SKIN OPTICS AND PHOTOTHERAPY OF JAUNDICE

Abstract The Kubelka–Munk theory of radiation transfer is applied to determine the influence of skin optical losses on the efficiency of phototherapy of jaundice. Using a multi-layer model of the skin the photon absorption rate of bilirubin molecules is calculated for spectrally Gaussian light sources and fluorescent lamps used in phototherapy. Light absorption and scattering processes in the skin layers shift the optimum value of the peak excitation wavelength from λ= 453 nm (absorption maximum of bilirubin in vitro ) to λ= 480 nm. This suggests the clinical investigation of narrow-spectrum lamps emitting in the blue-green region of the spectrum.     

ALTERATIONS OF PROTEOGLYCANS IN ULTRAVIOLET-IRRADIATED SKIN

Abstract— The effect of UVB exposure on the distribution and synthesis of dermal proteoglycans was measured in the skin of hairless mice. Two groups of mice were included: one was irradiated for 10 weeks; the other was kept as control. After intraperitoneal injection of sodium ³⁵S-sulfate, punch biopsies were taken for histology and proteoglycans were extracted from the remaining skin with 4 M guanidinium chloride, containing 3–[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate (0.5%, weight per volume). Following proteolytic digestion, the glycosaminoglycan constituents were isolated and analyzed by quantitative cellulose acetate electrophoresis and enzymatic digestibility.
Under the influence of UVB radiation, newly synthesized proteoglycans measured by ³⁵SO₄ uptake increased as much as 60%. In addition, the irradiated skin had a higher average content of proteoglycan than had control skin (4981 μg vs 4134 μg/g dry weight). This could be ascribed to an increase in heparin (1400 vs 533 μ g/g dry weight) and heparan sulfate (472 vs 367 μg/g dry weight), whereas no change in the concentration of hyaluronic acid (1243 vs 1372 μg/g dry weight) and dermatan sulfate (1866 vs 1863 μg/g dry weight) was observed. The irradiated animals also exhibited a marked increase in the synthesis of heparan sulfate and heparin (62% and 71%, respectively). These results demonstrate that chronic doses of UVB altered proteoglycan metabolism through both quantitative and qualitative changes.     

SPECTROSCOPIC AND MICROSCOPIC CHARACTERISTICS OF HUMAN SKIN AUTOFLUORESCENCE EMISSION

To improve the understanding of human skin autofluorescence emission, the spectroscopic and microscopic characteristics of skin autofluorescence were studied using a combined fluorescence and reflectance spectroanalyzer and a fiber optic microspectrophotometer. The autofluorescence spectra of in vivo human skin were measured over a wide excitation wavelength range (350–470 nm). The excitation–emission matrices of in vivo skin were obtained. An excitation–emission maximum pair (380 nm, 470 nm) was identified. It was revealed that the most probable energy of skin autofluorescence emission photons increases monotonically and near linearly with increasing excitation photon energy. It was demonstrated that the diffuse reflectance, R, can be used as a first order approximation of the fluorescence distortion factor f to correct the measured in vivo autofluorescence spectra for the effect of tissue reabsorption and scattering. The microscopic in vitro autofluorescence properties of excised skin tissue sections were examined using 442 nm He–Cd laser light excitation as an example. It was demonstrated that the fluorophore distribution inside the skin tissue is not uniform and the shapes of the autofluorescence spectra of different anatomical skin layers vary. The result of this study confirms that the major skin fluorophores are located in the dermis and provides an excellent foundation for Monte Carlo modeling of in vivo autofluorescence measurements.     

SYSTEMIC INFLUENCE OF PRE-IRRADIATION OF A LIMITED SKIN AREA ON UV-TUMORIGENESIS

Abstract— It has been established that chronic UV irradiation of mice produces a systemic effect. The animals become incapable of rejecting an implanted UV-induced tumor. A possible consequence of the induction of this systemic effect could be an enhancement of the de novo formation of tumors by chronic UV irradiation. We have therefore carried out an investigation to determine whether such an effect is demonstrable in an animal model. Hairless mice (Skh hr 1) were pre-irradiated for a few months with UV radiation while certain skin areas of the animals were shielded from the radiation. Subsequently, the initially shielded skin areas were chronically exposed to UV radiation, which resulted in the development of tumors in these skin areas. It was found that the formation of tumors in the initially shielded skin areas was enhanced by the pre-irradiation of the other skin areas. Thus, a systemic effect appeared to have influenced the development of tumors in the initially shielded skin areas.     

SKIN PHOTOSENSITIVITY AND PHOTODESTRUCTION OF SEVERAL POTENTIAL PHOTODYNAMIC SENSITIZERS

The major side effect associated with porphyrins (Photofrin II) in clinical photodynamic therapy is skin photosensitivity. In order to avoid this deleterious reaction, patients must remain out of the sunlight for approximately 1 month. A possible procedure to reduce the amount of skin photosensitivity is to photodegrade (photobleach) the compound in the skin. In this study, we report a series of experiments describing the photodegradation rates of two photosensitizers currently receiving attention due to their potential for use in PDT (mono L-aspartyl chlorin e6 and chloroaluminum sulfonated phthalocyanine). These compounds are compared to Photofrin II (PfII). Experiments consisted of determining photodegradation rates and efficiencies of the sensitizers in (i) phosphate buffered saline (PBS), (ii) PBS with fetal calf serum (to enhance absorption and simulate cellular binding or deaggregation), (iii) Chinese Hamster Ovary cells, and (iv) Balb/c mice. We performed two standardized skin sensitivity assays using the Hartely albino guinea pig irradiated with a UV blue point lamp and Balb/c mice irradiated with the therapeutic wavelength of each sensitizer. In addition, we performed a cell clonogenicity assay comparing photodegraded and fresh PfII on CHO cells. The photodegraded PfII exhibited significant phototoxicity, although the fluorescence was bleached by more than 70%. The results show that PfII causes major skin photosensitization and that the other compounds produce no substantial skin sensitivity. Our studies suggest that photodegradation of PfII with 630 nm light has little influence on the phototoxicity of the compound. In addition, skin sensitivity was not alleviated with prior photobleaching with 405 nm light.     

ULTRAVIOLET-RADIATION and SKIN CANCER. EFFECT OF AN OZONE LAYER DEPLETION

The effect of changes in the ozone layer on the incidence of skin cancer was explored using data for Norway. Attempts were made to arrive at a relationship between the "environmental effective UV-dose" and the skin cancer incidence. Norway is well suited for this purpose because of the large variation in the annual UV-dose from north to south. Furthermore we have a well developed cancer registry and a homogeneous population with regard to skin type. Four different regions of the country, each with a broadness of 1 degree in latitude (approximately 111 km), were selected (located around 69.5, 63.5, 60 and 58.5 degrees N). The annual effective UV-doses for these regions were calculated, assuming normal ozone conditions throughout the year and the action spectrum proposed by CIE, which extends up to 400 nm. The incidence rate (in the period 1970-1980) of malignant melanoma and non-melanoma skin cancer (mainly basal cell carcinoma) increased with the annual environmental UV-doses. For both these types of cancer a quadratic dose-effect relationship seems to be valid to a first approximation. The present data indicate that the incidence of skin cancer would increase by approximately 2% for each percent ozone reduction.     

EFFECTS OF UV IRRADIATION ON A LIVING SKIN EQUIVALENT

Abstract— The Living Skin Equivalent (LSE™) is an organotypic coculture composed of human dermal fibroblasts interspersed in a collagen-containing matrix and overlaid with human keratinocytes forming a stratified epidermis. The LSE has a dry, air-exposed epidermal surface suitable for the application of oils, creams and emulsions. These features suggested its feasibility as an in vitro skin model for studying the protective effects of sunscreens. Using the thiazolyl blue (MTT) conversion assay as a measure of mitochondrial function, the extent of cytotoxicity induced by various doses of UV-R (280–400 nm) or UV-A (320–400 nm) was evaluated in the LSE. The doses of UV radiation that caused 50% reductions in MTT conversion (UV-R₅₀ or UV-A₅₀) in different lots of LSE were 0.053 ± 0.021 J/cm² (n = 29) and 11.6 ± 4.9 J/cm² (n = 17) for UV-R and UV-A, respectively. The protective effects of an 8% homosylate standard and of five UV-A sunscreens, topically applied to the LSE, were determined and compared with their reported protection factors in human skin. Morphological changes and the release of proinflammatory mediators (interleukin-1-α, tumor necrosis factor-α and prostaglandin E2) implicated in UV-induced erythema were also demonstrated in the LSE exposed to UV-A or UV-B. The data suggest that the LSE can be used for studying the effects of U V radiation on skin and may have utility for assessing the efficacy of certain sunscreens against UV-B and UV-A.     

CAROTENOIDS AFFECT DEVELOPMENT OF UV-B INDUCED SKIN CANCER

One large dose of UV-B (8 × 10¹⁴ J m^-2: 290-320 nm) has been found to cause the development of skin tumors in hairless mice, and carotenoid pigments prevent or delay tumor development in this system. This model was used to determine if the protective effect of carotenoid pigments against UV-B induced skin tumors occurred during the induction phase or progression phase of UV-B carcinogenesis. The results indicate that the carotenoids canthaxanthin and (J-carotene interfered with the progression phase in this system; whether they also had an effect during induction could not be definitely determined from our data.     

ENHANCEMENT OF UV-INDUCED SKIN CARCINOGENESIS BY AZATHIOPRINE: ROLE OF PHOTOCHEMICAL SENSITISATION

Abstract The phototoxicity of various drugs (chlorpromazine (CPZ), metronidazole (MET), 8-methoxypsoralen (8-MOP), azathioprine (AZA) and the azathioprine metabolites, 6-mercaptopurine (6-MP), methylnitrothio-imidazole (MNTI), methylnitroimidazole (MNI)) was determined in hairless (Skh-hrl) mice exposed to a light source with broad emission (290–700 nm). Chlorpromazine, MET, 8-MOP, AZA, MNI and 6-MP were phototoxic, as determined by the oedematous response of skin, at doses comparable to those used clinically.
The effects of long-term drug therapy and UV radiation on skin carcinogenesis were then determined. Chlorpromazine and MET, and to a lesser extent AZA, MNTI and 6-MP, enhanced photocarcinogen-esis. In each case, both the tumour yield and the proportion of malignant:benign skin tumours were increased. The results of this study imply that prolonged treatment of mice with low-level phototoxins predisposes to photocarcinogenesis.     

THE ULTRAVIOLET DOSE DEPENDENCE OF NON-MELANOMA SKIN CANCER INCIDENCE

Abstract— We correlate annual ultraviolet dose estimates with age specific and age adjusted incidence data for non-melanoma skin cancer in the United States, United Kingdom, Canada and Australia. We first examine (1) a reciprocity or photographic model in which incidence rates (R) are related to exposure (E) which is the product of age (T) and annual dose (D). We also test several models which violate reciprocity including models identified by the labels: (2) Dose potency; (3) Double cause; (4) Age-exposure and (5) separable. Our analyses together with the recent National Cancer Institute study favors the age-exposure model and/or the double cause models. All models lead to biological amplification factors (defined as the ratio of the percent increase in skin cancer incidence due to a 1% increase in dose) greater than unity. For the U.S. we find the biological amplification to be approximately 1.8 for the population center but greater in regions of higher UV annual dose, and less in regions of lower annual UV dose.     

PHOTOREPAIR OF PYRIMIDINE DIMERS IN HUMAN SKIN IN VIVO

Abstract— The exposure of human skin in vivo to UV radiation emitted from a sunlamp induces the formation of pyrimidine dimers. The number of dimers, as detected by UV-endonuclease, decreases following exposure of the UV–irradiated skin to visible wavelengths of light. These results suggest that humans possess a mechanism by which pyrimidine dimers are photorepaired upon illumination of human skin in vivo with visible light.     

ACTIVATION OF BENZOPORPHYRIN DERIVATIVE IN THE CIRCULATION OF MICE WITHOUT SKIN PHOTOSENSITIVITY

In vitro experiments with benzoporphyrin derivative monoacid ring A (BPD) confirmed earlier studies that it was taken up rapidly (within 30 min) to maximum concentrations by all cells tested. It was also confirmed that rapidly dividing tumor cell lines and mitogen-activated murine T lymphocytes took up significantly more (5-10-fold) BPD than did normal splenic lymphocytes. Further experiments were undertaken to determine whether BPD could be activated by whole-body irradiation with red light in the blood of animals, shortly after intravenous (i.v.) administration, in the absence of skin photosensitivity. It was found that shaved and depilated mice injected i.v. 60 min earlier with BPD at between 0.5 and 1.0 mg/kg could tolerate 160 J/cm² of broad-band red light (560-900 nm) delivered, at a relatively low rate, over a 90 min time interval without developing skin photosensitivity or general phototoxicity. During the treatment time, plasma levels of BPD were between 0.7 and 1.0 μg/mL. The light treatment resulted in between 70 and 80% photoinactivation of circulating BPD. When LI 210 tumor cells were preincubated with BPD and injected i.v. into mice immediately before total-body light treatment (160 J/cm² of 590-900 nm light delivered over 90 min), significant reductions in circulating clonogenic tumor cells were observed in blood samples taken immediately following treatment. This indicated that sufficient light was being delivered to BPD in the blood flowing in the peripheral vasculature to effect cytotoxicity to cells containing the photosensitizer without causing either vascular or skin photosensitivity. Thus, activation of this photosensitizer in the circulation can be achieved by transdermal light exposure without causing skin photosensitivity provided that light exposure is performed at a time when the first phase of plasma clearance is complete and when the drug has not yet accumulated in skin.     

EFFECT OF IONIZING RADIATION UPON TOTAL DIFFUSE SPECTRAL REFLECTANCE OF ULTRAVIOLET LIGHT BY SKIN

Abstract— Irradiation of guinea-pig skin with X rays and beta particles resulted in decreased total diffuse reflectance (DSR) of 330–400 nm light. Qualitatively, this response resembled that seen after irradiation of the skin of normal guinea-pigs with ultraviolet (UV) radiation of wavelength shorter than 300 nm or that of photosensitized guinea pigs with UV wavelengths longer than 300 nm. We postulate that the transformations which depress the DSR result from energy-transfer processes, independent of the class of radiation. Moreover, they are intimately related to subsequent changes in vascular permeabilities (delayed erythema) which occur after the same radiation exposures that lower the 330–400 nm DSR of skin surfaces.     

IRREVERSIBLE BINDING OF NITROFURANTOIN TO SKIN AND TO PLASMA PROTEINS OF UV-A EXPOSED RATS

Abstract— Allergic reactions to the widely applied urinary tract disinfectant nitrofurantoin (NFT) often concern the skin. They are probably mediated by a NFT-protein adduct. which has been suggested to result from incomplete nitro-reduction during metabolism. In this study it was investigated whether photoactivation of NFT in rats, upon exposure to UV-A, leads to formation of adducts between the drug and biomacromolecules. Rats were given p.o. doses of [¹⁴C]-NFT, and some were exposed to UV-A. More irreversible binding was found in skin of the back (both in dermis and in epidermis). tail, ears, eyes, plasma proteins, and spleen of light-exposed rats compared to those kept in the dark. This photobinding increased (up to ∼0.6 nmol/mg protein =∼25 nmol/g tissue) with dose and light-intensity. When rats were kept at 32°C, instead of 22°C during NFT/UV-A treatment, even more irreversible binding was observed; this is probably caused by an increased dermal blood flow. Under these conditions, irreversibly bound radioactivity was even found in kidney, lung and liver. Irreversible binding in these inner organs is explained by systemic distribution of radioactivity, photobound to plasma proteins. Photodecomposition of NFT in the skin, followed by reaction of photoproducts with (cellular) biomacromolecules may explain some of the skin rashes and other (allergic) reactions reported for this drug.     

EPR PERSISTENCE MEASUREMENTS OF UV-INDUCED MELANIN FREE RADICALS IN WHOLE SKIN

Electron paramagnetic resonance is used to detect the formation of free radicals caused by exposure to ultraviolet radiation in chemically untreated rabbit skin. A fast jump in EPR signal level, occurring over a few seconds, is observed immediately after a skin sample is exposed to UV. This is followed by a slower increase toward an elevated steady-state signal over a period of hours as the skin is continuously exposed to a UV light source. Upon cessation of UV light exposure, EPR signal levels undergo an abrupt drop followed by a slower decay toward natural levels. Elevated free radical concentrations following UV exposure are found to persist for several hours in whole skin. These results are consistent with time-resolved EPR measurements of photoinduced radicals in various natural melanins.     

PROJECTIONS OF INCREASED NON-MELANOMA SKIN CANCER INCIDENCE DUE TO OZONE DEPLETION

Abstract— Projections of increase in non-melanoma skin cancer incidence due to ozone layer depletion by chlorofluorocarbons are presented. Projections have been made for five different ozone depletion scenarios, based on US. Environmental Protection Agency estimates of potential worldwide industrial production and commercial applications of chlorofluorocarbons, and their eventual release into the atmosphere. The least favorable scenario, a regulatory cap on production at estimated 1990 levels, would lead to an eventual 30% ozone depletion and to an eventual doubling of skin cancer incidence by the year 2300. The most favorable scenario, a reduction in production commencing now and reaching a low production target by 1990, would limit ozone depletion to an eventual 2.8%, and increase in skin cancer to about 5%. Compared to the least favorable scenario, the most favorable one would prevent an average of about 100,000 cases of skin cancer per year in the United States between now and the year 2100.     

POTENTIAL EFFECTS OF ALTERED SOLAR ULTRAVIOLET RADIATION ON HUMAN SKIN CANCER

There is highly significant evidence that non-melanoma skin cancers are primarily due to chronic repeated exposure to solar ultraviolet radiation, and that there is a significant, although somewhat different relationship between solar radiation and the development of cutaneous malignant melanoma. Recent experimental and epidemiologic studies show that the biologically most effective UVR wavelengths are in the segment of the solar UVR spectrum that would be significantly augmented by decreases in stratospheric ozone content. A recent report on measurements of column ozone changes in the stratosphere has shown that in the past 18 yrs, there has been an ozone decrease between 2 and 3%, greater in the winter months, and somewhat differing with latitude in the Northern Hemisphere. Calculations of the relationship of ozone decrease to increase in biologically effective UVR show great dependence on the biologic action spectrum assumed. Based on extensive epidemiologic studies of skin cancer incidence, it appears that the estimated increase in biologically effective UVR due to the measured ozone decreases in the past (almost) two decades are not likely to be the cause of the sharp increase in skin cancer incidence which have been observed. Most likely these increases in incidence are the result of increasing personal exposure, due to striking changes in personal behavior that have taken place for social reasons. However, there is every reason to believe that increases in biologically effective UVR due to stratospheric ozone decreases will have significant impact on human skin cancer incidence in the future.     

PHOTOSENSITIVITY IN THE SKIN OF THE LIZARD, Anolis carolinensis

Skin of the lizard, Anolis carolinensis, is remarkably sensitive to light. Illuminated in vitro with visible light from a tungsten source (110 W (m-2)), skin changes from brilliant green to dark brown (50% reduction in reflectance) within 2-4 min as a result of dispersion of melanin from a perinuclear position within dermal melanophores into superficial dendritic processes. Reversal of the process, reaggregation of pigment, will occur within 2.0 min upon return to darkness. This photic response can be initiated with light levels as low as 5.0 W m(-2) and is maximized by light levels only 5% that of midwinter sunshine. Pigment dispersion in response to both melanocyte simulating hormone and to light is inhibited by cytochalasin-B, indicating that microfilaments may be the motor element for pigment movement in that direction. Colchicine, but not cytochalasin-B, totally blocks pigment reaggregation following melanocyte stimulating hormone exposure and partially blocks it in the dark phase of the photic response. The results of this study are consistent with a model for pigment movement in A. carolinensis that provides microfilaments for pigment dispersion and microtubule involvement in both dispersion and aggregation. Finally, because it is readily visible, easily quantified, rapid and reversible, photic response in the skin of A. carolinensis is recommended as a valuable model system for the study of saltatory movement of organelles within cells.     

DIFFUSE SPECTRAL REFLECTANCE MODIFICATION OF SKIN BY U.V. IRRADIATION

Abstract— Irradiation of guinea pig skin in vivo with light shorter than 300 nm produced a significant decrease in 330–400 nm reflectance. A similar decrease in reflectance was seen by irradiation of excised guinea pig and human skin. Chemical or physical vasodilation had no effect on the 240–400 nm reflectance. Irradiation of guinea pig skin in vivo with light longer than 300 nm produced no change in 330–400 nm reflectance unless photosensitized with 8-MOP. U.V. irradiation of skin (in the presence of suitable endogenous or exogenous photo-sensitizers) may result in the formation of new products that effectively absorb 330–400 nm photons.     

FUNCTIONS OF LIPIDS ON HUMAN SKIN

In order to clarify the roles of lipids in the water-holding property of stratum corneum, the forearm skin of healthy male volunteers was treated with acetone/ether (1/1) or sodium dodecyl sulfate (5%) for 1-30 min. A prolonged treatment period of 5-30 min produced a chapped and scaly appearance of the stratum corneum without any inflammatory reactions. Under these conditions, there was a marked decrease in the water-holding capacity of the stratum corneum accompanied by a selective loss of stratum corneum lipids such as cholesterol, cholesterol esters, and sphingolipids. Two daily applications of the isolated stratum corneum lipids to experimentally induced dry skins caused a significant increase of conductance, accompanied by a marked improvement in the level of scaling. Meanwhile, the isolated sebaceous lipids exhibited no significant recovery in both the conductance value and the scaling. Out of chroma-tographically separated fractions of the stratum corneum lipids, topical applications of ceramide fraction induced the highest increase in the conductance value. Topical applications of synthesized pseudo-ceramides also showed a significant recovery of the water-retaining properties accompanied by an improvement in the scaling only when the polar group has an amide bond in the major linkage. Analysis of the alkyl chain structures has revealed that a structural requirement for the recovery of the water retaining capacity is the presence of saturated-straight alkyl chains, not unsaturated or branched alkyl chains. These structural characteristics required for water-retaining function also paralleled their capacity to form multiconcentric lamellae vesicles in vitro which is also capable of acquiring bound water as shown by DSC thermograms. The present study suggests that ceramides with relatively shorter alkyl chain length serve as a water modulator in the multi-lipid bilayers through the stratum corneum.