acute, chronic and beneficial effects ov uvr on...

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