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Sun Sensitivity: Know Your Meds & Their Side Effects

This past October I wrote a blog about drugs potentially causing photosensitivity – a heightened sensitivity to exposure to UVR.  I gave a general overview of the types of drugs – antibiotics, psoralens and diuretics that can increase the skin’s susceptibility to reddening and burning from UVR exposure.  I also discussed the difference between photosensitivity and phototoxic and urged that you know the problems or side effects associated with any medication you take.

Pharmaceutical companies include warnings about sun sensitivity in the brochures found in the packaging for most medicines.  However, often people don’t thoroughly read these documents.  Further, many people don’t realize that vitamin supplements can also cause photosensitivity.

Here are three important websites that can help you identify any drug, supplement or herb that may cause photosensitivty .

www.MedicineNet.com lists 2,500 common drugs with descriptions of uses, and advice for how to use, side effects, precautions, drug interactions, overdose, notes, missed doses and storage.  This list has clearly been organized and written for the lay person.  The advice is clear and very helpful, and while the number of drugs covered is small in comparison to other websites, the information is extremely comprehensive.

According to the home page, MedicineNet.com is a “Nationally recognized, Doctor-Produced by a network of over 70 U.S. Board Certified Physicians… Loaded with content produced by practicing physicians – yet focused towards the general public – MedicineNet.com is the Internet’s comprehensive source for people who want to research a variety of medical and health subjects. Individuals can peruse the site at their own pace, searching for information that will enlighten their decision making processes or simply satisfy their curiosity. They can research ailments, treatments, and medications. Moreover, when the search for one answer raises even more questions, they can research those questions with the click of a mouse.”

I like the fact that this website is interactive and you can ask questions directly.  If you are concerned about whether a drug or supplement you are taking can cause sun sensitivity, go to this website and ask.

www.medlineplus.gov was developed by and updated daily by the U.S. National Library of Medicine and the National Institutes of Health.  Its purpose is to provide as much information as possible so patients can make informed decisions.  It provides an extensive list of drugs, supplements and herbal medicines with descriptions of ingredients, uses, and side effects, including photosensitivity.  There are articles, studies and reviews of clinical trials, all written for the lay person.  It is an easy to use web-site and you will likely find the information you want.  It is not, however, interactive.

www.drugdigest.org, created by Express Scripts, provides vital information about most drugs on the market today.  Thousands of medicines and supplements are listed alphabetically, each with a brief description of ingredients and possible side effects, including photosensitivity.   This is a public service provided by Express Scripts and while it is probably used most often by pharmacists, it is an important source for locating information about medicines that may not be as common as those listed on other websites.

It is important to know your risk factors for skin cancer. Photosensitivity is a risk factor.  Check all medications and supplements to find out if you have an increased risk for burning or sun sensitivity.

Be SunAWARE and be safe.

Four Types of Melanomas

SunAWARE, as you know, was developed to help fight skin cancers.  The SunAWARE blog hopefully provides timely insights into the numerous issues associated with both prevention and detection of the disease, as well as providing solid information about what is happening in the skin care community.  Today I decided that, while readers can easily go to the Skin Cancer Foundation or to the American Academy of Dermatology for similar information, it is important to give you a description of the most deadly form of skin cancer as a reminder that this is not just a intellectual exercise, it is real and it can be life threatening.

Melanoma is the deadliest form of skin cancer.  It is categorized into four basic types.  The first three begin in a localized area at the surface of the skin and are called “in situ.” These become invasive if left untreated, but can generally be cured when treated early.  The fourth type of melanoma, nodular melanoma, is the most aggressive and, as it is invasive from the start, is the most dangerous. (Thanks to the American Academy of Dermatology’s Skin Cancer Net for these pictures.)

Superficial spreading melanoma. While this melanoma is the type most often found amongst young patients, according to the Skin Cancer Foundation, it is accounts for 70 percent of all melanomas diagnosed.  It is easy to detect and treat early if you are careful to watch for changes in your skin.  Superficial spreading melanoma acts as its name suggests – it spreads along the surface of the skin before penetrating more deeply.  It usually takes the form of a flat or slightly raised patch with colors that vary from white to black with irregular borders.  It may take take the form of an older mole that has changed or a new one that has appeared.  It can be found anywhere on the body, but is common on the legs of women, and on men’s torsos.  They are also found on the upper backs and shoulders of both men and women, which suggests it would be useful to have someone periodically check these areas for you.

Lentigo maligna.  This melanoma is most often found amongst the elderly, but like superficial spreading melanoma, it can be found in all ages.  Fortunately, lentigo meligna stays close to the surface of the skin for some time before penetrating more deeply, which mean you can detect it early and treat it before it spread.  It is found on parts of the body that are most often exposed to UVR and appears flat or slightly elevated, often on the face. It is usually an uneven or mottled tan, brown, or dark brown.  This will become an invasive melanoma if left untreated.

Acral lentiginous melanoma. This melanoma is perhaps one of the most sinister as it is often mistaken for a bruise or other skin problem.  It is the most common melanoma found in African-Americans, and it usually appears under the nails or on the soles of feet or palms of hands, as a black or brown discoloration.  It spreads superficially over the skin before penetrating more deeply.  Unfortunately, as most education about skin cancer has not traditionally been directed at dark-skinned people, it is often not detected until its later, more life threatening stages.

Nodular melanoma.  This is mainly found in the elderly and is perhaps the melanoma most people think of when discussing the disease.  This is the most aggressive melanoma and is usually invasive by the time it is diagnosed.  A bump which is often black, but can be tan, red, brown, blue, gray or white, is the malignancy.  According to the Skin Cancer Foundation, it is most frequently found on the legs, arms and torso and in found in 10 to 15 percent of melanoma cases.

See your dermatologist immediately if any of these symptoms appears. And, remember,  an important step in SunAWARE is:

R- Routinely check your skin, be aware of the need for vitamin D, and report any concerns to your health care provider.

Be SunAWARE and be safe!

Broad Sun Protection Message Needed in the U.S.

Over the last three decades it has not been difficult to persuade different segments of the American public that exposure to the sun causes skin problems.

This has been common knowledge since the 1980’s when the pharmaceutical companies launched an effective and on-going campaign urging the use of sunscreens, especially for children.  Providing protection with a lotion was an easy concept to grasp and it became routine for many to rely upon it for total sun protection.  Now, however, as the numbers of skin cancers have continued to escalate in this country, the use of sunscreen, while still considered important, is not regarded as the first line of protection against skin cancer.  (The issues surrounding the use of sunscreen are well documented by the medical and research communities.)

In the same period that Americans were learning about the importance of sunscreen, the state of Victoria in Australia recognized an epidemic of skin cancers in that country. It reacted by developing the “Slip Slop Slap” campaign which in 1981 became the basis for a national educational program. The “Slip Slop Slap” slogan and its mascot “Sid,” a carton seagull are credited with changing attitudes and behaviors in Australia resulting in a decrease in squamous cell and basal cell carcinomas, although the incidence of melanoma has continued to increase.

The “Slip Slop Slap” slogan promoted the use of several different methods of sun protection including sunscreen, sun protective clothing and hats.  Then, in 2007, Australian health authorities recognized that the advice contained in “Slip Slop Slap” was too limited and amended it to include “Seek and Slide,” a reference to seeking shade and sliding on sunglasses.

As various concerned communities in the U.S. now grapple with how to fight a similar epidemic of skin cancers, it is logical to look to Australia for answers and to learn what worked, how it worked and what challenges educators face.

Many organizations concerned with the disease assume that simply adopting the Australian “Slip Slop Slap” message is the best and easiest approach to educating the general public here.  And, they are right in this regard:  the U.S. does need an on-going educational campaign under the umbrella of one consistent message that can begin to slow the epidemic of skin cancers here, estimated at more than one million annually. However, as the Australians learned with the original “Slip Slop Slap” campaign, it is vital that the message be broad enough to encompass complete medical advice while simple enough to remember and act upon.

In addition, it’s important to recognize the lessons from our own history. As we have seen, the heavy promotion of sunscreen in the 1980s convinced a vast portion of the public that sunscreen provides complete sun protection. It does not and today, these are attitudes the skin cancer communities are working hard to change.

We believe lawmakers, educators, public policy makers, the medical and research communities and health activists should come to a general agreement that a national education campaign unified under a simple, easy to remember message is a sound public policy response to the epidemic of skin cancer in the U.S.  The recent general agreement on the dangers posed by tanning beds is a solid first step in that process. However, we think it’s vital that we not stop with reclassifying tanning beds or limiting their use. They are only part of an overall public education problem.

In the coming weeks, we will be discussing various aspects of the need for a national educational message, what that message should be, and how it can be backed by solid programs and materials. In the meantime, follow the simple steps outlined in SunAWARE and be safe.

SunAWARE: Essential Sun Protection Advice for OTRs

A group I have not yet discussed but one which is in desperate need of skin cancer prevention and detection education are

organ transplant recipients (OTRs).

More than 230,000 people in the United States have received donated solid organs such as kidneys, pancreases, livers, lungs, or hearts and who are at exceptionally high risk for all types of skin cancers.

According to the National Cancer Institute, the immunosuppression associated with organ transplants, contributes to the formation of nonmelanoma skin cancers.  The NCI estimates that among solid organ transplant recipients, the risk of squamous cell carcinoma is 65 to 250 times higher, and the risk of basal cell carcina is 10 times higher than that observed in the general population

“With the long-term success of organ transplantation improving to 90%, more organ transplant recipients (OTR) will be at continued risk of skin cancer.  Skin cancer (squamous cell cancer, basal cell cancer, or melanoma) has serious outcomes ranging from scarring and cosmetic disfigurement to death.  In OTR, skin cancer is highly aggressive and hard to treat; therefore prevention and detection are critical for improving survival,” according to the NCI.

For organ transplant recipients, adequate information about skin cancer prevention and detection is essential, including the five steps outlined in SunAWARE.

You can also help.  If you know someone who is an organ transplant recipient, please introduce them to SunAWARE and the advice contained in this blog. Reinforce the message yourself by following the advice.  Habits to prevent and detect skin cancer should be practiced by everyone. Keep extra clothing, hats, sunscreen, shade tools, etc., with you and share them.  Make being SunAWARE as normal for the transplant recipient as it is for you.

Be SunAWARE. Be safe.

SunAWARE Endorses Tanning Tax

Today, SunAWARE formally endorsed the proposed tanning tax. Here is the text of the press release we issued.

MINNEAPOLIS, January 25, 2010—SunAWARE, a not-for-profit educational advocacy group for the prevention and detection of skin cancer, today endorsed the proposed 10 percent federal tax on tanning beds.

“Until Congress enacts laws banning access to tanning beds for all minors, the proposed tax should act as a deterrent, especially for young people,” said Mary Barrow, executive director of SunAWARE, based in Minneapolis.

On an average day in the U.S., more than one million people tan, Barrow said. Of those, nearly 70 percent are girls and women, most between 16 to 29 years of age.

In July 2009, the International Agency for Research on Cancer (IARC), a division of the World Health Organization, announced a finding that UV radiation (UVA and UVB) from tanning devices is “carcinogenic to humans.” Other carcinogenic agents in the same risk group as tanning devices include cigarettes, mustard gas, and plutonium, according to the IARC.  The World Health Organization has recommended that individuals under eighteen years old should not use tanning beds.

During the most recent 20-year period (1984-2004) studied by the National Cancer Institute’s Division of Cancer Epidemiology and Genetics, the annual incidence of invasive melanoma, the most deadly form of skin cancer, increased by 50 percent among Caucasian women in the United States between the ages of 15 and 39.

“The tanning industry has attempted to portray the proposed tax as a punitive measure against small business,” Barrow said. “We do not seek punishment, we seek good health safeguards for susceptible, socially driven teen girls. In the absence of federal access restrictions, we seek to create an economic reason for young women to think twice before stepping into a tanning bed.”

Barrow noted that a study by IARCA also demonstrated that people who use tanning beds before age 30 increase their chance of developing melanoma by 75 percent.

In large powerful tanning units, the UVA irradiation intensity may be 10-15 times stronger than that of the midday sun. Such powerful sources of UVA radiations do not exist in nature. The UVA doses per unit of time received by the skin during a typical sunbed session are far higher than what is experienced during daily life or during sunbathing outdoors. “There is no such thing as a safe tan,” Barrow said.

The Skin Cancer Foundation is spearheading a Congressional letter writing campaign urging Congress to pass the tanning tax. “We believe this is an important effort and deserving of public support. Add your voice to the growing chorus demanding this tax,” Barrow said.

Mary Barrow is the executive director of SunAWARE, a not-for-profit educational advocacy group. She is the creator of the SunAWARE acronym outlining simple steps to prevent and detect skin cancer and is the author of several books including “Sun Protection for Life: Your Guide to a Lifetime of Healthy and Beautiful Skin” (New Harbinger Press). Her blog can be found at http://www.sunaware.org/blog and you can follow her on twitter @sunaware.

Vitiligo Possible Risk Factor for Melanoma

When you routinely check your skin it is important to understand any risk factors for skin cancers.  Risk factors include:

• The presence of dysplastic nevi (moles that tend to be larger than ordinary ones)
• Having more than 50 moles
• Fair skin
• Personal or family history of melanoma or skin cancer
• Weakened immune system
• Severe blistering sunburns
• UVR including exposure to sunlamps and tanning beds.

One which many may not be aware of is Vitiligo.

The Mayo Clinic describes Vitiligo (vit-ih-LI-go) as “a condition in which your skin loses melanin, the pigment that determines the color of your skin, hair and eyes. Vitiligo occurs when the cells that produce melanin die or no longer form melanin, causing slowly enlarging white patches of irregular shapes to appear on your skin.”

While there is some question about whether individuals with Vitiligo are at an increased risk for non-melanoma skin cancers, there is evidence that these individuals are at a higher risk for melanoma. The following are comments given to the American Vitiligo Research Foundation by Professor KU Schallreuter: “The observation that melanoma is more frequent in patients with vitiligo originates from a study which included 623 Caucasian patients with melanoma of the Oncology Clinic at the Department of Dermatology at the University of Hamburg/Germany (Schallreuter KU et al, Dermatologica (1991).

“In this study 11/623 patients with melanoma had a true vitiligo long before their melanoma was diagnosed. Considering that 1 in 200 has vitiligo and 1 in 12,000 develops melanoma, these results suggested a significantly higher risk to develop melanoma for patients with vitiligo and fair skin (Schallreuter KU et al, Dermatologica (1991).

“In our Institute for Pigmentary Disorders we have indeed found in 2 Caucasian patients with vitiligo melanoma in a patient group of 1800 Caucasian patients with vitiligo supporting the above findings (Schallreuter KU, unpublished results).

“Based on the above results the take home message and recommendation is that patients who have vitiligo should undergo an annual total body examination at their Dermatologists in order to recognise a possible melanoma as early as possible.”

Vitiligo is not a curable disease, nor is it life-threatening.  It is however, a difficult disease to live with as the appearance of individuals who have it can be misunderstood.  The American Vitiligo Research Foundation is a strong source for information and support.

Routinely checking skin is a vital part of detecting skin cancers, particularly melanoma.  Know your risk factors – skin type, family history, vitimin D needs and medical conditions.  Report any concerns to your health care provider.

Be SunAWARE.  Be safe.

Anti-Tanning Beds Grassroots Initiative

We are seeing more evidence of grassroots initiatives aimed at protecting children against the dangers of tanning beds.

Yesterday, the Delaware Country Health Department (Muncie, Indiana) announced steps it would take to protect minors in its jurisdiction. The Department passed a resolution authorizing its staff to inspect tanning salons. The move came after Delaware County Commissioners indicated they would not pass a similar ordinance.

In Indiana, state law requires children 16 and under using a tanning bed to be accompanied by a parent or guardian and requires written parental consent under 18. State law also requires tanning bed operators to post warning signs and regulates eyewear, maintenance, exposure limits, training and other aspects of running a tanning business.

The problem, according to the Delaware County Health Department, is that state law isn’t being enforced.
In Indiana, tanning salons are regulated by the State Board of Cosmetology Examiners. However, the state employs only four inspectors and they are responsible not only for tanning salons, but for beauty salons, nail parlors and other licensed establishments.

Dr. Gerard Costello, a member of the county health board, said: “Imagine if the state employed only four state police to enforce traffic laws or only four excise police to enforce liquor laws, there would be an uproar.”

The county health department took the step only after county commissioners indicated they would not pass a similar ordinance. According to quoted statements by commissioners, they felt there is already too much government intrusion into the lives of private citizens and that it is the responsibility of parents whether to allow their children to use tanning beds.

This, of course, is nonsense.

Last July, the International Agency for Research on Cancer, part of the World Health Organization, concluded that tanning devices were “carcinogenic to humans.” The agency recommended banning commercial indoor tanning for those younger than 18. And, study after study has linked indoor tanning to increases in skin cancer among people under 35.

We protect children from cigerettes and alcohol. We don’t allow them to drive before a certain age. Why is protecting them from the dangers of UVR from tanning any different?

The names of the members of the Delaware County Board of Health are: Judith Harris, Chairperson, Gerald Costello, M.D., Ben Delk, Ruth Anne Reagan, RN, John Peterson, M.D.,
Phyillies Burks Beatty and Terri Townsend, RN.

They deserve the thanks of every parent they serve.

Australian Tanning Laws: The Good and Bad News

Report: Business Ignoring New Tanning Regs

News reports from Australia highlight the difficulties in enforcing tanning bed restrictions and underline the need for strong, national support for public education on the dangers of unprotected UVR exposure.

New regulations introduced in May, 2009 under the Australian Radiation Control Act prohibit children under 18 and people with very fair skin from using tanning beds or what the Australians call “solariums.”  The regulations also require solarium operators  display proper warnings about the risks of ultraviolet radiation exposure, limit the amount and frequency of solarium use, provide protective eyewear and ensure proper supervision. (One of the major concerns in regulations being considered in the UK are the number of coin operated tanning beds where there is no supervision.)

A government audit of 89 solarium businesses found that 98% of  operators failed to comply with the new regulations. The findings were called “appalling” by the Minister of Health.

Last year, the World Health Organization placed tanning beds in the highest cancer-risk category alongside smoking and asbestos.  In 2007, the Queensland Institute for Medical Research found that people younger than 35 who used a tanning bed increased their risk of developing melanoma by 98 percent. These findings prompted the tough new regulations in Australia which has waged a vigorous war against skin cancer for decades.

No such broad legislation is pending in the United States. However, proposed health care legislation contains a 10% tax on tanning bed usage and a number of states and local counties and municipalities are moving to restrict its usage. In addition, we believe there is something of a grassroots effort opposing tanning beds. We recently heard from a Washington man who on his own is convincing local clubs to phase out tanning beds.

The good news is that although it appears that businesses are not complying with the new regulations, Australians are beginning to avoid tanning. The same report detailing the level of compliance showed a thirty percent reduction in tanning bed usage in Australia since the new regulations were adopted.

For a number of years, we have been saying that we need a strong, unified educational message on the dangers of unprotected UVR exposure here in the United States. The Australian report proves our point that an informed public is a proactive public. That is, despite non-compliance by business, an educated Australian public is moving away from this dangerous practice.

Broad, sustained and on-going public education is the best hope for combating the epidemic of skin cancer. Fritz, referenced above, is a model of what an individual can do in his or her community.

Use the five steps in SunAWARE to create programs for your schools and your day care centers.  Help everyone understand why UVR from any source can be harmful and how following the steps in SunAWARE can help prevent and detect skin cancers. And, if you need help, contact us at sunaware1@gmail.com

Be SunAWARE.  Be Safe.

US Needs National UVR Protection Policies

While researching advice available from around the world, I am continuously discouraged that the United States

does not have government policies about sun protection for outdoor workers.  In Australia, the Occupational Health and Safety Act 2000 makes it a law that employers have a duty towards employees to protect their health and safety.

That law mandates employers:
– Provide and maintain equipment needed to protect outdoor workers from the sun;
–Set up systems of work to reduce the amount of time workers spend in the sun;
–And, provide any information, instruction, training and supervision needed.

And the onus is not just on the employers.  “Once you do your bit, the law says your employees must cooperate”  says WorkCover NSW, a publication of the New South Wales government.

Other countries, including Australia, Germany, the United Kingdom, Bolivia and France are members of the INTERSUN Programme established during the 1992 United Nations Conference on Environment and Development. The program has three primary goals:

In the U.S. it can be argued that the proposed tax on tanning beds contained in healthcare reform legislation is an indirect way of approaching a  national policy on UVR protection.

However, the issue should be squarely addressed. Much of the work in this area has already been done. U.S.  legislators need to look at the facts and figures about skin cancers and get motivated.

Be SunAWARE and be Safe.

Sunglasses for Children Help Provide Complete Sun Protection

Yesterday the American Academy of Ophthalmology released a statement reminding parents that sunglasses aren’t

just for sunny days. According to the Academy, sunglasses are also needed during the winter season when reflections from snow, water, sand or pavement can intensify UV rays to extremely high levels.

The AAO statement is backed by the American Academy of Pediatrics which says that children’s eyes are at increased risk for permanent damage from sunlight until they are at least 10 years old, because their eyes are highly sensitive and still developing. Furthermore, 90% of total lifetime damage from the sun’s harmful rays occurs by age 18.

It may seem counter-intuitive, but sunglasses are needed during the winter when reflections from snow, water, sand or the pavement can intensity UV rays to extremely high levels. In addition, the sun’s rays pass right through haze and thin clouds.

Although SunAWARE is a not-for-profit organization, we do feel it’s occasionally appropriate to mention products sold by our sponsors. Coolibar, a sun protective clothing company headquarted in Minneapolis, sells sun glasses for infants and children. Not only are these low cost, they protect against 100 percent of UVA and UVB.

But whether you purchases sunglasses for your infants and/or children from Coolibar or another company, please be aware that they are important for complete sun protection.

Be safe. Be SunAWARE.