Use Of Sun Protection Measures Research Articles

Drug-Induced Photosensitivity

Photo-induced drug eruptions are cutaneous adverse events due to exposure to a drug and either ultraviolet or visible radiation. Based on their pathogenesis, they can be classified as phototoxic or photoallergic drug eruptions, although in many cases it is not possible to determine whether a particular eruption is due to a phototoxic or photoallergic mechanism. In this review, the diagnosis, prevention and management of drug-induced photosensitivity are discussed. Diagnosis is based primarily on the history of drug intake and the clinical appearance of the eruption, primarily affecting sun-exposed areas of the skin. Phototesting and photopatch testing can be useful adjuncts in making a diagnosis. The mainstay of management is prevention, including informing patients of the possibility of increased sun sensitivity and the use of sun protective measures. However, once the eruption has occurred, it may be necessary to discontinue the culprit medication and treat the eruption with a potent topical corticosteroid. Drugs that have been implicated in causing photosensitive eruptions are reviewed. Tetracycline, doxycycline, nalidixic acid, voriconazole, amiodarone, hydrochlorothiazide, naproxen, piroxicam, chlorpromazine and thioridazine are among the most commonly implicated medications. We review the medical literature regarding evidence for the culpability of each drug, including the results of phototesting, photopatch testing and rechallenge testing.

The Use of Commercially Available Personal UV‐meters Does Cause Less Safe Tanning Habits: A Randomized‐controlled Trial

UV Index information is currently recommended as a vehicle to raise public awareness about the risk of sun-exposure. It remains unknown to what extent this information can change personal sun-protective behavior. The aim of the study was to analyze the effects of UV-Index (UV-I) information provided by low cost, commercially available UV-I sensors on major indicators of sun-tanning behavior. A randomized-controlled trial was carried out on 94 healthy volunteers aged 21-23 years. After the exclusion of subjects with photosensitive disorders (n=3), 91 subjects were randomized in two arms after stratification based on phototype and sex. Both arms received a diary to be filled every day with a log of intentional sun-exposure during summer. Subjects in the intervention group also received a commercially available UV-I sensor. The UV-I sensors were switched on and the UV-value was recorded in 77% of days with sun-exposure. During days of sun-exposure, subjects randomized to the intervention group had longer average time of sun-exposure (227.7 vs 208.7 min per day, P=0.003), also between noon and 4 pm (P<0.001), and less frequently adopted sun protective measures than controls (hat [6.4%vs 10.2%, P=0.007], sunglasses [23.9%vs 30.8%, P=0.003], sunscreen [41.4%vs 47.2%, P=0.02]) and they experienced more frequent sunburns (27.8%vs 21.5%, P=0.004). The odd ratio of sunburns was 1.60 for subjects in the intervention group compared with controls (after adjustment for sex, sunscreen use and skin type). The mean UV-I value recorded by volunteers was lower (5.6 [SD+/-0.9]) than that (7.3 [SD+/-0.46]) recorded by a professional instrument in the same period at the same latitude. Poststudy laboratory tests showed that the sensor was able to detect only about 60% of the solar diffuse radiation. The use of UV-I sensors changed the sun protective behavior of sunbathers in the direction of less use of sun protective measures. One possible explanation is that the low cost UV-meters may have functioned incorrectly and under-reported UV exposure. This may have led to an underestimation of UV-I values, erroneously reassuring subjects and causing a less protective sunbathing behavior. Another hypothesis relies on a cognitive pitfall in the subjects' dealing with intermediate UV-I values, as they may have been discouraged in the use of sunscreen as they did not feel that they had yet been exposed to very harmful UV radiation.

Sun exposure, birth weight, and childhood lymphomas: a case control study in Greece

To explore whether the inverse association of sun exposure with non Hodgkin lymphoma among adults is also evident among the childhood population and test the specificity of the relation by contrasting the findings to those for Hodgkin lymphoma. A total of 87 cases of childhood (0-14 years) with non Hodgkin lymphoma and 71 with Hodgkin lymphoma, diagnosed in Greece through the national network of childhood Hematology-Oncology Units, during a 7-year period, along with 164 age- and gender-matched control children were enrolled in the study. The guardians of all eligible children were interviewed in person on the basis of a structured questionnaire covering socio-demographic, anthropometric, and perinatal characteristics. Average time of sunbathing per year at a seaside resort was used as a proxy variable of exposure to sun controlling for use of sun protection measures. The estimated incidence of 10.2 cases per 1,000,000 children-years {95% Confidence Intervals (CI), 8.4-12.1} for NHL during the study period in Greece is around the average figure in countries of the European Union. There was an inverse association of sun exposure with Non Hodgkin lymphoma, namely, for an increment of 15 days of sunbathing at seaside resorts children had almost 40% lower risk (Odds Ratio: 0.60, 95% CI: 0.43-0.83), whereas no such association was evident for Hodgkin lymphoma. The risk for non Hodgkin lymphoma has been found to be statistically and significantly higher in birth weight (Odds ratio: 1.42 and 95% CI, 1.04-1.92, for every 500 g increment), whereas there was no substantial indication that maternal education or maternal smoking during the child's life were important risk factors for the disease. This is the first study to provide epidemiological evidence that increased sun exposure of children may also be associated with a decreased risk of developing childhood non Hodgkin, but not Hodgkin lymphoma.

Sun exposure and sunburn among Swedish toddlers

Skin cancer is an emerging public health problem in Sweden. Even though the most important preventable risk factor for the development of skin cancer – sun exposure – is known, the incidence of skin cancer is still increasing. Studies have showed an association between increased risk of skin cancer and sunburn early in life. The aim of the present paper was to examine the frequency of sun exposure, sunburn and use of sun protective measures among an urban sample of Swedish toddlers. In March 2003, the parents of 4000 randomly selected children born between September 2001 and August 2002 were contacted by mail, and asked to fill out an enclosed questionnaire. The questionnaire concerned their own and their one-year-old child’s sun exposure and sunburn history, and a few questions about knowledge, attitudes and protective activities were also included. One fifth of the children had been severely sunburnt at least once. Thirty-six percent of all children had been abroad on vacation to a sunny resort. More knowledge among parents increased the likelihood that the child was properly protected when in the sun, and parents own time in the sun was positively related to child’s time in the sun. Being of the opinion that children look healthier when tanned was also positively associated with child sunburn. Thirty-five percent of all parents spent two hours or more in the sun during peak hours (11 a.m. – 3 p.m.) on a typical work-free day in the summer, and almost 10% of all parents had their children exposed to the sun for two hours or more during peak hours. We conclude that children in Sweden seem to get exposed to extensive sun exposure very early in life. Information and increased knowledge among parents to young children seems to be a potential way of increasing sun protection behaviour and decrease sun exposure among very young children.

Sun‐safety behaviors of skiers and snowboarders on the South Island of New Zealand

To study sun-protective behaviors among skiers and snowboarders on the South Island of New Zealand and to identify associations with personal characteristics or weather conditions. Two hundred twenty-six skiers and snowboarders completed an interviewer-administered questionnaire during September and October 2002. Reported behaviors were used to derive a composite sun-protection index, which was used to divide the sample into "protected" and "unprotected" groups. Odds ratios of being unprotected were calculated by logistic regression. Forty-eight percent (95% CI 42-54%) of interviewees recalled being sunburned while skiing or snowboarding in the past. Sixty-eight percent (95% CI 62-74%) were unaware of any educational messages specific to sun protection while skiing or snowboarding. Women were more likely to be protected from the sun (OR 0.47; 95% CI 0.27-0.81). Having a skin type resistant to burning (OR 1.93; 95% CI 0.92-4.06) and reported awareness of education messages (OR 1.66; 95% CI 0.92-2.99) were associated with not using sun protection. Sunburn is common and sun protection not used by all. Men are less likely to report use of sun-protection measures. There is no evidence from this study that current strategies are effective in promoting skin protection while skiing or snowboarding.

Effects of pictures and textual arguments in sun protection public service announcements

Background: The effect of public service announcements aimed at promoting primary prevention of skin cancer may be limited by superficial cognitive processing. The use of both pictures and textual arguments in sun protection public service announcements were evaluated for their potentially beneficial effects on judgment, cognitive processing and persuasiveness. Methods: In a 2 × 2 factorial experimental design individuals were shown public service announcements that advocated the advantages of sun protection measures in different versions in which a picture was present or not present and a textual argument was present or not present. The 159 participants were randomly assigned to one of four conditions. In each condition, participants were shown 12 different public service announcements designed according to the condition. Participants judged each public service announcement on attractiveness, credibility, clarity of communication and the required amount of reflection. After the judgment task, they completed a questionnaire to assess knowledge, perceived advantages and disadvantages of sun protection and intended use of sun protection measures. Results: Pictures enhanced attractiveness, but diminished comprehension. Textual arguments enhanced attractiveness, credibility and comprehension. Pictures as well as textual arguments increased knowledge of sun protection measures. Conclusion: Pictures and textual arguments in public service announcements positively influence the individual's perception of the advantages of sun protection methods and the advantages of their adoption.

Impacts from repeated mass media campaigns to promote sun protection in Australia.

Campaigns using television, radio and print media were conducted over three summers in New South Wales, Australia, aiming to increase the use of sun protection measures among children under 12 years. The evaluation entailed cross-sectional telephone surveys before and after each of the first two campaigns and following the third campaign. The study group were parents of children under 12 years. Random digit dialling yielded samples of approximately 800 for each survey. Measures addressed campaign recall and sun protection knowledge, attitudes and behaviours. The surveys revealed significant levels of campaign recall. Knowledge about the protective benefits of sunscreens, hats and protective clothing was high at baseline and showed little improvement over the campaigns. Knowledge levels about the benefits of shade cover and of the relative risks of skin cancer from childhood sun exposure were lower, and also did not show improvement. Just one of the four attitude factors showed significant improvement, and this concerned the importance that parents placed on the issue of child sun protection. After the final campaign there were increases compared with baseline in childrens' use of sunscreen, protective clothing and shade, but it was notable that between campaigns levels of these behaviours were similar to or below those at baseline. There was no evidence of a campaign-related increase in hat wearing by children. All sun protection measures were used less often by adults than children, but these showed similar trends. Mass media campaigns may contribute to short-term increases in some sun protection behaviours; however, as their impact is not sustained they should be repeated and supplemented by educational, policy and environmental strategies.

Sun Protection for Children: What Parents Do

Sun Protection for Children: What Parents Do

Reduced sun exposure and tanning in children after 2 years of a school-based intervention (Australia).

This paper presents the results of the evaluation of measured suntan and parent-reported sun exposure in participating children after 2 years of the Kidskin study, a 5-year school-based sun protection intervention undertaken in Perth, Western Australia (1995-1999). The study involves three groups: a control, a "moderate", and a "high" intervention group. Participants were 5 or 6 years of age at the beginning of the study. Control schools received the standard Health Education curriculum, while intervention schools received a multicomponent intervention including a specially designed curriculum. Children in the high intervention group also received program materials over the summer vacation and were offered sun-protective swimwear at low cost. At the end of the second summer, suntan was measured and parents completed a questionnaire about their child's sun-related behavior. Children in the intervention groups--especially the high group--were less tanned at the end of the summer; this effect was greater for the back than for the forearms. These children were also reported to have received less sun exposure and made greater use of sun protection measures. Intensive school-based interventions can reduce tanning and reported sun exposure in children.

Improved sun protection behaviour in children after two years of the Kidskin intervention

ObjectiveTo evaluate a school-based intervention in terms of reducing children's sun exposure and improving their use of sun protection measures. Methods‘Kidskin’ is a five-year, school-based intervention study in Perth, Western Australia, of a cohort of children who were five or six years old in 1995. The study involves three groups: control, ‘moderate’ and ‘high’ intervention. Children in the control schools received the standard health curriculum; those in the intervention schools received a multicomponent intervention, including a specially designed curriculum. Children in the high intervention group also received program materials over the summer holidays and were offered sun-protective swimwear at a low cost. After two years, parents completed a questionnaire about their child's sun-related behaviour. ResultsChildren in the intervention groups — especially the ‘high’ group — were reported to have had less sun exposure. This involved covering the back more often, spending more time in the shade when outdoors and wearing a style of swimsuit that covered the trunk. There was also evidence that children in the intervention groups spent less time outdoors in the middle of the day. There was little difference between groups in the wearing of hats or sunscreen. ConclusionsOur school-based intervention improved children's sun protection, but had little effect on specific behaviours that have already been vigorously promoted. ImplicationsSchool-based prevention campaigns would benefit from focusing on sun protection using clothing and shade, and reducing sun exposure in the middle of the day. There may be little potential to improve hat and sunscreen use.

The Prevalence and Predictors of Solar Protection Use among Adolescents

Background. Adolescence has been identified as a critical period in the etiology of subsequent melanoma and nonmelanocytic skin cancer. This study examines the prevalence and predictors of solar protection use among adolescents.Methods. A total of 3,642 adolescents between the ages of 11 and 16 years were recruited from a random sample of 27 schools in an Australian state. The participants completed a validated survey that provided information on a range of demographic, knowledge, attitudinal, and behavioral factors. Sun protection practices adopted during the preceding weekend were assessed using a validated self-report diary. A formula that quantifies protection status was then employed to categorize adolescents into those who were using adequate versus low levels of solar protection.Results. Overall 54% of males and 44% of females were classified as adequately protected during the preceding weekend. Logistic regression analyses identified the following as significant predictors of having an adequate level of sun protection—gender (males more likely to be protected), age (11 to 13 year olds more likely to be protected than 14 to 16 year olds), ownership of a broad-brimmed hat or cap, attitudes relating to the discomfort associated with wearing a hat, image to peers, “hassle” associated with the use of sun protective measures, school attended, and sun protective policies of the school.Conclusions. Implications of these findings for future preventive strategies are discussed and include improved targeting of sun protection programs to non-adopters, modification of attitudes relating to suntans and image to peers, reducing the level of perceived difficulty associated with utilizing sunscreen, and the potential role that schools may play in fostering sun protection.

Skin Cancer Risk and Sun Protection Learning by Helpers of Patients with Nonmelanoma Skin Cancer

Background. Knowledge-based skin cancer risk and prevention educational interventions by physicians and nurses were directed to subjects who had a nonmelanoma skin cancer. These high-risk patients asked relatives or friends to assist with postoperative care rendered after surgical removal of the skin cancer. The patient′s experience with the nonmelanoma skin cancer was expected to raise the awareness of the helper. The study examined whether the patient became a source of information, risk assessment, and skills training for his or her helper. Methods. Sequential patients between 30 and 60 years of age and their designated helpers completed a self-report questionnaire prior to the intervention and 1 year after the intervention. The questionnaire examined: (a) knowledge of skin cancer and sun protection; (b) individual susceptibility as determined by ease of sunburning or tanning; (c) attitudes about self-esteem, sun exposure, and health locus of control; (d) intentions to use sun protection; and (e) behaviors of sun protection used. Results. Over the course of 1 year, 200 pairs were entered into the study. Both patients and helpers demonstrated an increase in knowledge after the educational intervention with the patients. There was a change in the self-reported intention to use sun protection and the behaviors of sun protection used in both patients and helpers after the intervention; however, there was no attitudinal change demonstrated in pre- and post-tests for either patients or helpers. Among both patients and helpers, gender-specific differences in attitudes, intentions, and behaviors existed. Women expressed a greater likelihood of taking precautions, including the use of sunblock; however, men reported the protective strategy of wearing a hat more than women did. Men valued a tan more than women and had greater outdoor exposure, which they restricted after the intervention. Women helpers ceased using indoor tanning devices after the intervention. Behavioral change in use of sun protection measures, including protective clothing or sunblock use and decrease in hours of outdoor sun exposure or use of indoor tanning devices, was dependent upon the patient or helper′s own reported susceptibility as determined by his or her history of poor tanning and ease of sunburning. Conclusion. Patients transferred knowledge to their helpers. intention to change behavior and behavioral change were strongly correlated with the individual′s reported susceptibility to easy sunburning and poor tanning. Despite a lack of change in attitudes, changes in both intention to change behavior and behavior itself occurred in those who perceived themselves to be at risk. While the attitudes of participants in this study reflected popular beliefs, targeted education of high-risk adults with a nonmelanoma skin cancer caused changes in sun protection behaviors in both the patients and their helpers.

Lupus Erythematosus and Polymorphous Light Eruptions: An Experimental Study on Their Possible Relationship

The term chronic polymorphous light eruption, introduced by Hausmann and Haxthausen in 1929 (1), describes a “prurigo-like” as well as an eczematous eruption, both of which are induced by exposure to sunlight. Other names for them include dermatopathia photogenica, erythema perstans solare, and prurigo aestivalis (2). This paper, however, deals only with the prurigo-like eruption which Hutchinson (3) called “Summer Prurigo. Summer prurigo is characterized by recurrent eruptions on those portions of the body exposed to sunlight. There may be prodromal symptoms of burning or itching. Erythema and some degree of urticaria-like swelling soon develop. The early lesions may fade but are usually replaced by more or less persistent, discrete, inflammatory papules or plaques which may become confluent resulting in diffuse involvement of the exposed skin. This condition commonly begins in late spring or early summer and usually terminates spontaneously in the fall. Remission often follows the use of sun-protective measures (2, 4, 5). Lamb and his associates have recently elaborated on some of the details of this affection (4).