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Understanding individuals\' skin pigmentation and photosensitivity is important in judging risk of skin cancer and response to certain treatment modalities. However, individuals with darkly pigmented skin are poorly represented in the widely used Fitzpatrick skin phototype (FST) system. Moreover, the FST system is prone to misuse, as it relies on subjective patient and clinician assessment of skin type, and does not clearly differentiate pigmentation from photosensitivity. By evaluating the key literature surrounding the FST system, its criticisms and proposed alternatives, this review serves to understand how skin phototype classification can be optimised.

Raising awareness about sun protection is an ongoing challenge. In 2018, a Survey Monkey questionnaire was distributed among healthcare professionals in the United Kingdom looking at their own habits of sunscreen usage. A total of 165 responses were collected. Eighty-nine percent of our respondents would use sunscreen when outdoors 11am-3pm on a cloudless, sunny day in August in the UK. However, only 27% of these healthcare professionals would regularly reapply sunscreen every 2 hours. The most important reason for using sunscreen was avoiding sunburn (importance weighted average of 4.71, on a scale from 1 to 5), followed by avoiding skin cancer (4.49) and skin ageing (4.06). On an importance scale from 1 to 5, the most important sunscreen characteristics, when choosing or recommending a product, were the level of UVA protection (importance weighted average 4.48), its stickiness (3.85) and degree of water-resistance (3.77).

Photobiomodulation (PBM) has been suggested as an alternative treatment for melasma. In vitro studies have shown PBM with amber light inhibits the tyrosinase enzyme, induces autophagy and reduces the melanin content, but randomised controlled clinical trials are still needed. This study aims to evaluate the efficacy of amber PBM (590 nm) in the treatment of melasma compared with liposomal tranexamic acid.
This study is a controlled, randomised, double-blind, non-inferiority trial. This study will be performed in two centres (Universidade Nove de Julho Facility, Campus Vergueiro, and Galache Odontology Clinic, São Caetano do Sul, both in São Paulo State, Brazil). The sample (54 participants) will be divided into two groups in a 1:1 ratio; one group will receive active PBM and a placebo cosmetic and the other will receive sham PBM and liposomal tranexamic acid. Women presenting facial melasma, aged 35-50 years, with skin phototypes II-IV, will be eligible for inclusion. Women who use oral contraceptives, intrauterine devices, hormone replacement or photosensitive drugs, those with autoimmune disease and those who have undergone facial treatments in the last 3 months will be excluded from the study. The participants will receive PBM weekly for 12 weeks and will use the cosmetic two times per day at home during this period. The severity of melasma will be evaluated through the Melasma Area and Severity Index (MASI) as the primary outcome; pigmentation of the epidermis evaluated by corneomelametry, the photographic records, the global diagnosis of the face and the quality-of-life questionnaire (Brazilian Portuguese version of the Melasma Quality of Life Questionnaire) will assessed as secondary outcomes. All assessments will be made before starting the study (week 0), mid-study at 6 weeks and at the completion of treatment (week 12). MASI will also be evaluated during follow-up (weeks 16 and 20). The data will be analysed based on the intention-to-treat analysis using a generalised mixed model, and α <0.05 will be considered statistically significant.
The protocol was approved by the Research Ethics Committee of Universidade Nove de Julho (5 332 384). All participants will fill out the patient informed consent form. The results obtained in this trial will be presented at conferences and submitted for publication.
ClinicalTrials.gov Registry (NCT05326997).

UNASSIGNED: Research exists examining sunburn risks, sun protective behaviors, and interventions among pool lifeguards; however, ocean lifeguard research is limited. This study aimed to determine sunburn prevalence and associations between sunburn with photoprotective attitudes and habits among Florida ocean lifeguards.
UNASSIGNED: A cross-sectional study was electronically administered in 2021 to ocean lifeguards using sun protection questions. Recruitment occurred through three lifeguard agencies. The frequency of self-reported sunburns from the prior season and the opinions and practices related to photoprotection and tanning were obtained.
UNASSIGNED: Complete data were obtained from 77 (37%) of 207 lifeguards who served during the 2020 swimming season (mean [SD] age, 22.9 [8.31] years; 40 male (52.0%) and 37 female (48.0%)). Sunburn was common with only four (5.2%) lifeguards reporting no sunburn. In total, 26 (33.8%) reported five or more sunburns. The median sunburn frequency was three. Reporting three or more sunburns was positively associated with being a teenager (16 to 18 years) (aOR: 14.9, 95% CI 3.5 to 64.2) or young adult (19 to 23 years) (aOR: 6.4, 95% CI 1.6 to 25.2) and having a neutral opinion regarding sunscreen effectiveness (aOR: 4.5, 95% CI 1.1 to 18.7) in logistic regression models.
UNASSIGNED: Self-reported sunburns were recalled and not clinically evaluated. Recall, participation, and social desirability biases may have been present.
UNASSIGNED: Ocean lifeguards reported appreciably high rates of sunburn, especially younger lifeguards. Increased photoprotection education, engineering controls, and research are warranted for this occupational group.

Vitiligo is a chronic skin condition with no cure. Clinical assessment and treatment evaluation relies heavily on clinometry tools and expert knowledge. The Vitiligo Extent Score has been proposed as one of the most reliable and easy-to-use clinometry tools for vitiligo.
We proposed a scoping review to identify all the available evidence on the clinical research availability around the Vitiligo Extent Score. The following databases will be searched: MEDLINE (PubMed), Embase, Open Grey, Lens and Directory of Open Access Journals. In addition, the approach proposed in the Joanna Briggs Institute Reviewer\'s Manual will be followed. Finally, this review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.
Ethics approval for this review is not required. We intend to publish the results in a specialised peer-reviewed journal and local, national and international conference presentations. It will also be incorporated as educational material in our institution\'s postgraduate programme in dermatology.

BACKGROUND: Hand eczema (HE) is one of the most common skin disorders and an important cause for morbidity and occupational disability. The 1-year prevalence of HE is estimated to be up to 10% and it is estimated that 5%-7% of those develop severe chronic HE. However, current clinical evidence is not compelling enough to guide clinical practice. In a survey among 194 UK dermatologists the most frequent first choice approaches were psoralen combined with ultraviolet A (UVA) treatment (PUVA), oral steroids and alitretinoin (AL). When asked which strategy was most efficient for long-term outcome 20% of clinicians indicated they did not know; 43% of clinicians reported AL and 30% reported PUVA.
METHODS: ALPHA is a multicentre, open, prospective, two-arm parallel group, randomised controlled trial comparing PUVA and AL with a planned sample size re-estimation. Between 500 and 780 participants will be randomised on a 1:1 basis. The physician\'s global assessment (PGA) will direct treatment after randomisation, non-responders will be treated according to usual clinical practice; providing valuable pilot data on second line therapeutic approaches to inform future trials.Assessments will be conducted up to 52 weeks post randomisation. The primary outcome measure is the Hand Eczema Severity Index at 12 weeks. Secondary outcome measures include modified Total Lesion Symptom Score, PGA, time to relapse, patient reported outcome measures and DNA extraction and assessment of genetic variants. A substudy on molecular inflammatory mediators will provide information on subgroup specific treatment responses. Photographs will be taken and HE severity assessed by a central review panel.
BACKGROUND: Ethics approval was obtained from Leeds West Research Ethics Committee (14/YH/1259).Trial results will be disseminated at relevant clinical conferences and societies, published in peer-reviewed journals and through relevant patient groups.
BACKGROUND: ISRCTN80206075.

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BACKGROUND: Biases inherent in self-assessment of sun exposure and sun-safe behavior may lead to inaccurate conclusions about the effectiveness of sun-safety educational programs.
OBJECTIVE: We aimed to compare self-reports to objective measures of sun exposure, when examining the effectiveness of passive versus active educational interventions.
METHODS: From May to June 2018, 73 participants recruited at a dermatology clinic were sequentially assigned to receive sun-safety education through one of 3 modes: interactive online module, video, or no education. A baseline Sun Exposure and Behavior Inventory (SEBI) questionnaire was administered, and spectrophotometric measurements of sun-exposed and sun-protected areas were taken and reported in the CIE L*a*b* color space. Participants were followed 4-8 and 16 weeks after the initial visit where the SEBI was re-administered, and serial measurements of skin color were taken. The change in SEBI scores and L*a*b values, as calculated by the individual typology angle (ITA°), was analyzed.
RESULTS: There was a significant increase in skin darkening in all the groups at 4-8 and 16 weeks follow-up. There was no statistically significant difference between the groups in the magnitude of color change. However, subjectively at 4-8 weeks post-intervention, participants in the interactive module and video groups had significantly improved self-reported SEBI scores compared to control (p < .05, Kruskal-Wallis). By 16 weeks, only the interactive module group showed significant improvement in SEBI scores compared to control (p < .05, ANOVA).
CONCLUSIONS: In determining the effectiveness of sun-safety programs, spectrophotometric evaluation of sun-induced skin pigmentation can allow for a more complete evaluation of self-reported sun exposure and sun-protective behavior.