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Most of us have probably had a bit of sunburn. In my youth the occasional burn was a badge of honour, especially when achieved in pursuit of a suntan in the closing days of an overseas vacation. A fair skinned and freckled friend of mine recalls the teenage use of olive oil resulting in excruciating sunburn.
We know better than that now, though, don't we? Of course we do, but these days we and our patients choose—and can afford—to take holidays where there is a lot of sunshine.
Sun exposure is an important health issue in Queensland, where one in three adults will have some sort of skin malignancy in a lifetime. There are three main factors contributing towards this. Firstly there is the latitude, with the tropic of Capricorn running through Rockhampton, and the southernmost part of the state at a mere 28 degrees south. Secondly there is the equitable climate, with places like the Sunshine Coast truthfully boasting 300 days of sunshine a year. And thirdly, there is the hole in the ozone layer, somewhere in the Southern Hemisphere which, if you think about it, isn't like a punch biopsy, but must represent the end point in a thinning process extending for unknown thousands of kilometres around the actual hole.
The consequences of this have been well demonstrated in research from the Centre for Astronomy and Atmospheric Research at the University of Southern Queensland, based in Toowoomba, 100 km inland from Brisbane. Scientists there have shown that if you spend the whole of a Queensland summer in good shade, you'll get as much UV exposure as if you spend the whole of an (uncharacteristically) sunny British summer in direct sunlight. This confused me until I was reminded why the sky was blue, which is because shorter wavelengths of light are more scattered by the atmosphere than longer ones. UV light, with an even shorter wavelength than blue, is, in effect, getting to you wherever you have direct sight of the sky. Years ago on elective in Jamaica I received an object lesson in this; I omitted the sunscreen when taking a long walk on a cloudy day, with very painful consequences.
The Australian slip-slap-slop campaign aims to address the fact that people—and especially children—will continue to go into the sun. The message is as follows:
Slip on a T-shirt; preferably a long sleeved one. You can buy UV opaque shirts, which, unlike cotton, retain their opacity when wet from perspiration or swimming. Unofficially rated at sun protection factor (SPF) 300 or more—officially in Australia you are only allowed to go up to 30—they can be bought in trendy surf brands like Billabong and Quicksilver. For good protection they have to be worn quite tight, which means that mine demonstrates starkly to me that I'm destined never to have “six pack” abdominal definition; sadly more of a keg or beer barrel.
Slap on a hat, preferably a wide brimmed one. Mine has never quite recovered from being worn in a sub-tropical downpour, and now is not so much Clint Eastwood as Quentin Crisp. While you're at it you should slip on a good pair of sunglasses, with good UV filters. With luck they'll make you look trendy, will prevent you from squinting and hopefully, in the long term, reduce cataract formation.
Slop on the sunscreen. Really do slop it on, which is to emphasize the fact that a thumbnail blob is enough for an area the size of your hand. Reapply after swimming or perspiring, remembering that reapplication doesn't prolong the effect, but instead reinforces whatever factor you were starting at. The “slopping it on” attitude is helped by the fact that sunscreen is very affordable in Australian shops, contrasting with British prices which seem to imply that it is a luxury item. Total block—zinc creams for high exposure points like lips and nose—come in fun luminous colours, and their popularity is boosted by their use by some high profile cricketers and tennis players
Much of your lifetime risk of melanoma is acquired in childhood, during “binge” exposure to the sun, as during a fortnight in the Spanish sunshine. Skin protection is therefore a paediatric health issue. The challenge, for me at least, is how best to get the message across while looking like Quentin Crisp with a keg. Well, at least my sunglasses are cool...