A Little Ray Of Sunshine, But Not Too Much, Important For Health - Experts Release New Guidelines On Sun Exposure

Main Category: Dermatology
Also Included In: Cancer / Oncology
Article Date: 21 Jun 2007 - 1:00 PST

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New guidelines have been released to tell Australians how much sun they need to avoid vitamin D deficiency and stay healthy without increasing their risk of skin cancer. The new guidelines follow research showing some Australians are deliberately seeking sun exposure over summer because they are concerned about vitamin D deficiency. CEO of The Cancer Council Australia, Professor Ian Olver, says the new data shows the wrong people are concerned about vitamin D deficiency.

"We're alarmed that a small but significant number of Australians are deliberately seeking sun exposure without sun protection because they're concerned about vitamin D, and are therefore more likely to be putting themselves at risk of skin cancer," Professor Olver said. "The reality is too many Australians get too much sun in summer and increase their risk of cancer, while some people don't get enough sun, particularly in winter, and risk vitamin D deficiency with possible serious health consequences."

The Cancer Council has joined with other health experts from Osteoporosis Australia, The Australasian College of Dermatologists and the Australian and New Zealand Bone and Mineral Society to address the public's confusion about Vitamin D deficiency.

"Today our organisations are releasing new guidelines on how much sun exposure Australians need to maintain Vitamin D for good health without increasing their risk of skin cancer," Professor Olver said.

"Sensible sun protection does not put people at risk of vitamin D deficiency. But there are times when it's actually important to leave your hat and sunscreen off."

"In winter, most people in the southern states - Victoria, Tasmania and South Australia - do not need to use sun protection during the day because UV Index levels are not high enough to cause significant skin damage."

"In summer, most Australians get adequate vitamin D levels in just a few minutes through the sun exposure they receive during typical day-to-day outdoor activities."

The new guidelines recommend:

-- Fair skinned people can maintain adequate vitamin D levels in summer from a few minutes of exposure to sunlight on their face, arms and hands or the equivalent area of skin on either side of the peak UV Index periods on most days of the week.

-- In winter in the southern parts of Australia, where UV radiation levels are less intense, people need about 2-3 hours of sunlight to the face, arms and hands or equivalent area of skin over a week.

Professor Peter Ebeling, Medical Director of Osteoporosis Australia, and Head of Endocrinology, University of Melbourne at Western Hospital, said some people could be facing long-term health consequences due to vitamin D deficiency and may need vitamin D supplementation.

"It's important to stress that the majority of Australians have sufficient levels of vitamin D."

"However, those likely to be at risk of vitamin D deficiency include people with very dark skin, people who are housebound or in institutionalised care, women who wear concealing clothing for cultural purposes, and breastfed babies of vitamin D deficient women," he said. Professor Ebeling said vitamin D levels can be checked through a simple blood test, and inadequate levels can be easily treated with supplements, rather than additional exposure to UV radiation. Supplements are particularly useful in those with pigmented skin.

"Anyone who thinks they may be vitamin D deficient should seek medical advice, not seek more sun," Professor Ebeling said.

Secretary of the Australasian College of Dermatologists, Dr Stephen Shumack, stressed that the new advice developed by the four organisations takes into account the intensity of the sun in different parts of Australia.

"While those in southern states in many cases don't need sun protection in winter, sun protection is still necessary in places like the Northern Territory, Queensland and parts of Western Australia, all year round, because UV Index levels are high enough to cause significant skin damage."

"It's important to remember that skin cancer is a very significant problem in Australia. Every year around 1500 Australians die from skin cancer, and one in two Australian will develop skin cancer in their lifetime," Dr Shumack said.

Cancer Council research found that 17% of teenagers and 13% of adults thought they needed to go out in the sun more without sun protection as a result of hearing media reports about the issue.

Alarmingly, the research found young people who were sun seekers - those who tanned or wanted to tan - who were more likely to think they needed to sun themselves without sun protection. 20% of teenagers in this group said they thought they needed to go out in the sun without protecting their skin to get vitamin D.

The new guidelines 'The risks and benefits of sun exposure' can be found at http://www.cancer.org.au/positionVitD

Vitamin D

Vitamin D forms in the skin when it is exposed to UV from sunlight. It can also be obtained in some foods, such as oily fish, eggs and meat. However the vitamin D in food makes a relatively small contribution to a person's overall vitamin D levels. Vitamin D is important to maintain strong, healthy bones and reduce the risk of falls and fractures.

Vitamin D production decreases during winter when the intensity of UV radiation is lower. The body can rely on tissue stores of vitamin D for between 30 and 60 days assuming vitamin D levels are adequate prior to winter. In most cases, any vitamin D reduction in winter is corrected in summer.

Those who are more likely to be at risk of vitamin D deficiency include:

-- Naturally dark skinned people - who need more UV exposure to produce adequate levels of vitamin D as the pigment in their skin reduces UV absorption
-- People who cover their skins for cultural reasons
-- The elderly and people who are housebound or in institutional care
-- Babies and infants of vitamin D deficient mothers, especially babies who are exclusively or partially breastfed.
-- People who are vitamin D deficient may need to take a vitamin D supplement.

Health consequences of vitamin D deficiency

Vitamin D deficiency in infants and children can cause rickets, characterized by muscle and bone weakness and bone deformities. Adults with low vitamin D are at risk of bone and joint pain, muscle and bone weakness, osteoporotic fractures and falls.

New sun exposure guidelines - How much sun do we need?

Most people get adequate vitamin D levels through the sun exposure they receive during typical day-to-day outdoor activities.

-- In summer - a few minutes of exposure to sunlight on the face, arms and hands or the equivalent area of skin on either side of the peak UV periods on most days of the week.
-- In winter in the southern parts of Australia - about 2-3 hours of sunlight to the face, arms and hands or equivalent area of skin over a week.

UV radiation levels are higher in northern Australia, so in Queensland, the Northerrn Territory and some parts of Western Australia, sun protection is needed all year round in the peak UV period.

When is sun protection needed?

Most Australians need sun protection when the UV Index is 3 or above because that is when the intensity of the sun's UV rays is strong enough to damage your skin.

The SunSmart UV Alert appears when the UV Index reaches 3 or above. You can find it on the weather page of all Australian daily newspapers, or on the Bureau of Meteorology website at http://www.bom.gov.au (do a search for 'UV Alert'). The UV Alert is issued for over 200 locations across Australia, and shows the time period you need sun protection for that day. When UV Index levels are below 3, the SunSmart UV alert will say 'No UV Alert' and sun protection may not be necessary.

People who spend time at high altitudes or near reflective surfaces such as sand, snow and water will still need to use their hats, sunglasses and SPF 30+ sunscreen, as skin and eye damage can occur in these situations.

Some people are at high risk of skin cancer, including people who have had skin cancer, have revived an organ transplant or are highly sun sensitive. These people need to have more sun protection and therefore should discuss their vitamin D requirements with their medical practitioner to determine whether vitamin D supplements are preferable to sun exposure.

Skin cancer statistics

-- Over 1, 500 Australians die from skin cancer each year, and over 380,000 Australians are treated for skin cancer each year.

-- Australia has the highest rate of skin cancer in the world. People in Queensland, Western Australia and New South Wales face the highest risk of developing melanoma, followed by Tasmania, ACT, South Australia, Victoria and Northern Territory.

-- Each year Australians are four times more likely to develop a common skin cancer than any other form of cancer.

Cancer Council research - Vitamin D and sun protection behaviours

Cancer Council research conducted over summer 2006-07 found:

-- There was a high awareness of news reports on vitamin D and sunlight - 35% of teenagers and 60% of adults were aware of media coverage about this issue.

-- Of those people who recalled seeing or hearing news reports on this issue, 17% of adolescents and 13% of adults said the information made them think they should go out in the sun more without protecting their skin.

-- However, 20% of teenagers who attempted to tan said the news reports made them think they should go out in the sun more without protecting their skin.

The Cancer Council, Australia