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Ultraviolet radiation in sunlight produces a range of acute and chronic adverse effects on the skin including sunburn, photosensitivity rashes, immunosuppression, photoageing and carcinogenesis. Sunscreens aim to provide protection, but standard testing procedures primarily involve assessment of ability to protect against acute erythema, as evidenced by the sun protection factor (SPF). The SPF may correlate poorly with other aspects of protection, particularly since ultraviolet A is weakly erythemogenic compared with ultraviolet B, yet may make a greater contribution to certain other skin effects of sunlight. Nevertheless, there is an increasing tendency for the sunscreen industry to make claims for their products beyond the SPF data. There is a need to develop systems for clinical testing of sunscreens against other endpoints caused by ultraviolet exposure of skin, including immunosuppression and photosensitivity rashes. In particular, there is a largely unrecognized need for testing of sunscreens against the condition known as polymorphic light eruption, a photosensitivity disorder estimated to affect a staggering 10–20% of the population in the northern hemisphere. Ultimately, protection of the skin by sunscreens can only be as effective as their adequacy of application to the skin surface in the everyday setting permits. Optimal sunscreen formulation, and public and patient education in appropriate application technique, both make vital contributions to efficacy of sunscreen protection. This article focuses on the need for extended clinical testing of sunscreens, with particular reference to the photosensitivity disorders, and for improvements in sunscreen formulation and in the adequacy of sunscreen application to the skin surface. [ABSTRACT FROM AUTHOR]

Ultraviolet-B-induced erythema (one, two, or four times the minimal erythema dose) was reduced but not abolished by application of 1% indomethacin gel immediately after irradiation of human skin. Continuous synthesis of prostaglandins is reflected by similar levels of indomethacin-mediated inhibition of erythema at any time within 48 h after irradiation. Repeated applications of indomethacin did not increase the inhibition. Twenty-four hours after irradiation with four minimal erythema doses, mean prostaglandin E[sub 2] levels in suction blisters were 27.2 ng per ml (SEM 11) compared with 8.6 ng per ml in unirradiated skin (n = 25; p < 0.01). Prosta glandin E[sub 2] levels in dermal tissues, sampled by microdialysis (depth 0.6 ± 0.1 mm), were 310 pg per ml (SEM 123) and 237 pg per ml (SEM 88) in irradiated and unirradiated skin, respectively (n = 7, n.s.). Nitric oxide also made a significant contribution to ultraviolet-B-induced erythema. Ultraviolet erythema was inhibited by L-NAME in a dose-related fashion with 2 mM L-NAME causing total abolition of the response. L-NAME was effective at all time points up to 48 h suggesting that NO was produced continuously. NO was undetectable in suction blister fluid but in dermal microdialysate NO was present at 44.3 ng per ml (SEM 6.2) following ultraviolet B compared with 26.0 ng per ml (SEM 8.0) in unirradiated skin (p < 0.05), approximately 1000 times the molar concentration of prostaglandin E[sub 2]. These findings confirm prostaglandin E[sub 2] and NO to be mediators of ultraviolet-induced erythema. They also show that there is prolonged synthesis of both mediators within the erythemal response and that synthesis of NO is induced by lower doses of ultraviolet B compared with that of prostaglandin E[sub 2]. [ABSTRACT FROM AUTHOR]

Background: Photodynamic therapy (PDT) is used to treat cutaneous cancers. It may induce cell death through direct and indirect means, including apoptosis, inflammation and certain immune mechanisms, with the depth of penetration as a potential modifying factor. Objectives: To examine the pathways of apoptosis in the intralesional PDT of basal cell carcinoma (BCC) and intraepidermal squamous cell carcinoma (Bowen's disease). Methods: Sixteen patients with superficial or nodular BCC and Bowen's disease were treated with intralesional aminolevulinic acid‐PDT. Biopsies were taken at baseline and 24 h post‐PDT, and sections were examined by immunohistochemistry for the expression of markers of apoptosis, such as caspase 3, involved in the intrinsic apoptotic pathway, granzyme B, a caspase‐independent apoptotic mediator, and the proapoptotic markers BAX and BAK. Results: Apoptotic cells stained with TUNEL showed statistically significant staining at 24 h post PDT (p < 0.01 in both BCC and Bowen's lesions). Caspase 3 (p < 0.01 in BCC and p < 0.05 in Bowen's) and granzyme B (p < 0.01 in BCC and p < 0.01 in Bowen's) were significantly increased at 24 h post‐PDT. BAX expression was apparently increased compared to baseline in Bowen's lesions at 24 h post‐PDT, whereas Bak was upregulated both in BCC and Bowen's disease at baseline and at 24 h post‐PDT. Conclusion: Intralesional PDT induces apoptosis in BCC and Bowen's disease via common and alternative apoptotic pathways involving granzyme B. Proapoptotic factors Bak in both BCC and Bowen and Bax in Bowen's disease appear to increase by intralesional PDT at 24 h. [ABSTRACT FROM AUTHOR]

This assessment by the Environmental Effects Assessment Panel (EEAP) of the Montreal Protocol under the United Nations Environment Programme (UNEP) evaluates the effects of ultraviolet (UV) radiation on human health within the context of the Montreal Protocol and its Amendments. We assess work published since our last comprehensive assessment in 2018. Over the last four years gains have been made in knowledge of the links between sun exposure and health outcomes, mechanisms, and estimates of disease burden, including economic impacts. Of particular note, there is new information about the way in which exposure to UV radiation modulates the immune system, causing both harms and benefits for health. The burden of skin cancer remains high, with many lives lost to melanoma and many more people treated for keratinocyte cancer, but it has been estimated that the Montreal Protocol will prevent 11 million cases of melanoma and 432 million cases of keratinocyte cancer that would otherwise have occurred in the United States in people born between 1890 and 2100. While the incidence of skin cancer continues to rise, rates have stabilised in younger populations in some countries. Mortality has also plateaued, partly due to the use of systemic therapies for advanced disease. However, these therapies are very expensive, contributing to the extremely high economic burden of skin cancer, and emphasising the importance and comparative cost-effectiveness of prevention. Photodermatoses, inflammatory skin conditions induced by exposure to UV radiation, can have a marked detrimental impact on the quality of life of sufferers. More information is emerging about their potential link with commonly used drugs, particularly anti-hypertensives. The eyes are also harmed by over-exposure to UV radiation. The incidence of cataract and pterygium is continuing to rise, and there is now evidence of a link between intraocular melanoma and sun exposure. It has been estimated that the Montreal Protocol will prevent 63 million cases of cataract that would otherwise have occurred in the United States in people born between 1890 and 2100. Despite the clearly established harms, exposure to UV radiation also has benefits for human health. While the best recognised benefit is production of vitamin D, beneficial effects mediated by factors other than vitamin D are emerging. For both sun exposure and vitamin D, there is increasingly convincing evidence of a positive role in diseases related to immune function, including both autoimmune diseases and infection. With its influence on the intensity of UV radiation and global warming, the Montreal Protocol has, and will have, both direct and indirect effects on human health, potentially changing the balance of the risks and benefits of spending time outdoors. [ABSTRACT FROM AUTHOR]

The article reports on photosensitivity and chronic actinic dermatitis in two 17-year-old atopic dermatitis patients. One patient is a female of Indian descent with atopic eczema and asthma; the other is a Caucasian male with a history of eczema and hay fever. A discussion of their erythema thresholds to ultraviolet B and ultraviolet A light as well as their development of focal dermatitis is presented.

While ultraviolet radiation (UVR) is a major cause of skin ageing and carcinogenesis, public pursuit of a novel tanning strategy circumventing the need for UVR is increasingly reported in the media and scientific press. This involves the subcutaneous self-administration of unregulated products labelled as melanotan I and/or II, synthetic analogues of α-melanocyte stimulating hormone (α-MSH), as obtained via the internet, tanning salons and gyms. The Medicines and Healthcare products Regulatory Authority has recently raised awareness of the public health risk of transmission of blood-borne viruses from the needle sharing that may occur, and of the potential impurity of these products. Dermatologists should also be aware that these agents can complicate the clinical presentation of patients with pigmented lesions; their use may be suspected in unexpectedly tanned individuals with rapidly pigmenting naevi. Meanwhile, the regulated α-MSH analogue afamelanotide (Clinuvel Pharmaceuticals Ltd, Melbourne, Australia) is showing promise for its photoprotective potential, and is undergoing phase II and III clinical trials in people with photosensitivity disorders and those prone to nonmelanoma skin cancer. The photoprotective and other biological effects of α-MSH analogues await full determination. [ABSTRACT FROM AUTHOR]

Photopheresis or extracorporeal photochemotherapy (ECP) is a novel immunomodulatory therapy which involves separation of the patient's leucocyte-rich plasma, followed by ex vivo administration of a photosensitizer and ultraviolet A radiation, before reinfusion. ECP has been used successfully for the treatment of cutaneous T-cell lymphoma (CTCL: Sézary syndrome), graft-versus-host disease (GVHD) and cardiac transplant rejection. ECP has a dose-sparing effect on concurrent immunosuppressive therapy. The procedure induces apoptosis of the irradiated lymphocytes, but the exact mechanism by which ECP exerts its therapeutic effect in these different conditions is uncertain. The treatment has very few adverse effects and in particular is not associated with an increased incidence of opportunistic infections. The evidence for the efficacy of ECP has been appraised by a combined British Photodermatology Group and U.K. Skin Lymphoma Group workshop on the basis of evidence published up to the end of 2001 and on the consensus of best practice. There is fair evidence for the use of ECP in erythrodermic CTCL and steroid-refractory GVHD, but randomized controlled studies are needed. There is good evidence supporting the use of ECP in preventing cardiac rejection following transplantation. Randomized controlled trials have also shown a therapeutic benefit in type 1 diabetes mellitus, but the inconvenience associated with the procedure outweighed the clinical benefit. There is fair evidence not to use ECP for the treatment of systemic sclerosis and multiple sclerosis, and good evidence not to use ECP for other forms of CTCL. [ABSTRACT FROM AUTHOR]

Background Smith–Lemli–Opitz syndrome (SLOS) is an autosomal recessive malformation syndrome characterized by a disorder in cholesterol metabolism. SLOS is caused by mutations in the DHCR7 gene which encodes 7-dehydrocholesterol reductase, an enzyme that catalyses the final step in cholesterol biosynthesis. We have previously established the clinical and photobiological features of the photosensitivity that is frequently a feature of SLOS. Objectives In this study, we have performed mutational analysis of the DHCR7 gene in individuals from five families with SLOS. In each family, one member was affected by severe photosensitivity as a manifestation of SLOS. Methods Fifteen samples (including family controls) were screened using polymerase chain reaction amplification and direct automated sequencing. Results Six different DHCR7 mutations were identified of which five were single point mutations that caused missense amino acid substitutions (P51H, T93M, L99P, E448K and R450L). The other was a splice site mutation (G→C in splice acceptor site) affecting the intron 8–exon 9 splice junction (IVS8-1 G→C). This splice site mutation and four of the five missense mutations have been previously published as causal in SLOS but the P51H is a novel mutation which has not previously been reported. Conclusions This is the first study in which DHCR7 gene mutational analysis has been performed on SLOS subjects with severe photosensitivity and indicates that no single mutation is responsible for the photosensitivity which characterizes this disorder. [ABSTRACT FROM AUTHOR]

Background/Purpose: Sunscreens are employed with the aim of reducing the deleterious effects of ultraviolet radiation (UVR), but little is known about their use in the UK. Methods: This questionnaire survey assessed attitudes to and usage of sunscreens in northwest England in 2000. Subjects (186 females and 102 males) were recruited from the waiting rooms of four general practices, with a high response rate of 97%. Results: Females were more frequent users of sunscreens than males, but only 35% females and 8% males reported their regular use. Twenty-two per cent of the study population did not use sunscreens at all, whereas 66% of subjects bought a sunscreen product once a year or less. Thirty-four per cent subjects reported experiencing sunburn in the last 2 years. Interestingly, more (60%) sunburns were found to occur at home in the UK than on holidays abroad, and these frequently occurred during outdoor activities other than deliberate sunbathing. Conclusion: There remains much scope for sunscreen education in the British public. [ABSTRACT FROM AUTHOR]

Tanning (melanisation and epidermal thickening) is a photoprotective response to solar UVR exposure, but it's unclear to what degree low-level exposures induce this in light-skin individuals, or whether this modifies the histological inflammatory response to UVR. Objectives were to examine if, in light-skin people, a simulated summer's casual sunlight exposures induces (i) melanogenesis, (ii) epidermal thickening and (iii) demonstrable protection against both clinical (erythema) and histological (neutrophil infiltration) impacts of higher-level, pro-inflammatory UVR challenge. A UVR intervention study was designed to simulate a summer's brief sunlight exposures (95% UVA, 5% UVB) as can provide sufficient vitamin D. Ten healthy adults of phototype II, median 47 years (range 30–59 years), 2 male/8 female, received 1.3 SED 3× weekly for 6 weeks, and were subsequently challenged with 2× personal MED of UVB on small areas of UVR-exposed and UVR-protected buttock skin. Skin erythema and pigmentation were measured spectrophotometrically. Punch biopsies were taken from (i) unexposed skin (ii) skin following the ×18 low-level UVR exposures and (iii) skin at 24 h following the 2 × MED challenge, with skin sections evaluated for epidermal thickness, and for neutrophil infiltration by immunohistochemistry. The 6-weeks' UVR exposures significantly increased skin pigmentation, skin lightness (L*) reducing from 69.37 (SD 2.8) to 65.52 (2.33) at course-end (p < 0.001), and stratum corneum thickness rising from 29.3 (9.59) to 41.5 (12.7)μm (p < 0.05); there was no influence on neutrophil numbers. Following the pro-inflammatory (2× MED) UVR challenge, there was a small (18%) reduction in erythema but a proportionately greater (71%) reduction in neutrophil infiltration in skin prior-exposed to the UVR course compared with photoprotected skin (both p < 0.05). Thus, findings add to information on risk-benefit of low-level sunlight exposure. Even very light-skin people show measurable although modest photoprotective responses to repeated low-dose UVR; greater impact is seen on histological than clinical inflammation. [ABSTRACT FROM AUTHOR]

This assessment, by the United Nations Environment Programme (UNEP) Environmental Effects Assessment Panel (EEAP), one of three Panels informing the Parties to the Montreal Protocol, provides an update, since our previous extensive assessment (Photochem. Photobiol. Sci., 2019, 18, 595–828), of recent findings of current and projected interactive environmental effects of ultraviolet (UV) radiation, stratospheric ozone, and climate change. These effects include those on human health, air quality, terrestrial and aquatic ecosystems, biogeochemical cycles, and materials used in construction and other services. The present update evaluates further evidence of the consequences of human activity on climate change that are altering the exposure of organisms and ecosystems to UV radiation. This in turn reveals the interactive effects of many climate change factors with UV radiation that have implications for the atmosphere, feedbacks, contaminant fate and transport, organismal responses, and many outdoor materials including plastics, wood, and fabrics. The universal ratification of the Montreal Protocol, signed by 197 countries, has led to the regulation and phase-out of chemicals that deplete the stratospheric ozone layer. Although this treaty has had unprecedented success in protecting the ozone layer, and hence all life on Earth from damaging UV radiation, it is also making a substantial contribution to reducing climate warming because many of the chemicals under this treaty are greenhouse gases. [ABSTRACT FROM AUTHOR]

Background: Locally acting, well-tolerated treatments for systemic sclerosis (SSc) digital ulcers (DUs) are needed. Objectives: Our primary aim was to investigate the safety, feasibility, and tolerability of a novel low-level light therapy (LTTT). A secondary aim was to tentatively assess efficacy. Methods: A custom-built device comprising infrared (850 nm), red (660 nm), and violet (405 nm) LEDs was utilized. DUs were irradiated with 10 J/cm2 twice weekly for 3 weeks, with follow-up at weeks 4 and 8. Any safety concerns were documented. Patient opinion on time to deliver, feasibility, and pain visual analogue score (VAS; 0–100, 100 most severe) was collected. Patient and clinician DU global assessment VAS were documented. DUs were evaluated by laser Doppler perfusion imaging pre- and post-irradiation. Results: In all, 14 DUs in eight patients received a total of 46 light exposures, with no safety concerns. All patients considered LTTT 'took just the right amount of time' and was 'feasible', with a low associated mean pain VAS of 1.6 (SD: 5.2). Patient and clinician global DC VAS improved during the study (mean change: –7.1 and –5.2, respectively, both p <.001). DU perfusion significantly increased post-irradiation. Conclusions: LTTT for DUs is safe, feasible, and well tolerated. There was an early tentative suggestion of treatment efficacy. [ABSTRACT FROM AUTHOR]

The Montreal Protocol has limited increases in the UV-B (280–315 nm) radiation reaching the Earth's surface as a result of depletion of stratospheric ozone. Nevertheless, the incidence of skin cancers continues to increase in most light-skinned populations, probably due mainly to risky sun exposure behaviour. In locations with strong sun protection programs of long duration, incidence is now reducing in younger age groups. Changes in the epidemiology of UV-induced eye diseases are less clear, due to a lack of data. Exposure to UV radiation plays a role in the development of cataracts, pterygium and possibly age-related macular degeneration; these are major causes of visual impairment world-wide. Photodermatoses and phototoxic reactions to drugs are not uncommon; management of the latter includes recognition of the risks by the prescribing physician. Exposure to UV radiation has benefits for health through the production of vitamin D in the skin and modulation of immune function. The latter has benefits for skin diseases such as psoriasis and possibly for systemic autoimmune diseases such as multiple sclerosis. The health risks of sun exposure can be mitigated through appropriate sun protection, such as clothing with both good UV-blocking characteristics and adequate skin coverage, sunglasses, shade, and sunscreen. New sunscreen preparations provide protection against a broader spectrum of solar radiation, but it is not clear that this has benefits for health. Gaps in knowledge make it difficult to derive evidence-based sun protection advice that balances the risks and benefits of sun exposure. [ABSTRACT FROM AUTHOR]

The article discusses studies in the U.S. and Europe that assessed the safety and efficacy of afamelanotide to decrease pain and improve quality of life. Study highlights include the duration of pain-free time in the U.S. study after six months, assessment of quality of life through the Erythropoietic Protoporphyria Quality-of-Life questionnaire, and a decrease in the total number of phototoxic reactions after nine months among patients in the European Union trial.

Summary Background Topical photodynamic therapy (PDT) elicits a therapeutic response in both skin cancer and immune-mediated skin disorders. While PDT induces direct cell death, host inflammatory and immune responses to PDT may contribute to the therapeutic effects. Objectives To examine the impact of topical PDT on leucocyte trafficking and mediators of chemotaxis in healthy human skin. Methods Aminolaevulinic acid (ALA)-PDT was performed on the buttock skin of seven healthy volunteers. Biopsies for immunohistochemical assessment were taken 1, 4 and 24 h post-PDT and from untreated contralateral buttock skin (baseline). Results A significant dermal neutrophilic infiltrate appeared early, peaking at 4 h ( P < 0·01) and returning to near baseline by 24 h. Expression of E-selectin was significantly higher at 4 h ( P < 0·05) and correlated strongly with neutrophil numbers ( r = 0·93). Expression of intercellular adhesion molecule 1 was significantly elevated after 24 h ( P < 0·05) with an apparent gradual increase in CD4+ T cells up to this time point. Notably, epidermal Langerhans cells were significantly reduced 24 h post-PDT compared with baseline ( P < 0·01) and comprised a significantly larger proportion of cells with migratory rather than dendritic morphology ( P < 0·05). The number of epidermal cells expressing tumour necrosis factor-α significantly increased at 4 h ( P < 0·05) and remained elevated 24 h post-PDT, whereas no significant change in expression of interleukin (IL)-1β or IL-8 was seen. Conclusions Reduction of Langerhans cells by topical PDT of human skin may play a significant role in PDT-induced local immunosuppression, potentially benefiting the treatment of immune-mediated skin disorders but negatively impacting on antitumour responses. Further exploration according to disease indication/treatment protocol is warranted. [ABSTRACT FROM AUTHOR]

Previous epidemiological, animal and human data report that lycopene has a protective effect against ultraviolet radiation (UVR)-induced erythema. We examined whether tomato paste - rich in lycopene, a powerful antioxidant - can protect human skin against UVR-induced effects partially mediated by oxidative stress, i.e. erythema, matrix changes and mitochondrial DNA (mtDNA) damage. In a randomized controlled study, 20 healthy women (median age 33 years, range 21-47; phototype I/II) ingested 55 g tomato paste (16 mg lycopene) in olive oil, or olive oil alone, daily for 12 weeks. Pre- and postsupplementation, UVR erythemal sensitivity was assessed visually as the minimal erythema dose (MED) and quantified with a reflectance instrument. Biopsies were taken from unexposed and UVR-exposed (3 × MED 24 h earlier) buttock skin pre- and postsupplementation, and analysed immunohistochemically for procollagen (pC) I, fibrillin-1 and matrix metalloproteinase (MMP)-1, and by quantitative polymerase chain reaction for mtDNA 3895-bp deletion. Mean ± SD erythemal D was significantly higher following tomato paste vs. control (baseline, 26·5 ± 7·5 mJ cm; control, 23 ± 6·6 mJ cm; tomato paste, 36·6 ± 14·7 mJ cm; P = 0·03), while the MED was not significantly different between groups (baseline, 35·1 ± 9·9 mJ cm; control, 32·6 ± 9·6 mJ cm; tomato paste, 42·2 ± 11·3 mJ cm). Presupplementation, UVR induced an increase in MMP-1 ( P = 0·01) and a reduction in fibrillin-1 ( P = 0·03). Postsupplementation, UVR-induced MMP-1 was reduced in the tomato paste vs. control group ( P = 0·04), while the UVR-induced reduction in fibrillin-1 was similarly abrogated in both groups, and an increase in pCI deposition was seen following tomato paste ( P = 0·05). mtDNA 3895-bp deletion following 3 × MED UVR was significantly reduced postsupplementation with tomato paste ( P = 0·01). Tomato paste containing lycopene provides protection against acute and potentially longer-term aspects of photodamage. [ABSTRACT FROM AUTHOR]

Vitamin D is necessary for bone health and is potentially protective against a range of malignancies. Opinions are divided on whether the proposed optimal circulating 25-hydroxyvitamin D [25(OH)D] level (≥ 32 ng mL) is an appropriate and feasible target at population level. We examined whether personal sunlight exposure levels can provide vitamin D sufficient (≥ 20 ng mL) and optimal status in the U.K. public. This prospective cohort study measured circulating 25(OH)D monthly for 12 months in 125 white adults aged 20-60 years in Greater Manchester. Dietary vitamin D and personal ultraviolet radiation (UVR) exposure were assessed over 1-2 weeks in each season. The primary analysis determined the post-summer peak 25(OH)D required to maintain sufficiency in wintertime. Dietary vitamin D remained low in all seasons (median 3·27 μg daily, range 2·76-4·15) while personal UVR exposure levels were high in spring and summer, low in autumn and negligible in winter. Mean 25(OH)D levels were highest in September [28·4 ng mL; 28% optimal, zero deficient (<5 ng mL)], and lowest in February (18·3 ng mL; 7% optimal, 5% deficient). A February 25(OH)D level of 20 ng mL was achieved following a mean (95% confidence interval) late summer level of 30·4 (25·6-35·2) and 34·9 (27·9-41·9) ng mL in women and men, respectively, with 62% of variance explained by gender and September levels. Late summer 25(OH)D levels approximating the optimal range are required to retain sufficiency throughout the U.K. winter. Currently the majority of the population fails to reach this post-summer level and becomes vitamin D insufficient during the winter. [ABSTRACT FROM AUTHOR]

Background Photosensitivity disorders involve an abnormal skin reaction to sunlight exposure and affect a substantial percentage of the population. No previous studies have directly compared lifestyle attributes between photosensitive and healthy individuals. Objectives To assess the impact of photosensitivity on time spent outdoors in the U.K., holiday behaviour, use of sunscreens and vitamin D supplements, and employment status. Methods Questionnaires were completed by ambulant photosensitive and healthy adults aged 18-60 years residing in Greater Manchester. Results Forty-five adults with moderate-severe photosensitivity and 124 healthy adults completed the questionnaire. This revealed that photosensitive subjects spent significantly less time outdoors in the U.K. on both summer weekdays ( P < 0·01) and summer weekends ( P < 0·0001) than healthy subjects, took fewer holidays per year ( P < 0·05), and spent less time outdoors on a sunny holiday ( P < 0·0001). They wore clothing that covered a wider skin area ( P < 0·0001), and use of sunscreen was greater (both frequency of application and area covered) in the photosensitive group outside of holiday time ( P < 0·0001), but not when on a sunny holiday, as healthy people increased their sunscreen use at this time. Despite the reduced sun exposure, photosensitive subjects were no more likely to take vitamin D supplements than healthy subjects were; they also exhibited a significantly higher rate of unemployment ( P < 0·05). Conclusions Photosensitivity disorders negatively influence lifestyle including employment status; more attention is required to the socioeconomic impact of these conditions. [ABSTRACT FROM AUTHOR]

Background Polymorphic light eruption (PLE) is a prevalent photosensitivity condition associated with psychological distress. Objective To examine patients with PLE for evidence of anxiety and depression, the influence of demographic and clinical variables, and the coping strategies used. Methods In a cross-sectional design, patients with PLE ( n = 145) who had attended a hospital dermatology department completed validated questionnaires assessing anxiety, depression, social anxiety, and coping strategies. Clinical variables examined were: (i) number of months of the year affected by PLE; (ii) facial involvement; (iii) time taken for the rash to resolve; and (iv) whether the patient ever used steroids for their condition. Results Participants ranged in age from 16–78 (mean 44 years, SD 11·9), 81% female, with a mean age at onset of PLE of 28 years. Evidence of high levels of anxiety and depression was found in PLE, with 22% and 8% of patients scoring as probable cases for anxiety and depression, respectively. Higher levels of anxiety were associated with younger age of onset of PLE ( r = −0·25, P < 0·01) and facial involvement ( t = 2·84, P < 0·01), and depression was also associated with facial involvement ( t = 3·60, P < 0·01). Furthermore, higher levels of depression and anxiety were associated with the use of maladaptive coping strategies, and depression was found to be the principal predictor of quality of life. Conclusions High levels of anxiety and depression occur in PLE. Clinicians should be alert to the potential need for psychological management, particularly in patients with facial involvement and a younger age of onset of PLE. [ABSTRACT FROM AUTHOR]

Background Polymorphic light eruption and erythropoietic protoporphyria (EPP) have been demonstrated to have a moderate and large impact on the quality of life (QoL) of patients, respectively. However, there is little information available about the impact of other photodermatoses on QoL. Objectives To assess and compare the impact of all forms of photodermatoses on patients’ QoL using the standard 1-week Dermatology Life Quality Index (DLQI) questionnaire and a modified questionnaire to assess the impact over the previous year. Methods All patients with photodermatoses seen between 2001 and 2005 at five U.K. photobiology centres were contacted by post on the same day during a forecasted sunny week across the U.K. and asked to complete DLQI questionnaires. Results A total of 1877 patients were contacted. Seven hundred and ninety-seven (42%) patients replied, with a range from 30% to 48% for the five individual centres. Nearly two-thirds of patients with actinic prurigo (AP) and more than one-third of patients with photoaggravated dermatoses (PAD), chronic actinic dermatitis, EPP and solar urticaria had a DLQI of > 10, confirming a very large effect of the disorders on QoL. Of the cutaneous porphyrias, both variegate porphyria (median DLQI 3) and porphyria cutanea tarda (median DLQI 1·5) had a much lower impact on QoL than EPP. Conclusion This is the first large-scale study to attempt to measure the impact of a range of photodermatoses on QoL. Photodermatoses have a major impact on QoL. This impact is highest in AP and PAD. [ABSTRACT FROM AUTHOR]

Background  Methyl aminolaevulinate–photodynamic therapy (MAL-PDT) is an effective treatment in facial/scalp actinic keratosis (AK). Objectives The aims of this study were to compare efficacy, safety, cosmetic outcome and patient preference of MAL-PDT vs. cryotherapy in patients with AK at other locations. Methods A multicentre, controlled, randomized, open, intraindividual, right–left comparison was performed. Patients with nonhyperkeratotic AK were treated once with MAL-PDT and cryotherapy on either side of the body. At week 12, lesions showing noncomplete response were retreated. The primary efficacy variable was the lesion response at week 24. Investigator’s assessment of cosmetic outcome, patient’s preference in terms of cosmetic outcome and a patient preference questionnaire were also analysed at week 24. Results In total, of 121 patients with 1343 lesions (98% located on the extremities and the remainder on the trunk and neck) were included. Both treatments provided a high mean percentage reduction in lesion count at week 24 with significantly higher efficacy for cryotherapy: 78% for MAL-PDT and 88% for cryotherapy ( P = 0·002, per protocol population). Investigator’s assessment of cosmetic outcome was significantly better for MAL-PDT than cryotherapy ( P < 0·001), 79% of lesions having an excellent cosmetic outcome with MAL-PDT vs. 56% with cryotherapy at week 24. The cosmetic outcome achieved by MAL-PDT compared with cryotherapy was also preferred by patients (50% vs. 22%, respectively, P < 0·001), and 59% of patients would prefer to have any new lesions treated with MAL-PDT compared with 25% with cryotherapy ( P < 0·001). Both treatment regimens were safe and well tolerated. Conclusions MAL-PDT showed inferior efficacy for treatment of non-face/scalp AK compared with cryotherapy. However, both treatments showed high efficacy, and MAL-PDT conveyed the advantages of better cosmesis and higher patient preference. [ABSTRACT FROM AUTHOR]

Background Photoallergic contact dermatitis can be difficult to diagnose if not appropriately investigated. Currently, the most common U.K. photoallergens appear to be sunscreen chemicals. The investigation of choice is photopatch testing (PPT), which is probably underused. In part, this is due to differences in methodology and results interpretation. Objectives To conduct PPT using a group of sunscreen chemicals, defined indications and a standardized methodology including interpretation and relevance of reactions in patients attending for investigation at 17 centres across the U.K., Ireland and the Netherlands. Methods Patients ( n = 1155) who fulfilled the inclusion criteria were investigated with PPT using sunscreen chemicals in addition to suspected topical products. Readings were taken at 24, 48 and 72 h following standardized ultraviolet A irradiation (5 J cm−2). The clinical relevance of any reaction was recorded. Results Of the 1155, 130 had allergic reactions (11·3%). Of these, 51 had photoallergy (PA) (4·4%), 64 had contact allergy (CA) (5·5%), and 15 patients had combined PA and CA (1·3%). Multiple PA was seen in some. The most common photoallergen was benzophenone-3 (27 reactions; 21%). Most reactions (60%) were clinically relevant. The most common indication for testing in patients found to have PA was a history of reacting to a sunscreen (41%). The other 59% had an exposed-site dermatitis/skin problem or a photodermatosis. Some centres ( n = 8) performed readings after the standard 48-h reading, and an extra 32 PA and 22 CA reactions were detected, which were not evident at 48 h. A new photoallergen (octyl triazone) was detected in two patients. Conclusions Sunscreen PA and CA are probably equally uncommon. Most reactions, of both reaction types, were relevant clinically. A large proportion of patients (59%) found to have PA was unaware of reacting to a sunscreen chemical, suggesting that PA should be considered as an explanation in any exposed-site dermatitis. Although this study focused on reactions at 48 h postirradiation, readings performed up to 96 h, while inconvenient, add value by detecting additional relevant responses. A previously unknown photoallergen was found, highlighting the need for awareness of novel photoallergens in the marketplace. A standardized PPT method not only encourages more use of this investigation, but also facilitates comparison of results between centres and so will improve our understanding of PA. [ABSTRACT FROM AUTHOR]

Background Dermatology is one of many specialities competing for space in the undergraduate curriculum, and recent review reveals that in some medical schools only a minority of students receives direct teaching from dermatologists. Enlargement of medical schools and dispersion of students over multiple sites further increase the strain on teaching resources. Objectives To develop and obtain 'proof of concept' for a technology to teach skin examination, using an approach grounded in modern theories of learning. Methods The requirements for an e-learning technology were identified through literature review and qualitative analysis of stakeholders' requirements with respondent and expert validation. A method of teaching skin examination was developed by applying Anderson's theory of skills acquisition. It was prototyped first on paper, then electronically, and its usability as an instructional tool was evaluated. Results The project delivered, firstly, a specification for skin examination derived from published evidence, textbook content, and staff and student consensus; and secondly, a very useable technology to help students learn skin examination (http://www.skillsbase.man.ac.uk). A validation task was completed in 20 min without significant usability problems, and evaluators found it simple, intuitive, interactive and enjoyable to use. Students saw it as an adjunct that would help them build confidence and revise for examinations. Nonstakeholder teachers expressed concern about the apparent simplicity of its contents and felt that it should only be used in association with traditional teaching methods. Conclusions Students, educationalists and teachers were able to codesign a useable skin examination package, which merits evaluation of efficacy. In view of the logistic difficulties of teaching dermatology to the growing student population, the technology may be a useful adjunct to traditional teaching methods. Our approach may inform further developments in educational technology in dermatology. [ABSTRACT FROM AUTHOR]

Summary Photodynamic therapy (PDT) has been reported to be useful in treating certain nonmelanoma skin cancers and a variety of benign skin conditions. We examined whether PDT might be effective in the treatment of disseminated superficial actinic porokeratosis. Three patients with classical disseminated superficial actinic porokeratosis had a small test area treated with topical aminolaevulinic acid PDT. Following the first treatment, the disorder cleared in the test area in one patient, but failed to respond in the other two patients. After subsequent treatment, the initial benefit seen in the first patient was not sustained, and no response was seen in the second patient, while the third patient was not retreated due to hyperpigmentation induced by the procedure. The results obtained in this small case series suggest that topical PDT is not a promising treatment for disseminated superficial actinic porokeratosis. [ABSTRACT FROM AUTHOR]

Pityriasis rubra pilaris (PRP) is a rare papulosquamous condition with an estimated incidence of one in 35 000 to one in 50 000. Psoralen and ultraviolet A (UVA) therapy has been used in its treatment but some patients are reported to be clinically photosensitive. We describe the photoinvestigation of a patient with PRP in whom sensitivity to broadband UVA was demonstrated. [ABSTRACT FROM AUTHOR]

Solar urticaria is a well defined although uncommon photosensitivity disorder, and is said to be the underlying cause of chronic urticaria in approximately 0.5% cases. In contrast, solar angioedema is seldom reported. We describe two patients with postulated solar angioedema, associated with clinical and/or phototest features of solar urticaria. Recognition of solar provocation of angioedema has important consequences for patient management. [ABSTRACT FROM AUTHOR]

Objectives/Methods: Although photodermatoses are common skin diseases, epidemiological data are lacking. In the framework of the European project SUNALL ( ) we performed a survey in indoor workers (mainly hospital staff) on prevalence, signs, symptoms and treatment of photodermatoses (sun allergies) using a standardised questionnaire within Europe. Results: In 6 centres distributed from the Mediterranean to Scandinavia, the data of 6866 participants were analysed. 18% of them answered that they do get an itching rash/ abnormal skin after sun exposure (a so-called sun allergy), which does not fit the criteria of a sunburn. In 29% the photodermatoses have been confirmed by a physician (55% dermatologists). Women are nearly three times more often affected than men (23% vs. 9%). Comparing the different centres we found the following lifetime prevalence rates for photodermatoses: Athens (Greece) men 15%/women 26%, Besançon (France) 5%/21%, Heidelberg (Germany) 9%/29%, Leiden (Netherlands) 7%/26%, Manchester (Great Britain) 9%/26% and Turku (Finland) 2%/14%. Increasing pigmentation correlates with a decrease of photodermatoses (overall prevalence skin type I 32%, II 26%, III 14%, IV 9%). About half of the photodermatoses have been treated mostly with sun block cream (65% of those treated). Other treatments: steroid cream (42%), phototherapy (9%) or steroid tablets/injections (7%). Only 54% get their rash during springtime but over 90% during sunny holidays. 93% get itching during the rash. 25% of people with photodermatoses report a reduction of their quality of life. Conclusions: Our data document the high prevalence of photodermatoses in Europeans. Interestingly, we found no increase in regions far away from the equator, but we found a more pronounced sex ratio. [ABSTRACT FROM AUTHOR]