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Topical treatments for photoaged skin. Separating the reality from the hype.

Most patients have committed the usual folly of recreational sunbathing in childhood, and in adulthood they notice the manifestations in the mirror. Increasingly, they are seeking professional advice regarding the growing stream of products that promise to improve their photoaged skin. Physicians need to be informed about the great range and complexity of products available, if for no other reason than to steer patients clear of traveling-medicine-show products. A better reason is to be able to provide guidance on proper use of formulations that have proven benefit.

Administration, Topical↗

Suntanning: differences in perceptions throughout history.

In ancient times, the sun was venerated as a source of life in some cultures. Scientifically, the relationship between vitamin D and sunlight and the deficiency of vitamin D in patients with rickets were ultimately discovered. In 1903, Niels Finsen was awarded the Nobel Prize in medicine or physiology for his "Finsen light therapy" for infectious diseases, especially lupus vulgaris. In the 1930s and 1940s, the medical profession promoted sunbathing as beneficial for children. From these bases, the popularity of suntanning emerged, promoted by the availability of more leisure time and, eventually, the development of sunlamps and commercial tanning salons. Although the precise role of ultraviolet light in the pathogenesis of melanoma is uncertain, a melanoma epidemic began to be noticed in the 1970s. During the past 15 years, campaigns have attempted to educate the public about the potential dangers of suntanning and exposure to ultraviolet light. Whether the melanoma epidemic can be reversed remains to be seen.

Attitude to Health↗

Vitamin D status of women in the Geelong Osteoporosis Study: association with diet and casual exposure to sunlight.

OBJECTIVE: To assess vitamin D intake and casual exposure to sunshine in relation to serum 25-hydroxyvitamin D (25OHD) levels. DESIGN: Cross-sectional study of a population-based, random sample of women aged 20-92 years, assessed between 1994 and 1997. SETTING AND PARTICIPANTS: 861 women from the Barwon Statistical Division (population, 218000), which includes the city of Geelong (latitude 38 degrees south) in Victoria. MAIN OUTCOME MEASURES: Vitamin D intake; serum 25OHD level; season of assessment; exposure to sunshine. RESULTS: Median intake of vitamin D was 1.2 microg/day (range, 0.0-11.4 microg/day). Vitamin D supplements, taken by 7.9% of participants, increased intake by 8.1% to 1.3 microg/day (range, 0.0-101.2 microg/day) (P< 0.001). A dose-response relationship in serum 25OHD levels was observed for sunbathing frequency before and after adjusting for age (P< 0.05). During winter (May-October), serum 25OHD levels were dependent on vitamin D intake (partial r2= 0.01; P<0.05) and were lower than during summer (November-April) (age-adjusted mean, 59nmol/L [95% Cl, 57-62] v 81 nmol/L [95% CI, 78-84]; P<0.05). No association was detected between serum 25OHD and vitamin D intake during summer. The prevalences of low concentrations of serum 25OHD were, for <28nmol/L, 7.2% and 11.3% overall and in winter, respectively; and, for <50 nmol/L, 30.0% and 43.2% overall and in winter, respectively. CONCLUSIONS: At latitude 38 degrees south, the contribution of vitamin D from dietary sources appears to be insignificant during summer. However, during winter vitamin D status is influenced by dietary intake. Australia has no recommended dietary intake (RDI) for vitamin D, in the belief that adequate vitamin D can be obtained from solar irradiation alone. Our results suggest that an RDI may be needed.

Adult↗

Why does cancer cluster?

What do Florida sunbathers, midwestern farmers, rural black men, and Long Island women have in common? They all have higher-than-average risks for certain cancers. Researchers know that cancer clusters are usually caused by several factors. As cancer becomes America's leading cause of death, the public will be keenly interested in sorting out the causes and reducing the risks.

Cluster Analysis↗

Cutaneous malignant melanoma: Tabuk experience.

Cutaneous melanoma (CM) has a rising morbidity and mortality in the western world but is rare in certain geographical areas including the Middle East. The aim of this study is to define the pattern of CM in this environment over a period of about two decades. A review of associated histological reports, dermatology, plastic general surgical admissions and outpatient census statistic of the North West Military Hospital (N.W.A.F.H.) were carried out from January 1978 to June 1996. The clinico-therapeutic information from both the review case and newly discovered CM was then studied. The result shows that CM is probably rare in the Tabuk military environment and possibly has a low mortality among the affected individuals. The presence of only 2 cases of CM among 73,955 patients over about 20 years suggests that this neoplasm is rare in N.W.A.F.H. Surgery, with localised expert reconstruction, probably offers the best cure for uncomplicated CM in this area. It is suggested that the geographical environment, genetic attributes, custom, attitude, presence of white, painted, sun-reflecting buildings, traditional dress-code and behaviour of the indigenes probably contribute to the suppression of and protection against CM in Tabuk. It is recommended that regular, antimlanoma education awareness programmes among the indigenes and avoidance of sunbathing attitude of the expatriate community should be encouraged in order to maintain this suggested natural selection protection.

Cheek↗

Melanoma and other skin cancers in circumpolar areas.

During the recent decades, the thickness of the ozone layer over the northern hemisphere has declined by 10 to 40 percent during the winter and spring months. Since ozone is the major barrier protecting the earth from dangerous short wave UV-radiation (UVB), the depletion in the ozone layer consequently increases the amount of UV-radiation reaching the earth's surface. As a rule a 10 percent reduction in the ozone layer causes ca. 20% increase in UV-radiation and a 40% increase in skin cancers. Thus relatively minor changes in ozone layer thickness may a have marked impact on the health of humans. Skin cancer is the most common cancer in humans, i.e. in Finland about 4000 new basal cell carcinomas, 700 other skin cancers, mostly spinous cell carcinomas and 500 melanomas occur yearly. Up to recent years the incidence of skin cancers has steadily increased in northern countries. As an explanation, changes in sunbathing habits have been suggested to play a central role. Due to the high mortality rate in melanoma, and marked morbidity in other skin cancers, it is important to try to prevent skin cancers and inform the public about the risks of excessive sun exposure, and of the ways in which the skin can be protected. Proper clothing and use of sunscreens have been shown to reduce the incidence of both melanomas and other skin cancers. Furthermore, it is important to identify those at high risk for acquiring skin cancers, like individuals with type 1 skin character (fair skin which burns easily), or numerous dysplastic nevi, or a family history of skin cancers.

Antarctic Regions↗

Cancer-preventive effects of sunscreens are uncertain.

Provocative findings have been published suggesting that the use of sunscreens may promote skin cancer. A recent meeting of international experts on the use of sunscreens and skin cancer was held at the International Agency for Research on Cancer in Lyon. The workshop concluded that the topical use of sunscreens reduces the risk of sunburn and that sunscreens probably prevent squamous-cell carcinoma of the skin when used mainly during unintentional sun exposure. No conclusion could be drawn about the cancer-preventive activity of topical sunscreens against basal-cell carcinoma and cutaneous melanoma. The use of sunscreens can extend the duration of intentional sun exposure, such as sunbathing. Such an extension may increase the risk for cutaneous melanoma. The workshop warned against relying solely on sunscreens for protection from ultraviolet radiation.

Basal Cell Carcinoma↗

Healthcare and disease management in Ayurveda.

Because the disharmony of mental doshas (satogun, rajogun, and tamogun) and body doshas (vata, pitta, and kapha) are the major cause of illness, the goal of illness management in Ayurveda is to bring back harmony among the doshas. The management includes clinical examination, diagnosis, and dietary and lifestyle interventions and treatment. The clinical examination consists of Astha Sthana Pariksha (8-point diagnosis: pulse-diagnosis, urine, stool, tongue, voice and body sound, eye, skin, and total body appearance examinations) and examination of the digestive system and the patient's physical strength. The treatment consists of cleansing (Panchkarma), palliation (improve digestion, remove toxic waste, fasting, observe thirst, exercise, sunbathing, and meditation), mental nurturing, and spiritual healing depending on the disturbed doshas and the patient's constitution. The preferred use of bhasms and herbal formulas over the respective metallic salts or the single herbs is discussed. This review suggests a great potential for integration of Ayurvedic therapies into the healthcare system in the United States.

Delivery of Health Care, Integrated↗

Sun protection practices, knowledge and attitudes to tans among New Zealand adolescents, 1991-1997.

AIMS: To examine change in the self-reported sun protection, knowledge and attitudes to tans amongst fourth form students from 1991 to 1997. METHODS: Questionnaires were mailed to 20 New Zealand secondary schools, where 20 students were randomly selected to participate in each school. RESULTS: The proportions of adolescents who reported getting sunburnt over summer, and sunbathing for the purpose of tanning increased significantly from 1991 to 1997, while there were decreases in the proportions who reported getting a suntan, wearing clothing for sun protection and having heard of melanoma. There was also some evidence of a decrease in the attribution of positive qualities to a tan. CONCLUSIONS: Some positive changes in attitudes to tanning among New Zealand adolescents were present over the 1991-1997 period. Although these changes are promising there was little change in utilisation of sun protection measures, in fact, there was evidence that this had worsened.

Adolescent↗

Cancer clusters: findings vs feelings.

The issue of cancer clusters, which has been in the spotlight recently, is plagued by a wide disparity between public perceptions and scientific findings. Movies like Erin Brockovich have led the public to think that industrial pollution in the environment is causing local "cancer clusters" where cancer cases are more prevalent due to cancer-causing chemicals. There are many scientifically documented instances in which chemical exposure has caused cancer in humans, but the evidence for purely environmental exposures causing cancer is sparse. The clusters that scientists have been able to attribute successfully to a particular cause have been occupational (such as workers in a factory developing a particular type of cancer from daily exposure to a specific chemical), linked to a particular medicine, or linked to behaviors such as smoking or sunbathing. There is some indication that chemicals dissolved in drinking water may elevate the risk of gastrointestinal and bladder/urinary tract cancers and that living next to a smelter or other "point source" of air pollution may elevate risk of lung cancer. The many efforts that have been made to demonstrate links between other types of cancer and environmental contamination have not conclusively identified such links. Several challenges bedevil any cancer cluster investigation and can result in ambiguous or misleading conclusions. This report discusses the potential cancer clusters in Toms River, New Jersey and Long Island, New York, because they contain many elements typical of cancer cluster investigations and have received considerable media attention.

Bias↗

Photo-recall of sunburn induced by radiation therapy 50 years later.

A patient is described whose foolish sunbathing practices during adolescence predisposed her to an intense and unpleasant skin reaction during the course of radiation therapy approximately 50 years later. The phenomenon suggests that solar-induced changes in the skin can persist over a very long period of time and emphasizes the need for light-skinned individuals to protect their skin from the intense rays of the sun.

Adenocarcinoma↗

Open trial of topical tacalcitol [1 alpha 24(OH)2D3] and solar irradiation for vitiligo vulgaris: upregulation of c-Kit mRNA by cultured melanocytes.

Vitiligo vulgaris is a common skin disease, however some cases show poor clinical responses to topical steroid ointment or PUVA therapy. Such regimens are generally avoided in the treatment of facial lesions or in pediatric cases because of the undesirable side effects. To confirm the excellent response to combination therapy with topical vitamin D3 ointment and solar irradiation for vitiligo achieved in the initial patients, we conducted an open trial on other patients, most of whom had poor clinical responses to the prior therapies. Fifteen patients (9 men and 6 women) with vitiligo vulgaris were enrolled in this study. Each patient was instructed to sunbathe for 30 minutes within 1 hour after topical application of the tacalcitol [1 alpha 24(OH)(2)D(3)] ointment or cream to the skin lesions every day. Six of 15 patients showed a fair and excellent clinical response to the combination therapy (more than 30% clearance of the vitiligo). The clinical effect was more apparent in patients with a history of less than 5 years of vitiligo (4 of 6 cases) in contrast to those with a history of more than 5 years (2 of 9 cases). In vitro experiments revealed that tacalcitol upregulated the expression of c-Kit mRNA by melanocytes irradiated with linear polarized infrared, UVA or short period solar irradiation. These results suggest that combination therapy with topical vitamin D(3) ointment and solar irradiation can be used as an alternate therapy for vitiligo vulgaris.

Administration, Cutaneous↗

Promoting dietary change in the Stockholm Cancer Prevention Program.

The Stockholm Cancer Prevention Program (SCPP) is a community-based program aimed at reducing cancer incidence and mortality by reducing risk factors related to life-style: dietary habits, tobacco use, and sunbathing. The program, which came about as a result of a political initiative and commitment, has as its dietary objectives to reduce fat intake to 30% of energy and to increase fiber intake to 30 g/day. SCPP strives to achieve these goals by simultaneously affecting food supply and food demand. To date, the program collaborates with 12 municipalities and several large occupational health services and restaurant chains. It has developed cook books for caterers and the general public and has organized food fairs targeting policymakers and those working with food, education, or health promotion. SCPP emphasizes collaboration across sectors of society and has initiated contests for students studying food service technology and for retailers with the aim of promoting dietary change. The intervention is based on the principles and strategies of community organization.

Adult↗

[Protection from uv-light-induced oxidative stress by nutritional radical scavengers].

Two series of examinations were carried out in two voluntary test groups for the purpose of elucidating the correlation between ultraviolet light load and oxidative stress as well as the way it is influenced by nutritive radical scavengers. After a 6 to 7-hour impact of sunshine on the whole body (sunbathing beach) at n = 8 a continuous progredient increase of thiobarbituric acid reactive substances could be identified in the serum (from 5.56 +/- 0.98 to 8.91 +/- 0.99 mumol/l, p < 0.001), which after new exposure to sunshine reached 11.3 +/- 2.4 mumol/l. Likewise, a 15-minute exposure to ultraviolet light at n = 24 induced increases of TBRS concentrations lasting from 1-2 days. After 14-day supplementation with beta-carotene (n = 6), D-alpha-tocopherol (n = 6), selenium (n = 6), and ginkgo biloba extract (n = 6) the extent of the oxidative stress could be inhibited during a second exposure to ultraviolet light up to the following efficiency: Se > Ginkgo > beta-carotene > vitamin E. The clastogenous effect of sunshine and ultraviolet light must be regarded as a factor for initiating and promoting cancerogenesis in the total organism. Concerning the aetiopathogenesis of malignant melanoma the paramagnetic properties of free radicals with their nonenergetic effects of the magnetic field have to be considered more carefully in scientific examinations.

Adult↗

College students' knowledge and attitudes about cancer and perceived risks of developing skin cancer.

Skin cancer is the most commonly occurring cancer in the United States. Primary prevention practices for skin cancer are fully documented in the literature for reducing the damaging effects of ultraviolet radiation on skin. Late adolescents, inherent to their young age and risk-taking behaviors, are more likely to sunbathe. The cancer attitudes and suntanning knowledge, attitudes, perceptions, beliefs, and behaviors among college students were examined. Gender-specific interventions for educating this age group are recommended.

Adolescent↗

The efficacy and safety of low-dose diclofenac sodium 0.1% gel for the symptomatic relief of pain and erythema associated with superficial natural sunburn.

A randomised, double-blind, single-centre, vehicle-controlled clinical trial was conducted to assess the efficacy and tolerability of diclofenac-Na 0.1% gel in 172 subjects suffering from acute first-degree natural sunburn. Overall 172 subjects with skin phototypes II-IV were randomised in a ratio of 2:1 to receive two applications of either diclofenac-Na 0.1% Emulgel gel or its vehicle Emulgel gel, 6 and 10 hours after the end of sun exposure. Subjects were drawn from a target population of healthy volunteers and well outdoor sunbathers with normal tolerance to ultraviolet light and the sun. Previously untanned areas were exposed to carefully determined standardised doses of sun (2.8 individual minimal erythema doses) on 15% body surface area to induce first-degree sunburn. After administration of diclofenac-Na 0.1% gel, subjects reported a significant reduction in spontaneous pain intensity compared with those on vehicle. Pain relief was rapid with a reduction in erythema, which was apparent within the first few hours after the first application of the trial medication with a maximum effect observed up to 30 hours after sun exposure. A good', very good', or excellent' cooling effect was recorded by 85% of subjects after treatment. Reported treatment-emergent adverse effects were infrequent, generally mild and none were considered to be related to the trial medication. Only one severe treatment emergent adverse event (abdominal pain) was recorded in the active group, and another (burning sensation) with vehicle.

Administration, Cutaneous↗

Mid dermal elastolysis with wrinkling. Report of two cases and review of the literature.

BACKGROUND: We observed two patients who had mid dermal elastolysis with wrinkling. OBJECTIVE AND METHODS: We reviewed the pertinent features of the four cases reported in the literature and of our two cases. We also compared mid dermal elastolysis with other disorders of acquired elastolysis, such as postinflammatory elastolysis and cutis laxa, anetoderma, and (regular) cutis laxa. RESULTS: Our two patients with mid dermal elastolysis with wrinkling were middle-aged, white women. Physical examination showed widespread wrinkling, erythematous patches (macules), and papules. Histologic examination showed patchy loss of elastic tissue limited to the mid dermis. In one of our patients, elastolytic skin lesions appeared on areas not covered by a two-piece swimsuit. She used to sunbathe frequently. In our other patient, skin lesions were also more prominent on exposed areas. CONCLUSION: We speculate that sun exposure is one of the main causative factors of mid dermal elastolysis with wrinkling.

Adult↗

Knowledge of the effects of sun exposure of Turkish high school students and their sun bathing habits.

Cancer, long a serious problem in developed countries, is now becoming a serious health concern throughout the world. There has been an alarming increase in the number of new cases of melanoma each year, this cancer increasing at a faster rate than any other neoplasm in some regions. This may be a result of depletion of the ozone layer. An association between non-melanocytic skin cancer and exposure to the sun appears to have first been suggested in 1894; it was not until about 1952 that it was argued that exposure to the sun also causes melanoma. It is commonly believed that skin cancers develop only after long-term exposure to UVR. At the individual level, people who live in sunnier climates comparatively have a higher risk for skin cancer than do people who live in colder climates. This is particularly the case for migrant populations with a fair skin. The present study was conducted to evaluate the knowledge of the young generation in Turkey related to the side effects of sun exposure, and their sun bathing habits. Sun sensitivity, use of sunscreens, sunbathing habits and protective behaviours were determined for a total of 1244 high school students from the answers to a questionnaire completed by them. Data from 627 (50.4 %) females and 617 (49.6 %) males were evaluated. All were aged between 15 and 18 years. Sunscreen use was found to be higher in female students (59 %) than in their male counterparts (45.8 %). The wearing of sunglasses was reported by 36.7 %, whereas the incidence of hat wear was found to be 55.1% overall. The results of this study indicate that, although most high school students are aware of the side effects of sun exposure, they do not pay sufficient attention to protective behaviour. A further study should now be conducted to evaluate the use of sunscreens in a large group.

Adolescent↗