Janet H. Prystowsky, MD, PhD 225 East 64 th Street New York, NY 10065

Janet H. Prystowsky, MD, PhD225 East 64th StreetNew York, NY 10065

The sun causes many skin cancers

Sunshine is necessary for vitamin D production

Sunscreen blocks both harmful UV rays AND vitamin D production

Vitamin D deficiency has become common

A new balance is necessary

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https://eapbiofield.wikispaces.com/Phototsynthesis+Review+Trey+J

http://eucerin.co.uk/media/the_solar_spectrum

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Sunscreen

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VITAMIN DSYNTHESIS

All Sunscreens block Vitamin D synthesis

BBBB

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https://www.health.harvard.edu/newsweek/images/latitude-vitamin D.jpg

http://skincancer.dermis.net/content/e02factors/index_eng.html

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Sunscreen use spf > 8Clothing customsLatitude SeasonMelanin (Skin type/ Tanning)Weather/Pollution/Tall buildings

http://www.janetprystowskymd.com

Sun exposure/sunburn history Vacations Employment Leisure Activity

Tanning ParlorsSkin Type I and IIGenetics (Family history)Immune StatusPrecancerous lesions


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Seek shadeUse sunscreen spf >30Protective clothingSelf examFollow up with dermatologist

Treat precancerous lesionsRemove suspicious molesDestroy solar keratosesTreat with retinoids/5-fluorouracil/imiquimod


Ultraviolet B causes sunburn & skin cancer

Ultraviolet B is required to make vitamin D Sunscreens (>spf 8)block sunburn and

vitamin D synthesisDiet even with food fortification is usually

inadequate for vitamin DVitamin D deficiency causes rickets, weak

bones, immune weaknesses, ?cancer, ?multiple sclerosis, other health problems


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70 % whites, 97% blacks, 90% Hispanics in US had vitamin D inadequacy 2001-2004 according to U.S. National Center for Health Statistics (Arch. Intern. Med. 169:551, 2009)

This is a big increase (about 50%) over levels measured from 1988-1994.

Causes: more time indoors, too little sun and use of a lot of high protection sunscreen

www.Bloomberg.com 03-23-09

10 million Americans over 50 have osteoporosis, the most common bone disease-it is a silent condition

34 million are at risk for developing osteoporosis

1.5 million people per year suffer a bone fracture related to osteoporosis 1 in 5 older Americans who suffer hip

fracture die within a year of the fracture

www.fda.gov

By 2020 half of all Americans over 50 will be at risk of fractures from osteoporosis and low bone mass if no immediate action is taken by Individuals at riskDoctorsHealth systemsPolicymakers

Treatment: calcium, vitamin D, healthy weight, physical activity

www.fda.govFDAConsumer Magazine Jan-Feb 2005

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Sun exposure is more efficient than diet to maintain good vitamin D levels.

http://www/janetprystowskymd.com

Vitamin D

Skin Cancer


Measure serum 25-hydroxy vitamin D to determine stores

<20 ng/ml means DEFICIENCY>20 but <30 ng/ml means

INSUFFICIENCY>30-100 ng/ml is NORMAL

Note: >120 ng/ml may occur in patients getting phototherapy (17 treatments over 3 weeks) without toxicity


16 adults 23-78 yo (mean 44) were evaluated for vitamin D status in a NYC dermatology practice

All had clinical presentations suggesting risk for vitamin D deficiency

The mean vitamin D level was 19 ng/ml. (Normal is >30. 20-30 is considered insufficient levels.)

The range was <7 to 30.6.(All but one was <30).


No tanNo vitamin supplements or erratic

intakeLow consumption of milkUse high spf sunscreenHistory of skin cancer (more

conscientious about sun protection)Fatigue


Sun exposure/Artificial ultraviolet

Oral supplementsIntramuscular injectionsTopical vitamin D (?)


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1000 IU Recommended Daily

LIVAD Skin Care, LLC www.livadskincare.com

1000 IU Vitamin D3 in 2 T

Sun exposure: e.g. 15 minutes daily –depends on latitude (no Vitamin D made above 37o in fall/winter)will provide approximately 1000 IU.

A whole body exposure that gives you a light pink reaction will deliver approximately 10,000 IU.


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Apply sunscreen to body after 15-30 minutes of sun

Apply sunscreen to head and neck and backs of hands before going outside

American Academy of Dermatology feels all vitamin D should be obtained through the diet or supplements—everyone should avoid the sun

My clinical experience shows that many patients have difficulty maintaining adequate vitamin D levels with oral supplements

Conclusion: judicious sun exposure combined with supplements is a reasonable approach


Maximum sun protection: Avoid all sun exposure, always use sunscreenVitamin D 1000-2000 IU daily year roundCheck Vitamin D blood levels 2 X yearly

Moderate sun protection:Protect head and neck, and backs of hands

with sunscreen/clothingAllow unprotected sun exposure on arms, legs,

trunk for up to 30 minutes; then apply sunscreen

Vitamin D 1000-2000 IU daily October-April (above 37o latitude).

Check Vitamin D blood levels yearlyhttp://www.janetprystowskymd.com

Skin type I – red-heads/always burnHistory of skin cancer or sun abuse

behaviorStrong family history of skin cancerHistory of precancerous lesions

Dysplastic moles (atypical nevi)Solar keratoses

Weakened immune statusOrgan transplant patientsChronic lymphocytic leukemia


Skin types II-IV No history of skin cancer, no

precancerous lesions, good immune status

No family history of melanoma and minimal history of basal or squamous cell carcinoma

No history of sun abuse (e.g. evidence of significant sun damage, multiple sun-burns, significant tanning parlor use)


Test under study checks skin biopsies for abnormally high levels of proteins made by 5 genes that are overactive in melanoma—90-95% accuracy discerning between benign and malignancy

Misdiagnosis of melanoma is the second most common reason for cancer malpractice claims in the USA (after mistakes in breast cancer diagnosis)

Bloomberg News 03/31/2009

Dx

Tricorder Sensor

Volatile organic compounds (VOCs) are released by basal cell carcinomas

Monell Chemical Senses Center, Philadelphia, PA in Daily Diagnosis 08-21-2008

VOCs

To prevent vitamin D deficiency, moderate sun exposure +/- supplements is reasonable for most persons.

For persons with a history of skin cancer or “red heads”, stringent sun protection with vitamin D supplements is advised.

When relying on vitamin D supplements check the level checked at least once yearly to ensure adequate intake.

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Documents

Janet H. Prystowsky, MD, PhD 225 East 64 th Street New York, NY 10065