Skin Health

In this newsletter, I share some insights and perspectives on maintaining skin health, covering topics such as photoaging, vitamin D, sunscreens, and skin cancer. As someone who has personally dealt with melanoma twice, I am deeply invested in sharing my knowledge and experiences with others to promote skin health awareness.

What is UV radiation?

Invisible rays are part of the energy that comes from the sun. Ultraviolet radiation that reaches the earth's surface comprises two types of rays, called UVA and UVB. Ultraviolet radiation also comes from sun lamps and tanning beds.

How does UV radiation impact our skin?

UV radiation can have both positive and negative effects on our skin. Moderate exposure can help produce vitamin D, but excessive exposure can cause skin damage, including sunburn, premature aging, and skin cancer.

• UVA: deeper skin penetration which can contribute to aging
• UVB: can cause sunburn and helps in Vitamin D synthesis

How does sunlight impact the vitamin D production?

Vitamin D is a fat-soluble vitamin that plays an important role in maintaining bone health, immune function, and cell growth regulation.

There are two main forms of vitamin D:

• Vitamin D2
• Vitamin D3 ?(the more bioactive form)

For vitamin D synthesis 2 things are needed:

1. UVB radiation converting D2 (pre-vitamin of D3) into D3 (the bioactive vitamin D)
2. Heat; including body heat

UVB (sunlight) combined with body heat facilitates the production of vitamin D3.

Vitamin D sources

• Sunlight
• Food: fatty foods like eggs, fish oil, and fortified dairy products.
• Supplements: available in various forms: My favorite is D3/K2

How much Vitamin D do we need?

Here it gets already a bit confusing as it depends on which lab is examining your blood sample.

What factors can contribute to Vitamin D deficiency?

1. Sun exposure: depends on skin type, time of the day, geographical location
2. Adipose tissue: An increase in adipose tissue results in a higher amount of vitamin D being stored in fat cells, leading to reduced bioavailability of the vitamin.
3. Magnesium levels
4. Skin tone:

Caucasians (skin type I-IV) require minimal sun exposure to maintain sufficient Vitamin D levels. Darker skin types require 3-4 times more sun exposure under the same conditions as Caucasians.

Excessive Sun Exposure can accelerate Photoaging

Consequences:

• Wrinkles
• Sagging skin

The photo shows a truck driver who spent 32 years with the left side of his face exposed to the sun and even with the window mostly closed, some UV penetration occurred, demonstrating the cumulative effect of UV exposure. Click on study

What types of Skin Cancer do we know?

1. Basal cell carcinoma (BCC): Most common, usually appears on sun-exposed areas, is slow-growing, and rarely spreads to other parts of the body.
2. Squamous cell carcinoma (SCC): Second most common, usually appears on sun-exposed areas, can grow and spread quickly if left untreated.
3. Melanoma is the least common but most dangerous type of skin cancer, capable of appearing anywhere on the body and often characterized by changes in existing moles or the development of new pigmented lesions. If not detected and treated early, it can rapidly spread to other parts of the body. Having dealt with melanoma twice, I urge everyone to seize the day and prioritize skin health.

Importance of Early Detection and Prevention:

Understanding the types and risks associated with skin cancer, especially those influenced by UV exposure, underscores the importance of prevention and regular skin checks to catch potential issues early. In particular:

• Avoiding Sunburns: Regardless of the exact impact on melanoma risk, avoiding sunburns is advisable to reduce photoaging and potential skin damage.
• Childhood Sun Exposure: Emphasize protecting children from severe sunburns to reduce future melanoma risk.
• Use of hats, shirts, and UV-repellent clothing is encouraged.

Are tanning beds dangerous?

• Despite indoor tanning potentially leading to fewer sunburns, it significantly increases the risk of all forms of skin cancer.
• This elevated risk is present even when tanning beds predominantly provide UVA over UVB.

How can sunscreens reduce the risk of skin cancer?

Chemical sunscreens:

• UV gets absorbed and converted into heat preventing UV from reaching the skin
• Lighter sunscreen and more sheer
• More likely to cause skin reactions
• More data is needed due to the uncertainties about their safety at current usage levels

Mineral sunscreens:

• UV gets absorbed and converted into less harmful forms of heat.
• Generally considered as safer
• Tend to be a bit heavier with a white film
• But less likely to irritate the skin

It is not the physical blockage but the absorption of UV radiation.

What is the meaning of SPF (Sun Protection Factor)

SPF refers to what radiation goes into the skin and causes damage. This is a linear relationship. In other words sunscreen with for example SPF 30 works twice as well as one with SPF 15. Unfortunately, many people use it to try to calculate how long their sunscreen will protect them from sunburn, which is deceptive. Another challenge is that most lab tests are based on 2mg per square centimeter of skin. But on average we only put 1 mg. Therefore I recommend applying cream twice.

Example of SPF Ratings

• SPF 30:1/30th of UV radiation reaches the skin
• SPF 50:1/50th of UV radiation reaches the skin

some well-tested sunscreen products

• Daylong
• EltaMD
• NeutroGena
• CeraVe
• Blue Lizard
• Eucerin

My personal Skin Health prevention protocol:

• Testing my Vitamin D Levels once per year
• Supplementing with Vitamin D3/K2 during the winter months: 5000 IU/day
• Unprotected sun exposure only until max 30 minutes
• For everything > 30 mins, I use mineral sunscreen (SPF 30-50) depending on the external circumstances (UV-Index, reflection of water and snow, etc.). I am not sunbathing but love to be outdoors (triathlon, ski touring, fishing, etc.).
• I also try to remember to apply the sunscreen 30 minutes prior to sun exposure and to apply the cream twice after the first application dried out
• I have a Derma-Check 4 times a year (due to my skin cancer history) and my family once per year
• I also try to convince my sons (as they might be genetically predisposed) to apply sunscreen and not to make the same mistakes I did while in my 20s (playing tennis for ours without a t-shirt and sunscreen or skiing using cow fat to impress with a good tan…

KEEP IT UP!

Resources:

• Definition of vitamin D deficiency:? Meeting Vitamin D Requirements in White Caucasians at UK Latitudes: Providing a Choice | Nutrients (A Webb et al 2018)
• New Hampshire Skin Cancer Study: Non Melanoma Skin Cancer and Subsequent Cancer Risk | PLOS ONE (J Rees et al 2014)
• No association of melanoma with outdoor workers: Skin cancer risk in outdoor workers: a European multicenter case-control study | Journal of the European Academy of Dermatology and Venereology (M Trakatelli et al 2016)
• Aging Decreases The Capacity Of Human Skin To Produce Vitamin D3. Journal Of Clinical Investigation 76, 4. MacLaughlin, J; F. Holick, Michael (1985)
• Role Of Magnesium In Vitamin D Activation And Function The Journal Of The American Osteopathic Association 118, 3. Razzaque, M. Shawkat; Uwitonze, Anne Marie (2018).
• Vitamin D: Biology, Action, And Clinical Implications Osteoporosis ,Feldman, David; Malloy, Peter J.; Krishnan, Aruna V.; Balint, Eva (2008).
• Effect of Sunscreen Application Under Maximal Use Conditions on Plasma Concentration of Sunscreen Active Ingredients – Matta et al. (2019)