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HealthHints Newsletter, Texas AgriLife Extension Service, The Texas A&M University System

Sun Safety

Volume 2, Number 4 - May/June 1998

Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, and Janet M. Pollard, MPH, Extension Associate-Health

Inside HealthHints....

Sun Safety

With the arrival of summer, we face several health concerns. Sunburn, heat exhaustion, heat stroke, hot work environments, and skin cancer are just a few of the risks we face when the hot summer sun arrives.

Equipped with a little bit of knowledge and a few safety tools, however, we can prevent all of these problems, and know how to treat them when necessary.

No Such Thing as a "Healthy Tan"

The sun worshipers who stretch out on the beach or at the swimming pool for hours seek bronzed bodies which they believe symbolize attractiveness, youth, fitness, and the "good life." - American Academy of Dermatology, 1998b

A sunny day provides us an ideal setting to pursue many popular activities, such as outdoor sports, leisurely walks, gardening, picnicking, or just relaxing.

Unfortunately, though sun exposure had long been thought to be a healthy benefit of outdoor activity, the reality is that too much time in the sun without appropriate protection can result in sagging, aging skin, skin cancer, and even death (American Academy of Dermatology, 1998a).

Coming Attractions

During the Children,Youth, and Families Institute, one of the concurrent sessions offered will be "You've Got My Attention." During this session you will be given ideas for audience participation, active learning ideas, and learning through games. Participants will create a low cost exhibit to take home.

Additionally, Dr. Kay Vendrell Rankin, DDS, Baylor College of Dentistry, will inform participants about "Tobacco and the Mouth," with slides showing the realities of tobacco use she has encountered.

A section on breast self exam will also be conducted. Participants will receive a breast model to use with their Breast Health Awareness Notebook.

Why Does the Sun Damage Our Skin?

Some of the sun's rays are what damages our skin. The sun emits both rays we can see and rays that are invisible. These invisible rays are called ultraviolet or UV rays (American Academy of Dermatology, The Sun and Your Skin).

Ultraviolet radiation is known to damage skin and cause cancer. The amount of UV exposure, and thus the amount of damage, however, depends on the strength of the light, the length of exposure, and whether the skin is protected (American Cancer Society, 1998).

Ultraviolet Index

The Ultraviolet Index was developed by the National Weather Service (NWS) and the Environmental Protection Agency (EPA), and is issued daily as a national service.

The Ultraviolet Index is designed to provide important information to help you plan your outdoor activities and avoid overexposure to the damaging rays of the sun.

Here's how the UV Index works:

The UV Index predicts the next day's amount of exposure to UV rays, much like the weather report predicts the next day's forecast. The UV Index predicts levels of UV radiation on a 0-10+ scale.

Index Number Exposure Level:

You should always take precautions against overexposure, and take special care when the UV Index predicts exposure levels of moderate to very high (5-10+).

(American Academy of Dermatology, 1998c).

Ultraviolet Rays

There are two types of UV rays that reach the Earth: UVA and UVB. Scientists now believe that both types of UV rays contribute to skin damage, including skin cancer. There are no safe UV rays (American Cancer Society, 1998).

What Type of Skin Damage Occurs with UV Radiation?

Here are just a few of the ways UV rays can damage your skin:

How Susceptible Am I to Sun Damage?

Although people with light skin tend to be more susceptible to sun damage, darker skinned people, including African Americans and Hispanic Americans, can also be affected.

Additionally, extra care should always be taken to protect babies and children from the sun. Scientists report that one or more severe, blistering sunburns as a child or teenager could increase the risk for melanoma, an often fatal form of skin cancer.

Individuals who fall into any of the following categories should be particularly careful, as they are some of the most susceptible to sun damage:

Types of Skin Cancer

Skin cancer is caused by too much sun. Bad sunburns and long-term exposure are major contributors. Over 90% of all skin cancers occur on parts of the body exposed to the sun, face, neck, ears, forearms, and hands being the most common areas affected.

There are three main types of skin cancer:

Other Effects of the Sun

Aside from skin cancer, there are other health effects of the sun we should protect against to avoid immediate and long-term problems. These effects of the sun include sunburn, tanning, premature wrinkling, eye damage, allergies, and problems with the immune system.

Sunburn

If you stay in the sun too long, you may notice your skin turning red in a few hours. Reactions to sunburn often include pain, tenderness, swelling, and blistering. Additionally, you may also experience fever, chills, and nausea.

Wet compresses, cool bathes, and soothing lotions may help relieve some of the symptoms, but there is no cure for sunburn. See your health care provider if blistering occurs over 1/2 of the affected body part with a fever of 102 degrees or higher, or if you feel very ill or have dizziness and visual problems after cooling off (Kemper, 1997).

Tanning

A tan does not prevent skin damage, it is sun damage (American Academy of Dermatology, 1998c).

Though many people believe a tan is a sign of good health and good looks, a tan is actually a sign of skin damage. Tanning results when UV rays penetrate the skin and injure the pigment cells. Your skin remembers all damage; thus, with every burn or tan, the skin becomes more damaged.

Premature Wrinkling

Too much sun changes the texture of the skin. The skin gradually loses it's elasticity with sun exposure causing sagging and deep wrinkles. (If skin was never exposed to the sun, it would look like the smooth skin of the buttocks.) The sun may also cause yellow, grey, or brown spots as well as Keratoses leading to skin cancer.

Eye Damage

Without appropriate protection, the sun can cause cataracts and other eye damage. Cataracts are among the leading causes of blindness.

Allergies

Bumps, hives, blisters, or red blotchy areas appearing after sun exposure may indicate an individual who has developed an allergy to the sun. Medications, cosmetics, perfumes, and even some sun preparations can make some people more sensitive to the sun.

Immune System Damage

Even short periods of sun exposure can damage a person's immune system, making the body more susceptible to infections and cancers. Additionally, some diseases can be worsened by sun exposure. These diseases include herpes simplex (cold sores), chicken pox, lupus, and certain genetic problems (American Academy of Dermatology, 1998c).

Are Tanning Beds a Safe Alternative to the Sun?

Advertisers claim that tanning beds are a safe alternative to tanning in the sunlight. Here are the advertisers claims and the real facts provided by the Federal Trade Commission (1997):

Claim: You can receive a deep, year-round tan with gentle, comfortable, and safe UVA light.

Fact: Ultraviolet light is divided into two wavelength band - shortwave rays and can burn the outer layer of skin. UVA rays are longwave rays which penetrate more deeply and can weaken the skin's inner connective tissue.

Long-term exposure to sun and to artificial sources of ultraviolet rays can result in skin cancer.

Claim: No harsh glare, so no goggles or eye shades are necessary.

Fact: Studies show that too much exposure to ultraviolet rays, including UVA, can damage the retina; burn the cornea; and over time, change the structure of the lens so that it begins to cloud, leading to cataracts.

Closing your eyes, wearing ordinary sunglasses, and using cotton balls will not protect the cornea from UV radiation in tanning beds. Your skin may remain cool in a tanning device, but actually the intensity of lights used is much greater, and potentially more harmful, than that of natural sunlight.

Claim: Tan year round without the harmful side effects often associated with natural sunlight.

Fact: Exposure to tanning salon rays increases damage caused by sunlight because ultraviolet light actually thins the skin, making it less able to heal. Unprotected UV exposure also results in premature aging (e.g., wrinkling, sagging) of skin.

Claim: No danger in exposure or burning.

Fact: Whether you tan indoors or out, the combination of UV rays and some medicines, cosmetics, birth control pills, and soaps may accelerate skin burns or produce painful skin reactions (e.g., rashes). Tanning devices may also induce light-sensitive ailments, such as cold sores.

Seven Steps to Safer Sunning

About a quarter of US white adults report frequent sunbathing, and only about a quarter of sunbathers use sunscreen. (Koh, et.al., 1997)

We can't avoid the sun completely; and it would be unwise to limit our level of activity to avoid going outside. So, how do we avoid the health hazards of ultraviolet radiation? Here are seven steps you can take to be safer in the sun. These recommendations come from numerous experts including the American Academy of Dermatology, American Cancer Society, American Academy of Ophthalmology, Skin Cancer Foundation, American Academy of Pediatrics, National Cancer Institute, National Weather Service, and Food and Drug Administration.

  1. Avoid the Sun
    • It is especially important to limit your exposure to the sun between 10 a.m. and 3 p.m. because this is when the sun's rays are strongest. You will also want to listen to the daily UV Index and avoid the sun when the UV Index is moderate to high. (Check the local newspaper, TV, or radio broadcast, or the National Weather Service Internet site for the UV Index in your area.)
    • Also, don't assume you are safe in cloudy conditions or in the water. UV radiation can penetrate both clouds and water. Additionally, be particularly careful in sand, snow, and on concrete because they all reflect UV rays and increase exposure.
  2. Use Sunscreen
    • Sunscreen or sunblock lotions, creams, ointments, gels, or wax sticks absorb, reflect, or scatter some or all of the sun's rays when applied to the skin.
    • Be sure to read labels. Some sunscreen products only protect against UVB rays, once thought to be the only dangerous rays. "Broad-spectrum" products, now available, protect against both UVA and UVB rays. Look for waterproof brands if you know you will be swimming or sweating. Buy a PABA free brand if you are sensitive to this ingredient, and, for oily skin, choose a water-based lotion. Keep in mind, more expensive products are not necessarily better.
    • Choose a broad-spectrum product with a sun protection factor (SPF) of at least 15 and apply liberally (about 1 ounce per application for an average size person) 15 to 30 minutes before going outdoors, reapplying every 2 to 3 hours. Apply evenly on all exposed areas of the skin, including lips, ears, nose, neck, hands, feet, eyelids, and to exposed areas of the scalp. Take special care not to get the product in the eye. If this occurs, rinse the eye thoroughly with water.
    • Sunscreen should not be used on babies younger than 6 months. Protect babies with hats, clothing, and other shading.
    • For children 6 months to 2 years, use a sunscreen with at least an SPF of 15.
  3. Wear a Hat
    • A hat with at least a 3 inch brim is ideal for protecting areas often exposed to sun, such as the neck, ears, eyes, and scalp. A shade cap (which looks like a baseball cap with about 7 inches of material draping down the back and sides) is also good. These can be found at most outdoor clothing and sporting goods stores.
    • Baseball caps and visors also provide some protection to the front of the head and face, but do not cover the back of the neck. Try placing a bandana under your baseball cap.
  4. Wear Sunglasses
    • Wearing sunglasses with appropriate protection can help protect your eyes from sun damage.
    • Check the label to see that the sunglasses block 99 to 100 percent of UVA and UVB radiation. The sunglasses do not have to be expensive to protect your eyes. If there is no label do not buy the sunglasses.
    • Additionally, the darkness of a lens does not indicate UV ray protection -- protection comes from an invisible chemical applied to the lenses, not from the color of the lenses.
  5. Cover Up
    • Wear lightweight, loose-fitting, long-sleeved shirts, pants, or long skirts as much as possible when you are in the sun. Tightly woven cloth is best because most material and colors absorb or reflect rays. If you can see light through a fabric, UV rays can get through it, too.
    • Try not to wear wet clothes, such as a wet T-shirt, because wet clothes allow the suns rays to pass through more easily.
    • Some clothing is now available which is labeled as providing protection against the sun or UV radiation. This clothing is considered a medical device and is regulated by the FDA. If you are interested in these clothes, look for companies or labels that specialize in photoprotective clothing.
  6. Avoid Artificial Tanning
    • Many people believe that tanning beds are safe because they emit only UVA rays, once thought to be safe. Studies now report that UVA can cause serious skin damage, and may be linked to the most serious form of skin cancer, melanoma.
    • Experts advise avoiding any type of sunlamp for tanning. (See the article "Are Tanning Beds a Safe Alternative to the Sun?" in this newsletter for more information on these devices.)
    • Other tanning products claiming a safe alternative to the sun also carry risks. Tanning pills, for instance, contain carotenoid color additives, which are distributed through the body, especially in skin, making it orange. Although the FDA has approved such color additives for foods, it has not approved them for tanning products. At the high levels that are consumed in tanning pills, these additives may be harmful. Additionally, the main ingredient in tanning pills, canthaxanthin, can deposit in the eyes as crystals, which may cause injury and impaired vision.
    • Tanning accelerators, which claim to stimulate the body's own tanning process have been reported as ineffective and also may be dangerous. The FDA considers them unapproved drugs that have not been proven safe or effective.
    • Two other tanning products, bronzer and extenders, are considered cosmetic for external use, and do not provide any protection against the sun. These products can be washed off (bronzers) or wear off within a few days (extenders). The only color additive approved for extenders is dihydroxyacetone. Additionally, the chemicals in bronzers may react differently on various parts of the body, producing a tan of many shades.
  7. Check Skin Regularly
    • Check your skin regularly to improve your chances of finding precancerous skin conditions, such as actinic keratosis (a dry, scaly, reddish, slightly raised lesion) and skin cancer. The earlier you identify signs and see your health care provider, the better your chances are for successful treatment.
    • The best time to examine your skin is after a bath or shower. Get to know your birthmarks, moles, and blemishes so that you know what they usually look like and can identify any changes they undergo. Signs to look for are changes in size, texture, shape, and color, or a sore that does not heal. Call a doctor if you notice any changes, and ask your doctor to check for changes at your regular checkups (adapted from American Cancer Society, 1998).

Sun exposure depends on many things. It varies with the time of day, season, latitude, and altitude. High amounts of UV rays can penetrate clouds. Clouds, water, white sand, concrete, and snow all reflect UV rays and increase exposure. Exposure to the midday sun or for long periods of time is more damaging. (American Academy of Dermatology, Ultraviolet Index: What You Need to Know)

Early Detection of Skin Cancer

Early detection of skin cancer gives you the best possible chance for successful treatment. You should give yourself a skin exam at least once a month. Use a hand mirror to check your back side. Check for the following signs:

Beat the Heat

In addition to the dangers of UV radiation, there are other health problems that can result simply from heat, including heat rash, heat cramps, heat exhaustion, heat stroke, and dehydration. You can recognize and avoid these heat dangers by using a few preventive measures.

The normal human body temperature is 98.6 degrees Fahrenheit. During exercise, work in hot environments, or when the surrounding temperature is above 98.6 degrees Fahrenheit, the body temperature begins to rise. If the body temperature gets too hot, heat problems can occur, including heat cramps, heat exhaustion, and life-threatening heat stroke (Corbin, 1997).

Keeping Your Cool

If you did not sweat, you could cook yourself to death (Clark, 1997).

The human body has its own way of regulating body temperature and avoiding heat problems, most of the time. During exercise, work outside or in hot environments, or even during inactivity in hot weather, you perspire or sweat! The evaporation of this sweat results in cooling, which helps keep the body's temperature within normal limits. If the climate is both hot and humid, however, this evaporation process is less effective.

Excessive sweating or lack of fluid replacement (drinking water), may result in dehydration. A person who is dehydrated stops sweating, so evaporation can no longer be used to cool the body. This can result in the most dangerous type of heat problem -- heat stroke (Corbin, 1997).

As sweat evaporates, it cools the skin, which in turn, cools the blood, which cools the inner body. A body temperature higher than 106 degrees Fahrenheit damages the cells. At 107 degrees, protein coagulates (like egg whites do when they cook), and the cell dies (Clark, 1997).

The Word on Water (Fluid Replacement)

Water is one of the most important nutrients in your diet. You can survive for weeks without food, but only a few days without water. Drinking too little water, or losing too much through profuse sweating inhibits your ability to work or exercise at your maximum potential.

There are three main ways to know if you are getting enough water:

  1. Check your urine. If your urine is dark in color or small in quantity, it is concentrated with metabolic wastes, and you need to drink more fluids. Your urine should be a pale yellow color and normal quantity when you are getting enough fluids. If you are not going to the bathroom every 2 to 4 hours, you are not drinking enough.
  2. Weigh yourself. By weighing yourself before and after work or exercise, you can monitor the pounds lost during your activity. For every pound lost, you should drink at least 2 cups of fluid. In hot weather, those who work outside or exercise may find they've sweat off as much as 5 to 8 pounds. This is water loss, not fat loss.
  3. Monitor yourself. Monitor your feelings. If you feel chronically fatigued, lethargic, or have a constant headache, you may be dehydrated. Monitor yourself and others for impaired performance, heat cramps, chills, clammy skin, rapid pulse, gastrointestinal problems, dizziness, dry mouth, hallucinations, no sweat or urine, swollen tongue, unsteady walk, high body temperature, refusal of water, vomiting, changes in levels of consciousness. These may all be signs and symptoms of severe heat problems (American Red Cross, 1991; Clark, 1997).

Note: You should always replenish your fluids at regular intervals before you become thirsty. Thirst is not an indicator of when fluids are needed. Some individuals may even refuse water when under heat stress.

Drinking the Right Fluids

Adequate water replacement is the most important factor in preventing heat disorders (Hoeger, 1997).

A rule of thumb is to try to drink 4 ounces (i.e., 1/2 cup) of cool water every 15 minutes during work or exercise in a hot environment to prevent dehydration. Cold fluids seem to be absorbed more rapidly from the stomach than those that are warm or room temperature (Hoeger, 1997).

Commercial sports drinks can help to replace fluids as well, but should not contain more than 6 to 8% glucose or be high in fructose. Glucose concentrations higher than 8% will slow down water absorption when working or exercising in the heat (Hoeger, 1997).

Soft drinks contain between 10 to 12% glucose, which is too high for proper rehydration during work or exercise in the heat (Hoeger, 1997).

Additionally, caffeine is not advised due to its diuretic effect. If you choose to drink iced tea, for example, choose a decaffeinated type.

Alcoholic beverages should be avoided as a means for replacing fluids. Alcoholic beverages can impede performance, are high in calories, and low in carbohydrates. It is a myth that beer is a good sports drink, filled with carbohydrates, potassium, and B vitamins. In fact, beer is a poor source of carbohydrates (only 50 of the 150 calories in a beer are carbohydrates), and you would have to drink 11 cans of beer to get recommended intakes of some B vitamins. Beer also has a dehydrating effect because it causes frequent urination and loss of fluid; and pre-exercise alcohol can interfere with normal blood sugar control (Clark, 1997).

Consumption of salt or salt solutions are not necessary. The concentration of sodium in your blood actually increases during exercise because you lose proportionately more water than sodium. Your first need is to replace fluids. You will get adequate sodium in the foods you eat. In one study, even athletes who lost 6% of their body weight only lost 1 to 2 teaspoons of salt. Additionally, the less salt you eat, the less you lose because kidneys and sweat glands tend to conserve sodium when it is in short supply (Clark, 1997).

Other Heat Precautions

In addition to fluid replacement, other precautions should be taken to prevent heat disorders:

Steps to Cool the Body

In the event that you or someone you are with gets overheated, take the following steps:

Activity Ideas

A Raisin in the Sun

Materials: grapes and raisins (enough for each participant to have 2 to 3), Fry Now, Pay Later brochure. Contact the American Cancer Society for copies at (800) ACS-2345.

Audience: Hand out the grapes and raisins and ask the audience to inspect them. Ask the audience "What is the difference between the grapes and raisins?"

Answer: Human skin reacts the way grape skin reacts when too much time is spent in the sun without protection. The damage caused by the sun can result in the formation of skin cancer.

Audience: Ask participants how they can protect themselves from the hazards of the sun.

Answer:

  1. Limit the time spent in the sun during peak hours (10 a.m. to 3 p.m.).
  2. Wear protective clothing, such as light cotton, long-sleeved shirts and hats.
  3. wear sunscreen that has a minimum SPF of 15.

Handout: Pass out the brochure Fry Now, Pay Later.

Adapted from American Cancer Society, Texas Division, Inc., Cancer Concerns: Health Breaks for Cancer Control, September, 1996.

Check for Change

Materials: Assorted castoff clothing items: hats, scarves, jewelry, gloves, etc.; Melanoma/Skin Cancer: You Can Recognize the Signs brochure (code 904). Contact the American Cancer Society for copies at (800) ACS-2345.

Audience: Pair up the participants and give them 30 seconds to look at their partner and observe their appearance, especially clothing.

Have one person turn their back to the speaker and close their eyes. Have the other partner change an article of clothing or use the castoff clothing items.

Allow the person whose eyes were closed to look for the clothing change for 30 seconds.

Inform: Pass out the Melanoma/Skin Cancer: You Can Recognize the Signs brochure.

Inform participants of the need to look for changes in the skin's appearance. Changes can be signs of skin cancers. Stress the need to see a doctor if one of the changes discussed persists for a week or more.

Adapted from American Cancer Society, Texas Division, Inc., Cancer Concerns: Health Breaks for Cancer Control, September, 1996.

Short, but Sweet

Materials: Enough cookies for all participants, including a half-dozen burned (crispy) cookies; Melanoma/Skin Cancer brochure (code 904); Slip, Slap, Slop video (code P55). Contact the American Cancer Society for copies at (800) ACS-2345.

Activity: Pass out the tray of cookies, some of which are burned. Ask participants not to eat the cookies until everyone has one. Notice that the burned cookies are the last ones to be chosen.

Highlight: "No one likes to go out with a burned cookie!" Notice that the smaller the cookie is, the more likely it is to be burned. Small children burn more easily than adults, fair skinned people burn more easily as well.

Activity: Show the Slip, Slap, Slop video (code P55). This video is available through the American Cancer Society or in each District Extension Office.

Adapted from American Cancer Society, Texas Division, Inc., Cancer Concerns: Health Breaks for Cancer Control, September, 1996.

Extension Resources

Skin Cancer

Exhibits

Teaching Resources

Videos

Slides

Games

Herbal Update

Comfrey

This herb is considered to be hazardous because of documented cases of liver damage. Comfrey is believed to cause healing. It is used externally and internally.

Some species of comfrey are more toxic to the liver than others. There is no guarantee which combination of species anyone gets when they buy this or any herb. There is no quality control for processors of this or any herb. One reference points out that nightshade, which is deadly, closely resembles comfrey, and that inexperienced herbalists can mistakenly think they are supplying comfrey when they are really supplying nightshade (Tyler, 1993).

Websites with Reliable Information

References

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