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Objective: aim of this study was been the evaluation of daily and monthly changes of solar short ultraviolet (UVB) in a central Mediterranean area (Naples city, 40.8623° North) from 1997-2002. Materials and methods: the measurements were automatically collected and expressed as physical units (mW/cm2) and biological units (Minimal Erythema Dose/hour = MED/h). The irradiance unit may be converted to UV Index (UVI) by the conversion factor: 1 [MED/h] = 2.3 on the UVI scale. These values were processed with a special software Solar Light IDL 2.0 that informed us about current UV dose, accumulated UV dose, current UVI, peak UVI, time until sunburn, expressed in mins. Moreover, we studied these parameters by means of a statistical data analyser software called SPSS version 10.0 to obtain information about average values in this last 5 years of measurements. Results: the results showed that: i) the sporadic peaks of maximal irradiance occurred in June; ii) the maximal value of the monthly mean irradiance was observed in June-July, while the minimal one in December-January; iii) the amount of solar UVB that reaches the ground and therefore our skin during the last 5 years has been unmodified. About 20-30% of total daily UVB is received during the interval of time between 60 mins both before and after midday in summer, with 75% between 9 am and 3 pm. In Naples during the summer, half an hour of midday sun exposure of the unacclimatized skin of Caucasian subjects is normally sufficient to result in a subsequent mild reddening of the skin. We report that in Naples the average UVB sunstroke is equal to about 2 MED/day in winter; 7 MED/day in spring and in autumn, 12 MED/day in summer. According to Diffey algorithm, in Naples annual MED is about 2600, and these values have been confirmed by our measurements (2676 MED in 1998, 2591 MED in 1999, 2724 MED in 2000, 2612 in 2001, 2634 in 2002). Conclusions: our results show that erythema could appear, in individuals with skin type II and III living in a touristic Mediterranean area, after about 30 mins of sun exposure, in July; ii) the sunburn risk is higher just during the months when skin hasn't yet acquired the natural defences to respond to the peak of UVB. This monitoring may give more information about photodermatitis, photocarcinogenesis and some preventative devices of exposure to sun rays.

The urocanic acid (UCA) undergoes trans-cis isomerization after exposure to UV light. In this study we estimated in vitro the sunscreen's ability to absorb UV-light. The sunscreens were put in touch with the UCA-standard-solutions into an apparatus built for this specific problem. The apparatus was irradiated using a UVB lightsource Philips TL12 (6 tubes 40 W). Afterwords we tested the amount of cis-UCA formed from trans-UCA. The results were compared with those obtained without sunscreen's application. In this experience we demonstrated a strict inverse correlation between sunscreens's Protection Factor and amount of cis-UCA. This method is useful for an initial screening of the sunscreen's ability to shade the UVB-light. But tests 'in vivo' are necessary to estimate the real photoprotective sunscreen's ability to protect the skin from UVB.

Ubidecarenone (coenzyme Q) is a lipidsoluble quinone with anti-oxidative properties, which exerts a scavenger effect on oxygen free radicals. The effectiveness of ubidecarenone in modifying cutaneous reaction to light was evaluated in 7 patients with solar urticaria and 8 with polymorphic light eruption. The diagnosis was made for each patient by inducing lesions through phototests. Ubidecarenone was administered per os at a daily dose of 100 mg for 2 months. At the end of the treatment the phototests indicated the absence or reduction of skin photosensitivity in the majority of patients. These results suggest that ubidecarenone may be useful for the treatment of idiopathic photodermatitis.

Ultraviolet B and psoralen plus UVA treatment induce antigenic and enzymatic changes in Langerhans cells (LC). The aim of this study was to investigate the visible (VIS) effect on mice LC surface markers. As visible source, a slide projector equipped with a 150-W tungsten lamp, emitting between 400 and 740 nm (maximum at 580 nm) was used. Mice (BALB/c and C3H) were divided into groups, each irradiated with visible single fixed doses (ranging from 10 to 1000 J/cm2). The mice backs were shaved before irradiation. Skin biopsies obtained immediately after irradiation were processed for immunofluorescence and electron microscopy. Immunofluorescent studies showed: 1) a complete depletion of LC membrane markers at a dose of 700 J/cm2; 2) no effect at visible doses ranging between 0 and 75 J/cm2; 3) a dose-dependent effect with doses between 100 and 700 J/cm2. Electron microscopy revealed no cellular damage of LC at the visible doses administered.

The aim of this study was to verify the effectiveness of topical khellin applications followed by UVA exposures for treatment of vitiligo. Nine patients, with symmetric depignented patches, applied 5% khellin cream on one side of the body and only the vehicle on the other side before each irradiative session. Another group of 14 patients with asymmetric localization of the patches, received only the vehicle before each irradiation. As ultraviolet-A source, a bank of six Philips TL09/40 W was employed. The patients underwent the irradiative session every two days for 9 months; the mean total dose able to induce an initial follicular repigmentation was, on an average, 550 J/cm2 (range 100-950 J/cm 2), equal to three months of therapy (range 1-5 months). These results show that, at least with the drug concentration and the vehicle used, there is no difference among areas treated with khellin and the control ones, and that the repigmentation observed is only due to UVA exposure.

Literature reports that patients affected by X-linked ichthyosis (XLI) have a reduction of sweat glands and a decrease of sweat production. The sweat physiology of 28 patients, 14 with XLI, 7 with lamellar ichthyosis, 7 with dominant ichthyosis and 28 control subjects were examined with sweat test, performed by pilocarpine iontophoresis. In the same patients we have performed skin biopsy to evaluate quantitative and qualitative reduction of sweat glands.

The minimal erythema dose (MED) and minimal phototoxic dose (MPD) have been evaluated in 20 patients undergoing photochemotherapy or phototherapy. MPD and MED have been performed both at 30 and at 60 cm from the lamp in order to determine variations depending on the exposure time. Results have shown that MED values obtained at 60 cm from the lamp were higher than at 30 cm with a medium average of 60 mJ/cm2. Moreover, the MPD values at 60 cm were higher than at 30 cm with a medium average of 2 J/cm2.

A great number of dermatological patients, in particular during summer time, need photo-protection measures. Nevertheless there are no scientific data on the filtrating capacity of summer clothes. In this study the transmittion of visible light and ultraviolet radiation, UVB and UVA light, has been measured through various samples of common summer clothing fabrics. The results show that type and structure (warf and woof) of tissues are more important than colour in determining the protective nature of the material.

The effectiveness of a sunscreen containing methoxy cynnamate and dibenzoylmethane has been evaluated in 12 healthy volunteers. For each subject, two symmetric areas of bottoms (one of them previously receiving the sunscreen) have been irradiated with a bank of three 400 W metal halide lamps, emitting in the UVB range (max at 300 nm), in order to detect the Minimal Erythema Dose (MED). The MED values have been determined by a color analyzer. The results have shown that, at least in the UVB range, the MED values of the sunscreen-protected skin areas were 3-8 fold higher than that of the unprotected areas.

Two patients suffering from lichen amyloidosus on all four limbs were treated with 0.05% topical tretinoin. Itching was relieved within 2-4 weeks; cutaneous lesions were completely cleared within 8-10 weeks. As maintenance therapy the application of drug three times a week was sufficient. The possible mechanism of action of the drug is discussed.

Photochemotherapy of vitiligo is an extremely common treatment. A major problem in the use of psoralens in photochemotherapy is the hazard of mutagenicity and cutaneous phototoxicity. For that reason we have used an other photosensitizing: khellin. We have treated for 6 months two groups of patients either with topycal application or via sistemic administration of khellin and subsequent exposure to solar radiation. 50-60% of all patients have partially repigmented. No side effects have been observed. Results obtained in both groups of patients are discussed.

In six healthy volunteers the 8-methoxypsoralen (8-MOP) plasma levels have been determined by high resolution liquid chromatography (HPLC) respectively 15, 30, 60, 90, 120, 150 and 180 minutes after the oral intake of an oral formulation of the drug (0.6 mg/kg b.w.). In order to evaluate the cutaneous photosensitivity, each subject has been exposed to UVA (wavelength 320-400-nm) at 15, 30, 60, 120, 150 minutes intervals from the 8-MOP intake. During each UVA exposure eight areas (1 cm in diameter) received 1, 2, 3, 4, 5, 6, 7 and 8 J/cm2. The results show that the lowest MPD is achieved from 30 and 60 minutes after the highest plasma level of the 8-MOP.

A controlled trial of topical photochemotherapy of plaque-type psoriasis using hematoporphyrin derivative (HPD) in combination with red light (590-700 nm) was performed on 8 patients. For each patient HPD (1%) in N-methylpyrrolidone was applied on one psoriatic patch, only the vehicle being applied on the control one. Both patches were daily irradiated with incoherent red light (60 J/cm2/day) for a week. Comparative evaluation of clinical and histologic results are discussed.

Basal cell nevus syndrome (BCNS), also known as Gorlin-Goltz syndrome, is a rare autosomal dominantly inherited disorder characterized by the development of basal cell carcinomas (BCCs) from a young age, multiple keratocysts, palmar and/or plantar pits, calcification of falx cerebri, and family aggregations. Other criteria are skeletal anomalies, frontal bossing, cardiac and ovarian fibromas, medulloblastoma, glaucoma, and cleft lip/palate. The disorder is caused by an alteration of the sonic hedgehog signaling pathway, which results in constitutive activity and tumor cell proliferation. Some germline pathogenic variants of these genes, including PTCH1 and SUFU, have been found and are responsible for clinical heterogeneity. Only 2 case reports have described the occurrence of melanoma in patients with BCNS, but neither reported the occurrence of collision lesions [1,2]. Here we present clinical, dermoscopic, and histological features of a collision tumor of BCC and in situ melanoma in a patient with multiple BCCs and BCNS.

Pigmentary traits such as red hair, fair skin and the lack of tanning ability are generally recognized as risk factors for melanoma and other skin cancers. However different response to UV exposure are observed among individuals exhibiting similar phenotypes. The association between loss of function mutations at the melanocortin-1 receptor (MC1R) and high risk red hair phenotypes has now been firmly established but a relationship of such genetic traits and the type and amounts of cutaneous melanins have not so far been extensively investigated, nor has the presence of pheomelanins, the typical red hair pigments, been assessed in those individuals bearing the most common allelic variants. We reported that pheomelanic tissues may be identified by analysis of two highly specific structural markers namely 1,3-thiazole-2,4,5-tricarboxylic acid (TTCA) and 6-(2-amino-2-carboxyethyl)-2-carboxy-4-hydroxybenzothiazole (BTCA) obtained by chemical degradation of the pigments. Most of the red human hair examined showing different hues afforded TTCA in variable yields, while BTCA was obtained only from a restricted number of samples. BTCA positive individuals exhibited a marked tendency to actinic damage as evidenced by MED values. These preliminary data have now been confirmed on a larger group of red haired individuals. The lowest MED values and 5-days delayed pigmentation was associated with BTCA-positive subjects while TTCA-positive subjects gave statistically significant higher MED values. The potential of pheomelanin markers associated with determination of photobiogical parameters and quantitation of other metabolic markers for predicting individuals at high risk for skin cancer and melanoma in large populations will be discussed.

Background: Our surroundings are full of non-ionizing electromagnetic radiation (EMR) of different frequency and power. The non-ionizing EMRs emitted by television, computer and cellular phone (CF) sets have been increasing over the past few years. Objective: The aim of our study was to assess the effects of non-ionizing EMRs (frequency 3 × 108 to 3 × 1011 Hz), emitted by CFs, on cutaneous blood flow in healthy volunteers. Methods: Thirty healthy volunteers (14 male and 16 female; age: 18–53 years) entered the study. Measurements of cutaneous blood flow were taken under standard conditions (temperature and humidity), using a laser Doppler He-Ne flowmeter that was applied to the ear skin by an optical fibre probe. Microflow values were recorded without CF contact with the skin (T₀), with the CF turned off but in contact with the ear skin (T1), with CF contact and turned on (T2), with CF contact, turned on and receiving (T3). The microflow values were also recorded backwards: with CF contact and set turned on (T4), with CF contact and turned off (T5), without CF contact (T6). Results: The mean value of basal microflow (T₀), expressed as perfusion units (PU), was 51.26 ± 11.93 PU. During the T1 phase, the microflow increase was 61.38%; in T2 it was 131.74%, in T3 157.67%, in T4 139.21% and in T5 122.90%; in T6, the microflow value was 57.58 ± 10 PU (similar to the basal microflow). Statistically significant cutaneous microflow values (p < 0.050) were observed comparing the T1 to T5 values with basal microflow (T₀). Furthermore, in comparison with T1 values (CF turned off in contact with the ear skin), the T2, T3 and T4 data were statistically significant (T2 vs. T1: t = 7.763 with p < 0.050; T3 vs. T1: t = 9.834 with p < 0.050; T4 vs. T1: t = 8.885 with p < 0.050).

Photodynamic therapy (PDT) with 5-aminolaevulinic acid (ALA) is an alternative tool for the treatment of superficial non-melanoma skin cancers. Recently ALA-PDT has been employed with encouraging results also for warts, condylomata and psoriasis. In this study the effects of topical ALA plus irradiation with visible light on intact human skin have been evaluated. Five skin areas (A, B, C, D, and E) on the inner upper part of the arms of five healthy volunteers (skin types III and IV) were treated with (A) ALA 20% in base cream without irradiation, (B) only the vehicle (base cream) without ALA, (C, D and E) ALA cream at the concentrations of 5, 10 and 20%, respectively; all treatments were applied with an occlusive dressing. Four hours after ALA or vehicle application areas B, C, D and E were irradiated with a fixed dose of 40 J/cm 2 . ALA penetration through the intact skin was evaluated by in vivo fluorescence determination. The effects on healthy skin were evaluated by clinical and chromometric examinations, light microscopy, immunohistochemistry and electron microscopy. Results: (1) in vivo fluorescence demonstrated that ALA is able to penetrate through the intact skin, when applied with occlusive dressing and induces a classical fluorescence peak due to Protoporphyrin IX (PpIX) formation, which is the active photosensitiser. (2) Skin areas receiving ALA plus irradiation showed erythema and swelling just after the irradiative session and hyperpigmentation 48–72 h later. (3) Colourimetric data confirmed significant skin colour changes: values a * (representing the erythematous changes) increased only on the skin areas where ALA+irradiation were applied and during the 48 h after irradiation, thereafter a * began to decrease; values L * (pigmentation) increased during the 2 weeks following treatment. (4) Histopathological, immunohistochemical (S100, HMB-45) and electron microscopic findings showed an absolute increment of the number of melanocytes, which appeared clearly activated. In conclusion the application of ALA cream followed by irradiation is able to induce a pigmentation response in healthy human skin, at least in skin types III and IV. This melanocytic activation could have a potential for the treatment of skin disorders characterised by hypopigmentation.

Background: Port-wine stains (PWSs) are characterized by an increased number of ectatic vessels. The treatment of choice is the use of some lasers such as pulsed dye lasers. However, some lesions are nonresponsive to laser treatment. Perhaps the vessels’ depth and diameter and the thickness of the vessel wall are important factors influencing the effectiveness of the laser treatment. Methods: To investigate whether epiluminescence microscopy (ELM) could be useful in determining the effectiveness of laser treatment of PWSs, we studied a group of patients with PWSs using both ELM and histological analysis. Results: A correlation existed between a gray-whitish veil seen by ELM and the vessel depth judged by histology: when the veil was absent, the vessels were always found to be located only in the upper third of the dermis. Conclusion: We think that the gray-whitish veil is a distinctive dermoscopic feature that is able to differentiate between superficial vessels (absence of veil) and deeper vessels (presence of veil).

We investigated possible alterations induced by psoralen and ultraviolet A radiation (PUVA) on platelet function both in vitro and in vivo. In vitro, using conventional aggregometry and adenosine diphosphate (ADP), collagen, ristocetin and arachidonic acid as aggregating agents, platelet aggregation was determined on platelet-rich plasma (PRP) from normal subjects at basal conditions and following the addition of increasing concentrations of 8-methoxypsoralen (8-MOP) with and without exposure to ultraviolet A (UVA) light (5 J/cm2) and compared with UVA light exposure alone. At basal conditions and following exposure to UVA light alone, no changes in the normal platelet aggregation patterns were observed. Exposure to UVA light of PRP containing 8-MOP also demonstrated no abnormality in the platelet aggregation patterns at 8-MOP concentrations of 200 ng/ml. However, abnormal platelet aggregation as a response to ADP and collagen was observed at higher concentrations of 8-MOP, which was augmented upon exposure to UVA light. In vivo, platelet aggregometry was performed on PRP from 4 patients submitted to PUVA treatment at basal conditions, 2.5 h after oral ingestion of 8-MOP (0.6-0.8 mg/kg) and after 4 PUVA sessions. No patient showed modification of the platelet aggregation profile after either 8-MOP ingestion or PUVA treatment. Our study shows that 8-MOP at high concentrations in vitro impairs platelet aggregation by ADP and collagen augmented by UVA light exposure, but PUVA therapy causes no detectable abnormality in platelet function in vivo.

Literature on phototherapy and photochemotherapy of non-psoriatic dermatoses is reviewed and integrated with observations on 152 personal cases. The technique, indications and limitations of the treatment are discussed.

We investigated the effect of treatment with peptide T on severe psoriasis in 5 patients. Within 2 months, peptide T led to complete remission of all lesions in 1 patient and to good improvement in 3 others. In 1 patient, no effect was observed.