COST 726 Training School COST 726 Training School OctoberOctober 6th, 6th, -- 10th, 2008, 10th, 2008, ViennaVienna
ACUTE, CHRONIC ACUTE, CHRONIC AND BENEFICIAL AND BENEFICIAL EFFECTS OF UVR EFFECTS OF UVR ON HUMAN HEALTHON HUMAN HEALTH
Harald Maier, M.D.Harald Maier, M.D.Professor of Professor of DermatologyDermatologyDiv. Special and Environmental DermatologyDept. DermatologyMedical University of Vienna
COST 726 - UVR EFFECTSRed LineRed Line
• UVR• Skin• Interaction UVR & biologic matter• Adverse UVR effects
acute – sub-acute - chronic• Photodermatoses
PhotoinducedPhotoaggravated
• Beneficial UVR effects Phototherapy• Photodiagnostic →→ Introduction Photolab• Photoprotection→→ Lecture II
UVR
SONNENSCHUTZ BEI BERUFLICHER UV-EXPOSITION
UVUV--QuellenQuellen
• Natürliche UV-Quelle (Ambiente Strahlung)
• Künstliche UV-Quellen (Lampen, Lichtbogen)
Man & Sunlight
Mitigating factors:
Ozone layerAerosoles
CloudsShading objects
ReflectionEtc.
Solar emmission spectrum
Ambient radiation
Wolkenloser Himmel (11.Juli)
Bewölkter Himmel (8. Juli)
Artificial UVR Sources
COST 726 - UVR EFFECTSRed LineRed Line
• UVR• Skin• Interaction UVR & biologic matter• Adverse UVR effects
acute – sub-acute - chronic• Photodermatoses
PhotoinducedPhotoaggravated
• Beneficial UVR effects Phototherapy• Photodiagnostic →→ Introduction Photolab• Photoprotection→→ Lecture II
(Human) Skin
UV
CU
VC
UV
C
UV
A
UV
B
Epidermis
Dermis
Subcutaneous fattytissue
Dermo-epidermalconjunction zone
Phototypen nach Fitzpatrick
I II III
IV V VI
COST 726 - UVR EFFECTSRed LineRed Line
• UVR• Skin• Interaction UVR & biologic matter• Adverse UVR effects
acute – sub-acute - chronic• Photodermatoses
PhotoinducedPhotoaggravated
• Beneficial UVR effects• Phototherapy• Photodiagnostic →→ Introduction Photolab• Photoprotection→→ Lecture II
Wavelength-dependent Skin Penetration
Photophysical / PhotochemicalPhenomena
COST 726 - UVR EFFECTSRed LineRed Line
• UVR• Skin• Interaction UVR & biologic matter• Adverse UVR effects
acute – sub-acute - chronic• Photodermatoses
PhotoinducedPhotoaggravated
• Beneficial UVR effects Phototherapy• Photodiagnostic →→ Introduction Photolab• Photoprotection→→ Lecture II
SONNENSCHADEN,SONNENSCHUTZ SONNENSCHADEN,SONNENSCHUTZ -- BasicsBasics
AktinischeAktinische HautschHautschäädenden
vom akuten Typ
vom subakuten Typ
vom chronischen Typ
SonnenbrandIPD
Solare Urtikaria
Idiopathische Photodermatosen(z.B.,PLE)
DPD, PigmentverschiebungenPhototoxische/-allergische
DermatitisPhotoaggravierte Dermatosen
NMSC, MELVerruccae vulgares
PhotoagingCAD
HM 2008
Acute Photodermatoses
Sub-acute Photodermatoses
HM 2008
ChronicChronic PhotodamagePhotodamage
Photoimmunsuppression
Photodegeneration
Photokarzinogenese
Photoaging• Increased thickness
at the beginning• Dyspigmentations• Coarse wrinkles• Fine wrinkling• Teleangiectasies• Loss of elasticity• Yellow patches• Dryness• Giant comedos• Keratoses
PhotoagingPhotoaging
HM 2008
SONNENSCHADEN,SONNENSCHUTZ SONNENSCHADEN,SONNENSCHUTZ -- BasicsBasics
FormaleFormale KarzinogeneseKarzinogeneseAngeborene Oncogene- Basalzellnävus S.- XP- Nävuszellnävus S.
Erworbenes Oncogen=UVR- Intermittierende Exposition
- Chronische Exposition
Tumorpromotoren
-Immunsuppression
-Chronische Entzündung
-Bestimmte chemische
Substanzen
-Oncogene VirenHM 2008
Maligne Hautumore & BerufMaligne Hautumore & BerufÜÜbersichtbersicht formaleformale
KanzerogeneseKanzerogenese
Tumorüberwachung
• Lympho-histiozytäre
Stromareaktion
-Entzündung
-Immunsurveillance
• Reparaturenzyme
• Anti-Onkogene =
Onkogene Faktoren
• Komplette Karzinogene
• Inkomplette Karzinogene
• Ko-Karzinogene
(Tumorpromotoren)
Mod. nach: Bankl & Bankl: Arbeitsbuch Pathologie II/ Allgemeine Pathologie, Wien 2002
Why do we know that UVR mayhave deletarious effects ?
• Empirical knowledge
• Epidemiology
• Experiments
Arguments for a positive correlation betweennon-melanomaskin cancer and UVR
• UVR–exposed locations• Congenital defects of photorepair
mechanisma• Occupational risk• Migration of fair-skinned people in regions
with low latitude• Increasing frequency
Tierexperimentelle Modelle der Tierexperimentelle Modelle der HautkrebsentstehungHautkrebsentstehung
Mausmodell NMSC Fischmodell MELANOM
HM 2008
Incidence of melanoma
Lens & Dawes, Br J Dermatol 2004
Melanom-Inzidenz AUSTRALIEN
Regionale Inzidenzunterschiede
ChronicChronic PhotodamagePhotodamage
HM 2008
MalignantMalignant MelanomaMelanoma
LM(M) SMM
NMMAmelanotischesMelanom
HM 2008
Malignant MelanomaABC(D)- Criterias
A = AsymmetryB = Begrenzung –
BorderC = Farbe – ColorD = Diameter > 0,5 cm
COST 726 - UVR EFFECTSRed LineRed Line
• UVR• Skin • Interaction UVR & biologic matter • Adverse UVR effects
acute – sub-acute - chronic• Photodermatoses
PhotoinducedPhotoaggravated
• Beneficial UVR effects• Phototherapy• Photodiagnostic →→ Introduction Photolab• Photoprotection→→ Lecture II
Positive Positive EffectsEffects of UVRof UVR
Vitamine D 3 metabolism
Adaptation of the skin(Pigmentation, „Lichtschwiele“)
Therapeutical efficacy
HM 2008
Vitamine D Metabolism
Pigmentation (Pigmentation („„TanningTanning““))
Epidermalthickening
Persistent pigment darkening
(PPD UVA, PPD UVB)Immediate pigmentdarkening (IPD)
COST 726 - UVR EFFECTSRed LineRed Line
• UVR• Skin • Interaction UVR & biologic matter • Adverse UVR effects
acute – sub-acute - chronic• Photodermatoses
PhotoinducedPhotoaggravated
• Beneficial UVR effects• Phototherapy• Photodiagnostic →→ Introduction Photolab• Photoprotection→→ Lecture II
Indications for UVB phototherapy
PsoriasisAtopic DermatitisParapsoriasisVitiligoPolymorphic Light EruptionPruritus
Management ofUVB Therapy
MED assessment1st dose 70% of MED2-5 sessions / weekContinous increase of dose
Psoriasis before / after NB-UVB
Vitiligo before/after NB-UVB
Indications for PUVA(=Psoralen + UVA)
PsoriasisParapsoriasisCutanes T cell-lymphomaAtopic dermatitisLichen ruber planusGranuloma anularePrurigoPhotodermatosesVitiligoEtc.
Durchführung deroralen PUVA Therapie
Einnahme von 0.6 mg/kg 8-MOP oder
1.2 mg/kg 5-MOP 1h bzw. 2h vor Bestrahlung
Bestimmung der MPD
Minimal Phototoxic Dose(MPD)
Definition: the first dose which induces an sharply demarcated pototoxic erythema
Indication: PhotochemotherapyEvaluation: 2 -3 days after the irradiation
Psoriasis vor/nach PUVA Therapie
CTCL vor/nachPUVA Therapie
PUVA OFLEUKAPHERESED
BLOOD
STANDARD TREATMENT COMPONENT 2007
Two to three treatments in a row or back to backTreatment intervals between one to four weeksTreatment series between 2 and 12 months
1994First Report
SUCCESSFUL TREATMENT OF CHRONIC GRAFT-VERSUS-HOST
DISEASE WITH EXTRACORPOREAL
PHOTOPHERESISOwsianowski M., Gollnick H., Siegert W.,
Schwerdtfeger R., Orfanos C.
Bone Marrow Transplantation 14; 845-848; 1994
SOLID ORGAN TRANSPLANTATION
20078• Excellent Survival Rate• Absence of Side-Effects• Low Morbidity
COST 726 - UVR EFFECTSRed LineRed Line
• UVR• Skin • Interaction UVR & biologic matter • Adverse UVR effects
acute – sub-acute - chronic• Photodermatoses
PhotoinducedPhotoaggravated
• Beneficial UVR effects• Phototherapy• Photodiagnostic →→ Introduction Photolab• Photoprotection→→ Lecture II
AKTIONSSPEKTRUMAKTIONSSPEKTRUM
UVAUVAPhotoallergiePhotoallergie
VISVISPorphyrienPorphyrienVISVISUVAUVAUVBUVBUrticariaUrticaria solarissolaris
VISVISUVAUVAUVBUVBChronisch Chronisch aktinischeaktinischeDermatitisDermatitis
UVAUVAHidroaHidroa vacciniformevacciniforme
UVAUVAPhototoxische Reaktion Phototoxische Reaktion UVAUVAUVBUVBPolymorphe Polymorphe LichtdermatoseLichtdermatose
Phototoxische ReaktionPhototoxische ReaktionGrGrääserkontakt (serkontakt („„Dermatitis Dermatitis pratensispratensis““) )
PolymorphicPolymorphic Light EruptionLight Eruption
PorphyriaPorphyria cutaneacutaneatardatarda
PorphyriasPorphyrias
HidroaHidroa vacciniformiavacciniformia
Selective Photothermolysis(Anderson & Parrish 1982)
(no pain ) (no collateral damage)
Benign hemangiomatosis
Strawberry mark in proliferativephase
COST 726 - UVR EFFECTSRed LineRed Line
• UVR• Skin • Interaction UVR & biologic matter • Adverse UVR effects
acute – sub-acute - chronic• Photodermatoses
PhotoinducedPhotoaggravated
• Beneficial UVR effects• Phototherapy• Photodiagnostic →→ Introduction Photolab• Photoprotection→→ Lecture II