A randomized study to evaluate the efficacy and effectiveness of two sunscreen formulations on Indian skin types IV and V with pigmentation irregularities

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.

Photoaging's portrait: The road map towards its photoprotection

OBJECTIVE

To summarize key research published by the author's group, dealing with skin photoaging and its photoprotection.

MATERIALS AND METHODS

Two methodologies (standard photographs and selfies imaging) resulting from referential skin ageing atlases were applied on 2487 subjects of different ancestries, ages and gender. These aimed at first to best assess and grade the variable severities of some facial signs (texture/wrinkles, pigmentary spots, sagging and vascular disorders) that occur progressively during the photoaging process. Second, such methodologies were used to record the benefits brought by a photoprotective regimen (671 women and men).

RESULTS

In all studied ancestries, each facial sign show an increase severity along decades, at its own pace, some showing a linear like progression, whereas some plateau at early ages. These changes differed according to skin innate colour (phototype) and with individual behaviours vis-à-vis sun exposures, more so among European women than North-East Asian women. An effect of gender (less severe alterations) was observed on Chinese men, as compared to Chinese women. Pigmentary disorders were found hallmarks of photo-aged North-East Asian women. Globally, photoaging impact the apparent age of the different subjects. The counteracting effects of strong topical Photoprotective regimens were evidenced along a 6-month seasonality in Chinese and French women or 1-year period in Brazilian women with phototypes II to VI. Photoprotection led to a more even skin complexion among Indian subjects with pigment irregularities.

CONCLUSION

Two factors clearly hamper a better assessment of the efficiency of photoprotection of the sun-induced cutaneous ageing: short durations (months) of the studies with regard to the global fate of photoaging by decades and the number of studied subjects, limited to hundreds for practical reasons. The methodology based on the automatic analysis of facial signs through selfies images could theoretically bypass both factors, allowing thousands of subjects to be studied along years.

Impact on facial skin aging signs of a 1-year standardized photoprotection over a classical skin care routine in skin phototypes II-VI individuals: A prospective randomized trial

BACKGROUND

Data reflecting the impact of photoprotection on cutaneous aging are scarce and mostly limited to fair skin.

OBJECTIVE

To assess the effectiveness of a photoprotective product in counteracting the photoaging process in different skin phototypes over 1 year compared against a classical routine.

MATERIALS AND METHODS

Two hundred and ninety Brazilian women aged 30-65 years, with skin phototype II-VI were equally randomized in two groups. Group 1 kept on their routine whereas Group 2 applied, twice daily, a photoprotective product (SPF 60, PPD = 24.1) replacing the one they routinely used. Volunteers reported the duration of their daily sun-exposure. Standardized photographs taken at D0 and D365 were analysed by 15 dermatologists to assess eight wrinkles and pigmentation signs.

RESULTS

A global increase in severity was reported which was significant for Group 1. This increase was lower in Group 2 where only half the signs showed significant worsening. In Group 2 versus Group 1, the increase in forehead wrinkles, marionette lines, wrinkles created by ptosis and size of dark spot was significantly (p < 0.05) decreased by 30%-50%.

CONCLUSION

Daily application of a high photoprotective product significantly decreases the progression of skin aging signs after 1 year in skin phototypes II-VI.

Objective and automatic grading system of facial signs from smartphones' pictures in South African men: Validation versus dermatologists and characterization of changes with age

OBJECTIVE

To evaluate the capacity of the automatic detection system to accurately grade, from selfie pictures, the severity of eight facial signs in South African men.

METHODS

Selfie pictures (obtained from frontal and back cameras) of 281 South African men differently aged (20-70 years) were obtained and analyzed by an automatic artificial intelligence (AI)-based automatic grading system. Data were compared with the clinical gradings made by experts and dermatologists.

RESULTS

In all facial signs, both series of gradings were found highly correlated with, however, different coefficients (0.59-0.95), those of marionette lines and cheek pores being of lower values. No differences were observed between data obtained by frontal and back cameras. With age, in most cases, gradings show up to the 50-59 year age-class, linear-like changes. When compared to men of other ancestries, South African men present lower wrinkles/texture, pigmentation, and ptosis/sagging scores till 50-59 years, albeit not much different in the cheek pores sign. The early onset (mean age) of visibility of wrinkles/texture for South African men were (i.e., reaching grade >1) 39 and 45 years for ptosis/sagging.

CONCLUSION

This study completes and enlarges the previous works conducted on men of other ancestries by showing some South African specificities and slight differences with men of comparable phototypes (Afro American).

Objective and automatic grading system of facial signs from selfie pictures of South African women: Characterization of changes with age and sun‐exposures

OBJECTIVE

To evaluate the capacity of the automatic detection system to accurately grade, from smartphones' selfie pictures, the severity of fifteen facial signs in South African women and their changes related to age and sun-exposure habits.

METHODS

A two-steps approach was conducted based on self-taken selfie images. At first, to assess on 306 South African women (20-69 years) enrolled in Pretoria area (25.74°S, 28.22°E), age changes on fifteen facial signs measured by an artificial intelligence (AI)-based automatic grading system previously validated by experts/dermatologists. Second, as these South African panelists were recruited according to their usual behavior toward sun-exposure, that is, nonsun-phobic (NSP, N = 151) and sun-phobic (SP, N = 155) and through their regular and early use of a photo-protective product, to characterize the facial photo-damages.

RESULTS

(1) The automatic scores showed significant changes with age, by decade, of sagging and wrinkles/texture (p < 0.05) after 20 and 30 years, respectively. Pigmentation cluster scores presented no significant changes with age whereas cheek skin pores enlarged at a low extent with two plateaus at thirties and fifties. (2) After 60 years, a significantly increased severity of wrinkles/texture and sagging was observed in NSP versus SP women (p < 0.05). A trend of an increased pigmentation of the eye contour (p = 0.06) was observed after 50 years.

CONCLUSION

This work illustrates specific impacts of aging and sun-exposures on facial signs of South African women, when compared to previous experiments conducted in Europe or East Asia. Results significantly confirm the importance of sun-avoidance coupled with photo-protective measures to avoid long-term skin damages. In inclusive epidemiological studies that aim at investigating large human panels in very different contexts, the AI-based system offers a fast, affordable and confidential approach in the detection and quantification of facial signs and their dependency with ages, environments, and lifestyles.

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

Increasing evidence on the impact of the different wavelengths of sunlight on the skin demonstrates the need for tailored recommendations of sunscreen according to skin phototype and dermatoses, which is now possible due to advances in the filters and formulations of sunscreens. A selective literature search was performed by an international expert panel, focusing on the type of sunscreen to recommend for photoaging, skin cancers, photodermatoses, pigmentary disorders and skin inflammatory disorders. Protection against ultraviolet (UV)B is especially important for light skin as there is a high risk of sunburn, DNA damage and skin cancers. Darker skin may be naturally better protected against UVB but is more prone to hyperpigmentation induced by visible light (VL) and UVA. Protection against UVA, VL and infrared A can be helpful for all skin phototypes as they penetrate deeply and cause photoaging. Long‐wave UVA1 plays a critical role in pigmentation, photoaging, skin cancer, DNA damage and photodermatoses. Adapting the formulation and texture of the sunscreen to the type of skin and dermatoses is also essential. Practical recommendations on the type of sunscreen to prescribe are provided to support the clinician in daily practice.

Daily photoprotection to prevent photoaging

BACKGROUND

Extrinsic skin aging or photoaging was previously thought to be almost exclusively due to solar ultraviolet (UV) radiation. However, recent literature has described other contributing factors and clarification is thus required as to what extent and what type of daily photoprotection is needed to mitigate extrinsic skin aging.

METHODS

We reviewed the existing scientific evidence on daily photoprotection, and specific requirements at the product level, to prevent extrinsic skin aging. We critically reviewed the existing evidence on potential ecological and toxicological risks which might be associated with daily photoprotection.

RESULTS

Evidence shows that broad protection against the entire solar range of UVB, UVA, UVA1, visible light, and short infrared (IRA) is required to prevent extrinsic aging. Other exposome factors, such as air pollution and smoking, also contribute to skin aging. Daily broad-spectrum sunscreen photoprotection should thus contain antioxidant ingredients for additional benefits against UV, IRA, and pollution-induced oxidative stress as well as anti-aging active ingredients to provide clinical benefits against skin aging signs, such as wrinkles and dark spots. Broad-spectrum sunscreen containing pigments, such as iron oxide, may be required for melasma prevention. There is no conclusive clinical evidence that daily sunscreen use is unsafe or that it compromises vitamin D synthesis.

CONCLUSION

Daily use of broad-spectrum sunscreen containing antioxidant and anti-aging active ingredients can effectively reduce extrinsic aging.

Evaluating the respective weights of some facial signs on perceived ages in differently aged women of five ethnic origins

BACKGROUND

New gratification assessments, after skincare routines or makeup products, could benefit from innovative methods that could predict the culturally based perceptions of age.

AIMS

To determine the facial signs that most influence the perception of age in women of five different ethnic ancestries, assessed by the same ethnical naïve panel.

PATIENTS/METHODS

The faces of 1351 women, differently aged (18-80 years), from five countries (China, France, India, Japan, and South Africa) were photographed under the same standardized conditions in the five countries. Fourteen to 24 facial signs (grouped under five clusters, ie, Wrinkles/Texture, Ptosis/Sagging, Pigmentation disorders, Vascular disorders, and Cheeks skin pores) were focused, and their respective severities were graded using referential Skin Aging Atlases by the same panel of 15 experts and dermatologists. Five naïve panels, all comprising 100 local women, allowed to collect the perceived age, assessed from blind-coded full-face photographs.

RESULTS

Although perceived ages and real ages were found highly correlated, their differences vary according to ethnicities, particularly among a large part of Indian and South African women, judged older by about 5 and 7 years, respectively. Results show that the clusters of Wrinkles/Texture and Ptosis/Sagging are predominant factors taken into account in almost all ethnicities, albeit at various extents, reaching almost 100% in French women. Pigmentation disorders appear important secondary factors in Japanese, South African, and Indian women. Vascular disorders, of a difficult grading in darker skin tones, were found of some impact in Japanese and Chinese women. Cheek skin pores were of minor or nil weight in the attribution of age, at the exception of South African women. Regarding facial areas which drive aging perception, it seems the upper-half face has prevalence for Chinese and Japanese women whereas the lower-half face has major importance for South African women.

CONCLUSION

Facial traits are differently perceived as signs of aging according to un-separable ethnic ancestries and cultural factors.