Sun-protective behaviors and sunburn among US adults

Photoaging: Current Concepts on Molecular Mechanisms, Prevention, and Treatment

Photoaging is the consequence of chronic exposure to solar irradiation, encompassing ultraviolet (UV), visible, and infrared wavelengths. Over time, this exposure causes cumulative damage, leading to both aesthetic changes and structural degradation of the skin. These effects manifest as rhytids, dyschromia, textural changes, elastosis, volume loss, telangiectasias, and hyperkeratosis, collectively contributing to a prematurely aged appearance that exceeds the skin's chronological age. The hallmarks of photoaging vary significantly by skin phototype. Skin of color tends to exhibit dyschromia and features associated with "intrinsic" aging, such as volume loss, while white skin is more prone to "extrinsic" aging characteristics, including rhytids and elastosis. Moreover, susceptibility to different wavelengths within the electromagnetic spectrum also differs by skin phototype, influencing the clinical presentation of photoaging, as well as prevention and treatment strategies. Fortunately, photoaging-and its associated adverse effects-is largely preventable and, to some extent, reversible. However, effective prevention and treatment strategies require careful tailoring to an individual's skin type. In this review, we summarize molecular mechanisms underlying photoaging, examine its clinical manifestations, outline risk factors and prevention strategies, and highlight recent advancements in its treatment.

Association between sun-protective behaviours and psoriasis in US adults in the National Health and Nutrition Examination Survey, 2009-2014: a cross-sectional study

OBJECTIVE

To evaluate the association between sun-protective behaviours and psoriasis in a nationally representative sample of US adults.

DESIGN

Analysis of cross-sectional data.

SETTING

National Health and Nutrition Examination Survey (NHANES), 2009-2014.

PARTICIPANTS

A total of 9735 participants aged 20-59 years with available data on psoriasis, sun-protective behaviours and covariates were included in the analysis.

OUTCOME MEASURES

Information on sun-protective behaviours (staying in the shade, wearing long sleeves and using sunscreen) and psoriasis was obtained from questionnaires in the NHANES database. Logistic regression models and subgroup analyses were employed to investigate the association between sun-protective behaviours and psoriasis.

RESULTS

After adjusting for sociodemographic variables, body mass index (BMI), alcohol drinking status, smoking status, sun sensitivity and time spent outdoors in the multivariable logistic regression model, moderate wearing of long sleeves was negatively associated with psoriasis (OR, 0.55; 95% CI 0.33 to 0.90, p=0.02), while frequent wearing showed no significant relationship. There was no significant association between staying in the shade and psoriasis, regardless of frequency. Subgroup analyses stratified by age, gender, race/ethnicity and smoking status revealed no significant associations in most groups, but moderate wearing of long sleeves was found to be negatively associated with psoriasis among those aged 20-39 years (OR, 0.42; 95% CI 0.18 to 0.98, p=0.04), among non-Hispanic white individuals (OR, 0.52; 95% CI 0.28 to 0.97, p=0.04) and among non-smokers (OR, 0.49; 95% CI 0.25 to 0.95, p=0.04), as it was among women in terms of overall sun protection (OR, 0.58; 95% CI 0.35 to 0.97, p=0.04). However, among non-Hispanic white individuals (staying in the shade: OR, 1.69; 95% CI 1.00 to 2.84, p=0.049) and former/current smokers (overall: OR, 3.28; 95% CI 1.41 to 7.63, p=0.009), frequent sun protection was positively associated with psoriasis.

CONCLUSIONS

Moderate sun-protective behaviours among US adults were found to be negatively associated with psoriasis. However, among non-Hispanic white individuals and former/current smokers, frequent sun protection was positively associated with psoriasis. Future studies with rigorous study design could further explore and validate the potential reasons for these associations to better inform evidence-based behavioural recommendations that protect human health.

Examining U.S. Adults Risk Perceptions and Skin Protection Behaviors Using the 2022 HINTS Database

Background

This study aims to provide a general overview of cancer risk perceptions and reported sunburns to prevent sunburn and reduce the long-term risk of developing skin cancer.

Methods

Data were obtained from the 2022 Health Information National Trends Survey 6 and analysis was carried out with SPSS. Descriptive statistics were conducted to explore sociodemographic characteristics, cancer risk perceptions, and behaviors surrounding sunburns in our sample. Associations between number of sunburns and sociodemographic variables were reported using multinomial regression analysis.

Results

When asked how confident patients felt about their ability to take good care of their own health, most respondents felt either very confident (44.0%) or completely confident (27.3%). When asked how often they experienced a sunburn in the past 12 months, 2.1% reported experiencing more than 6 sunburns, 30.3% reported having between 1-5 sunburns, and 67.6% reported experiencing no sunburns. Using multinomial regression analysis, statistically significant associations were reported between number of sunburns and age, gender, occupation status, marital status, education, Hispanic origin, race, and income level.

Conclusion

The results of our study reinforce the need for public health interventions that effectively disseminate information on skin cancer risk across ethnic minority groups, especially in underserved communities within the U.S.

The evolving landscape of laser-based skin cancer prevention

In the United States, 1 in 5 Americans develop keratinocyte carcinoma (KC) by age 70, placing the disease among the five most expensive cancers based on Medicare expenditure. Current preventative measures have failed to stem rising KC rates, highlighting the need for alternative strategies. Evolving evidence indicates that lasers conventionally used to treat photoaging, may provide protective effects against the development of KC and precursor lesion, actinic keratosis (AK). This review first delves into existing evidence on fractional infrared laser-based KC and AK prevention. Next, the work discusses potential underlying mechanisms that might explain fractional infrared lasers' prophylactic effects. A comprehensive literature search of PubMed and Web of Science databases was conducted from inception to April 2024 using preselected search terms. Interventional human and animal studies, epidemiological analyses, and case reports on fractional infrared laser-based prevention of KC or AK were screened according to predefined inclusion/exclusion criteria. Included evidence demonstrates that ablative fractional lasers reduce and delay development of AK/KC, shown in two controlled trials of photodamaged patients and two murine studies (i.e. Er: YSGG and CO2 lasers). Weaker evidence of KC prevention by nonablative infrared lasers is provided by a retrospective cohort study. In the laser literature, three mechanisms are proposed to drive these prophylactic effects, including the ability of infrared lasers to (i) remove DNA-damaged epidermal cells, (ii) activate the insulin-like growth factor-1 pathway by reducing fibroblast senescence, and (iii) initiate immunomodulating effects. Based on current evidence, infrared fractional lasers show promise particularly for secondary KC prevention in photodamaged populations.

Evaluating UV exposure and skin cancer prevention behaviours in Canada: a national population-based cross-sectional study

Introduction

Cutaneous melanoma is a common cancer with increasing incidence and significant economic burden. Sun-protective behaviours are crucial in addressing UV-related skin cancer risk and are responsive to public health intervention. This study provides a comprehensive overview of recent prevalence and trends in sun protection and UV exposure in Canada.

Methods

Using data from the Canadian Community Health Survey (CCHS), we examined sun-protective behaviours and UV exposure in a sample of over 77 000 individuals aged ≥18 years during 2011-2018. The analysis employed multivariable logistic regression, considering factors including age, sex, income and immigration status, with results weighted to reflect the Canadian population. We further evaluated temporal trends in UV exposure and sun-protective practices from 2007 to 2018.

Results

Age, sex, income and immigration status significantly influenced sun-protective behaviours. One-third (33.3%) of respondents reported having had a sunburn in the past 12 months, and most reported irregular or 'never use' of sunscreen on their body (64.3%) and face (58.1%). Women had significantly higher odds of using sunscreen on their body and face compared with men (OR 2.85, 95% CI 2.68 to 3.03 and OR 4.22, 95% CI 3.96 to 4.49, respectively). Individuals in the highest income quintile were similarly more likely to use sunscreen on their body and face than those in the lowest income quintile (OR 1.78, 95% CI 1.55 to 2.04 and OR 2.45, 95% CI 2.10 to 2.86, respectively). Temporal trends demonstrated an increasing prevalence of spending 2 hours or more in the sun and a decreasing trend in the use of any sunscreen on the body and face.

Conclusions

The findings highlight disparities in sun protection linked to demographic factors. Public health strategies should target high-risk groups to enhance sun-protective behaviours and reduce melanoma incidence. Future interventions must address these disparities to improve skin cancer prevention.

The Importance of Early Detection and Prevention of Atypical Skin Lesions and Other Melanoma Risk Factors in a Younger Population

BACKGROUND/OBJECTIVES

Skin cancer is becoming increasingly common due to increasing risk factors such as excessive ultraviolet (UV) radiation, genetic predisposition, fair skin, and a history of sunburn. Melanoma accounts for only 1% of cases but causes most skin cancer deaths. Dysplastic nevi (DN) are important precursors of melanoma. The aim of this study was to investigate the influence of these risk factors on the incidence and stage of skin cancer.

METHODS

The study included 591 patients aged 18 to 64 who visited the Department of Dermatology and Venereology in 2022-2023 for skin examinations. Each patient completed a questionnaire regarding the risk factors for melanoma and atypical melanocytic nevi and then underwent a dermatoscopic examination of the whole body using a digital videodermatoscope.

RESULTS

Dermatoscopic examination revealed a lesion suggestive of melanoma in 1.69% of the patients. Risk factors for developing melanoma included male gender, family history of melanoma, number of skin moles, sunburn in childhood, sun-dependent hobby, using a tanning bed, using low sun protection factor (SPF) cream, not avoiding sun exposure, and co-occurrence of actinic keratosis.

CONCLUSIONS

Risk factors for melanoma and dysplastic nevi are still common among patients, but the situation has been improving over the years. Early intervention and education on sun safety can play pivotal roles in reducing the incidence of atypical moles and potentially preventing malignant transformations.

Epidemiology and Risk Factors of Actinic Keratosis. What is New for The Management for Sun-Damaged Skin

Actinic keratosis (AK) is considered a chronic skin disease mostly caused by long-term exposure to UV radiation and other risk factors such as immunosuppression, leading to an individual susceptibility for skin cancer manifestation. The treatment of AK is laborious and costly, and the incidence of skin cancer is forecasted to double until the year 2030 in an aging society.Risk factors in AK for malignant transformation in cutaneous squamous cell carcinoma (cSCC) are not fully understood, but studies suggest that histological features, such as atypia in the basal epidermal third and basal proliferation (PRO score) in AK play a pivotal role for development of malignancy. As the clinical appearance of AK does not correlate with the risk for malignancy, guidelines suggest treating every single AK lesion upon diagnosis. Skin imaging techniques, such as line-field confocal optical coherence tomography (LC-OCT) can help to provide an individual holistic follow-up for AK lesions by non-invasive visualization of atypia and basal proliferation. A follow-up for patients with AK may be critical for treatment success in terms of strengthening therapy adherence. When AK presents therapy refractory, cSCC manifests in nearly 30% of the cases after several years. Patients with AK suffering from field cancerization and immunosuppression are susceptible for a severe course of disease including metastasis and high mortality rates. Those vulnerable subgroups benefit from close skin cancer screening, early adequate treatment and chemoprevention, such as niacinamide or acitretin. Skin cancer prevention is substantial. Primary prevention should include chemical and physical UV-light protection and avoidance of indoor tanning. Secondary prevention is essential in high-risk populations, such as fair skin type elderly men and STORs. Tertiary prevention should comprise adequate treatment strategies to prevent therapy resistance, reoccurrence and cSCC, especially when field cancerization and immunosuppression are present.

The Burden of Thin Melanomas in Tuscany, Italy, 1985-2017: Age- and Sex-Specific Temporal Trends in Incidence and Mortality

A steady increase in the incidence and mortality burden correlated to thin melanomas (≤1 mm) has been reported in recent years in some international studies, but there is currently a paucity of data from the Mediterranean area. We aimed to describe the epidemiological characteristics of thin melanoma in Tuscany, Central Italy. A total of 6002 first cutaneous invasive melanomas occurring from 1985 to 2017 were selected for analysis; data were retrieved from the local population-based cancer registry. The standardized incidence rate was 15.0 per 100,000 in the population, higher among men than women (16.5 vs. 14.1). Incidence rates tended to increase over time across all age group-specific population strata, with annual percent changes moderately higher among men (+8.0%) than women (+6.9%), especially among the elderly. Among both sexes and in each age group, the trend toward increasing incidence rates was particularly strong for thin melanomas. Survival was better among women than men across all categories of thickness. Approximately 15% of deaths occurred among patients with thin lesions, with no major temporal changes in recent years. This study contributes to an improved understanding of melanoma epidemiology in Tuscany and underscores the need for primary prevention strategies tackling the growing burden of thin melanomas.

Skin Cancer Prevention across the G7, Australia and New Zealand: A Review of Legislation and Guidelines

Incidence rates of melanoma and keratinocyte skin cancers have been on the rise globally in recent decades. While there has been a select focus on personal sun protection awareness, to our knowledge, there is a paucity of legislation in place to help support citizens' efforts to protect themselves from the harmful effects of ultraviolet radiation (UVR). Given this, we conducted a comprehensive review of legislation and guidelines pertaining to a variety of sun protection-related topics in countries of the Group of Seven (G7), Australia and New Zealand. Australia was the only country to have banned tanning beds for individuals of all ages, while other select countries have instituted bans for minors. In workplace policy, there is very little recognition of the danger of occupational UVR exposure in outdoor workers, and thus very few protective measures are in place. With regard to sports and recreation, certain dermatological/professional associations have put forward recommendations, but no legislation was brought forward by government bodies outside of Australia and New Zealand. With regard to youth, while there are various guidelines and frameworks in place across several countries, adherence remains difficult in the absence of concrete legislation and standardization of procedures. Finally, only Australia and a few select jurisdictions in the United States have implemented sales tax exemptions for sunscreen products. In light of our findings, we have made several recommendations, which we anticipate will help reduce the rates of melanoma and keratinocyte cancers in years to come. However, minimizing UVR exposure is not without risk, and we, therefore, suggest the promotion of vitamin D supplementation in conjunction with sun protective practices to limit potential harm.