b. Covering up
1. Key Messages – from British Association of Dermatologists
You don't have to avoid the sun all year, but taking a few steps when out and about in the summer sun or when on a sunshine holiday will help to protect you from sunburn and the risk of skin cancer.
- Protect the skin with clothing, including a hat, T shirt and UV protective sunglasses
- Spend time in the shade between 11am and 3pm when it’s sunny
- Use a sunscreen of at least SPF 30 (SPF 50 for children or people with pale skin) which also has high UVA protection
- Keep babies and young children out of direct sunlight
- The British Association of Dermatologists recommends that you tell your doctor about any changes to a mole – if your GP is concerned about your skin, make sure you see a Consultant Dermatologist (on the GMC register of specialists), the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS.
Sunscreens should not be used as an alternative to clothing and shade, rather they offer additional protection. No sunscreen will provide 100% protection
Please note that Cancer Research UK advise Factor 15 + sunscreen, whilst BAD advise factor 30 +. Further information about sunscreen can be found below, p4.
Don’t forget to apply sunscreen to sensitive areas like ears, toes and nose.
2. Key messages – Cancer Research UK (CRUK)
A sunburn is a clear sign that ultraviolet (UV) radiation from the sun or sunbeds has damaged the genetic material in your skin cells - their DNA.
Damaged DNA can cause cells to start growing out of control. This can lead to skin cancer. Getting a painful sunburn just once every two years can triple the risk of melanoma, the most serious type of skin cancer.
Your body's attempt to repair this damage is what causes the painful symptoms of a sunburn.
Why do sunburns peel?
Sometimes, the sun damages skin cells so severely that they must be destroyed. Peeling after sunburn is your body's way of getting rid of these damaged cells. This is necessary because cells damaged by the sun are at risk of becoming cancerous.
Although skin peels and new skin layers form, some damage may remain. This can increase your risk of skin cancer. So it is important to try to avoid burning in the first place.
Are sunburns like burns you get from touching something hot?
No, sunburns are caused by ultraviolet radiation (UV) from the sun, which does not feel warm. The heat in the sun comes from infrared rays, which do not burn your skin. This is why people can still burn on cool days.
When you touch a hot object, your skin may also become red, swollen and painful. But the DNA inside your skin cells is not damaged. Both heat burns and sunburns will fade, but only sunburns can cause lasting damage to the DNA in your skin cells.
Why are sunburns red, hot or painful?
When UV radiation damages DNA, your body tries to repair the damage. The blood vessels in the local area swell, allowing blood to rush into it. This is why sunburn looks red.
Blood inside your body is also hot, which is why it feels like sunburns give off heat - actually, they are usually no hotter than your core body temperature.
The wider blood vessels allow the cells of your immune system to travel to the site of the damage. They also release chemicals which trigger inflammation - this is why bad sunburns are swollen and painful.
How does the sun damage DNA?
There are two major types of UV rays that damage our skin
- UVB is responsible for the majority of sunburns and it can cause skin cancer.
- UVA penetrates deeper into the skin. It ages the skin, but contributes much less towards sunburn.
Recent evidence tells us that both UVA and UVB can damage DNA in the skin, which can lead to skin cancer. A third type of UV ray, UVC, is the most dangerous of all, but it is completely blocked out by the ozone layer and doesn’t reach the earth's surface
Is the DNA damage from the sun permanent?
Your body has ways of repairing most of the damage. But it is not perfect - some damaged DNA can be left behind. This is why it is important to avoid getting caught out by sunburn.
Do I have to worry about sunburn in the UK?
Most people think about sunburn as something that happens on holiday or in hot, sunny places. But more than half of people suffering sunburn are burnt here in the UK.
Many cases of sunburn occur when people are out and about, rather than deliberately 'sunbathing'. You may be outdoors watching sport, doing the gardening, walking round town or just sitting in the park.
How can I protect myself?
Don't let sunburn catch you out. When your risk of burning is high you can use shade, clothing and SPF 15 + sunscreen to protect your skin.
When there's no shade around, the best way to protect your skin from the sun is with loose clothing, a wide-brimmed hat and good quality sunglasses
What to look for
The more skin that is covered by your clothing, the better the protection. Look for materials with a close weave, as they will block out the most UV rays. Holding the material up to the light is a good way to see how much light and UV rays will get through.
Be aware that when some clothes get wet, they stretch and allow more UV Rays through to your skin. This is particularly a problem for cotton clothes. A wet cotton t-shirt may only offer half the protection of a dry one.
Don't forget your hat and sunglasses
Hats are great for protecting the face, eyes, ears and head. Choose a wide-brimmed hat for the most protection.
When choosing sunglasses look for one of the following:
- the 'CE Mark' and British Standard (BS EN 1836:1997)
- a UV 400 label
- a statement that the sunglasses offer 100% UV protection
Also, make sure that the glasses offer protection at the side of the eye. The wraparound style of glasses are popular in Australia where sun safety is very important.
As well as damaging the skin, overexposure to UV rays can damage the eyes too. Too much UV can lead to cataracts as well as rare types of eye cancer. Wearing sunglasses in strong sunlight can help to protect the eyes from damage.
We recommend buying sunscreens with:
- a Sun Protection Factor (SPF) of at least 15 protection against UVA rays - the more stars the better
Also look out for brands that:
- have not gone past their expiry date - most sunscreens have a shelf life of 2-3 years
Other tips for using sunscreen properly
- Apply to clean, dry skin.
- Apply plenty of sunscreen and reapply it regularly. Sunscreen can be easily washed, rubbed or sweated off.
- Even sunscreens that claim to be ‘waterproof’ should be reapplied after going in the water.
- Use sunscreen together with shade and clothing to avoiding getting caught out by sunburn.
- Don’t be tempted to spend longer in the sun than you would without sunscreen.
- Do not store sunscreens in very hot places as extreme heat can ruin their protective chemicals.
- Don’t forget to check the expiry date on your sunscreen. Most sunscreens have a shelf life of 2-3 years but ensure your sunscreen has not expired before you use it.
What factor sunscreen should I buy?
We recommend that people apply a sunscreen with at least SPF 15 – the higher the better. The same principle applies for UVA protection, too: the more stars the better (see below for more information on the star rating system).
An SPF15 sunscreen filters out 93% of UVB radiation, while an SPF30 sunscreen filters out 96%.
No sunscreen, no matter how high the factor, can provide 100% protection. And no sunscreen, whether it’s factor 15 or 50, will provide the protection it claims unless it is applied properly. Therefore, it is crucial that you apply sunscreen generously and regularly.
Research has shown that people apply much less sunscreen than they need to. And, worryingly, many people burn more frequently when they use higher factors of sunscreen because they stay out in the sun for longer. There is a concern that higher factor sunscreens may lure people into a false sense of security.
What is the star-rating?
Some sunscreens block out UVA rays as well as UVB - these rays can also lead to skin cancer. In the UK we measure UVA protection with the 'star' system. Sunscreens can have anywhere from 0 to 5 stars. The number of stars is not an absolute measure and depends on how much UVB protection the sunscreen offers. For example, an SPF 25 with 3 stars may screen out more UVA overall than an SPF 10 with 4 stars.
How to apply sunscreen
Sunscreen only works if you use enough. No sunscreen, whether it’s factor 15 or 50, will give the protection it claims unless you apply it properly. When your risk of burning is high, ensure that all exposed skin is thoroughly covered in sunscreen. As a guide, for an average person, this means
- around two teaspoonfuls of sunscreen if you're just covering your head, arms and neck.
- around two tablespoonfuls if you're covering your entire body, while wearing a swimming costume.
It is important to remember that no sunscreen gives 100% protection against UV rays.
Brands of sunscreen
Cancer Research UK does not endorse any specific brand of sunscreens. All sunscreens use the same method to determine how protective they are.
This means that brand and price are less important than things like the SPF and star ratings, which tell you how much protection they offer.
Organic and inorganic sunscreens
When it comes to sunscreens, the word “organic” does not have the same meaning that it does when used on food. It does not mean that a sunscreen is “natural” or contains fewer chemicals.
“Organic” is a technical term used in chemistry to describe molecules that contain carbon atoms. So the active ingredients in “organic sunscreens” contain carbon-based molecules, while the active ingredients in “inorganic sunscreens” do not - they are molecules like titanium dioxide.
Both types can help to prevent sunburn if used correctly - they just work in different ways.
- Organic sunscreens, also known as chemical sunscreens, work by absorbing ultraviolet rays from the sun.
- Inorganic sunscreens, also known as physical sunscreens or sunblocks, work by reflecting those rays.
Most available brands are now a mix of both types.
Both types of sunscreen can help to protect you from sunburn. The truth is that how you use sunscreen will have a far greater impact on reducing your risk of skin cancer than the type or brand that you pick.
P20/Once a day application sunscreen
Some sunscreens claim to provide effective protection after just one application. But we know that reapplying sunscreens regularly is very important because you are more likely to get even coverage and avoid missing bits that may then get burnt.
Young skin is delicate and very easily damaged by the sun. All children, no matter whether they tan easily or not, should be protected from the sun.
Children with fair or red hair, pale eyes or freckles are at most risk. Keep babies under six months out of direct sunlight, especially around midday.
Ten tips for protecting children in the sun
- Set good habits for the futureTeaching children safe sun habits while they are young sets a good pattern for later life.
- Remember you can burn in the UKThe Great British sun is quite capable of burning your child! Take extra care at home as well as abroad.
- Use shadeKeep babies in complete shade: under trees, umbrellas, canopies or indoors. Provide shade for prams and buggies, if possible.
- Cover them upWhen outdoors, protect a baby’s skin with loose-fitting clothes, and a wide-brimmed hat that shades their face, neck and ears.
- Wear sunglassesBuy good quality, wraparound sunglasses for children, as soon as they can wear them. Sunglasses don't have to be expensive brands.
- Find hats they likeEncourage children to wear hats with brims, especially if they are not wearing sunglasses. The wider the brim, the more skin will be shaded from the sun.
- Use sunscreen wiselyUse at least a factor 15 sunscreen and choose a "broad-spectrum" brand that protects against UVA rays - the more stars the better. Apply to areas that cannot be protected by clothing, such as the face, ears, feet and backs of hands. Choose sunscreens that are formulated for children and babies' skin. These products are less likely to contain alcohol or fragrances that might irritate the skin and cause allergic reactions.
- Apply sunscreen generously and regularly. Put some on before children go outdoors. Sunscreen can easily be washed, rubbed or sweated off – so reapply often throughout the day.
- Don't forget school timesRemember play times and lunch breaks on summer school days too. Give children a hat to wear and, if they can't apply sunscreen at school, cover their exposed skin before they go.
What about vitamin D?
We all need some sunlight to make enough vitamin D, but most of us get enough through casual exposure to the sun. Parents should not worry too much about short periods when their children might be out in the sun. But for longer times, the tips above will help to protect a child from burning in the sun.
Infants and toddlers may need more protection. Indirect sun exposure may help a baby’s vitamin D levels. But if mothers have enough vitamin D while they are pregnant, then the chances are that their babies will do too. It is best to speak with your doctor if you are concerned about your baby’s vitamin D levels
- Sunbeds aren't a safe alternative to tanning outdoors. Like the sun, sunbeds give out harmful UV rays which damage the DNA in our skin cells and can cause skin cancer.
- Sunbeds are estimated to cause around 100 deaths from melanoma every year in the UK.
- Sunbeds also cause premature skin ageing, which means that your skin becomes coarse, leathery and wrinkled at a younger age. So when the tan fades, the damage remains.
People use sunbeds for all sorts of reasons. Here, we clear up a few of the most common myths.
Being tanned is not a sign of health
The simple fact that your skin has changed colour is a sign of damage. Without goggles, UV from sunbeds can also damage your eyes and lead to irritation, conjunctivitis and eye cancer.
Skin damage from sunbeds is just as big a problem for young people
You can't always see the damage that UV does straight away as it builds up gradually. But every time you use a sunbed you are damaging your skin, making it look worse in the long run. Using sunbeds for the first time before the age of 35 increases the risk of developing melanoma skin cancer by 75%. Surgical treatment for skin cancer can result in serious scarring.
Spending more time on sunbeds will not make your tan look any better
We each have our own tanning limits. No matter how much UV you receive there comes a point when your skin won't get any darker. Using sunbeds will make your skin coarse, leathery and wrinkled. Boosting your tan by having two sunbed sessions within 24 hours or after sunbathing is particularly harmful. Get your beauty sleep in your own bed, rather than on a sunbed.
Sunbed tanning is no safer than sun tanning
Sunbeds are not a 'safe' alternative to sun tanning. The main cause of skin cancer is overexposure to ultraviolet (UV) radiation. Like the sun, sunbeds give off UVA and UVB rays. While sunburn is mostly caused by UVB, both types of UV can cause DNA damage, which can lead to skin cancer.
Modern sunbeds emit mostly UVA rays, but UVB rays can make up anywhere from 0.5-4% of their total output. These emissions can be comparable to the midday sun. And the amount of UVA given off can be 10-15 times higher than the midday sun. .
You cannot tan safely by building your sunbed tan gradually
Unfortunately, using sunscreen or limiting your time on a sunbed will not completely protect your skin from damage and ageing. In fact, short periods of intense, irregular UV exposure, like you get on a sunbed, are the fastest way to damage your skin.
A tan will not provide much protection from the sun on holiday
A tan offers very limited protection from sunlight or burning. At most, a sunbed tan is the equivalent to a sunscreen with SPF of just 2-4. Not enough to keep you safe in the sun. And if you don't tan easily in the sun, you won't tan easily on a sunbed.
You don't need to burn to get a tan
Burning or going red under a sunbed is a sign that you have seriously harmed your skin. UV can penetrate deep into the skin's layers and damage the DNA in our skin cells. Cells damaged by UV are at greater risk of mutating and then dividing uncontrollably, which is what happens in cancer.
You don't need a sunbed to produce vitamin D
Vitamin D is essential for good health. Our bodies make the vitamin when our skin is exposed to UV rays and it is also present in certain foods. You only need short exposures to the sun to produce adequate amounts. So you don’t need a sunbed to get your vitamins!
Who is most at risk?
People with fair skin that tends to burn are at higher risk of problems from sunbed use than those with darker skin. Young people also have delicate skin and are more likely to damage it by using sunbeds.
You should NEVER use a sunbed if you:
- are under 18
- have fair or freckly skin
- burn easily
- have a lot of moles
- have had skin cancer in the past
- have a family history of skin cancer
- are using medication that increases your sensitivity to UV.
Sunbed use in children
Cancer Research UK was commissioned by the National Cancer Action Team, supported by the Department of Health, to explore the extent and patterns of sunbed use among children in England. Some of the main findings of the research (published in the British Medical Journal, March 2010) included:
- More than one quarter of a million children aged 11-17 are risking their health by using sunbeds.
- In England, on average, six per cent of 11-17 year olds use sunbeds.
- In Liverpool and Sunderland 50 per cent of 15-17 year-old girls use sunbeds, and more than two in five use sunbeds at least once a week.
Across the Network, the incidence of Malignant Melanoma is higher in females, although mortality is higher in males. However, this varies across PCT/CCGs.
Nationally (England), the incidence for Malignant Melanoma is:
The incidence of non melanoma skin cancer is much higher than malignant melanoma, and again more common in men. Mortality from this form of skin cancer is very rare.