Relevance of skin phototyping to a Korean population

We have determined skin phototype by a self-reporting questionnaire proposed by Fitzpatrick in 128 Korean medical students. We also measured the minimal erythema dose (MED), minimal melanogenic dose and investigated their relationship to phototype. A questionnaire of skin phototypes revealed that 13.3% of the students are skin phototypes I and II. Based on MEDs, we demonstrated that 14.8% of the students fall into the UV-sensitive group as defined by an MED of less than 40 mJ/cm² which is the upper range of MED of phototypes I and II in a white population. The skin phototypes did not show a positive correlation to MEDs and only 2.3% of students classified as skin phototypes I and II showed an MED below 40mJ/cm². This study indicates that the skin phototyping method proposed by Fitzpatrick does not reliably predict UV-sensitive individuals within the Korean population.     

Baumann Skin Type in the Korean Male Population

BackgroundResearch into the Baumann skin type (BST) has recently expanded, with growing interest in the development of an efficient and effective skin type classification system for better understanding of this skin condition.ObjectiveWe aimed to identify male-specific skin type characteristics with investigation into the distribution of BST by age and region in the Korean male population and to determine the intrinsic and extrinsic factors related to skin type.MethodsA questionnaire was administered to collect information about age, region, working behavior, drinking behavior, smoking behavior, usual habit of sun protection, medical history, and the BST which consisted of four parameters; oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T).ResultsWe surveyed 1,000 Korean males aged between 20 and 60 years who were divided equally by age and region. Of the total respondents, OSNW type accounted for the largest percentage and ORPW type the lowest. In terms of Baumann parameters, O type was 53.5%, S type was 56.1%, N type was 84.4% and W type was 57.5%. Several behavioral factors were found to have various relationships with the skin type.ConclusionThe predominant skin type in the Korean male respondents was OSNW type, and the distribution of skin types with regards to age and region was reported to be distinct. Therefore, skin care should be customized based on detailed skin types considering the various environmental factors.     

Reliability of self-assessment in determining skin phototype for Korean brown skin

The widely used skin phototype system first introduced by Fitzpatrick, which is based on the history of an individual tendency to burn and tan, was studied in 733 Korean men by means of a self-assessment questionnaire. Combining two factors, individual burning and tanning tendency, less than half (43.9%) could be classified according to the skin phototype system. Furthermore, the concordant ratio between subjective skin phototypes assessed by the subjects themselves and classification by combining self-reported burning and tanning tendencies was much lower (34.4%). In a subgroup of 156 subjects, the minimal erythema dose (MED) was determined and compared with the reported tendencies to burn and tan. The results showed that subjects with higher MEDs tended to report more tanning. We concluded that in Korean brown skin, there is a disconcordant relationship between reported burning and tanning tendencies and, though reliable for white skin, self-assessed skin phototypes are unreliable in Korean brown skin.     

Epidemiology of cutaneous malignant melanoma in Reunion Island

IntroductionThe incidence of cutaneous malignant melanoma (CMM) is increasing worldwide. The aim of this study was to evaluate the epidemiology of CMM in Reunion Island, a French overseas department whose population is characterized by high ethnic diversity and high exposure to ultraviolet radiation.MethodsThis cross-sectional study examined all cases of in situ CMM and invasive CMM diagnosed between 1 January and 31 December 2015 in the Reunionese population.ResultsOne hundred and three new cases of CMM were recorded in Reunion Island in 2015: 33 cases of in situ CMM and 70 cases of invasive CMM. The sex ratio of men to women was 1.3 and 80% of patients had a fair skin phototype (Fitzpatrick skin phototype ≤ III). Age-standardized incidence rates of invasive CMM for all skin phototypes combined were 6.7/100,000 person-years (PY) in women and 5.3/100,000 PY in men. Crude incidence rates of invasive CMM for fair skin phototypes were estimated to be over 21/100,000 PY in women and over 25/100,000 PY in men.ConclusionsIn Reunion Island, the incidence of CMM in the population with fair skin phototype is very high. Primary and secondary prevention measures should be reinforced and tailored to the local context.     

Prevalence of dermatological complaints in patients undergoing treatment for breast cancer

Background:Internal malignancies such as breast cancer, as well as their treatment can often result in skin changes.Objective:To assess the prevalence of dermatological complaints in patients who are undergoing oncological treatment for breast cancer in a hospital in Tubarão, Santa Catarina, Brazil.Methods:Observational, cross-sectional study, from October 2015 to February 2016 in which 152 patients with the diagnosis of breast cancer, undergoing treatment with chemotherapy, radiotherapy, hormone therapy and/or surgery, were interviewed and completed a research protocol developed by the author.Results:The treatment of breast cancer was associated with dermatological complaints in 94.1% of the interviewed, being with hair loss the most frequent, present in 79.6% of the sample, followed by nail changes (56%). Patients with lighter skin phototypes (I, II and III) had a lower risk (p=0.045) of developing skin changes when compared to darker phototypes. Radiation therapy (p=0.011) and oncological surgery (pFisher=0.004) were statistically significant when related to skin changes.Study limitations:Inherent to the design of the study, as well as recall bias.Conclusions:It was found that most patients diagnosed with breast cancer showed dermatologic manifestations during the proposed cancer treatment. Patients undergoing radiotherapy and surgery showed skin changes with greater statistical significance.     

Intense pulsed light (IPL) treatment for the skin in the eye area – clinical and cutometric analysis

Objective: The aim of the research was to establish the influence of IPL treatment on skin ageing in the eye area. Material and methods: This study included 24 women, aged 38–63 years (mean age was 48.04) with Fitzpatrick skin type II and III who underwent five successive treatment sessions with an IPL in two-week intervals. The Cutometer (Courage + Khazaka electronic) reference test was an objective method for the assessment of the biomechanical properties of the skin. The measurements were made in three places around the eye. The photo documentation was used to compare state of skin before and after three months of treatments. Additionally, patients filled in a questionnaire, which contained questions concerning self-assessment of the procedure effects. Results: Cutometric analysis showed significant improvement of skin elasticity (statistical significance level is mostly < 0.0001). The comparison of clinical changes in the therapy, based on photo documentation, showed a 25% improvement. Conclusions: This treatment was used in order to improve skin elasticity and decrease the amount and depth of wrinkles. It is a non-invasive treatment, with low risk of complications.     

Objective measurement of periocular pigmentation

Purpose: To evaluate the Minolta CR‐400 chromameter in objectively measuring periocular/facial pigmentation in subjects of different ethnicities. Methods: The CR‐400 was used to obtain skin color measurements from 75 African‐American, Caucasian and Hispanic subjects in 16 facial and periocular locations. Comparisons between ethnic and Fitzpatrick groups and instrument reliability were analyzed. Results: Significant differences in L^* were observed among all three ethnic groups, while values a^* and b^* were less sensitive to differences in pigmentation. Comparison between Fitzpatrick groups again identified value L^* as being the most sensitive, demonstrating significant differences between the more heavily pigmented groups. The 16 facial locations measured were found to be statistically similar to each other, and the chromameter demonstrated excellent inter‐ and intra‐instrument reliability. Conclusions: The Minolta CR‐400 chromameter reliably measures facial pigmentation and can be useful for studies evaluating changes in skin pigmentation. Value L^* is the parameter that is most sensitive to differences between ethnic and Fitzpatrick groups. Overlap between groups was observed, demonstrating that in future studies, each individual must serve as their own control when monitoring changes in pigmentation. The similarity between all the locations tested demonstrates uniformity of facial pigmentation within an individual.     

Melasma and assessment of the quality of life in Brazilian women

BACKGROUND

Melasma is a chronic, acquired hyperpigmentation disease on sun-exposed areas of the skin, which affects patients'' quality of life.

OBJECTIVE

To assess the impact on the quality of life of women living in Florianópolis, Brazil, through questionnaire (MelasQol), and investigate the clinical aspects and risk factors for melasma, correlating them with the MelasQol scores.

METHODS

This study was performed on 51 melasma patients cared for at the University Hospital of the Universidade Federal de Santa Catarina. The variables included were: age, gender, age of onset of melasma, Fitzpatrick phototype (I-VI), duration and family history of melasma, onset of melasma during pregnancy, use of hormonal contraceptive, thyroid disorder and distribution of melasma. The MelasQoL questionnaire, validated for Brazilian Portuguese (MelasQoL-BP), was applied.

RESULTS

The mean age was 38.43±6.75 years. All patients were women. The most common Fitzpatrick skin phototypes were III (49.02%) and IV (33.33%). Melasma had a mean age of onset of 29.18±7.05 years and a mean duration of 9.25±6.18 years. The majority of patients did not have familial history of melasma (50.98%). Melasma onset was associated with pregnancy (45.10%). The MelasQoL-BP analysis revealed significant emotional impact on patients, such as feeling bothered (94.11%), frustrated and embarrassed (64.71%), and depressed (52.94%) about their skin appearance, as well as unattractive (78.43%). No social impact was observed (P>0.05).

CONCLUSION

Melasma has a strong emotional impact on quality of life, resulting especially from feelings about skin appearance.     

Diffuse reflectance spectrophotometry for skin phototype determination

Background: The Fitzpatrick skin phototype classification scheme has become the standard method for assessing the reaction of the skin to solar stimuli; this method can be easily biased by different factors, such as ethnicity or chronic sun exposure. Methods: Diffuse reflectance spectrophotometry (DRS) is an objective and non‐invasive method used in this work to determine constitutive skin color from the upper volar arm as an objective way of measuring skin pigmentation. A DRS‐determined melanin index that accounts for skin pigmentation was obtained for 35 subjects of Hispanic origin, this melanin index was compared with the physician‐diagnosed and self‐reported skin phototypes. Results: The results show that at least for Hispanic individuals, there is a clear clinical distinction between subjects with skin phototype I and their DRS‐determined melanin index; however, subjects with skin phototypes II–VI have a large melanin index overlap. Conclusion: Clinical assessment of skin phototype can be complemented by using DRS.     

Oily skin: specific features in Chinese women

BACKGROUND/PURPOSE: Inconsistent data are available on the various types of skin, their prevalence and characterization, particularly regarding Asian skins. This observation prompted to conduct a large study in China to assess the prevalence of oily skin and identify the specific factors related to that type of skin. METHODS: The multicentre trial involved 1787 Chinese women in Shenyang, Harbin, Beijing, Chengdu and Suzhou, between 18 and 65 years of age. Data on history of acne, the presence of environmental factors and a detailed self-evaluation of the skin were collected using a standardized questionnaire. A clinical evaluation of facial skin oiliness was carried-out by a dermatologist at each centre. Sebum secretion was measured on the forehead using Sebumeter SM810. Statistical analysis (multiple correspondence analysis) of typology was conducted based on self-evaluation data. RESULTS: According to self-evaluation data, oily skin prevalence in the overall Chinese population of the study was 25.6%. Self-evaluation results were quite consistent with sebum measurements and with clinical assessment by dermatologist. Parameters associated with oily skin were (i) shiny skin and a past history of acne, (ii) irregular menstruation, and (iii) highly reactive or sensitive skin. Moreover, a clear and significant link was noted between oily skin and the ingestion of spicy or sweet food. Lastly, sebum levels were found to be twice as high in Beijing as in the other cities and were correlated to higher oily skin prevalence. CONCLUSION: The study demonstrated the capacity of women for proper self-evaluation of their skin type. It also suggests a potential link between nutritional factors such as spicy and/or sweet diets and oily skin as well as between sensitive and oily skin in this population.     

In vivo assessment of chronological ageing and photoageing in forearm skin using reflectance confocal microscopy

Background Skin ageing is a complex process due to intrinsic chronological factors (chronoageing) and extrinsic environmental factors. The primary extrinsic factor is cumulative ultraviolet (UV) exposure, and is therefore termed photoageing. The current standards for measuring cumulative sun damage are biopsy histology and skin microtopography. However, skin biopsies are too invasive for population studies and skin replicas render only superficial skin architecture data. Reflectance confocal microscopy (RCM) is a noninvasive imaging tool that allows for in vivo imaging of the skin at quasihistological resolution. Objectives To define and identify RCM features associated with chronological ageing and photoageing on the forearm in two age groups with different skin phototypes and to assess whether these results agree with previous findings. Methods We obtained RCM images of dorsal and volar nonlesional skin of the lower forearm of 75 individuals with skin Fitzpatrick phototypes I–III in two age groups (20–30 years and 50–60 years). From each participant and body site, 21 RCM features were assessed and statistically significant differences between the two age groups and different forearm sites determined. Results RCM enabled identification of changes in architecture, cell morphology and extracellular matrix (collagen) at the level of the epidermis, dermoepidermal junction and papillary dermis. Changes that were correlated with chronological ageing and which were aggravated on the UV‐exposed dorsal forearm were: loss of small skin furrows resulting in wider and less intersecting furrows; irregularity of the epidermal honeycomb pattern; irregularly distributed (mottled) pigmented keratinocytes/melanocytes; irregularity of the papillary rings and/or effacement of the rete ridges; and loss of thin collagen fibres and presence of collagen clods. Conclusion We have tested previously reported and new parameters for skin ageing evaluation by RCM, and identified 15 statistically significant RCM features that can be used to quantify ageing and photoageing in forearm skin noninvasively.     

Determinación de la dosis eritemática mínima y reacciones anómalas a radiación ultravioleta A según fototipo

BackgroundPhototesting is a technique that assesses the skin's sensitivity to UV radiation by determining the smallest dose of radiation capable of inducing erythema (minimal erythema dose [MED]) and anomalous responses to UV-A radiation. No phototesting protocol guidelines have been published to date.MethodologyThis was a multicenter prospective cohort study in which 232 healthy volunteers were recruited at 9 hospitals. Phototests were carried out with solar simulators or fluorescent broadband UV-B lamps. Each individual received a total of 5 or 6 incremental doses of erythemal radiation and 4 doses of UV-A radiation. The results were read at 24 hours.ResultsAt hospitals where solar simulators were used, the mean (SD) MED values were 23 (8), 28 (4), 35 (4), and 51 (6) mJ/cm² for skin phototypes i to iv, respectively. At hospitals where broadband UV-B lamps were used, these values were 28 (5), 32 (3), and 34 (5) mJ/cm² for phototypes ii to iv, respectively. MED values lower than 7, 19, 27, and 38 mJ/cm² obtained with solar simulators were considered to indicate a pathologic response for phototypes I to IV, respectively. MED values lower than 18, 24, and 24 mJ/cm² obtained with broadband UV-B lamps were considered to indicate a pathologic response for phototypes ii to iv, respectively. No anomalous responses were observed at UV-A radiation doses of up to 20 J/cm².ConclusionsResults were homogeneous across centers, making it possible to standardize diagnostic phototesting for the various skin phototypes and establish threshold doses that define anomalous responses to UV radiation.     

Development and validation of a questionnaire to evaluate how a cosmetic product for oily skin is able to improve well-being in women

BACKGROUND: Skin diseases are known to negatively affect self-image and to have detrimental psychosocial effects. Oily skin is a cosmetic skin problem that women often describe as 'invalidating'. OBJECTIVE: To develop and validate a questionnaire to assess the psychological and psychosocial effects of oily skin condition in women and the outcome of a targeted cosmetic skincare treatment. METHODS: We developed and validated a concise 18-item questionnaire [oily skin self-image questionnaire (OSSIQ)] to assess perception, behavioural, and emotional consequences associated with oily skin condition. The questionnaire was then used to assess the effects of a skincare treatment for oily skin and compare them with sebum level measurements. RESULTS: The 18-item questionnaire clearly distinguished the oily skin group from the control group. Responsiveness, reliability, and construct validity showed satisfactory performance. The questionnaire provided a relevant assessment of the psychological benefits associated with the skincare programme. CONCLUSION: The OSSIQ is a valid tool that can be used to monitor the benefits of cosmetic skincare treatments.     

Different Cosmetic Habits Can Affect the Biophysical Profile of Facial Skin: A Study of Korean and Chinese Women

BackgroundPrevious studies on the age-, climate, and skin care habit-related changes of biophysical parameters have mainly focused on Caucasians, and studies on Asians are in paucity.ObjectiveThis study was aimed to investigate the variations of cutaneous biophysical parameters in Chinese and Korean women (northeast Asians) and to assess the association between those parameters and age, climate, and cosmetic habits.MethodsA cross-sectional study included 361 healthy Chinese and Korean women between 18 and 49 years of age in 4 cities (Guangzhou, Nanjing, and Shijiazhuang in China, and Suwon in Korea). We measured skin surface temperature, hydration, transepidermal water loss (TEWL), sebum, elasticity, skin pore, wrinkle, and skin tone (brightness) using non-invasive instruments. Demographic profiles and cosmetic habits were assessed using a questionnaire.ResultsSkin elasticity and tone decreased, and pore size and wrinkle increased with age. Subjects in Suwon (Korean) showed higher hydration level, lower TEWL and lower sebum, less severe wrinkle and brighter skin than those in the 3 cities in China. After adjusting for age and region, using sunscreen everyday, wearing base makeup daily, and using moisturizers improved hydration, TEWL, and elasticity significantly.ConclusionWomen in Suwon (Korea) were found to have a better profile of biophysical parameters than women in the 3 Chinese cities, which might be attributed to cosmetic habits, besides age and climatic factors. The fact that appropriate cosmetic habits are associated with favorable skin biophysical parameters underscores the importance of daily skin care routine in preserving skin functions.     

Explore highly relevant questions in the Baumann skin type questionnaire through the digital skin analyzer: A retrospective single-center study in South Korea

Background

Baumann skin type questionnaire (BSTQ) has been widely used for evaluating skin types in dermatology. However, it requires excessive assessment time and lacks sufficient clinical validation for the Asian population.

Aims

We aimed to establish optimized BSTQ based on dermatological assessment of the Asian population.

Methods

This was a single-center retrospective study, where the patient completed a modified BSTQ and a digital photography examination. The answers to four question groups for evaluating skin properties, including oily versus dry (O-D), sensitive versus resistant (S-R), pigmented versus non-pigmented (P-N), and wrinkled versus tight (W-T) were compared with the measurements. Highly relevant questions are selected using two different strategies and used to determine the threshold level, which was compared with skin-type measurement.

Results

In O-D, S-R, P-N, and W-T, 3–5 out of 6, 2–6 out of 9, 3–6 out of 7, and 4–9 out of 11 questions were selected, respectively. As a result, skin type scores from two strategies and measurements showed similar Pearson correlation coefficient values compared to modified BSTQ (for O-D and sebum, 0.236/0.266 vs. 0.232; for O-D and porphyrin, 0.230/0.267 vs. 0.230; for S-R and redness, 0.157/0.175 vs. 0.095; for S-R and porphyrin, 0.061 vs. 0.051; for P-N and melanin pigmentation, 0.156/0.208 vs. 0.150; for W-T and wrinkle, 0.265/0.269 vs. 0.217).

Conclusion

Two strategies for optimizing BSTQ are proposed and validated for Asian patients. Compared to the BSTQ, our methods show comparable performance with a significantly reduced number of questions.     

Fractional non-ablative laser treatment at 1410 nm wavelength for periorbital wrinkles – reviscometrical and clinical evaluation

Objective: The aim of the research was to establish the influence of 1410-nm fractional non-ablative laser treatment on skin aging in the eye area. The reviscometer reference test is an objective method of estimating the flexibility of the skin. The photographic records were used as the auxiliary method of the therapy quality effectiveness. Materials and methods: The study involved the group of 13 people (12 females and 1 male, aged 33–47 with prototype II and III according to the Fitzpatrick scale), who underwent two sessions of fractional non-ablative laser therapy (wavelength of 1410 nm) with a 2-week interval. In order to evaluate the effectiveness of the quality of the treatment a reviscometer probe was used to measure the skin elasticity (Reviscometer RVM 600). The measurements were taken twice: directly before and two weeks after the treatment. Furthermore, to facilitate the clinical evaluation an anonymous photographical documentation was prepared. Results: An improvement of the skin flexibility in the eye area was observed and the fact was confirmed by values obtained using the reviscometer probe (significant statistic differences: P < 0.0001) as well as clinical assessment based on photographical records. Conclusion: On the basis of the reviscometer measurements analysis and photographical records, 1410-nm fractional non-ablative laser treatment appears to be an efficient method contributing to the improvement of the skin flexibility of the eyes area as well as to the reduction of the number of wrinkles. The post-treatment observation proves that the method is well-tolerated in the sensitive eyes area and does not cause any significant side effects.     

Hair removal with an Athos Nd:YAG 3.5 ms pulse laser: a 3-month clinical study

INTRODUCTION/OBJECTIVE : This study aimed to evaluate the safety and efficacy of a 3.5 ms Nd:YAG laser for the removal of hair in subjects with Fitzpatrick skin types I-IV. Thanks to a pulse shorter than the hair Thermal Relaxation time (TRT), photothermolysis was thus achieved. METHODS : This study assessed the percentage of hair reduction at 1 month and at 3 months after a single Nd:YAG laser treatment (Athos; Quantel Médical, France); 3.5 ms pulse, single shot to 3 Hz, a maximum fluence of 80 J/cm 2 , 4 mm spot, no cooling system, no anaesthesia. The treatment sites consisted of three adjacent squares (optimum fluence, no treatment, -20% optimum fluence). Computerized hair counting was realized on digital pictures. The phototype, pain, side effects and patient's satisfaction were noted. Biopsies were performed 15 min after treatment. The enrolment consisted of 17 women, 22-60 years old, phototypes I-IV, with a follow-up at 1 month and 3 months of 25 sites. RESULTS : Counting at 1 month and at 3 months revealed a significant hair reduction compared with the control sites: 60% at 1 month ( P < 0.001) and 24% at 3 months ( P < 0.05) for optimal fluence (25-80 J/cm 2 ), compared with 31% and 0% on the control sites; values similar to those published for Nd:YAG or diode lasers. There were no adverse effects at all. Biopsies showed lesions from necrosis coagulation of the root sheaths and hair disruption to isolated apoptotic cells in the outer root sheath, depending on the fluence applied. CONCLUSION : Results from this study show that the Athos Nd:YAG is efficient and safe for removing pigmented hair in phototypes I-IV.     

Fractional photothermolysis treatment for resistant melasma in Chinese females

Background: Melasma is a common disorder of pigmentation which is common in women of Asian and Latina descent. Melasma lesions are resistant to numerous laser therapies, but have responded well in clinical studies to fractional photothermolysis. Objective: To determine whether Chinese women with resistant melasma will respond to fractional photothermolysis. Methods: Six female patients &lpar;Fitzpatrick skin types III-IV&rpar; were treated with fractional photothermolysis at approximately 4 week intervals. Three to four treatments were performed for each patient. Before and after photos were taken of each patient in order to identify the degree of improvement of the pigmented lesions treated. Results: All patients who participated in the study experienced at least 20% improvement in the appearance of their melasma lesions. Three patients obtained 50% improvement, two obtained 30% improvement, and one obtained 20% improvement. Conclusion: Fractional photothermolysis is a useful treatment modality for Chinese women who have resistant melasma.     

Counts of Common and Atypical Melanocytic Nevi in Korean Young Men: Assessment of Their Risks and Correlations with Associated Factors

Two hundred and thirty-five Korean young men were examined for the count of melanocytic nevi (MN). The mean count of common MN of at least 2 mm diameter was 16.1. Three subjects had more than 50 common MN and another four had clinically atypical MN. We determined skin phototype by interview with questionnaires in the same persons as proposed by Fitzpatrick. All subjects were classified with respect to skin phototype and the number of previous sunburns. The correlations between common MN and the skin phototype or the number of previous sunburns were statistically analyzed. The skin phototype showed the correlation with the number of common MN, which means if skin phototype of any subject belongs to type I, he could to be predicted to have many more common MN than subjects with darker phototypes, like type VI. The correlation between number of previous sunburns and number of common MN was not statistically significant. This study shows persons at moderate risk of cutaneous melanoma (CM) do exist and skin phototype is associated with the prevalence of common MN in Koreans.