Fitzpatrick Phototype Research Articles

Basal cell carcinoma risk and solar UV exposure in occupationally relevant anatomic sites: do histological subtype, tumor localization and Fitzpatrick phototype play a role? A population-based case-control study

BackgroundA two-fold risk increase to develop basal cell carcinoma was seen in outdoor workers exposed to high solar UV radiation compared to controls. However, there is an ongoing discussion whether histopathological subtype, tumor localization and Fitzpatrick phototype may influence the risk estimates.ObjectivesTo evaluate the influence of histological subtype, tumor localization and Fitzpatrick phototype on the risk to develop basal cell carcinoma in highly UV-exposed cases and controls compared to those with moderate or low solar UV exposure.MethodsSix hundred forty-three participants suffering from incident basal cell carcinoma in commonly sun-exposed anatomic sites (capillitium, face, lip, neck, dorsum of the hands, forearms outside, décolleté) of a population-based, case-control, multicenter study performed from 2013 to 2015 in Germany were matched to controls without skin cancer. Multivariate logistic regression analysis was conducted stratified for histological subtype, phototype 1/2 and 3/4. Dose-response curves adjusted for age, age2, sex, phototype and non-occupational UV exposure were calculated.ResultsParticipants with high versus no (OR 2.08; 95% CI 1.24–3.50; p = 0.006) or versus moderate (OR 2.05; 95% CI 1.15–3.65; p = 0.015) occupational UV exposure showed a more than two-fold significantly increased risk to develop BCC in commonly UV-exposed body sites. Multivariate regression analysis did not show an influence of phototype or histological subtype on risk estimates. The restriction of the analysis to BCC cases in commonly sun-exposed body sites did not influence the risk estimates. The occupational UV dosage leading to a 2-fold increased basal cell carcinoma risk was 6126 standard erythema doses.ConclusionThe risk to develop basal cell carcinoma in highly occupationally UV-exposed skin was doubled consistently, independent of histological subtype, tumor localization and Fitzpatrick phototype.

Sun Exposure and Photoprotection: Habits, Knowledge and Attitudes Among Elite Kitesurfers.

Kitesurfing is one of many water sports that are growing in popularity throughout the world. In such sports, practitioners are exposed not only to direct sunlight but also to reflection from the water surface, which aggravates the impact of solar radiation on the skin. This study sought to analyse the photoprotection and photoexposure habits and knowledge of elite kitesurfers and their beliefs and attitudes in this respect. A sample of convenience of 72 male kitesurfers completed a validated questionnaire in full. By Fitzpatrick phototype, the most common classes were types I and II (69.4%). On average, kitesurfers had been practising their sport for 10.93years, at a rate of 13.93h per week. During the last sports season, 84.7% of respondents had suffered at least one sunburn, while 43.1% had been sunburned at least three times. The sun protection practice most commonly adopted was the use of sunscreen cream, which was used by 79.2% of respondents. Although 43.2% of respondents recognized to be worried about they might get skin cancer from the sun, 31.9% does not like using sunscreen and 44.4% like sunbathing. Regarding the respondents' knowledge of facts about sun exposure, the average rate of correct answers for the items evaluated was 66.9%. In conclusion, elite kitesurfers are potentially exposed to dangerous levels of UV radiation, which caused numerous sunburn episodes during the last sports season. It is necessary to raise these athletes' awareness of their risk of developing skin cancer and of the need to improve their sun protection and skin surveillance practices.

Representation of dark skin images of common dermatologic conditions in educational resources: A cross-sectional analysis

Representation of dark skin images of common dermatologic conditions in educational resources: A cross-sectional analysis

Striae Gravidarum, Acne, Facial Spots, and Hair Disorders: Risk Factors in a Study with 1284 Puerperal Patients.

Objective To determine the prevalence of skin changes during pregnancy and to relate their occurrence to specific factors in a population of south Brazil. Methods A cross-sectional analytical study was carried out with 1284 puerperal patients. A questionnaire about skin changes during pregnancy was developed and applied by the authors to all puerperal women admitted in a tertiary hospital in south Brazil. Results The appearance of striae during pregnancy was reported by 633 women (49.5%) and had a statistically significant association with primiparity, presence of stretch marks before pregnancy, and gestational weight gain above 21 kg. Facial blemishes were reported by 33.9% (n = 434) and were associated with a positive family history, multiparity, and the use of facial sunscreen (p < 0.0001). The onset or worsening of acne was identified in 35.7% (n = 456) and was statistically associated with primiparity and Fitzpatrick phototypes IV and V. Hair alterations were reported by 44.5% (n = 569) and were associated with primiparity (p = 0.029). Conclusion Although most of the skin changes during pregnancy are considered “physiologic,” they can cause significant discomfort. Thus, it is important to know them and to understand which risk factors may be associated with such changes.

Belimumab for refractory manifestations of cutaneous lupus: A multicenter, retrospective observational study of 16 patients

Belimumab for refractory manifestations of cutaneous lupus: A multicenter, retrospective observational study of 16 patients

Fitzpatrick phototype disparities in identification of cutaneous malignancies by Google Reverse Image

Fitzpatrick phototype disparities in identification of cutaneous malignancies by Google Reverse Image

Efficacy of a repair cream based on Rhealba Oat plantlets extract and active healing compounds in peelings: benefit to patient's downtime and pain.

The frequency of dermatological procedures is steadily increasing, accompanying a growing demand from patients. Chemical peels are a method of resurfacing in the treatment of various skin conditions. However, during the early healing process, patients may impose downtime on themselves. The erythema, pain and poor aesthetic appearance of the skin can lead to unwillingness to participate in social or professional activities. The objective of this study was to evaluate the tolerance and efficacy of a repair cream based on Rhealba Oat plantlets extract and active healing compounds after a peeling procedure. Men and women, aged 18-65years, with Fitzpatrick phototype I-IV, who had previously received a medium-depth chemical peel on the face (TCA 30%) entered with their consent a clinical study evaluating the new test product based on Rhealba Oat and active healing compounds. At the beginning of the study, the selected patients received a TCA 30% medium-depth peel. Afterwards, they were treated during 29days with the repair cream and evaluated for the benefits to downtime and pain. Significant reductions of pain (P<0.0114) and erythema (P<0.0001) were observed in the study. The downtime reduction with the tested cream was 92% - from 9days after the previous peeling procedure to 0.74days with application of the tested cream - a difference of 8.39days. In consequence, the tested repair cream based on Rhealba Oat plantlets extract and active healing compounds brings clinical benefit to patients who undergo peeling procedures. By reducing pain and downtime, it allows patients to get back to their daily life activities a week earlier than with previous peels.

Efficacy and safety of a new resilient hyaluronic acid dermal filler, in the correction of moderate-to-severe nasolabial folds: A 64-week, prospective, multicenter, controlled, randomized, double-blind and within-subject study.

BackgroundInjectables that behave similarly to native tissue and preserve facial expressiveness represent a new frontier in aesthetic medicine. A range of fillers made of high molecular weight hyaluronic acid (HA) chains with low crosslinking have been specifically developed to complement facial dynamics.AimsThe efficacy and safety of one of these resilient HA fillers, and its noninferiority to an effective comparator available in the US, were tested in the treatment of dynamic wrinkles.MethodsA 15‐month, prospective, multicenter, controlled, randomized, double‐blind, within‐subject (split‐face) clinical trial was conducted on 140 subjects with moderate‐to‐severe nasolabial folds (NLF). Study endpoints included improvement on a proprietary Wrinkle Severity Rating Scale (WSRS) and Global Aesthetic Improvement Scale, according to Blind Live Evaluators (BLE), subjects, and treating investigators (TI). Subject perception was evaluated with FACE‐Q and satisfaction scales.ResultsThe per‐protocol population included 88 subjects (92% women) of all Fitzpatrick phototypes, with a mean age of 57 years. WSRS improvement was significantly greater with the resilient HA than its comparator over 15 months, including at week 24 (primary endpoint), as rated by BLE and TI. Results demonstrated the noninferiority of the resilient HA filler to its comparator. Aesthetic improvement and subject satisfaction were durably high, with an overall trend toward higher scores for the resilient HA filler. Both treatments were safe and well tolerated.ConclusionThe resilient HA filler made of long chains lightly crosslinked is at least equivalent to a well‐established comparator for the correction of NLF in subjects of diverse skin phototypes.

Ashy dermatosis: a review

Ashy dermatosis is characterized by asymptomatic, symmetrically-distributed, gray-colored macules located on the trunk, neck, face, and upper extremities. The condition occurs most commonly in patients with Fitzpatrick phototype III-V skin. The etiology is unknown, but drug ingestion, infection, and genetic factors have been suggested to elicit ashy dermatosis. No gold standard treatments have been established yet. The most successful treatment to date has been clofazimine, although topical tacrolimus, oral dapsone, narrowband ultraviolet light B phototherapy, and isotretinoin have shown treatment success. Ashy dermatosis is primarily a cosmetic concern, but can be a very distressing condition, especially for dark skinned individuals. Therefore, an increase in clinician awareness and more studies are needed to further understand the etiology and treatment options for this disease. This review serves as a single source for clinicians to stay up-to-date regarding the history, clinical presentation, histology, pathogenesis, differential diagnosis, and management options for ashy dermatosis. It also suggests an alternative name that more appropriately encompasses the clinical and histopathologic features, while acknowledging our lack of understanding of its etiology: macular hyperpigmentation of indeterminate etiology.

Radiofrequency and Telangiectasias

Introduction: The treatment of telangiectasias represents a main place of demand of aesthetic legs. The spider veins localized on lower limbs, in relation with pathology of the venous tissue, raises mainly a problem of cosmetic order. These fi ne dilations of the superficial venous network are not still of easy achievement and the results are sometimes uncertain, connected to the quality of the operator and also to the requirement of the patient. The radio frequency uses a current of the order of 4 MHz and offer on these small vessels of the interesting therapeutic perspectives. The aim of this prospective study is to measure efficiencies of radio frequency in only one session treatment. Methods: 30 patients, 25 at 63 old aged, present lower limbs reticular veins and telangiectasias. The CEAP classification is C1 A SE p As 1, pn. The Fitzpatrick photo type is 1 at 4. 8 treatment areas are identified. 250 impulsions by session are useful used. Patients are visited at 15 D and 60 D. We observed the efficiency of the radio frequency after a single session on telangiectasias of small diameters, following the treated area. Results: We consider positive results a total disappearance of vessel. One treatment session is necessary to treat some areas like ankles, feet (85% of positive outcomes) legs is also a good indication for 75% positive results. One the other hand, knee and thigh area is more resistant. It has 30% good results. Conclusion: Knowing that a number of high sessions are oft en necessary with the micro sclerotherapy the classic treatment of telangiectasias, to obtain satisfactory results. The obtained results are very encouraging

Skin cancer phototype: A new classification directly related to skin cancer and based on responses from 2869 individuals.

Fitzpatrick phototype (FST) classification (based on ability to tan and tendency to burn) is widely used for evaluating skin cancer risk; however, it was not developed for that purpose and has been criticised scientifically. The purpose of the present study was a first approach in establishing a new skin cancer phototype (SCP) classification with direct relation to skin cancer risk, based on the questions originally proposed by Fitzpatrick. However, contrary to Fitzpatrick, the questions are in the present study kept separate. Validated information on skin cancer and answers about participants' tendency to burn (4 answers) and ability to tan (4 answers) were obtained from 2869 Danes. The 16 (4×4 answers) possible answers formed a matrix, on which a logistic regression was carried out. Successively, the matrix neighbours which were insignificantly different were identified; of which the neighbours with the mutual lowest difference were merged. The merging resulted in four different SCP classes. There was a linear relationship between SCP classes and skin cancer risk. Further, SCP was as good a predictor of skin cancer as objectively measured skin phototype. As skin phototype is an important factor in skin cancer research, SCP has great potential in investigative studies of skin cancer risk.

Aging in Skin of Color: Disruption to Elastic Fiber Organization Is Detrimental to Skin’s Biomechanical Function

Skin aging is a complex process involving the additive effects of time-dependent intrinsic aging and changes elicited via skin's interaction with the environment. Maintaining optimal skin function is essential for healthy aging across global populations; yet most research focuses on lightly pigmented skin (Fitzpatrick phototypes I-III), with little emphasis on skin of color (Fitzpatrick phototypes V-VI). Here, we explore the biomechanical and histologic consequences of aging in black African-American volunteers. We found that healthy young buttock and dorsal forearm skin was biomechanically resilient, highly elastic, and characterized histologically by strong interdigitation of rete ridges, abundant organized fibrillar collagen, and plentiful arrays of elastic fibers. In contrast, intrinsically aged buttock skin was significantly less resilient, less elastic, and was accompanied by effacement of rete ridges with reduced deposition of both elastic fibers and fibrillar collagens. In chronically photoexposed dorsal forearm, significant impairment of all biomechanical functions was identified, with complete flattening of rete ridges and marked depletion of elastic fibers and fibrillar collagens. We conclude that in skin of color, both intrinsic aging and photoaging significantly impact skin function and composition, despite the additional photoprotective properties of increased melanin. Improved public health advice regarding the consequences of chronic photoexposure and the importance of multimodal photoprotection use for all is of global significance.

Basal cell carcinoma treated with Mohs micrographic surgery in young Ibero-American patients.

The incidence of basal cell carcinoma (BCC) in younger individuals has increased in recent decades. However, the characteristics of BCCs in this population, especially in Ibero-Latin American countries, have not been completely defined. To describe the demographic, clinical, and histopathological characteristics of BCCs in patients younger than 40 treated with Mohs Micrographic Surgery (MMS). A multicenter, retrospective study conducted between January 2009 and December 2014, in five Ibero-American countries, included biopsy-proven BCCs in patients younger than 40 that were treated with MMS. Demographic, clinical, histopathological, and surgical characteristics were described. The study included 301 tumors in 241 patients, of whom 61% were female. The most common Fitzpatrick phototype was III. The most common histological subtypes were nodular (37.5%) and infiltrative (18.9%). Perineural invasion was encountered in 1.7%, and tumor clearance was achieved in 87.4% within two stages of MMS. This is the first Ibero-Latin American transnational study describing the characteristics of BCCs in young patients treated with MMS. Despite darker skin phototypes in this population, BCCs can occur in early ages and may present with aggressive features. Therefore, MMS may be considered an appropriate first-line treatment option in this population.

Actinic keratosis - review for clinical practice.

Actinic keratosis (AK) is a lesion that arises as a result of excessive exposure to solar radiation and appearing predominantly on Fitzpatrick phototype I and II skin. Given that some AKs evolve into squamous cell carcinoma, these lesions are considered premalignant in nature, occurring mostly in elderly men and immunosuppressed individuals chronically exposed to ultraviolet (UV) radiation. There are several mechanisms for the formation of AKs; among them are oxidative stress, immunosuppression, inflammation, altered proliferation and dysregulation of cell growth, impaired apoptosis, mutagenesis, and human papillomavirus (HPV). Through the understanding of these mechanisms, several treatments have emerged. Among the options for AK treatment, the most commonly used include 5-fluorouracil (5-FU), cryotherapy, diclofenac, photodynamic therapy (PDT), imiquimod (IQ), retinoids, and ingenol mebutate (IM). There have been recent advances in the treatment options that have seen the emergent use of newer agents such as resiquimod, betulinic acid, piroxicam, and dobesilate. The combination between therapies has presented relevant results with intention to reduce duration of therapy and side effects. All AK cases must be treated because of their propensity to transform into malignancy and further complicate treatment. In addition to medical or surgical care, education about sun exposure prevention remains the best and most cost-effective method for AK prevention. The objective of this article is to conduct a literature review of the clinical presentation of AK including advances in treatment options available.

The effect of pre-phototest sun exposure on minimal erythema dose and minimal melanogenic dose among skin phototypes III, IV and V.

Ethnicity, skin phototype and colour influenced minimal erythema dose (MED). Sun exposure has been postulated to increase MED. We determined immediate pigment darkening dose to UVA (IPDDA), MED and minimal melanogenic dose (MMD) for UVB and UVA, and investigated factors affecting these doses. Skin phototype was determined using Fitzpatrick phototype quiz, DSMII ColorMeter measured skin colours, sun exposure quantified using an index (SEI) and phototest performed with MEDlight-Multitester. A total of 167 healthy volunteers participated. There were 110 (66%) females and 56 (34%) males; 124 (74.7%) were Malay, 27 (16.3%) Chinese and 14 (8.4%) Indians. One hundred and nine (65.7%) skin phototype IV, 30 (18.1%) phototype III and 27 (16.3%) phototype V. IPDDA ranges from 6±1.5-5.7±1.4J/cm2 . MED-UVB were 96.9±17.6, 124±29.3 and 118.6±27.4mJ/cm2 for phototype III, IV and V, respectively. All MED-UVA were outside the tested dose range of 3.6-11J/cm2 . MMD-UVB were 106±18.2, 134±25.6 and 136±31.1mJ/cm2 while MMD-UVA were 4.1±4.1, 4.9±3.8 and 5.7±3.7J/cm2 respectively for phototypes III, IV and V. MED-UVB, MMD-UVB and MMD-UVA did not depend on skin phototype. Facultative skin whiteness (L*), erythema (E) and melanin content (M) correlated significantly with MED-UVB while constitutive skin colours were significant for L*, yellowness (b*), E and M. Sun exposure did not significantly correlate with MED-UVB and MMDs, however, an inverse relationship with MED-UVB was demonstrated. Minimal erythema doses in our cohort were slightly different from other regional countries. Constitutive and facultative skin whiteness, erythema and melanin content correlated with MED. There was no association between skin phototype and sun exposure with MED or MMD.

606 The impact of oral phytochemicals on ultraviolet B-induced erythema response in human skin

UV radiation (UVR) induces pyrimidine dimer formation and generates reactive oxygen species leading to skin cancer and photoaging. Sunscreen and protective clothing are primary modalities for photoprotection, but rising skin cancer rates support the rationale for adding systemic photoprotective agents. We showed topical sulforaphane extracts from broccoli reduced erythema resulting from UVB irradiation in humans, and the antioxidant curcumin has well established its anti-inflammatory effects. However, it is not known whether the photoprotective effects of phytochemicals can be achieved through oral delivery. Our study of 20-day duration was designed to evaluate the photobiologic effects of these two edible plant components, separately and in combination. Here we report preliminary results of 6 subjects (3 male/3 female, ages 18-46) with Fitzpatrick phototype I-II. In Phase 1 (Day 1–10), all subjects avoided food or supplements containing phytochemicals. In Phase 2 (Day 11–20), subjects were randomized to receive either the sulforaphane precursor glucoraphanin (450 mg), or curcumin (1000 mg), or both, as oral supplements. On Day 7 [Phase 1] and Day 17 [Phase 2], skin was irradiated with 2-times the minimum erythema dose of UVB. Colorimetry was performed immediately before and 24 hr after UVR. The erythema index was measured as a*, a unit-less ratio of intensities of red reflectivity of the skin, and our photoprotection metric is the percent difference in a* measured at these two time points. The mean reduction in UV-induced erythema following supplementation was 11% (n=6, NS; range = 5% - 36%). The top two responders in erythema reduction (36% and 20%) were recipients of sulforaphane, either alone or with curcumin. These results suggest that select diet-based phytochemical may have utility as oral adjunct to abrogate the negative photobiologic effects of UVR.

Skin acceptability of a cosmetic moisturizer formulation in female subjects with sensitive skin.

PurposeThis 3-week, open-label, noncomparative clinical study evaluated the skin acceptability of a cosmetic moisturizer in subjects with sensitive skin, by monitoring adverse events (AEs) and cutaneous discomfort related to normal usage.Materials and methodsFemale subjects aged between 18–60 years, with Fitzpatrick phototype classification I–IV and sensitive skin, verified by a positive reaction on the stinging test at screening, were included. Subjects applied the moisturizer to their face and body twice daily for 21±2 days at home and recorded study product usage and feelings of cutaneous discomfort (eg, dryness, prickling, stinging, and itching) in a diary; any AEs were reported to the clinic. At study end, skin acceptability of the moisturizer was investigator-assessed based on the nature of AEs and subjects’ self-reported feelings of discomfort, and by clinical evaluation of skin reactions in the area of moisturizer application (appearance of erythema, formation of edema, and skin desquamation; scored according to an adapted Draize and Kligman scale). Only subjects with a treatment compliance of ≥80% were included in the final analysis.ResultsIn total, 35 subjects initiated and completed the study; all were compliant to the minimum study product usage. Per investigator clinical dermatological assessment at study end, none of the 35 subjects had skin reactions in the area of moisturizer application and there were no reported AEs. One subject reported sensations of mild prickling and itching immediately after applying the moisturizer (not classified as AEs), which spontaneously remitted after complete absorption of the product and were noted only in exposed areas. These events were considered by the investigator as being possibly/probably related to the use of study product; however, no clinical signs of skin reaction were observed in the exposed areas.ConclusionThis cosmetic moisturizer appears generally well tolerated and suitable for topical use in subjects with sensitive skin.

A study of skin disease spectrum occurring in Angola phototype V-VI population in Luanda.

Prevalence of skin diseases in Luanda (Angola) is unknown, and publications are barely found in the literature. We aim to describe, for the first time, the frequency of skin disease spectrum in phototype V-VI Angolan population in Luanda City. We included Fitzpatrick phototype V-VI Angolan patients who consulted the Dermatology Unit in Luanda Medical Center during a 1-year period. Medical information was recovered from the electronic database, and diagnoses were based on ICD-10. Only the main complaint was registered, and the results were classified according to age and sex. Criteria exclusion consisted of incomplete clinical records, Fitzpatrick phototype I-IV Angolan, or foreign patients from the study. From a total of 3938 patients, 3554 met the inclusion criteria, of which 2742 were adults 13 years or older. In this group, acne (23.6%), dermatophytosis (11.0%), and pityriasis versicolor (8.6%) were the main complaints. On the other hand, in the pediatric population (n = 812), atopic dermatitis (29.4%), tinea capitis (13.7%), and molluscum contagiosum (12.5%) were the most frequent disorders. In adult females, acne (31.3%) was the main condition, while in adult males, dermatophytosis (13.5%). In children, the frequency of atopic dermatitis was comparable: 29.1% and 28.6% in girls and boys, respectively. We published for the first time the frequency of the skin disease spectrum in Fitzpatrick phototype V-VI Angolan population in Luanda City, highlighting the prevalence of acne, dermatophytosis, and atopic dermatitis.

Parental use of sun protection for their children-does skin color matter?

Excessive sun exposure during childhood is a risk factor for skin cancer. This study aimed to compare the frequency of ideal sun protection use between parents with lighter- and darker-skinned children and explore their attitudes and beliefs on sun safety and their choice of sun protection. Parents of children aged 6months to 6years completed self-administered questionnaires about sun protection practices for their children. Parents assessed their child's Fitzpatrick phototype and were divided into lighter- (Fitzpatrick phototype I-III) and darker-skinned (Fitzpatrick phototype IV-VI) groups. Sun safety guidelines from the Canadian Dermatology Association were used to qualify ideal sun protection. A total of 183 parents were included. Overall, 31 parents (17%) used ideal sun protection for their children. As their children grew older, parents were less likely to use ideal sun protection (odds ratio=0.69, 95% confidence interval=0.53-0.90). Parents in the lighter-skinned group were more likely to use ideal sun protection for their children (odds ratio=7.4, 95% confidence interval=2.7-20.1), believe that sun exposure was harmful (odds ratio=17.2, 95% confidence interval=4.0-74.9), and perceive value in sun protection (odds ratio=11.4, 95% confidence interval=3.3-39.0); the darker-skinned group believed that darker skin tones provided more sun protection (odds ratio=12.4, 95% confidence interval=6.1-25.4). Ideal parental sun protection efforts are overall low, particularly in parents of darker-skinned children. The identified attitudes toward and beliefs about sun safety may aid in delivery of future sun protection interventions, especially in multiracial populations.

Pilot-study of photodamaged skin and melasma using reflectance confocal microscopy

Introduction: Photoaging and melasma are frequent dermatological complaints. Confocal reflectance microscopy (CRM) is a recent technique that can be used for diagnostic evaluation of these dermatoses. Objectives: To evaluate the characteristics of the epidermis and dermis containing pigmentary alterations caused by photodamage and melasma with the assistance of CRM, and compare the findings linked to these changes with the perilesional region. Methods: A pilot study was conducted with eight female individuals (aged 38 to 50 years, Fitzpatrick phototypes from II to IV) with clinical diagnoses of photodamage (n = 4) and melasma (n = 4) in the facial malar region. The perilesional and lesional regions were compared regarding the thickness of the stratum corneum and viable epidermis, the depth of the interpapillary crests, and the presence of hyper-refractive structures. Results: The pigmentary alterations in the photodamaged skin revealed a morphological pattern — such as an increase in the depth of the interpapillary ridges in the lesion region — typical of solar lentigo. In the lesional region of volunteers bearing melasma, it was possible to observe the presence of dendritic cells in the epidermis and melanophages in the dermis. All volunteers had hyper-refractive keratinocytes in the lesional epidermis region. Conclusions: Considering the number of patients evaluated, it was possible to characterize and compare cutaneous pigmentary alterations caused by photodamage to those cause by melasma.