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Background With the global sunscreen market expected to reach $24.4 billion worldwide by 2029, this demonstrates the increasing awareness of the damaging effects of sunlight. Sunscreen has been gradually evolving, and new photoprotective ingredients are continuing to be produced in response to growing scientific evidence on the effect of solar radiation on the skin. Aims This literature review aims to provide an updated view of the history of sunscreens. Methods A literature search was conducted with the keywords "Sunscreen, history, regulation, ultraviolet A, ultraviolet B, visible light" from PubMed, Medline, and online search engines. Results Humankind has always found ways to provide photoprotection since 4000BC. Only in the last century, evidence-based sunscreens have existed. The first ultraviolet B filters were produced in 1928, its evidence of efficacy and safety discovered in 1956 and development of sun protection factor in 1974. Similarly, sunscreen containing ultraviolet A filters was released in 1980 and the ultraviolet A star rating system developed in 1992. Regulatory bodies for sunscreen were introduced in the 1970s and have sought to review the safety and efficacy of ingredients. With the rising number of researches on the effects of visible light on hyperpigmentation over the past decade, the need for photoprotection beyond ultraviolet has been increasing. Conclusion To provide consumers with evidence-based sunscreen, challenges remain in acquiring further evidence, regulation, and rating systems.

Chronic actinic dermatitis (CAD) is a common debilitating photodermatosis. Patients often have to completely avoid outdoor activities, which severely impacts their quality of life. Phototherapy is effective for CAD and seems to increase patients' tolerance towards sunlight and consequently decrease the extent of disease. Unfortunately, the slower onset and time-consuming nature of phototherapy limits the clinical application. Considering the effectiveness and time-saving nature of ultraviolet (UV)-A rush hardening in solar urticaria, we performed a pilot study to determine whether UV-A rush hardening is effective in CAD. Six patients with CAD were exposed to multiple sessions of UV-A for 4-5 days at 1-h intervals/day. Subsequently, maintenance UV-A exposure was performed at 1-2-week intervals. Phototesting at baseline showed that three patients were sensitive to both UV-A and -B, and the other three patients only showed UV-A sensitivity. All of the patients responded well to UV-A rush hardening and four (67%) maintained a good remission status after 1 year. The results of this pilot study suggest that UV-A rush hardening phototherapy is effective and well tolerated in the treatment of CAD, while future larger prospective studies using objective scores of disease activity and quality of life are needed.

Background Phototherapy has been a first-line treatment for early-stage mycosis fungoides (MF) since 1976. Oral 8-methoxypsoralen plus ultraviolet A (oral PUVA) and narrow-band ultraviolet B (NB-UVB) are favorable modalities owing to their availability. In previous studies, phototherapy was conducted thrice per week initially, which is not feasible for many patients. Objectives To evaluate the initial clinical responses and time to relapse in patients with early-stage MF treated with oral PUVA and NB-UVB at a twice-weekly regimen. Methods We reviewed the records of patients with biopsy-proven MF who received oral PUVA or NB-UVB in 2002-2014. Demographic data, staging, response to initial course of phototherapy, and initial relapse-free interval were collected. Results Among 70 patients, 14 (20%) and 56 (80%) were treated with oral PUVA and NB-UVB, respectively. The majority had early-stage MF (IA, 22.9%, IB, 57.1%, and IIA, 4.3%). Oral PUVA led to a complete response (CR) in 2 (14.3%) patients and partial response (PR) in 7 (50%) patients; 17 (30.4%) and 25 (44.6%) patients, respectively, achieved CR and PR with NB-UVB. The number of treatments was similar in both groups. The cumulative dose was 520.7 J/cm2 for PUVA and 41.6 J/cm2 for NB-UVB. There was no initial relapse in the 2 (100%) patients and in 10 (58.8%) patients treated with oral PUVA and NB-UVB at 18 months and 9.14 months of follow-up, respectively. Conclusion Patients with early-stage MF can achieve clinical response with oral PUVA and NB-UVB, with a twice per week regimen. The initial relapse-free interval was longer than 1 year.

Background Narrowband ultraviolet B (NB-UVB) phototherapy has become a widely used, standard treatment modality in dermatology. The effect of 8-methoxypsoralen plus ultraviolet A on antinuclear antibody (ANA) formation has been investigated extensively, but there are very scarce data about the potential risk of NB-UVB phototherapy inducing production of ANAs. The aims of this study were evaluation of ANA status before and after NB-UVB treatment and comparison of ANA status with the healthy control group. Methods Phototherapy unit database was used to identify patients who had received whole body NB-UVB treatment. Analyses of ANA were performed twice in the study group that were before initiation of the NB-UVB phototherapy and after cessation of the therapy. Also, ANAs were screened in the control group. Results A total of 95 patients (50 males and 45 females; mean age: 43.03 ± 13.40) treated with NB-UVB radiation and 90 age- and sex-matched controls were included in the study. Thirteen patients (13.7%) were found to develop ANAs at the end of the treatment. ANA positivity was significantly more common in patients after phototherapy than in patients before phototherapy and than in the control group. None of the patients in the positive ANA group was diagnosed with any connective tissue diseases. Conclusion This study revealed that ANA positivity increased after NB-UVB phototherapy. However, it did not provide evidence for increased connective tissue disease risk. Therefore, ANA might not need to be routinely checked before treatment unless the patients have signs and symptoms indicating autoimmune diseases.

Background Pathogen reduction (PR) of platelet concentrates (PCs) contributes to the safety of platelet (PLT) transfusion by reducing the risk of transfusion‐transmitted infections and transfusion‐associated graft‐versus‐host disease. In vitro quality of pathogen‐reduced double‐dose PC (PR‐PC) made of eight whole blood (WB)‐derived buffy coats (BCs) were evaluated. Methods Eight small‐volume WB BCs from donors with at least 200 × 109 PLT/L were pooled with an additive solution to produce double‐dose PCs (DD‐PCs), which were treated with amotosalen/ultraviolet A light in a dual storage processing set, yielding 2 units of PR‐PC. Quality controls were undertaken as per European Directive for the Quality of Medicines (EDQM) guidelines. PLT recovery rates were measured. Production costs and savings were compared over the 3 years before and after PR implementation. Results In the pre‐PR period, 19 666 PCs were produced, compared to 17 307 PCs in the PR period. Single BC in the PR period had 41 ± 2 mL, hematocrit 0.39 ± 0.04 and 1.06 ± 0.18 × 1011 PLTs, and showed a recovery of 91% ± 8%. After pooling, separation, PR treatment of DD‐PC, and splitting, each single PC had 189 ± 6 mL with 2.52 ± 0.34 × 1011 PLTs, compared to 2.48 ± 0.40 in the pre‐PR period. The PLT recovery rate after PR was 87% ± 14%. EDQM requirements were met. An increase of about €12 (+7.5%) per PC from the pre‐PR to the PR period was identified. Conclusion A new production method resulting in two PR‐PCs made from pools of 8 BCs with use of one PR set was successfully introduced, and our experience of nearly 3 years demonstrated the high efficacy and in vitro quality of the PR‐PCs obtained.

Background The INTERCEPT Blood System pathogen reduction technology (PRT), which uses amotosalen and ultraviolet A light treatment (amotosalen/UV-PRT), inactivates pathogens in plasma and platelet components (PCs). This review summarizes data describing the inactivation efficacy of amotosalen/UVA-PRT for a broad spectrum of viruses and parasites. Methods Twenty-five enveloped viruses, six nonenveloped viruses (NEVs), and four parasites species were evaluated for sensitivity to amotosalen/UVA-PRT. Pathogens were spiked into plasma and PC at high titers. Samples were collected before and after PRT and assessed for infectivity with cell cultures or animal models. Log reduction factors (LRFs) were defined as the difference in infectious titers before and after amotosalen/UV-PRT. Results LRFs of ≥4.0 log were reported for 19 pathogens in plasma (range, ≥4.0 to ≥7.6), 28 pathogens in PC in platelet additive solution (PC-PAS; ≥4.1-≥7.8), and 14 pathogens in PC in 100% plasma (PC-100%; (≥4.3->8.4). Twenty-five enveloped viruses and two NEVs were sensitive to amotosalen/UV-PRT; LRF ranged from >2.9 to ≥7.6 in plasma, 2.4 or greater to greater than 6.9 in PC-PAS and >3.5 to >6.5 in PC-100%. Infectious titers for four parasites were reduced by >4.0 log in all PC and plasma (≥4.9 to >8.4). Conclusion Amotosalen/UVA-PRT demonstrated effective infectious titer reduction for a broad spectrum of viruses and parasites. This confirms the capacity of this system to reduce the risk of viral and parasitic transfusion-transmitted infections by plasma and PCs in various geographies.

Background and Objectives Transfusion-associated graft-versus-host disease (TA-GVHD) is a serious complication of blood component transfusion therapy, caused by donor T lymphocytes. γ-Irradiation or pathogen inactivation methods, capable of inactivating proliferating T cells in blood components, should be selected to prevent TA-GVHD. This review summarizes the published evidence to support the use of pathogen-reduced platelets with amotosalen (150 μm) and ultraviolet A light (UVA, 320–400 nm, 3 J/cm2) for preventing TA-GVHD. Materials and Methods Available literature on the use of pathogen-reduced platelets to prevent TA-GVHD was reviewed. Results Observational studies, animal models, in vitro studies and mechanistic studies of pathogen-reduced platelets with amotosalen and UVA light showed that inactivation of T cells are equal or even superior to γ-irradiation. Conclusion Pathogen-reduced platelets with amotosalen and UVA light can be used as a measure to prevent TA-GVHD.

We demonstrate roll-to-roll fabrication of ultraviolet A light-activated colorimetric oxygen indicators on paper and plastic substrates. Such large-scale, cost-effective and non-toxic oxygen indicator and production method can find applications as a very low-cost leakage indicator for modified atmosphere packages by printing the material directly or gluing the pre-printed indicator label inside the lid. The introduction of leakage indicators onto all modified atmosphere packages could result in improved food safety and reduced food spoilage. Copyright © 2017 John Wiley & Sons, Ltd.

Background Phototherapy is a well-recognized treatment in adults and children. Previous articles have reported success in treating recalcitrant skin disorders such as atopic dermatitis (AD), psoriasis, pityriasis lichenoides chronica, and vitiligo in children. Methods This was a retrospective review over an 18-month period from June 2012 to December 2013 of all children receiving phototherapy in a tertiary pediatric dermatology center. Results Seventy-five patients 3 to 17 years of age (mean 10.6 years; 35 male, 40 female) were included. Forty-eight (64%) patients had AD and 21 (28%) had psoriasis. Seventy received narrowband ultraviolet B (NBUVB) treatment and five received hand and foot psoralen and ultraviolet A (PUVA) treatment. All patients with AD were treated with NBUVB and four (8.3%) were also treated with hand PUVA. After phototherapy, 76% had documented clear to almost clear skin. At the 12-month follow-up, 52% of the patients with AD remained clear. All 21 patients with psoriasis underwent NBUVB phototherapy. The clearance rate after phototherapy was 86%. At the 12-month follow-up, 43% of the patients with psoriasis remained clear. Conclusion Phototherapy can reduce disease burden in individuals with severe AD and psoriasis and should be considered as a second-line therapy if standard topical regimens are unsuccessful.

SummaryBackground Long-term eye radiation with ultraviolet A (UVA) denatures the cells of the cerebral hippocampus. However, the influence on memory and learning ability in mice is not known. Methods HR-1 mice were used. We irradiated the eyes or dorsal skin of the mice with UVA at a dose of 110 kJ/m2 using an FL20SBLB-A lamp for 6, 12, and 24 months. Results The mean escape latency in the water maze was significantly increased in the UVA-irradiated mice in comparison with that seen in the controls. In the mice in which UVA eye irradiation was performed for 24 months, the depression of memory and learning ability was remarkable. The acetylcholinesterase activity, choline acetyltransferase activity, and acetylcholine content in the brain in the UVA eye-irradiated mice were significantly less than those observed in the control mice. Furthermore, during UVA eye irradiation, the levels of β-amyloid (Aβ), γ-secretase, which produces Aβ peptide, and advanced glycation end products increased. Moreover, the effects of UVA eye irradiation increased with the duration of irradiation (or aging), and the introduction of glucose into the brain also decreased with UVA eye irradiation. Conclusions These results indicate that UVA eye irradiation induces a decreased memory and learning ability in mice.

With age, structural and functional changes can be observed in human cornea. Some studies have shown a loss of corneal transparency and an increase in turbidity associated with aging. These changes are caused by modifications in the composition and arrangement of extracellular matrix in the corneal stroma. In human skin, it is well documented that exposure to solar radiation, and mainly to the UVA wavelengths, leads to phenotypes of photoaging characterized by alteration in extracellular matrix of the dermis. Although the cornea is also exposed to solar radiation, the extracellular matrix modifications observed in aging corneas have been mainly attributed to chronological aging and not to solar exposure. To ascertain the real implication of UVA exposure in extracellular matrix changes observed with age in human cornea, we have developed a model of photoaging by chronically exposing corneal stroma keratocytes with a precise UVA irradiation protocol. Using this model, we have analyzed UVA-induced transcriptomic and proteomic changes in corneal stroma. Our results show that cumulative UVA exposure causes changes in extracellular matrix that are found in corneal stromas of aged individuals, suggesting that solar exposure catalyzes corneal aging. Indeed, we observe a downregulation of collagen and proteoglycan gene expression and a reduction in proteoglycan production and secretion in response to cumulative UVA exposure. This study provides the first evidence that chronic ocular exposure to sunlight affects extracellular matrix composition and thus plays a role in corneal changes observed with age.

Summary Localized phototherapy including topical psoralen plus ultraviolet A (PUVA) and targeted ultraviolet B (UVB), and photodynamic therapy (PDT) have been increasingly used in the treatment of localized psoriasis. Yet, there are no systematic reviews or meta-analyses that scientifically evaluated the pooled efficacy of these treatments in psoriasis. We searched Medline, Embase, and Cochrane databases during the period of January 1980 to June 2012. Our systematic search resulted in 765 studies, 23 of them were included in the review. The primary outcome was 75% reduction in severity score from baseline. A meta-analysis using random effect model found topical PUVA to be more effective than non-laser targeted UVB [odds ratio: 3.48 (95% confidence interval 0.56–21.84), P = 0.183]. The pooled effect estimate of the efficacy (75% reduction in severity score) of topical PUVA, targeted UVB, and PDT were as follows: 77% (topical PUVA), 61% (targeted UVB), and 22% (PDT). Topical PUVA and targeted UVB phototherapy are very effective in the treatment of localized psoriasis. Topical PUVA seems more effective than non-laser targeted UVB phototherapy. On the other hand, PDT has low efficacy and high percentage of side effects in treating localized psoriasis.

SummaryBackground Catechol-O-methyltransferase (COMT) activity is increased in patients with mild/moderate psoriasis. Narrowband ultraviolet B (nbUVB) phototherapy decreases COMT activity. However, the effect of psoralen plus ultraviolet A (PUVA) on this enzyme activity is unknown, and it remains to be clarified if the nbUVB-induced effect in COMT activity is related to clinical response. The aim of this study is to evaluate COMT activity in moderate/severe psoriasis and assess whether PUVA therapy modifies this activity. Methods An observational study was conducted on 18 patients with moderate/severe psoriasis and 13 matched controls. Patients were treated with PUVA twice weekly during 6 weeks, and they were evaluated for Psoriasis Area and Severity Index (PASI) and COMT activity before photochemotherapy, at the end of it and 4 weeks after stopping. Results Before PUVA therapy, S(soluble)-COMT activity was significantly (P

Summary Background Previous success rates of psoralen and ultraviolet A (PUVA) and narrowband UVB (NB-UVB) in the treatment of chronic urticaria are reported in few studies with no previous reports on the comparable efficacy of both modalities in the disease. Aim We aimed to compare the efficacy of PUVA versus NB-UVB in the treatment of chronic urticaria. Methods Twenty-four patients with chronic urticaria were included and divided into two groups: 12 patients subjected to PUVA and 12 subjected to NB-UVB. They were compared according to the urticaria Total Severity Score (TSS) before and after treatment, cumulative dose, and side effects. Results There was a statistically significant decrease in urticaria TSS in both the NB-UVB- and PUVA-treated groups after than before treatment (P 0.05). Gastrointestinal upset was reported at a significantly higher percentage in the PUVA-treated group than in the NB-UVB-treated group. Conclusion Both NB-UVB and PUVA show comparable efficacy in the treatment of chronic urticaria with minimal reversible side effects.

BACKGROUND: There were no previous studies about the quality of cryoprecipitate prepared from fresh-frozen plasma (FFP) inactivated with amotosalen and ultraviolet A (UVA) light. The aim of this study was to analyze the quantity and quality of coagulation factors in cryoprecipitate prepared from FFP treated with amotosalen and UVA light. STUDY DESIGN AND METHODS: FFP was obtained from whole blood donations and inactivated with amotosalen and UVA light according to the manufacturer’s instructions. Fibrinogen, factor VIII (FVIII), von Willebrand factor antigen (VWF : Ag) and activity (VWF : RCo), the von Willebrand factor cleavage protease activity (ADAMTS-13), and the multimeric structure of VWF were analyzed. RESULTS: The content of fibrinogen, FVIII, and ADAMTS-13 was lower in cryoprecipitates prepared from amotosalen-treated plasma when compared with cryoprecipitates prepared from nontreated plasma (35, 40, and 18% loss, respectively). The quantity and quality of VWF as well as VWF multimer patterns were not affected by the inactivation method. CONCLUSION: Cryoprecipitates prepared from amotosalen-treated FFP contained significantly reduced levels of fibrinogen, FVIII, and ADAMTS-13. However, the VWF quantity and quality was well preserved.

Background and Objectives There are conflicting data regarding the therapeutic efficacy of platelets inactivated using amotosalen and ultraviolet A light. We have performed a meta-analysis to summarize the results of different randomized controlled trials (RCT). Materials and Methods Five RCTs reported through March 2011 met the criteria for meta-analysis. Weighted mean difference (WMD) in corrected count increment (CCI) at 1 h, CCI-24 h, and transfusion interval (days) and summary odds ratio (OR) of bleeding in inactivated platelet (I-P) group vs. noninactivated platelet (C-P) group were calculated across studies. Results Randomized controlled trials were statistically homogeneous when we analysed CCI-24 h, and the transfusion of C-P was associated with a higher CCI-24 h when compared with the transfusion of I-P (WMD, 3 × 103; 95% CI, 2·32 × 103–3·69 × 103; P

Background Several lines of evidences support a major role for Th1 cells in psoriasis. Treatment of psoriasis with cyclosporine, methotrexate and psoralen plus ultraviolet A (PUVA) is associated with clinical improvement and decrease in epidermal hyperplasia. Osteopontin (OPN) exerts a T-helper type 1 (Th1) cytokine function, regulating inflammatory cell accumulation and function. Objective To detect the effects of methotrexate, cyclosporine and PUVA on OPN expression in psoriatic plaques, and whether these changes correlate with clinical response. Methods For three groups of psoriatic patients (each including 12 patients), the Psoriasis Area Severity Index (PASI) and levels of lesional skin OPN were determined using enzyme-linked immunosorbent assays before and after treatment with methotrexate, cyclosporine or PUVA. Skin biopsies from 20 healthy volunteers served as control for OPN levels in normal skin. Results Baseline lesional skin of psoriatic patients showed a statistically significant elevation of OPN levels in comparison to controls. Three months after therapy, the three therapeutic modalities were associated with a significant decrease in the mean levels of PASI and tissue OPN, with the PUVA group showing the highest level of reduction in OPN levels and cyclosporine group showing the highest level of reduction in PASI. Conclusion Our study points to the possible role played by OPN in the pathogenesis of psoriasis and in reflecting disease severity. These standard therapeutic modalities used in the current study were associated with a significant decrease in PASI and OPN levels. They constitute highly effective therapeutic modalities for psoriasis, which might exert their anti-psoriatic activity partially through altering the expression of OPN.

The anticancer and immunosuppressant thiopurines cause 6-thioguanine (6-TG) to accumulate in nuclear DNA. We report that 6-TG is also readily incorporated into mitochondrial DNA (mtDNA) where it is rapidly oxidized. The oxidized forms of mtDNA 6-TG inhibit replication by DNA Pol-γ. Accumulation of oxidized 6-TG is associated with reduced mtDNA transcription, a decline in mitochondrial protein levels, and loss of mitochondrial function. Ultraviolet A radiation (UVA) also oxidizes mtDNA 6-TG. Cells without mtDNA are less sensitive to killing by a combination of 6-TG and UVA than their mtDNA-containing counterparts, indicating that photochemical mtDNA 6-TG oxidation contributes to 6-TG-mediated UVA photosensitization.

Background/purpose: To study the characteristics of chronic actinic dermatitis (CAD) in a heterogeneous group of Singaporean patients. Methods: The photobiologicial features of all patients phototested and diagnosed with CAD from January 2005 to December 2009 were examined retrospectively. Results: Fifty-eight patients were diagnosed as having CAD. The mean age at diagnosis was 62 years (range 35–83). Forty-one were (70.7%) Chinese, six (10.3%) Indians, eight (13.8%) Malays, and three (5.2%) Others. Forty-seven were (81.0%) male and 11 (19.0%) were female. Forty-nine (84.5%) had Fitzpatrick skin phototype IV and nine (15.5%) had phototype V. Three of 26 (11.5%) tested for human immunodeficiency virus were positive. The face, neck, and forearms were most commonly affected. Thirty-two patients (55.2%) had reduced minimal erythema dose (MED) to both ultraviolet B (UVB)and ultraviolet A (UVA), 23 patients (39.7%) had lowered MED to UVB only, while three (5.1%) had reduced MED to UVA only. Patients were followed up for a mean of 16.8 months. All were treated with photoprotection and topical steroids; however, a few required oral immunosuppression with partial improvement. Conclusion: In Singapore, CAD was seen more commonly in elderly Chinese males of Fitzpatrick skin phototype IV. Reduced MED to both UVB and UVA was the most common phototest finding.

Background: The efficacy of a phototoxic dose of ultraviolet A (UVA) after topical application of 8-methoxypsoralen (8-MOP) in the treatment of alopecia areata (AA) was evaluated previously in only one study. However, the possibility of spontaneous regrowth of hair cannot be excluded as sessions were carried out every 3 months. Objective: To determine the efficacy of a phototoxic dose of UVA after topical application of 8-MOP in the treatment of AA resistant to other lines of treatment. Subjects/Methods: Thirty-five patients with AA were treated by topical 8-MOP application to the lesions followed by UVA irradiation using a phototoxic dose every 3 months for a maximum of four sessions. Severity grading of AA was carried out using the Severity of Alopecia Tool (SALT) score before and after treatment. Results: Fifty-seven percent of patients showed a positive treatment response (40% showed complete and 17% showed partial response) with significant improvement of SALT score. The mean cumulative UVA dose was 22±8.3 J/cm2. Mild reversible side effects were observed in 63% of patients after the first session. Conclusion: Phototoxic psoralen and ultraviolet A therapy after topical application of 0.1% 8-MOP is an effective treatment option for resistant AA, with low total cumulative UVA dose, few treatment sessions, and minimal reversible side effects.

BACKGROUND: Amotosalen plus ultraviolet A (UVA) light inactivates a broad range of bacteria, viruses, protozoa, and leukocytes in platelet (PLT) and plasma components. Upon UVA illumination a small fraction of amotosalen reacts with the nucleic acid of contaminating pathogens and residual white blood cells and the remaining fraction undergoes photodegradation into defined photoproducts. The levels of amotosalen and photoproducts can be accurately quantified. STUDY DESIGN AND METHODS: This study evaluated the relationship between the extent of photodegradation of amotosalen and the level of pathogen inactivation in PLT components. PLT components containing of 3.78 × 1011 to 7.23 × 1011 PLTs in 300 to 450 mL of 35% to 50% plasma and 50% to 65% PLT additive solution and up to 5 × 106 red blood cells (RBCs)/mL were prepared. Each component was contaminated with 105 to 106 colony-forming units/mL Klebsiella pneumoniae and treated with 115 to 200 µmol/L amotosalen and 0 to 3 J/cm2 UVA light. For each treatment condition, the level of K. pneumoniae inactivation (log-reduction) was measured by microbiologic methods. The initial and postillumination amotosalen concentrations (µmol/L) were determined by high-performance liquid chromatography. RESULTS: For a defined set of treatment conditions, the extent of amotosalen photodegradation was consistent and reproducible. The bacterial log-reduction correlated linearly with the extent of amotosalen photodegradation with a regression correlation coefficient (r2) between 0.845 and 0.890 regardless of the treatment variables such as PLT content, component volume, plasma content, RBC content, initial amotosalen concentration, and UVA dose. CONCLUSION: This study demonstrated that the extent of amotosalen photodegradation can serve as an intrinsic actinometer which directly correlated with the level of pathogen inactivation.

Background: Orange-red fluorescence in the follicle openings, induced by ultraviolet A light, originates from porphyrins, the metabolic products of Propionibacteria acnes. Purpose: To investigate the relationship of orange-red follicular fluorescence with the severity of acne and the amount of sebum secretion. Methods: Twenty-five volunteers were included. The severity of acne was rated on a 4-point scale. The casual sebum level was measured using a Sebumeter and the follicular fluorescence was determined using the camera Visiopor. Results: Casual sebum level and the intensity of fluorescence (percentage of the area and number of orange-red spots) were higher at the T zone than at the U zone in all patients regardless of their skin type. Sebum amount and area of fluorescence spots were significantly negative in correlation with the clinical grade of acne. There was a significant positive correlation between the orange-red fluorescence and the casual sebum level. Conclusion: The orange-red fluorescence showed stronger correlation with the presence of non-inflammatory acne lesions (comedones) and high sebum amount than the presence of inflammatory acne lesions (pustules) and low sebum amount. The fluorescence diagnostic imaging could be useful in the objective evaluation and monitoring of treatment efficacy in subjects with acne-prone skin and patients with acne.

Scleredema is an uncommon condition characterized by induration of skin. The pathogenesis is not known, although the increased expression of collagen-producing fibroblasts in the skin has been demonstrated. Scleredema has been difficult to treat with scattered reports of success with bath psoralen plus ultraviolet A (PUVA), cream PUVA, UVA1 and others. The use of low-dose broad-band UVA phototherapy was found to be effective in the treatment of morphea. Colchicine has been shown to interfere with collagen synthesis and is used successfully in scleroderma. We report the first case of scleredema that improved markedly with low-dose broad-band UVA plus colchicine treatment.

Background/purpose: Assessing the ultraviolet (UVA) protection factor of sunscreen formulations has been discussed for the past 20 years. The purpose of this study is to correlate the measurements of the UVA protection factor value (PFA value) via in vivo diffuse reflectance spectroscopy (DRS) and to compare this method with the in vitro method of measuring the PFA value, as well as with the in vivo persistent pigment darkening (PPD) and PFA methodologies. Methods: The UVA protection factor via DRS technique was assessed in two clinical studies. The first study was performed in 12 subjects and the second one consisting of 10 subjects. All subjects in these studies had Fitzpatrick skin phototypes II–IV. DRS measurements were performed using a SkinScan spectrofluorimeter (Spex SkinScan, Yvon Horiba). The in vitro PFA measurements were performed using Labsphere™ UV-1000s UV Transmission Analyzer. Results: The results obtained from the non-invasive DRS studies were used to correlate with the in vitro testing and with the in vivo PFA/PPD multicenter study. A positive relationship (regression coefficient r2=0.90) of PFA values was found between in vitro PFA testing and the in vivo DRS testing. There was also a very good correlation (regression coefficient r2=0.99) between the in vivo PFA/PPD values and UVA protection factor obtained from the DRS method. Conclusion: This paper presents studies using the DRS technique to assess the UVA protection factor in different sunscreen formulae correlating with in vitro and in vivo PFA/PPD values. It is a fast method, non-invasive and does not involve any subject irradiation. The technique is a good estimator for the in vivo UVA protection factor as well as a way to assess, in vivo, the photostability of sunscreen formulation in the UVA.

Background: A combination of oral psoralen with narrowband ultraviolet B (UVB), defined as ‘psoralen-narrowband UVB’, was shown to have a superior efficacy than UVB alone and even a comparable efficacy to psoralen and ultraviolet A in psoriasis. Objective: To find out whether topical psoralen-narrowband UVB provides any additional benefit to narrowband UVB alone in psoriasis. Methods: Nineteen patients with plaque psoriasis were included. Phototherapy was given three times per week. Two symmetrical lesions were selected as target lesions. In the first 12 sessions of phototherapy, the target lesion on one side was treated with 1% 8-methoxypsoralen (MOP) gel 30 min before UVB radiation whereas the target lesion on the other side served as a control. Target lesion scores were assessed at baseline, third, sixth, ninth and 12th sessions. Side effects were recorded. Results: Sixteen patients completed the study. Target lesion scores decreased significantly on both sides (P

Hairless (HRA/Skh) mice were administered one of four dietary concentrations (50, 100, 625 or 1250 ppm) of 8-methoxypsoralen (8-MOP) or 5-methoxypsoralen (5-MOP), or molar equivalent concentrations of 5-methylisopsoralen (5-MIP) or 3-carbe-thoxypsoralen (3-CPS) by ‘pulse feeding’ technique, 3 days per week for 13 weeks, for the final 11 weeks psoralen derivative administration was followed by exposure to 0.2 or 48 J/cm2 of unfiltered ultraviolet-A (UVA) radient energy from FR74T12PUVA lamps. At 0 and 13 weeks eyes were dilated with 0.2% atropine solution and were examined using a binocular indirect ophthalmoscope with a +20.0 D condensing lens. The lids, cornea, anterior chamber and the lens were evaluated for pathological changes. Ocular damage consisting of dense central corneal opacification was seen at significant levels in animals given 8-MOP or 5-MOP and exposed to UVA. In addition, opacities in the area of the posterior lens were seen in all experimental groups and appeared to be related to drug treatment, independent of light exposure, and therefore appeared not to be related to drug-light interaction. Some corneal and lenticular opacifiction was seen at non-significant levels in all experimental and control groups.

Palmoplantar psoriasis is an idiopathic disabling condition, often resistant to conventional therapies. The purpose of this study was to evaluate the efficacy and safety of local narrowband ultraviolet B (NB-UVB) phototherapy and to compare it with local psoralen plus ultraviolet A (PUVA) paint in patients with palmoplantar psoriasis unresponsive to conventional therapies other than phototherapy. A cohort of 25 patients with palmoplantar psoriasis were included in this study, which was based on a left-to-right comparison pattern. The treatments were administered with local narrowband UVB irradiation on one side and local PUVA on the other side three times a week over 9 weeks. Clinical assessments were performed at baseline and every 3 weeks during the 9-week treatment. There was a statistically significant decrease in the mean clinical scores at the third, sixth and ninth week with both treatments. The difference in clinical response between the two treatment modalities was statistically significant at the end of the treatment period, with the percentage reduction in severity index scores with the PUVA-paint-treated side being 85.45% compared with 61.08% for the NB-UVB treated side (t = 5.379, P = 0.0001, Student's t-test for unpaired samples). Our results show that, although some clinical improvement was achieved with local NB-UVB phototherapy, the results were better with local PUVA, and such a treatment option may be reserved for patients with palmoplantar psoriasis who experience phototoxic reaction to psoralens.

Although antitumor necrosis factor (anti-TNF)-alpha therapy provides beneficial effects on various chronic inflammatory skin diseases including psoriasis, cutaneous side-effects have also been reported. We describe four patients who showed psoriasiform eruption following anti-TNF-alpha therapy (infliximab) for Crohn's disease. In all patients, Crohn's disease had responded well to infliximab. Three patients developed plaque-type psoriasiform eruption on the trunk and four extremities, while one patient showed pustular eruption on the palms and soles accompanied with plaque-type psoriasis. In all these patients, skin lesions subsided with topical application of corticosteroid ointment or psoralen plus ultraviolet A treatment.

TiO2 has been tested to be toxic to DNA under the photo-irradiation of ultraviolet A (UVA). However, in the dark conditions, after several days of treatment with TiO2 in aqueous solution, the interaction between TiO2 and two types of DNA was detected and the mechanisms were studied by the methods of gel-electrophoresis, IR spectroscopy and TEM. The results showed that the DNA would be bound to TiO2; the ratio of binding was related to the concentration and the treating time; the mechanism of binding is related to phosphate groups of DNA. Besides, DNA with different structure showed different degree of binding. These findings showed a new possible way through which the TiO2 nanoparticles interact with DNA.

Background A photochemical treatment (PCT) system has been developed to inactivate a broad spectrum of pathogens and white blood cells in platelet (PLT) products. The system comprises PLT additive solution (PAS III), amotosalen HCl, a compound adsorption device (CAD), a microprocessor-controlled ultraviolet A light source, and a commercially assembled system of interconnected plastic containers. Study design and methods A clinical prototype of the PCT system was used in a large, randomized, controlled, double-blind, Phase III clinical trial (SPRINT) that compared the efficacy and safety of PCT apheresis PLTs to untreated apheresis PLTs. The ability of multiple users was assessed in a blood center setting to perform the PCT and meet target process specifications. Results Each parameter was evaluated for 2237 to 2855 PCT PLT products. PCT requirements with respect to mean PLT dose, volume, and plasma content were met. Transfused PCT PLT products contained a mean of 3.6 x 10(11) +/- 0.7 x 10(11) PLTs. The clinical process, which included trial-specific samples, resulted in a mean PLT loss of 0.8 x 10(11) +/- 0.6 x 10(11) PLTs per product. CAD treatment effectively reduced the amotosalen concentration from a mean of 31.9 +/- 5.3 micromol per L after illumination to a mean of 0.41 +/- 0.56 micromol per L after CAD. In general, there was little variation between sites for any parameter. Conclusions The PCT process was successfully implemented by 12 blood centers in the United States to produce PCT PLTs used in a prospective, randomized trial where therapeutic efficacy of PCT PLTs was demonstrated. Process control was achieved under blood bank operating conditions.

BACKGROUND: The SPRINT trial examined efficacy and safety of photochemically treated (PCT) platelets (PLTs). PCT PLTs were equivalent to untreated (control) PLTs for prevention of bleeding. Transfused PLT dose and corrected count increments (CIs), however, were lower and transfusion intervals were shorter for PCT PLTs, resulting in more PCT than control transfusions. PLT dose was analyzed to determine the impact of the number of PLTs transfused on transfusion requirements. STUDY DESIGN AND METHODS: Transfusion response was compared for patients with all doses of ≥3.0 × 1011 and the complementary subset of patients with any dose of fewer than 3.0 × 1011. Analyses included comparison of bleeding, number of PLT and red blood cell (RBC) transfusions, transfusion intervals, and CIs between PCT and control groups within each PLT dose subset. RESULTS: Mean PLT dose per transfusion in the PCT group was lower than in the control group (3.7 × 1011 vs. 4.0 × 1011; p

Background The use of an adequate initial dose of ultraviolet A (UVA) radiation for photochemotherapy is important to prevent burns secondary to overdosage, meanwhile avoiding a reduced clinical improvement and long-term risks secondary to underdosage. The ideal initial dose of UVA can be achieved based on the phototype and the minimal phototoxic dose (MPD). The objective measurement of constitutive skin color (colorimetry) is another method commonly used to quantify the erythematous skin reaction to ultraviolet radiation exposure. The aim of this study was to determine variations in MPD and constitutional skin color (coordinate L(*)) within different phototypes in order to establish the best initial dose of UVA radiation for photochemotherapy patients. Methods Thirty-six patients with dermatological conditions and 13 healthy volunteers were divided into five groups according to phototype. Constitutional skin color of the infra-axillary area was assessed by colorimetry. The infra-axillary area was subsequently divided into twelve 1.5 cm(2) regions to determine the MPD; readings were performed 72 h after oral administration of 8-methoxypsoralen (MOP) followed by exposure of the demarcated regions to increasing doses of UVA. Results The majority of the participants were women (73.5%) and their mean age was 38.8 years. The MPD ranged from 4 to 12 J/cm(2) in phototypes II and III; from 10 to 18 J/cm(2) in type IV; from 12 to 24 J/cm(2) in type V and from 18 to 32 J/cm(2) in type VI. The analysis of colorimetric values (L(*) coordinate) and MPD values allowed the definition of three distinctive groups of individuals composed by phototypes II and III (group 1), types IV and V (group 2), and phototype VI (group 3). Conclusions MPD and L(*) coordinate showed variation within the same phototype and superposition between adjacent phototypes. The values of the L(*) coordinate and the MPD lead to the definition of three distinct sensitivity groups: phototypes II and III, IV and V and type VI. Also, the MPD values bear a strong correlation to coordinate L(*) values. Mean MPD values described for each of the three major sensitivity groups were higher than the values commonly used in clinical settings for the different phototypes. Therefore, phototype alone is not a good parameter to define the initial UVA dose. MPD and colorimetry could be used in pre-treatment evaluation of patients who are to be submitted to photochemotherapy, in a non-invasive and more accurate way when compared with the classical phenotype clinical criteria.

Fixed drug eruption is a common cutaneous adverse reaction in young patients with a characteristic clinical appearance. However, the diagnosis and identification of the substance may be difficult if food or food additives provoke the fixed eruption. A 26-year-old man had a history of two episodes of cutaneous erythema with residual pigmentation. Close examination of the history including his diet in addition to an oral challenge test and patch testing led to the diagnosis of fixed eruption secondary to quinine in tonic water. We examined for the presence of quinine in commercially available brands of tonic water using ultraviolet A and irradiation and high-performance liquid chromatography. Both Schweppes and CANADA DRY brands of tonic water emitted fluorescent light upon ultraviolet A irradiation, and contained quinine at concentrations of 67.9 and 61.3 mg/L, respectively. Quinine contained in some tonic waters may trigger fixed eruption.

BACKGROUND: A photochemical treatment (PCT) method to inactivate pathogens in platelet concentrates has been developed. The system uses a psoralen, amotosalen HCl, coupled with ultraviolet A (UVA) illumination. STUDY DESIGN AND METHODS: Three sequential clinical trials evaluated viability of PCT platelets prepared with a prototype device. Posttransfusion recovery and lifespan of 111Indium-labeled autologous 5 day-old platelets in healthy subjects was assessed. In the first study, 23 subjects received transfusions of autologous PCT and/or control platelets. In a second study, 16 of these subjects received PCT platelets processed with a Compound Adsorption Device (CAD) (PCT-CAD) to reduce patient exposure to residual amotosalen. In the third study, the effect of gamma-irradiation on PCT platelets was studied. Data from control transfusions from Study A were used for paired comparisons in the latter 2 studies. RESULTS: Mean PCT-CAD platelet recovery for the 16 subjects with paired data was 42.5 ± 8.7% versus 50.3 ± 7.7% for control platelets, mean difference of 7.8% (p

Erythrophores derived from Nile tilapia (Oreochromis niloticus) are sensitive to visible light of defined wavelengths in primary culture in the same manner as erythrophores in the skin. Cultured erythrophores aggregate their pigment in response to light with peak wavelengths near 400 or 600 nm, while dispersion is caused by light near 500 nm. In this study, we report that ultraviolet A (UVA) with a peak wavelength near 365 nm also induces pigment aggregation in erythrophores in the skin and in primary culture. The responses of erythrophores in the skin or in culture depend on the light intensity, although the photo-sensitivity differs among individual cells. From the results, we conclude that the action of visible light and UVA light on tilapia erythrophores is direct, and that multiple types of visual pigments may coexist in individual erythrophores.

Synopsis 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. Resume Les radiations ultraviolettes de la lumiere solaire provoquent sur la peau une serie d'effets indesirables aigus et chroniques comme des brulures, des eruptions photo induites, des reactions d'immunosuppression, de photo vieillissement, voire des manifestations cancereuses. Les filtres solaires sont destines a proteger la peau, mais les procedures des tests standardises ne concernent que leur facultea la proteger de l’erytheme aigu, comme en temoigne le FPS. Le FPS est tres peu correle avec les autres aspects de la protection evoques ci-dessus. C'est en particulier le cas avec les rayons U.V.A qui, moins erythemogenes que les U.V.B, peuvent contribuer a aggraver les effets sur la peau de la lumiere solaire. Toutefois, la tendance croissante a utiliser, dans l'industrie, les valeurs FPS pour soutenir l'argumentaire des produits, necessite le developpement de tests cliniques capables de prendre en compte les autres effets des ultraviolets sur la peau notamment l'immunosuppression et les eruption photoinduites. En particulier, il existe un besoin encore meconnu, celui de tester l'efficacite des filtres solaires contre la lucite polymorphe, une photosensibilite cutanee touchant d'apres les estimations 10 a 20% de la population de l'hemisphere nord. Puisqu'en fin de compte la protection de la peau par les filtres solaires ne peut etre obtenue que par une application adequate a la surface de la peau d'un produit dans le cadre journalier autorise, l'optimisation des formulations solaires et l’education des consommateurs dans l'emploi et l'application des produits seront deux contributions essentielles a la protection solaire. Cet article fait le point sur le besoin d’etendre les tests cliniques, en particulier dans le domaine des desordres cutanes provoques par la photosensibilite solaire, ainsi que sur l'amelioration des formulations et l'adequation de leur application sur la peau.

Many parrots have plumage that either reflects strongly in the ultraviolet-A (UVA) waveband, between 315-400 nm, or exhibits UVA-induced fluorescence. Previous experimental work on budgerigars (Melopsittacus undulatus) suggests that UVA reflectance plays a role in mate choice, as in other diurnal birds, but evidence for fluorescent cues playing a role is unconvincing. Here we report two experiments on budgerigars, designed to determine whether fluorescent cues play a role in signalling when UVA reflectances are absent, an approach which separates removal of UVA reflectance from removal of fluorescence. First, we determined whether the choices of different females are correlated under these treatment conditions. Secondly, we investigated female preferences for fluorescing and non-fluorescing males when UVA reflections are absent, to determine whether the yellow emissions of fluorescence are playing a role in mate choice. Results from experiment 1 do not suggest that females agree on which males are attractive when UVA reflectances are absent, with only half of the subjects choosing the same male. Neither did different females make the same choices in experiment 2. This lack of agreement provides further evidence that UVA reflectances from males play an important role in female choice in this species. Experiment 2 provides no evidence to suggest that UVA-induced fluorescence plays a role in mate choice. Overall, our study supports previous findings showing that UVA reflectance plays a role in sexual signalling in this species, but provides no evidence to suggest the same for fluorescence when UVA reflectances are absent.

Background: Visual perception has hindered the development of blinded, placebo-controlled ultraviolet light exposure conditions in humans. New acrylic thermoplastics that block or transmit ultraviolet light have visual properties that may provide a solution. Methods: In a series of triangle taste tests, 60 subjects were tested for the ability to visually perceive ultraviolet light transmission by two of four types of acrylic thermoplastics. Results: Forty-six of sixty (67%) subjects were unable to visually detect ultraviolet light transmitting acrylics among ultraviolet blocking acrylics in both an ambient light background condition and an ambient light background condition with ultraviolet A light supplementation. Conclusion: Acrylic thermoplastics allow for the production of blinded, placebo-controlled ultraviolet light exposure conditions by eliminating visual discrimination differences between active and control groups.