Broad-spectrum Sunscreen Research Articles

Broad-spectrum sunscreens containing the TriAsorB™ filter: In vitro photoprotection and clinical evaluation of blue light-induced skin pigmentation.

Blue light (BL), particularly high-energy visible (HEV) light (400-450 nm), can cause skin damage and pigmentation. Therefore, effective sunscreens should offer photoprotection beyond ultraviolet (UV) radiation to also prevent or limit BL-induced cutaneous effects. To evaluate the in vitro BL photostability and photoprotection properties of nine sunscreens containing the broad-spectrum UV/BL phenylene bis-diphenyltriazine (PBDT or TriAsorB™) filter, together with three other organic UV filters, and to assess the in vivo photoprotection level provided by two of these products against BL-induced skin pigmentation. In vitro BL photostability and photoprotection factors, comprising the percentage of BL radiation stopped by the product (%BL) and the critical wavelength extended to BL (BL-CW), were determined by spectrophotometry. The in vivo photoprotection provided by two representative sunscreens (i.e. similar formulations, one non-tinted and one tinted) was assessed in two open randomized studies (20 and 16 women, respectively) after exposure of two test areas (with and without sunscreen) on the back of each subject to a 412-nm irradiation dose at 50 J/cm2 , using instrumental and clinical measurements of skin pigmentation. The percentage sunscreen photoprotective effectiveness (%PPE) was calculated by comparing intrasubject post-exposure pigmentation changes between the with and without sunscreen test areas. In vitro, the nine PBDT-containing products were highly photostable and had a BL-CW ≥385 nm and a %BL ≥30% (range: 30%-50%), thus allowing effective BL photoprotection. In vivo, both representative sunscreens prevented BL-induced immediate skin pigmentation (1 and 24 h post-exposure) with %PPE values ranging from 50.7% to 75.5% for colorimetric assessments (p < 0.001) and from 31.2% to 72.7% for visual scores (p ≤ 0.001). All PBDT-containing sunscreens were considered effective at absorbing BL radiation in vitro. The two representative broad-spectrum sunscreens tested in subjects significantly reduced BL-induced immediate skin pigmentation following single exposure to monochromatic BL radiation.

Comparison of efficacy of oral and topical route of tranexamic acid in patients of melasma

Background: Melasma is a common pigmentary disorder which presents with brown coloured macules that occurs around the sun-exposed areas of the skin, particularly on the face. Many treatment modalities are present but often it is resistant to treatment. The aim of our study was to compare the therapeutic efficacy and safety of tranexamic acid administered by oral and topical route in patients of melasma. Methods: Our study was a prospective, randomised study which consisted of 40 new melasma patients. 20 patients were given Oral Tranexamic acid 250 mg twice daily, classified as Group 1, other 20 patients were given topical Tranexamic acid (3%) twice a day (fully covering the lesion), classified as Group 2 for a period of 8 weeks and both were given broad spectrum sunscreen (SPF 50). MASI was determined before starting treatment (baseline), 4 weeks and 8 weeks. Based on the reduction in the mean MASI, the therapeutic response is graded and subjective response and adverse effects were also recorded at each visit. Results: Mean percentage reduction in MASI scores was higher in oral (52.1%) as compared to topical (31.9%) group. In oral group, headache was the only adverse effect, however, in topical group, erythema, burning, acneiform eruptions were reported. At final assessment, fair improvement was seen in both groups. Conclusions: Both oral as well as topical tranexamic acid were efficacious for treatment of melasma, however, of the two oral tranexamic acid was safer and provided a better proportional response.

Multi-omics approach to understand the impact of sun exposure on an in vitro skin ecosystem and evaluate a new broad-spectrum sunscreen.

A reconstructed human epidermal model (RHE) colonized with human microbiota and sebum was developed to reproduce the complexity of the skin ecosystem in vitro. The RHE model was exposed to simulated solar radiation (SSR) with or without SPF50+ sunscreen (with UVB, UVA, long-UVA, and visible light protection). Structural identification of discriminant metabolites was acquired by nuclear magnetic resonance and metabolomic fingerprints were identified using reverse phase-ultra high-performance liquid chromatography-high resolution mass spectrometry, followed by pathway enrichment analysis. Over 50 metabolites were significantly altered by SSR (p < 0.05, log2 values), showing high skin oxidative stress (glutathione and purine pathways, urea cycle) and altered skin microbiota (branched-chain amino acid cycle and tryptophan pathway). 16S and internal transcribed spacer rRNA sequencing showed the relative abundance of various bacteria and fungi altered by SSR. This study identified highly accurate metabolomic fingerprints and metagenomic modifications of sun-exposed skin to help elucidate the interactions between the skin and its microbiota. Application of SPF50+ sunscreen protected the skin ecosystem model from the deleterious effects of SSR and preserved the physiological interactions within the skin ecosystem. These innovative technologies could thus be used to evaluate the effectiveness of sunscreen.

The effects of UV filters on health and the environment.

Sunscreens are an important means of protection against sunburns, dyspigmentation, photoaging, and photocarcinogenesis. Sunscreens come in a variety of formulations that can protect against ultraviolet B (UVB) radiation, both UVB and ultraviolet A (UVA) radiation (broad-spectrum sunscreens), and UVB, UVA, and visible light (tinted broad-spectrum sunscreens). In the USA, there is currently a paucity of FDA-approved broad-spectrum filters on the market. Studies have identified the presence of multiple UV filters in water sources globally. Many laboratory studies have implicated the potential impact of UV filters on coral reef bleaching, the food chain, and human health. However, many of these studies are performed at concentrations that are much higher than those present in the natural environment. With increasing discussion surrounding the role of organic and inorganic UV filters as potential environmental pollutants over the past decade, approval of additional broad-spectrum filters would be an important means of alleviating the use of more controversial filters. The aim of this article is to review the effects of UV filters on health and the environment and explore potential adjunctive agents for photoprotection.

SKIN CANCER ABOUT A CLINICAL CASE, IMPORTANCE OF EDUCATION FOR ITS PREVENTION

Skin cancer is one of the most common types of cancer worldwide. It affects people of all ages, genders and ethnicities. However, the good news is that most cases of skin cancer are preventable and treatable if caught early. Education and prevention are critical to reducing the risk of developing skin cancer and improving people's quality of life. Below is a case study of a 35-year-old patient who was diagnosed with squamous cell carcinoma, a type of skin cancer that can spread if not treated properly. The dermatologist recommended surgery to remove the tumor, which proved successful. After surgery, the importance of prevention and how to reduce the risk of developing another squamous cell carcinoma was emphasized. It was recommended to limit sun exposure, wear protective clothing, hats and sunglasses, and apply broad-spectrum sunscreen with an SPF of 50 or higher. Regular skin self-exams and follow-up appointments were also advised. This case demonstrates the importance of prevention in skin cancer and the need to take measures to reduce the risk of developing this type of cancer.

Xanthophyll-Rich Extract of Phaeodactylum tricornutum Bohlin as New Photoprotective Cosmeceutical Agent: Safety and Efficacy Assessment on In Vitro Reconstructed Human Epidermis Model.

The nutritional and health properties of algae make them perfect functional ingredients for nutraceutical and cosmeceutical applications. In this study, the Phaeodactylum tricornutum Bohlin (Phaeodactylaceae), a pleiomorphic diatom commonly found in marine ecosystems, was investigated. The in vitro culture conditions used favoured the fusiform morphotype, characterized by a high accumulation of neutral lipids, as detected by fluorescence microscopy after BODIPY staining. These data were confirmed by HPLC-DAD-APCI-MS/MS analyses carried out on the ethanolic extract (PTE), which showed a high content of xanthophylls (98.99%), and in particular of fucoxanthin (Fx, 6.67 g/100 g PTE). The antioxidant activity (ORAC, FRAP, TEAC and β-carotene bleaching) and photostability of PTE and Fx against UVA and UVB rays were firstly evaluated by in vitro cell-free assays. After this, phototoxicity and photoprotective studies were carried out on in vitro reconstructed human epidermidis models. Results demonstrated that PTE (0.1% Fx) and 0.1% Fx, both photostable, significantly (p < 0.05) reduce oxidative and inflammatory stress markers (ROS, NO and IL-1α), as well as cytotoxicity and sunburn cells induced by UVA and UVB doses simulating the solar radiation, with an excellent safety profile. However, PTE proved to be more effective than Fx, suggesting its effective and safe use in broad-spectrum sunscreens.

Expert recommendations on supportive skin care for non-surgical and surgical procedures.

A thorough knowledge of non-surgical procedures (laser, peelings, injections, threads) and surgical procedures (combined surgeries and skin grafts), including contraindications and potential risks and side effects, (e.g. infection, hypopigmentation, hyperpigmentation, and scarring) is essential to be able to reduce their incidence and ensure the patient receives the most benefit from the procedure. Individuals with darker skin and of high Fitzpatrick phototype are at higher risk of dyschromias, notably melasma and post-inflammatory hyperpigmentation, which may be treated using aesthetic procedures but may also arise as a complication of some procedures. A group of experts in cosmetic surgery and dermatology reviewed the published literature and discussed recommendations for optimizing outcomes with practical advice on supportive skincare before, during and after non-surgical or surgical procedures. A broad-spectrum sunscreen with a high sun protection factor against UVB and high protection against UVA, especially long UVA, is essential for all treatment modalities for the prevention and potential improvement of pigmentation disorders. Supportive skin care management to prepare, cleanse and protect the skin and post-procedure skin care with healing and anti-inflammatory ingredients are recommended to speed up regeneration and wound healing whilst minimizing scarring and downtime. Additionally, adjunctive skin care to procedures with antioxidant, anti-ageing and lightening properties may enhance skin benefits.

Evaluating The Efficacy And Safety Of Tranexamic Acid To Hydroquinone And Triple Combination Cream In The Treatment Of Melasma

Background: Melasma is acquired skin condition characterized by sporadic hyperpigmented macules or patches that affects photo-exposed areas which occur chronically. Melasma seriously impairs a patient’s quality of life. Current treatments for melasma include hydroquinone, corticosteroids, retinoids, natural substances, and triple combination creams (TCC), which demonstrate variable efficacy and side-effect profiles. Melasma can now be treated with tranexamic acid (TA), a well-known anti-fibrinolytic drug. Oral, topically applied, and procedural techniques were used to administer TA. Purpose: This review evaluating the efficacy and safety of tranexamic acid to hydroquinone and triple combination cream in the treatment of melasma and suggests steps that need to be taken to mainstream TA use in clinical settings. Review: Among the recent melasma treatments are including hydroquinone (HQ), triple combination topicals, and regular use of broad-spectrum sunscreen. .1 Because plasmin has been shown to have melanogenic properties, tranexamic acid (TA) is an essential therapy option for melasma due to its anti-plasmin (and consequently anti-fibrinolytic) properties. Recent research has shown that melasma-affected skin has enhanced vascularity and VEGF expression in the epidermis, suggesting yet another method by which TA may treat melasma clinically. Conclusion: The review revealed that a combination of tranexamic acid and hydroquinone has better efficacy in treating melasma rather than hydroquinone alone. Oral tranexamic acid combined with TCC can prevent recurrence and sustain the outcome.

Revealing the relationship between molecular weight of lignin and its color, UV-protecting property

Lignin has great potential as a natural, green, and sustainable broad-spectrum sunscreen active ingredient. However, the coexistence of dark color and sunscreen properties hinders its application in cosmetics. In this study, we focus on the effects of the molecular weight of lignin on tis UV-protecting property and color in order to prepare lignin-based sunscreen with high performance. A prepared sunscreen containing low molecular weight lignin (F5, <1000 g/mol) exhibits good UV-protecting property (sun protection factor (SPF) = 7.14) and light color advantages (ΔE = 46.2). Moreover, a strong synergistic effect on UV-protecting property exists between low molecular weight lignin and ethylhexyl methoxycinnamate (EHMC), resulting in high SPF of F5@EHMC-based sunscreen (55.56). Additionally, added TiO2 can efficiently mitigate the dark color of lignin-based sunscreens due to prominent covering power of TiO2. Moreover, lignin-based sunscreens have good biocompatibility with HaCaT cells. This work is useful for understanding the mechanism of the UV-protecting property and dark color of lignin, and for designing an efficient and safe lignin-based sunscreen.

Sunscreen Protection Against Visible Light: Is It Needed?

ABSTRACT Ultraviolet radiation and Visible light (VL) have biological effects on the skin. VL causes erythema in light-skinned individuals and pigmentation in dark-skinned individuals. Broad-spectrum sunscreen protects skin against ultraviolet radiation but does not adequately protect against VL. The purpose of this study was to analyze the biological effects of visible light (VL) and the choice of sunscreen that can protect it. The research method used in this study is a qualitative descriptive method. The type of data used in this study is qualitative data, which is categorized into two types, namely primary data and secondary data.The protection provided by organic (mineral) and inorganic sunscreen filters can prevent skin damage due to ultraviolet radiation, but does not provide protection against VL. Only tinted sunscreens that use formulations of concentrated iron oxide and titanium dioxide can provide protection against VL. Various steps have been taken to provide photoprotection against VL. There are many sunscreens available that combine percentages level of iron oxide and titanium dioxide pigment to suit all skin types. This tinted sunscreen is beneficial for melasma and post-inflammatory hyperpigmentation and photodermatosis induced by VL. Keywords: Iron Oxide, Photoprotection, Tinted Sunscreen, Titanium Dioxide, Ultraviolet Light, Visible Light

Evaluation of a Sunscreen Product Compared with Reference Standards P3, P5 and P8 in Outdoor Conditions: a Randomized, Double-Blinded, Intra-individual Study in Healthy Subjects

IntroductionThe shortcomings of standardized sunscreen testing have been discussed in recent years, noting differences between how sunscreens perform in indoor clinical (in vivo) laboratory testing compared with real-life conditions. We previously developed an outdoor clinical method for ranking sunscreens by performance level. We used this method to test the performance of a new broad-spectrum sunscreen against International Organization for Standardization (ISO) reference products P3, P5 and P8.MethodsSixty-five healthy volunteers with individual typology angle (ITA) ≥ 28° (light to intermediate skin colour) participated in an outdoor study in Mauritius. Test areas were marked on their backs, which were treated with the different products: one commercially available broad-spectrum sun protection factor (SPF) 50 sunscreen [investigational product (IP)] and the three reference products P3 (SPF 15), P5 (SPF 30) and P8 (SPF 50+) from ISO norm 24444:2019 for SPF testing. The test areas were exposed for 2–3 h, depending on the baseline skin colour. They were also compared with an unprotected positive control area and a non-exposed negative control area. Clinical and colorimetry assessment of erythema and pigmentation were performed at 24 h and 8 days, respectively.ResultsOverall, according to this outdoor clinical testing method, the sunscreens’ efficacy was ranked in an appropriate order given their established SPF levels, with higher SPFs giving greater protection against erythema and pigmentation. Between the different levels of SPF, the differences were statistically significant, for both clinical and colorimetry assessments. The new broad-spectrum SPF 50 IP performed similarly to the SPF 50+ (P8) reference product. Even the highest SPF products, SPF 50 and SPF 50+, had some instances of photoprotection failure.ConclusionThese findings confirm the feasibility of this outdoor clinical testing method in ranking sunscreens and provide further evidence, in addition to standardized SPF and UVA protection factor (UVAPF) testing, on how this new broad-spectrum SPF 50 sunscreen performs in extreme outdoor solar exposure: in line with reference product P8 (SPF 50+).Trial Registration No.ISRCTN95394014.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00815-w.

Safer and More Broad-spectrum Ultraviolet Protective Sunscreens Available in Other Countries: Need FDA Approval for Public Health of Americans STAT

Safer and More Broad-spectrum Ultraviolet Protective Sunscreens Available in Other Countries: Need FDA Approval for Public Health of Americans STAT

Sunscreen-using U.S. adults are using higher sun protection factor sunscreens: Data from the National Health Interview Survey 2005-2015

To the Editor: Sunscreen reduces skin cancer, sunburn, and photo-aging risks, with higher sun protection factor (SPF) values providing enhanced protection.1 The American Academy of Dermatology recommends broad-spectrum sunscreens with SPF ≥30.2 We investigated temporal trends of SPF among sunscreen users to determine consumer preference changes over time.

34428 Clinical and biophysical assessment of the effects of daily use of a nature-based, broad-spectrum mineral sunscreen containing bakuchiol in photoaged skin

Background: Skin exposure to ultraviolet radiation causes disruption of fibroblast-extracellular matrix interactions causing loss of/damage to collagen, decreased fibroblast cell density and morphology and degeneration of the elastic fiber network. These result in clinical degenerative changes such as wrinkles, sallow complexion and loss of hydration and elasticity. We developed a photostable, broad-spectrum SPF 30 product with inorganic sunscreen actives and a natural retinol alternative, bakuchiol. Objective: To investigate the effects of a nature-based mineral broad-spectrum sunscreen to improve clinical outcomes of photodamaged skin. Methods: A single-center, open-label study was performed on 49 female subjects aged 35 to 60 years with mild to moderate signs of photodamage. Evaluations of the nature-based sunscreen product were made at baseline and at week 6 after twice daily minimum topical application on the face. The dermatologist investigator and subjects assessed efficacy and tolerability using a 5-point ordinal scale (0 = none, 4 = severe). Noninvasive measurements of skin hydration, barrier function and elasticity were conducted. Results: Investigator clinical evaluations showed significant improvements in skin laxity, fine lines, smoothness, pigmentation, and texture. Subject-rated change from baseline demonstrated similar efficacy as the investigator. Skin hydration significantly improved by 21%. A significant 32% decrease in the retraction time (ms) was measured after 6 weeks of product use, indicating improved skin elasticity. There was no disruption to skin barrier function. No tolerability related issues were observed during study duration. Conclusion: Daily photoprotection using a nature-based broad-spectrum mineral sunscreen containing bakuchiol visibly improved the signs of photodamage and the skin’s biophysical properties.

A Case Report The Evaluation of Malondialdehyde Level on Acne Vulgaris Treatment

Abstract: Acne vulgaris (AV) is a multifactorial disease of the pilosebaceous unit with varying degrees of severity, recurrent and characterized by polymorphic lesions. Recent studies have found that the etiopathogenesis of AV is caused by oxidative stress. Each factor that causes AV is interrelated and is under the control of hormones and immunity. Measurement of malondialdehyde (MDA) level in the blood becomes a biological marker or an indicator of cell and tissue damage caused by oxidative stress. Case: A 23-years-old female private employee visited the clinic for multiple comedones and papulopustular lesions scattered over cheeks, nose, and chin that spread to the whole face four months ago. There were multiple comedones, papules, pustules, nodules on the maxillary, nasalis, left and right zigomatic, mentalis and frontalis region. We also found multiple scars on the left and right buccal. She was diagnosed with Severe AV. Serum MDA level was measured according to the enzyme-linked immunosorbent assay (ELISA) method before and after therapy. She was treated with doxycycline 100 mg, 0.025% tretinoin cream, 5% benzoyl peroxide, 1.2% clindamycin gel, and broadspectrum sunscreen with SPF 50. Result: After eight weeks of treatment, there were noticeable improvements in acne lesions and overall healthier-looking skin. Serum MDA levels are decreased (22.6 nmol/ml to 17.9 nmol/ml) as the impact of the therapy.&#x0D; Keyword: Acne Vulgaris, Malondialdehyde, Oxidative Stress

34481 A dual regimen skincare treatment for hyperpigmented and photodamaged facial skin

Background: Broad-spectrum mineral sunscreens have assisted in correction of pigmentary disorders. A vitamin C moisturizer (VCM) containing 30% tetrahexyldecyl (THD) ascorbate clinically demonstrated improvement in patients with mild to moderate wrinkles and hyperpigmentation in a standalone study. A dual regimen treatment containing a 100% mineral TMS and a VCM, may offer further benefits in patients concerned with their hyperpigmented and photodamaged facial skin. Study design: MatTek EpiDerm tissues topically treated with 100% mineral TMS, exposed to UVB (300 mJ/cm2) 24 hours posttreatment, and incubated for an additional 24 hours, were analyzed by ELISA for CPD formation, 8-OHdG content, and H2A.X phosphorylation (n = 3). In a multicenter, open-label study, 36 female subjects (35-60 years) with moderate to severe facial hyperpigmentation and moderate global face photodamage were recruited to assess the efficacy and tolerability of a skincare regimen containing VCM and 100% mineral TMS over 12 weeks. Clinical grading using a modified Griffith 10-point scale for hyperpigmentation, overall photodamage, and skin tone evenness were performed at baseline, weeks 4, 8, and 12. Results: The 100% mineral TMS repaired UVB induced DNA damage, including CPD formation by 85% (P < .05). When paired together, the VCM and 100% mineral TMS improved hyperpigmentation and photodamaged facial skin in patients across three clinical sites compared with baseline (P < .05). Conclusion: In vitro results coupled with in vivo results strongly suggest that the dual regimen containing 100% mineral TMS paired with the VCM was strongly effective and tolerable in improving hyperpigmented and photodamaged skin.

33691 Prospective pilot evaluation in Fitzpatrick skin phototypes III to VI of a crystal-free brush-tip exfoliation device with variable vacuum pressure and skin infusion for hyperpigmentation

Unmet needs in skin of color include satisfactory long-term treatments for hyperpigmentation, whether primary or a sequela of various dermatoses. Surveys report that pigmentary disorders are the second most common dermatoses among African American patients consulting dermatologists, and that hyperpigmentation significantly impairs quality of life. This single-center, open-label pilot evaluation prospectively assessed safety, efficacy and tolerability in patients with Fitzpatrick skin phototypes III to VI of an FDA 510(k)-cleared crystal-free brush-tip exfoliation device with adjustable vacuum pressure and skin infusion containing 1% each of alpha-arbutin, glutathione, kojic acid plus azelaic acid; lactic acid; and salix alba bark extract. 23 female patients aged 26 to 71 with mild, moderate or severe facial hyperpigmentation received 3 to 6 treatments at 2 to 4 weekly intervals. Patients applied broad spectrum sunscreen daily. Three weeks after the third treatment, blinded assessment of standardized digital images found that all patients had improvements in skin tone, texture and brightness/radiance (≥2 points on 10-point scales), and 15 (65%) had ≥1 point improvement in pigmentation. Physician and patient GAIS scoring ranged from Improved to Very Much Improved. DQLI improved for 12 (52%). The procedure was well tolerated, with no significant adverse effects. Post-procedural erythema lasted 15 minutes to under 24 hours. All patients reported satisfaction with treatment and increased These pilot data show safety, efficacy and tolerability in skin of color. The ability to patient-tailor all procedural steps, including exfoliation depth, magnitude of vacuum pressure and infusion type, may confer benefits over conventional aluminum oxide crystal microdermabrasion.

Self-applied topical interventions for melasma: a systematic review and meta-analysis of data from randomized, investigator-blinded clinical trials.

Melasma is a common dermatological condition. Although its relevance as a skin condition is primarily of a cosmetic nature, it may affect the patient's wellbeing and quality of life. A broad range of treatment options is available, which makes it difficult to choose the most appropriate of those treatments. To summarize and critically appraise evidence from investigator-blinded randomized controlled trials (RCTs) on the efficacy and safety of self-applied topical interventions for melasma. We systematically searched MEDLINE and the Cochrane CENTRAL trials database for RCTs on topical, self-administered interventions for patients diagnosed with melasma. Eligibility was limited to RCTs that explicitly stated in their methods section (i) how they generated the random allocation sequence, and (ii) that the study outcome assessor was blinded to the participants' group allocation. Outcomes of interest included evaluator-assessed clinical scores (such as the Melasma Area and Severity Index), quality of life and patient-reported outcomes, as well as safety outcomes. The study findings were meta-analysed, pooling data from studies on the same comparisons, if this was possible. We assessed confidence in effect estimates using the GRADE approach. Our searches yielded 1078 hits. We included 36 studies reporting on 47 different comparisons of interventions. These included medical treatments such as 'triple combination cream' (TCC), over-the-counter cosmetic and herbal products, as well as sun creams covering different light spectra. Pooling data was possible for only two comparisons, topical tranexamic acid (TXA) vs. hydroquinone (HQ) and cysteamine vs. placebo. Direct comparisons were available for a variety of interventions; however, the reported outcomes varied greatly. Overall, our confidence in the effect estimates ranged from very low to high. Our findings indicate that TCC and its individual components HQ and tretinoin are effective in lightening melasma. Besides these established self-applied treatment options, we identified further medical treatments as well as promising cosmetic and herbal product treatment approaches. Furthermore, evidence suggests that using broad-spectrum sunscreen covering both the visible and ultraviolet-light spectrum enhances the treatment efficacy of HQ. However, with mostly small RCTs comparing treatments directly using a broad range of outcomes, further research is needed to draw conclusions about which treatment is most effective. What is already known about this topic? Melasma is a common dermatological disease. Although it is primarily a cosmetic condition, it can severely affect the patient's wellbeing and quality of life. Treatment options for melasma include a broad range of medical, cosmetic and herbal products. Given the large number of available interventions, it is difficult for clinicians and for patients to make informed decisions about which treatment to choose. What does this study add? We systematically assessed data from investigator-blinded randomized controlled trials of self-applied topical interventions. Our GRADE evaluations of confidence in the findings ranged from very low to high and may help clinicians and patients navigate treatment decisions. Besides the established self-applied medical treatment options, we identified promising cosmetic and herbal treatment approaches. Evidence suggests sunscreen covering the ultraviolet (UV)- and visible light spectra increases treatment efficacy compared with UV-only protection.

35377 Protection from UV light-induced telomere shortening by a broad-spectrum sunscreen product

35377 Protection from UV light-induced telomere shortening by a broad-spectrum sunscreen product

Ultraviolet Light Protection: Is It Really Enough?

Our current understanding of the pathogenesis of skin aging includes the role of ultraviolet light, visible light, infrared, pollution, cigarette smoke and other environmental exposures. The mechanism of action common to these exposures is the disruption of the cellular redox balance by the directly or indirectly increased formation of reactive oxygen species that overwhelm the intrinsic antioxidant defense system, resulting in an oxidative stress condition. Altered redox homeostasis triggers downstream pathways that contribute to tissue oxinflammation (cross-talk between inflammation and altered redox status) and accelerate skin aging. In addition, both ultraviolet light and pollution increase intracellular free iron that catalyzes reactive oxygen species generation via the Fenton reaction. This disruption of iron homeostasis within the cell further promotes oxidative stress and contributes to extrinsic skin aging. More recent studies have demonstrated that iron chelators can be used topically and can enhance the benefits of topically applied antioxidants. Thus, an updated, more comprehensive approach to environmental or atmospheric aging protection should include sun protective measures, broad spectrum sunscreens, antioxidants, chelating agents, and DNA repair enzymes.