P6250Audit of phototherapy services in Wales, United Kingdom

Kazeem Salako, MBBS, Welsh Institute of Dermatology, Cardiff, United Kingdom;Alex Anstey, MD, Welsh Institute of Dermatology, Cardiff, United Kingdom

Phototherapy is an effective, low-cost outpatient treatment for psoriasis and otherinflammatory skin diseases. We carried out an audit of phototherapy services acrossWales to establish if our phototherapy centers meet theminimum national standardsas contained in the British Association of Dermatologists (BAD) Working PartyReport 2011. Wales is a nation that is part of United Kingdom (UK) with populationof about 3 million with 15 phototherapy centers across the nation. An audit toolcovering all the components of the standards was developed and sent to photo-therapy centers. We also carried out random physical inspections to ensure that thetools were appropriately completed. The audit showed that all phototherapycenters had an adverse event policy in place. However, only 71% of the centers had anamed lead clinician. 86% of patient referrals to phototherapy were from consultantdermatologists and general practitioners with special interest in dermatology(GPwSI); 14% were from other health care professionals such as specialist nurses.79% of the centers had routine referral to treatment time within 6 weeks; 85% ofcenters complied with urgent referral to treatment time of \3 weeks.Multidisciplinary team (MDT) meetings took place in 79% of the centers on a 3-monthly basis or more often; 7% had less frequent meetings; 14% of the centers hadno team meetings. 79% of the phototherapy staff in Wales had formal core training;update training had been undertaken by 53% of staff in the last 2 years, 26% morethan 2 years; 10% had no trainingwhile we had no response from 11% of staff. 74% ofequipment met European Union (EU) standard and ‘‘CE’’ marked and the remaining26% were purchased before the introduction of the CE marking by the EU in 1993.98% of centers presented acceptable documentary evidence of maintenancecontaining records of visits and UV calibration results. Only 41% of the centershad replacement policy for equipment in place. There are wide variations inphototherapy services across Wales. This audit confirms the need to ensureimproved and uniform standards of care for phototherapy services across Wales.Strong clinical leadership and investment is required to maintain phototherapy as animportant core service for patients with inflammatory dermatoses. This is partic-ularly important when topical therapies have failed as a step to prevent or delay theneed for systemic therapies.

AB184

cial support: None identified.

Commer

P6781Clinical improvement with 12-hydroxystearic acid: A cosmetic PPAR lipidfor skin lightening benefits in photodamaged arms

Stacy Hawkins, PhD, Stacy Hawkins, Trumbull, CT, United States; Brian Crotty,Unilever R&D, Trumbull, CT, United States; Brian Dobkowski, Unilever R&D,Trumbull, CT, United States; Helen Meldrum, PhD, Unilever R&D, Trumbull, CT,United States; Kumar Subramanyan, PhD, Unilever R&D, Trumbull, CT, UnitedStates; Mark Presser, PhD, Unilever R&D, Trumbull, CT, United States

The development of safe and efficacious hand and body lotions for skin lighteningbenefits is a key priority for consumers in southeast Asia, for improving skinappearance with aging and photodamage. Since the development of the Kligmanprescription formulation for skin lightening (hydroquinone 5%, tretinoin 0.1%, anddexamethasone 0.1%), other skin lightening combination treatments have beenidentified for cosmetic application, including niacinamides, AHAs, retinols, naturalextracts, etc. However, the most efficacious products often result in some degree ofskin irritation and/or are not suitable for body care formulations, because offormulation stability and total area of application. The goal of this research was toevaluate the efficacy of 12-hydroxystearic acid, a cosmetic PPAR lipid ingredientwhich is safe and nonirritating, in combination with niacinamide compared to amarketed skin lightening hand and body lotion. Forty-five Healthy Indonesian femalesubjects, ages 25-55 years, were provided informed consent to participate in thisinstitutional review boardeapproved, double-blind, paired forearm applicationstudy. Subjects applied a different test product to each forearm twice daily for 12weeks, followed by 1 week of regression with no moisturizers applied to either arm.The 2 test products were moisturizing body lotions e product A) a combination ofniacinamide and 12-hydroxystearic acid, and product B) a combination of licoriceand berry extracts. Overall skin color and discrete pigmentation were evaluated byexpert visual assessment of skin color intensity, spectrophotometer (L*), andSiascopy (melanin intensity) after 2, 6, 8, and 12 weeks of product application,and following 1 week of regression. Both products showed significant improvementin skin lightening over time, and an increased magnitude of improvement over thecourse of product application. Product A showed statistically significant visualimprovement (P\.05) by 2 weeks of application, and product B showed statisticallysignificant visual improvement (P\.05) after 6 weeks of product application. Theskin lightening efficacy of ppoduct Awas significantly better than product B after 12weeks of application, and this difference was maintained in the regression phase forvisual assessment, spectrophotometer (L*), and Siascope (melanin). The methodsemployed in this study allow for objective differentiation of skin lightening efficacyunder normal use conditions.

ponsored by Unilever R&D.

100% is s

J AM ACAD DERMATOL

P6254Delayed, transient, sun-induced pruritus on the trunk: A report of 2 cases

Kazeem B. Salako, MBBS, Welsh Institute of Dermatology, Cardiff, UnitedKingdom; Alex Anstey, MD, Welsh Institute of Dermatology, Cardiff, UnitedKingdom; Richard Logan, MBChB, Princess of Wales Hospital, Bridgend, UnitedKingdom

We present 2 cases of delayed and transient pruritus of the trunk after sun exposure.The first was a 40-year-old man with a 4-year history of intense itching of the trunk.Pruritus was typically delayed until 10 to 14 days after returning home from a sunnyholiday, and resolved spontaneously 4 to 6 weeks later. The second patient was a 69-year-old man who presented with sun-induced itching on the chest 12 to 24 hoursafter sun exposure with resolution after 1 to 3 days. There was no contributorymedical or medication history in either case, nor did they show any rash or sign ofskin inflammation. Monochromator light testing (MCLT) was normal in the firstpatient. Autoimmune and porphyria screenings were also normal in both cases.Photoprotection measures were advised; both patients are still being monitored.Severe pruritus following sun exposure has been reported previously, but is rare.The unusual but striking feature in these 2 cases was the delay in onset of pruritusbetween sun exposure and the onset of symptoms. In both cases, symptoms weresufficiently severe to impact significantly on quality of life. Pruritus of this typeshares with brachioradial pruritus a relationship to sun exposure; differencesinclude delay in onset of clinical symptoms and the anatomic location for pruritus.The pathogenesis for sun-associated pruritus is unclear. Mast cell degranulation isunlikely to be an initiating event in this condition, but is inevitable followingvigorous scratching. More likely is an effect of sunlight, perhaps UVA, on cutaneoussensory nerve receptors or peripheral fibers that has yet to be determined. These 2cases extend the clinical spectrum of sun-induced pruritus. The patient’s responseto rigorous sun protection and the natural history of the condition has yet to bedetermined.

cial support: None identified.

Commer

P6311Enhancing skin hydration with topical sunscreen formulations

Hao Ouyang, PhD, Johnson & Johnson Consumer Companies, Inc, Los Angeles,CA, United States; Connie Cao, Johnson & Johnson Consumer Companies, Inc,Los Angeles, CA, United States; Laura Singleton, MS, Johnson & JohnsonConsumer Companies, Inc, Los Angeles, CA, United States

It is well documented that chronic UV exposure also leads to skin dehydration,although the mode of action for this response is still being elucidated. Sunscreenformulations are designed primarily to protect skin from UV damage, but newresearch demonstrates that even recreational sunscreens can hydrate the skin. Inthis study, novel sunscreen lotions were designed which incorporated glycerin, awell-known humectant ingredient. The hydration effects of the SPF 30 and SPF 50lotions were tested in a 24-hour moisturization protocol on the lower leg of patients(N ¼ 24). Significant improvements in skin hydration at 4, 8, and 24 hours aftertreatment were observed versus baseline with expert grading of visual dryness andbiophysical skin conductance measurements. In addition, two 8-hour comparativemoisturization studies were conducted, one on a lower leg (N¼ 20) and the secondon the forearm (N ¼ 10), to compare 2 lotion formulations, SPF 30 and SPF 50, to acommercially available SPF 30 spray that does not contain glycerin. Although all skinsites treated by sunscreens showed significant improvement in hydration (by bothvisual grading and objective measure) over baseline at 4 and 8 hours, the two lotionsperformed significantly better than the spray at both time points by the objectivebiophysical skin conductance measurement in both studies. Finally, a comprehen-sive comparative skin hydration study was conducted on 8 separate cells of patients(N¼ 8-10 per cell) over a period of 12months to compare 30 recreational sunscreenformulations. Products were applied and instrumental testing was performed on theforearm of patients. The changes from baseline in skin conductance at 4 hours and 8hours were used to compare the hydration efficacy across formulations. Statisticalanalysis indicated that the sunscreen lotions with glycerin consistently outper-formed other sunscreens in the assessment of hydration. These results establish thata broad range of recreational sunscreen formulations can actually enhance skinhydration. Practicing dermatologists will now have clinical evidence demonstratingthat sunscreen formulations containing glycerin can provide skin hydration benefits,in addition to their value in sun protection.

ywas sponsored in full by Johnson & Johnson Consumer Compan

This stud ies, Inc.

APRIL 2013