Primary prevention
Primary prevention of sunburn is critical, as current treatments are minimally effective in reducing signs and symptoms of sunburn. As yet no therapy has been shown to reverse ultraviolet-induced DNA damage.[11] The best form of prevention is sun avoidance, particularly during peak hours from 10 a.m. to 4 p.m. Individuals should be counseled on protective clothing and the appropriate use of sunscreen.
A global solar ultraviolet index (UVI) has been developed by the World Health Organization through an international collaboration. This depicts, through a simple numerical scale, the intensity of ultraviolet (UV) radiation at the Earth’s surface that is relevant to effects on the human skin. Global Solar UV Index Opens in new window UV indices of 1 to 2 indicate that it is safe to be outside without sun-protective measures, UV indices of 3 to 7 recommend shade during midday hours and sun-protective measures at all other times, and UV indices of 8 or above indicate that individuals should practice sun avoidance during midday hours, with mandatory sun protection at all times. A consensus statement for Australia and New Zealand recommends the application of daily sunscreen when the UVI is 3 or higher.[17]
Counseling of young adults and pediatric patients (and their parents) regarding minimizing exposure to ultraviolet radiation is recommended by the U.S. Preventive Services Task Force for pediatric patients through age 24 years with fair skin types.[12] Other sunburn prevention interventions utilize fear tactics: a cluster randomized clinical trial in Brazilian adolescents demonstrated that a face-aging mobile phone app intervention may increase skin cancer protection behaviors (including sun protection application at 6 months) in this population.[18] The Centers for Disease Control and Prevention (CDC) has detailed information on sun protection measures: CDC: Sun Exposure Opens in new window
It is a misconception that using tanning beds or units before a vacation will safeguard against future sunburn. These units rely on ultraviolet A radiation, and so while a visible increase in tanning or pigmentation may occur, this does not increase melanin production.[19][20]
Secondary prevention
This is much the same as primary prevention. The use of long-sleeved shirts (tightly woven material provides the best ultraviolet [UV] protection) and wide-brimmed hats should be encouraged. Clothing with UV protection ratings as well as laundering agents such as bis-ethylhexyloxyphenol methoxyphenyl triazine that improve a fabric's ability to shield the skin from sunlight are commercially available.[35]
The sun protection factor (SPF) is a measurement ratio that indicates the time a person with sunscreen can be exposed to UVB radiation before sunburn occurs relative to the time to sunburn without sunscreen. For example, an SPF of 15 allows a person who would normally burn after 10 minutes in the sun without sunscreen to be protected in the sun for 150 minutes. The majority of individuals do not apply an adequate amount of sunscreen to achieve the listed SPF rating (2 mg/cm²).[15] To achieve the SPF rating listed, an average 1.7 m adult should apply 34 g, or a little more than 1 ounce, of sunscreen for a total body skin application, 20 minutes prior to going outdoors, with periodic reapplication. A minimum of SPF 15 is recommended. Water or sweat-resistant sunscreens will maintain their SPF for 40 or 80 minutes after exposure, and thus also need to be periodically reapplied. FDA regulations, therefore, ban the use of the words “waterproof” or “sweatproof”, as these terms are misleading. Sunscreens with water or sweat resistance will now be labeled as offering 40 minute or 80 minute protection. FDA regulations that went into effect in 2012 aim to make sunscreen labels more clear for the public. FDA: for consumers - sunscreen products Opens in new window The regulations also establish a standard test to determine which products can be labeled as “broad spectrum” UVA/UVB protection. To meet this test, sunscreens must protect against UVB with an SPF of 15 or higher, and must also shield at least a part of the UVA spectrum. However, many of the sunscreens that will be labeled as “broad spectrum” do not block UVA1. The consequence of ineffective UVA1 exposure is tanning, which has been associated with skin cancer and skin aging. In 2019, the FDA issued a proposed rule with updated requirements for sunscreens, in addition to providing guidance on how to apply and store sunscreen, and information regarding the sunscreen label and ingredients.[33] The FDA reports the following as acceptable active ingredients for sunscreen: Aminobenzoic acid, avobenzone, cinoxate, dioxybenzone, homosalate, meradimate, octocrylene, octinoxate, octisalate, oxybenzone, padimate O, ensulizole, sulisobenzone, titanium dioxide, trolamine salicylate, and zinc oxide. Only two of these 16 ingredients, zinc oxide and titanium dioxide, are “generally recognized as safe and effective.” The 2019 proposed rule also includes a proposal to increase maximum SPF value on sunscreen from 50 to 60.[34]
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