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 Series Introduction

During the past 25 years there has been a vast explosion of new information relating to the art
and science of dermatology, as well as fundamental cutaneous biology. Furthermore, this
information is no longer of interest to only the small but growing specialty of dermatology.
Clinicians and scientists from a wide variety of disciplines have come to recognize both the
importance of skin in fundamental biological processes and the broad implications of under-
standing the pathogenesis of skin disease. As a result, there is now a multidisciplinary and
worldwide interest in the progress of dermatology.
With these factors in mind, we have undertaken this series of books specifically oriented
to dermatology. The scope of this series is purposely broad, with books ranging from pure basic
science to practical, applied clinical dermatology. Thus, while there is something for everyone,
all volumes in this series will ultimately prove to be valuable additions to the dermatologist’s
library.
The latest volume in the series (No. 38), by Lim, Hönigsmann, and Hawk, presents a com-
prehensive and current review of photomedicine by world renowned authorities. The role
of photobiology in medicine has received increased emphasis in the past decade as a result
of considerable new information regarding the molecular biological effects of ultraviolet
light, its effect on the immune system, its role in the promotion of skin cancer, and its
abuse by profiteers who market suntan parlors. It is, therefore, critically important that
dermatologists, physicians in general, biologists, and public health scientists remain current
in photomedicine. I believe that Dr. Lim and his coeditors have produced a timely and
critically important addition to our series, which is both timely and comprehensive.

Alan R. Shalita, MD
Distinguished Teaching Professor and Chairman
Department of Dermatology
SUNY Downstate Medical Center
Brooklyn, New York, U.S.A.
 Preface

Within the past 30 years photomedicine has developed from empiricism into one of the most
exciting fields in biomedical research. Studies on the effects of visible and ultraviolet radiation
on skin have led to a fruitful collaboration between basic scientists and clinicians. The success-
ful use of the new ultraviolet techniques for the treatment of skin disease, along with a rapidly
increasing understanding of the pathogenesis of photodermatoses, thereby markedly improv-
ing their treatment, have been the driving force for the development of a new subspecialty of
photodermatology. This now encompasses the diagnosis and treatment of sunlight-induced
disorders; all aspects of phototherapy, including the use of such new modalities as photody-
namic therapy for skin tumors and other diseases; as well as photoprotection, which continues
to evolve with the development of new generations of ultraviolet filters. In the past decade,
therefore, very significant advances have occurred throughout this novel subspecialty, particu-
larly in photoimmunology, molecular biology, and genetics. In more detail, these include better
recognition and understanding of:

. Acute and chronic effects of ultraviolet radiation on the skin: in vitro studies, animal
models, photoaging, and epidemiology of skin cancers;
. Clinical manifestation of photodermatoses: actinic prurigo, pin-head papule form of poly-
morphous light eruption, novel genetic mutations in porphyrias, and so on;
. Pathophysiology and treatment of photodermatoses: polymorphous light eruption, actinic
prurigo, chronic actinic dermatitis, xeroderma pigmentatosum, photo-exacerbated derma-
toses, and so on;
. The science of photoprotection: new ultraviolet filters, photoprotection by clothing, photo-
protection by oral agents, and so on;
. Phototherapy: narrowband ultraviolet B, ultraviolet A1, visible light;
. Topical photodynamic therapy;
. Medical and cosmetic applications of laser and similar radiation sources; and
. New insight on the use of laser and radiation sources on people of color.

In planning for this book, our vision as editors was to create a book that is comprehensive
and up-to-date, yet is user-friendly to its intended readers who are busy, practicing dermatol-
ogists, photodermatologists, and trainees in dermatology. The editors are pleased that recog-
nized experts from many parts of the world willingly put in the effort and contributed most
informative chapters for this book.
The book consists of six sections. Section I is on history and basic principles, followed
by the effects of ultraviolet radiation on normal skin in Section II. Section III covers all the
photodermatoses, while Section IV and V discuss photoprotection and ultraviolet and visible
radiation therapy. Section VI is a practical description of testing methods used in photoderma-
tology and guidelines of setting up a phototherapy and laser center.
The three of us work in the United States, Europe, and the United Kingdom. We have
taken great care to make sure that materials covered in this book reflect an international
point of view. For example, international coverage is done on actinic prurigo (commonly
seen in Central and South America), photoprotection (different ultraviolet filters available in
different parts of the world), light sources and laser, and many other topics. It is our hope
that the readers will find that this book provides a good perspective on the worldwide scope
of photodermatology.
vi Preface

On a personal note, the three of us have been colleagues and friends for many years; all of
us have separately published books in photodermatology in the early and late 1990s. It has
been a real pleasure to combine our experience and to work on editing this book together.
We do hope that the readers will enjoy this book as much as we have enjoyed writing and
editing it.

Henry W. Lim, MD
Herbert Hönigsmann, MD
John L. M. Hawk, MD
 Acknowledgments

Henry W. Lim would like to thank his parents, for providing him the opportunity to succeed,
and his wife Mamie, for her unending patience and support.

Hebert Hönigsmann would like to thank his wife Xandi, for tolerating the lack of care
and attention to the family during the preparation of this book.

John L. M. Hawk would like to thank his wife, Lorna, for her continuing tolerance and support,
as ever previously, throughout the preparation of this book.

The editors would like to thank Sandra Beberman and her team at Informa Healthcare for
working with us to produce this book.
 Contents

Series Introduction Alan R. Shalita, MD iii

Preface v
Acknowledgments vii
Contributors xiii

Section I: History and Basic Principles

1. History of Human Photobiology 1
Rik Roelandts

2. Basic Principles of Photobiology 15

Brian L. Diffey and Irene E. Kochevar

3. Radiation Sources and Interaction with Skin 29

Harvey Lui and R. Rox Anderson

Section II: Effects of Ultraviolet Radiation on Normal Skin

4. The Molecular and Genetic Effects of Ultraviolet Radiation
Exposure on Skin Cells 41
Marjan Garmyn and Daniel B. Yarosh

5. Photoimmunology 55
Thomas Schwarz and Gary M. Halliday

6. The Acute Effects of Ultraviolet Radiation on the Skin 75

Lesley E. Rhodes and Henry W. Lim

7. The Chronic Effects of Ultraviolet Radiation on the Skin: Photoaging 91

Mina Yaar

8. The Chronic Effects of Ultraviolet Radiation on

the Skin: Photocarcinogenesis 107
Antony R. Young and Norbert M. Wikonkál

9. The Epidemiology of Skin Cancer 119

Luigi Naldi and Thomas Diepgen

Section III: Photodermatoses

Part A: Basic Principles
10. Evaluation of the Photosensitive Patient 139
Henry W. Lim and John L. M. Hawk
x Contents

Part B: Immunologically-Mediated Photodermatoses

11. Polymorphous Light Eruption, Hydroa Vacciniforme,
and Actinic Prurigo 149
Herbert Hönigsmann and Maria Teresa Hojyo-Tomoka

12. Chronic Actinic Dermatitis 169

John L. M. Hawk and Henry W. Lim

13. Solar Urticaria 185

Takeshi Horio and Erhard Hölzle

Part C: Drug and Chemical-Induced Photosensitivity

14. Drug and Chemical Photosensitivity: Exogenous 199
James Ferguson and Vincent A. DeLeo

15. Cutaneous Porphyrias 219

Gillian M. Murphy and Karl E. Anderson

Part D: DNA Repair-Deficient Photodermatoses

16. Xeroderma Pigmentosum and Other DNA
Repair-Deficient Photodermatoses 239
Mark Berneburg and Kenneth H. Kraemer

Part E: Photoaggravated Dermatoses

17. Photoaggravated Dermatoses 251
Victoria P. Werth and Herbert Hönigsmann

Section IV: Photoprotection

18. Photoprotection 267
Henry W. Lim and Herbert Hönigsmann

19. Novel Developments in Photoprotection: Part I 279

Uli Osterwalder and Henry W. Lim

20. Novel Developments in Photoprotection: Part II 297

André Rougier, Sophie Seite, and Henry W. Lim

21. Public Education in Photoprotection 311

Cheryl Rosen and Mark Naylor

Section V: Ultraviolet and Visible Radiation Therapy

22. Phototherapy with UVB: Broadband and Narrowband 319
Michael Zanolli and Peter M. Farr

23. Ultraviolet-A1 and Visible Light Therapy 335

Jean Krutmann and Akimichi Morita

24. Psoralen Photochemotherapy 347

Warwick L. Morison and Herbert Hönigsmann

25. Extracorporeal Photochemotherapy (Photopheresis) 359

Robert Knobler and Peter W. Heald
Contents xi

26. Photodynamic Therapy 369

Sally H. Ibbotson and Rolf-Markus Szeimies

27. The Principles and Medical Applications of Lasers and Intense-Pulsed Light in
Dermatology 389
Iltefat Hamzavi and Harvey Lui

28. Lasers and Energy Sources for Skin Rejuvenation and Epilation 401
Robert A. Weiss and Michael Landthaler

29. Laser Treatment on Ethnic Skin 417

Henry Hin Lee Chan and Brooke Jackson

Section VI: Appendices

Appendix A. Phototesting 433
Peter M. Farr and Robert S. Dawe

Appendix B. Photopatch Testing 441

Percy Lehmann, Frank C. Victor, and David E. Cohen

Appendix C. Guidelines for Setting Up a Phototherapy Referral Center or an

Office-Based Phototherapy Unit 449
Michael Zanolli and Roy Palmer

Appendix D. Guidelines for Setting Up a Laser Center 457

Macrene R. Alexiades-Armenakas and Jeffrey S. Dover

Index 463
 Contributors

Macrene R. Alexiades-Armenakas Department of Dermatology, Yale University School of

Medicine, New Haven, Connecticut, U.S.A.

Karl E. Anderson Department of Internal Medicine, Division of Gastroenterology and

Hepatology, University of Texas Medical Branch, Galveston, Texas, U.S.A.

R. Rox Anderson Wellman Center for Photomedicine and Department of Dermatology, Harvard
Medical School, and Massachusetts General Hospital, Boston, Massachusetts, U.S.A.

Mark Berneburg Department of Dermatology, Eberhard Karls University, Tuebingen, Germany

Henry Hin Lee Chan Division of Dermatology, Department of Medicine, University of

Hong Kong, and Department of Medicine and Therapeutics, Chinese University of
Hong Kong, Hong Kong, China

David E. Cohen Ronald O. Perelman Department of Dermatology, New York University

School of Medicine, New York, New York, U.S.A.

Robert S. Dawe Department of Dermatology, Ninewells Hospital and Medical School,

Dundee University, Dundee, Scotland, U.K.

Vincent A. DeLeo Columbia University, St. Luke’s– Roosevelt Hospital Center, New York,
New York, U.S.A.

Thomas Diepgen Department of Clinical Social Medicine, Occupational and Environmental

Dermatology, Heidelberg, Germany

Brian L. Diffey Department of Regional Medical Physics, Newcastle General Hospital,

Newcastle, England, U.K.

Jeffrey S. Dover Department of Dermatology, Yale University School of Medicine, New Haven,
Connecticut, and Dartmouth Medical School, Hanover, New Hampshire, U.S.A.

Peter M. Farr Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne,
England, U.K.

James Ferguson Photobiology Unit, Ninewells Hospital, Dundee, Scotland, U.K.

Marjan Garmyn Department of Dermatology, University of Leuven, Leuven, Belgium

Gary M. Halliday Dermatology Research Laboratories, Melanoma and Skin Cancer Research
Institute, University of Sydney, Sydney, Australia

Iltefat Hamzavi Department of Dermatology, Henry Ford Hospital, Detroit, and Hamzavi
Dermatology, Port Huron, Michigan, U.S.A.

John L. M. Hawk Photobiology Unit, St. John’s Institute of Dermatology, St. Thomas’ Hospital,
King’s College of London, London, England, U.K.
xiv Contributors

Peter W. Heald Department of Dermatology, West Haven VA Medical Center, Yale University
School of Medicine, New Haven, Connecticut, U.S.A.

Maria Teresa Hojyo-Tomoka Departamento de Dermatologia del Hospital General Dr. Manuel
Gea González, Tlalpan, Mexico City, Mexico

Erhard Hölzle Department of Dermatology and Allergology, Klinikum Oldenburg, Oldenburg,

Germany

Herbert Hönigsmann Department of Dermatology, Medical University of Vienna, Vienna, Austria

Takeshi Horio Department of Dermatology, Kansai Medical University, Osaka, Japan

Sally H. Ibbotson Department of Dermatology, Ninewells Hospital and Medical School,

University of Dundee, Dundee, Scotland, U.K.

Brooke Jackson Skin and Wellness Center of Chicago, Chicago, Illinois, U.S.A.

Robert Knobler Division of Special and Environmental Dermatology, Department of Dermatology,

Medical University of Vienna, Vienna, Austria, and Department of Dermatology, College of
Physicians and Surgeons, Columbia University, New York, New York, U.S.A.

Irene E. Kochevar Wellman Center for Photomedicine, Massachusetts General Hospital,

Harvard Medical School, Boston, Massachusetts, U.S.A.

Kenneth H. Kraemer Basic Research Laboratory, Center for Cancer Research, National Cancer
Institute, Bethesda, Maryland, U.S.A.

Jean Krutmann Department of Dermatology and Environmental Medicine, Institut für

Umweltmedizinische Forschung (IUF), Heinrich-Heine University, Düsseldorf, Germany

Michael Landthaler Department of Dermatology, University Clinic Regensburg, Regensburg,

Germany

Percy Lehmann Klinik für Dermatologie, Allergologie und Umweltmedizin, HELIOS-Klinikum

Wuppertal, Universitätsklinikum der Universität Witten-Herdecke, Wuppertal, Germany

Henry W. Lim Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, U.S.A.

Harvey Lui Department of Dermatology and Skin Science, Vancouver Coastal Health Research
Institute, University of British Columbia, Vancouver, British Columbia, Canada.

Warwick L. Morison Department of Dermatology, Johns Hopkins University, Baltimore,

Maryland, U.S.A.

Akimichi Morita Department of Geriatric and Environmental Dermatology, Nagoya City

University Graduate School of Medical Sciences, Nagoya, Japan

Gillian M. Murphy Department of Dermatology, Beaumont Hospital, Dublin, Ireland

Luigi Naldi Centro Studi GISED, Ospedali Riuniti, Bergamo, Italy

Mark Naylor University of Oklahoma, Tulsa, Oklahoma, U.S.A.

Uli Osterwalder Ciba Specialty Chemicals, Basel, Switzerland

Roy Palmer Photobiology Unit, St. John’s Institute of Dermatology, St. Thomas’ Hospital,
London, England, U.K.

Rik Roelandts Photodermatology Unit, University Hospital, Leuven, Belgium

Contributors xv

Lesley E. Rhodes Department of Dermatological Sciences, Photobiology Unit, University of

Manchester, Salford Royal Foundation Hospital, Manchester, England, U.K.

Cheryl Rosen Division of Dermatology, Toronto Western Hospital, University of Toronto,

Toronto, Ontario, Canada

André Rougier La Roche-Posay Pharmaceutical Laboratories, Asnières, France

Thomas Schwarz Department of Dermatology, University of Kiel, Kiel, Germany

Sophie Seite La Roche-Posay Pharmaceutical Laboratories, Asnières, France

Rolf-Markus Szeimies Department of Dermatology, Regensburg University Hospital,

Regensburg, Germany

Frank C. Victor Ronald O. Perelman Department of Dermatology, New York University

School of Medicine, New York, New York, U.S.A.

Robert A. Weiss Department of Dermatology, Johns Hopkins University School of Medicine,

Baltimore, and Maryland Laser Skin & Vein Institute, Hunt Valley, Maryland, U.S.A.

Victoria P. Werth Department of Dermatology, University of Pennsylvania, and Philadelphia V.A.

Medical Center, Philadelphia, Pennsylvania, U.S.A.

Norbert M. Wikonkál Department of Dermatology, Semmelweis University, School of Medicine,

Budapest, Hungary

Mina Yaar Department of Dermatology, Boston University School of Medicine, Boston,

Massachusetts, U.S.A.

Daniel B. Yarosh Applied Genetics Incorporated Dermatics, Freeport, New York, U.S.A.

Antony R. Young Division of Genetics and Molecular Medicine, St. John’s Institute of
Dermatology, King’s College London, London, England, U.K.

Michael Zanolli Division of Dermatology, Vanderbilt University Medical Center, Vanderbilt

University, Nashville, Tennessee, U.S.A.
Section I: HISTORY AND BASIC PRINCIPLES

1 History of Human Photobiology

Rik Roelandts
Photodermatology Unit, University Hospital, Leuven, Belgium

B Study on visible light was first published by Newton in 1672, and study
on action spectrum of ultraviolet light was published by Hausser and
Vahle in 1922.

B Relationship between sunlight and skin aging was first published by

Unna in 1894, and relationship between sunlight and skin cancer was
published by Dubreuilh in 1907.

B First description of a photodermatosis (eczema solare) was in 1798 by

Wilan.

B First commercially available sunscreen (benzyl salicylate and benzyl

cinnamate) was in 1928 in the United States. The concept of SPF was
developed by Greiter in 1974, and adopted by the United States Food and
Drug Administration in 1978.

B Modern day phototherapy started with Goeckerman in 1925 and PUVA

with Parrish in 1974.
2 Roelandts

THE BEGINNING OF A SCIENTIFIC INTEREST

he endless chain of days and nights since life began must have been an important source

T of imagination during history. This may explain why the Egyptians saw the Sun God Re
sailing the heaven in a boat and why the Greeks saw Apollo driving a chariot through the
sky. The Aztecs even offered beating human hearts to the Sun God, to give him enough
strength to reappear the next day. In nearly every civilization, people have adored the sun.
It was not only a question of religion but also of necessity. The sun is the universal source
of light and heat, and without the sun it would be dark and cold forever. This has nothing
to do with science. However, from early humankind on, people realized that the sun is extre-
mely important for life and it was, therefore, a topic of major concern. Stimulating people’s inter-
est is the beginning of science. Apart from this, there is also human experience. In many
civilizations, people realized that the sun could have a beneficial effect on certain diseases and
this, of course, had a stimulating effect on people’s imagination. It can take a very long time
before imagination evolves into a critical and structured approach, and in many cases this is a
step-by-step process.
The beginning of a real scientific interest in the solar spectrum dates from the 17th
century. One of the most important steps forward was the discovery of the visible spectrum
of the sun by Isaac Newton in England. He published the results of his experiments in 1672,
whereby the visible spectrum of the sun was fractionated by a prism into the different colors
of the rainbow (1). When Newton projected green plus red light on a wall, no green or red
light appeared, but only yellow light. When he added blue light, no green, red, or blue light
appeared, but only white light. To make white light, Newton did not need all colors, but
only red, green, and blue—the three basic colors.
In 1800, William Herschel, again in England, did some experiments with a thermometer to
evaluate which colors of the visible solar spectrum had the highest temperature. He noted that the
thermometer registered a higher temperature above the red visible light and, thus, discovered the
infrared spectrum of the sun (2).
The discovery of ultraviolet rays came a year later and can be attributed to the German
Johann Wilhelm Ritter. This discovery was partly based on previous experiments, by Carl
Wilhelm Scheele in Sweden, which had already been published in 1777 (3). Scheele could
show that paper strips dipped in a silver chloride solution became black after exposure to
the sun, because of a reduction of the silver, and that silver chloride did not become black in
the dark. Later on, this became the principle of analogous photography. Scheele could also
show that this was more pronounced with blue light than with red light. Ritter, a young scien-
tist, was convinced that invisible rays not only existed beyond the red end of the visible spec-
trum, as Herschel had demonstrated, but he also believed a similar invisible spectrum must
exist below the visible blue end of the spectrum. He first started his experiments with a ther-
mometer as Herschel did. Because he could not find a further decrease in temperature below
the visible blue as compared to the blue, he changed to Scheele’s method of using paper strips
dipped in silver chloride. He started measuring below the visible blue, where Scheele had
ended, and noted that the paper strips became even darker when exposed to invisible wave-
lengths shorter than the visible blue light. He, thus, discovered in 1801 the ultraviolet spectrum
of the sun, which he called “infraviolet” (4,5). Ritter died, unhappy, at the age of 33, without
ever realizing the importance of his discovery (6).
It took many years before the importance of ultraviolet rays became clear. After Ritter’s
death it was still a common belief that sunburn was due to heat damage. This changed with the
experiments of Everard Home in England in 1820 (7). Home wondered why the skin of black
people living in a hot climate was better protected than white skin, although black was absorb-
ing more heat. Therefore he exposed one of his own hands to the sun and covered the other one
with a black cloth. He developed sunburn on the exposed hand although a thermometer regis-
tered a higher temperature on the hand under the black cloth (8). Information at that time was
not so easily available as it is nowadays, which is illustrated by the fact that Moriz Kaposi, as
late as 1891, still believed that solar-induced erythema, and also pigmentation, were due to the
heat of the sun (9). Another illustration is the fact that Niels Finsen in Denmark, as late as 1900,
repeated Home’s experiment, independently, unaware of the previous experiment.
History of Human Photobiology 3

Although the damaging effects of ultraviolet radiation became gradually better known, it
took a few more years before real action-spectrum studies were undertaken. During Word War
I, Karl Hausser was the chief radiation physicist for Siemens AG in Germany. While working
near the battlefields, he got pulmonary tuberculosis and was sent to Davos in Switzerland for
heliotherapy. He took long walks in the mountains and noted that sunburn occurred easier at
noontime than in the afternoon hours (10). As a result, he and Vahle made the first detailed
action-spectrum studies for erythema and pigmentation of human skin. They could show
that erythema and pigmentation depend upon the wavelengths of the ultraviolet radiation
and that the effect is mainly due to wavelengths shorter than 320 nm (11). In 1922, they pub-
lished the action spectra for the induction of erythema and pigmentation in human skin
using a monochromator and an artificial mercury lamp.
During the Second International Congress on Light in 1932 in Copenhagen, Denmark,
William Coblentz proposed to divide the ultraviolet spectrum of the sun into three spectral
regions: UVA (315 –400 nm), UVB (280 – 315 nm), and UVC (,280 nm) (9).
Measuring the intensity of solar irradiation was another problem. Many different systems
were available (12). Although cadmium cathodes were already used in Potsdam in Germany
and in Davos in Switzerland as early as 1910, the first integrating analog meter was developed
by Rentschler in the mid-1930s, using a zirconium photodiode (11). However, these photo-
diodes showed great individual variability and temperature sensitivity. In addition, good
amplifiers were not available at that time. In the mid-1950s, Robertson developed a UVB
detector with a stable cold cathode thyratron to amplify the weak detector output (11). This
detector was later redesigned and became the popular Robertson-Berger meter.

ERYTHEMA, PIGMENTATION, AND NATURAL PHOTOPROTECTION

The concept that sun exposure is responsible for sunburn is known since early humankind. In
1799, Johan Christoph Ebermaier in Germany noticed different degrees of sunburn depending
on the time of exposure, whereby paler skin types reacted more severely than darker skin types
(13). However, until the experiments of Home in 1820 and even much later, it was commonly
believed that the heat of the sun was responsible for sunburn. The first to show that solar-
induced erythema is really induced by ultraviolet rays was Jean Martin Charcot in France in
1858. He noticed severe sunburn and keratitis in two scientists working with electric arcs
(9,14). This is also the first medical publication about accidental UV exposure. In 1877,
Arthur Henry Downes and Thomas Porter Blunt in England could show that sunlight also
may have a bactericidal action (15).
For a long time, it was a common belief that the heat of the sun was also responsible for
tanning, induced by sun exposure. In 1808, the German Placidus Heinrich noticed that the light
and not the heat of the sun was responsible for tanning (16). In 1829, John Davy from Scotland
first described immediate pigment darkening (9). It was only in 1885 that Paul Unna of
Germany suggested that the violet end of the solar spectrum, and thus the ultraviolet radiation,
was responsible for the pigmentation of the skin (17). A few years later, in 1889, Erik Johan
Widmark proved experimentally in Sweden that sunburn and tanning were due to the ultra-
violet rays and had nothing to do with heat (9,18). As soon as this was generally accepted,
research started into the mechanism of pigmentation. In 1917, Bloch published his experiments
on the mechanism of melanin formation in human skin and discovered dopa-oxidase (19).
Around the same time, Riehl reported a particular form of hyperpigmentation on both
cheeks and on the lateral parts of the neck after chronic sun exposure (20).
In 1928, Jean Saidman of France, published an interesting textbook, Les rayons ultra-violets
en thérapeutique, in which he describes how the minimal erythema dose (MED) may vary
according to the individual pigmentation, the site of the body, and age. He also describes vari-
ations in the MED in the case of certain skin disorders and in the case of oral intake of certain
drugs (12). He even made a device with a timer and several diaphragms to determine the MED,
automatically.
That sun exposure could induce an increase in skin thickness was already reported in
1799 by Ebermaier in Germany (13). In 1900, Magnus Möller reported that sun exposure
could induce a double protection mechanism in the epidermis, an increase of the stratum
4 Roelandts

corneum thickness, and an increase in pigmentation (21). In 1931, Guido Miescher of

Switzerland noticed an increase in thickness of all layers of the epidermis after sun exposure,
thus reducing the intensity of the penetrating radiation (22).

SKIN AGING AND SKIN CANCER

Gradually, it became clear that sun exposure could not only induce short-term but also long-
term skin changes. In 1893, Robert Bowles of England had already suggested that
sunlight could be responsible for skin cancers: “If the sun’s rays will produce sunburn,
erythema, eczema solare, inflammation, and blistering, it is clearly capable of producing
deep and intractable ulcerations of a low and chronic nature” (23). One year later, in 1894,
Paul Unna in Germany discovered the relationship between sun exposure and skin aging,
by studying sailor’s skin (24). He also associated the severe degenerative changes on the
exposed areas of sailors’ skin with the development of skin cancer (11). Around the same
time, in France, Dubreuilh noticed that people working in the vineyards around Bordeaux
had more skin cancers than people living in the city (25). He was the first to establish a
clear-cut relationship in 1906 –1907 between skin cancer and solar exposure (26). Both con-
ditions were dose-dependent. Skin aging was, therefore, more pronounced in the neck of
people working outside, which resulted in the description of cutis rhomboidalis nuchae by
Jadassohn and Nikolsky in 1925 (27).
In 1928, George Findlay reported that daily irradiation of mice with ultraviolet light from a
mercury arc could induce skin cancer (28) and that the interval time was reduced if tar were used
before the ultraviolet exposure. The first action-spectrum studies of skin photocarcinogenesis were
published by Angel Roffo from Argentina in 1939 (29), where he showed that window glass can
prevent the induction of skin cancer by both mercury arc radiation and by natural sunlight.
Shortly afterward, Harold Blum, Kirkby-Smith, and Grady, in the United States, conducted a com-
prehensive series of experiments on photocarcinogenesis in mice and were able to obtain highly
reproducible ultraviolet-induced skin cancers (30). These experiments were the beginning of a
large number of experiments on animal photocarcinogenesis during the following decades.

PHOTODERMATOSES
Probably the first to describe a photodermatosis was Robert Willan in 1798. He called the
disease eczema solare (31). The same condition was again described in 1887 by Veiel. What
they called eczema solare was, most likely, what we currently consider as polymorphous or
polymorphic light eruption. The name polymorphous light eruption was first used by Rasch
in Copenhagen, in 1900 (8). The same condition had also been described as prurigo aestivalis,
by Jonathan Hutchinson in 1878 (32). In 1919, Haxthausen used the term polymorphous light
eruption as a collective name for eczema solare and prurigo aestivalis, because it was not pos-
sible to differentiate between the two conditions (33).
Hydroa vacciniforme was first described by Bazin in 1860 (8). Later on, this term became
more confusing because it was not only used to describe hydroa vacciniforme, as it is known
currently. Some authors used the same terminology to describe what is, presently, called con-
genital erythropoietic porphyria.
Moriz Kaposi was the first to describe xeroderma pigmentosum in 1870 (8), but he did not
make the relationship with solar exposure or light, which was only done many years later by
Paul Unna (24).
The symptoms of congenital erythropoietic porphyria have been described under differ-
ent names such as pemphigus leprosus by Schultz in 1874 (34), xeroderma pigmentosum by
Gagey in 1896 (35), hydroa vacciniforme by M’Call Anderson in 1898 (36), hereditary syphilis
by Vollmer in 1903 (37), hydroa aestivale by Ehrmann in 1905 (38) and Linser in 1906 (39), until
Günther described the condition, in 1911, as a porphyria (40). One of the first symptoms of this
disease is the dark coloration of the urine, which was already noticed in the first description by
Schultz in 1874 (34), whereas M’Call Anderson was the first to recognize in his description of
1898 that the disease was caused by light (36). That the lesions resulted from the sensitization of
the skin to light exposure by porphyrins, was first suggested by Ehrmann, in 1909 (41). The
History of Human Photobiology 5

name Günther’s disease, to describe congenital erythropoietic porphyria, dates from a later
period. Even in 1926, Rasch still proposed to call the disease M’Call Anderson’s disease (8).
The same year the same author published a case report of a patient with porphyrinuria
and blisters on the back of both hands (8). Rasch did not make use of the terminology por-
phyria cutanea tarda, till that time, but he clearly made the link with alcoholism. The name
porphyria cutanea tarda was first used in 1937 by Waldenström, who also extensively
studied acute intermittent porphyria (42). The other porphyrias were described later, even
after World War II.
While the previous photodermatoses have mainly been described for the first time in the
19th century, solar urticaria has been described at the beginning of the 20th century. Probably
the first report of the induction of urticaria by sunlight is the one reported by Merklen, in 1904
(43). He was the first to consider urticaria, caused by light, to be a distinct clinical entity. A year
later in 1905, Ward, for the first time, provoked urticaria by means of sun exposure under con-
trolled conditions (44). The name “solar urticaria” was suggested by Duke in 1923 (45), and in
1928, Wucherpfennig could quantify the urticarial response by phototesting with increasing
doses of different wavelengths (46). In 1942, Rajka reported the passive transfer to normal
volunteers by an intradermal injection of serum from a person with solar urticaria (47).
The history of topically or systemically-induced photosensibilization starts earlier.
The first reports of systemically-induced photosensibilization were mainly due to occasional
intake of plant extracts. Already, in the 16th century, skin reactions have been observed in
animals after eating buckwheat followed by sun exposure (48). Similar observations have
been made in the 18th century in Sicily and in Napels in Italy, where white sheep showed
severe skin reactions after eating Hypericum, while the black sheep did not (49).
Between 1908 and 1910 Hausmann discovered that hematoporphyrin can photosensitize
animal skin and that the responsible wavelengths are in the green visible light around 500 nm
(50). The first clinical proof that some substances can photosensitize human skin in combination
with sun exposure dates from 1912, when our colleague Meyer-Betz injected himself with hema-
toporphyrin and exposed himself to the sun (51). By doing this he could demonstrate that the
combination of a photosensitizing substance and sun exposure can induce a skin reaction that
each of these two components separately would not induce, which is the definition of a photo-
sensibilization. Another example of a systemic photosensibilization in human skin is the “eosin
disease,” which was seen in patients treated with oral eosin for epilepsy or for other reasons (50).
In 1939, Stephen Epstein could demonstrate in human volunteers, using sulfanilamide as
the photosensitizer, that two mechanisms are involved: a dose-dependent phototoxic reaction
and a nondose-dependent photoallergic reaction (52).
It was first reported in 1913 by Louis Lewin, that topically applied agents can photosen-
sitize in workers using coal tar pitch (53). In 1916, Emanuel Freund reported phototoxic reac-
tions to eau de cologne, which was the first description of a berloque dermatitis, and he
concluded that oil of bergamot was most probably the photosensitizing substance (54). The
first description of a phytophotodermatitis dates from 1920 by Moritz Oppenheim (55). Hans
Kuske could show that the photosensitizing substances in these plants were furocoumarins,
and that their action spectrum was mainly between 334 and 366 nm, which was the first deter-
mination of an action spectrum for the furocoumarins (56). The photopatch test was introduced
in 1941 by Burckhardt (57).

PHOTOPROTECTION
It has always been part of human nature to protect the skin against sunburn by avoiding sun
exposure or by wearing appropriate clothes. During history, many substances have probably
been tried out as photoprotectors. As far as we know, the first scientific reports date from
the end of the 19th century. In 1878, Veiel reported the use of tannin as a photoprotector, but
its use was limited because of its staining potential (58). In 1891, Friedrich Hammer of
Germany even published a monograph, probably the first large monograph on photobiology,
discussing photoprotection and experimenting with different topical agents, to prevent
sunburn (9,59).
Another Random Scribd Document
with Unrelated Content
 Ethics - Problem Set
First 2022 - School

Prepared by: Prof. Miller

Date: August 12, 2025

Lesson 1: Ethical considerations and implications

Learning Objective 1: Problem-solving strategies and techniques
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 2: Interdisciplinary approaches
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 3: Literature review and discussion
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 3: Diagram/Chart/Graph]
Learning Objective 4: Current trends and future directions
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 5: Practical applications and examples
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 5: Diagram/Chart/Graph]
Note: Experimental procedures and results
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 6: Diagram/Chart/Graph]
Important: Literature review and discussion
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Study tips and learning strategies
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Comparative analysis and synthesis
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 9: Practical applications and examples
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice 2: Fundamental concepts and principles
Key Concept: Problem-solving strategies and techniques
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Historical development and evolution
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Best practices and recommendations
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Theoretical framework and methodology
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Study tips and learning strategies
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Case studies and real-world applications
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 16: Learning outcomes and objectives
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Interdisciplinary approaches
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 18: Comparative analysis and synthesis
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 19: Diagram/Chart/Graph]
Definition: Comparative analysis and synthesis
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice 3: Theoretical framework and methodology
Remember: Literature review and discussion
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Best practices and recommendations
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Fundamental concepts and principles
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Historical development and evolution
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 24: Diagram/Chart/Graph]
Example 24: Experimental procedures and results
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 25: Diagram/Chart/Graph]
Key Concept: Current trends and future directions
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Problem-solving strategies and techniques
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Interdisciplinary approaches
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Practical applications and examples
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Best practices and recommendations
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Unit 4: Comparative analysis and synthesis
Remember: Fundamental concepts and principles
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Case studies and real-world applications
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 32: Best practices and recommendations
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 33: Literature review and discussion
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 34: Current trends and future directions
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Literature review and discussion
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Key terms and definitions
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Comparative analysis and synthesis
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 38: Assessment criteria and rubrics
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Literature review and discussion
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Methodology 5: Statistical analysis and interpretation
Definition: Theoretical framework and methodology
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 41: Diagram/Chart/Graph]
Important: Case studies and real-world applications
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Learning outcomes and objectives
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 43: Diagram/Chart/Graph]
Example 43: Key terms and definitions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 44: Diagram/Chart/Graph]
Remember: Ethical considerations and implications
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Statistical analysis and interpretation
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Ethical considerations and implications
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Assessment criteria and rubrics
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 48: Diagram/Chart/Graph]
Important: Historical development and evolution
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Assessment criteria and rubrics
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Results 6: Learning outcomes and objectives
Practice Problem 50: Practical applications and examples
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 51: Diagram/Chart/Graph]
Practice Problem 51: Theoretical framework and methodology
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Problem-solving strategies and techniques
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Practical applications and examples
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Study tips and learning strategies
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Key terms and definitions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Key terms and definitions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 57: Critical analysis and evaluation
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Study tips and learning strategies
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 59: Statistical analysis and interpretation
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Topic 7: Case studies and real-world applications
Important: Statistical analysis and interpretation
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Experimental procedures and results
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Fundamental concepts and principles
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Research findings and conclusions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Current trends and future directions
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 65: Statistical analysis and interpretation
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 66: Historical development and evolution
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Critical analysis and evaluation
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Definition: Problem-solving strategies and techniques
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 69: Diagram/Chart/Graph]
Remember: Learning outcomes and objectives
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 70: Diagram/Chart/Graph]
Part 8: Literature review and discussion
Key Concept: Case studies and real-world applications
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 71: Diagram/Chart/Graph]
Note: Current trends and future directions
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Problem-solving strategies and techniques
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 73: Study tips and learning strategies
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Theoretical framework and methodology
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Interdisciplinary approaches
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Assessment criteria and rubrics
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Comparative analysis and synthesis
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Critical analysis and evaluation
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Research findings and conclusions
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Test 9: Practical applications and examples
Important: Key terms and definitions
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 81: Diagram/Chart/Graph]
Remember: Learning outcomes and objectives
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Statistical analysis and interpretation
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 83: Research findings and conclusions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 84: Diagram/Chart/Graph]
Remember: Ethical considerations and implications
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 85: Statistical analysis and interpretation
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Literature review and discussion
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Theoretical framework and methodology
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Current trends and future directions
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Ethical considerations and implications
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 90: Diagram/Chart/Graph]
Results 10: Literature review and discussion
Example 90: Literature review and discussion
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Problem-solving strategies and techniques
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 92: Best practices and recommendations
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Assessment criteria and rubrics
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 94: Comparative analysis and synthesis
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 95: Key terms and definitions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Problem-solving strategies and techniques
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 97: Current trends and future directions
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 98: Assessment criteria and rubrics
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Historical development and evolution
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Lesson 11: Case studies and real-world applications
Important: Learning outcomes and objectives
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Problem-solving strategies and techniques
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Experimental procedures and results
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 103: Learning outcomes and objectives
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Best practices and recommendations
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 105: Case studies and real-world applications
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 106: Diagram/Chart/Graph]
Important: Learning outcomes and objectives
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 107: Study tips and learning strategies
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Theoretical framework and methodology
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Practical applications and examples
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Topic 12: Comparative analysis and synthesis
Note: Literature review and discussion
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Current trends and future directions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 112: Critical analysis and evaluation
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Theoretical framework and methodology
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Case studies and real-world applications
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Experimental procedures and results
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Theoretical framework and methodology
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 117: Interdisciplinary approaches
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Statistical analysis and interpretation
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Example 119: Fundamental concepts and principles
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Chapter 13: Experimental procedures and results
Remember: Practical applications and examples
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 121: Historical development and evolution
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Case studies and real-world applications
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 123: Problem-solving strategies and techniques
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Assessment criteria and rubrics
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 125: Diagram/Chart/Graph]
Remember: Study tips and learning strategies
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Study tips and learning strategies
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Current trends and future directions
• Study tips and learning strategies
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Formula: [Mathematical expression or equation]
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- Example: Practical application scenario
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- Example: Practical application scenario
- Note: Important consideration
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