L E Rhodes

The University of Manchester, Manchester, England, United Kingdom

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Publications (138)503.5 Total impact

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    ABSTRACT: The simultaneous analysis of free-form and conjugated flavonoids in the same sample is difficult but necessary to properly estimate their bioavailability. A method was developed to optimise the extraction of both free and conjugated forms of catechins and metabolites in a biological sample following the consumption of green tea. A double-blind randomised controlled trial was performed in which 26 volunteers consumed daily green tea and vitamin C supplements and 24 consumed a placebo for 3 months. Urine was collected for 24h at 4 separate time points (pre- and post-consumption) to confirm compliance to the supplementation and to distinguish between placebo and supplementation consumption. The urine was assessed for both free and conjugated metabolites of green tea using LC-MS(2) analysis, after a combination extraction method, which involved an ethyl acetate extraction followed by an acetonitrile protein precipitation. The combination method resulted in a good recovery of EC-O-sulphate (91±7%), EGC-O-glucuronide (94±6%), EC (95±6%), EGC (111±5%) and ethyl gallate (74±3%). A potential total of 55 catechin metabolites were investigated, and of these, 26 conjugated (with methyl, glucuronide or sulphate groups) and 3 free-form (unconjugated) compounds were identified in urine following green tea consumption. The majority of EC and EGC conjugates significantly increased post-consumption of green tea in comparison to baseline (pre-supplementation) samples. The conjugated metabolites associated with the highest peak areas were O-methyl-EC-O-sulphate and the valerolactones M6/M6'-O-sulphate. In line with previous studies, EC and EGC were only identified as conjugated derivatives, and EGCG and ECG were not found as mono-conjugated or free-forms. In summary, the method reported here provides a good recovery of catechin compounds and is appropriate for use in the assessment of flavonoid bioavailability, particularly for biological tissues that may contain endogenous deconjugating enzymes.
    Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 09/2014; 972C:29-37. · 2.78 Impact Factor
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    ABSTRACT: Background Low vitamin D status is prevalent in winter-time in populations at northerly latitudes. Photosensitive patients are advised to practise sun-avoidance, but their sunlight exposure levels, photoprotective measures and resulting vitamin D status are unknown.Objectives Examine seasonal vitamin D status in photosensitive patients relative to healthy individuals and quantitatively assess behavioural and demographic contributors.DesignLongitudinal prospective cohort study (53.5°N) examining year-round 25-hydroxyvitamin D (25(OH)D) levels, sun-exposure behaviour and oral vitamin D intake in photosensitive patients diagnosed at a photoinvestigation unit (n=53) compared with concurrently-assessed healthy adults (n=109).ResultsPhotosensitive patients achieved seasonal 25(OH)D variation, but insufficient (<20ng/ml; 50nmol/l) and even deficient (<10ng/ml; 25nmol/l) levels occurred at summer-peak in 47% and 9% patients respectively, rising to 73% and 32% at winter-trough. Adjusting for demographic factors, mean values were lower than for healthy volunteers by 18% (95%CI 4 to 29%) in summer (P=0.02), 25% (7 to 39%) in winter (P=0.01). Behavioural factors explained 25(OH)D differences between cohorts. Patients demonstrated lower weekend UVB-doses (P<0.001), smaller skin surface-area exposure (P=0.004) and greater sunscreen use (P<0.001), while average oral vitamin D intake was low in both groups (photosensitive: 2.94μg/day). Supplementation and summer surface-area exposure predicted summer-peak and winter-trough 25(OH)D; 1μg/day increment in vitamin D supplement raised summer and winter 25(OH)D by 5% (95%CI 3 to 7%) and 9% (5 to 12%) respectively (both P<0.001).Conclusions Photosensitive patients are, through their photoprotective measures, at high risk of year-round low vitamin D status. Guidance on oral measures should target this patient group and their physicians.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 08/2014; · 3.76 Impact Factor
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    ABSTRACT: Animal studies report photodynamic therapy (PDT) to improve healing of excisional wounds but the mechanism is uncertain and equivalent human studies are lacking. To explore the impact of methyl aminolaevulinate (MAL)-PDT on clinical and microscopic parameters of human cutaneous excisional wound healing, examining for potential modulation through production of transforming growth factor (TGF)-β isoforms. In healthy older men (60-77 years; n=27), a 4 mm punch biopsy wound was created in skin of the upper inner arm and treated with MAL-PDT three times over five days. An identical control wound to the contralateral arm was untreated and both wounds left to heal by secondary intention. Wounds were re-excised at time points examining the inflammatory phase (7 days, n=10), matrix remodelling (3 weeks, n=8) and cosmetic outcome/dermal structure (9 months, n=9). Production of TGF-β1, TGF-β3 and matrix metalloproteinases (MMPs), key mediators of matrix deposition and remodelling, was assessed by immunohistochemistry alongside microscopic measurement of wound size/area and clinical assessment of wound appearance. MAL-PDT delayed re-epithelialisation at 7 days, associated with increased inflammation. However, 3 weeks post-wounding, treated wounds were smaller with higher production of MMP-1 (P=0.01), MMP-9 (P=0.04) and the anti-scarring cytokine, TGF-β3 (P=0.03). TGF-β1 was lower than control at 7 days and higher at 3 weeks (both P=0.03). At 9 months MAL-PDT treated wounds showed greater, more ordered deposition of collagen I, collagen III and elastin (all P<0.05). MAL-PDT increases MMP-1, MMP-9, and TGF-β3 production during matrix remodelling, ultimately producing scars with improved dermal matrix architecture. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 07/2014; 171:55-62. · 3.76 Impact Factor
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    ABSTRACT: Acute inflammation occurs in human skin following topical aminolevulinic acid photodynamic therapy (ALA-PDT). Experimental models of PDT have identified potential mediators of this response but their involvement following PDT in human skin is little explored. We previously showed histamine to mediate the immediate ALA-PDT induced inflammatory response, but not the more prolonged erythema. We have additionally, through a series of novel studies in human volunteers, examined the involvement of proinflammatory mediators prostaglandin (PG) E2 and nitric oxide (NO) in the erythemal response. Duplicate dose-series of ALA were applied to the skin of each ventral forearm using the quantitative delivery system of iontophoresis, and exposed to 100 J/cm2 red light. In separate studies, arms were randomised within subject to receive treatment with the cyclooxygenase inhibitor indomethacin or control, or to receive treatment with NO synthase inhibitor N-nitro-L-arginine (L-NAME), or control. Following PDT, the erythemal response was quantified to determine the impact of treatment. Release of PGE2 and NO following ALA-PDT was also assessed directly using the technique of dermal microdialysis. Microdialysate was collected over 30 min periods immediately pre-irradiation, during irradiation and up to 24 h post-irradiation and mediators quantified by ELISA and chemiluminescence assay, respectively. An ALA dose-related erythema occurred by 3 h post-PDT which persisted to 48 h. Application of topical indomethacin immediately following ALA-PDT reduced the slope of the erythemal dose-response assessed at 3 h and 24 h post-PDT. Intradermal injection of L-NAME was also shown to reduce the ALA-PDT-red cell flux dose-response at 24 h post-PDT, and to reduce the red blood cell flux at sites treated with ALA-PDT from 3 to 48 h post-PDT. Analysis of dermal microdialysate confirmed NO and PGE2 to be released by PDT, with different time courses. In conclusion, topical ALA-PDT upregulates production of PGE2 and NO in human skin, both of which mediate the clinical inflammatory response. These mediators may play a role in PDT-induced acute adverse events and on PDT efficacy in human topical ALA-PDT, and could potentially be modulated to influence PDT outcomes.
    American Society for Photobiology, San Diego; 06/2014
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    ABSTRACT: Vitamin D is important for bone health, is linked to many other health benefits including protection against a range of malignancies and autoimmune disorders, and is known to modulate many biological responses including cell differentiation. It is therefore important to evaluate the vitamin D status of the general population in the context of recommended target levels and public health advice on vitamin D acquisition. The accepted best indicator of vitamin D status is the circulating level of 25-hydroxyvitamin D (25OHD). The Institute of Medicine for the USA and Canada advises a target 25OHD level of ≥20 ng/ml (50 nmol/L) based on parameters of bone health, and recommends oral intake of ≥600 IU daily. The target is currently under review in the UK, where most adults are not advised of any oral vitamin D requirement as adequate intake has been assumed to occur from cutaneous synthesis following regular brief UV exposures. Through a series of intervention studies, we demonstrated that a 6 week course of low dose (1.3 SED) UV radiation exposures (3 times a week to 35% skin surface area), simulating a summer’s casual sunlight exposures, could produce 25OHD ≥20 ng/ml in 90% of the white Caucasian adult (phototype I-IV, aged 20-60 years) population. However, no adults of South Asian ethnicity (phototype V) reached sufficiency following an identical course of exposures. Increased UV exposure, up to 3 times that given to white Caucasians, raised 25OHD levels in South Asians enough to avoid deficiency i.e.25OHD ≥10 ng/ml but the majority could not reach 20 ng/ml.. Our observation studies have shown that 77% of white Caucasian adults aged 20-60 years actually achieve 20 ng/ml at summer end (September) in the UK, falling to 40% at the winter trough in February. In contrast, 25OHD levels in a cohort of South Asian adults in the same age range were startlingly low, with only 7% ever achieving 20 ng/ml. Due to the diverse roles of vitamin D, suboptimal status may impact on responses to therapy, as well as on various health outcomes. Considering our observation and intervention studies in tandem, more effectively targeted guidance on sunlight exposure and oral vitamin D acquisition could assist those at risk of low levels.
    American Society for Photobiology, San Diego; 06/2014
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    ABSTRACT: Background Photoprotection including sunscreen use in children is encouraged by health campaigns. While sunscreen chemicals are common causes of photoallergic (PA) contact reactions in adults, limited data is available in children.Objectives To assess the frequency of PA and contact allergy (CA) to sunscreens in children <18 years undergoing investigation for suspected photosensitivity.Methods Retrospective analysis of data on children who underwent photopatch testing to a standard series of 9 ultraviolet (UV)-filters and to sunscreen-products in a single photoinvestigation centre (2000-2011). Duplicate series of UV-filters and the children's own sunscreen-products were applied to the back, with readings taken at sample removal, and at 24 and 48h post 5J/cm2 UVA exposure of one set.ResultsThe analysis comprised 157 children (3-17 yrs, 69 males and 88 females). A total of 10 (6.4%) children showed positive photopatch responses to UV-filters and/or their sunscreen-products (4.5% to UV-filters, 5.7% to their sunscreen-products). The responsible UV-filters most often identified were benzophenone-3 and ethylhexyl methoxycinnamate. Additionally, CA reactions were observed in 9 (5.7%) children, with overall 16 (10.2%) children showing PA and/or CA to UV-filters and/or sunscreen-products.Conclusion This is the largest series of photopatch testing reported in children, and shows that sunscreen PA and also CA are quite frequent in those undergoing photoinvestigation. Photopatch testing should be considered in children presenting with features of photosensitivity.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 03/2014; · 3.76 Impact Factor
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    ABSTRACT: Background: Sun exposure has positive and negative effects on health, yet little is known about the sun-exposure behaviour of UK adolescents, including those more prone or less prone to sunburn. Objective: To examine sun exposure behaviour of UK white Caucasian adolescents including time spent outdoors, holiday behaviour, use of sunscreen and clothing, with assessment for differences between sun-reactive skin type groups. Methods: White Caucasian adolescents (12-15 years) attending schools in Greater Manchester completed a 2 page questionnaire to assess sun exposure and photoprotective behaviour. Results: 133 adolescents (median age 13.4 years; 39% skin type I/II, 61% skin type III/IV) completed the questionnaire. In summer, adolescents spent significantly longer outdoors at weekends (median 4 h/day, range 0.25-10) than on weekdays (2, 0.25-6; P<0.0001). When at home in the UK during summer, 44% reported never wearing sunscreen compared to just 1% when on a sunny holiday. Sunscreen use was also greater (frequency/coverage) when on a sunny holiday than at home in the UK summer (P<0.0001). Adolescents of skin types I/II (easy burning) spent significantly less time outdoors than skin types III/IV (easy tanning) on summer weekends (P<0.001), summer weekdays (P<0.05) and on a sunny holiday (P=0.001). Furthermore, skin types I/II reported greater sunscreen use during summer in the UK and on sunny holiday (both P<0.01), and wore clothing covering a greater skin area on a sunny holiday (P<0.01) than skin types III/IV. There was no difference in sun-exposure behaviour/protection between males and females. Conclusion: The greater sun-protective measures reported by adolescents of sun-reactive skin type group I/II than III/IV suggest those who burn more easily are aware of the greater need to protect their skin. However, use of sunscreen during the UK summer is low and may need more effective promotion in adolescents.
    Journal of the European Academy of Dermatology and Venereology 01/2014; · 2.69 Impact Factor
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    ABSTRACT: Eicosapentaenoic acid (EPA), abundant in oily fish, is reported to reduce skin inflammation and provide photoprotection, potential mechanisms include competition with arachidonic acid (AA) for metabolism by cyclooxygenases/lipoxygenases to less pro-inflammatory mediators. We thus examine impact of EPA intake on levels of AA, EPA and their resulting eicosanoids in human skin with or without ultraviolet radiation (UVR) challenge. In a double-blind randomised controlled study, 79 females took 5 g EPA-rich or control lipid for 12 wk. Pre- and post-supplementation, red blood cell and skin polyunsaturated fatty acids were assessed by GC, and eicosanoids from unexposed and UVR-exposed skin by LC-MS/MS. Active supplementation increased red blood cell and dermal EPA versus control (both p < 0.001), lowering relative AA:EPA content (4:1 versus 15:1 and 5:1 versus 11:1, respectively; both p < 0.001). Pre-supplementation, UVR increased PGE2 , 12-hydroxyeicosatetraenoic acids, 12-HEPE (all p < 0.001) and PGE3 (p < 0.05). Post-EPA, PGE2 was reduced in unchallenged skin (p < 0.05) while EPA-derived PGE3 (non-sign) and 12-HEPE (p < 0.01) were elevated post-UVR. Thus, post-EPA, PGE2 :PGE3 was lower in unchallenged (12:1 versus 28:1; p < 0.05) and UVR exposed (12:1 versus 54:1; p < 0.01) skin; 12-hydroxyeicosatetraenoic acids:12-HEPE was lower in UVR-exposed skin (3:1 versus 11:1; p < 0.001). Dietary EPA augments skin EPA:AA content, shifting eicosanoid synthesis towards less pro-inflammatory species, and promoting a regulatory milieu under basal conditions and in response to inflammatory insult.
    Molecular Nutrition & Food Research 12/2013; · 4.31 Impact Factor
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    ABSTRACT: Skin cancer is a major public health concern and the primary aetiological factor in the majority of skin cancers is UVR exposure. Ultraviolet radiation not only induces potentially mutagenic DNA damage, but also suppresses cell mediated immunity (CMI), allowing cancerous cells to escape destruction and progress to tumours. A considerable proportion of an individual's annual sun exposure is obtained outside the vacation period when topical and physical measures for photoprotection are irregularly used. Certain nutrients could provide an adjunctive protective role and evidence is accruing from experimental studies to support their use in abrogation of photoimmunosuppression. Moreover, developments in clinical research methods to evaluate impact of solar simulated radiation on cutaneous CMI allow the immune protective potential of nutritional agents to be examined in humans in vivo. This article summarises the mediation of CMI and its suppression by UVR, evaluates the methodology for quantitative assessment in vivo, reviews the human studies reported on nutritional abrogation of photoimmunosuppression including recent randomised controlled trials, and discusses the mechanisms of photoprotection by the nutrients. This includes, in addition to antioxidants, novel studies of omega-3 polyunsaturated fatty acids and nicotinamide.
    Photodermatology Photoimmunology and Photomedicine 11/2013; · 1.52 Impact Factor
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    ABSTRACT: Skin cancers have a higher incidence than all other cancers combined and are a major cause of morbidity worldwide. Laboratory data suggest certain dietary constituents, notably omega-3 polyunsaturated fatty acids (n-3 PUFAs), could potentially protect against skin malignancy, although no large-scale review has been conducted in humans. The objective of this review and meta-analysis was to determine the relationship between dietary n-3 PUFAs and skin cancer incidence. It considered all published randomised controlled trials and observational studies up to March 2013. Five studies (two case-control, three cohort) were identified pertaining to oral n-3 PUFA consumption and incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), melanoma (or a combination) and were included in a random-effects meta-analysis. A further six studies considering non-dietary n-3 PUFA exposure (e.g. by tissue analysis) and/or recognised biological markers of skin cancer risk (e.g. p53 expression) were analysed qualitatively. Dietary n-3 PUFAs were not associated with BCC (pooled OR 1.05, 95% CIs 0.86-1.28). Consumption of high levels of n-3 PUFAs were inversely associated with melanoma, although with only one estimate available (OR 0.52, 95% CI=0.34-0.78), and SCC, although non-significantly (pooled OR 0.86, 95%CIs 0.59-1.23). Available evidence is suggestive, but currently inadequate, to support the hypothesis that n-3 PUFAs protect against skin malignancy. © 2013 Wiley Periodicals, Inc.
    International Journal of Cancer 11/2013; · 6.20 Impact Factor
  • Photodermatology Photoimmunology and Photomedicine 10/2013; 29(5):272-5. · 1.52 Impact Factor
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    ABSTRACT: Public health guidelines in the UK assume that from school age to retirement (ages 4 - 64 years) all vitamin D requirements are met by synthesis of the vitamin in skin after exposure to solar (UV) radiation. The exceptions are "at risk" groups including pregnant and lactating women, and those over 65, for whom 10 ug/day (400 iu) is recommended. Under the age of 4, during rapid growth and with acknowledgement of the vulnerability of delicate skin to sun exposure, and intake of 8.5, falling to 7 ug/day is recommended. These intakes, defined in 1991 and re-assessed and unchanged in 1998, are predicated on avoiding rickets and maintaining a healthy skeleton, with 25 nmol/l (10 ng/ml) of circulating 25-hydroxyvitamin D defined as the lower limit of acceptable vitamin D status. They do not address other potential benefits of vitamin D. In a series of studies in the Greater Manchester (UK) area we have investigated both the dietary and the sun-induced skin synthesis contributions to vitamin D status, measured by circulating 25-hydroxyvitamin D, as a function of season. Our population groups have included white Caucasian and South Asian (skin type V) adults, white Caucasian and South Asian adolescents, and individuals with photosensitivity disorders. The results must be assessed with respect to changes in our understanding of vitamin D and its relation to bone health and other disorders, and to societal changes that have influenced our diet and activities over the past 20-30 years. Despite differences within and between population groups, it was apparent that dietary intake of vitamin D is consistently low year round. Each group has a seasonal cycle in circulating 25(OH)D, albeit of different amplitudes. Summer sunlight increases circulating 25(OH)D, and dietary intake is insufficient to maintain summer levels through the winter, when the sun is too low in the sky to elicit any appreciable vitamin D synthesis in skin. In this respect the basic assumption that vitamin D status is dependent on synthesis in the skin remains correct. The differences between behaviour and vitamin D outcome for various population groups, and the implications for health, will be explored further.
    European Society for Photobiology, Liege, Belgium; 09/2013
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    ABSTRACT: Topical 5-aminolevulinic acid-photodynamic therapy (5-ALA-PDT) causes a clinical inflammatory response in human skin. While histamine mediates the immediate reaction, the mediators of the prolonged erythema are unknown OBJECTIVE: To examine for involvement of pro-inflammatory mediators prostaglandin E2 (PGE2 ) and nitric oxide (NO) in topical PDT-induced erythema in human skin. A series of studies were performed in forearm skin of healthy volunteers (n=35). Following definition of the erythemal time-course and dose-response to 5-ALA-PDT, duplicate 5-ALA dose-series were iontophoresed into the skin of each ventral forearm and exposed to 100J/cm(2) broadband red light. Within subject, arms were randomised to control or treatment with cyclooxygenase and nitric oxide synthase inhibitors, indomethacin and N(ω)-nitro-L-arginine methyl ester (L-NAME), respectively, and impact on 5-ALA-PDT induced erythema quantified. Additionally, release of PGE2 and NO was directly assessed by sampling dermal microdialysate at intervals following 5-ALA-PDT. A 5-ALA dose-related delayed erythema occurred by 3h (r= 0.97, P<0.01), with erythema persisting to 48h post-PDT. Topical indomethacin applied immediately post-PDT reduced the slope of erythemal response at 3 and 24h (P<0.05). Intradermal injection of L-NAME into 5-ALA-PDT treated sites reduced the slope of response at 24h post-PDT (p<0.001) whilst significantly inhibiting erythema from 3-48h post-PDT (P<0.01). Analysis of dermal microdialysate showed release of NO and PGE2 following topical 5-ALA-PDT. Topical 5-ALA-PDT upregulates PGE2 and NO in human skin, where they play a significant role in the clinical inflammatory response. The potential relevance of these mediators to PDT of human cutaneous pathology warrants study. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 08/2013; · 3.76 Impact Factor
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    ABSTRACT: Long-standing concerns over vitamin D status of South Asian adults in the UK require studies using statistically valid sample sizes to measure annual variation and contributory lifestyle factors. Measure annual variation in vitamin D status and determine associated lifestyle influences. Evaluate with respect to a similar study of white Caucasian adults. A single-centre, prospective cohort study measuring circulating 25(OH)D, sunlight exposure levels and lifestyle factors for one year in 125 ambulant South Asian adults with sun-reactive skin type V, aged 20-60 years, in Greater-Manchester, UK (53.5°N). The 25(OH)D levels of South Asians were alarmingly low. In summer, their median (IQR) 25(OH)D was 9.0(6·7-13·1)ng/mL (22·5nmol/L) falling to 5·8(4·0-8·1) ng/mL (14·5nmol/L) in winter. This compared to white Caucasian values of 26·2(19·9-31·5) ng/mL (65·5nmol/L) in summer and 18·9(11·6-23·8) ng/mL (47·2nmol/L) in winter. Median daily dietary vitamin D was lower in South Asians (1·32μg versus 3·26μg for white Caucasians) and compounded by low supplement use. Despite similar times spent outdoors, UV-dosimeters recorded lower personal UV exposure amongst South Asians, indicating sun avoidance when outside, while sun exposure diaries recorded lower amounts of skin surface exposure. The majority of South Asians never reached sufficiency in vitamin D status. Lifestyle differences, with lower oral intake, sun exposure and rates of cutaneous production due to darker skin, indicate that standard advice on obtaining sufficient vitamin D needs modification for the South Asian community in UK. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 07/2013; · 3.76 Impact Factor
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    ABSTRACT: BACKGROUND: Vitamin D is essential for bone health, and cutaneous synthesis is an important source. South Asians cannot attain adequate amounts of vitamin D by following general recommendations on summer sunlight exposure at northerly latitudes, and increased exposure may be appropriate for improving their vitamin D status. OBJECTIVE: We examined the efficacy of a dose range of simulated summer sunlight exposures in raising vitamin D status in UK adults of South Asian ethnicity. DESIGN: In a dose-response study, healthy adults of South Asian ethnicity (n = 60; 20-60 y old) received 1 of 6 ultraviolet exposures ranging from 0.65 to 3.9 standard erythema doses (SEDs), which were equivalent to 15-90 min unshaded noontime summer sunlight at 53.5°N (Manchester, United Kingdom), 3 times/wk for 6 wk, while wearing casual clothes that revealed a 35% skin area. Serum 25-hydroxyvitamin D [25(OH)D] was measured weekly, and dietary vitamin D was estimated. RESULTS: At baseline, all completing participants (n = 51) were vitamin D insufficient [25(OH)D concentrations <20 ng/mL], and a high proportion of participants were deficient [35% of subjects had 25(OH)D concentrations <5 ng/mL, and 90% of subjects had 25(OH)D concentrations <10 ng/mL, which are concentrations at which osteomalacia and rickets occur). The 25(OH)D concentration rose significantly in all dose groups. Postcourse, all participants achieved 25(OH)D concentrations ≥5 ng/mL, whereas only 6 subjects attained 25(OH)D concentrations ≥20 ng/mL. Participants who received exposures ≥1.95 SEDs (equivalent to 45 min unshaded sunlight; n = 33) attained a mean (±SD) 25(OH)D concentration of 15.7 ± 5 ng/mL (mean rise: 8.7 ± 5.7 ng/mL; 95% CI: 6.8, 10.6; P < 0.001), and 94% of subjects achieved concentrations >10 ng/mL. CONCLUSIONS: Targeted guidance on sunlight exposure could usefully enhance vitamin D status to avoid deficiency [25(OH)D concentration >10 ng/mL] in South Asians living at latitudes distant from the equator. This trial was registered at the ISRCTN Register (www.isrctn.org) as 07565297.
    American Journal of Clinical Nutrition 04/2013; · 6.50 Impact Factor
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    ABSTRACT: In order to establish a consensus recommendation for performing photopatch testing, a photopatch test taskforce group was established under the joint umbrella of the European Society for Contact Dermatitis and the European Society for Photodermatology in 2000. After proposing the most adequate methodology in 2004 and completing a European multicentre photopatch test study in 2011, this taskforce is recommending a list of photoallergens that should form part of a baseline series for photopatch testing in Europe. It contains mainly ultraviolet filters and drugs, mostly non-steroidal anti-inflammatory drugs. The choice of chemicals was based on the results of a recent multicentre study, previous published cases of photoallergy, and use of the substances in the European market. It is suggested that an extended list of photoallergens should be photopatch tested in selected cases, along with patients' own products. Two contact allergens, cinnamyl alcohol and decyl glucoside, should be simultaneously patch tested in order to clarify photopatch and patch test reactions, respectively, to ketoprofen and methylene bis-benzotriazolyl tetramethylbutylphenol (Tinosorb M™).
    Contact Dermatitis 04/2013; 68(4):239-243. · 2.93 Impact Factor
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    ABSTRACT: BACKGROUND: Skin cancer is a major public health concern, and the majority of cases are caused by solar ultraviolet radiation (UVR) exposure, which suppresses skin immunity. Omega-3 (n-3) PUFAs protect against photoimmunosuppression and skin cancer in mice, but the impact in humans is unknown. OBJECTIVES: We hypothesized that EPA-rich n-3 PUFA would abrogate photoimmunosuppression in humans. Therefore, a nutritional study was performed to assess the effect on UVR suppression of cutaneous cell-mediated immunity (CMI) reflected by nickel contact hypersensitivity (CHS). DESIGN: In a double-blind, randomized controlled study, 79 volunteers (nickel-allergic women, 22-60 y old, with phototype I or II) took 5 g n-3 PUFA-containing lipid (70% EPA plus 10% DHA) or a control lipid daily for 3 mo. After supplementation, nickel was applied to 3 skin sites preexposed on 3 consecutive days to 1.9, 3.8, or 7.6 J/cm(2) of solar-simulated radiation (SSR) and to 3 unexposed control sites. Nickel CHS responses were quantified after 72 h and the percentage of immunosuppression by SSR was calculated. Erythrocyte [red blood cell (RBC)] EPA was measured by using gas chromatography. RESULTS: SSR dose-related suppression of the nickel CHS response was observed in both groups. Photoimmunosuppression appeared less in the n-3 PUFA group than in the control group (not statistically significant [mean difference (95% CI): 6.9% (-2.1%, 15.9%)]). The difference was greatest at 3.8 J/cm(2) SSR [mean difference: 11% (95% CI: 0.5%, 21.4%)]. Postsupplementation RBC EPA was 4-fold higher in the n-3 PUFA group than in the control group (mean difference: 2.69% (95% CI: 2.23%, 3.14%), which confirmed the EPA bioavailability. CONCLUSION: Oral n-3 PUFAs appear to abrogate photoimmunosuppression in human skin, providing additional support for their chemopreventive role; verification of study findings is required. This trial was registered at clinicaltrials.gov as NCT01032343.
    American Journal of Clinical Nutrition 01/2013; · 6.50 Impact Factor
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    ABSTRACT: Green tea catechins (GTC) reduce UV radiation (UVR)-induced inflammation in experimental models, but human studies are scarce and their cutaneous bioavailability and mechanism of photoprotection are unknown. We aimed to examine oral GTC cutaneous uptake, ability to protect human skin against erythema induced by a UVR dose range and impact on potent cyclo-oxygenase- and lipoxygenase-produced mediators of UVR inflammation, PGE2 and 12-hydroxyeicosatetraenoic acid (12-HETE), respectively. In an open oral intervention study, sixteen healthy human subjects (phototype I/II) were given low-dose GTC (540 mg) with vitamin C (50 mg) daily for 12 weeks. Pre- and post-supplementation, the buttock skin was exposed to UVR and the resultant erythema quantified. Skin blister fluid and biopsies were taken from the unexposed and the UVR-exposed skin 24 h after a pro-inflammatory UVR challenge (three minimal erythema doses). Urine, skin tissue and fluid were analysed for catechin content and skin fluid for PGE2 and 12-HETE by liquid chromatography coupled to tandem MS. A total of fourteen completing subjects were supplement compliant (twelve female, median 42·5 years, range 29-59 years). Benzoic acid levels were increased in skin fluid post-supplementation (P= 0·03), and methylated gallic acid and several intact catechins and hydroxyphenyl-valerolactones were detected in the skin tissue and fluid. AUC analysis for UVR erythema revealed reduced response post-GTC (P= 0·037). Pre-supplementation, PGE2 and 12-HETE were UVR induced (P= 0·003, 0·0001). After GTC, UVR-induced 12-HETE reduced from mean 64 (sd 42) to 41 (sd 32) pg/μl (P= 0·01), while PGE2 was unaltered. Thus, GTC intake results in the incorporation of catechin metabolites into human skin associated with abrogated UVR-induced 12-HETE; this may contribute to protection against sunburn inflammation and potentially longer-term UVR-mediated damage.
    The British journal of nutrition 01/2013; · 3.45 Impact Factor
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    Proceedings of The Nutrition Society 01/2013; 72(OCE4). · 3.67 Impact Factor
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    ABSTRACT: Abnormal cutaneous sensitivity to the ultraviolet and/or visible radiation in sunlight characterizes photosensitivity disorders. Little is known regarding their impact in childhood. Our objective was to characterize childhood photosensitivity disorders presenting to a photoinvestigation unit, evaluating their impact on quality of life (QoL). Photoinvestigation records of children attending from 2000 to 2007 were evaluated for diagnosis, clinical, demographic and phototest parameters. These children were subsequently contacted during summertime to evaluate the impact of photosensitivity on QoL, utilizing the children's dermatology life quality index (CDLQI). 83 children underwent photoinvestigation; 62 (74.7%) were diagnosed photosensitive (mean age 8.6 years, range 2-16; 33 female), with abnormal phototest findings in 35 children. 38/55 questionnaires (69.1%) were returned. Mean (± standard deviation) CDLQI score (all diagnoses) was 10.2 ± 7.3 with very high scores in xeroderma pigmentosum (20.7 ± 5.7; n = 3) and actinic prurigo (18.2 ± 7.1; n = 6) and moderate scores in photoaggravated eczema (7.9 ± 4.2; n = 8) and polymorphic light eruption (6.2 ± 4.4 n = 18). CDLQI correlated with number of months affected per year (r = 0.595, P = 0.001). Photosensitivity disorders have a substantial impact, ranging from moderate to extremely large, on QoL in childhood, and the psychological consequences should be considered in their management.
    Photodermatology Photoimmunology and Photomedicine 12/2012; 28(6):290-2. · 1.52 Impact Factor

Publication Stats

3k Citations
503.50 Total Impact Points


  • 2002–2014
    • The University of Manchester
      • • Institute of Inflammation and Repair
      • • Centre for Dermatology
      • • School of Translational Medicine
      • • School of Earth, Atmospheric and Environmental Sciences
      Manchester, England, United Kingdom
    • Nottinghamshire Healthcare NHS Trust
      Nottigham, England, United Kingdom
  • 2010–2013
    • Salford Royal NHS Foundation Trust
      Salford, England, United Kingdom
  • 2011
    • University of Bradford
      • Centre for Skin Sciences
      Bradford, ENG, United Kingdom
  • 2009–2011
    • Central Manchester University Hospitals NHS Foundation Trust
      Manchester, England, United Kingdom
  • 2008
    • Goethe-Universität Frankfurt am Main
      Frankfurt, Hesse, Germany
    • National Health Service
      • Department of Dermatology
      Radditch, England, United Kingdom
  • 2007
    • Leiden University Medical Centre
      • Department of Dermatology
      Leiden, South Holland, Netherlands
  • 1994–2007
    • University of Liverpool
      • School of Medicine
      Liverpool, ENG, United Kingdom
  • 2006
    • Baylor College of Medicine
      • Department of Dermatology
      Houston, TX, United States
  • 1992–2004
    • Royal Liverpool and Broadgreen University Hospitals NHS Trust
      • • Department of Dermatology
      • • Department of Medicine
      Liverpool, England, United Kingdom