Kids, wear your sunblock

A few days ago, I saw this photo on a friend's Facebook feed, accompanied by a caption claiming that it showed a truck driver who had exposed half his face to the sun for 30 years.

There wasn't any link and naturally, being Facebook, I assumed this was probably not an accurate description of what was going on in the photo and kind of just brushed it aside.

And then Mo Costandi posted the same photo on Twitter along with a link to its original source—The New England Journal of Medicine. Oh, s&*%.

The patient reported that he had driven a delivery truck for 28 years. Ultraviolet A (UVA) rays transmit through window glass, penetrating the epidermis and upper layers of dermis. Chronic UVA exposure can result in thickening of the epidermis and stratum corneum, as well as destruction of elastic fibers. This photoaging effect of UVA is contrasted with photocarcinogenesis. Although exposure to ultraviolet B (UVB) rays is linked to a higher rate of photocarcinogenesis, UVA has also been shown to induce substantial DNA mutations and direct toxicity, leading to the formation of skin cancer. The use of sun protection and topical retinoids and periodic monitoring for skin cancer were recommended for the patient.

Basically, this gentleman does not yet seem to have skin cancer. Instead, the skin on that side of his face had thickened (a sign that his skin cells aren't growing and sloughing off in a normal way). The elastic tissue on that side of the face had also started to degenerate, leaving deep wrinkles, as well as wide pores that became multiple blackheads. Also, small cysts had formed around the follicles of fine hairs on his face.

Read the full (very short) case report at the New England Journal of Medicine.

Maggie Koerth-Baker is the science editor at BoingBoing.net. She writes a monthly column for The New York Times Magazine and is the author of Before the Lights Go Out, a book about electricity, infrastructure, and the future of energy. You can find Maggie on Twitter and Facebook.

Maggie goes places and talks to people. Find out where she'll be speaking next.

MORE: aging • health • photos • Science • skin • sun • sunblock

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awjt

Reminds me of this, from Hiroshima (this is one of the less gruesome ones)
- awjt
  
  ” Like”??? Oy.
http://twitter.com/SBBurzmali Michael Curran

Kind of sucks that many many of the chemicals found in some sunblocks are pretty much just as bad as UV damage.
- http://maggiekb.com/ Maggie Koerth-Baker
  
  Citations, please.
  - Ito Kagehisa
    
    Well, any exposure whatsoever to certain sunblocks causes my eyes to inflame for several days and make my skin itchy and red, which is in my opinion a bad thing. (The no-ad stuff is never a problem.) Also many of them stink. Whereas brief exposure to moderate sunlight clears up acne, and destroys mold and mildew, and feels nice.
    
    To you, anecdotes. But to me – the absolute purest form of science – quantifiable empirical evidence! Thus does the subjective nature of reality itself rule all our lives.
    
    Edit: full disclosure – I am a skin cancer survivor and have lots of visible sun damage. These days I am very careful about my sun exposure and very fond of wide-brimmed hats.
    - GrumpySteen
      
      What you’ve described is almost certainly an allergic reaction. You can argue that the chemicals found are bad for you, but you cannot extrapolate your individual result to suggest that the rest of the population will suffer the same result.
      
      The fact is that most people are not allergic to sunblock, so your allergy does not prove that the chemicals in sunblock are “pretty much just as bad as UV damage.”
      - Ito Kagehisa
        
        Hey, I provided a data point, and correctly labeled it as anecdotal. Did I say it “proved” anything? Did I say I had an “argument”? No. I just gave a data point – my reason for preferring sunblocking mechanisms that aren’t full of substances invented in chem labs.
        
        You can use battery acid mixed with coal tar and urushiol if that’s what you prefer. Not my business.
    - Antinous / Moderator
      
      Epicuren clear-drying zinc oxide is great. It’s not greasy and if it hasn’t irritated my skin, it’s probably safe for most people. Unfortunately, it’s $20 per ounce.
      - Ito Kagehisa
        
        Youch, for a year’s supply of that I can probably buy a wool stetson and a straw boater!
        
        Hey, you should hit them for a kickback, though – this is a highly trafficked site. Maybe they’ll send you a free case. ;)
      - penguinchris
        
        @boingboing-506774f849b3f6f756077ca458da621a:disqus @joeposts:disqus Have any of you tried “Neutrogena Ultra Sheer Dry-Touch” sunscreen? I hate sunscreen but decided I needed to get serious about it when I moved to California and got a few burns.
        
        I did some research and tried some in stores and hated them all until I found this. It dries and truly doesn’t feel greasy, doesn’t get nasty when you sweat, doesn’t do any damage to clothing, and it actually smells really, really nice. And crucially for me, it doesn’t block pores and give me acne.
        
        It’s more expensive than most of the stuff on the shelf, but it isn’t $20 an ounce (more like $3-4 an ounce).
      - Ito Kagehisa
        
        Thanks, Mr. Penguin! I’m notoriously cheap.
  - http://boingboing.net/ Rob Beschizza
    
    You know, it’s practically impossible to research cosmetics ingredients because of all the hysteria about parabens and sulfates and what have you. The decision to take an interest in ingredients immediately meets a brick wall of brutally self-assured pseudoscience.
    
    And it’s worse because it’s all pitched as “how to” SEO douchemania.
    - http://maggiekb.com/ Maggie Koerth-Baker
      
      Someday, I’m going to start a website where you can find useful health information about topics that have gotten completely swamped by crap in Google searches.
      
      To be included: Parabens and pthalates, anything related to pregnancy and miscarriage, etc, etc, etc.
      - phlavor
        
        Kickstart that shizzy.
  - http://twitter.com/SBBurzmali Michael Curran
    
    http://breakingnews.ewg.org/2012sunscreen/sunscreens-exposed/does-sunscreen-damage-skin/
    - Antinous / Moderator
      
      That’s a joke, right? An article by nobody from Breaking News!
      - Ito Kagehisa
        
        Now, now – it has dozens of cites in it. It’s really poor form to ask for cites and then refuse to look them up. Look them up and then mock them.
        
        Edit: Ah, yes, as per Maggie above. Should have seen that.
  - Ipo
    
    Some citation.
    - http://maggiekb.com/ Maggie Koerth-Baker
      
      Significantly, none of that supports the argument that using sunscreen is just as bad for you as not using it. What you’ve got is:
      > a Vitamin D deficiency risk (easily solved with diet/supplements and some moderated sun exposure)
      > some extremely correlational data that says people who use sunscreen most also have the most skin cancer (given that this is talking about extremely pale people who are more likely to get skin cancer anyway, there’s a very good chance that this data can really just be interpreted as “people most likely to get skin cancer are most likely to get skin cancer, even though they also use sunscreen more often.” And, notably, because of the history of sunscreen use rates in the US, many of us didn’t use it regularly as children, which makes a difference for your risk later in life.)
      >A handful of studies that show, in a lab, that some ingredients of sunscreen can cause DNA damage, but not any evidence that this actually happens in real life and, if so, what the end result of that would be for a real life person
      >Data showing that a small percentage of the ingredients in sunscreen can be absorbed through the skin … and no information on what, if anything, the effects of that would be.
      
      All of which is contained in a Wikipedia article that has been flagged as having POV problems.
      
      Yeah, sorry, as someone with a high risk of skin cancer, this utterly fails to convince me that sunscreen use is just as bad as getting sunburnt every time I step outside (which is what happens to me without sunscreen).
      - joeposts
        
        That’s just it – a med I was on made me very sun-sensitive, especially my nose and cheeks. I blister if I burn at all. So worrying about chemical exposure isn’t really an option when a bit of sun results in weeping sores.
        
        I hate sunscreen though… I sweat and am hairy like gorilla, so blech. Usually I just wear a trenchcoat and fedora when I want to hit the surf.
      - Antinous / Moderator
        
        I hate sunscreen though… I sweat and am hairy like gorilla
        
        Clinique makes a spray sunblock. It’s about the consistency of bug spray, so not ideal, but still better than smearing ranch dressing on your skin.
      - Antinous / Moderator
        
        I already had a basal cell when I was in my 30s. And I have dysplastic mole syndrome, which means a one in five-to-ten chance of melanoma. So, yeah. I’m wearing whatever armor I can find.
      - Ipo
        
        I wasn’t trying to convince, not being convinced myself, but I feel that doubters of sunscreen aren’t without reason.
        I wasn’t the one claiming that many many of the chemicals found in some sunblocks are pretty much just as bad as UV damage, and I wouldn’t, but I thought it interested you to see some other side.
        
        “Some” was meant as a qualifier, downgrading the term citation.
        I don’t agree with the point of view concerns, in any case they stem from review, something a bOINGbOING post’s comment thread doesn’t count as.
        
        I’m impressed that you so quickly read, comprehended, summarized and counter-argued that citation even though you really wanted to just dismiss it*. You care.
        *Me thinks.
        
        This subject ties with your post from yesterday:
        Skin coloration is a result of natural selection.
        All peoples have the pigmentation, or lack of, that enables them to live out their natural life expectancy of 30 to 40+ years, in the latitude and environment their ancestors lived in.
        
        A tribe of imaginary Pleistocene Irish redheads living in equatorial Africa would probably have gone extinct from radiation damage while their African counterpart would have gone extinct due to Vitamin D deficiency living at the edge of the ice where today Ireland is an island.
        (Or would’ve eaten fish a lot.)
        
        We know Neanderthals had the ginger gene and I expect for science to show that “we” got “white” skin from them, enabling us to survive in northern latitudes with their short summers without rickets and such.
        We didn’t have to wait for those mutations and the long process of selection to become Europeans. We inherited that from our predecessors who had been Europeans for over 300.000 years when we met them.
        
        Sucks for many Australians.
      - teapot
        
        @boingboing-acc24295a031cec540665b451bde7e07:disqus I’m Australian, I freckle, I live in a beachy area, I love snowboarding and I hate (the feeling of) sunscreen. I’m screwed.
      - http://www.facebook.com/monika.norwid Monika Norwid
        
        Just curious – have you tried really small increments of sun exposure, so that your skin can adapt without getting seared? Melanin itself is a natural form of protection from the sun. Does your body not produce enough of it? Or does it maybe take longer, with small increments of exposure, to kickstart the process? Just wondering because sun block seems like a good idea for extreme exposure, but if you’re using it ALL THE TIME, it would seem that you’re basically preventing your body from creating any block of its own.
      - Antinous / Moderator
        
        Just curious – have you tried really small increments of sun exposure, so that your skin can adapt without getting seared?
        
        The concept of the ‘base tan’ has been thoroughly repudiated by science.
      - http://maggiekb.com/ Maggie Koerth-Baker
        
        Monica, I realize you’re trying to be helpful, but when you suggest to somebody who has been dealing with a peculiarity of their own body for 31 years that they are probably just doing it wrong, you come across as a little condescending.
        
        Yes, I have tried doing without sunblock. It was incredibly obnoxious to deal with when I was a hyperactive and forgetful small child. It made me feel uncool when I was a teenager. And, frankly, I’m still somewhat forgetful today as an adult.
        
        My body doesn’t tan. I have enough melanin to freckle, but even in small doses of sun I will burn. I’ve literally started burning in 20 minutes of exposure in Minnesota in March. I’d much rather use sunblock then continue to add to my risk of skin cancer.
  - Sharon Marsh
    
    found this:
    
    http://abcnews.go.com/Health/truth-sunscreen-labels-lying/story?id=16432348#.T804tJlYtod
http://profile.yahoo.com/UHUKZFVO4FYDN3UMAFPV62L54Q D

Roll up that window….. http://www.ncbi.nlm.nih.gov/pubmed/12925188
- http://twitter.com/dgreekas David Greekas
  
  “D” He did have the window UP,they note this was from UVA exposure. From your link as well; “In individuals with polymorphic light eruption, produced by long-wave UVA, additional protection by plastic films, clothes or sunscreens appears necessary.”
  - awjt
    
    old glass without the plexi layer does not absorb UVB
  - http://profile.yahoo.com/UHUKZFVO4FYDN3UMAFPV62L54Q D
    
    Sorry, I don’t think the man accurately reported his exposure.
    
    The link tells you that only 3-4 % UV is transmitted through auto glass.The man tells you that he had his window up. His skin (the evidence) tells you that the man probably didn’t keep that window up in the summer. Auto glass has had the polymer layer for decades. He could have been driving something ancient, but for the average person….just roll-up the window. The additional protection described is for those with compromised skin.
    - GTMoogle
      
      Given that side window glass breaks into shards instead of spiderwebbing like a windshield, I would guess the side windows generally don’t have a polymer layer.
  - Ipo
    
    And sunscreens don’t typically block UVA , it doesn’t cause sunburns.
    
    Edit: They do now. In Europe Sunblockers have been required to block a minimum of 33% of the UVA since 2006.
FreakCitySF

Is this something only fair skinned folks have to worry about? Also anyone ever heard about sunblock not protecting against certain UV rays and thus not protecting against certain cancers?
- http://maggiekb.com/ Maggie Koerth-Baker
  
  This is not something only fair-skinned folks have to worry about. We have less protection, but even black people can get skin cancer and premature aging. Most sunblock these days will protect against UVA and UVB. About this time last year, I posted a sunscreen story on BoingBoing that might be of interest http://boingboing.net/2011/06/16/4-things-you-didnt-k.html
user1234567

Millions of people have driven to work every day right next to the same type of window. Statistically, if this were a real phenomenon then it would have happened to people all over the world, not to one guy. He may have cancer, and it may be from the sun, but it was not caused simply by driving a truck.
- Just_Ok
  
  driving TO work is different than driving WHILE working.
  - awjt
    
    exacterey, which is why it’s known as a “trucker tan”… in the USA, it’s the left arm & left side of the face and neck
    - Just_Ok
      
      and left leg if you’re wearing shorts.
    - niktemadur
      
      ”Trucker tan”, LOL!
      
      Dashboard, pedals and steering wheel should be attached to an inner horizontal rail that gives you the choice to drive from either side of the cabin, all you gotta do is unlock the whole kajigger, slide it sideways, lock in place and there you have it – trucker’s choice for an even tan.
- Amit Nandy
  
  If he was a long-distance truck driver, that implies that he is behind the wheel and on the road for a significant part of every day. That is why his face was subject to much higher amounts of exposure than the average daily driver would be. If every one of us spent 8+ hours on the road every day for 30 years, we would likely face the same problems as this man.
  
  Point being, we are all exposed to this type of radiation when we are behind the wheel and behind our windshields, we just do not have to worry about the same degree of exposure because people don’t typically drive the whole day, every day.
  - user1234567
    
    According to the first Google response, there are 3.5 million truck drivers in the US:
    
    http://www.truckinfo.net/trucking/stats.htm
    
    Maybe not 8-hour-a-day drivers, but even 10% of that number would leave
    you 350,000. 1/350,000 is still far below the “normal” cancer rate, which the CDC lists as 8.5% in the US:
    
    http://www.cdc.gov/nchs/fastats/cancer.htm
    
    My point is not to compare him to you and me, it’s that one case is not enough to determine causation and that there is a strong lack of statistical evidence to support the implied cause.
    - teapot
      
      Let’s all go home and forget about it then.
      
      This is actually like Donald Unger, winner of the 2009 Ig Nobel prize, who systematically cracked his left (but not his right) knuckles for over 60 years. There was no difference in his hands after this time, meaning he proved (anecdotally) that cracking knuckles doesn’t lead to arthritis.
      
      Just like Donald Unger showed there is probably not much to the claimed link between cracking knuckles and arthritis, this suggests pretty heavily that sun exposure leads to visible signs of aging while it’s been conclusively proven that exposure to UV radiation can give you cancer.
      
      Statistical evidence might be bullet-proof, but anecdotal evidence is still better than none.
Greg Miller

If you want the full contrast, open this page in two windows, and move them such that in each half of his face is hanging off either side of the screen – he looks like two completely different people.
- BombBlastLightingWaltz
  
  That is spooky.
- teapot
  
  Or, you know… Photoshop:
  - Greg Miller
    
    Fine, use your fancy tools ;-)
    Yes, I know I could have even used paint. I was just lazy like that.
sarahnocal

oops
Robert

For anyone 50 or younger, isn’t this like cigarette smoking? I mean, they know full well the toxicity, and yet they’ll do it anyway because of a combination of peer pressure, feels so good, and lack of immediate consequences? Seriously, how do you not know that exposure to the sun is damaging to skin, even through a window?
- Greg Miller
  
  For me, it’s the added hassle. It’s one more thing to pack, to remember to take care of at the trailhead, to get through airline security. And unless you’re a ginger like me*, most of the time you never see an immediate consequence to not putting on the sunscreen – hell, if you have the right skin, the more sun you get the more attractive you look to a majority of the population. It’s just 30 years down the line when you’re getting skin cancer all over the place that you realize the errors of your ways.
  
  * – I have seen immediate consequences to not putting on sunblock – 2nd degree sunburns are a b17©h. So, I now always carry an extra tube of SPF 50 in the car, and my hiking pack, and my day bag…
http://profile.yahoo.com/4R4LSWO25O3AYM5FPXTFN22C54 Dingos

Not sure if this is appropriate. If not… Mr. Moderator…please delete:
Consumer Reports recently rated “No Ad: Vitamin E with Aloe” to be 1 of the best “broad spectrum” sun screens. Cheap and effective. So there’s no need to spend gobs of $ on frufru sunscreen. Just fyi…. :)
- GTMoogle
  
  From http://www.cbsnews.com/8301-504763_162-57443073-10391704/consumer-reports-rates-top-sunscreens-for-2012/
  The wording is a little confusing. There were seven sunscreens that were very good against UVA and excellent against UVB, but No Ad wasn’t listed among them. It was listed as a ‘best buy’ given that it was so cheap for its fairly high rating. It sounds like it might not be the cast that it is ’1 of the best’, but still very good, and very inexpensive.
  
  (I could be entirely wrong, I could only find an article on the consumer reports study, not the study itself)
  - http://profile.yahoo.com/4R4LSWO25O3AYM5FPXTFN22C54 Dingos
    
    “The wording is a little confusing. There were seven sunscreens that were very good against UVA and excellent against UVB, but No Ad wasn’t listed among them”
    
    Uhhh…. That’s b/c they only listed 5 products. Doesn’t mean for sure it was 1 of the remaining 2(I don’t have access to the original article either). But last time I checked 5 items doesn’t exhaust a list of 7 products.
    
    From your link:
    “No-Ad lotion with aloe & vitamin E SPF 45 had a high overall score and at only $.59 per ounce,..”
    Right… high score and cheap.
    
    “It was listed as a ‘best buy’ given that it was so cheap for its fairly high rating.”
    Ok.. and how is that not 1 of the best? Certainly there are other, better products. However, if I could buy a Toyota Corolla that did nearly everything a Lamborgini does… you wouldn’t think that was 1 of the best options available to you?
    
    “It sounds like it might not be the cast that it is ’1 of the best’, but still very good, and very inexpensive.”
    For me “cheap and effective” = 1 of the best. It does what it says and you’re not spending 20$ an ounce. Did you have a real objection or did you just want to mince words for no other reason than to be pedantic? The stuff works, it works well and isnt’ expensive. So what’s the problem??
http://twitter.com/doggo doggo

5 years driving 7 hours a day. I got some ferocious sunburns on my left arm.
- Just_Ok
  
  just drive in reverse
kP

As a student I worked for the Southern California RTD during the 1984 Olympics (in Los Angeles). The Olympics were a glamour assignment reserved for the RTD’s most experienced bus drivers, all of them having at least 20 years experience.

Without exception, the bus drivers all had hearing aids in their left ears.
http://profiles.google.com/peterwok Peter Ellis

What’s the explanation for why his eyes are at different levels? The difference is marked enough that I don’t think it’s an optical illusion, but I can’t see how UV would affect the bone structure of his skull.
- orangedesperado
  
  I was assuming that it was because the skin was damaged on the left side of his face that the connecting fibers within in the skin (sorry — not a dermatologist or scientist here) had also become damaged, thus the greater droopiness, which also pulls the eye down slightly.
http://www.facebook.com/profile.php?id=1822828 Philip Viana

This guy looks like someone you would talk to in one of the original Fallout games.
BombBlastLightingWaltz

And he is only 45 years old but maybe not vegetarian.

Side note: This ‘condition’ maybe the reason their drive on the wrong side of the road in Europe with steering on passenger side.
Payne Hertz

Finally someone gets it. If this kind of asymmetrical facial degeneration were a common problem in long-distance drivers it would be as well known as trucker’s tan.
dainel

how long do sunscreens last? should he have just smeared that on the window? that’ll be better than putting it on your skin for 8 hours a day, for 30 years. what about a film or a piece of hard plastic you can cut to shape and attach to the side window?
http://www.facebook.com/people/Peter-Dickson/1280707658 Peter Dickson

He only drives north in the morning and south in the evening.
Adela Doiron

For the up all thread discussions on sun protection products try the Coolibar site for alternatives.
I saw this fella last month when I was going through the NEJM images archives for something else. Then in a lot friend feeds for melanoma awareness. Nice to seem him getting a conversation going.
Jan_Willem

I thought Everybody’s Free to Wear Suncreen.
http://www.facebook.com/monika.norwid Monika Norwid

Okay lesson is clear, don’t be putting your face on the UV grill for 8 hours a day. HAVING SAID THAT – don’t go to the other extreme and avoid the sun. “Kids” especially should be getting enough sun when young to ensure they’re not Vitamin D deficient. They’re just now discovering the far-reaching, dangerous effects of Vit. D deficiency, which are far scarier than a leathery face, and include deadly cancers (though internal ones, as opposed to melanoma). Unfortunately we once again come to this infuriating conclusion: be sensible and do stuff in moderation. http://www.nytimes.com/2010/07/27/health/27brod.html
lillyd

Maybe the title should be “Kids, cover up in the sun”. There are many causes for concern about sunscreen; others have cited them. There is no such concern about wearing a hat, long sleeves and using that thing they call the “sun visor” (that blocks the sun). If you do start to burn, put on a zinc oxide or titanium dioxide sunscreen. ALL others do not block UVA completely, so using them is just a delusion of protection…but primarily GET OUT OF THE SUN!

I’ve done a lot of research on this (see link below as one reference), but I don’t have time to write a research paper about it. Some journalist should do it. Recommending sunscreen before getting out of the sun and covering up is not based on facts.

http://www.ucsd.tv/search-details.aspx?showID=15770
- Antinous / Moderator
  
  There’s not a single MD on that panel.
  - lillyd
    
    I’d like to think MDs get their information from scientific studies, but in my experience it is more from the prevailing conventional wisdom which evolves slowly over time. What would an MD have told you about Vitamin D 10 years ago? Something about rickets and 200mg probably. What would they have said about UVA and UVB?
    
    Was it last year Maggie had the post about how sunscreens don’t neccessarily cover UVA (most don’t). I found that out that 3 years ago when I researched it when pregnant with my first child. The people on that panel knew it years before me. Wait around for the MDs and the media to catch up if you want, but I’ve got children to worry about now. Because of that research I’ve given my daughter 3 years of better cancer protection by using better sunscreens.
    
    Because of my research, I took Vitamin D then without any MDs recommendation to do so (though I did clear it with them). I just had my second child and now they are recommending Vitamin D. I’m glad I did my own research.