Sun-Induced Skin Disorders & Sunburn Self Care

Prevention of Sun-induced Skin Disorders

1. Sun exposure: Ultraviolet radiation (UVR)

a. Small portion of the sun’s rays, but a main cause of skin damage from the sun

b. Complications:

i. Sunburn

ii. Premature aging

iii. skin cancers

iv. Cataracts

v. Photodermatoses

vi. Exacerbation of other conditions (i.e. herpes simplex labialis, systemic

lupus erythematosus)

UVB

“Sunburn radiation”

UVA

Premature photoaging and

photosensitivity reactions

Skin cancer

a. Nonmelanoma skin cancers are the most common cancer type in the US

b. Strong correlation with UVR exposure

c. Public health need for patient education regarding risk and prevention of sun-

induced skin disorders

Photodermatoses

a. Skin disorders precipitated by exposure to sunlight

b. Reaction due to a photosensitivity

c. Photosensitivity

Photoallergy

Not dose-related

Immunologic

Usually occurs with prior exposure

Phototoxicity

Dose-related

Not immunologic

Often with first exposure

Medication-induced photosensitivity

Amiodarone

Antibiotics: Bactrim (sulfamethoxazole/trimethoprim), ciprofloxacin/levofloxacin, doxycycline

Naproxen

Accutane (isotretinoin)

Diuretics: HCTZ, Lasix (furosemide)

Prevention goals

a. Short term: Avoid or minimize sunburn, photosensitivity reactions, and UVR-

induced or –exacerbated photodermatoses

b. Long term: Prevent skin cancer and avoid premature aging of the skin

Self-monitoring

a. Monitoring moles for ABCD (E)

. A = asymmetric shape

ii. B = border irregularity or poorly defined borders

iii. C = color variation within same mole

iv. D = diameter > 6 mm

v. E = evolving: change in size, shape, color, elevation, or another trait

1. Any new symptom such as bleeding or crusting

Risk factors

a. Fair skin that always burns and never tans or history of > 1 serious or blistering

sunburn

b. blonde or red hair

c. Blue, green, or gray eyes

d. History of freckling

e. Previous growth on skin or lips caused by UVR exposure

f. Family history of melanoma

g. Current use of immunosuppressive drug or photosensitizing agent

h. Excessive lifetime exposure to UVR (including tanning beds and booths)

i. History of autoimmune disease

More prevention

a. Avoid sun exposure:

i. Best approach for patients with risk factors for developing UVR-induced

problems

ii. Only option for those with an allergy to all sun protectant ingredients

or infants less than 6 months of age

b. Protective clothing: hat with 4-inch brim, long pants, long-sleeved shirt

c. Sunscreen (see next section)

Counseling (Slip, Slop, Slap and Wrap)

a. Highest intensity from 10am-4pm

b. Greater exposures:

i. At latitudes closer to the equator

ii. In areas of less tree coverage

iii. Spring and summer

c. Cloud coverage

i. 70-90% of UVR penetrate through clouds

ii. Only eliminates infrared radiation (heat)

iii. False sense of security

d. Light colored surfaces (i.e. snow or sand) reflect UVR

e. Water: 95% of UVR penetrates through water

f. Clothes:

i. Dry clothes reflect almost all UVR (if tightly woven)

ii. Wet clothes allow transmission of ~50% UVR

g. Windows:

i. UVB do not penetrate windows but UVA does

ii. Most car windshields filter UVA, side windows typically do not

Sunscreens

1. Sun Protection Factor (SPF)

a. Minimal erythema dose (MED) = “minimum UVR dose that produces clearly

marginated erythema in the irradiated site, given as a single exposure”

b. Used to calculate SPF

MED on protected skin = SPF

MED on unprotected skin

250 J/cm3 on skin with sunscreen = SPF 10

25 J/cm3 on unprotected skin

i. Product specific based on final formulation

ii. Not directly related to the time of UVR exposure as other factors play into

dose of radiation that will cause erythema

Spf 15

93%

spf 30

97%

spf 50

98%

Sunscreen FDA labeling

a. Broad-spectrum = protect against UVA and UVB

b. To reduce the risk of skin cancer and early skin aging = Broad spectrum and SPF

15

c. Water-resistant= effective for either 40-80 minutes while swimming or

sweating

i. Substantivity

ii. Property from the active ingredient, vehicle, or both

d. “Drug Facts” on all labels

e. Combination products

i. Additive protection and contribute desirable traits to final product

1. Avobenzone adds UVA coverage, but is easily degraded, so adding

octocrylene provides photostablization -degrades in sun

f. Federal regulations

i. Sunscreen monograph/rule book for sunscreen development and

marketing finalized in March 2020

1. Proposed changes submitted in 2021, but not yet published or

effective

Sunscreens

a. 16 sunscreen ingredients

Chemical sunscreen

Active ingredient absorbs at least 85% of

UVR at 290-320 nm

Physical sunscreen

Reflect and scatter UVR at 290-777 nm

i. Zinc oxide and titanium dioxide

ii. Broad spectrum protectants

iii. Now more cosmetically appealing

iv. Less dermal irritation

approved dosage forms

adverse effects

a. Oils

b. Lotions

c. Creams

d. Gels

e. Butters

f. Pastes

g. Ointments

h. Sticks

i. Sprays (additional labeling and testing requirements in proposed regulation order)

j. Powders (more data needed for GRASE designation with proposed regulation

order)

5. Adverse effects

a. Photosensitivity or allergic reactions

i. Rash, vesicles, hives, or exaggerated sunburn

b. Should stop use if reaction occurs

Product selection

a. Recommend a broad-spectrum product with SPF 15

b. Patient factors

i. Skin types that burn easily and tan minimally → SPF 30

ii. Water resistant products → swimming or partaking in vigorous activity

iii. Acne → noncomedogenic products, gel formulations

iv. History of sensitivity to a sunscreen product → hypoallergenic, fragrance-

free product

v. Dry skin → avoid ethyl and isopropyl alcohols, use cream formulation

vi. Previous reaction to chemical sunscreen → avoid offending product,

physical sunscreens less likely to cause dermal reactions

Administration

Poor protection usually due to:

i. Inadequate amount

ii. Infrequent reapplication

iii. Neglected areas (i.e. lips, scalp, ears)

b. Application

i. 15-30 minutes prior to exposure

ii. Reapply at least every 2 hours

iii. Reapply after each episode of swimming, towel drying, and excessive

sweating (40 or 80 minutes)

iv. Watch expiration date -if none then 3 yrs

c. Amount

i. FDA recommends 2 mg/cm2 of BSA

ii. Face and neck: ½ tsp

iii. Arms and shoulders: ½ tsp to each side of body

iv. Torso: ½ tsp to front and back

v. Legs and top of feet: 1 tsp to each side

vi. Total = 4.5 tsp or 22.5 mL

vii. At nearly 1 ounce for each application and applied every 80-90 minutes

1. Should use multiple containers a week if outside regularly

Oral “sunscreens”?

can use along with sunscreen

Sunburns

1. Pathophysiology

a. Reaction to exposure to UVA and UVB rays

b. Development of burn or tan depend on:

i. Type and amount of radiation

ii. Skin pigmentation

iii. Skin hydration

iv. Thickness of epidermis

2. Stages of burns

1=red 2=blistering we can treat these not 3 or 4 refer

3. Treatment

a. Goals:

i. Relieve symptoms

ii. Promote healing

iii. Protect burn from further injury

iv. Minimize scarring

b. Contraindications to self-treatment

i. Large areas of blistering

ii. Additional symptoms: fever, extreme pain, headache, confusion, vision

changes, lightheadedness, severe swelling, or signs of infection

i. Stage lll and lV burns

ii. Burns involving eyes, ears, face, hands, feet, or perineum

iii. Persons of advanced age

iv. Patients with DM or multiple medical conditions

v. Immunocompromised patients

avoid further sun exposure

no blistering and blistering

No blistering

Immerse area in cool tap water for 10-30

minutes

Cleanse area with water and mild soap

Apply non-adherent dressing or skin

protectant

Blistering

Follow same immersion and cleansing

instructions

Avoid rupturing blisters if possible

Hydrocolloid dressing

pain relief

Pain relief

NSAIDs

Helpful for inflammation

during first 24 hour after

sunburn

Acetaminophen

When patient cannot tolerate

or use NSAID

Pain relief only

Topical anesthetics (benzocaine 0.5-

20%, lidocaine 2-5%)

Apply maximum of 3-4 times daily

Short duration of action (15-45 minutes)

Use higher concentration products on

intact skin

Aloe vera

a. Natural product

b. Contains vitamins A, B, C, and E, enzymes, amino acid, and sugars

c. Has been shown to reduce the number of days to wound healing

i. May be in part due to moisturizing effect