Treatment of Sun-Induced Skin Disorders and Sunburn

What are the sun induced skin disorders?

• photodermatoses

• skin cancer

• premature aging of the skin

• sunburn

Which type of UV radiation is most likely to cause sunburn and skin cancer?

• UV B

What are the risks of exposure to UV radiation?

• cloud cover

• white or light-colored surfaces (sand, snow)

• altitude - closer to the equator too

• wet clothing

• water

What are the 3 types of UV Radiation (UVR)?

• UVA

• UVB

• UVC

What are the two photosensitivity reactions?

• phototoxicity

• photoallergy

What are phototoxicity characteristics?

• not immunologic

• occurs after first dose

• dose-related

• no drug cross-sensitivity

• can occur with plants, soaps, and cosmetics

What are photoallergy characteristics?

• immunologic

• occurs after a prior exposure

• not dose-related

• potential for cross-sensitivity

What are the two types of skin cancer?

• Keratinocyte cancer (non-melanoma)

• melanoma

What are the types of non-melanoma?

• basal cell (BCC)

• squamous cell (SCC)

What are the ABCDEs of skin cancer?

• A - asymmetric

• B - border irregularity

• C - changing color

• D - diameter (>6mm)

• E - evolving or changing mole

What are the categories/classes of drugs associated with photosensitivity?

• anticonvulsants

• antidepressants

• antihistamines

• antihypertensives

• anti-infectives

• antipsychotics

• diuretics

• NSAIDs

• antimalarials

• Misc.

What are the Misc. drugs that are associated with photosensitivity?

• amiodarone

• benzoyl peroxide

• isotrentinoin

• quinidine salts

• retinoids

• statins

What is premature aging?

• wrinkling and yellowing of the skin

• cracking

• telangiectasia (spider vessels)

• solar keratoses (growths)

• ecchymoses (subcutaneous hemorrhagic lesions)

What is elastosis?

• degeneration of the skin caused by breakdown of the skin’s elastic fibers

What is the pathophysiology of sunburns?

• UVR → inflammatory mediators → vasodilation → swelling endothelium and leakage of RBC

What are the symptoms of a superficial or first degree burns?

• mild erythema

• tenderness

• pain and swelling

What are the symptoms of second degree burns?

• vesicles

• bullae

• fever

• chills

• shock

What is a characteristic of sunburns/when do they develop?

• the reaction may be delayed

• Max response at 12-24

What is important medical history to obtain for sunburn patient assessment?

• allergies

• skin sensitivity and other disorders

Who is at risk for sunburns?

• fair skin

• history of severe or blistering sunburn

• blonde or red hair

• blue, green, or gray eyes

• history of freckling

• previous growth on lips or skin caused by UV exposure

• existence of a UV induced disorder

• family history of melanoma

• current use of an immunosuppressive drug

• excessive lifetime exposure to UVR, including tanning beds

• history of an autoimmune disease

What are the protective measures for sunburns?

• limit sun time, especially between 10am-4pm

• wear protective clothing

• broad spectrum sunscreen with SPF 15 or higher

• reapply sunscreen at least every 2 hrs

• use water resistant if swimming or sweating

What type of clothing is considered protective?

• hat with 4-inch brim

• long pants, long sleeved shirt

• sunglasses

What is SPF?

• sun protection factor

• measure of how much UV radiation is required to produce sunburn on protected skin relative to the amount of UV radiation required to produce a sunburn on unprotected skin

What is Broad spectrum SPF?

• covers the minimum requirement of both UVB and UVA

• anything less than SPF 15 can’t be classified as broad spectrum

At SPF 15, what percent of UVB is blocked?

• 93%

At SPF 30, what percent of UVB is blocked?

• 96.7%

At SPF 40, what percent of UVB is blocked?

• 97.5%

American Academy of Dermatology (AAD) recommends at least ________ for everyone.

SPF 30

What are the two types of sunscreen?

• chemical

• physical (mineral)

What is the MoA of Chemical sunscreen?

• absorb and thus block the transmission of UVR

What is the MoA of physical (mineral) sunscreen?

• generally opaque; reflect and scatter UVR

What are the two types of Physical (mineral) sunscreen?

• Zinc oxide

• titanium dioxide

When should sunscreen be applied?

• 15-30 mins before exposure to allow binding to the skin

• every 2 hrs after that

If someone is in the water how often should sunscreen be reapplied?

• 40-80mins of swimming

• after towel drying

What is important to remember of spray sunscreens?

• rub it in

• cover all areas

What are the amounts required on each body part for sunscreen?

• 1 tsp on each leg and top of foot

• ½ tsp on everything else

Sunscreen for children must be labeled with:

• “Children under 6 months: ask a doctor”

If a child is under 6 months, recommend _______ in sunscreen use.

avoidance

Regular use of SPF 15+ product from __ months to __ years will dec. lifetime skin cancer risk.

6, 18

What is TTB?

• time to burn calculation

What is the equation for TTB?

• TTB (w/ sunscreen in mins) = SPF X TTB (w/o sunscreen)

If someone burns in 10 mins w/o sunscreen and uses SPF 5, how long will it take to burn with sunscreen use?

• 50 mins to burn

What are the exclusions to self care of sunburns?

• large areas of blistering

• fever

• extreme pain

• headache or confusion

• lightheadedness or confusion

• severe swelling signs of infection

• *areas of redness or red streaks or moving away from open blisters

• *open blisters that are draining pus

What are the goals of treatment and management of sunburns?

• relieve symptoms

• promote healing

• minimize scaring

What are some pain-relieving medicines with anti-inflammatory effects?

• NSAIDs, Tylenol

• Aloe Vera or hydrocortisone 1% if skin is intact

• topical antibiotics

• avoid local anesthetic creams

What are some non-pharm treatments for sunburns?

• avoid sun

• drink plenty of water to avoid dehydration

• apply cool compresses or soaks

What are the characteristics of UVA?

• photoaging

• skin cancer

• NOT blocked by windows

What are the characteristics of UVB?

• photoaging

• skin cancer

• erythema

• highest intensity between 10am and 4pm

• blocked by most sunscreens and glass windows

What are the characteristics of UVC?

• all UVC is removed by the ozone layer

Epidemiology of non-melanoma (keratinocyte cancer):

• 2012 - incidence >5.4 million

• very low risk of death

Epidemiology of melanoma:

• 2.6% (1 in 38) risk of melanoma in whites

• 0.1% in blacks

• 0.6% in Hispanics

• 2021:

  • 106,110 new melanomas estimated to be diagnosed

  • 7,180 people are expected to die of melanoma

What are exclusions for sunscreen use?

• allergy to sunscreen ingredients

• <6 months of age

What are some important patient counseling points when it comes to sunscreen?

• intended use

• previous use

• length of frequency of use

What does the Fitzpatrick Scale measure?

• a person's skin pigmentation and reaction to UV light

• determines how likely a person’s skin is to tan

• Type 1 = pale

• Type 6 = very dark/brown

What SPF is suggested for those who burn easily?

• >/= 30

What SPF is suggested for those who want to tan?

• 15-30

What type of sunscreen is suggested for acne-prone individuals?

• non-comedogenic

What type of sunscreen is suggested for those that are allergy prone or those with sensitive skin?

• fragrance-free

What type of sunscreen is suggested for pregnant women?

• discuss with PCP

• physical sunscreens are safest choice

What are some characteristics of Physical (mineral) sunscreen?

• often used in combination with chemical sunscreens

• classified as safe and effective

What ingredients are in chemical sunscreens?

• aminobenzoic acid

• anthranilates

• benzophenes

• cinnamates

• dibenzoylmethane derivaties

• salicylates

What are the adverse effects for sunscreen?

• rash

• blisters

• hives

• exaggerated sunburn

What can be a cause of the adverse effects of sunscreen?

• photosensitivity or allergic reaction

• more likely with aminobenzoic acid and derivatives

• oxybenzone is most likely to cause skin reactions

• fragrances and preservatives

Oxybenzone and octinoxate have been banned in several states due to the damage they cause to _________.

coral reefs