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• W2000443186 abstract "To the Editor: The editorial by Holick1Gloth III, FM Lindsay JM Zelesnick LB Greenough III, WB Can vitamin D deficiency produce an unusual pain syndrome?.Arch Intern Med. 1991; 151: 1662-1664Crossref PubMed Scopus (105) Google Scholar published in the December issue of Mayo Clinic Proceedings misleads readers. Holick writes, “Some dermatologists advise that people of all ages and ethnicities…should always use sun protection when outdoors. This message is not only unfortunate, it is misguided and has serious consequences, ie, the risk of vitamin D deficiency and increased risk of many chronic diseases. There is little evidence that adequate sun exposure will substantially increase the risk of skin cancer; rather, long-term excessive exposure and repeated sunburns are associated with nonmelanoma skin cancers.” Overwhelming evidence links the development of most skin cancers to exposure of skin to ultraviolet radiation contained in sunlight.2Plotnikoff GA Quigley JM Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain.Mayo Clin Proc. 2003; 78: 1463-1470Abstract Full Text Full Text PDF PubMed Scopus (539) Google Scholar Holick hints that judicious daily exposures might be safe. However, I believe that every photon hitting the skin could produce a photomutation leading to skin cancer. Even if Holick's allegations were true, patients generally cannot gauge the correct amount of “noninjurious” exposure. Indeed, Holick admits that “the amount of time for adequate exposure depends on time of day, season, latitude, skin pigmentation, and the area of skin surface that has no sun protection.” Trying to stay well by exposing skin to just the right amount of sun-provided ultraviolet radiation would likely overexpose at least some skin, sometimes to a point that even Holick would agree causes injury. One cannot see or feel ultraviolet radiation, and the brightness of sunlight offers little clue to the ultraviolet dose received. Finally, patients with xeroderma pigmentosum scrupulously avoid all sun exposure because their bodies cannot repair sun-damaged DNA, and skin cancers develop if they do not avoid sunlight. In 8 sunlight-protected patients with xeroderma pigmentosum (none of whom had consumed vitamin D supplementation beyond normal dietary intake), mean levels of 25-hydroxyvitamin D, calcium, ionized calcium, and parathyroid hormone were normal.3Malabanan AO Turner AK Holick MF Severe generalized bone pain and osteoporosis in a premenopausal black female: effect of vitamin D replacement.J Clin Densitom. 1998; 1: 201-204Abstract Full Text PDF Scopus (42) Google Scholar Thus, implying that sun exposure is good is really bad. The risk-benefit ratio clearly favors dietary vitamin D supplementation over sun exposure. According to Holick, “Long-term prevention of vitamin D deficiency can be accomplished by giving 50,000 IU of vitamin D once or twice a month.” Personally, I would take the pill and leave the ultraviolet radiation for the flowers. Sun Exposure, Vitamin D Metabolism, and Skin Cancer: In ResponseMayo Clinic ProceedingsVol. 79Issue 5PreviewThere is no question that chronic excessive exposure to sunlight and the number of sunburning incidents in teenagers and young adults increases the risk of nonmelanoma skin cancers. What is alarming is that sunphobic propaganda from the American Academy of Dermatology and affiliated nonprofit, sunscreen industry-sponsored organizations such as the Skin Alliance has resulted in a resurgence of vitamin D deficiency in both children and adults throughout the United States.1,2 Recently, Gordon et al3 reported that 48% of adolescent children in Boston were vitamin D deficient. Full-Text PDF" @default.
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• W2000443186 date "2004-05-01" @default.
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• W2000443186 title "Sun Exposure, Vitamin D Metabolism, and Skin Cancer" @default.
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