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Latest update 07/09/2010
This chapter is set out as follows:
Introduction
- The latest recommendations are as follows:
- All individuals and in particular children should avoid sunburn
- Sunbed avoidance - a recent meta-analysis has shown that the use of sunbeds, particularly under the age of 35 increases the risk of melanoma
- Patients at risk of developing skin cancer (please refer to chapter on melanoma) should limit their recreational sunlight by taking adequate UV protection measures
- It is inappropriate to greatly reduce sun exposure in those at low-risk of developing skin cancer
- Vitamin D3 is produced by our body during light exposure, and is essential for human health. Patients needing to limit their UV exposure should be advised to supplement their intake of dietary vitamin D, or take supplements. Foods containing vitamin D include cod liver oil, fortified milk, salmon, mackerel, sardines, egg yolk and beef
- This chapter provides an insight into UV protection. For more information please refer to the Sunsmart Organisation
UV risk assessment
- Patients should be aware that because the summer solstice occurs on the 20th June the sun has equal intensity on the 20th April and the 20th August
- An individual's risk of burning depends on the UV index (the UV index for the day can be checked on the Met Office website and on some weather forecasts) and the patients skin type. The following are recommendations:
- Low-risk: no protection is needed
- Medium-risk: take care around midday and do not spend too long in the sun unprotected
- High-risk: cover up and spend time in the shade between 11 and 3. Use sunsceen on exposed skin
- Very high-risk: be sure to cover up and be in the shade between 11 and 3. Use sunscreen on exposed skin
Shade and clothing
- One of the best forms of UV protection is to find shade under trees, umbrellas, canopies or indoors
- The use of shade is most important between the hours of 11am and 3pm
- When there is no good shade around, the best way to protect your skin from the sun is with loose clothing, a wide-brimmed hat and good quality sunglasses. Check that sunglasses have a British, European or US kite mark to prove that they meet the correct standards for UV protection
- Clothing that is too thin or old may not give adequate UV protection – some clothes have built in UV protection
- Extra attention needs to be given to protecting the skin of babies and young children
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Figure 1 - Sunburn while on a UK holiday
Be careful not to use old 'washed' out t-shirts - as I found out on a trip to the beach these give little protection. The use of copious sunscreen protected my arms
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Sunscreen (including the Dundee mix)
- Sunscreens must not be seen as an adequate replacement for shading and clothes
- Use a sunscreen of at least SPF 30 (UVB protection) with a 4 or 5 star rating (UVA protection)
- It is important to apply the cream thickly and evenly to the skin 15 minutes before going outside. Sunscreens applied too thinly or rubbed vigorously into the skin will not provide adequate protection
- Reapply sunscreens every 3-4 hours - even sunscreens that claim to be 'waterproof' should be reapplied after going in the water
- Check that sunscreens have not gone past their expiry date - most sunscreens have a shelf life of 2-3 years. Do not store sunscreens in very hot places as extreme heat can ruin their protective chemicals
- Some sunscreens e.g. P20 claim to provide effective protection after just one application - unfortunately we are not very good at applying sunscreen and so it is recommended to apply all sunscreens regularly to get even coverage and avoid missing bits that may then get burnt
- It is possible for patients to develop an allergic reaction to sunscreen known as a photo-allergic contact dermatitis, which is suggested by an eczematous eruption on sites where the sunscreen has been applied. Patients will normally try alternative sunscreens but if they continue to have difficulties they can be referred for photo-patch testing - for more information please refer to the chapter on photodermatoses
- The Dundee Reflectant Sunscreen beige / coffee / coral pink:
- This is a physical sunscreen containing zinc oxide and titanium dioxide made in Dundee. Beige / coffee / coral pink indicates a difference in colour
- When used correctly they provide improved protection against UVA, UVB and visible light in patients with photosensitive dermatoses
- Two colours may be prescribed at a time – this allows patients to mix small amounts of the two prescribed creams together in a small container and match it to their own skin colour / pigment, before applying as above
- A GP can prescribe the Dundee Reflectant Sunscreen, the prescription needs to be ACBS endorsed. Orders should be sent to Tayside Pharmaceuticals Ltd, Ninewells Hospital & Medical School, Dundee DD1 9SY
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