May 74 min read

Safe sun exposure and skin types

(and the research on nutrition and sun protection)

A flat lay of a heart shaped wooden bowl containing various fresh fruits and vegetables, with a prescription pad, stethoscope, glass of water, hand weights and trainers

Better weather will be starting soon (hopefully!) and many of us are thinking about our summer holidays. So it is a good time to talk about safe sun exposure. And as a GP accredited with an Extended Role in Dermatology, it won’t surprise you to know that it’s a hot topic of mine (excuse the pun!).

Melanoma skin cancer is the fifth most common cancer in the UK, and worryingly in the past 10 years, melanoma incidence has risen by a third in the UK. And as 4 out of 5 cases are preventable and caused by overexposure to UV light, one of the most important lifestyle interventions we can make is encouraging safe sun exposure.

Melanoma and UV exposure

The association between melanoma and UV exposure is too complex to do it justice in this article. We know that intermittent sun exposure (i.e. the beach holiday deep tan, and burning and UV from sunbeds) increases melanoma risk.

There may also be a risk from UVA emitted from nail salon polish dryers, LED and UV lamps, as a 2023 study in Nature Communications has found. (Though a systematic review published in 2020 in the Journal of Clinical and Aesthetic Dermatology found there was no increasing incidence in melanoma or non melanoma skin cancer linked to gel manicures, there would certainly be no harm in advising the wearing of fingerless gloves, or applying sunscreen prior to a gel manicure.)

How can we best protect ourselves from UV exposure?

People these days are generally more aware of using shade, covering up and using sunscreen to prevent burning and skin ageing. Often when people do burn, it's due to a lack of applying enough sunscreen, or not reapplying sunscreen often enough (as it easily rubs off, especially if you are sweating or going in water). It's also easy to miss patches when applying it, another reason why reapplying it is useful, as it helps cover the patches missed initially.

The importance of skin type

Skin type is also important, as it determines how long you can spend in the sun without burning. I have skin type V on the Fitzpatrick skin type scale, which includes various ethnic groups. My ancestry is Indian, which means I rarely burn, but tan easily, and my skin cancer risk is low.

The people with the highest risk of skin cancer are those with Fitzpatrick skin type II – i.e. those who mostly burn, but sometimes tan. This is because they will risk burning to try to achieve a tan. Those who always burn and never tan (Fitzpatrick skin type I) are usually rigorous with their sun protection, and so their risk level is actually not the highest.

Balancing UV exposure and vitamin D

It's a complex topic, as skin type also determines how much sun exposure we need in order to synthesise vitamin D. Darker skin takes longer to make vitamin D, so we have to strike a balance between the feel-good benefits of being in the sunshine and vitamin D absorption, and reducing skin cancer risk. Studies show that we produce enough vitamin D in much less time than it takes to get sunburned.

Red flowers growing in a meadow under a blue sky with bright sunshine falling on them

What about nutrition and sun protection?

We know that nutrients are required for collagen synthesis and tissue health, and that certain skin conditions, such as telogen effluvium, angular stomatitis, poor wound healing and gingivitis, are a result of nutrient deficiency.

There is limited evidence for the photoprotective effect of specific nutrients or specific diets. A prospective study in the American Journal of Clinical Nutrition in 2019 showed an association between adherence to the Mediterranean diet and lower melanoma risk in 98,995 French women.

Supplements and dietary antioxidants in whole foods

Other studies have looked at the role of supplements and dietary antioxidants in photoprotection and prevention of free radical-mediated DNA damage caused by UV prevention. A review in Journal of Skin Cancer 2015 looked at the research on supplements and whole foods. It concluded that studies on dietary whole foods are needed, as there are promising trends from some human studies.

The research is interesting, but not enough to make specific recommendations in relation to skin cancer, although there are many other reasons to recommend a diet high in antioxidants.

Tips to help you and your patients protect yourselves from the sun:

Avoid being in the sun for too long, according to your skin type. You shouldn't burn or excessively tan.
Cover up when in the sun (hat, long sleeves, sunglasses)
When using sunscreen, apply liberally and often

Often when people do burn, it's due to a lack of applying enough sunscreen, or not reapplying sunscreen often enough (as it easily rubs off, especially if you are sweating or going in water). It's also easy to miss patches when applying it, another reason why reapplying it is useful, as it helps cover the patches missed initially.

Are you ready to see how Lifestyle Medicine can revolutionise your approach with patients - and improve their health?