Since the beginning of time, our existence has always depended on the climate around us. The type of clothing we use, the activities we engage ourselves in and the type of food we eat all depend on the season we are in – such specificities give our life flavour, colour and inerasable memories.

Despite what Coco Chanel believed in her heyday, a tan shows the body has been damaged by ultraviolet radiation and has attempted to counteract this by increasing the secretion of melanin- Moira Mizzi

For many living in temperate climates, the sun is the centre of their daily lives during the summer. Being in the Mediterranean community, our islands enjoy copious amounts of sunlight, especially during this season.

Thousands of people enjoy its rays lavishly day in, day out, on the myriad of beaches and coastal areas enveloping our country; one can safely say some are addicted to it.

Sunlight is made up of various forms of radiation, each having its specific wavelength and effects. Ultraviolet rays, especially UVA and UVB are the most widely known and discussed possibly because they are the ones that mainly affect our health.

UVA accounts for 95 per cent of the UV radiation reaching the earth’s surface. It has a long wavelength and can penetrate to the deeper layers of our skin and also through glass. It is known to be responsible for the immediate tanning effect and was also found to contribute to skin ageing and wrinkling.

Although it has less energy than UVB, it can still cause lasting damage and recent studies have also implicated it in the development of skin cancers.

Due to its much shorter wavelength, UVB can only brush the superficial layers of the skin and is blocked by glass.

Despite this, it is still the main catalyst in the formation of Vitamin D in the body and the culprit responsible for delayed tanning, skin burning and cancers.

Vitamin D in the body is important in the build-up and maintenance of our bones.

Fifteen minutes of light sun exposure to our face and hands three times a week during the summer months are enough to replenish the stores of this vitamin to last throughout the winter, so one definitely does not need to burn in the sun to make enough of it.

The problems associated with ultraviolet radiation do not just lie in the length of exposure but have much to do with its intensity.

In the past decades, the intensity of ultraviolet radiation has almost doubled as the damage in the ozone layer ceased being a concern discussed in science lectures and documentaries and became an actual reality.

Staying in the sun, especially between 11 a.m. and 4 p.m., is akin to a terrorist attack on the skin, with disasterous outcomes both on a cosmetic and health level.

Dermatologist Susan Aquilina offers no compromise on this issue.

“People, especially of the younger generation underestimate the ravages that excessive sun exposure can have on their skin and their health,” she exclaims.

“Despite what Coco Chanel believed in her heyday, a tan shows that the skin has been damaged by ultraviolet radiation and that the body has attempted to counteract this by increasing the secretion of the protective pigment melanin,” she stresses.

Ironically, while many stay in the sun for cosmetic reasons in the belief that a tan is more fashionable and appealing, the damage caused due to exposure to the ultraviolet rays boosts skin ageing and pigmentation, none of which is flattering on any countenance.

“Ultraviolet radiation stimulates the release of free radicals, which cause a lot of damage to the collagen fibres that keep the skin taut and supple,” explains Dr Aquilina. “The result over a number of years is the characteristic weather-beaten face with deep wrinkles, especially around the eyes and mouth, sagging skin that can be thinner or thicker, age spots and pigmentation and a web of broken capillaries.

“Sadly none of these can be that easily remedied despite the number of avant-garde cosmetic treatments available on the market today,” she adds.

The bleakest scenario in the spectrum of sun-mediated skin disorders is skin cancer.

There are two main types, namely the melanoma and non-melanoma types, which in their turn constitute basal cell carcinomas and squamous cell carcinomas.

“Ninety per cent of non-melanoma and 65-90 per cent of melanoma cancers are linked to excessive ultraviolet radiation exposure,” Dr Aquilina explains.

“Melanoma is the least common but the most dangerous and life-threatening and is also found in the younger age groups, while the other types are more common but less vicious.”

A study of all invasive malignant melanomas of the skin over a 10-year period carried out by the Department of Dermatology at Sir Paul Boffa Hospital and the Department of Health Information showed an exponential increase over a 10-year period, especially in the older age groups, as shown in the graph below.

One positive aspect in this bleak scenario is that locally, most melanomas are thin, so they have not invaded the skin deeply, which indicates that the Maltese public not only is more educated on these cancers, but also seek out help at an early stage, often at the slightest change in existing moles or the sprouting of new ones.

Dr Aquilina insists that the only way to protect ourselves and our skin is to stay away from the sun as much as possible.

“Staying under an umbrella or a canopy does not eradicate the risk as UV radiation can be reflected off concrete, sand and water.

“UV radiation penetrates seawater – at half a metre depth, UV is still 40 per cent as intense as at the surface, “ she stresses.

“Appropriate clothing is also a must; this should include a wide brimmed hat to protect the face and ears, sunglasses, and clothes which do not allow a lot of light to pass through – special sun protective clothing are obviously the ideal choice.

“A sunscreen should be applied on a regular basis on any uncovered areas of skin, including the lips.”

The choice of sunscreens available on the market is as endless as the hours of teleshopping transmitted on our local channels.

Dr Aquilina explains that the choice of sunscreen should hinge on the presence of both UVA and UVB filters, its waterproof properties and the level of the sun protection factor. “Water resistant sunscreen is effective after 40 minutes of water immersion while very water-resistant sunscreen has double this efficacy,” she says.

“The sun protection factor (SPF) indicates the theoretical time one may stay in the sun before burning; for example if one burns within 15 minutes in the midday sun, a sunscreen with a SPF of 20 will take 300 minutes or five hours to do so.

“Reapplying the sunscreen will only replace that lost and certainly does not increase the level of protection.

“People usually use a thinner smear of sunscreen than is recommended which decreases its strength. Obviously people with fairer skin need higher protection than people with darker skins,” she explains.

The ideal thing is to plan your outdoor activities before 10a.m. or after 4 p.m. and protect your skin with appropriate clothing and sunscreen.

The skin should also be examined regularly for new lesions or any changes in existing ones, such

as increase in size, darkening of colour or change of shape, and expert advice sought at the first warning signs.

“The skin should be taken care of and kept as healthy as possible like any other organ or system in the body.

“One can still enjoy the pleasures of the summer months without putting ourselves into unnecessary risks” Dr Aquilina concludes with emphasis.

Ironically, humans seem to be fatally attracted to excess to get its pleasure, turning even the healthiest of habits into unhealthy and often risky ones.

We constantly strive to find new cures and remedies for all our ailments without realising that most of the time all we need to do is learn how to stop and be happy with the limits of the satisfaction any source of pleasure can give.

Sadly, most of the time, we choose to put our health in danger in the fear of losing out on something or the other, when there is nothing worse losing out on than our health and our lives.

These precious gifts should be in the foreground of our focus, not buried deep beneath a vertiginous hotchpotch of other priorities.

Life is short enough – without us making it shorter.

Skin tips

• Wear a hat/bandana to protect your head.

• Wear sunglasses with side panels that provide 99 to 100 percent UVA and UVB protection.

• Apply sunscreen factor 15 and above about 45 minutes before going out. This gives the ingredients enough time to absorb into your skin and protect it.

• Protect babies and young children: always keep babies in the shade.

• If you are wearing makeup, apply sunscreen underneath – before you put it on.

• Avoid staying out in the sun too long, especially around midday.

• Remember to always re-apply sunscreen every couple of hours.

• Be aware that the fairer your skin, the more at risk you become because the sun can penetrate more easily. However, people with darker skin can still develop melanoma in places less pigmented such as the hands or soles of the feet.

• Activities in or near reflective surfaces such as swimming, canoeing, sailing, surfing, snorkel­ling, fishing or any other activity that requires you to be close to water (even sunbathing beside a pool), in­creases your total UV exposure.

Always remember

• There are more holes in the ozone layer than ever before, which is why we need to take extra precautions to sunlight. Ozone absorbs some of the UV radiation from the sun. As it is depleted, more UV radiation reaches the earth’s surface.

• Sun in moderation is fine. Vitamin D is vital to our immune system. But do not forget that sun is extremely stronger in tropical areas, so check your sun cream protection level for hotter places.

• Using a tanning bed more than 10 times a year makes people seven times more likely to develop skin cancer than those who do not use them.

Radiation in sunlight

There are three types:

• visible light, which gives us the colours we see
• infrared radiation, which gives us the warmth we feel
• ultraviolet (UV) radiation

Except in extreme situations, neither visible light nor infrared radiation from sunlight causes health problems. However, ultraviolet radiation can cause harmful effects to the skin.

The UV index (UVI) is the international standard for UV measurement. The higher the UVI value, the greater potential damage to the skin and eye, and the less time it takes for harm to occur. Sun protection should be used when the UV index is three or above - it is usually above eight during summer in Malta.

Your looks

• The sun’s rays make us feel good, and in the short term, make us look good. But our love affair is not a two-way street: exposure to sun causes most of the wrinkles and age spots on our faces. A woman of 40 who has protected her skin from the sun will have the skin of a 30-year-old!

• We often associate a glowing complexion with good health, but skin colour obtained from being in the sun, or in a tanning booth, accelerates the effects of aging and increases the risk of skin cancer.

• Over time, the sun’s ultraviolet light damages the fibres in the skin called elastin. When these fibres break down, the skin begins to sag and stretch and loses its ability to go back into place.

Most at risk

• Most skin cancer occurs in areas of skin most heavily exposed to sunlight (ears, forehead and arms).

• Skin cancer among people who are sensitive to sunlight is more common in regions that have stronger sunlight.

• People with genetic diseases that make them more sensitive to sunlight have a greater chance of developing skin cancer.

• Occasional exposure during childhood and adolescence may be important predictors for basal cell carcinoma, and cutaneous malignant melanoma.

• High levels of chronic exposure, such as working outdoors, is more often associated with squamous cell tumours.

Exposure to the sun causes:

• Pre-cancerous and cancerous skin lesions – caused by loss of the skin’s immune function.

• Benign tumours.

• Fine and coarse wrinkles

• Freckles.

• Discolored areas, known as mottled pigmentation.

• Sallowness – a yellow discoloration of the skin.

• Telangiectasias – the dilation of small blood vessels under the skin.

• Elastosis – the destruction of the elastic and collagen tissue (causing lines and wrinkles).

• Sunburn is the most familiar and immediate effect of ultraviolet radiation. It is an inflammation caused by an increase in blood-flow beneath the skin.

Other dangers

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

• Approximately 18 million people worldwide are blind as a result of cataracts; of these five per cent of all cataract-related disease burden is directly attributable to UV radiation exposure.

• Sun protection is recommended when the UVI is three or above.

• Use hair conditioning products that offer UV protection to keep your locks in the best and apply sun screen to your hairline.

• Short periods of sun exposure can damage the human immune system and make the body more susceptible to infections.

• Some diseases can become worse with sun exposure. These include herpes simplex (cold sores), chicken pox, lupus, and certain genetic problems.