Time to celebrate!

Camp Korey

Today is a day of celebration. We celebrate our country. We celebrate the freedoms we enjoy as a result of our forefathers declaration of independence. We celebrate the special memories we get to create with family and friends as we gather around picnic tables, bonfires and watch Technicolor fireworks illuminate the sky in honor of this declaration. Sure, we celebrate a day off work and throw in some good sales too, why not? In the spirit of celebration and honoring amazing things, I wanted to share my adoration for Camp Korey. What is Camp Korey? I am so glad you asked! Camp Korey is an amazing haven that provides recreational programs for children and young adults with serious medical conditions who are unable to attend traditional enrichment programs due to their high medical needs. Camp Korey is a place that provides kids the opportunity to build self-esteem, meet friends that can relate to similar challenges and empower them to try new things rather than feeling isolated or limited as they might elsewhere. It is the place where pure joy is palpable.

I had the privilege of volunteering at Camp Korey as medical staff this past week. On a larger scale, the camp is part of the Serious Fun Children’s Network and in partnership with the American Academy of Dermatology hosts Camp Reflection, which is a camp specifically geared towards children with skin disorders and is held on the Camp Korey campus. As a dermatologist, I had the opportunity to oversee the medical care of children with both relatively common skin conditions such as atopic dermatitis to rare entities that most of us only read about during our training. The diversity of skin disorders at camp may have been vast, but the love of fun, camaraderie, mutual respect and unwavering support was homogenous. The kids had a blast, and no one was left behind or left out. From the beginning of camp where a young woman had such severe social anxiety that she wouldn’t utter a word to me, to the end of camp where she bestowed upon me a smile that could light up the darkest of skies, it was magical. Although I was there to serve in a professional capacity as a physician, I was gifted a profound personal re-awakening. Today is a day of celebration of our nation’s independence, but I would suggest that every day should be a celebration. The kids at Camp Korey reminded me that we can and should celebrate our abilities, but we should also celebrate our limitations to help catapult us beyond them to achieve true bliss. Happy 4th everyone!

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What’s the big deal?

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Skin cancer is a big deal. More than 3.5 million cases of nonmelanoma skin cancer in over two million people and over 70,000 cases of melanoma are reported each year, which makes skin cancer the most commonly diagnosed cancer the United States. This means that on an annual basis there are more new cases of skin cancer than the incidence of cancers of the breast, prostate, lung and colon combined. To break this down further, one in five Americans (one in three Caucasians) will develop skin cancer during the course of a lifetime. Bottom line…skin cancer is a big deal. In my skin cancer and sun safety basics post I go over a lot of the facts, so please refer back to it for a more in-depth discussion, and please feel free to reach out if you have any questions. Also check out skincancer.org for a wealth of great information and photos of all of the different types of skin cancers.

So if I already talked about these facts in a previous post, why am I all riled up and repeating myself you might ask? Contrary to what my kids may say (and my husband and possibly the neighbors, but who likes nosy neighbors anyway?) I have not lost my mind, but my mind is most certainly boggled. A recent study reported that greater than 27% of melanoma survivors never put on sunscreen when spending more than an hour in the sun. Researchers at Yale also found that 15.4% of skin cancer survivors rarely or never sought shade from the sun, and 2.1% used tanning beds. This is insanity. Tanning beds? Evidence from several studies has shown that exposure to UV radiation from indoor tanning beds is linked with an increased risk of melanoma, the deadliest form of skin cancer, and non-melanoma skin cancer. In fact, studies have demonstrated a 75 percent increase in the risk of melanoma in those who have been exposed to UV radiation from indoor tanning. 75 percent! This evidence is the basis for championing the passage of legislation to ban the use of tanning beds for minors (currently 33 states have restricted teen’s access to tanning beds). So if these are the facts, and people who have already been diagnosed with skin cancer have been educated about these facts, and believe me, as dermatologists we tell our patients, over and over again, then why are skin cancer patients still ignoring them? This is a dilemma. This is my dilemma and I want to help change these statistics. But I need your help to do it.

We know that protecting your skin from the damaging UVA and UVB rays of the sun is imperative to minimizing your risk of developing skin cancer. Sun protection is a multi-faceted process: practicing sun avoidance during the hottest parts of the day, seeking shade (I promise you can find bliss there), wearing sunscreen (daily and reapplying often) and wearing clothing that has a UPF rating greater than 30, are all important to keeping you safe in the sun.

Based on the staggering number of skin cancers diagnosed annually and the results of the recent study noted above, it would appear that telling people this information isn’t enough. It would appear that a cultural shift, a “shade revolution” if you will, is in order. For starters, we need to embrace vintage times, go retro…what’s old is new again. It works for current fashion trends (hello neon and leg warmers!) and toys (yes, cabbage patch kids I’m talking about you!) so why can’t we embrace the way we used to behave in the sun. Back in the day our ancestors spent plenty of time outdoors, but clothing protected the majority of their body. Being pale was in vogue, whereas having a tan was undesirable. We can do this! You don’t have to give up that Caribbean vacation or frolic on the beach, just be sun savvy! Tap into your sun-conscious and take the necessary steps to protect your skin. Together we can change the perception of what’s “hot” in the sun and you will find your shaded bliss, I promise!

Just the facts ma’am….

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Sgt Joe Friday (Jack Webb)

I was recently asked by a new acquaintance if I had been diagnosed with ADHD. My initial response was surprise. Me? Attention problem? As someone who has sat in the same spot for hours on end reading textbooks cover to cover, studying for medical boards and looking at hundreds of slides (one of my favorite parts of dermatology and why I became a dermatopathologist) without getting up to eat, drink or use the loo (that just sounds better than “potty” don’t you think?), it hadn’t occurred to me that I might have a problem staying focused.  I know I have my idiosyncrasies and nuances, and that certain” je ne sais quoi” that I like to think of as part of my charm (aka: a New Yorker without a filter=inappropriate and sometimes vulgar to which I credit  my father: love you Dad ), but I didn’t think attention or focus was a problem. But as I thought about her comment some more, I came to the realization that my issue is not an inability to stay focused when tasked, it’s more that I am perpetually interested in lots of things and often more interested in something other than what I am doing at that moment. Which brings me to the whole point of this post.

I had originally intended to post topics that only had “dermatology” titles: topics relating to the health of your skin, how to manage issues with your skin, and how to protect it, as my passion is educating people about skin cancer and melanoma, but somehow I keep getting side-tracked. Like I said, I am interested in a lot of things, especially eating. Learning new ways to cook (or just learning to cook for that matter) has opened a whole new world for me and I am having fun experimenting and I want to share that with you.

You see, your skin is a window to the overall health of your body. There are many systemic diseases which manifest characteristic skin findings. Therefore, examination of the skin can be key to making diagnoses as well as prompting a more extensive evaluation to pursue the possibility of internal organ involvement. Though not common, skin findings can be the first clue to metastasis of internal malignancy leading to diagnosis, work-up and subsequent management.

So what I am getting at is that what you eat can have a big impact on your skin. For example, those of you with Celiac disease may have experience with dermatitis herpetiformis (DH). DH is a chronic, intensely itchy, blistering skin manifestation of gluten-sensitive enteropathy (Celiac disease) which affects 15 to 25 percent of people with the disease and is found mainly in adults (more common in men and people of northern European descent). A strict gluten-free diet is the only treatment for the underlying disease, though some people may require temporary use of oral medication in order to get relief from their skin symptoms as they transition their diets.

So even though my plan was just to stick to the “derm facts”, there are so many facets of our lives that are intimately linked to the health of our skin: food, fitness, travel (bed bugs, myasis and leishmaniasis, oh my) that you may find my attention wandering in different directions. Feel free to reign me in if you have questions, or jump on board and enjoy the ride it should be interesting!

By the hair of my chinny chin chin….

My dog Beaudi. He graciously agreed to be the model.

My dog Beaudi. He graciously agreed to be the model.

As a kid, hearing about  hair on your chinny chin chin was an amusing part of a fairy tale. As an adult female, having hair on your chinny chin chin is no laughing matter, right ladies? And not to leave the guys out …..having rogue earlobe hairs and feeling like a sasquatch may not be your thing, so the good news is that over the last few decades the options for hair removal have expanded and improved.

There are numerous methods available for hair removal, some of which are very temporary and some of which have the potential to permanently reduce hair growth. Notice I didn’t say permanently remove hair. I am a New Yorker to my core, despite living on the West Coast for many years,  I’m gonna tell it like it is…if it sounds too good to be true, it most likely is…so I’m not going to try to convince you otherwise.  As a dermatologist it is my job to provide facts, details and opinions so that my patients can make informed decisions. So even though this site is not intended to treat, diagnose or cure any disease or ailment, and as readers you are not patients, I am committed to providing clear, concise (well maybe not that concise, I am known to ramble a bit) explanations of issues in hopes of being helpful.

So let’s start with the basics of hair. I am sure many of you have tweezed, shaved, waxed, threaded,  sugared or “been lasered” only to be befuddled by the fact that some hairs stay gone and others rear their wiry heads way too soon. This is due to the fact that hair grows in three phases: the actively growing phase (anagen), which comprises about 80-90% of hairs. On the scalp this phase lasts about 2-6 years, whereas on the arms, legs, eyelashes, and eyebrows the phase is only about 30-45 days which helps explain why hair in these areas is much shorter than the scalp. The next phase or  transitional phase known as catagen comprises 3% of all hairs at any time. This phase lasts for about 2-3 weeks. The last phase is the resting  phase (telogen) which comprises 10-15% of hairs and last approximately 100 days. It is during the telogen phase when “shedding” occurs and about 25-100 telogen hairs are shed each day. The kicker is that hairs are not in sync with each other and while some hairs are growing, others are transitioning or falling out.  Moreover, it’s only when hairs are in anagen (growing hairs) that they are responsive to removal modalities (i.e. electrolysis, laser).

Now that we have the basics down, how do you choose the best hair removal method? There are several factors to consider: convenience, pain threshold (a very subjective factor), cost, goal for temporary vs. more long-lasting results and anatomic location. Most of these factors are intimately intertwined.

For instance, shaving is very convenient as you can do it yourself, in your home, cost is lower (although the cost of razor blades these days is nutty), pain is minimal but the results are very temporary as you have to shave every few days because you are only trimming the hair not removing it.

Waxing/threading/sugaring: convenient as the service is readily available and it’s quick, cost is relatively low, can be done on most if not all external anatomic locations. The downside is that it can be painful and the results usually only last about 3-6 weeks. With repeated treatments the hair follicles may be disrupted/ damaged  which may lead to permanent hair loss (but most likely patchy at best).

Electrolysis: So how does it work? An electric current is applied with a very fine needle-shaped electrode, or metal probe into each hair follicle to destroy the root. The pros are that this method has a good track record for permanent hair reduction and in some cases permanent removal. Since it targets the follicle itself, this method can be used on most skin types. The cons are that it can be painful, requires many treatments (can be upwards of 15-30)  and can be expensive. Also operator dependent so results can vary.

Laser: Laser hair removal is one of the most commonly performed cosmetic procedures in the U.S. A beam of  highly concentrated light penetrates into hair follicles. It is the pigment in the follicles that absorbs the light and this destroys the hair.  The technology of lasers has advanced so that patients of color can safely have laser performed without damaging skin tone. As with other methods, only the anagen follicles are targeted so treatments need to be repeated every 6-8 weeks to capture more and more of the anagen follicles until the desired level of hair reduction is achieved.

The pros are that laser can be done relatively quickly depending on the site treated and the results are long-lasting. Treatments literally can take as little as 5 minutes! The cons are cost, number of treatments required (usually 6-12) depending on body part treated and pain. I can attest to the fact that current lasers are way less painful than lasers used in 2008 even, and that is saying a lot because I am a big wimp. Risks of treatment other than pain , include swelling at treatment site, burns (go to someone with expertise and experience, and have a test spot done first: settings can be adjusted to avoid this). Although with the advances in technology this does not happen as often, but lightening or darkening of the skin in the treated area can occur.  The other issue with lasers are that they are best used on course hair: legs, back, bikini, underarm, men’s beards. Although they are used for women’s facial hair, the light colored, peach fuzz found on women’s cheeks, chins and lips is unlikely to respond as well. Lasers target a color and the lighter the hair the less there is to target.

Topical therapy: A serendipitous discovery of hair loss was noted when using an anti-malarial drug (eflornithine). The medicine is formulated under the trade name Vaniqua which is a prescription cream used to reduce facial hair growth in women. The mode of action is to block the enzyme that leads to hair growth. This ” blockage” is gradual and can take up to six months to take effect, during which time other hair removal methods would need to be continued. It’s a twice daily application and the downside is that once you stop using it…the hair growth is no longer blocked and hair will eventually return.

So as you can see there are many options…this is a good thing. The best expected outcome is permanent hair reduction and in some cases permanent hair removal may occur. Now don’t get me wrong, I’m a glass half full kind of a girl (and if the wine is really good, fill her up’) but when it comes to issues in medicine I am a realist, and I hope armed with this information you will be too so that you can decide which if any of these modalities might work for you and you will not be disappointed with the result. If none of these float your boat, au natural is beautiful too!

Smelling like a rose, or at least like lavender and rosemary

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What’s in a name? That which we call a rose by any other name would smell as sweet. -William Shakespeare

Roses. They conjure up so many images. Images of love, romance, beauty. It’s amazing really that a simple flower can conjure up complex emotions; the promise of new beginnings or the celebration of established relationships and reminders to cherish all that we already have with the well-known saying of, “take time to smell the roses.” Sound advice which I am trying to follow in my new digs.  Same with blossom where you are planted. That’s a good one too. Easier said then done of course, but I am working on it!

I have roses on the brain because last night my sweet husband brought home not one, but two dozen roses for me (see pics above) because he thought I sounded a little, shall we say, blue. I can’t even recall what was going on at the time that would have provoked his assumption, but honestly it was a welcome surprise and reminds me of how lucky I truly am…literally I am smelling the roses.

This quote and recent turn of events brings me to the whole point of this post actually, which is the smell of roses. The smell of things in general for that matter, including your armpits which is a great topic. What a segway right? I just dove right in there huh? You bet I did. So now let’s dive right into that topic. Smelly armpits! I know, not exactly glamorous or what you want to read about while sipping a glass of wine or drinking your morning coffee, but let’s be honest, we all have the ability to excel in this department. Some are higher achievers than others (those who shall not be named), but we are all participants in this club.

So, my new journey into reading labels has not been limited to food ingredient lists. I have been reading cosmetic and medicinal labels as well. After nearly 15 years of practicing medicine, I am opening my eyes and my mind to not just accepting what’s on the shelves and the teachings of my mentors. There is a lot of “stuff” on the shelves, even marketed as “natural” that I can’t even pronounce or understand. How is that good for you? So, as a result of this discovery as a skin professional, I feel it is my obligation to make a change. I have been researching what other people have tried, reading about natural alternatives and experimenting with my own recipes.

As a dermatologist, I am trained to be an expert of the skin. Most of my career has been focused on diagnosis and management of skin cancer (especially melanoma) both clinically and histologically but at the moment, I am retraining myself in many ways and for now I am retraining to be an expert on the health and smell of armpits. Mine and yours if you are game.
I am on day 5 of my new “deodorant” and I am smelling like a proverbial rose if you will. With a blend of shea butter, pumpkin butter, a few other butters, corn starch, baking soda, and an essential oil blend of lavender and rosemary I have kickboxed, kettle belled and pilateed (don’t know if that’s a word but just roll with it) without knocking out my classmates with stink. My husband ( I did mention he was a saint didn’t I), even stuck his nose right in my armpit to test the power of my concoction and he didn’t flinch. I smelled like lavender and rosemary!
The current deodorant version is predominantly a solid, so I will be working on the formula to make application a bit more user-friendly over the next few weeks and will keep you posted with the specifics in case you want to experiment on your own.

So what’s in a name? These days it’s hard to know when reading labels of food and personal hygiene products, but when you make it yourself there is no question. It can be simple, easy and you can come up smelling like roses….or at least like lavender and rosemary in my case. More to come, I promise….

The sunny side of rainy days

We recently moved from Northern California to the Pacific Northwest. Days of endless sunshine have been replaced by gray skies punctuated by rain showers with only glimpses of the sun. The weather folk on tv call these “sun breaks”.  It is an odd concept to wrap my head around, but I am getting used to it. At least I keep telling myself that.

I admit that seeing the sun peek out from the clouds at the end of long wet day, feels like being greeted by a warm smile when you enter an unfamiliar room. It immediately lifts my spirits. I know sunshine has this effect on many people. It’s the reason why so many of us travel to warm, sunny and tropical places in the winter to experience that instantaneous mood elevation. (Of course, that’s also why I am marred by sun damage and saw so many patients in my office with skin cancers, but that’s a downer, so let’s focus on mood elevation!) The good news, is that I have recently found the sunny side of rainy days. Who knew there was one right? But there is….just look in the mirror, it’s you.

Spending more time indoors, I have spent more time getting to know me. It sounds strange, that after all these years of being me, I never spent much time really listening to my inner voice: what she likes, dislikes and is curious about learning. She talks a lot by the way, so for the longest time I just shut her up because I had work to do, or kids to chase around, or frankly (and most truly) I was afraid of what she might be saying. But this recent move has provided me with an opportunity to spend more time indoors and by default more time with me, so I have indulged her (speaking about myself in the third person is odd, I know, but bear with me).

She wanted to cook. Now for those of you who know me, know that this is outrageous because the stove and I had never really bonded. There was always the occasional flirting with brownies and chocolate chip cookie baking, but real cooking… not a chance. My sweet husband had indulged my culinary incompetence for the last 18 years (I know, he is a saint) and whipped up delicious meals for the kids and I.  Until now.  At the beginning of the new year I started critically reading food labels and realizing that despite my umpteen years of schooling and learning the crazy terms and acronyms that lend themselves to dermatology, I couldn’t pronounce or understand 90% of what was on the ingredient lists of most packaged food. I knew I didn’t need to have gone to medical school to know that this was not a good thing.

So what next? I got schooled. I recruited the help of a nutrition counselor (love her!) and delved into the realm of whole foods. Now I know this is not a new concept. But while the rest of the gang was getting wise to the ways of nutrition, I had my nose in the derm books and remaining blissfully ignorant to all the additives and preservatives that filled the boxes in my pantry.  Long story short (sort of…I told you “she” had a lot to say), empowered with my new knowledge and abundance of rainy days, I put on my figurative big girl pants and dove into cooking. I have  roasted vegetables. That’s right rutabaga, you don’t scare me anymore. I have made soups, stews, gluten-free and dairy-free entrees, desserts, sides and salads… it has been life altering. For me. For the kids. For my my husband.

Yes, the warmth and vision of the sun is uplifting emotionally, there is no doubt. But you may find that if you step into the shade, whether literally or figuratively, and listen to your inner voice, she/he may have something interesting to say and lead you to a new type of “shaded bliss.”

Skin cancer and Sun-safety basics

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My daughter at 6 months

We are in the midst of a skin cancer epidemic.  Skin cancer is by far the most common malignant neoplasm.  In fact there are more than twice as many skin cancers each year in this country as all other forms of cancer combined. The most common type of skin cancer is basal cell carcinoma , and the second most common type is squamous cell carcinoma. It is estimated that one out of every five Americans will develop skin cancer at some point in their life.  Ultraviolet radiation (UVR) is the cause of the vast majority of the nearly 3.7 million skin cancers which are diagnosed in the US annually. UVR is also responsible for up to 90 percent of the visible changes commonly attributed to aging, including wrinkles, sagging skin and brown spots.

Malignant melanoma, the deadliest form of skin cancer, is also an increasingly important public health problem in the United States and worldwide. The incidence of melanoma has increased 3.1% annually during the past 20 years, which translates to an incidence that is increasing faster than that of any other cancer in the United States. Melanoma is not just a disease of the elderly; it is the second and third most common cancer of women and men in their 20’s respectively.  It is the most common deadly skin cancer of women between the ages of 20 and 35.  Someone dies every hour in this country from melanoma. The current lifetime risk of an American developing invasive melanoma is 1 in 59.  This rate is alarming when contrasted with the 1 in 1500 lifetime risk for Americans born in 1935.   The increased incidence of skin cancer appears to be multi-factorial. Sun exposure, both recreational and occupational, changing patterns of dress favoring more skin exposure, ozone depletion and increased life expectancy are likely contributing factors. Additional risk factors including family and personal history of skin cancer, immunosuppression, and carcinogens may also influence developing and dying from skin cancer. People at highest risk include those individuals with light skin and eyes, an inability to tan, freckle easily and have a large number of typical or atypical moles.  Of all these risk factors, sun exposure, is the only established modifiable cause of skin cancer.

The skin is the most exposed organ to environmental ultraviolet radiation (UVR) and to its related effects. The sun emits UVR waves that range from 200 to 400nm. Solar radiation that reaches the earth’s surface comprises approximately 95% UVA (320-420nm) and 5% UVB (290-320nm) rays.  UVB is largely responsible for sunburn, while UVA rays, which penetrate the skin more deeply, are associated with wrinkling, sagging, leathering and discoloration; these changes are also referred to as the effects of photoaging. UVA rays are relatively constant throughout the day and the year. They also can penetrate through window glass, so you are at risk of exposure even when indoors and in your car.  UVB rays, in contrast, have greater intensity in summer than in winter, at midday than in morning or late afternoon, and in places closer to the equator and at high altitudes. It’s important to be aware that certain surfaces reflect the sun’s UV rays, allowing them to hit your skin and eyes twice. Not only does water reflect an extra 10 percent of UV light ; UVR can penetrate water to a depth of 60cm resulting  in significantly increased exposure.

It is well established that there is a strong causal relationship between UV exposure and the development of melanoma and non-melanoma skin cancer (basal and squamous cell carcinoma). Children spend a lot of time outdoors and there is compelling evidence that childhood is an especially vulnerable time for the damaging (carcinogenic) effects of the sun.  The negative effects of UV radiation are accumulated during an entire lifetime and the risk of skin cancer increases with age. It is estimated that approximately 25 percent of our total sun exposure is acquired by age 18, and men over age 40, who spend the most time outdoors, get the highest annual doses of UV rays.   There is epidemiologic evidence supporting the causal relationship between sun exposure and skin cancer which includes a higher incidence of malignant melanoma in persons with a history of sunburns during childhood and adolescence; increased frequency of skin cancers with higher sun-exposure history; heightened risk of melanoma for those with increased childhood sun-exposure history; and relationship between sun exposure and increasing number of nevi, which may predispose to melanoma. The anatomic areas that skin cancer develops on appear to be somewhat related to the average amounts of UV exposure to those sites. For example, melanoma tends to be found more frequently on the legs in women, and the back in men. However, there is a trend toward increasing rates of melanoma on the trunk of women, due in part to clothing styles with increased skin exposure, opportunities for leisure activities in sunny areas and indoor tanning.

With increased life expectancies, and spending more leisure time outdoors, preventing ongoing accumulation of sun damage needs to be incorporated as an important part of a healthy lifestyle. Just as we try to limit our children’s exposure to other known carcinogens such as cigarette smoke, we should do everything we can to minimize their exposure to the ultraviolet radiation from the sun.

With the incidence of skin cancer on the rise, now is the time to take action against the ONE AND ONLY modifiable risk factor : excessive sun exposure. The purpose of sun-safety behavior is not to avoid outdoor activities, but rather to protect the skin from the detrimental sun effects. There are important steps you can take to decrease your risk of skin cancer without compromising the fun, or the competitive edge of any sport in which you may be competing.

Sun safety requires implementing a comprehensive set of sun safe behaviors, because no behavior alone will provide sufficient sun protection. While complete sun avoidance is not realistic, seeking shade when possible and capitalizing on the fluctuation of the intensity of UVB rays, by exercising outdoors in the early morning and late afternoon/early evening is recommended. The UVA rays will remain intense throughout the day, therefore the detrimental effects of the sun still exists at these times as does the risk of sunburn.  Additional sun protective measures include use of sunscreen. Sunscreens are chemical agents that help prevent the sun’s UV radiation from reaching the skin.  As UV radiation is comprised of both UVB (sunburn) and UVA (photoaging) rays it is important to use a product that protects against both types of rays, designated as “Broad spectrum.”  Sunscreens are designated by their SPF –Sun Protection Factor- which is a measure of a sunscreen’s ability to prevent UVB from damaging the skin. An example of how this works is as follows: If it takes 20 minutes for your unprotected skin to begin turning red, using an SPF 15 sunscreen should prevent reddening 15 times longer which is about 5 hours. It is estimated that sunscreens with SPF 15 block approximately 93 percent of all incoming UVB rays. SPF 30 blocks approximately 97 percent; and SPF 50 blocks approximately 98 percent.  Although these may seem like minor differences; for those individuals who are sunlight sensitive or who have a history of skin cancer, these extra percentages will make a difference. It is also important to note that no sunscreen can block 100 percent of UVB rays, and we do not currently have an established metric to calculate protection against UVA rays. So while “reddening” of the skin is an indication of your reaction to UVB rays, there is no immediate telltale sign of the UVA damage you may be accumulating.

Although moisturizers and after-shaves with SPF15 or higher may be sufficient for everyday activities where you spend a few minutes intermittently in the sun, stronger water-resistant sunscreens are required for aquatic sports participants as well as the spectators spending hours outdoors.  Currently in the US, many of the sunscreens available combine different active chemical sunscreen ingredients in order to provide broad-spectrum protection. Typically, at least three ingredients are combined to achieve this goal including PABA derivatives, salicylates, and/or cinnamates for UVB absorption; benzophenones (for example Oxybenzone and sulisobenzone) for shorter-wavelength UVA protection; and avobenzone (Parson 1789), ecamsule (Mexoryl), titanium dioxide, or zinc oxide for the remaining UVA spectrum. For individuals with sensitive skin, sunscreens composed of only titanium dioxide and zinc oxide are available. These latter ingredients are referred to as “physical blockers” as they function by reflecting the UV rays rather than absorbing and subsequently dispersing them like  “chemical blockers”  such as Parsol 1789, (which can irritate the skin in some individuals) .  The level of protection against UV rays is comparable between the physical and chemical blockers. To ensure that you get the full SPF of a sunscreen, however, you must apply a sufficient amount, which is 1 ounce-about a shot glass full.  Most people only apply half to a quarter of this amount, which translates to a lower SPF on the body than advertised on the sunscreen label. A good example for a long day in the sun that lasts hypothetically 8 hours would require the use of 4 ounces of sunscreen, or half of an 8 ounce bottle for just one person. Another significant factor in ensuring sun protection is when sunscreen is applied. Sunscreens should be applied 30 minutes prior to sun exposure to allow the ingredients to fully bind to the skin. Despite sunscreens being labeled as “water-resistant” and “waterproof”, they are only effective up to two hours and therefore require reapplication of the same amount every two hours. Sunscreens should also be reapplied immediately after swimming and toweling off.

We know that sunscreen alone cannot fully protect you from the damaging UV rays and risk of skin cancer. Although reapplication of sunscreen every two hours is recommended, it is not always feasible. Therefore, there are additional sun safe practices that should be adopted. Clothing is the single most effective form of sun protection as it is our first line of defense against the sun’s damaging ultraviolet rays.  Wearing sunglasses and wide-brimmed hats with at least a 3 inch brim will help protect your eyes, head and neck is prudent. For the rest of your body, there are several factors to consider when choosing the ideal attire for sun safety, and one of these is UPF, which stands for Ultraviolet Protection Factor. UPF measures the amount of UV radiation that penetrates the fabric and reaches your skin.  For example, a fabric with a rating of UPF50 will only allow 1/50th of the sun’s UV rays to pass through which means the fabric will significantly reduce your skin’s exposure to harmful UV radiation because only 2 percent of the UV rays will get through. When choosing clothing for every day wear, heavier weight and tightly woven or closely knitted fabrics (corduroy,denim,wool) , as well as synthetic  and semi-synthetic fabrics (such as polyester and rayon) offer the greatest sun protection . Dark and bright colors offer greater UVR protection than whites or pastels. A good rule to remember is that if you hold up fabric to the light and you can see through it, then UV radiation can penetrate it …as well as your skin. Also when clothing gets wet or excessively stretched, the UPF will go down. On a positive note, there are easy ways to increase the UPF of everyday by washing your clothing with a laundry additive such as Rit Sun GuardTM. This product has the active ingredient TinosorbTM which increases clothes sun protective abilities for up to 20 washings. It changes your everyday white cotton shirt from a UPF of 7 to 30.

For aquatic activities, choosing swim suits and rashguards that have been specially treated with chemical UV absorbers, known as colorless dyes are preferable. There are currently national criteria as well as international standards for UPF testing; a UPF label may state that the item meets the standards of the American Society for Testing and Materials and/or the AS/NZS Standard. In addition, choosing swimsuits with the greatest body coverage is paramount to protecting the skin from the harmful UV rays, especially during long practices and endurance events where reapplication of sunscreen is not feasible. Swimsuits with full back coverage and leg coverage either to the knee or ankle will help ensure more comprehensive protection. If such swimsuits are not readily available, wearing a rashguard over your swimsuit will be a useful substitute.

Key points:

  1. Sun safety should be incorporated into your everyday life as the sun’s harmful UV rays are present 365 days a year
  2. Wear broad spectrum sunscreen everyday: for daily activities a moisturizer or after-shave lotion with SPF15 or higher is sufficient; but for aquatic activities or prolonged outdoor exposure choose SPF 30 or higher; apply 30 minutes prior to exposure and reapply every 2 hours
  3. Wear sunglasses, a wide-brimmed hat (brim at least 3 inches) and choose clothing that is tightly woven, closely knit and dark or bright-colored. UPF labeled clothing is available or you can increase your own clothing’s UPF by using a product like Rit Sun GuardTM
  4. Seek the shade, but be aware that sunlight may reflect off surfaces like concrete ,water and sand and can reach you beneath an umbrella or tree
  5.  Avoid activities during peek sun exposure  hours between 10am and 4pm
  6. Healthy habits are best learned at a young age, therefore practicing sun safety for your children should be a priority. Damage from UV rays occurs with each unprotected exposure and accumulates over the course of a lifetime, therefore people of all ages need to be safe in the sun to minimize their risks of melanoma and non-melanoma skin cancer.

Acknowledgements:

This post is a modification of an article I wrote for a publication for FINA, the international governing board for all competitive aquatic sports.

Many of the facts used in this post were obtained from the Skin Cancer Foundation website:
http://www.skincancer.org