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Gilaberte Y, Piquero-Casals J, Schalka S, Leone G, Brown A, Trullàs C, Jourdan E, Lim HW, Krutmann J, Passeron T. Exploring the impact of solar radiation on skin microbiome to develop improved photoprotection strategies. Photochem Photobiol 2024. [PMID: 38767119 DOI: 10.1111/php.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/29/2024] [Accepted: 04/25/2024] [Indexed: 05/22/2024]
Abstract
The skin microbiome undergoes constant exposure to solar radiation (SR), with its effects on health well-documented. However, understanding SR's influence on host-associated skin commensals remains nascent. This review surveys existing knowledge on SR's impact on the skin microbiome and proposes innovative sun protection methods that safeguard both skin integrity and microbiome balance. A team of skin photodamage specialists conducted a comprehensive review of 122 articles sourced from PubMed and Research Gateway. Key terms included skin microbiome, photoprotection, photodamage, skin cancer, ultraviolet radiation, solar radiation, skin commensals, skin protection, and pre/probiotics. Experts offered insights into novel sun protection products designed not only to shield the skin but also to mitigate SR's effects on the skin microbiome. Existing literature on SR's influence on the skin microbiome is limited. SR exposure can alter microbiome composition, potentially leading to dysbiosis, compromised skin barrier function, and immune system activation. Current sun protection methods generally overlook microbiome considerations. Tailored sun protection products that prioritize both skin and microbiome health may offer enhanced defense against SR-induced skin conditions. By safeguarding both skin and microbiota, these specialized products could mitigate dysbiosis risks associated with SR exposure, bolstering skin defense mechanisms and reducing the likelihood of SR-mediated skin issues.
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Affiliation(s)
- Yolanda Gilaberte
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Zaragoza, Spain
| | - Jaime Piquero-Casals
- Department of Dermatology, Dermik Multidisciplinary Dermatology Clinic, Barcelona, Spain
| | - Sergio Schalka
- Medcin Skin Research Center and Biochemistry Department, Chemistry Institute of São Paulo University, São Paulo, Brazil
| | - Giovanni Leone
- Photodermatology and Vitiligo Treatment Unit, Israelite Hospital, Rome, Italy
| | | | | | - Eric Jourdan
- Innovation and Development, ISDIN, Barcelona, Spain
| | - Henry W Lim
- The Henry W. Lim Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Jean Krutmann
- IUF - Leibniz-Institut für umweltmedizinische Forschung, Düsseldorf, Germany
| | - Thierry Passeron
- Department of Dermatology, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
- Centre Méditerranéen de Médecine Moléculaire, INSERM U1065, Université Côte d'Azur, Nice, France
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Granger C, Trullàs C, Sokeechand NB, Jourdan E, Krutmann J, Francois-Newton V, Hosenally M. Evaluating the factors influencing sun protection factors (SPF): Pooling data from multiple studies involving two reference ISO 24444:2019 sunscreen products (P2 and P8). Photodermatol Photoimmunol Photomed 2024; 40:e12942. [PMID: 38288771 DOI: 10.1111/phpp.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/27/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Standardized methods for sun protection factor (SPF) testing are still beset with endpoint and method-driven issues, and can be influenced by multiple factors. The purpose of this analysis is to explore the factors influencing the results of sun protection factor (SPF) testing in human subjects according to the ISO 24444:2019 standard. Intrinsic factors, such as baseline skin color, age and gender, the minimal erythemal dose on an unprotected area (MEDu), as well as environmental factors such as season/weather influences, are considered for analysis. METHODS Datasets generated for two reference products (P2 and P8) during the conduct of 50 such studies using the ISO standard 24444:2019 for the testing of SPF products, from a single testing center located in Bucharest, Romania between April 2021 and December 2022, were retrieved and compiled. Overall, the data for 334 subjects was available, with 276 observations for the reference P8, and 171 for P2. RESULTS No effects due to gender or age were detected. Seasonal changes, the individual typology angle (ITA°) and MEDu were found to have an influence on the outcome of the SPF values. CONCLUSIONS This study adds new original data about the impact of intrinsic and extrinsic factors on SPF variations pertaining to ISO reference sunscreen P8 (SPF 50+). The findings suggest that some factors will inevitably impact the results between two SPF experiments for the same product and SPF testing laboratory. The interconnections between the sources of this variation are discussed. The findings of this research help to identify and characterize factors that contribute to SPF testing variability.
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Affiliation(s)
| | | | | | - Eric Jourdan
- Innovation and Development, ISDIN, Barcelona, Spain
| | - Jean Krutmann
- IUF Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany
- Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
| | | | - Muzzammil Hosenally
- Centre International de Développement Pharmaceutique (CIDP), Phoenix, Mauritius
- Department of Economics and Statistics, University of Mauritius, Réduit, Mauritius
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Piquero-Casals J, Morgado-Carrasco D, Rozas-Muñoz E, Mir-Bonafé JF, Trullàs C, Jourdan E, Piquero-Martin J, Zouboulis CC, Krutmann J. Sun exposure, a relevant exposome factor in acne patients and how photoprotection can improve outcomes. J Cosmet Dermatol 2023; 22:1919-1928. [PMID: 36946555 DOI: 10.1111/jocd.15726] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/21/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Acne pathophysiology includes a complex interaction among inflammatory mediators, hyperseborrhea, alteration of keratinization and follicular colonization by Propionibacterium acnes. AIMS To describe the impact of the exposome on acne and how photoprotection can improve outcomes. METHODS A narrative review of the literature was carried out; searches with Google Scholar and Pubmed from January 1992 to November 2022 were performed. The keywords used were "acne," "sunscreens," "photoprotection," "cosmetics," "cosmeceuticals," "pathogenesis," "etiology," "exposome," "sunlight," "stress," "lack of sleep," "diet," "postinflammatory hyperpigmentation," "pollution," "exposome," "ultraviolet radiation," and "visible light." RESULTS Environmental factors such as solar radiation, air pollution, tobacco consumption, psychological stress, diverse microorganisms, nutrition, among others, can trigger or worsen acne. Solar radiation can temporarily improve lesions. However, it can induce proinflammatory and profibrotic responses, and produce post-inflammatory hyperpigmentation and/or post-inflammatory erythema. While photoprotection is widely recommended to acne patients, only four relevant studies were found. Sunscreens can significantly improve symptomatology or enhance treatment and can prevent post-inflammatory hyperpigmentation. Furthermore, they can provide camouflage and improve quality of life. Based on acne pathogenesis, optimal sunscreens should have emollient, antioxidant and sebum controlling properties. CONCLUSIONS The exposome and solar radiation can trigger or worsen acne. UV light can induce post-inflammatory hyperpigmentation/erythema, and can initiate flares. The use of specifically formulated sunscreens could enhance adherence to topical or systemic therapy, camouflage lesions (tinted sunscreens), decrease inflammation, and reduce the incidence of post-inflammatory hyperpigmentation/erythema.
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Affiliation(s)
- J Piquero-Casals
- Department of Dermatology, Clínica Dermatológica Multidisciplinar Dermik, Barcelona, Spain
| | - D Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - E Rozas-Muñoz
- Department of Dermatology, Hospital San Pablo, Coquimbo, Chile
| | - J F Mir-Bonafé
- Department of Dermatology, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - C Trullàs
- Innovation and Development, ISDIN, Barcelona, Spain
| | - E Jourdan
- Innovation and Development, ISDIN, Barcelona, Spain
| | - J Piquero-Martin
- Department of Dermatology, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - J Krutmann
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
- Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Krutmann J, Piquero-Casals J, Morgado-Carrasco D, Granger C, Trullàs C, Passeron T, Lim HW. Photoprotection for people with skin of colour: needs and strategies. Br J Dermatol 2023; 188:168-175. [PMID: 36763874 DOI: 10.1093/bjd/ljac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 09/02/2022] [Accepted: 10/06/2022] [Indexed: 01/09/2023]
Abstract
Skin of colour or pigmented skin has unique characteristics: it has a higher eumelanin-to-pheomelanin ratio, more mature melanosomes, an increased amount of melanin distributed in the upper layers of the epidermis, and more efficient DNA repair compared with lighter skin. However, individuals with skin of colour are at a significant risk of skin damage caused by ultraviolet radiation, including the development of photodermatoses and photoageing changes such as uneven skin tone, and are predisposed to pigmentary disorders. In fact, one of the most common conditions leading to dermatology consultations by patients with skin of colour is photoexacerbated pigmentary disorders. Unfortunately, individuals with skin of colour may be less prone to engage in photoprotective measures, including the use of sunscreens. Physicians are also less likely to prescribe sunscreens for them. There is thus a clear need for better education on photodamage and for more efficient and suitable photoprotection in populations with skin of colour. However, this need has thus far only partially been met, and the development of sunscreen products designed to provide optimal photoprotection for people with skin of colour remains a challenge. Targeted sunscreens for individuals with skin of colour require optimal cosmetic appeal (leaving no white residue and not disrupting skin tone). They should include broad-spectrum [ultraviolet (UV)B/UVA] protection with high sun protection factor, as well as protection against long-wave UVA (UVA1) and visible light, as these wavelengths are capable of inducing or augmenting pigmentary disorders. They may also contain depigmenting agents for patients with pigmentary disorders.
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Affiliation(s)
- Jean Krutmann
- IUF - Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany.,Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Daniel Morgado-Carrasco
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Thierry Passeron
- University Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France.,University Côte d'Azur, INSERM U1065, C3M, Nice, France
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
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Aguilera FR, Viñas M, Sierra JM, Vinuesa T, R. Fernandez de Henestrosa A, Furmanczyk M, Trullàs C, Jourdan E, López-López J, Jorba M. Substantivity of mouth-rinse formulations containing cetylpyridinium chloride and O-cymen-5-ol: a randomized-crossover trial. BMC Oral Health 2022; 22:646. [PMID: 36575444 PMCID: PMC9793821 DOI: 10.1186/s12903-022-02688-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The efficacy of mouth-rinses strongly depends upon their substantivity. The use of natural and non-toxic products that avoid secondary effects is gaining interest in preventive dentistry. The purpose of this study was to evaluate the substantivity of two formulations of mouth-washing solutions based on cetylpyridinium (CPC) and O-cymen-5-ol. METHODS This was a randomized, double-blind, crossover trial conducted at the Faculty of Medicine and Health Sciences of the University of Barcelona. Bacterial re-colonization was followed by live/dead (SYTOTM9 + propidium iodide) bacterial staining and measured by confocal laser scanning microscopy and fluorometry. Unstimulated saliva samples were collected from 16 healthy individuals at baseline saliva and then, at 15 min, 30 min and 1, 2, 3, and 4 h after the following mouth-rinses: (i) a single, 1-min mouth-rinse with 15 ml of placebo (negative control); (ii) a single, 1-min mouth-rinse with 15 ml of CPC (0.05%) ; (iii) a single, 1-min mouth-rinse with 15 ml of O-cymen-5-ol (0.09%); (iv) a single, 1-min mouth-rinse with 15 ml of CPC (0.05%) + O-cymen-5-ol (0.09%). RESULTS Proportion of dead bacteria was significantly higher for all mouthrinses during the first 15 min compared to baseline (CPC = 48.0 ± 13.9; 95% CI 40.98-56.99; p < 0.001, O-cymen-5-ol = 79.8 ± 21.0; 95% CI 67.71-91.90; p < 0.05, CPC + O-cymen-5-ol = 49.4 ± 14; 95% CI 40.98-56.99; p < 0.001 by fluorometry and 54.8 ± 23.0; 95% CI 41.50-68.06; p < 0.001, 76.3 ± 17.1; 95% CI 66.36-86.14; p < 0.001, 47.4 ± 11.9; 95% CI 40.49-54.30; p < 0.001 by confocal laser scanning microscopy, respectively). Nevertheless, after 4 h, CPC + O-cymen-5-ol was the only one that obtained significant values as measured by the two quantification methods used (80.3 ± 22.8; 95% CI 67.15-93.50; p < 0.05 and 81.4 ± 13.8; 95% CI 73.45-89.43; p < 0.05). The combined use of CPC + O-cymen-5-ol increased the substantivity of the mouthrinse with respect to mouthrinses prepared with either of the two active products alone. CONCLUSION The synergistic interaction of CPC and O-cymen-5-ol prolongs their substantivity. The resulting formulation may be as effective as other antimicrobials, such as triclosan or chlorhexidine, but without their undesirable secondary effects. Thus, mouthrinsing products based on Combinations of CPC and O-cymen-5-ol may replace in the near future Triclosan and Chlorhexidine-based mouthrinses.
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Affiliation(s)
- Felipe-Rodrigo Aguilera
- grid.5841.80000 0004 1937 0247Laboratory of Molecular Microbiology and Antimicrobials, Department of Pathology and Experimental Therapeutics, Faculty of Medicine, University of Barcelona & IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain ,grid.7119.e0000 0004 0487 459XDental School, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Miguel Viñas
- grid.5841.80000 0004 1937 0247Laboratory of Molecular Microbiology and Antimicrobials, Department of Pathology and Experimental Therapeutics, Faculty of Medicine, University of Barcelona & IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M. Sierra
- grid.5841.80000 0004 1937 0247Laboratory of Molecular Microbiology and Antimicrobials, Department of Pathology and Experimental Therapeutics, Faculty of Medicine, University of Barcelona & IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Vinuesa
- grid.5841.80000 0004 1937 0247Laboratory of Molecular Microbiology and Antimicrobials, Department of Pathology and Experimental Therapeutics, Faculty of Medicine, University of Barcelona & IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Marta Furmanczyk
- grid.487221.a0000 0004 1795 1224Innovation and Development, ISDIN, Barcelona, Spain
| | - Carles Trullàs
- grid.487221.a0000 0004 1795 1224Innovation and Development, ISDIN, Barcelona, Spain
| | - Eric Jourdan
- grid.487221.a0000 0004 1795 1224Innovation and Development, ISDIN, Barcelona, Spain
| | - José López-López
- grid.5841.80000 0004 1937 0247Department of Dentistry, Faculty of Medicine, University of Barcelona & IDIBELL, Barcelona, Spain
| | - Marta Jorba
- grid.5841.80000 0004 1937 0247Laboratory of Molecular Microbiology and Antimicrobials, Department of Pathology and Experimental Therapeutics, Faculty of Medicine, University of Barcelona & IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
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Morgado‐Carrasco D, Piquero‐Casals J, Granger C, Trullàs C, Passeron T. Melasma: The need for tailored photoprotection to improve clinical outcomes. Photodermatol Photoimmunol Photomed 2022; 38:515-521. [PMID: 35229368 PMCID: PMC9790748 DOI: 10.1111/phpp.12783] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/24/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND/PURPOSE Melasma is a frequent photoexacerbated hyperpigmentary disorder, which can significantly impact on the quality of life. We sought to review the pathogenesis of melasma, and the role of photoprotection in the prevention and treatment of this disorder. METHODS We conducted a narrative review of the literature. We performed literature searches with PubMed from January 1990 to December 2021 using the keywords "melasma," "pathogenesis," "ultraviolet radiation," "visible light," "photoprotection," and "sunscreens." RESULTS The physiopathology of melasma includes a complex interaction between genetics, sex hormones, and sun exposure. Visible light, in particular high-energy visible light (HEVL), and long-wave UVA (UVA1) play a key role in melasma pathophysiology, and recent research suggests that melasma shares many features with photoaging disorders. Melasma disproportionately affects dark-skinned individuals. Some 30% to 50% of South Americans and Asians, among other ethnicities, can present with melasma. Dark-skinned patients take fewer photoprotective measures. Also, the majority of melasma patients do not adequately follow photoprotection recommendations, including the application of sunscreen. Intensive use of a broad-spectrum sunscreen can prevent melasma in high-risk individuals, can lessen melasma severity (associated or not with depigmenting agents), and can reduce relapses. CONCLUSIONS Due to the physiopathology of melasma, sunscreens should be broad-spectrum with high sun protection factor, and provide high protection against UVA1 and VL. Sunscreens should be cosmetically acceptable and leave no white residue. Tinted sunscreens are an excellent choice, as pigments can protect from HEVL and UVA1, and may provide camouflage, but they must offer colors that match the skin tone of each patient.
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Affiliation(s)
| | | | | | | | - Thierry Passeron
- Department of DermatologyUniversity Côte d’AzurCHU NiceNiceFrance,University Côte d’Azur, INSERM U1065C3MNiceFrance
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Granger C, Petkar G, Hosenally M, Bustos J, Trullàs C, Passeron T, Krutmann J. Evaluation of a Sunscreen Product Compared with Reference Standards P3, P5 and P8 in Outdoor Conditions: a Randomized, Double-Blinded, Intra-individual Study in Healthy Subjects. Dermatol Ther (Heidelb) 2022; 12:2531-2546. [PMID: 36173595 PMCID: PMC9588103 DOI: 10.1007/s13555-022-00815-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The shortcomings of standardized sunscreen testing have been discussed in recent years, noting differences between how sunscreens perform in indoor clinical (in vivo) laboratory testing compared with real-life conditions. We previously developed an outdoor clinical method for ranking sunscreens by performance level. We used this method to test the performance of a new broad-spectrum sunscreen against International Organization for Standardization (ISO) reference products P3, P5 and P8. METHODS Sixty-five healthy volunteers with individual typology angle (ITA) ≥ 28° (light to intermediate skin colour) participated in an outdoor study in Mauritius. Test areas were marked on their backs, which were treated with the different products: one commercially available broad-spectrum sun protection factor (SPF) 50 sunscreen [investigational product (IP)] and the three reference products P3 (SPF 15), P5 (SPF 30) and P8 (SPF 50+) from ISO norm 24444:2019 for SPF testing. The test areas were exposed for 2-3 h, depending on the baseline skin colour. They were also compared with an unprotected positive control area and a non-exposed negative control area. Clinical and colorimetry assessment of erythema and pigmentation were performed at 24 h and 8 days, respectively. RESULTS Overall, according to this outdoor clinical testing method, the sunscreens' efficacy was ranked in an appropriate order given their established SPF levels, with higher SPFs giving greater protection against erythema and pigmentation. Between the different levels of SPF, the differences were statistically significant, for both clinical and colorimetry assessments. The new broad-spectrum SPF 50 IP performed similarly to the SPF 50+ (P8) reference product. Even the highest SPF products, SPF 50 and SPF 50+, had some instances of photoprotection failure. CONCLUSION These findings confirm the feasibility of this outdoor clinical testing method in ranking sunscreens and provide further evidence, in addition to standardized SPF and UVA protection factor (UVAPF) testing, on how this new broad-spectrum SPF 50 sunscreen performs in extreme outdoor solar exposure: in line with reference product P8 (SPF 50+). TRIAL REGISTRATION NO ISRCTN95394014.
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Affiliation(s)
| | - Gitanjali Petkar
- Centre International de Développement Pharmaceutique, Phoenix, Mauritius
| | - Muzzammil Hosenally
- Centre International de Développement Pharmaceutique, Phoenix, Mauritius.,Department of Economics and Statistics, University of Mauritius, Réduit, Mauritius
| | | | | | - Thierry Passeron
- Department of Dermatology, CHU Nice, University Côte d'Azur, Nice, France.,C3M, INSERM U1065, University Côte d'Azur, Nice, France
| | - Jean Krutmann
- IUF Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany.,Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
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Molina-García M, Granger C, Trullàs C, Puig S. Exposome and Skin: Part 1. Bibliometric Analysis and Review of the Impact of Exposome Approaches on Dermatology. Dermatol Ther (Heidelb) 2022; 12:345-359. [PMID: 35112325 PMCID: PMC8850514 DOI: 10.1007/s13555-021-00680-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Most skin disorders, such as atopic dermatitis, psoriasis, skin cancer or age-related skin issues, are the result of a complex interaction between genetic and environmental factors over time. As an external organ, the skin provides the opportunity to study the link between exposure to the environment and several specific biological responses using an exposome approach. The aim of this review was to identify the state of the art of exposome approaches and elucidate the impact of the new era of exposomics on dermatology. Methods Two parallel and independent bibliometric analyses were conducted based on documents extracted from the Core Collection and the Science Citation Index Expanded (SCI-Expanded) databases from the Clarivate Analytics’ Web of Science (WOS) platform by using the following search terms “exposome” and “skin exposome”. In both searches, we used the topic field that includes title, abstract, author keywords and keywords plus terms and the following filters: “English language” and all documents published up to 30 September 2021. We further analysed and interpreted documents extracted in plain text format. Results Based on the defined searches, 910 documents were identified as being related to “exposome” and 45 as being related to “skin exposome”. Environmental sciences and toxicology were the most impacted research areas, and aging, cancer and respiratory allergies were the most documented diseases while, surprisingly, dermatology was much less impacted. Krutmann et al. were the pioneers in implementing this new concept in dermatology with publication of “The skin aging exposome” in 2017 (J Dermatol Sci. 2017;85:152–61). After this tipping point, the number of publications in dermatology evaluating the impact of exposome factors in many skin disorders has steadily increased. Conclusions Exposome studies are rapidly attracting interest in dermatology. The results of these studies will undoubtedly improve our understanding of why and under which circumstances some individuals develop skin disorders and help design tailored prevention strategies for patients suffering from these disorders.
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Affiliation(s)
- Manuel Molina-García
- School of Medicine and Health Science, University of Barcelona (UB), 143 Casanova, 08036, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Melanoma Unit, Dermatology Department, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Corinne Granger
- Innovation and Development, ISDIN, S.A., 33 Provençals, 08019, Barcelona, Spain
| | - Carles Trullàs
- Innovation and Development, ISDIN, S.A., 33 Provençals, 08019, Barcelona, Spain
| | - Susana Puig
- School of Medicine and Health Science, University of Barcelona (UB), 143 Casanova, 08036, Barcelona, Spain. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Melanoma Unit, Dermatology Department, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain. .,Centro de Investigación en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain.
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9
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Piquero-Casals J, Morgado-Carrasco D, Granger C, Trullàs C, Jesús-Silva A, Krutmann J. Urea in Dermatology: A Review of its Emollient, Moisturizing, Keratolytic, Skin Barrier Enhancing and Antimicrobial Properties. Dermatol Ther (Heidelb) 2021; 11:1905-1915. [PMID: 34596890 PMCID: PMC8611129 DOI: 10.1007/s13555-021-00611-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Indexed: 11/29/2022] Open
Abstract
Urea is a hygroscopic molecule (capable of absorbing water) present in the epidermis as a component of the natural moisturizing factor (NMF) and is essential for the adequate hydration and integrity of the stratum corneum. Urea improves skin barrier function including antimicrobial defense by regulating gene expression in keratinocytes relevant for their differentiation and antimicrobial peptide production. It also plays a fundamental role in regulating keratinocyte proliferation. One of the first uses of urea in modern medicine was the topical treatment of wounds due to its proteolytic and antibacterial properties. At present, urea is widely used in dermatology to improve skin barrier function and as one of the most common moisturizers and keratolytic agents. Urea-containing formulations are available in diverse formulations and concentrations. Multiple clinical trials on the use of urea-containing formulations have shown significant clinical improvement in many of the dermatosis presenting with scaly and dry skin such as atopic dermatitis, ichthyosis, xerosis, seborrheic dermatitis and psoriasis, among others. Furthermore, urea can increase skin penetration and optimize the action of topical drugs. Urea-based products are well tolerated; their side effects are mild and are more frequent at high concentration. Here, we present a review of the use of urea in dermatology, discussing its mechanism of action, safety profile and frequent indications.
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Affiliation(s)
| | - Daniel Morgado-Carrasco
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Jean Krutmann
- IUF-Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany.,Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Granger C, Ong G, Andres P, Trullàs C, Hosenally M, Lai W, Liu W, Krutmann J, Passeron T, Lim HW. Outdoor sunscreen testing with high-intensity solar exposure in a Chinese and Caucasian population. Photodermatol Photoimmunol Photomed 2021; 38:19-28. [PMID: 34157168 PMCID: PMC9292406 DOI: 10.1111/phpp.12710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 05/24/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Currently, sunscreens' sun protection factor (SPF) and ultraviolet (UV) A protection are tested separately under indoor conditions, without considering external conditions that may affect performance. Studies are often conducted in Caucasian individuals; other racial groups may respond differently. METHODS An outdoor, double-blind, intra-individual study was performed in 63 healthy Chinese and Caucasian volunteers in Singapore. Subjects underwent one outdoor sun exposure lasting 2-3 hours. ISO reference products P3 (SPF 15), P5 (SPF 30), and P8 (SPF 50+) applied at 2 mg/cm2 were compared against each other and against an untreated exposed area (positive control) and an unexposed area (negative control). Endpoints were investigator global assessment (IGA) of erythema at 24 hours, IGA of pigmentation at 1 week, and colorimetry (a*, L*, and ITA) at 24 hours and 1 week. RESULTS Clinical erythema and pigmentation scores were statistically significantly different among the three sunscreens, with the highest SPF product providing the highest protection, confirming the discriminatory capacity of the model used. Colorimetric assessment correlated well with clinical evaluation. CONCLUSION This study confirmed the feasibility of ranking sunscreens (at 2 mg/cm2 ) based on clinical effects of high-intensity outdoor solar radiation. Larger studies are needed to look at differences in erythema and pigmentation reactions between Chinese and Caucasian individuals, which could be relevant for photoprotection.
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Affiliation(s)
| | - Gavin Ong
- The Dermatology Practice @ Gleneagles, Singapore City, Singapore
| | | | | | - Muzzammil Hosenally
- Department of Economics and Statistics, University of Mauritius, Réduit, Mauritius.,Centre International de Développement Pharmaceutique, Phoenix, Mauritius
| | - Wei Lai
- Department of Dermatology, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Liu
- Department of Dermatology, Air Force General Hospital, PLA, Beijing, China
| | - Jean Krutmann
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.,Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Thierry Passeron
- Department of Dermatology, Centre Hospitalier-Universitaire de Nice, Université Côte d'Azur, Nice, France.,INSERM C3M (U1065), Université Côte d'Azur, Nice, France
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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11
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Krutmann J, Granger C, Trullàs C, Passeron T. Daily photoprotection: What does it really mean? Photodermatol Photoimmunol Photomed 2021; 37:569-570. [PMID: 34133801 PMCID: PMC9292177 DOI: 10.1111/phpp.12707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/28/2021] [Accepted: 06/13/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Jean Krutmann
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.,Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | | | - Thierry Passeron
- CHU Nice, Department of Dermatology, University Côte d'Azur, Nice, France.,INSERM U1065, C3M, University Côte d'Azur, Nice, France
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12
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Lim HW, Kohli I, Granger C, Trullàs C, Piquero-Casals J, Narda M, Masson P, Krutmann J, Passeron T. Photoprotection of the Skin from Visible Light‒Induced Pigmentation: Current Testing Methods and Proposed Harmonization. J Invest Dermatol 2021; 141:2569-2576. [PMID: 34112516 DOI: 10.1016/j.jid.2021.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022]
Abstract
Visible light (VL) can induce pigmentary alterations, especially in dark-skinned individuals, and exacerbate photodermatoses and pigmentary disorders. Currently, there is no standardized method for assessing sunscreen protection against VL. On the basis of a critical review of published in vitro and in vivo methods, a VL photoprotection assessment method based on pigmentation is proposed.
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Affiliation(s)
- Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA.
| | - Indermeet Kohli
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA; Department of Physics and Astronomy, College of Liberal Arts and Sciences, Wayne State University, Detroit, Michigan, USA
| | | | | | | | | | | | - Jean Krutmann
- IUF - Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany; Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
| | - Thierry Passeron
- Department of Dermatology, Centre Hospitalaire Universitaire de Nice, University Côte d'Azur, Nice, France; C3M, INSERM U1065, University Côte d'Azur, Nice, France
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13
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Trullàs C, Granger C, Lim HW, Krutmann J, Masson P. Linear and exponential sunscreen behaviours as an explanation for observed discrepancies in sun protection factor testing. Photodermatol Photoimmunol Photomed 2019; 36:351-356. [PMID: 31376288 PMCID: PMC7540522 DOI: 10.1111/phpp.12500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/08/2019] [Accepted: 07/24/2019] [Indexed: 11/28/2022]
Abstract
Background In vivo testing of sun protection factor (SPF) values can show considerable interlaboratory variability. We studied the underlying reasons and clinical implications. Methods Following the ISO 24444:2010 SPF testing method, seven contract research organizations (CROs) tested eight sunscreens marketed as SPF50 or SPF50+ and the reference SPF15 sunscreens P2 and P3 and SPF43 P6. We analysed differences in the products and CRO testing methods with regard to SPF variability. We tested the erythema prevention capacity of five of the products in subjects exposed to high doses of natural sunlight in Mauritius. Results Sun protection factor values varied dramatically between different CROs for some, but not all of the sunscreens. Those with the largest variability had an SPF50+, and their SPF values differed from a maximum of 62.4 to a minimum of 5.5. These products did not share a common sun‐filter composition, and some CROs used low and others high irradiation dose regimens. When comparing these two regimens, test products fell into two categories: (i) they either behaved similarly (“linear”) or (ii) they behaved differently (“exponential”). In the outdoor clinical study, exponential and linear sunscreens did not differ in their photoprotection capacities. Conclusion Differences in reported SPF values depend on the linear vs exponential behaviour of such products if subjected to low‐ vs high‐dose test regimens. Under real‐time exposure to natural sunlight, exponential and linear sunscreens did not differ in their erythema prevention capacity. Laboratory SPF testing of exponential sunscreens bears the risk of underestimating their in‐use SPF.
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Affiliation(s)
| | | | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Jean Krutmann
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
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14
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Granger C, Krutmann J, Bustos J, Sola Y, Hosenally M, Trullàs C, Andres P, Passeron T. New Methodology to Evaluate Sunscreens Under Outdoor Conditions: A Double-Blind, Randomized Intra-Individual Clinical Study of a Water-Based Broad-Spectrum SPF50+ Versus SPF15 (P3) and SPF50. Dermatol Ther (Heidelb) 2019; 9:589-599. [PMID: 31352672 PMCID: PMC6704267 DOI: 10.1007/s13555-019-00315-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction This study explored a new method to test sunscreens in outdoor conditions (very high to extreme ultraviolet [UV] radiation) approximating real-life solar exposure while maintaining scientific standards and acceptable conditions, and assessed the efficacy of a water-based sun-protection factor (SPF) 50+ versus a reference SPF15 and two comparator SPF50+ products. Methods Thirty-five subjects underwent testing in summertime Mauritius. In each subject, five test areas were marked on the back. One area was left unprotected, and four sunscreens were applied to the others: investigational product (IP), SPF15 (ISO 24444:2010 reference standard P3), and two marketed SPF50+ controls. Subjects spent 1–2 h (depending on skin type) in the sun. After 24 h, erythema was assessed by clinical scoring (0–5) and colorimetry (a*, L*, and ITA). Secondary endpoints were correlation between clinical and colorimetry assessment, product tolerability, and total UV radiation received. Results All subjects were exposed to a very high UV index (≥ 8) and 30/35 were exposed to an extreme UV index (≥ 11). The IP showed statistically significant differences in clinical erythema scoring compared with unprotected skin and SPF15, but not with SPF50+ controls. On colorimetry, differences in a* (redness) and L* (lightness) reached statistical significance for the IP vs SPF15 but not vs SPF50+ controls. Clinical and instrumental erythema assessment correlated strongly (Spearman’s rho 0.663). No tolerability issues were reported. Conclusion This exploratory study confirmed the ability of this outdoor model to discriminate sunscreens with different SPF using clinical evaluation as an objective measure. The water-based sunscreen maintained its efficacy in outdoor conditions of very high to extreme UV radiation: it was superior to SPF15 and comparable to SPF50+ controls in preventing erythema. The method used represents an option for sunscreen efficacy comparison outside of the laboratory. Funding Isdin. Electronic supplementary material The online version of this article (10.1007/s13555-019-00315-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jean Krutmann
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | | | - Yolanda Sola
- Meteorology Group, Department of Applied Physics, University of Barcelona, Martí I Franquès 1, 08028, Barcelona, Spain
| | - Muzzammil Hosenally
- Department of Economics and Statistics, University of Mauritius, Réduit, Mauritius.,Centre International de Développement Pharmaceutique, Phoenix, Mauritius
| | | | | | - Thierry Passeron
- Department of Dermatology, Centre Hospitalo-Universitaire de Nice, Université Côte d'Azur, Nice, France.,Inserm C3M (U1065), Nice, France
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Narda M, Ramos-Lopez D, Bustos J, Trullàs C, Granger C. A novel water-based anti-aging suncare formulation provides multifaceted protection and repair against environmental aggressors: evidence from in vitro, ex vivo, and clinical studies. Clin Cosmet Investig Dermatol 2019; 12:533-544. [PMID: 31413615 PMCID: PMC6661990 DOI: 10.2147/ccid.s209728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/20/2019] [Indexed: 12/31/2022]
Abstract
Background Ultraviolet (UV) radiation is an established cause of skin aging, and the role of pollution is increasingly acknowledged. In this study, we evaluated the efficacy of an antipollution and anti-aging suncare product in in vitro, ex vivo, and clinical studies. Methods We assessed 1) sunburn cell (SBC) and cyclobutane pyrimidine dimer (CPD) formation and gene expression profile in reconstructed human epidermis following solar irradiation, 2) malondialdehyde (MDA) level, Nrf2 immunostaining, and genetic expression in skin explants exposed to pollution, 3) carbon particle adhesion to healthy forearm skin in a clinical study, and 4) skin firmness, elasticity, and pigmentation spots in healthy women following 56 days of application. Results 1) The product fully protected against CPD formation, and provided a high protection against SBC formation, with levels close to non-irradiated samples. Expression of genes encoding pro-inflammatory and oxidative stress response markers was lower in product-treated than untreated skin. 2) Compared with pollution-exposed untreated controls, product-treated skin had 23% lower MDA levels (P<0.01), weaker Nrf2 immunostaining, and attenuated upregulation of CYP1A1. 3) The product significantly decreased adhesion of carbon particles to the skin (15.2% less than control; P<0.01). 4) Clinically, product use led to a decrease in brown spots, with a relative reduction in the count of −1.9% (NS), and in area, −5.0% (P<0.01), and decrease in UV spots, with a relative reduction of −6.9% (P<0.01) and −9.3% (P=0.02) for count and area, respectively. Firmness increased significantly by 14.1% (P<0.01). Participants reported skin was more even in tone (80%), more moisturized (93%), and firmer (74%). Conclusion This water-based anti-aging SPF50 suncare formulation containing photolyase encapsulated in liposome, active biopeptides, antioxidants, and hyaluronic acid provides multifaceted protection and repair action against pollution and UV-induced skin aging, ideal for everyday use.
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Affiliation(s)
| | | | - Javier Bustos
- Innovation and Development, ISDIN SA, Barcelona, Spain
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16
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Granger C, Sola Y, Gilaberte Y, Trullàs C. Outdoor testing of the photoprotection provided by a new water-based broad-spectrum SPF50+ sunscreen product: two double-blind, split-face, randomized controlled studies in healthy adults. Clin Cosmet Investig Dermatol 2019; 12:461-467. [PMID: 31303776 PMCID: PMC6604753 DOI: 10.2147/ccid.s211335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/27/2019] [Indexed: 11/24/2022]
Abstract
Purpose Users often under-apply sunscreens, and one of the main reasons cited for this is the cosmetic formulation of the product. To address this, we developed a water-based sunscreen. The product underwent standard laboratory testing (ISO 24444: 2010) and was determined as sun protection factor (SPF) 50+. However, such laboratory testing does not take into account environmental factors of in-use conditions that could potentially affect sunscreen efficacy, particularly of new cosmetic formulations. We aimed to test this product in conditions more representative of real-life solar exposure, to confirm its reported laboratory efficacy. Methods Two double-blind, randomized, controlled, split-face intra-individual studies were conducted during summer months in Barcelona. One study compared the product against an SPF15 control (reference standard P3 of ISO 24444: 2010), while the other compared against an SPF50+ control (another commercially available sunscreen). A technician applied the products before sun exposure: investigational product (IP) to one half of the face and the respective control product to the other. Subjects spent 4–6 hrs outdoors performing quiet activities, and sunscreens were reapplied at 2 hourly intervals. A dermatologist clinically scored facial erythema at baseline and at 24 hrs. Results Sixty-five subjects were included in total. In both studies, skin treated with the IP showed no significant increase in clinical erythema scoring at 24 hrs. There were statistically significant differences between the IP and the SPF15, but not between the IP and the SPF50+ control. SPF15 did not protect all subjects against solar-induced erythema. Conclusion These outdoor studies confirm the efficacy of this new SPF50+ water-based sunscreen in conditions that closer represent real-life sun exposure.
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Affiliation(s)
| | - Yolanda Sola
- Meteorology Group, Department of Applied Physics, University of Barcelona, 08028 Barcelona, Spain
| | - Yolanda Gilaberte
- Dermatology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Academia Española de Dermatología y Venereología , Zaragoza, Spain.,Revista Actas Dermo-Sifiliográficas , Zaragoza, Spain.,Health Sciences, University of Zaragoza, Zaragoza, Spain
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