Lifestyle Choices

Long-term effects of UV

These can be divided into photoaging, potentially malignant and frankly malignant tumors. The changes result from a cumulative dose of UVB over many years. At present the worst affected are fair-skinned Britons who have been brought up in tropical or subtropical climates, e.g. Northern Australia or the southern states of the USA. Other groups include men who spent years in the desert in World War Two. The victims of the future are today’s young men and women who roast themselves on sunny beaches every summer and who then try to maintain the tan by using sunbeds through the winter months.

Photoaging

Multiple small freckles appear together with rather larger and more pronounced flat brown spots often called liver spots. The skin shows unevenness in thickness and blood vessels become visible through the thinner areas: there is also unevenness of color with yellow or dirty yellow sheets appearing particularly on the temples, face and neck. It may become studded with blackheads and small white cysts. Not only do fine wrinkles appear but larger permanent furrows become a prominent feature around the eyes, mouth, forehead and neck.

Potentially malignant

Solar keratoses are sand-papery or barnacle-like areas of skin found mainly in fair-skinned people or after middle- age. The face, scalp (if bald), ears, neck and backs of the hands are the usual sites. Very early examples may only show a redness on the skin and late or well-developed ones can be large heaped-up tumors. They may be multiple or form a sheet over one to three square inches. There are two reasons for treating solar keratoses. First, they may be ugly, itchy or annoying because of their site, but secondly there is a small risk of transformation into a squamous cell cancer. This is really only a possibility in the larger ones with a red swollen base so treatment to all solar keratoses is not essential. Bowen’s disease is a less common pre-malignant condition. It usually begins as a flat red scaly area which gradually enlarges with a well- defined edge. Any part of the body may be involved and more than one area may start simultaneously. The risk of change into a true skin cancer is very low.

Malignant tumors

The first two seem to be the result of a high cumulative dose over many years but the melanoma may stem more from skin which has been repeatedly burned. Melanoma is nearly twenty times commoner in whites than in blacks and it almost always occurs on sun- exposed skin.

What you can do

We are in a health-conscious age and one of the great advances has been a reduction in the number of adults who smoke. An equally simple remedy is available for those who wish to reduce drastically the risk of skin problems, including skin cancers. Strange though it may seem there are a lot of young people who are prepared to listen to advice because they are more worried about wrinkles than they are about skin cancers. Commonsense is one of the most important ingredients for success.

Awareness

Take note of the strength of the sun: i.e. how close you are to the equator, what is the time of day, what time of year is it, is there cloud cover, are there reflective surfaces such as sand or snow? Under the strongest UV conditions it may be sensible to spend only a few minutes unprotected in the sun. Noel Coward sensibly commented that only mad dogs and Englishmen go out in the midday sun.

What is safe?

There is no such thing as the right amount or wrong amount of sun. Everything is best in moderation and very few doctors will advise that you should not get any suntan at all. If you are on a one-week holiday there is probably not enough time to safely get much tan.

Skin type

Those with a very fair skin may not be able to tan at all, so there is little point in trying. If you do not tan you will build up no protection against the sun and will be burnt just as easily at the end of a holiday as at the start. People who never burn are luckier in this respect. UV will still age the skin and lead to other problems but to a lesser degree. It should not be forgotten that melanin only absorbs some of the UVB.

Shade

Visible light is reflected off various surfaces into the shade. It is not often appreciated that UV is reflected in a similar way and can burn your skin while in the shade.

Clothing

This must be the simplest way to protect the skin. A little UV can in fact penetrate some lightweight clothing but it remains a very useful way of blocking the worst effects. Hats protect much of the face and in bald people are most important. Sunglasses make life more comfortable but also protect the skin around the eyes. It is best to buy Polaroid lenses. Long-sleeved shirts and long trousers or skirts should be taken on hot holidays. After swimming in the sea it may be best to put on these garments until you next go in, especially at the start of a holiday.

Medical treatment of aging

There is no doubt that prevention is better than cure for all effects of UV on the skin. Premalignant and malignant problems can be dealt with by surgery, cryotherapy and radiotherapy. We are left with the aging skin and what can be done about that. In the last few years there has been a great stir revolving around a derivative of vitamin A called retinoic acid. Quite extensive experiments on animals have suggested that regular use of this compound as a cream can slow up the aging process of the skin or perhaps even reverse some of the earliest changes. Trials on humans have to an extent confirmed these ideas but it is difficult to get people to agree what are the physiological hallmarks of aging. Any hesitation and dialogue has been swept away, in the USA, by an overwhelming demand for the cream just in case it works. It is too early to say whether it does have protective properties for the skin but the sort of person who digs deep into their pocket to buy the cream is also likely to avoid excessive sun exposure.

Cosmetic surgeons come into their own when dealing with the ravages of time and sun. For them the market is enormous. There is no doubt that some operations are very effective at reducing wrinkles and furrows. The general term is a face lift and this operation tightens the skin; it does not make it young again. To get an idea of the likely result you should look into a mirror and gently pull the skin from the cheek towards your ear; and that from the forehead towards your hairline. Having established that such a maneuver makes things look better, the surgeon then makes incisions around the hairline and in front of the ears, frees the skin over the cheeks, gently tightens it, and removes redundant skin before sewing the area together again.

Another technique is to inject an inert substance into wrinkles to make them flat with the rest of the skin. Collagen is the actual substance present in our own skin and the purified injection is made from cow’s collagen. It is expensive and the effects only last a year or so before your body breaks down the collagen.

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