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Too Hot to Handle

By: Risa Caldoza-De Leon MD, FPAPSHPIToo Hot to Handle

"Some sunshine is good for the soul, but I always make sure I wear a big hat."  – Miranda Kerr, actress

Blazing sun above your head, fine sand on your toes, and cool water lapping at your waist … what heavenly bliss! You break into a wide smile when you see your complexion turning into a gorgeous golden tan. Until the prickle of sunburn pulls you back to reality!  A lousy 15 minutes, that’s all it took to burn.

As citizens of a sun-drenched, beach-loving nation, we are no strangers to the unfortunate consequences of the outdoor life. But so is everyone else it seems. Sunburn is common worldwide, with rates as high as 70 percent reported in cross-sectional studies in Europe and Australia. The US Centers for Disease Control and Prevention (CDC) says that sunburn is more common in kids than in adults and in people with light skin. One blistering sunburn in childhood or teen years doubles the risk of the skin cancer melanoma later in life; five sunburns by any age doubles the risk.

Sunburn is the most immediate example of Ultraviolet Radiation (UVR) damage, usually appearing within a few hours after too much exposure to the sun or artificial sources like sunlamps. Most sunburns are classified as superficial or first-degree burns.

Melanin, the pigment in the outer layer of skin (epidermis), gives your skin its color. When exposed to UV light, melanin production goes into hyperdrive to protect you, resulting in a tan. But remember, a tanned skin is damaged skin. Eventually, too much UVR will result in sunburn.

With sunburn, soldiers of our immune system (called mast cells) race to the injured skin site and try to heal the skin by dilating the blood vessels. The skin’s ability to protect itself from UVR is in the outmost tiny fraction of a millimeter of skin called the epidermis. Your skin turns pink or red and hot to the touch – even your earlobes and lips. It’s painful and itchy and may swell. Pain is usually the worst six to 48 hours after exposure. Small fluid-filled blisters may form and break. Your eyes feel gritty and tender. Your head aches, you become feverish, dizzy, fatigued and nauseous.

Sunburn is self-limiting, so most simple cases resolve spontaneously in three to seven days. After peeling, your skin may be patchy and irregularly colored. A bad sunburn may take several days or longer to heal. In some cases, sunburn may be so severe that it results in second-degree burns, dehydration, or secondary infection. 

You can pop some non-steroidal anti-inflammatory drugs such as ibuprofen for the pain but there is little evidence that numbing creams such as benzocaine or lidocaine are effective. Some experts advise using cool wet cloths on the sunburned areas to help ease the pain. Drinking extra water helps prevent dehydration. If your sunburn worsens over time, head out to your skin care physician immediately.

Burn baby burn!

Sunlight is made up of different types of electromagnetic radiation, mostly infrared, visible, and UV. UVR, a wavelength of sunlight, is of three types: Ultraviolet A (UVA) makes up to 95 percent of UV light reaching the earth and linked to skin aging (called photoaging) and penetrates deepest into the skin up to the dermis. Ultraviolet B (UVB) is the culprit in sunburn and implicated in cataract formation. UVC is totally absorbed by the ozone layer and doesn’t reach the earth … yet! It is estimated that 60 to 80 percent of total lifetime sun exposure occurs in the first 18 years of life.

Factors like altitude, latitude, and the reflective nature of sand and water affect how you burn. Even the stratospheric ozone — the earth’s sunscreen — has a role to play. However, the total ozone layer has decreased over the last 20 years, meaning more skin damage for us mere mortals. For every 1,000 feet above sea level, UV exposure rises up to 10 percent, which means that UVR is 50 percent stronger at an altitude of 9,000 feet or the top of Mt. Apo.

Since the Philippines is near the equator, the sun delivers more UVR per minute of exposure. The all-time summer destination, Boracay is at 11 degrees north of the equator, putting it smack in the middle of the tropical burn zone. Boracay’s pristine white sand also reflects 25 percent of the sun’s rays, making you burn more. And don’t be fooled by that cool water. Its reflectiveness can boost UV intensity by up to 50 percent. In shallow water, the sun’s rays can even reflect off the ocean’s sandy bottom, piling UVR upon UVR in your skin. UVR is strongest between noon and at 4:00 p.m. Yes, even if it’s cloudy! Sure, clouds block UVB rays, but up to 80 percent of UVA still pass through. Clouds even magnify UVR.

Then there are photosensitizing drugs such as ibuprofen, anti-allergies, blood pressure medications, and antimalarial antibiotic doxycycline that can raise the risk of sun damage. You can ask your doctor about these.

Sun smart

Even in ancient times, Greeks relied on olive oil to protect themselves from the sun while Egyptians slathered rice, lupine (a plant of the pea family), and jasmine extracts. Native Americans used a type of pine needle to soothe sunburns. They have been sun smart and we should be, too!

In the 1920s, the first commercial sunscreen was produced, and the rest is history. It was only in 1978 that the US Food and Drug Administration (FDA) stepped in to regulate sunblock and classify it as an over the counter (OTC) drug.

Sun Protection Factor (SPF) is a rating that measures protection against UVB only. It takes 20 minutes without sunscreen to produce redness, so an SPF 15 might prevent reddening 15 times longer or about five hours. SPF 15 sunscreens filter out 93 percent of UVB, while SPF 30 and SPF 50 protects against 97 percent and 98 percent, respectively.

The Skin Cancer Foundation says that SPF 15 or higher is okay for UVB protection for normal everyday activity, and SPF 30 or higher should be used for extended or intense outdoor exposures.  The AAD recommends using sunscreen that is SPF 30 or higher, water resistant, and provides broad-spectrum coverage.

Sunscreens that protect against both UVB and UVA are called “broad-spectrum.” They combine UVB- and UVA-absorbing chemicals and/or physical screens, and give better protection. The CDC does not recommend products that combine an insect repellent with a sunscreen.?You may use sunscreen on babies six months or older. For younger ones, the American Academy of Pediatrics (AAP) recommends using other forms of sun protection, such as shade or clothing.

Sunscreen ingredients may either be physical screens or chemical absorbers of UVR. The former typically use titanium dioxide and zinc oxide, sometimes combined with other additives to protect against both UVB and UVA. Chemical sunscreen uses cinnamates, salicylates, homosalate and benzophenone group of organics. Sunscreens usually last up to three years, as long as you store it in a cool place so heat won’t break it down.

According to the American Academy of Dermatology (AAD), sunscreen should be applied 15 minutes before going outside, giving the skin time to absorb it, and re-applied at least every two hours outdoors, and immediately after swimming or heavy sweating. How much to slather? At least one ounce or two tablespoons for the whole body. Most people only apply 25 to 50 percent of the recommended amount.  In routine daily activity with lesser outdoor exposure, sunscreen can be applied just once at the start of your day.

Sun exposure and repeated sunburns accelerate the skin's aging process. They weaken the connective tissues that make the skin supple and elastic. Your skin becomes dry and rough, and fine red veins crisscross your cheeks, nose, and ears. Freckles appear on your face and shoulders. Dark or discolored spots, called solar lentigines erupt on your face, back of hands, arms, chest, and upper back. And let’s all hope it ends there. Because once rough scaly patches (whitish, pink or brown) appear, we might be talking of pre-cancerous skin lesions. These actinic keratoses may evolve into a dreaded skin cancer or melanoma. If that doesn’t scare the living daylights out of you, I don’t know what does. So wear sunscreen and have fun in the sun!

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