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L'addiction Au Soleil, Son Estocade Et La Parade Des Crèmes Solaires

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L'addiction Au Soleil, Son Estocade Et La Parade Des Crèmes Solaires L’ADDICTION AU SOLEIL, SON ESTOCADE ET LA PARADE DES CRÈMES SOLAIRES C. PIÉRARD-FRANCHIMONT (1,2), T. HERMANNS-LÊ (3), G.E. PIÉRARD (4), P. DELVENNE (5) RÉSUMÉ : Toute discordance entre la pigmentation cutanée SUN ADDICTION, ITS FINISHING BLOW AND THE PARRY OF SUNSCREENS innée et le comportement vis-à-vis de l’exposition solaire est SUMMARY : Any mismatch between the innate cutaneous un challenge sérieux pour la peau. Les bains de soleil et les pigmentation and lifetime behaviour regarding sun exposure bancs solaires conjuguent leurs effets dommageables. Les is a serious challenge for the skin. Sunbaths and sun parlours risques de réactions inflammatoires photoinduites (coup de combine their deleterious effects. The risks for inflamma- soleil et autres lucites), de photovieillissement chronique, de tory reactions (sunburns and other photoreactions), chronic photocancérogenèse cutanée en champs, de certaines tumeurs photoageing, skin field photocancerogenesis, some equivocal équivoques (kératose actinique, porokératose actinique) et de tumours (actinic keratosis, actinic porokeratosis, …) and overt cancers cutanés (carcinome basocellulaire, carcinome spino- skin cancers (basal cell carcinoma, squamous cell carcinoma, cellulaire, mélanome) sont des pathologies communes. Pour le melanoma) are common conditions. For the public at large grand public et les médias, les crèmes solaires visent à prévenir and medias, sunscreens aim at preventing these issues. Clearly, ces problèmes. Tous ces buts ne sont cependant pas atteints. each of these goals is not fully achieved. MOTS-CLÉS : Ultraviolet - Photoprotection - Cancer - Photovieil- KEYWORDS : Ultraviolet - Photoprotection - Cancer - Pho- lissement - Mélanome - Bain de soleil toageing - Melanoma - Sunbath Le comportement des individus vis-à-vis Elle est synonyme de congé, de «farniente», de de l’exposition aux rayons ultraviolets (UV) luminosité bienfaisante, de la perception sen- (lumière solaire, banc solaire, sources d’irra- sorielle d’une douce chaleur ambiante et de diation professionnelle) est fréquemment dis- l’acquisition d’un teint hâlé, indice (fallacieux) cordant par rapport à la couleur innée de la de bonne santé et d’un rang social qui peut se peau et à sa réactivité à la lumière définie par permettre des vacances. En réalité, hormis les le phototype (1). La recherche d’un bronzage endorphines du plaisir qui sont libérées pendant affirmé et d’une sensation de bien-être dans un temps bref et la vitamine D que s’empresse l’environnement douillet d’un bain d’UV sont de synthétiser la peau photoexposée aux UVB, souvent des incitants plus persuasifs que les tout le reste des conséquences à l’exposition principes de photoprotection et de modération à intense au soleil est à ranger dans le tiroir des l’exposition solaire répétés à longueur de temps effets néfastes et indésirables (10). ces dernières décennies. Les sources artificielles et récréatives Nul ne peut ignorer que l’exposition solaire d’UV, communément appelées bancs solaires, intense et répétitive, ainsi que les bancs solaires débitent en grande partie des UVA avec une sont mis en cause, tant dans le domaine du pho- quantité négligeable à modeste d’UVB. Dans tovieillissement de la peau que dans celui des les conditions d’utilisation usuelle sans prise cancers cutanés (2-8). L’OMS, par son Agence d’agent photosensibilisant, le signal «danger» Internationale pour la Recherche sur le Cancer, de l’érythème du coup de soleil n’apparaît a publié des rapports plaçant les bancs solaires pas, ce qui incite à prolonger l’exposition pour dans le groupe 1 des agents comportant le plus atteindre le «graal» d’une peau couleur choco- haut risque cancérologique (6, 9). lat. Les doses reçues d’UVA sont alors hors du commun et expriment leurs effets indésirables SOLEIL JE T’ADORE, MAIS MA PEAU qui consistent en un photovieillissement accé- N’OUBLIE PAS léré et un risque de photocancérogenèse (2-9). La recherche du plaisir à se dorer au soleil se cultive dans l’actualité de notre civilisation. CONSTAT SOCIÉTAL ACTUEL Depuis plusieurs décennies, les popula- (1) Chef de Service, CHR hutois, Service de Derma- tions occidentales tentent, par des expositions tologie, Huy. solaires intensives, prolongées et répétées, de (2) Chargé de Cours adjoint, Chef de Laboratoire, (3) Maître de Conférences, Consultant Expert cli- garder un hâle de vacancier. Le comportement nique, (5) Professeur, Chef de Service ff, Service de compulsif poussant à une exposition volontaire Dermatopathologie, CHU de Liège. et immodérée à un carcinogène connu comme (4) Professeur invité, Université de Liège et Professeur honoraire, Université de Franche-Comté, Besançon, les UV suggère que le désir du bronzage est une France. motivation puissante et parfois irrésistible. Rev Med Liège 2013; 68: 5-6 : 321-325 321 C. PIÉRARD-FRANCHIMONT ET COLL. Le bronzage immodéré à haut risque combine (coup de soleil), des effets préventifs contre le des signes de dépendance à la fois physique et photovieillissement, les lésions précancéreuses psychologique (addiction). Lorsque le besoin (kératose actinique) et les cancers cutanés (car- s’en fait sentir, les bancs solaires sont sollicités, cinomes basocellulaire et spinocellulaire, méla- parfois sur un mode impulsif de dépendance. nome) semblent plus aléatoires. L’efficacité des L’espoir est de paraître jeune, en pleine forme, PPP est déterminée de manière objective par jouissant d’une santé resplendissante. Si on n’y des méthodes in vitro et in vivo qui établissent prend garde, l’effet réel à moyen terme est l’in- le Sun Protection Factor (SPF), la protection verse avec un photovieillissement précoce de la UVA, la photostabilité et la rémanence de l’ef- peau et un risque accru de photocancérogenèse fet sur la peau (13-17). si souvent soulignés. Paradoxalement, l’arrivée des vacances d’été Ce problème a été pris à bras le corps en suscite de manière rituelle dans les médias des Australie où la population a pu être adéquate- histoires souvent sans lendemain, qui apeurent ment sensibilisée. La solution fait appel à une un public naïf et crédule craignant divers effets réduction de l’exposition solaire dangereuse, à néfastes suite à l’application de crèmes solaires. une photoprotection vestimentaire adéquate et La communauté scientifique se pose donc des à l’emploi de produits photoprotecteurs (PPP). questions, ce qui alimente des controverses par- Cette stratégie a porté ses fruits à l’antipode de fois vives (18-20). l’Europe. En revanche, ici, la population ne se Divers risques potentiels ont ainsi fait l’objet conforme pas assez aux règles de prudence et d’études fouillées (21). Un risque de toxicité est de prévention vis-à-vis de l’exposition solaire potentiellement lié au passage transcutané des immodérée et aux bancs solaires. En parti- PPP. La pénétration des filtres organiques est culier, les réglementations de prohibition des estimée entre 0,1 et 5% lorsque tout le corps est bancs solaires pour les adolescents sans autori- enduit (22). En revanche, les particules miné- sation parentale sont loin d’être appliquées par rales insolubles ne pénètrent pas la peau intacte. tous (1). Les filtres récents obéissent à des règles strictes de sécurité toxicologique (15) et aucun risque LES PRODUITS PHOTOPROTECTEURS : UNE de type disrupteur hormonal n’a été documenté PANACÉE ? chez l’homme. A en croire certaines publicités, ainsi que des L’incidence des allergies de contact et des articles de grande presse, une solution radicale photoallergies aux PPP est apparemment en existerait sous forme de crèmes solaires. Cepen- croissance depuis l’introduction de filtres UV dant, cette photoprotection par des PPP n’est dans de nombreuses crèmes cosmétiques pour peut-être pas aussi attrayante qu’il y paraît. En le visage (23). réalité, au sein de l’Union Européenne, les PPP Il fut un temps où un rôle paradoxal des PPP sont classés parmi les cosmétiques (11). Dès a été évoqué pour expliquer l’accroissement lors, pour répondre aux exigences légales (12), mondial de l’incidence du mélanome. Il est ces produits ne peuvent pas être positionnés pour maintenant démontré qu’il n’en était rien (24). la prévention, l’éradication ou le traitement de Une étude australienne récente indique même maladies, car il s’agirait alors de médicaments. un effet protecteur des PPP contre la survenue Par voie de conséquence, une firme cosmétique de mélanomes (25). Le même constat a été éta- européenne n’investira vraisemblablement pas bli pour la prévention des kératoses actiniques dans une étude clinique risquant de démontrer et des carcinomes basocellulaires et spinocel- l’efficacité d’un PPP dans la prévention des lulaires (26, 27). L’allégation liant l’usage de kératoses actiniques, des carcinomes cutanés PPP avec une diminution de la vitamine D et un et du mélanome. En effet, faire connaître tout accroissement de cancers internes n’a pas reçu résultat positif obérerait la commercialisation de preuves convaincantes (28-30). du produit en tant que cosmétique et le ferait passer sous les règles et contraintes des médi- INDICE DE PROTECTION SOLAIRE OU caments ou des dispositifs médicaux. Nous CONTRE LES COUPS DE SOLEIL ? sommes ainsi placés dans la situation où les PPP européens les plus actifs, et appartenant Les effets photoprotecteurs des PPP sont à la classe des cosmétiques, ne peuvent prou- apportés par des filtres organiques et/ou des ver, de manière directe, leur efficacité clinique. écrans minéraux. Chaque PPP est identifié Même si on peut espérer une protection rela- par son indice de protection contre le coup de tive ou maximale contre un érythème actinique soleil. Celui-ci est reconnu par son sigle SPF 322 Rev Med Liège 2013; 68 : 5-6 : 321-325 ADDICTION AU SOLEIL qui correspond à «Sun Protection Factor» ou, TABLEAU I. CATÉGORISATION DES INDICES DE PROTECTION CONTRE de manière plus précise à «Sunburn Protec- LES COUPS DE SOLEIL (SPF) tion Factor». La codification est réglementée et standardisée internationalement afin d’évi- Niveau de protection SPF «Sun(burn) Protection Factor » ter des dérives commerciales et le «n’importe quoi» (tableau I).
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