Vitamin D basics

Maddy Draper, APRN, a health care provider at OSF OnCall, says vitamin D is a nutrient our body needs to produce calcium. Calcium helps create strong teeth and bones. So logically, not having enough vitamin D leads to brittle bones (a risk for greater injury after a fall), plus muscle aches and pains. Others with a vitamin D deficiency may not show symptoms. Either way, a provider may order a blood test to confirm the issue and then may advise you to take a supplement. This is usually in pill form and can be prescribed or bought over the counter by itself or as part of a multivitamin.

“Or the provider may just talk about vitamin D-rich foods first before starting a supplement,” Draper says. “High fat fishes, egg yolks, some cheeses and mushrooms.”

Draper adds that pregnant women, babies (especially babies who are breastfed), the elderly and people with darker skin often lack vitamin D.

On the flip side, Draper says it’s rare, but a person can get too much vitamin D. Symptoms include nausea, vomiting and heart palpitations (feeling like your heartbeat is fast, pounding or otherwise irregular). You may also suffer kidney damage.

Summer sun

Here’s advice to commit to memory: Draper says research shows 10 to 15 minutes of sun exposure three times a day can get you a healthy amount of vitamin D.

“You want to protect your skin while doing that,” Draper adds. “Sunscreen and protective clothing like a hat and sunglasses. There’s not any research showing that sunscreen or clothes will prevent you from getting the vitamin D you need.”

Experts say your sunscreen should have a sun protection factor (SPF) of 30 or higher, and you should reapply every two hours. Clothing should be lightweight and light colored (Dark colors absorb more sunlight, leading to quicker heat illness.) Stay hydrated, and watch for redness and blisters from sunburns and suspicious moles that may be skin cancer. See a provider right away if you have issues from getting too much sun.

Another thing to note: Experts say a specialized lamp can help with seasonal affective disorder, a mental health condition often seen in the winter due to decreased daylight. The same logic does not apply for vitamin D. You need natural, not artificial light to get the vitamin D you need.

The bottom line

Draper says most people don’t have to worry about getting too much or too little vitamin D.

“The average person will get it through the sun,” Draper says. “If you live in a cold and dark environment, you’re at higher risk for vitamin D deficiency. People farther away from the equator are higher risk.”

If you have symptoms of too much or too little vitamin D or just have a concern, talk to your primary care provider.

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• YES: moles, blisters, bumps, acne, boils, peeling skin from a sunburn, rashes, poison ivy or similar skin reactions, warts, skin tags and bug bites
   
• YES, BUT: Dr. Kumar says freckles and birthmarks are lesions, but they are not harmful.

In other words: “A skin lesion is any type of abnormal growth. It can happen anywhere on the body. If it doesn’t look like normal skin, it’s considered a growth,” Dr. Kumar says.

Causes for each of these lesions vary. We know acne is due to bacteria, and warts are from a virus, for example. Medications, lifestyle choices (like eating certain food that doesn’t agree with you) and medical conditions (such as diabetes and liver failure) are other culprits. But when the cause is unexplained, health care providers might need to investigate.

“We look at the lesion. The majority of the time, we can tell if something is benign or malignant. If we have questions, we err on the side of caution and do a biopsy,” Dr. Kumar explains. That involves cutting out part of the lesion and sending it off to a lab for analysis. “Biopsies can be done in the office. If it’s a bigger procedure, we have to go to the operating room.”

If the biopsy confirms evidence of a problem, such as cancer, the doctor will remove the rest of the bad tissue. Or, Dr. Kumar says some people come to him with a cosmetic or practical reason. They have a large birthmark or cyst on their face, are self-conscious about their appearance and would like it removed, for example. Or, they wear a hard hat for work, and the hat rubs against a lesion on their forehead, causing discomfort.

Dr. Kumar outlines how he would remove a lesion: “Let’s say it’s on your arm. We clean up the arm. We inject some lidocaine, which is a numbing agent. Then with a knife or other instrument, I’m able to cut it all out. Depending on how deep it is and the size of the lesion, we can glue it back together or put stitches in.” Regardless of the method, Dr. Kumar says most of these procedures are routine for providers with minimal aftereffects for the patient. In complex cases, like if the lesion goes down into a muscle, a plastic surgeon might be consulted.

Prevention

We can’t control if we have things like freckles or moles. But there are plenty of things you can do to help prevent problematic lesions.

• Limit your exposure to ultraviolet rays from the sun or by tanning. In fact, Dr. Kumar would not recommend tanning at all. For outdoor activities, use waterproof sunscreen of 50 sun protection factor (SPF) or higher, and reapply every few hours. Wear long sleeves and a wide brimmed hat.
   
• Wear bug spray when doing outdoor activities, such as hiking, where insects are present.
   
• Wash your body regularly.
  
  “Don’t overclean,” Dr. Kumar warns. “If you scratch your skin, that allows bacteria and other things to get into your skin and cause infections.”
   
• Don’t smoke. Dr. Kumar says smoking changes your skin for the worse, such as developing wrinkles and lesions.
   
• Find the right skincare products. If you use a lotion and it causes a rash, for example, don’t use that product again. Dr. Kumar adds that Vaselines and petroleum jellies are good for moisturizing your skin. But they’re thick and can clog pores.
  
  “Keep it simple. The $100 face cream is going to work the same as the $10 one,” Dr. Kumar says.
   
• Know the ABCDEs of suspicious moles.

o    A is for asymmetry. One half of the spot is not like the other half.

o    B is for border. The mole has an irregular, scalloped or poorly defined border.

o    C is for color. The spot has varying colors, like tan, brown, black, white, red or blue.

o    D is for diameter. Dermatologists say melanoma skin cancers are usually greater than six millimeters, or about the width of a pencil eraser. But they can be smaller, so don’t consider diameter alone.

o    E is for evolving. The mole looks different from the rest or is changing in size, shape or color. Dr. Kumar says you can take pictures to show your provider how the mole has changed.

                           If your lesion has any of the ABCDE red flags or you just have a concern, see a provider.

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Sunburns and skin cancer don’t have an exclusive partnership with hot months at the beach. Ultraviolet (UV) rays are still present, even when the temperatures cool down.

November is National Healthy Skin Month, a time to raise awareness about skin health and promoting healthy skin care habits.  

Karen Boyd, an oncology nurse navigator with OSF HealthCare, says sunscreen is an important part of skin safety 365 days a year.

“There are SPF {sun protection factor} sunscreens, we recommend 30 or above that you need to apply to your face, your neck and your ears if they are exposed,” Boyd says. “Don’t forget about your lips; lip balm is so important.”

You’ve probably been told that the sun reflects off the sand or water and can increase your chances of sunburn when you’re at the lake or beach. Boyd says it’s the same idea with snow.

“Even if there’s snow on the ground, you have that glare. Your eyes can feel the effect from the sun,” Boyd says.

And that’s why Boyd recommends UV protective sunglasses.

“UV rays damage eye surface tissue, the cornea, the lens, and can even affect you later, as far as cataracts, acute macular degeneration and even cancers of the eye,” Boyd says while quoting an American Association of Retired Persons (AARP) excerpt. “We don’t think about cancers of the eye often.”

Photokeratitis, also known as an “eye sunburn,” can be very painful. Boyd says an important way to keep your skin healthy, in general, is by hydrating.

“Oral hydration is the key, and water is always the best thing. So, hydrate yourself in the summer and in the winter. It will help protect your body and your skin,” Boyd says.

After a cold and windy day of shoveling snow outside, you may head inside for a mug of hot cocoa and notice your face is extra red. People usually chalk this up to wind burn or just the cold; Boyd says this isn’t always the case.

“How do we know for a fact that that’s not the UV rays?” Boyd asks. “It may be from the reflection off the snow, and it could be sunburn as well.”

The ABCDEs of melanoma skin cancer are important things to keep in mind when it comes to your skin health.

·         A: Asymmetry. “Is it unevenly shaped or notched. Does it look different?” she asks.

·         B: Border irregularity. “The edges of the mole; has it changed? Is it not clearly defined? Is it not a perfect circle?” she asks.

·         C: Color. “Was it a light brown pigmentation but now it’s turning darker? If it looks crusty and it peels off, that’s another key point,” she says.

·         D: Diameter. “Has it changed in size or grown?” Boyd asks.

·         E: Evolution. “Has it evolved or changed? Does it look different?” Boyd asks.

Boyd says, if you’re concerned, you know your body. Mention it to your doctor and they can refer you to a dermatologist.

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Put on sunscreen. Wear a hat. Stand in the shade.

These are probably a few things you’ve heard once, or a thousand times, over the years by a parent, teacher or coach.

However, roughly 5.4 million basal and squamous cell skin cancers are diagnosed each year, affecting more than three million people (some individuals have more than one skin cancer). Skin cancers are by far the most common type of cancer in the United States. The American Cancer Society says this is probably due to better skin cancer detection, people getting more exposure to the sun, and people living longer.

But what are we forgetting? Tim Smile, MD, is a radiation oncologist with OSF HealthCare. He breaks down key tips for people to remember before heading outside.

Use broad-spectrum sunscreen

"When you're choosing a sunscreen, it's important to pick one that has good UV-A and UV-B protection, so a broad-spectrum one,” Dr. Smile says. “If you have any questions about that, talk to your primary doctor or a dermatologist."

Don’t forget the tops of your ears, the back of your neck or between the top of your chest and neck

"A lot of people wear a nice baseball hat that covers their faces really well, but the tops of your ears, neck, and even the front of the top of your sternum area can get exposure to the sun without you realizing it,” Dr. Smile says. “Keep an eye on those areas and make sure you're applying sunscreen there." 

A cloudy sky doesn’t mean the UV rays aren’t there

"If it's overcast, you can still get UV exposure on your skin. So, that's something to keep in mind,” he adds.

Dr. Smile says the sun is the strongest from 10 a.m. to 2 p.m. and recommends using the shade, wearing a broad-brimmed hat and applying sunscreen as good first steps. But don’t forget to reapply, as sunscreen doesn’t last all day. The general recommendation is to reapply every two hours during the day.

Head and neck are high-risk areas

"In my practice in radiation oncology, we deal with high-risk skin cancers. The vast majority of skin cancers are treated with topical treatments or minimally invasive surgeries,” Dr. Smile says. “Rarely, skin cancers can present with locally advanced tumors requiring radiation therapy. My practice consists mostly of patients with locally advanced head and neck skin cancers because it’s an area that is not usually covered from sun exposure by your clothing.”

"A lot of times, skin cancers that happen in the head and neck are not only cosmetically challenging to deal with surgically but have a higher risk of deep invasion, spreading along nerves, or spreading to lymph nodes. A lot of challenging cancers can present in the head and neck area, which is why it's so important to minimize your sun exposure."

Don’t forget your lips!

"A lot of people don't apply sunscreen to their lips, the lips can get sunburnt and can get skin cancers due to UV exposure there,” Dr. Smile adds. “You can find lip balms that have SPF in them."

Dr. Smile says you should speak with your primary care provider and/or dermatologist once a year to keep things in check.

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