Photosensitive patients often comment that sunscreen products seem of little benefit. We used fluorescence spectroscopy to assess quantitatively their sunscreen application technique. A dose-response relationship for sunscreen skin surface thickness and fluorescence intensity was determined for an intrinsically fluorescent sunscreen, Neutrogena sun protection factor (SPF) 15. Ten women with long-standing photosensitivity conditions were asked to apply this sunscreen in the manner they would normally on a bright sunny day. Fluorescence measurements were taken from all unclothed body areas, comprising 17 sites of the head, neck, upper and lower limbs. Geometric regression analysis of the dose-response data showed a high level of correlation (r = 0.99) between sunscreen thickness and fluorescence intensity, allowing fluorescence measurements to be converted to an equivalent sunscreen thickness. The overall median sunscreen thickness was 0.5 mg/cm2, with median thicknesses of individual sites ranging from 0 to 1.2 mg/cm2. The most frequently missed sites were the posterior neck, lateral neck, temples and ears, all of which had median thicknesses of 0 mg/cm2. Hence, photosensitive patients fail to apply sunscreen in some prominently exposed sites, and use average thicknesses far less than the manufacturers' recommendation (2 mg/cm2). The level of protection is much lower than anticipated from the stated SPF of the product.
Patient acceptance of PDT for treatment of nonmelanoma skin cancer is improved with lessened morbidity assessed with concurrent use of cold air analgesia to the treatment field.
Photosensitive patients are known to apply insufficient sunscreen and to neglect several prominently exposed skin sites. The aim of this study was to use fluorescence spectroscopy to assess the effect of education on sunscreen application technique in the short and longer term. Six patients with longstanding photosensitivity conditions were asked to apply an intrinsically fluorescent sunscreen to exposed skin, as they normally would on a sunny day. Detailed fluorescence measurements were taken from 70 sites on the head, neck and arms. Using the previously established dose-response relationship for cream fluorescence, measurements were converted to equivalent thicknesses of cream. Patients were told the results of their sunscreen application assessment and deficiencies in technique were highlighted. Following education, application technique was reassessed twice, after intervals of 2 weeks and 6 months. Before education, sunscreen application was poor with inadequate amounts applied, and prominently exposed sites including ears, temples and neck often missed. At 2 weeks following education, improved application was seen at all sites, and the improvement was sustained at 6 months. Overall, education improved sunscreen application from a baseline median sunscreen thickness of 0.11 mg/cm2 to 0.82 mg/cm2 at 2 weeks and 1.13 mg/cm2 at 6 months (P<0.0001). Notably, median sunscreen thickness on the face improved from a baseline of 0.33 mg/cm2 to 1.51 mg/cm2 at 6 months. These findings demonstrate the importance of careful instruction to patients concerning sunscreen application technique; failure to do this may result in overconfidence in the ability of a sunscreen to protect. The next step is to assess a larger number of photosensitive patients with different diagnoses and to see whether improved technique correlates with improvement in clinical features.
A 47-year-old man presented with a several month history of non-specific acquired ichthyosis, an unknown period of generalized lymphadenopathy and a short history of erythematous papules and nodules affecting the cutaneous drainage area of his right axillary lymph nodes. Histology confirmed these lesions to be specific lesions of Hodgkin's lymphoma; that is, metastatic retrograde lymphatic spread from his axillary lymph nodes of CD30+, CD15+, Reed-Sternberg cells as well as mononuclear Hodgkin's cells. This is the most common site and mode of spread of Hodgkin's disease to the skin. As is typical of advanced Hodgkin's disease, as evidenced by specific cutaneous involvement, this patient died shortly after definitive diagnosis was made.
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