Skin

Overexposure to the sun without adequate sun protection will result in sunburn, where the skin becomes red and tender and may even blister and peel.

While sunburn used to be regarded as a temporary inconvenience of getting a suntan, it is now widely accepted that sunburn is a serious medical complaint. Many deaths occur as a result of excessive exposure to the sun, causing the body’s temperature to rise uncontrollably, through a condition known as acute heat stroke or acute sunstroke. On the otherhand, regular exposure to the sun damages the underlying layers of the skin, causing premature ageing of the skin, age spots (also known as lentigo or liver spots) and increasing the risk of skin cancer.

It is estimated that there are over 75,000 new cases of skin cancer diagnosed each year in the UK, many more cases are probably missed. Over 2,300 people die from skin cancer each year in the UK. Most of these cases of skin cancer are believed to be due to damage caused by sunlight.

The number of cases of skin cancer has trebled since the early 1980s, an increase largely attributed to the increase in holidays to sunny destinations, outdoor leisure persuits, sun bed use, to people living longer and to people ignoring advice to protect themselves from the sun.

When skin is exposed to the sun, a brown pigment called melanin is secreted by special cells within the skin called melanocytes. The pigment is produced to stop the skin from burning, and it is the pigment's brown colour that creates a suntan. Sunburn occurs when the amount of exposure to the sun exceeds the protective ability of melanin.

Fair skinned people, those with fair hair, red hair or blue eyes have less melanin than black or brown skinned people and therefore tend to burn more quickly when exposed to the sun and are more likely to develop skin cancer.

The rays of the sun carry two main types of ultraviolet (UV) light, called UVA and UVB. UVB rays burn the topmost layer of skin, causing sunburn and cell damage that can lead to cancerous changes. UVA rays do not burn, but penetrate deep into the layers of the skin. They cause cell damage that contributes to premature ageing of the skin and skin cancer. UVA and UVB radiation levels vary from country to country but the nearer a country is to the equator, the stronger the UV radiation. UV radiation levels also vary during the day and from day to day. The rays are strongest between 11a.m. and 3p.m. than at any other time during the day, and are stronger in the summer months than they are in the winter months when the sun is lower in the sky.

Unlike a burn caused by a hot object, the symptoms of sunburn are not felt immediately and do not appear immediately but tend to develop a number of hours after exposure to the sun. The problem is that by the time the skin starts to appear red and become sensitive, the damage has already been done. Pain is worst between 6 and 48 hours after exposure to the sun. The skin becomes red, swells and the area affected looks ‘puffy’. If the sunburn is severe, the skin will blister and, after about 3 to 8 days, will peel and be shed.

Skin cancer develops as the long term consequences of overexposure to the sun. There are three main types of skin cancer - malignant melanoma, basal cell cancer and squamous cell cancer.

Malignant melanoma is a cancer which usually starts in the skin, either in a mole or in normal-looking skin. It is very rare in childhood, but children and young adults who are overexposed to the sun and have severe burning or blistering are at risk of developing melanoma in later life. One blistering sunburn in childhood doubles the risk of developing malignant melanoma later in life.

Basal cell carcinoma is a cancer of the cells at the bottom of the skin's outermost layer, the epidermis. Squamous cell carcinoma is a cancer of the epidermis. The risk of developing these types of skin cancer is directly related to the amount of sun exposure, determined by skin pigmentation and hours in the sun.

Other long term consequences of the sun are the damaging effects of UVA radiation on the collagen in the skin. As a result, the skin loses its elasticity and becomes prematurely aged. Finally, sun exposure and ultraviolet damage have been implicated in the development of cataracts in the eyes leading to blindness.

Medicines

Sunburn and the long term consequences of overexposure to the sun can largely be avoided by taking some simple precautions:

• Stay out of the sun between 11a.m. and 3p.m.
• Wear a hat, sun glasses and a cotton T-shirt
• Use a high factor sunscreen and reapply after swimming
• Never allow your skin to burn
• Take extra care with children
• Avoid use of sun lamps and sun beds; use fake tans instead

• Understanding Sun Protection

Skin needs to be protected from both UVB and UVA rays, and all products should be clearly labelled with both an SPF and star rating.

SPF stands for sun protection factor. The higher the SPF number, the better the protection from burning UVB rays. A high SPF of at least 30 is recommended, particularly when first exposed to the sun, for fair skinned people who do not tan easily and for children. An SPF of at least 15 is recommended at all other times. Total Sunblock should be used on particularly exposed and sensitive areas such as the nose, ears and lips.

Although sunscreens with a high SPF factor allow you to stay in the sun for longer, it does mean that you are exposed to more UVA rays. The star rating system indicates the level of a product’s protection against UVA rays in relation to its protection against UVB rays. This means the higher the SPF, the more UVA protection is needed to achieve the same amount of stars. So an SPF 30 sunscreen with three stars will have more UVA protection than an SPF 15 sunscreen with four stars. To protect skin from ageing and wrinkling, a product with at least four stars should be used.

In all cases, the sun protectant should be applied liberally, about 30 to 40g for each application for an adult and about 20g for each application for a child. Apply about 30 minutes before going out in the sun and reapply after swimming.

Babies under 12 months should be kept in the shade and covered up with a high factor sun lotion or sunblock. Young children should be encouraged to play in the shade and they should be made to wear sunhats and protective clothing. High SPF lotions should be applied liberally to any exposed areas.

After Sun products will help keep skin hydrated and soothe any redness. A lotion containing aloe vera or calamine is ideal, but do not use these on broken skin.

If you do get sunburnt, a cold flannel, a cool bath or shower should help ease the symptoms, especially if you have been bathing in the sea as salt can irritate the skin. Painkillers such as paracetamol can also help with the pain. Try to rest and increase your fluid intake to guard against dehydration.

Creams and lotions providing protection against the sun are available from your local pharmacy. Your pharmacist or healthcare assistant will be able to explain the SPF and star rating of the products if you are not sure. If you are purchasing the products for other members of your family, remember that the level of protection they require may differ. Allow sufficient amounts to treat everyone, remembering that most people do not usually apply enough cream or lotions. Use sun protectants whether going on holiday for summer sun, winter skiing or following other outdoor activities.

If you develop vomiting, fever, headache and shivering you might have sunstroke. Drink plenty of fluids, try to stay cool and consult your doctor. If a baby or toddler has sunburn you should also seek medical advice.