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RF- Insufficient Exposure to Sunlight and Global Mortality: Should We Advise Against or Recommend Sun Exposure?
FR- Exposición solar insuficiente y mortalidad global: ¿debemos recomendar o desaconsejar la exposición solar a nuestros pacientes?
M.T. Monserrat-García
Autor para correspondencia
marite_monserrat@hotmail.com

Corresponding author.
, A. Ortíz-Prieto, P. Martín-Carrasco, J. Conejo-Mir-Sánchez
Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sistemic effects of UV radiation&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">UV radiation is the main modifiable risk factor in the development of skin cancer&#44; both melanoma &#40;which is more closely related to intense intermittent sun exposure and sunburns&#41; and nonmelanoma skin cancer &#40;NMSC&#41; &#40;which follows a dose-dependent pattern&#41;&#46; However&#44; the question of whether restriction of sun exposure would be justified in patients with skin cancer has been a subject of debate because a growing body of scientific evidence suggests that insufficient exposure to UV radiation is associated with risks to overall health and even life expectancy&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In a recent study&#44; a Swedish cohort of more than 20&#160;000 women were categorized in 3 groups according to their degree of sun exposure&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The authors found that&#44; as a result of cardiovascular mortality and other noncancer causes&#44; the mortality rate was twice as high in women who avoided sun exposure as in women with a higher degree sun exposure&#46; They concluded that insufficient sun exposure was a risk factor for death of the same magnitude as smoking&#46; The study controlled for possible confounding factors such as age&#44; smoking&#44; exercise&#44; education level&#44; economic status&#44; and marital status&#46; Cancer mortality increased with greater sun exposure and could be explained by increased longevity in this group&#46; The study had limitations that prevent us from extrapolating the results to the general population&#46; Future studies that include both sexes and a larger geographic area are needed&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">UV radiation is involved in vitamin D synthesis&#46; Multiple studies have linked UV radiation deficiency to numerous chronic diseases&#44; mainly cardiovascular diseases&#44; autoimmune diseases&#44; skeletal diseases&#44; diabetes&#44; and colorectal cancer&#46; These studies suggest that maintaining vitamin D levels of at least<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL could reduce overall mortality by half&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">UV radiation has other mechanisms of action that are independent of vitamin D&#44; including an antihypertensive effect caused by direct arteriolar vasodilation and an increase in nitric oxide&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> as well as antidepressant and anxiolytic effects&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although dermatologists are responsible for treating and preventing skin cancer&#44; we must do so with a holistic view of the patient&#46; We should recognise the benefit of sun exposure in terms of life expectancy and diseases with high mortality rates&#8212;such as hypertension&#44; diabetes mellitus&#44; cardiovascular disease&#44; and osteoporotic hip fracture&#8212;even if it means an increased risk of skin cancer &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; which&#44; despite its prevalence&#44; has a much lower impact on mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">From a public health perspective&#44; it makes sense to educate people about the harmful effects of both excessive and insufficient sun exposure&#46; In routine practice&#44; dermatologists should recommend to most patients adequate sun exposure as part of a healthy lifestyle&#44; together with a varied diet&#44; and consider supplementation in cases of vitamin D deficiency&#46; Restriction of sun exposure should be reserved for patients with diseases associated with a high risk of skin cancer such as immunodeficient patients&#44; transplant recipients&#44; and patients with DNA repair-deficiency disorders such as xeroderma pigmentosum&#46;</p></span>"
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