阳
光让我心情愉快。实际上，就像体育锻炼一样，紫外线可以刺激人体产生内啡 ，这是大脑中一种能产生愉快感觉的化学物质。由于常晒太阳，我的维生素D水平很高，因此我认为自己患很多疾病的风险都得以降低。但这些天来，坐在阳光下也让我感到惭愧。身为健康专栏作家，皮肤却晒成古铜色？真丢脸。
美国皮肤癌基金会（Skin Cancer Foundation）和美国皮肤病学会（American Academy of Dermatology）都坚持认为没有“安全美黑”这回事，而且它们一直在提高警示水平。有些人将急于晒黑的行为（即“日晒痴迷症”）和吸毒、酗酒等成瘾行为划上等号。
Ray Bartkus
多数皮肤病专家都建议不要在没涂防晒霜的情况下出门，他们说，仅仅防护导致皮肤灼伤的中波紫外线（UVB）还不够。波长较长、强度较低的长波紫外线（UVA）会加速衰老──它甚至能穿透云层和玻璃窗。我们还需要特制的防护服。
所有这些保护措施真的有必要吗？甚至是对于我这种容易晒黑的皮肤类型而言？在本月召开的一次由Coppertone日光研究中心（Coppertone Solar Research Center）举办的防晒护理研讨会上，我向皮肤病专家和其他专家提出了一些问题。应该承认，我希望有人能说我晒日光浴的习惯没有错，但我却不断受到打击。
《华尔街日报》：自从生命之初，阳光就一直照耀着我们。它是从什么时候起变成敌人的？
答：这些专家称，皮肤癌患病率上升主要是由于和以前相比，我们现在更多地将身体暴露在阳光之下。也就是在过去50年间，人们才开始将古铜色肌肤看做健康和有钱的象征。之前的数百年中，上层阶级都保有白皙的肤色，只有劳工、牛仔和农民会晒成一身古铜色，而且那时他们不会在大中午穿着比基尼躺在户外。
我们的寿命也比以前长，而紫外线的伤害是日积月累的，因此五十多岁、六十多岁和七十多岁的人开始由于多年暴露在阳光下而患上皮肤癌。
专家们说，导致这些问题的并不只是阳光。人工美黑仪发出的长波紫外线要强烈得多。“每个月我都会见到患上皮肤癌的二十多岁的年轻人”，耶鲁大学医学院（Yale School of Medicine）的皮肤病学教授莱费尔（David Leffell）说。“他们无一例外都用过人工美黑仪，现在都追悔莫及。”
《华尔街日报》：晒黑的皮肤不能提供一些防护吗？
答：你会认为我在引火烧身寻开心。与会专家坚持认为，晒黑的皮肤确实是一个危险信号，它说明紫外线正在伤害皮肤的DNA。这时身体将向皮肤表层释放出黑色素（身体自然产生的色素）以阻挡紫外线进入到深处。新泽西州巴斯金山脊地区（Basking Ridge）的纪念斯隆-凯特琳癌症中心（Memorial Sloan-Kettering Cancer Center）的皮肤科主任史蒂文•王（Steven Q. Wang）说，晒黑的皮肤的确能提供一些防护──防护效果相当于SPF 2或SPF 3，“但你必须以牺牲DNA为代价。”
他和其他人还指出，晒太阳会通过破坏深层胶原纤维和产生皮肤松垂与皱纹加速衰老过程。“这种警告看来比患皮肤癌的警告还有力”，王博士指出。毕竟，衰老的风险是100%的。
《华尔街日报》：晒太阳的好处有哪些──比如维生素D和内啡 ？
答：霍利克（Michael Holick）在他的新书《健康的秘诀：维生素D》（The Vitamin D Solution）中力证，“适度晒太阳”能够预防乳腺癌、结肠癌、前列腺癌和其他癌症，由此而减少的死亡人数与因晒太阳患皮肤癌而死亡的人数相比要高得多。（确切的适度日晒量因皮肤类型、纬度和时节而异；他认为在美国多数地区的夏天，白种人在不涂防晒霜的情况下每周应晒太阳三次，每次晒10到30分钟）他还将普遍的维生素D缺乏症归咎于他所谓的日渐兴起的“阳光恐惧”文化。由于他所持的此类观点，2004年，他选择从波士顿大学医学院（Boston University Medical School）皮肤病学系辞职，尽管他仍是医学、生理学和生物物理学教授。
皮肤病专家称，关于维生素D仍有许多未解之谜，例如人们究竟需要多少维生素D，以及维生素D是否真能预防癌症和其他疾病。只有知道了这些，才能做出权衡取舍。除此以外，他们说，维生素D已经可以通过补充剂来摄入，而无须冒患皮肤癌的风险。然而，迄今为止，没有一种药剂可以产生阳光带来的改善心情的效果。
《华尔街日报》：不同肤色的人或世界上不同地区的人患皮肤癌的风险是否有差异？
答：“绝对有差异”，莱费尔博士说。他指出，终有一天，个性化医学将能准确预测谁可以安全地沐浴在阳光下。而目前，专家们只能基于宽泛的人群类别提出建议。
肤色白皙、有雀斑、红发或金发、总会晒伤而不是晒黑的人患皮肤癌的风险最高。他们是所谓的菲氏量表（Fitzpatrick scale）中的第1型和第2型，该表是由哈佛大学的皮肤病专家托马斯•菲茨帕特里克（Thomas Fitzpatrick）于1975年编制的。根据皮肤癌基金会的建议，他们只要在阳光下，就应涂上至少为SPF 30的防晒霜，并寻找遮荫处。第5型和第6型的人──即天生为棕色或黑色皮肤的人──患皮肤癌的风险要低得多，尽管他们可能患上黑色素瘤。像我这样属于第3型或第4型的人，以及第5型和第6型的人，在上午10点至下午4点外出时应涂上SPF 15的防晒霜并寻找遮荫处。
对于皮肤癌而言，皮肤类型是比纬度地区大得多的风险因素，这解释了为何澳大利亚、新西兰、北美和北欧等地的金发人种皮肤癌患病率最高，甚至比赤道附近地区的人还高，即使赤道附近地区的阳光更强烈。皮肤病专家称，金发人种在阳光充足的地方或在高海拔、雪面会反射阳光的滑雪场中度假时需要格外小心。
Melinda Beck
所有这些保护措施真的有必要吗？甚至是对于我这种容易晒黑的皮肤类型而言？在本月召开的一次由Coppertone日光研究中心（Coppertone Solar Research Center）举办的防晒护理研讨会上，我向皮肤病专家和其他专家提出了一些问题。应该承认，我希望有人能说我晒日光浴的习惯没有错，但我却不断受到打击。
《华尔街日报》：自从生命之初，阳光就一直照耀着我们。它是从什么时候起变成敌人的？
答：这些专家称，皮肤癌患病率上升主要是由于和以前相比，我们现在更多地将身体暴露在阳光之下。也就是在过去50年间，人们才开始将古铜色肌肤看做健康和有钱的象征。之前的数百年中，上层阶级都保有白皙的肤色，只有劳工、牛仔和农民会晒成一身古铜色，而且那时他们不会在大中午穿着比基尼躺在户外。
我们的寿命也比以前长，而紫外线的伤害是日积月累的，因此五十多岁、六十多岁和七十多岁的人开始由于多年暴露在阳光下而患上皮肤癌。
专家们说，导致这些问题的并不只是阳光。人工美黑仪发出的长波紫外线要强烈得多。“每个月我都会见到患上皮肤癌的二十多岁的年轻人”，耶鲁大学医学院（Yale School of Medicine）的皮肤病学教授莱费尔（David Leffell）说。“他们无一例外都用过人工美黑仪，现在都追悔莫及。”
《华尔街日报》：晒黑的皮肤不能提供一些防护吗？
答：你会认为我在引火烧身寻开心。与会专家坚持认为，晒黑的皮肤确实是一个危险信号，它说明紫外线正在伤害皮肤的DNA。这时身体将向皮肤表层释放出黑色素（身体自然产生的色素）以阻挡紫外线进入到深处。新泽西州巴斯金山脊地区（Basking Ridge）的纪念斯隆-凯特琳癌症中心（Memorial Sloan-Kettering Cancer Center）的皮肤科主任史蒂文•王（Steven Q. Wang）说，晒黑的皮肤的确能提供一些防护──防护效果相当于SPF 2或SPF 3，“但你必须以牺牲DNA为代价。”
他和其他人还指出，晒太阳会通过破坏深层胶原纤维和产生皮肤松垂与皱纹加速衰老过程。“这种警告看来比患皮肤癌的警告还有力”，王博士指出。毕竟，衰老的风险是100%的。
《华尔街日报》：晒太阳的好处有哪些──比如维生素D和内啡 ？
答：霍利克（Michael Holick）在他的新书《健康的秘诀：维生素D》（The Vitamin D Solution）中力证，“适度晒太阳”能够预防乳腺癌、结肠癌、前列腺癌和其他癌症，由此而减少的死亡人数与因晒太阳患皮肤癌而死亡的人数相比要高得多。（确切的适度日晒量因皮肤类型、纬度和时节而异；他认为在美国多数地区的夏天，白种人在不涂防晒霜的情况下每周应晒太阳三次，每次晒10到30分钟）他还将普遍的维生素D缺乏症归咎于他所谓的日渐兴起的“阳光恐惧”文化。由于他所持的此类观点，2004年，他选择从波士顿大学医学院（Boston University Medical School）皮肤病学系辞职，尽管他仍是医学、生理学和生物物理学教授。
皮肤病专家称，关于维生素D仍有许多未解之谜，例如人们究竟需要多少维生素D，以及维生素D是否真能预防癌症和其他疾病。只有知道了这些，才能做出权衡取舍。除此以外，他们说，维生素D已经可以通过补充剂来摄入，而无须冒患皮肤癌的风险。然而，迄今为止，没有一种药剂可以产生阳光带来的改善心情的效果。
《华尔街日报》：不同肤色的人或世界上不同地区的人患皮肤癌的风险是否有差异？
答：“绝对有差异”，莱费尔博士说。他指出，终有一天，个性化医学将能准确预测谁可以安全地沐浴在阳光下。而目前，专家们只能基于宽泛的人群类别提出建议。
肤色白皙、有雀斑、红发或金发、总会晒伤而不是晒黑的人患皮肤癌的风险最高。他们是所谓的菲氏量表（Fitzpatrick scale）中的第1型和第2型，该表是由哈佛大学的皮肤病专家托马斯•菲茨帕特里克（Thomas Fitzpatrick）于1975年编制的。根据皮肤癌基金会的建议，他们只要在阳光下，就应涂上至少为SPF 30的防晒霜，并寻找遮荫处。第5型和第6型的人──即天生为棕色或黑色皮肤的人──患皮肤癌的风险要低得多，尽管他们可能患上黑色素瘤。像我这样属于第3型或第4型的人，以及第5型和第6型的人，在上午10点至下午4点外出时应涂上SPF 15的防晒霜并寻找遮荫处。
对于皮肤癌而言，皮肤类型是比纬度地区大得多的风险因素，这解释了为何澳大利亚、新西兰、北美和北欧等地的金发人种皮肤癌患病率最高，甚至比赤道附近地区的人还高，即使赤道附近地区的阳光更强烈。皮肤病专家称，金发人种在阳光充足的地方或在高海拔、雪面会反射阳光的滑雪场中度假时需要格外小心。
Melinda Beck
The sun makes me feel good. In fact, ultraviolet (UV) rays stimulate the production of endorphins, the feel-good brain chemical, like exercise does. And my vitamin D levels are great, thanks to the sun's rays, so I figure I'm lowering my risk for a wide range of diseases.
But these days, sitting in the sun makes me feel guilty as well. A health columnist with a tan? Shameful.
Both the Skin Cancer Foundation and the American Academy of Dermatology maintain there's no such thing as a safe tan. And they keep raising the alarm levels. Some equate the urge to tan (or 'tanorexia') with addictive behaviors like drug and alcohol abuse.
Most dermatologists advise never to step outside without sunscreen and they say it's not enough just to guard against UVB rays, the kind that cause burns. It's the longer, less intense UVA rays that accelerate aging -- and those even penetrate cloud and glass windows. We also need specially made protective clothing.
Is all this protection really necessary, even for skin types like mine that tan easily? I posed some questions to dermatologists and other experts at a sun-care symposium, sponsored by the Coppertone Solar Research Center, this month. Admittedly, I was hoping someone would say that my tanning habit is OK. But I kept getting shot down.
WSJ: The sun has been shining on us since life began. When did it become the enemy?
A: Skin cancer is rising mainly because we're exposing more of our bodies to the sun than ever before, these experts said. It's only been in the past 50 years or so that people equated a tan with health and wealth. In centuries past, the upper classes stayed pale; only laborers, cowboys and farmers sported tans, and they didn't lie out at noon in bikinis.
We're also living longer than ever, and UV damage is cumulative, so 50-, 60- and 70-year-olds are getting skin cancer based on decades of exposure.
And it's not just the sun that's causing problems, they said. Tanning parlors emit UVA rays far more intensely. 'Not a month goes by when I don't see someone in their 20s with skin cancer,' said David Leffell, a professor of dermatology at Yale School of Medicine. 'Invariably they've been to tanning parlors and they are consumed by guilt.'
WSJ: Doesn't a tan provide some protection?
A: You'd think I had suggested setting myself on fire for fun. The assembled experts insisted that a tan is really a distress signal that UV rays are damaging the skin's DNA; the body sends melanin, its naturally occurring pigment, to the skin's upper layer to block UV rays from penetrating deeper. Tanning does provide some protection -- the equivalent of an SPF 2 or 3, said Steven Q. Wang, director of dermatology at Memorial Sloan-Kettering Cancer Center in Basking Ridge, N.J. 'But you have to pay for it with your DNA.'
He and others also pointed out that sun exposure hastens the aging process, by damaging deeper collagen fibers and creating sagging and wrinkles. 'That message seems to be more powerful than the skin cancer message,' Dr. Wang noted. After all, there's a 100% risk of aging.
WSJ: What about the benefits of sun exposure -- like vitamin D and endorphins?
A: In his new book, 'The Vitamin D Solution,' Michael Holick argues that 'sensible sun exposure' can prevent many more deaths from breast, colon, prostate and other cancers than it will risk from skin cancer. (The exact amount differs by skin type, latitude and time of year; it's 10 to 30 minutes three times a week, without sunscreen for Caucasians in much of the U.S. in the summer.) He also blames the widespread vitamin D deficiency on what he calls the rising culture of 'sunphobia.' Because of views like that, he chose to resign from Boston University Medical School's department for dermatology in 2004, though he remains a professor of medicine, physiology and biophysics.
The dermatologists said there are still many unknowns about vitamin D, such as how much people really need and whether it really protects against cancer and other diseases, to make such tradeoffs. Besides, they said, vitamin D is readily available from supplements without risking skin cancer. So far, however, there's no pill to replicate the mood-enhancing effects of the sun.
WSJ: Isn't the cancer risk different for people with different skin tones or different parts of the world?
'Absolutely,' said Dr. Leffell, who noted that someday personalized medicine may be able to predict exactly who can bask in the sun safely. In the meantime, experts are left with fairly broad categories of recommendations.
The people at highest risk for skin cancer are those who have fair complexions, freckles, red or blond hair and who always burn instead of tanning. They are Types 1 and 2 on what's known as the Fitzpatrick scale, developed in 1975 by Harvard dermatologist Thomas Fitzpatrick. They should wear SPF 30 or more and seek shade anytime they're in the sun, according to the Skin Cancer Foundation. People with Types 5 and 6 -- with naturally brown or black skin -- are at much lower risk, even though they can get melanoma. People with Type 3 or 4, like me, as well as the 5 and 6's should wear SPF 15 outside and seek the shade between 10 a.m. and 4 p.m.
Skin type is a much bigger risk factor for cancer than latitude, which explains why skin cancer rates are highest among fair-haired people in places like Australia, New Zealand, North America and northern Europe, than in areas near the equator, even though the sun is stronger. Dermatologists say that fair-haired people need to be especially cautious when they vacation in sun-drenched places, or on ski slopes, with high altitudes and reflected sun on snow.
Melinda Beck
But these days, sitting in the sun makes me feel guilty as well. A health columnist with a tan? Shameful.
Both the Skin Cancer Foundation and the American Academy of Dermatology maintain there's no such thing as a safe tan. And they keep raising the alarm levels. Some equate the urge to tan (or 'tanorexia') with addictive behaviors like drug and alcohol abuse.
Most dermatologists advise never to step outside without sunscreen and they say it's not enough just to guard against UVB rays, the kind that cause burns. It's the longer, less intense UVA rays that accelerate aging -- and those even penetrate cloud and glass windows. We also need specially made protective clothing.
Is all this protection really necessary, even for skin types like mine that tan easily? I posed some questions to dermatologists and other experts at a sun-care symposium, sponsored by the Coppertone Solar Research Center, this month. Admittedly, I was hoping someone would say that my tanning habit is OK. But I kept getting shot down.
WSJ: The sun has been shining on us since life began. When did it become the enemy?
A: Skin cancer is rising mainly because we're exposing more of our bodies to the sun than ever before, these experts said. It's only been in the past 50 years or so that people equated a tan with health and wealth. In centuries past, the upper classes stayed pale; only laborers, cowboys and farmers sported tans, and they didn't lie out at noon in bikinis.
We're also living longer than ever, and UV damage is cumulative, so 50-, 60- and 70-year-olds are getting skin cancer based on decades of exposure.
And it's not just the sun that's causing problems, they said. Tanning parlors emit UVA rays far more intensely. 'Not a month goes by when I don't see someone in their 20s with skin cancer,' said David Leffell, a professor of dermatology at Yale School of Medicine. 'Invariably they've been to tanning parlors and they are consumed by guilt.'
WSJ: Doesn't a tan provide some protection?
A: You'd think I had suggested setting myself on fire for fun. The assembled experts insisted that a tan is really a distress signal that UV rays are damaging the skin's DNA; the body sends melanin, its naturally occurring pigment, to the skin's upper layer to block UV rays from penetrating deeper. Tanning does provide some protection -- the equivalent of an SPF 2 or 3, said Steven Q. Wang, director of dermatology at Memorial Sloan-Kettering Cancer Center in Basking Ridge, N.J. 'But you have to pay for it with your DNA.'
He and others also pointed out that sun exposure hastens the aging process, by damaging deeper collagen fibers and creating sagging and wrinkles. 'That message seems to be more powerful than the skin cancer message,' Dr. Wang noted. After all, there's a 100% risk of aging.
WSJ: What about the benefits of sun exposure -- like vitamin D and endorphins?
A: In his new book, 'The Vitamin D Solution,' Michael Holick argues that 'sensible sun exposure' can prevent many more deaths from breast, colon, prostate and other cancers than it will risk from skin cancer. (The exact amount differs by skin type, latitude and time of year; it's 10 to 30 minutes three times a week, without sunscreen for Caucasians in much of the U.S. in the summer.) He also blames the widespread vitamin D deficiency on what he calls the rising culture of 'sunphobia.' Because of views like that, he chose to resign from Boston University Medical School's department for dermatology in 2004, though he remains a professor of medicine, physiology and biophysics.
The dermatologists said there are still many unknowns about vitamin D, such as how much people really need and whether it really protects against cancer and other diseases, to make such tradeoffs. Besides, they said, vitamin D is readily available from supplements without risking skin cancer. So far, however, there's no pill to replicate the mood-enhancing effects of the sun.
WSJ: Isn't the cancer risk different for people with different skin tones or different parts of the world?
'Absolutely,' said Dr. Leffell, who noted that someday personalized medicine may be able to predict exactly who can bask in the sun safely. In the meantime, experts are left with fairly broad categories of recommendations.
The people at highest risk for skin cancer are those who have fair complexions, freckles, red or blond hair and who always burn instead of tanning. They are Types 1 and 2 on what's known as the Fitzpatrick scale, developed in 1975 by Harvard dermatologist Thomas Fitzpatrick. They should wear SPF 30 or more and seek shade anytime they're in the sun, according to the Skin Cancer Foundation. People with Types 5 and 6 -- with naturally brown or black skin -- are at much lower risk, even though they can get melanoma. People with Type 3 or 4, like me, as well as the 5 and 6's should wear SPF 15 outside and seek the shade between 10 a.m. and 4 p.m.
Skin type is a much bigger risk factor for cancer than latitude, which explains why skin cancer rates are highest among fair-haired people in places like Australia, New Zealand, North America and northern Europe, than in areas near the equator, even though the sun is stronger. Dermatologists say that fair-haired people need to be especially cautious when they vacation in sun-drenched places, or on ski slopes, with high altitudes and reflected sun on snow.
Melinda Beck
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