Facts on Tanning, Sun, Aging and Skin Cancer

Having a blog requires keeping it up to date and therefore most bloggers are continually looking for relevant topics.  I recently read a fantastic journal article in a journal called Dermatologic Surgery.  Tanning and Cutaneous Malignancy by Sheffif F. Ibrahim, M.D. and Mark Brown, M.D. is one of the best written and most comprehensive articles on the subject I have ever read.  I thought it would be interesting to summarize the important points of the article as well as some of my own facts.  I believe each bullett point is self explanatory and they are in no particular order.  After reading these, one should have a good idea that tanning (whether indoors or outdoors) and especially sunburn is dangerous and puts patients at a greater risk of melanoma and nonmelanoma skin cancers.  There is  no safe tan!  Although many doctors recommend no direct sun, ever, I believe that most  patients will not do that, so I am a believer in moderation.  I realize that all sun causes damage, but I also believe that you cannot control behavior.

1. Every civilization has had an unwavering reverence for the sun

2. Before the industrial revolution a tan was a sign of lower class field workers and “porcelain paleness was the epitome of high society” and after that workers went into factories and those with leisure became tanned.

3. Fashion Icon Coco Chanel  sparked the tanning craze in the western world  proclaiming “a 1929 girl must be tanned….A golden tan is the index of chic”

4. Bikini’s were introduced in 1946 and the “California Beach Culture” of the 1960’s further exposed the skin and increased sun exposure.

5. A 1907 study in France noted the grape pickers developed increased numbers of cancers on sun exposed areas.

6. Over the past 40 years, the association between sun exposure, prematurely aged skin, and cutaneous malignancy has become indisputable.

7. However the desire to tan is higher than ever before.

8. In a survey of 8,000 Americans 94%  were concerned that exposure to UV light could lead to skin cancer, yet 68% felt they looked better with a tan.

9. The first ad for a sun lamp appeared in Vogue in 1923 and there are up to 50,000 indoor tanning facilities in the USA.

10. There is little sound evidence for any medical benefit from recreational tanning.

11. We are currently experiencing a skin cancer epidemic and exposure to UVR remains the single most modifiable risk factor for the prevention of skin cancers.

12. Sunlight is 95% UVA and 5% UVB.  UVB is a complete carcinogen and are largerly responsible for sunburn, tanning and carcinogenesis.

13. Tanning is a response to DNA damage.

14. Cancer Stats

a. The WHO estimated in the year 2000 up to 70,000 deaths worldwide were attributable to excessive UV exposure.

b. In the USA skin cancer represents for more that 50% of all malignancies

c. Mortality from melanoma in the USA occurs at the rate of approximately one life per hour or more that 8,000 deaths annually.

d. Although melanoma only represents 3% of total skin cancers, they are responsible for over of 80% of skin cancer deaths.

e. Skin cancer incidence is rising faster than any other cancer and the lifetime risk of an American to develop melanoma has increased 2,000% in the last 75 years.

f. Melanoma is currently the second most common cancer (after thyroid) form women in their 20’s.

g. Residents of New Zealand and Australia have the highest melanoma rates in the world due to largely fair skin and live close to the equator.

h. Caucasians have 23 times higher incidence of melanoma than blacks.

15. Red heads, fair skinned people and light eye color are at more risk, as is excessive sun exposure before the age of 18, and sunburn at any age have been repeatedly shown to increase one’s lifetime risk for development of melanoma.

16. “A single severe in childhood may double the risk of melanoma” (ref 77 in article).

17. The tanning industry generates $5 billion annually, up from 1 billion in 1992.  1 million people tan daily and 70% are Caucasian females form 16-49.  30% of teens between 13 and 19 are tanning with girls 2-3X over boys.

18. Indoor Tanners are

a. More likely to tan outdoors

b. Less likely to use sun protection

c. Less knowledgeable about skin cancer risks

d. More influenced by social factors

e. More concerned about weight

f. More likely to smoke

g. More likely to binge drink

h. More likely to use recreational drugs

i. More likely to have parents who tan

19. 20 minutes in a tanning bed is equal to 2-3 hours in the noon day sun.

20. Evidence shows several positive associations between indoor tanning and melanoma, particular with exposure before age 35.

21. Patients that use indoor tanning think they are protected and hence spend more time in outdoor sun, which is bad.

22. Studies show that up to 88% of tanning salons allowed minors to tan without parental permission and 75% provided reassurance of the safety of tanning.

23. Sun is not necessary for Vit. D which is in many foods, 5 minutes at noon in the June Boston sun is adequate for maximal cutaneous production.  2 glasses of milk or orange juice cover it, as does incidental exposure of face and back of hands.

24. Tanning can produce endorphins and contribute to “tanner’s high”

25. The link between natural and artificial sun and skin cancer is becoming much like cigarettes and lung disease or alcohol abuse and liver damage.

 

 

Sunscreens: don’t get burnt!

Although sunscreens are important all year round, they are especially important in the summer months to protect your skin from aging and cancers.

Consumer Reports reviewed 10 well known sunscreens in July 2009 and assessed UVA and UVB protection and their waterproof effectivness and had some interesting findings.  To clear up some definitions:

• UVA rays are penetrating rays that can cause sunburn, wrinkles, pigmentation disorders and skin cancers.
• UVB rays cause sunburn and other sink damage and also contribute to skin cancer.  The UVB rays are most responsible for sunburn. 
• SPF is sun protection factor and measures the UVB sunburn protection on treated skin as compared to skin with no sunscreen.  The way this is calculates is as follows.  Untreated skin normally takes 10 minutes to turn red.  An SPF of 30 lengthens that time to about 300 minutes. 
• Broad Spectrum implies that the product blocks both UVA and UVB rays (but does not indicate how effective the product is at each).
• PABA-Free means that the product contains no esters of para-aminobenzoic acid.  Older products with PABA can cause skin reactions, but are rare in products made in the USA.
• Water Resistant means that the product maintains the stated SPF for 40 minutes in the water.
• Vary Water Resistant means that the product maintains the stated SPF for 80 minutes in the water.
• Total Sun block are those with pigments such as zinc oxide that do not allow any sun rays to penetrate.  These are often worn on the nose or lips of sun sensitive individuals.
• Nanoparticles are particles different chemical or physical characteristics from normal sized particles.  These are often used with zinc oxide or other pigments that totally block the sun rays.  My using nanoparticles, the material looks clearer on the skin. There is some concern about the safety of nanoparticles on human health.  For more info go to www.consumerreportshealth.org and search for nanotechnology.

When shopping for sunscreens, purchase a product labeled “very water resistant” or “waterproof” with an SPF of at least 30 which is plenty for most people.  An SPF of 30 is an easy number to remember and in fact, the FDA is has announced plans to limit SPF numbers at 50.  With this change, sunscreens that provide more than protection than 50 will be labeled 50+.

The highest rated sunscreens by Consumer Reports were:

1. Aveeno Continuous Protection Spray SPF 45. Cost $2.43

2.  Target Sport Continuous Spray SPF 30. Cost $.87

3.  CVS Sunblock with Zinc Oxide for Face, Nose & Ears lotion. SPF 45. Cost $2.33

The Consumer Reports Best Buy were:

1. Walgreen’s Continuous Spray Sport SPF 50. Cost $1.33

2.  Coppertone Water Babies SPF 50 Lotion. Cost $1.14

3.  Target Sport Continuous Spray SPF 30. Cost $.87

You can see that you don’t have to spend a lot to get good sun protection and in fact many people waste money on exotic sounding labels that may provide less protection.  There are some important facts to remember before going into the sun.

• Apply sunscreen 15-30 minutes before going out in the sun to allow for the absorption and coverage.
• Apply at least 2-3 table spoons of sunscreen for the average adult.  This is a lot of sunscreen!  Most people apply way too little product.
• Reapply every 2 hours or after swimming or heavy sweating.  This is very important
• Wash your clothes after a day at the beach as all of the products can cause stains when left on clothes.
• Discard sunscreens that are more than 2 years old as they lose potency.  Since there is no expiration date on the bottle, mark the purchase date with a magic marker!
• Don’t rely solely on sunscreen to prevent aging and cancer.  Protect you skin with clothing, hats and sunglasses.  This is especially important for people with light skin, hair and eye color.
• Avoid direct sunlight during the hottest times from 10AM-2PM.

There is no doubt that sun exposure accelerates skin aging and the incidence of skin cancer.  Every patient should have a full body mole exam on a yearly basis.  The excessively tanned look is a thing of the past and very few patients are going to avoid the sun completely, so use your head, use moderation and use sunscreen to stay younger longer.

Much sun damage is invisible to the naked eye and Dr. Niamtu offers complimentary skin scanning with the Canfield Reveal Skin Scanner.  You can see in the picture below that in normal light a patient shows little skin damage but with the scanner, there is no doubt about the extent of the damage.  Most patients are shocked to see the degree of sun damage they have.

 This image shows a patient in normal light and in the Reveal Skin Scanner.

To keep your skin younger it is important to use Retin-A and some form of bleaching cream.  The Obagi Nu Derm systemis an excellent means of maintaining young and healthy skin.  For patients that desire to reverse sun damage and improve wrinkles and sunspots as well as tighten the skin, Dr. Niamtu offers many treatments including CO2 laser resurfacing, Fraxel Laser, Active FX laser and Deep FX laser as well as Vascular Lasers for spider vein treatment.  Chemical peels are also effective for reversing sun damage and Dr. Niamtu provides numerous types of chemical face peels.

 

The above image shows a patient before and after CO2 laser skin resurfacing to improve wrinkles,sun damage and sun spots.

Visit http://www.lovethatface.com to find out more about reversing sun damage and keeping healthy skin as well as other cosmetic facial surgery topics.

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

Tanning, Sun, Premature Facial Aging and Skin Cancer

 

 

Having a blog requires keeping it up to date and therefore bloggers are continually looking for new, interesting and relevant content.  I have recently read a fantastic journal article in Dermatologic Surgery about Tanning and the associated dangers. 

Ibrahim SF, Brown MD.

Tanning and cutaneous malignancy.

Dermatol Surg. 2008 Apr;34(4):460-74.

This article by Drs. Ibrahim and Brown is entitled “Tanning and Cutaneous Malignancy” is one of the best and most authoritative articles I have ever seen on the subject.  I have summarized the article by a series of self explanatory and sometimes startling facts and also added a few of my own.  After reading these bullet points, one should have a good understanding of the dangers of outdoor and indoor tanning.  All tanning is dangerous.  A tan (and worse, a  burn) represents DNA damage to the skin cells and increased the chances of melanoma and nonmelanoma skin cancers.  There is no such thing as a safe tan.  Although it would be ideal to never get any sun exposure, it is ludicrous to think that younger people will refrain, so I recommend moderation and common sense.  The basis of these facts will be self evident and gives us all something to think about.  Tan now, pay later!

 

Facts about Sun Exposure and the Associated Dangers

1.       Every civilization has had an unwavering reverence for the sun

2.       Before the industrial revolution a tan was a sign of lower class field workers and “porcelain paleness was the epitome of high society” and after that workers went into factories and those with leisure became tanned.

3.       Fashion icon Coco Chanel  sparked the tanning craze in the western world  proclaiming “a 1929 girl must be tanned….A golden tan is the index of chic”

4.       Bikini’s were introduced in 1946 and the “California Beach Culture” of the 1960’s further exposed the skin and increased sun exposure.

5.       A 1907 study in France noted the grape pickers developed increased numbers of cancers on sun exposed areas.

6.       Over the past 40 years, the association between sun exposure, prematurely aged skin, and cutaneous malignancy has become indisputable.

7.       However the desire to tan is higher than ever before. 

8.       In a survey of 8,000 Americans 94%  were concerned that exposure to UV light could lead to skin cancer, yet 68% felt they looked better with a tan.

9.       The first ad for a sun lamp appeared in Vogue in 1923 and there are up to 50,000 indoor tanning facilities in the USA.

10.   There is little sound evidence for any medical benefit from recreational tanning.

11.   We are currently experiencing a skin cancer epidemic and exposure to UVR (ultraviolet radiation) remains the single most modifiable risk factor for the prevention of skin cancers.

12.   Sunlight is 95% UVA and 5% UVB.  UVB is a complete carcinogen and are largerly responsible for sunburn, tanning and carcinogenesis.

13.   Tanning is a response to DNA damage.

14.   Cancer Stats

a.       The WHO estimated in the year 2000 up to 70,000 deaths worldwide were attributable to excessive UV (ultraviolet) exposure.

b.      In the USA skin cancer represents for more that 50% of all malignancies

c.       Mortality from melanoma in the USA occurs at the rate of approximately one life per hour or more that 8,000 deaths annually.

d.      Although melanoma only represents 3% of total skin cancers, they are responsible for over of 80% of skin cancer deaths.

e.      Skin cancer incidence is rising faster than any other cancer and the lifetime risk of an American to develop melanoma has increased 2,000% in the last 75 years.

f.        Melanoma is currently the second most common cancer (after thyroid) form women in their 20’s.

g.       Residents of New Zealand and Australia have the highest melanoma rates in the world due to largely fair skin and live close to the equator.

h.      Caucasians have 23 times higher incidence of melanoma than blacks.

15.   Red heads, fair skinned people and light eye color are at more risk, as is excessive sun exposure before the age of 18, and sunburn at any age have been repeatedly shown to increase one’s lifetime risk for development of melanoma.

16.   “A single severe in childhood may double the risk of melanoma” (ref 77 in article).

17.   The tanning industry generates $5 billion annually, up from 1 billion in 1992.  1 million people tan daily and 70% are Caucasian females form 16-49.  30% of teens between 13 and 19 are tanning with girls 2-3X over boys.

18.   Indoor Tanners are

a.       More likely to tan outdoors

b.      Less likely to use sun protection

c.       Less knowledgeable about skin cancer risks

d.      More influenced by social factors

e.      More concerned about weight

f.        More likely to smoke

g.       More likely to binge drink

h.      More likely to use recreational drugs

i.         More likely to have parents who tan

19.   20 minutes in a tanning bed is equal to 2-3 hours in the noon day sun.

20.   Evidence shows several positive associations between indoor tanning and melanoma, particular with exposure before age 35.

21.   Patients that use indoor tanning think they are protected and hence spend more time in outdoor sun, which is bad.

22.   Studies show that up to 88% of tanning salons allowed minors to tan without parental permission and 75% provided reassurance of the safety of tanning.

23.   Sun is not necessary for Vit. D which is in many foods, 5 minutes at noon in the June Boston sun is adequate for maximal cutaneous production.  2 glasses of milk or orange juice cover it, as does incidental exposure of face and back of hands.

24.   Tanning can produce endorphins and contribute to “tanner’s high”

25.   The link between natural and artificial sun and skin cancer is becoming much like cigarettes and lung disease or alcohol abuse and liver damage.

To find out more about skin aging and facial rejuvenation see

www.lovethatface.com

Joe Niamtu, III DMD

Richmond, Virginia