Episode 1

A Horror Story

It’s a dark and windy evening. The four friends are sitting in the living room of the old villa. There is rattling and squeaking everywhere, the shutters are flapping against the wall. The only light in the room comes from some candles which throw large shadows across the room. Max wants to read his new horror story to his friends, it’s the one he has been working on for the last few days. This is his first horror story.

Suddenly a clap of thunder is heard. Natalya shrieks. “Oh, my God! I won’t sleep tonight; first a horror story and now a thunderstorm, oh, I hate it!” Natalya doesn’t really like horror stories and is rather afraid of ghosts and creepy things. “But come on, what can happen as long as I am here? I will protect you!” Paolo never misses any opportunity to show his manly superiority. “Do be quiet, you don’t understand,” Natalya retorts, putting the hood of her jacket over her head and withdrawing to a darker corner.
Max starts reading. 

This is Natalya’s chance. What she never seems to manage during the lively camp days, she will try to do now: following a recipe downloaded from the internet she is mixing herself a tincture against her spots. “This is the perfect mixture, your spots will disappear overnight and never come back,” they promised on the internet site . On the way to the villa she had picked the last of the herbs she needs, and now she’ll grind them and put them into the mixture. She opens the glass jar.

“Whoooaaah!”

Thelma is screaming, being carried away by Max’s story. Natalya, who has not heard a word of Max’s story, jumps with fright  and the jar  falls from her hands. It hits the floor with a loud bump and rolls across the room. “What was that?” Heroically, Paolo jumps to his feet and follows the noise. In the dark, he touches something green and slimy. “Eeeeeh! What’s that?”  Natalya covers her face in her hands. The others gather around the thing on the floor. “It’s a jam jar, and there is something slimy and green and awful in it,” Max states matter-of-factly. “Is this yours?” Thelma asks Natalya, the first to guess what this might be about. The boys look at each other bewildered. “Are you trying to poison someone? Maybe some supervisor? But hopefully not us?” Paolo asks interested. Natalya stays quiet for a while, her mind racing. What can she say? Will they really understand, especially the boys? But these are her friends, she owes them an explanation, because what would she do without them in the camp?

“It’s… from the internet…” she stammers, “a recipe… against spots… you know,” she is sobbing now. Thelma puts her arm around her shoulders. “And you thought this would help?” she asks. “They say so,” Natalya is regaining her voice. “Do you know what it’s like to go around with spots all the time? It’s so awful!” She sounds desperate now. “When I get these bouts I don’t want to go out of the house any more and I really hate myself.”

“Of course, I do understand,” Paolo says quietly after a short silence. “My grandma tried all her old recipes on me. Awful stuff – onion and garlic and all kinds of soap and so on, but they were bullshit. In the end, I found out that putting tooth paste on them works rather well. It seems to disinfect or something.” Natalya looks at him, because he seems so much less cool and much more grown-up than usual. “But for some years it was really bad.” He shrugs.

Max, who has been quiet up to now, is asking, a bit embarrassed: “Is it really so difficult to get rid of them ? I thought maybe you just squeeze them, and then they heal and that is that?” Thelma shakes her head. “I have them as well sometimes,” she says, “and they are not that easy to deal with. I went to see a doctor in the end, and his cream helped. But, Natalya, don’t try this poisonous stuff, please. You don’t know what will happen. Maybe you’ll get red spots everywhere, I  had that once.” Natalya looks horrified and stamps the jar with her foot, catapulting it under an old bookshelf. “Okay, okay. Thanks, guys,” she says, still a bit embarrassed. “Why don’t we get on with the real horror story?”

On the way home, Max and Natalya walk together. After a period of silence, Max takes heart and says: “The boys really like you, Natalya, and nobody has ever said  a word about your spots. I don’t think anybody cares.” Natalya starts smiling shyly. “And you know what, if you want to,” Max hesitates a little, “I mean, I can create a story. What do you think if together we write a real “horror story” about acne and being young? I would really like to do that, and maybe we can do it together…?” Natalya smiles more broadly now and she takes Max’s arm . “Yes, why not, that’s a good idea. And I have some horrors to tell!” They walk back to the camp in an understanding.silence.

Interactive

Everything fine with your skin? The latest acne test!

Natalya stands in front of the mirror. It’s already late in the evening. She thinks about the old villa again and the muddle of opinions after her friends had discovered her green „acne potion“. Natalya remembers the typical sayings from Max: “Oh, I thought one should just squeeze the pimples thoroughly, and they are healed the next morning.” And from Paolo: "Squeeze them? Nonsense. Put on tooth paste over night, and the next morning they are gone. A friend of mine does that, and it works fine for him.” And from Thelma: „No, no, guys, are you crazy, that’s all nonsense. You shouldn’t do anything. Or maybe see a doctor?” What do you think?

"What do you know about acne? Are you experts like me because you had to learn perforce? Or are you clueless like Max and Paolo? Or something in between like Thelma? Test yourself. Below you can check your knowledge and have some fun as well! You may choose between three levels (easy, medium, difficult). Try it out."

How to do it: Choose one of the two characters and lend him/her your name. There you go!

		The quiz opens in a new window. So you can always switch between this page and the quiz. Click here to go to the quiz!
		For the quiz, you will need the Flash Player. Download the Flash Player here.
		Everything clear? No? Then read some helpful hints and information here. Then it will be very easy for you. The Hints and Info section also open in a new window. Thus, you will have everything within your view. Press here for the Hints & Info section around acne!

Hints & Info

You all know it: at the age of about 12, with the beginning of puberty, many of you start to get greasy skin, comedones and all sorts of spots and lumps.

Acne is a widespread skin disease that affects especially adolescents aged 12 to 20, but occurs in adults as well. Acne is a disorder of the sebaceous glands caused by the hormonal ups and downs in puberty. Acne affects a very high number of adolescents. You inherit your skin type and other bodily characters from your parents; so how much you are affected by acne may be similar to the level by which your parents were affected in their youth.

For more information: Definition and Origination.

Acne can have unpleasant side effects: it may be painful, for example, and you may have trouble finding yourself attractive for others. And this may really undermine your self-confidence, giving you the feeling of wanting to withdraw from the world and not showing your face any more.
Acne occurs predominantly in the face, the upper body (chest and back) and sometimes also on the upper arms, regions very visible to everyone and difficult to hide.

For more information: Myths and Consequences.

But you can do something against these irksome spots: gentle cleaning and conditioning of the skin are very helpful, and it’s something you can do yourself. Besides you should ask for professional attention by a doctor, a dermatologist or a medically trained cosmetic assistant.
The more you know about the causes and types of acne, the better you can become active and improve your condition.

For more information: Treatment.

One of the most important things, however, is to keep your chin up and strengthen your self-esteem. Who you are as a person is much more important than just your appearance.

Definition

It starts at the age of around 12: the skin becomes greasy and develops comedones, annoying smaller and larger spots and papules. This is called acne. It is one of the most frequent skin conditions in the world. It affects a very large number of adolescents, and adults can get it as well.

Acne is a disease of the sebaceous glands and appears especially on the regions of the body where the most sebaceous glands are located: in the face, on the upper part of the body and on the upper arms.

Sebaceous Glands. The sebaceous glands are located in the dermis and discharge into the hair follicles. They produce an oily secretion (sebum) that is delivered to the skin surface and protects the skin against drying-up. Every sebaceous gland has an excretory duct leading to the skin surface.  The upper part of this duct consists of horn-forming cells.

Acne can occur more or less severely and tends to occur in episodes. Sometimes it is just a bit annoying, but for every third or fourth adolescent it is quite severe, being clearly visible and often leaving scars. Acne starts with the beginning of puberty, i. e. at the age of about 10 to 12, and usually disappears around the age of 18 to 20. Sometimes the acne persists into adulthood or doesn’t occur before that age (e. g. chloracne, acne inversa).

Girls often get spots a bit earlier than boys, as puberty mostly starts earlier in girls than in boys, while boys often develop a more lasting and severe forms of acne. 

Acne types
The word acne summarizes a number of skin conditions that may help to distinguish the different forms of acne: comedones (whiteheads and blackheads), spots (papules, pustules) and sometimes also nodules and cysts located deeper in the skin. More about the acne types:  

1. Acne comedonica
		Whiteheads and blackheads (comedones) appear. The blackheads do not consist of dirt, but it is sebum (oil) that has been colored darkly by the melanine pigments (this is the dark dye produced within the skin). You can imagine comedones like the cork of a bottle: the horny substance blocks the exit of the sebaceous gland.
2. Inflammatory acne
		The blocked exit and the irritation of skin and gland lead to an infection of the sebaceous gland – a spot or papule develops. The infection makes the spots become red and swollen.
3. Nodulous acne
		The infection spreads to the surrounding tissues and leaves scars after healing. Nodules and cysts occur.

Acne can really work on one’s nerves, but there are a lot of things you can do to improve your condition and to reduce the duration of your acne. In this way it makes sense to find out what exactly causes acne and what you can do against it.

Origination

Human skin is a sensitive organ. It reacts to hot and cold temperatures, dirt and dust, sun, stress and touch, internal factors like nutrition and events like hormonal changes and illness.

Hormones. Hormones are chemical messengers that are produced within the human body and sent through the body to initiate certain changes. They are e. g. responsible that we grow, that our heart pounds if we are excited, that boys get a beard and girls get breasts during puberty; and they have an effect on the skin.

In some phases of life, e. g. in puberty, pregnancy, menopause and during the female menstrual cycle, the quantity and the composition of the hormones in the so-called “hormonal metabolism” may change. In puberty it changes remarkably. Especially, more androgens (male hormones) are discharged, in girls as well as in boys.

These hormones cause the maturation of the sexual organs and, as a side effect, stimulate the sebaceous glands of the skin to produce more sebum than usual. At the same time, by effect of the hormones, more horny cells are produced in the excretory duct of the sebaceous glands, and they block the duct like a plug and hinder the increased amounts of sebum from draining off. Thus the sebaceous gland is clogged, the locked-in sebum making it swell.

From outside you can see these horn plugs as white or dark-coloured little domes or points. These are the so-called comedones (whiteheads and blackheads). The dark color is not dirt but results from the dark skin pigment (melanin) within the horny substance.

Bacteria. The skin of every human being is populated by many bacteria that are important to the health of the skin. Among them are the Propionibacteria acnes, a bacterium which is normally harmless on the skin surface.

If comedones develop, this bacterium lives on the increased sebum, multiplies rapidly and causes infections in the clogged sebaceous glands. These start to swell, the skin becomes red and tense, and a white or yellow point becomes visible – a spot has formed (inflammatory acne).

If the infection of the gland becomes more intense, the gland may even burst and distribute its content into the surrounding tissues. Pustules and nodules develop which may be painful and can leave scars after healing (nodulous acne).

Myths

There are a lot of myths about acne that one should know but not take too serious:

Acne is not infectious, in spite of bacteria being involved, as everyone is carrying these bacteria on their skin. Having acne doesn’t mean that one is neglecting one’s personal hygiene. Acne is not an infectious disease and cannot be passed on by hugging or kissing.

It is very important to keep to a regular and gentle cleaning of the skin, according to one’s skin type, but acne is caused by hormonal changes in the body and cannot be removed by good and gentle skin hygiene.

There is also the myth that acne is caused by eating chocolate, sweets, coca-cola and other food. This is not correct. Acne is not caused by diet.
Should you notice that your skin reacts to certain food, please ask your doctor or dermatologist for advice.

"Sinful thoughts" and masturbation don’t cause acne either.

 

 

Treatment

Acne usually disappears around the age of 18 to 20. But that doesn’t mean that you have to sit and endure passively, but you are able to do a lot of things to alleviate the acne, shorten its duration and reduce the frequency of acne episodes. This will improve not only your skin condition but also your emotional wellbeing!

Acne tends to occur in episodes, which means that it may appear and disappear in the course of weeks and months. This is more often the case for girls, and the episodes are usually related to their menstrual cycle. But boys as well have episodes with stronger acne alternating with periods relatively free of skin problems.

You can reduce these episodes if you gently clean your skin on a regular basis and follow the therapy recommendations of your doctor or dermatologist. But it is mostly not possible to avoid the episodes entirely. It’s good to be prepared, and to be aware that you usually haven’t done anything wrong, but that this is simply the nature of acne. After a while, you will develop a fine intuition for your own body, learn to understand the first signs and be able to react to them.

Which are the measures that can you take against the acne?

Adequate skin cleaning is the first step. More...

Consumer promotion tries to make us believe that the main remedy against acne is skin cleaning. This is nonsense. As a matter of course, you should clean your skin one to two times a day (but not more frequently) with a solution of a mild synthetic detergent. This detergent should possess about the same pH value as the skin, i. e. 5.5, to make sure that the natural protective layer on the skin will not be destroyed. This will prevent an additional infection of the blemished skin with bacteria. If you wash your skin very frequently or if you use soap or alcohol-containing cleansers from the drugstore, this may irritate your skin and even lead to the development of comedones. If your skin tends to shine greasily, you may dab it cautiously with cosmetic tissues during the day. Cleansing products should be applied sparingly and washed off afterwards thoroughly. For helpful hints on how to care for acne skin, please read the pages with general information on skin: Skin care.

How do I best take care of my skin? More...

Try to avoid oily products for skin conditioning, as they may clog the pores and reinforce the acne. Try instead to adapt your conditioning to your skin type (dry / oily). For dry skin, mild products containing moisturizer are recommended, to return the necessary moisture to the skin after cleaning, without clogging the pores. Your doctor, dermatologist or medical cosmetician can recommend suitable products to you. Many of the acne medicaments currently prescribed may be produced in base substances with a conditioning effect. For helpful hints on how to care for acne skin, please read the pages with general information on skin: Skin care.

Make-up. More...

Using make-up is completely okay; lipstick, eye shadow etc. are mostly entirely unproblematic. But choose your face cream carefully: if it is too oily, it may clog your pores and cause comedones. If you want to know more about which ingredients of cosmetics may worsen acne, please continue to read here.

Ingredients of cosmetics It can be quite interesting to become aware of the ingredients of cosmetic products. They may contain substances that favour the development of comedones, as e. g. peanut oil that is part of many conditioning creams. The manufacturer is obliged to quote all ingredients of his product on the package. If a product contains one or several of the following substances, you might want to look for another product: Butyl Stearate Cetyl Alcoho Hexyne Glycol Isopropyl Myristate Lanolin Sodium Lauryl Sulfate PEG-12 Sesamum Indicum Stearic Acid Sulfur

Consult a doctor or dermatologist. More...

Acne is a skin disease and as such may and should receive professional medical treatment. Your physician will set up an individual therapy programme with you. The measures will depend on your acne type and your skin type. Please find below an overview of the treatment possibilities: Therapy Treatment External (local) therapy Creams and ointments that treat the inflammatory regions, dissolve the strong hornifications and fight the bacterial infection and the overactivity of the sebaceous glands; deep cleansing by a medical cosmetician; recommendations for skin cleansing and skin care. Internal (systemic) therapy Oral intake of medications to fight the inflammations, the strong hornifications and the overactivity of the sebaceous glands. Girls: possibly intake of a special birth control pill. Besides it can be helpful if you regularly see a medical cosmetician, especially if you have serious acne. Depending on the severity of the acne, it can be helpful to do this one to three times in three months. She will do professional skin cleansing and e. g. remove the comedones to avoid inflammations and treat the affected skin areas. Please ask your doctor or dermatologist for a recommendation.

Medical cosmetics Medical cosmetics is a sensible complementary measure in acne therapy. Privat insurances usually bear the costs, if it is prescribed by a doctor or dermatologist. Statutory health insurances may also often bear the costs in severe cases, if prescribed by a doctor or dermatologist, but sometimes this can be more difficult. Perhaps an appropriate therapy can also be carried out by the dermatologist. It is best to obtain advice from the doctor or dermatologist.

Don’t squeeze your spots. More...

It must be very much recommended not to squeeze your spots. In squeezing, you will very often unwillingly harm the skin around the spot, which can lead to an infection and may leave scars. Besides, most of the sebum will not be discharged to the outside, but will be pressed into the surrounding tissues where it causes further inflammations. Please consult a doctor, dermatologist or a cosmetician instead.

Acne therapy needs some time. Patience pays! More...

Please bring some patience: acne therapy doesn’t usually show its effect immediately, but only after some weeks. Then you will experience a remarkable improvement of your skin condition. Skin is as individual as every human being, so your doctor or dermatologist will have to try out different medications before he/she finds the adequate product for you. It would be good if you could bring up the patience for this process as well. In the end you will notice that it was worth the effort.

Acne and sun. More...

Excessive sunbathing can damage the skin. Enjoyed in a moderate way, however, sunlight can be helpful in acne: Sunlight can have an anti-inflammatory influence on the skin, and on a lightly tanned ski, the acne is less visible. Please inform yourselves on the pages "Skin and sunlight" on how to enjoy sunlight in a reasonable and healthy way.   In the learning module "Sunlight", you can read in detail how you can enjoy the sun in a reasonable way.

Take care of your personal wellbeing. More...

Puberty is a time of transition from childhood to adulthood and a time of development of one’s own personality. This is at the same time an exciting and stressful phase in your life, and especially when you have acne episodes it is very important that you develop a positive relationship to yourself. Pursue hobbies and interests, cultivate friendships and other contacts. Sometimes it really helps to speak openly about your situation and your feelings with your family and friends – you will feel less lonely and ashamed: other adolescents are in the same situation and share your feelings. If you feel very bad, it may be a good idea to consult a professional person, for example to talk to a psychologist about your feelings. This may be very helpful.

 

Episode 2

Beach robbers and rednoses

“… suddenly they stood in the forest. It was so dark that they couldn’t see their hands in front of their eyes, nor did they find any trace of the thieves. But suddenly a noise: rustling and the breaking of twigs. They heard the sound of heavy steps approaching them. Tom and Bastian held their breath…”

“Oh, this is all bullshit that I am writing, I don’t have any good ideas,” shouts Max and throws his pen into the white sand of the French bay.

“Oh come on, it’s not so bad,” Paolo tries to console him, “I really like it.”

“No,” Max replies, “How in heaven can I write something really exciting if I never experience any adventures?”

Paolo frowns. “Everybody has some adventures from time to time.”

“You maybe,” Max says frustrated. “You seem to have the words “adventure” and “super hero” written right there on your forehead. But I never have any adventures!” Natalya and Thelma are lying in the sun next to the two boys, listening with broad grins to their discussion.

“Hey, super hero, would you put some sun-protection cream on my back?” Thelma asks Paolo who can never refuse this pretty-eyed girl anything. “Sun-protection factor 50 – isn’t that a bit excesssive?” he asks, looking at the bottle.

“Not everyone wants to have leathery skin like you,” Thelma hisses. “No?” Paolo replies and winks provocatively at her, “Tell the truth – you find it cool, don’t you?” Thelma snatches the bottle out of his hands and gives it to Natalya. “Could you please, Natalya? I think this guy is too busy with other things. And maybe you want to put some of it on, too? I think your nose is looking a bit red already.”

Natalya takes the bottle. “No, thanks”, she says. ”I have already put some on,” she declines because she is afraid that the greasy cream might worsen her acne.

“Mon Dieu! Mon argent, mon portemonnaie…” cries an elderly lady who has just come back to her towel from swimming in the sea. The four young people in the sun rise startled from their towels. “What’s the matter?” asks Paolo who doesn’t speak any French. “She says that her purse with all her money is gone,” explains Max, to the admiration of his companions who hadn’t understood a word. “She thinks she has been robbed. There appears to be a thief who has been stealing on this beach for months.”
“Is that really true?” Natalya asks Max mockingly. “Or have you invented this so as to have a fine horror story to tell?” The others are laughing. “No, I am serious,” Max replies. “Come on, guys, it’s not nice to lose your money, you can’t earn it so easily. Maybe we could do something to catch the thief? And help the lady get her money back?”

The others look at each other. “Not bad”, Paolo says. “Let’s hear your strategy! Go ahead, and we’ll follow you!” Max, who has been standing in the sun, staring up and down the beach, jumps back under the umbrella. “No”, he stammers, “and anyway, I haven’t put on enough sun-protection cream.” Paolo frowns. “Why are you always talking about this bloody sun-protection cream? You are sissies…” This is something Max cannot put up with. He thinks a while and then jumps out from under the umbrella. “I have an idea!”

Max draws his battle plan in the white sand. The others gather around him and listen to his explanations. It is noon. The sun is at the highest position of the day, and the bodies of our four friends barely cast any shadows on the sand. Max talks and gesticulates, the others listen and nod their heads. When they have all understood the plan, they go into action. The girls pick up their airbeds and walk into the water. They act as the lure. The boys hide behind a nearby sand dune . They are in an ideal position to observe the girls and their abandoned bags, and to catch the thief as soon he tries to attack. Thelma and Natalya paddle merrily in the sea. They look so distracted that a thief would have it very easy.

Max and Paolo are lying behind the dunes in the full sun, sweating. Nothing happens. It’s very quiet around them. They stare intensely towards the towels. The heat shimmers upon the hot sand. After a while Natalya and Thelma get tired and return to their towels. Paolo and Max give up. Max’s back burns and is red as fire. Totally absorbed in his role as detective, he has completely forgotten the strength of the sun. Disappointed, they gather at their place again.

“That was not exactly a success,” Max says, his face glowing red. “Maybe we should come back tomorrow morning and try again. The thief will almost certainly attack again very soon.” Paolo agrees. “Yes, let’s go back to the camp. I have had enough, and I have a bad headache”, he says, sounding rather exhausted, which is unusual for him. When the four friends have packed their belongings and pass by the elderly lady, they see her playing quietly and happily with her small dog.

She smiles at them. “This mischievous little devil,” she says, waving her hand in the dog’s direction. “He scared me so much. Didn’t he go and pick up my purse and bury it in the sand like a bone? He is supposed to protect me and find things for me, not pilfer and hide things. I thought a thief had robbed me. But thank God he was so proud he had to show me what he had buried, and so I have my purse back now… What a mischievous little creature!” The lady looks very relieved.

“Oh man,” Paolo and Max moan in one voice. “We lay there in the full sun and the heat for hours, to become the heroes of the camp, and now we find that the thief was a little dachshund, and what do we get?”
“Impressive sunburn,” says Natalya whose nose has become so red that it will glow in the dark. Thelma shrugs and smiles a bit. “Guys, you didn’t want to listen. Sun protection-cream isn’t such a bad idea after all – not just for sissies, but also for superheroes and detectives!”
“But it’s no cure-all either,” giggles Natalya and points to Thelma’s face and shoulders that are very red as well. “Tomorrow we’ll do T-shirt day”, the friends decide, and for a change they all agree with each other.

Interactive

Fit for summer? Virtual sunbathing

Thelma cautiously dabs her red face with a cooling cream. It’s a sunny morning, and it looks as it would become even hotter than yesterday – the day when the four of them caught sunburn because of this silly beach robber story. Thelma is annoyed and mumbles under her breath: "Why do I buy such expensive cream? And Paolo’s malicious grin… he may be red as well, but without having spent so much money for it…". Thelma thinks about what Paolo had said: "Sun protection factor 50?! Isn’t that a bit exaggerated?" "Bloody shit, what I look like – certainly everybody will say this is typical for an English girl…"

"Believe me, you can really get into problems if you believe what the advertisements say: sunbathing without remorse – you got to be kidding! Sunscreen is one thing, but who is as silly as I am and forgets that the sun is strongest around noon – oh my God! But it really is complicated – everybody has a different skin, and it depends where you are and when, and and and… But you don’t believe it before you tried it yourself – but below you can try this out without any danger, namely by means of a simulator… "

		The simulator opens in a new window. Thus you can always switch between this page and the simulator. Access the simulator!
		Are you an expert? Show your knowledge at the simulator! In the following tasks you can test how fit you are for the sun. Task 1 Task 1 Max caught a sunburn during the beach adventure. Probably he used sunscreen with a too low SPF (sun protection factor) or he didn’t repeat the usage of the sunscreen. Which minimum SPF should Max use to be safe against sunburn during the adventure? a) Find out the minimum SPF that Max should use in the preset simulation by changing the level of SPF. b) As you can see, you can get a grip on sunburn. But how about other effects of sunlight? Try out what happens if you don’t stay in the sun so long… c) Now you know which minimum SPF Max should use and how long he may stay in the sun without problems. But what happens when Max goes swimming during that time? Put the button “Swimming” on “Yes” and change the environment from beach to water. Try to vary the SPF as well as the time that Max stays in the sun. What happens? d) Can you now explain why Thelma, in spite of using SPF 50, has sunburn at the end of the story?   Task 2 Task 2 Click on “Reset Properties” in order to return to the default values. Enter the minimum SPF that you found out for Max. a) Does the same minimum SPF apply for Max if he had had the adventure while skiing in the Alps? Find out the new SPF by changing the buttons “Season”, “Altitude” and “Environment”. b) Max doesn’t like to go skiing in his bathing trunks. Change his clothes accordingly and then again adapt the SPF.   Task 3 Task 3 You come to help the four friends during their beach adventure. In the following, you should prepare yourself to avoid skin damages… a) Find out your skin type. Check in the following table: (skin types ) and enter the value in the simulator. b) Find out your ideal sun protection factor (SPF) to be able to stand the given 180 minutes on the beach without getting sunburn. c) Sunscreen is not a “cure-it-all”, as Natalya correctly discovers, and is no guarantee for an absolute protection against UV radiation damages. How can you protect yourself in addition to using sunscreen? For this purpose, reset the SPF back to 1, to make the effects of your measures more visible. Try out different possibilities at the simulator. Find out as well if weather and time of the day play a role in this.
		For the simulator you need the Flash Player. Download the Flash-Player here.
		Everything clear? No? Then read some helpful hints and information here. This will make it easy for you. The Hints and Info section also open in a new window. Thus you will have everything within your view! Press here for the Hints & Info section around sunlight and skin health!

Hints & Infos

The sun is the base of our existence. Without sunlight, there would be no life on our planet – no plants, no animals and no human beings. When, after a rainy or cold period, the first sunbeams meet our skin, we feel simply happy. The sun does our souls and our bodies well. It drives away blue feelings, makes the skin produce vitamin D and thus build up the bones, and it alleviates skin diseases.

Skin forms a border between the internal body and the external world and protects us against various environmental factors, as for example against the ultraviolet (UV) radiation of the sun. In doing so, the skin can unfortunately sometimes suffer damages.
The radiation intensity of the sunlight is often underestimated, may it shine or be hidden behind clouds, and if you expose yourself to natural or to artificial UV light as for example in a solarium. The problem is - you can neither see nor immediately feel UV light. Too much of it is bad for the skin: it can cause sunburn, reactions of hypersensitivity and even skin ageing or skin cancer.

More about ultraviolet (UV-) radiation.

UV radiation does have an impact on the skin. Its strength depends on the individual skin type which is genetically determined. Every person is different, and so is everybody’s skin. Geographical situation, altitude, weather, environment, season of the year, time of the day as well as intensity and duration of the sun bath play an important role in this.

More about: Impacts and Myths.

But don’t worry: if you observe some rules, you will be able to enjoy the sun untroubled. One of the rules is, for example, to stay in the shadow during midday (between 10 am and 4 pm), as these are the hours when the UV values are highest. Another effective measure is to protect the skin with adequate clothing and sunscreen. Learn to assess your personal risk: Which skin type am I? How much sun can I endure without damage? Try to adapt “sun-wise” behaviour - it’s simply a question of attitude. If you are tanned, you are not automatically cool and good-looking. It’s much cooler to be healthy, and that means to have your own “natural tanning”.

More about healthy sun pleasure.

UV radiation

Skin fulfils a number of different functions in the human body. One of them is the protection against external environmental influences, for example against the ultraviolet (UV) radiation.

But what is UV radiation exactly? Within this capter you will find all important information about UV radiation.

 

UV radiation. Sunlight is composed of many different forms of light. Of these, only visible light, heat rays (infrared light) and UV light reach the surface of the Earth. UV light has an impact on our skin. It contains so much energy that it is able to enter the skin, while you can neither see nor feel them. More details about UV radiation...

UV radiation in detail Among UV radiation, we have to distinguish between UV A, UV B and UV C rays. While UV C rays never reach the Earth as they are withheld by the ozone layer, UV A and UV B rays reach our planet and have an impact on our skin. They contain so much energy that they are able to enter the skin, while you can neither see nor feel them. UV B rays for example enter the upper skin layer (epidermis) where they cause tanning and sunburn.

UV A rays can penetrate into a deeper skin layer (dermis). They can cause skin ageing and the so-called “sun allergy”. For the development of skin cancer, both types of rays are responsible, UV B still more than UV A.

UV radiation can be of different intensity. This depends on the season and the daytime. In summer and around noon (between 10 am and 4 pm), it is usually especially strong.

The geographical situation and the altitude play an important role as well. Around the equator, the radiation is more intensive as it hits the Earth vertically. In the mountains and in clear air we get remarkable more UV radiation than in a valley.

Important is as well the surrounding in which we are exposed to the sunlight: snow, water and tarmac strongly reflect the UV light, and this is the reason why sunlight is so intensive on the beach, on the ski slope and when we are swimming in the water.

It’s unfortunately an error to think that a cloudy sky would keep the sunrays at bay. Clouds can weaken the intensity of the rays, but cannot completely stop them. In some exceptional cases they may even intensify the impact of the light.

The so-called UV index shows the intensity of the sunlight.

UV index

The UV index shows the intensity of the UV radiation on a certain day in a certain location.

It starts at 1 and ends at 10. The higher the index number, the higher is the intensity. And the higher the UV index is, the more important it is to apply sun protective measures. The UV index is often published together with the weather forecast in radio, television, newspapers and internet. The given number indicates the maximum intensity at noontime.

As of an UV index of 3 it is recommended to protect one’s skin against the sun by using adequate clothing, sunscreen or simply by avoiding direct sunlight.

Please check here for the UV index of the place where you live: http://www.epa.gov/sunwise/whereyoulive.html.

Impacts

Sunlight and warmth of the sun are, up to a certain level, healthy and make us feel well. Thus, the sun is generally good for humans.

But if the UV exposition exceeds a certain level – a level that may vary from individual to individual – the skin will suffer.

What exactly are the effects the sunlight has on us and our skin?

 

Sunlight supports the production of vitamin D. More...

UV light enables the body to produce vitamin D. This vitamin is very important for the human body: it is essential for the development of the bones. The body does not need large amounts of sunlight, however, to produce vitamin D: 10 to 15 minutes per day on face, arms and hands are sufficient, even with cloudy sky.

Sunlight cheers human beings up. More...

The visible light and the warmth of the sun enhance our mood. Beside the positive feelings a sunny day creates, the sun is having a chemical influence on our mood: messenger substances (like serotonin) are released in our brain that make us feel euphoric and relaxed. No wonder, thus, that every beginning of spring delivers thousands of people from the so-called "winter depression".

UV radiation can be used therapeutically in various skin diseases. More...

UV radiation can be helpful in the treatment of various skin diseases when used systematically. This is called "phototherapy". An adequate UV dose can improve eczema or psoriasis: the light reduces skin inflammations and alleviates or ends itching. It is essential that a doctor or dermatologist determines the adequate dosage of UV radiation. Eczema (also called atopic dermatitis or atopic eczema) Eczema is a specific congenital form of eczema which reacts to specific triggers that do not play an important role in other forms of eczema. Eczema is related to strong itching and usually comes in bouts. The nerves have an important part in eczema. Firstly, the itching is reported to the brain by the nerves, as is the case with pain. Secondly, eczema has also a lot to do with our mind. In eczema, all body regions and all ages can be affected. The inflammatory reactions are usually not based on an allergy but result from completely different causes. From its appearance, it is very difficult to distinguish between eczema and other forms of dermatitis (e. g. allergic contact dermatitis or irritant contact dermatitis).

Sunlight makes us tan. More...

To protect itself against harmful radiation, the skin reacts by thickening the upper skin layer and by tanning. The latter results from an increased production of the skin pigment melanin, a substance produced within the human body. In this way, the energy of the UV radiation is absorbed already on the skin surface and is prevented from penetrating more deeply into the skin. Tanning is actually a warning from the side of the skin! Thus, it’s the normal skin colour that is a sign for health, not the tanned one.

UV radiation can cause sunburn. More...

Excessive sunbathing, if in natural or in artificial UV light, can become visible few hours after sun exposure: you’ll get sunburn. In sunburn, like in a burn by fire, three degrees of burn are differentiated: Degree 1 = Painful reddening, swelling Degree 2 = Development of blisters Degree 3 = Extensive destruction and ablation of the upper skin layer (epidermis) The time in which someone will get sunburn depends on the skin type, and on the duration and the intensity of the sun exposure. The skin only seems to recover from sunburn. Every single sunburn leads to damages in the skin which the body will not be able to repair them completely. This can lead to premature skin ageing or even to skin cancer. But if you protect yourself adequately, you will be able to avoid this.

UV radiation can accelerate skin ageing. More...

Frequent sunbathing accelerates and supports the premature skin ageing visibly. In the short run, too much UV light makes the skin lose humidity, dry out and scale. In the long run, the UV rays lead to a loss in elasticity in the skin and to the development of wrinkles and pigment moles (age spots).

Sunrays can cause skin cancer. More...

The skin remembers every single damage that it has ever carried away from UV radation. Exaggerated sunbathing can lead to skin cancer. There are different forms of skin cancer: in the first group, basal cell carcinoma and squamous cell carcinoma, in the second group malignant melanoma. The first group occurs predominantly in older people and the chances for healing are very good if it is diagnosed early, as it does not spread to other parts of the body. The second group, malignant melanoma, often affects young people, too. This cancer type is more aggressive and more difficult to treat, as it tends to spread to other organs of the body.   The best way to prevent skin cancer is sun-wise behaviour. See more under healthy sun pleasure.

The skin can develop an oversensitization to UV light. More...

Sometimes, the skin reacts very sensitive to UV radiation: it develops skin problems like reddening, blisters and pustules, often combined with strong burning sensations and itching. This can happen for example if the skin is not used to strong sunlight and is called "sun allergy". In the so-called "Mallorca acne", however, the skin reacts to the combination of strong UV radiation and the greases and emulsifiers in the sunscreens. You will get skin problems like in normal acne, with pimples and pustules. There are also some medicines, cosmetics or plants that can, in combination with UV radiation, lead to troublesome skin problems.

All in all, sunlight is necessary for our life, but enjoyed in an excessive manner, it can be harmful – sometimes even in a way that cannot be undone. As a matter of principle, everybody should look into the subject of UV radiation and its consequences.

How someone reacts to UV radiation depends on a person’s skin type or pigmentation type. If the skin of a person is fair or dark is genetically determined.

People with fair skin or freckles, with fair or red hair and blue eyes sunburn rather quickly and often don’t actually get tanned. Darker skin types are less sensitive to sunlight; they rarely sunburn and get a tan more quickly.

Six different skin types (I-VI) have been determined. The most frequent types in Europe are the types I-IV.

 

Please find more information on skin types here. Maybe you want to try to find out your own skin type by using this table?

The skin determines our appearance to a large extent. One of the factors is the skin type or pigmentation type – in short, the “skin colour”.

An American dermatologist developed the following scheme of six skin types in order to allow recommendations for skin protection against the sun.

Skin type 1
		Characteristics: Very fair and extremely sensitive skin with freckles Fair eye colour and ginger hair No tanning and mostly sunburn (after 10 min without protection) Protective measures: Avoid sunburn, better remain in the shadow (especially between 11 am and 3 pm) Use hat with neck cover, adequate clothing and sun glasses with 100% UV protection Use sunscreen with high protective factor ( min. SPF – sun protective factor - 30) Protect especially well nose, ears, lips and neck
Skin type 2
		Characteristics: Fair and sensitive skin, often freckles Fair eye and hair colour Slow tanning and mostly sunburn (after 20 min without protection) Protective measures: Avoid sunburn, better remain in the shadow (especially between 11 am and 3 pm) Use hat with neck cover, adequate clothing and sun glasses with 100% UV protection Use sunscreen with high protective factor ( min. SPF 25) Protect especially well nose, ears, lips and neck
Skin type 3
		Characteristics: Skin average fair, fair or dark eye colour, brown hair Simple and slow tanning, often sunburn (after 30 min without protection) Protective measures: Avoid sunburn between 11 am and 3 pm Wear hat and sunglasses Use sunscreen with at least SPF 15 Protect especially well nose, ears, lips and neck
Skin type 4
		Characteristics: Brownish and little sensitive skin Dark eyes, dark brown or black hair, Quick and deep tanning, sometimes sunburn (after 45 min without protection) Protective measures: Wear hat and sunglasses Use sunscreen with at least SPF 15 At the seaside and in the mountains, protect well lips and neck
Skin type 5
		Characteristics: Dark and little sensitive skin Dark eyes, black hair Rarely sunburn (after 60 min without protection) Protective measures: Wear hat and sunglasses Use sunscreen with at least SPF15 At the seaside and in the mountains, protect well lips and neck
Skin type 6
		Characteristics: Black and little sensitive skin Dark eyes, black hair Very rarely sunburn (in 90 min without protection) Protective measures: At the seaside and in the mountains wear hat and sunglasses Protect lips well Use sunscreen with at least SPF 15 After a longer time without sun exposure, also dark skin can develop sunburn after prolonged sunbathing

 

 

 

Myths

A lot of paper has been filled on the subject sun and sunlight. But not all information around this is correct.

Many people believe, for example, that tanned skin is not only especially beautiful but also especially healthy. This is actually an image that prevails today in Western societies. But this doesn’t make it true. Tanning is a warning signal of the skin. Skin that is really healthy has a natural colour.

Many people who know that too much UV radiation is not healthy, or who long for light and warmth on grey and cold days, decide to go to a solarium. But even if the radiation in the solarium is artificial, it is not less dangerous.

Also the so-called "pre-tanning" before vacation or before midsummer, in a solarium or through self-tanning creams, is no improvement in terms of protection against sunlight. The norm for your behaviour should be how much sunlight your skin can endure without getting burnt.  You should take protective measures according to your individual skin type, that’s the most important thing.

People with darker skin may believe that the sunlight will not hurt them and that only fair-skinned people have to care about skin protection. But that’s not true at all. Dark skin types can become sunburnt as well if they exaggerate sunbathing – it only takes a bit longer with them.

Protection against the sun is also not something you should think about only on sunny, cloudless midsummer days, in the way of: no sun, no UV radiation - no danger. The opposite is the case: 80% of the UV radiation manages to get through the clouds. In winter, snow reflects the sunlight, thus you can become sunburnt even in the cold season. It is recommendable to always be aware of the UV index: it indicates the UV values per location.

If you think: "Oh, come on, what damage does a sunburn here and there", you are mistaken: skin never forgets.

healthy sun pleasure

The many nice sides of sunlight may make forget the shady side of it. Protection against the sun is very important, and everybody can do something.

With the right behaviour and a sensible attitude you can enjoy the beautiful sides of the sunlight and protect yourself against its negative effects.

If you follow the hints below, you will be on the sunny side of it!

Change your attitude and prefer your natural skin colour. More...

Many people in Western societies find extended sunbathing in the middle of the day completely normal and consider tanned skin a sign of health and beauty. This should be challenged: isn’t it that only healthy skin with a natural tan is beautiful? The awareness that there exist various skin types and that everybody should be happy with his or her natural skin colour is the first step into the direction of “sun-wise” behaviour. Even many prominent people have become aware of this: If you look at them thoroughly, you might notice that only few of them look darkly tanned. More information about skin and beauty: formerly, nowadays and elsewhere Our skin determines our appearance: One person has rather dark skin, another person numerous freckles and so forth. There have always been different notions of what is beautiful. The beauty ideal and with it the skin colour of beautiful people, depends mostly of the culture in which we live and its beauty ideal. In our western society today, those who are tannend are often considered beautiful and healthy. This has not always been the case: there were times when bright skin was considered particularly beautiful. In the Middle Ages and the Renaissance for instance, "gentle paleness" was considered a sign of beauty and especially of wealth: those who had bright skin could "afford" to make others work for them. Those who were tanned had to earn their living through hard work (e.g. field labour). Similar to some people who use the solarium today in order to conform to the tanned beauty ideal, people then tried to avoid the sun as much as possible. Also, they treated themselves with various tinctures which brightened up the skin. Those agents often were rather unhealthy. It has not been the case for long that tanned skin has been considered particularly healthy and beautiful. For the first time tanned skin was desirable in the 1920s, with the following thought: Those who are tanned can afford to go on holiday or have enough leisure time which can be spent outdoor instead of sitting in the office. In the light of the many skin cancers, these views are changing at some places and a tendency towards natural skin colour becomes accepted again. These developments apply especially for industrialised countries. In other cultures, different views prevail. People there want the exact opposite: In Africa and Asia a skin as bright as possible is a sign of beauty and also of wealth and success. Some African and Asian people use cremes which are brightening up, in order to conform to their culture specific beauty ideal und thus hope for better opportunities in the future - job-related and personal. This brightening up of the skin is not always safe. Many can only afford cheap (often illegal) products, which often contain dangerous or prohibited ingredients und harm health.

Avoid sunburn. More...

Avoid sunburn The best protection against UV radiation damage on the skin is to avoid sunburn and not to expose oneself to sunlight too much. Our skin never forgets.

Wear protective clothing and sunglasses. More...

Adequate clothing is a good protection against UV radiation. Among these should be a hat or cap with a wide brim, which protects eyes, ears, face and neck. Tightly woven, loose fitting and possibly long clothes offer optimal UV protection. Furthermore sunglasses with standardized UV filters are recommended.

Apply sunscreen. More...

Sunscreen is another measure of UV radiation protection. Best apply it generously to your skin about 30 minutes before going into the sun, so it can develop its full effect. Sunscreen should contain UV A and UV B protection. The so-called "sun terraces", i. e. face, ears, shoulders, neck, the back of your hands and feet, should be protected with special care. If you want to go swimming, apply a water-resistant sunscreen. It helps to repeat the application of sunscreen, but be careful – this doesn’t extend the protection time, it only keeps the protection up. Please be aware to use the adequate protection factor (SPF: Sunlight Protection Factor). It depends on your skin type, but should never be lower than 15. But be careful: sunscreen does not grant total protection against skin damages from UV radiation, and it’s not a free ticket for limitless sunbathing!

Avoid the sun, seek shadow. More...

UV radiation varies in intensity depending on the time of day and year and on geographical location. Avoid the sun especially at midday (between 10 am and 4 pm). During these hours, the sun shines down on Earth in a right angle and is therefore especially strong. At that time, you might better want to seek shadow. In the mountains, on the beach and in the water, special attention is recommended – but that doesn’t mean that you are out of danger in the schoolyard or on the balcony.   The best way is to consult the UV index for the intensity of the UV radiation.

UV index The UV index shows the intensity of the UV radiation on a certain day in a certain location. It starts at 1 and ends at 10. The higher the index number, the higher is the intensity. The higher the UV index, the more important it is to apply sun protective measures. The UV index is often published together with the weather forecast in radio, television, newspapers and internet. The given number indicates the maximum intensity at noontime. From UV index 3 it is recommended to protect one’s skin against the sun by using adequate clothing, sunscreen or simply by avoiding direct sunlight.   Please check here for the UV index of the place where you live: http://www.epa.gov/sunwise/whereyoulive.html.

Apply protective measures at any time. More...

You can get sunburn everywhere: during an excursion, at home on the balcony or on the schoolyard during break. Thus, protection against the sun makes sense everywhere.

Avoid artificial tanning. More...

Solariums or tanning parlours are not an alternative to healthy tanning. Every UV radiation, be it artificial or natural, can damage your skin. That is why you should avoid the use of tanning parlours or sunlamps. They are not even really convenient as "holiday preparation" as the body’s own protection against UV rays is not increased by them. This is also true if you try to tan by using chemical tanning creams.   By the way: the European Union discusses to prohibit the use of solariums by children and adolscents under the age of 18. Maybe you find this more understandable after having read these observations?

Find out your individual skin type and take adequate protective measures. More...

Find out your individual skin type and take adequate protective measures. The most important criterion in sun protection is the skin type. Depending on this, your skin will notice the negative effects of UV radiation sooner or later. That’s the reason why the protective measures should be adapted to the individual skin type. The brighter the colour of your skin, the shorter is the time you can stay in the sun without risking sunburn. Therefore, people with bright skin have to apply more skin protection than people with dark skin. You can find more information on skin type here. If you want, you can judge your own skin type using the table.

The skin determines our appearance to a large extent. One of the factors is the skin type or pigmentation type – in short, the “skin colour”.

An American dermatologist developed the following scheme of six skin types in order to allow recommendations for skin protection against the sun.

Skin type 1
		Characteristics: Very fair and extremely sensitive skin with freckles Fair eye colour and ginger hair No tanning and mostly sunburn (after 10 min without protection) Protective measures: Avoid sunburn, better remain in the shadow (especially between 11 am and 3 pm) Use hat with neck cover, adequate clothing and sun glasses with 100% UV protection Use sunscreen with high protective factor ( min. SPF – sun protective factor - 30) Protect especially well nose, ears, lips and neck
Skin type 2
		Characteristics: Fair and sensitive skin, often freckles Fair eye and hair colour Slow tanning and mostly sunburn (after 20 min without protection) Protective measures: Avoid sunburn, better remain in the shadow (especially between 11 am and 3 pm) Use hat with neck cover, adequate clothing and sun glasses with 100% UV protection Use sunscreen with high protective factor ( min. SPF 25) Protect especially well nose, ears, lips and neck
Skin type 3
		Characteristics: Skin average fair, fair or dark eye colour, brown hair Simple and slow tanning, often sunburn (after 30 min without protection) Protective measures: Avoid sunburn between 11 am and 3 pm Wear hat and sunglasses Use sunscreen with at least SPF 15 Protect especially well nose, ears, lips and neck
Skin type 4
		Characteristics: Brownish and little sensitive skin Dark eyes, dark brown or black hair, Quick and deep tanning, sometimes sunburn (after 45 min without protection) Protective measures: Wear hat and sunglasses Use sunscreen with at least SPF 15 At the seaside and in the mountains, protect well lips and neck
Skin type 5
		Characteristics: Dark and little sensitive skin Dark eyes, black hair Rarely sunburn (after 60 min without protection) Protective measures: Wear hat and sunglasses Use sunscreen with at least SPF15 At the seaside and in the mountains, protect well lips and neck
Skin type 6
		Characteristics: Black and little sensitive skin Dark eyes, black hair Very rarely sunburn (in 90 min without protection) Protective measures: At the seaside and in the mountains wear hat and sunglasses Protect lips well Use sunscreen with at least SPF 15 After a longer time without sun exposure, also dark skin can develop sunburn after prolonged sunbathing

By the way: It is a good idea to check your skin regularly. Should you see anything unusual on it like a painful or changing mole, you should better consult a doctor or dermatologist and get some advice on what to do.

 

Here you will find some hints on how to do a self examination.

Self examination Skin cancer is the only form of cancer that is visible from the outside. Thus it can be noticed more easily and earlier than other cancer types. In the case of developing the disease, early recognition increases the chance for healing. For this reason, you should see your doctor or dermatologist once a year for a skin screening, and you should check your skin yourself thoroughly from head to feet once in three months. One of the types of skin cancer, for example, appears as raised and palpable nodules on the skin surface and as rough skin areas. The "ABCDE rule" helps to identify the first signs of malignant melanoma. With the help of this rule, please examine your whole body for moles and dots that show the following characteristics: A = Asymmetry: Does the pigmented mole have an irregular form? B = Border: Does the mole have a rough, ragged, uneven border or does it look as it would "leak out"? C = Color or coloration: Does the mole have a varying pigmentation? D = Diameter: Does the mole have a diameter larger than 5 mm? E = Elevation and evolution: Does the mole feel raised and palpable? Does the mole change in the course of time?

Episode 3

The secret door

At the end of an exhausting day with beach running and a volleyball competition, our four friends decide to enjoy a quiet and cosy evening at their secret meeting point. They pick up blankets, torches and provisions and creep through the forest to the old villa.

They walk around the old building and climb through the small back window as usual, when suddenly Paolo makes a discovery. “Look here, guys,” he says, “There is a door behind this green stuff. Let’s check if we can use this!” Max, Thelma and Natalya stop and direct their torches on the old wooden door hidden behind the overgrown ivy. Paolo pushes the plants aside and fights with the door. With a creaking noise, it finally opens. The four friends look inside. In the light of their torches, they see an open trapdoor and stairs leading downwards. This is a part of the villa the four friends have never been in. “These steps don’t look reliable,” hesitates Max. “Should we really go? Maybe the wood will break…” Paolo takes his torch and steps forward. “Don’t make such a fuss, “ he says resolutely, “we’ll go in there and see what’s in the basement.

Who knows what the landlord hid there? Maybe we’ll find a treasure?” “A treasure, oh, oh,” says Natalya, “more likely some old books and cobwebs.” She is not really fond of this idea and fears  encountering lots of spiders and centipedes. Nevertheless, the four friends cautiously descend the squeaking steps and go around a corner to enter an old study. They look around with wide eyes. The walls are covered with shelves and the shelves with dusty books, and in the middle of the room there is a large old wooden desk covered with notebooks, sheets of paper and cobwebs.  The four friends look around curiously.

“Oh, look what I’ve found!” Thelma picks  a pair of earrings with green stones out of a little bowl. She puts them to her ears. “Do they look nice on me?”
Max looks aghast. “You can’t just take them like that. That’s stealing!”
Thelma shakes her head. “Who said anything  about stealing? I am just trying them on. Nobody says I’m taking them. Aren’t they nice?” Paolo admires the earrings while Max and Natalya glance at each other and shake their heads. 

On the wall behind the desk full of piles of dusty papers and old books they discover a certificate in a dark frame. It is so dusty that the letters are very difficult to read. Max is wiping his sleeve across the glass to clean it, when Paolo sneezes violently, and unintentionally clears the layer of dust off the glass. “Thanks, Paolo, very helpful,” jokes Max. “You’re welco-o-ome,” stammers Paolo and has to sneeze again. Max smiles amusedly and offers Paolo a handkerchief. “Allergic to dust, are you?” He points his torch at the certificate and starts to read:” Certificate to honour the special merits in  Allergy Research at the University of Montpellier … we grant the title of Doctor Honoris Causa to Professor Dr. Marie Prurit.” 

Max stops for a moment. “Prurit? That’s French and means – atishoo!” Now Max starts sneezing as well. “That means Atishoo?” Paolo asks disbelievingly. “Our researcher is a woman and is called Atishoo?” The girls burst into giggles. “No, no,” explains Max who has recovered from his sneezing bout, “Prurit is a French word and means itching.”

“Talking of itching,” says Natalya and turns to Thelma,” I would be careful about using other people’s earrings. A friend of mine recently brought back some earrings from vacation. She didn’t know that she is allergic to nickel. After only a day, her ears were red as fire and itched like crazy. Mrs. Prurit would have been very interested!” Thelma touches her ears and hesitates. “Nonsense, these are not made from nickel.”

“But you might be allergic to stolen earrings,” Max emphasizes again. “Or maybe it’s an old family heirloom and a curse rests upon it…” Thelma suggests dreamily but  decides to keep the beautiful earrings on for at least the rest of their time in the villa.

“What kind of research did the lady do?” Paolo asks Max who is carefully studying the faded document. “Allergies and Dermatitis,” Max reads aloud.
“Allergies and what?” asks Thelma. “Dermatitis? What is that? Is that a kind of swelling?” “Yes,” says Max, “like your ears very soon probably, if you have a nickel allergy like Natalya’s friend”.
“Shh,” says Paolo, “could you be serious for a second? There is something like a title on this paper: “Facts and Myths about Dermatitis” it says, but the rest of the sheet is missing, what a pity. Let’s look at the other papers around here, maybe we can find out more about it…”

Bang! A terribly loud noise makes them freeze. “The trapdoor, the trapdoor,” laments Natalya. “I knew it was a bad idea. Now we are trapped in here and will never see our homes again and will  starve and die here...”  The others signal her to be quiet and listen motionless.

Through the basement window they see someone walking in the garden with a torch. It looks like a young man and he shouts in French: “Hello, is there anybody around?” Paolo gives Max a little push, who takes a deep breath and answers loudly: “Yes, in the basement. We are just four young people from the summer camp. We are not thieves, and we haven’t done anything!” They hear the slamming of the trapdoor and then steps in the hall. A black-haired young man with a narrow,  tanned face appears in the door to the study.

“Ah, you four, hello, “he says, in a tone that’s  not unfriendly. “This villa attracts kids from the summer camp every year, it’s like magic. It literally seems to call them.” The four friends look down in front of them embarrassed. “I’m Henri,” the young man continues when nobody speaks, “Henri Molé. I’m the owner of this house, but unfortunately I have no money to have it renovated. That’s why it looks as it does. My great-grandmother lived and worked here.”
Max is curious. “Your great-grandmother was this famous professor? We saw her certificate over there on the wall.”

“Yes, that’s her. But now back to business. You’ll understand that you cannot simply enter other people’s houses and labs, and use their belongings and things… and earrings,” he looks at Thelma. Thelma, blushing deeply, takes off the earrings and puts them back in the bowl where she found them. Henri looks at her seriously. “They wouldn’t be good for you anyway. You wouldn’t be the first person to react to them with a nickel allergy.” Natalya looks around proudly – hasn’t she been on the right track with her warning?

Paolo seems to regain confidence as well. “Are you following your great-grandmother’s footsteps?” Henri nods. “Yes, I am trying to. I study medicine at the University of Montpellier. But now you guys should get going and leave. I’ll turn a blind eye on this occasion and won’t tell anybody, but please don’t enter the villa again. However… you may go on using the veranda!”

Interactive

Investigating dermatitis – The adventure

Max is certain: the laboratory in the basement of the villa was a real adventure. Neither Natalya’s “inner horror story” nor the beach robber story left such an impression and so many new ideas in his head like the secret door and the old scientific tools of Madame Prurit. "I could make something of that, maybe a fantasy or mystery story”, Max thinks, “… like in a computer game…".

Max can see it right before his eyes: old and dirty books, covered by inches of dust; the old desk, a layer of cobwebs on it and the old notebook with nearly unreadable remarks; the unsorted packs of papers and huge piles of books; the certificate on the wall, so dusty that it’s nearly not readable any more.

An ideal situation for a mystery story having to do with myths and meanders in medicine! Does this also make you curious about some mysteries in the basement? Get started now!

		The adventure opens in a new window. Thus you can always switch between this page and the adventure. Click here to acces the adventure!
		For the adventure, you need the Flash Player. Download the Flash-Player here.
		Everything clear? No? Then read some helpful hints and information here. Then it will be very easy for you. The Hints and Info section also open in a new window thus you’ll have everything within your view! Press here for the Hints & Info section around dermatitis!

Hints & Info

We all have dry skin from time to time. This is completely normal, as our skin has to cope with a lot of influences during the day. Usually the skin recovers quickly, so we don’t pay much attention to smaller irritations. But sometimes the skin problems occur so often or continue for such a long time that we feel disturbed and constrained by them. Such skin problems, often simply described as “dry skin”, can lead to the so-called dermatitis.

Skin that appears dry is just one symptom of dermatitis, however. Dermatitis is an inflammation of the upper skin layers and can produce itching, small blisters, fine fissures and skin swelling. These symptoms can, of course, be very troublesome and disturbing, and skin problems of that type can have a serious impact on your career choice and your personal contacts.

More Info here: Definition and Consequences.

A number of people have inherited the predisposition to develop dermatitis from their parents, but they don’t occur to the same extent in all affected people. Dermatitis can also result from various internal and external causes, for example substances one has contact with, or an allergy.

More Info here: Origination and Myths.

For this reason, it is a good idea to become active before your skin problems become serious. The more you know about the causes of and remedies for dermatitis, the better you can do something to take care of your skin. Important activities are to avoid irritating substances and allergic triggers, to apply optimal skin care and skin protection measures and to receive specific medical treatment.

More Info here: Protection and Treatment

Nobody has to endure dematitis passively. There is a lot you can do to avoid this skin condition or at least ease it remarkably.

Definition

Many of you will have heard or read the term “dermatitis/eczema” in magazines, television or internet. But most people are not sure what this word exactly means.

Dermatitis is very often related to itching and dry skin, but can show a range of other symptoms as well.

 

Dermatitis is an inflammation of the upper skin layers. The inflammation leads to the appearance of small blisters, which are itching and are visible as small red dots. If these blisters become or are scratched open, a clear fluid – lymph - is discharged. After that, the skin dries out and scales off.

If you examine your hands thoroughly, you may find some areas with the described skin condition. These “mini dermatitis” are usually not very troublesome, but they may start to trouble you when larger skin regions are affected.

Here you find a few images of forms of dermatitis for illustration:

The hands are frequently affected, as they are exposed to a high number of different strains. This is not astonishing if you imagine what your hands touch during the day! In the morning, you wash your hands and use water, detergent and a towel. Then you prepare and eat your breakfast, touching plates, cutlery, bread, cheese, milk, cereals etc. If you go to school by bicycle, you get in contact with your keys, the metal of your bicycle, the leather or plastic of your school bag; and at school you’ll touch paper, pencils, books etc.

Dermatitis can occur at any age. In babies, it tends to appear in the face, in working people on the hands, and in older people the skin of the body is often generally dry and shows some changes in skin condition.

Consequences

Dermatitis can be experienced as more or less troublesome. That depends on the seriousness of the medical condition. If you just have a slight itching at the earlobe combined with a light reddening, you will probably not pay much attention. If you have serious skin lesions with oozing wounds, strong itching and swellings, this will be quite different.

The afflictions can be rather constrictive. Reddening and itching can persist for a long time. The longer the problems persist and the stronger the sensations are, the more you will feel restrained in your normal life.

Dermatitis can appear on all parts of the body and will cause uncomfortable sensations. On body parts visible to our environment (hands, face) or used in our everyday life (hands), the impairment will feel especially strong. Above all, our hands are very important tools to get in contact with the rest of the world.

For illustration here are images of dermatitis on different parts of the body:

Hand dermatitis is particularly unpleasant. In addition, we cannot really hide our hands under our clothing. This would look quite unusual. Therefore, our skin lesions are visible to everyone. More information...

Hand dermatitis

If the skin of the hands is swollen, irritated or thickened and cracky, the skin nerves located under these skin parts cannot take in the signals of touch or only in a changed form. You may have a sensation of having a layer of dry soil to be glued to your hands. As this dry layer is not elastic, you will not be able to move your fingers well, neither can you really feel anything if you touch objects.

When a person has stronger skin problems, he or she avoids direct skin contact to other people. If you touch someone (e. g. when shaking hands), the dry hand feels like a grater. That is the reason why skin contact to friends and other contacts are often avoided without any other necessity.

 

 

Origination

Human skin is very robust, but also very sensitive. It reacts to external factors like heat, cold, dirt, and to internal factors, like stress, food and illnesses.

Everybody may react differently to these trigger factors, and a part of this reaction is inherited from one’s parents. If the barrier function of the skin is impaired, dermatitis can develop, depending on the personal and genetic disposition. Dermatitis can also be related to allergies.

The following factors contribute to the development of dermatitis:

Internal (endogenous) triggers

The way our skin feels, healthy or ill, depends among other things onto processes, that happen inside our body. Those processes also influence the development of dermatitis. The development of dermatitis may for example be influenced by genetic factors; it can befamiliy-related. Furtheron dermatitis may also be affected due to our wellbeeing (e.g. fear, stress) or an illness like a flu. For more information about the internal triggers that may cause dermatitis just see the following Abschnitt.

Genetic factors. More...

The genetic predisposition to react to the various dermatitis triggers plays an important role. If someone has a genetic (inherited) disposition to show dermatitis, this is called “atopy”. Dermatitis that develops in this situation is called "eczema" or “atopic eczema. Many people have this disposition unknowingly. Besides the increased probability for eczema, it also increases the probability to develop so-called atopic diseases, e. g. hay fever. The inflammations can also change location and move from the skin to the respiratory tract (asthma) or other mucous membranes (running nose, irritated and streaming eyes).

Eczema Eczema (or atopic eczema) is a specific congenital form of dermatitis which reacts to specific triggers that do not play an important role in other forms of dermatitis. (Atopic) Eczema is related to strong itching and usually comes in bouts. The nerves have an important part in eczema. Firstly, the itching is reported to the brain by the nerves, as is the case with pain. Secondly, eczema has also a lot to do with our mind. In eczema, all body regions and all ages can be affected. The inflammatory reactions are usually not based on an allergy but result from different causes. From its appearance, it is very difficult to distinguish between eczema and other forms of dermatitis (e. g. allergic contact dermatitis or irritant contact eczema).

Mood. More...

The skin is subject to constant changes. Many body functions have a remarkable impact on the skin condition and on this replacement scheme. Among these body functions are for example the menstrual cycle in girls and women, the hormonal metabolism in general, developments like ageing, which is related to the loss of elasticity of the skin, and individual events like infections and stress. All these factors trigger the discharge of substances within the body, their transport to the skin by the blood circulation and the skin’s reaction to this. These inner factors can be especially important for the course of eczema. More...

Eczema and the mind The main triggers in eczema are of endogenous (internal) character. Among them, the mind is the most important factor, that means our mental wellbeing. Mind and eczema can influence each other in a “vicious cycle”. Effects of the mind on eczema Every kind of mental stress can have an impairing influence on the skin. Mourning a break-up, homesickness, exam nerves, a job interview, conflicts with friends – all this can suddenly cause itching. This reaction can be explained as follows: our nervous system influences the immune system, which causes an intensified inflammatory reaction. Effects of eczema on the mind Just as our mind has an impact on eczema, eczema also has an impact on our mind. During an acute episode, the skin discharges inflammatory substances (“mediators”) that travel through the blood system into the central nervous system (brain, spinal cord). During an episode people suffering from eczema may therefore be particularly sensitive, irritable and restless. The inner restlessness that may accompany strong itching may lead to lack of sleep. This increases irritability and the capability to deal with stress goes down: small events can lead to tensions and aggravate the condition. The lack of sleep can lead to reduced concentration at school and work and reduce performance, which causes additional potential for conflict. Changes in visible parts of the body, especially in the face, can have negative consequences: the reaction of the people around you (curiosity, astonishment, sympathy etc.) can lead to social withdrawal. Looking into the mirror can become a nuisance. Patients can be seen as principally introverted, withdrawn or little outgoing, while this behaviour has nothing to do with their general personality but is simply caused by their health condition. Eczema can literally “work on your nerves".

External (exogenous) triggers

The condition of our skin is also influenced by external triggers which are also able to evocate dermatitis. Those triggers include beside climatic conditions (heat, Cold, dry and humid air) mainly different substances which may get in contact with our skin.   Concerning substances that provocate dermatitis one makes a difference between (strongly) irritation substances and allergens which cause allergies. For more information about external triggers causing dermatitis read the following paragraphs.

Skin irritation substances. More...

The external world challenges our skin permanently as well. Long-term cycles like the seasons of the year or short-term factors like the contact with irritating or drying substances (intensive contact with water, chemical substances like solvents, permanent wave) can change the skin condition remarkably and trigger dermatitis. In this case, the genetic factor is not predominant. A dermatitis that is caused strongly by irritation and abrasion or wearing is called irritant contact dermatitis.

Irritant contact dermatitis (subtoxic cumulative dermatitis) Irritant contact dermatitis is neither triggered by an allergy nor does genetic disposition play an important role. The term “wearing dermatitis” explains a bit better what the cause of this skin condition is. Contact dermatitis develops when the skin is irritated by an aggressive substance. With a certain dosage and exposure time, any person would develop contact dermatitis. “Subtoxic” means that the substance is not strongly irritating for the skin (= “toxic”) but only “slightly irritating”. “Cumulative” expresses that the frequent (=cumulative) contact with a substance causes the skin condition. The most frequent trigger substances for subtoxic cumulative contact dermatitis are water, soap, shampoo, cleaning substances, acids, bases and solvents. A mechanic skin irritation like rubbing can aggravate a skin lesion additionally. Affected by this type of dermatitis are especially persons that have to deal regularly with skin irritating substances, e. g. in the household, in the medical field by regular hand washing, and hairdressers. As it is often not easy to classify dermatitis according to its appearance, it may become necessary to do some allergy testing. In addition, the skin irritability can be tested by bringing a slightly irritating substance onto the skin and observing the reactions. Therapy includes the reduction or avoidance of contact with the irritating substances, careful skin care and, if necessary, the use of protective gloves in certain activities.

Allergies. More...

Allergies Allergies form a very specific form of influence on the skin condition. The number of allergies has strongly increased in the past decades. Allergies are skin reactions to natural substances (polls, cat hair, latex) or artificial substances (hair dyes, soap). As soon as the immune system has become contact with the substance classified as alien, e. g. when inserting an earring into the earlobe, a chain reaction is unleashed: as defence against the intruder, the skin area swells and reddens. Specific allergies are not inherited, but what you may inherit is the increased risk to acquire allergies in the course of your life. But the way your body reacts (which chain reaction it produces) is genetically determined. Allergies are a reaction that the body “learns” in the course of life. They can also change the location of reaction. There is also one form of dermatitis which is basically caused by an allergic reaction: so-called allergic contact dermatitis .     Medical scientists differentiate between an immediate reaction type and a late reaction type. The names indicate that, in the case of an immediate reaction type, the reactions occur immediately after contact with the allergen (e. g. hay fever), while in the late reaction type they occur some time after the contact (hours to days).

Allergic immediate response (type I allergy) The allergic immediate response (type I allergy) is the prototype of an allergic reaction. It appears seconds to minutes after contact with the allergen. The triggers are mostly natural substances. Typical examples for this allergy type are hay fever (running nose), allergic asthma (dyspnoea, coughing) and the anaphylactic shock following insect bites (anaphylactic reactions). The most frequent trigger substances in the immediate allergic reaction type are grass and birch pollen, house dust mites, mould and cat's hair. Type I reactions can be determined by a prick test, laboratory tests and a thorough evaluation of the patient history. In a prick test, the suspected trigger substance is placed onto the skin and the skin is slightly pricked. The response is controlled after 20 minutes.

Allergic late response type (type IV allergy) The allergic late response type (type IV allergy) is the cause of contact allergies of the skin. This type is a reaction to substances that get in contact with the skin directly (e. g. nickel in jewelry; cosmetics), by the air (perfume, fragrances, solvents), or by oral intake through the blood system (medication). In type IV allergies, the reactions appear only after hours to days. Type IV reactions are determined by a so-called “patch test”. The suspected trigger substances are placed in very low concentrations on the back of the patient under a plaster. After 2 to 3 days the doctor controls if dermatitis has developed.

Allergic contact dermatitis The allergic contact dermatitis is usually the result of a type IV allergy (allergy of the late reaction type). The immuno-competent cells must have had contact with the triggering substance at least once. When an allergy develops (this is called “sensitization”), specific immuno-competent cells “save” the “data” of this substance and define it as dangerous for the body. As soon as the body, after this sensitization, gets exposed to this substance again, the substance is identified on the base of the “saved data” and the defence reaction is initiated. The consequence is allergic contact dermatitis with reddening, blisters and itch. Such an allergy usually develops in the course of years. In exceptional cases, a sensitization can also emerge within 7 to 10 days. Important to know: the “data storage” will never be emptied again in life; an allergy will persist for the rest of your life. These are the most frequent trigger substances for allergic contact dermatitis: metals (especially nickel, very often contained in costume jewellery, metal buttons, belt-buckles, belt-eyes etc., then cobalt and potassium-dichromate), additives used in rubber production, cosmetics (fragrances, additives), medicines, disinfectants, e. g. formaldehyde, epoxy resin (e. g. used in the plastics and electrical industry). With the start of a vocational career, occupation related substances start to play an important role. In children and adolescents, an increasing number of allergies to henna tattoos can be found nowadays. The trigger substance is not the henna itself but p-Phenylenediamine (PPD), a chemical colouring substance that is often added to the henna to increase colour intensity and stability.

 

Myths

The less we know about diseases and health problems, the more insecure we feel in dealing with them. In addition, there are a lot of myths about dermatitis which we should know to find our way when looking for information and help:

Dermatitis is not infectious. It cannot be transmitted from an affected body area (e. g. the hands) to a healthy body area (e. g. the face) by touching. And you can’t get it by handshaking with someone who has hand dermatitis. If you have dermatitis, you don’t have to fear that you might transmit it to other people; dermatitis does not work this way.

Even less is poor skin hygiene the reason for dermatitis. On the contrary – too intensive or wrong skin care can even cause it. If your skin gets in contact with water too intensively, the skin dries out, even when you add oily bathing or showering substances.

Dermatitis is not necessarily a chronic skin condition that you can’t get rid off any more. You may keep the disposition for dry skin for the rest of your life, but dermatitis disappears again very often or occurs in some situations and/or in specific body areas only.

Food is seldom playing an important role in the development of dermatitis in adolescents and adults. Some people react allergic to certain foods, and they will have to avoid these triggers in the future. If an “allergy vaccination” (desensitization) can be undertaken, the allergic reactions will diminish or completely disappear in the course of treatment.

Protection and treatment

Dermatitis tends to take a very varying development and rarely persists without phases of healing in between: that means, dermatitis occurs in bouts or episodes.

There are a number of possibilities to prevent the occurrence of dermatitis or to keep the inflammations as mild as possible. This is something everybody can do.

The measures must be chosen according to the causes and triggers of the skin condition on one side and according to the occurring skin problems on the other side.
Everyone who has dermatitis or wants to protect his or her skin against developing dermatitis can take several measures, and often it is a good idea to combine them.

Please find some hints below:

Avoid possible or already known trigger factors. More...

It is very important to avoid strong trigger factors. In most cases, it is easy to detect which influences dry out the skin.. The most frequent cause is water (washing, showering). That doesn’t mean, of course, that you shouldn’t wash any more. But it might be recommendable to reduce the frequency of water exposure and to use mild detergents. The water contact should also be as short as possible. For that reason, showering is encouraged more than bathing. The detergents should be chosen according to your skin type and condition. Please use only detergents that have about the same pH-value as the human skin (5.5 on the pH scale). They are called pH neutral detergents. This will avoid damage to the protective skin layer. If you know your allergic triggers, please avoid them (e. g. costume jewellery). For many triggers this is possible, but for others you may need professional support (physician, nutritionist) to be successful.

Apply adequate skin cleaning and skin care. More...

If you already have dermatitis or want to avoid getting it: adequate skin cleaning and skin care are important measures to keep your skin healthy and to alleviate the consequences of skin problems. Intensive water exposure makes the skin dry and can lead to dermatitis. Therefore it is recommended to avoid intensive water exposure (e. g. bathing for longer than 15 minutes). Shorter water exposure is to be preferred (e. g. showering). Additives with a slight conditioning and moisturizing effect lessen the drying-up of the skin produced by water contact. It is a good idea to use conditioning products with as few ingredients as possible, to reduce the possibility to become allergic to or irritated by one of them. The best choice in skin cleansing products are mild synthetic detergents. Their pH value should be around 5.5, corresponding to the pH value of the human skin, to avoid damage of the protective skin barrier. It is important to use skin cleaning and care products you feel comfortable with: you should find them relaxing to your skin and notice a reduction of your itching or skin dryness. And they should be adequate to your skin type and condition, especially regarding their fat content: in summer and with warm weather, highly greasy products are usually experienced as uncomfortable, the skin feels clammy and “closed” then. In winter, when the heating dries up the air anyway, greasy ointments can be much more welcome.

Take care of your dermatitis. More...

Has dermatitis occurred anyway, there are various substances available to soothe the skin. Beside the pharmaceutical agent, the lipid content of the cream or ointment is important. Oozing dermatitis prefer a treatment with a more fluid cream (lotion): it will cool the skin, take away the itch and stop the development of blisters and the discharge of lymph. In dry dermatitis, however, a fat cream (ointment) will make the skin more elastic again. The helpful pharmaceutical substances can be added to any kind of lotion or ointment. In this, it is important to observe not only short-term, but also long-term effects. Cold water may be nicely cooling and take away the itching for the moment, but in the long run it will dry out the skin even more: the afflictions are reduced for a short while and come back more strongly later.

Ask for professional help. More...

Dermatitis is a skin disease. Light dermatitis often heals without additional measures. But dermatitis that lasts for a longer time or appears frequently should receive professional treatment. The physician will try to find out together with you, like a detective, the causes of your skin problems. As soon as there are some “suspects”, more detailed examinations and testings can be carried out. If you find the triggers of the dermatitis, you can take measures to deal with the skin problems in everyday life. Sometimes it is not possible or also not enough to avoid the triggers completely; in that situation there are a number of other measures that can be taken to bring the dermatitis to a quick healing. These measures will be adapted to your skin condition and your personal situation.

To be avoided: scratching! More...

It is very important to prevent drying-up of the skin. When your skin itches, please don’t scratch! The itching may cease for the moment when you scratch, but the scratching usually leads to lesions and wounds that will aggravate the situation. Better beat or press lightly onto the skin with the palm of your hand. Wet packs should only be applied on skin that you have lotioned before, to avoid the skin to dry up. Heat often worsens the itch.

Be patient. More...

Be patient Dermatitis can be rather annoying, as it often appears without warning and without a visible reason. The skin problems come quickly and take a long time to leave. This may be a hard strain on one’s patience. It is very important to keep to your treatment routine patiently. This will help you to be successful in getting rid of them again.

Don’t give up, but become an expert. More...

In the course of life, dermatitis appears in many people. There is no reason to bury one’s head in the sand. There are a lot of things one can do to avoid dermatitis, and even when it occurs, you can learn to deal with the situation by applying adequate treatment and skin care measures. Many people with dermatitis become “experts” about their skin condition and know when to take which measures. And there is a lot of information to be found if one knows where to look for it.

 

Episode 4

Doing it our own way

Slowly, the end of the summer camp is approaching. Traditionally, there is always a competition during the last week. This year’s theme is difficult and exciting at the same time: “Love can’t make you sick – or can it?”
The theme causes a lot of confusion, and the camp supervisors help the young people by telling them about the competitions of previous years. Last year’s theme had been “Don’t play with your life” – equally difficult and fascinating.

Now, what is this competition about?
The young people in the camp are supposed to invent and design creative, funny or thought-provoking posters or films.  The necessary material and technical equipment is provided. The young people are working in groups of four to six and have a week in which to prepare.. In the end, three winners are selected, and the other young people don’t come away empty-handed either at the Farewell Party.

Thelma, Natalya, Paolo and Max are racking their brains over this year’s theme. They soon agree that the subject must be sexually transmittable diseases. Natalya has overcome her “acne depression”, as Thelma calls it, long ago and offers the first idea, a song with lyrics that  make Max blush: “Bad girls are fun, but the gonococci quickly come!” “No?” Natalya looks around. “Ah, no, this is better: Everybody is anxious, about AIDS and syphilis!” Roguishly, Natalya winks  from under her hair. “Or even : Better do it with a condom, than become Mum and Dad at random!” Thelma is clutching her belly with laughter, while Max is blushing more deeply with every sentence. Paolo looks rather self-conscious, as inventing these kind of sayings are usually his role. But after a while they all laugh and rhyme around wildly. They are aware however that they won’t win the contest with these kinds of ideas. Max has no better idea than to write a modern fairy tale, and Thelma admits that she is not really creative in that direction. Paolo wraps himself in silence.

Therefore Max, Thelma and Natalya are very surprised when Paolo  arrives late for their meeting on the veranda of the old villa the next day with a roguish smile on his face, and announces: “I have something that will solve our problem!” Under the curious gaze of his friends he pulls a CD out from under his jacket. “I worked a little bit on Eva, she is  in the tent next to you girls, and the other day she showed me last year’s winner when her older sister was in the camp. And because I am such a nice guy, she lent me this until tomorrow!” Thelma tries to take the CD out of his hands, but Paolo holds it tightly. Thelma raises her eyebrows. “And now we look at it with our laser eyes and read what’s on it?” she asks mockingly. Paolo is taking a laptop out of his bag. “They also lent you this?” Natalya grins. “Of course!” Paolo puts the CD into the laptop and starts the film. When the short film ends, the four friends stay unusually quiet for a while. They are impressed. “Don’t play with your life”, Max murmurs quietly. “We could hand in this film for the contest,” suggests Paolo. “Yeah, what a super idea – the same thing twice,” Natalya looks at him sympathetically. “And what does the film want to tell us?” asks Max who is mulling over its content. This question provokes  a lively discussion, and it becomes  quite clear that they all have only a superficial knowledge of the subject.
“Did you know that AIDS can be transmitted by kissing?” Paolo asks. “Oh no, that’s nonsense,” replies Natalya. “You only get AIDS when you have unsafe sex.” And Thelma adds: “But the probability that you get infected is not very high.”

“But even if you get infected, “Max remembers, “Some medication against AIDS has been developed. So now AIDS can be cured.” Natalya does not agree. “We have never heard about this in Romania, and we have a lot of people with the HIVvirus in our country.” - “Before, in my parents’ generation, AIDS didn’t exist.”  Paolo adds, “My father told me that they didn’t know anything about condoms. And he should certainly know, because he was the greatest gigolo of Calabria!” Max is astonished: “Like father like son.” Natalya can’t suppress a giggle. Thelma looks at Paolo with big, round eyes. “But then, where does the disease come from?” Max asks and finds that everyone is looking perplexed. “We don’t seem to know very much,” says Thelma, summing up.

Paolo has had enough. “Listen, we can’t do something about AIDS again. We don’t know much about it, and besides, the subject won the first prize last year. Let’s think about other diseases that you can get, or let’s do something completely different!”
“How do you mean, something completely different?” The others don’t understand what he’s getting  at.

He explains: “Yeah, see, they do this competition every year. Everybody comes up with some nice ideas about AIDS, syphilis or other diseases, about which we should have some knowledge but haven’t, as we have just noticed. But it really gets on my nerves that we only talk about these things when someone from outside makes us, I mean, the supervisors here in the camp, or the media, the television, the newspapers. Do you understand?”

The others look confused. “Not really,” says Natalya, and Max and Thelma agree.
Paolo tries harder. “See, I don’t want to make a movie like last year. This one here is far too professional anyway, and we wouldn’t have any chance, given the fact that we are already too late anyway. Why not do something on the subject of:  we only start to think about things when the media try to make us do so? You get it now?”

Paolo looks questioningly at the small group and continues: “The message I want to send is: Let’s look at it ourselves!” Max, Thelma and Natalya stand in front of Paolo with open mouths. What he says is not complicated but turns everything upside down .Thelma is very impressed: never has she seen Paolo like this during the last weeks – so excited, so committed. Enthusiastically she agrees with him: “Yes, Let’s look at it ourselves! That’s a motto I like! If we can’t win the competition, then why not go down in history as having the best outsider idea ever?” Thelma and Max nod and immediately share their first ideas. The ice is broken, they start  work.

Movie

Don’t play with your life

Paolo is unusually excited: Today there will be the announcement if they won anything in the competition or not, and if, as Natalya says, they won a “special award for missing the point in an especially ingenious way”, or if they failed completely. Apart from that, Paolo is very happy that Thelma was so enthusiastic about his idea. Without her, he would have never had this idea, and without her he wouldn’t have cared so much and wouldn’t have put so much effort – he knows himself well enough to be sure of that. Paolo thinks about his own words and how difficult it had been to explain it to the others: "Look, I don’t want to make a film like for example the one from last year. That one is way too professional for us. We wouldn’t have the slightest chance, the more so as we are already so much behind time. If we don’t want to make a film, then let’s do something about the subject that we only start to think about something when the media want us to do so."

"Exactly," Paolo affirms again in his mind. That was the crucial point, and now it is important that the jury also gets the point: Why do we as teenagers always let ourselves be pushed on that kind of subjects only from the outside? Why do we only deal with the subjects that others set for us?

			Everything clear? No? Then read some helpful hints and information here. This will make it easy for you. The Hints and Info section also open in a new window, so you will have everything within your view. Press here for the Hints & Info section about sexually transmitted diseases!

Hints & Info

Skin is an important sensory organ for humans: it routes sensory perceptions to the brain. In sexual encounters, sensory perception plays an important role. Touching each other creates feelings of lust and satisfaction in various ways.

If in petting without intercourse, oral or anal sex or vaginal intercourse, sex always means skin contact between two people and usually the exchange of body fluids like semen, vaginal fluid or even blood. Sexual encounters in their different forms are exciting, but can also lead to infection with a disease. This kind of diseases is called “sexually transmitted diseases (STD)” or “sexually transmitted infections (STI)”. Among these are e. g. infections with chlamydia, gonorrhoea, syphilis, hepatitis B, herpes, genital warts and HIV / AIDS.
These diseases are caused by germs (mostly viruses or bacteria), that can be transmitted in any kind of sexual contact by the mucosa of the sexual organs or (less often) the mouth.

More information here: Definition, Transmission and Diseases.

Most sexually transmitted diseases become noticeable by unpleasant symptoms in the genital area or around the mouth: the skin changes, you may observe discharges, pain, itching or burning. Sometimes you may not notice this immediately, and thus we may have and spread an infection to other people unknowingly.
This can be rather awkward for yourself and your partner/s. In this, it is important to know that sexually transmitted diseases can cause irreparable secondary damages, like e. g. sterility (i.e. the inability to reproduce), chronic diseases or the life-threatening general immunodeficiency (AIDS), an illness that makes the body defenceless against all sorts of germs.

More Information here: Consequences and Myths.

Who knows one's body and who knows about sexually transmitted infections, how they are treated and how one can protect oneself, can enjoy sexuality without consequences for one's health and one's partner's health. Sexually transmitted diseases can be avoided through Safer Sex, above all the proper use of condoms. Also, there are vaccines against some diseases in the meanwhile.

More Information here: Protection.

But if you should catch an infection anyway, please be alert when you notice the first symptoms, take them serious, talk to your partner and see your doctor. In many of these diseases it is true that, if you notice them and have them treated early, the chance of healing is very good.

More Information here: Treatment.

Catching a sexually transmitted infection is something that can happen to everyone – it is not a reason for shame. If you look for information and protect your partner/s by practising Safer Sex, you can avoid sexually transmitted diseases and enjoy sex untroubled.

Definition

Sexually transmitted diseases have been known for centuries. They are infections that can be transmitted by sexual contact between humans.

The expression “sexually transmitted infection” is in use very often as well. Infection means that there is a germ (virus, bacterium, parasite) within the body of a person with the potential to cause a disease. 

A person can be infected without showing an illness. This is called an asymptomatic infection. Symptoms A sexually transmitted disease or infection can be identified by various symptoms, i. e. by typical signs that show that a certain infection has taken place: pain or itching at the penis, vagina or anus Reddening, spots, nodules or abscesses on the skin pain in urinating or in sexual intercourse, unusual discharges from vagina or penis

Attention! Very often the infection remains completely unnoticed at first. But it is very important, in order to avoid the continuing and the negative consequences of a sexually transmitted disease, to take early symptoms serious and to see a doctor. Most sexually transmitted diseases can be treated well, especially in an early state. Who does not take serious early symptoms risks to transmit the infection to other people unknowingly.

 

Diseases

If you talk about sexually transmitted diseases, the first thing that will probably come to your mind is HIV/AIDS. There are many other diseases, however, that are very frequent in modern society as well and which can also be transmitted in unsafe sexual intercourse.

There are various sorts of germs that may transmit sexually transmitted diseases: there are bacteria and viruses, while other diseases are transmitted by fungi or parasites.

The table below shows the most important sexually transmitted diseases. If you would like to read more, please just click on the name and a new page will open. 

 

 

Diseases transmitted by bacteria

Chlamydia. More...

Chlamydia Description Chlamydia is one of the most frequent sexually transmitted diseases; in Germany the number of new infections is estimated to be around one million per year. The infection can be transmitted by mucosa contact in vaginal intercourse, oral or anal sex. The bacteria can form colonies in different places, e.g. in the cervix, urethra, bowels or anus, but also in the eyes or in the mouth.  Symptoms Symptoms like pain in urinating or slimy and pyic fluid discharging from penis or vagina usually appear one or several weeks after an infection has occurred. Men may develop painful swellings of the testicles, women may get pain in the lower belly or unclear pain and bleedings during intercourse. If the infection happens by oral sex, the infected partner may develop throat pain; following anal sex, you may notice unusual discharges from the intestines. If the germs reach the eyes, e. g. by touching them with your hands, one can also develop conjuncitivits (pinkeye).   The tricky thing with chlamydia is that the infection is often not accompanied by symptoms at all. Because of this, the infection is often not noticed. Consequences An unnoticed infection with chlamydia can even lead to sterility. Actually, chlamydia is the most frequent cause for sterility in women. In men, sterility is at risk as well if a chlamydia infection with chlamydia is left untreated. Protection The risk to pick up chlamydia is remarkable reduced if condoms are used during sexual activity. And this is how safe sex works... Healing If you should have caught chlamydia, the infection can be treated with antibiotics. It is important that the partner receives treatment as well. Antibiotics can only be prescribed by a physician; thus it is very important that you see a doctor if you suspect you may have been infected.

Gonorrhoea („The Clap“). More...

Gonorrhoea („The Clap“) Description Another disease transmitted by bacteria is gonorrhoea, also sometimes called “the clap”. It is caused by a bacterium called Neisseria gonorrhoeae. Symptoms Usually the infection with gonorrhoea becomes noticeable some days later by burning while urinating or unnatural discharges. These symptoms may be very weak, but the infection can be transmitted to other people all the same. This occurs especially frequently with mouth infections (by oral sex) or infections of the intestines (by anal sex). Consequences Untreated gonorrhoea leads to inflammations. Women tend to develop these in the fallopian tubes, the ovaries and the mucosa of the womb (uterus). Men tend to get inflammations in the spermatic cord, the prostate and the epididymis. This can lead to sterility in women and men. In severe cases, the whole body can become affected; the patient develops fever, joint pains and rashes.  Protection and healing Condomes provide an effective protection against gonorrhoea. And this is how safe sex works... If one catches an infection anyway, gonorrhoea can be treated with antibiotics. If it is treated early, it heals completely. The partner needs to be treated as well.

Syphilis (Lues). More...

Syphilis (Lues) Description Syphilis is another sexually transmitted disease which is transmitted by bacteria. Symptoms and consequences. If left untreated, syphilis progresses through three stades. Stade 1  (about 3 weeks after infection) At the place where the bacterium penetrated (penis, labia, mouth, anus) a painless sore called chancre develops. In the surrounding of the chancre, the lymph nodes are swelling. The chancre heals and disappears after some weeks – this is a reason why the infection is so often left unnoticed or ignored. Stade 2  (eight weeks to two years after infection) Rashes appear that don’t hurt or itch; additionally fever and swollen lymph nodes. These symptoms also disappear after a while. Stade 3  (several years after infection) Inner organs (e. g. liver), the nervous system and the bones  deteriorate severely. Since the end of the nineties, syphilis infections have been increasing remarkably. It is absolutely important to take symptoms serious in any case, even when they are not joined by pain or itching. Every contact with the bacteria can actually lead to an infection – if the carrier has sores in the mouth, the infection can even be transmitted during kissing. Healing Syphilis can be treated and healed in every stade with antibiotics. Organ damages in the third stade, however, can’t be reversed any more. Partners need to receive treatment as well. Protection The best way is to use condoms during sex, as they provide protection against a transmission. And this is how safe sex works...

Diseases transmitted by viruses

Hepatitis B. More...

Hepatitis B Description  Hepatitis B is one of the most frequent infectious diseases in the world. The virus is contained in all bodily fluids and is therefore also transmitted by semen and vaginal fluid in sexual intercourse. The virus can be transmitted as well if semen comes into the mouth. Hepatitis B can even be transmitted by saliva (spittle) during kissing. Symptoms One to six months after infection, a flu-like condition develops. These complaints are often very weak, and the infection is not noticed. Consequences  In 90% of all cases hepatitis B heals completely, and the affected persons will stay immune against the virus for the rest of their life. In the remaining 10% of the infected persons, the disease becomes chronic, the virus stays active in the body and leads to a permanent deterioration of the liver. Sometimes the result may be liver cirrhosis (liver shrinkage) or liver cancer. Protection  The risk of infection is reduced by using condoms, but cannot be completely excluded as there are various ways of transmission (other bodily fluids like saliva etc.).  And this is how safe sex works... Vaccination provides the most effective protection. In Germany, it is recommended for babies, adolescents and for members of high-risk groups (medical staff, men who have sex with men) and is in these cases paid for by the health insurance in these cases.  Healing An infection with hepatitis B is diagnosed by blood testing. If the disease is chronic, the physician will try, by means of an antiviral therapy, to stop the multiplication of the virus and to alleviate the inflammation.

Herpes. More...

Herpes Description  Many of us know herpes sores on the lips. They are caused by the virus HSV I (herpes simplex virus type I). Herpes can also afflict the genital region; this is caused by another virus (herpes simplex virus type II, HSV II), but HSV I infections can be transferred to the genital region by oral sex or lack of hygiene as well. Symptoms Some days after the initial infection, inflammation of the mucosa and rashes appear, which may be accompanied by fever and a swelling of the lymph nodes. The skin burns, itches, reddens and blisters appear. The fluid-filled blisters burst and sores develop. These usually heal in the course of some weeks. Consequences  As soon as you have had a herpes infection once, you will stay carrier for the rest of your life. Most people have had a herpes infection once in their life and since then developed antibodies against the virus. But not all people who carry the virus develop the described symptoms. In some people, the sores return regularly. The outbreak can be triggered by factors like stress, UV radiation or exhaustion. If someone has a weak immune system, the virus may spread to the whole body. Infections are especially problematic in pregnancy, as they can lead to grave diseases in the baby during pregnancy and during birth, e. g. to meningitis (brain fever). Protection  Condoms protect against transmission of the virus in vaginal, oral and anal sex. As the virus is so highly contagious, transmission cannot always be avoided.  And this is how safe sex works... Healing It is good to know the symptoms and to see a doctor after a possible infection. Herpes can then be treated with antiviral medicaments.

Human Papilloma Virus (Genital and Anal Warts). More...

Human Papilloma Virus (Genital and Anal Warts) Description  The infection with HPV (Human Papilloma Virus) is one of the most frequent sexually transmitted infections. HPV may cause genital and anals warts which look like small pointed or flat warts and usually appear in the vulva, vagina, penis and anus. Some types of HPV may cause cell changes which, after some years, may develop into cancer (cervical, penile, anal cancer). Symptoms The virus is mostly transmitted in unsafe oral, vaginal or anal sex. After some weeks or months, the first symptoms appear (small warts that may spread quickly, sometimes joined by burning and itching, but often without symptoms). Often, there are no noticeable symptoms at all. Consequences  The infection with HPV may cause cancer after some years (most frequently cervical cancer in women, but also anal and penile cancer in men), and this is also the case for infections that do not cause any symptoms or visible warts at all. Protection  Condoms provide protection agaginst the transmission, but only insofar as they prevent skin contact with the affected skin areas, which contain the viruses. Direct contact with the warts must be absolutely avoided. And this is how safe sex works... Annual cancer screening is especially important for women, but also men should have regular medical exams. In the so-called PAP test, the gynecologist, doctor or nurse will take some cells from the cervix mucosa and have it analyzed. Thus, the state of the mucosa can be checked and infections, cell changes and e. g. the existence of HPV can be detected. In case of treatment, the partner/s may need to receive treatment as well.  But here is good news: a vaccination has been developed against two sorts of the Human Papilloma Virus (types 16 and 18). Since 2007 it is available and recommended for girls aged 12 to 17. The vaccination needs to be realized prior to the first sexual contacts. As there is no vaccination against all sorts of the HPV, the yearly preventive medical checkups should be continued in any case. Healing There is no cure for HPV, but the immune system often fights off the virus in some month’s time. In other cases, one may stay carrier of the virus for longer time or the rest of one’s life. The warts can be treated symptomatically, e. g. by removing them by medicaments and surgical or chemical treatments. Due to its chronic character, the virus may stay in the skin and the warts tend to reappear, thus the treatment may ask a lot of patience from the side of the infected person.

HIV/AIDS. More...

HIV/AIDS Description  The acronym AIDS means acquired immune deficiency syndrome and is acquired by infection with HIV (human immunodeficiency virus), a virus weakening the human immune system. The HI virus can be transmitted when blood, semen or vaginal fluid containing the virus get onto the mucosa of the vagina or the intestines of another person. The HI virus is transmitted predominately through contact of bodily fluids with vaginal or anal mucosa. The mucosa of the intestines is especially sensitive and can absorb the HI virus directly. This is the reason why the transmission risk is highest with anal sex. The risk is still very high in vaginal intercourse. In oral sex, the transmission happens before all when semen enters the mouth and when the mucosa of the mouth is weakened, e. g. if one has an infection or little wounds. If someone already has other sexually transmitted diseases, the risk to catch HIV is increased, as the virus can more easily penetrate inflamed skin as for example in an infection with chlamydia or gonorrhoea.   Symptoms and consequences  Initially, most people infected with HIV don’t have any symptoms for years, before the immunodeficiency starts to develop.  In an advanced stage, one develops typical infections with germs that do not harm healthy persons at all.  In addition, rare tumor diseases may develop. Healing It is still not possible to cure HIV/AIDS, and there is no vaccination either.  The virus cannot be removed from the body. That is the reason why a person in whose blood the virus cannot be detected any more, can still transmit the virus.  Today, drug therapy is available: the so-called combination therapy suppresses the virus reproduction and thus delays the progression of the disease. Thus, AIDS does not lead to death as quickly as it did formerly, and infected people have the chance to lead a better life. Combination therapy means that the patient takes several drugs together, as the HI virus strains may change and may become resistant against various substances. Another name for this treatment is HAART: highly active anti-retroviral therapy. Protection This very positive development in the medical treatment of HIV/AIDS has unfortunately led to a less careful behaviour in terms of safer sex recently, and thus the number of new infections has increased during the last years. Safer sex is the most effective protection against HIV/AIDS.  And this is how safe sex works...

Other diseases

Trichomoniasis. More...

Trichomoniasis Description  Trichomoniasis is caused by the trichomonad, an endoparasite. They bed in vagina, intestines or urethra. Trichomonads are usually transmitted in unsafe sex, especially in anal sex. The transmission can also happen by commonly used objects like towels or sextoys. Symptoms Symptoms appear some days to weeks after infection. Men tend to have painful urination and frequent urges to urinate, but sometimes they don’t show any clear symptoms at all. Women usually develop a white or yellowish-green foamy vaginal discharge with an accompanying unpleasant odor. Many women also experience painful sexual intercourse, lower abdominal pain, itching and burning. Consequences  The perfidy of an infection with trichomoniasis is that that it increases the risk to catch other sexually transmitted diseases (among which HIV).  Protection  Condoms provide protection against infection. And this is how safe sex works... Healing If the infection has already happened, trichomoniasis can be treated and healed with antibiotics. It is important that the partner receives examination and treatment as well.

Scabies. More...

Scabies Description  Scabies is not a classical sexually transmitted disease, as it can be contracted in any kind of more intensive skin contact. It is transmitted by microscopic mites that burrow into the skin and lay eggs. Symptoms and consequences Small spot-like bumps appear on the skin (between the fingers, at the wrist, in the genital region and in the armpits). After some weeks, strong itching, especially at nighttime, comes up as a further symptom. If the bumps become infected by scratching, these places form entry routes for additional infections. Protection  Scabies can be avoided through careful hygiene and regular changing of clothes. Healing If someone has been infected, he or she can undergo external chemical treatment. All sex partners and family members need to be treated as well.

Pubic lice („crabs“). More...

Pubic lice („crabs“) Description  Pubic lice are small insects without wings that bed in the pubic hair and lay eggs called „nits“. In severe cases, they can also be found in armpit hair or other bodily hair.  The transmission happens through intensive bodily contact, i. e.  also through sexual contact. Symptoms and Consequences After some days, the infected person develops itching as well as dots and flecks on the skin, caused by lice bits. Healing Treatment is done with shampoos, ointments or lotions. The nits must be removed with a special comb. Clothes and mattresses should be disinfected.

Consequences

Sexually transmitted diseases can have grave consequences. Without knowing, we can infect other people, if we do not notice infections by their symptoms, or if these are so weak that we are not aware of them.

As we may transmit the infection to other people, we need to inform our partner/s if we suspect or know that we have an infection. This can be awkward and may cause conflicts in the relationship, for example if someone has to admit that he or she has been unfaithful.

Many sexually transmitted infections can, if left untreated, lead to secondary damage that cannot be repaired any more. For example, they can cause sterility in men and women. Thus, some infections can cause chronic and lasting damage, while others, like HIV / AIDS, are even life-threatening.

Especially an infection with HIV still usually leads to social exclusion and stigma.

Myths

We all have some ideas about sexually transmitted infections in our heads. But they are not always correct.

One of these ideas is that AIDS and other sexually transmitted diseases exist among homosexual men only. This idea stems from the 1980s, when the AIDS epidemic began and the disease was first observed among homosexual men only. Actually every person having sex with someone whose HIV status is unknown, is at risk to become infected with HIV. It is correct that the risk of infection is higher in the group of men having sex with men, but this simply has to do with sexual practices.

History of HIV/AIDS In 1981, suddenly a high number of infections were observed that usually only occur in humans with a weakened immune system. But these infections then hit young – homosexual – men in Los Angeles that had been completely healthy before they caught these infections. In 1982, scientists already suspected an acquired immunodeficiency syndrome. When various cases of infection were observed among heterosexual drug addicts and people who had received a blood transfusion, it became clear that the disease had nothing to do with homosexuality. By the way, in Germany the first case was diagnosed in 1982. After some years of investigation, science discovered that it is a certain virus that causes AIDS. In 1986, the name HIV (Human Immunodeficiency Virus) was introduced. In 1985, the first Worldwide AIDS Conference took place. In 1987, the first drug against HIV/AIDS was officially approved and introduced to the market. However, in the 1980s and in the first half of the 1990s, many people died of AIDS, among which some popular people like the Queen vocalist Freddy Mercury, who died in 1991. In the 1990s, the medical science made remarkable progress, for example by developing the so-called combination therapy. This development remarkably increased the quality of life and the life-span of people infected with HIV. Since the beginning of the 1990s, the red AIDS ribbon has been a symbol for solidarity with HIV positive and AIDS patients all over the world. Until the end of 2004, about 73,000 people had been infected with HIV in Germany since the beginning of the epidemic. 46,500 were still alive at that time. The annual rate of new infections has been increasing again since 2002. In 2005, it was about 2,600 new cases per year. Worlwide, nearly 33,2 millions of men, women and children are living with HIV/AIDS. The image below from the German Robert-Koch-Institute shows an estimate of how many adults and children lived with HIV/AIDS in 2007. Image: © Robert-Koch-Institute

Many people also believe that the number of sexually transmitted infections is decreasing. Unfortunately, this is not the case: in many countries, the rates of new infections are rising, e. g. for syphilis and HIV / AIDS.

The notion that sexually transmitted infections cannot be transmitted by petting or oral sex is also very common. This is unfortunately not true either; it rather depends on the situation and on the germ. The risk of infection may be lower with oral sex, but if you have small wounds in the mucosa of your cheeks or in the gingiva, or an infected throat, or if the penetrating partner has an infection of the urthra, then the risk of infection is increased. Should the mouth come in contact with menstrual blood or infected vaginal fluid, an infection can be transmitted as well.

Many people think that sex with a condom is not nice or not cool. That’s actually only a question of attitude, in boys as well as in girls. Women and girls may often think: „If I insist on a condom, he might not want to sleep with me any more.” There are so many kinds of condoms nowadays, however, e. g. ultrasenstitive ones. You should only decide to have sex without a condom in a stable relationship and in mutual agreement. A HIV test taken together may be the starting point.

„If I don’t feel anything, I have no infection“– that’s an attitude which is not helpful with sexually transmitted diseases. Many infections proceed for days, weeks, months or years without any symptoms. This is one of the differences to other diseases that we know. Another particularity in sexually transmitted diseases is the fact, that it is often not suffice that only the one person that shows symptoms gets treatment. Usually it is necessary that the partner gets treated as well.

 

Protection

It is impossible to protect 100% against the infection with a sexually transmitted disease. But your own behaviour can protect you so you can enjoy sex without worry. The most important measure in this is Safer Sex. For some diseases, a vaccination has been developed in the recent past. Appropriate hygiene is important as well.

Safer Sex. In safer sex, no body fluids are exchanged between humans. Neither semen nor vaginal fluids enter the body of the partner.

The easiest way to practice Safer Sex is to wear a condom in vaginal intercourse or anal sex. Condoms can be bought nearly everywhere: in pharmacies, drugstores and supermarkets.

If you do this in the right way, condoms can provide a very good protection against infections. How to do this exactly, please read here.

How to use a condom in the right way The first important thing is to avoid damage of the rubber of the condom (e. g. with the fingernails), when ripping open the condom package: Do not roll open the condom to check if it is okay! When you do this, it may become damaged. After that, press out the air of the reservoir of the condom with thumb and forefinger, to have space for the later ejaculation. After that, the condom can be rolled down on the stiff penis. If it doesn’t work properly of if by accident you put on the condom the wrong way (reel inside), better take a new one. Image sequence: © German Federal Centre for Health Education (BZgA) After orgasm, the penis should best be withdrawn from anus or vagina as long as it is still stiff. Doing this, hold the condom to avoid that it slips off in withdrawing. Please take care that no semen is pressed out – this is very important! And please use a condom only once, and throw it away afterwards into the garbage and not in the toilet. It is important that you only use condoms carrying a „CE“sign with a control number, and that the date of expiration is not yet exceeded. In addition, the wrapping should not be damaged. Condoms need to be safe from pressure (purse, trouser pocket) and heat. For anal sex, there are also extra tearproof condoms. To facilitate the penetration of the penis into vagina or anus, many people use lubricants – please be aware, however, that condoms may only be used with fatfree and watersoluble lubricants. Oils and fat may affect the latex and can make a condom tear. If a woman prefers to contracept additionally with suppositories or foam, it is important to use fatfree products in this as well. In anal sex, a fatfree lubricant helps to reduce the pressure on the condom. By the way: You can watch in detail how a condom works in a video here.

In addition, it is important to take care not to take in semen when doing oral sex – in oral sex with men you can use a condom, in oral sex with women there is a special cloth (available in pharmacies and in anti-AIDS action committees) that can be used to cover the vagina. In any case, it is very much recommended to avoid contact with visible skin changes like spots, warts or abscesses. They can be a sign for an acute infection and may be contagious.

The most important thing is that you talk about safer sex with your partner – before you start having sex. This is nothing that must be feared. Usually, both sides will be happy that the subject is discussed, and sex can be experienced without fear.

 

 

 

Vaccinations. There are some sexually transmitted diseases against which you can protect yourself by vaccination.

The German Vaccination Committee recommends a vaccination against hepatitis B (usually administered together with Hepatitis A) and against Human Papilloma Virus (HPV) for young people, to be administered prior to the first sexual contact.

 

 

 

Hygiene. Adequate hygiene also contributes to the protection against sexually transmitted diseases. Regular hygiene in the genital region helps to get a better feeling for your own body and to notice possible changes in an early state.

For women it is very important, however, to take care that the natural bacterial balance is not damaged, which can easily happen by using vaginal douches, deodorants etc. in the genital region. As soon as the skin of the vagina becomes dry, it becomes easy for germs to penetrate.
Many germs love a warm and humid surrounding. For this reason, it’s a good idea to wear breathable clothes if possible (e. g. cotton underwear).

Treatment

Sexually transmitted diseases need to receive treatment by a physician. Even in the case of only slight symptoms it is best to see a doctor. The treatment of sexually transmitted diseases is done by dermatologists, as well as gynecologists for women and urologists for men. In other countries, treatment is being done by general practioners or in special treatment centres (so-called genito-urinary clinic, GUM clinic)

Many people feel ashamed when they see a doctor because they noticed changes in the genital region. But for the physician, that kind of health problem is something very normal, as it is relatively frequent. In total, the number of infections with a sexually transmitted disease is increasing.

Allways remember: If you seek treatment early enough, there are very good chances for
healing. Treatment should be done after a thorough medical examination
done by a physician – self-medication can delay infections or lead to
irreparable damage.

It is very important that both partners receive treatment, otherwise the infection can see-saw between the partners (“ping-pong effect”). Also, former partners should be informed about an infection if the contact has not happened long ago. The same is true for people who have sex with more than one partner.

In principle, everyone who is affected or assumes to be affected by a sexually transmitted infection should always talk to the partner/s. This may be a bit uncomfortable, but it will help to prevent to spread the infection.

Everybody who assumes to have an infection or notices symptoms that might be a sign for one, should be aware to use condoms when having sex. And, even if it may be difficult: in such a case, it would be best to not have sex at all until healing.    

By the way: In Germany there is an obligation for a number of infections to notify the Health Authorities, among them HIV and syphilis.

If you have several or changing sex partners, or want to have sex without condoms with one partner, you should by all means do an HIV test.  This can be done at a physician or at the Health Authorties (at a low fee or free of charge). In an HIV test it is examined if the body has formed antibodies (i. e. defence cells) against the HI virus. An infection can be excluded by test not earlier than three months after the last risk situation.