Melanoma: un desafío para el pediatra. Dos casos clínicos / Melanoma: A pediatric challenge. A two cases report

El melanoma es la forma más grave de cáncer de piel. La morbimortalidad es variable, ya que se relaciona con las medidas de prevención implementadas, la detección temprana y el acceso al tratamiento temprano. La incidencia ha aumentado en los últimos años a pesar de la mayor concientización con respecto a la exposición a la luz solar y la utilización de cremas protectoras. A su vez, el rango etario se ha ampliado, y esta enfermedad afecta a individuos cada vez más jóvenes. Se estima que del 1 % al 4 % de todos los casos de melanoma ocurren en menores de 20 años.Se presentan dos casos pediátricos, con evolución prolongada y diagnóstico inicial erróneo. Es fundamental para el pediatra general, primer contacto del paciente con el sistema de salud, conocer las características de estas lesiones. Un alto índice de sospecha permitiría la derivación al especialista de forma temprana.

Melanoma is the most serious skin cancer. Morbimortality is variable as it is related to the preventive measures, early detection, and access to early treatment. The incidence has increased in recent years, despite the raise in awareness of avoiding sun exposure and the use of sunscreen. What is more, the disease age range has expanded, affecting increasingly younger individuals. It is estimated that 1 to 4 % of all melanoma cases occurred in people younger than twenty years old.We present two pediatric cases with prolonged evolution and wrong initial diagnosis. Since the general pediatrician is the patient's first contact with the health system, it is extremely important to know the characteristics of these lesions. A high index of suspicion would allow an early referral to the specialist.

Non-use of sunscreen among adults and the elderly in southern Brazil

Abstract Background One of the main prevention methods against skin cancer is the use of sunscreen; however, incidence of this disease has not declined despite prevention campaigns. Objective Investigate the prevalence of non-use of sunscreen and its associated factors. Method A population-based cross-sectional study with individuals aged 18 years or over living in the urban area. Conducted between April and July of 2016. Participants were interviewed about socioeconomic, demographic, and behavioral questions. Non-use of sunscreen was considered as the outcome. For multivariate analysis, Poisson regression with robust adjustment for variance was used. Results Among the 1300 participants, prevalence of non-use of sunscreen was 38.2% (95% CI: 34.6-41.8). The variables independently associated with the outcome were male sex, older age, brown or black skin color, lower income, fewer years of education, no physical activity in leisure time, no medical consultations in the last year, and self-perception of health as regular or poor. Study limitations The prevalence may be underestimated by reports of more use of sunscreen than actually used, which could increase the figure in the outcome. Conclusion It was estimated that about four out of ten adults and elderly do not use sunscreen in this sample. Prevention strategies are needed to advance health policy and ensure that sun protection options are easily accessible.

Development and validation of an instrument to assess the knowledge of general practitioners and pediatricians about photoprotection and solar radiation

Abstract Background The knowledge of general practitioners about photoprotection is unknown. Objectives To develop and validate an instrument to evaluate the knowledge of general practitioners and pediatricians about photoprotection, gauging the knowledge of these professionals. Methods The study followed the steps: (1) Literature identification and item elaboration related to the theme; (2) Content validation; (3) Apparent validation; (4) Construct validation: internal consistency analysis and discriminatory analysis; (5) Reliability analysis. In Step 4, the instrument was applied to 217 general practitioners and pediatricians who worked in the host city of the study; the scores were compared with dermatologists scores. Results The final instrument had 41 items and showed satisfactory internal consistency (Cronbach's alpha = 0.780), satisfactory reproducibility and good test-retest reliability (good-to-excellent kappa statistic in more than 60% of items). The discriminatory analysis registered a mean score of 54.1 points for dermatologists and 31.1 points for generalists and pediatricians, from a total of 82 possible points, representing a statistically significant difference (p < 0.001). Generalists and pediatricians demonstrated an understanding of the relationship between excessive sun exposure and skin cancer, but they revealed lack of technical information necessary for their professional practice. Study limitations The instrument evaluates only knowledge, without evaluating the conduct of the participants. Conclusion The results show that the instrument has good internal consistency and good reproducibility. It could be useful in the identification of general practitioners and pediatricians knowledge gaps on the subject, for the subsequent development of training and educational strategies.

Knowledge and habits of sun exposure in university students: a cross-sectional study in Southern Brazil

Abstract BACKGROUND: Excessive sun exposure is the major risk factor for skin cancer. Thus, sun exposure behavior is the major focus for prevention of this disease, since it is potentially modifiable. Increasing the knowledge on sun related habits and other skin cancer risk factors is fundamental in the development of preventive programs, especially when directed to young people. OBJECTIVES: To assess the photoprotection habits and the knowledge about skin cancer in college students. METHODS: We conducted a cross-sectional study from Oct. 16 to Feb. 17, including 371 students from the Federal University of Santa Maria, RS, Brazil, through a self-administered questionnaire. RESULTS: The level of knowledge about skin cancer and photoprotection was unsatisfactory in more than 10% of the students. The occurrence of sunburn was extremely high among students, and 25% reported at least one episode of second degree sunburn. Proper use of sunscreen was referred by only 34% of individuals. Students who reported having received photo education in college were associated with a more consistent use of sunscreen. STUDY LIMITATIONS: health area represented a large part of the sample; instrument validated outside Brazil. CONCLUSIONS: Young people are unaware of basic information about sun protection and exposure. Even among those with proper knowledge, the use of photoprotective measures is very low. The sun exposure has shown to be excessive in most of the students, which makes this population an important target for photo-educational measures.

Photoprotection in adolescents: what they know and how they behave

Abstract: Background: The greatest sun exposure occurs until adolescence and this is the only factor involved in photocarcinogenesis subject to modification with photoprotection. Objective: The objective of this study was to evaluate the habits and knowledge of adolescents regarding photoprotection. Method: Cross-sectional study that included 512 students from primary and high school. Data were collected by questionnaires with questions about habits and knowledge on sun protection. For data analysis, Pearson's Chi-square test and Yates test were applied, with 5% level of significance. Results: We evaluated 512 students, with a mean age of 14 years old. The teenagers agreed that ultraviolet rays cause skin cancer and aging (96% and 70%, respectively). Knowledge about the occurrence of burns even on cloudy days was recorded in 68% of cases, as well as the need for photoprotection for sports in 72%. The source of information about sun protection were by parents in 55%. In 70% was observed previous occurrence of sunburn, the daily use of sunscreens was found in 15% and 67% used only at the beach. of sunscreens with SPF higher than 30 was reported by 70% of students and 57% reported going to the beach between 10h and 16h. In 68% of cases it was registered insufficient sun protection, attributed, in 57% of the time to forgetfulness. Study limitations: The sample refers to two schools of Curitiba (PR), Brazil. Conclusion: Teenagers know the risks of sun exposure, but they do not adopt the practices for adequate protection.

Llega la primavera y florecen los eritemas polimorfos solares / Spring arrives and with it the polymorphous light eruption

El eritema polimorfo solar es la fotodermatosis más frecuente y suele aparecer en primavera con la primera exposición intensa al sol. Sus manifestaciones cutáneas son variadas y el diagnóstico se basa en la clínica junto al antecedente de exposición solar. En los casos leves, la fotoprotección suele ser suficiente para el control de la enfermedad, pero en formas más graves se requieren otras terapéuticas, como corticoides, antihistamínicos, o fototerapia, que genera una "fotoadaptación" de las áreas de piel afectadas. Presentamos un caso típico de erupción polimorfa solar que respondió de forma adecuada a medidas de fotoprotección. (AU)

The polymorphic solar eruption is the most frequent photodermatosis, and usually appears in spring with the first intense exposure to the sun. It has multiple cutaneous manifestations, and its diagnosis is based on the clinic and the antecedent of solar exposition. In mild cases, photoprotection is usually enough to control the disease, but in more severe forms, other therapies are required, such as corticosteroids, antihistamines, or phototherapy to generate a "photo-adaptation" of the affected skin areas. We present a typical case of polymorphic solar eruption that responded adequately to photoprotection measurements. (AU)

Prevalence and factors associated with exposure to sunlight and sunscreen among physical education teachers in Pelotas, southern Brazil

Abstract: Background: Decreasing the time of exposure to the sun and increasing sunscreen use are important actions to prevent skin cancer. Objective: This study aimed to verify the prevalence of exposure to the sun and the use of sunscreen, as well as associated factors among physical education teachers of the basic education network from city of Pelotas, southern Brazil. Methods: A census type study was conducted with physical education teachers of the basic education network from Pelotas. This study assessed the time of exposure to the sun in the workplace for at least 20 min, between 10am and 4pm, and the use of sunscreen during the workday. Results: 188 teachers answered the questionnaire. The prevalence of exposure to the sun between 10:00am and 4:00pm was 89.2% (95% CI of 83.8% -93.3%), while sunscreen use was 63.3% (95% CI of 56.0% -70.2%). However, when the sample was stratified by sex, women reported a higher rate of sunscreen use (78.5% -95% CI of 72.2-84.3) than men (38.9% -95% CI of 31.8-46.2) (p<0.001). Teachers with longer work weeks were at greater risk of exposure to the sun. In addition, women, with normal weight and who worked less hours, were more likely to use sunscreen. Study limitations: Cross-sectional study and lack of information on the proper use and frequency of use of sunscreen. Conclusion: Physical education teachers were highly exposed to solar radiation, and less than two-thirds used sunscreen during the workday. Interventions with this professional group are necessary to reduce the risk of skin cancer.

Prevalence of photoprotection and its associated factors in risk group for skin cancer in Teresina, Piauí

Abstract: Background: The incidence of skin cancer has increased worldwide, particularly melanoma rates, which had a mean development of 2.6 % a year in the last 10 years. The agreement on the relation between long-term or chronic exposure to the sun and the emergence of these neoplasias has made several workers who perform activities exposed to solar radiation to form a risk group for the development of skin cancer, community health agents included. OBJECTIVES: To analyze the prevalence of sunscreen-use-related factors to skin cancer in a labor risk group. METHODOLOGY: Cross-sectional study with community health agents selected through simple random sampling. After collecting data using semi-structured interviews, a descriptive analysis was performed for the qualitative variables, bivariate analysis was employed for checking the association between sunscreen use and sociodemographic, occupational and knowledge about skin variables, and multivariate analysis was conducted to check independent variables associated to sunscreen use. A 5% significance level was used. Results: Of 261 health gents selected, 243 were able to participate in the study. The prevalence rate of sunscreen use was 34.2% (95% CI: 28.2-40.2). Factors associated with sunscreen use were female sex, advanced age, use of sunscreen in situations when the skin got burnt, knowledge of the negative effects of the sun on the skin and skin cancer history. Conclusions: The prevalence found reveals that there is a need for implementing educational strategies in health services regarding photoprotection.

Hábitos de fotoprotección en los niños que concurren a Dermatología Pediátrica del Centro Hospitalario Pereira Rosell: Photoprotective habits in children seen at the Pediatric Dermatology Unit of CHPR / Photoprotective habits in children seen at the Pediatric Dermatology Unit of CHPR

Introducción: la exposición a la radiación ultravioleta durante la infancia y la adolescencia juega un papel trascendente en el desarrollo futuro del cáncer de piel. Los niños se exponen al sol tres veces más que los adultos y antes de los 21 años se ha recibido entre el 50 y el 80 % de la radiación solar total. Objetivo: conocer qué saben los padres de la población objetivo sobre los efectos del sol en la piel y los ojos, y cuáles son sus hábitos de fotoprotección, los de sus hijos y los factores relacionados con ello. Métodos: estudio transversal a padres de niños que concurrieron a la policlínica de Dermatología Pediátrica del Centro Hospitalario Pereira Rossell durante los meses de octubre 2013 a enero 2014. Resultados: se entrevistó a un total de 100 padres, la media de edad de los hijos fue de 7,85 años, el 62% de los niños eran provenientes de familias de bajo nivel socioeconómico y educacional. El 43% de los encuestados respondió que le gusta estar bronceados, en comparación con un 28% que no le gusta. La medida de fotoprotección más utilizada tanto por padres (73%) como por hijos (86%) fue el protector solar, seguida de los lentes de sol en los adultos y del uso rutinario de sombrero en los niños. Conclusiones: los métodos utilizados se basan en gran medida en el uso de protectores solares con un uso inadecuado de los mismos en gran parte de los encuestados.

Introduction: exposure to ultraviolet radiation during childhood and adolescence plays an important role in the future development of skin cancer. Children are three times more sun exposed than adults. Before age 21, people receive between 50 and 80% of the total solar radiation throughout their lives. Objective: to determine what parents know about the impact of the sun on the skin and eyes, and to learn about their photoprotective habits for them and their children and some associated factors. Methods: a cross-sectional study to parents of children who were seen at the Pediatric Dermatology Unit of CHPR during the months of October 2013 to January 2014. Results: a total of 100 surveys were conducted, the average age of the children was 7.85 years old, 62% of the children came from families of low socioeconomic status. 43% of respondents declared who like to be tan, compared to 28% who did not like it. The most widely used photoprotective measure by both parents (73%) and children (86%) was sunscreen, followed by sunglasses in adults and the routine use of a cap by children. Conclusions: the photoprotection method used is based largely, on sunscreen but with an improper use in most of the respondents.

Práticas de exposição e proteção solar de jovens universitários / Prácticas de exposición y protección solar de jóvenes universitários / Exposure and sun protection practices of university students

RESUMO Objetivo: conhecer práticas de exposição e proteção solar de jovens universitários. Método: estudo descritivo, transversal, realizado em uma universidade de São Paulo. Resultados: a amostra foi composta por 385 jovens e a coleta de dados realizada por meio de formulário. Do total, 239 (62%) jovens classificaram-se como fototipo III e IV e 69 (17,9%) afirmaram ter histórico de câncer de pele na família. A maioria afirmou exposição ao sol entre as 10 e 16 horas e por mais de uma hora de duração; 112 (29,1%) informaram não empregar meios de proteção. Dentre os que utilizam protetor solar, a minoria o faz regularmente. Conclusão: embora a amostra tenha sido constituída por pessoas com maior acesso a informações, constatou-se exposição e proteção solar de modo impróprio. Ações educativas, individuais e coletivas devem ser fortalecidas e priorizadas tendo em vista a incidência de câncer de pele no país.

RESUMEN Objetivo: conocer las prácticas de exposición y de protección solar de jóvenes universitarios. Método: estudio descriptivo, transversal, realizado en una universidad de São Paulo. Resultados: la muestra estuvo constituida por 385 jóvenes y la colecta de datos realizada a través de formulario. Del total, 239 (62%) jóvenes fueron clasificados como tipo de piel III y IV y 69 (17,9%) afirmaron tener cáncer de piel en la historia familia. La mayoría afirma exposición al sol entre las 10 y 16 horas y durante más de una hora; 112 (29,1%) reportaron no emplear métodos de protección. Entre los que usan protector solar, la minoría lo hace regularmente. Conclusión: a pesar de que la muestra haya sido constituída por personas con mayor acceso a informaciones, se constató exposición y protección solar de manera impropia. Acciones educativas, individuales y colectivas deben fortalecerse y priorizarse teniendo en cuenta la incidencia de cáncer de piel en el país.

ABSTRACT Objective: to learn exposure and sun protection practices for university students. Method: a descriptive, cross-sectional study performed at a university in São Paulo. Results: the sample consisted of 385 young and data collection conducted through a form. Of the total, 239 (62%) young people were classified as skin type III and IV and 69 (17.9%) affirmed to have a history of skin cancer in the family. Most affirmed exposure to the sun between 10 a.m and 04 p.m and for more than one hour; 112 (29.1%) informed not employ safeguards. Among those who use sunscreen, the minority does so regularly. Conclusion: although the sample was made up of people with greater access to information, it was found exposure and sunscreen improperly. Education, individual and collective actions should be strengthened and prioritized given the incidence of skin cancer in the country.

Validity and Reliability of Sun Protection Behavior Scale among Turkish Adolescent Population

PURPOSE: The aim of this research was to adapt the Sun Protection Behavior Scale (SPBS) to Turkish and to perform validity and reliability analyses. METHODS: The scale was administered to a total of 900 adolescents, the retest to 91 adolescents. The construct validity of the scale was evaluated using exploratory (EFA) and confirmatory factor analysis (CFA). The EFA and CFA were applied to sample groups of 449 and 451 people, respectively. RESULTS: The Cronbach alpha coefficients for the Turkish form of the SPBS (alpha = .74) and its sunscreen (alpha = .88) and hat use (alpha = .70) subscales were found to be > or =.70 while the sun avoidance subscale was calculated to be .67. The item-total score correlation between the scale and its subscales was > or =.26 and the test-retest correlations were found to be > or =.51. The CFA results verified the 8-item, 3-factor Turkish version of the SPBS. The confirmatory factor loadings for the scale were .45-.80 for sun avoidance, .72-.93 for sunscreen use, and .66-.83 for hat use. In particular, SPBS and sunscreen use (p < .001) exhibited significantly high mean scores among girls and economically better backgrounds (p = .007, p < .001, respectively). In addition, SPBS (p = .004) and hat use (p < .001) revealed that the mean scores were significantly high in younger adolescents. CONCLUSIONS: The SPBS was found to be valid and reliable and its psychometric characteristics acceptable. The scale can be used to measure the behavior of Turkish adolescent populations with respect to sun protection.

Hábitos de exposição ao sol e uso de fotoproteção entre estudantes universitários de Teresina, Piauí / Habits of sun exposure and sunscreen use among university students from Teresina, Piauí State, Brazil / Hábitos de exposición al sol y uso de fotoprotección entre estudiantes universitarios de Teresina, Piauí, Brasil

Objetivo: investigar hábitos de exposição solar e de fotoproteção entre estudantes universitários de Teresina-PI, Brasil. Método: estudo transversal, com amostra representativa; foram investigadas associações entre características demográficas e hábitos de exposição ao sol e de fotoproteção. Resultados: dos 398 universitários entrevistados, 54,8 por cento informaram expor-se ao sol menos de 2 horas diariamente; a maioria (66,8 por cento) preferia horários de menor intensidade de radiação; 45,2 por cento dos entrevistados referiram uso de filtro solar em seu dia-a-dia, e 82,4 por cento, em exposição voluntária ao sol; o uso de camisetas foi outro recurso de fotoproteção referido (44,2 por cento) e 29,9 por cento dos acadêmicos receberam alguma orientação profissional sobre fotoproteção; as mulheres referiram mais frequentemente do que os homens o uso de fotoprotetores diariamente e em situação de exposição voluntária (p<0,001). Conclusão: a maioria dos universitários referiu preferir horários de baixa intensidade de radiação, fazer uso de filtro solar e de outras medidas de fotoproteção em exposição voluntária ao sol.

Objective: to investigate sun exposure and sunscreen use habits among university students in Teresina-PI. Method: cross-sectional study with a representative sample. Associations between demographic characteristics and sun exposure and sunscreen use habits were investigated. Results: 398 students were interviewed. 54.8 percent reported exposing themselves to the sun less than 2 hours daily. The majority (66.8 percent) preferred times when radiation is less intense. 45.2 percent reported sunscreen use as a daily habit and 82.4 percent reported its use in voluntary sun exposure. T-shirt use was another form of photoprotection reported (44.2 percent) and 29.9 percent of students had received some professional guidance on photoprotection. Females reported daily and voluntary exposure sunscreen use (p <0.001) more often than males. Conclusion: most students referred preferring exposure to the sun at times when radiation intensity is low, using sunscreen and other sun protection measures during voluntary sun exposure.

Objetivo: investigar hábitos de exposición solar y de fotoprotección entre estudiantes universitarios de Teresina-PI, Brasil. Método: estudio transversal, con muestra representativa; se investigaron asociaciones entre características demográficas y hábitos de exposición al sol y de fotoprotección. Resultados: de los 398 universitarios entrevistados, 54,8% informó que se exponía al sol menos de 2 horas diariamente; la mayoría (66,8%) prefiere horarios de menor intensidad de radiación; 45,2% de los entrevistados refirió el uso de filtro solar en su diario vivir, y 82,4%, en exposición voluntaria al sol; el uso de camisetas fue otro recurso de fotoprotección referido (44,2%) y 29,9% de los académicos recibió alguna orientación profesional sobre fotoprotección; las mujeres relataron el uso de fotoprotectores diariamente com más frecuencia que los hombres y en situación de exposición voluntaria (p<0,001). Conclusion: la mayoría de los universitarios relató preferir horarios de baja intensidad de radiación, usar filtro solar y otras medidas de fotoprotección en exposición voluntaria al sol.

Determinação do fator de proteção solar (in vitro) de produtos magistrais na forma de gel. avaliação dos aspectos sensoriais e físicoquímicos / Determining factor solar protection (in vitro) products in masterful gel method. sensory evaluation of aspects and physical and chemical

A exposição ao sol pode resultar em muitos benefícios para as pessoas como a saúde física e mental, a síntese de vitamina D, o tratamento de icterícia, entre outros. No entanto, também pode causar danos à pele pela exposição excessiva. Os filtros solares são produtos concebidos para absorver os raios ultravioleta A e B. Para avaliar o desempenho destes foram adquiridos em farmácias magistrais cinco produtos (amostras 1, 2 e 3), filtros solares solúveis em água contendo (ácido 2 - fenilbenzimidazol - 5 - sulfónico) e submetidos a ensaios físico-químicos. A análise dos dados revelou que nenhum dos produtos e respectivas amostras (1, 2 e 3) mostrou um valor de pH dentro das especificações (7,2-7,5) necessário para a solubilização completa do filtro solar. O tempo de escoamento relacionado com a viscosidade dos géis mostrou que apenas as amostras do produto D exibiram valores muito semelhantes, ao passo que as amostras da farmácia C apresentaram maiores diferenças. As amostras que correspondem às outras farmácias também mostraram mudanças suaves, contudo, quando aplicado sobre a placa de vidro, não houve percepção visível. Considerando-se o Factor de Proteção Solar (FPS), nas amostras estudadas os FPS encontrados "in vitro" pelo método Mansur (1986b) e modificado por (Renata, 2004), apresentaram valores bem abaixo do FPS rotulado, especialmente produtos C e E não mostraram nenhuma característica do espectro de absorção, indicando a ausência de protetor solar hidrossolúvel.

Lesão palpebral como manifestação primária do lúpus eritematoso discóide / Eyelid lesion as a primary manifestation of discoid lupus erythematosus

O lúpus eritematoso discóide é uma desordem autoimune que geralmente afeta áreas da pele expostas ao sol. A apresentação de lesões palpebrais na ausência de outras anormalidades cutâneas é incomum, sendo o envolvimento da pálpebra inferior prevalente em apenas 6% dos pacientes com lúpus eritematoso cutâneo crônico. Relatamos o caso de uma paciente do sexo feminino de 40 anos, com hiperemia, madarose e ulceração na pálpebra inferior do olho esquerdo refratária ao tratamento para blefarite. Inicialmente, outra lesão semelhante havia sido descrita na pálpebra superior do olho direito. No entanto, as biópsias incisionais mostraram-se inconclusivas. Diante de uma lesão migratória palpebral de características semelhantes à primeira, a hipótese clínica de lúpus eritematoso discóide foi aventada e o diagnóstico confirmado por meio de revisão histopatológica. Uma forte suspeita clínica e o reconhecimento precoce podem evitar erros diagnósticos, complicações clínicas e tratamentos inapropriados, como descrito neste caso de lesão palpebral como manifestação primária do lúpus eritematoso discóide.

The discoid lupus erythematosus is an autoimmune disorder which generally affects the sun-exposed skin. Presentation of lesions on the eyelids in the absence of any other cutaneous abnormality is uncommon and the lower-eyelid involvement is seen in 6% of patients with cronic cutaneous lupus erythematosus. We have reported the case of a 40 year-old, woman who presented hyperemia, madarosis and ulceration on the lower eyelid of the left eye. She was treated for blepharitis without resolution. Before that, another similar lesion had been described on the upper eyelid of the right eye. Nevertheless, the incisional biopsies of that eyelid were inconclusive. Faced with a migratory lesion similar to the first one, the clinical hypothesis of discoid lupus erythematosus was suggested and diagnosis was confirmed by histopathological review. A high index of suspicion and early recognition may prevent misdiagnosis, clinical complications and inappropriate treatment, as described in the case of eyelid lesion as a primary manifestation of discoid lupus erythematosus.

Fotoproteção na prática clínica / Photoprotection in clinical practice

A exposição solar sem a adequada proteção pode ter efeitos agudos e crônicos prejudiciais à pele. A escolha do tipo de proteção solar depende da idade, fototipo de pele e das atividade individuais. Os autores fazem uma revisão bibliográfica sobre os tipos de radiação e a respectiva proteção solar.

The sun exposure with no adequate protection may have acute and chronic detrimental effects in skin. The choice of the type of photoprotection depends on the age, skin phototype and individual activities. The authors make a literature review about the types of radiation and photoprotection.

Perceived Relevance of Educative Information on Public (Skin) Health: A Cross-sectional Questionnaire Survey / 예방의학회지

OBJECTIVES: Unprotected leisure time exposure to ultraviolet radiation from the sun or artificial tanning beds is the most important environmental risk factor for melanoma, a malignant skin cancer with increasing incidences over the past decades. The aim of the present study was to assess the impact of skin health information provided by several sources and different publishing issues on knowledge, risk perception, and sun protective behavior of sunbathers. METHODS: A cross-sectional questionnaire survey was conducted among Austrian residents (n=563) spending leisure time outdoors in August 2010. RESULTS: Print media, television, and family were perceived as the most relevant sources of information on skin health, whereas the source physician was only ranked as fourth important source. Compared to other sources, information provided by doctors positively influenced participants' knowledge on skin risk and sun protective behavior resulting in higher scores in the knowledge test (p=0.009), higher risk perception (p<0.001), and more sun protection (p<0.001). Regarding gender differences, internet was more often used by males as health information source, whereas females were more familiar with printed information material in general. CONCLUSIONS: The results of this survey put emphasis on the demand for information provided by medical professionals in order to attain effective, long-lasting promotion of photoprotective habits.

Prevalência de lesões labiais em trabalhadores de praia e fatores associados / Prevalence and factors associated with orolabial lesions in beach workers / Prevalencia de lesiones labiales en trabajadores de playa y factores asociados

OBJETIVO: Analisar a prevalência de lesões labiais decorrentes da exposição solar e potenciais associações em trabalhadores de praia. MÉTODOS: Estudo transversal com 362 trabalhadores de cinco praias urbanas em Natal, RN, de agosto a dezembro de 2010. Os participantes responderam um questionário validado com dados pessoais, de ocupação e de saúde e passaram por exame clínico dos lábios feito por pesquisadores calibrados. As possíveis associações das variáveis sociodemográficas, ocupacionais e de saúde geral com a presença de lesões labiais foram avaliadas pelo teste do qui-quadrado para um nível de significância de 5%. A análise multivariada foi feita utilizando-se a regressão robusta de Poisson. RESULTADOS: Dos trabalhadores examinados, 27,1% apresentavam lesões labiais. Desses, 76,8% eram do sexo masculino; 61,6% tinham pele morena ou negra; 94,5% trabalhavam informalmente; e 85,4% trabalhavam expostos ao sol. A maioria (81,1%) relatou uso de algum tipo de fotoproteção: protetor solar (38,7%); protetor labial (15,3%); boné/chapéu (72,4%). Aproximadamente 28% eram fumantes e 48% consumiam álcool regularmente. A fotoproteção com uso de boné/chapéu foi associada à presença de lesões labiais decorrentes da exposição solar. CONCLUSÕES: Observou-se alta prevalência de lesões labiais nos indivíduos expostos ao sol, a qual foi associada ao uso de boné/chapéu como forma de fotoproteção.

OBJECTIVE: To assess the prevalence and factors associated with orolabial lesions caused by sun exposure in beach workers. METHODS: Cross-sectional study with 362 beach workers from five urban beaches in the city of Natal, northeastern Brazil, from August to December 2010. All subjects completed a validated questionnaire to collect personal, occupational, and health-related information and underwent an orolabial clinical examination by trained examiners. Potential associations between sociodemographic, occupational, and health-related variables and the presence of orolabial lesions were assessed using the chi-square test at a 5% significance level. The multivariate analysis was performed using Poisson regression. RESULTS: Of the 362 workers examined, 27.1% had orolabial lesions. Of these, 76.8% were males, 61.6% dark or black skinned, 94.5% informal workers, and 85.4% reported sun exposure. Most (81.1%) reported using sun protection methods including sunscreen (38.7%), lip balm (15.3%), and cap/hat (72.4%). Twenty-eight percent reported smoking and 48% regular drinking. Sun protection with cap/hat was associated with orolabial lesions caused by sun exposure. CONCLUSIONS: There was found a high prevalence of orolabial lesions in workers exposed to sunlight that was associated with the use of a cap/hat as a sun protection method.

OBJETIVO: Analizar la prevalencia de lesiones labiales productos de la exposición solar y potenciales asociaciones en trabajadores de playa. MÉTODOS: Estudio transversal con 362 trabajadores de cinco playas urbanas en Natal, RN, Brasil, de agosto a diciembre de 2010. Los participantes respondieron un cuestionario validado con datos personales, de ocupación y de salud y se evaluaron a través de exámenes clínicos realizados por investigadores calibrados. Las posibles asociaciones de las variables sociodemográficas, ocupacionales y de salud general con la presencia de lesiones labiales se evaluaron por medio de la prueba de Chi-cuadrado para un nivel de significancia de 5%. El análisis multivariado fue realizado utilizándose la regresión robusta de Poisson. RESULTADOS: De los trabajadores examinados, 27,1% presentaban lesiones labiales. De estos, 76,8% eran del sexo masculino; 61,6% tenían piel morena o negra; 94,5% trabajaban informalmente y 85,4%, expuestos al sol. La mayoría (81,1%) relató uso de algún tipo de fotoprotección: protector solar (38,7%); protector labial (15,3%); gorra/sombrero (72,4%). Aproximadamente 28% eran fumadores y 48% consumían alcohol regularmente. La fotoprotección con uso de gorra/sombrero fue asociada a la presencia de lesiones labiales productos de la exposición solar. CONCLUSIONES: Se observó alta prevalencia de lesiones labiales en los individuos expuestos al sol y esta se asoció al uso de gorra/sombrero como forma de fotoprotección.

Fotoproteção tópica na infância e na adolescência / Topical photoprotection in childhood and adolescence

OBJETIVO: A exposição à luz solar na infância ocorre, frequentemente, de forma mais intensa do que em muitos adultos. Dados da literatura comprovam de maneira inequívoca a associação desse comportamento social com o risco de desenvolvimento do melanoma maligno e do câncer cutâneo não melanoma mesmo na vida adulta. Além disso, o fotoenvelhecimento cutâneo é semeado já na infância com a exposição solar inadequada. Esta revisão tem como objetivo orientar os pediatras nas medidas adequadas de fotoproteção tópica nas crianças e adolescentes, o que irá alterar de maneira positiva o futuro desses pacientes. FONTES DOS DADOS: Realizou-se uma revisão da literatura indexada na base de dados MEDLINE/PubMed entre os anos de 1999 e 2012 sobre fotoproteção na infância, selecionando-se como fonte os artigos de revisão mais relevantes, do ponto de vista de abrangência do tema fotoproteção em crianças e adolescentes, fotoproteção e vitamina D, fototerapia na neonatologia e impacto no câncer cutâneo, bronzeamento artificial e câncer cutâneo. SÍNTESE DOS DADOS: Crianças e adolescentes devem adotar medidas adequadas de fotoproteção para diminuir o risco de câncer cutâneo melanoma e não melanoma. CONCLUSÕES: Há dados na literatura que suportam a associação de hábitos de exposição solar segura e uso de fotoprotetores tópicos em crianças e adolescentes com a redução da ocorrência do câncer cutâneo.

OBJECTIVE: Exposure to sunlight in childhood is often more intense than in adults. Literature data unequivocally show the association between this social behavior and the risk for developing malignant melanoma and non-melanoma skin cancer, even in adulthood. Furthermore, skin photoaging begins already in childhood through inadequate sun exposure. This review aims to guide pediatricians on appropriate measures of topical photoprotection in children and adolescents, which will positively change the future of these patients. SOURCES: A review of the literature indexed in MEDLINE/PubMed between the years 1999 and 2012 on photoprotection in childhood was conducted. The most relevant review articles on photoprotection in children and adolescents, photoprotection and vitamin D in neonatal phototherapy and impact on skin cancer, artificial tanning and skin cancer were selected as sources. SUMMARY OF THE FINDINGS: Children and adolescents should adopt appropriate measures of photoprotection in order to decrease the risk of melanoma and non-melanoma skin cancer. CONCLUSIONS: There are published data that support the association between sun exposure habits and safe use of topical sunscreens in children and adolescents on the one hand and a reduced occurrence of skin cancer on the other.