We would like to comment on the three contributions in the Journal of the National Cancer Institute, Vol. 97, No. 3, February 2, 2005: Kathleen M. Egan, Jeffrey A. Sosman, William J. Blot: Editorial: Sunlight and Reduced Risk of Cancer: Is the Real Story Vitamin D? (pp. 161-163) ; Marianne Berwick, Bruce K. Armstrong, Leah Ben-Porat, Judith Fine, Anne Kricker, Carey Eberle, Raymond Barnhill: Sun Exposure and Mortality From Melanoma. (pp. 195-199) ; Karin Ekström Smedby, Henrik Hjalgrim, Mads Melbye, Anna Torrång, Klaus Rostgaard, Lars Munksgaard, et al.: Ultraviolet Radiation Exposure and Risk of Malignant Lymphomas. (pp. 199-209)

Hoffmann, Gerd

Meffert, Hans

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Apparent contradiction between negative effects of UV radiation and positive effects of sun exposure

Hoffmann, G

Meffert, H

German Medical Science

Hochschulschriftenserver - Universität Frankfurt am Main

Letter to the Editor Apparent contradiction between negative effects of UV radiation and positive effects of sun exposure Gerd Hoffmann1, Hans Meffert2 1Johann Wolfgang Goethe University, Institute of Sports Sciences, Frankfurt/Main, Germany 2University Hospital Charité, Campus Charité Mitte, Medical Faculty of the Humboldt University Berlin, Clinic of Dermatology, Venereology and Allergology, Department of Photodermatology, Berlin, Germany GMS Ger Med Sci 2005;3:Doc01                provisional PDF   We would like to comment on the three contributions in the Journal of the National Cancer Institute, Vol. 97, No. 3, February 2, 2005: • Kathleen M. Egan, Jeffrey A. Sosman, William J. Blot: Editorial: Sunlight and Reduced Risk of   Cancer: Is the Real Story Vitamin D? (pp. 161-163) [1] • Marianne Berwick, Bruce K. Armstrong, Leah Ben-Porat, Judith Fine, Anne Kricker, Carey Eberle,   Raymond Barnhill: Sun Exposure and Mortality From Melanoma. (pp. 195-199) [2] • Karin Ekström Smedby, Henrik Hjalgrim, Mads Melbye, Anna Torrång, Klaus Rostgaard, Lars   Munksgaard, et al.: Ultraviolet Radiation Exposure and Risk of Malignant Lymphomas. (pp. 199-209)  [3] The apparent contradiction between the well known negative effects of UV radiation on humans and the newly described positive effects of sun exposure (like reduced risk of cancer) is easily solved, when taking into account, that sun exposure ("sunlight") consists of at least three biologically active parts of radiation: ultraviolet radiation (UV), visible light (VIS) und infrared (IR).  Especially infrared A (780-1400 nm) with adequate irradiation intensity has been shown not only to be harmless to human skin [4], but to have protective abilities against damage caused by UV radiation  [5], [6]! In moderate climate zones, sun radiation is filtered by water vapor in the atmosphere before reaching the surface of the earth, by this decreasing infrared C, infrared B and the absorption bands within infrared A, leaving a large amount of water-filtered infrared A (wIRA) with good penetration properties into skin and without bringing much thermal burden to the surface of the skin [7]. Infrared A, especially water-filtered infrared A, is able to increase tissue temperature, tissue perfusion and tissue oxygen partial pressure [7], [8]: these three thermal effects are prerequisites of a high energy production in tissue and can therefore improve energy dependent immunologic reactions. Beside this, wavelengths within infrared A, especially near to visible light (approximately 780-1000 nm), have been shown to stimulate cells in a positive manner even with very low irradiation intensities (below intensities with thermal effects) [9], [10], [11], [12].  In addition, sunlight includes high irradiation intensities of all five absorption bands of protoporphyrin IX (approximately 406 nm, 505 nm, 540 nm, 574 nm, 629 nm [13]), which can react with endogenously formed protoporphyrin IX with and without oxygen in photooxidative reactions (type I and type II), giving a mild form of a photodynamic therapy (PDT), being able to modulate the immune system or to bring damaged cells to apoptosis [7], [13].                                              1Corresponding author: Prof. Dr. med. Gerd Hoffmann, Johann Wolfgang Goethe University, Institute of Sports Sciences, Ginnheimer Landstraße 39, 60487 Frankfurt/Main, Germany, Tel.+Fax+Q: 0049-6181-62287,  eMail: Hoffmann@em.uni-frankfurt.de Hoffmann et al. Apparent contradiction between negative effects of UV radiation and positive effects of sun exposure.  GMS Ger Med Sci. 2005;3:Doc01.                                                                                                          provisional PDF   2Furthermore, it is well known that modalities of UV irradiation, like its dose, increase, quality and the frequency of applications, are of crucial importance whether wanted or unwanted effects will take place. With a given daily sun exposure of less than .3 Minimal Erythema Doses (MED) vitamin D status is sufficient in babies. We calculated a simple diagram which shows how to get .3 MED at different times of the day and different seasons [14]. As a minor remark: Although the main statements of the publications of Berwick and Smedby will most likely be unchanged, both publications miss an alpha error adjustment, which is necessary in cases of multiple testing and which typically leads to a marked decrease in the number of significant differences or effects, when large numbers of tests are done.   References 1.   Egan KM, Sosman JA, Blot WJ. Sunlight and reduced risk of cancer: is the real story vitamin D?  J Natl Cancer Inst. 2005;97(3):161-3. 2.   Berwick M, Armstrong BK, Ben-Porat L, Fine J, Kricker A, Eberle C, Barnhill R. Sun exposure and mortality from melanoma. J Natl Cancer Inst. 2005;97(3):195-9. 3.   Smedby KE, Hjalgrim H, Melbye M, Torrång A, Rostgaard K, Munksgaard L, Adami J, Hansen M, Porwit-MacDonald A, Jensen BA, Roos G, Pedersen BB, Sundstrom C, Glimelius B, Adami HO. Ultraviolet radiation exposure and risk of malignant lymphomas. J Natl Cancer Inst. 2005;97(3):199-209. 4.   Burri N, Gebbers N, Applegate LA. Chronic infrared-A radiation repair: Implications in cellular senescence and extracellular matrix. In: Pandalai SG, ed. Recent Research Developments in Photochemistry & Photobiology, vol. 7. Trivandum: Transworld Research Network; 2004.  p. 220-31. 5.   Menezes S, Coulomb B, Lebreton C, Dubertret L. Non-coherent near infrared radiation protects normal human dermal fibroblasts from solar ultraviolet toxicity. J Invest Dermatol. 1998;111(4):629-33. 6.   Applegate LA, Scaletta C, Panizzon R, Frenk E, Hohlfeld P, Schwarzkopf S. Induction of the putative protective protein ferritin by infrared radiation: implications in skin repair. Int J Mol Med. 2000;5(3):247-51. 7.   Fuchs SM, Fluhr JW, Bankova L, Tittelbach J, Hoffmann G, Elsner P. Photodynamic therapy (PDT) and waterfiltered infrared A (wIRA) in patients with recalcitrant common hand and foot warts. Ger Med Sci 2004;2:Doc08. Available from:  http://www.egms.de/en/gms/2004-2/000018.shtml (shtml),  http://www.egms.de/pdf/gms/2004-2/000018.pdf (PDF) 8.   Vaupel P, Krüger W, eds. Wärmetherapie mit wassergefilterter Infrarot-A-Strahlung [Thermal therapy with water-filtered infrared A radiation]. 2nd ed. Stuttgart: Hippokrates; 1995. 9.   Albrecht-Buehler G. Surface extensions of 3T3 cells towards distant infrared light sources.  J Cell Biol. 1991;114(3):493-502. 10. Karu TI. Primary and secondary mechanisms of action of visible to near-IR radiation on cells [review]. J Photochem Photobiol B. 1999;49(1):1-17. 11. Karu TI, Pyatibrat LV, Kalendo GS. Cell attachment to extracellular matrices is modulated by pulsed radiation at 820 nm and chemicals that modify the activity of enzymes in the plasma membrane. Lasers Surg Med. 2001;29(3):274-81. 12. Ehrlicher A, Betz T, Stuhrmann B, Koch D, Milner V, Raizen MG, Käs J. Guiding neuronal growth with light. Proc Natl Acad Sci USA. 2002;99(25):16024-8. doi:10.1073/pnas.252631899. 13. Ackermann G. Photophysikalische Grundlagen zur Fluoreszenzdiagnostik von Tumoren der Haut [Thesis] [Photophysical fundamentals of fluorescence diagnosis of skin tumors]. Regensburg: University Regensburg; 2001. Available from:  http://www.bibliothek.uni-regensburg.de/opus/volltexte/2001/27/ 14. Siafarikas A, Piazena H, Hesse V, Meffert H. Importance of solar UV exposures to prevent rickets by supporting vitamin D production in the skin of babies (first results). 2nd Euroskin Conference, Orvieto, Italy, October 1-5, 2001. 

Cell attachment to extracellular matrices is modulated by pulsed radiation at 820 nm and chemicals that modify the activity of enzymes in the plasma membrane. Lasers Surg Med.

Chronic infrared-A radiation repair: Implications in cellular senescence and extracellular matrix.

Guiding neuronal growth with light.

Importance of solar UV exposures to prevent rickets by supporting vitamin D production in the skin of babies (first results).

Induction of the putative protective protein ferritin by infrared radiation: implications in skin repair.

Non-coherent near infrared radiation protects normal human dermal fibroblasts from solar ultraviolet toxicity.

Photophysikalische Grundlagen zur Fluoreszenzdiagnostik von Tumoren der Haut [Thesis] [Photophysical fundamentals of fluorescence diagnosis of skin tumors].

Primary and secondary mechanisms of action of visible to near-IR radiation on cells [review].

Sun exposure and mortality from melanoma.

Sunlight and reduced risk of cancer: is the real story vitamin D?

Surface extensions of 3T3 cells towards distant infrared light sources.

Ultraviolet radiation exposure and risk of malignant lymphomas.

Wärmetherapie mit wassergefilterter Infrarot-A-Strahlung [Thermal therapy with water-filtered infrared A radiation]. 2nd ed. Stuttgart: Hippokrates;

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Apparent contradiction between negative effects of UV radiation and positive effects of sun exposure

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