July Is National Ultraviolet Awareness Month

July is National Ultraviolet (UV) Awareness Month and the role of the pharmacist in sun safety is crucial. Pharmacists are an accessible medical profession because pharmacies are easily located, and usually, there is no need for an appointment. We can often do more for our patients than both the lay public and other health care providers may realize.

Pharmacy’s role in sun protection dates to the early half of the 20^th century. A pharmacist named Benjamin Green created the first sunscreen available for use in the United States. As an airman during World War II, Mr. Green used red veterinary petrolatum as a physical barrier against ultraviolent rays.¹ His original sunscreen compound was mixed with cocoa butter and coconut oil, which went on to become the popular sunscreen known today as Coppertone.² Just under a century after this landmark invention, pharmacists continue to play a role in sun protection.

During pharmacy school, pharmacists learned about sunscreen selection, skin cancer, and abnormal mole screening that put patients at risk of skin cancers. This service is of substantial value to patients, though many may not be aware of their availability.

Medication counseling can be a pharmacist’s unique role in helping patients concerning UV safety.

In addition to sun safety and UV rare exposure, pharmacists can help manage the effects and consequences of photosensitive medications, which can be classified as either a phototoxic or a photoallergic reaction. Phototoxic reactions are a non-immunologic reaction that increase a patient’s susceptibility to sunburn. when UV-A rays react with certain medications, particularly if the concentration of the medication in the body is high. Patients will present with a severe sunburn that quickly peels within a few days. Photoallergic reactions are less common. This type of photosensitivity is an immunologic reaction nor concentration dependent and can occur in any patient. It presents as a delayed hypersensitivity reaction due to UV-A rays that looks like a skin rash in sun exposed areas. Unlike phototoxic reactions,

photoallergic reactions can still occur after the patient has stopped taking the medication.³ Therefore, if a patient presents with a concern of a severe sunburn, a thorough medication history should be gathered. Some of the common culprits are:^3,4,5

• Diuretics: Lasix (furosemide), Hydrodiuril (hydrochlorothiazide)
• Antibiotics: Cipro (ciprofloxacin, Levaquin (levofloxacin), Vibramycin (doxycycline), Bactrim (trimethoprim/sulfamethoxazole)
• Painkillers: Motrin (ibuprofen), Aleve (naproxen), Celebrex (celecoxib)
• Allergy medications: Benadryl (diphenhydramine)
• Antinausea: Phenergan (promethazine)
• Birth control pills
• Acne medications: Accutane (isotretinoin), Retin-A (tretinoin)
• Diabetic medications: Micronase (glyburide), Glucotrol (glipizide)

It is a duty of a pharmacist to provide helpful instruction for safe medication use and instruction on ow to safely protect a patient from the sun when taking a photosensitizing agent.

When a pharmacist is recommending a product or filling a prescription, they should counsel patients on the photosensitizing risk of medications. Pharmacists should ask patients about their exposure to sun, discuss the risk of prolonged sun exposure while using these medications, discuss what a reaction would look like, and assist the patient in picking out a broad-spectrum sunscreen.

A pharmacist should recommend nonpharmacologic strategies if a patient must be outside for prolonged periods of time such as appropriate attire to reduce exposure. Patients should be encouraged to talk to their pharmacist about any concerns they have about their medications or if they have increased susceptibility to sunburn. When sunburn does occur, pharmacists are in a prime position to help patients select appropriate management options to ease the discomfort. From the start of sun protection to today, pharmacy has a role.

Co-written with Lindsey Hamrick PharmD Candidate 2018 Harrison School of Pharmacy Auburn Univeristy.

References

1.

Oldfield E. Sun Protection: Pharmacist have the facts. Pharmacy Times. 2015 June 21. Available from: http://www.pharmacytimes.com/publications/otc/2015/otcguide-2015/sun-protection-pharmacists-have-the-facts

2.

Sunscreen: a history. The New York Times. 2010 June 23. Available from: http://www.nytimes.com/2010/06/24/fashion/24skinside.html?mcubz=0.

3.

Marneros AG, Bickers DR. Photosensitivity and other reactions to light. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e New York, NY: McGraw-Hill; 2014. Available from: http://accesspharmacy.mhmedical.com/content.aspx?bookid=1130§ionid=79727606.

4.

Law RM, Law DS. Dermatologic drug reactions and common skin conditions. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 10e New York, NY: McGraw-Hill; 2014. Available from: http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146079670.

5.

Zhang AY, MD. Drug-induced photosensitivity. Available from: http://emedicine.medscape.com/article/1049648-overview.