Prevention of Polymorphic Light Eruption Afforded by a Very High Broad-Spectrum Protection Sunscreen Containing Ectoin

Luc Duteil, Catherine Queille-Roussel, Sonia Aladren, Xavier Bustos, Carles Trullas, Corinne Granger, Jean Krutmann, Thierry Passeron, Luc Duteil, Catherine Queille-Roussel, Sonia Aladren, Xavier Bustos, Carles Trullas, Corinne Granger, Jean Krutmann, Thierry Passeron

Abstract

Introduction: Polymorphic light eruption (PLE) is the most common idiopathic, acquired photodermatosis. The pathophysiology of PLE is not yet fully understood but seems to involve immunological mechanisms, UVA-induced oxidative stress, and the subsequent elicitation of a cellular stress response affecting keratinocyte gene expression and skin immune function. In the present study, a high broad-spectrum sunscreen medical device (MD), containing a very high protection complex of UVB and UVA filters and ectoin, was investigated for its ability to protect against UVA-induced PLE.

Methods: The study was carried out as a monocentric, double-blinded, randomized, untreated controlled design. The test MD was applied (2 mg/cm2) on one side of the chest according to a randomization list of 15 patients with a typical history of PLE, and the contralateral area remained untreated. After product application, the test areas were exposed daily to increasing doses of UVA radiation (from 40 to 60 J/cm2) until a PLE reaction was detected or for a maximum of five consecutive days. Evaluations of induced PLE included clinical scoring and chromametry for erythema and pigmentation.

Results: Overall, no positive PLE reaction was observed on the side of the chest treated by the test MD, whereas positive PLE reactions were triggered on the untreated side of 13 subjects. Subjective sensations were very rare on the MD-treated side but were numerous and more severe on the untreated side. Chromametry and clinical visual inspection indicated that the skin color was unchanged on the MD-protected side, whereas high increased values of erythema and pigmentation were observed on the untreated chest side.

Conclusion: This MD sunscreen based on a complex of UVA-UVB filters and 1% of ectoin may be effective in preventing UVA-induced PLE. New studies comparing this MD sunscreen versus the same product without ectoin should be conducted.

Clinicaltrials: gov identifier: NCT05320315 (retrospectively registered 09/17/2021).

Keywords: Ectoin; Polymorphous light eruption; Sunscreen.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Cumulated number of subjects who did not develop a positive reaction over time
Fig. 2
Fig. 2
PLE worst severity scores observed during the study
Fig. 3
Fig. 3
Worst subjective scores observed during the study
Fig. 4
Fig. 4
a Chromametry parameter a* over time. Error bars represent standard error of mean (SEM). Double stars (**) indicate significant difference (p < 0.001). b Chromametry parameter ITA over time. Error bars represent standard error of mean (SEM). Double stars (**) indicate significant difference (p < 0.001)
Fig. 5
Fig. 5
Comparison of the protected chest side (left) versus the unprotected chest side (right) for one subject. PLE reaction is clearly visible on the unprotected side, whereas no reaction is observed on the protected side

References

    1. Gruber-Wackernagel A, Byrne SN, Wolf P. Polymorphous light eruption: clinical aspects and pathogenesis. Dermatol Clin. 2014;32:315–334. doi: 10.1016/j.det.2014.03.012.
    1. Stephansson E, Ros AM. Expression of intercellular adhesion molecule-1 (ICAM-1) and OKM5 in UVA- and UVB-induced lesions in patients with lupus erythematosus and polymorphous light eruption. Arch Dermatol Res. 1993;285(6):328–333. doi: 10.1007/BF00371832.
    1. Hölzle E, Plewig G, von Kries R, et al. Polymorphous light eruption. J Invest Dermatol. 1987;88(3 Suppl):32s–38s. doi: 10.1038/jid.1987.7.
    1. Hasan T, Ranki A, Jansen CT, et al. Disease associations in polymorphous light eruption. A long-term follow-up study of 94 patients. Arch Dermatol. 1998;134:1081–1085. doi: 10.1001/archderm.134.9.1081.
    1. Bissonnette R, Nigen S, Bolduc C. Influence of the quantity of sunscreen applied on the ability to protect against ultraviolet-induced polymorphous light eruption. Photodermatol Photoimmunol Photomed. 2012;28:240–243. doi: 10.1111/j.1600-0781.2012.00678.x.
    1. Gozali MV, Zhou B, Luo D. Update on treatment of photodermatosis. Dermatol Online J. 2016;22:2. doi: 10.5070/D3222030080.
    1. Schleyer V, Weber O, Yazdi A, Benedix F, Dietz K, Röcken M, Berneburg M. Prevention of polymorphic light eruption with a sunscreen of very high protection level against UVB and UVA radiation under standardized photodiagnostic conditions. Acta Derm Venereol. 2008;88(6):555–560.
    1. Schaefer H, Moyal D, Fourtanier A. State of the art sunscreens for prevention of photodermatoses. J Dermatol Sci. 2000;23(1):S62–S74. doi: 10.1016/S0923-1811(99)00068-7.
    1. Ahmed RS, Suke SG, Seth V, Jain A, Bhattacharya SN, Banerjee BD. Impact of oral vitamin E supplementation on oxidative stress & lipid peroxidation in patients with polymorphous light eruption. Indian J Med Res. 2006;2016:8.
    1. Hadshiew IM, Treder-Conrad CV, Bülow R, Klette E, Mann T, Stäb F, et al. Polymorphous light eruption (PLE) and a new potent antioxidant and UVA-protective formulation as prophylaxis. Photodermatol Photoimmunol Photomed. 2004;20(4):200–204. doi: 10.1111/j.1600-0781.2004.00103.x.
    1. Rippke F, Wendt G, Bohnsack K, Dörschner A, Stäb F, Hölzle E, et al. Results of photoprovocation and field studies on the efficacy of a novel topically applied antioxidant in polymorphous light eruption. J Dermatol Treat. 2001;12(1):3–8. doi: 10.1080/095466301750163491.
    1. Buenger J, Driller H. Ectoin: an effective natural substance to prevent UVA-induced premature photoaging. Skin Pharmacol Physio. 2004;17:232–237. doi: 10.1159/000080216.
    1. Grether-Beck S, Bonizzi G, Schmitt-Brenden H, Felsner I, Timmer A, Sies H, Johnson JP, Piette J, Krutmann J. Non-enzymatic triggering of the ceramide signalling cascade by solar UVA radiation. EMBO J. 2000;19(21):5793–5800. doi: 10.1093/emboj/19.21.5793.
    1. Grether-Beck S, Salahshour-Fard M, Timmer A, Brenden H, Felsner I, Walli R, Füllekrug J, Krutmann J. Ceramide and raft signaling are linked with each other in UVA radiation-induced gene expression. Oncogene. 2008;27(35):4768–4778. doi: 10.1038/onc.2008.116.
    1. Grether-Beck S, Timmer A, Felsner I, Brenden H, Brammertz D, Krutmann J. Ultraviolet A-induced signaling involves a ceramide-mediated autocrine loop leading to ceramide de novo synthesis. J Invest Dermatol. 2005;125(3):545–553. doi: 10.1111/j.0022-202X.2005.23782.x.
    1. Bünger J, Degwert J, Driller H. The protective function of compatible solute ectoin on the skin, skin cells and its biomolecules with respect to UV-radiation, immunosuppression and membrane damage. IFSCC-Magazine. 2001;4:2.
    1. Phan NQ, Blome C, Fritz F, et al. Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus. Acta Derm Venereol. 2012;92(5):502–507. doi: 10.2340/00015555-1246.
    1. Duteil L, Esdaile J, Maubert Y, Cathelineau AC, Bouloc A, Queille-Roussel C, Passeron T. A method to assess the protective efficacy of sunscreens against visible light-induced pigmentation. Photodermatol Photoimmunol Photomed. 2017;33(5):260–266. doi: 10.1111/phpp.12325.
    1. Chardon A, Crétois I, Hourseau C. Skin colour typology and suntanning pathways. Int J Cosm Scien. 1991;125:191–208. doi: 10.1111/j.1467-2494.1991.tb00561.x.
    1. Ling TC, Richards HL, Jansen AS, et al. Seasonal and latitudinal impact of polymorphic light eruption on quality of life. J Invest Dermatol. 2006;126(7):1648–1651. doi: 10.1038/sj.jid.5700306.
    1. Richards HL, Ling TC, Evangelou G. Psychologic distress in polymorphous light eruption and its relationship to patients' beliefs about their condition. J Am Acad Dermatol. 2007;56(3):426–431. doi: 10.1016/j.jaad.2006.10.035.
    1. Richards HL, Ling TC, Evangelou G. Evidence of high levels of anxiety and depression in polymorphic light eruption and their association with clinical and demographic variables. Br J Dermatol. 2008;159(2):439–444. doi: 10.1111/j.1365-2133.2008.08623.x.
    1. Rizwan M, Haylett AK, Richards HL. Impact of photosensitivity disorders on the life quality of children. Photodermol Photoimmunol Photomed. 2012;28(6):290–292. doi: 10.1111/j.1600-0781.2012.00691.x.
    1. Allas S, Lui H, Moyal D, Bissonnette R. Comparison of the ability of 2 sunscreens to protect against polymorphous light eruption induced by a UV-A/UV-B metal halide lamp. Arch Dermatol. 1999;135(11):1421–1422. doi: 10.1001/archderm.135.11.1421.
    1. Jeanmougin M, Peyron JL, Thomas P. Polymorphic light eruption: prophylaxis using a topical combination of antioxidants and UVA protection formulation. Ann Dermatol Venereol. 2006;133(5 Pt 1):425–428. doi: 10.1016/s0151-9638(06)70932-2.
    1. Rippke F, Wendt G, Bohnsack K, et al. Results of photoprovocation and field studies on the efficacy of a novel topically applied antioxidant in polymorphous light eruption. J Dermatolog Treat. 2001;12(1):3–8. doi: 10.1080/095466301750163491.
    1. Hadshiew I, Stäb F, Untiedt S, Bohnsack K, et al. Effects of topically applied antioxidants in experimentally provoked polymorphous light eruption. Dermatology. 1997;195(4):362–368. doi: 10.1159/000245989.
    1. Schleyer V, Weber O, Yazdi A, et al. Prevention of polymorphic light eruption with a sunscreen of very high protection level against UVB and UVA radiation under standardized photodiagnostic conditions. Acta Derm Venereol. 2008;88(6):555–560. doi: 10.2340/00015555-0509.
    1. Fourtanier A, Moyal D, Seité S. Sunscreens containing the broad-spectrum UVA absorber, Mexoryl SX, prevent the cutaneous detrimental effects of UV exposure: a review of clinical study results. Photodermatol Photoimmunol Photomed. 2008;24(4):164–174. doi: 10.1111/j.1600-0781.2008.00365.x.
    1. Guarrera M. Polymorphous light eruption. Adv Exp Med Biol. 2017;996:61–70. doi: 10.1007/978-3-319-56017-5_6.
    1. Galinski EA. Compatible solutes of halophilic eubacteria: molecular principles, water-solute interaction, stress protection. Experienta. 1993;49:487–496. doi: 10.1007/BF01955150.
    1. Botta C, Di Giorgio C, Sabatier AS, et al. Genotoxicity of visible light (400–800 nm) and photoprotection assessment of ectoin, L-ergothioneine and mannitol and four sunscreens. J Photochem Photobiol B. 2008;91(1):24–34. doi: 10.1016/j.jphotobiol.2008.01.008.
    1. Bownik A, Stępniewska Z. Ectoine as a promising protective agent in humans and animals. Arh Hig Rada Toksikol. 2016;67(4):260–265. doi: 10.1515/aiht-2016-67-2837.

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