Sunscreens: a review of health benefits, regulations, and controversies.

Ultraviolet radiation plays a major role in the development of nonmelanoma and melanoma skin cancers. Photoprotection by sunscreens has been shown to prevent the development of actinic keratosis, squamous cell carcinoma, melanoma, and photoaging. However, these benefits are only derived if the users apply sunscreen appropriately and practice other sun protection measures. This review discusses the health benefits provided by sunscreen use, updates the latest regulatory landscape on sunscreen, and addresses the controversies and limitations associated with sunscreen use.

Sunscreens: obtaining adequate photoprotection.

Adequate photoprotection plays a paramount role in reducing the burden of both photoaging and photocarcinogenesis. The scope of photoprotective strategies employed by the public, from most to least effective, includes: sun avoidance, seeking shade, the use of protective clothing, and the application of sunscreen. Among these options, sunscreen use remains the strategy most frequently employed by the public--a reversal of the preferred order of photoprotection. Given this trend, it is clear why sunscreens invariably take center stage in any discussion regarding obtaining adequate photoprotection.

The role of antioxidants in photoprotection: a critical review.

Free radicals have long been studied as a contributor to aging and disease processes. Endogenous production of radicals from cellular metabolism and exogenous sources from ultraviolet radiation and pollution can damage the skin on the cellular and tissue levels. Although the body possesses an elegant defense system to prevent radical damage, this innate system can be overwhelmed and lead to a state of oxidative stress or immunosuppression, and can even trigger carcinogenesis. Topical supplementation of antioxidants can provide additional protection to neutralize reactive oxygen species from both endogenous and exogenous sources. This review will discuss our current understanding of the mechanisms of free radical damage and evaluate the potential benefit of topical antioxidants in sunscreens and skin care products.

Tolerability and Efficacy of Retinoic Acid Given after Full-face Peel Treatment of Photodamaged Skin.

OBJECTIVE: All-trans retinoic acid is a well-established topical treatment of photodamaged skin. This study assessed the tolerance and efficacy of all-trans retinoic acid after full-face treatment with a chemical peel. DESIGN: This was a split-face, randomized study. One side of each face was treated with peel and the other side with peel and all-trans retinoic acid (3%). Four treatments were given during the 10-week study period. SETTING: Physician office. PARTICIPANTS: Fifteen female subjects 39 to 55 years of age. MEASUREMENTS: RESULTS were evaluated at Baseline; Weeks 4, 7, and 10; and at a 13-week follow-up visit by dermal grading of visual symptoms of irritation, subjective experiences of irritation, clinical grading of skin condition, and self-assessment questionnaires. RESULTS: Both peel and peel plus all-trans retinoic acid treatments achieved significant improvement in fine lines, radiance, roughness, skin tone clarity, skin tone evenness, and hyperpigmentation appearance. Improvement in wrinkles and firmness was not observed in the peel plus all-trans retinoic acid arm, while pore appearance failed to improve in either treatment arm. Improvement in overall facial appearance was greater in the peel alone arm. Peel alone and the addition of all-trans retinoic acid did not cause dryness, edema, or peeling, and the frequency of peel-induced erythema did not increase with the addition of all-trans retinoic acid. Subject-perceived improvements with the peel treatment did not differ significantly from subject-perceived improvements of the peel plus all-trans retinoic acid treatment. Adverse events requiring intervention or discontinuing treatment were not observed in either treatment arm. CONCLUSION: The addition of all-trans retinoic acid after peel treatment does not significantly enhance peel-induced improvement in photoaging parameters, peel-induced adverse effects, and subject-perceived improvements.

Correlates of health-related quality of life in women with severe facial blemishes.

BACKGROUND: Facial appearance plays a large role in self-perception and interaction with others. Visible facial skin lesions are a common condition. Purpose This study assessed factors associated with health-related quality of life (HRQOL) in women with visible facial skin lesions. METHODS: The study included 73 women with one or more of the following conditions: acne, dermatosis papulosis, hypopigmentation, lentigenes, melasma, rosacea, vascular proliferations and other facial scars. The Skindex-16 was used as a measure of HRQOL. Fear of negative evaluation (FNE) was assessed to determine whether self-perception characteristics relate to HRQOL. RESULTS: There were strong correlations in both bivariate and multivariate analyses among increased FNE, heightened perception of QOL without the facial condition and lower overall HRQOL (P< 0.05 and P< 0.01, respectively). There were no differences in HRQOL by type of facial condition, as well as no effects of the area covered by the condition on HRQOL. Interestingly, women not using foundations represented only 10% of the study population and had better HRQOL than women who did use foundations. CONCLUSIONS: Severe facial blemishes of any cause have a significant impact on women's QOL, and the effect of these lesions is mediated in part by psychological characteristics related to self-perception and self-presentation.

Corrective cosmetics are effective for women with facial pigmentary disorders.

Visible facial lesions are a common and burdensome skin problem. This study examines the impact of corrective cosmetics in women with severe facial pigmentary disorders. Enrollment consisted of 73 women with one or more of the following conditions: acne, dermatosis papulosis, hypopigmentation, lentigines, melasma, rosacea, vascular proliferations, or other facial scars. The corrective cosmetic (Dermablend) was applied at the initial visit, at which time instructions and a supply of product were provided. Assessments were conducted at baseline, 2-week, 4-week, and 3-month follow-up visits on 63 patients using the Skindex-16. The corrective cosmetic was well tolerated. There was improvement in Skindex-16 scores after application of the corrective cosmetic, which continued at each follow-up visit and after adjustment for baseline confounders using multiple regression analyses. At 3 months, there was a 30% improvement in Skindex-16 score (P < .001). The corrective cosmetic was well tolerated and represents a valuable option that dermatologists can offer to patients with these conditions.

Large B-cell lymphoma of the leg: clinical and pathologic characteristics in a North American series.

BACKGROUND: Large B-cell lymphoma (LBCL) of the leg is an uncommon subset of primary cutaneous B-cell lymphoma that has been described in a series of European patients. OBJECTIVE: Our purpose was to evaluate the clinical manifestation, diagnostic histopathology, immunophenotype, clinical course, and response to treatment of LBCL of the leg. METHODS: We conducted a retrospective case series of 3 patients with primary LBCL of the leg. RESULTS: The 3 elderly patients presented with progressive erythematous nodules on bilateral or unilateral lower extremities. All 3 patients had pre-existing peripheral edema or peripheral vascular disease. Histopathologic examination of the nodules showed dense lymphocytic infiltrates composed predominantly of large dysplastic lymphocytes that marked as B cells (CD20(+)). In 2 cases, the neoplastic cells were BCL-2 positive. All patients responded to initial therapy with localized electron beam radiation and chemotherapy but had disease progression. One patient had a complete and durable second response to anti-CD20 monoclonal antibody (rituximab). CONCLUSIONS: The patients described have similar clinical and histopathologic features to those previously described. There may be an association between LBCL and pre-existing lower-extremity vascular disease. Treatment of LBCL is difficult, but 1 patient responded well to systemic anti-CD20 monoclonal antibody.

Effects of systematic asymmetric discounting on physician-patient interactions: a theoretical framework to explain poor compliance with lifestyle counseling.

BACKGROUND: This study advances the use of a utility model to model physician-patient interactions from the perspectives of physicians and patients. PRESENTATION OF THE HYPOTHESIS: In cases involving acute care, patient counseling involves a relatively straightforward transfer of information from the physician to a patient. The patient has less information than the physician on the impact the condition and its treatment have on utility. In decisions involving lifestyle changes, the patient may have more information than the physician on his/her utility of consumption; moreover, differences in discounting future health may contribute significantly to differences between patients' preferences and physicians' recommendations. TESTING THE HYPOTHESIS: The expectation of differences in internal discount rate between patients and their physicians is discussed. IMPLICATIONS OF THE HYPOTHESIS: This utility model provides a conceptual basis for the finding that educational approaches alone may not effect changes in patient behavior and suggests other economic variables that could be targeted in the attempt to produce healthier behavior.