We must throw more light on skin protection

People with chronic skin problems generally have a tough time of things. Conditions such as eczema and psoriasis are often poorly managed, usually because, quite frankly, GPs aren't interested in them and don't give good treatment advice.

This usually means that the myriad effective creams and lotions available are not properly explained, and good, clear instructions on exactly how to use them are not provided. We have known this for some time, but unfortunately have only recently decided to apply this same observation to sunscreens.

Exposure to ultraviolet light - UVA or UVB - from sunlight accounts for 90 per cent of the symptoms of premature skin ageing such as wrinkles and skin cancers. The most important skincare product available to prevent these is sunscreen, but most people do not use it correctly. We need to have a radical rethink on which factor is most appropriate to use and better instructions on how to apply it. Even the guidelines issued by the National Institute for Health and Clinical Excellence (Nice), which state "SPF 15 is sufficient if applied adequately" are being questioned.

The Drug and Therapeutics Bulletin argues that as few people apply enough sun cream with sufficient regularity, SPF 30 should be recommended instead.

This does seem to make sense given that research into the true effectiveness of sunscreens has shown most people get no more than half, at best, of the protection indicated by the SPF.

Melanoma has been the fastest rising cancer in the UK over the past 25 years, with more than 10,000 cases a year and 2,000 deaths. It is the second most common cancer in young adults aged 15 to 34 and affects twice as many women as men.

Nice's defence is that its advice is appropriate for this country, but given the rather foolish way we Brits have of running out and frying ourselves on the only sunny day of the year, it seems naïve.

But there does need to be a balance between significantly and effectively reducing the risk of skin cancer and getting the health benefits of sunlight and its role in vitamin D production.

Some authorities have suggested that daily use of a SPF 15 is better in the long term than sporadic use of a high-factor cream.

Perhaps Nice can atone for its alleged blunder by making sure that it doesn't block the prescription of a new gene treatment for melanoma that has just been announced. Designed to target cases of the disease which involve a faulty gene called a BRAF mutation - about half of all cases - it has been shown to reduce the risk of death by almost two-thirds in patients with the advanced form of the cancer. But at a likely cost of tens of thousands of pounds per patient per year, it is certain to make Nice sweat - even out of the sun.

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