The Photomedicine Society
promotes a greater understanding
of light in health and disease.

 

The 26th Annual Meeting of The Photomedicine Society

The 26th Annual Meeting of The Photomedicine Society was held:

March 3, 2016
Marriott Marquis
Marquis Salons 12/13
901 Massachusetts Avenue NW
Washington, DC, USA


PROGRAM
7:30 – 7:55 Registration
7:55 – 8:00 Opening Remarks
Sewon Kang, M.D., Baltimore, Maryland
Session 1: Photoaging
8:00 – 8:30 Nada Elbuluk, MD, MSc, FAAD, New York, New York
Effects of Infrared Irradiation on Collagen Metabolism in Lightly and Darkly Pigmented Skin
Session 2: Visible Light
8:30 – 9:00 Anna L. Chien, M.D., Baltimore, Maryland
Beyond the Ultraviolet Spectrum: What We Know About Visible Light
9:00 – 9:30 Indermeet Kohli, Ph.D., Detroit, Michigan
Photo Protection against Visible Light Induced Pigmentation
9:30 – 10:00 Nikiforos Kollias, Ph.D., British Columbia, Canada
The "Colors" of Facultative Pigmentation Induced By Ultraviolet and Visible Radiation
10:00 – 10:15 Break
Session 3: Home-use Light-based/Energy Devices
10:15 – 11:00 J. Frank Nash, Ph.D., Cincinnati, Ohio
Light-based Home Use Devices: Are They Safe and Efficacious?
11:00 – 12:00 Abstract Session A
12:00 – 1:30 Break for Lunch
Session 4: Radiation Treatment
1:30 – 2:15 Armand B. Cognetta, Jr., MD, Tallahassee, Florida
Superficial Radiotherapy: “Back to the Future”
2:15 – 2:30 Break
Session 5: Vitamin D
2:30 – 3:30 Antony R. Young, MD, PhD, London, United Kingdom
Impact of Sunscreens and Melanin on Vitamin D Synthesis
3:30 – 4:30 Abstract Session B

Speakers

Anna L. Chien, M.D.
Beyond the Ultraviolet Spectrum: What we know About Visible Light

Dr. Chien is an Assistant Professor at Johns Hopkins Department of Dermatology. She graduated summa cum laude from Emory University and received her medical degree from the University of Chicago. Dr. Chien completed her residency in dermatology at the University of Michigan. She joined the faculty of Johns Hopkins Department of Dermatology in 2009 and is the Co-Director of the Cutaneous Translational Research Program. Her research interests include skin again and the effects of visible light on the skin.

Armand B. Cognetta, Jr., MD
Superficial Radiotherapy: “Back to the Future”

Dr. Armand Cognetta is founder and president of the Dermatology Associates of Tallahassee, a 12 person practice serving the Florida panhandle. He received his medical degree from the University of Connecticut Medical School in 1979, and served his dermatology residency at the University of Alabama in Birmingham. Dr. Cognetta also did his MOHs Fellowship at the University of Alabama in Birmingham under Gary D. Monheit, M.D.

Dr. Cognetta is a clinical professor of dermatology and chief of division of dermatology at the Florida State University College of Medicine. He is a fellowship director for the American College of MOHs Micrographic Surgery and Cutaneous Oncology, and currently trains one Fellow per year. Dr. Cognetta is widely published and lectures on early detection and melanoma and skin cancer management.

Indermeet Kohli, Ph.D.
“Photo Protection against Visible Light Induced Pigmentation”

Dr. Kohli is a Research Physicist at the Henry Ford Department of Dermatology. She graduated summa cum laude from Wayne State University with her Ph.D. in Physics. She was a faculty of Physics at Wayne State and joined the research team at Henry Ford Health System Department of Dermatology in 2013. Her research interests include imaging and photomedicine.

J. Frank Nash, Ph.D.
Light-based Home Use Devices: Are They Safe and Efficacious?

Dr. Nash is currently a Research Fellow in the Central Product Safety department at Proctor and Gamble. He received his M.S. and Ph.D. degrees in Pharmacology and Toxicology from Purdue University in 1984 and 1986, respectively. He completed a Fellowship at Case Western Reserve University in 1988. He was an Assistant Professor in Biological Psychiatry at the Case Western Reserve School of Medicine until 1992. He joined Proctor and Gamble as a toxicologist in 1992.

Dr. Nash’s areas of expertise include, dermal toxicology, specializing in photobiology/phototoxicology models and efficacy/safety evaluation of cosmetic products, sunscreens and IPL/laser devices.

Nada Elbuluk, MD, MSc, FAAD
Effects of Infrared Irradiation on Collagen Metabolism in Lightly and Darkly Pigmented Skin

Dr. Nada Elbuluk is a board-certified dermatologist and assistant professor at the NYU Langone Medical Center’s Ronald O. Perelman Department of Dermatology. She received her medical degree from the University of Michigan where she graduated with distinction in research. While there she received an NIH award that allowed her to also obtain a Master of Science in Clinical Research from the University of Michigan School of Public Health. She completed her dermatology residency at Johns Hopkins Hospital.

Dr. Elbuluk’s clinical and research interests include general and cosmetic dermatology, with a special interest in ethic skin and pigmentary disorders including vitiligo, melasma and postinflammatory hyperpigmentation.

Antony R. Young, MD, PhD
Impact of Sunscreens and Melanin on Vitamin D Synthesis

Professor Young has been involved in research on the effects of ultraviolet radiation (UVR) on human skin for the past 25 years. The European Commission (EC), UK Department of Health, UK Medical Research Council, research charities and industry have largely funded this research. Professor Young has a long-standing interest in photoprotection, and is also currently working on vitamin D, the photobiology of different skin types and the development of natural marine sunscreens. He was recently the coordinator of a 4-year EC €3.5-million research project, within its Framework 7 Environment and Climate Change Programme, entitled “The impact of climatic and environmental factors on personal ultraviolet radiation exposure and human health”. This multi-national project assessed the beneficial and detrimental health impacts of UVR in field studies of human populations in work and leisure situations in different European countries.

Professor Young is an active member of the American Society for Photobiology (ASP) and the European Society for Photobiology (ESP). He an associate editor of Photodermatology, Photoimmunology and Photomedicine, and a section editor of the Journal of Dermatological Science. Professor Young is also a member of the United Nations Environment Programme (UNEP) - Environmental Effects Assessment Panel.



Abstracts


  1. Hao Ou-Yang and Thomas Shyr
    Johnson & Johnson Consumer Inc., Skillman, NJ

    Statement of purpose: Shade works by physically shielding skin from direct harmful UV rays. However, UV rays can also reach the skin from other angles. There is a lack of measure regarding how effective the shade is and a lack of clinical evidence that shade can provide sufficient protection when used in real life.

    Methods: We have set up a general physical model to assess the sun protection factor of any shades including a beach umbrella. The model takes into consideration the diffuse UV portion, the shade geometry, the ground albedo and the transmission of the shade material. The model was validated in multiple settings by measuring biologically weighted UV intensities with and without the shade with a calibrated UV meter.

    We directly measured sunburn protection offered by a beach umbrella in comparison to a high SPF sunscreen in a randomized, evaluator blinded in-use clinical study. Eighty-one subjects were divided into two groups (using only shade vs, using only sunscreens). The subjects of both groups were kept side-by-side for three and half hours at beach in Texas during a summer day. Clinical sunburn evaluation was conducted at baseline and 24 hours following the exposure.

    Results: We found with modelling and real life measurement that the optimal SPF offered by a shade is less than 7 in real life usage conditions due to the large portion of diffused UV rays and the limited protection angles by a typical shade. In the clinical study, we confirmed that beach umbrella offered poor sunburn protection compared to high SPF sunscreen. Of the subjects in shade group 78% showed an increase of erythema in one or more sites vs. only 25% of the subjects in sunscreen group.

    Conclusions: We conclude that shade, such as that produced by a beach umbrella, may not provide sufficient sun protection for an extended exposure. It is important to consider multiple sun protection measures and combine them, rather than relying on a single approach.

  2. JM Menter, L Freeman, O Edukuye
    Morehouse School of Medicine, Atlanta, GA

    Statement of Purpose: Mammalian collagens exhibit weak intrinsic UV fluorescence that depends on the age and previous history of the sample. Post-translational modifications result in additional fluorescent products (e.g. DOPA, dityrosine, and advanced glycation end products (AGE)). UV radiation can cause longer wavelength fluorescent oxidative bands. The fluorescence of unirradiated acid – extracted Skh – 1 hairless mice collagen reflects considerable autoxidation. We wonder why MMP-1 production is not evident. This work is aimed at further study of this system.

    Methods: Fluorescence spectra were recorded at 20 o C pH = 7.4 in a Perkin – Elmer Fluorescence Spectrophotometer at excitation/emission wavelengths of 270/300 (tyrosine), 270/330 (DOPA), 270/360 DOPA oxidation product(s)), 325/400 (dityrosine), and 370/450 nm, DOPA oxidation product(s). Parameters of 270/360 nm fluorescence fading and concomitant 325/400 nm increase are r2 and r1 respectively

    Summary of Results: We found a reciprocal relationship between the rates of decrease in the 270/360 nm fluorescence and concomitant increase in 325/400 nm fluorescence. Their relative rates depend on the age of the collagen sample. There is a reciprocal relationship between r1 and r2. This relationship results because both ground state autoxidation and excited state photo-dimerization proceed via a common tyrosyl radical intermediate.

    Statement of Conclusions: There is a common link between ground - and excited state reactions in type I collagen. Although the collagen molecular scaffolding is weakened by the resulting changes, MMP production is apparently not enhanced noticeably. We have not studied the effect of AGE on these results. Further work is needed in this area. Supported by DOD Grant #911 NF-10-1, MBRS Grant #GM08248, and RCMI Grant #.RR 3034.

  3. SNG Hughes1, C Cole2, KG Gross3, LA Mark3, J Stanfield4, H Hughes1.
    1Sun Precautions/Sun Protection Foundation, Seattle WA,
    2Sun & Skin Consulting LLC, Ringoes NJ,
    3Skin Surgery Medical Group, San Diego CA,
    4 Suncare Research Laboratories, Winston-Salem, NC

    Our research evaluates natural sunlight protection of 8 high SPF, broad spectrum sunscreens and 6 sun protective fabrics, all sold in North America. Currently, sun protection for sunscreens is determined indoors using in vivo and in vitro laboratory tests. In 1978, the advisory committee to the FDA recommended both indoor testing and outdoor natural sunlight SPF testing, but, in 1993, the FDA removed the natural sunlight SPF testing method based on 2 research papers published in 1978-79 citing equivalence (using a low SPF sunscreen). We tested sunscreens and fabrics on 11 subjects in natural sunlight for up to 3 hours using a protocol similar to that described by the FDA in 1978. Erythema and persistent pigment darkening (PPD) were assessed by evaluators 22 hours after exposure. When skin sites protected by sunscreen at the 2 hour mark were scored, 73% of the sites were graded 1 MED erythema or 1 MPPDD or higher and discernible sun induced erythema and PPD was observed at 92% of the sites. For two sunscreens—labeled SPF 30 and SPF 45+ —SPF factors of 4 and 5, respectively, were calculated (n=10). No discernible sun-induced injury was observed at the sites protected by sun protective fabrics. The pronounced erythema and PPD at the sunscreen protected sites were unexpected given the broad spectrum, high SPF sunscreen claims.

    Subsequently, we performed indoor SPF testing using a solar simulator modified to increase visible and IR irradiation and to lower the intensity to solar levels (5 mW/cm2). The 45+ SPF labeled sunscreen had a 11.8 SPF, closer to the value of 5.2 SPF obtained in natural sunlight. More research is needed to understand the differences between indoor and outdoor testing and to explain the discrepancy between product SPF claims and natural sunlight performance.

  4. Shaun Hughes1, Curtis Cole2, Joseph Stanfield3.
    1Sun Precautions/Sun Protection Foundation, Seattle,WA,
    2Sun & Skin Consulting LLC, Ringoes NJ,
    3Suncare Testing Laboratory, Winston-Salem, NC

    Indoor laboratory testing of a sunscreen product was conducted on human subjects to evaluate the level of photoprotection provided when a solar simulator’s spectrum and intensity were modified to more closely match actual outdoor sunlight conditions and the results were compared to actual outdoor testing results. Previous results presented at the 2015 Photomedicine Society meeting highlighted poor performance of sunscreen products with high SPF, broad spectrum protection claims when tested outdoors with real sunlight. To understand the potential differences between laboratory determined SPF claims and outdoor testing results, a broad spectrum 45+ SPF inorganic sunscreen was evaluated in clinical laboratory testing with a solar simulator modified to more closely approximate solar spectrum and intensity. The UG5 filter was removed from a 150W xenon arc solar simulator and the intensity was reduced to 6 mW/cm2 to include more visible and infrared energy in the exposure. Overall intensity was reduced by including neutral density screening. SPF testing was conducted on 10 subjects and the results were compared with those obtained for that same SPF 45+ labeled sunscreen tested under natural sunlight conditions. The modified indoor test results indicated an SPF value of 11.8, comparing more closely with the natural sunlight SPF of 5.2, but still significantly below the 45+ SPF claim. These data suggest that either there may be a significant failure of dose-reciprocity when testing at solar intensities (4-6mW/cm2) compared with typical clinical SPF testing conducted at 70 – 150 mW/cm2, or the inclusion of even modest amounts of visible and infrared radiation significantly affects the results, or there are dose-reciprocity failure because of additional visible and infrared radiation mediated oxygen reactions that are rate limited by availability of sufficient oxygen. Further evaluations to examine these hypotheses are underway.

  5. Vincent Richer1,2, Harvey Lui1.
    1Department of Dermatology and Skin Science, University of British Columbia and Photomedicine Institute, Vancouver Coastal Health Research Institute
    2Department of Medicine, Dermatology Division, Centre Hospitalier de l’Université de Montréal

    Background and Purpose: Acute adverse reactions during UVA1 phototherapy include erythema, tanning, pruritus, polymorphous light eruption and herpes simplex reactivation. The time course of these effects during UVA1 phototherapy has not been specifically studied. The purpose of this study was to describe the chronology and frequency of acute adverse reactions and their resultant influence on UVA1 dosing during the course of treatment.

    Methods: A chart review of patients who underwent UVA1 phototherapy from June 2009 to April 2015 was performed for this cross-sectional study. Clinical data, acute adverse reactions and treatment adjustments were extracted. Random-effects regression analysis was performed to identify factors associated with any acute adverse reactions, any treatment adjustments, any erythema, and total number of episodes of erythema.

    Results: Forty-nine patients received a total of 72 UVA1 phototherapy courses, which corresponded to 1,581 UVA1 exposures. Acute adverse reactions to UVA1 occurred in 44% (32/72) of treatment courses, which corresponded to 7.1% (112/1581) of treatment exposures. Treatment adjustments were necessary in 24% (17/72) of courses, which corresponded to 7.5% (118/1581) of exposures. Adverse reactions occurred more frequently within the first half of treatment courses (p = 0.0202 and 0.0161 for first and second courses respectively, Wilcoxon test). High-dose (i.e. 100-130 J/cm2) versus medium-dose (i.e. 40-80 J/cm2) UVA1 was associated with the occurrence of adverse reactions (OR 20.33, 95% CI [2.66 – 155.61]) treatment adjustments (OR 5.14, 95% CI [1.09 – 24.26]), erythema (OR 17.81, 95% CI [2.91 – 108.84]) and frequency of erythema (OR 3.78, 95% CI [1.84 – 7.77] p < 0.001). Baseline minimal erythema doses to UVA1 did not correlate with the occurrence of acute toxicity in this study.

    Conclusions: Adverse reactions to UVA1 phototherapy are relatively frequent and occur more often during the first half of a treatment course. High-dose UVA1 phototherapy is associated with more toxicity than medium-dose UVA1 and necessitates dose adjustments more often.

  6. Tasneem F. Mohammad, Indermeet Kohli, Prescilia Isedeh, Cynthia L. Nicholson, German Treyger, Henry W. Lim, Iltefat H. Hamzavi
    Henry Ford Hospital Department of Dermatology, Detroit, MI

    Background: Visible light causes erythema, thermal damage, free radical production, and pigmentation. Few sunscreens protect against visible light, which can exacerbate photodermatoses. Polypodium Leucotomos Extract (PLE) has antixodiant, photoprotective, chemoprotective, anti-inflammatory, and immunomodulatory properties.

    Objective: To determine the effectiveness of PLE in preventing visible light induced pigmentation.

    Methods: 13/22 subjects with Fitzpatrick SPT IV-VI have been completed. On day 0, subjects were irradiated with visible light (VL). Evaluation occurred immediately, 24 hours, and 7 days after irradiation to assess immediate pigment darkening (IPD), persistent pigment darkening (PPD), and delayed tanning (DT) respectively. Subjects then received a 28 day supply of PLE. Irradiation and evaluation were repeated on days 35, 36, and 42. Pigmentation was assessed by investigator’s global assessment, clinical photography, diffuse reflectance spectroscopy, and biopsies.

    Results: At a dose of 480 J/cm2, eight subjects demonstrated decreased IPD after VL irradiation post-PLE, while nine subjects had a decrease in delayed tanning at Day 7 assessment. Pre-PLE spectral features indicate production of new pigment for 9/13 subjects seven days after VL exposure, compared to 5/13 subjects post-PLE.

    Conclusions: Spectral characteristics indicate an effect of PLE on visible light induced pigmentation. Final conclusions will be drawn at study completion.

  7. Audrey A Jacobsen B.A.1, Yotam Papo M.D.2, Robert Sarro M.D.2, Kurt Weise MD2, John Strasswimmer M.D./Ph.D.2,3,4
    1University of Miami Miller School of Medicine, Miami FL
    2Florida Atlantic University Internal Medicine Residency Program, Boca Raton FL
    3Dermatology Residency, Broward Health, Ft Lauderdale FL
    4Strasswimmer Mohs Surgery Delray Beach FL

    An alternative for voriconazole-induced photocarcinogenesis for at-risk patients has not been well studied. Here we present a patient who has been successfully treated with posaconazole after developing severe voriconazole- induced photocarcinogenesis.

    An elderly light-skinned female had been receiving voriconazole and low- dose corticosteroids for suppression of chronic exophiala dermatitidis meningitis for the last 5 years. She had no history of hematologic malignancy, solid organ transplantation or other immunosuppressed state. Several months after starting voriconazole, the patient developed a severe photosensitivity reaction, which progressed to extensive actinic keratosis (AK) development. The patient subsequently required 3 Mohs surgeries for large, aggressive SCCs on her extremities, had 348 AKs treated, and 32 of 41 biopsies positive for SCC over 21 months. We compared the number of AKs treated during six months preceding the switch with a six-month period after, allowing for a “transition” time in between. AKs trended down, decreasing from 22.2 (SD=13.0) to 6.6 (SD=8.2) and no subsequent Mohs surgery was required.

    Treatment options for Exophiala Dermatitidis, a dematiaceous fungi with melanin-like pigment in the cell wall, are not well documented, but voriconazole is widely used for treatment and prophylaxis of fungal infections. However, approximately 8-10% of patients experience dermatologic side effects including phototoxicity, new-onset squamous cell carcinoma, pseudoporphyria, discoid lupus erythematosus, and accelerated photoaging. These adverse events have not been reported with posaconazole and a recent meta-analysis ranked posaconazole superior to voriconazole in preventing invasive fungal infections (Zhao et al. 2015). Considering that posaconazole has a favorable side effect profile and has shown good efficacy in invasive fungal infection prophylaxis and treatment, it should be considered more often as a first line drug in at-risk patients.

  8. Jaclyn Smith, Leonora Culp, Steven R. Feldman
    Wake Forest Baptist Health Department of Dermatology, Winston-Salem, NC

    Sponsor or funding source: National Biological Corporation and Blue Cross Blue Shield of North Carolina

    Purpose: Ultraviolet B phototherapy is a first-line treatment for moderate-to-severe psoriasis. Home phototherapy is a safe, effective, and convenient option but is underutilized, in part because of high copayments, which can range from $1,000 to $2,390. The purpose of this pilot study was to assess the effect of eliminating the copayment on utilization of home phototherapy.

    Methods: Patients with North Carolina State Health Plan insurance, a diagnosis of psoriasis, and candidates for home phototherapy as determined by their dermatologists were eligible for home phototherapy units without any out-of-pocket costs. Ten patients who received a home phototherapy prescription were surveyed by phone at baseline and two 3-month intervals. They were asked if they would have taken a biologic medication if they did not get the home phototherapy device.

    Results: Two of the ten patients said they would have started biologics if they had not gotten a home phototherapy unit. The two most common reported reasons for not wanting to start a biologic were fears of the medication’s side effect profile and having already been on a biologic medication. Affordability was the most common reported reason for the inability to start a biologic for those who would had they not been given a home phototherapy unit.

    Discussion: Heavy copayments on home phototherapy incentivize patients to choose more costly biologic treatments. Eliminating copayments for home phototherapy is a rational approach to reducing overall cost of psoriasis management while maintaining high quality care.

  9. Uli Osterwalder and Bernd Herzog
    BASF PCN GmbH, Monheim, Germany

    Due to their historical development as means for “tanning without sunburn”, most sunscreens still provide a UVB-biased protection spectrum. Ideally sunscreens should provide spectral homeostasis, i.e. attenuate, but not change the UV spectrum; similar to clothing that is undisputed in skin cancer prevention. The purpose of the study is to propose a simple and reliable method to identify and quantify differences between sunscreens regarding the total UV burden that the skin is receiving.

    Sunscreen performance can be assessed by knowing its UV filter composition and their individual absorption spectra. The transmittance of any chosen solar spectrum through an irregular film of sunscreen can be calculated at every wavelength for the whole UV range in order to derive SPF and common UVA metrics. Such a simulation program is accessible on the Internet for free since 2002 (www.basf.com/sunscreen-simulator). Recently a new metric has been introduced. The “normalized transmitted UV dose at 1 minimal erythema dose” (NTUVD) compares the total transmittance of a given sunscreen with spectral homeostasis.

    NTUVD values of current sunscreens vary between one (= spectral homeostasis) up to four or more. The sunscreen simulation tool is used to develop sunscreens with lower NTUVD. Two examples are given for illustration: 1) How could US sunscreens be improved if the FDA is approving the pending broad-spectrum UV filters bemotrizinol, bisoctrizole, drometrizole and/or ecamsule? Sunscreen simulations show that at a given high SPF the total UV burden could be halved. 2) How much less Vitamin D can be produced through a UVB-biased sunscreen. The simulation results show that uniform rather than UVB-biased protection may allow more Vitamin D synthesis by a factor of two or more.

    Total doses of UV radiation received with sunscreens of a given SPF can vary by factors of two to four. For the prevention of skin cancer it is crucial to have a tool to assess the differences of sunscreens regarding total transmittance of UV radiation.

  10. Cynthia Nicholson, M.D., Indermeet Kohli, Ph.D., Tasneem Mohammad, M.D., German Treyger, Henry Lim, M.D., Iltefat Hamzavi, M.D.
    Henry Ford Hospital Department of Dermatology, Detroit, MI

    Background: Visible light (VL) has been shown to induce erythema, pigmentation, and photodamage. Sunscreens effective against VL contain inorganic filters, but are often cosmetically unacceptable in darker skin tones. Antioxidants possess photoprotective properties and may serve as an alternative.

    Objective: To investigate the synergistic effect of sunscreen plus antioxidant against the visible light biological effects.

    Methods: 18/22 subjects with Fitzpatrick skin type IV-VI had topical application of sunscreen plus antioxidant, topical sunscreen, and topical antioxidant prior to VL exposure. The pigmentation response was compared to subject’s baseline VL response. Investigator’s global assessment scores, photography, and diffuse reflectance spectroscopy were performed immediately after VL exposure to assess immediate pigment darkening (IPD), at 24 hours to assess persistent pigment darkening (PPD), and 7 days after to assess delayed tanning (DT).

    Results: The analysis of 18/22 subjects indicates a statistically significant decrease in PPD for sunscreen plus antioxidant treatment. However, statistical significance was not reached for any treatment when IPD and DT response was compared to control.

    Conclusions: Based on these initial results, a combination product of sunscreen and antioxidant seems to be more effective than sunscreen or antioxidant alone in decreasing VL induced pigmentation. Study completion will lead to final conclusions.




Upcoming

26th Annual Meeting of the Photomedicine Society
Thursday, March 2, 2017
Hyatt Regency Orlando
Plaza Ballroom D
9801 International Drive
Orlando, FL USA
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