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Background: The principal risk factor for development of skin cancers is exposure to ultraviolet (UV) radiation. The universal solar UV index (UVI) consists of a simple measurement of UV radiation at the earth's surface, which provides an indicator of the risk of skin lesions in the absence of protective measures and taking into account individual phototype. The UVI is recommended by the WHO and is used to educate populations about the need to take protective measures in the event of exposure to UV radiation. There have been very few studies to assess understanding of this index, and these have been conducted primarily among the general population. Our study assesses understanding and use of the UVI among dermatologists in metropolitan France., Materials and Methods: This survey was conducted in December 2011 among 400 randomly selected French dermatologists. The questions asked concerned their personal and professional knowledge and their use of the UVI., Results: We analysed 165 (41.5%) of the answers. The UVI was known to 79% of the dermatologists questioned. Less than one third of dermatologists knew the key values in the UVI. Less than half of the dermatologists aware of the UVI reported acting upon the values in question. Only 12.1% of the dermatologists said that they used the index in their communication concerning prevention of sunburn., Discussion: The results of our study show that the UVI is poorly known and not very widely used among dermatologists in France. This index, readily understood by anyone, could be incorporated by dermatologists in their prevention messages concerning solar radiation and it could be used throughout the year, particularly in target populations such as schoolchildren and children taking part in outdoor sports., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Excessive exposure to solar or artificial sources of UV radiation is deleterious to the skin and can cause or worsen several diseases. Detrimental effects of UV radiation exert an important role in the development of skin cancers, cause alterations on the immune response, and act as a trigger or aggravating factor for pigmentary disorders. A group of measures, including education, change of habits, use of physical barriers and sunscreens constitutes a significant part of the treatment of many skin disorders and are valuable preventive tools. This article summarizes the relevant studies addressing these issues, emphasizing the many aspects of photoprotection., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Lasers are a very effective approach for treating many hyperpigmented lesions. They are the gold standard treatment for actinic lentigos and dermal hypermelanocytosis, such as Ota nevus. Becker nevus, hyperpigmented mosaicisms, and lentigines can also be successfully treated with lasers, but they could be less effective and relapses can be observed. However, lasers cannot be proposed for all types of hyperpigmentation. Thus, freckles and café-au-lait macules should not be treated as the relapses are nearly constant. Due to its complex pathophysiology, melasma has a special place in hyperpigmented dermatoses. Q-switched lasers (using standard parameters or low fluency) should not be used because of consistent relapses and the high risk of post-inflammatory hyperpigmentation. Paradoxically, targeting the vascular component of the melasma lesion with lasers could have a beneficial effect. However, these results have yet to be confirmed. In all cases, a precise diagnosis of the type of hyperpigmentation is mandatory before any laser treatment, and the limits and the potential side effects of the treatment must be clearly explained to patients., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

The varieties of normal skin color in humans range from people of "no color" (pale white) to "people of color" (light brown, dark brown, and black). Skin color is a blend resulting from the skin chromophores red (oxyhaemoglobin), blue (deoxygenated haemoglobin), yellow-orange (carotene, an exogenous pigment), and brown (melanin). Melanin, however, is the major component of skin color ; it is the presence or absence of melanin in the melanosomes in melanocytes and melanin in keratinocytes that is responsible for epidermal pigmentation, and the presence of melanin in macrophages or melanocytes in the dermis that is responsible for dermal pigmentation. Two groups of pigmentary disorders are commonly distinguished: the disorders of the quantitative and qualitative distribution of normal pigment and the abnormal presence of exogenous or endogenous pigments in the skin. The first group includes hyperpigmentations, which clinically manifest by darkening of the skin color, and leukodermia, which is characterized by lightening of the skin. Hypermelanosis corresponds to an overload of melanin or an abnormal distribution of melanin in the skin. Depending on the color, melanodermia (brown/black) and ceruloderma (blue/grey) are distinguished. Melanodermia correspond to epidermal hypermelanocytosis (an increased number of melanocytes) or epidermal hypermelanosis (an increase in the quantity of melanin in the epidermis with no modification of the number of melanocytes). Ceruloderma correspond to dermal hypermelanocytosis (abnormal presence in the dermis of cells synthesizing melanins) ; leakage in the dermis of epidermal melanin also exists, a form of dermal hypermelanosis called pigmentary incontinence. Finally, dyschromia can be related to the abnormal presence in the skin of a pigment of exogenous or endogenous origin., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Purpose: To compare glare sensitivity measured by the intraocular scattered light between WFG-PRK and WFG-LASIK at 12 months follow-up and to assess its correlation to patients' complaints., Patients and Methods: Prospective and randomized study on 13 patients treated with WFG-LASIK, 13 patients with WFG-PRK and a control group of 35 patients. The intraocular stray light was measured by the Oculus C-Quant 12 months after surgery and before surgery for the control group. Photopic and mesopic contrast acuity and glare symptoms were reported pre- and postoperatively., Results: Stray light values were normal in 79% of patients after WFG-LASIK and PRK and 86% in the control group, with mean values of 1.05 log, 1.03 log, and 0.99 log, respectively (p>0.05). All the patients with significant glare complaints had impaired stray light values versus 31.5% in the no-complaint group. Photopic and mesopic contrast acuity and glare symptoms were improved 1 year after surgery compared to preoperatively (no significant difference between groups)., Conclusion: WFG-LASIK and PRK are safe and equivalent procedures regarding quality of vision. The measurement of stray light can be a discriminative test to assessing patients' glare complaints.

The environment, especially solar irradiation, plays a major role in skin aging. In humans, cutaneous areas frequently exposed to solar radiations are subject to premature skin ageing (heliodermatitis) which has specific clinical and histological features distinct from those observed in photoprotected skin. Most of the cellular and molecular mechanisms implicated in chronologic aging are observed in both ultraviolet exposed and photoprotected skin and can be stimulated in vitro and in vivo by repeated ultraviolet exposures. This article reviews the epidemiological, clinical and histological characteristics of photoaging and summarizes the recent findings acquired in this field.

Chronic urticaria is defined as an eruption of oedematous and pruriginous papules, localized or widespread, evolving for more than 6 weeks. Cutaneous lesions occurs daily or recurs with remissions of a few days at a few weeks. Diagnosing chronic urticaria is easy, but to find an etiology is much more tiresome. This is why a detailed anamnesis and a clinical examination are significant elements in the assessment of chronic urticaria. The analysis of the literature according to criteria's of the National Agency of Accreditation and Evaluation in Health shows that the anamnesis and the clinical examination are sufficient to carry a diagnosis in the majority of physical urticaria. However, they bring elements to suspect an urticarial vasculitis, a systemic disease or another etiology, allowing orientation of complementary examinations. The anamnesis permits to detect worsening factors, in particular drugs and/or food, their suppression leading to an improvement of symptomatology.

Background: Jessner's lymphocytic infiltration of the skin is a rare and benign disorder. Its clinical course is cyclic with remissions and exacerbations. In this disease, photosensitivity was previously noticed by authors and recently demonstrated. We report four new cases with positive photobiological investigation., Case Reports: Four patients (2 males, 2 females), with a mean age 36 years were seen with erythematous papules or discoid plaques on face, arms and upper trunk. The onset of disease occurred after sun exposure in summer. Skin biopsies showed perivascular lymphocytic infiltration in the dermis. All patients relapsed cyclically with incomplete healing during winter. Photobiological investigation elicited skin lesions in a broad spectrum of UV: UVB (2 cases), UVA (1 case), UVA and UVB (1 case). In all patients treatment with oral antimalarials and external photoprotection was effective., Discussion: Our data suggest that photosensitivity history in patients with Jessner's lymphocytic infiltration of the skin should be searched for, and confirmed by provocative phototesting. This relevant event could guide the therapeutic strategy because antimalarials were effective for the Jessner's lymphocytic infiltration cases with photosensitivity.

Background: Contrary to other countries, in which a unique entity is recognized, two sub-groups of light eruption, benign summer light eruption and polymorphous light eruption, are identified in France. Benign summer light eruption was individualized with a few criteria: age at onset between 25-35 years old, female predominance, onset within 12 hours after an intensive exposure to sun, presence of lesions on areas which have not been regularly exposed to sunlight such as the upper chest, absence of lesions on the face, improvement during the summer period and negativity of the polychromatic phototest. In fact patients usually presenting with benign summer light eruption do not have all the criteria and they gradually develop a polymorphous light eruption. The aim of this study was to quantify, among the patients presenting with a light eruption, the population with three main criteria of benign summer light eruption., Patients and Method: Eighty-seven patients presenting with a light eruption, a polymorphous light eruption or a benign summer light eruption, were selected by a dermatologist. For each patient the presence or absence of the 3 main criteria were noted: a) no lesion of the face, b) improvement of the eruption during the summer period, c) negative polychromatic phototest., Results: Among the 87 patients, 9 of them (10 p. 100) had the three main criteria of benign summer light eruption., Discussion: Benign summer light eruption is either rare or defined with wrong criteria. The polychromatic phototest was gradually replaced by the UVA phototest. In fact, provocation UVA phototests do not individualize benign summer light eruption from polymorphous light eruption. Individualization of the benign summer light eruption is not justified because there is a continuous spectrum of light eruptions, ranging from the benign eruption which improves during the summer period and the chronic eruption with a high photosensitivy and lesions of the face.

Background: We report a case of photosensitivity which occurred as the presenting sign of HIV infection. Photosensitivity regressed completely after introducing antiretroviral tritherapy., Case Report: A 44-year-old woman developed a photo-distributed eczematous eruption which did not respond to topical steroids or hydroxychloroquine. Histologic examination showed eczematous dermatitis. T-cell marker analysis showed a majority of CD8 cells in the infiltrate. The patient was found to be HIV-positive and CD4 counts were markedly reduced to 190/mm3 while CD8 counts were increased to 1260/mm3. Antiretroviral tritherapy cured the photosensitivity. Cure was apparently related to increased CD4 lymphocyte and normalized CD8 lymphocyte counts., Discussion: Photosensitivity was the presenting disorder of HIV infection in this case. Cure of the photosensitivity with antiretroviral tritherapy has not been reported previously. CD8 T-cell infiltration and very low CD4/CD8 ratio would appear to play a key role in the pathogenesis of photosensitivity in these patients.

Introduction: A case of photosensitive prurigo during AIDs is reported. This is the second case in the literature. We discuss the relations between HIV infection and photodermatoses., Observations: A woman, known to be HIV seropositive from 1990, developed during the spring 1990 a prurigo on light exposed areas who received the next year. A photobiological investigation was performed, showing a polymorphic light eruption induced by UVB., Discussion: Patients infected with HIV have a high prevalence of UV radiation responsive skin diseases. On the other hand, UVA radiations, UVB and UVC have been shown to induce activation and replication of HIV. PUVA therapy and UVB therapy have shown their efficacity in the treatment of many photodermatoses associated with HIV infection, without any worsening of the illness. Many questions are not yet solved in the relationship between HIV and photosensitivity and the photobiological investigation should be more frequently done.

Unlabelled: INTRODUCTION This case report of benign summer light eruption emphasizes the importance of phototests in the diagnosis of photosensitive dermatoses., Case Report: A 25-year-old man, phototype II, had experienced a pruriginous papulovesicular erythematous eruption of the axillary and inguinal regions each summer for 12 years. A high-dose UV phototest (40 J/cm2 x 3 days) directed on the right posterior axillary area and a whole body exposure test (4 J/cm2 UVA, 20 mJ/cm2 UVB x 3 days) were positive both clinically and histologically on day 4. DEM B was normal at 26 mJ/cm2. Iterative polychromatic phototest (DEM x 3 days) in the area usually involved (left posterior axillary region) was negative. The simple UVA (13 J/cm2) and iterative phototests performed on the back were negative. The results of the phototests led to the diagnosis of benign light eruption despite the unusual localization., Discussion: The diagnosis of benign light eruption is generally clinical. Phototests are unnecessary in most cases. Benign light eruption can be triggered by high-dose iterative UVA exposure of the susceptible area or whole body phototests (UVA-UVB). These specific phototests are indicated in atypical forms or localizations in order to determine the course of benign light eruption and to uncover simulations.

Introduction: Erythropoietic protoporphyria was generally assumed to be an autosomal dominant disease with variable penetrance. The determination of the ferrochelatase activity and the biological molecular studies have shown that both autosomal dominant and recessive patterns of inheritance are possible., Case Report: Is reported the case of a 17 years-old male patient with erythropoietic protoporphyria and porokeratosis. There are some hepatic biochemical abnormalities without cholelithiasia and without pathological change of the liver biopsy. Leucocyte ferrochelatase activity is decreased to 5 p. 100 of the normal mean level. In both the parents, without photosensitivity, the enzyme activity is reduced to 40 p. 100 of the normal values., Discussion: The patients with severe ferrochelatase defect have no more important clinical manifestations than in the usual form of erythropoietic protoporphyria. For clarify the exact mode of inheritance, the determination of the ferrochelatase activity and the identification of the mutations in the patient and his parents are necessary. In our patient the porokeratosis should be in relation with the protoporphyrin induced phototoxic reaction which facilitate the emergence of a mutant cellular clone of epithelial cells.

Introduction: Rothmund-Thomson syndrome is a genodermatosis associated with early poikilodermal lesions. The condition usually occurs in children. Features include skeletal deformations and increased risk of malignancy., Case Report: A 3 and a half year-old girl with poikilodermal lesions predominating in photoexposed areas presented a rash after exposure to sun. The first manifestations occurred during the first months of life. Examination of DNA repair on a culture of UV irradiated fibroblasts showed reduced DNA repair capacity., Discussion: Other childhood photodermatoses were eliminated by the clinical signs. It would be important to know whether there is a correlation between DNA repair and development of neoplasia in Rothmund-Thomson syndrome.

Introduction: Porphyria cutanea tarda (PCT) is an unfrequent disorder in patients with acquired immunodeficiency syndrome (AIDS) due to deficiency in uroporphyrinogen decarboxilase. The more frequent cutaneous manifestations are skin fragility and hypertrichosis., Case Report: A 44-years-old man with AIDS presented an intense cutaneous hyperpigmentation, preferently involving sun-exposed areas. Histopathologic studies showed perivascular PAS-positive deposits. Biochemical studies confirmed the diagnosis of PCT., Discussion: PCT should be included in the differential diagnosis of cutaneous hyperpigmentation in patients infected by human immunodeficiency virus (HIV).

Objective: Provocative phototests are used regularly to explore photobiology in patients with photodermatoses. Our objective was to determine the reliability of the phototest in the diagnosis of idiopathic and exogenous light eruption in order to identify the ideal date for the histological examination by correlation between the histological aspects of light- triggered and spontaneous lesions., Patients and Methods: Among 66 patients, there were 48 with polymorphous light eruptions, 13 with exogenous eruptions and 5 with chronic actinodermatitis. The histological findings of the provocative phototests were correlated with the clinical aspect, the date of biopsy and the histological aspect of the spontaneous lesions., Results: In polymorphous light eruptions (48 cases) this test triggered a photoallergic reaction in 48% of the patients. There was a good correlation between the histological findings and clinical features in 96% of the cases. The histological image of the light-triggered lesion on day 6 was the closest to that of the spontaneous lesion. In exogenous eruptions and chronic actinodermatitis (18 cases), only 33% of the clinically positive phototests were also positive at histological examination. The histological image was the same for the provocative tests whether they were clinically positive or negative, with signs of epidermal phototoxicity, regeneration acanthosis and moderate perivascular lymphocyte infiltration of the superficial dermal layer., Conclusions: Our findings confirmed that the phototest provides a good correlation between histological findings and clinical presentation in idiopathic polymorphous light eruptions, justifying simple clinical interpretation, but did not demonstrate a rate of positive results as high as reported in the literature. Day 6 is the ideal date for a phototest biopsy. In exogenous light eruptions, the phototest is less reliable since the correlation between histology and clinical presentation is weaker. It is difficult to reproduce spontaneous lesions with the phototest, but if used, the phototest biopsy should be done on day 18.

Background: Although cutaneous photosensitivity is one of the major criteria used for the diagnosis of systemic lupus erythematosus, this criterion is not precise., Objective: To evaluate the interest of photobiological exploration in patients with cutaneous lupus erythematosus, and to compare the results to clinical photosensitivity., Methods: Nineteen patients consecutively seen in one year, have been tested using a standardized method., Results: Clinical photosensitivity was present in 16 cases. The clinical presentation of cutaneous disease was classified in 3 groups: acute, subacute, and chronic. One patient with no history of photosensitivity had positive photobiological tests, and five patients had negative tests though they experienced clinical photosensitivity. Positive phototests with UVA and UVB were present in 6/8 subacute lupus cases, 3/6 acute lupus cases, 3/5 chronic lupus cases. Histological aspect of cutaneous biopsies from phototest was not characteristic of lupus. Minimal erythematous doses was comparable in lupus group and in controls. No correlation between positivity of phototests and the presence of systemic involvement or anti-Ro/SSA antibodies was established., Conclusion: Phototesting is useful to assess photosensitivity in lupus patients.

Background: Actinic lichen planus is a distinct variant of lichen planus involving mainly children and teenagers with racial predilection to orientals. The clinical and histopathologic features of actinic lichen planus in ten tunisian patients were studied., Results: The mean age was 14 years. The eruption was distributed over sun-exposed areas, with particular predilection for the face. In most cases the lesions consisted of erythematous brownish plaques with an annular configuration. Less commonly, hypermelanotic patches, sometimes assuming a melasma-like appearance, were present. The histopathologic feature consisted of a lichenoid dermatitis., Conclusion: The cause of actinic lichen planus is unknown. Sunlight appears to be the major precipitating factor and therefore the disease would best be included among the photodermatoses.

Psoralens are photosensitizing substances present in many vegetables, some of which are routinely consumed. These vegetables are responsible for contact phytophotodermatitis, but it was agreed that they did not produce photodermatitis when taken orally. Ljunggren has recently questioned this concept by reporting a case of phototoxic accident which occurred after ingestion of 450 grams of celery roots (Apium graveolens). In a study in healthy volunteers we looked for psoralens in blood and analyzed the cutaneous photosensitivity by the minimal phototoxic doses (MPD) method, after ingestion of celery in large amounts (500 grams and more). Plasma concentrations of psoralens were inexistant in all subjects and at all sampling times, and no phototoxic reaction was detected by MPD. Celery roots, therefore, do not seem to be photosensitizing, even after ingestion in large amounts, but they might increase the risk of phototoxicity in PUVA-therapy. The same applies to fennel and parsnip.

Halogene sources are used increasingly in general illumination. Their quartz envelop is technically necessary, but presents the disadvantage of to letting the emitted UVA, UVB and UVC go through. Originally used as in indirect lighting, they have been introduced as desk-top lamps, without filter. We have proceeded to the verification of their output with a spectrophotometer calibrated by actinometry and we have calculated their relative erythemal efficacy according to the Parrish's action spectrum for human erythema. We found that, at 10 cm from the human skin, the irradiance was able to induce a minimal erythema in about 10 minutes on clear back skin. At working distance (50 cm), a barely perceptible erythema could be observed on the back of the hands after 8 consecutive hours working. We also found that sunburn cells were present in the skin sensitized with a potent phototoxic agent (8-methoxypsoralen) applied 15 minutes before a 4-6 minutes irradiation with the halogen source (at 20 cm), thus, indicating a potential risk for local phototoxicity and photoallergy. The cumulative doses per year, for 4 hours exposure per day, five days a week, reaches 125 minimal erythemal doses, equivalent to the average yearly exposure of individuals for work and leisure. If one assumes that this regimen is maintained for 30 years, the risk for induction of skin cancers on the dorsal aspect of the hands and the forearms, may be increased by a 3.4 factor, according to the widely accepted previsional models.(ABSTRACT TRUNCATED AT 250 WORDS)

We present herein clinical, serological and genetic findings on 27 Greek, subacute cutaneous lupus erythematosus (SCLE) patients. Twenty-three (85 p. 100) presented with a psoriasifom rash in a photosensitive distribution. Two patients (7.5 p. 100) had an annular rash in a polycyclic pattern. Two other patients exhibited both types of lesions. The majority of our patients also had other skin manifestations, including butterfly rash, discoid lesions and maculopapular rash. Systemic manifestations were: arthralgias or arthritis in 50 p. 100, low grade fever in 35 p. 100, central nervous system involvement in 15 p. 100, Sjögren's syndrome in 18 p. 100 and serositis in 8 p. 100. Anti-nuclear antibodies were found in 93 p. 100; antibodies to Ro (SSA) and/or La (SSB) in 70 p. 100. Twenty-one (78 p. 100) satisfied the ARA criteria for systemic lupus erythematosus (SLE). No HLA-DR3 antigen association was found in the 16 patients tested. These findings are somewhat different from those reported previously: a) the frequency of the psoriasiform rash rather than the annular one is the highest in Greek SCLE patients; b) most patients also have other skin manifestations mimicking the full spectrum of SLE with prominent cutaneous lesions; and c) no HLA-DR3 antigen association was found in Greek patients. Environmental, ethnic or genetic factors may be responsible for these differences.

A progressive papular eruption on the face, limbs and vulva had been present for seven years in a 38-year old female patient. Some papules were small and confluent while others were sparse, as in nodular prurigo. Histology showed massive proliferation of the follicular sheath epithelium, connected to the lower surface of the epidermis. The lesion formed a plate-like area very similar to that observed in superficial basal cell carcinoma and corresponding to a tumour of the follicular infundibulum. Remarkable features of this case were the large number of lesions, their photosensitivity (they became pruriginous and increased in size after exposure to the sun), the presence of eccrine sweat glands beneath a skin lesion of the thigh, the basal cell degeneration of two lesions and the slight improvement observed after etretinate therapy. To our knowledge, such findings have not yet been reported in tumours of the follicular infundibulum.

Juvenile spring eruption is seen in early spring and needs a combination of different factors such as light exposure and chilling. It affects mainly boys aged 5-15 or young male adults. It involves the ears in most of the cases and may itch. The helix develops reddish papules, many of which becoming vesicular and later on crusty. Sometimes papular lesions appear on the back of the hands. The lesions heal within 2 weeks without scarring. Recurrences during following springs can be seen. Juvenile spring eruption cannot be reproduced. Histopathology study performed on 2 cases reveals a picture close to erythema mulutiforme and confirms Burckhardt's findings.

PUVA-induced generalized bullous pemphigoid is reported is 8 patients with psoriasis and compared with the bullous pemphigoid described in 25 patients treated by other techniques (Goeckerman, UVB, anthralin, sun exposure, topical steroids). Furthermore they must be differentiated from all the other types of bullae induced by photochemotherapy in psoriatic patients. Diagnostic criteria should be improved in order to allow a better classification of these bullous diseases and to separate the photo-toxic bullae which are the commonest, from other bullae such as epidermolysis bullosa acquisita, localized bullous pemphigoid and drug-induced bullous pemphigoid.