Here Comes the Sun
April and May are surprisingly huge months for sunburns. There is still a slight chill in the air, so most people don’t bother with sunscreens. Teens on doxycycline and minocycline antibiotics for acne have forgotten the warnings that they are extremely sensitive to the sun on these medications. The follicularly challenged men (also known as balding) neglect to wear their baseball caps. They have already forgotten the discomfort of my liquid nitrogen treatment of their precancerous scalp spots last year. The runners forget they need a waterproof sunscreen that resists sweating. And the walk-a-thons! So many painful, red, swollen noses and forearms.
There is no question that ultraviolet light contributes to the development of skin cancer, just as cigarettes contribute to lung cancer. It has also been proven that protecting from the sun reduces the incidence of skin cancer. Furthermore, and many of my patients will heed this warning more, ultraviolet light makes you look old before your time. Wrinkles, brown spots, big pores, yellowish bumps, a sallow tone, these are the harvest of the sun worshiper. By protecting, you will look younger, period. One recent article tells the story best. A study showed facial photos (sun exposed area) of people in their 20s, 30s, 40s, 50s. 60s and 70s to a group of observers, and asked them to rate the age of the people in the photos. The same photo subjects also had their sun protected buttock skin photographed and the same observers rated the age of the buttocks. You would think that observers could correctly identify a 20 year old buttock from a 70 year old one. The ages of the facial photo subjects were correctly determined 90-100% of the time, whereas the ages of the buttock photo subjects were correctly identified about 20% of the time. Sun exposure is much more aging than time and gravity! This is supported by earlier data that sun exposed skin of the forearm produces 50% less Collagen type I than does sun protected (buttock) skin. Want collagen? Protect your skin from the sun.
We dermatologists do not expect you to hide in a cave all summer. There are great ways to protect from the damaging UVA and UVB waves. Common sense is the rule. Wear a hat. When I am asked what is the most cost effective cosmetic treatment, I instantly respond, “A hat.” A hat prevents skin cancer, wrinkles, brown spots, broken capillaries, fine lines, crinkly skin texture. The trick is to find one that you will actually put on your head and wear. Even in front of other people. Do not spend $100 on a tube of cream and only $10 on a hat. Buy a beauty. And wear it. Adding sun glasses will make you more chic, and protected.
Other forms of non-sunscreen sun protection are also extraordinarily helpful in preventing sunburn, chronic sun damage and eventually skin cancer. The swim shirt or rashguard is a close fitting shirt that goes over your bathing suit and protects from the sun as well as from abrasions (from surfing, windsurfing etc.). Getting your kids used to wearing these is a great way to limit their lifetime exposure. Some of the most attractive swim shirts are available through surfer brands such as Quicksilver, and high quality versions for kids area available from many catalogs including Coolibar’s. And don’t forget the umbrella. Whether using a portable one for your day excursion, or taking advantage of a resort’s cabanas, staying in the shade can keep you from getting fried during a long day at the beach. In addition, a long lunch break in the shade, removing you from the sun’s rays during the peak hours (about 11:30 a.m. to 1:30 p.m. in the northeast) will save your skin from damage, and your kids from painful sunburns.
Use sunscreen. SPF or sun protection factor rates how well a sunscreen shields you from UVB rays. Find an SPF 30 or above product that also states “broad spectrum” or UVA/UVB protection, as protection from UVA rays is not part of the SPF rating. Ratings of higher than 30 do not mean that the product works much better than one that states 30. Because of the way the ratings are calculated, there is a much greater difference between SPF 15 and 30 than there is between 30 and 45 or 45 and 60. The higher numbers give you a false sense of security. In fact, Australian sunscreens can only be labelled up to 30+ to avoid this misconception in the skin cancer capital of the world down under.
Many patients ask how safe the chemicals in sunscreen really are. All sunscreen chemicals have been approved by the FDA, but there are some limits to how high a percentage may be used in sunscreens. The safest and least likely to cause an allergic reaction on your skin are the “physical” sun blocks, Zinc and Titanium. An additional advantage is that Zinc and Titanium work immediately to protect you. Suntegrity is a line of sunscreens without chemical sunblocks, and no artificial preservatives (like parabens or formaldehyde releasing chemicals). Another great physical sunblock without chemical sunscreen ingredients is very water resistant Elta UV Pure . This product does not have any parabens or formaldehyde releasing preservatives. Elta and Suntegrity rate among the most safe sunscreens by the Environmental Working Group. Both Suntegrity and Elta UV Pure are available in our office or over the internet. The physical sunblock Aveeno Mineral Block, available in your local pharmacy, also contains Zinc and Titanium, but its variety of chemical preservatives make Suntegrity and Elta UV Pure better choices for those wishing to use less allergenic and artificial products. However, among the choices at your neighborhood drug store, Aveeno Mineral Block is a good option.
Most chemical sunscreens require at least 30 minutes on your skin to become active, so you are relatively unprotected when you first apply. For chemical sunscreens, it is important to apply early, and not to wait until you are about to go out in the sun. Combinations of physical and chemical sun blocks work very well and are easy to apply. We love Elta UV Shield SPF 45 particularly for acne or rosacea prone skin. Coppertone Kids Sunscreen Lotion combines physical and chemical sunblocks in a waterproof formula. If you are using a traditional sunscreen off the shelf that does not contain zinc or titanium, just make sure it is SPF 30 or above, broad spectrum, apply an adequate amount, and leave 30 minutes between application and sun exposure.
Enjoy your summer and beach vacations! Improving your sun protection habits is easy. Your good behavior will inspire your family to do the same. Feel free to cheat using bronzers and self tanners (these are not harmful) or treat yourself to a professional spray tan (try the fabulous Blush in Wellesley). Never, never using a tanning booth. Look good, stay beautiful, and decrease your chance of skin cancer. Finally, and I apologize for repeating myself, get a hat!
Madeline Krauss, M.D.