Sun Care 101

Well, it’s finally summer. Even though 2020 has not turned out exactly as expected, one thing is certain: Warmer weather means sunshine.

For some rowers, the easing of pandemic restrictions brings the chance to get out on the water–maybe just in singles for now or in larger crews of people within your quarantine bubble. For others, summer training might mean pulling the erg out of the basement into the backyard or onto the apartment balcony.

For a few, like two-time U.S. Olympic sculler Gevvie Stone, who has had to rethink her anticipated post-Olympic return to medical training as a resident doctor this August, summer means being one step closer to figuring out what normal training might look like with the Tokyo Olympics a year away–again.

However you spend your time outside, soaking up sunshine comes with benefits and risks, especially for rowers. “Rowing is a doubled sun exposure,” Stone told me, “from both the sun above and the reflection of sun off the water.”

Besides Stone, I reached out to two experts in the field: Jim Walker, a former Canadian Olympian and semi-retired dermatologist; and Lisa Kottschade, chief operations officer of the Midwest Melanoma Partnership, an organization that recently partnered with USRowing to raise awareness about melanoma and promote safe sun care for rowers.

Dark side of the sun

From Hippocrates to Florence Nightingale, the healing properties of sunlight–for both physical and mental health–have been praised for thousands of years. Modern research has only strengthened the link between sunlight and good health. It is, for example, the best source of vitamin D.

Yet, as with so many other things that are good for us, sunlight can also do us harm; too much can even prove fatal. Cancer, of course, is the big concern when it comes to sun-related disease, but it isn’t the only reason to protect your skin.

Blocking out the sun’s ill effects also has a long history, with plant-based sunscreens in use for millennia by diverse cultures around the world. The last two centuries have seen more rapid advances in the science of sunlight, including the development of more effective sunscreens since the 1950s and ’60s.

Rowing into medicine

I gave Walker a call one evening to talk about his experiences with rowing and dermatology. It wasn’t long before the formal “Dear Dr. Walker” of my initial email changed to “Jim” as the friendly voice on the other end of the line and I fell into a relaxed conversation.

Walker got his start in rowing at the Leander Boat Club in Hamilton, Ontario, in the spring of 1968. “It was actually Al Morrow [Canada’s now retired long-time women’s team coach] who encouraged me to start rowing when we were in high school together,” he told me.

As Walker’s rowing advanced, so too did his studies, and he was soon balancing training with medical school. “I was in medicine when I went to the Munich Olympics in ’72. I was fortunate because [in those days] you had the summer off between second and third year, so I was able to fit it in.

“We flew back from Munich, and I was already about three days late for school. After that, it was hard to commit to a crew.”

With elite rowing behind him, Walker threw himself into medicine, opting to specialize in dermatology–the study and care of the skin.

Over the years, Walker has maintained his connection to the sport, delivering information seminars and working with athletes and coaches on Canada’s national team.

The sun-protection checklist

Even with the danger from sun exposure higher than ever in this age of climate change and a thinner ozone layer, Walker is optimistic about the current state of understanding among rowers and coaches when it comes to sun protection.

“When I’ve spoken to athletes, there is pretty good awareness,” he told me. “The problem is the logistics of getting around it when you are rowing and the practicalities of using sunscreen.

“The important thing is that you think not just about sunscreen,” he stressed. He shared this three-point sun-protection checklist:

1. Stay out of the sun.

“With training, it is in some ways easier because you can schedule your training sessions in mornings and evenings. The sun is most intense between 10 in the morning and 4 in the afternoon. At regattas, of course, you have to row at any time.”

2. Seek shade, or make your own.

“In rowing, when you are on the water, you have to create your own, and that is done with hats and clothing. All rowers should be wearing a hat every time they are on the water. At a regatta, between races, seek other forms of shade.”  

3. Use sunscreen on whatever you can’t cover.

“If you put sunscreen on your forehead, it runs into your eyes when you sweat. Hats can protect the scalp and top of the face; put sunscreen on the rest.

“In rowing, you also have to be careful that you don’t have sunscreen on the palms of your hands. Make sure to wash just your palms after applying sunscreen.”

4. Assess you innate risk.

Those with lighter skin are at higher risk for sun-induced skin cancer.

Dermatologists use the Fitzpatrick scale to indicate the level of risk from sun exposure, based on how the skin responds to solar radiation. Type I (light skin that always burns and never tans) has the greatest risk, while Type VI (dark skin that very rarely burns) has the lowest risk. That said, whatever your skin type, taking precautions, such as covering up and wearing sunscreen, is important. 

Light–The long and short of it

The light from the sun we can see is called the visible spectrum. It is colorless, but when it passes through something like a crystal or even a drop of rain, it separates into various wavelengths in a beautiful display of color.

The wavelengths of light we can see are actually only a tiny portion of the much larger electromagnetic spectrum. Violet is both the shortest wavelength and highest-energy radiation we can see; beyond it is ultraviolet (“beyond violet”) radiation. Red is the longest wavelength and lowest-energy radiation we can see; beyond it is infrared (“below red”) radiation.

Fortunately, Earth’s atmosphere blocks most harmful solar radiation. The invisible threat we have to take precautions against on a day-to-day basis comes primarily from ultraviolet (UV) and infrared (IR) radiation.

UV radiation

UV radiation can do a lot of harm.

“Skin cancer is the greatest risk from too much sun exposure,” said Kottschade, a nurse practitioner and associate professor of oncology at the prestigious Mayo Clinic in Rochester, Minn,

“Additionally, premature aging and skin damage can also result.”

Casting shade on some myths

    Kottschdale addressed a few misconceptions head on:

• I won’t get a sunburn on cold days.
• FALSE. “People can get sunburns even in the winter (e.g., skiing).”

• I won’t get a sunburn on cloudy days.
• FALSE. “People are as much at risk for damage from sun exposure on overcast/shady days since the UV rays can penetrate through clouds.”

• People have been out in the same sunlight for tens of thousands of years; there’s no big deal about it today.
• FALSE. “With decreasing protection from the ozone layer, the sun has become more intense. Today, most skin cancer is diagnosed in people between the ages of 60 and 80. One hundred years ago, [most] people died of something else before reaching that age.”

Causes of skin cancer

There are three types of skin cancer from sun exposure: basal cell carcinoma, squamous cell carcinoma (both very common), and melanoma, which while less common, is the most deadly.

“They are all very clearly sun related,” Walker told me.

“Overall, sunburns are one of the biggest risk factors for developing skin cancer,” Walker said. “One of the goals of sun protection is to avoid sunburn; this lowers your risk of developing skin cancer exponentially.”

Significantly, skin cancer is a disease that not just older adults need to worry about. “It can affect young people as well,” Walker said. “Melanoma is one of the cancers connected with the greatest number of lost years of life. You can find 35-year- olds with melanoma who end up dying, and that is a lot of lost life.”

“Skin cancer can affect young people as well. You can find 35-year-olds with melanoma who end up dying, and that is a lot of lost life.” – Jim Walker

What to watch for

“A new or changing skin lesion is the most common sign,” said Kottschade.

What that change looks like can vary among individuals, said Walker. “It depends on the person and the nature of the cancer. A lesion is a broad term meaning anything on your skin, like a mole, but cancers don’t all start from moles.

“It could be a changing spot, something multi-colored, a new red persistent nodule or an ulcer that won’t heal. Most of these cancers will occur in older masters rowers more than younger rowers. The exception is melanoma–one you don’t want to miss–that can affect the young.

“If you have a lesion that is changing or multi-colored or growing and that persists more than three to four weeks, get it checked out.

“Most skin cancers appear in areas either exposed chronically, such as the face and hands, or exposed intermittently and burned. If you look at most melanomas in young people, they appear in places that are intermittently exposed and sunburned. For men, it is mostly on the trunk and shoulders. For women, who mostly cover their chests, melanoma commonly appears on the back and legs.”

Walker cautioned: “Melanoma can appear even on protected areas. The sun is not the only cause of skin cancers. You can have cancers on the genitalia and areas that have never seen the sun.”

Fortunately, skin cancer, if caught early, can be treated successfully. For those who have recovered, getting back in the sun is all right, but protecting yourself is more important than ever.

Premature aging

The increasingly shorter wavelengths of light in the ultraviolet spectrum interact with the layers of skin differently the deeper they penetrate the body, Walker explained.

“The ultraviolet penetration of cells on the skin surface causes most of the cancer. The deeper penetration causes other effects like premature aging as it breaks down the deeper layers of skin

“Collagen is what makes the skin strong, and elastin is what gives it rebound. They are both damaged by the penetration of longer wavelengths of ultraviolet radiation.”

Sunscreen

“In terms of sunscreens, if used properly, they are all pretty great at blocking burns,” said Walker, but they are not all created equal.

“There are two basic types. Physical blockers create a barrier so the sunlight hits the blocker and reflects, instead of being absorbed by the skin. Chemical blockers have chemicals that absorb the radiation before it reaches the living cells of the skin.”

While there is still work that needs to be done to alleviate many of the concerns about the safety of newer chemical blockers, physical blockers have a long history of effective use, and their basic ingredients are hypoallergenic. “Physical blockers are probably the safest sunscreens to use,” he said.

“There are two compounds in essentially all physical blockers: “Zinc oxide and titanium dioxide. They reflect light. Titanium dioxide is orange in color, and zinc oxide is white.”

UVA, UVB and SPF

When it comes to the effectiveness of sunscreen, the letters on the front of a bottle of sunscreen have most of the information you need.

UVA and UVB stand for “Ultraviolet A” and “Ultraviolet B,” the range of UV radiation wavelengths that penetrate Earth’s atmosphere. “UVB probably causes most of the skin cancer, and the deeper-penetrating UVA, the wrinkling and aging,” said Walker.

SPF may be the most familiar set of initials, standing for “sun protection factor.” “In other words,” explained Kottschade, “how well does it protect a person from the sun’s harmful rays?”

Bear in mind, cautions Walker, that “SPF is the measure of protection against only UVB. In essence, a high-index sunscreen has a high SPF (degree of protection against UVB), and one that protects against the full ultraviolet spectrum of UVA and B provides broad-spectrum protection.

“People should get sunscreen that protects against both UVA and UVB rays as well as has an SPF factor of 30 or greater,” said Kottschade.

However strong your sunscreen’s protection, Walker stressed the importance of staying out of the daytime sun when possible and covering up with light clothing and a hat rather than relying on sunscreen alone.

Infrared and overheating

“Infrared is the radiation that causes most of the heating, in addition to ambient temperature and exercise,” said Walker.

“Sweating and dilation of surface blood vessels are methods the body uses to protect itself from overheating. With perspiration, it’s the evaporation of water from your skin that cools you down. The dilated vessels emit excess body heat, if the ambient temperature is below body temperature.

“Covering up can help reduce infrared absorption, to a degree,” but “sunscreens block only UV light.”

For more on internal overheating, I turned to the medical section of the website of the World Rowing Federation (FISA): http://www.worldrowing.com/athletes/medical-and-antidoping/medical

Among its collection of health-related publications for rowers are FISA’s guidelines for dealing with hot weather.

Compiled by Jurgen Steinacker, chair of FISA’s Sports Medicine Commission, and his colleagues, the guidelines offer this advice:

Dehydration

“Adequate hydration is critical for heat tolerance and part of a successful acclimatization to warm climates,” the guidelines state. “Dehydration impairs work tolerance and is a potential risky condition.”

“Athletes should drink two liters per day as a baseline. For each additional hour of rowing exercise, an additional liter of fluid should be given to the athlete. For each 9°F increase in ambient temperature above 77°F, one additional liter should be added to the drinking schedule.”

“Heat-related illness begins with dehydration and is accompanied by core-temperature elevation. Exercise further increases heat load of the body. With increased core temperature, energy demands for temperature regulation increase, which results in further depletion of energy resources, particularly glucose stores. These conditions can predispose to heat-induced illness. However, it should be mentioned that in case of excessive thermal load, heat exhaustion and heat stroke may occur without dehydration.”

A hot sunny day, especially infrared radiation, is a contributing factor.

Heat exhaustion

Not dealing with dehydration can often lead to heat exhaustion, “characterized by a high heart rate, dizziness, headache, loss of endurance/skill/confusion and nausea,” the guidelines continue. “The skin may still be cool/sweating, but there will be signs of developing vasoconstriction, e.g. pale color. Athletes will pass little urine, which will be highly concentrated. Cramps may be associated with dehydration.”

In an athlete with heat exhaustion, body temperature can rise as high as 104°F, and after exercising and racing, the athlete can collapse.

Heat stroke

When heat exhaustion goes unnoticed or unchecked, heat stroke can follow quickly. This condition is “similar to heat exhaustion, but with dry skin, confusion and collapse,” the guidelines say. It is “a potentially fatal condition and must be treated immediately by a medical professional.”

“Any athlete with a temperature above 104°F that does not resolve after 30 minutes of cooling and rehydration is to be considered a medical emergency.” 

The best ways to prevent the above are to stay hydrated and seek shade and cooling measures, such as a fan, air conditioning, and water spray.

Stepping up your game

Finding a reason that motivates you is essential, Stone said. “Whether you’re motivated by fear of skin cancer or wrinkles, it’s important to protect your skin from damage.”

“Protect the face with sunscreen (preferably zinc and SPF 30+) and a hat with a brim,” she advised. “Protect the eyes with polarized sunglasses–yes, the polarization is worth it. Protect the rest of exposed skin with sunscreen (SPF 30+) and sun wear (light long sleeves, etc.).”

Don’t stop at prevention, she continued. “Schedule an appointment with your primary doctor if you notice a mole change significantly or with any of the following features: asymmetry, border irregularity, color irregularity, diameter greater than eight millimeters. Basically, better to be safe than sorry.”

Lastly, while skin cancer is largely a disease of older adults, even younger people can be affected, and melanoma can be fatal, if left untreated. “I have a good friend who had a melanoma removed at age 24,” said Stone. “It triggered me to step up my game.”