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13 June 2014

American Academy of Dermatology responds to Nautilus article

SCHAUMBURG, Ill. (Jun. 13, 2014) —
Michael Segal
Editor
Nautilus
Dear Mr. Segal, 
On behalf of the American Academy of Dermatology (Academy) and its 17,000 members, I am writing to express serious concerns about the Nautilus article, America is Getting the Science of Sun Exposure Wrong. The misinformation in this article undermines the sound scientific principles around UV radiation and may discourage your readers from using sunscreen, inherently increasing their risk of skin cancer.
It is a well-established fact that UV radiation from sun or indoor tanning can cause skin cancer. In fact, a study comparing low-level exposure to UVA and UVB in all populations found DNA damage to the skin cells in all skin types, including in very dark skin.1 
The relationship between the amount of UV exposure, skin type, and risk for melanoma is complex and is influenced by both genetic and environmental factors.  While there have been some studies on the protective effects of sun exposure on melanoma, these studies do not prove a direct causal effect of sun exposure and lower melanoma risk.  Bottom line, the risk of skin cancer, including melanoma, exists in all skin types and UV exposure is an avoidable risk factor to the development of skin cancer.2,3
Regarding the association of vitamin D and disease, the National Academy of Sciences Institute of Medicine (IOM) has concluded that while evidence links a person’s vitamin D level to their bone health, the evidence linking vitamin D with other health benefits is inconsistent, inconclusive, and insufficient.4  A recent systematic review on vitamin D and ill heath showed that intervention studies did not show an effect of vitamin D on disease occurrence, including colorectal cancer.5
Moreover, while some studies have documented an increase in the reported cases of rickets in the U.S. and Australia, these studies also highlight that rickets remains a rare condition in infants and children.6,7  Given this, the American Academy of Pediatrics has had a long-standing recommendation for vitamin D supplementation for all infants that mirrors the recommendations from the IOM.8
Although skin cancer rates may vary among the population, it is important to recognize the scientific evidence that all skin colors are at risk for skin cancer. Therefore, the Academy recommends that people reduce their risk by seeking shade, covering up and wearing broad-spectrum, water-resistant sunscreen of SPF 30 or higher regardless of their skin type. 
While there are potential health benefits of vitamin D in addition to bone health, encouraging sun exposure to get vitamin D is highly irresponsible. The typical use of sunscreen still allows for most people to make vitamin D from the sun.9  Therefore, there is no need to seek the sun for vitamin D development. To avoid vitamin D insufficiency, we recommend a healthy diet and dietary supplementation as a safe and effective means to obtain vitamin D. 
The Academy promotes skin cancer prevention and detection strategies for all patients, regardless of ethnic background and socioeconomic status. Dermatologists feel strongly about educating everyone – no matter their skin color – on the risks of skin cancer, including how to properly protect themselves from UV and how to identify suspicious spots on their skin in order to have them diagnosed and treated in a timely manner.  
Ultraviolet exposure is a strong risk factor for developing skin cancer, and the easiest to avoid.  Vitamin D supplements are reliable and effective.  The responsible choice seems obvious.
Nautilus has an obligation to its readers, and the viewers of its YouTube channel, to correct misinformation and relay it to its audience. 
Sincerely, 
 
Brett M. Coldiron, MD, FAAD
President, American Academy of Dermatology 

1Tadokoro, T., Kobayashi, N., Zmudzka, B.Z., Ito, S., Wakamatsu, K., Yamaguchi, Y. et al. UV-induced DNA damage and melanin content in human skin differing in racial/ethnic origin. FASEB J. 2003; 17: 1177–1179
2American Cancer Society. Cancer Facts and Figures 2014. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014/index
3Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, Roberts WE, Draelos ZD, Bhushan R, Taylor SC, Lim HW. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-62.
4Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine:  what clinicians need to know. J Clin Endocrinol Metab. 2011;96(1):53-8.
5Autier P, Boniol M, Pizot C, Mullie P. Vitamin D status and ill health: a systematic review. Lancet Diabetes Endocrinol. 2014 Jan;2(1):76-89
6Thacher TD, Fischer PR, Tebben PJ, Singh RJ, Cha SS, Maxson JA, Yawn BP. Increasing incidence of nutritional rickets: a population-based study in Olmsted County, Minnesota. Mayo Clin Proc. 2013 Feb;88(2):176-83. 
7Robinson PD, Högler W, Craig ME, Verge CF, Walker JL, Piper AC, Woodhead HJ, Cowell CT, Ambler GR. The re-emerging burden of rickets: a decade of experience from Sydney. Arch Dis Child. 2006; 91(7):564-8. 
8Wagner CL and Greer FR. Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents Pediatrics 2008;122(5):1142-1152.
9Kannan S, Lim HW. Photoprotection and vitamin D:  a review.  Photodermatol Photoimmunol Photomed 2014;30(2-3):137-45.

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