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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
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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
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SONNENSCHUTZ BEI BERUFLICHER UV-EXPOSITION
UVUV--QuellenQuellen
• Natürliche UV-Quelle (Ambiente Strahlung)
• Künstliche UV-Quellen (Lampen, Lichtbogen)
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Man & Sunlight
Mitigating factors:
Ozone layerAerosoles
CloudsShading objects
ReflectionEtc.
Solar emmission spectrum
Ambient radiation
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Wolkenloser Himmel (11.Juli)
Bewölkter Himmel (8. Juli)
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Artificial UVR Sources
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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
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(Human) Skin
UV
CU
VC
UV
C
UV
A
UV
B
Epidermis
Dermis
Subcutaneous fattytissue
Dermo-epidermalconjunction zone
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Phototypen nach Fitzpatrick
I II III
IV V VI
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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
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Wavelength-dependent Skin Penetration
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Photophysical / PhotochemicalPhenomena
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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
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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
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Acute Photodermatoses
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Sub-acute Photodermatoses
HM 2008
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ChronicChronic PhotodamagePhotodamage
Photoimmunsuppression
Photodegeneration
Photokarzinogenese
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Photoaging• Increased thickness
at the beginning• Dyspigmentations• Coarse wrinkles• Fine wrinkling• Teleangiectasies• Loss of elasticity• Yellow patches• Dryness• Giant comedos• Keratoses
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PhotoagingPhotoaging
HM 2008
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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
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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
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Why do we know that UVR mayhave deletarious effects ?
• Empirical knowledge
• Epidemiology
• Experiments
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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
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Tierexperimentelle Modelle der Tierexperimentelle Modelle der HautkrebsentstehungHautkrebsentstehung
Mausmodell NMSC Fischmodell MELANOM
HM 2008
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Incidence of melanoma
Lens & Dawes, Br J Dermatol 2004
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Melanom-Inzidenz AUSTRALIEN
Regionale Inzidenzunterschiede
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ChronicChronic PhotodamagePhotodamage
HM 2008
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MalignantMalignant MelanomaMelanoma
LM(M) SMM
NMMAmelanotischesMelanom
HM 2008
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Malignant MelanomaABC(D)- Criterias
A = AsymmetryB = Begrenzung –
BorderC = Farbe – ColorD = Diameter > 0,5 cm
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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
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Positive Positive EffectsEffects of UVRof UVR
Vitamine D 3 metabolism
Adaptation of the skin(Pigmentation, „Lichtschwiele“)
Therapeutical efficacy
HM 2008
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Vitamine D Metabolism
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Pigmentation (Pigmentation („„TanningTanning““))
Epidermalthickening
Persistent pigment darkening
(PPD UVA, PPD UVB)Immediate pigmentdarkening (IPD)
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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
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Indications for UVB phototherapy
PsoriasisAtopic DermatitisParapsoriasisVitiligoPolymorphic Light EruptionPruritus
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Management ofUVB Therapy
MED assessment1st dose 70% of MED2-5 sessions / weekContinous increase of dose
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Psoriasis before / after NB-UVB
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Vitiligo before/after NB-UVB
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Indications for PUVA(=Psoralen + UVA)
PsoriasisParapsoriasisCutanes T cell-lymphomaAtopic dermatitisLichen ruber planusGranuloma anularePrurigoPhotodermatosesVitiligoEtc.
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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
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Minimal Phototoxic Dose(MPD)
Definition: the first dose which induces an sharply demarcated pototoxic erythema
Indication: PhotochemotherapyEvaluation: 2 -3 days after the irradiation
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Psoriasis vor/nach PUVA Therapie
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CTCL vor/nachPUVA Therapie
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PUVA OFLEUKAPHERESED
BLOOD
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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
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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
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SOLID ORGAN TRANSPLANTATION
20078• Excellent Survival Rate• Absence of Side-Effects• Low Morbidity
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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
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AKTIONSSPEKTRUMAKTIONSSPEKTRUM
UVAUVAPhotoallergiePhotoallergie
VISVISPorphyrienPorphyrienVISVISUVAUVAUVBUVBUrticariaUrticaria solarissolaris
VISVISUVAUVAUVBUVBChronisch Chronisch aktinischeaktinischeDermatitisDermatitis
UVAUVAHidroaHidroa vacciniformevacciniforme
UVAUVAPhototoxische Reaktion Phototoxische Reaktion UVAUVAUVBUVBPolymorphe Polymorphe LichtdermatoseLichtdermatose
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Phototoxische ReaktionPhototoxische ReaktionGrGrääserkontakt (serkontakt („„Dermatitis Dermatitis pratensispratensis““) )
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PolymorphicPolymorphic Light EruptionLight Eruption
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PorphyriaPorphyria cutaneacutaneatardatarda
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PorphyriasPorphyrias
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HidroaHidroa vacciniformiavacciniformia
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Selective Photothermolysis(Anderson & Parrish 1982)
(no pain ) (no collateral damage)
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Benign hemangiomatosis
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Strawberry mark in proliferativephase
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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