DSAP, Sun Exposure & Autoimmune Disease

by Summer Kramer, melanoma survivor and founder of SummerSkin

SUN EXPOSURE. As a melanoma survivor, I think about sun exposure every day, and as with many skin conditions, safe sun habits are a necessity.  One such condition that has been shown to be affected by sun exposure is Disseminated Superficial Actinic Porokeratosis (DSAP).

The known key risk factors for developing DSAP are genetic inheritance, immunosuppression and exposure to ultraviolet (UV) radiation.

What is Immunosuppression?

Immunosuppression can be defined as the decreased ability of the body’s immune system to fight infections and harmful or foreign substances. As a result, the body is more susceptible to the development of infections, cancers, and disorders normally kept under control by the immune system.

Various factors can lead to a weakened immune system. Immunosuppression can be inherited as immunodeficiency disorders, but it can also be acquired through conditions such as:

  • Cancer and cancer treatments
  • Organ transplant and transplant medications
  • Autoimmune disorders and treatments
  • HIV infection
  • Uncontrolled Diabetes Mellitus
  • Overexposure to UV radiation
  • Aging (the immune system naturally weakens with age)

How is the immune system affected by sun exposure?

The immune system is both positively and negatively affected by UV exposure. Small amounts of UV radiation from sun exposure can activate Vitamin D synthesis in the skin, which plays a role in boosting the immune system. However, moderate to high levels of UV radiation begin to have the opposite effect and can reduce the immune system’s ability to fight against harmful or foreign invaders. Of the various types of UV rays, UVB radiation has been shown to have immunosuppressive effects on human skin, similar to those seen with targeted UVB treatments of such inflammatory skin conditions as psoriasis.

How is DSAP affected by immunosuppression and sun exposure?

DSAP has been shown to occur or flare during times of immunosuppression, and lesions are typically localized to areas of the body that receive the most sun exposure (legs, arms, and face).

Diagnoses of DSAP occur most frequently in women with a history of UV exposure, and continued UV exposure – either from the sun or from an artificial source – may cause DSAP to worsen.

Further, DSAP lesions may improve or resolve if any underlying immunosuppression resolves and with use of sun-protective behaviors.

When should we be practicing sun protection?

Year-round! Sun exposure is not limited to the summer months or vacations. We receive sun exposure throughout the year (even on cloudy days), and it is important to take the necessary steps to keep our skin healthy for life. For those with increased sensitivity to sun exposure, year-round sun protection is exceptionally important.

What are our options for staying safe in the sun?

Staying indoors for an eternity is not practical, nor recommended. Active, healthy lifestyles include time outdoors, and safe sun habits are a great way to reduce negative effects from the sun during outdoor activities.

Safe sun habits include:

  1. Seek shade, and limit time outdoors during peak hours (10am to 4pm).
  2. Know your area’s UV Index and take extra measures during higher UV Indexes.
  3. Avoid artificial tanning beds and sunlamps!
  4. Use Sunscreen with at least SPF 30, using the correct amount and re-applying every two hours.
  5. Wear UPF 50+ sun-protective clothing, hats, and sunglasses. Sun-protective clothing for everyday wear is ideal to incorporate into your daily wardrobe.

Polyvore Palazzo Pant Polyvore Denim and Hat

For an artistic view on the effects of sun exposure, “How the Sun Sees You” is a beautiful video, by artist Thomas Leveritt, showing the power of sunscreen and the effects of sun exposure that can’t be seen with the naked eye.


Summer Kramer, PharmD is a licensed pharmacist, melanoma survivor and founder of SummerSkin, which designs and produces fashionable sun-protective clothing for every day wear. Dr. Kramer has studied at both the University of New Mexico and the University of Oregon – two US states with high rates of skin cancer – and now dedicates her time to growing public awareness for sun safety.


National Institutes for Health: Immunodeficiency Disorders. Accessed Oct. 24, 2014. http://www.nlm.nih.gov/medlineplus/ency/article/000818.htm

World Health Organization: UV Health Effects. Accessed Oct. 24, 2014. http://www.who.int/uv/health/en/

US Environmental Protection Agency: Health Effects of UV Radiation. Accessed Oct. 24, 2014. http://www2.epa.gov/sunwise/health-effects-uv-radiation

Medscape: Porokeratosis. Accessed Oct. 24, 2014.  http://emedicine.medscape.com/article/1059123-overview#a0101

Zasloff, M. Sunlight, Vitamin D, and the Innate Immune Defenses of the Human Skin. Nature; 125:5 November 2005. Accessed Oct. 24, 2014. http://www.nature.com/jid/journal/v125/n5/pdf/5603599a.pdf

Images: Polyvore – SummerSkin Official Page. Accessed Oct. 24, 2014. http://yoursummerskin.polyvore.com/



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