Henry W. Lim's research while affiliated with Henry Ford Health System and other places
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Publications (479)
Background
The treatment of vitiligo can be challenging and depends on several factors such as the subtype, disease activity, vitiligo extent, and treatment goals. Vitiligo usually requires a long‐term approach. To improve the management of vitiligo worldwide, a clear and up‐to‐date guide based on international consensus with uniform stepwise recom...
Sunless tanning products have risen in popularity as the desire for a tanned appearance continues alongside growing concerns about the deleterious effects of ultraviolet radiation exposure from the sun. Dihydroxyacetone (DHA) is a simple carbohydrate found nearly universally in sunless tanning products that serves to impart color to the skin. The F...
Background
Behavioural interventions can improve attitudes towards sun protection but the impact remains inconsistent worldwide.
Objective
To assess awareness of and attitudes towards the multiple facets of sun exposure and suggest ways to improve prevention from overexposure to the sun in all geographical zones and multiple skin types.
Methods
O...
https://doi.org/10.1093/bjd/ljad285
Dear Editor, Vitiligo is a depigmenting skin disorder that has a considerable effect on patient quality of life.¹ The Vitiligo Area Scoring Index (VASI) is a tool² for measuring repigmentation after patients undergo vitiligo treatment,¹ offering a standardized, quantitative scale without the need for specialized...
Background
Childhood exposure to ultraviolet radiation (UVR) plays an important role in the development of keratinocyte carcinomas and melanomas. Therefore, sun-protective measures ought to be implemented during early childhood. Young children are largely dependent upon adult care providers’ in achieving proper sun protection.
Objectives
To develo...
Background:
Infrared radiation (IR) is the portion of the electromagnetic spectrum between visible light (VL) and microwaves, with wavelengths between 700 nm and 1 mm. Humans are mainly exposed to ultraviolet (UV) radiation (UVR) and IR through the sun. Unlike UVR which is well known for its carcinogenic properties, the relationship between IR and...
Sunscreens are an important means of protection against sunburns, dyspigmentation, photoaging, and photocarcinogenesis. Sunscreens come in a variety of formulations that can protect against ultraviolet B (UVB) radiation, both UVB and ultraviolet A (UVA) radiation (broad-spectrum sunscreens), and UVB, UVA, and visible light (tinted broad-spectrum su...
e21578
Background: This survey investigates knowledge and behaviors regarding sun exposure among population who have been treated with immunosuppressive anti-graft rejection drugs because of an organ transplantation. Methods: The survey (N = 17,001) was conducted online in 17 countries (5 continents) from 28 September-18 October 2021. Automated sel...
e21575
Background: This survey investigates knowledge and behaviors regarding sun exposure among population who have been treated for skin cancer (melanoma/non melanoma) or pre-cancerous lesions in 17 countries. Methods: The survey (N = 17,001) was conducted online in 17 countries (5 continents) from 28 September-18 October 2021. Automated selectio...
Hidradenitis suppurativa (HS), an inflammatory skin-disease, manifests as painful lesions in intertriginous skin. Despite their central role in innate immunity the role of monocytes in HS is largely unknown. Here we utilized cytometry by time-of-flight (CyTOF), imaging CyTOF (IMC), cellular indexing of transcriptomes and epitopes by sequencing (CIT...
Background:
Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL). Single-fraction radiation therapy has been used as a skin-targeted therapy to treat localized CTCL lesions.
Objective:
To investigate the treatment outcomes associated with single-fraction radiation therapy for CTCL.
Methods:
We retrospectively stud...
Background:
Two previously published clinical studies by our group assessed erythema and pigmentation responses in outdoor conditions with three reference sunscreens, comparing their effectiveness under the full spectrum of natural sunlight. These studies followed an almost identical protocol but were conducted in two different locations and in tw...
Hidradenitis suppurativa (HS) is a multifactorial, inflammatory skin disease. Increased systemic inflammatory comorbidities and serum cytokines highlight systemic inflammation as a feature of HS. However, the specific immune cell subsets contributing to systemic and cutaneous inflammation have not been resolved. Here, we generated whole-blood immun...
The importance of skin of color and diversity, equity, and inclusion (DEI) started to be recognized in the late 1990s. Since then, because of the advocacy and effort of several highly visible leaders in dermatology, noticeable progress has been achieved. Leadership lessons learned for successful implementation of DEI include the following: (1) comm...
Background
Hidradenitis suppurativa (HS) is a multifactorial, inflammatory skin disease. Increased systemic inflammatory comorbidities and serum cytokines highlight systemic inflammation as a feature of HS. However, the specific immune cell subsets contributing to systemic and cutaneous inflammation have not been resolved.
Objective
Identify featu...
Introduction:
Polymorphous light eruption (PMLE) and chronic actinic dermatitis (CAD) have been classically described in White individuals, although recent studies have reported higher prevalence in patients with dark skin types, particularly African Americans.
Objective:
To evaluate for differences in demographic, and clinical features between...
Background:
In the 2022 monkeypox (mpox) outbreak, 79,000 global cases have been reported. Yet, limited dermatologic data have been published regarding lesion morphology and progression.
Objective:
To characterize skin lesion morphology, symptomatology, and outcomes of mpox infection over time.
Methods:
The AAD/ILDS Dermatology COVID-19, Monke...
Hot and humid countries such as Indonesia have a higher prevalence of acne vulgaris (AV). The activity of skin microbes, not only Cutibacterium acnes, contribute to the formation of AV. Topical and oral antibiotics are routinely prescribed to treat AV. As antimicrobial resistance rates increase globally, there are concerns about decreased efficacy....
The medical literature on aesthetic dermatology has primarily focused on a light-skinned patient population, yet patients of darker skin types have different needs and priorities. In Chinese individuals, key concerns include altered pigmentation, which is perceived to age the individual, and also relates to the Chinese cultural standard of beauty o...
Skin of colour or pigmented skin has unique characteristics: it has a higher eumelanin-to-pheomelanin ratio, more mature melanosomes, an increased amount of melanin distributed in the upper layers of the epidermis, and more efficient DNA repair compared with lighter skin. However, individuals with skin of colour are at a significant risk of skin da...
Background:
Availability of new UV filters in the United States lags behind the European Union (EU), partly due to differing approval processes.
Objective:
To review available human safety data of all US- and EU-approved UV filters.
Methods:
Data from Food and Drug Administration and EU regulatory guidelines, federal governmental documentation...
The biologic effects of visible light, particularly blue light, on the skin at doses and irradiances representative of sunlight have been established. Recent research studies investigated the effects of blue light (BL) from electronic screen devices; however, it is unclear if the evidence can be generalized to real life. The aim of this systematic...
As populations in many parts of the world are projected to become more racially diverse over the coming decades, we must better understand the unique characteristics of the skin of populations with skin of color (SOC). This review aims to highlight important physiologic and clinical considerations of photoprotection in SOC. Ultraviolet radiation an...
The World Health Organization declared the global monkeypox outbreak a public health emergency of international concern in July 2022. In response, the American Academy of Dermatology and International League of Dermatological Societies expanded the existing COVID-19 Dermatology Registry to become the "AAD/ILDS Dermatology COVID-19, Monkeypox, and E...
Targeted marketing and media may serve as potential sources of health information for consumers, influencing knowledge, practices, perception, and utilization of health care services. In addition to this vulnerable consumerism, there are barriers to healthy consumerism including exposure to different sources or lack thereof, lack of knowledge, inad...
Objective:
The synergistic effects of VL and long wavelength UVA1 (VL+UVA1, 370-700 nm) on inducing pigmentation and erythema in skin have been demonstrated and linked to exacerbation of dermatologic conditions including melasma and post-inflammatory hyperpigmentation. This study aims to compare the photoprotection of organic sunscreens enriched w...
Background
Comparing keloid treatment modalities and assessing response to treatments may be predicted by a better classification system.
Objectives
To develop and validate the Detroit Keloid Scale (DKS), a standardized method of keloid assessment.
Methods
Forty-seven physicians were polled to develop the DKS. The scale was validated in 52 patien...
A variety of non-filtering agents have been introduced to enhance sunscreen photoprotection. Most of those agents have only weak erythema protective properties but may be valuable and beneficial in supporting protection against other effects of UV radiation, such as photoimmunosuppression, skin aging, and carcinogenesis, as well as photodermatoses....
Tranexamic acid is a plasmin inhibitor that is used off‐label for the treatment of melasma. The use of tranexamic acid has expanded in the field of dermatology based on its anti‐inflammatory and anti‐melanin‐producing properties, which include the treatment of rosacea, urticaria, and post‐inflammatory hyperpigmentation. Tranexamic acid may have mor...
Vitiligo is characterized by the development of depigmented macules and patches. Autoimmunity has been established as a factor in disease pathogenesis, leading to utilization of immunosuppressive agents. Topical immunosuppressants are commonly used; however, this treatment modality is often cumbersome and inefficient, as many patients have active d...
Disorders of hyperpigmentation are common, and depending on the extent and location of involvement, can affect quality of life and pose a significant psychological burden for patients.1,2 Given the similarities in presentation of various causes of hyperpigmentation, it is often difficult to elucidate the etiology of these conditions, which is impor...
Key challenges in the management of pigmentary disorders such as melasma and post-inflammatory hyperpigmentation (PIH) are their resistance to treatment, tendency to recur after treatment, and the risk of exacerbating hyperpigmentation with many treatment modalities. The second article in this two-part continuing medical education series on pigment...
Clothing is recognized by leading health agencies as a primary method to protect against the harmful effects of photodamage caused by ultraviolet (UV) radiation and visible light. The photoprotective capacity of clothing is commonly measured as the ultraviolet protective factor (UPF). While the technology driving photoprotective clothing has been w...
The effect of coronavirus disease 2019 (COVID-19) on patients receiving conventional immunosuppressive (IS) therapy has yet to be fully determined; however, research on using IS therapy for treating COVID-19 in acutely ill patients is increasing. While some believe that IS therapy may be protective, others argue that these agents may make patients...
The effects of solar radiation on human skin differ based on skin phototype, the presence or absence of photodermatoses, biological capacity to repair DNA damage, wavelength, intensity of sun exposure, geographic latitude, and other factors, underscoring the need for a more tailored approach to photoprotection. To date, the focus of photoprotection...
Terrestrial sunlight is the portion of electromagnetic radiation that is emitted by the sun and reaches Earth’s surface. It encompasses 3 major components, which include ultraviolet (UV) radiation (290-400 nm), visible light (VL, 400-700 nm), and infrared radiation. The deleterious effects of UV radiation have been appreciated for decades, particul...
Until recently, the primary focus of photobiology has centered on the impact of UV radiation on skin health, including DNA damage and oncogenesis; however, the significant effects of visible light (VL) on skin remains grossly underreported. VL has been reported to cause erythema in light skin, Fitzpatrick skin types (FST) I-III, and pigmentary chan...
The negative effects of sun exposure have become better accepted among healthcare professionals and the lay public over recent decades. Most attention has been focused on the effects of ultraviolet (UV) light, particularly UVB wavelengths (290-320 nm). Accordingly, products to protect skin from sunlight-associated harm (sunscreens) have been develo...
Individual typology angle (ITA) measures constitutive pigmentation while skin phototypes (SPT) categories are based on sun reactiveness. However, the association between the two, ITA and SPT, is yet to be established. Since both systems provide six categories, recent studies have used ITA classifications as synonymous to SPT. The results of this st...
The role of topical antioxidants (AO) on visible light plus ultraviolet A1 (VL+UVA1)-induced skin changes were evaluated. Twenty subjects with skin phototypes (SPT) I-VI had placebo and concentrations of an AO blend applied to their back (AO 0.5, 1.0, and 2.0%). Treated and control sites were irradiated with VL+UVA1. Colorimetric and diffuse reflec...
Since December 2020, the American Academy of Dermatology and the International League of Dermatologic Societies’ COVID-19 Dermatology Registry has tracked dermatologic reactions post-COVID-19 vaccination. Within months, a variety of cutaneous manifestations were reported after the Moderna and Pfizer-BioNTech COVID-19 vaccines.¹ As of April 2021, a...
One early problem during the height of the COVID-19 global pandemic, caused by severe acute respiratory syndrome 2 (SARS-CoV-2), was the shortage of personal protective equipment donned by healthcare workers, particularly N95 respirators. Given the known virucidal, bactericidal, and fungicidal properties of ultraviolet irradiation, in particular ul...
Background
Cutaneous reactions after COVID-19 vaccination have been commonly reported. However, histopathologic features and clinical correlations have not been well characterized.
Methods
From an international registry, we evaluated all reports of COVID-19 associated vaccination reactions for history of skin biopsy. When histopathology reports we...
Human skin is not only affected by ultraviolet radiation, but also by visible light wavelengths emitted by sunlight, electronic devices, and light emitting diodes. Similar to ultraviolet radiation, visible light has been implicated in photoaging. In this review, the effects of blue light, yellow light, red light, and broad visible light are discuss...
Photoaging induced by both ultraviolet and visible light has been shown to lead to increased inflammation and dysregulation of the extracellular matrix. Standardized extract of the Polypodium leucotomos fern, PLE, possesses anti-inflammatory and antioxidant properties, and has been shown to potentially mitigate photoaging through various mechanisms...
Sunscreens have been on the market for many decades as a means of protection against ultraviolet-induced erythema. Over the years, evidence has also shown their efficacy in the prevention of photoaging, dyspigmentation, DNA damage, and photocarcinogenesis. In the USA, most broad-spectrum sunscreens provide protection against ultraviolet B (UVB) rad...
The Janus kinase- signal transducer and activator of transcription (JAK-STAT) intracellular signaling pathway is utilized by many pro-inflammatory molecules to mediate downstream effects and activate gene transcription. Activation of the JAK-STAT pathway contributes to a number of inflammatory dermatoses, and clinical trials and smaller studies hav...
The Janus kinase- signal transducer and activator of transcription (JAK-STAT) intracellular signaling pathway is implicated in the pathogenesis of a number of inflammatory dermatoses. Clinical trials and other studies have demonstrated the efficacy of JAK inhibitors in the treatment of a variety of dermatologic conditions. Herein we review JAK inhi...
Background
Facial involvement of vitiligo is an important factor in patient’s life and has often been evaluated separately from body surface area in clinical trials. However, no reliable measurement tools to measure facial vitiligo specifically are available thus far.
Objective
To develop and validate a practical instrument for assessing facial vi...
There are many variations in the way phototesting protocols in clinical research are reported in the photomedicine literature. Specifications regarding the light system, lamp type, irradiance and other components are too often missing or inadequately detailed, making it difficult to fully appreciate the methods used in each study, or compare the fi...
Background
Currently, sunscreens’ sun protection factor (SPF) and ultraviolet (UV) A protection are tested separately under indoor conditions, without considering external conditions that may affect performance. Studies are often conducted in Caucasian individuals; other racial groups may respond differently.
Methods
An outdoor, double-blind, intr...
Visible light (VL) can induce pigmentary alterations, especially in dark-skinned individuals, and exacerbate photodermatoses and pigmentary disorders. Currently, there is no standardized method for assessing sunscreen protection against VL. On the basis of a critical review of published in vitro and in vivo methods, a VL photoprotection assessment...
Background
Cutaneous reactions after mRNA-based COVID-19 vaccines have been reported but are not well characterized.
Objective
To evaluate morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines.
Methods
A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination.
Results
From D...
Hidradenitis suppurativa (HS) is a chronic, relapsing, and remitting inflammatory disease of the skin with significant heritability and racial disposition. The pathogenesis of HS remains enigmatic, but occlusion of the terminal hair follicle and dysregulation of the local innate immune response may contribute to pathogenesis. Genetic predisposition...
To the editor: Changes in the incidence of sunburn and ultraviolet (UV) damage during the COVID‐19 pandemic are not well described, however sunburn prevention remains important for the general public as UV exposure exacerbates a variety of dermatologic conditions, most importantly cutaneous cancers.
High-quality dermatology patient registries often require considerable time to develop and produce meaningful data. Development time is influenced by registry complexity and regulatory hurdles that vary significantly nationally and institutionally. The rapid emergence of the COVID-19 global pandemic has challenged health services in an unprecedente...
The Sunscreen Innovation Act was enacted on November 26, 2014, to help expedite the approval process for UV filters by the US Food and Drug Administration (FDA), given that no new filters had been approved in several years. Nearly 5 years later, on February 26, 2019, the FDA released a proposed rule (84 FR 6204)¹,2 in response to the Sunscreen Inno...
Excess amounts of skin surface oil can lead to adverse psychological consequences. Grease-spot photometry-based techniques measure sebum production rate. However, besides being tedious, these measurements are influenced by contact area, applied pressure, and time of application. Image analysis of polarized images has the potential to provide object...
Cutaneous photobiology studies have focused primarily on the UV portion of the solar spectrum. However, VL comprises 50% of EMR that reaches the earth's surface, and, as discussed in Part I of this CME, VL has cutaneous biologic effects such as pigment darkening and erythema. Photoprotection against VL includes sun avoidance, seeking shade, and the...
Approximately fifty percent of sunlight reaching the Earth's surface is visible light (400-700 nm). Other sources of visible light include lasers, light-emitting diodes (LEDs), and flash lamps. Photons from visible light are absorbed by photoreceptive chromophores (e.g., melanin, heme, and opsins), altering skin function by activating and imparting...
