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Photodamage: cause, clinical manifestations, and prevention.

It is now recognized that intrinsic aging changes are distinct from those caused by habitual exposure to the sun (photoaging). Not only are these sun-induced alterations unsightly, but they also serve as a marker for patients at risk for developing skin cancer. Because of increased leisure time and affluence in our society, and an emphasis on sunbathing and other outdoor recreational activities during the last few decades, photoaging and skin cancer are becoming an ever-increasing problem and source of concern for health care professionals. The purpose of this article is to review the cause, clinical manifestations, and implications of photodamage. Photoprotection and other preventive measures to minimize photoaging and the risk of skin cancer will be discussed.

Health Behavior↗

[Vitamin deficiency and marginal vitamin deficiency].

Fat-soluble vitamin deficiency and marginal deficiency of this type of vitamin will be discussed. The trias of vitamin A deficiency is composed of nyctalopia, xerophthalmia and hyperkeratosis follicularis. Vitamin D deficiency causes rachitis and osteomalacia. In Japan, vitamin D deficiency is more often caused by impaired vitamin D activation due to renal failure, than by a lack of sunbathing or insufficient ingestion of vitamin D from diet. At present, it is quite rare that the physician encounters patients with deficiency of vitamin E or other vitamins. According to surveys of occult vitamin deficiency, the prevalence of marginal fat-soluble vitamin deficiency was lower than that of marginal water-soluble vitamin deficiency. Marginal vitamin deficiency seems to be absent or very rare among healthy individuals. In patients, however, marginal vitamin deficiency is sometimes observed. Since marginal vitamin deficiency can modify the underlying disease or trigger complications, the physician should take adequate measures to prevent the onset of marginal vitamin deficiency in managing patients with various diseases.

Humans↗

Alternative therapies commonly used within a population of patients with psoriasis.

Alternative therapies are known to be employed by dermatology patients. This study investigates the use of alternative medical treatments for psoriasis and the sociodemographic variables, conventional medical treatment, and psoriasis disease severity. Our study population consisted of 578 university dermatology clinic patients with psoriasis and data was analyzed from 317 (55 percent) questionnaire respondents. The majority of our sample were women (57 percent) and nonwhites represented 8 percent of our sample. Psoriasis severity was measured using the validated Self-Administered Psoriasis Area and Severity Index. Alternative medicine was used by 62 percent of respondents. Excluding sunlight and nonprescription tanning equipment, 51 percent used one or more of the remaining alternative therapeutic modalities. The psoriasis severity was worse in those who had tried herbal remedies, vitamin therapy, and dietary manipulation. With the exception of vitamin therapy, we observed no association between the intensity of conventional medical treatment and alternative treatment. The present or prior use of herbal remedies was correlated with the use of vitamin therapy and sunbathing, and dietary interventions were significantly correlated with vitamin therapy. Of the 113 (36 percent) who had used nonprescription tanning equipment for their psoriasis, 68 percent believed this modality was effective. We found that alternative medical therapies were widely utilized by subjects participating in this study. Clinicians need to continue to be aware of nonallopathic remedies employed by their patients to discover useful information about future therapies and to monitor for adverse effects.

Adolescent↗

[Adverse effects of sunlight on the skin].

Many people consider a summer's day pleasant: warm and bright. The sun's ultraviolet rays do not contribute to the pleasure, and are biologically mainly harmful. As UV radiation does not penetrate any deeper than our skin, this organ has to be particularly well adapted to the UV exposure. The skin exploits the UV radiation for the synthesis of vitamin D3. Our day-to-day exposure suffices for this beneficial UV effect. Excessive exposure, as in sunbathing, only contributes to the adverse effects, like sunburn and suppression of cellular immunity in the short term, and 'photoaging' and skin cancer in the long term. The UVB radiation in sunlight is mainly responsible for these harmful effects, the UVA radiation to a far lesser extent (10-20% contribution). The UVA radiation from modern tanning equipment does not differ from that in sunlight, but UVA radiation does not lead to vitamin D3 production; it rather degrades vitamin D3 and a tan offers insufficient protection against the UVB radiation in full sunlight.

Cholecalciferol↗

[Effects of sunscreening agents and reactions with ultraviolet radiation].

The use of sunscreens is extensive. During the last few years there have been indications that UV radiation causes breakdown of the sunlight absorbing filters in the sunscreens, i.e. the sunscreens are not photostable. We describe briefly UV propagation in skin, the chemical and physical properties of sunscreens, and how these may react during UV irradiation. We have studied the stability of several sunscreens in vitro. The stability tests were performed by applying a thin film of the sunscreen preparation to the wall of a quartz window, irradiating it with a sun simulator, and measuring the absorbance with spectrophotometry before and during irradiation. The sunscreen agent studied most thoroughly was the UVB filter octyl methoxy cinnamate, but other UVA and UVB filters and some commercial products were also tested. Considerable breakdown of most filters was observed after doses of irradiation equivalent to moderate sun exposure. It can be questioned whether the breakdown products of sunscreens also possess other physical or biological properties. General practitioners should be able to advise their patients on sun protection and the proper use of sunscreens, considering the extensive use of sunscreens and the fact that sunbathing may be a health hazard.

Cinnamates↗