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<p class=MsoNormal style='text-autospace:none'><font size=2 face=Arial
FAMILY=SANSSERIF><span style='font-size:10.0pt;font-family:Arial'>All,</span></font></p>
<p class=MsoNormal style='text-autospace:none'><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial'> The summer sun is upon
us! UV damage to our skin and that of our patients causes sunburn, wrinkles,
skin aging and skin cancer, but here are some facts you may not be aware of.
Relevance to ophthalmology: lid cancer, pterygia, pingueculae, chronic "conjunctivitis",
MS (multiple sclerosis).</span></font></p>
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<p class=MsoNormal style='text-autospace:none'><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial'>1. Many children come in during the
summer months with chronically or acutely injected eyes from sun exposure. A
close look shows interpalpebral injection. The conjunctiva of the eye does not
tan! Chronic sun damage will eventually lead to eye problems such as pterygia, pingueculae,
and Salzman's degeneration. This can be avoided by getting out of the sun or by
using a hat, UV-protecting sunglasses and swim goggles (many are these days).</span></font></p>
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style='font-size:10.0pt;font-family:Arial'> </span></font></p>
<p class=MsoNormal style='text-autospace:none'><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial'>2. UV exposure is classified in two
broad categories, UVA and UVB (see the graph below). Standard sunblocks (even
those protecting against UVA and B) do not block much of the UVA light: the SPF
number refers to the UVB protection only. There is a new "reflective"
sunblock ingredient in some sunblocks. This microfine zinc oxide is nearly
invisible (I put it on my bald pate every day) but does a much better job
protecting against UVA; an example is the Coppertone’s "Spectra
3" block available from the Commissary.</span></font></p>
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style='font-size:10.0pt;font-family:Arial'> </span></font></p>
<p class=MsoNormal style='text-autospace:none'><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial'>See <a
href="http://www.aad.org/pamphlets/SunSkin.html">http://www.aad.org/pamphlets/SunSkin.html</a>
or <a href="http://www.sunscreens.net/">http://www.sunscreens.net/</a> </span></font></p>
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style='font-size:10.0pt;font-family:Arial'> </span></font></p>
<p class=MsoNormal style='text-autospace:none'><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial'><img border=0 width=640 height=279
src="cid:image001.gif@01C42189.DCCBDAC0"></span></font></p>
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style='font-size:10.0pt;font-family:Arial'> </span></font></p>
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<p class=MsoNormal style='text-autospace:none'><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial'>3. The downside to avoiding sun
exposure is lack of vitamin D. Simply stated, you need about twice the RDA and
should get this in pill form (it is cheap). Here are some quotes about the
importance of vit D:</span></font></p>
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face="Times New Roman"><span style='font-size:10.0pt'> </span></font></p>
<p class=MsoNormal style='text-autospace:none'><font size=2
face="Times New Roman"><span style='font-size:10.0pt'>“Inverse
correlations are found for UV-B radiation for a number of cancers, with those
for bladder, breast, endometrial, ovarian, prostate, and renal cancer, and multiple
myeloma and NHL having the strongest correlations in this and ongoing multicountry
ecologic studies. These studies add further support for the role of UV-B
radiation and vitamin D in reducing the risk of a large number of
cancers.” <b><span style='font-weight:bold'>Grant WB. </span></b>Ecologic
studies of solar UV-B radiation and cancer mortality rates. Recent Results
Cancer Res. 2003;164:371-7. Review. <u><font color=blue><span style='color:
blue'>PMID: 12899536
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12899536&dopt=Abstract></span></font></u></span></font></p>
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style='font-size:10.0pt;font-family:Arial'> </span></font></p>
<p class=MsoNormal style='text-autospace:none'><font size=2
face="Times New Roman"><span style='font-size:10.0pt'>“Intake of vitamin
D from supplements was also inversely associated with risk of MS; the RR
comparing women with intake of >or=400 IU/day with women with no
supplemental vitamin D intake was 0.59 (95% CI = 0.38 to 0.91; p for trend =
0.006). No association was found between vitamin D from food and MS
incidence.” <b><span style='font-weight:bold'>Munger KL, Zhang SM,
O'Reilly E, Hernan MA, Olek MJ, Willett WC, Ascherio A. </span></b>Vitamin D
intake and incidence of multiple sclerosis. Neurology. 2004 Jan 13; 62(1):
60-5. <u><font color=blue><span style='color:blue'>PMID: 14718698
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14718698&dopt=Abstract></span></font></u></span></font></p>
<p class=MsoNormal style='text-autospace:none'><u><font size=2 color=blue
face="Times New Roman"><span style='font-size:10.0pt;color:blue'><span
style='text-decoration:none'> </span></span></font></u></p>
<p class=MsoNormal style='text-autospace:none'><font size=2
face="Times New Roman"><span style='font-size:10.0pt'>“The recommended
adequate intakes for vitamin D are inadequate,<sup> </sup>and, in the absence
of exposure to sunlight, a minimum of 1000<sup> </sup>IU vitamin D/d is
required to maintain a healthy concentration<sup> </sup>of 25(OH)D in the
blood.” <b><span style='font-weight:bold'>Holick MF.</span></b> Vitamin
D: importance in the prevention of cancers, type 1 diabetes, heart disease, and
osteoporosis. Am J Clin Nutr. 2004 Mar;79(3):362-71. PMID: <u><font color=blue><span
style='color:blue'>14985208
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14985208&dopt=Abstract></span></font></u></span></font></p>
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