Tis the Season for Sunburns: A Lobster’s Tale

Fresh off a relaxing Memorial Day weekend trip to South Lake Tahoe, I have returned to Premiere Spine & Sport sporting  bright patches of red skin to prove I have an adventurous and outdoorsy side.  The joy of hiking, kayaking, and rafting came with a price that my skin had to pay, though!  Despite taking precautions with copious applications of sunscreen, the combination of 1) the long time I spent outside, 2) the failure rate of the sunscreen mixed with sweat/water, 3) my fair/white skin since I hadn’t been outside at all this summer, and 4) lack of sunscreen coverage in hard to reach spots or around the edges of a life jacket.  Ultimately, perfect protection was not a possible reality.  Judging by the look of my patients throughout this past week, I was not alone in the quest to become king of the patchy, spotted, or full-coat lobsters!

Erythema, the ten cent word for sunburn, is a relatively common symptom of prolonged sun or tanning bed exposure.  There are a ton of simple ways to prevent it from happening.  Other than the obvious risks of skin cancer and premature aging,  sunburns can affect your routine chiropractic and physical therapy treatments in a negative way.  Don’t let the new fad of sunburn art fool you – artistic lobsters are still lobsters!

 

Prevention

In order to know your risk of being scorched by the large ball of fire in the sky, you’ll want to find your minimum erythema dose (MED).  Ultraviolet (UV) light/radiation, which is just beyond the spectrum of visible light (smaller wavelength than purple), is transmitted by the sun through outer space, the Earth’s atmosphere, and then into our bodies through our skin.

The skin absorbs the light energy and that energy creates superficial heat.  If you can withstand the sun’s rays for a long period of time with minimal burn, you have a high MED.  If you burn after a short exposure time to the sun, you have a low MED.  The timing is relative for every individual, based mainly on skin pigmentation/genetics.  The darker your skin, the more concentration of melanocytes you have, which help absorb the sun’s rays so you don’t get burned.

This chart, known as the Fitzpatrick Scale, explains the basic classification system:

Skin Phototype	Typical Features	Tanning ability	MED (mJ/cm2)
I	Pale white skin, blue/hazel eyes, blond/red hair	Always burns, does not tan	15-30
II	Fair skin, blue eyes	Burns easily, tans poorly	25-40
III	Darker white skin	Tans after initial burn	30-50
IV	Light brown skin	Burns minimally, tans easily	40-60
V	Brown skin	Rarely burns, tans darkly easily	60-90
VI	Dark brown or black skin	Never burns, always tans darkly	90-150

If you are interested in learning what your specific MED is – follow the steps in this article. The lower your MED, the more precautions you should take when exposing yourself to the sun, tanning bed, or any other UV light source.

 

Histology 101

Excessive UV light exposure damages skin cells to the point of deformation of the cell’s DNA, resulting in inflammation and apoptosis (self-destruction) of skin cells.  This is readily visualized as redness on the surface of the skin due to vasodilation of the cutaneous blood vessels.  Below is a slide of what sunburned cells look like compared to healthy skin cells:

Normal Skin Cells (Labeled)

 

Healthy Skin Cells

 

Sunburned Skin Cells

 

The Three Forms of Ultraviolet Light

UV light comes in three types: A, B, and C.  UV-C rays don’t make it past the earth’s atmosphere, so they don’t pose a threat to our skin.  This chart highlights the differences between UV-A and UV-B light:

UV-A	UV-B
Less potent than UV-B but is the wavelength that reaches the surface of the earth most (about 90% at midday) Also penetrates into the middle skin layer (dermis) and subcutaneous fat causing damage to the site where new skin cells are created Long-term exposure causes injury to the dermis resulting in ageing skin	Much more potent at causing erythema About 90% is absorbed by the surface skin layer (epidermis) Epidermis responds by releasing chemicals that cause the reddening and swelling characteristic of the early signs of sunburn Repeated exposure causes injury to the epidermis resulting in ageing skin

 

 

Risk Factors for Sunburns

Be wary of the following items, which will increase your risk of getting burned:

• Wavelength: UV-B is more erythemogenic than UV-A.
• Skin Phototype: Compared with type I-II skin, people with type IV-V skin require 3-5 times more UV radiation exposure to cause erythema.
• Hydration: UV radiation causes erythema in moist skin more effectively than dry skin.
• Environmental Reflection: Radiation is 80% reflected by snow and ice, compared with 15% by sand.
• Ozone Coverage: Increased levels of ozone filter out more UV radiation.
• Altitude: Thinner atmosphere at higher altitudes absorbs less UV radiation.
• Latitude: Exposure is greater nearer the equator.
• Time of Day: UV radiation exposure is greatest from 10 am to 4 pm, when the sun is highest in the sky.

 

Sun Benefits:  Vitamin D synthesis and Tanning

UV radiation enables the creation of Vitamin D on the surface of the skin.  America is currently riddled with an epidemic of Vitamin D deficient people, so any way to boost production is typically warranted in those individuals.  Vitamin D deficiency manifests anywhere from being asymptomatic to increased joint aches/pains and feelings of lethargy/lack of energy.  Severe cases can lead to bone pain, muscle wasting/weakness, and difficulty ambulating/walking around.  You should get a blood test to measure your Vitamin D level from your medical doctor, but if you don’t spend much time outside and don’t take any Vitamin D supplements, you are likely to be deficient.

Here is a flow chart of the chemical process involved when turning light into Vitamin D:

The trick to utilizing the sun as a source of Vitamin D is to find the balance between getting enough bare skin exposed to create a significant dosage and overextending your welcome such that you go beyond your skin’s MED.  This time frame is called low intensity or short duration exposure and it is what will help darken the pigment of your skin over time with repeated exposures.

Specifically, melanin is the pigment responsible for creating a tan, which is produced by melanocytes in response to the repeated exposures.   The skin essentially becomes thicker over time, making the skin more dense and opaque, like stacking sheets of computer paper on top of one another, which protects it from being burned.

A condition known as vitiligo occurs when melanocytes fail to form, thus disabling the creation of melanin.  Skin will appear void of pigment in a disorganized appearance, making the skin highly susceptible to burning.

Other common situations arise in life where sometimes you are simply unable get out of the sun’s destructive path.  All day excursions, Disneyland adventures, sporting events, you name it, will require you to lather up with sunscreen if you haven’t built up your tan, lest you want the dreaded lobster to take over your body.

 

SPF

The defining feature of sunscreens is the SPF (Sun Protection Factor).  SPF refers to the theoretical amount of time you can stay in the sun without getting sunburned. For example, an SPF of 15 would allow you to stay in the sun 15 times longer than you could without protection. So, if your unprotected skin starts to redden in 10 minutes, SPF 15 coated skin would allow you to stay in the sun for 150 minutes before the same burn would occur.  Higher SPFs also block out more rays; SPF 15 will filter out ~93% of UVB rays; SPF 30 will filter more, ~ 97 percent.

The problem is that sunscreen can easily wash away from water or sweat,  leaving your skin vulnerable.  SPF only applies protection from UV-B rays, too. There is no SPF equivalent for UV-A rays.  Zinc oxide and titanium dioxide are known ingredients that protect against UV-A, but there’s no standard measurement for how long they will keep you protected.

Here’s the Fitzpatrick Scale with corresponding SPF sunscreen recommendations:

Skin Phototype	Description	Skin Color	Routine SPF	SPF for Outdoor Activity
I	Always burns, never tans	White	15	25-30
II	Always burns, tans minimally	White	12-15	25-30
III	Burns minimally, tans slowly	White	8-10	15
IV	Burns minimally, tans well	Olive	6-8	15
V	Rarely burns, tans profusely/darkly	Brown	6-8	15
VI	Rarely burns, always tans	Black	6-8	15

 

2nd Degree Burns

Severe cases of erythema result in more than just swelling, redness,warmth, and tenderness to touch.  Blistering and fever can be signs of superficial partial-thickness or deep partial-thickness burns.  These injuries are classified as burns of the 2nd degree.

As you may be able to tell by now, I love to post on-theme, sometimes semi-random pictures; however, I will spare you from pictures of 2nd degree burns.  They are quite gross and not something to joke about, but if you are really into seeing the consequences of poor sun protection in action, google images is only a click away.

If you have sustained a 2nd degree or a worse burn, then you should seek out medical care from an Emergency Room or a Dermatologist immediately to provide first aid to your skin and for the resuscitation of fluids. Severely damaged skin loses the ability to retain water effectively, so you will likely become dehydrated incredibly easily.  Intravenous saline solutions can be administered to counteract the fluid loss.  Electrolyte fluids could also be recommended for mild cases.

 

Contraindications for Musculoskeletal Treatment

If you sustain 2nd degree burns you should refrain from the following common therapies performed here at Premiere Spine & Sport until you have recovered from the burn and have been cleared by your medical doctor.  Intense first degree burns could fit into this category, too.  It’s a judgment call that you and your health care provider should make together.  I always recommend erring on the side of giving the skin extra time to heal before receiving musculoskeletal therapies.  Mild burns could be ready for treatment within a day or two, while moderate to severe ones could take 1-3 weeks.

Pay extra attention to your skin and protect it if you know you have an injury or you need treatment at our office!  If you cannot receive treatment because of a serious sunburn you will be impeding your recovery process, which could make you miss that meet, game, race, or competition that you have been preparing so hard for!

• Adjustments
  • common hands-on techniques to increase joint range of motion will also stretch the skin too much and too quickly to be comfortable
• Soft-Tissue Release Techniques (ART/Graston/Cupping/Myofascial Decompresion/Massage)
  • too painful and damaging to the burned and raw skin cells
• Class IV Laser 
  • previously burned skin creates higher risk for burns from the laser
• Stretching/Exercises (specifically ones that challenge end ranges of motion)
  • increased risk of skin tearing since skin is less pliable
• Kinesiology Taping
  • more difficult to remove tape, increased risk of ripping off skin, painful!

 

Prevention

An ounce of prevention is worth more than a pound of cure, and if you’ve ever had a really bad sunburn, you would have wished you followed every piece of advice on the list below in order to avoid metamorphosing into the dreaded lobster:

• Avoid sun exposure, especially during the period of peak solar radiation (from 10 am to 4 pm)
• Regularly use sunscreen with an adequate SPF for your given skin type.
• Apply at least 30 minutes prior to sun exposure, and reapply every 2-3 hours or after swimming, sweating, or toweling off.
• Use waterproof sunscreen when swimming or perspiring heavily
• Apply at least 2 mg/cm² of sunscreen to achieve the advertised SPF (about 30 mL is adequate coverage for an average adult’s entire body). Most people apply one fifth of this amount.
• Physical barriers like zinc oxide and titanium dioxide provide excellent protection against UVA and UVB and are photostable.
• Chemical barriers are used in most sunscreens. Para-aminobenzoic acid (PABA) and PABA esters, UVB blockers, have fallen out of favor because of high rates of associated contact dermatitis and staining clothes. Other chemical UV-B blocking agents include cinnamates and salicylates.
• Chemical UV-A blockers include avobenzone (Parsol 1789) and the recently FDA-approved drometrizole trisiloxane and terephthalylidene (Mexoryl).
• Wear protective clothing, including wide-brimmed hat or sun visor.
• Specialized sun-protective clothing is available and usually states the SPF each garment provides.

 

Natural Sunburn Remedies

If you are looking for natural alternatives to sunscreens that contain high amounts of potentially toxic chemicals, then read this article highlighting 13 natural remedies that help relieve sunburn pain and improve burn protection.

 

Thanks for reading!  I’ll be sure to respond in the comments if you have any questions. Here’s to eating lobster instead of becoming one!  Sebastian here is technically a crab, but his skin tone could fool anyone with how lobsterific he has become with excessive, unprotected sun exposure!

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Dr. Chris Baker, D.C. | Sports Chiropractor
ART/Graston/PTR/SFMA Certified
RockTape Tennis Director

Premiere Spine & Sport
4982 Cherry Ave. San Jose, CA 95118
(408) 448-4445 (office) | (408) 448-4447 (fax)

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