The Sun and Your Skin

What ultraviolet rays are we worried about?

UVA and UVB

What are the risks of excessive sun exposure?

suntan, sunburn, premature aging, actinic keratosis, skin cancers, eye damage, immune system suppresion

What is actinic keratosis?

rough, scaly skin from years of sun exposure, small % develop skin cancer

What are the effects of UVA on the skin?

photoaging, pigment darkening, and skin carcinogenesis

What are the effects of UVB on the skin?

sunburn, inflammation, hyperpigmentation, skin carcinogenesis

True or False: tan is an indication that your skin has been damaged

true

What is the UV index?

measures the amount of skin damaging rays reach the Earth’s Surface during the day; scale 1-11

What is photokeratitis?

snowblidness

How long is the latent period of photokeratitis?

6-12 hours

What are the symptoms of photokeratitis?

intensely painful, self limiting

photophobia

inability to open eyes

facial erythema/edema

When does resolution of signs/symptoms of photokeratitis occur?

within 24-72 hours

What are some treatment options for photokeratitis?

• remove contacts

• stay indoors and wear sunglasses

• moisten eyes with artificial tears

• OTC pain relievers such as ibuprofen

• do not rub eyes

• cool, dampened washcloth over closed eyes may help

• if symptoms remain > 24 hours without improvement

What are examples of temporary bronzers?

caramel, walnut extract, fig extract, riboflavin

How do temporary bronzers work?

tint or stain skin temporarily; only lasts one day (wash off before bed)

What is the active ingredient in sunless tanning?

dihydroxyacetone

How does sunless tanning work?

does not need UV light to work; does not protect against UV light; fades within 2-3 days

What are examples of tan accelerators?

tyrosine based products, methyl or benzyl nicotinate

How do tan accelerators work?

require UV radiation

True or False: we should recommend tan accelerators

false

What are the signs/symptoms of sunburn?

• causes direct DNA damage

• erythema clinically apparent 3-6 hours after exposure

• peaks at 12-24 hours

• begins to subside at 72 hours

• blistering indicated more severe burn

• scaling, desquamation and tanning noted 4-7 days later

• increased skin sensitivity to heat and touch

• pruritis

What are the symptoms of sun posioning?

normal signs and symptoms + headache, fever, nausea, vomiting, dehydration

What are exclusions to self-treatment of sunburn?

• extreme pain

• large areas of blistering

• fever

• headache or confusion

• light headedness/vision changes

• swelling

• signs of infection

What are the treatment options for sunburn?

• get our of the sun

• cool compresses or soaks

• gently cleanse ruptured blisters with mild soap and water

• apply moisturizers

What are examples of sunburn moisturizers?

allantoin, cocoa butter, shea butter, mongo butter, coconut oil, petrolatum

What can be used for sunburn pain treatment?

NSAIDs (ibuprofen, naproxen) as soon as symtpoms are apparent

What is the role of aloe in sunburn treatment?

• not approved by FDA

• gel’s effects may be related to inhibition of pain- producing bradykinin

• may inhibit thromboxane and prostaglandins

• may have antibacterial and antifungal properties

Who is aloe not recommended for?

if allergic to garlic, onions, tulips

What topical anesthetics have questionable use in sunburn?

lidocaine, benzocaine, dibucaine, pramoxine

What are the clinical pearls of topical anesthetics?

• lessen pain by inhibiting transmission of pain signals

• relief for 15-45 mins

• small areas only to avoid systemic toxicity

• no more than 3-4 times daily

What is photosensitivity?

chemicals or drugs that are ingested or applied to skin to promote photosensitivity when individual is exposed to UV light

What is photoallergic?

cell mediated immune response, typically occur within 24 hours of re-exposure; takes 7-10 days for skin reaction which may spread to parts of body NOT exposed to sun

What is phototoxic?

direct tissue or cellular damage following UV radiation of a phototoxic medication; occurs within minutes to hours

Which type of photosensitivity is more likely to feel itching?

photoallergic

How do you treat photosensitivity?

• avoid or discontinue offending agents if possible

• avoid/minimize sun exposure and use sunscreen

• photoallergic: topical corticosteroids, antihistamines

• phototoxic: cool compress, TCS, NSAID, if severe prednisone 2-3 days

What medications can cause photosensitivity reactions?

• Voriconazole

• Estrogen

• Tetracycline

• Doxycycline

• Sulfonamides

• Diuretics (thiazide and loop)

• Citalopram

• Naproxen

• Sunscreens

• Chlorhexidine

• 5-fluorouracil

• Quinolone

True or False: UV light can cause cataracts

true

How do you prevent cataracts from UV light?

sunglasses, diets high in fruits and vegetables containing luetin/zeaxanthin

What is actinic keratosis?

most common precancer that forms on skin damaged by chronic UV rays resulting from the proliferation of atypical epidermal keratinocytes

What does actinic keratosis represent?

early lesions on a continuum with squamous cell carcinoma (SCC) and occasionally progress to BCC

What is the major risk factor for actinic keratosis?

chronic sun exposure— immunosuppression, tanning beds, x-rays, light skin

What are the treatment options for actinic keratosis?

surgery, chemical peels, or topical treatments

What are the topical treatment options for actinic keratosis?

• 5-fluorouracil cream

• diclofenac gel (Solarze)

• imiquimod cream (Zyclara)

What is an example of a chemical peel that can be used for actinic keratosis?

trichloroacetic acid

What is melanoma?

most dangerous form of skin cancer; unrepaired damage to DNA in skin cells triggers mutations that lead skin cells to multiply and form malignant tumor; tumors originate in the pigment-producing melanocytes in the basal layer of th epidermis

True or False: if melanoma is recognized and treated early, it is almost always curable

true

What is photoprotection?

reducing exposure to sun

What is the Fitzpatrick skin type scale?

type I: pale white skin → type VI: deeply pigmented dark brown to black skin

True or False: less pigment, has less protection and a higher risk of skin cancer

true

What are risk factors for UV radiation induced problems?

• Fair skin that always burns and never tans
• A history of one or more serious or blistering
sunburns
• Blonde or red hair
• Blue, green, or gray eyes
• A history of freckling
• A previous growth on the skin or lips caused
by UV exposure
• The existence of a UV-induced disorder
• A family history of melanoma
• Current use of an immunosuppressive drug
• Current use of a photosensitizing drug
• Excessive lifetime exposure to UVR,
including tanning beds and booths
• History of an autoimmune disease

What is inorganic (physical) sunscreen?

titanium dioxide/ zinc oxide

reflect and scatter ultraviolet and visible radiation

What is organic (chemical) sunscreen?

absorbs ultraviolet radiation, rarely causes allergic contact dermatitis, broad spectrum requires chemicals that absorb both UVA and UVB

True or False: you should mix organic and inorganic sunscreens together to increase the efficacy

false

What is considered GRASE for use in sunscreens?

zinc oxide and titanium dioxide

What is considered not GRASE for use in sunscreen?

aminobenzoic acid (PABA) and trolamine salicylate

What is SPF?

energy to produce 1 MED on protected skin / energy to produce 1 MED on unprotected skin

What is minimal erythema dose (MED)?

lowest dose of UVR delivered to the skin that produces a clearly marginated erythema in the irradiated site 24 hours after a single exposure

What is the FDA cap for SPF?

60

What is the recommended SPF that decreases risk of skin cancer?

15

What does water resistant or very water resistant mean?

if they maintain SPF after 40 or 80 minutes of swimming or sweating, respectively

How should infants and children be protected from the sun?

avoid sunscreen in < 6 months old

What type of sunscreen is preferred in young children?

inorganic

How much sunscreen is needed per adult?

30 mL

When should sunscreen be applied?

15-30 mins

How often should you reapply sunscreen

every 2 hours as needed