Photodermatology, photoimmunology & photomedicine最新文献

Background: There are no internationally agreed diagnostic criteria for actinic prurigo.

Objective: To analyze the clinical features of all patients ever reported in the medical literature with a diagnosis of 'actinic prurigo'.

Methods: A systematic literature review of all case reports, case series and retrospective studies published since 1946 about patients given a diagnosis of actinic prurigo. We tested our hypothesis that the patients divide into four clinically distinctive presentations: 'eczematous patch' (EP), 'papular' (P), 'labial' (L) or 'nodular' (N). We divided the papers analysed into these four categories by initial qualitative assessment and then tested our hypothesis of four clinically distinct subtypes by detailed quantitative analysis.

Results: Quantitative analysis confirmed the hypothesis that there are four clinically distinct subtypes of actinic prurigo: 'eczematous patch' (EP), 'papular' (P), 'labial' (L) and 'nodular' (N). They differ significantly in clinical features, geographical location, ethnicity of patients and HLA typing. All the subtypes are photosensitive inflammatory dermatoses, with the greatest overlap is between the 'EP' and 'P' subtypes.

Conclusion: We propose a new nomenclature for actinic prurigo to include these four subtypes. This improved diagnostic definition should make it easier to define the natural history of this disease and identify effective treatments.

Prospero: CRD42018085694.

Background: Despite decades of public health messaging promoting sun safety and universal sunscreen utilization, sunburn remains prevalent among U.S. adults, posing a significant public health concern due to its links to skin cancer and photoaging.

Objectives: This study aims to evaluate self-reported sunburn prevalence and associated risk factors using a nationally representative cross-sectional survey.

Methods: We analyzed data from the Centers for Disease Control and Prevention's (CDC's) 2019 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative cross-sectional survey of the US civilian noninstitutionalized population. Our sample included 15,545 adults aged 18 years and older who had complete data on sunburn and relevant variables. Multivariable logistic regression with adjustment for sampling probabilities was used to examine factors associated with self-reported sunburn in the last 12 months preceding the interview. All statistical analyses were performed using Stata 17.

Results: We found that 31.02% of American adults reported sunburn in the past year, with higher rates observed among younger adults, those with higher income and education, and rural residents. Binge drinking was strongly associated with increased sunburn risk. Despite increased sun-protective behaviors such as sunscreen use, seeking shade, and wearing protective clothing, these practices have not significantly reduced sunburn prevalence, particularly among high-risk groups.

Conclusions: Our findings suggest that public health campaigns may not sufficiently address the unique needs of certain populations, including young adults, rural residents, and binge drinkers. We recommend tailored interventions, multimodal sun protection strategies, and enhanced use of digital platforms for outreach. Further research is essential to refine these strategies and reduce the public health burden of sunburn and its associated risks.

Background: Rosacea, a prevalent chronic inflammatory skin condition primarily affecting the central facial convexities, is categorized into four clinical subtypes: erythematotelangiectatic rosacea (ETR), papulopustular rosacea (PPR), phymatous rosacea (PhR), ocular rosacea (OR). While ultraviolet (UV) radiation is recognized as a risk factor for rosacea, the differential skin sensitivity to UVA and/or UVB between healthy individuals and rosacea patients remains ambiguous.

Methods: This study comprised 70 patients diagnosed with rosacea and 100 healthy controls. The minimal erythema doses (MED-UVA and MED-UVB) were ascertained using an SUV-2000 solar UV simulator. A comparative analysis was conducted on the MED-UVA and MED-UVB results between the rosacea patient group and the healthy control group, as well as among rosacea patients with varying clinical subtypes. Furthermore, the correlation between MED values in rosacea patients and factors such as age, skin type, antinuclear antibodies (ANA), and the Clinical Erythema Assessment (CEA) scale was evaluated.

Results: In comparison to the healthy control group, the rosacea group demonstrated significantly lower MED-UVA (p < 0.05) and MED-UVB (p ≤ 0.001) values. However, no significant differences were observed in the MED-UVA (p > 0.05) and MED-UVB (p > 0.05) values among patients with varying clinical subtypes of rosacea, specifically between ETR and PPR.

Conclusion: Patients diagnosed with rosacea demonstrate a decreased minimal erythema dose to both UVA and UVB, suggesting heightened sensitivity to ultraviolet radiation. Consequently, it is advisable for individuals with rosacea to minimize sun exposure in order to mitigate or prevent exacerbation of the condition.

Background: Although a role for ultraviolet radiation (UVR) in cutaneous malignant melanoma (CMM) development is accepted, there is debate over the magnitude and mechanisms given its association with intermittent but not chronic exposure.

Objectives: To assess new ideas and data on the subject, review some debated topics, bringing a molecular view to epidemiological observations.

Methods: We reviewed some recent advances in the field of epidemiology and genetics, including phenome-wide association studies, evolutionary genetics related to skin cancer, and mechanisms of UVR-induced DNA adduct formation.

Results: High rates of CMM are strongly correlated with light colored skin across the globe. CMM shares risk factors associated with UVR sensitivity with keratinocyte cancer (KC). CMM risk is dominated by MC1R, a gene regulating the proportions of black and red melanin produced. An emerging mutagenic mechanism involves reactive melanin, particularly red pheomelanin, that can itself induce DNA adducts.

Conclusion: Demographically, epidemiologically, and mechanistically, pigmentation status is central to CMM risk and a shared genetic susceptibility, comprising several pigmentation genes, between CMM and KCs. In the general population, CMM risk is associated with pale skin and poor tanning ability, mechanistically due to a relative lack of protection against UVR adduct formation, or perhaps via an alternate manner in individuals with abundant pheomelanin. Overall, evidence suggests that UVR exposure impacts CMM risk.

Background: Chronic actinic dermatitis (CAD) is a refractory photoallergic skin disease characterized by inflammatory infiltration and UV sensitivity. While the role of microbiome dysbiosis has been established in various inflammatory skin conditions, its contribution to CAD pathogenesis remains unexplored.

Objective: To characterize the skin microbiome alterations in CAD patients and investigate their potential associations with disease severity and UV sensitivity.

Methods: Skin microbiome samples were collected from 15 CAD patients and 14 matched family controls, covering both photoexposed (PE) and photoprotected (PNE) areas. The microbial community composition was analyzed using 16S rRNA sequencing. Alpha and beta diversity analyses were performed, and correlations between microbial profiles, disease severity, and UV sensitivity were evaluated.

Results: CAD patients exhibited significantly reduced microbial diversity compared to controls, particularly in photoexposed areas (p < 0.001). This reduction in diversity showed a negative correlation with disease severity. Notably, Staphylococcus abundance was significantly increased in CAD lesions and positively correlated with disease severity. Linear Discriminant Analysis identified Staphylococcus as a potential biomarker for CAD. Interestingly, no significant correlations were found between microbial profiles and UV sensitivity, suggesting independent pathogenic mechanisms.

Conclusion: Our findings reveal significant alterations in the skin microbiome of CAD patients, characterized by reduced diversity and increased Staphylococcus colonization, which correlates with disease severity but not UV sensitivity. These results provide new insights into CAD pathophysiology and suggest potential therapeutic strategies targeting the skin microbiome.

Background: Verrucae (warts) are caused by human papilloma viruses. Photodynamic therapy (PDT) is a widely recommended option to treat warts.

Objectives: To assess the role of liquid crystal loaded methylene blue (MB) combined with intense pulsed light (IPL) in the treatment of verrucae.

Patients and methods: A total of 42 clinically and dermoscopically confirmed patients complaining of at least four cutaneous warts of various types were recruited in this clinical study. The lesions for the same patient were divided into 4 groups: Group (1) received topical 10% liquid crystal loaded MB, then was subjected to two passes of IPL with a 650 nm cutoff filter; Group (2) was subjected to two passes of IPL; and Group (3) received topical 10% liquid crystal loaded MB gel. They underwent four sessions at 2-week intervals. Group (4) was left with no treatment (control).

Results: Complete disappearance of warts was observed in 52.4%, 19%, and 4.8% in Group 1, 2, and 3, respectively, with no recurrence throughout the following 3 months. Regarding PDT-treated group, verruca plantaris showed the best result, followed by verruca plana, then verruca vulgaris. Comparing all groups, there was a statistically significant difference in which the PDT group showed the best result.

Conclusion: PDT using 10% liquid crystal loaded MB combined with IPL is an effective option in wart treatment with the best results in V. plantaris, followed by V. plana and V. vulgaris.