Abstract The preliminary study published in this issue of the Archives by Matsuoka et al1 addresses the question of whether the long-term use of sunscreens by the elderly will result in poor vitamin D status. Comparing two adult populations, one that used a p-aminobenzoic acid (PABA)-containing sunscreen with one that did not use sunscreen, these investigators found significantly lower levels of serum 25-hydroxyvitamin D (25-OH-D) in the group that used sunscreen. In our zeal to protect patients from the undesirable effects of sunlight, we encourage our fairskinned patients to apply sunscreen liberally and avoid the sun.2 Patients with fair skin, actinic damage, or a history of skin cancer are particularly encouraged to apply a sunscreen with a sun protection factor (SPF) of 15 or higher. Recently, tretinoin (Retin-A) has been advocated to reverse photoaging.3,4 These patients avoid the sun to minimize further photodamage. Because tretinoin use increases References 1. Matsuoka LY, Wortsman J, Hanifan N, et al: Lower body stores of vitamin D among sunscreen users: A preliminary study . Arch Dermatol 1988;124:1802-1804.Crossref 2. Simple Guidelines to Help Protect You From the Damaging Rays of the Sun . New York, The Skin Cancer Foundation. 3. Kligman AM, Grove GL, Hirose R, et al: Topical tretinoin for photoaged skin . J Am Acad Dermatol 1986;15:836-859.Crossref 4. Weiss JS, Ellis CN, Headington JT, et al: Topical tretinoin improves photoaged skin: A double-blind vehicle-controlled study . JAMA 1988;259:527-532.Crossref 5. Pathak MA, Fitzpatrick TB, Greiter F, et al: Preventive treatment of sunburn, dermatoheliosis, and skin cancer with sun-protective agents , in Dermatology in General Medicine . New York, McGraw-Hill International Book Co, 1987, pp 1507-1521. 6. Matsuoka LY, Ide L, Wortsman J, et al: Sunscreens suppress cutaneous vitamin D, synthesis . J Clin Endocrinol Metab 1987;64:1165-1168.Crossref 7. MacLaughlin JA, Anderson RR, Holick MF: Spectral character of sunlight modulates photosynthesis of previtamin D3 and its photoisomers in human skin . Science 1982;216:1001-1003.Crossref 8. Pathak MA: Sunscreens and their use in the preventive treatment of sunlight-induced skin damage . J Dermatol Surg Oncol 1987;13:739-750.Crossref 9. Hutchinson G, Hal A: The transmission of ultraviolet light through fabrics and its potential role in the cutaneous synthesis of vitamin D . Hum Nutr Appl Nutr 1984;38A:298-302. 10. MacLaughlin J, Holick MF: Aging decreases the capacity of human skin to produce vitamin D3 . J Clin Invest 1985;76:1536-1538.Crossref 11. Holick MF, MacLaughlin JA, Doppelt SH: Regulation of cutaneous previtamin D3 photosynthesis in man: Skin pigment is not an essential regulator . Science 1981;211:590-593.Crossref 12. Holick MF, Smith E, Pincus S: Skin as the site of vitamin D synthesis and target tissue for 1,25-dihydroxyvitamin D3 . Arch Dermatol 1987;123:1677a-1683a.Crossref 13. Holick MF: The photobiology of vitamin D and its consequences for humans . Ann NY Acad Sci 1985;453:1-13.Crossref 14. Markestad T: Effect of season and vitamin D supplementation on plasma concentrations of 25-hydroxy vitamin D in Norwegian infants . Acta Paediatr Scand 1983;72:817-821.Crossref 15. Lawson DEM: Symposium on nutrition and food problems of different age groups: Rickets and osteomalacia . Proc Nutr Soc 1984;43:249-256.Crossref 16. Holdsworth MD, Dattani JT, Davies L, et al: Factors contributing to vitamin D status near retirement age . Hum Nutr Clin Nutr 1984;38C:139-149. 17. Recommended Dietary Allowance , ed 9. Washington, DC, National Academy of Sciences, 1980. 18. Exton-Smith AN, Hodkinson HM, Stanton BR: Nutrition and metabolic bone disease in old age . Lancet 1966;11:999-1001.Crossref 19. Jenkins DHR, Roberts JG, Webster D, et al: Osteomalacia in elderly patients with fracture of the femoral neck: A clinicopathological study . J Bone Joint Surg Br 1973;55:575-580. 20. Al-Arabi KM, Wahab A, Elidrissy TH, et al: Is avoidance of sunlight a cause of fractures of the femoral neck in elderly Saudis? Trop Geogr Med 1984;36:273-279. 21. Harju E, Sotaniemi E, Puranen J, et al: High incidence of low serum vitamin D concentration in patients with hip fracture . Arch Orthop Trauma Surg 1985;103:408-416.Crossref 22. Rigby WFC: The immunobiology of vitamin D . Immunol Today 1988;9:54-58.Crossref 23. Davie MWJ, Emberson CE, Lawson DEM, et al: Low plasma 25-hydroxy vitamin D and serum calcium levels in institutionalized epileptic subjects: Associated risk factors, consequences and response to treatment with vitamin D . Q J Med 1983;205:79-91. 24. Frame B, Parfitt AM: Osteomalacia: Current concepts . Ann Intern Med 1978;89:966-982.Crossref 25. Haussler MR, McCain TA: Basic and clinical concepts related to vitamin D metabolism and action . N Engl J Med 1977;297:1041-1050.Crossref 26. Vitamin-Mineral Safety, Toxicity, and Misuse . Chicago, The American Dietetic Association, 1978. 27. Toss G, Andersson R, Diffey BL, et al: Oral vitamin D and ultraviolet radiation for the prevention of vitamin D deficiency in the elderly . Acta Med Scand 1982;212:157-161.Crossref 28. Adams JS, Clemens TL, Parrish JA, et al: Vitamin-D synthesis and metabolism after ultraviolet irradiation of normal and vitamin-D-deficient subjects . N Engl J Med 1982;306:722-725.Crossref
Archives of Dermatology – American Medical Association
Published: Dec 1, 1988
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