DermHelpCentral

Photosensitivity and Drugs

Jane Brody in the Tuesday, July 26, 2011 NY Times covered the topic of sun sensitivity to drugs quite well.

Intro:  "Many commonly used drugs can cause sun sensitivity,  These include antibiotics such as the tetracyclines (doxycycline is one), ciprofloxacin and the sulfa drugs (Bactrim, for example); the diuretic hydrochlorothiazide; and over-the-counter anti-inflammatory drugs, like ibuprofen and naproxen."   Note: not everyone who takes these will be photosensitive, and some of these drugs (like doxycycline and hydrochlorthiazide) are more likely to cause this than, say, ibuprofen or naproxen).  St. John's Wort can cause a bad sunburn, too.

The article is a keeper:  J. Brody on Photosensitivity.

Sunburn Pain Relief

Researchers at King’s College London have found a molecule in the body which controls sensitivity to pain from UVB irradiation, identifying it as a new target for medicines to treat pain caused by other common inflammatory conditions such as arthritis.
 
The molecule, called CXCL5, is part of a family of proteins called chemokines, which recruit inflammatory immune cells to the injured tissue, triggering pain and tenderness. This is the first study to reveal this molecule’s role in mediating pain.

This is a basic science article, but it is worth reading and explains why NSAIDs like ibuprofen may help.  Don't use naproxyn, however.  There's a small chance of photosensitivity with that drug.

See news article on study:  Sunburn study could lead to new pain relief (7/7/2011)

Sun Poisoning

When I practiced dermatology on Kauai, I was impressed with the large numbers of patients I saw with a distinctive photodermatitis.  It was seen mostly in the months of December to May, and almost all were tourists.  This reaction to sunlight followed the first few exposures of the year.  After a few weeks, by history, it would disappear and would not return until the patients had been out of the sun for months and were then re-exposed.  Gradually, my colleagues and I realized that this is a common problem,  Indeed, upwards of 10% of the public may suffer from this.

(These images were taken from the article we published and show typical findings in typical areas.) 

Sunscreens do not prevent it.  They may potentiate it because they allow individuals to stay out long enough to absorb enough radiation.  For prevention, graded small exposures work for most patients.  That can be achieved by going to a tanning parlor three or four times before a winter or spring trip to sunny areas.  These exposures should be short and are not intended to tan but to "harden" the skin to light.  Most people gradually harden in their home setting since their natural exposure is graded.

Dr. Yoon Cohen, a recent medical school graduate, found a copy of the 1985 article which I wrote with Morison and Hood and you can read the pdf here thanks to her: Sun Poisoning Article.

Treatment:  Cool tap water compresses for 20 minutes followed by a moderate to potent topical steroid cream for four to five days will help most patients.  For more severe cases systemic steroids for four to fice days will give relief and allow a patient to enjoy their vacation or the beach. Hydroxizine affords some relief of itching. Of course, these treatments should be administered by one's personal physician.

Explaining Sunscreen and the New Rules

by Jane Brody, NY Times June 21, 2011.

This is a fine article about sunscreens with reference to the new regulations.  If this is a topic that you ponder please Read "Jane Brody's Sunscreen Primer."

 

New Rules for Sunscreens in U.S.

"After 33 years of consideration, the Food and Drug Administration took steps [this week] to sort out the confusing world of sunscreens, with new rules that specify which lotions provide the best protection against the sun and ending claims that they are truly waterproof. Click on the image to read these. Read NY Times article "F.D.A. Unveils New Rules About Sunscreen Claims."

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European Suncreens

There has been a long wait in the U.S. for available and better UVA blockers.  The U.S. Federal Drug Administration (FDA) does not approve Tinosorb M, an effective UVA blocker.  The sunscreens we have in the States block UVB and many dermatologists feel this is not enough.  Yet, there is gridlock at the FDA in approving the use of newer UVA blockers which afford better protection.  Many consumers are getting these from Europe of Canada.  The lack of approval is not based on science, but is felt to be the result of lobbying by the makers of the sunscreens we have!  To learn more about this see:  UVA Reform in the NY Times (June 23, 2010).

Tanning Addiction

Jane Brody had a recent column in the NY Times on new studies which indicate that some people may actually be addicted to natural or artificial tanning.  The focus is on tanning salons which are more easily accessible to the public.

Here's an excerpt.
"Dermatologists express great frustration with their seeming inability to deter tanning behavior, particularly among adolescents and young adults, who are most at risk for the ill effects from these otherwise life-giving rays. There are many explanations for this failure, including the widespread belief that people look better (read healthier and perhaps thinner) when they are tan. This notion has helped to foster the multibillion-dollar indoor tanning industry, supported by some young patrons as often as 20 times a month.  But in recent years, another explanation has emerged for which there is now considerable scientific support: the idea that exposing one’s skin to UV radiation has addictive potential. As with alcohol, not everyone who is exposed becomes dependent on the sun. But there are enough UV abusers — one in five college students, perhaps half of beach habitués and 70 percent of indoor tanners, according to various studies — to warrant a new medical diagnostic category: tanning addiction.

The full article is worth reading.

Sun Screen Safety

It seems like every day a patient will ask a recommendation for a sunscreen.  One realizes that one knows little about the safety of these products.  The thrust of sunscreen promotion is the iconic SPF:  Sun Protective Factor.  This has gone from 15 to 30 to 50 to 80 and now to 100!!  The reality is that a SPF of 15 or 30 is enough.  What should concern you more is the safety of these products.  GoodGuide is reputable organization whose goal is to "provide the world's largest and most reliable source of information on the health, environmental, and social impacts of the products in your home."  Their guide to Sunscreens is worth visiting.  Click here to read more. 

(Thanks to Charles Katz of Great Barrington, Massachusetts for directing us to GoodGuide.)

Confused by SPF? Take a Number

This is a helpful article from the NY Times (May 14, 2009) on sunscreens and Sun Protective Factor.  Sunscreen use is a religion to some.  There is no evidence that it prevents melanoma when used in adults; but it may prevent some nonmelanoma skin cancers and may help some "at-risk" individuals.  Sunscreens are a huge market for the PIGs (pharmaceutical industry giants) -- so be an informed consumer!  This article from the NY Times should make you feel better about sticking to a sunscreen with a lower SPF.

"A sunscreen’s SPF, or sun protection factor, measures how much the product shields the sun’s shorter-wave ultraviolet B rays, known as UVB radiation, which can cause sunburn. It used to be that SPF topped out at 30. No more. These days, a race is on among sunscreen makers to create the highest SPF that R&D can buy.  

"The difference in UVB protection between an SPF 100 and SPF 50 is marginal. Far from offering double the blockage, SPF 100 blocks 99 percent of UVB rays, while SPF 50 blocks 98 percent. (SPF 30, that old-timer, holds its own, deflecting 96.7 percent). Thus, SPF 30 is all one really needs to prevent burning.

"A sunscreen’s SPF number is calculated by comparing the time needed for a person to burn unprotected with how long it takes for that person to burn wearing sunscreen. So a person who turns red after 20 minutes of unprotected sun exposure is theoretically protected 15 times longer if they adequately apply SPF 15. Because a lot of sunscreens rub off or don’t stay put, dermatologists advise reapplication every two hours or after swimming or sweating.

Here is the full article:  Confused by SPF.  

(Photos from the Times articles)

Turtles, Birds and Bears

Cancers follow three basic patterns: turtles, birds and bears.
1. Turtles move so slowly that you can still capture them while they’re moving slowly along;
2. The birds fly away so quickly that you can’t catch them in time;
3. The bears can escape if you ignore them, but if you catch them in time, you can capture them.

This simple but brilliant formula comes from a superb article by Christie Aschwanden on sunscreens and skin cancer that appeared in the July 10, NY Times.

Doctors Balk at Cancer Ad, Citing Lack of Evidence  See Permalink.

This is a reasoned piece based on the best evidence based information we have.  It is clear that the companies that make sunscreens benefit from a public that is running scared for many of the wrong reasons. Please read the article and draw your own conclusions.