EXPOSING SUN RISKS
By Dr. Stephen Juan

We all know that over exposure to the sun is a factor in skin cancers, especially life-threatening melanomas. But less well known is research suggesting that the sun may also be a factor in stroke, heart attack, blindness, and other health problems. Excessive exposure to the sun can cause painful sunburn, immune system suppression, cataracts, migraines and headaches, skin rashes, premature aging of the skin, besides less deadly forms of skin cancers, basal cell carcinoma and squamous cell carcinoma (SCC).

Excessive sun exposure can cause actinic keratosis (AK), leukoplakia (LKP), and actinic cheilitis (AC).

Actinic keratois (AK) is also known as solar keratosis. It is by far the most common pre-cancer. It takes the form of a small crusty or scaly bump or horn that arises on or beneath the skin surface. An AK can be the first step leading to a SCC. Some studies show that ten percent do advance, and 40-60 percent of SCCs begin as an untreated AK.

Leukoplakia (LKP) is a disease of the mucous membrane. White patches or plaques develop on the tongue or inside of the mouth. They have the ability to develop into an SCC. It is caused by sources of continuous irritation, including smoking or other tobacco use, rough edges on teeth, dentures or fillings. However, an LKP on the lips is caused mainly by sun damage.

Actinic cheilitis (AC) is a type of AK or LKP occurring on the lips. It causes lips to become dry, cracked, scaly, pale and/or white. It mainly affects the lower lip, which typically receives more sun exposure than the upper lip.

Over-exposure to the sun causes a condition known as temporal cell arteritis-polymyalgia rheumatica syndrome or TA-PMR. TA-PMR blocks the arteries and causes serious blood vessel (vascular) damage, particularly in people of middle and old age.
If the connection between TA-PMR and the sun exists, this means that we will have to be as careful of the sun for the same reasons we must be careful of fats and cholesterol in our diets.

“Sclerosis” is the medical term for diseases that harden and thicken. Arteriosclerosis is the hardening and thickening of the walls of the smaller arteries (arterioles). Atherosclerosis is a form of arteriosclerosis. In atherosclerosis, deposits of gluey, gooey, yellowish plaque (atheromas) which contain cholesterol, fats (lipids), and other substances, line the walls of the arteries. If this continues, then arteries become hardened, thickened, and blocked. When blockage occurs, life-giving, oxygen-bearing blood cannot circulate properly resulting in stroke, heart attack, perhaps permanent organ damage, even death.

Although conventional wisdom links cholesterol to atherosclerosis and hence to health risk, fascinating research relates the sun to TA-PMR and hence to the same risk.

In 1965 in the BRITISH JOURNAL OF DERMATOLOGY, Drs. P. Kinmont of the Derbyshire Royal Infirmary and D. McCallum of the Nottingham General Hospital described fourteen patients who suffered serious vascular complications after “excessive” or “merely unusual” exposure to the sun. In one case, a 64-year-old Englishwoman suffered headaches that culminated in sudden permanent blindness in one eye and diminished vision in the other. The two doctors argued that this was a direct consequence of her “sunny” continental holiday.

In 1978 in the same journal, Dr. John O'Brien of St. Vincent's Hospital in Sydney published evidence showing that long-term sun damage is common in the large arteries near the temple of the head (temporal arteries). Furthermore, he found that this damage is the probable reason why inflammation of these arteries sometimes takes place. This gives rise to the “temporal arteritis” part of TA-PMR.

Dr. O'Brien observed that, significantly, the temporal arteries run across the forehead in a position where they are continually exposed to large amounts of solar radiation over the course of a normal individual's life. He proposed that, ultimately, the essential supportive elastic tissue framework of these arteries is destroyed by radiation. Elasticity is necessary in arteries in order to allow the never ending expansion and contraction of arteries created by the heart-driven pulse---100,000 or more pulses every day.
Indeed, unlike the damaged arteries of the heart deep within, the damaged temporal arteries can be seen to become thick and hard as they are visible to the naked eye.

In an unpublished 1992 paper, Dr. O'Brien describes his theory: “Unfortunately elastic tissue has a singular fault, a peculiar life-long sensitivity to ordinary sunshine and other ‘benign’ radiation. Beginning in early childhood and continuing for the first half of life, radiation provokes a slow overgrowth of elastic tissue in exposed skin, e.g., in the face, where it produces a thick, coarse ‘weathering’ by mid-life. Subsequently, and again very slowly, radiation acts to destroy all elastic tissue and so the face ultimately sags or ‘ages’. This destructive process is called ‘actinic elastotic degeneration’. Most ‘ageing’ of exposed skin has this basis. The process is cumulative, each bit of radiant damage being added to that already existing.”

Dr. O'Brien points out that part of TA-PMR “is that the deep arteries of the brain, heart, and other organs are also involved through the destruction of their elastic tissue. It is these deep changes that make it so dangerous. They are probably not direct effects of radiation but are postulated to arise through ‘autoimmunity’, more easily understood as auto-aggression. It is believed that soluble elastic-destroying substances, called enzymes and antibodies, are released from the sun-damaged skin and its arteries and are carried internally by the blood to wreak their effects more widely. The deep changes may be accompanied by intense diffuse pain, often in muscles.” This gives rise to the “polymyalgia rheumatic” part of TA-PMR.

Dr. O'Brien, along with Dr. William Regan of the Repatriation Hospital at Concord, have attempted to alert the medical community to their findings. They have been doing this since their July, 1992 article in ARTHRITIS & RHEUMATISM. My own first humble effort in this regard was published in the JOURNAL OF PAEDIATRICS AND CHILD HEALTH in October, 1993.

Drs. Cornelia Weyand and Jorg Goronzy of the School of Medicine at Emory University in Atlanta write in the PRIMER ON THE RHEUMATIC DISEASES (edited by John Klippel, John Stone, Leslie Crofford, and Patience White, 13th edition, 2008) that they believe that visual loss is the most feared complication of TA-PMR and that diagnosis is usually made via biopsy of the temporal artery. So the medical community is well informed. But according to Dr. O'Brien, the public must be informed too. He notes that “the lay population should be informed of this emerging issue without further delay. The public has a fundamental right to know. It is easy and costs nothing for people to avoid or protect themselves in various ways from excessive sunshine and other sources of intense radiation such as saunas and solariums. Many who have previously suffered brain or heart-related episodes may well choose to do so immediately. As with malignant melanoma, this is a further reason for being cautious about radiation.”

Be careful everyone!

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