RESUMO
The Fitzpatrick Skin Phototypes (FSP) were developed to classify skin color and response to ultraviolet radiation. FSP are used clinically to assess risk for sunburn and skin cancer. Our aim was to determine the criterion-related validity of self-reported FSP when compared with skin color and sunburn history, controlling for age, race/ethnicity, and seasonality/geography. We performed a secondary analysis of data (N=466) from an observational study. The racial/ethnic composition of the sample was 45% White/White Hispanic (WWH), 40% Black/Black Hispanic (BBH), and 15% Other Identities. Outcome measures were self-reported FSP and sunburn history, as well as physiological measures of skin color (L* lightness/darkness, a* redness/greenness, b* yellowness/blueness). Correlation between FSP and L* was -.77 (95% CI -.81, -.73; P<.001). Although 60% of the variance in FSP was accounted for by L* values for the entire sample, only 5% of the variance was accounted for among BBH participants (r=-.23), and up to 30% for WWH/Other Identity participants (r=-.48 and -.52). Multiple regression analysis indicated L* and b* values, sunburn history, and race/ethnicity, but not geography/seasonality or a* values significantly and collectively accounted for 72% of the variance in FSP. While the criterion validity of FSP was established by the strong relationship between L* values and FSP for the entire sample, when examined at the level of individual racial/ethnic subgroups, criterion validity of FSP was not demonstrated. When self-reported FSP are used for clinical skin assessment and sun cancer screening, they provide a restricted range of options for people with darker skin that does not capture variations in their skin color. Inaccuracy of clinical data may lead to unequal treatment or inadequate cancer risk assessment.
Assuntos
Suscetibilidade a Doenças/classificação , Etnicidade/estatística & dados numéricos , Neoplasias Cutâneas/prevenção & controle , Pigmentação da Pele , Queimadura Solar/classificação , Adulto , Suscetibilidade a Doenças/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Medição de Risco , Autorrelato , Neoplasias Cutâneas/classificação , Queimadura Solar/diagnóstico , Raios UltravioletaRESUMO
BACKGROUND: The Fitzpatrick skin phototype scale (FSPTS) is a widely used instrument to assess skin type. METHODS: A cross-sectional survey collected responses from 254 subjects from Quito regarding self-reported FSPTS, gender, age, education, and tobacco and alcohol consumption. Univariate and multivariate logistic regression analyses were performed to determine if ethnicity, hair color, and eye color significantly predict FSPTS. In addition, we studied the correlation between FSPTS and the SCINEXA scale with Pearson's correlation coefficient. RESULTS: Ethnicity, eye color, and hair color are significant independent predictors of FSPTS (p < 0.0001). CONCLUSIONS: Patient self-reported race and pigmentary phenotypes are inaccurate predictors of sun sensitivity as defined by Fitzpatrick skin phototype. Our study does not fully represent the population of the country. There are limitations to using patient-reported race and appearance in predicting individual sunburn risk.
Assuntos
Transtornos de Fotossensibilidade/classificação , Transtornos de Fotossensibilidade/epidemiologia , Pigmentação da Pele , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Fotossensibilidade/diagnóstico , Transtornos de Fotossensibilidade/fisiopatologia , Grupos Raciais , Fatores de Risco , Autorrelato , Pigmentação da Pele/fisiologia , Queimadura Solar/diagnóstico , Queimadura Solar/epidemiologia , Queimadura Solar/etnologia , Queimadura Solar/fisiopatologia , Bronzeado/fisiologiaRESUMO
BACKGROUND: Over the past 15 years Punta Arenas, Chile, a medium-sized city located on the extreme southern tip of South America, has repeatedly been exposed to acute, sudden episodes of highly increased levels of ultraviolet B (UVB) 280-320 nm radiation because of the passage of the spring Antarctic "Ozone Hole" overhead, or nearby. OBJECTIVE: Our purpose was to observe the relationship between episodes of ozone depletion, increased UVB radiation, and sunburns and photosensitivity disorders in Punta Arenas, Chile, during spring. METHODS: Incidence of photosensitivity disorders and sunburns was registered by dermatologists during each of the past 15 springs. Local data of sudden, severe ozone depletions (<250 Dobson units) and the corresponding increase of UVB radiation were reviewed. RESULTS: Patients with sunburn increased significantly during the austral spring of 1999 (P <.01). This was especially noticeable (29/31 cases) on weekends with ozone depletion, and increased UVB radiation (P <.01) occurred on the Sundays Oct 31, Nov 21, and Dec 5, 1999. The incidence of photosensitivity disorders, although statistically not significant, increased 51% over the past 7 years. CONCLUSIONS: An acute impact on human health (sunburn) occurred because of abrupt ozone depletion and the accompanying increase in UVB during the mid and late austral spring of 1999. Most sunburns (93.5%) occurred on weekends. Ozone levels as well as seasonal and recreational factors played a mayor role in the increase in sunburns. The increase in radiation at 300 nm, the most carcinogenic wavelength, on days under the Antarctic ozone hole is a matter of special concern.
Assuntos
Ozônio/análise , Transtornos de Fotossensibilidade/epidemiologia , Queimadura Solar/epidemiologia , Raios Ultravioleta/efeitos adversos , Chile/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Transtornos de Fotossensibilidade/diagnóstico , Probabilidade , Sistema de Registros , Medição de Risco , Fatores de Risco , Queimadura Solar/diagnóstico , População UrbanaRESUMO
Se evaluó la eficacia clínica de 16 filtros solares con factor de protección (FPS) 15 o mayor, en 5 voluntarios sanos y en 4 pacientes fotosensibles. Se incluyeron productos de laboratorios dermatológicos, cosméticos y preparados magistrales. En todos los sujetos se midió la Dosis de Eritema Mínimo (DEM) UVB y UVA. Se consignó el FPS-B y el FPS-A para cada uno de los 16 filtros. En dos pacientes fotosensibles con DEM de UVA muy disminuida se evaluó el FPS-A de los mismos 16 filtros. Como fuente de luz se usaron tubos Houvalite con espectro de emisión continua y de peaks máximos en los 300 nm y 355 nm de UVB y A respectivamente. En voluntarios sanos, varios filtros - aunque no todos - lograron evitar la aparición de eritema 24 hrs luego de 15 DEM de UVB. En los pacientes fotosensibles con DEM-B disminuida varios filtros no lograron evitar la aparición de eritema con la aplicación de tan solo 5 DEM-B. De igual modo, en aquellos con DEM-A disminuida, varios filtros solares también fracasaron en evitar la aparición de eritema tras recibir tan solo 5 DEM-A. El hacer fototest A y B a cada paciente fotosensible nos permite conocer el rango de UV responsable de la afección y nos permite identificar el subgrupo de pacientes con DEM-A y/o B disminuida, es decir, aquellos que más fotoprotección requieren. Nos permite también testear clínicamente varios filtros solares en estos pacientes. Ello nos orienta sobre cuales serían los mejores filtros para cada fotodermatosis y en cada paciente en particular. Esta experiencia mostró a los filtros Nº 3, 6, 12 y 14 como los más efectivos en el UVA; y los Nº 3, 11 y 12 como los más efectivos en el espectro UVB. El filtro Nº3, el único que contiene Mexoryl SX resultó ser más útil en esta experiencia