Acta Dermato-Venereologica 97-10CompleteContent | Page 16

1196 INVESTIGATIVE REPORT Efficacy of a Daily Protective Moisturizer with High UVB and UVA Photoprotection in Decreasing Ultraviolet Damage: Evaluation by Reflectance Confocal Microscopy Antonio GOMES-NETO 1,2# , Paula AGUILERA 1–3# , Leonor PRIETO 4 , Sophie SEITÉ 5 , Dominique MOYAL 5 , Cristina CARRERA 1–3 , Josep MALVEHY 1–3 and Susana PUIG 1–3 1 Melanoma Unit, Dermatology Department, Hospital Clínic & IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), 2 Centro Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), 3 Departament de Medicina, Universitat de Barcelona, Barcelona, 4 La Roche-Posay Laboratoire Dermatologique, Madrid, Spain, and 5 La Roche-Posay Laboratoire Dermatologique, Asnières, France # These authors contributed equally to this work. Patients with photodermatoses or actinic keratosis be- nefit from very high ultraviolet B-ultraviolet A (UVB- UVA) photoprotection. However, poor compliance is an issue that jeopardizes adequate protection, leading to disease recurrence. This study evaluated the efficacy of a daily protective moisturizer with high UVB and UVA photoprotection applied 8 h before irradiation. A monocentric, open-label, prospective, control pilot study was performed including 10 patients. Patients were irradiated with UVB and UVA before and 8 h af- ter topical application of the product. Reflectance con- focal microscopy (RCM) assessment was performed 24 h later. Clinical assessment showed a statistically significant increase in minimal erythema dose (MED) after application of the product (p  < 0.001). Signs of UV damage according to RCM were not observed on photoprotected skin (p  < 0.05). Skin irradiated 8 h af- ter applying a daily protective moisturizer presented an increase in MED and RCM findings that equal the findings for non-irradiated skin. Key words: photosensitivity disorders; polymorphic light erup- tion; topical; sunscreen agent; confocal microscopy. Accepted Jun 28, 2017; Epub ahead of print Jun 29, 2017 Acta Derm Venereol 2017; 97: 1196–1201. Corr: Susana Puig, Melanoma Unit, Dermatology Department, Hospital Clinic Barcelona, Villarroel 170, ES-08036, Barcelona. Spain. E-mail: su- [email protected]; [email protected] H uman exposure to ultraviolet (UV) radiation from sunlight can have many adverse effects. Ultraviolet B (UVB) radiation (290–320 nm) is mainly responsible for the most severe damage: acute sunburn and long-term damage, including skin cancer. It has a direct effect on cell DNA and proteins (1). Unlike UVB, UVA radiation (320–400 nm) is not directly absorbed by biological targets (2), but can dramatically impair cell and tissue functions. UVA penetrates deeper into the skin than UVB. It particularly affects connective tissue, where it produces detrimental reactive oxygen species (ROS), also known as free radicals. As with UVB, UVA has been implicated in depression of the immune system (3, 4) and in the develop- ment of skin cancer, principally melanoma and squamous doi: 10.2340/00015555-2736 Acta Derm Venereol 2017; 97: 1196–1201 cell carcinoma (5, 6). Photosensitivity reactions, as well as photodermatoses, are mainly induced by UVA (7). Polymorphic light eruption (PLE) is the most common photosensitivity disease: approximately 15–20% of Euro- peans appear to have the condition (8, 9) as do 10–15% of those living in the northern USA (10), although only 5% of Australians (11) have the disease. PLE is characterized clinically by the occurrence within hours to days of ultraviolet radiation (UVR) ex- posure of non-scarring, pruritic, erythematous papules, papulovesicles, vesicles or plaques on sun-exposed skin areas, generally symmetrically, which then resolve com- pletely over several days to a week. It is commonly most severe in the spring or early summer, often diminishing in severity as summer progresses, before disappearing completely during the winter. The minimal erythema dose (MED) is usually normal. The mild disease in many patients is usually controlled by moderation of sun exposure at times of high UV in- tensity, use of protective clothing, and regular application of broad-spectrum sunscreens with high sun protection, particu larly against UVA. The effects of acute and chronic exposure to UV have been studied mainly by histology and immunostaining. However, novel non-invasive imaging techniques, such as RCM and optical coherence tomography (OCT), have recently been used to evaluate UV-exposed skin sites (12, 13). These techniques have the advantages of allowing the detection of morphological changes in the skin in vivo without removing the tissue and of allowing the possibility of repeated investigations of the same skin at different times. As melanin provides strong contrast on RCM, resulting in bright reflectance on RCM images, this technique has been used to evaluate pigmentation after repeated radiation with UVA and UVB in several studies (14, 15). In this regard, an increase in epidermal thickness, and a decrease in dermal reflectivity and vaso- dilatation have been shown in a recent comparative study of OCT and RCM after application of 1 and 3 MED of solar-simulated radiation (14). Acute and chronic effects of UVA exposure have also been shown by RCM, including epidermal hyperplasia This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica.