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Cumulative effects of UVA in human skin
CORRESPONDENCE Cumulative
effects of UVA
in human
skin
To the Editor: The testing of sunscreensfor their ability to protect against the effects of UVA damage has been limited to date by the lack of a reproducible system that can identify the damage itself. The study by Lavker et al. (JAM ACAD DERMATOL1995;32:53-62) is a step in the right direction, and one hopes that the test system can be further refined to show measurable dose-related responses. Meanwhile, other methods for measuring UVA protection by sunscreensare being advanced. The Standards Association of Australia has accepted a test system that measures spectrophotometrically the percentage transmission of UVA by the test material. On the basis of such technology butylmethoxy-dibenzolymethane (Pars01 1789, Givaudan-Roure) has been successfully introduced as a UVA-blocking ingredient in broad-spectrum sunscreensin Canada and Europe. Twenty-five sunscreens containing this ingredient are now on the market in Canada and it has become a standard of sorts, providing not only assistance in managing clinical photosensitivity problems, but also, we hope and believe, protection against recreational expoSLlE. Private industry has taken steps towards documenting protection of patients with photosensitive disorders. Complete protection against W/A-induced polymorphous light eruption has been demonstrated with the use of another UVA-absorber (terephthalylidene di-camphor sulfonic acid [Mexoryl SX, L’Or&l]) in combination with Pars011789, titanium dioxide, and UVB filters.* Although clinically highly relevant, such patient-based testing is likely impractical for most companies producing sunscreens.Nevertheless, this is another significant step in the right direction. The U.S. Food and Drug Administration (FDA) is presently considering the question of UVA protection as part of the development of its Monograph on Sunscreen Drug Products. It is to be hoped that the test system chosen by the FDA will addressthe need for a standard of UVA testing that will quantitate the degree of protection provided to the patient/consumer and not merely the ability of these chemicals to absorb light in an artificial environment. Towards that end, I wish to encourage the authors to assistthe FDA by facilitating the testing not only of sunscreen products presently on the world market (many of which have absorption spectra far superior to that of the sunscreen tested in the report) but also of new product formulations being considered for the medical and commercial markets. F. William Danby, MD Chair, Sunscreen Product Education Program Canadian Dermatology Association 400-190 Wellington St. Kingston, Ontario, Canada, K7L 3E4 “Schaefer H. Datapresented atDermatology Update 1994, Vancouver, Canada, October 1994. Journal of the American
Academy of Dermatology
Severe hypertrichosis as an uncommon feature of juvenile dermatomyositis To the Editor: Severe hypertrichosis as an uncommon feature of juvenile dermatomyositis has recently been described by Pope, Strimling, and Mallory (J AM ACAD DERMATOL1994;31:383-7) in a 4-year-old girl. Appa.rently, no similar cases have been reported in the American literature since 1948. I wish to call your attention to the fact that hypetichosis in dermatomyositis in Mexican children is rather common. Actually, as shown in a series of 21 children,’ 14 (66.6%) of the patients exhibited hypertrichosis of varying degrees, before any treatment. Hair growth was more apparent on the forehead, cheeks, forearms, and legs. Boys were affected more commonly (six of seven) whereas only 8 of 14 girls showed hypertrichosis. All patients were treated with oral prednisone2; partial remission of abnormal hair growth was observed after 4 months of treatment. Some patients observed for up to 10 years, in whom all other cutaneous and muscular signs of dermatomyositis cleared, still show a moderate degree of hypertrichosis. It should be pointed out that primary hypertrichosis in either sex is uncommon in normal Mexicans. Therefore there is a special propensity of hair follicles to react in this way in our patients with juvenile dermatomyositis. Maria Amparo Faure Fontenla, MD Laboratory of Immunology and Rheumatology Hospital Infantil de Mkxico ‘ ‘Federico Gbmez’ ’ Dr. Mbrquez # 162 Cal. Doctores Mkxico City, 06720, Mexico REFERENCES 1. Fame-Fonteula MA, Rodriguez-Sukrez R, Sienra-Monge JJ, et al. Dermatomiositis juvenil: caractetisticas clhicas, immunol6gicas y terapeuticas. Bol Med Hosp Infant Mex 1993;50:717-25. 2. Boyd AS, Neldner KH. Therapeutic options in dermatomyositis/polymyositis.Int J Dermatol 1994;33:240-50. Reply
To the Editor: We thank Dr. Fontenla for bringing to our notice that hypertrichosis in juvenile dermatomyositis is more common in Mexican children. This is interesting because our patient was of Native American descent. We have recently seen one other patient, a Caucasian child, who had a similar presentation. Perhaps this is not as uncommon a finding as we once thought. Susan B. Mallory, MD Director, Pediatric Dermatology St. Louis Children’s Hospital Dermatology Division I Children’s Place St. Louis, MO 63110 October 1995 691
effects of UVA
in human
skin
To the Editor: The testing of sunscreensfor their ability to protect against the effects of UVA damage has been limited to date by the lack of a reproducible system that can identify the damage itself. The study by Lavker et al. (JAM ACAD DERMATOL1995;32:53-62) is a step in the right direction, and one hopes that the test system can be further refined to show measurable dose-related responses. Meanwhile, other methods for measuring UVA protection by sunscreensare being advanced. The Standards Association of Australia has accepted a test system that measures spectrophotometrically the percentage transmission of UVA by the test material. On the basis of such technology butylmethoxy-dibenzolymethane (Pars01 1789, Givaudan-Roure) has been successfully introduced as a UVA-blocking ingredient in broad-spectrum sunscreensin Canada and Europe. Twenty-five sunscreens containing this ingredient are now on the market in Canada and it has become a standard of sorts, providing not only assistance in managing clinical photosensitivity problems, but also, we hope and believe, protection against recreational expoSLlE. Private industry has taken steps towards documenting protection of patients with photosensitive disorders. Complete protection against W/A-induced polymorphous light eruption has been demonstrated with the use of another UVA-absorber (terephthalylidene di-camphor sulfonic acid [Mexoryl SX, L’Or&l]) in combination with Pars011789, titanium dioxide, and UVB filters.* Although clinically highly relevant, such patient-based testing is likely impractical for most companies producing sunscreens.Nevertheless, this is another significant step in the right direction. The U.S. Food and Drug Administration (FDA) is presently considering the question of UVA protection as part of the development of its Monograph on Sunscreen Drug Products. It is to be hoped that the test system chosen by the FDA will addressthe need for a standard of UVA testing that will quantitate the degree of protection provided to the patient/consumer and not merely the ability of these chemicals to absorb light in an artificial environment. Towards that end, I wish to encourage the authors to assistthe FDA by facilitating the testing not only of sunscreen products presently on the world market (many of which have absorption spectra far superior to that of the sunscreen tested in the report) but also of new product formulations being considered for the medical and commercial markets. F. William Danby, MD Chair, Sunscreen Product Education Program Canadian Dermatology Association 400-190 Wellington St. Kingston, Ontario, Canada, K7L 3E4 “Schaefer H. Datapresented atDermatology Update 1994, Vancouver, Canada, October 1994. Journal of the American
Academy of Dermatology
Severe hypertrichosis as an uncommon feature of juvenile dermatomyositis To the Editor: Severe hypertrichosis as an uncommon feature of juvenile dermatomyositis has recently been described by Pope, Strimling, and Mallory (J AM ACAD DERMATOL1994;31:383-7) in a 4-year-old girl. Appa.rently, no similar cases have been reported in the American literature since 1948. I wish to call your attention to the fact that hypetichosis in dermatomyositis in Mexican children is rather common. Actually, as shown in a series of 21 children,’ 14 (66.6%) of the patients exhibited hypertrichosis of varying degrees, before any treatment. Hair growth was more apparent on the forehead, cheeks, forearms, and legs. Boys were affected more commonly (six of seven) whereas only 8 of 14 girls showed hypertrichosis. All patients were treated with oral prednisone2; partial remission of abnormal hair growth was observed after 4 months of treatment. Some patients observed for up to 10 years, in whom all other cutaneous and muscular signs of dermatomyositis cleared, still show a moderate degree of hypertrichosis. It should be pointed out that primary hypertrichosis in either sex is uncommon in normal Mexicans. Therefore there is a special propensity of hair follicles to react in this way in our patients with juvenile dermatomyositis. Maria Amparo Faure Fontenla, MD Laboratory of Immunology and Rheumatology Hospital Infantil de Mkxico ‘ ‘Federico Gbmez’ ’ Dr. Mbrquez # 162 Cal. Doctores Mkxico City, 06720, Mexico REFERENCES 1. Fame-Fonteula MA, Rodriguez-Sukrez R, Sienra-Monge JJ, et al. Dermatomiositis juvenil: caractetisticas clhicas, immunol6gicas y terapeuticas. Bol Med Hosp Infant Mex 1993;50:717-25. 2. Boyd AS, Neldner KH. Therapeutic options in dermatomyositis/polymyositis.Int J Dermatol 1994;33:240-50. Reply
To the Editor: We thank Dr. Fontenla for bringing to our notice that hypertrichosis in juvenile dermatomyositis is more common in Mexican children. This is interesting because our patient was of Native American descent. We have recently seen one other patient, a Caucasian child, who had a similar presentation. Perhaps this is not as uncommon a finding as we once thought. Susan B. Mallory, MD Director, Pediatric Dermatology St. Louis Children’s Hospital Dermatology Division I Children’s Place St. Louis, MO 63110 October 1995 691