Minimal Sun Exposure Research Articles

Epidemiological, clinical and histological characteristics of melanoma in young adults: a 30-year retrospective study (1993-2022).

Melanoma in young adults significantly impacts the survival of this age group. There are limited studies that analyze melanoma characteristics in young patients. We aimed to describe the epidemiological, clinical, and histological characteristics of melanoma in young adults and their temporal trends over the last decades. A retrospective observational study was conducted, involving 399 melanoma patients aged 18-44, over a 30-year period (1993-2022). Patients were divided into two groups based on their date of diagnosis (period 1, 1993-2007, and period 2, 2008-2022). Age at diagnosis was higher in the most recent period (34.3 vs 37; p=0.001). Over time, there was a reduction in thickness (1 vs 0.68 mm; p=0.01), a rise in melanomas located on the head and neck (6.5% vs 14.8%) and extremities (42.2% vs 45%), along with a decrease on the trunk (51.3% vs 40.2%) (p=0.009); and an increase in lentigo maligna (2.3% vs 5.3%) and superficial spreading melanomas (76.5% vs 84%), along with reduction in nodular types (16.1% vs 5.9%) (p=0.012). Women had, compared to men, higher limb melanoma prevalence (56.3% vs 27.1%; p<0.001), family history (11.7% vs 5.1%; p=0.020), lower thickness (0.69 vs 1.10; p= 0.001) and better prognosis (14.4% vs 20.9% deaths; p=0.012). Melanoma diagnoses in young adults occur at progressively advanced ages, with a rise in melanomas situated on the head and extremities and in histological types linked to prolonged sun exposure. Strategies like minimizing sun exposure from a young age and encouraging self-examination could lead to improved survival rates.

Photo protection and its relationship with skin injuries in outdoor workers

Introduction: occupational and recreational activities are the most important causes of exposure to solar radiation, the cumulative effect of which could lead to the development of skin cancer.Objective: determine dermatological injuries associated with sun protection among outdoor workers in the Provincial Municipality of Huánuco in 2023.Methods: an analytical observational study of a census nature was carried out. The instrument used was validated through five expert evaluations, obtaining a Kappa index of 0,94. The reliability of the instrument was evaluated using the α-Cronbach coefficient of 0,68 and Kuder-Richardson 20 of 0,69. The sample included 300 subjects. The techniques used were behavioral observation, interviews and surveys. The statistical analysis consisted of the use of Chi2.Results: a statistically significant association (p &lt; 0,05) was found between sociodemographic variables, hours of sun exposure, and sun protection practices. However, there was no association between dermatological injuries and sun protection practices in workers exposed and not exposed to solar radiation (p &gt; 0,05).Conclusion: dermatological injuries were observed due to solar radiation exposure in both groups, including those engaged in outdoor activities and those with minimal sun exposure

Assessing the solar radiation performance of self-shaded 3D-printed clay-based façades

ABSTRACT Earthen construction is known for its significant environmental benefits. It has been overshadowed by the growing popularity of industrial materials in the construction industry, leading to a detrimental impact on the environment. However, the emergence of 3D printing (3DP) techniques has received much consideration for using earth as a construction material. Despite its potential, the durability of the 3D-printed earthen structure remains a challenge that researchers are actively working to overcome. This research focuses on the feasibility of using 3D-printed clay-based façades in hot arid climates. The aim is to assess the solar radiation performance achieved by non-conventional 3D-printed walls, which are designed to provide maximum self-shading and minimize sun exposure. The methodology tackled several phases; material testing to assess extrudability and printability, exploring different geometries to optimize maximum self-shading, fabricating 3D-printed walls, and finally assessing their solar radiation performance. The findings demonstrate a significant reduction in solar radiation ranging from 52 to 158 kWh/m2 for the self-shaded walls where the inclination of the bump is inversely proportional to the solar radiation. However, due to the behavior of clay during printing a limitation for maximum cantilever angle not exceeding 17 degrees without support need. Nevertheless, this technique has the potential to serve as a passive design strategy for enhancing indoor thermal comfort. Further research is needed to optimize self-shading facades on a large-scale implementation, which can unlock the full potential of these passive strategies and contribute to creating comfortable living spaces.

Pigmented squamous cell carcinoma in situ with amyloid deposition mimicking melanoma

Pigmented squamous cell carcinoma in situ with amyloid deposition mimicking melanoma

XERODERMA PIGMENTOSUM - A CASE REPORT WITH OCULAR MANIFESTATIONS

Xeroderma Pigmentosum is a rare autosomal recessive genetic disorder characterized by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation and carcinogenic agents. Important clinical features are: intense cutaneous photosensitivity, xerosis, poikiloderma, actinic keratosis, acute burning under minimal sun exposure, erythemas, hyperpigmented lentiginous macules, and malignant lesions in sun-exposed areas, including basal cell carcinoma, squamous cell carcinoma, and melanoma. There is a great involvement of many parts of the body, especially head and neck. This paper reports a rare case of Xeroderma Pigmentosum in a 9-year- old male presenting mainly with ophthalmological and skin involvement.

Severe Hypocalcemia and Vitamin D Deficiency in Adolescence - A Case Series

Background: Hypocalcemia due to vitamin D (vit D) deficiency is uncommon among adolescents in the US. Only 3% to 6% of those ages 12- to 19-years-old have a vit D level <12 ng/ml.1 We present three cases of severe hypocalcemia secondary to vit D deficiency in non-obese adolescents with restricted diets and limited sun exposure. Clinical Cases: A 14-year-old Ethiopian male with history of absence seizures presented with bloody stool. Incidentally, labs revealed: Ca 5.6 (8.4–10.2) mg/dL, iCal 0.71 (1.2–1.38) mmol/L, PTH 295.1 (10.0–65.0) pg/mL, 25(OH)D <4 (20–100) ng/mL, Mg 1.9 (1.7–2.2) mg/dL, PO4 3.8 (2.5–4.5) mg/dL. He endorsed weight loss and knee pain, but denied paresthesias, tetany and seizures. He was a vegetarian and had minimal sun exposure. EKG and femur X-ray were unremarkable. He was started on IV calcium gluconate initially. Oral calcium carbonate and cholecalciferol were started on days three and four. He was discharged on day ten with iCal 0.84 on oral calcium carbonate and calcitriol.A 16-year-old male with history of autism, ADHD and bipolar disorder presented with a seizure. Labs revealed: Ca 5.7, iCal 0.62, PTH 372, 25(OH)D <4, Mg 1.9, PO4 3.5. Exam showed tetany, carpopedal spasms and positive Trousseau and Chvostek signs. EKG revealed prolonged QTc of 480 (<450) ms. He had a restricted diet and minimal sun exposure. His mother described his gait as “waddling” for the past two years. X-ray revealed bilateral femoral head fractures and evidence of rickets. He underwent bilateral surgical repair. He was started on IV calcium gluconate initially. Oral calcium carbonate and cholecalciferol were started on days two and four. He was discharged on day 14 with iCal 1.01 on oral calcium carbonate and cholecalciferol.A 16-year-old male with history of severe food allergies and restricted diet presented with a seizure. He visited urgent care three months prior for perioral tingling, muscle cramps and chest pain. He started a multivitamin for “low Ca” and “prolonged QTc.” The ED labs revealed: Ca 4.8, PTH 414.8, 25(OH)D 11, Mg 1.9, PO4 5.0, Alk Phos 539 (44–147) IU/L. Exam showed upper extremity twitching and QTc was 543 ms. He received 2 g calcium gluconate IV, then began oral calcium carbonate and cholecalciferol and continued supplementation following discharge on day six. Conclusions: Vit D deficiency among adolescents is re-emerging, likely due to decreasing sun exposure, unbalanced diets and increasing obesity.2 Adolescents with restricted diets due to allergy or behavioral disorders may be at higher risk of vit D deficiency. Increased screening of high-risk adolescents may lead to early identification of cases.

Associations between weather-related data and influenza reports: A pilot study and related policy implications

AimThe purpose of this retrospective, correlational pilot study was to explore the relationship between historical weekly weather data including temperature, dew point, humidity, barometric pressure, visibility, and cloud cover compared to weekly influenza-like illness reports over a four year period. BackgroundClimate and weather-related conditions may affect the viral activity and transmission of influenza, although this relationship has not been widely studied in nursing. Some research suggests that there are causal links between cold temperatures, low indoor humidity, minimal sun exposure, and influenza outbreaks. Additionally, rapid weather variability in a warming climate can increase influenza epidemic risk. MethodsData from a local public health district were extracted and used to correlate with weekly weather averages for the area. ResultsFindings showed that current influenza reports are significantly associated with temperature and visibility, both lagged two weeks. ConclusionsThough more research is needed, nurses must understand, recognize, and act upon weather and climate factors that affect the health of populations. With a greater understanding of the relationship between weather and influenza-like illness, nurses and other healthcare providers can potentially work to respond to and mitigate the consequences of weather-related illness as well as anticipate and prepare for increased flu burden. Furthermore, nurses can remain engaged in climate protective initiatives and policy development at their local community and/or organizational levels to underscore and advocate for the needs of populations and groups they serve.

Argyrophilic nucleolar organizing regions in patients with Xeroderma Pigmentosum Group E

Xeroderma pigmentosum E (XP-E) is a rare autosomal recessive inherited genodermatosis associated with less severe sun burning with minimal sun exposure. The affected individuals acquire abnormal pigmentation and are at high risk for skin cancer [1] . Notably, the DNA damage-binding protein 2 (DDB2) gene is responsible for XP- E disease [2] .

Coronavirus, the immune system and vitamin D

Vitamin D exerts extra-skeletal actions, given the presence in many different tissues of its nuclear receptors controlling transcription of genes related to autoimmune diseases and its endocrine effects mainly affecting calcium metabolism. Many papers have highlighted its ability to reduce infections and to modulate innate and adaptive cellular immunity, with an inverse correlation between the incidence of airway infections and serum vitamin D levels. During the COVID-19 epidemic, not only the elderly confined to the home, with no physical activity, minimal sun exposure and physiological reduction of the UV-radiation induced activation of vitamin D, but also people suffering from fragility fractures, often with comorbidities and treatments with bone-loss side effects (primarily steroids), as well as people in environments at high risk (such as patients and staff in hospitals), should take vitamin D supplements as an important step in the prevention of infections and their spread. In any case, randomised studies should be conducted on large populations to give value to this therapeutic strategy, given the lack of unequivocal of not univocal data on the immune supportive role of vitamin D, on the dose to be administered and blood levels to be achieved.

107 Increased prevalence of thyroid nodules in xeroderma pigmentosum patients: A feature of premature aging

Xeroderma pigmentosum (XP) is a rare autosomal recessive disease of DNA repair characterized by severe ultraviolet (UV) sensitivity resulting in a 10,000-fold increased risk for skin cancer. Symptoms include freckle-like pigmentation in sun exposed skin before age 2 years, severe burns after minimal sun exposure (50% of patients) and skin cancers in children. XP is also considered a premature aging disease because of its features such as: dry skin, increased sun-induced freckling in young patients, higher incidence of skin cancers in young patients and premature menopause.

084 UVB induces prolonged T cell activation in lupus-prone mice via type I IFN inhibition of T regulatory cells

Many patients with systemic lupus erythematosus (SLE) are photosensitive, which is characterized by the development of systemic and cutaneous symptoms following minimal sun exposure. While type I IFNs are increased in SLE skin after ultraviolet light (UV) exposure, the mechanisms to explain photosensitivity remain unclear. In-depth mechanistic studies conducted in wild-type mice show induction of a suppressive immune response to UVB, but how this applies to lupus-prone mice is unknown. This study explores the question of how activation of the adaptive immune system differs between wild-type mice vs. lupus-prone mice following UVB exposure, and how type I IFNs contribute to this difference. In order to examine UVB responses, 10-week old female lupus-prone (NZM2328), wild-type (BALB/c) and iNZM mice (lack type I IFN receptor on NZM background) were treated on their dorsal skin with 100mJ/cm2 of UVB for 5 consecutive days. No differences in the skin injury process (skin thickness) were noted between the mouse strains. Notably, however, only the NZM2328 mice showed an increase in draining lymph node size and T cell activation 2 weeks post UVB exposure. Both BALB/c and iNZM mice demonstrated an increase in functional T regulatory (Treg) cells 2 weeks post UVB treatment; this was not seen in NZM2328 mice. These data suggest that sustained UVB-mediated T cell activation is increased in lupus-prone mice in a type I IFN-dependent fashion through suppression of Tregs. Thus, we propose type I IFNs are important to the photosensitive responses in lupus and suggest that targeting type I IFNs could offer potential as a preventative treatment for UVB induced lupus flares.

Real-World Practice Patterns for Prevention and Management of Potential Adverse Events with Pirfenidone in Patients with Idiopathic Pulmonary Fibrosis.

IntroductionPirfenidone is an oral antifibrotic agent approved for idiopathic pulmonary fibrosis (IPF). Real-world data on adverse event (AE) management for pirfenidone are limited. Strategies for managing potential antifibrotic therapy AEs were examined in a sample of US pulmonologists.MethodsAn online, self-administered survey was fielded to pulmonologists between April 10 and May 17, 2017. Pulmonologists were included if they spent > 20% of their time in direct patient care and had ≥ 5 patients with IPF on antifibrotic therapy. Participants answered questions regarding initiation of pirfenidone, dose titration, and management of potential AEs.ResultsA total of 169 pulmonologists participated. Gastrointestinal (GI) intolerance was the most important factor in implementing alternative titration schedules for pirfenidone. Approximately three-quarters of pulmonologists recommended the standard titration scheme for starting treatment; however, a range of titration schedules up to 8 weeks were described, with a 4-week schedule being most common. Pulmonologists reported that most patients treated with alternative titration schedules could achieve the full dose of pirfenidone. Pulmonologists who were most effective at mitigating pirfenidone-related GI AEs by advising dosing at mealtimes more frequently recommended taking pirfenidone during a substantial meal than pulmonologists who were less effective. For photosensitivity AEs, pulmonologists recommended sunscreen use, sun avoidance, wearing a hat, and ultraviolet protection factor clothing.ConclusionsPulmonologists reported that alternative titration schedules for initiating pirfenidone were common and can aid in maintaining the full dose. Proposed strategies to ameliorate pirfenidone-related GI and photosensitivity AEs included taking pirfenidone during a substantial meal and minimizing sun exposure, respectively.FundingF. Hoffmann-La Roche Ltd./Genentech, Inc.Plain Language SummaryPlain language summary available for this article.

UVB induces early increases in IgG+ B cells in lupus-prone but not wild-type mice

Abstract At least 45% of patients with systemic lupus erythematousus (SLE) will experience photosensitivity, which is characterized by the development of cutaneous lesions following minimal sun exposure. Clinical and murine evidence support a correlation between ultraviolet (UV) light exposure and induction of systemic lupus flares, including autoantibody production, organ damage mediated by autoantibodies, and immune complex deposition. Therapies for preventing photosensitivity have remained elusive due to an incomplete understanding of the mechanisms involved. This study explores the question of how the B cell population changes after UVB exposure in a lupus prone mouse model (NZM2328) compared to wild-type (Balb/c) mice. In order to examine UVB responses, 10-week old female NZM2328 and Balb/c mice were treated on their dorsal skin with 100mJ/cm2 of UVB for 0,1, 3, or 5 days. No differences in the skin injury process (edema and scaling) were noted between the NZM2328 and Balb/c mice. Notably, however, only the NZM2328 mice showed an increase in the CD19+ IgG+ B cell population in the skin, draining lymph node and spleen within 3days. NZM2328, but not Balb/c mice also exhibited in increase in circulating anti-dsDNA IgG antibodies 2 weeks after 5 days of 100mJ UV treatment. These data suggest that NZM2328 mice have early activation of autoreactive memory B cell populations locally and systemically following UVB exposure compared to wild-type mice. This activation results in increased autoantibodies following UVB treatment. Thus, we propose memory B cell populations as important to photosensitive responses in lupus skin and suggest that targeting memory B cell activation could offer potential as a preventative treatment for SLE flares.

Dermatoporosis: a further step to recognition.

Skin ageing has long been considered only as a cosmetic issue. However, with increasing lifespan, we experience a functional dimension of skin ageing which extends beyond cosmetics and appearance. Ten years ago, we proposed the neologism dermatoporosis to cover different characteristics of a chronic cutaneous insufficiency/fragility syndrome, to understand underlying molecular mechanisms and to develop preventative or therapeutic strategies.

Xeroderma pigmentosum complicated by keratoacanthoma in a Kashmiri girl

Xeroderma pigmentosum is a rare autosomal recessive genetic disorder characterized by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. It manifests clinically as intense cutaneous photosensitivity, acute burning under minimal sun exposure, erythema, xerosis, poikiloderma, actinic keratosis, lentigines, and development of malignant lesions like basal cell carcinoma, squamous cell carcinoma, and melanoma in sun-exposed areas. We hereby report a case of xeroderma pigmentosum complicated by keratoacanthoma in a 9-year-old ethnic Kashmiri girl who had history of photosensitivity, dry skin, and pigmentary changes from the age of 2 years.

Artefactual 25-OH vitamin D concentration in multiple myeloma.

The most commonly used techniques to measure vitamin D are automated immunoassays which are known to be affected by interferences, especially from immunoglobulins present in the patient's serum. We present a case of a patient with myeloma in whom interference with the vitamin D assay was identified. An 83-year-old female, known to have IgG myeloma, was found to have a high concentration of 25-OH vitamin D on a routine test without any signs of vitamin D toxicity. She was not taking vitamin D supplements or any other multivitamin preparation and had minimal sun exposure. The initial and subsequent samples run by the ARCHITECT 25-OH vitamin D assay (chemiluminescent microparticle immunoassay technology, Abbott Laboratories, Abbott Park, IL) showed a high concentration of 25-OH vitamin D of 281 nmol/L and 327 nmol/L, respectively. Further fresh samples taken for 25-OH vitamin D and analysed by liquid chromatography-mass spectrometry (LC-MS/MS) and ARCHITECT analysis showed results of 49 nmol/L and 289 nmol/L, respectively. Our patient had high concentrations of circulating IgG paraproteins and had a long history of rheumatoid arthritis; paraproteins and rheumatoid factor may interfere in the assay. In conclusion, we report a case of a patient with IgG myeloma and rheumatoid arthritis with high concentrations of 25-OH vitamin D detected by the Abbott ARCHITECT, but not by a reference method (LC-MS/MS). The most likely cause of the discordant results is interference in the immunoassay by the paraprotein but interference from rheumatoid factor remains a possibility.

State of the science on prevention and screening to reduce melanoma incidence and mortality: The time is now.

Answer questions and earn CME/CNE Although overall cancer incidence rates are decreasing, melanoma incidence rates continue to increase about 3% annually. Melanoma is a significant public health problem that exacts a substantial financial burden. Years of potential life lost from melanoma deaths contribute to the social, economic, and human toll of this disease. However, most cases are potentially preventable. Research has clearly established that exposure to ultraviolet radiation increases melanoma risk. Unprecedented antitumor activity and evolving survival benefit from novel targeted therapies and immunotherapies are now available for patients with unresectable and/or metastatic melanoma. Still, prevention (minimizing sun exposure that may result in tanned or sunburned skin and avoiding indoor tanning) and early detection (identifying lesions before they become invasive or at an earlier stage) have significant potential to reduce melanoma incidence and melanoma-associated deaths. This article reviews the state of the science on prevention and early detection of melanoma and current areas of scientific uncertainty and ongoing debate. The US Surgeon General's Call to Action to Prevent Skin Cancer and US Preventive Services Task Force reviews on skin cancer have propelled a national discussion on melanoma prevention and screening that makes this an extraordinary and exciting time for diverse disciplines in multiple sectors-health care, government, education, business, advocacy, and community-to coordinate efforts and leverage existing knowledge to make major strides in reducing the public health burden of melanoma in the United States. CA Cancer J Clin 2016;66:460-480. © 2016 American Cancer Society.

Sun protection policies of Australian primary schools in a region of high sun exposure.

Queensland, Australia has the highest rates of skin cancer globally. Predetermined criteria were used to score the comprehensiveness of sun protection policies (SPP) of primary schools across Queensland. SPP were sought for schools in 10 regions (latitude range 16.3°S-28.1°S) from 2011 to 2014. Of the 723 schools sampled, 90.9% had a written SPP available publicly. Total SPP scores were low {mean 3.6 [95% CI: 3.4-3.9]; median 2 [interquartile range (IQR) 2, 4]}, with only 3.2% of schools achieving the maximum score of 12. Median SPP scores were higher in Northern and Central Queensland [both 2 (IQR 2, 6) and (IQR 2, 5), respectively] than in Southern Queensland [2 (IQR 2, 3); P = 0.004]. Clothing and hat-wearing were addressed in most policies (96% and 89%) while few schools used their SPP to plan outdoor events (5.2%) or reschedule activities to minimize sun exposure (11.7%). The SunSmart Schools program has been operating in Queensland for 17 years, and while most primary schools now have a written SPP, most are not comprehensive. Incentive-based approaches (5-star-rating award scheme and grants) may assist in addressing this issue, to reduce sun exposure of students and teachers. These data provide a baseline from which improvements in the comprehensiveness of school SPPs can be evaluated.

Xeroderma Pigmentosum.

Xeroderma pigmentosum (XP) is a rare disorder of defective UV-radiation induced damage repair that is characterized by photosensitivity with easy skin burning following minimal sun exposure, early freckling and development of lentiginous pigmentation along with other features of poikiloderma and a propensity for developing skin cancer at an early age. In this short review, the clinical, pathological, genetic and molecular aspects of XP are reviewed in the current literature. XP encompasses a spectrum of disease that overlaps with other diseases of DNA repair systems. In addition to cutaneous complications, patients are susceptible to eye conditions, neurodegenerative processes, central nervous system tumors and other tumors as a result of UV radiation exposure and its byproducts. Patients with XP frequently experience a shorter life span due to skin cancer and neurodegenerative sequelae, but aggressive preventative measures to minimize UV radiation exposure and damage can improve the course of disease and prolong life. The disease has served as a model for photoaging and UV radiation-induced cancer and has led to a better understanding of cell processes that prevent development of these disease features in normal individuals.

Sun Exposure and Protection Habits in Pediatric Patients with a History of Malignancy.

BackgroundSurvivors of childhood cancer are at high risk for developing non-melanoma skin cancer and therefore are firmly advised to avoid or minimize sun exposure and adopt skin protection measures. We aimed to compare sun exposure and protection habits in a cohort of pediatric patients with a history of malignancy to those of healthy controls.MethodsCase-control study of 143 pediatric patients with a history of malignancy (aged 11.2±4.6y, Male = 68, mean interval from diagnosis 4.4±3.8y) and 150 healthy controls (aged 10.4±4.8y, Male = 67). Sun exposure and protection habits were assessed using validated questionnaires.ResultsPatients and controls reported similar sun exposure time during weekdays (94±82minutes/day vs. 81±65minutes/day; p = 0.83), while during weekends patients spent significantly less time outside compared to controls (103±85minutes/day vs. 124±87minutes/day; p = 0.02). Time elapsed from diagnosis positively correlated with time spent outside both during weekdays (r = 0.194, p = 0.02) and weekends (r = 0.217, p = 0.01), and there was a step-up in sun exposure starting three years after diagnosis. There was no significant difference regarding composite sun protection score between patients and controls. Age was positively correlated with number of sunburns per year and sun exposure for the purpose of tanning, and was negatively correlated with the use of sun protection measures.ConclusionsAlthough childhood cancer survivors are firmly instructed to adopt sun protection habits, the adherence to these instructions is incomplete, and more attention should be paid to improve these habits throughout their lives. Since sunlight avoidance may results in vitamin D deficiency, dietary supplementation will likely be needed.