fava sunburns

which skin type has the highest skin cancer risk? highest propensity to burn? highest ability to tan?

cancer: type 1

burn: type 1

tan: type 6

compre UVA, UVB, UVC

UVA= premature aging

UVB= redness, cancer, vitamin D

UVC= screened out by ozone

how does altitude affect UVR exposure

UVB increases as altitude increases

how does water affect UVR exposure

MOST (95%) of UVR penetrates water (water is not protective)

describe how clothes can affect UVR exposure

- dry clothes reflect almost all UVR

- wet clothes give about 50% of protection

how does window glass affect UVR exposure

- UVA penetrates, UVB does not

- side windows do not filter UVR

how does cloud cover affect UVR exposure

- clouds filter very little (70-90% still penetrates) but it filters radiation which is why we feel less hot

what is the mechanism behind burning vs tanning

burn: UVB damages cell DNA

tan: UVR stimulates melanocytes to generate melanin

what is the clinical presentation of burns?

onset? peak?

onset: within a few hours

peak: 12-24hrs after exposure

t/f: a tan has protective effects against sun-induced skin disorders and future sunburns

false

t/f: darker skin tones produce more melanin

true

t/f: darker skin tones block more UVR

true

t/f: darker skin tones are at a lower risk for sunburn

true

t/f: darker skin tones do not have to wear sunscreen

false

t/f: darker skin tones are at a lower risk of skin cancer caused by UVR exposure

true

t/f: darker skin tones are at a higher risk for low VitD levels

true (more melanin= less cholecalciferol production)

which of the following is not a sunburn risk factor

a. lighter skin tone

b. certain drug therapy

c. history of auto-immune disease

d. dark hair

d. dark hair

photosensitizing drugs that increase risk of sunburns

VID BRANDS

1. Verapamil

2. Immunosuppressants

3. Diltiazem

4. Benzoyl peroxide

5. Retinoids

6. Antibiotics= quinolones (-floxacin), bactrim, tetracyclines

7. NSAIDs

8. Diuretics (HCTZ, furosemide)

9. Sulfonylureas (glipizide, glyburide, glimepiride)

which pt has the lowest risk of developing a sunburn

a. pt on glipizide

b. pt on hydrochlorothiazide

c. pt on levofloxacin

d. pt on metronidazole

e. pt on naproxen

d

others photosensitizing: sulfonylurea, diuretic, quinolone, NSAID

exclusion for sun protection product

less than 6 months old (avoid sun)

non-pharm sunburn prevention:

pharm sunburn prevention:

learning objective!!

non-pharm:

minimize exposure during 10-4, protective clothing

pharm: proper selection and application of sunscreen

what are the 2 things you will look for when recommending sunscreen

1. broad spectrum (both UVA and UVB)

2. spf>30

peak sun exposure time

10-4

what does broad spectrum mean

Protects against UVA and UVB

what does the SPF measure

how much UVR is needed to burn protected skin compared to how much UVR is needed to burn unprotected skin

(spf30= 96.7%)

t/f: SPF measure UVA and UVB blockage

false. does not measure UVA blockage

which ingredients are physical sunscreens

1. titanium dioxide

2. zinc oxide

chemical vs physical sunscreens

physical - reflect and scatter UV

- titanium dioxide, zinc

chemical - absorb and block UVR to epidermis

- benzophenones, cinnamates, etc

which of the following is a physical sunscreen protectant

a. cinnamate

b. ecamsule

c. salicylate

d. titanium dioxide

d

which vehicle is the most used for sunscreens

a. oil

b. cream

c. spray

d. lotion

e. ointment

d. lotion

decent adherence and barrier, absorbs easily

what kind of sunscreen would you recommend for the following pts:

1. very physically active

2. acne

3. young children

4. pregnant

1. active= water-resistant

2. acne= noncomedogenic, oil-free

3. young= physical sunscreen, clothing

4. pregnant= physical sunscreen

what kind of sunscreen would you recommend for a history of sensitivity to topicals

1. noncomedogenic (fragrance free and hypoallergenic)

2. avoid exacerbating agent

3. avoid PABA, avobenzone, oxybenzone

what would you recommend for dry skin

1. avoid tanning

2. avoid ethyl- and isopropyl (alcohol) products

sunscreen application instructions/ counseling

1. apply to DRY skin 15-30mins before exposure

2. apply and ensure full coverage

3. reapply every 2 hrs or after swim/sweat

4. apply to lips as well

jimmy goes to the beach and applies a broad spectrum spf15 chemical sunscreen spray. he goes for a swim and reapplies every 2 hours. he comes home with burns. what went wrong

- spf30+ recommended

- lotion is preferred

- reapply after swim, not just every 2hrs

which ages have a higher risk of complications from burns

less than 4yrs old or more than 60yrs old (thin skin)

which burn stages are ok to self treat? wound stages?

burns= stage 1 and maybe 2

wound= stage 1 and 2

which local factors can impact wound healing? systemic?

local: tissue blood perforation, infection, oxygenation, location

systemic: diseases, infection, malnutrition, drugs (steroid, chemo, blood thinner)

sunburn exclusions for self care

1. deeper than superficial + BSA >10% *adults) >5% kids

2. large blistering

3. extreme pain

4. headache, confusion, lightheaded

5. vision changes

6. severe swelling

7. infection (fever, redness, pus)

which pt would could you self treat, rather than refer

1. pt comes in with red aching back

2. pt comes in with large blistering and pain

3. pt comes in with severe swelling and fever

4, pt comes in with headache and light-headedness

1

minor burns and wounds exclusions for self care

cuts> ___ inches

burns>___ inches

cuts> .5 inches

burns> 3 inches in diameter

which is not an exclusion for self care of wounds

a. continues to bleed after applying pressure for 10mins

b. chemical, electrical, or inhalation burn

c. wound bc of animal bite

d. burn that is 2 inches in diameter

e. circumferential burn

f. pt with diabetes

d

referral if >3 inches in diamater

all burns/ wounds exclusions for self care

learning objective!!

1. cuts more than 1/2 inch

2. continues to bleed after pressure applied for 10mins

3. chemical, electrical, or inhalation burn

4. wound secondary to animal/human bite

5. deep partial thickness, full thickness, subdermal injury

6. suspected self harm

7. sign of infection

8. circumferential burn

9. medical conditions that delay healing (diabetes, immunocompromised)

10. has foreign matter after irrigation

11. chronic wound

12. involves hands, feet, joint, genitals

13. burns more than 3 inches in diameter

14. worsens in 7 days

if a burn/wound does not improve after ____ days, it is a referral rather than self-treat

7

primary treatment for burn that has occured in past 3 hours

irrigate affected area with cool tap water for 20mins

a pt has irrigated their wound and applied protectant. next steps?

1. NSAID or acetaminophen may be used for pain

2. if does not improve in 7 days= referral

dont pull at loose skin!

leave blisters intact!

all pts with burns and wounds should be assessed for which vaccine

Tdap = tetanus, diphtheria, pertussis

which vehicle is preferred for intact skin? open wound?

intact= ointment

open= cream

*fragrance-free

which pharm treatment is recommended for pain? secondary? mechs?

primary= NSAID; block COX1/COX2 prostaglandin production

secondary= acetaminophen

examples of topical NSAIDs

examples of topical anesthetics

topical NSAID= diclofenac 1%

topical anesthetics= benzocaine (.5-20%), lidocaine, others

MOA of topical anesthetics such as benzocaine and lidocaine

produce local loss of sensation (apply to intact skin)

- short lived relief

when are first aid antiseptics used

to disinfect INTACT skin SURROUNDING a wound. cleaning with tap water has been shown to be just as safe and effective

examples of OTC first aid antibiotics. when and why is it used?

bacitracin, neomycin, polymyxin B

-infection PREVENTION (not treatment)

- apply after cleaning and before dressing 1-3x/day for 7 days

bacitracin MOA

inhibits cell wall synthesis in gram positive microbes

neomycin MOA

inhibits protein synthesis in gram negative

Polymyxin B sulfate MOA

alters cell wall permeability against gram neg

t/f: neomycin can be used to treat an infection resulting from a wound

false. it is used as preventative tx not for infections

therapy to minimize scarring

1. avoid UVR

2. silicone therapy: AFTER injury is healed, apply silicone gel/sheets

Complementary and alternative medicine (CAM) for inflammation and infection

honey

- promotes moist wound healing, antimicrobial,. adsorbs exudates

proper way to dress a wound?

which wounds?

old way= let it scab (dont recommend this!!)

now=

1. add moisture-retentive dressing (gauze)= barrier to infection, absorb excess fluid

2. keep clean and change as needed-> dirty/ smell/ non-adherent

- for superficial to partial thickness wounds

(NOT mild superficial)