What is the ideal outside physical activity? Some patients have significant skin changes and are subject to peeling of skin and easy bruising. A more long-term problem with your skin is the occurrence of lesions related to sun exposure. All people should be very conscious about sun exposure. If untreated, these skin lesions can become cancerous. Sun blocks are available, and for those of you who cannot go without a little color, there is always sunless tanner.

Because skin malignancy is both dangerous and unsightly, all patients should avoid purposeful overexposure to the sun. Transplant surgeon and AAKP Board Member Amy L. Friedman, MD, shares with us how to have “Fun In The Sun.”

Sunlight is a vital part of the human environment that must be respected for both the wonderful advantages it brings to our health, and the dangerous consequences it may cause. As with most healthcare threats, it is safest to develop an approach to the sun that is well informed, incorporates moderation, and when needed, seeks assistance to manage negative outcomes. To do this well, you must understand both your individualized level of risk from sun exposure and the generalized amount of exposure to which you subject yourself.

Why worry about the sun?

The sun is the earth’s central source of heat and light. Too much exposure to the sun will damage your skin. The long term affects of the sun’s rays include wrinkles, sagging and pigmentation, which may result in an unwanted appearance of premature aging. These affects are not dangerous. More serious damage, including burning of the skin, has both immediate and long term consequences.

Your skin is the largest organ in your body and serves as a barrier between you and the microscopic organisms (bacteria, viruses and funguses) that can cause infections. When the skin becomes burned, this protective layer is no longer intact. Your most important defense mechanism has been damaged and serious infection can result. (In fact, this is the cause of illness and even death in individuals with other types of burns). The other key function of this barrier is to help retain moisture. Burned skin causes fluid in your body to drain (the damaged area appears to weep), and if the area is large enough, may make it difficult for your body to regulate temperature.

Preventing skin cancer is the primary reason for limiting sun exposure and damage. In the United States, more than one million new sun-related skin cancers are diagnosed each year. Most of these develop in the sun bathed areas of the body which suggests that they can be prevented by avoiding their exposure. The most common locations are on the face, ear, neck, lips and backs of the hand. Several factors contribute to your individualized risk of developing one of the skin cancers.

What is your own risk?

Most important is the lightness (or darkness) of your natural skin color. Melanin, the pigment that is responsible for skin color, protects against the sun’s ultraviolet rays. To classify your own skin type, answer three questions:

1. Do you easily get a sunburn?

2. Do you easily get a sun tan?

3. What are your natural skin, hair and eye colors?

Your responses determine which of six skin types you have. Those individuals with the lowest numbered categories have the least amount of pigmentation and natural sun defenses, and have the greatest risk for damage and skin cancer. Accordingly, they will require relatively more aggressive use of auxiliary protective measures.

How strong is the sunlight?

Another key factor to consider is the intensity of the sunlight to which your skin will be exposed. Those areas on the earth’s surface that are physically closest to the sun are exposed to the most intense rays. It is generally easiest to become sunburned in geographic regions that are hot, than those that are cool. As the earth tilts throughout the year, the location of the hottest (and closest to the sun) spots on the globe vary. It is important to recognize the impact of how elevated the specific location is, since significant heights will also shorten the distance to the sun, and increase the intensity of its rays. Standing on top of a high mountain in a very warm area will cause a greater amount of sun exposure than would be found in a cool region at sea level. The amount of sunlight is also effected by environmental factors such as surfaces that reflect light (such as sand particles at the beach), thereby increasing the amount of exposure. Finally, the factor that you are most able to alter is the length of time you spend in the sun. To understand the collective impact of these factors consider two examples. A very light skinned, blue eyed blonde individual with many freckles who spends one hour sitting on the top of Mount Kilimanjaro (located near the equator and at 5,885 meters, the highest peak in Africa) in the summer is likely to rapidly become seriously sunburned. A dark skinned, brown eyed person who spends the same amount of time in Central Park (New York City is 10 meters above sea level) during the winter is at much lower risk of becoming sunburned.

Moderation is the key

None of us can or should entirely avoid sun exposure. We need the effects of sunlight for adequate calcium metabolism, and for the normal processing of bilirubin, a by-product of normal red blood cell cycles. Moderation is the key. There are simple, inexpensive and effective strategies to limit these risks. Advance planning to ensure availability of the required materials should always be considered.

Which clothing you wear, what it is made of, and how much skin it covers are all factors within your control. Thus, light colors (because they reflect instead of absorbing light) and dense materials offer the most protection to skin. And uncovered skin is unprotected skin. Use of a hat to cover the vulnerable scalp, face and ears provides the dual benefit of limiting heat transfer and light exposure. The use of auxiliary devices, such as an umbrella should also be considered.

Lotions, creams and makeup commonly contain products that offer some protection. The SPF (sun protection factor) of these products indicates its ability to block sun rays, when measured in a laboratory. The higher the number, the more protection it offers. Thus, skin that would burn in 10 minutes, will take four times as long (40 minutes) to burn if protected with an SPF of four. Remember, even though such a product is applied, caution is still required, because it may be removed by rubbing, sweating or water. Additional product should be applied liberally and frequently in order to obtain maximum benefit.

Some medications cause sun sensitivity

A variety of medications can increase skin sensitivity to the sun. As with all drugs, it is important to read the label and other information provided with your prescription, to anticipate this type of danger, and plan your behavior accordingly. Be an informed patient!

When you seek help

The indications of important skin changes that should receive attention are a mole that is changing shape or color, any lesion that is painful or bleeds, and virtually any lump or bump that is rapidly changing. The most important advice is to seek help if you find any of these signs. Do not delay! Most skin cancers can be well treated and/or cured if found early. Your job is not to interpret whether or not a particular spot is cancerous, but rather to alert your healthcare provider to a worrisome change. Their job is to distinguish which spots may represent cancers and should be tested (biopsied). But they cannot do so, if you do not seek medical help! You should also have someone else intermittently look at the areas on your skin which are not visible to you.

Put it all together

Safely spending time in the sun requires anticipation of the specific risk to your skin, the intensity and duration of sun exposure to be encountered, and intentional use of the protective measures described before. By choosing to embrace, not deny these simple strategies you can optimize your own safety and still enjoy reasonable time in the outdoors.

Take Home Message

1. Seek shade (avoid sun between 10 a.m. and 4 p.m.)

2. Wear protective gear (clothing, hat, sunglasses)

3. Use sunscreen

4. Keep kids out of the sun

5. Self exam (have someone else look at the skin you cannot see)

6. Medical follow up for skin changes

Amy L. Friedman, MD, is an associate professor at Yale University School of Medicine, Department of Surgery in New Haven, Conn., and serves as Secretary on the AAKP National Board of Directors and the AAKP Medical Advisory Board.

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