Sun exposure, a relevant exposome factor in acne patients and how photoprotection can improve outcomes

BackgroundAcne pathophysiology includes a complex interaction among inflammatory mediators, hyperseborrhea, alteration of keratinization and follicular colonization by Propionibacterium acnes. AimsTo describe the impact of the exposome on acne and how photoprotection can improve outcomes. MethodsA narrative review of the literature was carried out; searches with Google Scholar and Pubmed from January 1992 to November 2022 were performed. The keywords used were acne, sunscreens, photoprotection, cosmetics, cosmeceuticals, pathogenesis, etiology, exposome, sunlight, stress, lack of sleep, diet, postinflammatory hyperpigmentation, pollution, exposome, ultraviolet radiation, and visible light. ResultsEnvironmental factors such as solar radiation, air pollution, tobacco consumption, psychological stress, diverse microorganisms, nutrition, among others, can trigger or worsen acne. Solar radiation can temporarily improve lesions. However, it can induce proinflammatory and profibrotic responses, and produce post-inflammatory hyperpigmentation and/or post-inflammatory erythema. While photoprotection is widely recommended to acne patients, only four relevant studies were found. Sunscreens can significantly improve symptomatology or enhance treatment and can prevent post-inflammatory hyperpigmentation. Furthermore, they can provide camouflage and improve quality of life. Based on acne pathogenesis, optimal sunscreens should have emollient, antioxidant and sebum controlling properties. ConclusionsThe exposome and solar radiation can trigger or worsen acne. UV light can induce post-inflammatory hyperpigmentation/erythema, and can initiate flares. The use of specifically formulated sunscreens could enhance adherence to topical or systemic therapy, camouflage lesions (tinted sunscreens), decrease inflammation, and reduce the incidence of post-inflammatory hyperpigmentation/erythema.

Automated summary

This article reviews the impact of the exposome on acne and how photoprotection can improve outcomes. It finds that environmental factors such as solar radiation, air pollution, and stress can trigger or worsen acne. Moreover, the use of sunscreens can significantly improve symptomatology, prevent post-inflammatory hyperpigmentation, and enhance adherence to therapy.