AAD president refutes The Atlantic’s ‘misleading’ message on sun safety

Key takeaways:

• The Atlantic published an article claiming the U.S. is not acknowledging health benefits from sun exposure.
• AAD president Seemal R. Desai, MD, FAAD, spoke on the dangers of this message.

Healio spoke to the president of the American Academy of Dermatology after the organization issued a letter to the editor of The Atlantic with “serious concerns” over its article entitled “Against sunscreen absolutism.”

Published on May 10, 2024, The Atlantic’s article claimed that “too much shade can be just as harmful as too much sun.” While showing that other countries have begun adopting this mentality, the article pointed out that the CDC and AAD have not reconsidered its counsel on “strict avoidance” of the sun — a stance the publication labeled as “outdated.”

In response to this message, the AAD issued a letter to the editor, which was penned by academy president Seemal R. Desai, MD, FAAD, stating that the article “contains misleading information that may discourage the public from using sun protection, thereby increasing their risk of skin cancer.”

In an exclusive interview, Healio spoke with Desai about the multiple claims made by The Atlantic, with the first being a tip of the hat to a popular vitamin.

Vitamin D

In 2023, a group of Australian health groups, led by the Australian Skin and Skin Cancer Research Center, banded together to author a position statement on “balancing the harms and benefits of sun exposure.”

In their manuscript, they argued for the importance of individuals absorbing vitamin D from the sun, stating that benefits such as this are evidence that “completely avoiding sun exposure is not optimal for health.”

The Atlantic repeated the risks that are known to be associated with low vitamin D such as strokes, heart attacks and many other diseases and then referenced a 2011 study concluding that vitamin D supplementation does not protect against these risks.

In speaking to Desai, Healio asked his thoughts on The Atlantic’s insinuation that a lack of sun equates to no vitamin D, and that supplements will not provide the vitamin D needed.

“That is what they wanted it to say,” Desai told Healio. “But, if you actually read the study, that is not what the study said.”

According to Desai, the study referenced that there were no benefits to vitamin D supplementation in protecting individuals against a number of diseases, but the study itself was not designed to address whether vitamin D from the sun would have protected against the development of those diseases either.

“The article was trying to link together these two things, but that is not how the study was designed,” he said. “Because of that, we feel that author’s conclusion from The Atlantic article was misleading.”

The truth is, it only takes a small amount of sun exposure to produce all the vitamin D that the body needs, Desai explained.

Additionally, the application of sunscreen does not mean that the body is not absorbing any vitamin D, according to Desai.

“We need the public to know that you cannot be scared of sunscreen because of this idea that if you wear sunscreen you’re never going to get vitamin D,” he said. “The two are not mutually exclusive. You can still protect your skin from the sun’s damaging rays and get vitamin D.”

The AAD recommends that individuals should obtain healthy amounts of vitamin D from their diet, including with foods and drinks that are rich in vitamin D, rather than the sun as the risks continue to outweigh the benefits.

“There is no fully studied level of unprotected sun exposure that enables the body to produce enough vitamin D without also increasing the risk of skin cancer,” he said. “This is really important for people to know.”

Inflammation

In its second point in the case against sunscreen absolutism, The Atlantic resurrected a century-old pattern observed by scientists around the world called the “latitude effect.”

The latitude effect described a phenomenon that people living at higher latitudes suffered from higher rates of diseases, particularly autoimmune diseases, compared with those living closer to the equator, even after adjusting for confounding variables. Not even vitamin D alleviated these conditions, spurring researchers to question if there was more to know about the benefits of sun exposure.

The Atlantic noted that, for years, doctors noticed sun exposure alleviated psoriasis plaques and scaling. It was later discovered that the reason this occurred was because ultraviolet light induces the immune system to stop attacking the skin which ultimately reduces inflammation.

According to the article, the sun’s ability to lower inflammation was not localized to the skin and did not just help patients with psoriasis. It was a body-wide benefit that can also treat multiple sclerosis, type 1 diabetes and rheumatoid arthritis.

However, The Atlantic neglected to differentiate between the types of UV the sun emits.

“We know that there are certain forms of UV light that do help skin diseases,” Desai said. “But I do not recommend patients go out in the sun to heal their psoriasis because, in addition to a few helpful UVB rays, you are also going to absorb a lot more powerful UVA rays that are going to potentially be carcinogenic.”

Instead, Desai advises that patients wanting to take a UV-approach to psoriasis seek phototherapy — a form of UV treatment that filters out harmful UVA rays.

Additionally, while Desai admits that a certain level of sun exposure provides benefits, he also argues that it is impossible to quantify a safe amount.

“There is no fully studied safe amount of unprotected sun exposure,” he explained. “When sunlight hits your skin, it damages healthy cells. Without sun protection, this damage can build up. In time, you see signs of sun damage like freckles, age spots and wrinkles. Some people develop precancerous skin growths, skin cancer or both.”

Who can patients and dermatologists trust?

The Atlantic continued to tout that many other countries, including Australia, the U.K. and other areas of Europe, are adopting a forward nuanced approach to sun exposure, whereas the U.S. remains steadfast in backward approaches, including sun avoidance and sunscreen application.

“We now know that many individuals at low risk of skin cancer could benefit from more sun exposure — and that doctors are not yet prepared to prescribe it,” the article stated. “A survey [cancer researcher Rachel Neale, PhD] conducted in 2020 showed that the majority of patients in Australia with vitamin D deficiencies were prescribed supplements by their doctors, despite the lack of efficacy, while only a minority were prescribed sun exposure.”

The article discussed the need for U.S. health authorities to especially recognize the growing diversity of skin types in the country, some of which may benefit from more sun exposure than others and adjust recommendations accordingly.

“There is a myth out there that people are becoming immune to the effects of the sun,” Desai said in response to this claim. “No one is immune to the sun. Every single person is at risk for developing skin cancer, including someone with darker skin tones just like me and others. Sending out mixed messages like this makes me very concerned.”

With health authorities in some countries but not others making mixed claims, both doctors and patients are left wondering who they can trust for their information.

“My thought is that the Australian data asserts conclusions without a full understanding of the epidemic of skin cancer,” Desai said. “One in five Americans develop skin cancer at some point in their life and nearly 20 Americans die from melanoma every day.”

According to the World Cancer Research Fund, Australia leads the world in the highest overall rate of skin cancer with 37 cases of skin cancer occurring per 100,000 citizens in 2022. In the same year, the U.S. saw 16.5 cases per 100,000 citizens.

In the U.S., Desai states that the AAD is still a trusted source for skin cancer education with every recommendation being supported by clinically published scientific data that have been vetted through numerous experts. As information from other countries and organizations, such as The Atlantic, continue to emerge, he encourages healthcare professionals and patients to think critically about their health decisions.

“I think trust is a really important question,” Desai told Healio. “Our job is to educate and empower the public so then they can make the best decisions for their health. I think more and more organizations will continue to come out with their own position statements and the only way they are going to have validity is if they have data to back them up, and it has to be more than just case reports and interpretations.”

References:

• AAD letter to The Atlantic in response to “Against sunscreen absolutism.” https://www.aad.org/news/letter-to-the-atlantic-against-sunscreen-absolutism. Published Nov. 8, 2024. Accessed Dec. 12, 2024.
• Against sunscreen absolutism. https://www.theatlantic.com/magazine/archive/2024/06/sun-exposure-health-benefits/678205/. Updated May 29, 2024. Accessed Dec. 10, 2024.
• Balancing the harms and benefits of sun exposure. https://www.assc.org.au/wp-content/uploads/2023/01/Sun-Exposure-Summit-PositionStatement_V1.9.pdf. Updated Jan. 27, 2023. Accessed Dec. 10, 2024.
• Cummings SR, et al. N Engl J Med. 2022;doi:10.1056/NEJMe2205993.
• Skin cancer statistics. https://www.wcrf.org/preventing-cancer/cancer-statistics/skin-cancer-statistics. Accessed Dec. 10, 2024.