OTC: Sun-Induced Skin Disorders

Ultraviolet Radiation

UVA: penetrates dermis, longest wavelength

UVB: only reaches epidermis, shorter wavelength

UVA and UVB responsible for photo-damaging effects so skin

• sunburn, skin aging, skin cancer, photodermatoses

“Sunburn”

Acute reaction to excessive UVR exposure:

• inflammation of exposed skin

• superficial burn with erythema

• swelling

severe reactions: produce partial thickness burns

• development of vesicles, bullae, systemic symptoms

Photoallergy Pathophys

Immunologic…

• occurs second time after prior first exposure

• cross-reactivity common

Characterized by: pruritis, eczematous lesions

• affected area confined to sun-exposed areas

Phototoxicity Pathophys

NOT immunologic…causes direct tissue inury

• is dose realated

• seen after first exposure to agent/drug

• no cross-reactivity

Characterized by: sunburn similar (redness, edema, pruritis)

• affected area confined to sun-exposed areas

Basal Cell Carcinoma

starts in basal cells (deepest part of epidermis)

• slow growing (rare metastasis)

• nodular

• translucent

• rolled border

• presents on sun-exposed areas of head or neck

Squamons Cell Carinoma

starts in squamous cells in outer part of epidermis

• slow growing

• skin colored nodule

• occurs on sun-exposed areas (lip)

Melanoma

starts in melanocytes

• arise from normal skin → moles

less common, greater metastatic ability

Self Examination for Melanoma

A - asymmetric shape

B - border irregularity

C - color variation

D - diameter

E - evolving or changing mole

immediate referral to dermatologist

Prevention of UVR-induced skin disorders

1. minimize UVR exposure

2. wear sunscreen

3. wear protective clothing

Types of Sunscreen

1. Chemical (organic): absorb UVR

2. Physical (inorganic): scatter and reflect UVR

   1. “considered broad-spectrum” products due to ability to shield from both UVA and UVB

GRASE INGRENDIENTS: zinc oxide and titanium dioxide (2 physical sunscreens)

Exclusions for Sun Protection Products

< 6 months old

Sunscreen Product Selection Guideliness

• at LEAST 15 SPF (> 30 preferred)

• Broad-spectrum

• Cream-based formulations = more moisturizing

• Spray products (Gel) = need to be rubbed in

Sunscreen Dosage and Admin

• apply 15 minutes BEFORE UV exposure

non-water resistance: at least every 2 hours

water resistance: every 2 hours, 40-80 minutes after swimming or sweating

Burn Exclusions to Self Care

• Electrical burn

• Chemical burn

Factors that impair Wound Healing Process

1. advanced age > 60 years and older

2. stress

3. inadequate nutrition

Classification of Minor Burns, Sunburns, and Wounds

Acute: tends to heal within 30 days

Chronic: no progress towards healing in 30 days

• requires medical referral

Depth Classification of Burns and Wounds

1. Superficial - only epidermis, no loss of any skin layers

   1. minor sunburn": skin not broken

2. Superficial Partial Thickness

   1. all epidermis and superficial dermis

   2. break in skin, blistering

3. Deep Partial Thickness

   1. extends deeper into dermis

   2. do NOT blanch with pressure

4. Full Thickness - most severe

   1. BEYOND subQ layer and may damage muscle or bone

   2. skin is destroyed

Minor Burn Criteria

Adults:

• TBSA < 10%

Children:

• TBSA < 5%

deep partial and full thickness burns are immediate referrals

Wound General Treatment Approach

Superficial and Superficial Partial Thickness Injuries

• apply moist wound care

• irrigate with cool clean tap water

SunBurn Exclusions to Self Care

• large areas of blistering

• fever

• extreme pain

• headache/confusion

• severe swelling

• signs of infection

Minor Burns and Wounds Exclusions to Self Care

• cuts longer than ½ inch

• cut that continues to bleed after 10 minutes of applied pressure

• animal bite

• deep partial thickness, full thickness

• infection

• lasts for 7 days and not healing

Wound Dressing

create moist wound environment that promotes healing

• moisture-retentive dressings

• skin protectant promotes moist environment

• avoid traditional gauze, adhesive bandages (DRYING)

Hydrocolloid Dressings: provide water healing environment

Transparent Adhesive: joints

Skin Protectant Products Commonly Used for Minor Burns, Wounds, and Sunburn

• PET

• Glycerin

• Cocoa butter

• Colloidal oatmeal

First Aid Antibiotics

Bacitracin, neomycin, and polymyxin B sulfate

indicated for PREVENTION OF infection NOT treatment of already infected wounds