LE Magazine July 1999
It is possible to enjoy the outdoors responsibly. While moderation in sunbathing and adequate garbs will help, topical protection from the sun's rays is an absolute must.
By JoAnn Knorr
Katherine remembers tanning on the roof-top of her house alongside her mother while growing up in California. The dangers of ultraviolet light or benefits of skin protection were not an issue-she knew nothing of them. Nor did Katherine change her sunbathing habits when raising her own children. They used oil without sun protection factors (SPFs), and baked in the sun. Given her early-in-life sunbathing habits, Katherine now recognizes the whys and wherefores of her wrinkled skin.
It is true that ultraviolet light is very important for the synthesis of vitamin D to build strong bones. It is also important in the treatment of neonatal jaundice for a healthy liver. An inactive form of vitamin D lies within the skin's surface. When exposed to ultraviolet light, this inactive form is stimulated to allow the liver and the kidneys to produce the active form of vitamin D, helping to build strong bones. The light also aides in the conversion of bilirubin in a newborn to a more soluble form to produce the bile necessary for proper digestion. However, without proper protection, the sun's rays can cause more harm than good.
Today, Katherine's children will not let their kids out of the house without a sun screen. These days, everyone seems to be more aware of the damage the sun can cause. Sunscreens are everywhere: cosmetics frequently have built-in sun screen in the foundations; there are area-specific sun screens for the eyes, lips, face, body. Just about everyone uses sun screen protection today. So why the big change? Are we just smarter? In part, yes. We are more aware of the increased number of skin cancer cases that occur annually: typically, around one million new cases of skin cancers are reported each year. Since our society revolves around beauty and youthfulness, we have become more aware of the aging and leathery look the sun produces. Furthermore, we are now also faced with the depletion of the ozone layer that allows the more harmful, unfiltered rays to pierce through to the surface of our atmosphere.
The rays that are emitted by the sun are ultraviolet A, B and C. They are also referred to as UVA, UVB, and UVC. UVC rays are short wavelength; these rays are mostly absorbed before they reach the earth's atmosphere. The most harmful rays are UVA and UVB. The UVB rays are more penetrating than the UVA rays, and overexposure causes burning. UVB rays stimulate the skin's pigment-forming cells, melanocytes, to produce melanin, a protective pigment. UVA rays are absorbed by the melanin; oxidation occurs, forming darkness and oxygen-free radicals. Thus, overexposure produces more melanin, which can lead to what we know as melanoma.
These oxygen-free radicals are common among many types of cancers. The oxygen-free radicals can degrade the cellular structure of the natural collagen and elastin fibers. Sometimes these radicals can genetically alter the original formation of cells, causing abnormal growths. Fortunately, skin damage can be prevented with both topical and oral measures. Antioxidants are the best oxygen-free radical reducing sources available naturally. We can take them, eat them and rub them on. What are they? Vitamins A, C and E. These vitamins-which we get naturally in many foods or via supplements-can prevent the chemical formation of the dangerous oxygen-free radical states. Yet while studies suggest that antioxidants may reduce the risks of many cancers, they alone will not prevent skin cancer. The skin needs physical protection because it is so exposed to the environment. Clothing and sun screens provide the coverage necessary to aide as a protective armor.
The American Academy of Dermatology has recommended that consumers use sun screens with a sun protection factor of at least a 15, and to use it year-round. Lotions with strong sun protection factors for younger developing children have been indicated by pediatricians, since the protective qualities of their melanocytes and immunological cells are still seeking maturity at birth. Thus, maturation time for these protective cells should be allowed to develop.
Taking antioxidants and protecting the skin's physical layer with antioxidant lotions, using SPFs of at least 15, and covering up are all vital for skin health. But the effects of the sun can be far more reaching than skin damage.
The skin is the largest organ of the body. The majority of skin is covered with a substance, called keratin, that is designed to hold in our body fluids so we do not dry out. On an average day, an individual loses 300-400 milliliters of water by diffusion through the skin. In high temperatures, the water loss due to sweating can increase to as much as 2 liters and as much as 5 liters during prolonged, heavy exercise. Since dehydration can occur under these circumstances, it is important to replenish bodily fluids with water and electrolyte-balancing beverages. When the body's critical temperature rises due to fluid loss, heat stroke occurs, which can lead to circulatory shock, kidney failure and, possibly, death.
Those who are under a physician's care for high blood pressure or are taking any type of cardiovascular drug should most certainly be aware of the dangers of sun exposure. Under normal conditions, the sun acts as a vasodilator to the skin. That is, the sun makes the blood vessels expand, slowing down the blood flow. For a person who is on a drug that causes vasodilation, this effect may be magnified to lead to more serious problems, such as heart attack. With vasodilation also comes the release of histamine, one of the chemical substances that is released from allergy-fighting cells. While insignificant to most, there are some individuals who are ultra sensitive to the release of histamine. Genetic propensity plays a key role in how much histamine each person tends to release and their tolerance for this type of reaction. Most people who have this type of hypersensitivity are aware of the dangers; allergy prone individuals may notice slight swelling of the skin and face when exposed to the sun.
It is important to note that some medications have photosensitive reactive qualities. That is, their effects can be magnified or nullified by the sun, or a hypersensitive reaction can be induced by it. Among the drugs to watch out for are certain antibiotics, antidepressants, neuroleptic medication, certain cancer drugs and drugs to aid persons receiving organ transplants. Most pharmacies will carry warning brochures when the prescriptions are filled. If you question the photosensitive nature of the medication you are taking, ask your physician or pharmacist.
People who go to tanning beds are more than aware of the drug lists that salons post, letting patrons know of the contra-indications involved in tanning while taking medication. Much to the patrons surprise is that manufactured tanning rays emit the same rays as the outdoors. That is, ultraviolet A and B are emitted through the bulbs that are positioned much closer to the skin. Thereby, while many wear tanning-enhancing products from the salons, they should also consider a sun screen for their protection, as well as protective eye wear. Not only do glasses or goggles protect the eyes from developing "crows' feet", but they prevent damage from direct rays on the cornea and iris as well. Those who have undergone cataract or other laser surgery have extremely light-sensitive eyes, which is why they often wear the full wrap-around eye wear for maximum protection.
Healthy skin is within reach. But to maintain skin health, the body must be taken care of-both inside and out. The sun's harmful rays that pierce through the deteriorating ozone layer can be filtered out by using sun screens with sun protection factors of greater than 15, wearing protective clothing and staying out of the sun during extreme temperatures. The skin can be nourished with protective antioxidants such as vitamins A, C and E that are found naturally in foods or can be ingested via supplements and lotions.
In these heat-filled days, moderation is key. It is not necessary to shy away from the outdoors. With proper skin protection, it is possible to take a step outside and enjoy all that nature has to offer.
Recognizing Sun Damaged Skin
The skin of a child is soft, smooth, thick, full and moist. When a child's skin is compared with that of an elderly person, it is evident how much moisture and thickness has been lost. The sun's damage is similar to the effect heat and cooking has on meat. In the cooking process, the meat's fat and juices seep out of it until its original size is reduced. When exposed to the sun, the skin's fats and important oils that once maintained its youthful thickness are "cooked out," resulting in a breakdown of the elastic and collagen fibers that causes the skin to wrinkle and lose fullness. A thin, wrinkled, almost leathery look is the result, along with the loss of elasticity that does not enable the skin to bounce back into position after the muscles beneath it are used.
While the sun has an obvious effect on aesthetics, its health-threatening effects must be taken into serious consideration.
Malignant melanoma is a type of cutaneous skin cancer that is less common but more serious than basal cell carcinoma or squamous cell carcinoma. There were more than 41,000 new cases of melanoma reported in 1998, with new cases increasing 4.3 percent each year. By the year 2000, a person's lifetime risk of developing melanoma will increase to one in 75. However, if diagnosed early, most melanomas can be cured via surgery and further prevented with adequate sun protection. If left undetected, melanomas can metastasize to other parts of the body.
About five percent of all melanomas arise from the iris, ciliary body and choroid areas of the eyes. There are two types of cells involved that correspond to two different prognosis. First, the cohesive type spindle cells that have a fairly good prognosis of a 15-year survival rate of 75 percent. Then, the poorly cohesive epithelioid cells that frequently metastasize, with a 15-year survival rate in 35 percent of those who have developed melanoma from these cells.
The most common malignant melanomas develop on areas most exposed to the sun: the backs of the hands, the face, ears, the back, lower legs and feet. When malignant melanoma spreads and secondary tumors have formed, it is then called metastatic melanoma. The spread can occur by traveling through the blood to nearby lymph nodes or even distant organs, such as the lungs, liver, brain and the bones. The spreading of the disease corresponds to various clinical stages. Stage I, in which the melanoma is localized in one area without metastasising, has a 95 percent survival rate when treated with surgery. Stage II occurs when the cancer has spread to another area within the same region. In Stage III, metastasis has occurred at a site more distant to the original melanoma, such as the organs. Survival is greatest in stage I and diminishes with the progression to the other stages, necessitating early detection.
Once a skin cancer has developed, a visit to the doctor is required for proper treatment. However, early detection begins with self examination. There are two main types of skin changes that should be pointed out to your physician. That is, vertical and horizontal changes in moles should be recognized. In a melanoma a flat moles' borders may change in size, appearing larger and wider, and may begin to develop color variations. Any changes of this sort need to be pointed out to a physician. A mole that keeps its horizontal size but grows vertically, i.e. a mole that is growing outward, should also be noted.
Although moles are one of the risk factors in developing melanoma there are other risk factors. Those who do not tan, typically fair-skinned individuals who have red or blond hair, freckles and blue eyes, are at greatest risk. Those with hereditary diseases that interfere with the DNA repair system, such as xeroderma pigmentosum, Bloom's Syndrome, Fanconi's anemia, and Ataxia telangiectasia, are also at risk, as their skin is unable to utilize its natural repairing devices. For this group, sunning is not an option.
Basal and squamous cell carcinoma
A basal cell carcinoma, which grows slowly and rarely metastasizes, is a very common and almost always curable type of skin cancer. Unlike melanoma, these tumors appear as small, shiny, pale, waxy lumps that crust or bleed as flat red spots, and could appear as four-to-six millimeter sores that do not heal. These nodules can penetrate deep in the dermal layer of skin. They have well defined, raised borders that may appear to sink into the middle, and are most common in fair-skinned individuals over the age of 40. They appear mostly on the face and around the eyelids.
The most common skin cancer of sun exposed skin, squamous cell carcinoma usually occurs in adults over the age of 60. It is most typical in fair-skinned adults and appears mostly on the face, legs and on the back of the hands. These tumors are well defined, red nodules or scaling plaques. Typically, they are very localized and hyperkeratotic (thick knots). Less than 5 percent of these tumors ever metastasize. However, this cancer can lead to actinic keratosis.
Actinic keratosis and keratoacanthoma
Actinic keratosis is a very noticeable, premalignant skin condition, and is associated with chronic over exposure to the sun and squamous cell carcinoma. It appears as superficial, flattened papules covered with dry scales and round or irregular borders that range in color from red and tan to grey. This skin condition can undergo malignant transformation and must be removed.
A benign skin condition, keratoacanthoma typically occurs in Caucasians over the age of 50 when areas of the face and hands have been over exposed to the sun. The lesion appears as flesh-colored keratin-filled craters that often disappear on their own.
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