Which Sunscreen Should I Use?

Speaking of melanoma (yesterday's blog), it's time for another review about the basics of sunscreens. Which one is the best? Sprays are so fast and convenient- but do they work? Which ingredients matter? 

Let's start with SPF. What does it mean? Sun Protection Factor is a measure of a sunscreen's ability to protect the wearer against UV radiation from UVB. Note that the sun produces both UVA and UVB, and BOTH cause damage that can lead to skin cancers. Right now, though, the SPF only addresses the UVB protection. So, SPF means that compared to bare skin, the sunscreen keeps you from burning X times longer. If it takes you a half hour to turn red with bare skin, a sunscreen with an SPF of 30 should in theory keep you from burning 30 times longer, which would be 900 minutes- 15 hours. Unfortunately, no sunscreen stays fully effective beyond two hours without re-application. Additionally, sunscreens with an SPF of 15 block roughly 93% of UVB rays, SPF 30 ~ 97%, and SPF 50 is 98%. Therefore, even with perfect application, no sunscreen blocks all UVB rays, and many block no UVA rays.

How much should you use to be effective? Surprise- would you believe it takes about an OUNCE (picture a shot glass), and that same amount should be reapplied every two hours. This means you will use roughly half of an 8 ounce bottle on ONE PERSON during a full day outdoors. (And no, I don't own stock or have financial interests in sunscreens.)

Which ingredients are important? Most dermatologists recommend combining the physical barrier ingredients that protect against the deep penetrating UVA rays, such as ZINC OXIDE & TITANIUM DIOXIDE (the ones that leave the white residue) along with the chemical barrier agents known to block UVBs, such as PABA, salicylates, cinnamates and benzophenones. Since nearly all sunscreens contain mixes of the chemical barriers, I grab a tube or bottle and scan to be sure it also lists either zinc oxide or titanium dioxide as well. Note that some people are sensitive to PABA or other ingredients, and may do best with purely barrier sunscreens and clothing (such as surf shirts.)

Back to the sprays...they are not my first choice. Why? Few have either zinc oxide or titanium dioxide, and those that do are very expensive and have these minerals broken down into "nanoparticles" to allow them to be in a light enough liquid to spray. In the medical literature, some debate exists as to whether these nano-sized minerals can potentially cause cancer, which is of course, the opposite of our intent. Regardless of these issues, probably the biggest issue with sprays is that people use TINY portions- picture that less than 10 second total body spray- and so they are not obtaining anywhere near the listed SPF. Would I prefer that over skipping sunscreen all together? Yes...which means I do keep some on hand.

What do I usually buy? Our family likes Banana Boat's "Baby" lotion. To it's credit, my kids complain that their skin is "way too white" because I never let them tan. I take that as a compliment! Probably more importantly, for extended sun exposure we all use swim shirts, and try to consistently wear hats and sunglasses.

BOTTOM LINE: Get a sunscreen that contains both chemical and barrier agents (think titanium dioxide) and realize an 8 oz tube should be used up by a family of four in ONE morning OR afternoon since each person needs ONE OZ every TWO HOURS.

Summer Skin Cancer Message

Recently a friend posted a very impactful message on her Facebook page (thanks, Lisa!) that I would like to recommend. The youtube video is called "Dear 16 year-old Me", and shows real people who lives have been deeply affected by melanoma, and the message they would love to go back in time and send to themselves (and their loved ones) before they started purposefully sun tanning to "look healthy".

Many people are unaware that the skin cancer MELANOMA is a very serious cancer. Because it looks like a simple little funny-looking mole on the skin, there is often the assumption that a quick skin biopsy will fully take care of the issue. Not so! While these cancers start in the pigment-producing skin cells, they can invade locally and then break off and metastasize to the liver, lungs and even the brain.

Melanoma skin cancers kill roughly 8000 people in the United States every year, and show up in an estimated 100,000 people annually. (Numbers on this vary greatly, partly because although melanoma cases should be reported to central cancer registries, many providers are unaware of this these reporting requirements.)  I know in my practice, I have seen younger and younger patients (not just because I am growing older!) with this scary diagnosis. Did you know that using a tanning bed before you turn 35 will cause a 75% increased risk of developing this cancer? Other risk factors include blistering sunburns in childhood, living at higher altitude (>2300 feet), family history of melanoma, fair skin, red or blond hair and more than 5 sunburns in your entire lifetime.

Remember the ABCDE's of Melanoma:
Asymmetry
Border (that looks irregular)
Color variation (including reds, blacks or blues)
Diameter (>6mm)
Elevation  (you can feel it as a bump above the skin)

And ultimately, remember this- if all your "moles" look the same, and ONE looks different- please go get that one checked out. Just like Sesame Street, if "one of these things is not like the others" then it "doesn't belong"!

BOTTOM LINE: Please, watch the video- the message is very effective. And remember to wear sunscreen and protective clothing this summer!

Modeling credit: A. Lampert (who will wear more sunscreen next time...)

Getting a Base Tan for Spring Break?

Here in Texas, we are alternating hot days of wearing shorts with chilly days or grabbing jackets, which means it's nearly time for SPRING BREAK- hooray! Many students and their families head to the beach for spring break, and before the women don their bikinis, the quest for a "base tan" to avoid a sunburn begins. I have had many patients ask my advice on what is better- going to a tanning booth or braving the capricious weather outside. My answer? NEITHER.

The entire notion of a "base tan" has no scientific basis, nor support from dermatologists. In fact, the American Academy of Dermatology (AADA) testified last year at FDA hearings about the risks of indoor tanning. These devices have shared the same low risk category as bandaids and tongue depressors, yet we have had medical evidence for years that they clearly cause skin cancers.

Melanoma rates are increasing across the board, and melanoma is now the number one cancer in young people aged 25-29, and the second most common cancer in 15-29 year olds. Use of a tanning bed before the age of 35 increases your risk of developing melanoma by a whopping 75%! I can personally attest in my own practice that I have diagnosed multiple cases of melanoma in the last couple years, primarily in people younger than I am- which really hits home. (I'm 47.) Having lost a friend to melanoma many years ago, I am very aware that skin cancers are not simply cosmetic nuisances.

Please be aware that tanning beds are not "safe", and they target young people (especially women) with their ads. Many tanning salons promote their "safe" or "harmless" type of UV radiation, but the UVA rays cause damage in the same fashion as UVB rays- only a bit more slowly and more deeply. Any change in skin color is a sign of damage from UV radiation. Period.

The American Academy of Dermatology hopes the FDA will ban indoor tanning devices all together, but at the least, should require a minimum age of 18 for ANY indoor tanning and should mandate obtaining informed consent from clients AFTER educating them about the real risks of skin cancer. The AADA also strongly recommends changing the risk category of these machines to match the health risks they create.

BOTTOM LINE: TANNING is NOT SAFE and "base tans" don't help! Use sunscreen, wear protective clothing and stay away from tanning beds all together.

Which Sunscreen is the BEST?

There are so many sunscreen products available that it often feels impossible to choose which type of sunscreen to purchase. I know most kids (& moms) prefer the sprays, because it makes the process so much faster. Unfortunately, I have yet to find a sunscreen with all the ingredients that I look for to ensure the best protection.

Let's start with SPF. What does it mean? Sun Protection Factor is a measure of a sunscreen's ability to protect the wearer against UV radiation from UVB. Note that the sun produces both UVA and UVB, and BOTH cause damage that can lead to skin cancers. Right now, though, the SPF only addresses the UVB protection. So, SPF means that compared to bare skin, the sunscreen keeps you from burning X times longer. If it takes you a half hour to turn red with bare skin, a sunscreen with an SPF of 30 should in theory keep you from burning 30 times longer, which would be 900 minutes- 15 hours. Unfortunately, no sunscreen stays fully effective beyond two hours without re-application. Additionally, sunscreens with an SPF of 15 block roughly 93% of UVB rays, SPF 30 ~ 97%, and SPF 50 is 98%. Therefore, even with perfect application, no sunscreen blocks all UVB rays, and many block no UVA rays.

How much should you use to be effective? You might be surprised to hear that it takes about an OUNCE (picture a shot glass), and that same amount should be reapplied every two hours. This means you will use roughly half of an 8 ounce bottle on ONE PERSON during a full day outdoors!

Which ingredients are important? Most dermatologists recommend combining the physical barrier ingredients that protect against the deep penetrating UVA rays, such as ZINC OXIDE & TITANIUM DIOXIDE (the ones that leave the white residue) along with the chemical barrier agents known to block UVBs, such as PABA, salicylates, cinnamates and benzophenones. Since nearly all sunscreens contain mixes of the chemical barriers, I grab a tube or bottle and scan to be sure it also lists either zinc oxide or titanium dioxide as well. Note that some people are sensitive to PABA or other ingredients, and may do best with purely barrier sunscreens and clothing (such as surf shirts.)

Back to the sprays...for me, there is not an acceptable spray yet, for several reasons. Primarily, there are few with either zinc oxide or titanium dioxide, and those that do are very expensive and have these minerals broken down into "nanoparticles" to allow them to be in a light enough liquid to spray. There is some debate whether these nano-sized minerals can potentially cause cancer, which is of course, the opposite of our intent. Regardless of these issues, probably the biggest issue with sprays is that people use minute portions- picture that less than 10 second total body spray- and so they are not obtaining anywhere near the listed SPF.

What do I buy? Our family typically uses Banana Boat's "Baby" lotion. To it's credit, my kids complain that their skin is "way too white" because I never let them tan. I take that as a measure of success! Probably more importantly, we all use swim shirts, and most of us consistently wear hats and sunglasses.

BOTTOM LINE: Get a sunscreen that contains both chemical and barrier agents (think titanium dioxide) and realize an 8 oz tube should be used up by a family of four in ONE morning OR afternoon since each person needs ONE OZ every TWO HOURS.

PS. NO, I do not have any financial ties to sunscreen makers!

Getting that "Base Tan" for Summer Vacation?

Marketing is everything, isn't it? How many of you have headed to a tanning booth to get that "base tan" before heading out for a beach vacation? Here's a note- that notion has no scientific basis, nor support from dermatologists. In fact, the American Academy of Dermatology (AADA) testified recently at FDA hearings about the risks of indoor tanning. These devices have shared the same low risk category as bandaids and tongue depressors, yet we have had medical evidence for years that they clearly cause skin cancers.

Melanoma rates are increasing across the board, and melanoma is now the number one cancer in young people aged 25-29, and the second most common cancer in 15-29 year olds. Use of a tanning bed before the age of 35 increases your risk of developing melanoma by a whopping 75%! I can personally attest in my own practice that I have diagnosed 3 cases of melanoma just in the past few months, primarily in people younger than I am- which really hits home. (I'm 45.) Having lost a friend to melanoma many years ago, I am very aware that skin cancers are not simply cosmetic nuisances.

Tanning beds are not "safe", and they target young people (especially women) with their ads. Many tanning salons promote their "safe" or "harmless" type of UV radiation, but the UVA rays cause damage in the same fashion as UVB rays- only a bit more slowly and more deeply.

The American Academy of Dermatology hopes the FDA will ban indoor tanning devices all together, but at the least, should require a minimum age of 18 for ANY indoor tanning and should mandate obtaining informed consent from clients AFTER educating them about the real risks of skin cancer. The AADA also strongly recommends changing the risk category of these machines to match the health risks they create.

BOTTOM LINE: TANNING is NOT SAFE! Use sunscreen and stay away from tanning beds all together.

Melanoma's "Ugly Duckling" Appearance

Do you have your ducks in a row when it comes to scanning your body for skin cancer? You may be familiar with the ABCDE's of melanoma (Asymmetry, Border, Color, Diameter, Evolving), but do you know about the "Ugly Duckling" concept? I love this one, because it echoes what I often say to patients when they ask why a certain mole looks "suspicious"- I tell them it's like the old Sesame Street concept that "one of these things is not like the others...one just doesn't belong"!

Like everything in medicine, each body has its own version of what we describe in textbooks. While diseases have a distinctive pattern, the actual specifics will vary from person to person. Along those lines, what we are looking for in melanoma is a mole that simply does not fit the PATTERN that your body has developed. For example, if you are covered in large brown moles, but you notice one small dark black one- it's that small one we worry about. If you have no moles at all except one medium light brown one, we worry about that medium-sized one, not because it is medium or brown, but because your "pattern" is NONE, and this is breaking that pattern. Make sense?


Here is a a graphic from the Skin Cancer Foundation that illustrates this concept. The arrows point to the odd man out, which is the mole that we would tend to prefer in a pathology lab than staying on your body.

BOTTOM LINE: Take a good look at your skin from top to bottom (use mirrors!) and learn to recognize the pattern of TYPES of moles that you have, so you will recognize that "ugly duckling" mole before it turns into full blown skin cancer!

A Scary Mole? Or not...

I think we have done a good job educating the public about melanoma. Most people wear sunscreen religiously if they are going to be outside for an extended period, and more are remembering to wear hats. People are in tune to notice dark black moles, especially any that are growing or changing, and often know the ABC’s of melanoma. (Asymmetry, Border, Color, Diameter, Evolving)

One side effect of all this education is that more people are coming in to ask about a mole on their body that they or their spouse has noticed. Frequently we have reassuring news for them, which is that the “mole” that they are afraid of is simply a seborrheic keratosis- SK for short.

SKs run in families, and tend to increase in number as we age. They are so common that most people will have at least one in their lifetime. SK's pop up most commonly on your chest, back, shoulders, face and abdomen. They are brown, black, or pale, raised and waxy or scaly, and look like they are stuck on, as though they can easily be scratched off. They can “itch and be ugly” (to quote my old dermatology teachers) but only very rarely become dangerous. If they are bothersome, a treatment with liquid nitrogen will typically make them go away. The bad news, however, is you are likely to make more. Check out the Mayo Clinic's pictures of SK's.

BOTTOM LINE: Do not hesitate to go to your family doctor or dermatologist and get your moles checked out- it's not all bad news, and many are easily treated if they bother you!