Teenagers after a suntan despite knowing the cost

Although Maltese secondary school pupils are well informed about the harm caused by sun exposure, most are still keen on acquiring a suntan, according to a study that will soon be published in the Journal of the European Academy of Dermatology and Venereology.

The paper, entitled Sun Awareness Among Maltese Secondary School Students, shows that while pupils in forms one, two and three have a considerable knowledge of the effects of sun on the skin, skin cancer and sun protection, a good number- 55 per cent - still believe that a suntan would make them look better.

The head of the Dermatology Department at Boffa Hospital, Lawrence Scerri - who worked on the paper together with doctors Sue Aquilina, Andrew Amato Gauci and Maria Ellul - said that although there was a high rate of correct answers to the questions posed, many of the pupils had a bad attitude and inappropriate behaviour when it came to protecting themselves from the sun.

In fact, while many youngsters knew that sun exposure could cause skin cancer when one got older, 64 per cent of boys and 48 per cent of girls said they felt better with a suntan. Almost half the boys and 38 per cent of girls said they thought getting sunburnt occasionally did not do them any harm.

Dr Scerri said quite a number of children believed that harm was only caused when the skin got burnt and he stressed that this was not the case. Only just over 30 per cent of girls and about 20 per cent of boys knew that one could get too much sun even on a cloudy summer day.

Another misconception was that sunscreen protects the skin for at least four hours, while only about 75 per cent of girls and 65 per cent of boys recognised the importance of protecting the skin even while staying under a beach umbrella. Dr Scerri said that although umbrellas were normally made out of thick material which most of the sun's rays did not penetrate, the rays were still reflected from the sand and sea.

On a positive note, most of the 963 youngsters interviewed knew that children's skin should be protected to avoid them getting skin cancer later on in their lives and that many bad sunburns during childhood increased one's risk of getting cancer later on. A great majority were aware that melanoma was the most dangerous type of skin cancer that could kill. Many also knew that sunscreen needed to have at least a Sun Protection Factor (SPF) of 15 to offer protection.

With regard to sunscreen, Dr Scerri said this never warded off all the sun's rays and the commonly used term "sun block" was therefore misleading. He explained that sunscreen blocked most of the ultra violet (UV) B rays, which are responsible for sunburn and a lot of skin cancer, but they only blocked part of the UVA rays.

"There is also the issue of how much sunscreen one uses," he said, explaining that it made a difference whether one used sunscreen sparingly or if a thick layer was applied.

And if motorists believe the sun's rays do not penetrate closed windows, they should think again, as many UVA rays actually make it through the glass, Dr Scerri said. This could explain why many drivers end with one arm darker than the other in the summer months.

The survey shows the presence of peer pressure, with 57 per cent of boys and a staggering 79 per cent of girls saying that most of their friends liked having a suntan. In addition, 24 per cent of boys and 12 per cent of girls said they were embarrassed to apply sunscreen in front of their friends. Around half of the respondents said covering up in the sun was a hassle, while 41 per cent of boys and 42 per cent of girls said wearing a t-shirt at the beach did not look cool.

When asked whether they have ever sunbathed during the top risk hours of 11 a.m. - 4 p.m., 59 per cent said they did. Dr Scerri said this was "very high".

"This issue is obviously not helped by the media, since adverts and fashion present us with a lot of bronzed bodies," Dr Scerri said.

However, in the last couple of years there has been an increase of adverts about fake tans, with an emphasis on the "fake, not bake" concept. While the perception of "brown is beautiful" remains, beauty pages in some magazines are also promoting the ideal tan without the sun, with recommendations on the best products on the market and tips on preparing the skin for the best results. Dr Scerri said this was a positive development since those people who were keen on getting a tan had the option of a non-harmful way to get the skin colour they desired.

Salons also offered professional fake tanning sessions, mostly through the airbrush technology.

"We have nothing against fake tans. The more on offer, the better, so long as it keeps people out of the sun," he said.

Even at an early age, youngsters still worry about the aesthetic effects that sun exposure would have on their body, mostly on their face. In fact, 61 per cent of girls said they were worried that sun exposure may lead to wrinkles. Boys were less worried, with only 31 per cent saying they were concerned about the onset of early wrinkles. Dr Scerri said this concern could be exploited in local campaigns to pass on the message that the sun's rays were harmful.

"It is good to know that youngsters are worried about their appearance and the long-term effects of sun exposure," he said.

Dr Scerri said that apart from wrinkles, long-term exposure to the sun causes blotchy pigmentation, with the texture of the skin becoming rough and leathery.

Asked whether sun damage was reversible, Dr Scerri said biologically it was not but aesthetically it could be treated through resurfacing interventions, including skin peels. These, he said, resurface the top levels of the skin, allowing it to regenerate.

However, he stressed that sun damage would not go away without any intervention and, in fact, it would progressively get worse. Although some prescribed medications could slow the process of skin aging, the skin would never be the same as if exposure was avoided. Procedures would most probably have to be repeated since the effects of sun damage would recur.

But not all is negative and Dr Scerri said the mentality was slowly changing. He said this season has seen an increase in UV protected swimsuits for children, made from a particular type of fabric that covers most of the body.

Another positive move was the shifting of many school sports days to earlier in the year when the weather was cooler. And although more shade should be provided, Dr Scerri said it was difficult to enforce certain regulations. He said it was imperative to educate children from a young age that the sun's rays were very harmful and sometimes even fatal.

"We are moving on but there is still a lot of work to be done," he said.

Dr Scerri said surveys among the younger generations in Australia and North America showed a change of mentality. He said the survey in Malta could not be compared to others to determine whether there had been an increase in awareness since this was the first one. Hopefully, the study would influence the authorities to attempt to change the attitude and behaviour of the younger generations, he said.