Photoprotection according to skin phototype and dermatoses: practical recommendations from an expert panel

Acne-induced Post-inflammatory Hyperpigmentation: From Grading to Treatment

Acne-induced post-inflammatory hyperpigmentation (AI-PIH) can occur without any visible clinical evidence of significant inflammation, even in patients with mild to moderate acne. Currently, visual assessment is the main criterion for evaluating the severity of PIH, including that of AI-PIH in daily clinical practice. Treatment indications are lacking. This work provides an easy-to-use AI-PIH severity grading tool for daily clinical practice as well as indications on how to prevent and treat AI-PIH using currently available treatment options. Five experts in acne provided a short overview concerning the epidemiology and physiopathology of AI-PIH, developed an AI-PIH severity grading tool, and proposed preventive measures as well as an AI-PIH treatment algorithm. Only a small number of epidemiological data on AI-PIH are available, confirming that the condition is mainly observed in patients with Phototypes IV to VI. The physiopathology of AI-PIH is still not completely understood. Innate immunity, Cutibacterium acnes, and external factors such as UV radiation, visible light, and air pollution play a role in its development. An easy-to-use AI-PIH severity grading tool (Acne PIgmentation Grading) allows quick assessment of acne severity during the consultation, and, in addition to proposed preventive measures, a treatment algorithm is proposed according to AI-PH severity. Patient education remains key. Providing an AI-PIH severity assessment tool as well as preventive and treatment recommendations may help to manage AI-PIH more efficiently.

Orientin attenuates UVB-induced skin photodamage by inhibiting ROS generation via the AMPK/Nrf2 axis

The accumulation of reactive oxygen species (ROS) in the skin following UVB exposure is a key contributor to ultraviolet-induced skin photodamage. Orientin, a bioactive flavonoid, has demonstrated antioxidant properties in previous studies. However, its efficacy in treating skin photodamage remains inadequately understood. This study investigates the effects of orientin in preventing UVB-induced immortalized human keratinocytes (HaCaT cells) and BALB/c mouse skin photodamage by activating the AMPK/Nrf2 axis. Results show that orientin protects HaCaT cell viability after UVB exposure, reduces ROS levels, and upregulates antioxidant enzymes, including SOD1, HO-1, and NQO-1, while concurrently suppressing the expression of inflammatory mediators such as COX-2, IL-6, and IL-8. Additionally, orientin promotes AMPK phosphorylation, which facilitates Nrf2 nuclear translocation, thereby enhancing the antioxidant defense of cells. This effect is diminished upon inhibition of AMPK or Nrf2. In the BALB/c mouse model of photodamage, topical application of orientin alleviates symptoms like skin roughness, scaling, and erythema induced by UVB irradiation, while also elevating antioxidant enzyme expression in skin tissues. These findings suggest that orientin mitigates ultraviolet-induced skin photodamage both in vitro and in vivo, boosts cellular antioxidant capacity, and diminishes inflammatory responses, suggesting its potential for further exploration in skin photodamage management.

One Acne™: A holistic management approach to improve overall skin quality and treatment outcomes in acne with or without sensitive skin

Acne and sensitive skin can take a profound toll on patients' well-being, which can be exacerbated if the conditions are experienced together. This narrative review aims to identify appropriate treatments to facilitate a holistic management approach to acne (One Acne™), sensitive skin, and acne-induced sequelae and describe the role of treatments in improving skin quality. Topical retinoids are considered the preferred first-line option for acne treatment by dermatologists, either as monotherapy or in combination with other treatments, because of their ability to target various aspects of the disease. Tretinoin, trifarotene, adapalene, and tazarotene have all been assessed in clinical studies for managing acne-associated scarring, with varying success, with the latter three reported to improve skin quality. Moreover, some corrective procedures, e.g., injectable non-animal stabilized hyaluronic acid (NASHA) fillers, have proven effective for treating acne scarring. Both treatment types may complement each other to provide optimal treatment outcomes and patient satisfaction, as observed in several patients receiving concomitant treatment with NASHA fillers/topical trifarotene. Adjunctive use of cleansers, moisturizers, and photoprotection-containing ingredients such as vitamin B3, glycerin, or pro-vitamin B3 may also complement drug/corrective treatments to reduce skin irritation and risk of scarring, as well as improve skin hydration, tone, and overall appearance. This narrative review highlights that comprehensive skincare regimens should be used throughout acne patients' journeys to reduce treatment-related irritation, improve treatment outcomes, adherence, and satisfaction, and enhance overall skin quality. Patients with sensitive skin should choose tailored skincare products to maintain skin barrier integrity and restore skin function.

A Comprehensive Review of the Role of UV Radiation in Photoaging Processes Between Different Types of Skin

Ultraviolet (UV) radiation significantly contributes to photoaging, with its effects varying among different Fitzpatrick skin types. Light skin (Types I-III) has a natural sun protection factor (SPF) of only 3.3, making it particularly vulnerable to DNA damage, collagen degradation, and skin cancer. Darker skin (Types IV-VI) has a natural SPF of 13.4, providing greater photoprotection while elevating the risk of post-inflammatory hyperpigmentation and delaying skin cancer diagnosis. UVA penetrates deep into the dermis, promoting collagen degradation, whereas UVB causes DNA mutations, increasing the risk of cancer. Eumelanin in darker skin mitigates oxidative stress, while pheomelanin in lighter skin functions as a pro-oxidant, increasing vulnerability to photoaging. Although incidence rates are lower, melanoma is identified at more advanced stages in those with darker skin, resulting in poorer outcomes. Protective measures, such as broad-spectrum sunscreens, antioxidants, and hydration, are crucial for all skin types but necessitate customized strategies. Individuals with lighter skin benefit from SPF 50+ and DNA-repairing compounds, whereas those with darker complexion necessitate SPF 30-50 and pigmentation-focused skincare. Comprehending the biological mechanisms and variations in UV damage facilitates the creation of customized photoprotection solutions, enhancing skin health and mitigating long-term UV-related issues for all skin types.

Here Comes the Sun! A Study on Sun Exposure and Associated Risks in the Canadian Population

OBJECTIVE

To evaluate the awareness of and attitudes toward various aspects of sun-exposure risks and protection methods among Canadians.

METHODS

An online survey conducted from September 28 to October 18, 2021, included 17,001 participants aged 18 years and above from 17 countries across 5 continents; the data presented are those of the Canadian population (n = 1,000). The survey focused on demographics, sun-exposure habits, comprehension of risks, and knowledge of photoprotection. The results were analyzed using descriptive statistics to identify prevalent trends and discrepancies in sun-protective behaviours among Canadians.

RESULTS

The majority of Canadian respondents (93%) acknowledged the health risks associated with sun exposure. While 81% of Canadians reported using some form of sun protection, only 10% systematically implemented all recommended protective measures, highlighting a gap in knowledge translation. Misconceptions regarding the safety of tanned skin and the effectiveness of sunscreens were widespread, particularly in younger demographics and in individuals with darker skin. Knowledge and preventive behaviours were markedly better among individuals who regularly consult dermatologists.

CONCLUSIONS

This study highlights general awareness of sun-protective behaviours but a lack of universal and comprehensive implementation among Canadians. Given the knowledge gaps in younger demographics and darker skin phototypes, targeted educational initiatives are essential to correct prevalent misconceptions about sun exposure and tanned skin. Dermatologists and other health care professionals can play a pivotal role in education and primary prevention strategies for skin cancer and other sun-related comorbidities.

Australian Sunscreens: The Price of Protection for Skin of Colour With Pigmentary Disorders

Australia experiences some of the highest ultraviolet radiation (UVR) levels globally, known for causing sunburn, skin cancers, photoageing and immunosuppression. While effects of UVA and UVB are well-studied, visible light (VL; 400-700 nm) is the driving force behind pigmentary disorders, especially in skin of colour (SOC) patients. Nearly 50% of Australians are affected, with significant impacts on appearance and psychological well-being. Tinted sunscreens containing iron oxides and pigmentary-grade titanium dioxide are the only effective options for blocking VL. However, Australia's stringent Therapeutic Goods Administration (TGA) regulations limit the availability of colour-matched tinted sunscreens, significantly impacting SOC patients. SOC patients may also underestimate their need for photoprotection, believing their skin provides sufficient natural protection. In dermatological practice, tailored sunscreen recommendations for darker skin tones may sometimes be overlooked. This review explores the barriers to effective treatment and the cost implications for SOC individuals suffering from pigmentary disorders in Australia. The goal is to guide both patients and dermatologists in making informed decisions on VL protection and skin tone matching.

Sunscreens in pigmentary disorders: time to revise the message

Current sunscreen messaging centres around skin cancer prevention, with an emphasis on mitigating the damaging effects of ultraviolet B (UVB) radiation. Darker skin is believed to be better protected against UVB owing to its higher melanin content, and therefore, this messaging has been largely targeted at people with lighter skin tones. This is reflected by low sunscreen use by people of darker skin types. However, visible light (VL) is now being appreciated as a culprit behind exacerbation of disorders of hyperpigmentation such as melasma and post-inflammatory hyperpigmentation (PIH) which is known to significantly impair quality of life (QoL) of those affected. The role of VL in melanogenesis is not well known to patients nor to dermatologists and is a missed opportunity in the management of pigmentary disorders. We propose that changing the terminology from 'sunscreen' to 'light protection' acknowledges the central role of VL in melanogenesis, underlining the importance of VL protection and making the messaging more inclusive for people of all skin colours.

Sunscreen Formula of FeO(OH)·H2O/TiO2 With Spectral Selectivity to Enhance Collagen Biosynthesis via Fibroblast Test

OBJECTIVE

To develop a sunscreen formula with spectral selectivity that filters harmful light (280-550 nm) while allowing beneficial light (550-760 nm) to permeate and thus to boost collagen generation.

METHODS

A variety of sunscreen filters and their combinations were tested for transmittance spectrum. The spectral selectivity was quantified by Selection Index (SI), and the optimal formula was identified. Then, human dermal fibroblasts (HDFs) were subjected to simulated sunlight exposure with the application of this formula. The cell viability and collagen levels were measured post-exposure.

RESULTS

The combination of TiO2 and FeO(OH)·H2O displays spectral selectivity and reaches the optimal SI value at the mixing ratio of 64:36. This mixture, when formulated with traditional UV filters, significantly elevates the level of Collagen I.

CONCLUSION

This work uncovers the influence of spectral selectivity on the enhancement of sunscreen performance and proposes a filter combination with spectral selectivity. This formula, when integrated with conventional UV sunscreens, allows for the beneficial effects of sunlight to be more pronounced. This discovery may provide fresh insights for the design of future sunscreen products.

Ultraviolet Light Causes Skin Cell Senescence: From Mechanism to Prevention Principle

The skin is an effective protective barrier that significantly protects the body from damage caused by external environmental factors. Furthermore, skin condition significantly affects external beauty. In today's era, which is of material and spiritual prosperity, there is growing attention on skincare and wellness. Ultraviolet radiation is one of the most common external factors that lead to conditions like sunburn, skin cancer, and skin aging. In this review, several mechanisms of UV-induced skin cell senescence are discussed, including DNA damage, oxidative stress, inflammatory response, and mitochondrial dysfunction, which have their own characteristics and mutual effects. As an illustration, mitochondrial dysfunction triggers electron evasion and the generation of more reactive oxygen species, leading to oxidative stress and the activation of the NLRP3 inflammasome, which in turn causes mitochondrial DNA (mt DNA) damage. Based on the current mechanism, suitable prevention and treatment strategies are proposed from sunscreen, dietary, and experimental medications respectively, aimed at slowing down skin cell aging and providing protection from ultraviolet radiation. The effects of ultraviolet rays on skin is summarized, offering insights and directions for future studies on mechanism of skin cell senescence, with an anticipation of discovering more effective prevention and cure methods.

Comparative efficacy and safety of the novel Picosecond Alexandrite Laser and the traditional combined Q-switched and long-pulse Nd: YAG lasers in melasma treatment: a randomized evaluator-blinded trial

Melasma significantly impacts life quality, and while various laser therapies show promise, rigorous comparative studies, especially between the novel Picosecond Alexandrite Laser (PSAL) and the traditional combined modality of Q-switched and Long-pulse Nd: YAG Lasers (QLNYL), are notably lacking. This study aims to fill this gap by evaluating the efficacy and safety of these modalities, providing insights into their comparative advantages for clinical practice. In a prospective, evaluator-blinded study, 40 participants with Fitzpatrick Skin Types (FST) III and IV underwent three treatment sessions at four-week intervals with either PSAL or QLNYL. Efficacy was primarily assessed by changes in Melasma Area and Severity Index (MASI) scores at baseline, 4, 8, 12, and 24 weeks, along with patient satisfaction evaluations at the 12- and 24-week marks, and safety assessments conducted throughout the study. Both groups experienced significant reductions in MASI scores post-treatment. Overall, the improvement in MASI scores in the QLNYL group significantly surpassed that in the PSAL group (P = 0.010). Patient satisfaction was comparably high between groups, and no significant differences were noted in safety profiles. The PSAL group showed a slightly higher incidence of adverse reactions (not significant) and significantly higher pain scores (P = 0.018). Recurrence rates at the 24-week follow-up were 10.5% for PSAL and 0% for QLNYL, with no significant difference. Both PSAL and QLNYL proved effective in treating melasma, with the traditional combined modality of QLNYL demonstrating superior efficacy in FST III-IV. Safety profiles were similar comparable.

Gain of Protection Afforded by the Methoxypropylamino Cyclohexenylidene Ethoxyethylcyanoacetate (MCE) UVA1 Filter on Pigmentary and Aging Signs: An Outdoor 4-Week Randomized, Intra-Individual Comparative Study in 52 Brazilian Women

BACKGROUND

Conventional sunscreens shield the skin from ultraviolet (UV) rays up to 370 nm leaving wavelengths between 370 and 400 nm unfiltered despite their potentially harmful biological and clinical effects.

OBJECTIVE

The beneficial effects of methoxypropylamino cyclohexenylidene ethoxyethylcyanoacetate (MCE) UVA1 filter were explored at 1% in a SPF50 sunscreen under outdoors summer conditions against pigmentation and aging signs compared against a reference SPF50 without the MCE filter.

MATERIALS AND METHODS

A prospective randomized comparative intra-individual study was conducted in 52 Brazilian women (phototype I-III). A hemiface application was performed for the SPF50 sunscreen with 1% MCE and SPF50 reference without MCE before 1-h outdoor sunlight exposure, twice daily for 4 weeks. Study endpoint included expert panel grading of pigmentation (3), vascular (1) signs as well as facial skin ageing and assessment of facial skin radiance and skin homogeneity by a naïve panel.

RESULTS

Significant differences were reported for all facial signs comparing areas protected with SPF50/MCE and SPF50, respectively: upper lip wrinkles, crow's feet wrinkles, upper lip texture, upper lip pigmentation, vascular abnormalities (all p < 0.0001), texture of the mouth contour (p = 0.001), ptosis of lower face (p = 0.003), lateral facial pigmentation (p = 0.005), and whole face pigmentation (p = 0.01). The evaluations performed by naïve panel showed a significant superiority of the SPF50/MCE product for skin homogeneity (p = 0.043).

CONCLUSION

Overall, this study demonstrates a significant gain of protection with the SPF50 containing 1% MCE in reducing hyperpigmentation, redness and aging signs compared to the same SPF50 sunscreen without MCE, thus supporting the need for an enlarged UVA1 photoprotection.

Personalized Photoprotection: Expert Consensus and Recommendations From a Delphi Study Among Dermatologists

BACKGROUND

Recommending comprehensive personalized photoprotection requires an accurate assessment of the patient's skin, including phototype, lifestyle, exposure conditions, environmental factors, and concomitant cutaneous conditions as well as deep knowledge of the available options: sunscreen ingredients (type of filters, spectrum coverage, sun protection factor, enhanced active ingredients), oral photoprotection, and other methods of sun protection and avoidance.

OBJECTIVES

To establish consensus-based recommendations endorsed by an international panel of experts for personalized medical photoprotection recommendations that are applicable globally.

METHODS

A two-round Delphi study was designed to determine the degree of agreement and relevance of aspects related to personalized medical photoprotection. Items with ≥ 80% agreement and relevance were considered approved.

RESULTS

A list of 28 recommendations for personalized medical photoprotection was approved by a panel of dermatology professionals from seven different countries. Recommendations were categorized as: (1) updated perspectives in photoprotection, (2) clinical management, (3) skin cancer prevention, (4) dark skin phototypes and skin prone to hyperpigmentation, and (5) age and lifestyle.

CONCLUSION

This study established recommendations for the implementation of personalized medical photoprotection worldwide, highlighting areas needing further scientific and clinical evidence.

Immune Checkpoint Inhibitor-Associated Cutaneous Adverse Events: Mechanisms of Occurrence

Immunotherapy, particularly that based on blocking checkpoint proteins in many tumors, including melanoma, Merkel cell carcinoma, non-small cell lung cancer (NSCLC), triple-negative breast (TNB cancer), renal cancer, and gastrointestinal and endometrial neoplasms, is a therapeutic alternative to chemotherapy. Immune checkpoint inhibitor (ICI)-based therapies have the potential to target different pathways leading to the destruction of cancer cells. Although ICIs are an effective treatment strategy for patients with highly immune-infiltrated cancers, the development of different adverse effects including cutaneous adverse effects during and after the treatment with ICIs is common. ICI-associated cutaneous adverse effects include mostly inflammatory and bullous dermatoses, as well as severe cutaneous side reactions such as rash or inflammatory dermatitis encompassing erythema multiforme; lichenoid, eczematous, psoriasiform, and morbilliform lesions; and palmoplantar erythrodysesthesia. The development of immunotherapy-related adverse effects is a consequence of ICIs' unique molecular action that is mainly mediated by the activation of cytotoxic CD4+/CD8+ T cells. ICI-associated cutaneous disorders are the most prevalent effects induced in response to anti-programmed cell death 1 (PD-1), anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4), and anti-programmed cell death ligand 1 (PD-L1) agents. Herein, we will elucidate the mechanisms regulating the occurrence of cutaneous adverse effects following treatment with ICIs.

Skin Cancer Knowledge, Sun Exposure, Photoprotection Behavior, and Perceived Barriers Associated with Skin Cancer Types in a Greek Cohort: A Cross-Sectional Study on the Island of Crete

BACKGORUND

This study aimed to explore the relationship between different types of skin cancer and factors such as sun exposure and photoprotection measures in a Greek cohort on the island of Crete.

METHODS

This cross-sectional observational study was conducted in the Dermatology Department of the University Hospital in Heraklion, Crete, between January 2019 and January 2024. The study population included consecutive patients diagnosed with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM), as well as healthy controls. The participants completed a self-reported questionnaire covering demographic and clinical data as well as questions about sun exposure and photoprotection habits.

RESULTS

A total of 265 skin cancer patients and 106 healthy controls participated in the study: 50.6% of the patients had basal cell carcinoma, 35.1% had squamous cell carcinoma, and 14.3% had malignant melanoma. The cohort comprised 41.5% females and 58.5% males, with a mean age of 73.2 years. As expected, the patients with skin cancer had a lighter skin phototype compared to the healthy controls (p < 0.01). They also reported greater occupational (p < 0.01) and leisure sun exposure (p < 0.01) and a higher median number of vacation weeks spent outdoors before the age of 18 (p = 0.030). Furthermore, the healthy controls were more likely to use sunscreen (p = 0.035) and preferred higher SPF (>50) when they did so (p < 0.01). The healthy controls also reported more frequent use of sunglasses (p < 0.01), brimmed hats (p < 0.01), and long-sleeved clothing (p < 0.01) compared to the skin cancer patients.

CONCLUSION

This is the first study to analyze sun exposure and photoprotection behaviors in patients with nonmelanoma skin cancer (NMSC) and malignant melanoma (MM) in Crete, revealing the key associations and underscoring the need for targeted prevention strategies.

Atorvastatin calcium alleviates UVB-induced HaCat cell senescence and skin photoaging

Excessive exposure to ultraviolet radiation B (UVB) has been shown to contribute to the aging of human skin cells. Previous research has demonstrated that atorvastatin calcium (Ato) can mitigate the aging effects caused by chemotherapy drugs. However, it remains unclear whether Ato can alleviate skin aging induced by ultraviolet radiation. In this study, through in vitro experiments with Hacat cells, we found that Ato can significantly reduce the UVB-induced increased expression of age-related protein p16 and age-related gene p21, and also reduce the up-regulation of inflammatory factors such as IL-1 and IL-6. Besides, it can reduce the expression of metallomatrix protein (MMP1 and MMP9), and inhibit cell senescence and inflammatory damage. Similarly, we found that Ato can enhance skin collagen fiber reduction and collagen volume decrease, repair skin photoaging and damage induced by UVB rays, and speed up the rate at which the wounded location heals in vivo using Balb/c mice. In the mechanism, Ato markedly decreased the expression of p-p38, p-p65, p-mTOR in vivo and in vitro, suggesting that it may act on Mitogen-activated protein kinase (MAPK), Nuclear factor κB (NF- κB) and Mammalian target of rapamycin (mTOR) signaling pathways to produce above marked effects. In conclusion, Ato obviously relieved UVB-induced photoaging and damage, thus providing evidence for its potential in mitigating skin aging caused by ultraviolet radiation.

Based on network pharmacology, molecular docking and experimental verification to reveal the mechanism of Andrographis paniculata against solar dermatitis

BACKGROUND

Solar dermatitis (SD) is an acute, damaging inflammation of the skin caused by UV exposure, especially UVB. Therefore, the discovery of novel anti-SD therapeutic agents is crucial. Andrographis paniculata (AP) is a medicinal plant with a wide range of pharmacological effects. Increased evidence shows that AP has potential therapeutic effects on SD. However, the therapeutic mechanisms of AP against SD have not yet been completely elucidated, which is an unexplored field.

PURPOSE

This study employed network pharmacology, molecular docking and experimental verification to ascertain the active constituents, possible targets, and biological pathways associated with AP in the treatment of SD.

METHODS

AP-related active ingredients and their potential targets were screened from TCMSP and Swiss Target Prediction database, respectively. Potential therapeutic targets of SD were collected using the GeneCards, DrugBank and OMIM databases. Then, we established protein-protein interaction (PPI), compound-target-disease (D-C-T-D) through Cytoscape to identify the major components, core targets of AP against SD. Next, the GO and KEGG pathway was identified by the David database of AP in the treatment of SD. Molecular docking techniques were used to estimate the binding force between the components and the hub genes. In this paper, we used UVB-irradiated HaCaT keratinocytes as an in vitro model and established the dorsal skin of UVB-irradiated ICR mice as an in vivo model to explore the mechanism for further verification.

RESULTS

There were 24 active components and 63 related target genes in AP against SD. PPI analysis showed that AKT-1, TNF-α, IL6, MMP9, EGFR, and PTGS2 shared the highest centrality among all target genes. KEGG pathway analysis revealed that the PI3K-Akt signaling pathway may be central in the anti-SD system. The molecular docking results showed that the main active components of AP have strong binding affinity with hub genes. In vitro results showed that WG had a protective effect on UVB-intervened HaCat cells. Western blot analysis showed that WG intervention achieved anti-inflammation by reducing the phosphorylated expression of AKT, PI3K proteins in the PI3K-AKT signaling pathway and downregulating the expression of TNF-α, IL-6, EGFR. Furthermore, Histological analysis confirmed that administration of WG to ICR mice significantly ameliorated UVB-induced skin roughness, epidermal thickening, disturbed collagen fiber alignment and wrinkles. Meanwhile, immunohistochemistry showed that administration of WG to ICR mice significantly reduced UVB-induced expression of MMP9, MPO, F4/80 in the skin. These results provide new insights into the contribution of WG to the development of clinical treatment modalities for UVB-induced SD.

CONCLUSION

The crucial element in the fight against SD is WG, with the primary route being PI3K/Akt. The main components and hub genes had robust binding abilities. In vitro and vivo experiments showed that WG could inhibit the expression level of the hub genes by inhibiting the PI3K/Akt pathway. In summary, the information presented in this study indicates that WG might be utilised as a treatment for UVB-induced SD.

Skin Phototype Classification with Machine Learning Based on Broadband Optical Measurements

The Fitzpatrick Skin Phototype Classification (FSPC) scale is widely used to categorize skin types but has limitations such as the underrepresentation of darker skin phototypes, low classification resolution, and subjectivity. These limitations may contribute to dermatological care disparities in patients with darker skin phototypes, including the misdiagnosis of wound healing progression and escalated dermatological disease severity. This study introduces (1) an optical sensor measuring reflected light across 410-940 nm, (2) an unsupervised K-means algorithm for skin phototype classification using broadband optical data, and (3) methods to optimize classification across the Near-ultraviolet-A, Visible, and Near-infrared spectra. The differentiation capability of the algorithm was compared to human assessment based on FSPC in a diverse participant population (n = 30) spanning an even distribution of the full FSPC scale. The FSPC assessment distinguished between light and dark skin phototypes (e.g., FSPC I vs. VI) at 560, 585, and 645 nm but struggled with more similar phototypes (e.g., I vs. II). The K-means algorithm demonstrated stronger differentiation across a broader range of wavelengths, resulting in better classification resolution and supporting its use as a quantifiable and reproducible method for skin type classification. We also demonstrate the optimization of this method for specific bandwidths of interest and their associated clinical implications.

A Practice Approach to Acne Fulminans in Adolescents

Acne fulminans (AF) is a severe form of inflammatory acne commonly associated with adolescents. It is characterized by an abrupt onset of painful nodules and plaques and can progress to suppurative, ulcerative, and hemorrhagic lesions. AF can be associated with systemic symptoms such as fever, arthralgia, and bone pain. The etiology of AF is unknown but it has been linked to the use of certain medications and has been rarely found in autoinflammatory syndromes. In previous years, there have been reports of <200 cases in the literature; however, AF may be more common in clinical practice than reported. The most common presentation of AF is seen in adolescents starting isotretinoin therapy. Diagnosis of AF is determined based on its clinical findings. The main purpose of this article is to provide clinicians with a practical approach to treating AF. Current evidence for its treatment is limited to case reports and case series. The mainstay treatment of AF is a combination of prednisone and isotretinoin. It is important to taper or discontinue any exacerbating or precipitating medications such as isotretinoin, antibiotics, or androgens when AF is identified. Along with treatment of AF, it is important to treat associated scarring. Early identification and treatment of AF in adolescents is crucial to minimize both acute symptoms and long-term scarring, and further research is needed to determine optimal management.

Considerations for Physicians Treating Skin of Color: A Narrative Review

Clinical research and medical education regarding dermatoses in people with skin of color (SoC) have historically been neglected, which has played a role in physicians lacking confidence and competence in recognizing and managing dermatoses in diverse cohorts. This has contributed to poorer outcomes in people with SoC in objective domains, such as disease severity indices and prognoses, and subjective domains, such as patient-reported quality-of-life indices. In the first instance, physicians should understand the basic physiological differences underpinning SoC diversity and its clinical implications. This narrative review provides an introductory evidence-based discussion on clinically important topics relating to SoC aimed at non-dermatologists. Topics covered include the cellular basis underpinning skin color diversity and how this affects photodermatoses and malignancies, as well as an overview of how scarring and inflammatory conditions may present differently in people with SoC.

Human adipose and umbilical cord mesenchymal stem cell-derived extracellular vesicles mitigate photoaging via TIMP1/Notch1

UVB radiation induces oxidative stress, DNA damage, and inflammation, leading to skin wrinkling, compromised barrier function, and an increased risk of carcinogenesis. Addressing or preventing photoaging may offer a promising therapeutic avenue for these conditions. Recent research indicated that mesenchymal stem cells (MSCs) exhibit significant therapeutic potential for various skin diseases. Given that extracellular vesicles (EV) can deliver diverse cargo to recipient cells and elicit similar therapeutic effects, we investigated the roles and underlying mechanisms of both adipose-derived MSC-derived EV (AMSC-EV) and umbilical cord-derived MSC-derived EV (HUMSC-EV) in photoaging. Our findings indicated that in vivo, treatment with AMSC-EV and HUMSC-EV resulted in improvements in wrinkles and skin hydration while also mitigating skin inflammation and thickness alterations in both the epidermis and dermis. Additionally, in vitro studies using human keratinocytes (HaCaTs), human dermal fibroblast cells (HDFs), and T-Skin models revealed that AMSC-EV and HUMSC-EV attenuated senescence, reduced levels of reactive oxygen species (ROS) and DNA damage, and alleviated inflammation induced by UVB. Furthermore, EV treatment enhanced cell viability and migration capacity in the epidermis and promoted extracellular matrix (ECM) remodeling in the dermis in photoaged cell models. Mechanistically, proteomics results showed that TIMP1 was highly expressed in both AMSC-EV and HUMSC-EV and could exert similar effects as MSC-EV. In addition, we found that EV and TIMP1 could inhibit Notch1 and downstream targets Hes1, P16, P21, and P53. Collectively, our data suggests that both AMSC-EV and HUMSC-EV attenuate skin photoaging through TIMP1/Notch1.

Anti-Melanogenic Potential of Malabar Spinach (Basella alba) in Human Melanoma Cells with Oxidative Stress Suppression and Anti-Inflammatory Activities

Basella alba has been used in Thai remedies to treat skin disorders, but scientific evidence supporting its efficacy is currently limited. In this study, we investigated the inhibitory effects of B. alba extracts on melanin production using melanoma cells, as well as their impact on oxidative stress and inflammation in keratinocytes. The results demonstrate that B. alba extracts inhibited melanin content and cellular tyrosinase activity in 3-isobutyl-1-methylxanthine (IBMX)-induced melanoma cells by downregulating MITF and the pigmentary genes TYR, TRP-1, and DCT. Interestingly, the MITF regulator gene was inhibited by both the 50% and 95% ethanolic extracts of B. alba with levels of 0.97 ± 0.19 and 0.92 ± 0.09 of the control, respectively, which are comparable to those observed in the arbutin treatment group at 0.84 ± 0.05 of the control. Moreover, after hydrogen peroxide (H2O2) exposure, pretreatment with B. alba reduced lipid peroxidation byproducts and increased the levels of antioxidant-related genes, including SOD-1, GPX-1, and NRF2. Notably, the suppression of the POMC promoter gene in keratinocytes was observed, which may disrupt melanogenesis in melanocytes involving the MC1R signaling pathway. MC1R mRNA expression decreased in the treatments with 50% and 95% ethanolic extracts of B. alba, with relative levels of 0.97 ± 0.18 and 0.90 ± 0.10 of the control, respectively, similar to the arbutin-treated group (0.88 ± 0.25 of control). A significant reduction in nitric oxide was also observed in the B. alba-treated groups, along with a decrease in genes associated with pro-inflammatory cytokines, including IL-1β, IL-6, and COX-2. These findings suggest that B. alba has potential in the prevention of skin-related problems.

The Tiny Big Difference: Nanotechnology in Photoprotective Innovations - A Systematic Review

UV radiation causes long- and short-term skin damage, such as erythema and skin cancer. Therefore, the use of sunscreens is extremely important. However, concerns about UV filter safety have prompted exploration into alternative solutions, with nanotechnology emerging as a promising avenue. This systematic review identified 23 experimental studies utilizing nanocarriers to encapsulate sunscreens with the aim of enhancing their efficacy and safety. Polymeric and lipid nanoparticles are frequently employed to encapsulate both organic and inorganic UV filters along with natural antioxidants. Nanocarriers have demonstrated benefits including reduced active ingredient usage, increased sun protection factor, and mitigated photoinstability. Notably, they also decreased the skin absorption of UV filters. In summary, nanocarriers represent a viable strategy for improving sunscreen formulations, offering enhanced physicochemical properties and bolstered photoprotective effects, thereby addressing concerns regarding UV filter safety and efficacy in cosmetic applications.

Neuromodulators in Skin of Color: An International Review

BACKGROUND

As the racial/ethnic diversity of the US population grows, it is imperative for dermatologists to recognize the nuances in the aesthetic treatment of diverse populations.

OBJECTIVE

This comprehensive review explores the safety and efficacy of botulinum toxin A (BTX-A) in skin of color (SOC) populations and highlights variations in aging patterns, skin properties, and aesthetic concerns in SOC populations.

MATERIALS AND METHODS

A review of PubMed/MEDLINE databases from 2004 to 2024 was performed using combinations of the terms botulinum toxin, SOC, Fitzpatrick, race/ethnicity, and Asian, Latin American, Caribbean, Middle Eastern, African, and Pacific countries.

RESULTS

Twenty-three articles examining the use of BTX-A in SOC populations were identified. Twelve studies were from East Asia, 5 from the United States and/or Canada, 3 from South Asia/Southeast Asia, 2 from South America, and 1 from the Middle East. Available data suggest that BTX-A is efficacious and well tolerated in SOC populations.

CONCLUSION

Increased SOC representation in clinical trials may guide the development of tailored treatment approaches to optimize aesthetic outcomes for patients with SOC. A comprehensive knowledge of the variations in aging patterns, skin properties, and aesthetic concerns across SOC populations is essential for providing culturally sensitive cosmetic dermatologic care for diverse populations.

Sunscreens prescribed to patients with skin of color and/or with melasma: A survey of 221 dermatologists and dermatology residents in Spain

BACKGROUND

Dark-skinned individuals (DSI) present high rates of melasma and post-inflammatory hyperpigmentation. The use of sunscreens with mineral filters is essential for prevention and treatment. Our objective was to determine the preferences of dermatologists and dermatology residents in the prescription of sunscreens for DSI.

METHODS

An anonymous survey of attendees at an online photoprotection event held on March 31, 2022, in Spain.

RESULTS

The survey was answered by 66.6% (221/332) of the attendees: 159 dermatologists (71.9%) and 62 dermatology residents (28.1%). Respondents reported recommending the use of sunscreen to a median of 80% of DSI [interquartile range (IQR), 50-90]. Physicians reported prescribing tinted sunscreens to a median percentage of 60% (IQR, 25-90) of DSI with acne; and to a median percentage of 90% (IQR, 58-99) of DSI with melasma. The most prescribed photoprotectors to DSI with melasma were organic broad-spectrum sunscreens with antioxidants: 102/220 (46.4%) and mineral broad-spectrum sunscreens (with iron oxides): 45/220 (20.4%). In DSI with melasma or other pigmentary disorders, the most preferred features of sunscreens were as follows: sun protection factor ≥ 30: 217/221 (98.2%), UVA protection: 214/221 (96.8%), color for camouflage: 150/220 (68.2%) and mineral filters such as titanium dioxide and zinc oxide: 151/220 (68.6%) or iron oxides: 131/220 (59.5%).

LIMITATIONS

Online survey, potential inclusion bias.

CONCLUSIONS

Respondents reported to prescribe sunscreens to the majority of DSI, and tinted sunscreens for the majority of DSI with pigmentary disorders. However, the most frequently recommended sunscreens for DSI were organic broad-spectrum sunscreens with antioxidants.

Blue light impairs the repair of UVB-induced pyrimidine dimers in a human skin model

In recent years, interest is growing in the biological cutaneous effects of high-energy visible light (400-450 nm). In the present study, we explored the impact of blue light (BL) on the repair of pyrimidine dimers, the major class of premutagenic DNA damage induced by exposure to sunlight. We unambiguously demonstrate that the exposure of in vitro reconstructed human epidermis to environmentally relevant doses of BL strongly decreases the rate of repair of cyclobutane pyrimidine dimers and pyrimidine (6-4) pyrimidone photoproducts induced by a subsequent UVB irradiation. Using the highly sensitive and specific liquid chromatography-tandem mass spectrometry assay, we did not observe induction of pyrimidine dimers by BL alone. Finally, we showed that application, during the BL exposure step, of a formula containing a new filter, named TriAsorB and affording BL photoprotection, prevented the decrease in DNA repair efficiency. These results emphasize the potential deleterious effects of BL on DNA repair and the interest in providing adequate skin protection against this wavelength range of sunlight.

Synergistic delivery of hADSC-Exos and antioxidants has inhibitory effects on UVB-induced skin photoaging

Ultraviolet B (UVB) light exposure accelerates skin photoaging. Human adipose-derived stem cell exosomes (hADSC-Exos) and some antioxidants may have anti-photoaging effects. However, it is unknown whether the combination of hADSC-Exos and antioxidants plays a synergistic role in anti-photoaging. In cellular and 3D skin models, we showed that vitamin E (VE) and hADSC-Exos were optimal anti-photoaging combinations. In vivo, VE and hADSC-Exos increased skin tightening and elasticity in UVB-induced photoaging mice Combined treatment with VE and hADSC-Exos inhibited SIRT1/NF-κB pathway. These findings contribute to the understanding of hADSC-Exos in conjunction with other antioxidants, thereby providing valuable insights for the future pharmaceutical and cosmetic industries.

Challenges and real-world solutions for adoption of holistic skincare routine (cleansing, treatment, moisturization, and photoprotection) in acne, rosacea, atopic dermatitis, and sensitive skin: An expert consensus

BACKGROUND

While treatment is a definitive therapeutic component in the management of inflammatory skin conditions, adjunctive skin care comprising of appropriate cleansing, moisturization, and photoprotection are just as important. Cleansing, treatment, moisturization, and photoprotection (CTMP) constitute the four major components of holistic skincare routine for dermatological conditions. However, inadequate patient understanding of the condition, limited resources for physicians, and insufficient time for patient education during busy dermatological consultations are the main obstacles to establishing a holistic skincare routine in the real world.

AIMS

This study aimed to identify key challenges in the implementation of a holistic skincare routine, and offer practical guidance to physicians to improve adoption in the management of acne, atopic dermatitis, rosacea, and sensitive skin syndrome.

METHODS

An expert panel comprising of nine dermatologists from Australia, China, Hong Kong, Taiwan, India, Philippines, Singapore, South Korea, and Thailand convened to develop consensus statements to stimulate real-world adoption of holistic skincare routine in acne, rosacea, atopic dermatitis, and sensitive skin syndrome using the Delphi approach.

RESULTS

Consensus was defined as ≥80% of panel rating statement as ≥8 or median rating of ≥8. The final statements were collated to develop consensus recommendations to encourage adoption of holistic skincare routine.

CONCLUSION

Promoting patient education on the skin condition, training support staff in patient counseling, and offering physician training opportunities are the key strategies to encourage real-world adoption of CTMP as a holistic skincare routine. The consensus recommendations presented here should be considered in all dermatology patients to accomplish the ultimate goals of improved treatment outcomes and patient satisfaction.

Combined multilevel anti-aging strategies and practical applications of dermocosmetics in aesthetic procedures

Management of the signs of facial aging and other cosmetic skin problems have greatly evolved in the past years. People are also seeking to improve their well-being and global skin appearance, and when they consider using cosmetic procedures, they expect natural and long-lasting aesthetic results. Combined dermocosmetic approaches that address the signs of facial aging at all levels are increasingly being used by dermatologists to meet patient expectations while ensuring their safety. Minimally invasive and reversible procedures that can be performed in only one session are popular approaches for skin restructuring and volumizing as they are flexible, rapid and less burdensome for patients. These interventions can achieve even better outcomes when they are combined with cosmeceuticals as pre- or post-procedural adjuvants to prepare the skin, accelerate recovery and sustain results. The use of topical dermocosmetics is also recommended as part of the daily skin care routine to improve skin quality and help maintain skin barrier function. This review thus outlines the most commonly used combined multilevel anti-aging strategies, which start by addressing the deepest skin layers and then the more superficial signs of skin aging. Examples of multi-active cosmeceuticals and skin delivery enhancing systems are also presented, together with examples of the use of dermocosmetics as supportive care for aesthetic procedures, to provide insights into current applications of dermocosmetic products.

Photoprotection: Current developments and controversies

This review aimed at summarizing some of the key points that were discussed during the photoprotection session at the International Forum of Dermatology in 2022. This international conference was designed to address prominent topics of clinical dermatology in a holistic way, allowing to articulate multiple viewpoints. Therefore, this review does not claim to be exhaustive, but is instead intended to give an overview of recent developments and ongoing controversies in the field of photoprotection. Cumulative ultraviolet radiation (UVR) exposure is the major aetiological factor in the development of photoageing, photoimunosuppression and photocarcinogenesis. UVA (320-400 nm) penetrates into the dermis and damages DNA and other intracellular and acellular targets primarily by generating reactive oxygen species (ROS). It is the major contributor to photoageing, characterized by fine and coarse wrinkles, dyspigmentation and loss of elasticity. UVB (290-320 nm) is responsible for sunburns through direct damage to DNA by the formation of 6-4 cyclobutane pyrimidine dimers (CPDs) and pyrimidine 6-4 pyrimidone photoproducts. Both UVA and UVB exposure increase the risk of basal cell carcinoma, squamous cell carcinoma and melanoma. In recent years, visible light (VL; 400-700 nm) has also been implicated in the exacerbation of conditions aggravated by sun exposure such as hyperpigmentation and melasma. Photoprotection is a critical health strategy to reduce the deleterious effects of UVR and VL. Comprehensive photoprotection strategies include staying in the shade when outdoors, wearing photoprotective clothing including a wide-brimmed hat, and sunglasses, and the use of sunscreen. Due to the absorption of UV filters, the safety of sunscreens has been questioned. Newer sunscreens are becoming available with filters with absorption even beyond the UV spectrum, offering enhanced protection compared with older products. Prevention of photocarcinogenesis, sun-induced or sunlight-exacerbated hyperpigmentary conditions and drug-induced photosensitivity is an important reason for adopting comprehensive photoprotection strategies.

Baicalin attenuates acute skin damage induced by ultraviolet B via inhibiting pyroptosis

As the outermost layer of the human body, the skin suffers from various external factors especially light damage, among which ultraviolet B (UVB) irradiation is common and possesses a relatively high biological damage capacity. Pyroptosis is a newly discovered type of programmed cell death, which can induce cell rupture and induce local inflammatory response. However, the molecular mechanisms of pyroptosis in photodamaged skin is poorly understood. Baicalin, a flavonoid extracted from the desiccated root of Scutellaria baicalensis Georgi (Huang Qin). Despite its antioxidant abilities, whether baicalin protects skin by attenuating UVB-induced pyroptosis remains unclear, which was the aim of this study. The UVB-induced acute skin damage model was established by using human immortalized keratinocytes (HaCaT cells) and Kunming (KM) strain mice. The protective dose selection for baicalin is 50 μM in vitro and 100 mg/kg in vivo. In in vitro study, UVB irradiation significantly decreased cell viability, increased cell death and oxidative stress in HaCaT cells, while pretreatment with baicalin improved these phenomena. Furthermore, the baicalin pretreatment notably suppressed nuclear factor kappa B (NF-κB) translocation, the NLRP3 inflammasome activation and gasdermin D (GSDMD) maturation, thus effectively attenuating UVB-induced pyroptosis. In in vivo study, the baicalin pretreatment mitigated epidermal hyperplasia, collagen fiber fragmentation, oxidative stress and pyroptosis in UVB-irradiated mouse skin. In a nutshell, this study suggests that baicalin could be a potential protective agent to attenuate acute skin damage induced by UVB irradiation through decreasing oxidative stress and suppressing NF-κB/NLRP3/GSDMD-involved pyroptosis.

Antioxidant, Anti-Inflammation, and Melanogenesis Inhibition of Sang 5 CMU Rice (Oryza sativa) Byproduct for Cosmetic Applications

Prolonged exposure to environmental oxidative stress can result in visible signs of skin aging such as wrinkles, hyperpigmentation, and thinning of the skin. Oryza sativa variety Sang 5 CMU, an inbred rice cultivar from northern Thailand, contains phenolic and flavonoid compounds in its bran and husk portions that are known for their natural antioxidant properties. In this study, we evaluated the cosmetic properties of crude extracts from rice bran and husk of Sang 5 CMU, focusing on antioxidant, anti-inflammatory, anti-melanogenesis, and collagen-regulating properties. Our findings suggest that both extracts possess antioxidant potential against DPPH, ABTS radicals, and metal ions. Additionally, they could downregulate TBARS levels from 125% to 100% of the control, approximately, while increasing the expression of genes related to the NRF2-mediated antioxidant pathway, such as NRF2 and HO-1, in H2O2-induced human fibroblast cells. Notably, rice bran and husk extracts could increase mRNA levels of HO-1 more greatly than the standard L-ascorbic acid, by about 1.29 and 1.07 times, respectively. Furthermore, the crude extracts exhibited anti-inflammatory activity by suppressing nitric oxide production in both mouse macrophage and human fibroblast cells. Specifically, the bran and husk extracts inhibited the gene expression of the inflammatory cytokine IL-6 in LPS-induced inflammation in fibroblasts. Moreover, both extracts demonstrated potential for inhibiting melanin production and intracellular tyrosinase activity in human melanoma cells by decreasing the expression of the transcription factor MITF and the pigmentary genes TYR, TRP-1, and DCT. They also exhibit collagen-stimulating effects by reducing MMP-2 expression in H2O2-induced fibroblasts from 135% to 80% of the control, approximately, and increasing the gene associated with type I collagen production, COL1A1. Overall, the rice bran and husk extracts of Sang 5 CMU showed promise as effective natural ingredients for cosmetic applications.

Ultraviolet Filters: Dissecting Current Facts and Myths

Skin cancer is a global and increasingly prevalent issue, causing significant individual and economic damage. UV filters in sunscreens play a major role in mitigating the risks that solar ultraviolet ra-diation poses to the human organism. While empirically effective, multiple adverse effects of these compounds are discussed in the media and in scientific research. UV filters are blamed for the dis-ruption of endocrine processes and vitamin D synthesis, damaging effects on the environment, induction of acne and neurotoxic and carcinogenic effects. Some of these allegations are based on scientific facts while others are simply arbitrary. This is especially dangerous considering the risks of exposing unprotected skin to the sun. In summary, UV filters approved by the respective governing bodies are safe for human use and their proven skin cancer-preventing properties make them in-dispensable for sensible sun protection habits. Nonetheless, compounds like octocrylene and ben-zophenone-3 that are linked to the harming of marine ecosystems could be omitted from skin care regimens in favor of the myriad of non-toxic UV filters.

The use of natural extracts with photoprotective activity: a 2015-2023 patent prospection

Synthetic sunscreen offers protection against excessive exposure to ultraviolet (UV) radiation from the sun, and protects the skin from possible damage. However, they have low efficacy against the formation of reactive oxygen species (ROS), which are highly reactive molecules that can be generated in the skin when it is exposed to UV radiation, and are known to play a role in oxidative stress, which can contribute to skin aging and damage. Thus, there is an ongoing search for sunscreens that do not have these negative effects. One promising source for these is natural products. Therefore, the current patent review summarizes topical formulations made from natural compounds that have antioxidant properties and can be used as photoprotective or anti-aging agents, either using a single natural extract or a combination of extracts. The review reports basic patent information (applicant country, type of applicant, and year of filing) and gives details about the invention, including its chemical composition, and the in vitro and in vivo tests performed. These patents describe natural products that can be used to protect the skin and validate their efficacy, and safety, in addition to standardizing their formulations. The compositions described illustrate the consistent innovation in the use of natural products to protect against UV damage and photoaging disorders, a promising field which is receiving growing global recognition.

New trends on personalized sunscreens

BACKGROUND/PURPOSE

Nowadays, there are emerging trends in customized and personalized photoprotection, focusing on the innovative approaches to enhance sun protection efficacy tailored to individual needs.

METHODS

We conducted an electronic search of the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Skin Group Specialised Skin Register, and TESEO. Specific search terms related to personalized photoprotection and the variables of age, genetic predisposition, skin phototype, photodermatosis, and physiological conditions such as pregnancy, as well as lifestyle habits were used.

RESULTS/CONCLUSION

The article highlights the challenges and opportunities in adopting personalized photoprotection strategies, aiming to promote skin health and prevent the harmful effects of UV radiation in the era of precision medicine.

Sunscreen Safety and Efficacy for the Prevention of Cutaneous Neoplasm

Sunscreen is widely used for ultraviolet radiation protection. Studies validate sun protection factors (SPFs) to prevent ultraviolet (UV)-induced skin changes such as melanoma and squamous cell carcinoma (SCC). Few studies examine sunscreen's impact on endocrine and immune system dysregulation, the production of radical oxygen species, and whether the ingredients deteriorate under prolonged exposure. We present an investigation of sunscreen labels and how ingredients impact sun safety and human health. A review of the literature was conducted using Embase and PubMed to examine sunscreen safety, efficacy, and use to prevent UV-induced skin damage. Increasing sunscreen reapplication, wearing protective clothing, and limiting exposure can reduce the incidence of skin cancer. Inorganic sunscreens form barriers to block UV light, but without titanium dioxide (TiO2), they may not be advantageous due to their low UVA protection. Organic sunscreens absorb into the skin and provide a better feeling after application. Octocrylene and avobenzone are stable and provide UVA and UVB protection with minimal adverse effects. Oxybenzone is harmful to the neuroendocrine system and should be avoided. Titanium dioxide works for broad-spectrum UV protection and offers minimal adverse effects. Octocrylene and avobenzone are organic sunscreen ingredients that also provide a better feeling on the skin after application, which enables higher rates of use. Oxybenzone should be avoided.

Integrated sun protection advice for the South African population

Exposure to solar ultraviolet radiation (UVR) is associated with several cutaneous adverse effects. However, to the best of our knowledge, in South Africa there are no formal guidelines on sun protection. A group of South African dermatologists and researchers convened over the course of 1 year to deliberate on integrated advice for sun protection among the multi-ethnic South African population. For people with light skin and those with genetic skin disorders (e.g., oculocutaneous albinism), sun protection was identified as critical to prevent sunburn, skin cancer, and photoaging. The evidence is less clear for people with medium and darker skin types, especially the latter, in whom melanin may confer a degree of protection against some parts of the solar spectrum. Recent studies have demonstrated that visible light can cause pigmentary changes in individuals with darker skin types in particular. Sun protection for people of all skin colors is beneficial to protect against photoaging and ocular damage. Herein sun protection advice is suggested for South Africans of all skin colors to reduce morbidity and mortality from sun exposure, particularly relating to skin cancer. Several knowledge gaps are identified as future research priorities.

The Comparison of Efficacy and Safety Between General and Topical Anesthesia on Micro-Plasma Radiofrequency Treatment for Hypertrophic Scar: A Retrospective Cohort Study

BACKGROUND

While micro-plasma radiofrequency (MPR) treatment has a significant impact on hypertrophic scars, patients often require anesthesia to alleviate substantial discomfort. Currently, patients with similar degrees of scarring may choose surface anesthesia or general anesthesia based on their personal preferences. Nevertheless, the effectiveness and safety of different anesthesia modalities remain uncertain.

OBJECTIVE

To assess the effectiveness and safety of both general and surface anesthesia in MPR treatment for hypertrophic scars.

METHODS

We conducted a retrospective cohort study involving 101 patients diagnosed with hypertrophic scars who underwent MPR with different anesthesia methods. The primary measures of efficacy included the Vancouver Scar Scale (VSS) scores assessed before the first treatment and six months after the final treatment. Pain relief was evaluated using Visual Analog Scale (VAS) scores. Safety was assessed by comparing the incidence of adverse reactions between the two groups.

RESULTS

Patients in the general anesthesia group showed a significant difference in scar pigmentation 6 months after the treatment and lower pain level than those in the surface anesthesia group in the treatment of MPR. The difference in safety was not statistically significant. After adjusting for confounding factors and propensity score matching, the outcome of VSS and VAS scores was stable.

CONCLUSION

General anesthesia, as opposed to surface anesthesia, appears to enhance both the effectiveness and safety of MPR while reducing postoperative pain in the treatment of hypertrophic scars. For patients with heightened pain sensitivity, general anesthesia may be the preferred treatment option.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

A pilot study examining a double-conjugated, retinoid-based skincare regimen for darker, blemish-prone skin

BACKGROUND

Retinoids and alpha- and beta hydroxy acids are common components utilized in regimens for blemish-prone skin. However, balancing efficacy and tolerability is often challenging.

PATIENTS/METHODS

This pilot study evaluated a double-conjugated retinoid serum specifically formulated for blemish-prone skin (AHARet-SA) in combination with exfoliating peel pads (double-conjugated retinoid, glycolic, lactic, and salicylic acids), a cleanser, mineral-based sunscreen, and a lightweight moisturizer in female participants with mild-to-moderate blemish-prone skin. Fifty-five percent of participants were Fitzpatrick Skin Type (FST) IV and 27% were FST V. Participants used the exfoliating peel pads (3x/week for 8 weeks; 2x/week for 4 weeks) followed by nightly AHARet-SA and a moisturizer (as needed). Improvements in skin were assessed using the 5-point Investigator Global Assessment Scale, and participant satisfaction and tolerability were assessed over 12 weeks.

RESULTS

Significant mean improvement from baseline in skin clarity occurred after 4 weeks (14%; p = 0.04) with progressive improvements through week 12 (52%; p = 0.004). Eighty-eight percent of participants reported improvements in the appearance and texture of their skin and fewer blemishes/breakouts. Mild, transient adverse events were reported.

CONCLUSIONS

A regimen comprised of a double-conjugated serum and exfoliating peel pads formulated for blemish-prone skin led to significant improvements from baseline in skin clarity after 12 weeks in participants with predominately darker skin tones and mild-to-moderate blemish-prone skin.

Predicting the evolution of clinical skin aging in a multi-ethnic population: Developing causal Bayesian networks using dermatological expertise

INTRODUCTION

Software to predict the impact of aging on physical appearance is increasingly popular. But it does not consider the complex interplay of factors that contribute to skin aging.

OBJECTIVES

To predict the +15-year progression of clinical signs of skin aging by developing Causal Bayesian Belief Networks (CBBNs) using expert knowledge from dermatologists.

MATERIAL AND METHODS

Structures and conditional probability distributions were elicited worldwide from dermatologists with experience of at least 15 years in aesthetics. CBBN models were built for all phototypes and for ages ranging from 18 to 65 years, focusing on wrinkles, pigmentary heterogeneity and facial ptosis. Models were also evaluated by a group of independent dermatologists ensuring the quality of prediction of the cumulative effects of extrinsic and intrinsic skin aging factors, especially the distribution of scores for clinical signs 15 years after the initial assessment.

RESULTS

For easiness, only models on African skins are presented in this paper. The forehead wrinkle evolution model has been detailed. Specific atlas and extrinsic factors of facial aging were used for this skin type. But the prediction method has been validated for all phototypes, and for all clinical signs of facial aging.

CONCLUSION

This method proposes a skin aging model that predicts the aging process for each clinical sign, considering endogenous and exogenous factors. It simulates aging curves according to lifestyle. It can be used as a preventive tool and could be coupled with a generative AI algorithm to visualize aging and, potentially, other skin conditions, using appropriate images.

A Narrative Review of Current Knowledge on Cutaneous Melanoma

Cutaneous melanoma is a public health problem. Efforts to reduce its incidence have failed, as it continues to increase. In recent years, many risk factors have been identified. Numerous diagnostic systems exist that greatly assist in early clinical diagnosis. The histopathological aspect illustrates the grim nature of these cancers. Currently, pathogenic pathways and the tumor microclimate are key to the development of therapeutic methods. Revolutionary therapies like targeted therapy and immune checkpoint inhibitors are starting to replace traditional therapeutic methods. Targeted therapy aims at a specific molecule in the pathogenic chain to block it, stopping cell growth and dissemination. The main function of immune checkpoint inhibitors is to boost cellular immunity in order to combat cancer cells. Unfortunately, these therapies have different rates of effectiveness and side effects, and cannot be applied to all patients. These shortcomings are the basis of increased incidence and mortality rates. This study covers all stages of the evolutionary sequence of melanoma. With all these data in front of us, we see the need for new research efforts directed at therapies that will bring greater benefits in terms of patient survival and prognosis, with fewer adverse effects.

Endoplasmic reticulum stress in skin aging induced by UVB

Aging is a normal and complex biological process. Skin is located in the most superficial layer of the body, and its degree of aging directly reflects the aging level of the body. Endoplasmic reticulum stress refers to the aggregation of unfolded or misfolded proteins in the endoplasmic reticulum and the disruption of the calcium ion balance when cells are stimulated by external stimuli. Mild endoplasmic reticulum stress can cause a series of protective mechanisms, including the unfolded protein response, while sustained high intensity stimulation leads to endoplasmic reticulum stress and eventually apoptosis. Photoaging caused by ultraviolet radiation is an important stimulus in skin aging. Many studies have focused on oxidative stress, but increasing evidence shows that endoplasmic reticulum stress plays an important role in photoaging. This paper reviews the development and mechanism of endoplasmic reticulum stress (ERS) in skin photoaging, and provides research directions for targeting the ERS pathway to slow aging.

Evaluation of the protection of sunscreen products against long wavelength ultraviolet A1 and visible light-induced biological effects

BACKGROUND

Long wavelength ultraviolet-A1 in combination with visible light induces hyperpigmentation, particularly in dark-skin phototypes. This study evaluated the efficacy of four sunscreen formulations in protecting against VL + UVA1 (370-700 nm).

METHODS

The test products (A-D) were applied to the back of 12 volunteers, then irradiated with 320 J/cm2 VL + UVA1 (3.5% UVA1 [370-400 nm]). Immediately after irradiation, and at Days 1, 7, and 14, erythema and pigmentation were assessed by investigator global assessment (IGA), colorimetry (Δa* and ΔITA) and diffuse reflectance spectroscopy (DRS)-measured relative dyschromia (area under the curve AUC). Control areas were irradiated without sunscreen.

RESULTS

Product D, containing titanium dioxide 11%, iron oxides 1%, and antioxidants, provided the highest and most consistent protection. Compared with unprotected irradiated control, it had statistically significantly less erythema on IGA, DRS (Δoxyhemoglobin), and colorimetry (Δa*) at Day 0; less pigmentation on IGA at all time points, on DRS (relative dyschromia) at Days 7 and 14, and on colorimetry (ΔITA) at Day 0. Product B, containing zinc oxide 12% plus organic UV filters, iron oxides 4%, and antioxidants, also showed some efficacy.

CONCLUSION

Of the sunscreens tested, the tinted products provided better protection against VL + UVA1 than the non-tinted products. Since the product with 1% iron oxides was superior to the product with 4% iron oxides, further studies are needed to evaluate whether iron oxide content correlates with better protection.

Awareness of sun exposure risks and photoprotection for preventing pigmentary disorders in Asian populations: Survey results from three Asian countries and expert panel recommendations

BACKGROUND

In this article, we review and discuss the photoprotection behavior of Asians based on the literature, along with a subanalysis of an original online survey, and make recommendations to optimize photoprotection for Asian populations to prevent photoaging and pigmentary disorders.

METHODS

An international panel of eight dermatologists from Asia (China, Korea, Japan, Singapore, Indonesia, and Vietnam) met to discuss sunscreen photoprotection for Asian patients. Additionally, a subanalysis of an online survey by 3000 respondents from three Asian countries (China, Indonesia, and Japan) investigated general public awareness and attitudes to sun exposure.

RESULTS

A pre-meeting survey of the eight experts from Asia showed key concerns of Asian patients consulting dermatologists are pigmentary disorders, especially actinic/senile lentigo, post-inflammatory hyperpigmentation, melasma, vitiligo, and Hori's nevus. The survey subanalysis of participants from China, Indonesia, and Japan with predominantly Fitzpatrick skin types (FST) II to IV revealed that they are particularly concerned about sun exposure causing photoaging and pigmentary disorders. Most of the respondents indicated they have limited knowledge on sunlight radiation and appropriate sunscreen protection factors. Only 22%, 13%, and 3% for China, Indonesia, and Japan, respectively, systematically use multiple protective measures (using sunscreen, avoiding midday sun, staying in the shade, wearing a hat, protective clothing, and sunglasses) when exposed to the sun.

CONCLUSIONS

Further education is needed for Asian populations on the importance of comprehensive daily photoprotection, including broad-spectrum sunscreen, with high UVA and visible light protection, to reduce and prevent photoaging and pigmentary disorders.

The impact of methoxypropylamino cyclohexenylidene ethoxyethylcyanoacetate (MCE) UVA1 filter on pigmentary and ageing signs: An outdoor prospective 8-week randomized, intra-individual comparative study in two populations of different genetic background

BACKGROUND

Of all ultraviolet (UV) radiations reaching the earth, UVA1 rays have a higher potential of penetrating and producing clinically harmful consequences. While UV radiations up to 370 nm are well-blocked by current sunscreens, a photoprotection gap remains for the UVA1 wavelengths between 370 and 400 nm.

OBJECTIVE

This study was to assess under outdoor summer conditions the impact on pigmentation and skin ageing signs of a protection against UVA1 using methoxypropylamino cyclohexenylidene ethoxyethylcyanoacetate (MCE) filter added to a reference SPF50 sunscreen, in comparison with the same sunscreen without the MCE filter.

MATERIALS AND METHODS

This prospective randomized comparative intra-individual study was conducted in 113 women in Brazil and China. Subjects had their face and two forearms exposed twice-daily to a 1-h outdoor sunlight exposure over 8 weeks. Before exposure, the SPF50 sunscreen containing 3% MCE was applied on one half-face and one forearm and the same reference product without MCE on the other half-face and forearm. Primary study endpoint was skin colour changes (chromametry). Other endpoints included expert panel grading of pigmentation and facial skin ageing, and naïve panel assessment of facial skin radiance and homogeneity.

RESULTS

After 8 weeks, the skin was darker on both forearms but the increase in sun-induced pigmentation was smaller with the SPF50/MCE sunscreen. Expert panel evaluations showed no change in severity scores for pigmentation and a decreased severity scores for facial skin ageing in areas protected with the SPF50/MCE product: severity scores in areas protected with the SPF50 alone were either increased (pigmentation) or unchanged (skin ageing). Naïve panel evaluations of skin radiance and homogeneity showed statistically significant superiority of the SPF50/MCE product.

CONCLUSION

Overall, this study demonstrates that a protection with the SPF50/MCE sunscreen significantly reduces pigmentation and ageing signs compared to the same SPF50 sunscreen.

Diversity of Asian skin: A review on skin biophysical properties

Asian is home to dozens of different ethnic groups that are characterised by fascinating social and cultural variations. Unfortunately, existing literature on the skin properties of Asians tends to group this diverse population solely based on skin colour, perpetuating the misconception and stereotype that all Asian skin is the same. While Asia is one of the largest continents in the world, the difference in the geographical location and climate have long shaped the population into various ethnic groups with significant differences in the collective and diverse customs, traditions, cultures and living habits. The diverse ethnic groups in this region hint us that their skin biophysical characteristics can be very different from each other. This review features the profiling of the distinctive skin biophysical properties of Asians. We learn more about the different ethnic groups in Asia and acknowledge the unique skin biophysical properties even from the same country.

Association between SPRY1 and TET3 in skin photoaging and natural aging mechanisms

BACKGROUND

SPRY1 is associated with the invasiveness and prognosis of various tumors, and TET3 affects aging by regulating gene expression.

AIMS

We investigated the roles of SPRY1 and TET3 in natural skin aging, replicative aging, and photoaging, along with the effect of UVA on genome-wide DNA methylation in HaCaT cells.

METHODS

TET3 and SPRY1 expression were measured in the skin of patients of different age groups, as well as in vitro human skin, HaCaT cell replicative senescence, and HaCaT and HaCaT-siTET3 cell photoaging models. Senescence was verified using β-galactosidase staining, and DNA damage was detected using immunofluorescence staining for γ-H2A.X. 5-Methyl cytosine (5-mC) content in the genome was determined using ELISA.

RESULTS

SPRY1 expression increased with age, whereas TET3 expression decreased. Similarly, SPRY1 was upregulated and TET3 was downregulated with increasing cell passages. TET3-siRNA upregulated SPRY1 expression in HaCaT cells. UVA irradiation promoted HaCaT cell senescence and induced cellular DNA damage. SPRY1 was upregulated and TET3 was downregulated upon UVA irradiation. Genome-wide 5-mC content increased upon TET3 silencing and UVA irradiation, indicating a surge in overall methylation.

CONCLUSIONS

SPRY1 and TET3 are natural skin aging-related genes that counteract to regulate replicative aging and UVA-induced photoaging in HaCaT cells. The cell photoaging model may limit experimental bias caused by different exposure times of skin model samples.

The effectiveness of S-LEC™ solar control film L in laminated glass for reducing the burning sensation caused by near-infrared radiation

OBJECTIVES

The aim of this study was to examine the potential for S-LEC™ Solar Control Film L, a heat insulating interlayer film for laminated glass developed by Sekisui Chemical Co., Ltd., to reduce the burning sensation caused by near infrared (NIR) radiation.

METHODS

A crossover study was performed in 49 male and female subjects, using three different combinations of laminated glass with interlayer films. Subjects placed their right hand under each glass in an NIR irradiation device. The dorsal side of the right hand was irradiated with NIR for 30 s and the onset and degree of a burning sensation was measured.

RESULTS

Laminated glass with S-LEC™ Solar Control Film L reduced the burning sensation caused by NIR and delayed the onset of the sensation, compared with the control glasses.

CONCLUSION

The use of S-LEC™ Solar Control Film L in the laminated glass of vehicles may improve passenger comfort and prevent skin disorders such as photoaging caused by prolonged exposure to NIR.

Sun exposure behaviours as a compromise to paradoxical injunctions: Insight from a worldwide survey

BACKGROUND

Behavioural interventions can improve attitudes towards sun protection but the impact remains inconsistent worldwide.

OBJECTIVE

To assess awareness of and attitudes towards the multiple facets of sun exposure and suggest ways to improve prevention from overexposure to the sun in all geographical zones and multiple skin types.

METHODS

Online survey was conducted from 28 September to 18 October 2021. Study population was selected from the Ipsos online Panel (3,540,000 panellists), aged ≥18 years, from 17 countries around the five continents. Demographics, sun-exposure habits and practices, understanding of risks and information on phototypes were documented and analysed using descriptive statistics.

RESULTS

Eighty-eight per cent of participants knew that sunlight can cause skin health problems (90% phototypes I-II, 82% phototypes V-VI, >90% in American and European countries, 72% in Asia and 85% in Africa). Eighty-five per cent used some form of protection against sunlight, predominantly: Seeking shade (77%), avoiding the midday sun (66%), facial application of sunscreen (60%) and wearing protective clothing (44%). The perception of sunlight itself is positive ('it gives energy' for 82%; 'tanned skin looks attractive' for 72%), although less in Asian countries and among individuals with dark skin phototypes. Eighty-three per cent reported having experienced sunburn, mainly in Australia, Canada, USA, Germany, France and Russia, and among individuals with dark skin phototypes. Only 12% systematically/often used all types of protection during exposure to the sun and 23% believed it is safe to go out in the sun with no protection when their skin is already tanned. From 13% (skin phototype I) to 26% (phototype VI) reported not using any form of protection against the sun. Knowledge and habits were significantly superior among people who are accustomed to seeing a dermatologist for a complete skin exam.

CONCLUSIONS

Dermatologists could play a crucial role in relaying novel prevention messages, more finely tailored to specific risks, populations and areas of the world.