooney D, Munshi T, Darlow SD, Perlis C, Manne SL, Oslin DW. Minimal Erythema Dose (MED) testing. J Vis Exp 2013:e50175. [PMID: 23748556 DOI: 10.3791/50175] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Ultraviolet radiation (UV) therapy is sometimes used as a treatment for various common skin conditions, including psoriasis, acne, and eczema. The dosage of UV light is prescribed according to an individual's skin sensitivity. Thus, to establish the proper dosage of UV light to administer to a patient, the patient is sometimes screened to determine a minimal erythema dose (MED), which is the amount of UV radiation that will produce minimal erythema (sunburn or redness caused by engorgement of capillaries) of an individual's skin within a few hours following exposure. This article describes how to conduct minimal erythema dose (MED) testing. There is currently no easy way to determine an appropriate UV dose for clinical or research purposes without conducting formal MED testing, requiring observation hours after testing, or informal trial and error testing with the risks of under- or over-dosing. However, some alternative methods are discussed.
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Affiliation(s)
- Carolyn J Heckman
- Cancer Prevention and Control Program, Fox Chase Cancer Center, USA.
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Falk M, Magnusson H. Sun protection advice mediated by the general practitioner: an effective way to achieve long-term change of behaviour and attitudes related to sun exposure? Scand J Prim Health Care 2011; 29:135-43. [PMID: 21682578 PMCID: PMC3347962 DOI: 10.3109/02813432.2011.580088] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate, in primary health care, differentiated levels of prevention directed at skin cancer, and how the propensity of the patients to change sun habits/sun protection behaviour and attitudes towards sunbathing were affected, three years after intervention. Additionally, the impact of the performance of a phototest as a complementary tool for prevention was evaluated. DESIGN Randomized controlled study. Setting and subjects. During three weeks in February, all patients ≥ 18 years of age registering at a primary health care centre in southern Sweden were asked to fill in a questionnaire mapping sun exposure habits, attitudes towards sunbathing, and readiness to increase sun protection according to the Transtheoretical Model of Behaviour Change (TTM) (n = 316). They were randomized into three intervention groups, for which sun protection advice was given, in Group 1 by means of a letter, and in Groups 2 and 3 orally during a personal GP consultation. Group 3 also underwent a phototest to demonstrate individual skin UV sensitivity. MAIN OUTCOME MEASURES Change of sun habits/sun protection behaviour and attitudes, measured by five-point Likert scale scores and readiness to increase sun protection according to the TTM, three years after intervention, by a repeated questionnaire. RESULTS In the letter group, almost no improvement in sun protection occurred. In the two doctor's consultation groups, significantly increased sun protection was demonstrated for several items, but the difference compared with the letter group was significant only for sunscreen use. The performance of a phototest did not appear to reinforce the impact of intervention. CONCLUSION Sun protection advice, mediated personally by the GP during a doctor's consultation, can lead to improvement in sun protection over a prolonged time period.
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Affiliation(s)
- Magnus Falk
- Research and Development Unit for Local Healthcare, County of Östergötland, Linköping.
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Anstey A. A paradigm for phototherapy clinical-genetic research. Br J Dermatol 2010; 163:901-2. [DOI: 10.1111/j.1365-2133.2010.10062.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chiarugi A, Ceroti M, Palli D, Cevenini G, Guarrera M, Carli P. Sensitivity to ultraviolet B is a risk factor for cutaneous melanoma in a Mediterranean population: results from an Italian case-control study. Clin Exp Dermatol 2009; 34:8-15. [DOI: 10.1111/j.1365-2230.2008.02836.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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