Protect your skin from the sun

Do you have red, scaly patches on your face or hands that feel almost like sandpaper? If so, you may have actinic keratosis (AK) – a condition that could develop into skin cancer if left untreated.

Selene Daly is a nurse who specialises in skin conditions (dermatology). She is based at Sligo Regional Hospital.

She has seen many cases of farmers with actinic keratosis in the past, so is well-placed to offer advice on the subject. AK is most common in people over 60 and usually affects the face, neck, ears and hands – the sun-exposed parts of the body. It is the result of sunburn in the past – often as long as 40 years ago. Here’s what she had to say:

Q: What is actinic keratosis?

A: “It’s pre-skin cancer. It is little cells that appear on the skin that indicate that a skin cancer might grow there if those cells aren’t treated.

“65% of the most common type of skin cancer (squamous cell carcinoma) results from actinic keratosis, but if it’s caught early and treated it will go away and skin cancer will not develop.”

Q: How would I know if I had actinic keratosis?

A: “You would know by the feel of the skin,” she says. “It will feel rough, like sandpaper, and it looks dry and scaly. Even if you put moisturiser on it, it will still feel the same.

“A lot of times, men come to the dermatology clinic saying: ‘I was shaving and this area started bleeding and it doesn’t seem to get better.’

People don’t realise that it’s a pre-cancerous skin lesion that they have. They think it’s just dry, funny-looking skin, but there is actually a little bit of activity going on there with some pre-cancerous cells growing.”

Q: What areas does it affect and why?

A: It mainly affects the face, scalp, ears, backs of hands and also the arms – the areas that have been exposed the most over the years.

“Irish people think they are not in danger from UV rays when it’s cloudy, but the sun is shining all the time. 80% of UV rays come through cloud cover. If farmers are out 365 days of the year, the sun is shining on their skin all the time.

“I see older men who come into the clinic and they have skin cancer on their nose and their face but they don’t have it on their bodies because they have usually always kept their shirts on in the past. Younger people are more likely to wear t-shirts and shorts and they have more skin exposed.”

Q: What does it look like?

A: “When I’m teaching teenagers about skin cancer awareness, I tell them, at mass, to look at the back of old people’s necks.

“You’ll see they’ve got what’s called solar elastosis – cracking and very heavy lines on the back of the neck. That’s an indication that somebody has had way too much UV light and, in some cases, might have skin cancer as well. It shows that the dermis has been really affected by the sun shining down on it.”

Q: Are Irish people aware enough of the problem?

A: “No, unfortunately we don’t have a culture of sun awareness in Ireland. There has been a huge prevention campaign targeted at farmers in Australia. We need something like that here. Their slogan is: ‘Protect your farm’s most important asset – you.’

“They said to farmers: ‘If you want to keep farming, you must protect yourself against skin cancer. The more you get sick, the less you’ll be able to work.’

“Sunscreen packaging is plain-looking in Australia and comes in gallon containers, so farmers there don’t see it as a feminine thing – something that often happens here, but shouldn’t.

“Australians also wear the legionnaire-style cap with the peak at the front and the flap at the back, or the typical (Crocodile Dundee type) Australian hat that protects the entire ears, face and neck area.

“The caps Irish farmers wear don’t protect the ears or the back of the neck. The UK are now making strides in sun awareness and are selling Legionnaire-style caps for £1 to children in schools in much the same way that high-vis jackets are sponsored for children in Irish schools.

“We should be wearing caps like that as well, children in particularly, to avoid getting sunburnt.

“It’s a cultural thing. In this country if you have sunburn it’s almost a badge of honour. In Australia, if you brought a child into A&E with sunburn, they’d call the social workers on you because it would be treated as abuse.”

Q: How do we avoid getting actinic keratosis?

A: “Follow the sun smart programme:

“Farmers should have sun screen at hand all the time – some in the tractor, the shed, the kitchen – and they should use it often. Don’t think that one bottle will do you for the summer – you’ll need several bottles.

“You should be applying it from the 1 March to the end of September, regardless of the weather.”

Q: Why is it so important to protect children’s skin?

A: “We receive 65% of our total lifetime UV exposure under the age of 18 because we’re playing outside so often. Farming children are out more, especially in the summer. I see a lot of farming children coming here with a lot of UV exposure. What we don’t want to see in children is loads of freckling – it’s not a good sign.

“We know that if you get sunburnt a lot as a child, you are more likely to get skin cancer later in life.

“With actinic keratosis, it takes 40 years for it to change into a skin cancer. Sunburn you get when you’re 10 can cause skin cancer when you’re 50. That is hard to get your head around sometimes, but that’s why we have to be aware.

“One significant skin blistering sunburn under the age of 10, doubles your chance of getting malignant melanoma later in life, so we need to reduce the amount of sun burnings that happen. We’re going to have an epidemic of skin cancer in years to come if we don’t do something about it now.

“Your skin is immature until you are 20-years-old, growing and changing. If immature skin gets short, intense bursts of UV light like we get here in Ireland, that’s what causes skin cancer.”

Q: How is actinic keratosis treated?

A: Treatment involves the lesion being either sprayed off with liquid nitrogen and treated with tablet chemotherapy or cut off. If the melanoma has spread, we don’t have a cure for it. The liquid nitrogen is at 990 degrees and destroys the tissue around the lesion which will, hopefully, get rid of it.

“There are also topical treatment (creams) that can be rubbed on, known as topical chemotherapy, and there is also a three-day gel treatment for actinic keratosis which gets rid of the funny-looking cells. The key messages are to get treated early and be sun aware so that no more damage happens.”

Did you know?

Sun damage contributes to the development of cataracts. UV light shining constantly on the eyes causes the lens in the eye to become cloudy. A cataract operation involves the natural lens being surgically removed and being replaced by an artificial one.Wearing sunglasses protects the eyes.