330例慢性光化性皮炎患者紫外线最小红斑量测定

目的:分析慢性光化性皮炎(CAD)患者与长波紫外线(UVA)、中波紫外线(UVB)的关系,以及最小红斑量(MED)的影响因素.方法:以SUV1000型日光紫外线模拟器作为照射光源,比较330例CAD患者不同性别、年龄、病程及不同季节受试者UVA-MED值及UVB-MED值.结果:男性患者UVB-MED值明显低于女性ME...     

Can ultraviolet erythema be used to identify the basal cell carcinoma phenotype?

Since a prolonged duration of a strong UBV erythema has been suggested as a marker for propensity to develop skin cancer, we objectively followed the duration and intensity of erythemas induced by UVB and UVA radiation for 28 days in 18 patients with basal cell carcinoma (BCC), and in 15 healthy controls using reflectance spectrophotometry. The erythema index, defined as the difference in redness between UV-exposed skin and normal, adjacent skin on the lower abdomen, did not differ significantly between the two groups at 24 h, when the reaction was maximal, following a dose of 6 MED of UVB. Erythema values after 7 and 14 days were slightly higher in the BCC group, but this difference did not reach statistical significance. At day 7 some patients in the BCC group showed very strong erythemas. At days 21 and 28 the two groups had almost identical erythemal reactions. Following a standard dose of UVA of 100 J/cm², patients with BCC and healthy controls both showed weak erythemal reactions, which declined somewhat over the study period. No significant differences in pigmentary response were noted between the BCC and the control group, neither following UVB nor UVA. Although individual patients with BCC deviate from the normal erythemal curve for UVB, the UVB response is not a suitable predictive instrument in screening patients with the basal cell carcinoma phenotype.     

Evaluation of narrow band ultraviolet B phototherapy in the treatment of chronic actinic dermatitis in Chinese patients

Few studies have been conducted in chronic actinic dermatitis (CAD) treated with narrowband ultraviolet B (NB UVB) phototherapy, especially in Asian patients. We aim to evaluate the efficacy and safety of NB UVB phototherapy in Chinese patients with CAD. 19 CAD patients of Fitzpatrick skin phototype IV received NB UVB phototherapy in spring and treatments were given 3 times weekly with incremental dose and maintenance therapy was given twice weekly for 3–4 weeks. The mean initial, endpoint, and cumulative dose of NB UVB was 0.08, 0.33, and 6.0 J/cm², respectively. Patients totally received 27 times of treatments in average. 87.5% of previously ultraviolet B（UVB） sensitive patients and 75% of previously ultraviolet A（UVA） sensitive patients had normal or improved MED after phototherapy. The percentage of patients returned to normal UVB phototesting was higher than that of patients returned to normal UVA phototesting (68.8% vs. 37.5%). The mean 1‐week DLQI and the need for using immunosuppressive agents and antihistamines were significantly reduced after treatment (p < .01 or p < .05). In conclusion, prophylactic NB UVB phototherapy is effective and safe in treatment of CAD in Chinese patients with Fitzpatrick skin phototype IV.     

Measurement of cutaneous erythema by means of photodensitometry: application to cutaneous photosensitivity

We have developed a photodensitometry method to evaluate the intensity of cutaneous erythema objectively. The method measures the optical density of photographic slides of cutaneous erythema. It combines techniques used commonly but separately by investigators: diffuse transmittance spectroscopy (which is a variant of diffuse reflectance spectroscopy) and photography. We have used this method to study photosensitivity in 22 volunteers who received increasing doses of ultraviolet radiation to the back. Our work confirms the usefulness of an important parameter in photobiology: the regression slope of the curve representing the erythema index, a function of the logarithm of the dose applied.     

慢性光化性皮炎62例临床分析

目的:了解62例慢性光化性皮炎诱发因素、临床和光生物学特征及治疗情况。方法:回顾性分析62例慢性光化性皮炎患者临床资料。结果:62例患者,男女比例为30:1,平均64岁;皮损分布于曝光部位,主要表现为浸润肥厚的红斑、斑块、苔藓样丘疹。病理上早期为光敏性皮炎(PD)象,后期可呈光化性网织细胞增生症(AR)象。光生物学试验测定最小红斑量(MED)中,96.77%患者对UVB敏感,82.26%对UVA敏感;避光和去除光敏物,服用B族维生素和抗组胺药、羟氯喹,局部外用糖皮质激素有较好疗效,严重病例口服小剂量泼尼松和免疫抑制剂可控制病情。结论:慢性光化性皮炎常见于老年男性,临床诊断主要依靠临床表现和光生物学试验、避光和去除光敏物,外用和内服药物是治疗关键。     

Melanin differentially protects from the initiation and progression of threshold UV-induced erythema depending on UV waveband

BACKGROUND/PURPOSE: This study aimed to determine the relationship between various measures of constitutive skin pigmentation and erythema caused by solar-simulated UV (ssUV), 290 and 310 nm UV. METHODS: Skin pigmentation was assessed clinically by skin typing as well as objectively by measurement of the melanin index (MI) by reflectance spectroscopy. Subjects having Fitzpatrick skin types I-IV were exposed to graded doses of ssUV and either narrowband 310 nm (n=70) or 290 nm (n=69) UV, and assessed 24 h after exposure. Minimal erythema dose (MED) was assessed visually as the lowest dose that caused minimally perceptible erythema. Susceptibility to further development of erythema with higher exposure doses was measured by the gradient of erythema dose-response curves. This was determined by linear regression using reflectance spectrometry data beyond the MED. RESULTS: Although there was considerable variation within each skin type, MI and ssUV MED increased with increasing Fitzpatrick skin type. MI correlated with ssUV MED and 310 nm UV MED, but not 290 nm UV MED. There was also a significant negative correlation between MI and erythema dose-response gradients caused by ssUV, 310 and 290 nm UV. CONCLUSION: Melanin situated near the basal epidermis may not protect from the initial development of threshold erythema caused by 290 nm UV because it penetrates poorly past the stratum corneum and is not well absorbed by melanin in vivo compared with 310 nm UV. Higher erythemal 290 nm UV doses may reach basal epidermal melanin, which may then afford protection against further 290 nm UV erythema.     

慢性光化性皮炎105例光试验研究

目的:总结日光模拟器对慢性光化性皮炎(CAD)患者进行光试验的结果与应用价值。方法:采用日光紫外线模拟器,对30名正常人和105例CAD患者进行长波紫外线(UVA)、中波紫外线(UVB)的最小红斑量(MED)测定。结果:在UVA波段,当剂量<40J/cm2时,30名正常人均无红斑反应,而105例CAD患者中63例出现不同程度的红斑反应(60%);在UVB波段,CAD患者的MED显著低于正常人(P=0.001)。结论:采用日光模拟器对CAD患者进行光试验,有助于对CAD的诊断。     

The effects of heating and cooling on ultraviolet radiation-induced erythema and pigmentation in human skin

Background/Purpose: As most biochemical systems are affected by temperature, thermal changes before or after ultraviolet (UV) irradiation could influence skin vascular blood flow changes and inflammatory responses. In this study, our aim was to investigate the influence of thermal changes on UV-induced acute skin reactions, namely, erythema and pigmentation.
Methods: Our volunteers consisted of 10 males, with ages ranging from 22 to 24 years and with Fitzpatrick's skin type III or IV. Skin temperatures were changed with a 45°C heating pad or by ice pack application before or after UV irradiation (control, 1 minimal erythema dose (MED), 2 MED) and then changes in erythema and pigmentation were measured by a Minolta Spectrophotometer CM-2002.
Results: The present study demonstrates that both heating and cooling increase skin erythema and reduce pigmentation, and that the timing of heating and cooling influences the UV-induced skin reaction. Pre-heating and post-cooling groups showed more UV-induced erythema than the post-heating and pre-cooling groups, respectively.
Conclusion: Our results indicate that alteration of skin surface temperature could modulate UV-induced erythema and pigmentation responses.     

Long-term evaluation of erythema and pigmentation induced by ultraviolet radiations of different wavelengths

BACKGROUNDS/AIMS: Although multiple studies have been reported about the biological effects of ultraviolet (UV) radiations, the comparative and long-term reactions of human skin by several different UV-wavebands were not reported. The aim of this study was to investigate a time course of erythema and pigmentation induced by UVA 1, broad-band UVA (BBUVA), narrow-band UVB (NBUVB) and broad-band UVB (BBUVB). METHODS: Ten volunteers participated in this study for 6 months. Four skin areas, from the back of each subject, were irradiated with two minimal erythema dose (MED) of four different UV wavelengths corresponding to UVA 1, BBUVA, NBUVB and BBUVB. Skin color changes were evaluated by visual scoring and values were converted into the L*a*b color system. RESULTS: For both UVA 1 and BBUVA, erythema and pigmentation were most pronounced immediately and 1 h after exposure. Thereafter, erythema rapidly diminished but pigmentation persisted throughout the study. For both NBUVB and BBUVB, test areas reacted with erythema of maximum intensity at 1 and 2 days, respectively. A maximum tanning was reached at 3-6 days for NBUVB and 4-7 days for BBUVB, and the return toward the original color point was at 1 and 3 months, respectively. No significant difference was found in visual and colorimetric evaluation for the time course of skin color changes. CONCLUSION: Two MED of UVA produced far prolonged erythema and pigmentation than UVB. For UVA, UVA 1 and BBUVA showed similar intensity and time course of skin reaction. For UVB, erythema and pigmentation produced by NBUVB were milder in intensity and shorter in time course than those by BBUVB. These results would provide standard data on time courses and intensity of skin color changes by different UV wavelengths.     

Minimal erythema dose in UV-shielded and UV-exposed skin predicted by skin reflectance measured pigmentation

Aims: To investigate the relationships between epidermal thickness, age, skin pigmentation and UV sensitivity in sun-exposed skin and skin not exposed to the sun in healthy people without skin cancer or skin diseases. Methods: Phototesting with a xenon arc solar simulator was performed in 137 healthy Caucasians in buttock skin un-exposed to UV (27 children, 34 young adults and 32 older adults) and in skin of the back exposed to UV (44 young adults). The pigmentation of the phototest sites was measured objectively by a skin reflectance spectrometer before phototesting. Thickness of the stratum corneum and the cellular epidermis were measured in skin biopsies from the phototest sites. All measurements were performed in the winter and spring months. Results: Stratum corneum and cellular epidermis were thinner at the back than at the buttocks (P<0.01). Thickness of the stratum corneum at the back or the buttocks was not related to the degree of skin pigmentation (P=0.62 and P=0.20, respectively). Thickness of the stratum corneum at the buttocks was unaffected by gender (P=0.42) and age (P=0.83) whereas cellular epidermis decreased with age (P<0.01) and was thinner in females than in males (P<0.01). In spite of the higher pigmentation at the back than at the buttocks, the minimal erythema dose (MED) was lower at the back than at the buttocks (x=2.7 and x=2.2 SED's, respectively; P=0.04). Given the same degree of skin pigmentation, there was no difference in the MED in buttock skin in children, young adults and older adults un-exposed to UV (P= 0.61). Prediction of the MED in un-exposed buttock skin and in exposed skin of the back by a theoretical model based on an exponential function of the measured skin pigmentation was found to provide good estimates of the MED determined by phototest. Conclusion: Skin pigmentation at un-exposed buttock skin can reliably predict the constitutive UV sensitivity in healthy Caucasian children and adults and is recommended in surveys where phototesting cannot be performed.     

A long-term evaluation of erythema and pigmentation induced by ultraviolet radiations of different wavelengths

BACKGROUND/AIMS: The long-term reactions of human skin by different ultraviolet (UV)-wavebands were not reported. This study was to investigate a time course of erythema and pigmentation induced by UVA-1, broadband UVA (BBUVA), narrowband UVB (NBUVB) and broadband UVB (BBUVB). METHODS: Ten volunteers participated in this study for 6 months. Four skin areas, from the back of each subject, were irradiated with two minimal erythema dose (MED) of four different UV wavelengths corresponding to UVA-1, BBUVA, NBUVB and BBUVB. RESULTS: For both UVA-1 and BBUVA, erythema and pigmentation were most pronounced immediately and 1 h after exposure. Erythema rapidly diminished but pigmentation persisted throughout the study. For both NBUVB and BBUVB, test areas reacted with erythema of maximum intensity at 1 and 2 days, respectively. A maximum tanning was reached at 3-6 days for NBUVB and 4-7 days for BBUVB, and the return toward the original point was at 1 and 3 months, respectively. CONCLUSION: Two MED of UVA produced far prolonged erythema and pigmentation than UVB. For UVA, UVA-1 and BBUVA showed similar intensity and time course of skin reaction. For UVB, erythema and pigmentation produced by NBUVB were milder in intensity and shorter in a time course than those by BBUVB.     

Validation of a semiautomated method of minimal erythema dose testing for narrowband ultraviolet B phototherapy

BACKGROUND: The most widely used method for establishing the minimal erythema dose (MED) before narrowband ultraviolet (UV) B phototherapy is time-consuming, inconvenient and may yield inconsistent results. OBJECTIVES: To assess the equivalence of MED assessment using a filtered xenon arc lamp UV source, a semiautomated MED tester, and a UV-opaque template method of MED determination with a panel of TL-01 311-nm UVB fluorescent tubes. Secondly, to gauge the current usage of MED testing, and the method used, in a large sample of U.K. phototherapy units. Thirdly, to assess variation in UV output of the semiautomated skin tester immediately after switching on to identify optimum warm-up time. Finally, to assess reproducibility of MED testing by assessing within-patient variability and interobserver variability of MED test results. METHODS: Sixty-five patients about to undergo UVB phototherapy had their MED determined using three different methods. Within each patient we compared the values of MED determined by a semiautomated Durham MED tester, a panel of narrowband UVB lamps with a UV-opaque template constructed by a phototherapist, and a 310-nm filtered xenon arc lamp with a liquid light guide. MED test results were assessed by clinical evaluation using a 6500 K colour temperature examination lamp. The output of the semiautomated MED tester was measured by spectroradiometer over a period of 20 min in order to identify the time to steady output. Reproducibility of MED testing with the semiautomated MED tester was carried out in 25 normal volunteers. All MEDs were assessed by at least two independent observers. A postal questionnaire was sent to 78 U.K. phototherapy units to assess routine practice concerning MED testing prior to narrowband UVB phototherapy. RESULTS: The semiautomated MED tester showed consistency with the panel method (r = 0.92, panel MED = -0.57 + 1.14 x Durham MED). The semiautomated MED tester produced a slightly lower MED result than the panel MED. Reproducibility tests showed high interobserver agreement (kappa value = 0.79), and high consistency for successive day testing (kappa value = 0.79). Questionnaires were returned from 67 of 78 phototherapy units (85%) and revealed that 19 units (28%) were routinely using MED testing prior to UVB therapy. CONCLUSIONS: This study has shown the Durham MED tester to be a convenient, valid and reproducible method for determining patient MED values prior to narrowband UVB phototherapy when used under carefully controlled lighting, by experienced observers.     

Effect of childhood and adolescent ultraviolet exposures on cumulative exposure in South East Queensland schools

Quantitative estimates of the childhood and adolescent erythemal ultraviolet (UV) exposure received in South East Queensland schools are provided in this paper for age groups 0 to 6, 7 to 12 and 13 to 19 years. For the neck, hand and lower arm, sites of high UV exposure that are generally not covered by clothing, 13 to 19 year olds received the highest exposure of the three age groups, followed by 7 to 12 year olds. Exposure for 13 to 19 year olds contributed up to 44% of cumulative exposure to 20 years of age, and exposures for the 7 to 12 year olds contributed up to 31%. If the annual UV exposure for these two age groups were reduced to the average of all the age groups, cumulative erythemal UV exposure from 0 to 20 years would be reduced by up to 16%. On the other hand, if mothers can protect their babies by reducing the level of annual exposure to 30% of the annual UV exposure of the 7 to 12 year olds for the first four years then cumulative exposure to UV to age 20 would be reduced by up to 19%. These data confirm the importance of targeting young age groups in public campaigns for sun protection.     

Pigmentation above the constitutive level: An indicator of excimer laser radiation-induced erythema in Koreans

Ultraviolet (UV) irradiation induces skin erythema, but it is not clear which factors have the greatest effects on UV sensitivity. Six healthy Korean adult men were enrolled and their melanin index (MI) and increment of erythema index (ΔEI) were measured. In each individual, 12 different sites were selected and 36 spots were irradiated with a single shot of monochromatic excimer laser with a dose of 350 mJ/cm(2) . The sites were categorized into three groups based on the cumulative sun exposure: UZ, unexposed zones; FEZ, frequently exposed zones; and IEZ, intermittently exposed zones. The sun exposure indexes (SEI) were also calculated based on previously described methods. ΔEI, MI and SEI were measured and calculated. The ΔEI of UZ was significantly higher than that of FEZ, but lower than that of IEZ. In general, there was a significant relationship between ΔEI and MI (R(2) = 0.135). However, IEZ did not show significant results. In contrast, there was a stronger relationship between ΔEI and SEI (R(2) = 0.344). Overall, the values were significantly higher for the SEI (0.541 [UZ], 0.281 [IEZ] and 0.228 [FEZ]) than for MI (0.311 [UZ], 0.011 [IEZ] and 0.073 [FEZ]). There were significant site variations in UV sensitivity along with skin pigmentation. In addition, significant differences were observed according to the exposure frequency. The SEI was found to be strongly correlated with UV sensitivity. These results suggest that the induced level of pigmentation above the constitutive level will be a better indicator for UV sensitivity than baseline MI.     

多形性日光疹患者紫外线最小红斑量测定

UVA和UVB均能引起光变态反应[1-2].为证实紫外线与多形性日光疹(PMLE)之间是否有相关性,我们测定了PMLE患者UVA、UVB的最小红斑量(MED).     

Assessment of erythema in irritant contact dermatitis

Assessment of erythema in experimentally-induced irritant contact dermatitis has been performed visually and using the laser Doppler flowmeter (LDF). A close correlation was shown between the 2 methods (r = 0.9079, p less than 0.001), with the LDF producing mean blood flow values which were able to discriminate between the different visual scores. Of the 100 patch tests evaluated, 3 gave poor correlations between their visual and LDF readings, including 2 dithranol reactions and 1 sodium hydroxide response. Patch tests with no visible erythema had blood flow values similar to those of normal untreated skin. Although the LDF was an easy instrument to operate, it was not considered suitable for use in the routine patch test clinic, due mainly to the unacceptable length of time required to measure each patch test.     

Change in ultraviolet (UV) transmission following the application of vaseline to non-irradiated and UVB-exposed split skin

BACKGROUND: Topical preparations such as emollients used in combination with phototherapy can interfere with such treatment. OBJECTIVES: This study was performed to investigate the impact of vaseline on the ultraviolet (UV) transmission of non-irradiated split skin and on split skin previously exposed to UVB radiation. METHODS: Split-skin specimens were obtained from 20 patients. In each case, one sample was taken from an area of non-irradiated skin, while the second was taken from an area that had been previously exposed to UVB. The transmission was spectrophotometrically measured with split skin placed in specially designed quartz glass cuvettes before and after the application of two different amounts of vaseline (2.5 and 17.5 mg cm-2). RESULTS: Application of vaseline to skin previously exposed to UVB caused significant (P < 0.0001) changes in UV transmission in certain wavelength ranges. In the UVA range, a greater increase in transmission was achieved with 2.5 mg cm-2 vaseline, whereas in the UVB range, a greater increase was achieved with 17.5 mg cm-2 vaseline. The thicker the layer of vaseline applied, the lower was the difference in transmission between non-irradiated split skin and UVB-exposed split skin. CONCLUSIONS: Application of the correct amount of vaseline can enhance transmission in either the UVA or UVB range, and would enable dose reduction during a course of phototherapy.     

97例慢性光化性皮炎患者作用光谱分析

【摘要】 目的 测定慢性光化性皮炎(CAD)的紫外线作用光谱并进一步分析患者病程及日均户外曝光时间对作用光谱最小红斑量(MED)降低的影响。方法 以SUV1000型日光紫外线模拟器为光源,测定108例疑似CAD患者的长波紫外线(UVA)和中波紫外线(UVB)的MED。 结果 108例患者中,97例确诊为CAD。97例患者中,85.57% UVA－MED降低,范围1.02～23.97J/cm2;70.10% UVB－MED降低,范围1.94～19.23mJ/cm2;29.90% 单一UVA－MED下降;14.43% 单一UVB－MED下降。在不同病程组中,>5年组作用光谱的MED显著低于3～5年和<3年组的相应测定值（P<0.01）;3～5年组和<3年组作用光谱的MED之间则无显著性差异（P>0.05）。就日均户外曝光时间而言,>7小时／天组作用光谱的MED显著低于5～7小时／天和<5小时／天组的相应测定值（P<0.01）;而5～7小时／天和<5小时／天组作用光谱的MED之间无显著性差异(P>0.05)。结论 UVA作为CAD的单一作用光谱,不容忽视。且CAD患者病程的发展和户外曝光时间的延长会导致作用光谱MED进一步降低。     

Use of digital photography and image analysis techniques to quantify erythema in health care workers

Background/aims: Nosocomial infections affect up to 26% of ICU patients. Compliance with the required hand hygiene procedures remains low, rarely exceeding 50%, with skin irritation as one of the main reasons for lack of conformity. The aim was to quantify the epidermal barrier effects, particularly erythema, from repetitive exposure to hand hygiene procedures among health care workers (HCWs) using an objective, reliable clinical method that could evaluate the entire hand surface. Methods: The hand skin of HCWs was evaluated before the initial scrub and at the end of multiple 2–3 days work cycles during spring (n=54) and winter (n=60) trials. The skin condition was measured with live visual skin evaluation (LSG), digital image analysis (DIA) of high‐resolution digital images, and visual perception evaluation (VPS) of image pairs. Results: The HCWs had significantly higher values of erythema than the non‐HCW control group with all methods. Knuckle erythema increased over the cycle in both seasons. It decreased during recovery in spring and continued to increase during recovery in winter. For the DIA area of excess redness, the quantitative measure of erythema, the decrease over the cycle in spring was significantly different than the increase over the cycle in winter. Minimal changes in area of excess redness occurred during recovery in both seasons. With the VPS, both judges found a decrease in erythema during recovery in spring and an increase during recovery in winter, indicating significant differences for spring vs. winter (P<0.05). No differences in VPS erythema were seen for either product set over the work cycle during spring. Correlations were observed for (1) results for the VPS vs. the LSG method and (2) between excess erythema (μ+σ) from DIA and the VPS erythema scores. Relatively low correlations were found between the DIA and VPS methods, i.e., knuckle μ+σ and VPS erythema. Conclusions: Significant work cycle effects for spring vs. winter were observed with DIA, while significant effects were found during the recovery period with VPS. DIA produced an objective quantitative measure of erythema that was not limited or influenced by other aspects of skin irritation (e.g., dryness, scaling) or texture encountered in the visual methods of LSG and VPS. The DIA method minimizes the difficulty in differentiating erythema severity. Standardization of image capture and processing allows assessment of skin condition across clinical locations. The VPS is a more reliable way to compare skin condition at different times, i.e. beginning vs. the end of a treatment cycle, because images are viewed simultaneously and can be carefully examined for differences.