Journal of Clinical and Aesthetic Dermatology • Hot Topics in Skin Health May 2023 • JOURNAL WATCH

☛ In the digital edition, click the PMID after each summary to access the article/abstract.

Summary. Hyperpigmentation disorders, such as melasma and postinflammatory hyperpigmentation (PIH), are common in patients with skin of color. Ultraviolet (UV) and visible light (VL) exposure contributes to melasma, and PIH occurs due to cutaneous inflammation caused by endogenous or exogenous factors. Utilizing sunscreen for photoprotection is the most effective way to protect against hyperpigmentation disorders. Various treatment options exist, but chemical peels and light therapy have an increased risk of posttreatment PIH in patients with skin of color.

Postinflammatory hyperpigmentation in dark skin: molecular mechanism and skincare implications

Markiewicz E, Karaman-Jurukovska N, Mammone T, Idowu OC. Clin Cosmet Investig Dermatol. 2022;15:2555–2565.

Summary. PIH occurs more frequently in darker skin tones, potentially due to differences in dermal-epidermal junctions, epidermal differentiation and stratification, and increased size and activity of melanocytes. UV radiation (UVR) can exacerbate PIH, so use of a broadspectrum sunscreen with a sun protection factor (SPF) of 30 or higher is recommended. Topical treatments can also help reduce inflammation and inhibit depigmentation.

Summary. Fliorent et al conducted a survey to evaluate racial differences in perceived sun exposure risks and sun-protective behaviors. Most of the 306 respondents were White (n=259), followed by Asian/Pacific Islander (n=19), Hispanic/Latino (n=15), and Black (n=13). Asian/Pacific Islander and Black participants had a significantly lower perceived risk of UV-related skin damage, compared to White participants. Black respondents reported significantly lower sunscreen usage than White respondents. White patients reported the highest level of education on sun exposure risks, but the difference was not significant between any group.

Summary. Here, Fazel et al aimed to develop educational messages to increase sun safety among outdoor workers. The primary recommended actions included providing information on the UV index, using group sources of shade (e.g., tarps, canopies), and accounting for safety goggle and glasses in eye protection. Tips on seeking shade, wearing appropriate clothing, and applying sunscreen were highlighted.

Attitudes, behaviors, and risks of sun protection to prevent skin cancer among children, adolescents, and adults

Summary. This review discussed attitudes toward and efforts to encourage sun-protective behaviors among youths and adults. For children and adolescents, the authors recommended implementing standardized educational programs to improve sun-protective behaviors and adding time for sunscreen reapplication during outdoor activities. Individualized programs or counseling might help reduce UV exposure in parents and their children; however, it is often difficult to cause positive behavioral changes, which poses a barrier to sun safety.

McKenzie C, Nahm WJ, Kearney CA, Zampella JG. Arch Dermatol Res. 2023:1–10. Epub ahead of print.

Summary. Analyzing data from the 2010, 2015, and 2020 National Health Interview Surveys (NHISs), McKenzie et al identified positive trends in engaging in sun-protective behaviors from 2010 to 2020. Respondents to the 2020 NHIS were more likely to seek shade, wear wide brimmed hats and long-sleeved shirts, apply sunscreen, and avoid sunburn than 2010 respondents. However, there was a decrease in sun avoidance from 2015 to 2020. Sex, age, education level, and sun sensitivity influenced certain behaviors.

Baig IT, Petronzio A, Maphet B, Chon S. Dermatol Pract Concept. 2023;13(1):e2023066.

Summary. Reviewing articles about education on or changing sun-protective behaviors in children, Baig et al found that the majority of studies measuring knowledge as an outcome saw significant increases in knowledge. Of the 60 studies that measured changes in behaviors, 48 demonstrated a positive impact on sunscreen application, wearing sun-protective clothing and hats, seeking shade, and avoiding outdoor activities during peak UVR exposure. Ten out of 15 studies showed decreases in sun exposure as well.

Association of sun safety behaviors and barriers with sunburn history in college students in a region with high UV exposure

Summary. From September to November 2019, Miller et al surveyed 458 college students in Tucson, Arizona, to determine sunprotective behaviors. A total of 46.9 percent of students reported at least one sunburn within the past three months, with 21 percent reporting multiple sunburns. Using sunscreen most or all of the time while in the sun was reported by 27.5 percent of respondents. Over half of respondents (53.3%) reported intentionally tanning their skin outdoors occasionally or more often, and tanning was significantly associated with sunburn history.

Dynamic visualization of ultraviolet dose on skin with sunscreen applied using minimum erythema dose

Summary. Here, Li et al developed a software system to dynamically visualize UVB dose on the skin. Environmental factors, SPF, and skin phototype were considered to accurately visualize UVB doses. A spectrum of red expressed in terms of minimum erythema dose (MED) was used to represent UVB dose in the models. Examples of outdoor and indoor exposure demonstrated the utility of the system.

Stump TK, Fastner S, Jo Y, et al. Int J Environ Res Public Health. 2023;20(7):5234.

Summary. Here, Stump et al analyzed UVR exposure and incidence of sunburn, measured with a wearable UVR sensor over 14 days, among parent-child dyads. Adjusting for Fitzpatrick skin phototype and location, total UVR exposure was associated with sunburn, with a one-standard erythemal dose (SED) increase raising the odds of sunburn by 1.26- and 1.28-fold among parents and children, respectively. Likewise, a one-SED increase during peak UVR exposure was correlated with increased odds of sunburn among parents and children.

Validity of a Self-Assessment Skin Tone Palette compared to a colorimeter for characterizing skin color for skin cancer research

Summary. Martin et al aimed to validate the nine-point Self-Assessment Skin Tone Palette (SASTP) through comparison with melanin index values from a colorimeter for the upper inner arm and outer forearm. Of the 188 participants, 50 percent were White, 30 percent were Hispanic/White-Hispanic, and 20 percent belonged to another racial category. SASTP was well correlated with the melanin index values for participants for both the upper inner arm and outer forearm.

1Tripathi R, Mazmudar, RS, Knusel KD, et al. Trends in emergency department visits due to sunburn and factors associated with severe sunburns in the United States. Arch Dermatol Res. 2021;313:79–88.