BACKGROUND AND OBJECTIVES:The incidence of skin cancer continues to rise, with ultraviolet (UV) radiation exposure representing its main modifiable risk factor. Military personnel constitute a particularly vulnerable population due to the combination of occupational and recreational sun exposure, together with operational constraints related to uniforms and working conditions. The aim of this study was to assess knowledge, habits, and attitudes related to sun exposure and photoprotection among Spanish military personnel, and to explore differences in photoprotective practices according to sociodemographic and professional variables. MATERIALS AND METHODS:A cross-sectional observational study was conducted using a validated self-administered questionnaire in a sample of 500 active-duty Spanish military personnel from different ranks. Data collected included sociodemographic and phenotypic characteristics, knowledge, habits, and attitudes. Descriptive analyses and bivariate inferential analyses using non-parametric tests were performed. RESULTS:Most participants reported frequent sun exposure in both occupational and leisure settings, with longer daily exposure during leisure time; 81.6% reported exposure of ≥ 3 h per day. Overall, 73.4% experienced at least one sunburn in the previous year. Sunglasses and sunscreen were the most commonly adopted photoprotective measures, whereas avoidance of peak sun hours and use of protective clothing were infrequent. Knowledge of UV radiation risks was generally high, although misconceptions persisted regarding shade protection and vitamin D exposure. Photoprotective practices were significantly poorer during leisure time than during occupational activities (p < 0.01). CONCLUSIONS:Spanish military personnel demonstrate adequate knowledge and positive attitudes toward photoprotection but insufficient protective practices, particularly outside the occupational setting. These findings highlight the need to strengthen health education and integrate photoprotection into military training and operational environments.
AIMS:The transdermal permeation of UV filters has long been a concern among consumers and researchers. Among them, the permeation of small-molecule UV filters such as homosalate (HMS) (molecular weight < 500 Da) and the regulatory effects of formulation components on its permeation have not been fully investigated. Furthermore, sunscreen formulations containing skin brightening agents have become increasingly prevalent in recent years. Thus, verifying how to adjust formulation components to reduce UV filter permeation while not influencing the permeation of active ingredients such as the skin-brightening agent niacinamide is worthy of research. METHODS:This study investigated the skin permeation of formulations containing HMS using an improved confocal Raman spectroscopy method. RESULTS:Among the tested UV filters, HMS exhibited the highest permeation, with a relative permeability rate of 4.2% and a maximum permeation depth of 60 μm. Subsequently, adjusting the proportion of components in the formulation indicated that thickeners (Carbomer and Acrylates/C10-30 Alkyl Acrylate Crosspolymer) and emulsifiers (PEG (Polyethylene Glycol)-100 Stearate/Glyceryl Stearate) could reduce the permeation of HMS, while the film-formers (VP (Vinylpyrrolidone)/Eicosene) had no impact on HMS permeation. Based on these findings, a real-life sunscreen formulation was designed and verified to reduce HMS permeation while ensuring effective skin permeation of niacinamide. CONCLUSION:The permeation of different single UV filters by confocal Raman spectroscopy suggested that HMS exhibited the deepest permeation. Subsequently, by designing a series of distinct formulations, we identified the formulation components that influence the permeation of HMS. Based on the study findings, a practical formulation was designed that not only minimizes the permeation of the UV filter (HMS) but also does not inhibit the permeation of the skin-brightening agent. This study may serve as a reference for subsequent investigations into the permeation of UV filters.
BACKGROUND/PURPOSE:Visible light (VL), and particularly high-energy visible light (HEVL), reaching Earth's surface has emerged as a relevant contributor to skin damage. VL has been implicated in oxidative stress, inflammation, pigmentation disorders, and photoaging, especially in individuals with darker skin phototypes. As conventional sunscreens offer limited protection in the visible spectrum, increasing attention has been directed toward complementary photoprotective strategies, including the use of natural compounds with antioxidant and anti-inflammatory properties. This systematic review aims to evaluate and synthesize the available preclinical and clinical evidence on the photoprotective effects of natural compounds against VL-induced skin damage, emphasizing their mechanisms of action, efficacy, and safety. METHODS:A comprehensive literature search was performed to identify studies reporting validated objective outcomes, including colorimetric parameters, diffuse reflectance spectroscopy, or clinical grading scales. Eligible studies were included, qualitatively synthesized, and risk of bias was evaluated. RESULTS:Preclinical studies demonstrated that natural compounds mitigated VL-induced oxidative stress, inflammation, and pigmentation-related pathways. Clinical studies showed that formulations containing natural compounds improved VL-induced erythema and pigmentation outcomes. However, considerable heterogeneity was observed in irradiation protocols, outcome measures, and study designs, precluding quantitative meta-analysis. CONCLUSION:Overall, available evidence supports a protective role for selected natural compounds against VL-induced skin damage, particularly through antioxidant and anti-inflammatory mechanisms, with the strongest clinical evidence focusing on natural sources of polyphenols. Nevertheless, this review highlights the need for standardized phototesting protocols and well-designed clinical trials. Future research should focus on comparative efficacy, long-term safety, and integration of natural compounds into combined photoprotection strategies tailored to different skin phototypes.
INTRODUCTION:Home phototherapy for psoriasis is non-inferior to office-based care, yet adoption remains limited by implementation barriers, inconsistent patient selection, and underrecognized safety gaps. This narrative review synthesizes recent evidence to address these gaps and provide actionable clinical guidance. METHODS:PubMed and Embase were searched for studies published between January 1, 2020, and March 1, 2026, yielding 12 included studies. Study types included randomized controlled trials (RCTs), observational studies, cost analyses, implementation reports, and technical device comparisons; findings are interpreted by study design without formal risk-of-bias assessment. RESULTS:The LITE randomized trial demonstrates that home narrowband ultraviolet B (NB-UVB) phototherapy is non-inferior to office-based treatment in patients with plaque and guttate psoriasis, with high satisfaction, improved adherence, and reduced indirect costs. Erythema was the most common adverse event and rarely led to discontinuation; long-term safety data remain limited. CONCLUSION:Home phototherapy is safe and effective for appropriately selected patients with plaque or guttate psoriasis and represents an underutilized, cost-effective alternative to office-based care. This review identifies three gaps that must be addressed to realize its potential: absence of long-term UV exposure and skin cancer data, equity barriers that may paradoxically limit access for the patients who stand to benefit most, and uncharacterized safety risks of over-the-counter devices. Closing these gaps through prospective safety studies, equity-centered implementation, and regulatory oversight will be essential to establishing home phototherapy as a widely accessible, evidence-based standard of care.
BACKGROUND:Post-inflammatory hyperpigmentation (PIH) is among the most burdensome sequelae of inflammatory dermatoses in skin of color (SOC), and reduction of visible pigmentation represents the primary clinical outcome of interest. Tinted sunscreens containing iron oxides and/or pigmentary titanium dioxide are currently the best-evidenced strategy for preventing visible light-driven PIH in SOC. However, cosmetic unacceptability-including white cast, poor shade match, and texture incompatibility with acne-prone skin-significantly limits real-world adherence. This concept paper proposes a clinical reframing: when pigment-based visible light filters are not tolerated, pigmentation reduction may be achievable through proactive topical actives with direct anti-pigmentation activity. METHODS:This commentary synthesizes the mechanistic and clinical literature on high-energy visible light (HEVL)-driven pigmentation in SOC, with particular focus on the opsin-3-MITF-melanogenesis axis and topical actives with demonstrated anti-pigmentation activity against HEVL-induced melanogenesis. Evidence is presented to support a proposed clinical reframing and pragmatic algorithm. RESULTS:HEVL activates opsin-3 on melanocytes, upregulating MITF and promoting formation of stable, autophagy-resistant melanosomes-a mechanism distinct from UVA-driven photooxidation and particularly relevant in darker phototypes. Four prototypical actives with direct clinical or preclinical evidence against HEVL-induced pigmentation are reviewed. CONCLUSION:Pigmentation reduction-rather than the mechanism by which it is achieved-should be recognized as the primary clinical endpoint in photoprotection for PIH in SOC. When pigment-based visible light filters containing iron oxides and/or pigmentary titanium dioxide are cosmetically unacceptable, a strategy combining broad-spectrum UVA1 photoprotection with a topical active with anti-pigmentation activity represents a rational, evidence-informed alternative that keeps the clinical goal firmly in focus.
BACKGROUND:The epidermal permeability barrier is crucial for skin homeostasis and defending against ultraviolet radiation. While it's known that barrier dysfunction is a feature of many dermatoses, how different degrees of barrier dysfunction affect acute and chronic responses to UVA and UVB remains unclear. This study compared erythema and pigmentation responses in skin with different levels of barrier dysfunction. METHODS:Forty-nine healthy female subjects (Fitzpatrick skin types III-IV) were enrolled. Barrier-impaired models were created on one volar forearm by tape stripping; the contralateral forearm served as a control. Both sites received graded doses of UVA and UVB. Skin color was assessed using a spectrophotometer to obtain L* (lightness) and a* (redness) values. Changes (△L, △a) were compared between barrier-impaired and normal skin immediately, 24 h, and 2 weeks after irradiation. RESULTS:The influence of skin barrier integrity on UVA-induced immediate pigment darkening varies with UVA dose: a more compromised barrier correlates with a stronger response at low doses, whereas normal skin exhibits a more pronounced reaction at higher doses. Moderate-to-severe barrier damage led to more pronounced persistent pigment darkening and delayed tanning after UVA. Following UVB exposure, severely impaired skin exhibited more pronounced delayed erythema and post-inflammatory hyperpigmentation than normal skin. CONCLUSION:An intact epidermal permeability barrier contributes to protecting the body from UV-induced damage. Therefore, restoring and maintaining an intact epidermal barrier should be considered a fundamental strategy in photoprotection and the clinical management of disorders associated with barrier dysfunction.
BACKGROUND:Visible light (VL, 400-700 nm) and long wavelength UVA1 (VL + UVA1, 370-700 nm) have been reported to cause erythema in light skin phototypes, Fitzpatrick skin types I-III (FST I-III), and to exacerbate pigmentary dermatologic conditions (e.g., melasma, hyperpigmentation, post-inflammatory hyperpigmentation) in individuals with dark skin phototypes (FST IV-VI). Until recently, limited options existed for photoprotection against VL + UVA1, including tinted formulations containing iron oxides (Fe2O3) or pigmentary titanium dioxide (TiO2), as well as antioxidant-enriched sunscreen systems. Zinc oxide (ZnO) and TiO2 are often utilized in the development of mineral-based (inorganic) sunscreens as the active ingredients to protect against broad spectrum Ultraviolet (UV) radiation via their absorption properties. However, some of these products often leave a white cast, particularly on dark skin, making these products unfavorable, altering skin tone appearance leading to concerns for sunscreen compliance. Tinted sunscreens (Fe2O3) are designed to enhance cosmetic elegance and improve compliance across diverse skin tones. This study aims to evaluate the photoprotection properties of a novel Zn-based inorganic tinted sunscreen enriched with five antioxidants (5 AOX) against VL + UVA1 induced biologic effects (hyperpigmentation and erythema). METHOD:Twelve healthy adult subjects with FST IV-VI were enrolled and the effectiveness of the new Zn/Fe2O3/5 AOX sunscreen, compared to several commercially available tinted and non-tinted mineral sunscreens, was evaluated. The erythema and pigmentation assessments were performed by diffused reflectance spectroscopy (DRS), polarized photography, and investigator global scoring immediately, 24 h, and 7 days after irradiation (320 J/cm2). RESULTS:DRS results demonstrated that the novel Zn/Fe2O3/5 AOX effectively reduced immediate erythema and pigmentation as well as delayed pigmentation when compared with formulas containing ZnO only (p < 0.05). Not all inorganic/Fe2O3 formulas significantly reduced erythema and pigmentation induced by VL + UVA1 when compared with the ZnO only formula. CONCLUSION:These results highlight the enhanced effects of 5 AOX-enriched tinted mineral sunscreen to be photoprotective against VL + UVA1, with a blendable tint designed for use on skin of all colors aimed at improving patient compliance and overall sunscreen use.
BACKGROUND:Despite scientific documentation of the role of oxidative stress in the pathophysiology of vitiligo, the effectiveness of antioxidants in treating the condition is still debated. The objective of this study was to compare the efficacy of gliadin-protected superoxide dismutase (GP-SOD) in combination with targeted ultraviolet B phototherapy to targeted phototherapy alone for patients with localized vitiligo. METHODS:A 6-month, prospective, single-center, comparative study was conducted in 40 vitiligo patients. All patients received an excimer lamp and half, randomly assigned, received in addition GP-SOD. The primary endpoint was the difference between the treatment arms in terms of repigmentation at 6 months, using the VASI (Vitiligo Area Scoring Index). VitiQol was used to assess the quality of life. RESULTS:At 6 months, GP-SOD + UVB and UVB alone groups both demonstrated a significant improvement in VASI, respectively: -1.65 ± 0.08 (standard error, SE) (p < 0.0001) and -1.14 ± 0.08 (SE) (p < 0.0001). The mean difference between the two groups was 0.51 (95% confidence interval (IC95%) 0.28-0.74, p < 0.0001). The VitiQoL improvement difference was 5.59 (IC95% 4.01-7.17, p < 0.0001), indicating a superior improvement in quality of life with the combination treatment. CONCLUSION:Combining GP-SOD with targeted phototherapy significantly increases the effectiveness of phototherapy in repigmenting vitiligo lesions.
BACKGROUND/PURPOSE:Phototoxicity is a common adverse effect triggered by systemic or topical drug treatments. It is mainly caused by drug-induced sensitization to UVA radiation, arising from either the drug's inherent photosensitizing potential or its interference with the metabolism of endogenous photosensitizers. A potent endogenous UVA sensitizer is 6-formylindolo[3,2-b]carbazole (FICZ), a tryptophan photoproduct formed in UVB-irradiated epidermal cells. By sequentially activating the aryl hydrocarbon receptor signaling pathway and inducing cytochrome P450 (CYP) 1A1 expression, FICZ induces its own degradation. Recently, we reported that the BRAF inhibitor vemurafenib interferes with CYP1A1 activity and sensitizes keratinocytes to FICZ/UVA-induced phototoxicity. Herein, we screened 12 clinical drugs, known to exhibit phototoxicity in patients, for their potential to interfere with the metabolism of (exogenous) FICZ and sensitize HaCaT keratinocytes to UVA-induced phototoxicity. METHODS:The UV-VIS absorption of the drugs was determined, and their effect on CYP1A1 activity and FICZ/UVA-triggered apoptosis was assessed in immortalized and primary human keratinocytes using 7-ethoxyresorufin-O-deethylase (EROD) and caspase-3 activity assays. Moreover, the impact of the candidate drugs on the metabolic degradation of FICZ in cells (LC analysis) as well as on the generation of oxidative stress (MitoSOX assay, qPCR analyses) was investigated. RESULTS:We identified two drugs, erlotinib and leflunomide, to sensitize human keratinocytes to FICZ/UVA-induced apoptosis by inhibiting CYP1A1 activity. Moreover, both drugs attenuated the metabolic breakdown of FICZ, enhanced the FICZ/UVA-triggered formation of mitochondrial superoxide anions, and increased heme oxygenase-1 (HMOX1) transcript levels, indicative of antioxidant defense activation. CONCLUSION:Disruption of FICZ metabolism may contribute to the phototoxicity of drugs.
BACKGROUND:Photoprotection has traditionally focused on ultraviolet (UV) radiation, particularly UVB and UVA. Recent evidence highlights the significant role of long-wavelength UVA1 (LW-UVA1, 370-400 nm) and visible light (VL; 400-700 nm) in inducing pigmentation, erythema, and photoaging. This review study summarizes recent advances in LW-UVA1 and VL photoprotection and discusses emerging UV-filter formulations, non-filtering protective ingredients (PINGs), personalized photoprotection, skin microbiome, and environmental considerations. METHODS:A literature review was conducted using PubMed and Google Scholar online databases to identify recent studies on LW-UVA1 and VL-related photoprotection. Studies were screened for direct relevance to VL and LW-UVA1 and excluded if not available in English, lacked relevance, or had insufficient methodological detail. This review represents a narrative synthesis without formal systematic quality assessment. Results are summarized. RESULTS:LW-UVA1 and VL exert synergistic effects on the skin, resulting in erythema and sustained pigmentation. Advances include tinted mineral sunscreens with expanding shade ranges, newer UV filters with broader coverage (e.g., Mexoryl 400, TriAsorB), and oral and topical PINGs to be used as potential adjuncts. Environmental concerns for currently used UV filters persist, however. Skin microbiome has also emerged as a target and potential source for novel photoprotective agents. Personalized photoprotection recommendations now provide an individualized approach, taking skin phototype, lifestyle, and risk profile into consideration. CONCLUSION:Photoprotection is expanding to include a broader-spectrum coverage, including LW-UVA1 and VL with new filters, formulations, and adjuncts. These innovations enhance UV protection, but environmental and long-term safety concerns highlight the need for continued research to ensure safe, effective, and inclusive photoprotection.
BACKGROUND:Sunlight is essential for vitamin D synthesis and contributes to mood regulation, but it is also a major risk factor for skin aging and carcinogenesis. While the cutaneous and immune effects of ultraviolet radiation are well documented, its potential impact on brain function remains poorly understood. This review aims to synthesize current evidence on the effects of ultraviolet exposure on the central nervous system, with a particular focus on photoimmunological mechanisms and skin-derived signaling pathways. METHODS:We conducted a narrative review of experimental and clinical studies investigating the systemic and neurological consequences of UV exposure. Findings from photodermatology, immunology, neuroscience, and microbiome research were integrated to examine potential skin-brain interactions. RESULTS:UV exposure induces systemic inflammatory responses and immunosuppression, alters the skin microbiome, and modulates circulating neuroactive mediators. These processes are associated with changes in neurotransmitter systems, neuroplasticity, and brain structure in both animal models and human studies. Emerging evidence supports the existence of indirect pathways linking UV-induced skin and immune responses to central nervous system function, including immune and microbiota-related mechanisms. CONCLUSION:Collectively, available data suggest that UV radiation may influence brain function indirectly through interconnected skin, immune, and microbiota pathways. As interest in balanced and "healthy" sun exposure increases, further interdisciplinary research is needed to clarify the neurological consequences of UV exposure and to assess its potential implications in photodermatology and photomedicine.
BACKGROUND/PURPOSE:The UVB and UVA components of terrestrial solar ultraviolet radiation (UVR) cause acute and chronic damage to skin. These adverse effects can be reduced by sunscreen application. The sun protection factor (SPF) is primarily a measure of UVB protection against erythema and does not quantify protection from UVA, which is the major component of solar UVR. The study aim was to assess UVA protection in relation to labelled SPF and to determine if this met the EU recommendation for a SPF/UVA-PF ratio of ≤ 3, as recommended by the EU. Unlike SPF assessment, there is no universal consensus for the determination and labelling of UVA-PF. METHODS:Thirty-eight sunscreens with SPF ≥ 50 were selected from Europe, Latin America, Oceania, and Asia. UVA-PF was determined with the ISO 24442:2011 in vivo method, which assesses the ability of a sunscreen to inhibit persistent pigment darkening induced by UVA radiation in a laboratory environment. RESULTS:There was variation of UVA-PF ranging from 3.6 to 46.6. Sixty-eight percent (26/38) of sunscreens complied with EU recommendations. Thus, about one third failed these standards, with SPF/UVA-PF ratios varying from 3.1 (borderline failure) to 16.7 (major failure). Failure to comply was observed in several products sold in Europe. CONCLUSION:The study demonstrates the limitations of many commercial sunscreens to reach EU standards, with significant variations in UVA protection and a lack of relationship between SPF and UVA-PF values. This highlights the importance of improving labelling standards to ensure consumers receive consistent and adequate UVA protection, especially for those with UVA-dependent photodermatoses. TRIAL REGISTRATION:ClinicalTrials.gov: NCT06068010.
BACKGROUND/PURPOSE:Granuloma annulare (GA) is a chronic inflammatory dermatosis with limited effective treatments and inconsistent response rates across modalities. The Goeckerman protocol, consisting of coal tar, phototherapy, and topical corticosteroids (TCS), has demonstrated robust efficacy in other inflammatory dermatoses but has not been systematically evaluated in GA. This study aimed to characterize treatment outcomes across multiple therapeutic approaches, including the Goeckerman protocol, and to explore clinical factors associated with treatment response. METHODS:A retrospective cohort study was performed at Sheba Medical Center (2010-2024) including 240 patients with biopsy-confirmed GA. Treatment modalities included TCS, phototherapy, combination therapy, the Goeckerman protocol, and observation. Responses were dermatologist-assessed as complete, partial, or none. Multivariate logistic regression was used to examine factors associated with treatment response. RESULTS:Among 240 patients (mean age 55.4 years; 77.5% female), 184 had follow-up data (median 3.0 months). The overall response rate was 58.2% (107/184). Response differed significantly by modality: Goeckerman protocol 93.5% (29/31), TCS + phototherapy 69.6% (16/23), TCS alone 56.3% (49/87), no active treatment 32.4% (12/37), and phototherapy alone 16.7% (1/6). In multivariate analysis, the Goeckerman protocol was the strongest factor associated with treatment response (odds ratio [OR] 32.52; 95% CI 7.45-233.64; p < 0.001), followed by combination therapy (OR 5.79; p = 0.006) and TCS (OR 2.82; p = 0.015). Hyperlipidemia was associated with response in univariate analysis but did not remain significant in the multivariable model. CONCLUSIONS:Treatment modality was the factor most strongly associated with treatment response in this cohort. The Goeckerman protocol demonstrated a notably high response rate compared with other commonly used therapies. Although these findings should be interpreted in the context of a retrospective design and potential selection bias, they suggest that intensive multimodal anti-inflammatory therapy may represent a promising treatment strategy for this challenging condition.
BACKGROUND:Solar urticaria is a rare photodermatosis in which exquisite photosensitivity can require extreme behavioural adaptations, resulting in a substantial impact on quality of life (QoL). Omalizumab therapy has been demonstrated to improve several clinical outcome measures, but the impact on behavioural measures is poorly understood. Our objectives were to examine daylight exposure behaviours and QoL measures pre- and post-omalizumab therapy. METHODS:Daylight exposure diaries were completed by n = 5 patients with solar urticaria and n = 7 healthy participants during different seasons in England, UK (51.1-53.5oN). These incorporated a range of measures, including time spent outdoors and clothing worn, and Dermatology Life Quality Index (DLQI) data were also collected. RESULTS:Prior to omalizumab, patients spent less time outdoors in sunny vs. non-sunny conditions in spring (mean 10 vs. 29 min/day, p < 0.05) and less than healthy volunteers (44 min in sunny conditions/day). On omalizumab, patients increased their time outdoors in sunny conditions, reaching similar levels to healthy volunteers in spring (45 min/day) and further increasing to 85 min/day in summer. This was accompanied by fewer days with symptoms (symptoms on 75% days in spring pre-omalizumab vs. 26% days in summer on omalizumab), an apparent doubling of skin surface area exposure and substantial improvement in patients' QoL (mean past-year DLQI pre-omalizumab vs. past-week summer on omalizumab 22 vs. 5, p < 0.001). CONCLUSION:Omalizumab therapy was associated with behavioural changes that increase daylight exposure, accompanied by improved QoL. This study highlights the importance of considering a range of outcome measures in assessing response to therapy.
BACKGROUND:Research shows that sunburn is related to the inflammatory response caused by lipids. The atherogenic index of plasma (AIP) can evaluate the lipid profile through the interaction of different lipid components. However, whether AIP is related to the risk of sunburn has not been confirmed. METHOD:The method is to include 11,241 National Health and Nutrition Examination Survey (NHANES) participants, and use multivariate logistic regression analysis to analyze the association between AIP and the risk of sunburn. Further subgroup analyses explored the correlation between AIP and sunburn, supplemented by interaction tests to assess model robustness. Additionally, restrictive cubic sample plots were examined to further investigate the nonlinear relationship between AIP and sunburn. RESULTS:Multivariate logistic regression analysis revealed that individuals with higher AIP indices exhibited a higher prevalence of sunburn. Restricted cubic spline analysis demonstrated a positive linear dose-response relationship between AIP and sunburn. Subgroup analysis and interaction tests indicated that the positive correlation between AIP and sunburn prevalence was consistently observed across different populations (all p > 0.05). CONCLUSION:There is a positive correlation between AIP and the risk and severity of sunburn. Future research needs to carry out longitudinal studies to determine the causal relationship.
