The SunAWARE acronym (adapted and expanded here) includes five easy action steps for prevention and early detection of skin cancer:
Avoid unprotected exposure to sunlight, seek shade, and never indoor tan (Box 15-1). Avoid being outside unprotected when the UV index is above 2 or between the hours of 10 AM and 4 PM. Sand, water, and snow increase UV radiation risk due to their reflective properties.
Wear sun-protective clothing, including a long-sleeved shirt (tightly woven), long pants, a wide-brimmed hat (3- to 4-inch brim), and sunglasses year round. Infants should wear bonnets. Clothing with a UPF rating of 50 or higher offers better protection.
Apply recommended amounts of broad-spectrum sunscreen with a sunburn protection factor (SPF) of at least 30 to all exposed skin and reapply every 2 hours, or as needed.
Routinely examine your whole body for changes in your skin and report suspicious changes to a parent or health care provider.
Educate your family and community about the need to be SunAWARE.
BOX 15-1. DNA Position Statement on Indoor Tanning
The Dermatology Nurses’ Association (DNA) recognizes the significant public health risks directly related to indoor tanning exposure and recommends the following:
Extensive public health education on the known carcinogenic effects and other associated health risks of artificial UVR and indoor tanning
Partnering with government, industry, agencies such as the CDC and AAD, other medical professionals, and schools to accomplish educational goals
An FDA ban of all nonmedical uses for artificial UVR, including the cosmetic use of indoor tanning beds
Adequate funding to comply with strict enforcement of current indoor tanning guidelines and routine inspection of all indoor tanning equipment
Prohibit use by minors under the age of 18.
Prominent display of warning signs listing the carcinogenic and health risks related to the use of tanning beds
Signed statement by each client that explicitly describes the health risks of indoor tanning Provision of sanitary eye protection for each client using indoor tanning facilities
Adequate training of all tanning device owners/operators that includes health risks of indoor tanning devices, safe operation and maintenance of equipment, recognition of UVR overexposure and emergency conditions, and first aid/emergency care for burns and UVR- related health injury, that is, disease exacerbations
Establish method to limit exposure time and alert client to end of tanning session.
Prohibit public messages or advertisements promoting the “safety” of indoor tanning.
From Dermatology Nurses Association. (2015). Indoor tanning. Retrieved from: http://www.dnanurse.org/indoor-tanning
IV. PHOTOTOXICITY AND
PHOTOALLERGY
A. Definition: photosensitivity reactions are created by combining light, generally UVA, with a photosensitizing chemical (Table 15-3). The two types of photosensitivity reactions are phototoxicity and photoallergy (Table 15-4).
B. Pathophysiology.
1. In order for a reaction to occur, light must be absorbed by the chemical in or on the skin.
2. The chemical may be systemic within the body, or introduced externally to the skin.
3. Although direct sunlight is the major source of light, fluorescent light may also cause response.
4. The clinical pattern of photosensitivity reaction appears on exposed areas of the skin such as the face, particularly the nose and cheeks, the ears, the backs of hands, and the neck area.
5. The most common cause of photoallergic reactions is external exposure to chemicals in the workplace and in rare cases to chemicals in the general environment or in commercially purchased goods.
V. SUNBURN
A. Definition: sunburn is the superficial inflammation of the skin caused by overexposure to UV light from the sun or artificial UV sources.
B. Etiology.
1. Repeated sun exposures and sunburns increase the risk of skin cancer and photoaging.
2. People who are skin types I, II, and III have very little melanin and tend to burn more readily than those with skin types IV, V, and VI.
3. Almost anyone, regardless of skin type or melanin content, can burn if they expose their skin long enough to the UV rays of the sun or to artificial sources.
4. Some drugs, such as tetracycline, sulfonamides, Diabinese, and griseofulvin are photosensitizing. Exposure to UV radiation should be minimized, and sun-protective agents (Box 15-2) should be used.
5. Erythema usually develops 2 to 12 hours after exposure and reaches its greatest severity at 24 hours.
C. Assessment.
1. The skin becomes red, tender to palpation, and warm to touch. In more severe cases, vesiculation appears.
2. There can be extreme burning discomfort accompanying a deeper burn.
3. Overexposure to UV radiation can cause eye damage resulting in painful, gritty eyes, and even temporary blindness.
4. Other symptoms experienced include headache, chills, malaise, and generalized weakness.
5. After a few days, the vesicles dry, and the skin tightens and peels.
6. The peeling leaves a mottled and sensitive skin underneath.
D. Treatment modalities.
1. The goal of treatment is to reduce discomfort, swelling, and pain.
2. Cool water compresses or cold baths can be helpful in the reduction of heat and pain.
3. The application of steroid lotions, aloe vera, and cooling creams can be helpful.
4. Systematic analgesics such as NSAIDs or acetaminophen will help decrease the pain. In extremely severe cases of sunburn, oral steroids may be necessary.
5. If blisters form, let them break open without manipulation. Clean the area with soap and water. Wet dressings initially may help relieve the pain and risk for infection.
6. If there has been any damage to the cornea of the eye, an ophthalmologist must be consulted.
TABLE 15-3 Common Phototoxic Agents, Photoallergens, and Phototoxin
TABLE 15-4 Phototoxicity versus Photoallergy
DNA, deoxyribonucleic acid; UVA, ultraviolet A; UVB, ultraviolet B.