Assessment of skin types, skin colours and cutaneous responses to ultraviolet radiation in an Asian population

Quantitative Assessment of Ultraviolet-Induced Erythema and Tanning Responses in the Han Chinese Population

Ultraviolet radiation (UVR) can induce erythema and tanning responses with strong diversity within and between populations, but there were no precise method for evaluating the variation in these responses. In this study, we assessed the time course of ultraviolet (UV)-induced responses based on the erythema index (EI) and melanin index (MI) over 14 consecutive days in a pilot cohort study (N = 31). From safety evaluations, we found that no skin blisters occurred at a UV dosage of 45 mJ/cm2, but there were significant skin reactions. Regardless of UV dosage, the measurements and variances of EI peaked on day 1 after UV irradiation, and those of MI peaked on day 7. Dose-response curves, including erythema dose-response (EDR) and melanin dose-response (MDR), could measure UV-induced phenotypes sensitively but more laboriously. As an alternative, we directly represented the UV-induced erythema and tanning responses using the erythema increment (ΔE) and melanin increment (ΔM). We found that ΔE and ΔM at 45 mJ/cm2 significantly correlated with erythema dose-response (EDR) (R 2 > 0.9) and melanin dose-response (MDR) (R 2 > 0.9), respectively. Therefore, ΔE and ΔM on day 1 and day 7 after UV irradiation at a dosage of 45 mJ/cm2 might be ideal alternative measures for assessing individual erythema and tanning responses. Then, a second cohort (N = 664) was recruited to validate the UV-induced phenotypes, and, as expected, the results of the two cohorts were in agreement. Therefore, we developed a simplified and precise method to quantify the UV-induced erythema response and tanning ability for the Han Chinese population.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43657-023-00105-1.

Skin biophysical properties including impaired skin barrier function determine ultraviolet sensitivity

BACKGROUND

The levels of burning susceptibility to ultraviolet (UV) radiations are affected by various factors, including Fitzpatrick skin types, skin color, sex, and ethnicity. However, studies on the relationship between skin biophysical properties and erythemal responses to UV radiations are rare.

OBJECTIVE

This study aimed to investigate biophysical properties of the skin that determined individual skin sensitivity to UV radiation.

METHODS

As an indicator of skin sensitivity to UV radiation, Korean women were subjected to minimal erythema dose (MED) testing. The skin biophysical properties, such as skin hydration, transepidermal water loss (TEWL) were measured. MED were also evaluated in further variations in the skin, including barrier disruption.

RESULTS

A significant negative correlation was observed between TEWL and MED. With an increase in TEWL, that represents reduced skin barrier function, skin UV sensitivity also increased. Artificial alteration of skin conditions also changed erythemal response to UV radiation. When the skin barrier was disrupted, MED significantly decreased, indicating increased skin UV sensitivity. It is hypothesized that the altered penetration of UV radiation into the stratum corneum under the respective skin conditions caused different erythema reactions.

CONCLUSION

For the first time in a clinical study, the skin biophysical properties, including skin barrier function, were found to have significant effects on skin sensitivity to UV radiation. This finding could help predict individual susceptibility to UV damage. Therefore, skincare products that improve skin conditions associated with UV sensitivity, as well as sunscreen are important for protection against the hazards of UV radiation.

Outdoor sunscreen testing with high-intensity solar exposure in a Chinese and Caucasian population

BACKGROUND

Currently, sunscreens' sun protection factor (SPF) and ultraviolet (UV) A protection are tested separately under indoor conditions, without considering external conditions that may affect performance. Studies are often conducted in Caucasian individuals; other racial groups may respond differently.

METHODS

An outdoor, double-blind, intra-individual study was performed in 63 healthy Chinese and Caucasian volunteers in Singapore. Subjects underwent one outdoor sun exposure lasting 2-3 hours. ISO reference products P3 (SPF 15), P5 (SPF 30), and P8 (SPF 50+) applied at 2 mg/cm² were compared against each other and against an untreated exposed area (positive control) and an unexposed area (negative control). Endpoints were investigator global assessment (IGA) of erythema at 24 hours, IGA of pigmentation at 1 week, and colorimetry (a*, L*, and ITA) at 24 hours and 1 week.

RESULTS

Clinical erythema and pigmentation scores were statistically significantly different among the three sunscreens, with the highest SPF product providing the highest protection, confirming the discriminatory capacity of the model used. Colorimetric assessment correlated well with clinical evaluation.

CONCLUSION

This study confirmed the feasibility of ranking sunscreens (at 2 mg/cm² ) based on clinical effects of high-intensity outdoor solar radiation. Larger studies are needed to look at differences in erythema and pigmentation reactions between Chinese and Caucasian individuals, which could be relevant for photoprotection.

Minimal Erythema Dose: Correlation with Fitzpatrick Skin Type and Concordance Between Methods of Erythema Assessment in a Patient Sample in Colombia

BACKGROUND AND OBJECTIVE

The minimal erythema dose (MED), an essential measurement in studies of skin photosensitivity, requires establishing MED values for specific populations, given genetic variation. Different ways to assess erythema are also relevant. We aimed to determine MED values in a sample of Colombian patients and correlations between MED and Fitzpatrick skin type. We also studied concordance correlation between MEDs and two alternative ways to assess erythema.

PATIENTS AND METHODS

Cross-sectional study of 113 individuals in Bogotá, Colombia. We used a solar simulator to measure UV-A radiation and combined UV-A and UV-B (UVA+UVB) radiation, o se podría suprimir este término porque UVA y UVB son términos conocidos for MED calculation. Narrowband UV-B (NBUVB) radiation was measured in a phototherapy cabin. Erythema was assessed visually and with a Mexameter MX 18 device.

RESULTS

The median MEDs of UVA+UVB radiation were 22mJ/cm² for Fitzpatrick skin typesI andII, and 33 and 43mJ/cm², respectively, for typesIII andIV. The MEDs of UV-A radiation were 22, 42, 86, and 100J/cm² for typesI, II, III, andIV, respectively. The MEDs of NBUVB light were 390, 550, 770, and 885mJ/cm² for the 4 skin types. The correlation between MEDs and skin types ranged from 0.5 to 0.69. Lin's concordance correlation coefficients between visual and Mexameter assessments of erythema were greater than 0.8 in all cases.

CONCLUSION

This study allowed us to understand MED values for UV-A, UVA+UVB, and NBUVB according to different skin types in the Colombian population. Concordance correlation coefficients between the different methods of erythema assessment were very good. Correlations between MEDs and skin types were moderate to good.

Skin characterization and immediate effects of different dermocosmetic treatments in French and Brazilian skin

BACKGROUND

All over the world, people face the same skin problems. However, their skin characteristics are different. Thus, it is a challenge to prescribe treatments that will be effective on different skin types. Therefore, it is very important to consider the skin biology when indicating a dermocosmetic treatment.

OBJECTIVES

To assess skin biophysical parameters in French and Brazilian subjects and to verify the efficacy of four dermocosmetic treatments in these populations.

METHODS

Five test areas were defined on each volar forearm of the eighteen Brazilian and eighteen French participants using a randomized design. Biophysical measurements in terms of skin hydration, skin barrier function, skin brightness, and skin viscoelasticity were performed before and after 60 minutes of treatment.

RESULTS

Skin biophysical differences between populations were found. French skin has been shown to be more hydrated regarding epidermal mechanic properties and stratum corneum water content and more radiant when compared with Brazilian skin. However, it showed more signs of cutaneous aging and fatigue effects on skin. The Brazilian skin showed better skin barrier function. In addition, the treatments were effective in both populations.

CONCLUSIONS

Despite the differences found in French and Brazilian skin, the proposed dermocosmetic treatments showed effective in both populations.

The effect of pre-phototest sun exposure on minimal erythema dose and minimal melanogenic dose among skin phototypes III, IV and V

BACKGROUND

Ethnicity, skin phototype and colour influenced minimal erythema dose (MED). Sun exposure has been postulated to increase MED. We determined immediate pigment darkening dose to UVA (IPDDA), MED and minimal melanogenic dose (MMD) for UVB and UVA, and investigated factors affecting these doses.

METHODS

Skin phototype was determined using Fitzpatrick phototype quiz, DSMII ColorMeter measured skin colours, sun exposure quantified using an index (SEI) and phototest performed with MEDlight-Multitester.

RESULTS

A total of 167 healthy volunteers participated. There were 110 (66%) females and 56 (34%) males; 124 (74.7%) were Malay, 27 (16.3%) Chinese and 14 (8.4%) Indians. One hundred and nine (65.7%) skin phototype IV, 30 (18.1%) phototype III and 27 (16.3%) phototype V. IPDDA ranges from 6 ± 1.5-5.7 ± 1.4 J/cm² . MED-UVB were 96.9 ± 17.6, 124 ± 29.3 and 118.6 ± 27.4 mJ/cm² for phototype III, IV and V, respectively. All MED-UVA were outside the tested dose range of 3.6-11 J/cm² . MMD-UVB were 106 ± 18.2, 134 ± 25.6 and 136 ± 31.1 mJ/cm² while MMD-UVA were 4.1 ± 4.1, 4.9 ± 3.8 and 5.7 ± 3.7 J/cm² respectively for phototypes III, IV and V. MED-UVB, MMD-UVB and MMD-UVA did not depend on skin phototype. Facultative skin whiteness (L*), erythema (E) and melanin content (M) correlated significantly with MED-UVB while constitutive skin colours were significant for L*, yellowness (b*), E and M. Sun exposure did not significantly correlate with MED-UVB and MMDs, however, an inverse relationship with MED-UVB was demonstrated.

CONCLUSION

Minimal erythema doses in our cohort were slightly different from other regional countries. Constitutive and facultative skin whiteness, erythema and melanin content correlated with MED. There was no association between skin phototype and sun exposure with MED or MMD.

The minimal erythema dose of broadband ultraviolet B in Taiwanese

The purpose of this study was to determine the cutaneous response to UVB radiation in Taiwanese subjects. The relationships among minimal erythema dose (MED) of broadband UVB, Fitzpatrick's skin phototype, and skin color were examined in 61 healthy Taiwanese volunteers. Thirty-one females and 30 males were enrolled. Overall, the mean MED was 142.3 mJ/cm(2); there was no significant gender difference. The mean MEDs of subjects with Fitzpatrick skin types II, III, IV and V were 122.9 mJ/cm(2), 136.2 mJ/cm(2), 148.3 mJ/cm(2) and 165.0 mJ/cm(2), respectively. Both the mean MEDs and the lower MED limits increased with skin phototypes. To identify patients with abnormal photosensitivity, physicians could use these lower limits as reference values. In addition, different starting doses of broadband UVB phototherapy could be used for different skin phototypes.

Skin phototyping in a Chinese female population: analysis of four hundred and four cases from four major cities of China

BACKGROUND/PURPOSE

The sun-reactive skin types in 404 Chinese females living in different cities were investigated in this study.

METHODS

A questionnaire was designed according to the original concept of skin types proposed by Fitzpatrick and the investigation was conducted in two ways: self-administered reporting and then a personal interview. Minimal erythema dose (MED) and minimal persistent pigmentation dose (MPPD) were also measured in part of the volunteers with a standard solar simulator.

RESULTS

The results show that in the way of personal interview, the predominant skin type of the investigated group is type III (71.4%), and then type II (14.7%) and type IV (14.2%), while in the self-reporting manner, the result is as follows: type III, 74.3%, type II, 25.6% and type IV, 1%. There are no skin type I, V or VI in the studied group. MED and MPPD from the same population show some relevance to the skin types, e.g. with the change of skin type from Type II to IV, the mean value of MED increases gradually and the MPPD decreases slightly.

CONCLUSIONS

From the study we concluded that the skin types of the investigated Chinese females are principally type III (more than 70%), and then type II and type IV. The different ways of answering the questionnaire did not affect the results remarkably. The measurements of photobiology parameters confirmed that there is a certain correlation between skin types and MED or MPPD determined in this group of volunteers.

8-Isoprostane is a dose-related biomarker for photo-oxidative ultraviolet (UV) B damage in vivo : a pilot study with personal UV dosimetry

BACKGROUND

Ultraviolet (UV) B irradiation causes visible erythema, which has been linked with DNA damage. However, besides such direct photochemical conformation changes, UVB also induces many indirect photochemical effects in the skin. Lipid peroxidation (LPO) is in this context one of the major pathways by which photo-oxidative stress disturbs cell signalling and promotes photocarcinogenesis and photoageing. So far we lack techniques for visualizing photo-oxidative stress in the skin. Furthermore, LPO has never been linked with individually acquired UVB doses measured by personal dosimetry.

OBJECTIVES

Measuring the skin reaction and photo-oxidative damage by LPO in vivo after UVB exposure in a pilot study surveyed by personal dosimetry in order to allow for a correlation analysis of acquired dose, skin reaction and amount of LPO.

METHODS

UVB exposure was measured with the opto-electronic X2000-1 (Gigahertz Optik, Puchheim, Germany) and the biological DLR Biofilm (German Aerospace Center DLR, Cologne, Germany) portable dosimeter. The skin reaction following UVB exposure was quantified with a Minolta chromameter (Minolta, Tokyo, Japan) and LPO in vivo was measured by 8-isoprostane generation by means of densitometric analysis of immunohistochemical samples obtained 30 min post-UVB irradiation.

RESULTS

Regression analysis revealed significant linear relations between UVB exposures recorded by the dosimeters and colorimetry parameters of the skin reaction. Furthermore, an even better linear relation with higher significance was found between the generation of 8-isoprostane in the skin and the dosimeter readouts.

CONCLUSIONS

LPO measured by the generation of 8-isoprostane provides a suitable intrinsic biomarker for photo-oxidative UVB damage in vivo. This study provides a new approach to visualizing photo-oxidative stress in the skin in vivo. Furthermore, future dosimeter readouts can now be set into relation to the expected increase of LPO that can be calculated within the limits of our study.

The Time Course of Photoadaptation and Pigmentation Studied Using a Novel Method to Distinguish Pigmentation from Erythema

The dynamics of human pigmentation in response to ultraviolet radiation (UVR) remain poorly characterized. In part, this is attributable to methodological issues relating to the overlap in spectra of hemoglobin and melanin. We describe a new method, based on the recording of reflectance properties following iontophoresis of a potent vasoconstrictor, noradrenaline. This removes the influence of blood, allowing measurement of pigmentation, represented as L* on the L*a*b* scale. Blood flow was separately assessed using laser Doppler flowmetry. We show that there is a clear dose response with the dose of UVR administered, that pigmentation peaks at 1 wk and declines over the following 10 wk, but does not return to baseline within this period. We show clear differences in the degree, but not the temporal pattern of pigmentation between different pigmentary groups. We also report that the relation between facultative pigment and constitutive pigment is incomplete, with a wide scatter of responses for the development of pigmentation irrespective of constitutive levels. For comparison we also document overall photoadaptation and relate changes in pigmentation to the overall changes in photoadaptation.

Determination of the Minimal Erythema Dose and Colorimetric Measurements as Indicators of Skin Sensitivity to UV-B Radiation¶

There is a strong relation between chronic UV-B-induced sunburns and the development of skin cancer. Therefore, it is important to obtain a method that can be reproduced easily to detect individuals with similar skin color but different sensitiveness to sun exposure. The study evaluated 193 healthy volunteers (68% women; the average age was 38 years). They were divided into six groups of at least 30 subjects, according to skin type. The minimal erythema dose (MED) was assessed in two non-sun-exposed areas (thorax-infra-axillary area and on the buttocks), using a UV-B source (0.5 mW/cm2), with openings of 1 cm2, in increasing doses. The same areas were evaluated with a Minolta CR 300 Chromameter (L*a*b* system). The MED values ranged from 13 to 156 mJ/cm2; the coordinate L* (brightness) ranged from 75.96 to 30.15. The correlation between the MED and the brightness was negative in both areas (Pearson's correlation r = -0.91, P < 0.05). Color measurements, especially brightness, can be used to quickly assess skin sensibility. Considering the MED, there is a substantial overlapping of adjacent phototypes, but they could be separated into two groups: more sensitive individuals (Types I, II, III and IV) and less sensitive ones (Types V and VI).

Prediction of experimental data for an independent variable using the experimental data collected for other independent variables in a study of skin cancer caused by exposure to UV radiation

In this study, two algorithms (ONE and TWO) are introduced to determine the position of the t-distribution of variable V(i) (with 95% confidence) in the treated group in reference to the t-distribution of variable V(i) (with 95% confidence) in the control group of an experimental study involving UV radiation exposure of a group of rodents. The outcome of applying the two algorithms is two discretized files. A reduct of each file is generated using the rough sets methodology and then the measurements for one independent variable are predicted using the measurements of the other independent variables in the same reduct. The rough sets methodology and the fuzzy-rough classifier are used for this prediction. The results reveal that (1) algorithm TWO is the best, (2) the values for non-core variables are predicted with minimum accuracy of 87%, and (3) the prediction of values for core variables is not successful.

Comparing quantitative measures of erythema, pigmentation and skin response using reflectometry

We measured a number of pigmentation and skin response phenotypes in a sample of volunteers (n=397) living in State College, PA. The majority of this sample was composed of four groups based on stated ancestry: African-American, European-American, Hispanic and East Asian. Several measures of melanin concentration (L*, melanin index and adjusted melanin index) were estimated by diffuse reflectance spectroscopy and compared. The efficacy of these measures for assessing constitutive pigmentation and melanogenic dose-response was evaluated. Similarly, several measures of erythema (a*, erythema index and adjusted erythema index) were compared and evaluated in their efficacy in measuring erythema and erythemal dose-response. We show a high correspondence among all of the measures for the assessment of constitutive pigmentation and baseline erythema. However, our results demonstrate that evaluating melanogenic dose-response is highly dependent on the summary statistic used: while L* is a valid measure of constitutive pigmentation it is not an effective measure of melanogenic dose-response. Our results also confirm the use of a*, as it is shown to be highly correlated with the adjusted erythema index, a more advanced measure of erythema based on the apparent absorbance. Diffuse reflectance spectroscopy can be used to quantify the constitutive pigmentation, melanogenic dose-response at 7 d and erythemal dose-response at both 24 h and 7 d postexposure.

The impact of epidermal melanin on objective measurements of human skin colour

Objective measurements of human skin colour were made with a tristimulus (L*a*b*) chromameter in a range of different ethnic skin types. These were compared with biochemical measurements of melanin content, melanin composition and melanosome size in skin biopsies obtained from the same sites. L*, a* and b* values were found to vary significantly with ethnicity. In general, constitutively dark skin types have lower L* values, higher a* values and higher b* values than constitutively light skin types. Total epidermal melanin content appears to be the primary determinant of L* values in human skin (r = -0.88; P < 0.00001), whilst melanosome size also has a significant but more subtle influence on L* values (r = -0.73; P < 0.00001). There is also a strong positive contribution to a* values from epidermal melanin (r = 0.66, P < 0.00001), which accounts for the ethnic variation in a* values observed in this study. Melanin is also a major contributor to b* values in lighter skin types (r = 0.71, P < 0.00001). However, this relationship breaks down in darker skin types where b* values actually reach a maximum and then decrease as the concentration of melanin in the skin increases. This appears to be because of optical masking of yellow light by high concentrations of melanin in the epidermis. Analysis of the relationships between L*, a* and b* values in human skin indicate that they are very closely interrelated, and suggest that the optical properties of melanin in the epidermis are very similar to those of a dye on a fabric substrate.

Dietary carotenoids contribute to normal human skin color and UV photosensitivity

The aim of the current study was to determine whether dietary carotenoids influence skin pigmentation and UV photosensitivity in a healthy unsupplemented panel (n = 22) of Caucasian (skin Type II) subjects. Skin spectrophotometric and tristimulus (L*a*b*) CR200 chromameter readings were made at various body sites to objectively measure skin carotenoid levels and skin color, respectively. The minimal erythemal dose (MED) was also measured to determine the intrinsic UV photosensitivity of the skin. We found that tristimulus b* values (but not L* and a* values) were consistently and closely correlated with skin carotenoid levels at a number of body sites including the back (r = 0.85, P < 0.00001), forehead (r = 0.85, P < 0.00001), inner forearm (r = 0.75, P < 0.0001) and palm of the hand (r = 0.78, P < 0.0001). Skin carotenoid levels and MED were also correlated in these subjects (r = 0.66, P < 0.001), as were tristimulus b* values and MED (r = 0.71, P < 0.0002). From these observations, we conclude that carotenoids from a normal, unsupplemented diet accumulate in the skin and confer a measurable photoprotective benefit (at least in lightly pigmented Caucasian skin), that is directly linked to their concentration in the tissue. Carotenoids also appear to contribute measurably and significantly to normal human skin color, in particular the appearance of "yellowness" as defined objectively by CR200 tristimulus b* values. On the basis of these findings we believe that objective measurements of skin color, in particular tristimulus b* values, may be a potentially useful means of monitoring dietary carotenoid status and assessing UV photosensitivity in Caucasian populations.

Effects of glycolic acid on light-induced skin pigmentation in Asian and caucasian subjects

BACKGROUND

Topical use of alpha-hydroxy acid (AHA) may increase skin photosensitivity, as demonstrated by increased numbers of sunburst cells. However, effects of AHA on tanning have not been studied.

OBJECTIVE

Our purpose was to study whether short-term use of glycolic acid hastens resolution of pre-existing light-induced pigmentation and whether the skin becomes tan more easily in Asian and Caucasian subjects after such treatment.

METHODS

Six Asian and six Caucasian volunteers received separate irradiations of UVB and UVA to both sides of the lower back. In a double-blind fashion, patients then applied a 10% glycolic acid gel, pH 3.52, to one side of the back, including the irradiated area, and the contralateral extensor forearms once daily for 7 days and then twice daily for 2 weeks. A placebo gel, pH 5.75, was applied to the opposite sides. The subjects returned for measurement of residual tanning with a colorimeter and received additional irradiation to forearms and a second site on the back. Resulting pigmentation was measured immediately after irradiation, at 2 hours, and at 1 week.

RESULTS

Increased UVB-induced skin tanning occurred on the forearm and the lower back in both races in areas pretreated with glycolic acid. UVA also caused increased tanning, but only on the extensor forearms in Asian subjects. Treatment with glycolic acid for 3 weeks had no effect on pre-existing light-induced pigmentation.

CONCLUSION

Short-term topical treatment of glycolic acid caused an increase in UVB tanning as well as in UVA tanning in some subjects, even in the absence of overt irritation. The inclusion of UVB, and even UVA, sunscreen in AHA products may be warranted.