Awareness and knowledge of sun exposure and use of sunscreen among adults in Aseer region, Saudi Arabia

Background

Excessive sun exposure and inadequate sunscreen use can lead to skin cancer and other harmful effects on the skin, eyes, and immune system.

Purpose

This observational cross-sectional study aimed to assess awareness and knowledge of sun exposure and sunscreen use among adults in the Aseer region, Saudi Arabia. This study also focused on evaluating the risks of skin cancer and participants' sun-protective attitudes and practices.

Methods

A population-based cross-sectional study was conducted among adults in the Aseer region, Saudi Arabia. Data were collected using a questionnaire from November 2022 to January 2023 that assessed participants' knowledge, practices, and beliefs regarding sun exposure and sunscreen use. A total of 400 participants were selected for the study. Approval for the study was granted by the Local Research Ethics Committee of the University of Bisha, Saudi Arabia.

Results

The results revealed that (59.8 %) of the participants were female, while (40.3 %) were male. Regarding age, the majority fell within the 26-35 age range (37.5 %), with (16.0 %) of participants using sunscreen regularly, with a total of (74.0 %) of participants using sunscreen. Men exhibited a higher prevalence of negative attitudes towards sun protection, while women demonstrated more favourable sun protection practices. In addition, (1.25 %) of the participants had skin cancer in the past; (81.0 %) of participants agreed that skin cancer could cause death, while (19.0 %) were unsure of the effects of skin cancer. Moreover, the results indicated that sun exposure had a significant positive effect on awareness levels (p < 0.05), indicating that increased sun exposure was associated with higher awareness of the harmful effects of the sun. Additionally, awareness level significantly positively affected sunscreen use (p < 0.01), suggesting that individuals with higher awareness were more likely to use sunscreen.

Conclusion

There was an average awareness of sun exposure and its detrimental effects. In addition, a significant portion of the population demonstrates proactive measures to minimize sunlight exposure. However, sunscreen usage among Saudi adults was low despite having knowledge and awareness. Future research must enhance sun protection practices and reduce sun-related skin damage in the Aseer region.

Long-term cost-effectiveness of a melanoma prevention program using genomic risk information compared with standard prevention advice in Australia

PURPOSE

Evidence indicates that a melanoma prevention program using personalized genomic risk provision and genetic counseling can affect prevention behaviors, including reducing sunburns in adults with no melanoma history. This analysis evaluated its longer-term cost-effectiveness from an Australian health system perspective.

METHODS

The primary outcome was incremental cost effectiveness ratio (ICER) of genomic risk provision (intervention) compared with standard prevention advice. A decision-analytic Markov model was developed using randomized trial data to simulate lifetime cost-effectiveness. All costs were presented in 2018/19 Australian dollars (AUD). The intervention effect on reduced sunburns was stratified by sex and traditional risk, which was calculated through a validated prediction model. Deterministic and probabilistic sensitivity analyses were undertaken for robustness checks.

RESULTS

The per participant cost of intervention was AUD$189. Genomic risk provision targeting high-traditional risk individuals produced an ICER of AUD$35,254 (per quality-adjusted life year gained); sensitivity analyses indicated the intervention would be cost-effective in more than 50% of scenarios. When the intervention was extended to low-traditional risk groups, the ICER was AUD$43,746 with a 45% probability of being cost-effective.

CONCLUSION

Genomic risk provision targeted to high-traditional melanoma risk individuals is likely a cost-effective strategy for reducing sunburns and will likely prevent future melanomas and keratinocyte carcinomas.

Ultraviolet sun exposure and sun protection behaviors in outdoor rock climbers

BACKGROUND

Overexposure to sunlight and sunburn are the main preventable causes of skin cancer. Outdoor sports are associated with significant levels of sunlight exposure.

AIMS

We sought to quantify the sun radiation exposure received by outdoor rock climbers and assess their sun exposure habits, sun protection behaviors, attitudes, and knowledge regarding skin cancer.

METHODS

From April to June 2021, outdoor rock climbers contacted via email completed an online validated self-reported questionnaire on sun related habits, behaviors, attitudes and knowledge. As a pilot trial, ten participants wore a personal dosimeter during two outdoor climbing weekends in May and November 2021. Ambient ultraviolet radiation (UVR) was also recorded.

RESULTS

A total of 217 outdoor rock climbers (103 women), mean age 36.8 ± 8.8 years (range 20-70 years) and median climbing practice per week of 8 h (IQR 7.5) were studied. Two in three (65.9%) participants reported at least one sunburn event during the previous rock climbing season. Of the survey respondents, 49.3% reported using sunscreen with SPF ≥ 15, 47% wore sunglasses, and 14.3% indicated they reapplied sunscreen every two hours. The median personal UVR dose measured during the two outdoor climbing weekends analyzed was 5.2 (IQR 1.8) and 8.8 (IQR 1.1) standard erythemal doses, respectively.

CONCLUSIONS

The high rates of sunburn, the elevated personal UVR measured and the clearly insufficient sun protection practices followed during rock climbing together with unsatisfactory attitudes towards tanning reveal the need to develop explicit sun protection campaigns and educational strategies to reduce the risk of skin cancer among the athletes studied.

Childhood sunburn and risk of melanoma and non-melanoma skin cancer: a Mendelian randomization study

Previous evidence has suggested that childhood sunburn could be a risk factor for cutaneous malignant melanoma (MM) and non-melanoma skin cancer (NMSC). However, existing observational studies could not reveal the causal associations genetically. This study aimed to investigate whether there was a genetic causal relationship between childhood sunburn and skin cancers. Univariable Mendelian randomization (MR) and Causal Analysis Using Summary Effect analysis was carried out for causal estimates and evaluation for the horizontal pleiotropy. Multivariable MR and the mediation effects analysis were used to test whether the causal associations were mediated by potential confounders. A suggestively significant causal association between childhood sunburn and MM was indicated (OR = 4.74; 95% CI: 1.31-17.19; p = 1.79E-02). Genetically predicted childhood sunburn was significantly associated with increased risk of overall melanoma in situ (MIS) (OR = 4.02; 95% CI: 2.00-8.08; p = 9.40E-05), MIS of face (OR = 18.28; 95% CI: 5.28-63.35; p = 4.59E-06), and MIS of trunk (OR = 7.05; 95% CI: 2.06-24.13; p = 1.88E-03). Similar trends were found for childhood sunburn and NMSC (OR = 8.16; 95% CI: 6.07-10.99; p = 1.53E-20), including both basal cell carcinoma (BCC) (OR = 3.76; 95% CI:2.96-4.77; p = 2.19E-08) and squamous cell carcinoma (SCC) (OR = 7.44; 95% CI: 5.09-10.87; p = 2.19E-08). After adjustment for hair and skin color, facial ageing, vitamin D levels, body mass index, alcohol consumption, and smoking status, childhood sunburn showed an independent association with MIS, MIS of face, MIS of trunk, as well as NMSC, including both BCC and SCC. Mediation analysis showed no significant mediation effect. This study demonstrated a causal relationship between childhood sunburn and the risk of both MM and NMSC, which suggested that enhanced screening and prevention for childhood sunburn could contribute to the early detection and decreased risk of MM and NMSC.

Sun exposure practices, attitudes and knowledge among students and teachers at a University School of Health Sciences in Ecuador

Skin cancer incidence is increasing worldwide. Late adolescence and young adulthood are fundamental stages of life to acquire good sun exposure practices, regarding both personal involvement in skin cancer prevention and being a role model for others, especially in a health education environment. This descriptive cross-sectional study is based on the validated CHACES questionnaire to study sun exposure and photoprotection behavior among students and teachers at the School of Health Sciences in the National University of Chimborazo, Riobamba (Ecuador). University members (814 students (89.8 %) and 93 teachers (10.2 %)) were studied, with a predominance of females and light-skin phototypes in both groups. Similar results were obtained regarding sun exposure, with higher recreative exposure in the teachers' group and higher occupational exposure in students. However, students significantly showed lower avoiding midday sun (41.9 % vs 60.9 %), and lower use of sunglasses (10.1 % vs. 41.6 %). Attitudes towards the sun and photoprotection knowledge issues were also equivalent between students and teachers (6.1/10 vs 6.2/10). Students' sunburn rate last year reaches 88.4 % and 52.7 % in teachers (p < 0.001). Using a multivariable logistic regression model, we identified risk factors associated with a greater risk of sunburn in our population. This study highlights areas to be improved regarding knowledge, attitudes and, especially, practices of photoprotection, among students and teachers at the University of Chimborazo. These results point out that awareness-raising campaigns should be implemented to reduce sunburns, morbidity and mortality of skin cancer in this environment.

Sun protection practices in India: Preliminary findings from a nationally representative sample

Sun safety research has mainly been conducted in the West, whereas little is known about sun protection practices in India. Using a survey design with a representative sample, we aimed to understand the frequency of sun protection practices in India. We also examined associations between demographic covariates and sun safe behaviours. We surveyed a representative sample (N = 1560) from the Indian population in November 2022. The study variables included sun safe behaviours, sunburn experience, demographic information, and skin tone. We employed descriptive and regression analyses to examine the prevalence of behaviours and their associations. To mitigate potential sampling biases, we applied poststratification weights in the analyses. More than half of the participants (64.2%) routinely performed at least one sun safe behaviour, with only 4.9% of the sample reporting no engagement with sun safe behaviours in the last 12 months. Physical protection (e.g., long sleeves, shade/umbrella) were more common than sunscreen use. Regression analysis showed that higher subjective social status, being younger, and living in one of the Eastern Indian states were the strongest predictors of sun protection practices. Our findings fill an important knowledge gap in global sun safe research, highlighting the urgent need for public sun safety education. Scalable and targeted interventions are needed to promote sun safety awareness and practices among people.

Rapid Remission of Sunburn-Induced Guttate Psoriasis with Guselkumab

Guselkumab is an anti-interleukin-23 monoclonal antibody that is approved for plaque psoriasis and psoriatic arthritis. We present a case of a 28-year-old female patient with acute onset of guttate psoriasis after a blistering sunburn. She had no personal or family history of psoriasis or chronic inflammatory skin disease. The guttate psoriasis was refractory to topical treatment. After the first dose of guselkumab (100 mg subcutaneous injection), the patient experienced near-clearance of her guttate psoriasis, with continued improvement and drug-free remission 8 months after cessation of treatment. Dermatologists could consider guselkumab as a treatment option for patients with guttate psoriasis. Future studies should examine the potential for guselkumab to induce drug-free remissions in guttate psoriasis.

Sun-protective behaviors and sunburn among US adults

Individuals can reduce the risk of developing skin cancer by minimizing ultraviolet sunlight exposure, though recent trends in sun-protective behaviors remain to be investigated. To evaluate sun-protective behaviors and sunburn among US adults. We analyzed data from the 2010, 2015, and 2020 National Health Interview Survey (NHIS), an annual, cross-sectional survey conducted by the US Census Bureau. Multivariable regression models were stratified by demographic variables and constructed to evaluate sun-protective behaviors and sunburn avoidance across time. From 2010 through 2020, US adults had significantly increased prevalence of seeking shade (p value, 0.003), wearing wide-brimmed hats (< 0.001), wearing long-sleeved shirts (< 0.001), using sunscreen (< 0.001), and avoiding sunburns (< 0.001) and significantly decreased prevalence of sun avoidance (< 0.001). Disparities in sun-protective behaviors also exist among different sexes, ages, education levels, and those reporting higher sun sensitivity. This cross-sectional study found that by 2020, US adults had an increased prevalence of wearing sun-protective clothing and sunscreen use, though decreased prevalence of sun avoidance. Although certain sun-protective behaviors have become more prevalent, the incidence of skin cancer continues to rise. Efforts to understand drivers of sun-protective behaviors and targeted intervention efforts are needed.

Sunburn Frequency and Sun Protection Attitudes among Ocean Lifeguards at Florida Beaches

Objective

Research exists examining sunburn risks, sun protective behaviors, and interventions among pool lifeguards; however, ocean lifeguard research is limited. This study aimed to determine sunburn prevalence and associations between sunburn with photoprotective attitudes and habits among Florida ocean lifeguards.

Methods

A cross-sectional study was electronically administered in 2021 to ocean lifeguards using sun protection questions. Recruitment occurred through three lifeguard agencies. The frequency of self-reported sunburns from the prior season and the opinions and practices related to photoprotection and tanning were obtained.

Results

Complete data were obtained from 77 (37%) of 207 lifeguards who served during the 2020 swimming season (mean [SD] age, 22.9 [8.31] years; 40 male (52.0%) and 37 female (48.0%)). Sunburn was common with only four (5.2%) lifeguards reporting no sunburn. In total, 26 (33.8%) reported five or more sunburns. The median sunburn frequency was three. Reporting three or more sunburns was positively associated with being a teenager (16 to 18 years) (aOR: 14.9, 95% CI 3.5 to 64.2) or young adult (19 to 23 years) (aOR: 6.4, 95% CI 1.6 to 25.2) and having a neutral opinion regarding sunscreen effectiveness (aOR: 4.5, 95% CI 1.1 to 18.7) in logistic regression models.

Limitations

Self-reported sunburns were recalled and not clinically evaluated. Recall, participation, and social desirability biases may have been present.

Conclusion

Ocean lifeguards reported appreciably high rates of sunburn, especially younger lifeguards. Increased photoprotection education, engineering controls, and research are warranted for this occupational group.

A meta-analysis of sunburn and basal cell carcinoma risk

Basal cell carcinoma (BCC) is the most common cancer in the United States. Sunburn is a modifiable risk factor for BCC. The objective of this project was to synthesize research on BCC and sunburn to quantify the impact and severity of sunburn at different life stages on BCC risk in the general population. A systematic literature search of four electronic databases was conducted and data were extracted by two independent reviewers using standardized forms. Data from 38 studies were pooled using both dichotomous and dose-response meta-analytic methods. BCC risk increased with ever experiencing a sunburn in childhood (OR=1.43, 95% CI: 1.19, 1.72) and with ever experiencing a sunburn in life (OR= 1.40, 95% CI: 1.02, 1.45). Every five sunburns experienced per decade in childhood increased BCC risk by 1.86 (95% CI: 1.73, 2.00) times. Every five sunburns experienced per decade in adulthood increased BCC risk by 2.12 (95% CI: 1.75, 2.57) times and every five sunburns per decade of life increased BCC risk by 1.91 (95% CI: 1.42, 2.58) times. The data on sunburn exposure and BCC show that an increase in number of sunburns at any age increased the risk of BCC. This may inform future prevention efforts.

Modeling acute and cumulative erythemal sun exposure on vulnerable body sites during beach vacations utilizing behavior-encoded 3D body models

Vacationers in a high-solar-intensity beach setting put themselves at risk of ultraviolet radiation (UV) over-exposure that can lead to acute and chronic health consequences including erythema, photoaging, and skin cancer. There is a current gap in existing dosimetry work on capturing detailed time-resolved anatomical distributions of UV exposure in the beach vacation setting. In this study, a radiative transfer model of the solar conditions of Tampa Bay, St. Petersburg, Florida, USA (27.8°N, 82.8°W) is combined with an in silico three-dimensional body model and data on typical beach vacation behaviors to calculate acute and cumulative body-site-specific UV exposure risk during a beach vacation. The resulting cumulative UV exposure calculated for a typical mix of clothing choices, settings, and activities during a week-long (7-day) beach vacation is 172.2 standard erythemal doses (SED) at the forearm, which is comparable with the average total annual UV exposure of European and North American residents and consistent with existing dosimetry studies. This model further estimates that vacationers choosing to spend a full day exclusively in the beach or pool setting can experience UV exposure in excess of 50 SED a day at multiple body sites. Such exposure indicates that significant sun protective measures would be required to prevent sunburn across all skin types in this setting. This work clarifies the significant role that beach vacations play in UV exposure and corresponding acute and cumulative health risks and highlights the importance of behavioral choices (including clothing, activity and photoprotection) as crucial factors in differentiating personal solar exposure risks.

Sun Protection Behaviour and Sunburns in Spanish Cyclists

Sunburn caused by overexposure to ultraviolet radiation is the main cause of preventable skin cancer. This study aimed to describe the sun protection habits and rate of sunburns associated with the practice of cycling and to identify predictive factors of sunburn among cyclists. A descriptive observational study based on online surveys was conducted. Recruitment of participants was conducted through the Andalusian Cycling Federation (Spain). A questionnaire on behaviour, attitudes, and knowledge related to sun exposure was used. A bivariate analysis was carried out with sunburn episodes during the previous year as outcome variable, and a multivariate logistic regression model was built. Of the 1018 surveys returned, 87.6% were answered by men, mean age was 41.8 years (SD: 11.0), and 37.6% of the participants had phototype I or II. Sunburns during the previous year were reported by 45.6% (95% CI: 42.5-48.7) of the respondents. Sunscreen use was reported by 39.2%, and 61.0% did not examine their skin regularly despite the fact that 34 subjects (3.4%) reported a personal history of skin cancer. The multivariate logistic regression analysis showed that there was a negative correlation between episodes of sunburn and age, phototypes I-II, more than 2 h of sun exposure, and inconsistent use of sunscreen. Cyclists have high rates of sunburns and thus constitute a high-risk group for developing skin cancer. Educational interventions specifically aimed at this group of athletes would improve sun protection knowledge and practices, particularly the use of sunscreen.

Are TRPA1 and TRPV1 channel-mediated signalling cascades involved in UVB radiation-induced sunburn?

Burn injuries are underappreciated injuries associated with substantial morbidity and mortality. Overexposure to ultraviolet (UV) radiation has dramatic clinical effects in humans and is a significant public health concern. Although the mechanisms underlying UVB exposure are not fully understood, many studies have made substantial progress in the pathophysiology of sunburn in terms of its molecular aspects in the last few years. It is well established that the transient receptor potential ankyrin 1 (TRPA1), and vanilloid 1 (TRPV1) channels modulate the inflammatory, oxidative, and proliferative processes underlying UVB radiation exposure. However, it is still unknown which mechanisms underlying TRPV1/A1 channel activation are elicited in sunburn induced by UVB radiation. Therefore, in this review, we give an overview of the TRPV1/A1 channel-mediated signalling cascades that may be involved in the pathophysiology of sunburn induced by UVB radiation. These data will undoubtedly help to explain the various features of sunburn and contribute to the development of novel therapeutic approaches to better treat it.

Physiological adjustment of pomegranate pericarp responding to sunburn and its underlying molecular mechanisms

BACKGROUND

Sunburn is common in pomegranate, and sunburned fruits have poor appearance and low marketability. However, the physiological and metabolic responses to sunburn and their underlying molecular mechanisms in pomegranate fruit are little understood. Fruit of sunburn-sensitive cultivar 'Hongyushizi' was used to carry out physiological parameter detection and widely-targeted metabolomics and transcriptome study.

RESULTS

Malondialdehyde and relative conductivity increased with the severity of sunburn, which indicated increased membrane injury. Meanwhile, the content of antioxidants (total phenols and flavonoids), which reduce and repair membrane damage, increased and were accompanied by increases in total antioxidant capacity. In sunburned fruits compared with controls, 129 metabolites changed (including naringenin, pelargonidin and kaempferol) and 447 differentially expressed genes including CHI (Pgr25966.1), F3'5'H (Pgr26644.1), and CHS (Pgr005566.1) may have contributed to these changes. Transcription factors, such as NAC 5 (Pgr008725.1), MYB 93 (Pgr001791.1), and MYB 111 (Pgr027973.1) may be involved in phenylpropanoid and flavonoid biosynthesis by regulating the CHI, F3'5'H, and CHS etc. CONCLUSIONS: These findings provide insight into the sunburn mechanisms of pomegranate, and also into the genetic improvement of fruit sunburn.

Genome sequence and transcriptome of Sorbus pohuashanensis provides insights into population evolution and leaf sunburn response

Sorbus pohuashanensis is a potential horticulture and medicinal plant, but its genomic and genetic backgrounds remain unknown. Here, we sequenced and assembled the S. pohuashanensis (Hance) Hedl. reference genome using PacBio long reads. Based on the new reference genome, we resequenced a core collection of 22 Sorbus spp. samples, which were divided into 2 groups (G1 and G2) based on phylogenetic and PCA analyses. These phylogenetic clusters were highly consistent with their classification based on leaf shape. Natural hybridization between the G1 and G2 groups was evidenced by a sample (R21) with a highly heterozygous genotype. Nucleotide diversity (π) analysis showed that G1 had a higher diversity than G2 and that G2 originated from G1. During the evolution process, the gene families involved in photosynthesis pathways expanded and the gene families involved in energy consumption contracted. RNA-seq data suggested that flavonoid biosynthesis and heat-shock protein (HSP)-heat-shock factor (HSF) pathways play important roles in protection against sunburn. This study provides new insights into the evolution of Sorbus spp. genomes. In addition, the genomic resources, and the identified genetic variations, especially those related to stress resistance, will help future efforts to produce and breed Sorbus spp.

Spatiotemporal analysis of solar ultraviolet radiation based on Ozone Monitoring Instrument dataset in Iran, 2005-2019

The solar ultraviolet radiation (UVR) at national, provincial and county levels in Iran during 2005-2019 were determined based on Ozone Monitoring Instrument (OMI) dataset. The temporal (annual and monthly) trends and spatial distributions of the UVR in terms of erythemally weighted daily dose (EDD), erythemally weighted irradiance at local solar noon time (EDR), and UV index and the major factors influencing the spatiotemporal trends were analyzed. The population-weighted average values of EDD, EDR, and UV index in Iran were respectively 3631 J/m², 176.3 mW/m², 7.1 in 2005 and rose by 0.22% per year to 3744 J/m², 181.7 mW/m², and 7.3, respectively in 2019, but the annual trend was not statistically significant. The EDD in Iran during the study period exhibited the highest monthly average value in June (6339 J/m²) and the lowest one in December (1263 J/m²). The solar UVA/UVB ratios at the national level during 2005-2019 were considerably lower in summer. The EDD provincial average values in the study period were in the range of 2717 (Gilan) to 4424 J/m² (Fars). The spatiotemporal variations of the solar UVR parameters were well described by the linear models as a function of cloud optical thickness (COT), ozone column amount, surface albedo, latitude, and altitude (R² > 0.961, p value < 0.001) and the temporal changes of the solar UVR parameters were mainly caused by the COT. The results indicated that non-burning exposure to solar UVR in summer can be more efficient for vitamin D synthesis due to higher contribution of UVB in the solar UVR. The spatial distributions and temporal trends should be considered to determine the optimal duration, time and condition of exposure to the solar UVR for the public and occupational training and public health measures.

Sun Exposure, Tanning Behaviors, and Sunburn: Examining Activities Associated With Harmful Ultraviolet Radiation Exposures in College Students

Understanding the behaviors that lead to sunburn is an important objective toward developing intervention strategies to reduce risk for skin cancers. Our cross-sectional study surveyed 400 college students aged 18 and older at a public state university in the northeastern US in 2018 to assess tanning behaviors, outdoor activities, sun protection, and sunburn over the past year. Sunburn was exceedingly common; over half reported one or more sunburns in the past 12 months. Outdoor intentional and unintentional tanning were also common. Male sex, White race, sun sensitive skin type, and outdoor intentional and unintentional tanning were independently associated with increased odds of sunburn. Water and non-water sports, sunbathing, and vacations were also associated with sunburn. These results indicate that tanning and outdoor activities such as sports are important behaviors on which to focus for sunburn prevention among college students. Understanding the behaviors that are associated with sunburn provides useful opportunities to prevent skin cancer among young people.

Sunburns among beachgoers in the northern coast of Peru: frequency and factors associated

Background

Overexposure to ultraviolet (UV) radiation has increased skin cancer incidence and the risk of sunburns, especially during the summer months.

Objective

Identify the frequency and factors associated with sunburns in a sample of beachgoers in the northern coast of Peru.

Methods

We conducted a secondary data analysis of a previous study that assessed the awareness, behavior and attitudes concerning sun exposure among beachgoers. We included adults between 18 and 59 years who went to a beach in northern Peru during summer (March 2018). Three generalized linear models of the Poisson family were constructed to evaluate the factors associated with having had at least one sunburn last summer. All regression models reported the adjusted prevalence ratio (aPR) with their respective 95% confidence interval (95% CI).

Results

Of a total of 402 participants, 225 (56.0%) had one to five sunburns and 25 (6.2%) had six or more. Beachgoers who were 1–15 days (aPR: 1.16, 95% CI [1.05–1.27]) or more than 15 days (aPR: 1.22, 95% CI [1.09–1.36]) exposed to the sun on the beach had a higher frequency of at least one sunburn. The non-regular wearing of a hat or cap also increased the frequency of sunburns (aPR: 1.06, 95% CI [1.01–1.12]). In contrast, those who had Skin Phototype III (aPR: 0.94, 95% CI [0.88–0.99]) or IV (aPR: 0.69, 95% CI [0.63–0.75]) had a lower frequency of sunburns.

Conclusion

Three out of five beachgoers had one or more sunburns in the last summer. The factors associated with a higher frequency were the time of sun exposure at the beach and the non-regular use of a hat or cap. Type III–IV skin phototypes were associated with a lower sunburn frequency.

Prevalence of tanning equipment use among Canadians

The objective of this study was to collect prevalence estimates of indoor tanning usage and associated injuries in Canada. The rapid response component of the 2019 Canadian Community Health Survey collected data on the use of tanning equipment in the previous 12 months, including reasons for use, frequency/duration of use, precautions taken and adverse reactions or injuries. The 2019 research findings were as follows, an estimated 3.0% (95% CI: 2.5-3.4%) of Canadians reported that they had used indoor tanning equipment in the past year. Among users, 71.1% (95% CI: 63.9-78.3%) were female and females aged 18-34 were significantly more prevalent users compared to females aged 45 or older. The prevalence of indoor tanning was higher among people without a university degree; however, there were no differences in prevalence by household income or region. Most users indicated they used indoor tanning equipment within a tanning salon (75.3%: 95% CI: 69.1-81.6%) and the most common reason for usage was to develop a "protective" base tan (72.1%: 95% CI: 65.2-78.9%). Over one third (39.2%: 95% CI: 31.1-47.2%) of all users reported 10 or more sessions in the past year. The prevalence of indoor UV tanning usage is declining in Canada. Similar to results in 2014, the majority of users continue to be female, with a large number in the 18 to 34 age group.

Birth cohort-specific trends of sun-related behaviors among individuals from an international consortium of melanoma-prone families

BACKGROUND

Individuals from melanoma-prone families have similar or reduced sun-protective behaviors compared to the general population. Studies on trends in sun-related behaviors have been temporally and geographically limited.

METHODS

Individuals from an international consortium of melanoma-prone families (GenoMEL) were retrospectively asked about sunscreen use, sun exposure (time spent outside), sunburns, and sunbed use at several timepoints over their lifetime. Generalized linear mixed models were used to examine the association between these outcomes and birth cohort defined by decade spans, after adjusting for covariates.

RESULTS

A total of 2407 participants from 547 families across 17 centers were analyzed. Sunscreen use increased across subsequent birth cohorts, and although the likelihood of sunburns increased until the 1950s birth cohort, it decreased thereafter. Average sun exposure did not change across the birth cohorts, and the likelihood of sunbed use increased in more recent birth cohorts. We generally did not find any differences in sun-related behavior when comparing melanoma cases to non-cases. Melanoma cases had increased sunscreen use, decreased sun exposure, and decreased odds of sunburn and sunbed use after melanoma diagnosis compared to before diagnosis.

CONCLUSIONS

Although sunscreen use has increased and the likelihood of sunburns has decreased in more recent birth cohorts, individuals in melanoma-prone families have not reduced their overall sun exposure and had an increased likelihood of sunbed use in more recent birth cohorts. These observations demonstrate partial improvements in melanoma prevention and suggest that additional intervention strategies may be needed to achieve optimal sun-protective behavior in melanoma-prone families.

Diosmetin, a novel transient receptor potential vanilloid 1 antagonist, alleviates the UVB radiation-induced skin inflammation in mice

UVB radiation-mediated inflammation and the oxidative process involve the transient receptor potential vanilloid 1 (TRPV1) channel activation in neuronal and non-neuronal cells. Once diosmetin has been identified as a novel TRPV1 antagonist, we evaluated the action of diosmetin from the inflammatory [ear oedema, myeloperoxidase (MPO) activity, histological changes, and cytokines levels] and oxidative [nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and SOD activities] parameters in mice exposed to UVB radiation (0.5 j/cm²). We also verified the action of diosmetin on UVB radiation-induced inflammatory parameters after cutaneous nerve fibers denervation by RTX (50 µg/kg s.c.). The topical treatment with the novel TRPV1 antagonist, diosmetin (1%; 15 mg/ear), reduced ear oedema, MPO activity, and MIP-2 and IL-1β cytokines levels by 82 ± 8%, 59 ± 10%, 40 ± 12%, and 85 ± 9%, respectively. The action of diosmetin on ear oedema and inflammatory cell infiltration was histologically confirmed. Topical diosmetin (1%) also reduced NADPH oxidase activity by 67 ± 10% and reverted SOD activity by 81 ± 13%. After cutaneous nerve fibers denervation using RTX, diosmetin reduced ear oedema, but not the inflammatory cell infiltration in mice exposed to UVB radiation. Diosmetin can be a promising molecule against skin inflammatory disorders as a result of sunburn induced by UVB radiation exposure.

Review of Wearable and Portable Sensors for Monitoring Personal Solar UV Exposure

Sunlight is one of the main environmental resources that keeps all the organisms alive on earth. The ultraviolet (UV) radiation from the sun is essential for vitamin D synthesis in the human body, which is crucial for bone and muscle health. In addition, sun exposure also helps to reduce the risk of some cardiovascular diseases and cancers. However, excessive UV exposure can lead to adverse effects, including some eye diseases, premature aging, sunburn and skin cancers. The solar UV irradiance itself depends on many environmental factors. In fact, the UV index reported in weather forecasts is an estimation under cloudless conditions. Personal UV exposure also depends on one's outdoor activities and habits. Furthermore, the UV intake depends on the skin sensitivity. Therefore, there is a need for research into monitoring the optimal daily UV exposure for health benefits, without developing potential health risks. To facilitate the monitoring of solar UV intensity and cumulative dose, a variety of UV sensors have been developed in the past few decades and many are commercially available. Examples of sensors being marketed are: portable UV dosimeter, wearable UV radiometer, personal UV monitor, and handheld Solarmeter®. Some of the UV sensors can be worn as personal health monitors, which promote solar exposure protection. The paper provides a comprehensive review of the wearable and portable UV sensors for monitoring personal UV exposure, including a discussion of their unique advantages and limitations. Proposals are also presented for possible future research into reliable and practical UV sensors for personal UV exposure monitoring.

Associations between ultraviolet radiation, tree cover and adolescent sunburns

Background

Sunburn is the strongest risk factor for melanoma and non-melanoma skin cancers. Adolescent sunburns are related to higher risk of developing melanoma later in life. Little is known about the association of sunburns and shade, particularly tree cover, around adolescent homes and schools. This linkage study assessed associations of adolescent self-reported sunburns with ambient ultraviolet radiation (UV) and tree cover.

Methods

We analyzed a U.S. national sample of parent–child dyads (n = 1333) from the 2014 Family Life, Activity, Sun, Health, and Eating (FLASHE) study conducted by the National Cancer Institute. The outcome was adolescent sunburns reported for the previous 12 months. GIS buffers around geocoded home and school addresses were used to summarize UV and tree cover. A sensitivity analysis assessed different UV measures and tree cover buffer distances. Logistic regression models estimated the adjusted odds of any sunburns for five models: (1) no environmental variables; (2) spatial variables of latitude and longitude; (3) UV; (4) tree cover; and, (5) a combined model with UV and tree cover. Covariates included common sunburn-related items such as sun protective behaviors, socio-demographics, and latitude. Model residuals were assessed for spatial dependency and clustering.

Results

Overall, 44% of adolescents reported any sunburns in the previous 12 months. For the bivariate associations, lower categories of UV were associated with any reported sunburns (p-trend = 0.002). Home tree cover was not associated with any reported sunburns (p-trend = 0.08), whereas schools with lower categories of tree cover were associated with sunburns (p-trend = 0.008). The adjusted odds of any sunburns by UV tertiles, as a linear tread, was 0.89 (0.76–1.05) (p = 0.17); school tree cover was: 0.91 (0.78–1.07) (p = 0.25). Neither UV nor tree cover, in a combined model, were significant. Sensitivity analyses resulted in the optimal buffer size of 200 m for summarizing tree cover. Spatial dependence of residuals was not significant and clustering was significant for about 6% or less of the sample in each model.

Conclusions

We did not find significant relationships between UV or tree cover and adolescent sunburns, when adjusted by sunburn-related covariates. Better contextual data about where sunburns occurred is needed to identify environmental correlates of sunburn.

Sun Protection Behaviors and Knowledge in Mountain Marathon Runners and Risk Factors for Sunburn

BACKGROUND AND OBJECTIVES

The incidence of skin cancer in our society is growing at an alarming rate due to overexposure to solar UV radiation in recreational and occupational settings. The aim of this study was to evaluate sun exposure and protection attitudes, behaviors, and knowledge among mountain ultramarathon runners and to assess risk factors for sunburn in this population.

MATERIAL AND METHODS

Cross-sectional survey of runners who participated in the «Gran Trail Aneto-Posets» race in Aragon, Spain. Using a validated questionnaire, we collected data on sociodemographic characteristics, running experience, sunburn in the previous summer, and sun exposure and protection behaviors. We calculated descriptive statistics and performed bivariate and multivariate analyses of associations using history of sunburn as the primary outcome. Statistical significance was set at a p level of less than 0.05.

RESULTS

We surveyed 657 runners (72.1% men) with a mean age of 39.71 years; 45.1% reported sunburn in the past year. The most common protective measures used were sunglasses (74.7%), sunscreen (sun protection factor ≥ 15) (61.9%), a hat (52.2%), and other protective clothing (7.4%). Risk factors for sunburn were younger age, low Fitzpatrick skin type (I and II), running for three or more hours a day, and staying in the shade as a protective measure. By contrast, protective factors were use of sunscreen and seeking shade rather than sun at midday (p < 0.001).

CONCLUSIONS

Sunburn is common among long-distance mountain runners, despite what appears to be adequate sun protection knowledge and behaviors. Targeted strategies are needed to improve sun protection behaviors among mountain runners.

Curling ulcer in the setting of severe sunburn: A case report

BACKGROUND

While sunburns are very common, especially in pediatrics, curling ulcers secondary to sunburns are a very rare entity that has not been noted in the literature in over fifty years. This case is the first addition to the literature since the originally documented case.

CASE SUMMARY

A previously healthy 17 year old male presents to the emergency room with lethargy, shortness of breath on exertion, dark stools and nausea. His fatigue started to become significantly worse four days prior to admission. Approximately two weeks prior to admission, the patient was on a beach vacation with his family at which time he suffered severe sunburns. He had developed crampy epigastric abdominal pain, which was followed by dark, loose stools. On exam, he is non-toxic appearing, but with pallor and peeling skin on his face and chest with epigastric tenderness. Infectious stool studies were all negative including Helicobacter pylori. He denies use of any non-steroidal anti-inflammatory drugs and also denies alcohol or recreational drug use. While admitted he is found to be significantly anemic with his hemoglobin as low as 6.3 requiring two units of packed red blood cells. Endoscopy revealed several severe and deep ulcerations in the antrum and body of the stomach indicative of stress or curling ulcers.

CONCLUSION

While the incidence of stress ulcers is not known, it is most common with severe acute illness, most commonly presenting as upper gastrointestinal (GI) bleeding. It is essential to be aware of the risk of curling ulcers secondary to severe sunburns as patients with stress ulcer GI bleeding have increased morbidity and mortality compared to those who do not have GI bleed.

Neuronal and non-neuronal transient receptor potential ankyrin 1 mediates UVB radiation-induced skin inflammation in mice

AIMS

Neuronal and non-neuronal TRPA1 channel plays an active role in the pathogenesis of several skin inflammatory diseases. Although a recent study identified the TRPA1 channel activation upon UVB exposure, its role in inflammatory, oxidative, and proliferative processes underlying UVB radiation-induced sunburn was not yet fully understood. We evaluated the TRPA1 channel contribution in inflammatory, oxidative, and proliferative states on skin inflammation induced by UVB radiation in mice.

MAIN METHODS

TRPA1 role was evaluated from inflammatory (ear edema, myeloperoxidase, and N-acetyl-β-D-glycosaminidase activities, histological changes, and cytokines levels), proliferative (epidermal hyperplasia, PCNA, and TRPA1 levels), and oxidative (reactive oxygen intermediates measure, H₂O₂ quantification, and NADPH oxidase activity) parameters caused by UVB radiation single (0.5 J/cm²) or repeated (0.1 J/cm²) exposure. We verified the contribution of non-neuronal and neuronal TRPA1 on UVB radiation-induced inflammatory parameters using RTX-denervation (50 μg/kg s.c.).

KEY FINDINGS

TRPA1 blockade by the selective antagonist Lanette® N HC-030031 reduced all parameters induced by UVB radiation single (at concentration of 1%) or repeated (at concentration of 0.1%) exposure. We evidenced an up-regulation of the TRPA1 protein after UVB radiation repeated exposure, which was blocked by topical Lanette® N HC-030031 (0.1%). By RTX-denervation, we verified that non-neuronal TRPA1 also interferes in some inflammatory parameters induction. However, cutaneous nerve fibers seem to be most needed in the development of UVB radiation-induced inflammatory processes.

SIGNIFICANCE

We propose the TRPA1 channel participates in the UVB radiation-induced sunburn in mice, and it could be a promising therapeutic target to treat skin inflammatory disorders.

Promoting sunscreen use in adolescents playing outdoor sports using UV detection stickers

Sunscreen is a popular form of sun protection and when applied sufficiently (2 mg/cm²) has been shown to block the harmful molecular effects of ultraviolet radiation (UV). This field study tested the effectiveness of UV detection stickers to improve sunscreen use. During a rugby league two-day sporting event (28–29 February 2020) in Queensland, Australia interested players 14–18 years old were provided with access to free sunscreen on DAY-1 and during the subsequent day (DAY-2) were provided with a free UV detection sticker and access to sunscreen. On DAY-2, one UV detection sticker was handed out to 550 attendees. The sunscreen bottles were weighted periodically by research staff throughout both event days. Primary outcomes were sunscreen usage. Overall, 868 g of sunscreen was used across both DAY-1 and DAY-2, with 19% (167 g) of sunscreen used on DAY-1 and 81% (701 g) of sunscreen used on DAY-2. This resulted in a >3-fold improvement in sunscreen use on DAY-2 when the UV detection stickers were provided. We found UV detection stickers may improve use of sunscreen in adolescents during sporting events in high UV environments.

[Effects of solar radiation and an update on photoprotection]

Sunburn, immunodepression, photoaging, and photocarcinogenesis, are some of the most significant adverse effects of solar radiation in humans. Children are population group of special vulnerability, due to the fact that exposure to the sun has more pronounced biological effects compared to adults. Furthermore, childhood is a critical period for promoting the development of photo damage and photocarcinogenesis in the later stages of life if adequate measures at not put into place. This is because it is estimated that between 18 and 20 years of age is when 40% to 50% of the accumulative exposure to ultraviolet radiation up to 60 years of age is received. The most important strategy for the photoprotection of children is changes in behaviour and habits associated with exposure to the sun at all levels (school, society, family, etc.). Resorting to the shade, reduction in overall time of exposure to the sun, and physical protection (clothes, hats, and sunglasses) are the best and least costly photoprotection strategies. The photoprotectors must be incorporated into the daily routine of children in the same way as adults, and must complete a series of requirements in order to make them effective, safe, and in line with the environment.

Incidence and public health burden of sunburn among beachgoers in the United States

The beach environment creates many barriers to effective sun protection, putting beachgoers at risk for sunburn, a well-established risk factor for skin cancer. Our objective was to estimate incidence of sunburn among beachgoers and evaluate the relationship between sunburn incidence and sun-protective behaviors. A secondary analysis, of prospective cohorts at 12 locations within the U.S. from 2003 to 2009 (n = 75,614), were pooled to evaluate sunburn incidence 10-12 days after the beach visit. Behavioral and environmental conditions were cross-tabulated with sunburn incidence. Multivariable logistic regression was used to estimate the association between new sunburn and sun-protective behaviors. Overall, 13.1% of beachgoers reported sunburn. Those aged 13-18 years (16.5%), whites (16.0%), and those at beach locations along the Eastern Seaboard (16.1%), had the highest incidence of sunburn. For those spending ≥5 h in the sun, the use of multiple types of sun protection reduced odds of sunburn by 55% relative to those who used no sun protection (Odds Ratio = 0.45 (95% Confidence Interval:0.27-0.77)) after adjusting for skin type, age, and race. Acute health effects of sunburn tend to be mild and self-limiting, but potential long-term health consequences are more serious and costly. Efforts to encourage and support proper sun-protective behaviors, and increase access to shade, protective clothing, and sunscreen, can help prevent sunburn and reduce skin cancer risk among beachgoers.

Oxidations in white grape (Vitis vinifera L.) skins: Comparison between ripening process and photooxidative sunburn symptoms

Oxidations in grape berries are gaining major interest as they affect grape characteristics and quality. Considering berries, Reactive Oxygen Species are involved in the responses to both ripening process and stresses, including photooxidative sunburn. Redox metabolism involves a multitude of chemical and enzymatic reactions. In this study, four white grape cultivars were examined for natural ripening and photooxidative sunburn effects (obtained in artificial conditions) on berry pigmentation, chemical composition and enzymatic activity. The measured parameters included reflectance spectra, pigmentation (including berry browning), content of photosynthetic pigments, organic acid profiles, antioxidant activity, concentrations of antioxidants (total phenolics, ascorbic acid and reduced glutathione), enzymatic activities (guaiacol peroxidases, ascorbate peroxidase and catalase). The effects of the treatment (natural ripening and artificial photooxidative sunburn) on each considered parameter are described in the paper. Photooxidative sunburn strongly affected the contents of antioxidants and chlorophylls, increased the browning index and modulated the enzymatic activities investigated. Samples clearly clustered depending on the oxidation status. Furthermore, the PCA highlighted the similarities and differences in the responses to oxidative stress during ripening and photooxidative sunburn. PCA produced five functions with eigenvalues higher than 1, representing 87.03% of the total variability. In particular, the scores of the function 1 discriminated the samples based on the oxidation status, while the function 2 separated the samples based on the sampling date, representing the physiological responses characteristic of ripening. Our work sheds light on this topic, and will allow a more conscious vineyard management, thus supporting the agricultural adaptation to climate changes.

The acute effects of ultraviolet radiation exposure on solar dermatitis in Shanghai, China

Ultraviolet radiation (UVR) has long been considered associated with solar dermatitis, but the associations have not been well quantified. To depict the full-range exposure-response association between daily UVR exposures and daily outpatient visits of solar dermatitis. We collected the daily number of outpatient visits of solar dermatitis and monitored hourly ground data of UVR (the sum of A- and B-band) from 1 January 2013 to 31 December 2017 in Shanghai, China. The data were analyzed using the time-series approach, in which overdispersed generalized additive model was used and time trends and weather conditions were controlled for. During the study period, we recorded a total of 15,051 outpatient visits of solar dermatitis. There was a consistently increasing risk of solar dermatitis associated with stronger UVR without a discernible threshold. The effects occurred on the present day, increased to the largest at lag 1 or 2 days, and attenuated to the null at lag 5 days or more. A unit (w/m²) increase in daily maximum-hour UVR was associated with 1.70% (95%CI: 1.19%, 2.20%) increase of outpatient visits of solar dermatitis. Stronger effects occurred among the young people, females, and in the warm season. The risks of solar dermatitis due to UVR exposure would be overestimated if ambient temperature was not adjusted. This study provides quantitative epidemiological estimates for the positive associations between short-term exposure to UVR and increased risks of solar dermatitis. The associations were more prominent among young people, females, and in warm seasons.

Sun Protection Habits and Sunburn in Elite Aquatics Athletes: Surfers, Windsurfers and Olympic Sailors

The objective of this study was to analyse the sun exposure habits of elite aquatics athletes, together with their sunburn history and skin examination habits, taking into account differences by sex and between sports. A cross-sectional health survey was conducted at world championship events during which elite surfers, windsurfers and Olympic sailors from 30 different countries were invited to participate. The athletes were asked to complete a self-administered questionnaire focused on sun protection habits, sun exposure and sports practices. The survey was completed by 240 athletes, 171 men (71.3%) and 69 women (28.8%), with a mean age of 22 years (SD 5.86) and skin phototypes I (6.3%), II (3.3%), III (22.0%), IV (32.5%), V (9.2%) and VI (1.7%). There were significant differences between male and female athletes in skin self-examination (p < 0.001) and in the use of sunglasses (p < 0.001). In sunburn history during the last season, there were significant differences (p < 0.001) among the three sports analysed, in both sexes. The mean rate of sunburn during the previous season was 76.7%, and 27.5% of participants reported having experienced three or more sunburns that lasted at least 1 day. This type of athlete is at high risk of sunburn and hence of future skin cancer. However, there is a general lack of awareness of this risk. This study highlights the need to inform such athletes and to raise awareness of the dangers, through educational interventions on the importance of protecting against sunburn in order to reduce the future incidence of skin cancer.

Copaiba oleoresin has topical antinociceptive activity in a UVB radiation-induced skin-burn model in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Copaiba oleoresin, extracted from Copaifera L., is used as a wound healing, analgesic, antimicrobial and, mainly, anti-inflammatory agent. Thus, in this study we investigated the antinociceptive and anti-inflammatory effects of a topical formulation containing Copaiba oleoresin (3%) in a UVB radiation-induced skin burn model (0.75 J/cm²) in mice and performed a cream-formulation stability study.

MATERIALS AND METHODS

The chemical composition of Copaiba oleoresin was analyzed using gas chromatography (GC-MS). The topical antinociceptive (evaluated through mechanical allodynia and thermal hyperalgesia) and the anti-inflammatory (dermal thickness and inflammatory cell infiltration) effects of treatments were assessed. The cream-formulation stability study was performed after two months, and organoleptic characteristics, pH, spreadability and rheological characteristics were analyzed.

RESULTS

Copaiba oleoresin cream was able to prevent UVB radiation-induced mechanical allodynia on the 2nd, 3rd and 4th day after UVB radiation exposure with a maximum inhibition (I_max) of 64.6 ± 7% observed on the 2nd day; it also reduced the thermal hyperalgesia on the 1st and 2nd days post UVB radiation, with a I_max of 100% observed on the 2nd day. Moreover, topical treatment with Copaiba oleoresin cream inhibited the inflammatory cell infiltration, but did not reduce the dermal thickness. Such effects can be attributed, at least in part, to the presence of biological components, such as β-caryophyllene and other sesquiterpenes identified by GC-MS.

CONCLUSION

Our results demonstrate that the topical formulation containing Copaiba oleoresin presented antinociceptive and anti-inflammatory effects in mice subjected to a UVB radiation and that the cream-formulation was stable for two months. Thus, use of Copaiba oleoresin is a promising strategy for the treatment of inflammatory pain associated with sunburn.

Patterns of sun safety behaviors in parents: Associations with physical activity, sedentary behavior, and access to neighborhood physical activity resources

Exposure to ultraviolet rays is associated with increased risk of sunburn - a biomarker of skin cancer risk - and physical activity can increase exposure. Sun safety behaviors can mitigate the increased risk of skin cancer. The objective of this cross-sectional study was to determine associations between physical activity behaviors, access to neighborhood physical activity resources, and sunburn across different patterning of sun safety behaviors. Data collected in 2014 from parents in the United States were analyzed (N = 1680; 75% female, primarily between the ages of 35-44 and 45-59, and 67% White). Latent class analysis was conducted to identify classes of sun safety behaviors based on engagement in sun protective behaviors (wearing a hat, shirt with sleeves, and seeking shade) and sun exposure (tanning outdoors). The latent classes were then examined as moderators of the association between physical activity related variables and sunburn. Three classes were identified corresponding to Low, Moderate, and High Risk for sunburn. There was no evidence of moderation, so equality constraints were imposed across the classes. Moderate-to-vigorous physical activity (MVPA) (odds ratio [OR] = 1.09) and neighborhood environments favoring physical activity (OR = 1.39) were associated with an increased likelihood of sunburn. Greater engagement in physical activity and access to built environments that favour activity are associated with a higher likelihood of sunburn, regardless of sun safety behaviors. Physically active parents are a vulnerable population for melanoma, and cancer prevention efforts focused on physical activity should also address sun safety.

Using Social Media to Determine the Affective and Cognitive Components of Tweets about Sunburn

BACKGROUND

The relationship between social media usage and the public's expressions of sunburn remains unexplored. This study is a content analysis of Twitter that was performed to identify the public's expressions, perceptions, and attitudes towards sunburn.

METHODS

Qualitative content analysis was conducted on tweets by Australian Twitter users during January 2007 and January 2016. Out of 2,000 tweets available, in-depth content analysis of 200 random tweets was performed.

RESULTS

Tweets in this study were categorised into 10 distinct themes, three of which were cognitive (fact based) and seven affective (emotional), while one was miscellaneous. Results reveal that tweets about sunburn overwhelmingly contained affective as opposed to cognitive components. In addition, the sentiments contained in the affective tweets were frequently positively (68.9%) rather than negatively valanced (31.1%). While humour was the most common theme (n = 68 tweets), many tweets also expressed a link between Australian national identity and sunburn (n = 25 tweets).

CONCLUSION

Many of the tweets analysed contained positive affective sentiments such as joy, rather than worry or concern, suggesting an avenue for further health promotion research.

Risk Perception Plays Minimal Role in Sun Exposure Behaviours

Despite decades of public health campaigns, tanning and sunburn still occur at unacceptably high rates. Skin cancer prevention campaigns predominately focus on increasing awareness of the risk of excessive sun exposure. This study sought to assess the efficacy of this approach, by interrogating correlations between risk perception and sun exposure behaviour. A 31-item questionnaire assessing skin cancer risk factors, tanning attitudes, sunburn and tanning behaviour was undertaken by individuals who attended a workplace skin check. Validated questions were included to assess cognitive and affective risk perception and to frame risk as absolute, comparative and conditional. One hundred sixty-seven respondents completed the questionnaire. No aspects of risk perception (absolute cognitive, affective or conditional) significantly correlated with protective sun exposure behaviour, with the exception of perceived comparative severity of skin cancer. Instead, positive tanning attitudes were far more significantly correlated with sun exposure behaviour. Actual risk and risk perception have very limited impact on sun exposure behaviour. Instead, sun exposure behaviour was significantly linked with positive tanning attitudes. It is suggested, therefore, that campaigns focussing solely on education regarding risk factors appear to have been ineffective in behaviour mitigation, and innovative approaches, aimed at influencing tanning norms, might complement the existing educational campaigns.

Topical transient receptor potential ankyrin 1 antagonist treatment attenuates nociception and inflammation in an ultraviolet B radiation-induced burn model in mice

BACKGROUND

Ultraviolet B (UVB) radiation exposure promotes sunburn and thereby acute and chronic inflammatory processes, contributing to pain development and maintenance. New therapeutic alternatives are necessary because typical treatments can cause adverse effects. An attractive alternative would be to target the transient receptor potential ankyrin 1 (TRPA1), a calcium-permeable, non-selective cation channel, which is involved in a variety of inflammatory pain models.

OBJECTIVE

Evaluate the peripheral participation of TRPA1 using a topical treatment (HC030031 gel formulation; a selective TRPA1 antagonist) in nociception and inflammation caused by a UVB radiation-induced burn model in male mice (25-30 g).

METHODS

The mice were anaesthetised, and just the right hind paw was exposed to UVB radiation (0.75 J/cm²). Topical treatments were applied immediately after irradiation and once a day for 8 days.

RESULTS

HC030031 gel presented suitable pH and spreadability factor, ensuring its quality and the therapeutic effect. HC030031 0.05 % reversed UVB-induced mechanical and cold allodynia, with maximum inhibition (I_max) of 69 ± 13 % and 100 % (on day 4), respectively. HC030031 0.05 % also reduced the paw edema and MPO activity, with I_max of 77 ± 6 % (on day 5) and 69 ± 28 %, respectively. Likewise, UVB radiation increased the H₂O₂ levels (a TRPA1 agonist) and the Ca²⁺ influx in mice spinal cord synaptosomes. UVB radiation-induced Ca²⁺ influx was reduced by HC030031.

CONCLUSION

These findings confirm the activation of the TRPA1 channel by UVB radiation, suggesting that topical TRPA1 antagonists can be a new strategy for the adjuvant treatment of sunburn-associated pain and inflammation.

Dermatological and Epidemiological Profiles of Patients with Albinism in São Paulo, Brazil, between 2010 and 2017: A Cross-Sectional Study

INTRODUCTION

Oculocutaneous albinism is an autosomal recessive disease caused by complete absence of or decrease in melanin biosynthesis in melanocytes. Due to the reduction or absence of melanin, albinos are highly susceptible to the harmful effects of ultraviolet radiation and are at greater risk of actinic damage and skin cancer. There are no epidemiological data on the incidence of albinism in Brazil.

OBJECTIVE

To analyze the clinical and epidemiological profile of patients with albinism treated by the Pró-Albino Program of the Dermatology Clinic of Santa Casa de Misericórdia from its beginning in 2010 until 2017.

METHODS

In this cross-sectional study, the records of all consecutive albino patients admitted to the service in the study period were reviewed. Sociodemographic data, family history, and dermatological clinical data were collected.

RESULTS

Between March 2010 and April 2017, 191 patients were admitted, of whom 109 were female (57.07%) and the age range was 0-92 years, with >30% under the age of 18 years. Consanguinity among the parents was confirmed by 26% of the patients. Unprotected sun exposure was reported by 109 (57.07%), and 138 (72.25%) had a history of sunburn. Of the 146 records with information, 38 had skin cancer (26%), with a mean age of 47.4 (p < 0.0001); the youngest patient diagnosed with a cutaneous tumor was 23 years old. The prevalence of actinic damage was high. There was information on solar elastosis and actinic keratosis in 148 medical records, of which 96 (64.8%) patients had elastosis and 75 (50.67%) keratoses. Elastosis, keratosis, and skin cancer were significantly associated with age, unprotected sun exposure, and sunburn (p < 0.05). Of the 37 (26% of the sample of 146) patients with a previous or current history of skin cancer, it was possible to identify the histological type in 29 (13 men and 16 women); of these, 18 (62%) were basal cell carcinomas (BCC), 15 (51%) were squamous cell carcinomas (SCC), and 2 (7%) were melanomas. Of these, 4 cases (14%) presented the 2 types of carcinoma (BCC and SCC), and the 2 that had a diagnosis of melanoma also had BCC. Some patients had multiple ulcerated tumors. The tumor site was preferentially in the head and neck (43%), trunk (37%) and limbs (20%).

CONCLUSIONS

Albinos represent a risk group for skin cancer and other actinic lesions. These lesions were found to be prevalent in the albinos seen by the program and probably reflect the characteristics found in the Brazilian albino population. Access to health care, especially through multidisciplinary programs that enable the diagnosis and early treatment of these lesions, health education, and the use of photoprotective measures can reduce morbidity and mortality and improve the quality of life of patients with this rare genetic condition.

New Methodology to Evaluate Sunscreens Under Outdoor Conditions: A Double-Blind, Randomized Intra-Individual Clinical Study of a Water-Based Broad-Spectrum SPF50+ Versus SPF15 (P3) and SPF50

Introduction

This study explored a new method to test sunscreens in outdoor conditions (very high to extreme ultraviolet [UV] radiation) approximating real-life solar exposure while maintaining scientific standards and acceptable conditions, and assessed the efficacy of a water-based sun-protection factor (SPF) 50+ versus a reference SPF15 and two comparator SPF50+ products.

Methods

Thirty-five subjects underwent testing in summertime Mauritius. In each subject, five test areas were marked on the back. One area was left unprotected, and four sunscreens were applied to the others: investigational product (IP), SPF15 (ISO 24444:2010 reference standard P3), and two marketed SPF50+ controls. Subjects spent 1–2 h (depending on skin type) in the sun. After 24 h, erythema was assessed by clinical scoring (0–5) and colorimetry (a*, L*, and ITA). Secondary endpoints were correlation between clinical and colorimetry assessment, product tolerability, and total UV radiation received.

Results

All subjects were exposed to a very high UV index (≥ 8) and 30/35 were exposed to an extreme UV index (≥ 11). The IP showed statistically significant differences in clinical erythema scoring compared with unprotected skin and SPF15, but not with SPF50+ controls. On colorimetry, differences in a* (redness) and L* (lightness) reached statistical significance for the IP vs SPF15 but not vs SPF50+ controls. Clinical and instrumental erythema assessment correlated strongly (Spearman’s rho 0.663). No tolerability issues were reported.

Conclusion

This exploratory study confirmed the ability of this outdoor model to discriminate sunscreens with different SPF using clinical evaluation as an objective measure. The water-based sunscreen maintained its efficacy in outdoor conditions of very high to extreme UV radiation: it was superior to SPF15 and comparable to SPF50+ controls in preventing erythema. The method used represents an option for sunscreen efficacy comparison outside of the laboratory.

Funding

Isdin.

Electronic supplementary material

The online version of this article (10.1007/s13555-019-00315-4) contains supplementary material, which is available to authorized users.

UV detection stickers can assist people to reapply sunscreen

Sunscreen when applied at the recommended concentration (2 mg/cm²) has been shown to block the harmful molecular effects of ultraviolet radiation (UVR) in vivo. In real world conditions, however, sunscreen is often not applied/reapplied sufficiently to yield protection. This field study tested the effectiveness of UV detection stickers to prevent sunburn and improve reapplication of sunscreen. During the Ashes Cricket Test match event (November 2017) in Brisbane, Australia interested spectators were recruited into the control group on DAY-1 and during subsequent days (DAY-2, DAY-3, DAY-4) new participants were recruited into the UV-Sticker group. Participants in both groups were provided with free sunscreen and participants in the UV-Sticker group were additionally provided with a UV detection sticker. Primary outcomes were self-reported sunburns and reapplication of sunscreen. Secondary endpoints included satisfaction with the UV detection stickers. 813 participants enrolled in the study, and complete data is available for 428 participants (52.6% response rate, n = 369 UV detection sticker, n = 59 control). Participants provided with a UV detection sticker were more likely to re-apply sunscreen than controls (80% vs 68%, p = 0.04); but do not reduce sunburn rates. UV detection stickers may improve sunscreen re-application in a high UV-environment. Trial registration: Australian and New Zealand clinical trials register (ACTRN12617001572358).

Association between sunburn and demographic factors and health behaviour among Danish students

Sunburn is associated with an increased risk for skin cancer. Denmark has one of the highest incidences of melanoma in the world, although it is a relatively northern country. The objective of this study was to determine whether sunburn is associated with demographic factors and health behaviour among young Danes. Cross-sectional data of >55,000 15- to 25-year-old students participating in the Danish National Youth Study were collected in 2014. Multilevel logistic regression analysis was used to determine associations. Overall, 45% of the students had experienced at least one sunburn in Denmark, and 60% had experienced one sunburn abroad in the past year. Females had higher odds for sunburns than males. Education and geographical region were associated with sunburn but with opposite trends related for sunburn experienced in Denmark and abroad. Students who had poor dietary habits (only abroad), indulged in binge-drinking, smoked (only in Denmark), and more physical activity (only abroad) had higher odds for having a sunburns. We conclude that sunburn is prevalent among young Danes, especially those travelling abroad. Although we found some associations with demographic factors and health behaviour, there were no evident tendencies, thus indicating that broad population-based campaigning should be the preferred intervention.

Behaviors, Attitudes, and Knowledge Related to Sun Exposure Among Medical Students at the Universidad de Las Palmas de Gran Canaria

INTRODUCTION

The incidence of skin cancer, for which the main risk factor is exposure to ultraviolet radiation, has risen worldwide. Sunburn is one of the simplest ways to assess sun exposure habits. To date, few studies have evaluated sun exposure in university students.

OBJECTIVES

To determine behaviors, attitudes, and knowledge related to sun exposure and sun protection measures among medical students at the Universidad de Las Palmas de Gran Canaria; and to assess their relation to sunburn frequency.

MATERIAL AND METHODS

The voluntary participants in this cross-sectional survey were first-, second- and sixth-year university students enrolled during the 2016-2017 academic year. The students responded to a validated questionnaire about their habits, attitudes, and knowledge in relation to sun exposure. Respondents were grouped according to the number of sunburns they had experienced during the previous summer.

RESULTS

A total of 286 students responded. The students demonstrated a high level of knowledge, but the percentage who experienced a sunburn was high. Multivariate analysis showed independent correlations between experiencing a sunburn and age, male sex, academic year of enrollment at the time of the survey, phototype, and negative attitudes toward the use of sun protection measures.

CONCLUSIONS

Our medical students' level of knowledge about sun exposure and sun protection is high and scarcely varies with time spent at the university. However, their knowledge is not reflected in their behavior and attitudes or in the frequency of sunburns.

Advanced approaches for quantitative characterization of thermal transport properties in soft materials using thin, conformable resistive sensors

Noninvasive methods for precise characterization of the thermal properties of soft biological tissues such as the skin can yield vital details about physiological health status including at critical intervals during recovery following skin injury. Here, we introduce quantitative measurement and characterization methods that allow rapid, accurate determination of the thermal conductivity of soft materials using thin, skin-like resistive sensor platforms. Systematic evaluations of skin at eight different locations and of six different synthetic skin-mimicking materials across sensor sizes, measurement times, and surface geometries (planar, highly curvilinear) validate simple scaling laws for data interpretation and parameter extraction. As an example of the possibilities, changes in the thermal properties of skin (volar forearm) can be monitored during recovery from exposure to ultraviolet radiation (sunburn) and to stressors associated with localized heating and cooling. More generally, the results described here facilitate rapid, non-invasive thermal measurements on broad classes of biological and non-biological soft materials.

[Sun protection factor 50+ : Pro and contra]

The use of sunscreens with sun protection factors beyond 50 is controversial. In order to avoid misleading the consumer, several countries have already decided not to declare SPF beyond 50 on sunscreen products. Arguments against high SPF include the following: the risk of imbalanced protection, which could increase the risk of damage caused by longer-wave ultraviolet radiation; imparting a false sense of safety, which could lead to the extension of sun exposure times; health risks from higher concentrations of filter substances; and the only marginally higher blockade provided by high SPF sunscreens. On the other hand, it has been realized that the functional SPF of sunscreens remains far behind the declared SPF in the practical application and, therefore, the use of higher SPF in sensitive individuals and during strong UV exposure could make sense.

Beach: A cohort study

BACKGROUND

Increases in outdoor temperature may lead to increases in sunburn, outdoor exposure, and skin cancer in human populations.

OBJECTIVE

This study aimed to quantify sunburn incidence and risk for Ohio beachgoers exposed to varying outdoor conditions.

METHODS

Sunburn incidence data were obtained through a prospective cohort study at East Fork Lake (Cincinnati, Ohio, USA). Recruitment occurred over 26 weekend days. Beach interviews and follow-up telephone interviews obtained exposure and health information. New sunburns were self-reported 8-9 days post-enrollment. Survey data were paired with ultraviolet radiation (UVR) index and temperature data for statistical analysis.

RESULTS

Among 947 beachgoers, new sunburns were reported in 18% of swimmers. Sunburn incidence was associated with temperature (odds ratio = 1.2; 95% CI: 1.1 - 1.4) and UVR index (odds ratio = 1.6; 95% CI: 1.0 - 2.5) in models adjusted for water exposure, arrival time, and beach visit frequency. Some evidence of a temperature+UVR interaction was observed.

LIMITATIONS

Exposure and sunburn data were self-reported without clinical diagnosis and date of onset. The follow-up period enabled sunburns to be reported from a variety of days rather than only the beach visit day thereby limiting interpretation. Sun protection behaviors were not evaluated.

CONCLUSIONS

Temperature and UVR influence sunburn frequency. Temperature, however was more strongly associated with sunburn in beachgoers than the nearest measured UVR index, suggesting future investigations are needed to better understand how temperature effects sunburn development. Interventions for decreasing sunburn are needed.

Sun Exposure Habits and Sun Protection Practices of Skaters

Beach activities and outdoor sports are risk factors for developing skin cancer. Skateboarding is among the most popular sports among adolescents. The aim was to analyse the sun exposure habits and sun protection practices of skaters, in comparison with corresponding sun exposure and protection practices on the beach. This cross-sectional study is based on health surveys carried out into sun exposure and protection practices among young skateboarders. The study population was composed of 102 skaters, of whom 84 (82.4 %) were male. Fifty-eight (56.8 %) of the participants reported having suffered at least one sunburn event the previous summer. Eighty-seven (91.6 %) said they practiced outdoor sports more than 90 days per year, while only six (6.1 %) spent this long at the beach. Forty-nine (52.1 %) practiced outdoor sports for 5 or more hours a day compared to 42 (43.3 %) who spent comparable periods at the beach. A long-sleeved shirt was worn more frequently during sports than at the beach. Keen skaters are a risk group for the development of skin cancer due to excessive sun exposure, high rates of sunburn and scant use of sun protection measures. Specific educational and behavioural interventions should be aimed at this risk group.

Histological observation of hairless mice skin after exposure to Simulated Solar Light: Comparison between the histological findings with different methodologies and 3R principle correlations

BACKGROUND

Albino hairless mouse (AHM) has been used as a biological model in photodermatology. However, the experimental landscape is diverse to follow and need particular attention.

PURPOSE

Irradiation parameters were investigated for the development of a protocol to assess alterations in the AHM skin using Simulated Solar Light (SSL). The present study was compared with published articles (last 15 years) according to irradiation protocols, morphological findings to minimize animal suffering and UV exposure.

MATERIALS AND METHODS

Three groups: Control (G1), experimental - sunburn (G2) and skin photodamage assay (G3). G2 were immobilized and exposed to SSL once for 15, 30 and 45min. G3 were exposed to SSL, without immobilization, for 15min once a day for one week. The dorsal skin was analyzed using hematoxylin and eosin technique.

RESULTS

G2 displayed different sunburn degrees. Based on the profile of the observed morphological alterations, a 15min irradiation was chosen as the exposure time to expose G3, without immobilization, for 5 consecutive days.

CONCLUSION

These conditions produced the same morphological changes in the AHM with a shorter solar exposure time, without immobilizing the animals but using environmental exposure fluences, conforming to 3R (reduction - refinement - replacement) recommendations.

Adolescents' Attitudes to Sun Exposure and Sun Protection

Adolescents are considered a risk group for the development of skin cancer in later life due to their high rates of sunburn. The aim of this study is to evaluate the association between attitudes to sun exposure and the sociodemographic characteristics of adolescents, their habits, practices and knowledge. As a secondary goal, we describe the magnitude and sign of the correlations between these attitudes. Cross-sectional study of adolescent students from 12 secondary schools in southern Spain, the subjects were asked to complete the 'Beach Questionnaire'. This instrument examines four dimensions of attitudes, with standardised scores of 0-100, related to the sun, sun tanning, sun protection and sun cream. The higher the score, the more positive the attitude. The study population was composed of 270 adolescents. The highest scores were obtained for attitudes towards sun protection practices (mean 66.2; SD 18.6) and towards sun tanning (mean 64.2; SD 21.1). The lowest scores were obtained for attitudes towards using sun cream (mean 50.1; SD 24.6). Significant differences were found for all four attitudes, with a positive sign for the relationship between the number of days of sun exposure and a higher score for attitudes towards sunbathing (27.3 points difference between response extremes) and for attitudes towards suntanning (20 points difference). Favourable attitudes towards sunbathing and sun tanning have most influence on inadequate habits of sun exposure and deficient measures of sun protection. Adolescents should be considered a priority group for targeted interventions to improve sun protection behaviour.

Choctaw Nation Youth Sun Exposure Survey

The incidence of skin cancer is rising among American Indians (AI) but the prevalence of harmful ultraviolet light (UVL) exposures among AI youth is unknown. In 2013, UVL exposures, protective behaviors, and attitudes toward tanning were assessed among 129 AI and Non-Hispanic (NHW) students in grades 8–12 in Southeastern Oklahoma. Sunburn was reported by more than half the AI students and most of the NHW students. One-third of AI students reported never using sunscreen, compared to less than one-fifth of NHW students, but racial differences were mitigated by propensity to burn. Less than 10% of students never covered their shoulders when outside. Girls, regardless of race, wore hats much less often than boys. Regardless of race or sex, more than one-fourth of students never stayed in the shade, and more than one-tenth never wore sunglasses. The prevalence of outdoor tanning did not differ by race, but more than three-fourths of girls engaged in this activity compared to less than half the boys. Indoor tanning was reported by 45% of the girls, compared to 20% of girls nationwide, with no difference by race. Nearly 10% of boys tanned indoors. Among girls, 18% reported more than ten indoor tanning sessions. Over one-quarter of participants agreed that tanning makes people look more attractive, with no significant difference by race or sex. Investigations of UVL exposures should include AI youth, who have not been represented in previous studies but whose harmful UVL exposures, including indoor tanning, may place them at risk of skin cancer.

Data on solar sunburning ultraviolet (UVB) radiation at an urban Mediterranean climate

This article describes data on the intensity of ultraviolet B (UVB) radiation collected during field questionnaire-based surveys in Athens, Greece. The surveys were conducted over 11 days of July and October 2010 at three different urban, outdoor sites. A total of 1104 interviews were conducted. The participants were asked to report whether they felt they got a sunburn at the moment of the interview. Questions related to personal characteristics including skin type and exposure time (visit duration at the interview site) were also included in the questionnaire.