Massage therapists see a lot of skin. All colors, all textures. Freckles, scars, stretch marks, moles. Skin with lots of hair and skin with none. Skin doesn’t surprise us.

Except when it does. 

Which is why we’re glad you’re reading about sun exposure. Because even though I’m not a dermatologist and you’re not going to burn while getting a massage, your skin is a friend I see regularly. And I want to be able to keep working with it for many healthy years to come.

What happens when you get a sunburn?

You’re exposed to the sun and then your skin turns red and itchy, right? Well, yes. But there’s more to it as well.

When you step out into the sunlight, you’re immediately bombarded by UV radiation. This radiation causes mismatches in the curlicue of your DNA in the nucleus of your skin cells, which is dangerous and can lead to cancer. As soon as this starts to occur, your skin jumps into protective action redistributing melanin, the pigment that causes suntans, and which helps to protect your DNA from further damage. 

But if you’re still outside and the damage doesn’t stop (especially if you’re fair skinned and don’t have much melanin to go around), you start to see an inflammatory response. This is the same kind of inflammation that you see when you sprain your ankle, only spread out across your damaged skin. Your blood vessels dilate to get more nutrients and infection-fighting cells to your skin, making the it red and warm to the touch. Itching and pain result, a warning signal from your body that something is wrong. You may feel thirsty and tired as your body works to repair itself.

If the burn is bad enough, you’ll start to see blisters as the plasma leaks from inside cells into the space between the dermis (the bottom layer of skin) and the epidermis (the top layer). These blisters form a cushion of fluid over your damaged tissue. (At this point, your body has already written that top layer of skin off.)

Eventually, even if you didn’t have any blisters, you will get flaking and peeling of the top layer of your skin. Interestingly enough, these skin cells weren’t killed by UV radiation. When skin cells recognize that their DNA has been severely damaged, they deliberately die off rather than risk becoming cancerous. This planned cell death is called apoptosis, and it’s the reason you see massive numbers of skin cells coming loose at once. 

So to be clear: all sunburns, no matter how mild, contain the beginning stages of skin cancer. It’s only because our skin kills itself off before these cells go haywire that we see as little skin cancer as we do. Even so, more than 5.4 million cases of non-melanoma skin cancer are diagnosed in the US each year, and 1 in 5 Americans will be diagnosed with skin cancer before the age of 70. UV radiation will play a role in many of these cases.

How can you protect your skin?

The short answer: Stay away from UV radiation. This means tanning beds as well as sunlight.

The longer answer: Unless you plan to become a vampire, you will probably be exposed to sunlight at least some of the time. The trick is to reduce that exposure to a safe level by seeking shade, wearing protective clothing, and using sunscreen.

How much sun is safe?

This depends on two main variables: the UV Index and your skin type.

UV Index

The UV Index is a measure of the level of UV radiation in your location at any given point in time. It’s something you can easily look up on your computer or phone before heading out the door. In general, global UV Index recommendationslook something like this:

• 1-2: Low. Enjoy being outside!

• 3-7: Medium. Seek shade at midday, put on a shirt and hat, wear sunscreen.

• 8+: High. Stay indoors at midday, seek shade as much as possible, sunscreen is an absolute must.

For all my fellow San Antonian’s, you can check out our daily and hourly UV report here: San Antonio Texas Daily UV Index Report. Be sure to save this link!

Skin Type

With the exception of people with albinism, everyone has some melanin in their skin. Those with more of the protective pigmentation are less susceptible to DNA damage in their skin cells from UV radiation than those with less. 

• Type I: Very pale, burns quickly, never tans.

• Type II: Pale, burns easily, rarely tans

• Type III: Burns moderately, tans over time to light brown

• Type IV: Burns minimally, tans to medium brown

• Type V: Rarely burns, tans to dark brown.

• Type VI: Never burns, rarely tans, deeply pigmented skin.

People with Type I skin can burn after as little as five or ten minutes, while those with Type VI skin can sometimes be outside for an hour without damage.

Note: You might have seen a skin type scale that goes from I-IV, especially if you are looking in an older medical textbook. That’s because the original Fitzpatrick scale was made in the 1970s for white people. This is the same scale, but expanded to include everybody.

Is sunscreen safe?

A 2001 study raised concerns that oxybenzone (the chemical that makes most sunscreens so effective) might impact hormones. In this study, rats fed large doses of oxybenzone developed enlarged uteruses. Studies in humans haven’t been conclusive. What we know for sure is that, if you’re a rat, you shouldn’t drink sunscreen. 

Some pediatricians recommend sticking to mineral-based sunscreens for infants and very young children just in case, until long-term studies are concluded over the next twenty or so years. But these are thick and need to be reapplied regularly. If your children are experiencing sunburns with mineral-based sunscreens, they are being put in significantly more danger than any potential hazard from oxybenzone.

What about vitamin D?

Yup, you need vitamin D in your body to stay health. And yes, your skin manufactures vitamin D in response to UV radiation. (People with lighter skin types make more vitamin D with less sun exposure than people with darker skin types.) So shouldn’t you go without sun protection sometimes for the nutritional benefits?

Luckily, there are a number of sources of vitamin D that don’t also cause skin cancer. Fish, mushrooms, eggs, and fortified dairy products are all excellent sources. And if you’re a tremendously picky eater, there are also vitamin D supplements you can take. For the severely deficient (diagnosed with a simple blood test), there are high-dose supplements or injections your physician can prescribe. And as always, be sure to check with your doctor before making any changes to your diet or adding any vitamin supplements. 

Caring about your skin isn’t about vanity.

It’s a critical organ, like any other. If you exercise for your heart and quit smoking for your lungs, then preventing sunburns is just another healthy habit.

Massage therapists love skin. We work with it on a daily basis and appreciate all it does to keep your insides in and your outsides out. It keeps you cool, it tells you what’s around you, it prevents infections and repairs itself at a remarkable rate. So take care of it! 

And maybe bring it in for a massage.