Sunscreen Graphics

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. 

Information is Beautiful has a superb post:  The Sunscreen Smokescreen meant to answer the question “How much sunscreen should you wear?”

The full graphic can be found here.  It begins by explaining UVA and UVB rays, goes on to explain SPF (UVA protection) and the star rating (UVB protection),  and protection times avoided by sunscreen.

I cropped out the middle section which is specific to the amount of sunscreen which should be used and how often it should be reapplied.  Not many (if any) of use use enough or reapply often enough.

The lower portion of the Information is Beautiful graph gives info on how cloud cover, reflective surfaces (snow, lakes, etc), and altitude affects the amount of  UVA/UVB radiation.  There is a section on skin cancers and one on the possible harmful effects of sunscreens.

Related posts:

Sun Protection (March 19, 2009)
Melanoma Review (February 25, 2008)
Melanoma Skin Screening Is Important (April 29, 2009)
Tanning Beds = High Cancer Risk (August 3, 2009)
Skin Cancer (March 24, 2010)
Safety of Sunscreens (June 14, 2010)
Dear 16-Year-Old Me (May 18, 2011)

New FDA Sunscreen Labeling  (June 15, 2011)

Shout Outs

Updated 3/2017:  photos and all links removed as many no longer active and it was easier than going through each one.

Shrink Rap is the host for this week’s Grand Rounds.  You can read this week’s Summer Solstice “Hot” edition here.

Shrink Rap is hosting our third Grand Rounds today on June 21, which is the first day of Summer. In keeping with the summer solstice theme, we asked for submissions that have a theme of "hot." However, "hot" may refer to not just  temperature, but also spiciness, luck, passion, anger, popularity, etc.

Our first Grand Rounds in 2007 featured a clicky brain, and the second featured the then-new iPhone 3G, complete with clicky iPhone apps. This time, we've used clicky pictures that exemplify the "hot" theme. . ……..

……………………………

Yesterday,  NPR ran this  article by Alix Spiegel on inattentional blindness:  Why Seeing (The Unexpected) Is Often Not Believing

……The goal of all this was to answer a question: Is it possible to see something really, really obvious and not perceive it?  …….

When psychologists Chabris and Simons ……..They do research on something called inattentional blindness, or how people fail to see things that are directly in front of them when they're focused on something else. And in Conley they felt they had found a compelling example.  ……….

This topic is important to patient safety as seen in this article:  Inattentional blindness: What captures your attention?

A nurse pulls a vial of heparin from an automated dispensing cabinet (ADC). She reads the label, prepares the medication, and administers it intravenously to an infant. The infant receives heparin in a concentration of 10,000 units/mL instead of 10 units/mL and dies. ……

Expectation has a powerful effect on our ability to pay attention and notice information. If the medication we are looking for comes in a carton with a highly stylized label, we come to expect this presentation every time we look for the medication…….

………………………….

Dr. Cynthia Bailey has a nice post on sunburn:  What is a sunburn?  

A sunburn tells you that damage and inflammation have happened inside your skin from UV exposure; you exposed yourself to more sun than your skin type can handle…..and there’s simply no good news about it!   ….

In this Sunburn Series I’m going to give you a dermatologist’s explanation of what happens in your skin when you get

• a sunburn (i.e. why it’s red and hurts)
• a tan (i.e. how much sun protection you get from one)

I’m also going to give you some helpful information to heal sunburned skin and explain how to prevent ever getting a sunburn again. …….

………………………………..

Dr Val, Better Health, is now hosting a radio show called, "Healthy Vision with Dr. Val Jones."  It is currently available here on iTunes.  The show has three segments (one about the importance of regular eye exams, one about contact lens care, and one about UV protection for eyes). It's available as a full show (20 minutes) and as individual segments.

……………………………….

Dr. Kathryn Clancy, Assistant Professor of Anthropology at the University of Illinois, answers the question:  Why do we menstruate?

…..I will answer three different ones for you: Why do we menstruate? What did we do back in the day? and What is appropriate today?

Why do we menstruate?

Humans are not the only animals to undergo cycles of growth and regression in our endometrial lining. Yet, only a few animals actually menstruate. Menstruation has occasionally been observed in other great apes (this is the primate group where humans belong, with the chimps, bonobos, gorillas and orangs), and a few other animals. As far as we can tell, everyone else resorbs the lining before growing a new one. It seems to be that those animals who menstruate, do so because the amount of lining they have is greater than what they are able to resorb.  …….

…………………………………….

Dr. Lisa, Call Me Dr. Lisa, write about her relationship with her physical therapist:   An S&M relationship for good!  (photo credit)

I’m in a Sadistic/ Masochistic relationship, and I like it.  Now don’t get any crazy ideas, but really I let this guy strap electrodes to my leg, put me in a 40 pound flack jacket and then do exercises, and that is just the beginning.  Yep, I’m talking about my physical therapist.  Still I go back twice a week because he knows what he’s doing and I’m getting better.  ………

I go, I go twice a week.  I spend 3 +/- hours there and I do whatever he says.  My reward, today he had me run on a treadmill.  5 months after my surgery and I’m starting to run again.  I’m well on the road back.  It feels great.  I’m good with this S&M thing we have going on! ……..

……………………………………………..

Sarah McFarland, Threads Magazine, has a piece announcing:  New Sewing Show, "It's Sew Easy," Starts June 30 on PBS

You may have heard about it through the sewing grapevine, but now it's nearly here - the premiere of "It's Sew Easy" is June 30 on PBS stations across the country. It's great news when a national audience is exposed to the fun of sewing!

"It’s Sew Easy" replaces "America Sews with Sue Hausmann," promising to give faithful viewers a new spin on sewing where America Sews left off.  …….

New FDA Sunscreen Labeling

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. 

Yesterday, the U.S. Food and Drug Administration released the new rules regarding labeling of sunscreen.  The goal is to make it easier for the average person to chose a sunscreen. 

The new labels will not be in place until next summer, so you need to be aware.

When the new labels are in place, NO sunscreen will be allowed to be labeled as a SUNBLOCK or as WATERPROOF.  

Under the new labeling rules

• Products that have SPF values between 2 and 14 may be labeled as Broad Spectrum if they pass the required test.
• Only products that are labeled both as Broad Spectrum with SPF values of 15 or higher may state that they reduce the risk of skin cancer and early skin aging, when used as directed.
• A warning statement will be required on any product that is not Broad Spectrum, or that is Broad Spectrum but has an SPF between 2 to 14 stating that the product has not been shown to help prevent skin cancer or early skin aging.

In addition to the final rule for sunscreen labeling, the FDA released a Proposed Rule which would limit the maximum SPF value on sunscreen labels to “50 +”, because there is not sufficient data to show that products with SPF values higher than 50 provide greater protection for users than products with SPF values of 50.

Sunscreens who use the claim of being water-resistant will be required to note how long the product resists being rinsed away while swimming.  In other words, will it rinse off within 15 minutes in the water or last 2 hours.  It is important to remember, no sunscreen is “towel resistant” and can easily be removed toweling off.  It is important to reapply your sunscreen.
It is recommended that a sunscreen labeled as both broad spectrum and SPF 15 be used to protect against both ultraviolet A (UVA) and ultraviolet B (UVB) radiation.  Both types of radiation contribute to skin cancer and premature skin aging.  Sunburns are primarily caused by UVB rays, so simply preventing of a sunburn doesn’t necessarily mean good protection from future skin cancer.

Proper Use of Sunscreen: 

• Apply the sunscreen 20-30 minutes before going outside.  Reapply every two hours when outside at a beach, etc. for adequate protection.
• Use enough. To ensure that you get the full SPF of a sunscreen, you need to apply 1 oz – about a shot glass full.
• Reapply after getting out of the water or toweling off. Even "water-proof" sunscreens are not usually "towel-proof".
• Use even on a cloudy day, up to 80% of the sun's ultraviolet rays can pass through the clouds. In addition, sand reflects 25% of the sun's rays and snow reflects 80% of the sun's rays.
• Don't forget to apply lip balm with SPF 15 or higher.

Other Sun Safe Practices:

• Staying in the shade, especially between the sun’s peak hours (10 a.m. - 4 p.m.).
• Covering up with clothing, a brimmed hat and UV-blocking sunglasses.
• Avoiding tanning and UV tanning booths.

ABC News has a nice piece:  Consumer Reports Health Rates Sunscreens

After testing 22 spray-on, cream and lotion sunscreens, Consumer Reports gave top honors to the least-expensive products.

The magazine recognized three "Best Buys" that provided excellent water-resistant protection for less than 88 cents per ounce: Up & Up Sport SPF 30 by Target; No-Ad with Aloe and Vitamin E SPF 45; and Equate Baby SPF 50.  ……..

Related blog posts:
Sun Protection (March 19, 2009)
Melanoma Review (February 25, 2008)
Melanoma Skin Screening Is Important (April 29, 2009)
Tanning Beds = High Cancer Risk (August 3, 2009)
Skin Cancer (March 24, 2010)
Safety of Sunscreens (June 14, 2010)
Dear 16-Year-Old Me (May 18, 2011)


REFERENCES
FDA Press Release; June 14, 2011;  FDA Announces Changes to Better Inform Consumers About Sunscreen
FDA:  Sunscreen

Nonmelanoma Skin Cancer in IBD Patients

 Updated 3/2017-- all links (except to my own posts) removed as many no longer active.

I stumbled across this review article (first full reference below) earlier this week.  

Skin cancer is the most common form of cancer in the United States.  Most skin cancers form in older people on parts of the body exposed to the sun or in people who have weakened immune systems (such as inflammatory bowel disease patients on immunosuppressive therapy). 

According to the National Cancer Institute (NCI), in there were more than one million new cases of nonmelanoma skin cancers (NMSC) in the United States in 2010.  There were less than 1,000 NMSC deaths during the same time.

NMSC includes  squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).   Both occur more frequently on sunlight-exposed areas such as the head and neck. BCC is far more common than SCC and accounts for approximately 75% of all NMSC.

The causes of NMSC in the general public are multifactorial, including both environmental and host factors. Known environmental risk factors for NMSC include sun exposure (ultraviolet [UV] light), ionizing radiation, cigarette smoking, and certain chemical exposures such as arsenic. Host risk factors include human papilloma virus infection, genetic susceptibilities, skin type, and immunosuppression. 

That last risk factor mentioned – immunosuppression—is one IBD patients have in common with solid organ transplant patients (kidneys, livers, lungs, face, hands).  Note the third reference below.  The results summary of that article

Two hundred patients developed a first NMSC after a median follow-up of 6.8 years after transplantation. The 3-year risk of the primary NMSC was 2.1%. Of the 200 patients with a primary NMSC, 91 (45.5%) had a second NMSC after a median follow-up after the first NMSC of 1.4 years (range, 3 months to 10 years). The 3-year risk of a second NMSC was 32.2%, and it was 49 times higher than that in patients with no previous NMSC. In a Cox proportional hazards regression model, age older than 50 years at the time of transplantation and male sex were significantly related to the first NMSC. Occurrence of the subsequent NMSC was not related to any risk factor considered, including sex, age at transplantation, type of transplanted organ, type of immunosuppressive therapy, histologic type of the first NMSC, and time since diagnosis of the first NMSC. Histologic type of the first NMSC strongly predicted the type of the subsequent NMSC

Attention is now being paid to other patients (ie IBD, rheumatoid arthritis) on immunosuppression and their increased risk of NMSC.

Millie D. Long, MD and colleagues (first reference) note that  no IBD-specific, evidence-based guidelines for NMSC prevention exist.  The current recommendations for prevention of skin cancer for the general population include sun avoidance and sun protection strategies include protective clothing, hats, sunglasses, and sunscreens.   Sun avoidance should include tanning bed avoidance.

Any skin lesion suspicious for malignancy in a patient with IBD on immunosuppression should be evaluated by a trained dermatologist.  Among solid-organ transplant recipients, annual skin examination is recommended by various transplant organizations.

Long and colleagues note “There are no guidelines for skin cancer screening in patients with IBD, as it is unclear whether the risk–benefit ratio of skin cancer screening in IBD patients correlates with that of the general population, or more closely with that of the solid-organ transplant population. Consideration could be given in the future to skin cancer screening programs for patients with IBD on immunosuppression.” 

REFERENCE
1.  Nonmelanoma skin cancer in inflammatory bowel disease: A review; Millie D. Long, Michael D. Kappelman and Clare A. Pipkin; Inflammatory Bowel Diseases Volume 17, Issue 6, pages 1423–1427, June 2011; Article first published online: 25 OCT 2010 | DOI: 10.1002/ibd.21484
2.  National Cancer Institute; Skin Cancer

3.  Incidence and Clinical Predictors of a Subsequent Nonmelanoma Skin Cancer in Solid Organ Transplant Recipients With a First Nonmelanoma Skin Cancer: A Multicenter Cohort Study; Gianpaolo Tessari; Luigi Naldi; Luigino Boschiero; Francesco Nacchia; Francesca Fior; Alberto Forni; Carlo Rugiu; Giuseppe Faggian; Fabrizia Sassi; Eliana Gotti; Roberto Fiocchi; Giorgio Talamini; Giampiero Girolomoni; Arch Dermatol. 2010;146(3):294-299

Maternal Influence

Updated 3/2017-- all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

Not all maternal influence on daughter behavior is good.  Take for example the influence of the unhealthy use of indoor tanning beds as presented in a recent Archives of Dermatology article (full reference below) which “investigated whether indoor tanning with one's mother the first time would influence frequency of tanning later in life and whether it was associated with age of initiation.”

Joel Hillhouse, Ph.D., of East Tennessee State University, Johnson City, and colleagues published a study the May 2010 issue of the Archives of Dermatology which looked at which health-based intervention worked best in reducing skin cancer risks.  They found that “Emphasizing the appearance-damaging effects of UV light, both indoor and outdoor, to young patients who are tanning is important no matter what their pathological tanning behavior status.”

For this study, Hillhouse and colleagues randomly selected a total of 800 female students  who were then sent a screening questionnaire on their indoor tanning history. Those who reported ever indoor tanning (n = 252) were invited to participate in the study and offered an incentive ($5). A total of 227 (mean age, 21.33 years; age range, 18-30 years) agreed, signed informed consent documents, and completed assessments.

One of the questions asked who accompanied the participant the first time they indoor tanned (ie, tanned alone, with friends, with mother, or other).

Of the 227 female participants, 70 were non-tanners; 113 were moderate tanners; and 44 were heavy tanners.

Nearly twice as many participants experienced indoor tanning for the first time with their mother (n = 88) than went alone (n = 45).  First time tanning with their mother was also higher than with a friend (n = 72) or with someone other than their friend or mother (n = 22).

The prevalence of current indoor tanning use among the 88 participants who went with their mother was nearly 81%, with 31.9% reporting heavy tanning.

Adjusting for age and skin type, the researchers found that the participants who reported tanning with their mother during their initial experience were 4.64 times more likely to be heavy current tanners than those who initiated tanning alone or with someone other than their mother

Let’s get out of the tanning beds and go walking or cycling or swimming or dancing or bowling together.  Mothers (and aunts) lets influence our daughters (and nieces) to be more active.

 

Related posts:
Tanning Beds = High Cancer Risk (August 3, 2009)
Skin Cancer: More than Skin Deep – an Article Review (December 14, 2009)
Get Girls to Focus on Skin’s Appearance (May 19, 2010)



REFERENCE

The Effect of Initial Indoor Tanning With Mother on Current Tanning Patterns; Mary Kate Baker, MPH; Joel James Hillhouse, PhD; Xuefeng Liu, PhD; Arch Dermatol. 2010;146(12):1427-1428. doi:10.1001/archdermatol.2010.349

Sun Sense

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

We are past spring breaks and headed toward the end of the school year and summer vacations.  I noticed this product in the April issue of PSP.  (photo credit)

UVSunSense is a wristband that monitors your exposure to sun.  If you and your children have trouble remembering to reapply sunscreen or to just get out of the sun, then this might be just the ticket. 

Even young children can be taught to recognize the color changes the band goes through with exposure to the sun’s UV rays.  You should use only one band a day.  After placing the band around the wrist, apply your sunscreen over your exposed skin AND the band.  The new band will turn a bright purple with exposure to the sun, indicating it has been activated. (photo credit)

 

When the band fades to light pink, it is recommended to reapply sunscreen on your body and on the band. 
When the band turns pale yellow, it is recommended to cover up or get out of the sun.
The bands are made of recycled plastic.  Recycle them after use.


Related blog posts:
Sun Protection (March 19, 2009)
Melanoma Review (February 25, 2008)
Skin Cancer—Melanoma (December 8, 2008)
Melanoma Skin Screening Is Important (April 29, 2009)
Skin Cancer -- Basal Cell Carcinoma  (December 3, 2008)
Skin Cancer – Squamous Cell Carcinoma  (December 4, 2008)
Moles Should Not Be Treated by Lasers  (July 27, 2009)
Tanning Beds = High Cancer Risk (August 3, 2009)
Skin Cancer (March 24, 2010)

Lightening Up

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

MedEsthetics has a nice article on skin lightening in the March/April 2010 issue written by Linda Lewis.

Skin lightening is often needed to improve postinflammatory hyperpigmentation, dyschromia, and melasma. Others have uneven skin tones due to sun damage.

Several physicians were interviewed for the article. All agree that a good skin care regimen before, during, and after treatment is key.

For uneven pigmentation:

Marta Rendon, MD (dermatologist) -- “For mild photodamage, I start with antioxidants and retinoids, and then add peels or lasers for stubborn cases.”

Joel Schlessinger, MD (dermatologist) -- “Typically, these patients do well with intense pulsed light (IPL) or laser treatments, but these should always be accompanied by a homecare treatment regimen, such as Nu-Derm by Obagi or another hydroquinone-containing product such as Tri-Luma or Epiquin Micro by SkinMedica.”

Leslie Baumann, MD (dermatologist) – “For patients with light skin I recommend monthly IPL treatments. For home care I suggest a glycolic cleanser, NIA24 niacinamide moisturizer or Aveeno Positively Radiant active soy, and a good sunscreen in the morning. For nighttime use, I prescribe Tri-Luma. For patients with darker skin, I use the same home care regimen, but offer a Jessner’s peel solution every two weeks instead of IPL. ”

Tina Alster, MD (dermatologist) -- “For light-skin patients I use IPL or a Q-switched pigment specific laser (alexandrite or Nd:YAG), with or without mild to moderate chemical peels. For daytime home care, I suggest a topical vitamin C with sunscreen (SPF 30 or higher) and at night glycolic/retinoic/kojic acid on an alternating basis.”

For melasma:

Dr. Baumann “I recommend a glycolic cleanser in the morning, followed by a vitamin C serum, such as Skinceuticals CE Ferulic, and a moisturizing sunscreen, such as LaRoche Posay Anthelios 60 Sunscreen Fluid. At night, the patient uses the same glycolic cleanser followed by Tri-Luma topped with a moisturizer if they have dry skin.” She also recommends microdermabrasion followed by Jessner’s solution TCA peels twice a week until the hyperpigmentation clears.

Dr. Alster “For melasma, I use only mild to moderate chemical peels (resorcinol, glycolic/lactic/mandelic or trichoracetic acid) in the office.”

It’s interesting to see the similar yet different approaches. It is extremely important to use sunscreen daily during and after treatment for any skin pigmentation issues.

Other reference:

Melasma; eMedicine, Dec 16, 2009; Andrew D Montemarano, DO, Hugh Lyford

Drug-Induced Pigmentation; eMedicine, Dec 10, 2008; David F Butler, MD, Deborah Zimmer Henderson, BA, MPH,