Acta Dermato-Venereologica 97-10CompleteContent | Page 16
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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
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Journal Compilation © 2017 Acta Dermato-Venereologica.