The sun, you and IBD
By Dr Nav Paul, Dermatology Fellow, Royal Free London NHS Trust
Maybe you have Inflammatory Bowel Disease (IBD), or perhaps know someone who does? Aside from stressing about your bowel problems, fatigue, side effects of medication and appointments with the Doctor, you now have to worry about the sun? Are we being serious? Sadly, yes but it does not mean life can’t still be fun! In this article, I will explain the reasoning behind it and make some recommendations for you.
Everyone needs to take care in the sun. The rates of skin cancer in the UK have been consistently rising and now generate around 50% of work carried out by most Dermatologists in the UK. People continue to be surprised by this statistic, but the reality is that the government has not prioritised skin cancer and Dermatology over the years, so the information conveyed to the UK population can be sparse. ‘Sun safety’ is commonly taught in countries like Australia, where the famous ‘Slip, Slop, Slap’ campaign took off. Cancer Research UK (CRUK) have recently developed something similar, which is now getting some traction.
Although everyone should check their skin for abnormal growths, there are certain populations that are at higher risk of skin cancer developing over their lifetime. These include people with:
- Fair skin that burns easily (Caucasian population)
- Light eyes, light hair or red hair (N.B. refers to your natural colour)
- A history of sunburns (especially if severe or blistering sunburn)
- Excessive UV exposure (sunbathing, outdoor activities, sunbeds)
- Living in sunny climates or high altitude (especially near the equator)
- Multiple moles or abnormal moles (E.g. a history of dysplastic naevi)
- A family history of skin cancer (particularly with Melanoma)
- A personal history of skin cancer (includes pre-cancerous conditions)
- A weakened immune system (E.g. people with HIV/Aids or on immune suppressant drugs for chronic diseases such as IBD or post-transplant)
I personally recommend everyone should wear sunscreen on a daily basis, which eliminates the need to ‘remember’ to put it on. Usually, most people in the UK will only put on sunscreen when going outdoors for long periods of time or rely on sun protection factor (SPF) in their moisturiser, but this may not be adequate. The British Association of Dermatologists (BAD) has produced a very helpful guide about what level of sunscreen individuals should be wearing (see below). It is important to monitor your own skin regularly and maybe check out your family members too (with their permission of course!).
In the UK, the Government recommends that people check their own skin regularly and see their GP if they are concerned. Most experts recommend looking out for growing red or scaly patches, new expanding growths on the skin or changes to existing ‘freckles or ‘moles’. We recommend you observe the area for closely for any rapid changes particularly in its colour, shape and size. Anything that persists on the skin, bleeds, crusts or scabs, ought to be checked out by a Doctor. GPs in the UK are highly trained and used to dealing with most skin complaints. If there is any doubt or concern, your GP can refer you to a Dermatologist.
In terms of sun safety advice, the British Association of Dermatologists (BAD) and British Skin Foundation (BSF) recommend all people consider the following advice. Firstly, it is important avoid actively tanning and sunburn as both the ‘tan’ and redness of sunburn is evidence that the skins cells have been damaged by UV light. In order to achieve this, one should consider wearing appropriate sunscreen, hats, clothing and sunglasses for protection. Everyone needs different levels of sunscreen according to their skin type, but the majority of people in the UK will be protected with sunscreen labelled SPF30+, assuming that it is applied regularly and in the correct quantities. However, some people are still prone to sunburn, are high risk or prefer to protect from ageing and other forms of sun damage, therefore SPF50+ may be more appropriate.
In order to protect the skin, it is recommended to stay in the shade during 11am until 3pm, when UV radiation is at its highest. Many people believe that they need to get a ‘tan’ to look healthy and maintain their vitamin D levels. However, the British Association of Dermatologists does not recommend sunbathing to maintain Vitamin D levels, instead to consider other safer sources of this, especially if you are at higher risk of skin cancer. To avoid Vitamin D deficiency, the Scientific Advisory Committee on Nutrition (SACN) recommends all people over the age of 4 take dietary supplementation of Vitamin D throughout the year (reference nutrient intake (RNI) of 10 micrograms daily).
As people with IBD may be on immune suppressant medication, Dermatologists recommend you are extra careful and consider your skin cancer risk factors (see above). Examples of immune-suppressant medications include Ciclosporin, Methotrexate, Azathioprine, Tacrolimus, Mycophenolate mofetil and Biologic agents. Most of these medications will have been initiated by your Specialist because they are necessary to maintain a functioning gut and remain healthy. In most cases, the benefits of the medication will outweigh the risks and will have been discussed with you. However, if you are on this type of medication Dermatologists would recommend that you practice sun safety advice and report unusual growths to your Doctor or GP.
If you are concerned by your skin cancer risk, it is important to discuss this with your Specialist or GP in the first instance. Dermatologists would not recommend any sudden changes in your treatment regime or stopping these treatments without consultation, as there is a risk of a flare in the IBD, which in itself can be life-threatening. Instead, it is important to initiate sun safe behaviours listed above and check your skin regularly. Lastly, if in doubt, check it out!
Further information available from the following websites: