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Skin Types

Definitions

Sunburn

Light Facts

Benefits of Sunlight

Who is Lightsensitive?

Drugs & Lightsensitivity

More than 1 million Americans are diagnosed with skin cancer each year, and many more with pre-cancerous conditions. These numbers continue to increase, not only in the United States, but worldwide. Despite the alarming increase in skin cancers, especially in the teen and young adult population, people continue to think that a tan is healthy, while the notion that sunscreen is an occasional summer-only accessory is still prevalent.

Several factors appear to be responsible for this alarming rise in skin cancer. The continual erosion of the earth's ozone layer due to pollution results in less available ozone protection than was afforded previous generations. Also, unlike previous generations, today there are over 400 medications1 prescribed that leave patients with an increased sensitivity to sun exposure and a heightened susceptibility to sun damage. Longer lifespan is also a contributing factor. Greater awareness, increased patient concern and better diagnosis may help to decrease this alarming rise in the rate of skin cancer.

Perhaps the most important factor in the rise of skin cancer rates is increased exposure to the UVA wavelength. Previously thought of as harmless, this wavelength is now known to contribute significantly to skin damage, skin cancer, DNA damage and immune system suppression. UVA rays penetrate the skin deeper and, unlike UVB rays (which cause initial redness and burning), damage from UVA rays is not immediately detected. Because UVA rays remain constant throughout the year and during the day, we are exposed to them continuously, whether it is midday in July, or 4 p.m. on an overcast winter afternoon.

When it comes to appearance, wrinkling and thinning of the skin are often thought of as a natural aging process. We now know that these effects are primarily the result of long-term exposure to sunlight. Cumulative exposure to the sun imparts damage to the epidermis (the outer layer) and the dermis, (the deeper layer where the skin's framework exists). Damage to the dermal layer changes the structural components, causing Elastin fibers to thicken and become more numerous. Collagen is damaged and degraded and 'reticulin' fibers appear throughout the dermis rather than outlining the specific dermal-epidermal junction.

With some simple and consistent steps, sun damaged skin can be repaired, and other sun related issues can be minimized and possibly even reversed. A crucial step is an awareness that sun protection needs to be a daily, year-round practice. In particular, children need to incorporate the use of sunscreen on a daily basis as frequent sun exposure and sunburn in childhood must be avoided as they appear to set the stage for high rates of melanoma later in life. A comprehensive sun protection program includes sunscreen as well as sun-protective clothing, sunglasses, and sun avoidance between 10 a.m. and 4 p.m.


KNOW YOUR SKINTYPE

Fitzpatrick Classification for Sun-Reactive Skin Types
Skin TypeColorReaction to UVAReaction to Sun
Type ICaucasian;blond or red hair, freckles, fair skin, blue eyesVery SensitiveAlways burns easily, never tans; very fair skin tone
Type IICaucasion; blond or red hair, freckles, fair skin, blue eyes or green eyesVery SensitiveUsually burns easiliy, tans with difficulty; fair skin tone
Type IIIDarker Caucasian, light AsianSensitiveBurns moderately, tans gradually; fair to medium skin tone
Type IVMediterranean, Asian, HispanicModerately SensitiveRarely burns, always tans well; medium skin tone
Type VMiddle Eastern, Latin, light-skinned black, IndianMinimally SensitiveVery rarely burns, tans very easily; olive or dark skin tone
Type VIDark-skinned blackLeast SensitiveNever burns, deeply pigmented; very dark skin tone

DEFINITIONS

Lightsensitive: sensitive or sensitized to the action of radiant energy

Phototoxic: 1. rendering the skin susceptible to damage (as sunburn or blisters) upon exposure to light and especially ultraviolet light: 2. induced by a phototoxic substance

Photoallergic: of, relating to, caused by, or affected with a photoallergy

SUNBURN AT A GLANCE

  • Sunburn is inflammation of the skin due to overexposure to ultraviolet (UV) rays.

  • The UV from "sun tanning" lamps is as damaging to skin as sun exposure.

  • Ultraviolet B rays have long been known to harm the skin.

  • Sunburn damages the skin; the damage can be permanent.

  • The main environmental cause of skin cancer is the sun.

  • Sunburn can be serious and require professional medical attention.

  • Victims of severe sunburn should avoid drinking or bathing in cold water.

  • Many prescription and non-prescription drugs and products increase the skin's sensitivity to sunlight.

  • Wear a broad brimmed hat and sunglasses that specify 95% or greater UVR (ultraviolet radiation) absorption. Wear protective, tightly woven clothing.

  • Reapply sunscreen frequently, especially if it is sunny or you are perspiring heavily.

  • Always use a broad-spectrum sunscreen with UVA and UVB coverage and a high SPF on all exposed skin, including the lips - even on cloudy days. If exposed to water, either through swimming or sweating, a water-resistant sunscreen should be used.

LIGHT FACTS

  • Sun damage to the skin is cumulative.

  • Not all skin is the same. Different skin types respond differently to sunlight. Know your skin type and determine your exposure.

  • A suntan can do you more harm than good. A suntan is actually a sign of skin damage. Any level of tanning indicates photo-damage, leading to wrinkling, aging and skin cancer.

  • The skin has a memory of all the sun damage that has happened to it before resulting in greater susceptibility to skin cancer.

  • Normal, healthy skin acts as a barrier and protects us from injury. Our skin regulates our temperature, receives sensory impulses and synthesizes Vitamin D.

  • The skin is the largest organ in the human body.

  • More than 90% of non-melanoma skin cancers occur in fair skinned people who tend to burn. However, even though the incidence of skin cancer is lower in dark skinned people, they are nevertheless susceptible to the damaging effects of UV radiation, especially to the effects on the eye and immune system.

  • Every 7 minutes someone dies of Melanoma.

  • Use of a higher SPF sunscreen helps overcome "user-errors": e.g., Sunscreen use is sporadic, reapplication is not frequent enough or with enough sunscreen.

  • The accuracy of the SPF number is questionable as testing is done with much more product than is realistically used when sunscreen is applied. Consider the reality that the true SPF number is about 1/2 or 1/3 of the stated number

  • When utilizing titanium dioxide and zinc oxide, the higher the SPF, the more UVA coverage.

  • SPF merely addresses the UVB wavelength not UVA, UVC, visible, or infrared light.

  • The UVA ray is more difficult to study on human subjects due to the length of time it takes for damage to appear. Aging skin or mutating skin cells are cumulative and can take decades to manifest fully.

  • Sun elevation: The higher the sun in the sky, the higher the UV radiation level.

  • Latitude: the closer to equatorial regions, the higher the UV radiation levels

  • Cloud cover: UV radiation levels are highest under a cloudless sky, but even with cloud cover, they can be high. Altitude: at higher altitudes, a thinner atmosphere absorbs less UV radiation.

  • Ozone: ozone absorbs some of the UV radiation that would otherwise reach the earth's surface.

  • Ground reflection: grass, soil & water reflect less than 10% of UV radiation; fresh snow reflects as much as 80%; dry beach sand about 15%; sea foam about 25%.

  • UVA radiation can penetrate glass. Even casual exposure to sunlight, while driving, walking to the store, taking an outdoor break is incremental in contributing to our cumulative lifetime radiation exposure, resulting in skin damage.

  • The UV index, developed by the National Weather Service and the Environmental Protection Agency, is a forecast of the amount of ultraviolet light expected to make it to the earth's surface when the sun is highest in the sky. The higher the index, the faster the UV radiation causes damage to the skin and eyes.

  • 1 in 5 Americans will develop skin cancer in their lifetime as a direct result of sun exposure.

  • Summer is not the only time to be aware of the sun's impact. The sun can cause significant damage during the winter months. Snow reflects up to 80% of the sun's rays, causing sunburn and damage to uncovered skin. High altitude increases the risk of sunburn, affording less atmosphere to block the sun's rays.

  • As the skin absorbs UV radiation from the sun, the melanocytes, the skin cells that produce melanin (pigment), enlarge, increase in number and are transported to cells of the outer skin, giving the sun damaged skin a leather-like appearance

  • Some of the damage caused by the sun's ultraviolet radiation are: permanent destruction of the skin's supporting structure; premature wrinkling; pre-cancerous skin lesions; drug reactions; eye damage; dilated blood vessels; sunburn; and skin cancer.

  • Ultraviolet radiation is a significant source of eye disease.

  • The sun's invisible rays are able to pass through clouds, making the skin almost as susceptible to sunburn on cloudy days as on sunny days.

  • UVA light has been shown to have immunosuppression effects and a direct relationship between these effects and skin carcinogensis in humans has been established

  • While those with naturally (inherited) dark skin are less prone to melanoma, those with artificially acquired darkened skin (i.e., a tan) do not have the same protection

  • Melanoma is the most common cancer for women aged 25-29 and the second most common cancer for women aged 30-34

  • The death rate for men over 50 with melanoma has risen 50% in the past 15 years

  • The immune system is vulnerable to modification by environmental agents such as UV radiation, which appears to diminish the effectiveness of the immune system by changing the activity and distribution of the cells responsible for triggering immune responses.

  • The probability of developing skin cancer in one's lifetime is one in five. Nearly 50% of all Americans age 65 or over will develop skin cancer at least once during their lifetime.

  • Skin cancer is the most prevalent of all cancers, with more than a million cases diagnosed each year in the US.

  • Skin is more vulnerable to sun damage post surgery or while undergoing treatments such as chemical peels.

  • Sunscreen has been proven effective at preventing tumors of squamous cell cancer

  • Consider specific products for specific areas. (eg: The face and chest typically receive significantly more exposure than do the back and abdomen.)

SUNLIGHT HAS ITS BENEFITS

Sunlight is a primary source for Vitamin D which helps keep our bones strong. The current recommended daily intake of Vitamin D is 200 IU from birth to age 50, 400 IU between 51 and 70 years, and 600 IU after age 71.

Recent studies suggest that 1,000 IU a day may reduce the incidence of certain cancers - such as those of the ovary, breast and colon - by as much as 50%. That is because Vitamin D strengthens the immune system and controls cell growth.

Vitamin D requirements may also be satisfied by diet (a serving of oily fish contains between 250 and 360 IU, and one tablespoon of cod liver oil has 1,360 IU); supplements (alone or combined with calcium).


WHO IS LIGHTSENSITIVE?

Non-Melanoma Skin Cancer and pre-malignant conditions: A direct cause and effect relationship has been established between ultraviolet light and skin cancer. Melanoma is life threatening and the most common cancer for women age 25-29. It is the second most common cancer for women 30-34. Melanoma has also been reported as having a 50% increase in death rates in men over 50 during the past 15 years

Lupus: Lupus is a chronic inflammatory disease that can affect single or multiple organ systems, especially the skin. Exposure to sunlight may result in the development of, or an increase in skin rash; more importantly, it may exacerbate the disease. Patients require complete full spectrum sun protection.

Chemotherapy and Post Radiation Therapy: Patients require complete full spectrum protection to help minimize specific drug-induced lightsensitive reactions experienced secondary to chemotherapy and tissue damage as a result of radiation therapy.

Transplant Immunosuppressed Therapy: Patients require complete full spectrum protection from all the damaging rays of the sun since immunosuppression after an organ transplant often puts the patient at risk for the development of skin cancer. One transplant patient can develop many small skin cancers, resulting in an overall risk that one of these cancers can pose a problem and can even cause death if left untreated.

Post Laser Skin Resurfacing, Chemical Peels, Microdermabrasion: Procedures which result in sensitive skin in which the overall healing process can be enhanced through proper sun protection.

Facial Cosmetic Surgery and Facial Trauma: Patients require complete full spectrum protection from the sun's damaging rays.

Vitiligo: A pigmentation disorder in which melanocytes (the cells that make pigment) in the skin are destroyed. As a result, depigmented patches of skin appear on the body. A single event, such as sunburn, can trigger the disorder and the treatment therapies for Vitiligo require that patients use complete full spectrum protection.

Rosacea: Rosacea is a chronic condition, aggravated by sunlight. The disease affects the skin of the face which usually starts with redness on the cheeks and can slowly worsen to include one or more additional symptoms. Patients require full spectrum sun protection and are advised to use non-comedogenic facial products.

Polymorphous Light Eruption: An acquired disease and is the most common of the idiopathic photodermatoses. PMLE is characterized by recurrent, abnormal, delayed reactions to sunlight, (ranging from erythematous papules, papulovesicles, and plaques to erythema multiformeąÍlike lesions on sunlight-exposed surfaces).

Solar Urticaria: An abnormal reaction to sunlight or artificial light. When exposed to light, the skin cells of someone with solar urticaria release potent chemicals (including histamine), causing their blood vessels to open and fluid to collect within the skin. Their skin feels itchy and has red patches, which may be swollen. These may look like wheals or a nettle rash, and can take up to an hour to appear after exposure to light, then coming on quickly and settling within a similar period.

Atopic Dermatitis: A skin disease characterized by areas of severe itching, redness, scaling, and loss of the surface of the skin (excoriation). When the eruption (rash) has been present for a prolonged time, chronic changes occur due to the constant scratching and rubbing known as lichenification (thickening of the skin with accentuation of the skin lines to form a crisscross pattern).

Genetic and Congenital Diseases can cause Heightened Photosensitivity

Bloom Syndrome: a rare autosomal recessive disorder characterized by telangiectases and photosensitivity, growth deficiency of prenatal onset, variable degrees of immunodeficiency, and increased susceptibility to neoplasms of many sites and types.

Cockayne's syndrome: a rare inherited disorder characterized by growth retardation, photosensitivity, premature ageing and early death. The extent and severity of the clinical symptoms vary in the affected individuals. Onset of symptoms in the second year of life is heralded by a scaly erythematous eruption in the sun-exposed areas of the skin that may resolve, leaving hyperpigmentation or scarring.

Chediak-Higashi syndrome: an inherited disorder of the immune system that results in chronic infection, decreased pigmentation in skin and eyes, neurological disease, and early death.

Darier's disease: also known as "keratosis follicularis", it is a rare genetic disorder that is manifested predominantly by skin changes. Onset of skin changes is usually in adolescence and the disease is usually chronic.

Dermatomyositis: A chronic inflammatory disease of skin and muscle which is associated with patches of slightly raised reddish or scaly rash.

Oculocutaneous Albinism: An hereditary disorder characterized by deficiency of the pigment melanin in the eyes, skin and hair. The lack of eye pigment causes photophobia (sensitivity to light), nystagmus, and decreased visual acuity.

Phenylketonuria: Phenylketonuria (commonly known as PKU) is an inherited disorder that increases the amount of the amino acid phenylalanine to harmful levels in the blood. (Amino acids are the building blocks of proteins.) If PKU is not treated, excess phenylalanine can cause mental retardation and other serious health problems. Children with classic PKU tend to have lighter skin and hair than unaffected family members, because phenylalanine is important for skin pigmentation. Children with the disorder are also likely to have skin disorders such as eczema.

Porphyrias: A diverse group of diseases in which the production of heme is disrupted. Porphyria is derived from the Greek word "porphyra", which means purple. When heme production is faulty, porphyrins are overproduced and lend a reddish-purple color to urine. All forms of porphyrias are inherited. The key clinical features are skin sensitivity to sunlight and/or by intermittent acute attacks of abdominal and nerve pain.

Rothmund-Thomson syndrome: An hereditary disease characterized by progressive degeneration (atrophy), scarring and abnormal pigmentation of the skin together with growth retardation, premature baldness, juvenile cataracts, depressed nasal bridge, and malformations of the teeth, hair, and bone.

Xeroderma pigmentosum: A genetic disease characterized by such extraordinary sensitivity to sunlight that it results in the development of skin cancer at a very early age. Children with xeroderma pigmentosum (XP) can only play outdoors safely after nightfall. They have been called midnight children, the children of the dark, the children of the night and, perjoratively, vampire children.


PRESCRIPTION DRUGS AND PHOTOSENSITIVITY

Four-hundred drugs are known to cause lightsensitive and photo-allergic reactions. Photosensitivity can be caused by commonly used drugs such as certain antibiotics, birth control pills, diuretics, antihistamines, antidepressants and many retinoids (such as Vitamin A acid).

Commonly Prescribed Drugs That Can Cause Photosensitivity: NSAIDs Chemotherapy Agents Immunosuppressive Agents ACE Inhibitors Statins Quinilones Hydrochlorothiazide Interferon Sulfa Drugs Calcium Channel Blockers Birth Control Pills Antiarrythmic Agents SSRIs Premarin Anti-Depressants Retin A™ Conticosteroids

Many medications as well as certain medical conditions increase one's sensitivity to the sun. Ask your Doctor or Pharmacist.

A. Drugs known to cause photoallergic, photo-recall, lightsensitive and phototoxic reactions by generic name *

ACAMPROSATEACETAMINOPHEN
ACETAZOLAMIDEACETOHEXAMIDE
ACYCLOVIRALDESLEUKIN
ALITRETINOINALLOPURINOL
ALMOTRIPTANALPRAZOLAM
AMANTADINEAMILORIDE
AMINOLEVULINIC ACIDAMINOSALICYLATE SODIUM
AMIODARONEAMITRIPTYLINE
AMOBARBITALAMOXAPINE
ANAGRELIDEANTHRAX VACCINE
ARSENICATAZANAVIR
ATENOLOLATORVASTATIN
ATROPINE SULFATEAZATADINE
AZATHIOPRINEAZITHROMYCIN
BENAZEPRILBENDROFLUMETHIAZIDE
BENZTHIAZIDEBENZTROPINE
BERGAMOTBETAXOLOL
BEXAROTENEBIMATOPROST
BISOPROLOLBROMPHENIRAMINE
BUMETANIDEBUPROPION
BUTABARBITALBUTALBITAL
CAPECITABINECAPTOPRIL
CARBAMAZEPINECARISOPRODOL
CARTEOLOLCARVEDILOL
CEFAZOLINCEFTAZIDIME
CELECOXIBCETIRIZINE
CEVIMELINECHLORAMBUCIL
CHLORDIAZEPOXIDECHLORHEXIDINE
CHLOROQUINECHLOROTHIAZIDE
CHLOROTRIANISENECHLORPHENIRAMINE
CHLORPROMAZINECHLORPROPAMIDE
CHLORTETRACYCLINECHLORTHALIDONE
CINOXACINCIPROFLOXACIN
CITALOPRAMCLEMASTINE
CLOFAZIMINECLOFIBRATE
CLOMIPRAMINECLOPIDOGREL
CLORAZEPATECLOZAPINE
CO-TRIMOXAZOLECOLCHICINE
CORTICOSTEROIDSCROMOLYN
CYCLAMATECYCLOBENZAPRINE
CYCLOTHIAZIDECYPROHEPTADINE
DACARBAZINEDANAZOL
DANTROLENEDAPSONE
DEMECLOCYCLINEDESIPRAMINE
DEXCHLORPHENIRAMINEDIAZOXIDE
DICLOFENACDIFLUNISAL
DILTIAZEMDIMENHYDRINATE
DIPHENHYDRAMINEDISOPYRAMIDE
DOCETAXELDONG QUAI
DOXEPINDOXYCYCLINE
DULOXETINEEFAVIRENZ
ENALAPRILENOXACIN
EPIRUBICINEPOETIN ALFA
ESOMEPRAZOLEESTAZOLAM
ESTROGENSETHACRYNIC ACID
ETHAMBUTOLETHIONAMIDE
ETODOLACFELBAMATE
FENOFIBRATEFLOXURIDINE
FLUCYTOSINEFLUOROURACIL
FLUOXETINEFLUPHENAZINE
FLURBIPROFENFLUTAMIDE
FLUVASTATINFLUVOXAMINE
FOSINOPRILFURAZOLIDONE
FUROSEMIDEGANCICLOVIR
GATIFLOXACINGEMIFLOXACIN
GENTAMICINGLATIRAMER
GLIMEPIRIDEGLIPIZIDE
GLYBURIDEGLYCOPYRROLATE
GOLD And GOLD COMPOUNDSGOLDENSEAL
GREPAFLOXACINGRISEOFULVIN
HALOPERIDOLHENNA
HEROINHYDRALAZINE
HYDROCHLOROTHIAZIDEHYDROFLUMETHIAZIDE
HYDROXYCHLOROQUINEHYDROXYUREA
HYDROXYZINEHYOSCYAMINE
IBUPROFENIMATINIB
IMIPRAMINEINDAPAMIDE
INDOMETHACININFLIXIMAB
INTERFERON BETA 1-AINTERFERON BETA-1B
INTERFERONS, ALFA-2IRINOTECAN
ISOCARBOXAZIDISONIAZID
ISOTRETINOINITRACONAZOLE
KANAMYCINKAVA
KETOCONAZOLEKETOPROFEN
KETOTIFENLAMOTRIGINE
LEUPROLIDELEVOFLOXACIN
LINCOMYCINLISINOPRIL
LOMEFLOXACINLORATADINE
LOSARTANLOXAPINE
MAPROTILINEMECLIZINE
MECLOFENAMATEMEDROXYPROGESTERONE
MEFENAMIC ACIDMELATONIN
MELOXICAMMEPROBAMATE
MERCAPTOPURINEMESALAMINE
MESORIDAZINEMETFORMIN
METHAZOLAMIDEMETHENAMINE
METHOTREXATEMETHOXSALEN
METHYCLOTHIAZIDEMETHYLDOPA
METHYLPHENIDATEMETOLAZONE
MINOCYCLINEMIRTAZAPINE
MITOMYCINMOEXIPRIL
MOLINDONEMOXIFLOXACIN
NABUMETONENALIDIXIC ACID
NAPROXENNAPROXEN
NARATRIPTANNEFAZODONE
NIFEDIPINENISOLDIPINE
NITROFURANTOINNORFLOXACIN
NORTRIPTYLINEOFLOXACIN
OLANZAPINEORAL CONTRACEPTIVES
OXAPROZINOXCARBAZEPINE
OXYTETRACYCLINEPACLITAXEL
PANTOPRAZOLEPAROXETINE
PENTOBARBITALPENTOSAN
PENTOSTATINPERPHENAZINE
PHENELZINEPHENINDAMINE
PHENOBARBITALPILOCARPINE
PIMOZIDEPIROXICAM
POLYTHIAZIDEPRAVASTATIN
PROCARBAZINEPROCHLORPERAZINE
PROCYCLIDINEPROMAZINE
PROMETHAZINEPROPRANOLOL
PROPYLTHIOURACILPROTRIPTYLINE
PSORALENSPYRAZINAMIDE
PYRIDOXINEPYRILAMINE
PYRIMETHAMINEQUETIAPINE
QUINACRINEQUINAPRIL
QUINESTROLQUINETHAZONE
QUINIDINEQUININE
RABEPRAZOLERAMIPRIL
RANITIDINERIBAVIRIN
RILUZOLERISPERIDONE
RITONAVIRROFECOXIB
ROPINIROLERUE
SACCHARINSAQUINAVIR
SCOPOLAMINESELEGILINE
SELENIUMSERTRALINE
SILDENAFILSIMVASTATIN
SMALLPOX VACCINESOTALOL
SPARFLOXACINSPIRONOLACTONE
ST JOHN'S WORTSTREPTOMYCIN
SULFACETAMIDESULFADIAZINE
SULFADOXINESULFAMETHOXAZOLE
SULFASALAZINESULFISOXAZOLE
SULINDACSUMATRIPTAN
TACROLIMUSTARTRAZINE
TERBINAFINETETRACYCLINE
THIMEROSALTHIOGUANINE
THIORIDAZINETHIOTHIXENE
TIAGABINETIMOLOL
TIOPRONINTOLAZAMIDE
TOLBUTAMIDETOLMETIN
TOPIRAMATETORSEMIDE
TRANYLCYPROMINETRAZODONE
TRETINOINTRIAMTERENE
TRIAZOLAMTRICHLORMETHIAZIDE
TRIFLUOPERAZINETRIHEXYPHENIDYL
TRIMEPRAZINETRIMETHADIONE
TRIMETHOPRIMTRIMETREXATE
TRIMIPRAMINETRIOXSALEN
TRIPELENNAMINETRIPROLIDINE
TROVAFLOXACINVALDECOXIB
VALPROIC ACIDVALSARTAN
VANCOMYCINVARDENAFIL
VENLAFAXINEVERAPAMIL
VERTEPORFINVINBLASTINE
VITAMIN AVORICONAZOLE
YARROWZALCITABINE
ZALEPLONZIPRASIDONE
ZOLMITRIPTANZOLPIDEM