Camouflage in xeroderma pigmentosum.

Sir,

Xeroderma pigmentosum (XP) is an autosomal recessive disorder resulting from abnormal DNA repair causing photosensitivity, oculocutaneous pigmentation, and early neoplasia.[1] Patients usually present with diffuse freckling of the skin in the photoexposed areas, which later develop numerous hypopigmented atrophic macules giving rise to a mottled appearance. The most important treatment in these patients is photoprotection.

Camouflage is a term derived from the French word “camoufler” meaning “to blind.” It is defined as concealment by some means that alters or obscures the appearance. Camouflage is well known to be used by army soldiers to hide from their enemies by wearing greens and browns to match their environment.

Camouflage creams are used to mask discoloration of the skin. The British Association of Skin Camouflage (BASC), founded in 1985, defined remedial cosmetic skin camouflage as “the art of concealing discoloration, blemish, or scar with the application of specialist camouflage creams that are matched to the surrounding skin tone.” In Dermatology, camouflage is commonly used in patients with vitiligo.[2]

A 27-year-old male patient, clinically diagnosed as a case of XP, presented with photosensitivity and mottled pigmentation of the face, arms, trunk, and back. A few erythematous macules were present over the nose and left cheek. Camouflage cream was applied over the face using the technique described in [Figure 1].

Figure 1

Camouflage set. Green camouflage cream was applied over the erythematous areas as a base

The patient was instructed to apply the camouflage on a daily basis using the above mentioned technique [Figures 2–4]. The patient was highly satisfied with the final outcome of the camouflage [Figure 5].

Figure 2

Camouflage set. Green camouflage cream was applied over the erythematous areas as a base

Figure 4

Selected camouflage cream was applied in multiple thin layers to achieve color matching

Figure 5

Before and after camouflage application

Camouflage color was selected according to the patient's skin color

Using camouflage creams is a simple method of concealing pigmentary changes in cases of XP. The procedure of application can be easily taught to the patients. The added advantage of the camouflage cream is that it gives some amount of photoprotection, which is beneficial to patients with XP. Camouflage can be applied over sunscreens in that multiple layers of camouflage cream are needed to achieve color matching. Sunscreens require repeated application. Moreover, an adequate amount of sunscreen to obtain the desired protection may not be applied.[3]

To assess the sun protection factor (SPF) of the camouflage cream, the Minimal Erythema Dose (MED) was determined in a volunteer before and after applying camouflage cream using a targeted phototherapy device Levia, a nonexcimer source of light which delivers in the wavelength range of 300 to 320 nm. Narrow band UV B was used instead of broadband UV B simulator, as it was not available [Figure 6]. The MED developed at a dose of 287 mJ [1.25 MED] over the normal skin, and it did not develop on camouflage-colored skin even at a dose of 3000 mJ [11.5 MED].

Figure 6

Determination of MED on normal skin and camouflage-covered skin using targeted phototherapy unit

The SPF was determined using the following formula:

SPF = MED of the sunscreen protected skin/MED of the unprotected skin

This yielded a SPF of at least 10.4.

Camouflage cream has shown to have sun protective properties, however, it may be advised to be used along with sunscreen for added sun protection.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.