Exposing skin to sunlight presents both health risks and health benefits. Sunlight is the major source of vitamin D-producing Ultraviolet B radiation, which has a wide range of positive health effects, including possibly inhibiting the growth of some cancers. On the other hand, long-term sunlight exposure is known to be associated with the development of skin cancer, skin aging, immune suppression and eye diseases such as cataracts. Sun exposure has also been associated with the timing of melatonin synthesis and reduced risk of seasonal affective disorder. A number of public health organizations state that there needs to be a balance between having the risks of having too much and the risks of having too little sunlight. There is a general consensus that sunburn should always be avoided.
However, not all physicians agree with the assertion that there is an optimal level of sun exposure, with some arguing that it is better to minimize sun exposure at all times and to obtain vitamin D from other sources.
Serum levels of 25(OH) D3 are below the recommended levels for a large portion of the general adult population and in most minorities, indicating that Vitamin D deficiency is a common problem in the United States.
Contents
Benefits
According to the U.S. National Institutes of Health Office of Dietary Supplements, most people in the United States can meet their vitamin D needs through exposure to sunlight, even though a large portion have serum 25(OH)D3 levels below recommendations. Ultraviolet (UV) B radiation with a wavelength of 290-315 nanometers penetrates uncovered skin and converts cutaneous 7-dehydrocholesterol to previtamin D3, which in turn becomes vitamin D3. Season, geographic latitude, time of day, cloud cover, smog, skin melanin content, and sunscreen are among the factors that affect UV radiation exposure and vitamin D synthesis. The UV energy above 42 degrees north latitude (a line approximately between the northern border of California and Boston) is insufficient for cutaneous vitamin D synthesis from November through February; in far northern latitudes, this reduced intensity lasts for up to 6 months. In the United States, latitudes below 34 degrees north (a line between Los Angeles and Columbia, South Carolina) allow for cutaneous production of vitamin D throughout the year.
Complete cloud cover reduces UV energy by 50%; shade (including that produced by severe pollution) reduces it by 60%. UVB radiation does not penetrate glass, so exposure to sunshine indoors through a window does not produce vitamin D. Sunscreens with a sun protection factor of 8 or more appear to block vitamin D-producing UV rays, although in practice people generally do not apply sufficient amounts, cover all sun-exposed skin, or reapply sunscreen regularly. Skin likely synthesizes some vitamin D even when it is protected by sunscreen as typically applied.
The factors that affect UV radiation exposure and research to date on the amount of sun exposure needed to maintain adequate vitamin D levels make it difficult to provide general guidelines. It has been suggested by some vitamin D researchers, for example, that approximately 5-30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back without sunscreen usually lead to sufficient vitamin D synthesis and that the moderate use of commercial tanning beds that emit 2%-6% UVB radiation is also effective. Individuals with limited sun exposure need to include good sources of vitamin D in their diet or take a supplement.
Risks
Despite the importance of the sun to vitamin D synthesis, it is prudent to limit exposure of skin to sunlight and UV radiation from tanning beds. According to the National Toxicology Program Report on Carcinogens from the Department of Health and Human Services, broad-spectrum UV radiation is a carcinogen thought to contribute to most of the estimated 1.5 million skin cancers and the 8,000 deaths due to metastatic melanoma that occur annually in the United States Lifetime cumulative UV damage to skin is also largely responsible for some age-associated dryness and other cosmetic changes.
It is not known whether a desirable level of regular sun exposure exists that imposes no (or minimal) risk of skin cancer over time. The American Academy of Dermatology advises that photoprotective measures be taken, including the use of sunscreen, whenever one is exposed to the sun.
Is there a safe level of sun exposure?
According to a recent study submitted by the University of Ottawa to the Department of Health and Human Services in Washington, D.C., there is not enough information to determine a safe level of sun exposure at this time.
There is no consensus on which component of Ultraviolet Radiation (UVA or UVB or UVC) actually is carcinogenic, and the composition of Ultraviolet Radiation changes throughout the day: At high noon, Ultraviolet Radiation reaching ground level is 95% UVA and 5% UVB, while before 10am and after 2pm this percentage changes over time to 99% UVA and 1% UVB. This is caused by the the reflection of UVB rays back into space due to sun angle as the earth slowly rotates on its axis. The rate of change is faster the farther the position moves away from the equator (ie more north or south) 99% UVA / 1% UVB sunlight is known as “bronzing” rays, as it provides the deepest colour tanning.
On average over a day, 98.7% of the ultraviolet radiation that reaches the Earth’s surface is UVA. UVC is almost completely absorbed by the ozone layer and does not penetrate the atmosphere in any appreciable quantities. As a result, only the combination (UVA, UVB, and UVC) known as “Ultraviolet Radiation” is listed as a carcinogen, the components are only “likely to become” known carcinogens. Solar radiation, also known as “sunlight” is also listed as a carcinogen because it contains Ultraviolet Radiation. This means also that the UV Index is a measure of total Ultraviolet Radiation, and not just Vitamin D-producing UVB.
Sunlight is therefore the only listed carcinogen that is known to have health benefits, in the form of helping the human body to make Vitamin D. This makes sunlight unique on the list of known carcinogens.
Homo sapiens evolved near the equator, and human skin color is a visible indication of direct sun exposure due to the pigmentation level. With new evidence of Vitamin D receptors in all body tissues, experts advise having a balance between Vitamin D from sun exposure and Vitamin D from supplements. The only way to quantify adequate levels of Vitamin D is with a serum 25(OH) D3 test.
