Recently, a friend of mine brought to my attention an article that made the case that regular sunlight exposure might help us live longer. This topic seems to be of broad general interest, so I thought it worth including in this month’s paper.
For years, the dermatology community has been preaching sun avoidance. This is only natural given that much of a dermatologist’s job is focused on the prevention, detection and treatment of skin cancer. The science linking ultraviolet radiation to skin cancer is solid. Melanoma has also been very strongly linked to sun burns and tanning bed use. The case is clear that sun exposure causes skin cancer.
During my residency, my attendings had us read numerous articles on vitamin D. One of the strongest arguments put forth by the pro-tanning bed community and pro-sun exposure community was that avoidance of the sun could lead to vitamin D deficiency, which leads to rickets in children, osteoporosis in adults, and a likely higher incidence of autoimmune diseases, infectious diseases and possibly even a higher incidence of some non-skin cancers.
To many dermatologists, this argument seemed weak because vitamin D supplements are readily available, and it seemed that oral vitamins could simply replace the vitamin D that the sun helps provide. We could have our cake and eat it, too. Avoid the sun and take vitamin D supplements, and you’ll avoid skin cancer and avoid vitamin D deficiency.
But the plot thickens. Researchers found out that ultraviolet radiation stimulates nitric oxide production in the skin, which lowers blood pressure and may lead to a lower incidence of cardiovascular disease. Because cardiovascular disease kills more people than skin cancer, the argument was made that sun avoidance might have a net effect of hurting rather than helping. Once again, the argument was made that we could simply take medication designed to lower blood pressure.
So, now, we are avoiding the sun, taking vitamin D supplements and taking antihypertensive medication.
But uh oh, additional data suggests that sun light might change serotonin levels and improve mood and regulate circadian rhythms and assist with sleep. But that can be fixed with medication.
So, now, we are avoiding the sun, taking vitamin D supplements, anti-hypertensives, fluoxetine, and melatonin. But…..additional concerns keep arising – autoimmune, cancer-related, and more.
What is everyone to do?
In my opinion, the answer seems to be that we need to embrace personalized medicine and customize our recommendations for the individual. There are unbelievable variations between levels of UV radiation in Ireland vs equatorial Africa, and we cannot expect sun light recommendations for Irish and African descendants to be identical. This is not to say that general rules can’t be created. For example, avoid blistering sun burns seems like fairly safe advice no matter who you are. However, a one size fits all approach to sun exposure is likely not wise. And it is responsible to admit that there exists a body of data and arguments that support both positive and negative effects of sun exposure.
If a patient comes to me in his 70s riddled with skin cancers on his face and scalp, then wearing hats and sunscreen, at least on the face and scalp, seems sage advice. If a young patient develops a melanoma, then avoiding sun burns and erring on the side of less sun exposure rather than more seems prudent along with very regular self and professional skin exams. For someone with equatorial African genetics, avoidance of sun might be more harmful than helpful. We just don’t know optimum doses of sun exposure, but ancestry likely informs us regarding optimum levels of sun exposure.
And who knows whether many of the positive health effects in those receiving a lot of sun came from active lifestyles and exercise. Many studies have not been able to convincingly control for exercise when quantifying health effects of sun exposure.
We likely do not need to have guilt from small amounts of sun exposure. Instead, we can enjoy the great outdoors, exercise, and the occasional ray of sun light, and we need to be honest with ourselves about our genetic heritage, our risk factors, what is hurting us, and make adjustments to fit our individual situations.
For professional dermatologic care that is personal and personalized, please consider Premier Dermatology and Mohs Surgery of Atlanta. It is our pleasure to serve you.
At Premier Dermatology and Mohs Surgery of Atlanta, it is our pleasure to meet your skin care needs. Board certified and fellowship-trained, Dr. Brent Taylor is a skin cancer, vein and aesthetic expert honored to be of service.