Dermatologists and other physicians should advise their skin-colored patients to practice sensible sun protection, including wearing protective clothing, staying in the shade in the open air, and applying a color. tinted. sunscreen with an SPF of 30 or higher in the exposed areas, according to Henry W. Lim, MD.
In addition, “with rigorous photoprotection, vitamin D. supplementation should be advised to patients, “said Lim, a former chair of the dermatology department at Henry Ford Health System, Detroit, during the pre-AAD meeting of the Society for Pediatric Dermatology.” One multivitamin a day should be enough for most patients. This is especially relevant because we know that patients with colored skin tend to have lower levels of vitamin D to begin with. “
Photoprotection for people of color helps minimize the development of photodermatosis, postinflammatory hyperpigmentation, polymorphic light eruption, and chronic actinic dermatitis, he said. In a retrospective graph review of 1,080 people performed at four academic medical centers in the United States, Lim and colleagues found a higher proportion of polymorphic light eruption and chronic actinic dermatitis in black individuals and a higher proportion of contact photoallergic dermatitis, phototoxic drug eruptions, phytophotodermatitis, porphyria i solar urticaria in white individuals.
“Another pediatric photodermatosis, actinic pruritus, tends to occur more often in mestizo individuals, patients of American Indian heritage,” he added. “This is an important issue, especially in Latin America.”
Systematically review of 20 studies in the medical literature, researchers evaluated quality of life and the psychological impact of photodermatosis in affected patients. The studies included in the review were based on 2,487 adults and 119 children. Among adults, the self-administered dermatological quality of life index (DLQI) revealed that photodermatoses negatively affected employment, education, and leisure activities in adults. Among children, the disease adversely affected outdoor activities and exacerbated symptoms in those with erythropoietic protoporphyria (PPE).
As for the risk of skin cancer, the association between exposure to UV light and the development of melanoma it is not as strong in people with colored skin, compared to fair-skinned individuals. In a recent one systematic review of 13 studies on the subject, 11 showed no association, one showed a small positive relationship in black men and 1 showed a weak association in Hispanic men.
“The conclusion of this review is that most studies do not support UV protection for melanoma prevention in people of color,” said Lim, who was not affiliated with the review. “The authors also noted, however, that the evidence is of moderate to low quality. Larger studies should be done.”
The association between exposure to ultraviolet rays and the development of squamous cell cancer in colored skin is also not strong. “However, we know that sun exposure is associated with the development of basal cell carcinoma in that population, ”he said.
Studies on sun protection ingredients
Lim also highlighted the results of two studies related to the effect of sunscreen application on the plasma concentration of active sunscreen ingredients, both in adults. In the most recent analysis, Food and Drug Administration scientists and colleagues conducted a randomized clinical trial in 48 people with skin type II-IV.
Participants applied sunscreen at 2 mg / cm2 to 75% of body surface area at 0 hours on day 1 and 4 times on day 2 on day 4 at 2-hour intervals. Over 21 days, the researchers collected 34 blood samples from each participant and evaluated six active ingredients in four sunscreen products: avobenzone, oxybenzone, octocrilen, homosalate, octisalate, and octinoxate.
For all active ingredients, levels above 0.5 ng / mL were detected after a single application on day 1. Levels above 0.5 ng / mL were detected until day 7 and day 21. for oxybenzone. All were detected on the skin on days 7 and 14 using stripping tape. The authors called for more studies to determine the clinical significance of these findings and stressed that the results “do not indicate that individuals should refrain from using sunscreen.”
The FDA is requesting additional studies on the safety of these 12 filters, noted Lim, who has been president of the American Academy of Dermatology. On February 26, 2019, the FDA issued a proposed rule with regard to sunscreen pharmaceuticals for over-the-counter human use. He proposes that the 16 UV filters be classified into one of 3 categories. The category I would include zinc titanium oxide and dioxide, which are generally recognized as safe and effective (GRASE). Category II would include PABA i trolamine salicylate, which are not used in the United States and are not GRASE. Category III will include 12 filters that do not have insufficient safety data to make a determination on GRASE.
The final FDA standard was scheduled for release in September 2020, but as a result of coronavirus aid, relief, and financial security (CURE) Act, the FDA “will move from a laborious regulatory process to an administrative order process, which means it shouldn’t take long to implement a monograph,” Lim said. “The FDA has decided that there will be no final rule on sunscreen pharmaceuticals,” but an administrative order proposal must be issued by Sept. 27, 2021, he said.
Once the final administrative order has been issued, manufacturers would have at least a year to comply with the sunscreen products offered in the United States. “The approximate timeline will likely be 2023,” he said.
Lim revealed that he is a researcher at Incyte, L’Oreal, Pfizer and the Patient-Centered Results Research Institute, and a consultant to Pierre Fabre, ISDIN, Ferndale, La Roche-Posay and Beiersdorf. He has been a speaker at general educational sessions sponsored by La Roche – Posay and Cantabria Labs.
This article originally appeared on MDedge.com, which is part of the Medscape professional network.
