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Health issues

Health Issues

Eyes and the Sun
- Lupus
- Medical Conditions and Ultra Violet Radiation
- Photosensitivity
- Psoriasis
- Rosacea
- Seasonal Affective Disorder - SAD
- Skin Ageing
- Skin Cancer - The Facts
- PF, CPF, UPF & EPF Explained
- Sunblock & Sun Creams
- Suncreams, Sunprotective Clothing or both?
- Sunprotective Clothing
- Vitamin D


Eyes and the sun

A number of eye diseases are caused, or aggravated, by the Sun that is the Sun’s UV (ultra violet) rays. 

Exposure to UV rays over the short term can cause painful inflammation of the eye whilst longer term exposure can cause conditions such as:

Cataracts - cloudiness of the lens Photo keratopathy - sunburn of the cornea like snowblindness Solar keratopathy - cloudiness of the cornea Pterygium - an overgrowth of the conjunctiva on to the cornea Cancer of the conjunctiva (the membrane covering the white part of the eye) Skin cancer of the eyelids

The following links give further details regarding many of these conditions. Our section on sun protection gives ideas and further links on how to prevent sun damage to eyes.

‘CIESIN’ (Centre for International Earth Science Information Network) gives further information on the harmful effects of UV ‘B’ rays on the human eye.
CIESIN Thematic Guides

‘Moorfields Eye Hospital’ - The foremost UK centre for research into eye disease and its treatment.
Moorfields Eye Hospital - NHS Foundation Trust

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Lupus
Lupus is a member of the auto-immune family of diseases which include rheumatoid arthritis, multiple sclerosis, juvenile diabetes, scleroderma and others. Lupus is not a form of cancer, is not related to AIDS and is not contagious. Systemic lupus erythematosus (SLE) is the most common and serious type of lupus. The auto-immune reaction in SLE may target any tissue in the body, including the skin, muscles, joints, blood and blood vessels, lungs, heart, kidney and/or brain. This isn't a condition which is caused by exposure to sunlight but it may cause sensitivity to sunlight. 

The Skin, Sunlight and Lupus 

UK Lupus website - very comprehensive information on Lupus with links to related health sites

Lupus Ontario - Charity dedicated to helping those that suffer from Lupus . Information and duspport resources

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Medical Conditions and Ultra Violet Radiation
Australia and New Zealand have been front-runners in responding to the increased danger of skin cancers caused by the thinning of the ozone layer. This layer protects the earth's surface from the worst of the Sun's ultraviolet radiation - or it did! Our cars, refrigerants and aerosols have caused a reaction in the ozone layer which has made it a much less effective UV filter. The problem began in the southern hemisphere but is now happening in the northern hemisphere as well. The bottom line is that we need to protect ourselves against excessive exposure to sunlight. If we don't, we are at much greater risk of skin cancers and eye-problems. Other conditions, or the drugs used to treat them, can make people sensitive to sunlight and cause unpleasant skin-reddening, rashes and lesions. 

However there are some conditions which are either caused or enhanced by lack of sunlight e.g. SAD and Vitamin D deficiency (rickets in children). 

How Much of a Problem is UVB?

Without sunlight there would be no life on earth. However without an efficient Ozone Filter, Ultra-Violet Radiation can be a threat to human health. Australians now have a 70% chance of having a skin cancer in their lifetimes. Even in the temperate United Kingdom, the incidence is 15% and rising. Obviously, outdoor workers and sports people are most at risk. Most skin cancers are treatable, especially if caught early. 

 

The following websites give a good overview of the effects of light on living organisms.

 

National Institute for Public Health and the Environment
is an authoritative European website that gives detailed scientific and medical information about current research into the way UVR affects people and animals. 

 

Centre for International Earth Science Information Network gives information on the health effects of Ultra Violet Radiation.

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Photosensitivity
The following sites give information on drugs and conditions which can make people sensitive to light.
Photosensitivity - Sensitivity to Sunlight. - Dermnet - New Zealand website for doctors and patients.

Psoriasis
Psoriasis is a skin condition which can be treated with UVA and UVB. The National Psoriasis Federation offer information and links to other helpful websites. 

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Rosacea
Rosacea is a chronic skin disorder which is manifested by blotchy red areas mostly on the nose, forehead, cheekbones and chin. The condition is generally aggravated by exposure to sunlight. For an in depth explanation of this condition visit the following site. 

National Rosacea Society

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Seasonal Affective Disorder - SAD
Lack of Sunlight can cause winter depression, though exactly why is uncertain. SAD is much more than the winter blues that most people get from time to time and can be disabling. As Spring arrives, the condition improves. Treatment with high-intensity light boxes to replace the missing sunlight helps some people. Others are helped with anti-depressants. 

 

Seasonal Affective Disorder - SAD Discovery Channel web site with good information on the topic.

 

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Skin Ageing
Skin ageing is a natural process (more specifically known as photoageing), that is accelerated by exposure to Ultra Violet Radiation. More than a third of people over the age of 65 have skin problems. Examples of skin conditions common to the elderly are excessive dryness, thin texture, looseness, dermatitis and warts. Other less common skin conditions related to ageing are solar keratoses, and hirsutism. Most skin diseases related to skin ageing are now treatable. 

Recently, people have become increasingly concerned about their appearance rather than their actual age. Most of the skin conditions associated with ageing should still be of concern as they are due to the general degradation of the skin's functions and abilities. These changes are much more apparent in commonly exposed areas like the hands and face. 

Skin composition
Our skin has many functions and abilities that are perhaps not always appreciated as we take our skin for granted and only appreciate how important it is when something goes wrong. Its most important feature is its ability to protect our bodies from the many different dangers around us. 

The diagram below shows a cross section of a general piece of skin.

Skin Diagram

A description of the different layers and components follows. The skin contains two distinctive layers - the epidermis and the dermis: 

The Epidermis
The epidermis protects the deeper layers of the skin, this is the layer that is mostly affected by sun radiation. The epidermis is split again into two layers: 

The Malpighian layer produces all of the cells that make up the epidermis. These cells are constantly dividing by mitosis (a process that produces two identical cells from one original cell). The newly produced cells gradually move towards the surface of the skin. As they do this, they slowly die and fill up with keratin, a protein. 

The Cornified layer is made up of these dead cells. The Cornified layer protects the softer living cells underneath, as the dying cells become harder and are waterproof. There are various parts of the body where the skin experiences much more wear, for example the bottom of the feet. Here, the Cornified layer grows thicker and is much more durable. 

Some of the cells in the Epidermis contain a brown pigment known as melanin. This pigment absorbs the sun’s harmful ultra-violet rays. These rays can, in large enough doses, damage the genetic information (DNA) stored in the nucleus of each cell. This will in turn cause the cell to die. Slightly smaller doses may alter the DNA which can lead to various forms of skin cancer. This can be more threatening than the cells dying. 

Much shorter prolonged doses of sun cause the condition Sunburn (see Sunburn section). Briefly, this is caused by the damaged epidermal cells releasing chemical substances which trigger a string of events leading to inflamed red “burnt” skin. 

For further and more detailed information on the stages of how the sun affects our skin cells, refer to the links at the bottom of this page. 

The Dermis
The dermis is made up of connective tissue which contains elastic fibres. These fibres give the skin its stretching abilities. As a person ages, these fibres lose elasticity causing the skin to become loose and wrinkly. The dermis also contains sweat glands which secrete sweat (mostly made up of water with dissolved amounts of urea and salt), to aid in the body’s temperature control. 
Also within the dermis lie blood vessels and nerve endings. The blood vessels supply the oxygen crucial to the process of mitosis in the epidermis layer of the skin. The nerve endings are sensitive to touch, pressure and temperature, keeping you aware of your surrounding environment. Beneath the epidermis lie layers of fat (containing large drops of oil). This fat helps insulate your body and acts as a food reserve, if needed. 

Wrinkles
The main cause of skin ageing is the sun's UV rays (see Solar Radiation section). These light rays damage the fibres, elastin and collagen mainly in the upper dermis of the skin, causing them to lose their ability to support the skin cells and maintain flexibility and elasticity (causing skin wrinkles). The sun’s UV rays very slowly accelerate the action of the enzymes that break down the proteins. Cells in the upper-layer of skin (keratinocytes) which are frequently shed and renewed slow down with age as their ability to re-generate is damaged by photoageing. Other cells, melanocytes are also irreversibly damaged. The overall effect of this causes the skin to tear and bruise a lot more easily and take longer to heal. 

Skin texture/dehydration 
Sebaceous, grease producing, glands also become less efficient causing dry skin which can lead to itchiness. In colder weather these problems are much worse, especially in colder climates that have a low relative humidity (for example, the north-east of the United States is notorious for these sorts of problems and the use of central heating systems dries up the air, adding to the problem). 

Skin Colour, Brown Spots and Warts
Ageing skin may also show other more subtle conditions such as changes in the colour of and the development of warts. On normally covered skin, a drop in the numbers of pigment cells and a reduction in their pigment production cause the skin to become slightly paler. This is not very apparent on sun-exposed skin however. Benign discolourations (brown patches) also occur on the backs of hands and the faces of elderly people. Many people find these discolourations (medically know as senile lentigos and more popularly as liver spots) unsightly. Many similar spots also appear on the back and chest and often develop a raised, hard and irregular warty surface. These spots are harmless, but have to be distinguished from other less benign spots which can be linked with skin cancer. 

Short term effects of UV exposure 
Many of us are aware of how periods spent in the sun can damage skin through sunburn which, in turn, can lead to skin cancer (see Skin Cancer Section). However there is less awareness of the long term effects of UV exposure and how this can lead to accelerated ageing of the skin. 

Long term effects of UV exposure 
UV radiation damage to the skin will usually not show until later in life as damage is usually done over a long period of time. Nothing can completely undo the damage, although skin can sometimes repair itself. However, by applying sunscreen and wearing clothes when exposed to the sun, the skin is protected from most of the sun's rays and therefore some of the damage can be avoided. It is never too late to start protecting yourself from the sun.

‘Skin Cancer Info’ - Skin Cancer public awareness site with further information on skin ageing and various skin types.
Wessex Cancer 

‘Medscape’ - A large collection of articles on just about every topic of medical science. The site requires you to register with them for a free login name, but it is well worth it.
Medscape 

‘The Biology Project’ - Another Biology resource designed for the use of students and teachers, but still a good resource for others. Contains more detailed information on skin composition as well as other Biology topics.
The Biology Project - The University of Arizona

‘Academic Info - Biological Sciences Internet Resource Directory’ - An academic directory of software, information, databases and other sites.
Academic Info 

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Skin Cancer
There is a definite link between over exposure to UVA and UVB rays and Skin Cancer and it has been proven that over exposure to these rays has damaging effects on skin cells. Visible damage includes tanning which, depending on the individual, can over time lead to wrinkles, age spots and sometimes Skin Cancer. Skin Cancer can also be caused by exposure to artificial sources of UV rays such as sun lamps and tanning booths. 
There are three types of Skin Cancer. The most common and most easily treated are Basal Cell and Squamous Cell. The third and most dangerous is malignant Melanoma. 
Skin Cancer is the second most common cancer in the United Kingdom, there are about 40,000 new cases every year around 6,000 of these are malignant melanomas and there are about 1,500 deaths from Skin Cancer annually. In the United States one in every seven Americans is affected by skin cancer annually, making it the most prevalent form of cancer. However, if detected and treated in time, 90 per cent of skin cancers can be cured. 

Basal Cell Carcinoma - this is the most common form of skin cancer arising from the cells in base of the skin. It is generally slow growing and usually does not spread. Despite this, basal cell carcinoma must not be ignored as it can erode the skin and cause ulcers known as rodent ulcers. Rodent ulcers often starts as small fleshy translucent bumps on the face, ears, lips or around the mouth. The bumps may become crusty or not heal easily, it is therefore necessary to ensure that they are removed. 

Who is at risk from Basal Cell Carcinoma? 
Generally fair skinned people Generally older individuals who have had many years of sun exposure and sunburn 

Squamous Cell Carcinoma - this form of skin cancer is the second most common, it starts in the top cells of the skin and may spread to other parts of the body. However the majority of people with this form of skin cancer can be cured. Scaly patches of raised skin often appear on the surface of the skin often on the tip of the nose, forehead, lower lip or hands and other areas of the body which have been repeatedly been exposed to the sun over a long period of time. As this form of skin cancer can spread it is essential to take action if there are any doubts at all. 

Who is at risk from Squamous Cell Carcinoma? 
Generally more common in men than women and usually those aged 55 and over Anyone who has been exposed to sunlight over a long period of time People with fair skin, light hair and light coloured eyes are at greater risk People who have been exposed to arsenic, certain types of tar, pitch, fuel oils (industrial), radiation (x-rays and Gamma rays) 
Squamous Cell Carcinoma - The Skin Site 

Malignant Melanoma - this is a rarer form of skin cancer which usually starts as a mole on the skin. It is more difficult to treat than other forms of skin cancer and can be fatal. Melanoma can spread two ways, horizontally and downwards which is much more dangerous as the malignant cells can invade the lymph glands and thereby spread the Melanoma to other parts of the body. 
Melanoma usually begins as a dark brown or black patch with irregular borders and may appear anywhere on the body often near an existing mole. As it has a tendency to spread it should be treated immediately. Both the Skin Cancer Foundation and the American Academy of Dermatology recommend using the ABCD method to help detect Melanoma: 

 

A - most early melanomas are asymmetrical

B - melanoma borders are uneven

C - colour, varied shades of brown, tan or black are often the first signs of melanoma

D - diameter, early melanomas tend to grow larger than common moles f

Malignant Melanoma is one of the most deadly and aggressive cancers, the only method of cure is either by prevention in the first place or by ensuring that it is surgically removed in the early stages of the disease.

Who is at risk from Malignant Melanoma? 
Everyone exposed to sunlight but more particularly those with a fair complexion, light or red hair with blue, green or grey eyes.
Anyone who does not tan easily and burns in the sun
Anyone with a history of severe sunburn before the age of 20
Anyone with a family history of melanoma or other skin cancer
Anyone with more moles than normal, unusual moles or congenital moles.
More common in women than men and more common in 40 - 60 age range Note Malignant Melanoma does not necessarily arise as a result of exposure to the sun, it can appear on parts of the body which are always covered by clothing Prevention is the best method of avoiding Malignant Melanoma. 

Melanoma Skin Cancer - The Skin Cancer Zone 

In conclusion, everyone who is exposed to the Sun runs a risk of getting skin cancer. Practising prevention is the best method of avoidance link to Sun Protection area. 

See the following link for further information on this subject: 

Intersun Global UV Project - this is a project being conducted by the World Health Organisation and has a vast amount of information covering UV radiation e.g. effects on the Ozone layer, health effects on skin, eyes, immune system, methods of protection etc. 

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SPF, UPF, CPF AND EPF Explained

Sun Protection Factor (SPF)
The Sun Protection Factor (SPF) is a numerical rating displayed on sun protection cream containers. For all normal purposes, SPF15 will provide a reasonable measure of protection from burning by the sun and from harmful ultra violet radiation from sunlight. 
If it takes ten minutes for you to begin to feel your skin reddening slightly, then with a good SPF 15 coating, you will be able to stand 150 minutes. However, be warned, sweating, swimming, towelling etc. can all weaken the coating and leave you open to skin damage. To enjoy adequate protection you must make sure that sun cream is applied evenly to all exposed parts of the body. SPF 15 is generally considered to be adequate for temperate zones however a higher protection factor such as SPF 30 gives better protection in zones where the sun is stronger. Sun cream is not only for summer use. Bright sunlight reflects off snow in winter, a good sun protection cream should be used in these conditions. 

For further information: 

L’Oreal Website - Sun Protection Factors. Excellent, well presented information from a commercial cosmetic company. 

 
CPF (Clothing Protection Factor) is more commonly displayed as UPF (Ultraviolet Protection Factor) on clothing. Clothing does not always provide as much sun protection as people believe. Protection varies with weave, fabric colour, wetness or dryness, the number of washes a garment has had, elasticity and composition. 

Visit the Health Protection Agency site for a detailed and authoritative NRPB account of how CPF is measured and what the CPF numbers mean. 

The Ultraviolet Protection Factor (UPF) rating is a more common and more widely recognised rating than CPF. The rating is given to clothing fabrics to define the level of protection from UVA and UVB rays. Clothing fabric is tested using a spectrophotometer and the rating is normally expressed as 15+, 30+, 50+ or 100+. The higher the rating the more protective. 

Eye Protection Factor - EPF 
The Eye Protection Factor (EPF) is much like the Sun Protection Factor (SPF). Sunglasses can block light but let through damaging ultraviolet rays, or they can block both safely. It is NOT the case that the darker the lens the greater protection it will give you. You are reliant on buying sunglasses which state clearly that they block a very high percentage of UVA and UVB. Ideally, the factor should be 100% or at least in the high 90s. The main danger is cataract but the outer surface of the eye and the skin around the eyes is also at risk of damage or cancer. As with damage to the skin, sun damage to the eyes is cumulative. Again as with skin protection, remember that in winter, especially at altitude and in snowy conditions, your eyes are at special risk from bright sunlight. 

Links: 

Australia Anti-Cancer Foundation - advice on selecting good sunglasses and EPF information. 

Me No Fry - good advice on eye protection from the Sun including an explanation of EPF. 

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Sunblock and Sun Creams
Sun blocks (or sunscreens) are the most common method of protection from the sun’s UV rays. To benefit from their protection, it is important that they are used correctly. 

What is a sunscreen and how does it work?
Sunscreens are chemicals that keep UVR (ultra violet radiation) from reaching your skin by either absorbing or reflecting the UV rays from the sun. There are two types of sunscreens: organic and inorganic. 

Organic sunscreens
Organic sunscreens were first on the market and have always been readily available since their initial production. They are made up of many different elements, the most dominant being hydrogen and carbon. These elements are partially absorbed by the skin. 
The most common organic sunscreens are para amino benzoic acid (PABA) and benzophenone. A large number of people find themselves to be allergic to either of these or even both. Most modern products contain less of the elements causing allergic reactions, however some people still experience reactions. Most organic sunscreens only block UVB. Certain brands manufacture sunscreen containing titanium and zinc. These brands absorb some UVA and UVR. 

 

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