Course Description 

It is hard not to appreciate the magnitude of effect that giant burning ball in the sky possesses. Without a doubt, the term powerful is appropriate. This term not only applies to its many roles in sustaining the planet, and the life on it, but also can be thought of in terms of its impact on our mood, energy, and ultimately our personal relation to the great outdoors. On the other side of the coin however is the ability for some of the energies it emits to wreak havoc with our skin. It drives the processes underlying skin aging, skin cancers, and even skin sensitivities. In this way again, we see its power. Ultimately, it’s the learning of how to balance both protecting ourselves properly from such damaging effects, with taking-in the many beneficial aspects the sun provides. 

This course is designed to provide a thorough review of the many facets of sun protection. To best understand sun protective interventions, we first explore details surrounding the pathophysiology of UV exposure. With a focus on both photocarcinogenesis and photoaging, we will describe the processes giving rise to such clinical and aesthetic concerns. With this as a basis, we then move into a deep review of sun protective topical products. The bulk of our focus will center around sunscreen filter ingredients. Among the topics explored will be: understanding the differences between the two filter types, and the specific filters they each contain; labelling of sunscreen products; exploring sunscreen-based research for various skin concerns; how sunscreen formulas are now accounting for the effects of the Visible Light spectrum; and common adverse effects, controversies, and debates surrounding certain filter ingredients. Extending past sunscreen filters, we will also discuss the emergence of cosmeceutical actives in sunscreen formulas. These include a variety of antioxidant compounds, sought for their ability to complement the action of filters while providing for more complete photoprotection. After-sun topicals will also be explored for their use, not only for their popular offering of post-sunburn soothing effects, but as a growing realm of protection post-UV exposure, with the inclusion of DNA repair agents to mitigate against initiation of cutaneous carcinomas. Examples of how various sunscreen filters and cosmeceutical actives may be combined in product formulation will be explored. 

The third section of this course will provide you with much information and tools for which you can effectively engage in patient education relating to sun protection behaviors. Strategies toward improving proper usage and compliance with sunscreens, and other forms of protection, will be described in detail. This will include reviewing the likes of: current sunscreen guidelines and recommendations surrounding them; optimal sunscreen application techniques; understanding the UV Index and the impact of various weather/environmental aspects on UV intensity; the role and selection of sun-protective clothing and sunglasses; and an exercise in using the information explored to help formulate your approach to countering commonly held myths surrounding sun protection.

The course will conclude with a detailed account and sampling of key dietary and nutritional/herbal oral supplemental agents researched for their photoprotective effects. Their ability to mitigate against UV-induced erythema, oxidative stress, and the processes underpinning photocarcinogenesis and photoaging are reviewed. Results of pertinent human trial data will be featured in this section. This information will help converge into a description for how some of these elements integrate into a full dietary approach as a means of adjunctive photoprotective care. Current evidence surrounding the influence of such plant-focused diets, like that of the Mediterranean diet, and the development of cutaneous carcinomas and signs of photoaging are highlighted. 

This course is beneficial for those Naturopathic Doctors and healthcare providers engaged in a general practice, as well as those who are focused on aesthetics, dermatological and/or dermato-oncological care. It is also designed to provide the course-taker with ample information, including numerous resources and references. As such, it is very much encouraged to explore these resources as a means of obtaining a deeper breadth of the topics we review.  

Learning Objectives 

• Understand the cutaneous effects and clinically relevant differences between the UVB, UVA, and Visible Light spectrums

• Understand the acute and chronic effects of UV radiation, including: erythemal response, tanning and other pigmentary effects, key details surrounding DNA damage and photocarcinogenic processes, immunosuppression, photodermatoses, and details surrounding photoaging processes 

• Identify the six phototypes according to the Fitzpatrick phototype scale

• Appreciate and integrate evaluation methods used to make the Fitzpatrick scale more applicable to a wider range of patient populations

• Review how aesthetics goals, and presentation of various cutaneous carcinomas, can differ across various patient populations

• Explore the history of sunscreen development

• Define & describe key terminology relating to this topic, including Minimal Erythemal Dose (MED) and Sun Protection Factor (SPF)

• Understand processes used to determine the SPF, for UVB protection, as well as methods used to characterize protection from UVA, including in vitro assessment and the PA system

• Recognize and understand key elements described on a sunscreen bottle label 

• Appreciate the general differences between the two types of sunscreen filter ingredients: organic/chemical & inorganic/mineral

• Describe the differing mechanisms of action between the two sunscreen filter types

• Identify the specific filters and filter categories for the two sunscreen filter types

• Identify the primary UVB and/or UVA-1 & UVA-2, and Visible Light spectrum bands which each sunscreen filter absorb/reflect

• Appreciate the role and effect of iron oxides additions to sunscreen formulas 

• Explore the research surrounding the use of sunscreens for a variety of skin concerns, including photoaging, carcinoma development, melasma/post-inflammatory hyperpigmentation, and photodermatoses such as polymorphous light eruption

• Recognize and evaluate the common concerns and debates relating to certain sunscreen filters, including common adverse cutaneous effects, changes to vitamin D status, and research exploring systemic absorption, endocrine and environmental concerns, among others

• Appreciate formula characteristics, and their role in supporting the effectiveness of a sunscreen formulation as well as consumer acceptability

• Identify natural compounds added to sunscreen formulas as a means of complementing sunscreen photoprotective effects

• Recognize the potential benefits antioxidants can provide to sunscreen formulation, as well as the formulation challenges they present

• Describe natural compounds commonly included in after-sun topical formulations

• Identify novel and emerging compound additions to sunscreen and/or after-sun topicals directed toward repairing/inhibiting DNA photolesion formation

• Integrate approaches toward the management of sunburns

• Identify sunscreen formulations to consider in certain clinical/aesthetic situations

• Explore examples of how various sunscreen filters and other agents, such as cosmeceutical actives, may be combined in product formulation

• Identify current guidelines relating to proper sunscreen application

• Communicate to patients other elements relating to sun protection behaviors, including optimal sunscreen application strategies, understanding the UV Index, the role and selection for sun-protective clothing and sunglasses, among others

• Explore assessment approaches and patient education strategies for sun protection

• Understand the effects of weather and environmental aspect on UV intensity

• Recognize and relate sun protective actions in relation to the UV Index

• Identify and address common myths surrounding sun protection

• Analyze the various forms of research pertaining to the photoprotective effects of various dietary and oral supplement compounds, including: various carotenoids, niacinamide, pomegranate, green tea, Vitamin C, polypodium leucotomos, among others

• Summarize the research relating to the role of a plant-based/Mediterranean diet in relation to cutaneous carcinomas, as well as its potential application for mitigating processes inherent to photoaging