Podcast
Questions and Answers
What is the primary reason for using sunscreen?
What is the primary reason for using sunscreen?
Which of the following is a risk factor for sun-induced problems?
Which of the following is a risk factor for sun-induced problems?
Which ingredient is most commonly found in sunscreen?
Which ingredient is most commonly found in sunscreen?
What is the significance of the 'A' in the ABCDEs of melanoma identification?
What is the significance of the 'A' in the ABCDEs of melanoma identification?
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What does the 'E' in the ABCDEs of melanoma identification indicate?
What does the 'E' in the ABCDEs of melanoma identification indicate?
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At what size is a mole considered concerning according to melanoma guidelines?
At what size is a mole considered concerning according to melanoma guidelines?
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In which stage of melanoma is the 5-year relative survival rate highest?
In which stage of melanoma is the 5-year relative survival rate highest?
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Which of the following is NOT a component of the ABCDE criteria for identifying melanoma?
Which of the following is NOT a component of the ABCDE criteria for identifying melanoma?
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What type of melanoma has a survival rate of 30% when diagnosed?
What type of melanoma has a survival rate of 30% when diagnosed?
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What is the proper recommendation when applying sunscreen?
What is the proper recommendation when applying sunscreen?
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What is the primary characteristic of a squamous cell carcinoma manifestation?
What is the primary characteristic of a squamous cell carcinoma manifestation?
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Which factor is NOT considered a risk factor for UVR-induced skin problems?
Which factor is NOT considered a risk factor for UVR-induced skin problems?
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What is the maximum recommended time for sun exposure when trying to synthesize vitamin D3?
What is the maximum recommended time for sun exposure when trying to synthesize vitamin D3?
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What should be done if a person develops photoallergy from medication use?
What should be done if a person develops photoallergy from medication use?
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Which of the following sunscreen types is best suited for sensitive skin?
Which of the following sunscreen types is best suited for sensitive skin?
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What is the primary purpose of using broad-spectrum sunscreens?
What is the primary purpose of using broad-spectrum sunscreens?
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What is commonly recommended for children less than 6 months old regarding sun exposure?
What is commonly recommended for children less than 6 months old regarding sun exposure?
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What SPF level is recommended by the American Academy of Dermatology?
What SPF level is recommended by the American Academy of Dermatology?
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Which ingredient in sunscreen is known to primarily absorb UVB rays?
Which ingredient in sunscreen is known to primarily absorb UVB rays?
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Which medication is known for increasing skin sensitivity to UVR?
Which medication is known for increasing skin sensitivity to UVR?
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Study Notes
Sunscreen
- Sunscreen protects skin from sun exposure, reducing risk of sun-induced problems.
- Key ingredients in sunscreen are identified for proper product recommendations and application.
- The lecture is based on resources like Prevention of Sun-Induced Skin Disorders and Clinical Resource, Shedding Light on Questions About Sunscreens.
Melanoma
- Melanoma stages and their relative 5-year survival rates are listed:
- Localized: No sign of spread, 99% survival rate
- Regional: Spread to nearby structures or lymph nodes, 68% survival rate
- Distant: Spread to lungs, liver, or other parts of skin, 30% survival rate
Melanoma Identification
- Asymmetry: One half of the mole or birthmark does not match the other.
- Border: Irregular, ragged, notched, or blurred edges.
- Color: Uneven color, including different shades of brown or black, or patches of pink, red, white, or blue.
- Diameter: Larger than 6 millimeters (about 1/4 inch).
- Evolving: Changes in size, shape, or color over time.
Other Warning Signs
- A sore that does not heal
- Spread of pigment beyond the border of a spot
- Redness or swelling beyond the mole's border
- Changes in sensation (itchiness, tenderness, pain).
- Changes in the mole's surface (scaliness, oozing, bleeding, lump or bump).
Skin Cancer Variations
- Most common malignancy in the US (35-45% in whites, 4-5% in Hispanics, 2-4% in Asians, 1-2% in Blacks).
- Epidermal melanin filters ultraviolet (UV) radiation.
- Later presentation and different prognosis in people of color.
- Common cancer types include: Basal Cell – usually on the face, and Squamous Cell
- Slow-growing, isolated papule or plaque.
Skin Lesions
- Different types of skin cancer and benign (non-cancerous) skin lesions are visualized.
- Images include melanoma, actinic keratosis, basal cell carcinoma and squamous cell carcinoma.
Risk Factors for UVR-Induced Problems
- Fair skin that does not tan
- History of serious or blistering sunburns
- Blonde or red hair
- Blue, green, or gray eyes
- History of freckling
- Previous skin growths or UV-induced disorders
- Family history of melanoma
- Current use of immunosuppressive or photosensitizing drugs
- Extensive lifetime exposure to UV radiation (tanning beds/booths)
- History of an autoimmune disease
Ultraviolet Radiation (UVR)
- UVA: Causes cancer and photoaging. UVB: Causes erythema, cancer, photoaging and synthesis of vitamin D3. UVC is filtered by ozone.
- Degree of exposure depends on cloud cover, surface color, altitude, water, clothing and time of day (highest intensity between 10 AM and 4 PM).
Damage from the Sun
- Sunburn: Erythema, swelling, pain (peaks 6-24 hours after exposure, lasts 72 hours).
- Immediate tanning: Redistribution of melanocytes (lasts 3-4 days).
- Delayed tanning: Increase in number and activity of melanocytes (lasts 10-30 days).
- Photodermatoses: Chemical induced reactivity to UV light (allergy and toxicity).
- Photoallergy: Antigenic inflammatory reaction (pruritis, erythema). Phototoxicity: Non-inflammatory, dose-related reaction.
- Premature aging: Wrinkles, yellowing, elastic fiber breakdown (elastosis), drying, thickening, spider vessels, growths (solar keratoses, ecchymoses).
Photosensitivity
- Cosmetics and drugs can trigger photosensitivity (rash or reaction)
- Prevention includes minimizing sun exposure, using protective clothing, and using broad-spectrum sunscreens. Discontinue medication if possible when dealing with a photoallergic reaction.
Sun Protection Factor (SPF)
- SPF is a measure of the amount of protection sunscreen provides
- Time to burn (TTB) is the multiple of the time it takes to burn without sunscreen
- Minimum SPF of 15 for everyone and 30 for infants and children under 6 months.
Goals
- Avoid or minimize sunburn, photosensitivity reactions, photodermatoses in the short term.
- Avoid skin cancer and premature aging in the long term.
Sunscreen Ingredients
- Chemical/organic: Absorb UVR, preventing it from entering the epidermis (absorbs 85% of radiation at wavelengths of 290-320 nm).
- Physical/inorganic/mineral: Reflect UVR and scatter UV and visible light (wavelengths 290-770 nm).
AAD Recommended Ingredients (List of ingredients)
Ingredient Considerations
- Octocrylene: Photostabilizer, preventing other sunscreens from losing effectiveness.
- Avobenzone: Covers part of the UVA spectrum but degrades easily in sunlight, needs to be combined with other ingredients.
- Octisalate and Homosalate: Salicylates, do not adhere well on its own.
- Oxybenzone: Primarily absorbs UVB but has safety and environmental concerns.
- Zinc oxide and Titanium dioxide: Physical, broad spectrum, opaque, which can be used in transparent products.
Safety Concerns
- Oxybenzone: Estrogenic effect when taken orally, but not relevant topically. Not recommended for children and pregnant mothers due to potential birth defects.
- Several agents (avobenzone, oxybenzone, octocrylene, homosalate, octisalate, and octinoxate) have shown systemic absorption and ongoing safety studies are underway.
- Mineral sunscreens use nanoparticles for ease of application and non-clogging (non-comedogenic). Nanoparticle formation of free radicals requires special coating to reduce formation of free radicals by 99%
Environmental Concerns
- Oxybenzone (and others) has been found to bleach coral reefs, exacerbated by rising water temperatures rather than human presence.
- Hawaii has banned oxybenzone and octinoxate products.
Choice of Product
- Spray for wet skin, gels for hairy areas.
- Non-comedogenic products for acne-prone skin.
- Mineral sunscreen for sensitive skin.
Babies
- Avoid sun exposure as much as possible. Choose lightweight clothing & brimmed hats.
- Mineral sunscreens are the safest option for younger babies.
Guidelines for Use
- Apply liberally about 15-30 minutes before sun exposure.
- Reapply every two hours and after swimming or sweating.
- Water-resistant sunscreens (may last 40-80 minutes).
- Allow sunscreen to dry before applying insect repellent or topical medication.
Product Storage
- Expiration is generally 3 years.
- Avoid storing in hot cars or high heat.
- Discard if consistency changes or left in high temperatures for extended period.
Sun-Induced Ocular Damage
- Photokeratitis: Pain and loss of vision.
- Uveal melanoma: Affects the iris and ciliary body.
- Different kinds of sunglasses are categorized by the amount of UVA/UVB protection they offer.
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