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2017 HCHB_digital

Sun Care Sunburn Sunburn

Sun Care Sunburn Sunburn occurs from overexposure to ultraviolet (UV) radiation, most commonly from the sun but also from sunbeds. Symptoms of mild sunburn include reddened skin that is painful and hot to touch, and tiredness and a headache from dehydration caused by prolonged exposure to the sun. With severe sunburn the skin blisters, and chills and fever result. Severe sunburn also causes dehydration which can lead to electrolyte imbalances, shock or even death. Four to seven days after exposure, sunburnt skin usually starts to peel and flake off. Sunburn causes microscopic changes in the skin, and weakens the skin’s immune defence system. One blistering sunburn is thought to double the likelihood of that person developing skin cancer. Premature ageing (wrinkling, sagging, age spots), brown spots and freckles, development of premalignant lesions (solar keratoses) and eye damage (see Sun Care: Eye Protection) also occur with long-term sun exposure, not necessarily just with sunburn. Sunburn and skin cancer The two most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. Adults of fair complexion who have had a lot of previous sun exposure, or repeated episodes of sunburn (especially during their childhood years) are more at risk. Melanoma is the deadliest form of skin cancer, killing more than 300 New Zealanders each year. UV index and the Sun Protection Alert UV radiation is not something that can be seen or felt. The UV index (UVI) is a standardised way of measuring the intensity of UV radiation on a particular day in a particular place. It takes into account the sun elevation angle, ozone amount, cloud cover, sun-earth separation, altitude, pollution and surface reflections (eg, snow cover). A UVI greater than 10 is considered extreme and a UVI of less than 3, low. Daily UV indices are available at www.niwa.co.nz The Sun Protection Alert is a simpler tool which tells people what to do when the sun is at its strongest (ie, seek shade, reapply sunscreen, wear a hat) and indicates the period of time during the day when people should protect themselves from the sun. A daily Sun Protection Alert is published in many New Zealand newspapers during summer and can also be found with town-specific predictions on several websites (eg, sunsmart.org.nz, www.metservice. com) and on the MetService weather App. In New Zealand, sun protection is generally required daily, even on cloudy and cooler days, from September through to April. Sun protection may also be required during winter, especially at high altitude and in snow. Sun protection and sunscreen Sun protection involves the use of protective clothing, sunglasses, avoidance of the sun around the hottest period of the day (solar noon: NZ 1pm) and use of sunscreen on exposed parts of the skin. Sunscreens either work chemically, by absorbing UV energy, or physically, by reflecting it off. In the UV spectrum, both UVA and UVB rays contribute to sunburn, skin cancer and wrinkling. Broad-spectrum sunscreens block out both UVA and UVB rays and usually contain various combinations of chemical TREATMENT OPTIONS Category Examples Comments Sunscreens (contain chemical with or without physical agents) Physical sunscreens Lip balms Sunburn treatment products Natural / herbal products / supplements [GENERAL SALE] eg, Hamilton Sunscreen* (SPF 50 + ), Banana Boat, Cancer Society range Neutrogena range, SunSense range [GENERAL SALE] eg, zinc oxide (Sunsense Sensitive Invisible*) [GENERAL SALE] eg, Nivea range, Sunsense Lip Balm SPF 50+ [GENERAL SALE] eg, moisturising products (Cancer Society After Sun Gel, Lucas Papaw) eg, cooling gel + vitamins (Sunsense After Sun) eg, MEBO Burn Repair eg, local anaesthetics (Soov Cream/Spray) Aloe vera gel Vitamin C with vitamin E Organic Children Sun Lotion Products with an asterisk have a detailed listing in the Sun Care section of OTC Products, starting on page 265. Chemical sunscreens absorb harmful ultraviolet light to protect the skin against sunburn. Some also contain physical agents such as titanium or zinc which deflect UV radiation. Deflect UV radiation from the skin rather than absorbing it. Both zinc oxide and titanium dioxide provide UVA and UVB protection and are formulated as ultra-fine particles so as not to leave a sheen on the skin. Less likely to cause allergies. Protect lips with special lip sunscreens – lips burn easily and sunburn can reactivate a cold sore on the lips. Reapply lip balm frequently as it gets “licked off”. A moisturiser will not prevent peeling or damage but will help relieve irritation of dry, flaky skin. Cooling gels can be kept in the fridge and applied when the skin is hot. MEBO Burn Repair promotes faster healing after suburn by encouraging stem cell regeneration. Also helps cool the skin and relieves discomfort. Local anaesthetics (eg, lignocaine) offer pain relief after sunburn. Avoid broken skin. Aloe vera has a soothing, cooling action on skin that has been exposed to the sun. Combinations of vitamin C and E taken orally or applied topically prior to sun exposure can reduce risk of sunburn. They can also help heal sunburn when applied afterwards. Organic Children Sun Lotion contains a naturally occurring UV filter which may be used on young babies. SENSITIVE INVISIBLE ZINC OXIDE DEFENCE • Dries clear • 4 hours water resistance Page 144 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Sun Protection Advice Slip, Slop, Slap and Wrap! •• Slip on a shirt and slip into the shade in summer »» Put on standard-approved sun-protective clothing or wear dark, tightly woven clothes. Seek shade between 10am and 4pm. •• Slop on sunscreen »» Use an SPF 50+ broad spectrum sunscreen (that meets the revised AUS/NZS 2604:2012) »» Apply thickly (use at least seven teaspoonsful or 35ml) 15–20 minutes before going outside »» Reapply every two hours as well as after swimming or sweating. •• Slap on a hat »» Choose a hat with a wide brim or a cap with flaps. •• Wrap on a pair of sunglasses. »» Choose standard-approved wrap-around sunglasses. Sunscreen should not be used as a way of staying out in the sun longer, but as a way of reducing risk of UV exposure. ingredients (eg, oxybenzone, octyl methoxy cinnamate, octocrylene) and physical sunscreens, such as zinc and titanium oxide. Sensible sun protection is unlikely to make people vitamin D deficient as vitamin D is still made by the skin in the shade with sunscreen on. Sunscreens that allow for vitamin D production allow one specific wavelength of UVB light to penetrate the skin in order to make vitamin D. Therefore the benefits of allowing vitamin D penetration need to be weighed against the risks of unlimited penetration of that UVB wavelength all day. Sunsmart NZ and the NZ Ministry of Health recommend 30 minutes of sun exposure without sunblock every day before 10am and after 4pm from September to April. From May to August, 30 minutes of sunblock-free sun exposure should take place around the middle of the day. Initial assessment Despite New Zealand having higher levels of UV radiation than most of the rest of the world, we are not generally very good at applying sunscreen. For customers buying sunscreen, take note of their skin type and stress the importance of never getting sunburnt, especially to those with fair skin. Explain the different types of sunscreen and encourage proper and regular application (see text box Sun Protection Advice above). Educate visitors from overseas about the dangers of our sun and that protection is often required for most of the day (ie, 9.30am – 5pm) during summer. Sell customers presenting with mild sunburn a topical cooling preparation (eg, aloe vera) and an SPF 50+ sunscreen for future use. Refer anybody with "yes" answers to the Refer to Pharmacist questions to a pharmacist. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, immunosuppression, cancer)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications) that may affect how long they should stay in the sun? • Does the person have severe sunburn and blisters? • Is the person in extreme pain, feeling unwell or have a headache? • Is the person complaining of burning more easily than before, especially if sun exposure has been minimal? • Is the person a young child with moderate to severe sunburn? • Does the person have any other symptoms, apart from sunburn? • Does the sunburn appear to be a recurring problem? • Does the person have any suspicious-looking moles? • Is the person allergic to any topical ingredients? »» ALL sunscreens need to be reapplied after immersion in water or after sweating. • Warn people taking phototoxic medications (eg, doxycycline) to limit sun exposure and use a broad-spectrum sunscreen when outside. • Avoid sunbeds since the risk of skin cancer is increased. Artificial tanning lotions may be used to create a tanned look without exposure to the sun. • Store sunscreen away from heat and discard once expired. Advice for customers • Sunscreen is considered safe to use on full-term babies over six months of age; however, it is still best to keep them out of the sun as much as possible. • Water-resistant sunscreen products retain sun protection properties for at least 40 minutes in water. SunSense is a premium sunscreen range, scientifically formulated for individual skin types. SunSense provides very high UVA and UVB broad spectrum protection. SunSense is fragrance free, non-comedogenic and contains added moisturisers to hydrate skin Always read the label, use only as directed NZ’s #1 Sunscreen brand in Pharmacy * *Iri Market Data, NZ National Pharmacy 13 wks to 22/01/17 Page 145

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