Dr. Heather Woolery-Lloyd of University of Miami Health System discussed ethnicity and skincare at the 2011 WellBeingWell Conference in Miami.

1. Skincare and Sun Protection Heather Woolery-Lloyd, M.D. Director of Ethnic Skin Care Voluntary Assistant Professor Department of Dermatology and Cutaneous Surgery Miller/University of Miami School of Medicine

2. Disclosures Johnson and Johnson-Investigator, Speaker Allergan-Investigator, Consulting Stiefel/Glaxo-Speaker Somabella Laboratories, LLC-Major Shareholder

3. Overview Skin Types Effects of ultraviolet light in the skin Photoaging Sun Protection Antioxidants in skin care Natural therapies

5. Sensitive or Resistant

6. Pigmented or Non-Pigmented

8. Skin type and Sun protection Every skin type needs sun protection To prevent photoaging and wrinkles To prevent skin cancer To prevent hyperpigmentation and brown spots

9. Understanding Solar Radiation

10. Understanding Solar Radiation UVC UVB UVA Visible Infrared

11. Summary of Solar Wavelengths

13. Immunosuppression

14. SunburnMitchell D . Et al Radiation Research. 1990;123:299-303 D’Ambrosio S et al Journal of Investigative Dermatology (1981) 77, 311–313 Benjamin CL et al ToxicolApplPharmacol 2007; 224: 241–248 Beissert S et al J InvestigDermatolSymp Proc 1999; 4: 61–64.

15. Sunburn Protective mechanism to remove the irreversibly damaged skin cells after excessive UV radiation Mechanism of programmed cell death-apoptosis

16. Long Term Effects of UV Epidermal thickening Skin cancers Pigmentary disorders-melasma, brown spots, age spots Visible signs of photoaging

17. Photoaging: Causes

18. Photoaging UVA and UVB UVB absorbed in epidermis Induces matrix metalloproteinases (enzymes that breakdown collagen) UVA absorbed in the dermis Induces reactive oxygen species (ROS) Induces mitochondrial DNA mutations

19. Photaging Dry and Rough Wrinkled Thin and fragile Poor elasticity Sallow color Dark spots Redness

20. Causes of skin aging Intrinsic 20% Genetic Extrinsic 80% Chronic sun exposure Smoking Pollution

21. Photoaging: Treatment and Prevention

22. Melanin: A Natural Photoprotectant Acts as a natural filter Five times as much UVR reaches the upper dermis of white skin when compared to black skin The average protection offered by melanin black skin SPF13.4 white skin SPF 3.4. Kaidbey KH, Agin PP, Sayre RM et al. J Am Acad Dermatol. 1:249, 1979.

24. increased melanin content

25. unique distribution of melanosomes in dark skinKaidbey KH. J Am AcadDermatol. 1:249, 1979.

26. Melanosomes in Black and White Skin Black White Szabo Ggerlad AB, Patnak MA, Fitzpatrick TB Nature 1969 Grosdahl IK, Szabo G J Invest Dermatol 1978 Jimbow K, Quevedo WC, Prota G, Fitzpatrick TB (1999) Biology of melanocytes. In I. M. Freedberg,

27. Prevention of Photoaging:Sunscreen

29. What does SPF mean? Sunburn protection factor Amount of protection from UVB Does not measure protection from UVA SPF 15 blocks 93% of UVB SPF 30 blocks 97% of UVB SPF 45 blocks 98% of UVB

30. What does SPF mean? SPF measures induced redness on unsensitized skin following UVB exposure SPF compares the time of UVB exposure necessary to induce redness in the presence of product with the time needed to induce the same redness in the absence of product This ratio (protected/unprotected) is the SPF Example: Sunburn in 30min(protected) /sunburn in 1 min(unprotected)=SPF30

31. What does PFA mean? PFA measures induced pigmentation on unsensitized skin following UVA exposure PFA compares the time of UVA exposure necessary to induce pigmentation in the presence of product with the time needed to induce the same pigmentation in the absence of product This ratio (protected/unprotected) is the PFA

33. Will be quantified on a four point scale of (1* to 4*)

35. Sun Protection Correct application: 2mg/cm2 Most users achieve an SPF of 20% to 50% of the expected SPF because inadequate sunscreen quantities are applied Examples: SPF 30 becomes SPF 10-15 SPF 15 becomes SPF 3-7 Stokes RP, Diffey BL. How well are sunscreen users protected? Photodermatol Photoimmunol Photomed 1997;13:186-188.

36. Facial Sunscreen

37. Sunscreen Application Realistically, individuals may not change the quantity of facial sunscreen Increasing the SPF from 15 to 30 for a product used daily is one possible solution to address this problem For extensive sun exposure such as at the beach and other outdoor events, generous sunscreen application is encouraged!

38. Treatment of Photoaging:Retinoids

39. Matrix Metalloproteinase (MMP) Induced by UVB Breakdown collagen in the skin Retinoic acid inhibits MMP’s Retinoids prevent and treat wrinkles Examples: tretinoin, tazorotene, adapalene

40. Tretinoin 0.02% cream Baseline 24 weeks

41. Treatment and Prevention of Photoaging:Antioxidants

42. What is an antioxidant? When our cells use oxygen, they naturally produce byproducts called free radicals Free radicals cause damage and inflammation in the skin Antioxidants act as "free radical scavengers” Antioxidants prevent and repair damage done by free radicals

43. Antioxidants Treatment of human skin with the antioxidants inhibits the induction of collagenase by ultraviolet light1 Skin uses antioxidants to protect itself from stress due to UV and pollution2 Topical antioxidants increase the skin’s antioxidant reservoir2 1. Kang S, et al. J Invest Dermatol. 2003;120:835-841. 2. Pinnell SR. J Am AcadDermatol. 2003;48:1-19.

44. Topical Antioxidants Physiologic Antioxidants Vitamin C – From diet Vitamin E – From diet Ubiquinone (coenzyme Q10) – Synthesized Glutathione – Synthesized Botanical Antioxidants Soy isoflavones Tea polyphenols Ellagic extract (Pomegranate) Coffeeberry Extract Pinnell SR. J Am Acad Dermatol. 2003;48:1-19.

45. Antioxidants in Sunscreen Antioxidants improve photoprotection act as free radical scavengers to prevent UV induced inflammation Adding antioxidants to sunscreen is a new concept in sun protection. Kang S, et al. J Invest Dermatol. 2003;120:835-841.

47. Natural Therapies in Skin Care

48. Licorice Extract Active components: Glabridin Liquiritin Licochalcone A Anti-inflammatory Used for redness Inhibits melanogenesis Used for brown spots Yokoda T, et al. Pigment Cell Res. 1998;11:355-361. Dieck K, et al. Poster abstract AAD; Feb 18-22, 2005; New Orleans, La. Kolbe L et al. Arch Dermatol Res. 2006;298:23-30.

49. Licorice Extract for RednessLichocalcone A 62 subjects with mild to moderate facial redness Four product skin care regimen for 8 weeks Improvement in redness at 4 and 8 weeks Compatible with the sensitive skin of patients with rosacea Weber TM. Journal of Cosmetic Dermatology. 5(3):227-32, 2006 Sep

50. Licorice for Facial Redness Weber TM. Journal of Cosmetic Dermatology. 5(3):227-32, 2006 Sep

51. Licorice Extract for PigmentLiquiritin Blinded vehicle controlled 20 women aged 18 to 40 years with melasma Split face (liquirtin vs vehicle) Twice daily for 4 weeks Significant improvement in melasma Amer M, Metwalli M. Int J Dermatol. 2000;39:299-301.

52. Licorice Extract One month Baseline

54. Photoprotectants

58. Mottled pigmentation

59. Blotchiness

60. Dullness

61. Fine linesOverall texture Overall skin tone Overall appearance Wallo W J Drugs Dermato 2007;6(9):917-22

62. Total Soy and SPF 30 Moisturizer 12 Weeks Baseline Nebus J, et al. Poster presented at: 64th Annual Meeting of the AAD. March 3-7, 2006; San Francisco, CA.

63. Oral Agents for Sun Protection Proanthocyanidins-Melasma Pine tree bark extract Grape seed extract Polypodium Leucotomos-Melasma Ellagic Acid Handog EB. International Journal of Dermatology. 48(8):896-901, 2009 Aug.

64. Summary Sunscreens can prevent UV damage Antioxidants and natural therapies offer good adjuncts to sun protection Basic skin care regimen AM: sunscreen + antioxidant PM: retinoid Oral photoprotective agents offer a novel mode of sun protection Photoaging is preventable

65. Thank You!