SUN SAFETY: EXPOSURE, DAMAGE, AND PREVENTION

1. SUN SAFETY:EXPOSURE, DAMAGE, AND PREVENTION By Teresa PattonTraining and Staff DevelopmentOklahoma Dept. of Corrections

2. Course Information Course Author: Teresa Patton, Training Administration Course Issued: July 3, 2007 Course Credit: 30 minutes ORACLE Course Code: SAF199000 Data Sources: Photos: U.S. National Library of Medicine/National Institutes of Health (used by permission) MayoClinic, May 2006 abcnews, website Federal Trade Commission, website University Health Care, 2003 American Academy of Dermatology, 2006 VCU Massey Cancer Center, 2006 Wikipedia, website Texas Cooperative Extension, website

3. Performance Objectives At the conclusion of this course, students will be able to: 1. Identify the three types of ultraviolet rays. 2. Discuss the dangers of UVA and UVB rays. 3. Name the two common sun-induced types of skin damage. 4. Discuss the symptoms, treatment and prevention of a sunburn. 5. Describe the danger of indoor tanning devices. 6. Understand the SPF rating on sunscreen and its proper use. 7. Discuss additional protection from the sun, i.e. sunglasses, hats, and sun protective clothing. 8. Explain why children need special protection from UV rays. 9. Understand the UV Index and its significance. 10. Identify the three different types of skin cancer and why early detection is vital. 11. Discuss the importance of keeping skin healthy.

4. Sun Exposure, Damage, and Prevention The sun emits a warm golden cast that is very appealing. Many people cannot resist spending hours basking in its warmth – especially after being cooped up during those winter months. Warmer temperatures, particularly in the summer, bring the time to bare the pale parts that have been covered all winter long. So here’s a question: Is there a price for having too much fun in the sun?

5. Sun Exposure, Damage, and Prevention Yes – particularly if you are spending time outdoors without protecting yourself from the sun’s ultraviolet radiation. Energy from the sun reaches the earth as visible, infrared and ultraviolet (UV) rays. The three types of UV rays are: UVA, UVB, and UVC Only UVA and UVB ultraviolet rays reach the earth’s surface. The earth’s atmosphere absorbs UVC wavelengths.

6. Sun Exposure, Damage, and Prevention What you should know about UVA and UVB rays: UVB UVB rays cause a much greater risk of skin cancer than UVA. UVB affects the surface skin layer. The skin responds by releasing chemicals that dilate blood vessels. This causes fluid leakage and inflammation – better known as sunburn.

7. Sun Exposure, Damage, and Prevention UVA UVA rays also increase the damaging effects of UVB including skin cancer and cataracts. UVA penetrates into the deeper skin layers and damages the site where new skin cells are born. Wrinkles, age spots and sagging skin are the results of long term exposure to UVA radiation.

8. Sun Exposure, Damage, and Prevention UVA and UVB rays react with melanin, a chemical that is found in most people’s skin. Melanin is the first defense against the sun as it absorbs dangerous UV rays before they do serious harm to your skin. The concentration of melanin differs among individuals and varies with skin color – the darker your natural skin color, the more melanin your skin has to protect itself. Though skin damage can occur in any skin color, persons with light complexions are more susceptible.

9. Sun Exposure, Damage, and Prevention More than likely you are familiar with two of the more common sun-induced types of skin damage: sunburns and suntans We say “skin damage” because that is exactly what a sunburn or suntan is.

10. Sunburn A sunburn is the skin’s reaction to the ultraviolet (UV) radiation in sunlight. Eventually, UV light causes the skin to burn, bringing pain, redness and swelling. Depending on the severity of the burn, the dead, damaged skin may peel away to make room for new skin cells. Although the symptoms of a sunburn may fade after several days, the damage to your skin remains. Sunburn peeling. The dehydration of the epidermis causes the top layer to flake off.

11. Sunburn Sunburn photographed 2 days after a 5-hour sun exposure. The dark red area is sunburned. The normal-colored skin was covered by her suit during exposure. Sunburned feet. The burn can cause swelling or inflammation.

12. Symptoms of a Sunburn • Change in skin color ranging from pink to red to even purple • Skin feels hot to the touch • Pain • Swelling • Fluid-filled blisters that may itch and eventually pop or break • Broken blisters peel to reveal even more tender skin beneath Sun Fact: A sunburn can occur in less than 15 minutes and can take a few days or weeks to heal depending on the severity of the burn.

13. Self-Help Treatments There is no cure for a sunburn except time and patience. Following are some suggestions to utilize while the body heals: • Drink plenty of water because you’re probably dehydrated as well as sunburnt. • Gently apply cool or cold compresses. Alternatively, bathe the area in cool water. • Avoid using soap as this may irritate your skin. • Don’t apply butter to sunburnt skin. • Avoid greasy substances. They “seal” in the heat and cause further damage. • To avoid infection, do not break blisters or peel skin. • There are a range of products available that help to soothe sunburn – talk to your pharmacist or doctor for suggestions. • Keep out of the sun until every last sign of sunburn has gone.

14. Professional Treatment You should see your doctor or seek immediate professional treatment if you experience symptoms including: • Severe sunburn with extensive blistering and pain • Sunburn over a large area • Headache • Nausea and vomiting • Fever • Dizziness or altered states of consciousness Sun Fact: You’re more likely to get sunburned when you’re relaxing and taking it easy, such as watching outdoor sports or picnicking at the park.

15. Prevention is Best A mild sunburn can be treated at home, but severe and blistered burns need prompt medical attention. The long term effects of repeated bouts of sunburn include premature wrinkling and increased risk of skin cancer. Once the skin damage occurs, it is impossible to reverse. This is why prevention is much better than cure.

16. Suntan A suntan is the result of injury to the epidermis – the top layer of your skin. A tan develops when UV light accelerates the production of melanin. Melanin is the dark pigment in the epidermis that gives your skin its normal color. The extra melanin– produced to protect the deeper layers of your skin – creates the darker color of a “tan.” A suntan is your body’s way of blocking out the ultraviolet rays to prevent further injury to the skin, but the protection only goes so far.

17. Suntan Even those with darker skin types can burn with repeated exposures to UV light. This intense exposure can produce dry, rough patches, wrinkling, and other skin disorders. So even though people with darker skin can tan and tolerate longer periods of sun exposure without “burning,” the sun can still cause skin damage.

18. Suntan Any tan is a sign of skin damage. Indoor tanning devices also give off ultraviolet rays that can be as harmful as those from the sun. There is a huge myth that tanning beds are safe. They are not. It doesn’t matter whether you get radiation from the sun or a man-made source, it still does damage. Sun Fact: The UV radiation emitted by indoor tanning lamps is much more intense than natural sunlight.

19. Sunless Tanners While some people will opt for a quick session in a tanning bed, others are turning to sunless tanning creams to get that attractive golden glow. Getting your tan from a cream or lotion designed to make the skin appear darker is one way to bypass exposure to UV rays and is a safe thing to do. However, sunless tanners may think this self-made tan offers the same amount of protection as a base tan would and forgo using additional sunscreen. Using a self-tanner will not stop you from getting a sunburn. If you want to be tan, the safest way is by self-tanning, but you must also use sunscreen protection.

20. Sunscreens Practically everyone is susceptible to sun damage; however, some individuals are naturally more at risk based upon their skin color. Individuals with light complexions for example tend to burn more rapidly than those with dark complexions. Basically, the length and intensity of exposure combined with your body’s inherent risk of sun damage will determine the level of protection you need.

21. Sunscreens “Sun Protection Factor” (SPF) refers to a sunscreen’s ability to block harmful UVB rays. It does not relate to the ability of a product to block UVA rays. For example, with a SPF 5 rated sunscreen, you can theoretically stay outside in the sunlight fives times longer before getting a sunburn compared to the time required to get a sunburn without using the sunscreen. The higher the SPF number, the longer you are protected against sunburn damage. Sun Fact: To get maximum protection from your sunscreen, apply at least one large handful about 30 minutes before you go outside. Reapply after swimming, toweling dry or participating in any vigorous activity that causes heavy perspiration.

22. Sunscreens The actual length of protection will vary for each individual given the same SPF rating. For instance, if “Jack” tends to burn in 10 minutes with a SPF of 15, then the sunscreen will provide up to 150 minutes of sun protection. However, if “Jill” usually burns in 20 minutes and applies the same SPF product, Jill is protected for 300 minutes. It may not be fair, but it’s true: We’re not all equal under the sun!

23. Sun Protective Clothing Another way to protect skin from the harmful effects of the sun is to wear sun-protective clothing. These fabrics differ from typical summer fabrics in several ways: they generally have a tighter weave or knit and are usually darker in color. Sun-protective clothes have a label listing the garment’s Ultraviolet Protection Factor (UPF) value, that is, the level of protection the garment provides from the sun’s UV rays. The higher the UPF, the higher the protection from the sun’s UV rays. The UPF rating indicates how much of the sun’s UV radiation is absorbed by the fabric. For example, a fabric with a UPF rating of 20 only allows 1/20th of the sun’s UV radiation to pass through it. This means that this fabric will reduce your skin’s UV radiation exposure by 20 times where it’s protected by the fabric. A garment should not be labeled “sun-protective” or “UV-protective” if its UPF is less than 15. Sun-protective clothing may lose its effectiveness if it’s too tight or stretched out, damp or wet, and if it has been washed or worn repeatedly.

24. Sunglasses As you apply sunscreen to protect your skin, don’t forget sunglasses to protect your eyes. The same harmful rays that damage skin can also increase your risk of developing eye problems, such as cataracts – a clouding of the eye’s lens that develops over years. In the short-term, people who spend long hours on the beach or in the snow without adequate eye protection can develop photokeratitis, reversible sunburn of the cornea. This painful condition can result in temporary loss of vision. When sunlight reflects off of snow, sand and water, it further increases exposure to UV radiation. Everyone is at risk for eye damage from the sun year-round. The risk is greatest from about 10:00 a.m. to 4:00 p.m.

25. Sunglasses Your glasses should block both UVA and UVB rays. Do not assume that you get more UV protection from pricier sunglasses or glasses with a darker tint. Look for a label that specifically states that the glasses offer 99 percent to 100 percent UV protection. Sunglasses should be dark enough to reduce glare, but not dark enough to distort colors and affect the recognition of traffic signals. Tint is mainly a matter of personal preference. For best color perception, Prevent Blindness America recommends lenses that are neutral gray, amber, brown or green. People who wear contact lenses that offer UV protection should still wear sunglasses. Sun Fact: Some people choose sunglasses that wrap all the way around the temples to block light from entering from the sides of sunglasses. A hat with a three-inch brim can help block sunlight from overhead.

26. Special Protection for Children Estimates are that 50 to 80 percent of an individual’s lifetime sun exposure occurs by the age of 18. It is critical to apply sunscreens with a minimum SPF15 to children’s skin about 30 minutes before they go outdoors. Reapply sunscreens after they swim, towel off or play hard. Infants six months and younger should be kept out of direct sunlight altogether. Sunscreens may irritate baby skin, and infants’ developing eyes are particularly vulnerable to sunlight.

27. Special Protection for Children Begin NOW to teach your children to follow the “ABCs for Fun in the Sun:” A – AWAY Stay away from the sun in the middle of the day. B – BLOCK Use SPF15 or higher sunscreen. C – COVER UP Wear a T-shirt and a hat. Sun Fact: Children, as well as adults, should avoid the midday sun and its intense rays. Schedule outdoor time before 10:00 a.m. and after 4:00 p.m. (daylight savings time 9:00 a.m. to 3:00 p.m.).

28. UV Index In response to the increasing incidence of skin cancer, cataracts and other effects from exposure to the sun’s harmful rays, the National Weather Service, the U.S. Environmental Protection Agency and the Centers for Disease Control and Prevention collaborated on a sun-awareness information program. As a result of this collaboration, the National Meteorological Center of the National Weather Service developed the UV Index. The index is a next-day forecast that estimates the amount of UV radiation that will reach the earth’s surface providing important information to help you prevent overexposure to the sun’s rays. The index also includes the effects of cloud cover on the anticipated UV exposure level for the next day.

29. UV Index Exposure Categories

30. UV Index Do not rely upon temperature as an indication of sun UV intensity. The index can change everyday, just as the temperature does. You can find the UV index in a local paper, your weather channel or on the internet. Sun protection should be practiced year round, in all seasons, and even on cloudy days. Sun Fact: Snow skiers are at particular risk considering that ultraviolet radiation increases 4 to 5 percent with every 1000 feet above sea level.

31. Skin Cancer Skin cancer is a malignant growth on the skin. It is the fastest growing cancer in the United States and in the USA represents the most commonly diagnosed malignancy, exceeding lung, breast, colorectal and prostate cancer. In the US, over 1 million people will be diagnosed with skin cancer in 2007. There are three types of skin cancer: basal cell squamous malignant melanoma

32. Basal Cell Skin Cancer Basal cell skin cancer: can cause disfigurement. Flesh-colored, red or black, round bump with apearly border, develops into ulcerating sore. Basal cell is the most common skin cancer and 85% occur in the head and neck region. Basal cell carcinomas enlarge slowly and steadily and can invade neighboring tissue, like the eye, but they usually do not spread to distant parts of the body (metastasize). It is fairly easy to treat when detected early.

33. Squamous Skin Cancer Squamous skin cancer: Can be life-threatening.Thickened, red, scaly bump or wart-like growth,develops into a raised, crusted sore. Squamous skin cancer is the second most common form of skin cancer.  When identified early and treated promptly, the future is bright.  However, if overlooked, they are harder to treat and can cause disfigurement.  While 96 to 97 percent of SCCs are localized, the small percentage of remaining cases can spread to other parts of the body, and the results are often fatal.

34. Melanoma Skin Cancer Melanoma Skin Cancer: Potentially Deadly Look for changes in: COLOR - new color, black, brown, red, blue or white. Malignant melanoma is the least common skin cancer. If it is recognized and treated early, it is nearly 100 percent curable.  But if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal, accounting for 75% of the total number of skin cancer deaths.

35. Early Detection Physician examinations and frequent self-examinations are essential for early detection of skin cancer. The self-exam should be done with the aid of bright lights and two mirrors – a hand held and a full length. Undress completely. Look systematically from head to toe and make sure that you do not miss any areas. Do it the same way every time.

36. Early Detection Take a close look at all moles because this is where melanoma begins. The following, known as the ABCD’s, are warning signs of potentially cancerous moles: A – Asymmetry. Common moles are usually symmetric. Draw an imaginary line though the center of the mole. If one side is noticeably different from the other, the mole is asymmetric and may be a problem. B – Border. An irregular border that seems notched or indistinct is a warning sign. C – Color. Common moles are usually one color. Multiple hues or colors is a warning sign. D – Diameter. A diameter great than 6 mm is a warning sign. See examples on the next slide

37. Early Detection

38. Moles Normal mole: round or oval, even color.Many moles -increased risk of melanoma skin cancer. Watch for these changes in moles: Atypical mole: mix of browns, smudged border, often bigger than 6 mm (the size of a pencil eraser). increased risk of melanoma skin cancer Sun Fact: Forty to 50 percent of Americans who live to the age of 65 will have skin cancer at least once.

39. Keep Your Skin Healthy All people, regardless of age, should take the necessary steps to protect their skin. For the most complete sun protection, use all three of the previously discussed methods: • Avoid the sun during high-intensity hours. Reduce the time you spend outdoors during the hours of 10:00 a.m. to 4:00 p.m. • Wear protective clothing. Cover your skin with clothing such as long-sleeved shirts, long pants and wide-brimmed hats. Don’t forget sunglasses. • Use sunscreen. Apply sunscreen liberally 30 minutes before going outdoors so that your skin has time to absorb the sunscreen. Re-apply according to the directions on the label – usually about every hour. Sun Fact: Some medications can make skin more susceptible to sun damage.

40. Conclusion The majority of skin cancers are preventable. Taking basic precautions can significantly reduce the health effects of chronic sun exposure. Preventing sun-related skin damage must start early in age and continue throughout your lifetime. Sun Fact: Your skin has a memory. This means that your skin remembers the damage that is done to it over time, which can result in skin cancer later in life, premature wrinkling, etc.

41. Course Review Self-Test

42. Course ReviewSelf-Test Question #1: Is there a price for having too much fun in the sun? Yes – particularly if you are spending time outdoors without protecting yourself from the sun’s ultraviolet radiation. Click for answer

43. Course ReviewSelf-Test Question #2: True or False Melanin is the first defense against the sun as it absorbs dangerous UV rays before they do serious harm to your skin. True Click for answer

44. Course ReviewSelf-Test Question #3: True or False Two of the more common sun-induced types of skin damage are sunburns and suntans. True Click for answer

45. Course ReviewSelf-Test Question #4: True or False A sunburn can occur in about 30 minutes time of being outdoors unprotected. False. A sunburn can occur in less than 15 minutes and can take a few day or weeks to heal depending on the severity of the burn. Click for answer

46. Course ReviewSelf-Test Question #5: True or False A suntan is your body’s way of blocking out the ultraviolet rays to prevent further injury to the skin. True. But the protection only goes so far. Click for answer

47. Course ReviewSelf-Test Question #6: True or False To get maximum protection from your sunscreen, apply at least one large handful about 10 minutes before you go outside. False. Sunscreen should be applied about 30 minutes before venturing outside. Click for answer

48. Course ReviewSelf-Test Question #7: True or False Everyone is at risk for eye damage from the sun year-round. True Click for answer

49. Course ReviewSelf-Test Question #8: True or False Infants six months and younger should be kept out of direct sunlight. True. Sunscreens may irritate baby skin, and infants’ developing eyes are particularly vulnerable to sunlight. Click for answer

50. Course ReviewSelf-Test Question #9: True or False The weather temperature is a reliable indication of the sun’s UV intensity. False. The sun’s UV index can change everyday, just as the temperature does. Click for answer