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Seven Steps to Safer Sunning

Put away the baby oil. Toss out that old metal sun reflector. Cancel your next appointment to the local tanning salon.

These are new days with new ways of sunning, and the practices that traditionally have gone into obtaining the so-called "healthy tanned" look are on the verge of fading into history.

In their place: safer sun practices that preserve people's natural skin color and condition.

That's what health experts are hoping for as the evidence against exposure to the sun and sunlamps continues to mount. Both emit harmful ultraviolet (UV) radiation that in the short term can cause painful sunburn and in the long term may lead to unsightly skin blemishes, premature aging of the skin, cataracts and other eye problems, skin cancer, and a weakened immune system.

The problems may become more prevalent, too, if, as some scientists predict, the Earth's ozone layer continues to be depleted. According to the Environmental Protection Agency, scientists began accumulating evidence in the 1980s that the ozone layer--a thin shield in the stratosphere that protects life from UV radiation--is being depleted by certain chemicals used on Earth. According to the most recent estimates from the National Aeronautics and Space Administration, the ozone layer is being depleted at a rate of 4 to 6 percent each decade. This means additional UV radiation reaching Earth's surface--and our bodies.

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

You may have already started to take precautions. But are you doing all you can?

The following recommendations come from various expert organizations, 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. FDA regulates many items related to sun safety, including sunscreens and sunblocks, sunglasses, and sun-protective clothing that makes medical claims. The agency also sets performance standards for sunlamps.

Here are seven steps to safer sunning:

1. Avoid the sun.

This is especially important between 10 a.m. and 3 p.m., when the sun's rays are strongest. Also avoid the sun when the UV Index is high in your area.

The UV Index is a number from 0 to 10+ that indicates the amount of UV radiation reaching the Earth's surface during the hour around noon. The higher the number, the greater your exposure to UV radiation if you go outdoors. The National
Weather Service forecasts the UV Index daily in 58 U.S. cities, based on local predicted conditions. The index covers about a 30-mile radius from each city. Check the local newspaper or TV and radio news broadcasts to learn the UV Index in your area. It also may be available through your local phone company and is available on the Internet at the National Weather Service Climate Prediction Center.

Don't be fooled by cloudy skies. Clouds block only as much as 20 percent of UV radiation. UV radiation also can pass through water, so don't assume you're safe from UV radiation if you're in the water and feeling cool. Also, be especially careful on the beach and in the snow because sand and snow reflect sunlight and increase the amount of UV radiation you receive.

People with darker skin will resist the sun's rays by tanning, which is actually an indication that the skin has been injured. Tanning occurs when ultraviolet radiation is absorbed by the skin, causing an increase in the activity and number of melanocytes, the cells that produce the pigment melanin. Melanin helps to block out damaging rays up to a point.

Those with lighter skin are more likely to burn. Too much sun exposure in a short period results in sunburn. A sunburn causes skin redness, tenderness, pain, swelling, and blistering. Although there is no quick cure, the American Academy of Dermatology recommends using wet compresses, cool baths, bland moisturizers, and over-the-counter hydrocortisone creams.

Sunburn becomes a more serious problem with fever, chills, upset stomach, and confusion. If these symptoms develop, see a doctor.

2. Use sunscreen.

With labels stating "sunscreen" or "sunblock," these lotions, creams, ointments, gels, or wax sticks, when applied to the skin, absorb, reflect or scatter some or all of the sun's rays.

Some sunscreen products, labeled "broad-spectrum," protect against two types of radiation: UVA and UVB. Scientists now believe that both UVA and UVB can damage the skin and lead to skin cancer.

Other products protect only against UVB, previously thought to be the only damaging type.

Some cosmetics, such as some lipsticks, also are considered sunscreen products if they contain sunscreen and their labels state they do.

Sunblock products block a large percentage of UV radiation.

FDA requires the labels of all sunscreen and sunblock products to state the product's sun protection factor, or "SPF," from 2 on up. The higher the number, the longer a person can stay in the sun before burning. In a 1993 tentative final monograph, FDA suggested 30 as the upper SPF limit because it was felt that anything above this offers little additional benefit and might expose people to dangerous levels of chemicals.

FDA also advised manufacturers that "water-resistant" or "sweat-resistant" products must list an SPF for both before and after being exposed to water or sweat. FDA also proposed that products claiming to be sunblocks have an SPF of at least 12 and contain titanium dioxide, the only opaque agent that blocks light. Also, any tanning product that doesn't contain a sunscreen would have to state on the label that the product does not contain a sunscreen, according to the tentative final monograph.

Manufacturers may already be following these recommendations.

Experts recommend broad-spectrum products with SPFs of at least 15. They also suggest applying the product liberally--about 30 milliliters (1 ounce) per application for the average-size person, according to The Skin Cancer Foundation--15 to 30 minutes every time before going outdoors. It should be applied evenly on all exposed skin, including lips, nose, ears, neck, scalp (if hair is thinning), hands, feet, and eyelids, although care should be taken not to get it in the eyes because it can irritate them. If contact occurs, rinse eyes thoroughly with water.

Sunscreens should not be used on babies younger than 6 months because their bodies may not be developed enough to handle sunscreen chemicals. Instead, use hats, clothing and shading to protect small babies from the sun. If you think your baby may need a sunscreen, check with your pediatrician.

For children 6 months to 2 years, use a sunscreen with at least an SPF of 4, although 15 or higher is best.

Use sunscreen products regularly on children, advises Stephen Katz, M.D., Ph.D., director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases and chief of the National Cancer Institute's dermatology branch. "Get them used to it, so they can use it regularly like toothpaste," Katz says.

3. Wear a hat.

A hat with at least a 3-inch brim all around is ideal because it can protect areas often exposed to the 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 sides and back) also is good. These are often sold in sports and outdoor clothing and supply stores.

A baseball cap or visor provides only limited protection but is better than nothing.

4. Wear sunglasses.

Sunglasses can help protect your eyes from sun damage.

The ideal sunglasses don't have to be expensive, but they should block 99 to 100 percent of UVA and UVB radiation. Check the label to see that they do. If there's no label, don't buy the glasses. And, don't go by how dark the glasses are because UV protection comes from an invisible chemical applied to the lenses, not from the color or darkness of the lenses.

Large-framed wraparound sunglasses are best because they can protect your eyes from all angles.

Children should wear sunglasses, too, starting as young as 1, advises Gerhard Cibis, a pediatric ophthalmologist in Kansas City, Mo. They need smaller versions of real, protective adult sunglasses--not toy sunglasses. Kids' sunglasses are available at many optical stores, Cibis says.

Ideally, says the American Academy of Ophthalmology, all types of eyewear, including prescription glasses, contact lenses, and intraocular lens implants used in cataract surgery, should absorb the entire UV spectrum.

You may want to put sunscreen on the eyelids and around the eyes, too, even if you're wearing sunglasses. According to Cibis, sunglasses prevent UV rays from getting into the eyes; they won't help protect the skin around them.

5. Cover up.

Wear lightweight, loose-fitting, long-sleeved shirts, pants or long skirts as much as possible when in the sun. Most materials and colors absorb or reflect UV rays. Tightly weaved cloth is best.

Avoid wearing wet clothes, such as a wet T-shirt, because when clothes get wet, the sun's rays can more easily pass through. If you see light through a fabric, UV rays can get through, too.

FDA's policy is that so-called "sun-protective" clothing will be regulated by the agency only if the clothing's label makes a medical claim, such as that it prevents skin cancer.As of early 1997, FDA had not approved any clothing for medical uses.

6. Avoid artificial tanning.

Many people believe that the UV rays of tanning beds are harmless because sunlamps in tanning beds emit primarily UVA and little, if any, UVB, the rays once thought to be the most hazardous. However, UVA can cause serious skin damage, too. According to some scientists, UVA may be linked to the most serious form of skin cancer, melanoma. A 1996 unpublished risk analysis by FDA scientists Sharon Miller, Scott Hamilton and Howard Cyr, Ph.D., concluded that people who use sunlamps about 100 times a year may be increasing their exposure to "melanoma-inducing" radiation by up to 24 times compared with the amount they would receive from the sun. This would depend on the type of sunlamp used and whether sunscreen is used regularly. The authors note that home users are a major concern because they may use their sunlamps as often as every day. But, Miller said, "This analysis was based on data from a nonmammalian animal model and the assumption that cumulative UV exposure--not just exposure that resulted in sunburns--contributes to the development of melanoma. The dose-response behavior of melanoma is not well understood, so our results must be regarded with caution."

Because of sunlamps' dangers, health experts advise people to avoid them for tanning.

Sunlamps remain on the market because, according to George Jan, Ph.D., a physicist in FDA's Center for Devices and Radiological Health, they represent an alternative to the sun, and unlike the sun, can be regulated to promote greater safety.

Under FDA regulations, sunlamp products must:

• have a timer to limit the amount of exposure a person can receive in one session
• have a label with recommended exposure position or distance from the sunlamp to reduce the risk of overexposure, even when the timer is set at its maximum limit
• limit the amount of short-wave UV radiation emitted from the product
• come with UV-blocking goggles, which the user should always wear
• carry a prominent warning about the dangers of overexposure, especially to those who are sensitive to UV radiation
• provide information on proper use.

Several products that claim to give a tan without UV radiation carry safety risks, too. These include so-called "tanning pills" containing carotenoid color additives derived from substances similar to beta-carotene, which gives carrots their orange color. The additives are distributed throughout the body, especially in skin, making it orange. Although FDA has approved some of these additives for coloring food, it has not approved them for use in tanning agents. And, at the high levels that are consumed in tanning pills, they may be harmful. According to John Bailey, Ph.D., acting director of FDA's Office of Cosmetics and Colors, the main ingredient in tanning pills, canthaxanthin, can deposit in the eyes as crystals, which may cause injury and impaired vision. There also has been one reported case of a woman who died from aplastic anemia, which her doctor attributed to her use of tanning pills.

Tanning accelerators, such as those formulated with the amino acid tyrosine or tyrosine derivatives, are ineffective and also may be dangerous. Marketers promote these products as substances that stimulate the body's own tanning process, although the evidence suggests they don't work, Bailey says. FDA considers them unapproved new drugs that have not been proved safe and effective.

Two other tanning products, bronzers and extenders, are considered cosmetics for external use. Bronzers, made from color additives approved by FDA for cosmetic use, stain the skin when applied and can be washed off with soap and water. Extenders, when applied to the skin, interact with protein on the surface of the skin to produce color. The color tends to wear off after a few days. The only color additive approved for extenders is dihydroxyacetone.

Although they give skin a golden color, these products do not offer sunscreen protection. Also, the chemicals in bronzers may react differently on various areas of your body, producing a tan of many shades.

7. Check skin regularly.

You can improve your chances of finding precancerous skin conditions, such as actinic keratosis--a dry, scaly, reddish, and slightly raised lesion--and skin cancer by performing simple skin self-exams regularly. The earlier you identify signs and see a doctor, the greater the chances for successful treatment.

The best time to do skin exams is after a shower or bath. Get used to your birthmarks, moles and blemishes so that you know what they usually look like and then can easily identify any changes they undergo. Signs to look for are changes in size, texture, shape, and color of blemishes or a sore that does not heal.

If you find any changes, see your doctor. Also, during regular checkups, ask your doctor to check your skin.

The more of these practices you can incorporate into your life, the greater your chances of reducing the damage sun can cause. And by teaching these same practices to your children, you can help them get off to a lifetime of safer sun practices.

Who's Most at Risk?

Take extra care to protect babies and children from the sun. Studies show 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.

You need to be especially careful to play it safe in the sun if you:

• have fair skin; blond, red, or light brown hair; and blue green, or gray eyes
• have freckles and burn before tanning
• spend a lot of time outdoors
• were previously treated for skin cancer
• have a family history of skin cancer, especially melanoma
• work indoors all week and then try to catch up on your tan on weekends
• live or vacation at high altitudes (ultraviolet radiation from the sun increases 4 to 5 percent for every 1,000 feet above sea level)
• live or vacation close to the equator
• have certain diseases, as lupus erythematosus
• take certain medicines, including:
  • acne medicines
  • antibiotics, such as tetracyclines
  • antihistamines
  • oral contraceptives containing estrogen
  • nonsteroidal anti-inflammatory drugs, such as naproxen sodium
  • phenothiazines (major tranquilizers and anti-nausea drugs)
  • sulfa drugs
  • tricyclic antidepressants
  • thiazide diuretics
  • sulfonylureas, such as oral anti-diabetics.

Ask your doctor about the risk of any medicines you may be taking that could be harmful to you when you are in the sun.

Which Sunscreen Product for You?

Sunburn and Tanning History Recommended SPF* Always burns easily rarely tans 20 to 30 Always burns easily ans minimally 12 to under 20 Burns moderately tans gradually 8 to under 12 Burns minimally always tans well 4 to under 8 Rarely burns tans profusely 2 to under 4 *Sun protection factor

(Source: FDA's 1993 tentative final monograph on sunscreen drug products)

Monthly Skin Self-Examination
The steps listed below are also illustrated in a 117k pdf file.

1. Examine your body, front and back, in the mirror, then the right and left sides with arms raised.
2. Examine back of neck and scalp with the help of a hand mirror--part hair or use blow dryer to lift hair and give you a close look.
3. Check back and buttocks with hand mirror.
4. Bend elbows and look carefully at forearms, upper underarms, and palms.
5. Look at backs of the legs and feet, including the soles and spaces between toes.

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