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WWW www.hautzone.ch

Dermatologie
 

Skin Cancer Prevention Campaign(see also Melanoma Quiz)

What's on this page:

Melanoma
Wie beurteile ich ein Muttermal?
Ihr Hautkrebsrisiko
UV-Index
Skin cancer foundation
Ozone depletion ?
Effect of UV
Synopsis of Photodermatosis
Precautions

DER SONNENSCHUTZ MUSS AB DEM SAEUGLINGSALTER BEACHTET WERDEN !!!

Damit das nicht passiert:

lentigo maligna

 

Die Hinweise für eine Korrelation zwischen malignem Melanom und extensiver Sonnenexposition mit schweren Sonnenbraenden ("Weisskragenarbeiter" "white collar workers") - vor allem in der Kindheit - sind stark. Das Basaliom und das Spinaliom, aber auch die Lichalterungs-Phänomene zeigen eine deutliche Dosisabhängigkeit der UV-Strahlung (UVB und kurzwelliges UVA). Der Lichtschaden ist kumulativ (die Haut vergisst keinen Sonnenstrahl).

Warum sind Kinder speziell zu schützen?

Epidemiologische Studien zeigen, dass der Lichtkonsum in der Kindheit grösser ist als im ganzen Erwachsenenalter. Untersuchungen aus Israel, Australien und Kalifornien belegen, dass bei Imigranten im Alter über 15 Jahren die Hautkrebsrate drei- bis viermal geringer ist als bei im Land Geborenen (1). Die ersten 10 bis 15 Lebensjahre sind also ganz entscheidend. Meinungsbilder fordern deshalb einen Sonnenschutz von Geburt an . Starke Sonnenbrände im Kindesalter sind absolut zu vermeiden, da sie das Melanom-Risiko auf bis das Achtfache steigern können; die Sonnenexposition ist der wichtigste externe Risikofaktor für die Entstehung des schwarzen Hautkrebses .

Die amerikanische Skin Cancer Foundation gibt deshalb folgende Richtlinien für Kinder :

-Kinder sollten vor einer Sonnenlicht-Ueberexposition geschützt werden.
-Der Lichtschutz beginnt ab dem ersten Tag (kritisch scheinen vor allem die ersten 10 Lebensjahre).
-Die tägliche Lichtexpositionszeit sollte reduziert werden. Zwische 11.00 und 15.00 Uhr mittags ist die Sonne weitgehend zu meiden.
-Während der kritischen Zeit sollten sich Kinder mit Textilien schützen. Ein Sonnenschutz ist auch bei bewölktem Himmel notwendig. In höheren Lagen ist die Strahlung intensiver.
-Kinder wie Eltern sollten sich auch regelmässig und sorgfältig mit stark wirksamen Sonnenschutzsmitteln schützen (Mindestfaktor 15).
-Teenager wie auch Erwachsene sollten Solarien meiden. Künstliche UV-Bestrahlung trägt zur vorzeitigen Hautalterung bei und erhöht das Hautkrebsrisiko (5): „Die bronzefarbene Schönheit von heute ist die vertrocknete Pflaume von morgen“.

Gibt es besondere Richtlinien für Säuglinge und Kleinkinder?

Das ideale Lichtschutzpräparat für Kinder sieht folgendermassen aus: -Gute Wirksamkeit gegen Sonnenbrände und die kumulativen UV-Schäden der Haut
-Gute Wasserfestigkeit
-Geringe Permeation der Lichtfilter (minimales toxikologisches Risiko)
-Bei Adoleszenten und Erwachsenen gute kosmetische Akzeptanz
Wegen der speziellen Penetrationsverhältnisse und der unvollständigen Metabolisierung bei Kleinstkindern werden hier vor allem zusätzlich verlangt: -Möglichst Produkte mit Mikropigmenten
-Keine Konservierungsstoffe
-Wasserfeste Grundlage
Daylong 16 und MicroSun 20 erfüllen obige Anforderungen weitgehend.
Für Extremsituationen können Daylong 16 und MicroSun 20 kombiniert werden; es resultiert ein Lichtschutzfaktor von über 35.

Wie beurteile ich ein Muttermal?

«Einfache» vs. «gefährliche» Nävi - klinische Differenzierung mittels der ABCD(E)-Regel

A

Asymmetrie

Gutartige Muttermale sind rund und symmetrisch.

Verdächtig: asymmetrische Form

B

Begrenzung

Die Begrenzung sollte scharf sein

Verdächtig: zackig oder unregelmässig begrenzt

C

Color (Farbe)

Normal ist eine gleichmässige Farbe.

Verdächtig: multiple, verschiedene Farben innerhalb derselben melanozytären Läsion

D

Durchmesser«

Als grundsätzlich unverdächtig maximal 6 mm.

Cave: Melanome können auch kleiner als 5 mm sein

Verdächtig: gilt ein Durchmesser von Nävusdurchmesser >6 mm

E

Evolution:

Sämtliche Veränderungen eines Nävus hinsichtlich Grösse, Form und/oder Farbe, ebenso wie subjektive Empfindungen des Betroffenen (Schmerz, Juckreiz etc.) sollten in die klinische Beurteilung einfliessen. Solche Kenntnisse können bei der Therapieentscheidung eine massgebliche Rolle spielen (weiche Kriterien,Bauchgefühl)

 

 

Uebrigens: Sonnebestrahlung ueber Jahre erhoeht nicht nur das Risiko fuer Hautkrebserkrankungen (Melanom, Spinaliom, Basaliom) sondern macht auch vor allem andere degenerative Veränderungen: Die Haut wird schrumpelig und faltig (Lichtalterung). Daneben kann es zu vermehrtem Auftreten von Komedonen (Mitessern, black head) kommen. Kinder auf der Banane

UV-Strahlung und ihre Wirkung auf die Haut

Wellenlänge Sofortreaktion Spätreaktion

UV-C (190-280 nm)

wird durch Ozonschicht gefiltert

 

UV-B (280-320 nm)

 

 

Erythem (Maximum nach 8-24h)
Ödem
Pigmentierung
verzögerte Bräunung
Bildung Lichtschwiele
(Hornschichtverdickung)
Synthese von Vitamin D

Fotokarzinogenese
Immunsuppression
Fotoalterung

 

 

UV-A (320-400 nm)

sofortige Pigmentierung

Fotoalterung
Immunsuppression
Fotokarzinogenese

 

Andere mit Sonne (Licht) verassozierte Erkrankungen im Steckbrief

Synopsis Photodermatosen

Gruppe Entitaet Charakteristiken Therapie
- Idiopathische Lichtdermatosen: Lichturtikaria
  • Vorkommen Selten
  • Erstmanifestation Erwachsenenalter
  • Definition Urtikarielle Sofortreaktion auf elektromagnetische Strahlung
  • Mechanismus IgE-vermittelte Histamin-Ausschüttung durch ein angenommenes Photoallergen
  • Aktionsspektrum UV-C, UV-B, UV-A; sichtbares Licht
  • Lichtschutz Kleidung
  • Meidung von Sonnenstrahlung
  • Sonnenschutzmittel meist unwirksam
  • Antihistaminika H1-Antagonisten ungenügend
  • Phototherapie Toleranz hält nur wenigeTage (Heliotherapie)
  • PUVA Sehr gut wirksam
  • Plasmapherese Experimentelle Behandlung (teuer)
  Polymorphe Lichtdermatose
  • Prävalenz 10-20%
  • Patienten Junge Erwachsene, Kinder w>m
  • Symptome Juckreiz - fleckiges Erythem - distinkte Läsionen
  • Prädilektion Ausschnittbereich, Arme, Handrücken, Oberschenkel, Gesicht
  • Beginn Einige Stunden nach intensiver Sonnenwxposition
  • Dauer Spontane Rückbildung innerhalb von wenigen Tagen ohne Residuen
  • Verlauf Saisonale Rezidive im Frühjahr und Sommer, Lichtgewöhnung
  • Phototestung Diagnose, auslösender Wellenbereich (UV-A, UV-B)
  • Beratung Lichtgewöhnung durch Verhalten, Kleidung, Sonnenschutzmittel
  • Phototherapie Starker Leidensdruck, Lichtgewöhnung nicht ausreichend
  • PUVA Ausnahmefälle mit extremer Lichtempfindlichkeit
  • Medikamente Wirkungsnachweis fehlt, empirisch als adjuvante Massnahme
  Hydroa vacciniformia    
  Aktinische Prurigo    
  Mallorca- Akne
  • Vorkommen: Weniger häufig bis selten
  • Manifestation Erwachsenenalter
  • Verlauf Nach mehreren Tagen intensiver Sonnenbestrahlung
  • Persistenz Tage bis wenige Wochen
  • Klinik: Monomorphe follikuläre rötlich-gelbliche glatte Papeln wenige mm gross
  • Aktionsspektrum Unbekannt
  • Kofaktoren Lipide oder Emulgatoren umstritten
Therapie: Komedolytika
- Chemische Photosensibilisierung Phototoxische Dermatitis    
  Photoallergische Dermatitis
  • Definition Typ-IV Reakton auf Photoprodukt des Photosensibilisators
  • Klinik Allergische Kontaktdermatitis an lichtexponierter Haut
  • Verlauf Crescendo Reaktion
  • Histopathologie Spongiotische Dermatitis
  • Phototestung Lichttreppen normal, Photopatch-Test positiv
  • Durchführung des Photopatch-Test
  • Testort Rücken
  • Applikation der Substanzen 24h, kleine Finn- Chambers (Scanpor)
  • Bestrahlungsgerät Fluoreszenzstrahler (Philips TI 09 N 320-400 mm)
  • UV-Dosis 10J/cm2 UV-A, Gegebenenfalls Med UV-A
  • Ablesung Sofort, 24, 48, 72 h nach Bestrahlung
  • Kontrolle Unbestrahlter Patch- Test
  Porphyrien (EPP, CEP, PV, PCT)    
- Persistierende Photosensitivität Chronische aktinische Dermatitis
  • Klinik Ausgeprägte Lichtempfindlichkeit
  • Chronische Dermatitis in lichtexponierter Haut
  • StreureaktionenHistopathologie Spongiotische Dermatitis
  • Selten T-Zell-Lymphom-artig
 
  Persistierende Lichtreaktion    
  Photosensitives Ekzem, chronische photosensitive Dermatitis  
  • Phototestung Dermatitis ohne Photosensibilisator
  • Aktionsspektrum UV-B
  • Fakultativ zusätzlich UV-A, sichtbares Licht
  Lichtaggravierte atopische Dermatitis    
       

 


Ultraviolet Index: What You Need to Know

Did you know that a few tips can help protect you and your family from skin and eye injury?

While some sunlight is necessary, it can be dangerous, causing sunburn, premature aging of the skin, skin cancer, cataracts, allergies, and damage to the immune system. Children can get 50% of their lifetime sun by the age of 18. Older people should also avoid the sun.

The new Ultraviolet (UV) Index provides important information to help you plan your outdoor activities and avoid overexposure to the damaging rays of the sun. Developed by the National Weather Service (NWS) and the Environmental Protection Agency (EPA), the UV Index is issued daily as a national service.

WHAT IS THE UV INDEX?

The UV Index gives the next day's amount of exposure to UV rays. The Index predicts UV levels on a 0-10+ scale:

INDEX NUMBER EXPOSURE LEVEL

sunStillCLRBg.gif (7291 bytes)  
0 - 2 MINIMAL
3 - 4

LOW

5 - 6 MODERATE
7 - 9 HIGH
10+ VERY HIGH
sunStillCLRBg.gif (7291 bytes)

Always take precautions against overexposure, and take special care when the UV Index predicts exposure levels of moderate to above (5 - 10+).

HOW MUCH SUN AM I GETTING?

Sun exposure depends on many things. It varies with the time of day, season, latitude, and altitude. High amounts of UV rays can penetrate clouds. Clouds, water, white sand, concrete, and snow all reflect UV rays and increase exposure. Exposure to the midday sun or for long periods of time is more damaging.

WHAT ROLE DOES OZONE-LAYER DEPLETION PLAY?

The ozone layer shields the earth from the sun's harmful UV rays. Although ozone changes from day to day and place to place, world scientists have measured long-term decreases in ozone over the last ten years. Decreases in the ozone layer lead to increases in the amount of dangerous UV radiation that reaches the earth's surface. Future levels of ozone will depend upon a combination of natural and man-made factors, including the phase-out of chloroflurocarbons and other ozone-depleting chemicals.

EFFECTS OF SUN

Sunburn

If you are in the sun too long, you may get red in a few hours. A bad reaction includes tenderness, pain, swelling, and blistering, and may include fever, chills, and nausea. There is no cure for sunburn. Wet compresses, cool tub bathes and soothing lotions may help. If you have a bad burn, see your dermatologist.

Tanning

Some people think that a tan means good health and looks. Dermatologists know that a tan is a sign of skin damage. A tan does not prevent sun damage, it is sun damage. Tanning occurs when the UV rays penetrate the skin and injure the pigment cells. Your skin "remembers" all damage; and with every burn, the skin becomes more damaged.

Premature Wrinkling

People who work or lay in the sun without sufficient protection get a tough, leathery skin that may make them look much older. Too much sun changes the texture of the skin and weakens the skin's ability to snap back after stretching causing sagging cheeks and deep wrinkles. If the skin was never exposed to the sun, it would look like the smooth skin on your buttocks. The sun can also cause unsightly red, yellow, gray, or brown spots. Scaly growths (actinic keratoses) occur and may develop into skin cancer. These changes are due to a lifetime of exposure to the sun, including the sun exposure you had in childhood.

Skin Cancer (See also Sonne & Hautkrebs)

Skin cancer is caused by too much sun -- long-term exposure and bad sunburns. More than 90% of all skin cancers occur on parts of the body exposed to the sun. The face, neck, ears, forearms, and hands are the most common places for skin cancer to develop.

The three main types of skin cancer are basal cell, squamous cell, and melanoma.

Basal cell carcinoma usually appears as a small, shiny, fleshy nodule on the exposed parts of the body. The basal cell carcinoma grows slowly and rarely spreads to other parts of the body; however, it can severely damage skin around and below it. When diagnosed and treated early, it has a high cure rate.

Squamous cell carcinoma typically develops on the face, ears, lips and mouth. It begins as a red scaly patch. Like basal cell carcinoma, it has a high cure rate when detected and treated early. Left untreated, squamous cell carcinoma can spread to other areas of the body and can be fatal.

Melanoma is the most dangerous form of skin cancer and usually appears as a dark brown or black lump with irregular edges. Sometimes, it is multicolored with shades of red, blue or white. If ignored, melanoma can spread or metastasize to other areas of the body. If this happens, melanoma can be fatal.

The alphabet of nail melanoma: Steps to keep in mind when examining nails for the presence of subungual melanoma

 
A
  • Age: Range 20-90 y, peak 5th-7th decades
B
  • Band (nail band): Pigment (Brown-Black)
  • Breadth (>3 mm)
  • Border (irregular/blurred)
  • Change: Rapid increase in size/growth rate of nail band
  • Lack of Change: Failure of nail dystrophy to improve despite adequate treatment
D
  • Digit involved:Thumb > hallux > index finger, Single digit > multiple digits
  • Dominant hand
E
  • Extension: Extension of pigment to involve proximal or lateral nail fold (Hutchinson's sign) or free edge of nail plate
F
  • Family or personal history: Of previous melanoma or dysplastic nevus syndrome

Eye damage

The sun can cause cataracts and other eye damage. Cataracts are one of the leading causes of blindness.

Allergies

Some people develop allergies to the sun. These reactions may occur after short periods of sun. Bumps, hives, blisters, or red blotchy areas may appear on sun exposed areas. Cosmetics, perfumes, drugs and even sun preparations can make some individuals sensitive to the sun.

Immune system suppression and disease

Short periods of sun exposure can damage the human immune system and make the body more susceptible to infections and cancers. Although the color of your skin may provide you with some protection against sunburn, the immune systems in people with dark and light skin are equally affected by the sun. Also, some diseases can become worse with sun exposure. These include herpes simplex (cold sores), chicken pox, lupus, and certain genetic problems.

WHAT ARE PROPER PRECAUTIONS?

Preventing skin cancer and eye damage

Skin cancer is increasing faster than any other form of cancer. Over 1 million new cases will occur in the US this year.

  • Listen to the UV Index reports.
  • Minimize sun exposure at midday (10:00 am to 4:00 pm)
  • Avoid sunlamps, tanning beds and tanning parlors.
  • Apply a broad-spectrum sunscreen with Sun Protection Factor-15 or higher and reapply every 2 hours.
  • Wear protective, tightly-woven clothing, a broad-brimmed hat and sunglasses. Children who will not wear sunglasses should wear a hat with a wide brim.
  • Protect children by keeping them indoors between 10:00 and 4:00 pm, and by applying sunscreen to children older than 6 months. Children under the age of 6 months should be kept out of the sun.

The Darker Side of Tanning


Public health experts and medical professionals are continuing to warn people about the dangers of ultraviolet (UV) radiation from the sun, tanning beds, and sun lamps. Two types of ultraviolet radiation are Ultraviolet A (UVA) and Ultraviolet B (UVB). UVB has long been associated with sunburn, while UVA has been recognized as a deeper penetrating radiation.

Although it's been known for some time that too much UV radiation can be harmful, new information may now make these warnings even more important. Some scientists have suggested recently that there may be an association between UVA radiation and malignant melanoma, the most serious type of skin cancer.

What are the dangers of tanning?

UV radiation from the sun, tanning beds, or from sun lamps may cause skin cancer. While skin cancer has been associated with severe sunburn, moderate tanning may also produce the same effect. UV radiation can also have a damaging effect on the immune system and premature aging of the skin, giving it a wrinkled, leathery appearance.

But isn't getting some sun good for your health?

People sometimes associate a suntan with good health and vitality. In fact, just a small amount of sunlight is needed for the body to manufacture vitamin D. It doesn't take much sunlight to make all the vitamin D you can use -- certainly far less than it takes to get a suntan!

Are people actually being harmed by sunlight?

Yes. The number of skin cancer cases has been rising over the years, and experts say that this is due to increasing exposure to UV radiation from the sun, tanning beds, and sun lamps. More than 1 million new skin cancer cases are likely to be diagnosed in the U.S. this year.

But aren't the types of skin cancer caused by the sun, tanning beds, and sun lamps easily curable?

Not necessarily. Malignant melanoma, now with a suspected link to UVA exposure, is often fatal. The number of cases of melanoma is rising in the U.S., with an estimated 38,300 cases and 7,300 deaths anticipated in 1996.

Why doesn't the skin of young people show these harmful effects?

Skin aging and cancer are delayed effects that don't usually show up for many years after the exposure. Unfortunately, since the damage is not immediately visible, young people are often unaware of the dangers of tanning. Physicians and scientists are especially concerned that cases of skin cancer will continue to increase as people who are now in their teens and twenties reach middle age.

But why is it that some people can tan for many years and still not show damage?

People who choose to tan are greatly increasing their chance of skin cancer. This is especially true if tanning occurs over a period of years, because the damage to the skin accumulates. Unlike skin cancer, premature aging of the skin will occur in everyone who is repeatedly exposed to the sun over a long time, although the damage may be less apparent and take longer to show up in people with darker skin.

Who is at greatest risk in the sun?

People with skin types I and II are at greatest risk.

WHICH SKIN TYPE ARE YOU? (Fitzpatrick)

Skin Type

Sunburn and Tanning History According to Skin Type

I

Always burns; never tans; sensitive ("Celtic")

II

Burns easily; tans minimally

III

Burns moderately; tans gradually to light brown (Average Caucasian)

IV

Burns minimally; always tans well to moderately brown (Olive Skin)

V

Rarely burns; tans profusely to dark (Brown Skin)

VI

Never burns; deeply pigmented; not sensitive (Black Skin)

Since most sun lamps and tanning beds emit UVA radiation, doesn't that make them safer than natural sunlight?

No. It's true that most sun lamps emit mainly UVA radiation, and that these so-called "tanning rays" are less likely to cause a sunburn than UVB radiation. But, contrary to the claims of some tanning parlors, that doesn't make them safe. UVA rays have a suspected link to malignant melanoma, and, like UVB rays, they also may be linked to immune system damage.

What's the government's position on using sun lamp products found in tanning parlors and in homes?

The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) encourage people to avoid use of tanning beds and sun lamps. You can get a fact sheet on the hazards of indoor tanning from FDA's Facts on Demand system by calling 1-800-899-0381; the information will be faxed to you on the same day (select 2 and then Division of User Programs and Systems Analysis or DUPSA). You can also go to the FDA Home Page on the World Wide Web at http://www.fda.gov. At this point, click on the Medical Devices and Radiological Health icon, click on Program Areas and choose Sun lamp Products.

Information on skin cancer is available on the American Academy of Dermatology home page on the World Wide Web at http://www.aad.org.

What do medical professionals say about tanning?

The American Medical Association (AMA) and the American Academy of Dermatology (AAD) have warned people for many years about the dangers of tanning. In fact, AMA and AAD have urged action that would ban the sale and use of tanning equipment for non-medical purposes. Doctors and public health officials have recommended the following steps to minimize the sun's damage to the skin and eyes:

  • Plan your outdoor activities to avoid the sun's strongest rays. As a general rule, avoid the sun between 10 a.m. and 4 p.m.
  • Wear protective covering such as broad-brimmed hats, long pants and long-sleeved shirts to reduce exposure.
  • Wear sunglasses that provide 98-100% UV ray protection.
  • Always wear a broad spectrum sunscreen (Sun Protection Factor-15 or more) that will block both UVA and UVB when outdoors and reapply it according to manufacturer's directions.

For more information on the levels of ultraviolet radiation reaching your area at noon, you can get the Ultraviolet Index (UVI) from your local newspaper, radio or TV. The UVI is a number from 0-10. The higher the number, the more intense the exposure. Call the EPA Hotline for more information on the UVI at 1-800-296-1996.

If you believe that some damage has already been done:

  • Seek medical attention if you receive skin or eye damage from the sun or if you experience an allergic reaction to the sun. Do this as soon as possible.
  • See your doctor if you develop an unusual mole, a scaly patch or a sore that doesn't heal.

    Funded under Cooperative Agreement #U50/CCU511453-02
    Centers for Disease Control and Prevention (CDC)
    U.S. Public Health Service

 

   

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