Sun protection and solar damage

Question 1

Explain sun damage

Answer 1

Accumulates over time
Lifetime exposure = risk
UV = sunburn, ageing, cataracts, immunosuppression, skin cancer.

Question 2

Compare UVA and UVB

Answer 2

UVA - 320-400nm= most UV light. Penetrates skin deeper than UVB (goes into superficial dermis). Causes indirect DNA damage and photoaging. Less efficiently filtered by sunscreen and can penetrate window glass. Tanning beds. Cause cancer.

UVB- 280-320nm. Intensity depends on season and time. Main cause of sunburn. Mostly absorbed by epidermis. Direct DNA damage.

Question 3

Signs and symptoms of sunburn

Answer 3

Painful erythema 2-6 hrs post exposure
Maximum severity at 24 hrs
Severe= malaise, fever, N/V
Resolution w/ peeling over 4-7 days

Question 4

Types of skin cancer

Answer 4

Basal cell carcinoma
Squamous cell carcinoma
Melanoma (most dangerous)

2/3 Australians diagnosed w/ skin cancer by 70 yrs.

Question 5

Discuss basal cell carcinoma

Answer 5

Mostly on head and neck
Rare metastasis but can cause localised damage
Small, shiny, firm, clear-pink, raised growth
Over time, visible blood vessels open and scab
Slow growing tumours
Biopsy needed

Question 6

Explain squamous cell carcinoma

Answer 6

Occurs on areas heavily exposed to sun (head, back of hands, neck, limbs)
Tender lesion that appears suddenly and grows rapidly/over weeks-months
Thick, scaly, irregular appearance, raised, firm (wart-like)
Damaged skin

Question 6

Basal cell carcinoma treatment

Answer 6

First- Treat w/ surgical removal except superficial
Superficial BCC = cryotherapy, PDT, and topical imiquimod
Advanced BCC= vismodegib (150mg od)

Question 7

SCC treatment

Answer 7

First- surgical treatment w/ a 3-5mm margin
Radiotherapy if no surgery

Question 8

Explain melanoma

Answer 8

Australia has highest incidence in world
Malignant tumours derived from melanocyte (arise within a mole or freckle)
Several different types and classifications

Question 9

Melanoma treatment

Answer 9

Surgical removal
prevention

Question 10

Melanoma warning signs

Answer 10

New or changing mole
Prominent and pigmented
Stands out from other moles
Rapidly growing nodule
Particular concern
Typical presentation

Question 11

ABCDE of melanoma detection

Answer 11

Asymmetry - not mirror image

Border - usually irregular

Colour - number of colours through it

Diameter - growing and changing in diameter and size

Evolution - changing and evolving

Question 12

Ingredients in sunscreen

Answer 12

Organic chemicals- absorbing agent
- salicylate, etc
allergic contact dermatitis possible

Inorganic substances- physical blockers
Zinc oxide, titanium dioxide

Question 13

How to apply sunscreen

Answer 13

Apply to exposed sites 15-30 mins before going outside, or when UV >3
Use generous amount 30-40ml for adult
Reapply every 2 hrs and after activity
Last 2-3 yrs if stored below 25c

Question 14

Explain SPF

Answer 14

Sun Protection Factor = how well sunscreen protects against sunburn. Based on UVB. Time for mild erythemal dose (MED) burn to appear with sunscreen / without sunscreen.
SPF50+ must be >60

Question 15

Sunburn treatment

Answer 15

Limited data for NSAIDs, oral/topical corticosteroids reducing severity of burn

Cool compress for symptoms
Water intake for dehydration

Anaesthetic spray (paxyl, solarcaine) relieve pain

After sun cream/gels

Cooling gels - solosite, solugel

Aloe vera limited evidence

Question 16

Actinic keratosis treatment

Answer 16

Fluorouracil cream - Apply od or bd for 2-4 weeks (face) or 3 weeks for arms and legs

Imiquimod 5% cream

Diclofenac 3% gel - bd for 60-90 days

Methyl aminolevulinate - 1x session of photodynamic therapy
patch or cream and then PDT

Question 17

Explain fluorouracil cream

Answer 17

Interfers w/ DNA synthesis
Continue treatment until inflammatory response
Normal to redden, peel, or crack.
3-4 weeks or longer
Face responds faster
Thin layer to area using non-metal applicator or rubber gloves
Avoid contact w/ eyes, nostrils and mouth

Question 18

Explain imiquimod 5% cream

Answer 18

Enhances immune response
Apply before bed - leave on for 6-10 hrs and then wash off with mild soap and water
Wash with mild soap and water and dry before applying
Wash hands before and after use
Avoid bathing/showering after application
Protect area from sunlight
Avoid eyes, lips and nostrils

Question 19

Explain diclofenac 3% gel

Answer 19

+ hyaluronic acid 2.5%
Block COX2, reduce angiogenesis and cellular proliferation
Avoid eyes and mouth
Do not cover w/ occlusive dressing
Protect area from sunlight
Take up to 30 days after finishing treatment for complete healing of lesions
Not interchangeable w/ voltaren
Potential systemic absorption

Question 20

Lifestyle changes

Answer 20

Slip - clothes
Slop - SPF30 on dry skin 20 mins before going outside
Slap - hat (not cap/visor)
Seek - shade (reflection of sun)
Slide - sunglasses

Question 21

Caring for skin after cryotherapy

Answer 21

Cryotherapy treats actinic keratosis
Freeze skin to produce destruction of lesion

Day 1 after- leave blisters alone or lance w/ sterile needle
Day 2/3- let weep open, wash with soap and water, cover with dressing if excessive
Day 3/4- let scab heal