Algae Metabolites as an Alternative in Prevention and Treatment of Skin Problems Associated with Solar Radiation and Conventional Photo-protection

Abstract The histological structure and biochemistry of the skin is affected by solar radiation having adverse effects ranging from sunburns, premature aging that includes wrinkles, spots, dryness, and loss of collagen to cancer development. The skin has defense mechanisms to prevent damage caused by radiation, but when radiation exposure is excessive these mechanisms are not strong enough to protect the skin. The use of sunscreen is the most common practice of photo- protection. The active ingredients of these cosmetic protective formulations are generally from synthetic origin and have presented several drawbacks at the level of photo-stability, systemic absorption and can generate contact and photo-contact dermatitis. This review illustrates skin solar radiation problems, common sunscreen ingredients limitation and mentions how algae can be an alternative according to studies that have evaluated the photo-protective potential of extracts and compounds isolated by different techniques.

Conductas de exposición y protección solar en adolescentes y adultos de la Ciudad de México / Sun exposure and sun protection behaviors among teenagers and adults in Mexico City

Resumen Objetivo: Conocer la prevalencia de las conductas exposición y protección solar en un grupo de adolescentes y compararlos con un grupo de adultos en la Ciudad de México. Material y métodos: Estudio transversal descriptivo en estudiantes de 16 a 18 años y en adultos mayores de 18 años. Resultados: Se encuestaron 748 alumnos, 60 % mujeres y 40 % hombres. El 90 % busca la sombra, el 70.1 % evita exponerse al sol de las 10 a las 16 horas y el 30.6 % usa filtro solar. De 620 adultos, 67.5 % mujeres y 32.4 % hombres, el 82.6 % buscan la sombra, el 60.2 % evita el sol de las 10 a las 16 horas y el 48.1 % utiliza filtro solar. El 72.9 % de adultos y el 80.8 % de adolescentes se exponen al sol debido a actividades domésticas. Discusión: Existe una tendencia similar en las conductas de protección y exposición solar en adolescentes y adultos. Es alta la prevalencia de uso de fotoprotector en adultos en comparación con los adolescentes.

Abstract Objective: To know the prevalence of sun exposure and protection behaviors in a group of adolescents and to compare them with a group of adults in Mexico City. Material and methods: Descriptive, cross-sectional study in students aged 16 to 18 years and in adults older than 18 years. Results: Seven-hundred and forty-eight students were surveyed; 60 % were females and 40 % males; 90 % seek shade, 70.1 % avoid exposing themselves to the sun from 10.00 to 16.00 hours and 30.6 % use sunscreen. Out of 620 adults, 67.5 % were women and 32.4 % were men; 82.6 % seek shade, 60.2 % avoid the sun from 10.00 to 16.00 hours and 48.1% use sunscreen; 72.9 % of adults and 80.8 % of adolescents are exposed to the sun due to domestic activities. Discussion: There is a similar trend in sun protection and exposure behaviors in adolescents and adults. The prevalence of sunscreen use in adults is high in comparison with adolescents.

Bathing, make-up, and sunscreen: which products do children use? / Banho, maquiagem e protetor solar: o que as crianças usam?

ABSTRACT Objective: To evaluate the hygiene practices and frequency of use of personal hygiene products, cosmetics, and sunscreen among children and adolescents. Methods: Cross-sectional study with interviews about skincare conducted with caregivers through closed-ended questions. We included patients up to 14 years of age waiting for consultation in pediatric outpatient clinics of a tertiary hospital. We performed a descriptive statistical analysis and applied the Kruskal-Wallis test and Fisher's exact test to compare the practices according to maternal schooling. Results: We conducted 276 interviews. The median age of the participants was age four, and 150 (54.3%) were males. A total of 143 (51.8%) participants bathed once a day and 128 (46.3%) bathed two or more times a day, lasting up to ten minutes in 132 (47.8%) cases. Adult soap was used by 103 (37.3%) children and bar soap by 220 (79.7%). Fifty-three (19.2%) participants used sunscreen daily. Perfume was used by 182 (65.9%) children, hair gel by 98 (35.5%), nail polish by 62 (22.4%), and some type of make-up by 71 (25.7%) - eyeshadow by 30 (10.8%), lipstick by 52 (18.8%), face powder and mascara by 13 (4.7%). Make-up use started at a median age of 4 years. Henna tattoo was done in eight children. Conclusions: The children studied used unsuitable products for their skin, such as those intended for adults, used sunscreen inadequately, and started wearing make-up early, evidencing the need for medical orientation.

RESUMO Objetivo: Avaliar os hábitos de higiene e a frequência do uso de produtos de higiene pessoal, cosméticos e protetor solar nas crianças e adolescentes. Métodos: Estudo transversal com entrevistas para cuidadores sobre cuidados com a pele, por meio de perguntas fechadas. Incluídos pacientes de até 14 anos que consultavam nos ambulatórios pediátricos de um hospital terciário. Realizada estatística descritiva e aplicados os testes de Kruskal-Wallis e exato de Fisher para comparar os hábitos conforme a escolaridade materna. Resultados: Foram realizadas 276 entrevistas. A mediana de idade foi de 4 anos, sendo 150 (54,3%) crianças do sexo masculino. O número de banhos por dia foi de um em 143 (51,8%) casos e dois ou mais por parte de 128 (46,3%) indivíduos, com duração de até dez minutos em 132 (47,8%) dos participantes. O sabonete destinado a adultos era utilizado por 103 (37,3%) crianças e o sabonete em barra por 220 (79,7%) delas. Protetor solar era utilizado diariamente por 53 (19,2%) participantes. Perfume foi utilizado por 182 (65,9%) integrantes da amostra, gel de cabelo por 98 (35,5%), esmalte por 62 (22,4%) e algum tipo de maquiagem por 71 (25,7%) - sombra em 30 (10,8%), batom em 52 (18,8%), pó facial e rímel em 13 (4,7%). A mediana de idade de início do uso de maquiagem foi de 4 anos. Tatuagem de hena foi realizada em oito crianças. Conclusões: As crianças estudadas utilizavam produtos inadequados para a sua pele, como os destinados à pele do adulto, e faziam uso incorreto do protetor solar e uso precoce de maquiagem, mostrando a importância da orientação médica.

Conocimiento y conductas de protección solar de pescadores en Chile / Knowledge and sun protection behaviors of fishermen in Chile

INTRODUCCIÓN: La sobreexposición a la radiación ultravioleta (RUV) es un factor de riesgo importante para el desarrollo de cáncer de piel (CP). Aquellos trabajadores que realizan labores al aire libre, como los pescadores, son un grupo de riesgo, por lo que es importante saber si tienen los conocimientos y realizan las conductas que les permitan protegerse de la RUV. OBJETIVO: Evaluar en un grupo de pescadores el conocimiento respecto a los riesgos de la exposición solar y sus conductas respecto a medidas de protección solar. MATERIAL Y MÉTODOS: Los datos fueron obtenidos por encuestas a 133 pescadores. Se obtuvieron antecedentes sociodemográficos y se aplicó un cuestionario de 11 preguntas para evaluar conocimiento sobre riesgos de la RUV y conductas de fotoprotección. RESULTADOS: La cohorte incluyó a 133 pescadores, todos fueron hombres con edad promedio de 48 +/- 11,2 años. Un 86% de los pescadores conocía la relación entre exposición solar/CP. En cuanto al uso de filtro solar (FS), un 54,8% de los trabajadores reportó nunca haberlo utilizado y un 41% lo hacía solo una vez al día. Los pescadores con escolaridad incompleta presentan 2,6 veces menor probabilidad de utilizar FS (OR 2.6; p<0.05). Además, aquellos con conocimiento de la relación RUV y fotoenvejecimiento, presentaban 3,75 veces más probabilidad de utilizar FS (OR 3.75) (p<0.05). CONCLUSIÓN: Este primer estudio sobre protección solar en pescadores muestra que la mayoría están en conocimiento de los riesgos a la salud. Sin embargo, no utilizan las medidas de protección recomendadas y aquellos que las utilizan, no lo hacen de la manera adecuada.

INTRODUCTION: Overexposure to ultraviolet radiation (UVR) is the main risk factor for the development of skin cancer (SC). Outdoor workers, such as fishermen are a risk group. Therefore, it is important to study if they have the knowledge towards sun exposure and also to know their solar protection behaviors. OBJETIVE: To evaluate in a group of fishermen if they have the knowledge about the risks of solar exposure and their behavior regarding sun protection measures. MATERIALS y METHODS: Data was obtained from a survey applied to 133 fishermen. Collected information included sociodemographic characteristics and 11 questions about knowledge and their sun protection measures. RESULTS: The cohort included 133 fishermen, all were male with an age average of 48 +/- 11,2 years. 86% knew about the relation between solar exposure and skin cancer. When asked about sunscreen use, 54.8% declared they never used it and 41,0% did only once a day. The fishermen who had incomplete secondary school studies were less likely to use sunscreen (OR 2.6) (p<0.05). Those who had knowledge of the relation between UVR and aging were 3,75 times more likely to use sunscreen. CONCLUSION: This is the first study about solar protection knowledge and photoprotection measures upon fishermen, performed in Chile. Most fishermen were aware of the health risks. However, they do not use the recommended protection measures, and those who use them, do not do it properly

Brazilian version of the shriners hospital upper extremity evaluation (shuee): translation, cultural adaptation, and evaluation of psychometric properties / Versão brasileira do shriners hospital upper extremity evaluation: tradução, adaptação cultural e validação das propriedades psicométricas

ABSTRACT Objective: To validate the upper limb assessments tool, Shriners Hospital Upper Extremity Evaluation (SHUEE), for individuals with hemiplegic cerebral palsy in the Brazilian population. Methods: Validation study to translate and culturally adapt the Manual and the instrument. The psychometric properties evaluated were reliability and convergent validity. Reliability was determined by internal consistency (Cronbach's α coefficient), ceiling and floor effect, sensitivity to changes, and intra- and interobserver agreement. Convergent validity was performed using the Pediatric Motor Activity Log, the self-care scale of the Pediatric Evaluation of Disability Inventory, and the Manual Ability Classification System. Results: We evaluated 21 individuals with hemiplegic cerebral palsy, with a mean age of 8.7±4.0 years. After the instrument was translated, there was no need for cultural adaptation. The total Cronbach's α coefficient was 0.887 (95% confidence interval [95%CI] 0.745-0.970). We calculated sensitivity to changes in five subjects who underwent treatment with Botulinum Toxin Type A and physical therapy, with a significant difference between pre- and post-treatment evaluations in the Spontaneous Functional Analysis and Dynamic Positional Analysis. Convergent validity showed a significant correlation of the Spontaneous Functional Analysis and Dynamic Positional Analysis with the scales evaluated. All items of SHUEE presented high intra- and interobserver agreement. Conclusions: The results revealed that the Brazilian version of the SHUEE demonstrated good reliability and convergent validity, suggesting that it is an adequate and reliable tool for individuals with hemiplegic cerebral palsy in the Brazilian population.

RESUMO Objetivo: Validar o instrumento de avaliação do membro superior, Shriners Hospital Upper Extremity Evaluation (SHUEE), para indivíduos com paralisia cerebral hemiplégica da população brasileira. Métodos: Estudo de validação no qual foi realizada tradução e adaptação cultural do manual e do instrumento. As propriedades psicométricas avaliadas foram confiabilidade e validade convergente. A confiabilidade foi determinada através da consistência interna (coeficiente α de Cronbach), efeito teto e chão, sensibilidade à mudança e concordância intra e interobservador. A validade convergente foi realizada utilizando-se o Pediatric Motor Activity Log, a escala de autocuidados do Pediatric Evaluation of Disability Inventory e o Manual Ability Classification System. Resultados: Foram avaliados 21 indivíduos com paralisia cerebral hemiplégica com idade média de 8,7±4,0 anos. Após a tradução do instrumento, não houve necessidade de adaptação cultural. O coeficiente α de Cronbach total foi de 0,887 (intervalo de confiança de 95% [IC95%] 0,745-0,970). A sensibilidade à mudança foi calculada em cinco indivíduos que realizaram aplicação de Toxina Botulínica tipo A e fisioterapia, apresentando diferença significativa entre a avaliação pré e pós-tratamento na Análise Funcional Espontânea e Análise Posicional Dinâmica. A validade convergente mostrou correlação significativa da Análise Funcional Espontânea e Análise Posicional Dinâmica com as escalas avaliadas. Todos os itens do SHUEE apresentaram concordâncias fortes, tanto na avaliação intra quanto na interobservador. Conclusões: A versão brasileira do SHUEE demonstrou um bom desempenho em relação à confiabilidade e validade convergente, sugerindo ser uma ferramenta adequada e confiável para os indivíduos com paralisia cerebral hemiplégica na população brasileira.

Exposição solar e envelhecimento precoce em trabalhadores praianos do município de Salinópolis/PA / Solar exposure and early aging in beach workers of the municipality of Salinópolis/PA

Objetivo: Identificar a presença do envelhecimento precoce de pele em pescadores de Salinópolis/PA. Métodos: A pesquisa foi realizada com 275 pescadores, de 18 a 59 anos, no período de março a maio de 2016, sendo aplicados dois questionários: "Protocolo de Avaliação Facial ­ PAF" e "Hábitos de exposição e fotoproteção solar", ambos modificados pelas pesquisadoras. Resultados: Foi observada prevalência de trabalhadores praianos de 26 a 35 anos (36%), pele parda (70%), fototipo III (64%) e com a presença de fotoenvelhecimento (61%), que se expunham diariamente ao sol (97%), não possuíam cuidados com a pele (91%) e não usavam protetor solar (92%). Os voluntários relataram que não gostavam de aplicar protetor solar (59%) e desconheciam que a radiação ultravioleta causava envelhecimento da pele (60%), manchas na pele (54%) ou câncer (56%). Conclusão: A maioria dos pescadores não utilizavam fotoprotetores e apresentavam fotoenvelhecimento com predisposição a desenvolver câncer de pele. (AU)

Objective: To identify the presence of precocious skin aging in fishermen in Salinópolis/PA. Methods: The research was carried out with 275 fishermen, from 18 to 59 years of age, from March to May 2016. Two questionnaires were applied: "Facial Evaluation Protocol ­ PAF" and "Habits of exposure and solar photoprotection", both modified by the researchers. Results: The prevalence of beach workers from 26 to 35 years of age (36%), of brown skin (70%), phototype III (64%) and photoaging (61%), who were exposed daily to the sun (97%), did not have skin care (91%) and did not use sunscreen (92%). The volunteers reported that they did not like to apply sunscreen (59%) and were unaware that ultraviolet radiation caused skin aging (60%), skin blemishes (54%) or cancer (56%). Conclusion: Most fishermen did not use photoprotectors and presented photoaging with a predisposition to develop skin cancer. (AU)

A importância da atuação do médico do trabalho na prevenção do câncer de pele ocupacional / The relevance of the occupational physician in the prevention of occupational skin cancer

Contexto: Este artigo apresenta uma revisão bibliográfica sobre o câncer de pele no meio ocupacional, a epidemiologia e os filtros solares para o médico do trabalho. Objetivo: Orientar o médico do trabalho sobre o assunto e melhorar as estratégias de prevenção do câncer de pele ocupacional. Métodos: Artigo retirado de monografia realizada após pesquisa bibliográfica em sites de artigos médicos e de órgãos relacionados à saúde e ao trabalho, utilizando artigos de 2009 a 2014 e publicações relevantes sobre o assunto. Conclusão: O médico do trabalho é fundamental na educação sobre a doença e suas diversas formas de prevenção, além da notificação dos casos relacionados ao trabalho.

Background: The present article presents a literature review on occupational skin cancer, its epidemiology and sunscreens of interest to occupational physicians. Aim: To provide a guide to occupational physicians on the subject of interest and improve the strategies for prevention of occupational skin cancer. Methods: The present article derives from an essay resulting from research in websites of medical articles and agencies related to healthcare and work; articles from 2009 to 2014 and relevant publications on the subject were analyzed. Conclusion: Occupational physicians are fundamental for education on occupational skin cancer and its various forms of prevention, in addition to the notification of cases.

Intake of oral photoprotectors by postmen in Porto Alegre

Introduction: Postmen are daily exposed to high levels of solar radiation, and lack of protection can result in many health damages. The present study aimed to identify cutaneous phototypes and evaluate the intake of oral photoprotectors by postmen. Methods: Cross-sectional study, carried out from August 2011 to December 2012 in the city of Porto Alegre, state of Rio Grande do Sul, Brazil. Socioeconomic and behavioral data regarding daily solar exposure were collected through a questionnaire. To evaluate the intake of beta-carotene, lycopene and omega-3, two 24-hour dietary recalls were applied. Cutaneous phototypes were assessed by Fitzpatrick's classification. Results: A total of 181 postmen were analyzed, whose mean age was 40.2±11.4 years old, and 140 (77.3%) were male. The cutaneous phototypes II, III and IV were the most prevalent (n=138), totaling 76.3% of the sample. The median for the oral photoprotectors intake was 1.16 mg (0.46-2.29) of beta-carotene, 3.60 mg (1.01-6.31) of lycopene and 0.95 g (0.61-1.45) of n-3 fatty acids, all values significantly lower than the minimal doses to obtain photoprotective effect (p<0.001). The individuals in the group of phototypes V and VI showed lower adherence to the use of sunscreen and lower intake of beta-carotene, comparing to the other groups. Conclusions: The intake of oral photoprotectors is low in this population. Future studies may evaluate the real effect of oral photoprotectors, so that preventive measures using this approach can be included in photoprotection education actions for outdoor workers (AU)

O conhecimento e a utilização de filtro solar por profissionais da beleza / Level of awareness and the adequate application of sunscreen by beauticians

Resumo O objetivo desta pesquisa foi verificar o nível de instrução dos profissionais da área de estética em relação à utilização de filtro solar, e também identificar as orientações que estes passam aos seus pacientes. O estudo foi exploratório-descritivo, adotando a metodologia qualitativa ao entrevistar 30 profissionais da área. A coleta de dados foi feita por entrevistas semiestruturada na cidade de Maringá (PR). Os dados foram tratados com o software Atlas.ti a partir análise qualitativa e categorização das respostas. Dos entrevistados, 83,33% possuíam graduação em Estética, 20% participaram de atividade de formação continuada sobre o assunto, 73,17% adquirem o protetor solar pela qualidade, e 86,67% não conhecem filtros solares com componentes antirradicais livres naturais. Dos entrevistados, 80% nunca atenderam pacientes com câncer de pele, porém mencionaram ter conhecimento sobre os cuidados em relação à exposição solar e à forma de utilização do filtro solar e a relação dessas práticas com a doença. Os resultados mostraram que a indicação e o uso de filtro solar por profissionais da beleza vêm ocorrendo de maneira adequada e consciente.

Abstract The scope of this research was to establish the level of awareness of beauticians regarding the importance of the application of sunscreen and to identify whether their patients had been properly instructed by these professionals. It involved a descriptive and exploratory study with interviews applying qualitative methodology among 30 beauticians. Data were gathered using the semi-structured interview technique in Maringá, in the southern state of Paraná. The data were analyzed using Atlas.ti software after applying quantitative analysis and response classification. Of those interviewed, 83.33% had a degree in Aesthetics, 20% attended ongoing training activities on sunscreen and 73.17% acquired sunscreen for its quality, though 86.67% were not familiar with sunscreens with natural anti-free radical components. Of those interviewed, 80% had never treated patients with skin cancer, though they reported having knowledge of care in relation to sun exposure and how to use the sunscreen and the relationship of these practices with the disease. The results showed that the recommendations and use of sunscreen by beauticians and users has been conducted in an adequate and conscientious manner.

Conocimiento y actitud frente a exposición solar del personal de salud en Atención Primaria, comuna Recoleta, Santiago, Chile / Knowledge and attitude regardings sun exposure in the workers from primary health care, district of Recoleta, Santiago, Chile

Skin cancer rates have increased worldwide despite the current prevention measures. It’s crucial to evaluate people’s knowledge, attitudes, and behaviour regarding sun exposure. Objective: To assess the knowledge and attitudes regarding sun exposure in the workers from primary health care. Method: 223 workers from three Family Care Centres(CESFAM) and from one Primary Emergency Service (SAPU) in the district of Recoleta were surveyed between the months of October and November 2015. Fisher’s exact test and Chi square test were used for statistic analysis. The survey included questions about demographic variables, knowledge of the association between sun radiation/skin cancer and attitudes towards sun protection. Results: the sample consists of 74 men and 149 women, with a mean age of 37 years ±SD 7.9. Phototype III was the most common (41.3percent). The majority of the surveyed declared to be aware of the association between sun exposure and skin cancer (93.3percent). As photoprotecting measures, sunscreens (87.4percent) and seeking shade (71.3percent) were the most frequently measures used. Regarding sunburns, 91.9percent declared to have at least one during their lifetime, 21.5percent occurring during the previous summer. As to the use of sunscreen, 42.1percent referred only using while at the pool / beach and 12.6percent declared not to use it at all. As for health promotion, 29.1percent declared they never recommend the use of sun protection measures in their working practice. Discussion: Although there is adequate knowledge regarding the effects of sun exposure, it doesn’t always reflect on favourable attitudes and photoprotecting measures. There was a significantly greater amount of females with adequate knowledge and use of sun protection measures. This study is one of the first to assess photoprotection behaviour in health care workers.

Ácido ferúlico em protetores solares: desenvolvimento e eficácia multifuncional in vitro, ex vivo e in vivo / Ferulic acid in sunscreens: development and multifunctional effectiveness in vitro, ex vivo and in vivo

A conscientização da população com relação aos malefícios da radiação ultravioleta (UV) levaram à adoção de hábitos preventivos, com destaque para a utilização diária de formulações fotoprotetoras. Ainda que os filtros solares tradicionais sejam efetivos na absorção ou reflexão da radiação UV, sabe-se que a sua atuação contra os radicais livres é limitada, fator que exige a incorporação de compostos antioxidantes às preparações, visando proteção cutânea de excelência. O presente trabalho objetivou o desenvolvimento e avaliação de formulações multifuncionais contendo os filtros solares bemotrizinol e octil triazona, acrescidos do composto bioativo ácido ferúlico - reconhecido pelas suas propriedades antioxidante e fotoprotetora. As formulações foram desenvolvidas de acordo com um delineamento experimental do tipo fatorial (DoE 23) e avaliadas por meio de metodologias in vitro, in vivo e ex vivo para determinação de sua eficácia fotoprotetora e potencial antioxidante. As emulsões foram consideradas estáveis, seguras, com valor de pH biocompatível com a pele e viscosidade aparente adequada ao uso proposto. O delineamento experimental comprovou o potencial antioxidante e fotoprotetor do ácido ferúlico, visto que a presença deste promoveu aumento de até 90% na atividade antioxidante in vitro das formulações, bem como acréscimo de 32% no Fator de Proteção Solar (FPS) in vivo e 24% no Fator de Proteção UVA (UVA-PF). Por meio do ensaio ex vivo, a formulação contendo o ácido ferúlico apresentou tendência em aumentar a atividade antioxidante natural da pele, comparativamente à formulação contendo apenas os filtros solares e à pele não tratada; ademais, houve queda no potencial antioxidante da pele após a exposição à radiação UV, enfatizando a necessidade de proteção cutânea frente aos danos oxidativos. Os resultados comprovaram os efeitos antioxidante e fotoprotetor combinados do ácido ferúlico, em especial quando em sinergismo com filtros solares, tornando o composto bioativo um candidato promissor no desenvolvimento de formulações multifuncionais inovadoras, seguras e eficazes contra os efeitos nocivos decorrentes da exposição solar

The public awareness regarding the harmful effects of ultraviolet (UV) radiation led to preventive habits, especially the daily use of sunscreens. Although traditional solar filters are effective in UV radiation absorption or reflection, it is known that their activity against free radicals is restricted, an aspect that requires the incorporation of antioxidants to preparations, aiming superior skin protection. Here, we developed and evaluated multifunctional formulations containing the sunscreens bemotrizinol and ethylhexyl triazone plus the bioactive compound ferulic acid - known for its antioxidant and photoprotective properties. Formulations were developed according to a factorial experimental design (DoE 23) and evaluated using in vitro, in vivo and ex vivo methods to determine its photoprotective effectiveness and antioxidant potential. The emulsions were considered stable, safe, with pH value biocompatible with the skin and apparent viscosity suitable for the proposed use. The experimental design evidenced the photoprotective and antioxidant potential of ferulic acid, once its presence increased to 90% the in vitro antioxidant activity of the formulations, as well as 32% increase in the in vivo Sun Protection Factor (SPF) and 24% increase in the UVA Protection Factor (UVA-PF). Through the ex vivo assay, the formulation containing ferulic acid tended to increase the natural antioxidant activity of the skin, compared to the formulation containing only UV filters or the untreated skin; moreover, there was a decrease in the antioxidant potential of the skin after UV radiation exposure, emphasizing the need for skin protection against oxidative damage. The results confirmed the antioxidant and photoprotective effects of ferulic acid, especially when in synergy with UV filters, making the bioactive compound a promising candidate in the development of innovative, safe and effective multifunctional formulations against the harmful effects of sun exposure

Risk factors associated with hypovitaminosis D in HIV/aids-infected adults / Fatores de risco associados à hipovitaminose D em indivíduos adultos infectados pelo HIV/aids

Objective To investigate risk factors associated with hypovitaminosis D in adult patients infected with HIV/aids, at a referral hospital in Maceió, Brazil. Subjects and methods This cross-sectional study involved 125 patients evaluated from April to September 2013 by means of interviews, review of medical records, physical examination, and laboratory tests. The data were analyzed using the SPSS® software, version 17.0; the prevalence of hypovitaminosis D and mean levels of vitamin D were determined. The association between hypovitaminosis D and the independent variables was assessed using the Chi-square or the Fisher’s exact tests; mean vitamin D concentrations were analyzed using Kolmogorov-Smirnov, Mann-Whitney, and Kruskal-Wallis tests. The level of significance was set at 5% across tests. Results The prevalence of hypovitaminosis D was 24%, with a significant association with higher household income (p < 0.05). Higher vitamin D levels were associated with female gender (p < 0.001), no use of sunscreen (p < 0.05), and previous opportunistic infections (p < 0.01). Lower values were associated with the use of antiretroviral medication (p < 0.05), overweight and obesity (p < 0.01). Conclusion Lower vitamin D concentrations were significantly associated with well-known risk factors for hypovitaminosis D: use of sunscreen, antiretroviral medication, overweight, and obesity. The prevalence of hypovitaminosis D in this study, considering values > 20 ng/mL or > 30 ng/mL as vitamin D sufficiency, was lower to that of previous studies with HIV-infected patients, a fact that might be related to the low latitude and high intensity of solar radiation of the location of the present study. .

Objetivo Investigar fatores de risco associados à hipovitaminose D em pacientes adultos infectados por HIV/aids, num centro de referência em Maceió-AL. Sujeitos e métodos Por meio de desenho transversal, 125 pacientes foram avaliados por entrevista, revisão de prontuário, exame físico e laboratorial, no período de abril a setembro de 2013. Os dados foram analisados por meio do software SPSS®, versão 17.0, sendo determinados a prevalência de hipovitaminose D e os níveis médios de vitamina D. Para avaliação da associação entre hipovitaminose D e as variáveis pesquisadas, foram utilizados o teste Qui-quadrado ou o teste exato de Fisher, enquanto para os níveis médios de vitamina D foram utilizados os testes Kolmogorov-Smirnov, Mann-Whitney e Kruskal-Wallis. O nível de significância foi de 5% para todos os testes. Resultados Foi observada prevalência de hipovitaminose D de 24% com associação significativa com maior renda familiar (p < 0,05); níveis de vitamina D mais altos nas mulheres (p < 0,001), em pacientes que não faziam uso de filtro solar (p < 0,05) e naqueles com infecções oportunistas pregressas (p < 0,01). Valores mais baixos foram associados ao uso de antirretrovirais (p < 0,05), sobrepeso e obesidade (p < 0,01). Conclusão Níveis mais baixos de vitamina D estiveram significativamente associados com tradicionais fatores de risco para hipovitaminose D como uso de filtro solar e antirretrovirais, sobrepeso e obesidade. A prevalência de hipovitaminose encontrada, considerando suficiência de vitamina D tanto para valores acima de 20 ng/mL quanto de 30 ng/mL, foi inferior a estudos anteriores em pacientes infectados pelo HIV, fato que pode estar relacionado às características da localidade do estudo, com baixa latitude e elevada incidência solar. .

Brazilian Consensus on Photoprotection

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection.

Prevalence of lip and perioral Ephelides in beach workers / Prevalência de Éfelides labiais e periorais em trabalhadores de praias

Ephelides are small hyperpigmented macules common in the skin, presenting as areas with increased melanin production. Ephelides are observed in genetically predisposed individuals, particularly fair-skinned people highly susceptible to sunburn. This study aimed to determine the prevalence of lip and perioral ephelides in 362 beach workers in the city of Natal (Rio Grande do Norte) and to investigate potential associations with sociodemographic, occupational and general health. For this purpose clinical tests were performed by calibrated examiners in the epidemiological area around the lips and the area bounded laterally by the nasolabial groove and at the bottom by the chin. A questionnaire was completed and assessed. The possible associations between sociodemographic variables, occupational and general health with the presence of lip and perioral ephelides were evaluated by chi-square test for a significance level of 5%. Approximately one third of the workers were affected by perioral ephelides (33.7%) and around a quarter of them by lip ephelides (24.0%). Gender was the only variable significantly associated with the presence of perioral ephelides (p = 0.002), unlike lip ephelides which proved to be significantly associated with habits (p = 0.036) and alcoholism (0.030). The prevalence of ephelides in lip and perioral region was high in the study population, with gender and certain habits associated with its occurrence. .

Efélides são máculas hiperpigmentadas pequenas, comuns na pele, que constituem uma área com maior aumento da produção de melanina. São observadas em indivíduos geneticamente predispostos, de pele clara, com grande suscetibilidade a queimaduras solares. Esse estudo teve o propósito de verificar a prevalência de efélides labiais e periorais em 362 trabalhadores de praias do município de Natal/RN e investigar potenciais associações com variáveis sociodemográficas, ocupacionais e de saúde geral. Para tanto, foram realizados exames clínicos por examinadores calibrados, na área correspondente aos lábios e na área delimitada lateralmente pelo sulco nasolabial e inferiormente pelo mento, além de preenchimento de questionário validado. As possíveis associações das variáveis sociodemográficas, ocupacionais e de saúde geral com a presença de efélides labiais e periorais foram avaliadas pelo teste do qui-quadrado para um nível de significância de 5%. Aproximadamente um terço dos trabalhadores foi acometido por efélides perioral (33,7%) e um quarto por efélides labial (24,0%). O gênero foi a única variável que se mostrou associada significativamente com a presença de efélides periorais (p=0,002), ao contrário das efélides labiais que mostrou-se associada significativamente com hábito (p=0,036) e etilismo (0,030). Conclui-se que a prevalência de efélides em região perioral e labial foi elevada na população estudada e o gênero e hábitos ...

Câncer de pele: o papel da exposição solar como fator causal e da fotoproteção na prevenção / Skin cancer: the sun exposure as a causal factor and photoprotection prevention

O câncer de pele se tornou, nas últimas décadas, um problema de saúde pública no Brasil, corespondendo a 25% do total dos tumores malignos registrados. Constata-se a necessidade de se estabalecer estratégias que visem minimizar os problemas relacionados às dificuldades na adoção de ações preventivas, bem como motivar as pessoas para a adesão às medidas de fotoproteção. Grande parte da população mundial se expõe ao sol de forma irracional, isto aliado à mudança de hábitos de vida, à diminuição da camada de ozônio e ao descuido quanto ao uso de fotoprotetores. Todos estes fatores têm contribuído significativamente para o aumento da incidência de câncer de pele e de outras alterações cutâneas relacionadas à exposição solar inadequada. O tipo de câncer de pele mais frequentemente encontrado na população brasileira é o não melanoma, representado pelos carcinomas basocelular e espinocelular. O melanoma de pelo corresponde a apenas 4% dos tumores cutâneos; entretanto, sua letalidade é alta. Quando a exposição passa a ser prolongada e irracional, o risco de alterações cutâneas relacionadas à exposição solar passa a ser maior, principalmente em pessoas de pele clara. Os filtros solares são comumente usados como proteção contra os danos solares. Eles reduzem a penetração de ondas ultravioleta solares na pele, pela reflexão ou por absorvê-las. A aplicação apropriada de filtro solar é fundamental como estratégia eficaz de saúde pública para prevenção do câncer de pele. Além do uso de fotoprotetores, medidas educativas de prevenção, como conscientização da proteção solar desde a infância, são necessárias pra se tentar diminuir a incidência dos cânceres de pele.

Skin cancer in recent decades has become a public health problem in Brazil, accounting for 25% of all malignant tumors recorded. There is a need to establish strategies for minimizing the problems hindering the adoption of preventive actions. as well as motivate people to adhere to measures for effective photoprotection. The solar exposure has been occurred in an irrational way by most of the people all over the world along with habit changes of everyday life, decreasing the ozone layer and careless to the use of photoprotectors as well. All these factors have contributed meaningfully for the increase of incidence of skin cancer and other cutaneous changes related to inadequate solar exposure. The type of skin cancer most often found in the Brazilian population is not melanoma, basal cell carcinomas and squamous cell carcinomas. The skin melanoma accounts for only 4% of skin tumors, but its mortality is high. When the exposure becomes prolonged and unreasonable risk of developing skin changes related to sun exposure becomes greater, expecially in people with white skin. Sunscreens are commonly used as protection against sun damage. They reduce the penetration of solar ultraviolet waves in the skin by reflecting or absorbing them. Proper application of sunscreen is essential to effective public health strategy for prevention of skin cancer. Besides the use of sunscreens, prevention and educational measures, awareness of sun protection from childhood are necessary to decrease the incidence of skin cancers.

Proteção à radiação ultravioleta: recursos disponíveis na atualidade em fotoproteção / Ultraviolet radiation protection: current available resources in photoprotection

A radiação ultravioleta pode provocar danos ao DNA, imunossupressão, alterações químicas e histológicas na epiderme, envelhecimento precoce, cataratas e carcinogênese, dentre outras deteriorações. A fotoproteção previne estes e outros efeitos danosos da radiação ultravioleta. Protetores solares, vestimentas, acessórios adequados e exposição segura ao sol são ferramentas essenciais da fotoproteção. Neste artigo, são apresentadas e discutidas as principais formas de fotoproteção, incluindo os protetores solares com filtros inorgânicos e orgânicos, a avaliação da eficácia dos mesmos e atualizações envolvendo o tema.

Ultraviolet radiation can damage the DNA, cause immunosuppression, chemical and histological alterations in the epidermis, early photoaging, cataracts and carcinogenesis, among others. Photoprotection prevents these and other harmful effects of ultraviolet radiation. Sunscreens, protective clothing, proper accessories and safe sun exposure are essential photoprotection tools. The main forms of photoprotection are presented and discussed in this article, including sunscreens containing organic and inorganic filters, the assessment of their efficacy and current developments on the topic.

Fator de proteção solar: significado e controvérsias / Sun protection factor: meaning and controversies

O Fator de Proteção Solar (FPS) é o principal dado para quantificação da eficácia fotoprotetora de um filtro solar, sendo universalmente aceito. Seu método é baseado na determinação da Dose Eritematosa Mínima (DEM), definida como sendo a menor quantidade de energia necessária para o desencadeamento de eritema, em áreas de pele protegidas e não protegidas pelo produto em estudo. O valor do FPS é, então, calculado como a razão numérica entre a DEM da pele protegida e a da pele não protegida. A primeira publicação demonstrando um método para determinação do valor do FPS foi apresentada em 1978 pela agência norte-americana FDA, seguida por outras publicações do próprio FDA e de outras agências regulatórias internacionais. Apesar de ser considerado o método referência para quantificação da eficácia fotoprotetora de produtos tópicos, existem controvérsias na literatura acerca do método para determinação do FPS e sobre as implicações das reais condições de uso na proteção atingida na prática pelos usuários.

The Sun Protection Factor (SPF) is the most important data to quantify the effectiveness of a sunscreen, being universally accepted. The method is based on determining the minimum erythematous dose (MED), defined as the smallest amount of energy required for triggering the erythema, in areas of protected and unprotected skin. The SPF value is then calculated as the ratio between the MED of protected and unprotected skin. The first publication of a method for determining the SPF was presented in 1978 by the U.S. FDA agency, followed by other publications of FDA and other international regulatory agencies. Although considered the reference method for quantification of sunscreen efficacy of topical products, there are controversies in literature about the method for determining the SPF and the implications of the real conditions of use in the protection achieved in practice by users.

Encuesta sobre protección solar en adolescentes deportistas de la provincia de Buenos Aires / Sun protection questionnaire in Buenos Aires adolescent athletes

Introducción. La exposición solar excesiva es el principal factor ambiental en el desarrollo de cáncer de piel. Los adolescentes que practican deporte al aire libre se encuentran bajo una intensae xposición a los rayos ultravioletas, la cual generará un daño acumulativo con mayor riesgo de padecer cáncer de piel en la vida adulta.Objetivos. 1) Evaluar los hábitos de protección solar en adolescentes deportistas argentinos de la Provincia de Buenos Aires. 2) Identificar las características del adolescente que ha sufrido quemaduras solares. Material y métodos. Estudio observacional, descriptivo y transversal, mediante una encuesta voluntaria, anónima, escrita y autorreferencial, a adolescentes deportistas de 11-18 años, participantes de un torneo deportivo.Resultados. Se evaluaron 554 adolescentes. El 26 por ciento había llevado protector solar al torneo. El 5,2 por ciento refirió utilizarlo de rutina durante el entrenamiento y el 6,1 por ciento en la práctica deportiva.El 45 por ciento refirió que el grado de fotoprotección utilizado le era indiferente. Los varones fueron los que más creían que un buen bronceado era signo de salud y las mujeres las que más asociaron el bronceado como signo de belleza. El 73 por ciento de los adolescentes había sufrido al menos una quemadura solar el verano anterior. Conclusiones. En este estudio, los adolescentes deportistas tuvieron una baja adherencia a la utilización del protector solar, a pesar de que lamayoría de ellos había padecido quemaduras solares recientes. En la actualidad, es necesario implementar campañas de educación dirigidas a este grupo de riesgo.

Disposición a la modificación de conductas de fotoprotección en estudiantes universitarios / Sun-protective behavioral changes in university students

Introducción: La exposición regular o prolongada a la luz solar se asocia a tasas más altas de cáncer de piel. El modelo transteórico del cambio de comportamiento (TTM) se ha utilizado con eficacia para explicar el patrón de adquisición y el cese de una variedad de comportamientos que potencialmente ponen en riesgo la salud. Éste consta de etapas del cambio denominadas de precontemplación (no pensado en el cambio), contemplación (considerando seriamente cambiar) y acción (inicio manifiesto del cambio de conducta). Objetivo: Evaluar según TTM la etapa de cambio en que se encuentra una muestra de universitarios y su correlación a sus hábitos de fotoexposición. Pacientes y métodos: Estudio prospectivo en 50 universitarios, a los cuales se les efectuó un cuestionario sobre conductas de fotoprotección y un cuestionario de disposición a la modificación de conductas de fotoprotección (RASP-B). Resultados: De los 50 universitarios, un 58 por ciento fueron mujeres, la edad media fue de 20 años y sus fototipos fueron 22 por ciento tipo II, 40 por ciento tipo III y 38 por ciento tipo IV. Un 68 por ciento reportaron el uso de fotoprotectores en las vacaciones en caso de exposición solar, sólo el 22 por ciento se lo reaplicaban y un 78 por ciento no usaban fotoprotector durante el resto del año. Un 48 por ciento de los universitarios estaban en etapa de acción , 18 por ciento en contemplación y 34 por ciento en precontemplación. Los universitarios en etapa de acción se asociaron a mayor uso de fotoprotectores (p=0.028), mayor uso de elementos de barrera (p=0049), menor exposición solar entre las 11 am y 3 pm (p=0019) y menor frecuencia de quemaduras solares con ampollas (p=0.02). Conclusión: La determinación de la etapa de disposición a cambiar los comportamientos de protección solar permite la planificación y la ejecución de intervenciones eficaces dirigidas a cada una de ellas que puedan ayudar a aumentar el nivel individual de fotoprotección (etapa de acción).

Introduction: Regular or prolonged sun ligth exposure is associated with higher rates of skin cancer. The transtheorical model (TTM) of behavior change has been effectively used to explain the adquisition and ending pattern of a variety of potential healththreatening behaviors. This model has stages of change called precontemplation (not thinking about change), contemplation (seriously considering changing) and action (manifest onset of behavioral change). Objective: to evaluate according to the TTM the stage of change found on a group of university students and to relate it to their habits of sun light exposure. Patients and methods: Cross sectional study in 50 university students which were evaluated through a questionnaire of sun-protective behavior and a questionnaire of sun-protective behavior (RASP-B). Results: Of the 50 university students, 58 percent were women, the mean age was 20 and their phototype were 22 percent type II, 40 percent type III and 38 percent type IV. A 68 percent reported the use of sunscreen on vacations, only 22 percent re-applied it and 78 percent did not use any sunscreen during the rest of the year. A 48 percent of university students were in action stage, 18 percent in contemplation and 34 percent in precontemplation. The student in action stage were associated with more use of sunscreen (p=0,028) and barrier elements (p=0,049), less sun exposure between 11 am and 3 pm (P=0,019) and lower frequency of sunburn with blisters (p=0.02). Conclusion: Determining the stage of readiness to alter sun-protective behavior allows for effective planning of interventions that can help increase the individual level of sun protection (action stage) which may decrease the probably of skin cancer.