After last month we told you about the best sunscreens for this summer, the FDA announced last week some new rules that are supposed to help you choose your sunscreen wisely. What exactly are these new regulations, and how can you know which sunscreens will help you prevent skin cancer and melanoma?

Photo by Achi Raz

What exactly do sunscreens do?

The purpose of sunscreens is to prevent UV (Ultraviolet) radiation from the sun to enter the skin. This UV radiation is divided into three types, called UVA, UVB and UVC. UVC is absorbed by the ozone layer and doesn’t reach us, so there is no need to protect the skin from it. Generally, UVA penetrates the skin better (so it can reach deeper in the skin), while UVB is more intense (so it can cause more damage where it gets).

UVA is responsible for tanning and also emitted by tanning booths. It was well known it has an important role in skin aging and wrinkling, but in the last decades it was discovered that UVA can also cause skin cancers.

UVB causes sunburns rather than tanning. It is the main cause for skin cancers and also plays a smaller role in skin aging. The old FDA regulations referred only to protection from UVB.

The FDA has set two main important regulations:

Broad Spectrum SPF: According to the new regulations, sunscreens will have to pass a “Broad Spectrum Test” which will check their protection from both UVA and UVB. Only sunscreens that will pass this test with 15 SPF or more will be considered to protect the skin from skin cancer and aging. Other sunscreens will be able to claim that they protect from sunburns only.

Water Resistance and other promises: Today, there is no regulation for promises like “waterproof”, “sweatproof”, “instant protection” and more. According to the new regulations, these qualities will have to be proved to the FDA if the sunscreen manufacturer wants to write it on the label. As for water resistance, there will be a standard test to prove that, and the label will indicate if the sunscreen remains effective on water for 40 or 80 minutes.

Photo by *tlc

This is also a great opportunity to remind you of other ways to protect yourself from the sun:

• Limit exposure, and especially try to avoid spending time in the sun at noon – between 10AM and 2PM.
• Dress up: Try to cover as much skin as you can – wear shirts with long sleeves, pants, sunglasses and a broad-brimmed hat.
• Use water resistant sunscreen, and remember to renew it at least every two hours.
• Avoid Tanning oil – it has the opposite effect of sunscreen, and increases the risk for skin cancer and melanoma.

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Danger level: Medium

What is it?

Psoriasis is a skin disorder causing red scaly patches on the skin.

Who gets it?

In the United States, 2-2.6% of the white population and 1.3% of African Americans have psoriasis, with about 200,000 new cases each year. Worldwide it affects about 1-5% of the population.

It’s more common in Caucasians, and a little more common in women than in men. It usually starts around age 20, but can start at any age.

In about 40% of people with psoriasis there is also a family history of psoriasis, since it probably has a genetic cause.

What causes it?

Our skin has many layers. In normal skin, new cells form all the time and move up the skin layers until they reach the most superficial layer. When they do, these cells die and then shed. This process takes between 28-30 days.

In psoriasis, new cells grow and move up the layers much faster: it takes them 3-4 days. The buildup of cells on the skin’s surface forms the scales and patches in the disease.

A piece of skin showing its layers. In psoriasis, skin cells move up the layers too fast, accumulating on the surface.

What causes this? One of the theories around psoriasis claims that it is an autoimmune disease. This means that the body’s immune system, which is usually meant to fight infections, also fights the body’s skin cells. (We covered other types of autoimmune diseases here before, such as Graves disease, vitiligo, lupus, and others). This results in an inflammation of the skin and the fast renewal of skin cells.

Outbreaks of psoriasis are caused by known triggers:

1. An injury to the skin
2. Emotional stress
3. Infections, such as a throat infection
4. Cold weather
5. Smoking
6. Heavy alcohol consumption
7. Some drugs – Such as lithium (for bipolar disorder), beta blockers (for high blood pressure), drugs against malaria and others.

How does it feel?

The symptoms in psoriasis include:

1. Areas of skin that are dry or red. They are usually also covered with silvery-white scales, and sometimes with raised edges.
   The skin in psoriasis. Photo by Marnanel.
2. These skin areas appear thick, but they bleed easily if the scales are picked up or rubbed off.
3. Itching
4. Nail abnormalities: Such as pitting (indentations on the nail), a change of color, or crumbly nails.
5. Sometimes psoriasis can also affect the joints, causing inflammation in them, which can cause them to swell and be stiff and painful.

The areas of the skin that are usually most involved in the disease are the scalp, the back of the elbows and knees, the buttocks, and the penis. The disease can affect just a few spots of skin or can cover large skin areas.

Although not life-threatening, psoriasis can greatly affect a person’s self-image.

How is it discovered?

Usually the doctor can decide that a person has psoriasis by looking at the skin. It some cases, they may perform a skin biopsy, in which a piece of skin is cut and looked at under the microscope, to make certain that it’s indeed psoriasis and not some other similar disease.

How is it treated?

There is no cure for psoriasis, but treatments are available to interrupt the cycle of fast skin cell renewal and to remove the scaly skin patches.

There are 3 types of treatment for psoriasis:

1. Medicines applied to the skin – This includes creams and ointments you rub on your skin. Usually these are used for a disease which is mild or moderate. More severe cases require other methods.
   Creams used here include steroid creams, vitamin D creams, retinoid creams and others.
2. Light therapy – Ultraviolet light is the light produced by the sun, and which can also be produced artificially by special machines. It’s been found that exposure to ultraviolet light slows the skin turnover in the disease and improves the scaling and inflammation of the skin. It’s important to do this under a doctor’s guidance, since too much exposure to ultraviolet light can be dangerous.
3. Drugs – There are some medications which can be taken by mouth to help treat psoriasis. They are usually given in severe cases. These include retinoids, methotrexate, cyclosporin and others.

What happens after treatment?

As mentioned above, there is no cure for psoriasis, and it lasts for life. Treatment, if taken, can greatly reduce the symptoms of the disease, even in severe cases.

There is no way to prevent psoriasis, but if you have it, there are some things you can do to reduce the activity of the disease:

1. Keeping the skin moist
2. Avoiding cold, dry climates – As mentioned above, cold weather makes the disease worse.
3. Avoiding scratching the skin or skin injuries
4. Avoiding stress
5. Avoiding infections – Such as throat infections
6. Avoid medications which can worsen the disease (see above)
7. Limiting alcohol – To no more than 2 drinks a day for men and 1 for women.
8. Stopping smoking

The American Academy of Dermatology and the National Psoriasis Foundation have joined together to form the Stop Hiding from Psoriasis public education campaign.You can visit their website at stophiding.org and watch this video, featuring singer LeAnn Rimes.

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Danger level: low

What is it?

Vitiligo is a disease in which there are patches of white skin. 

Who gets it?

It happens to 1-2% of people worldwide. About 30% of those have a family member with the disease.

Vitiligo usually appears in the ages 10-30.

What causes it?

As mentioned in the melanoma article, our skin is composed of layers of cells. Melanocytes is the name of one type of cells in our skin, and they are responsible for creating a pigment, or color material, which gives our skin color and which is also responsible for the color we get when we tan.

For unknown reasons, in vitiligo the melanocytes are destroyed. This might be related to an autoimmune process, meaning that the body’s immune system attacks the body instead of intruders. In this case it attacks the melanocytes. (We have talked about other autoimmune diseases here before, like lupus and Graves disease).

How does it feel?

It looks like white patches on the skin. It can range from one or two patches to areas covering a large part of the body. It’s most remarkable in people with dark skin (in fact, Michael Jackson claims his white skin is a result of vitiligo. Also, Lee Thomas, an anchor for Fox confessed in 2007 to having vitiligo).

A hand of a woman with vitiligo (Photo by Produnis).

These patches can grow, shrink or not change at all. They usually appear in a symmetrical way, on both sides of the body.

Maybe the main problem is the psychological affect it can have on patients, especially in dark skinned people.

How is it discovered?

Usually the looks of the skin are enough for the doctor to know it’s vitiligo. Sometimes, to make sure, the doctor might perform a biopsy (cut a small piece) of the skin or look at the skin under a special lamp called a “Wood’s lamp”.

How is it treated?

There is no cure for vitiligo: there are treatments that might help with the skin appearance, but the underlying process in the body will still happen. In some cases, the color may return by itself.

Treatments that can be tried include steroid creams, drugs that weaken the immune system (which, as said above, attacks the body here), or simply applying makeup to darken the area.

Exposure to UV light (same as the light produced by the sun) in a doctor’s office can cause the melanocytes not destroyed to produce the pigment and can help.

Skin grafting can also be used if areas of skin don’t respond to the above treatments (even melanocytes alone have been implanted successfully). Another option is skin bleaching, in order to give the skin an even color throughout (this is irreversible).

What happens after treatment?

Like mentioned here, there is no cure for vitiligo. While in some patients the color may return by itself, the process in most people is still there.

Unfortunately, there is no known way to prevent vitiligo.

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Each week we’ll tackle here a disease featured in that week’s episode of Grey’s Anatomy. Last night’s episode (Stand By Me, season 5, episode 18) dealt with Dr. Stevens’ Stage IV melanoma. We’ll try to explain what melanoma is, what the various stages mean, and what you can do to discover it on time.

Danger level: High

What is it?

Melanoma is a malignant tumor of the skin. It’s responsible for the majority of skin cancer deaths. While skin is where it usually arises, it can also start in the eyes, ears, gastrointestinal tract, the brain coverings, and around the mouth or genitalia.

Who gets it?

About 60,000 cases occur each year in the US, causing more than 8,000 deaths. It occurs mainly in white people. It’s much less common in people of African American origin and Hispanics, but when they do get the disease, it might be deadlier.

Until age 39 women are about twice as much likely to get melanoma, but after the age of 40 it’s more common in men.

Usually this cancer appears around age 50, but in women aged 25-29 it’s the most common cancer.

There are a few factors that can put you at risk for melanoma:

1. Fair skin, red or blond hair, blue eyes, freckles or if you tan poorly and sunburn easily.
2. Sun exposure
3. Family history or a personal history of melanoma
4. Increased number of skin moles (nevi)

What causes it?

Our skin is composed of several layers. In these layers are scattered cells of many types. One of those cell types are melanocytes – they produce a material called a pigment, which gives our skin color. That pigment is named melanin. When exposed to the sun, that pigment is created, which is why we get a tan: That pigment causes our skin to get darker.

On the left you can see a cut from the skin showing the layers. On the right is a magnification of the layer where melanocytes exist, producing melanin.

In melanoma, in a process which is not understood completely, melanocytes turn into malignant cells. These cells divide without dying, like normal cells would, and in this way spread in the area, enter blood vessels and send metastases (areas of tumor far from the original area) throughout the body.

About 50% of melanomas develop from moles on the skin, The rest can arise in any place where melanocytes exist: The skin, eye, ear, brain coverings, and so on.

How does it feel?

Melanoma starts on the skin. It looks like a dark spot. Below we will tell you how you can differentiate a normal mole and a melanoma. Here’s a picture of one -

Melanoma

Like mentioned above, it may start on the skin, but can spread throughout the body if not taken care of on time. Each level of spread is called a stage, and there are 4 of them:

• Stage 1 and 2: The melanoma is still on the skin area.
• Stage 3: The melanoma started spreading, and it exists in lymph nodes around the area it started. (A lymph node is an organ of our immune system. Many tumors find it easy to spread using them).
• Stage 4: The tumor sent metastases to far off places in the body.

How is it discovered?

If you have moles, or any of the risk factors listed above, you should get your skin examined at least once a year by a doctor. If a lesion on the skin looks like a melanoma, the only way to make sure about its true nature is to take a biopsy out of it (a biopsy is a cut made through the lesion, after which that piece will be looked at under the microscope).

How is it treated?

The main treatment is taking off the skin lesion surgically. The surgeon will take it off along with a margin around it, to make sure everything is taken out.

What happens if the tumor metastasized? Usually operation is not possible in these stages. There are cases when you can take out the metastasis itself. Chemotherapy and drugs called “biological therapy” might also be involved in treatment.

What happens after treatment?

The survival in cancers is usually counted for 5 years after the treatment, meaning how many people survive for 5 years after being treated, and is called the 5-year survival. In Stages 1-2, the 5 year survival is between 70-99%. In stage 4 it’s around 18%, but can go down according to the place the tumor has spread to.

1. Protect yourself from the sun: The best way is to avoid sun exposure between 10am-4pm, when it’s the most intense.
2. Wear protective clothing when out in the sun: A hat with a brim, a shirt with sleeves and pants.
3. Use sunscreen with an SPF of at least 15, and it should protect against both UVA and UVB sun rays. But please don’t think that this gives you full protection – you should always try to stay clear from the sun.
4. Examine your skin regularly:

Performing a skin self-exam -

• Stand in front of a mirror and examine your body: front and back, right and left. Don’t neglect any areas, like the feet and even the space between your toes.
• Check for the ABCD’s:

A. Asymmetrical skin lesion: The lesion should be equal from all sides. If it isn’t, it is suspicious.

B. Border: The border of the lesion should be regular, without any notches. Any irregularities in the border are suspicious.

C. Color: It shouldn’t have more than 2 colors. More than that, and the lesion is suspicious.

D. Diameter: It shouldn’t be greater than 6 millimeters (0.24 inches).

Do you know of anyone with melanoma, or have you experienced it yourself? Share in the comments.

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