.: July 2007 Newsletter: Summer Fun-Summer Safety :.

July is UV Safety Month; this means protect yourself from UV Rays, not only your skin but your eye. The American Ophthalmologic Society has some useful advice for your eyes at: http://www.eyecareamerica.org. The formation of cataracts, clouding of the lens of your eye, is associated with UV light and the fairer your eyes (lighter in color), the more at risk you are for cataracts. Also, it is possible to develop or be born with nevi (moles) on your iris (the colored part of the eye) and the retina (the back of your eye that is responsible for seeing). These nevi can become cancerous too. The eyelids are particularly sensitive parts of skin subject to basal cell and squamous cell cancer. Wide brimmed hats and sun glasses that block UVA and UVB offer protection. Even clear glasses bock some UV light.

We’ve covered eyes, now let’s talk skin. Any coloring of the skin, tanning or burning or freckling, is a sign of sun damage. Although we renew our skin, and can heal from cuts, etc, all new cells come from the base layer of cells and it is the base layer that is damaged by UV rays. This damage accumulates over a lifetime, as if it has a memory. So although many think being tanned looks healthy, it is actually causing sun damage. For many of us, this damage only results in thickening of the skin causing that leathery look and wrinkles, or that chronic “red neck” actually called solar elastosis. These changes are not reversible. But for some of us, it causes precancerous and cancerous lesions. The most common precancer caused solely by sun is actinic keratosis, which are pink scaly spots that never go away. But these turn into squamous cell cancer if left untreated (treatment usually is in the form of either an acid peel or freezing the lesions off). Squamous cell cancers need to be surgically removed; although it rarely metastasizes it can be disfiguring. The other main cancer caused solely by the sun is Basal Cell Cancer. Again, this rarely metastasizes but can results in large sections of skin being removed is it tends to invade locally in all directions. These appear as pink “pearly” papules (bumps). The worse player in this trio is melanoma. Melanoma usually starts in a mole that starts to change from lifelong UV exposure. You look for the ABCD and E’s; Asymmetry of shape (not round or oval), Borders that are irregular, like a squiggly line, Color that is not uniform, more than one color within the same mole whether light or dark, Diameter, size bigger than a pencil eraser, and Elevation, raised more than 2 mm.

So what do you do? Avoid tanning booths; there is no “healthier” UV Light. Wear sun screen; put it on when you get up in the morning or after your shower so you don’t “forget”. It is best applied 1-2 hours before going outside anyway. Reapply often with water sports and sweating. And cover up, especially during peak UV hours (10AM -2 or 3 PM), even on cloudy days. A t-shirt only provides the equivalent protection of SPF-10 and a worn, wet T-shirt even less protection.

Last skin topic is sunburn. A sunburn is a thermal burn, either 1st or 2nd degree. 1st degree burns are just redness and 2nd degree is with blisters. It is not immediately apparently which is why it sneaks up on you. Symptoms usually start 4 hours after sun exposure, worsen in 24-36 hours and then resolve over 3-5 days. There is no treatment other than time and symptoms relief, meaning pain relievers, moisturizers and cool compresses. So best thing to do is to avoid getting burned by following the precautions listed above. For more info, go to: http://wwwn.cdc.gov/travel/yellowBookCh6-Sunburn.aspx.

Insects and the diseases they carry. In NJ, there are two dreaded insects and diseases we worry about; first, is West Nile Virus carried by mosquitoes and second is Lyme disease carried by ticks, specifically the Ixodes scapularis known as the “deer tick”. There is also Erlichiosis and Rocky Mountain Spotted Fever which are carried by ticks but much less common.

West Nile Virus is a virus, which means that it can not be treated with antibiotics and all we can do is treat symptoms and provide supportive care until the person’s own immune system can fight it off. Fortunately, most cases are fairly mild and most people don’t know that they even had it. It can however be fatal for the already debilitated, meaning very young and very old. So, once again, prevention is the key. Avoid being outside when mosquitoes feed (dusk and dawn). If you are going to be outside, wear insect repellant. It must contain 20-30% DEET to be protective. This has been studied and is perfectly safe to apply to your skin and clothing. Try to mosquito proof your yard. They lay eggs in any standing water. This may be a wading pool, puddle, swamp or the abandoned lid of a jar or child’s sand box shovel. For more information, go to: http://www.cdc.gov/Features?WestNileVirus/. You are usually aware of being bitten by a mosquito, there is a little sting and then they leave an itchy welt or bump.

Ticks feed on mammals. And they may feed on more than one animal, which is how Lyme’s disease is transmitted. They can carry a bacterial called Borrelia burgdorferi in their stomachs. As they feed, some of their gastric contents are released into the host’s body. Deer are the important because they transport ticks and maintain tick populations, but they don’t actually become infected. Most human cases of illness occur in late spring and summer when the tiny nymphs are most active. Not every tick carries Lyme bacteria. Also, ticks don’t just bite you like mosquitoes and flies and spiders, they actually have to attach themselves for 24-48 hours to have an adequate blood feast. And they do not burrow in under your skin. Only their mouth parts, which are 2 barbed needle-like devices, puncture your skin. They actually inject a little anesthetic which is why you don’t feel it. Research has shown that the tick must be embedded for 24-48 hours to actually transmit Lyme’s disease. It is also possible to prevent Lyme’s disease after a tick bite by taking a prophylactic (preventative) dose of antibiotics after a known deer tick bite in which the tick is engorged. You are a candidate if you live where Lyme disease is common, the tick was attached at least one full day, and it has been less than 3 days since it fell off or you removed it.

Try to remove the tick in its entirety. Grasp it as close to the skin as possible and pull upwards and outwards firmly and slowly. Do not apply a match, alcohol or Vaseline. These do not help and can cause you injury or make it more difficult to remove the tick. If the mouth parts remain, they can not transmit Lyme, they are nothing more than “splinters” at this time. You can save the tick for identification if you are unsure of what kind of tick it is. Put it in a small container or sealed plastic bag with a damp piece of paper towel or cotton to preserve it. Do not place it in alcohol or drown it. Most doctors can tell you what kind of tick it was.

Prevention of tick bites is the best medicine. Effective repellents exist, containing 20-30% DEET. You can also treat clothing by applying Permethrin. Where light colored clothing when you will be out in tall grasses, brush or the woods, and check your body for ticks after you have been outside. There are insecticides that can decrease tick populations in your yard also. You can get more information at the following website: http://www.cdc.gov/ncidod/dvbid/lyme/index.htm.

Sincerely,

Dr. Saradarian