M&D Clinical Corner: UV Safety

The Clinical Corner is a monthly feature that highlights a variety of important pharmacist topics that is written by Dr. Jesica Mills, PharmD, ND, MBA, RPh, BCES, BCLS, BCNP.

• Understanding UV Radiation
• Risks of Prolonged Expsoure
• Types of Sunblock and Who should use them
• Additional UV Protection Methods
• Skin Cancer Detection Collaborations

Overview

• UV Safety Month highlights the importance of protecting skin from harmful UV radiation.
• UV Safety Month was established by the American Academy of Dermatology (AAD) in 2004. The AAD created this initiative to raise awareness about the dangers of UV radiation and to promote sun safety practices to prevent skin cancer and other UV-related skin damage.
• Pharmacists play a crucial role in educating patients about UV protection.
• This guide provides essential information on sunblock use, age recommendations, and skin cancer testing options.

Understanding UV Radiation

• UVA Rays:
  • Penetrate deep into the skin, and they cause premature aging and long-term skin damage.
• UVB Rays:
  • Affect the skin’s outer layers, cause sunburns, and are the main cause of skin cancer.
• Risks of Prolonged Exposure:
  • Types of Skin Cancer:
    • Basal Cell Carcinoma (BCC):
      • Most common and least aggressive.
      • Appears as a pearly bump or flat lesion on sun-exposed areas.
    • Squamous Cell Carcinoma (SCC):
      • Second most common type.
      • May appear as a firm red nodule or a flat lesion with a scaly crust.
    • Melanoma:
      • Most dangerous form of skin cancer.
      • Can develop in existing moles or suddenly appear as a new dark spot.
    • Mechanism:
      • UV radiation causes DNA damage in skin cells.
      • Accumulated damage can lead to mutations and uncontrolled cell growth.
• Premature Aging
  • Photoaging:
    • Wrinkles, fine lines, and leathery skin texture.
    • Age spots and uneven skin tone.
    • Loss of skin elasticity.
  • Mechanism:
    • UVA rays penetrate deep into the skin, breaking down collagen and elastin fibers.
  • Eye Damage
    • Cataracts:
      • Clouding of the eye’s lens, leading to vision impairment.
    • Macular Degeneration:
      • Damage to the retina, affecting central vision.
    • Photokeratitis:
      • Painful sunburn of the cornea, similar to snow blindness.
    • Mechanism:
      • UV radiation can penetrate the eyes and cause damage to various structures.
• Immune System Suppression
  • Impaired Skin Immunity:
    • UV radiation can weaken the local immune response in the skin.
    • Increases the risk of infections and skin disorders.
  • Systemic Effects:
    • Prolonged UV exposure can affect the body’s overall immune response.
• Sunburn
  • Long-term Effects:
    • Repeated sunburns increase the risk of skin cancer.
    • Can lead to chronic skin damage and premature aging.
  • Hyperpigmentation
    • Sunspots:
      • Dark spots on the skin, also known as age spots or liver spots.
    • Melasma:
      • Larger areas of darkened skin, often occurring on the face.
    • Mechanism:
      • UV exposure stimulates melanin production, leading to uneven pigmentation.
• Increased Risk of Other Skin Disorders
  • Actinic Keratosis:
    • Precancerous skin lesions caused by cumulative sun exposure.
  • Solar Elastosis:
    • Thickened, yellowish skin with a leathery texture.

By understanding and communicating these risks, pharmacists can play a vital role in educating patients about the importance of UV protection and encouraging proactive sun safety measures.

Types of Sunblock and Their Recommendations

• Chemical Sunblocks: (Coppertone, Banana Boat, etc)
  • Absorb UV radiation.
  • Contain ingredients like avobenzone and oxybenzone.
  • Often lighter and more easily absorbed into the skin.
  • May cause irritation for those with sensitive skin.
    • Individuals with sensitive skin or conditions like eczema and rosacea may experience redness, itching, and discomfort.
  • Require about 20 minutes to become effective after application
  • Ingredients such as oxybenzone and octinoxate have been shown to contribute to coral bleaching and damage to marine ecosystems. These chemicals can disrupt coral reproduction and growth, leading to long-term harm to coral reefs and marine life.
  • Some chemical sunblock ingredients, such as oxybenzone, are known to act as endocrine disruptors. These substances can mimic hormones in the body, potentially leading to hormonal imbalances and associated health issues.
• Physical Sunblocks: usually contain minerals (Blue Lizard, EltaMD, CeraVe Mineral)
  • Reflect UV radiation.
  • Contain zinc oxide or titanium dioxide.
  • Begin to work immediately upon application.
  • Generally more suitable for sensitive skin.
  • Can leave a white residue or feel thicker on the skin.
  • Opting for mineral sunblocks help avoid skin irritation, protect the environment, and reduce exposure to potential endocrine disruptors. Mineral sunblocks provide effective broad-spectrum UV protection and are generally safer for both individuals and the planet.
• Broad-Spectrum Sunblocks:
  • Protect against both UVA and UVB rays.
  • Essential for comprehensive protection.
• SPF Ratings:
  • SPF 30 blocks 97% of UVB rays.
  • Higher SPF offers slightly more protection, but no sunblock blocks 100%.

Sunblock Recommendations by Demographics

• Adults:
  • Use broad-spectrum SPF 30 or higher daily.
  • Choose water-resistant options for outdoor activities.
• Children:
  • Use SPF 50 for extra protection.
  • Select formulations for sensitive skin.
• Infants:
  • Avoid sunblock for infants under 6 months.
  • Keep infants out of direct sunlight.
  • Use protective clothing, hats, and shade.

Proper Application and Reapplication

• Application Techniques:
  • Apply a shot glass amount for the entire body.
  • Apply 15-30 minutes before sun exposure.
• Reapplication Guidelines:
  • Reapply every 2 hours.
  • Reapply immediately after swimming, sweating, or towel drying.

Additional UV Protection Strategies

• Protective Clothing:
  • Wear long sleeves, hats, and sunglasses.
• Seek Shade:
  • Avoid direct sun exposure between 10 AM and 4 PM.
• UV Index Awareness:
  • Educate patients on the UV index and how to use it.
  • Available on weather apps, websites, and local news channels.
  • It’s a scale going from 0-11+, indicating the need for sunscreen, what hours to avoid UV exposure, and a need for protective clothing or eyewear.
• Carrot seed oil
  • Offers minor sun protection and antioxidant benefits.
  • Contains natural compounds that can absorb some UV radiation, providing minor sun protection.
  • Antioxidants neutralize free radicals generated by UV exposure, reducing oxidative stress and subsequent skin damage.
• Optimizing vitamin D
  • Enhances skin repair and immune function, contributing to overall skin health and resilience against UV damage.
  • Short, regular periods of sun exposure (about 10-30 minutes several times a week) can help maintain adequate vitamin D levels without causing significant skin damage.
  • Include vitamin D-rich foods in your diet, such as fatty fish (salmon, mackerel), fortified dairy products, and egg yolks.
  • Vitamin D supplements can be used to maintain optimal levels, especially in individuals with limited sun exposure or higher needs.

Skin Cancer Awareness and Testing

• Early Detection:
  • Encourage regular skin checks.
  • Recognize and report suspicious moles or skin changes.
• Skin Cancer Testing Companies:
  • DermTech:
    • Non-invasive skin biopsy technology.
    • Easy and accessible for pharmacies.
  • MoleSafe:
    • Comprehensive skin surveillance program.
    • Partnership opportunities for pharmacies.
  • SkinIO:
    • Digital skin monitoring services.
    • Convenient integration with pharmacy services.

Conclusion

• Pharmacists can significantly impact UV safety awareness.
• Discuss UV protection proactively with patients.
• Provide resources and educational materials on UV safety.

Role of Pharmacists in Skin Cancer Screening and Education

• Skin Cancer Screening
  • Educating Patients:
    • Inform patients about the importance of regular skin checks, and organize an in-store event where patient’s can be screened by staff.
    • Teach patients how to recognize early signs of skin cancer, such as new or changing moles.
      • Asymmetry: One half of the mole doesn’t match the other half.
      • Border: Edges are irregular, ragged, or blurred.
      • Color: Uneven color with shades of black, brown, tan, or other colors.
      • Diameter: Larger than 6mm (about the size of a pencil eraser).
      • Evolving: Changes in size, shape, color, or elevation, or new symptoms like bleeding or itching.
    • Adults should start getting annual checks for skin cancer by a dermatologist at age 40. High-risk individuals (those using tanning beds and those with previous personal history or family history of skin cancer) should begin getting checked at ages 20-30. Adults should check themselves monthly for any changes.
  • Providing Resources
  • Collaborating with Dermatologists:
    • Refer patients to dermatologists for comprehensive skin exams.
    • Maintain a list of local dermatologists and skin cancer screening services.
  • Offering Skin Cancer Testing:
    • Partner with companies like DermTech, MoleSafe, and SkinIO to provide in-pharmacy skin cancer testing services.
• UV Safety Education:
  • Product Recommendations:
    • Advise on the appropriate use of sunblocks and other sun protection products.
    • Recommend broad-spectrum sunblocks with adequate SPF levels (30+) for adults.
    • Suggest physical sunblocks for sensitive skin or allergy-prone individuals.
  • Proper Use Instructions:
    • Demonstrate the correct application of sunblock.
    • Emphasize the importance of reapplying sunblock every two hours and after swimming or sweating.
  • Promoting Sun Safety Habits:
    • Encourage patients to wear protective clothing, hats, and sunglasses.
    • Advise on seeking shade during peak sun hours (10 AM to 4 PM).
    • Educate on the UV index and how to use it to plan outdoor activities.Community Outreach and Awareness
• Workshops and Seminars:
  • Organize or participate in community events focused on UV safety and skin cancer prevention.
  • Provide talks or workshops in collaboration with local health organizations or schools.
• Social Media and Marketing:
  • Use social media platforms to share UV safety tips and information.
  • Create and distribute educational materials, such as flyers and posters, within the pharmacy and community.
• In-Pharmacy Campaigns:
  • Set up UV safety information booths during UV Safety Month.
  • Offer free skin assessments or consultations on sun protection products.

By actively engaging in these roles, pharmacists can significantly contribute to the prevention and early detection of skin cancer, promoting overall UV safety within their communities.