As a tag team to June’s post, I thought I’d share a bit more about sun protection—with a little twist. Hope you enjoy!
Though excess UV can wreak havoc on the skin, we know the sun isn’t ALL bad. In addition to all it does for plants and the earth, its rays are used by our bodies to make vitamin D. In general it doesn’t take much sun to do so. According to a consensus statement of several national groups in the skin cancer capital of the world, Australia, there are times when it is considered safer for the general adult population to go out without sun protection. Summer mornings, late summer afternoons, and cooler months are times when the UV Index tends to stay under 3, thus unless outdoors for an extended period, protective measures are not needed. (1) The British Association of Dermatologists (BAD) and other British national organizations also made consensus statement pointing out that vitamin D can be efficiently produced in sufficient amounts at UV doses lower than what would cause sunburn. (2) Interestingly, they also highlight research indicating that with prolonged sun exposure vitamin D is turned into inactive substances in the skin—thus getting a lot of sun is NOT better for increasing vitamin D level. Excess exposure just increases the risk of the negative effects of the sun. Think of it like this: A small glass of red wine every day or so may be good for the heart. But excess alcohol can lead to heart failure. Similarly, some sun is good. Too much can be deadly. UV exposure is associated with DNA and collagen damage that lead to both sun-induced aging changes and skin cancer. Even darker skin develops DNA damage from sun, though it is more superficial and less extensive than in lighter skin. (3) Multiple studies have proven an inverse relationship between depth of skin pigmentation and DNA damage.
So this goes back to my stance on personalized photoprotection that I mentioned last month. For me, as a darker skinned person with a history of vitamin D deficiency who has never sunburned but who also cares about slowing sun-induced aging as much as possible, I tend to be ultra-vigilant about protecting my face with hats, sunglasses, and sunscreen to reduce DNA damage, but expose other areas to some sun. In contrast, before going outdoors to garden, for example, my fair-skinned husband applies sunscreen to all exposed skin, wears a sun-protective shirt, and puts on a wide-brimmed hat to properly protect his skin. (Proud wife moment.) 😉 The approach for our kiddos is in between—always taking care to avoid burning.
If you have darker skin, like me, consider getting your vitamin D level checked. Vitamin D deficiency is associated with a number of cancers and deleterious health conditions. Others at risk for vitamin D deficiency besides those with dark skin include pregnant women, the elderly, people who wear highly concealing clothing, those with a history of skin cancer, the obese, and people who rarely go outside. (2) I supplement with oral vitamin D as recommended by the American Academy of Dermatology and—especially after being diagnosed with vitamin D deficiency—allow my skin to make vitamin D by getting some sun as noted above. Multiple meta-analyses of randomized controlled trials (i.e., groups of good medical studies) have shown that daily vitamin D oral supplementation is associated with decreased mortality. (3) Because it is currently unclear if oral vs. sun-induced skin produced vitamin D are equivalent, a customized approach may be the best way to secure the protection needed while ensuring adequate vitamin D levels for general health. Your primary care physician or dermatologist can be your partner(s) in developing a plan that is right for you.
Until next month,
Kesha Buster, MD FAAD (board-certified dermatologist)
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- Cancer Council Australia, the Australasian and New Zealand Bone and Mineral Society, the Australasian College of Dermatologists, Endocrine Society of Australia, Osteoporosis Australia. Position statement (2016). Sun exposure and vitamin D: Risks and benefits. https://wiki.cancer.org.au/policy/Position_statement_-_Risks_and_benefits_of_sun_exposure#Key_messages_and_recommendations
- British Association of Dermatologists. Vitamin D Consensus Statement 2010. http://www.bad.org.uk/for-the-public/skin-cancer/vitamin-d/vitamin-d-consensus-2010
- Buster, K and Ledet J. Photoprotection and Skin of Color. In: Principles and Practice of Photoprotection. https://www.springer.com/us/book/9783319293813