Lichtschutz: Möglichkeiten und Grenzen

Protection against ultraviolet (UV) irradiation prevents from the development of acute skin damage such as erythema formation and chronic skin changes such as premature skin ageing. Especially those sunscreens with higher sun protection factors do not only protect against solar dermatitis but also inhibit UV‐induced immunosuppression by blocking the release of immunosuppressive mediators from UV‐exposed epidermis. In particular, the protection against UV‐induced immunosuppression by sunscreens is supposed to reduce the development of UV‐induced skin cancer. Besides immunosuppression UV‐irradiation is also able to induce “UV signature” mutations within UV‐exposed DNA. Topical application of DNA repair enzymes induces nucleotide excision repair and corrections of DNA damages. Thereby, the risk to develop UV‐induced skin malignancies is markedly reduced. Accordingly, future perspectives in the development of sunscreens include DNA repair enzymes or factors, which can induce the endogenous cellular DNA repair system. Until these developments come to practice reasonable sun protection according to the skin complexion is of primary importance.     

Klinik und Pathogenese UV‐induzierter Pigmentveränderungen

Solar and ultraviolet (UV) radiation, respectively, are the strongest stimuli for the induction of pigmentation in human skin. UV radiation induces pigmentation by exerting direct and indirect effects on melanocytes. Melanogenesis is a very complex process whose molecular mechanisms are not yet completely understood. Acute UV exposure induces the non‐protective immediate pigment darkening as well as delayed tanning which exerts photoprotective effects. Chronic UV exposure causes permanent pigmentary changes by inducing solar lentigines and pigmented actinic keratoses as well hypopigmentated areas. Artificial UV irradiation (UVA, PUVA) can also induce pigmentary disorders, including lentigines. Since the therapeutic options for UV‐induced pigmentary changes are limited consequent protection as a prophylactic measure is recommended.     

Chronological ageing and photoageing of the fibroblasts and the dermal connective tissue

In recent years, the exposure of human skin to environmental and artificial UV irradiation has increased dramatically. This is due not only to increased solar UV irradiation as a consequence of stratospheric ozone depletion, but also to inappropriate social behaviour with the use of tanning salons still being very popular in the public view. Besides this, leisure activities and a lifestyle that often includes travel to equatorial regions add to the individual annual UV load. In addition to the common long-term detrimental effects such as immunosuppression and skin cancer, the photo-oxidative damage due to energy absorption of UV photons in an oxygenized environment leads to quantitative and qualitative alterations of cells and structural macromolecules of the dermal connective tissue responsible for tensile strength, resilience and stability of the skin. The clinical manifestations of UV/reactive oxygen species (ROS)-induced disturbances result in photoaged skin with wrinkle formation, laxity, leathery appearance as well as fragility, impaired wound healing capacities and higher vulnerability. Strategies to prevent or at least minimize ROS-induced photo-ageing and intrinsic ageing of the skin necessarily include protection against UV irradiation and antioxidant homeostasis.     

Neue und etablierte Indikationen der UV‐B‐311‐nm‐Phototherapie

Phototherapy with ultraviolet (UV) irradiation of wavelengths between 280 and 320 nm (UV‐B) is a safe and effective treatment for a variety of inflammatory skin diseases. In addition to standard broad band UVB, narrow band phototherapy with fluorescent bulbs emitting near monochromatic UV between 310 – 315 nm has become an important treatment for diseases such as psoriasis, atopic dermatitis or vitiligo. Other diseases respond favorably to narrow band UV‐B phototherapy, the number of potential indications for such phototherapy is continuously growing. The differential effects of narrow band UV‐B phototherapy in comparison to other UV phototherapies, as well as new and established indications for this treatment modality are reviewed.     

Protective effects of a topical antioxidant mixture containing vitamin C,ferulic acid,and phloretin against ultraviolet‐induced photodamage in human skin

Background Ultraviolet (UV) irradiation of the skin leads to acute inflammatory reactions, such as erythema, sunburn, and chronic reactions, including premature skin aging and skin cancer. Aim In this study, the effects of a topical antioxidant mixture consisting of vitamin C, ferulic acid, and phloretin on attenuating the harmful effects of UV irradiation on normal healthy volunteers were studied using biomarkers of skin damage. Subjects/methods Ten subjects (age, 18–60 years; Fitzpatrick skin types II and III) were randomized and treated with antioxidant product or vehicle control on the lower back for four consecutive days. On day 3, the minimal erythema dose (MED) was determined for each subject at a different site on the back. On day 4, the two test sites received solar‐simulated UV irradiation 1–5× MED at 1× MED intervals. On day 5, digital images were taken, and 4‐mm punch biopsies were collected from the two 5× MED test sites and a control site from each subject for morphology and immunohistochemical studies. Results UV irradiation significantly increased the erythema of human skin in a linear manner from 1× to 5× MED. As early as 24 h after exposure to 5× MEDs of UV irradiation, there were significant increases in sunburn cell formation, thymine dimer formation, matrix metalloproteinase‐9 expression, and p53 protein expression. All these changes were attenuated by the antioxidant composition. UV irradiation also suppressed the amount of CD1a‐expressing Langerhans cells, indicating immunosuppressive effects of a single 5× MED dose of UV irradiation. Pretreatment of skin with the antioxidant composition blocked this effect. Conclusion This study confirms the protective role of a unique mixture of antioxidants containing vitamin C, ferulic acid, and phloretin on human skin from the harmful effects of UV irradiation. Phloretin, in addition to being a potent antioxidant, may stabilize and increase the skin availability of topically applied vitamin C and ferulic acid. We propose that antioxidant mixture will complement and synergize with sunscreens in providing photoprotection for human skin.     

Serum amyloid A1 secreted from UV‐irradiated keratinocytes induces matrix metalloproteinase‐1 in fibroblasts through toll‐like receptor 4

Ultraviolet (UV) irradiation on skin triggers photoageing‐related phenotypes such as formation of wrinkles. UV ray upregulates matrix metalloproteinase‐1 (MMP‐1), which in turn degrades extracellular matrix proteins, mostly collagens. Serum amyloid A1 (SAA1) is an acute‐phase protein of which plasma concentration increases in response to inflammation. Although the expression of SAA1 in the skin was reported, its function in the skin is yet to be studied. In this research, we found that the expression of SAA1 was increased in acute UV‐irradiated buttock skin and photoaged forearm skin in vivo. UV irradiation also increased SAA1 in normal human epidermal keratinocytes (NHEK), and treatment of recombinant human SAA1 (rhSAA1) induced MMP‐1 in normal human dermal fibroblasts (NHDF) but not in NHEK. Next, we demonstrated that NHDF treated with UV‐irradiated keratinocyte‐conditioned media showed the increased MMP‐1 expression; however, this increase of MMP‐1 in NHDF was inhibited by knockdown of SAA1 in NHEK. In addition, knockdown of Toll‐like receptor 4 (TLR4) inhibited rhSAA1‐induced MMP‐1 expression in NHDF. Taken together, our data showed that UV‐induced SAA1 production in NHEK, and this secreted SAA1 induced MMP‐1 expression in NHDF in a paracrine manner through TLR4 signalling pathway. Therefore, our results suggest that SAA1 can be a potential mediator for UV‐induced MMP‐1 expression in human skin.     

The expression of melanogenic proteins in Korean skin after ultraviolet irradiation

For proper melanin production, several specific enzymes such as tyrosinase, tyrosinase-related protein 1 (TRP-1) and dopachrome tautomerase are required. Their expressions are increased after exposure to UVB. However, it is not known how long tyrosinase and TRP-1 activities continue after UV irradiation in vivo. The purpose of this study is to measure the changes in expressions of tyrosinase, TRP1, and MITF after exposure to UV on skin in a Korean population. We established an immunohistochemical staining protocol for specimens which were obtained from UV-irradiated skin in five healthy Korean males on the 2nd, 5th, 7th, 28th, and 56th days after UV irradiation. Tyrosinase, TRP-1, and MITF expressions increased until 7 days after UV irradiation and then dropped to the basal constitutive level 4 and 8 weeks later. Interestingly, tyrosinase increased prior to TRP-1. This study reveals the time-sequence of melanin-synthesized enzymes and provides important information for the clinical evaluation of the effectiveness of whitening agents.     

Iron sensitizes keratinocytes and fibroblasts to UVA‐mediated matrix metalloproteinase‐1 through TNF‐α and ERK activation

Abstract: Oestrogen deficiency is regarded as the main causative factor in postmenopausal skin ageing and photoageing. While women after menopause experience low levels of oestrogen because of cease of ovarian function, they are also exposed to high levels of iron as a result of cessation of menstruation. In this study, we investigated whether this increase in iron presents a risk to the postmenopausal skin. Because of the lack of appropriate animal models to closely mimic the low oestrogen and high iron conditions, we tested the hypothesis in a high iron and low oestrogen culture model. Here, we showed that primary human dermal fibroblasts exposed to iron did not affect the baseline levels of matrix metalloproteinase‐1 (MMP‐1) activity. However, the iron‐exposed fibroblasts were sensitized to UVA exposure, which resulted in a synergistic increase in MMP‐1. UVA activated the three members of MAPK family: ERKs, p38, and JNKs. Additional activation of ERKs by iron contributed to the synergistic increases. Primary normal human epidermal keratinocytes (NHEK) did not respond to iron or UVA exposure as measured by MMP‐1, but produced tumor necrosis factor‐alpha (TNF‐α) in the media, which then stimulated MMP‐1 in fibroblasts. Our results indicate that iron and UVA increase MMP‐1 activity in dermal fibroblasts not only directly through ERK activation but also by an indirect paracrine loop through TNF‐α released by NHEK. We conclude that in addition to oestrogen deficiency, increased iron as a result of menopause could be a novel risk factor by sensitizing postmenopausal skin to solar irradiation.     

Ultraviolet light protection by a sunscreen prevents interferon‐driven skin inflammation in cutaneous lupus erythematosus

Irradiation with ultraviolet (UV) light is an important exacerbating factor in cutaneous lupus erythematosus (CLE) and induces various effects in the skin of patients with the disease, such as cell death and inflammation. Recently, we demonstrated the ability of a broad‐spectrum sunscreen to prevent UV‐induced damage both in patients with CLE and healthy controls (HCs). The aim of this study was to evaluate whether the UV‐dependent activation of interferon (IFN)‐driven inflammation in CLE can also be prevented by application of the sunscreen. In 20 patients with different subtypes of CLE and 10 HCs, defined areas on the upper back were treated with a broad‐spectrum liposomal sunscreen 20 min prior to a combined standardized UVA/UVB irradiation. Immunohistological analyses using antibodies directed against MxA, CD11c, CD123 and CD68 were performed from skin biopsies taken from areas before UV irradiation as well as from sunscreen‐treated and sunscreen‐untreated areas 24 and 72 h after UV irradiation. The expression of MxA was completely prevented by the sunscreen applied prior to UV irradiation in CLE patients and HCs. Additionally, sunscreen protection significantly diminished the number of the CD11c‐ and CD123‐positive dendritic cells, which are suggested to be a major source of type I/III IFNs, in UV‐irradiated skin of patients with CLE. Moreover, the application of the sunscreen prevented the increase in CD68‐positive macrophages in both groups 72 h after UV irradiation. The data of this study demonstrate that UV protection reduces lesional tissue damage and inhibits the typical IFN‐driven inflammatory response in CLE.     

Effects and interactions of increased environmental temperature and UV radiation on photoageing and photocarcinogenesis of the skin

Solar radiation is one of fundamental elements sustaining and maintaining life on earth. Previous studies on health effects from the sun exposure mostly focused on ultraviolet (UV) radiation. Although exposure to the solar radiation likely occurs in an environment with elevated temperature, the effects and interactions of elevated environmental temperature with UV radiation on the skin, especially in the context of ageing and carcinogenesis, have not been carefully examined. It is known that UVA radiation results in reduced production and increased degradation of dermal collagen, contributing to photoageing of the skin. Previous studies showed conflicting results regarding the effects of increased environmental temperature on dermal collagen. Additionally, we demonstrated that solar‐simulated radiation and increased environmental temperature have similar impacts on dermal fibroblasts through activation of distinct pathways. UVB radiation is well known for its carcinogenic capacity. Previously, it was reported that exposure to heat treatment before UVB radiation reduces epidermal keratinocyte cell death. We demonstrated that exposure to elevated environmental temperature prior to UVB radiation reduces UVB‐induced skin tumor formation. We proposed that alterations in molecular dynamics and quantum mechanics were involved for the observed increased environmental temperature‐induced protective effect against UVB damage. This review emphasizes that both environmental temperature and solar radiation are important elements in nature that have significant impacts on the human health, and future studies should focus on the biological effects and interactions of environmental temperature and solar radiation since this scenario is most relevant to the real‐world setting.     

Hautkrebs und Berufserkrankung

Although it is universally accepted that UV light exposure can cause malignant skin tumors, UV-induced skin cancers are not recognized as an occupational disease in Germany. Exposure to natural or artificial UV light occurs in many work places, so that the induction of occupational skin cancers is certainly plausible. In recent years, a special clause in the occupational disability rules has recognized some cases of UV-induced skin cancers. We discuss the nature of occupational UV exposure, explore preventative measures and review the data regarding occupational UV-induced skin tumors. After evaluating recent publications, we conclude that for squamous cell carcinoma the epidemiological proof of an at least doubled risk (RR >2) due to occupational UV radiation can be given. The clear dose response relationship supports these epidemiological findings. For the individual risk assessment, an attributive UV radiation >40% due to occupational factors must exist. Under those circumstances, squamous cell carcinoma should be recognized and compensated as an occupational disease.     

Skin cancer induced by natural UV‐radiation as an occupational disease – Requirements for its notification and recognition

In Germany over 2.5 million employees have an increased risk of skin cancer due to their occupational exposure to natural UV‐irradiation. The medical consultation board “Occupational diseases” of the Ministry of Labor and Social affairs has investigated the association between occupational UV‐irradiation and skin cancer risk and recommends to add the following new occupational disease into the appendix1 of the German ordinance on occupational diseases: “Squamous cell carcinoma and multiple actinic keratosis due to natural UV‐irradiation”. In this article we report in the view of the German Society of Occupational and Environmental Dermatology (ABD) and the German Statutory accident insurance (DGUV), whose criteria have to be fulfilled for the notification and recognition of an occupational skin cancer due to natural UV‐irradiation.     

Angiogenesis in skin aging and photoaging

Angiogenesis, the process of generating new blood vessels, is affected by various physiological and pathological conditions of skin. The skin aging process can be divided into intrinsic aging and photoaging. With aging, cutaneous blood vessels undergo pronounced alterations. A reduction of the cutaneous microvasculature has been observed in the skin of elderly individuals. Human skin is exposed daily to solar ultraviolet (UV) radiation, infrared rays and heat, and these stimuli are known to induce skin angiogenesis. Interestingly, although acute UV irradiation stimulates skin angiogenesis, cutaneous blood vessels are decreased in chronically photodamaged skin. The reason for the differential effects of acute and chronic UV exposure on skin angiogenesis remains to be elucidated. This review discusses the vascularization changes in intrinsically aged and photoaged human skin, the effects of UV irradiation, infrared rays and heat on skin angiogenesis, and the effects of topical retinoic acid treatment on UV-induced angiogenesis and cutaneous vascularity in aged and photoaged human skin. An understanding of the molecular mechanisms of aging- and photoaging-dependent changes of skin angiogenesis may provide us with new insights to prevent and treat the skin aging process.     

Mitochondrial DNA copy number – but not a mitochondrial tandem CC to TT transition – is increased in sun‐exposed skin

Mitochondrial DNA (mtDNA) mutations are causatively associated with photo‐ageing and are used as biomarkers of UV exposure. The most prominent mitochondrial mutation is the common deletion (CD), which is induced in many tissues by oxidative stress. More photo‐specific mutations might be CC to TT tandem transitions which arise from UV‐induced cyclobutane pyrimidine dimers. As nucleotide excision repair is absent in mitochondria, this DNA damage can presumably not be repaired resulting in high mitochondrial mutation levels. Here, we analysed levels of the CD, a mitochondrial and a chromosomal tandem transition in epidermis and dermis from exposed and less UV‐exposed skin. We also analysed mtDNA copy number, for which changes as a result of oxidative stress have been described in different experimental settings. Whereas mitochondrial tandem transition levels were surprisingly low with no discernible correlation with UV exposure, mtDNA copy number and CD were significantly increased in UV‐exposed samples.     

Extracellular superoxide dismutase tissue distribution and the patterns of superoxide dismutase mRNA expression following ultraviolet irradiation on mouse skin

Superoxide dismutases (SODs) are believed to play a crucial role in protecting cells against oxygen toxicity. There are three forms of SOD: cytosolic Cu-Zn SOD, mitochondrial Mn SOD, and extracellular SOD (EC SOD). Extracellular SOD is primarily a tissue enzyme, but the role of EC SOD in skin is unclear. Therefore, this study investigated the distribution of EC SOD in the skin using immunohistochemistry and examining the patterns of EC SOD gene expression following ultraviolet (UV) irradiation in comparison with those of Cu-Zn SOD and Mn SOD in mouse dorsal skin using Northern blot analysis. Immunohistochemical analysis showed that EC SOD was abundantly located in the epidermis as well as in the dermis, but the gene expression of EC SOD mRNA was more abundant in the dermis than in the epidermis. The gene expression levels of all three types of SODs after UV irradiation were induced differently according to the type and UV irradiation dose. The EC SOD mRNA expression level was increased relatively later than that of Cu-Zn SOD and Mn SOD. The EC SOD mRNA level was significantly higher at 6 h and 48 h after UVA irradiation and psoralen plus ultraviolet-A treatment, respectively. Ultraviolet-B irradiation increased the EC SOD mRNA expression level, with maximum at 48 h. These suggest that EC SOD participates in the majority of antioxidant systems in the skin, and it may have different defensive roles from Cu-Zn SOD and Mn SOD against UV-induced injury of the skin.     

Cyclobutane pyrimidine dimer formation and p53 production in human skin after repeated UV irradiation

Substantial differences in DNA damage caused by a single UV irradiation were found in our previous study on skin with different levels of constitutive pigmentation. In this study, we assessed whether facultative pigmentation induced by repeated UV irradiation is photoprotective. Three sites on the backs of 21 healthy subjects with type II-III skin were irradiated at 100-600 J/m(2) every 2-7 days over a 4- to 5-week period. The three sites received different cumulative doses of UV (1900, 2900 or 4200 J/m(2)) and were biopsied 1 day after the last irradiation. Biomarkers examined included pigment content assessed by Fontana-Masson staining, melanocyte function by expression of melanocyte-specific markers, DNA damage as cyclobutane pyrimidine dimers (CPD), nuclear accumulation of p53, apoptosis determined by TUNEL assay, and levels of p21 and Ser46-phosphorylated p53. Increases in melanocyte function and density, and in levels of apoptosis were similar among the 3 study sites irradiated with different cumulative UV doses. Levels of CPD decreased while the number of p53-positive cells increased as the cumulative dose of UV increased. These results suggest that pigmentation induced in skin by repeated UV irradiation protects against subsequent UV-induced DNA damage but not as effectively as constitutive pigmentation.     

Increased expression of TRPV1 channel in intrinsically aged and photoaged human skin in vivo

Abstract:  Transient receptor potential vanilloid type 1 (TRPV1) is activated by various stimuli including capsaicin, heat and acid. While TRPV1 has been localized in the epidermis, little is known about the physiological role of TRPV1 in the skin, especially in skin ageing. In this study, we investigated the effect of acute UV irradiation on TRPV1 expression in human skin and the changes in TRPV1 mRNA and protein in intrinsic ageing and photoageing using human sun-protected (upper inner arm) and sun-exposed (forearm) skin of young and elderly subjects.
Western blot analysis of UV-irradiated young buttock skin revealed that the expression of TRPV1 protein was increased at 24 h (2.3-fold) and 48 h (2.4-fold) after UV irradiation. Real-time PCR analysis also showed that the mRNA level of TRPV1 was augmented by 2.4-fold at 4 h after UV irradiation. TRPV1 protein was expressed at higher levels by 2.6-fold in the sun-protected skin of the elderly subjects than in that of young people according to western blotting, real-time PCR analysis and immunohistochemical staining. In addition, the photoaged skin of elderly showed increased expression of TRPV1 mRNA and protein compared with that of the sun-protected skin of the same individuals. Also, we found increased expression of TRPV1 in nerve fibres of elderly persons using double staining of TRPV1 and nerve fibres.
Based on the above results, our data suggest that the expression of TRPV1 is affected by both the intrinsic ageing and photoageing processes.     

Differential effects of UV irradiation on nuclear retinoid receptor levels in cultured keratinocytes and melanocytes

A major risk factor for skin cancer is UV irradiation, which not only damages DNA and other photosensitive compounds like vitamin A, but may also perturb cellular signaling, e.g. via the retinoid receptor system believed to be important for cancer protection. We used cultured normal human keratinocytes and melanocytes to examine the effects of UV irradiation on the expression of the predominant retinoid receptors in the human skin (RARalpha, RARgamma and RXRalpha) and the AP-1 protein c-Jun; mRNA levels were studied by real-time PCR and protein levels by Western blot. In keratinocytes, a single dose of UVB (50 mJ/cm2) caused a rapid drop in the expression of all three receptors (mRNA levels minus 35-50% after 4 h; protein levels minus 20-45% after 8 h), which was followed over the next 40 h by a variable response, leading to full normalization for RARalpha only. In contrast, the levels of c-Jun did not change significantly after UV exposure. In melanocytes, UVB caused a similar drop of the retinoid receptor levels as in keratinocytes but this was soon followed by an increased expression leading to a complete normalization of all receptor levels within 1-3 days. The c-Jun levels in melanocytes increased 1 day after UV exposure and remained high (plus 50%) thereafter. In both cell types, a approximately 3-fold increase in apoptosis (measured by DNA fragmentation) was observed 8-48 h after UVB irradiation. In conclusion, a depletion of vitamin A and retinoid receptors by UV irradiation, together with unchanged or even increased c-Jun levels, might seriously interfere with retinoid signaling and thus promote future tumor development, especially in keratinocytes.     

Unusual wrinkle formation after temporary skin fixation followed by UVB irradiation in hairless mouse skin

Abstract Generally, many wrinkles form on the human face, and temporary wrinkles eventually become permanent. We evaluated the effects of temporary skin fixation on wrinkle formation after UVB irradiation using the back skin of hairless mice. In the group treated with UVB irradiation immediately after production using cyanoacrylate resin of an artificial groove parallel to the midline, wrinkles formed parallel to the midline, an uncommon direction for wrinkle formation in this mouse model. These wrinkles did not disappear even when the skin was stretched. No such changes were observed in the group in which only the temporary groove alone was produced without UVB irradiation. In 3-D surface parameter analysis, all roughness parameters in the group treated with UVB irradiation immediately after production of an artificial groove were significantly increased relative to the age-matched control group. In contrast, no differences were observed between the group in which only the temporary groove alone was produced without UVB irradiation and age-matched controls. The results of this study suggest that both a temporary groove in the skin and UVB irradiation are necessary for wrinkle formation in the back skin of hairless mice.