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Protecting Your Skin against the Sun

Skin cancer has become a major health issue. Collectively, skin cancers account for greater than 50% of all human malignancies. This year, over one million new cases of skin cancer will be diagnosed in the U.S. alone. Of these, approximately 59,000 cases will involve melanoma – a particularly dangerous skin cancer that has doubled in incidence among Caucasians between 1973 and 1994. Another alarming trend: the increasing number of twenty- and thirty-something year old patients presenting with skin cancers.

Exposure to the sun’s and/or a tanning bed’s ultraviolet rays (UVR) appears to be the most important environmental factor in the development of skin cancer. Other types of injury may also play a role in certain individuals. For example, skin cancers occasionally arise in areas previously injured by blunt trauma, hot water or grease burns, and welding sparks. Radiation damage, such as that experienced by workers involved in the Chernobyl accident, can also induce skin cancers. However, sun exposure is by far the most important risk factor and fortunately, the one over which we have the greatest control. Skin cancers typically do not occur until 20-50 years after the actual damage has occurred. Therefore, the damage one accumulates when young is often responsible for tumors that develop later in life.

Several factors may contribute to the increased number of skin cancers seen today:

• Introduction of the bikini and more revealing clothing in the 1950’s and 1960’s.
• Increased U.S. affluence following WWII, which led to more beach vacations.
• The social acceptance of a tanned appearance as a sign of beauty and affluence starting in the 1950’s. One hundred years ago, “sophisticated” women donned gloves, hats, and parasols to shield their skin from the sun.
• Increased popularity of outdoor activities, such as golf, swimming, and fishing.
• Tanning beds: An unregulated industry that harms 28 million Americans and generates $5 billion in revenue each year!
• Sunscreens with an SPF factor of 15 or greater were not introduced until 1984.
• Depletion of ozone - a protective layer of atmospheric oxygen that blocks UV rays.
• Other environmental factors, such as pollution?

Certain individuals are at greater risk for developing skin cancer – those with:

• A personal or family history of skin cancer (genetic risk)
• Light skin color, blue eyes, and blonde or red hair
• A history of several sunburns early in life
• Certain types and a large number of moles
• Chronic exposure to the sun through work or recreational activities

However, it is important to remember that anyone can develop skin cancer, even African Americans. Please visit www.skincancer.org for an excellent photographic review of the common types of skin cancer.

There is simply no safe UV-induced tan, because a tan is only produced by injured skin. Tanning beds are particularly dangerous, because they emit about 2 times more UVB and 4 times more UVA than natural sunlight! Both UVA and UVB cause skin cancers. The tanning bed industry claims that a “baseline tan” will protect users against future sunburns. (This is akin to recommending daily consumption of alcohol to get the liver ready for planned weekend binging!) The reality is that a baseline tan offers an SPF of only 2 to 4 – not enough to be protective. UV radiation also suppresses the immune system in the skin. Herein lies the “double whammy”, because UV radiation not only causes damage, but promotes its transformation into potentially dangerous skin cancers.

Tanning bed UVA actually ages skin more quickly than natural sunlight (primarily UVB), because UVA penetrates 4 times deeper into the skin than UVB. Thirty minutes in a tanning bed delivers the same UVA insult to the skin as an entire day at the beach! This causes wrinkles, brown spots, and a leathery texture – hardly features of beautiful skin.

Fortunately, there are relatively simple lifestyle measures that can greatly protect you. Please note that the following recommendations should be implemented, as much as possible, on a daily basis and year-round - not just when at the beach or pool. Also, an estimated 80% of lifetime sun exposure occurs by age 18, so please teach these practices to your children and grandchildren. Infants can safely begin using sunscreens at age 6 months. By changing the habits of our children, we will truly make a difference in the battle against skin cancer.

SUNSCREENS
Sunscreen use can be a hassle, but there simply is no better method to protect those sun-exposed areas of the body not easily covered by clothing (face, neck, and hands). In addition, sunscreens supplement the protective effects of clothing on other areas of the body. In general, sunscreen-containing makeups are useful but slightly less effective than dedicated sunscreen lotions and creams.

To be effective, sunscreens need to be liberally applied approximately 20 minutes before going outdoors. Several studies suggest that people typically apply sunscreen too thinly. As a result, they do not achieve the full SPF protection promised on the packaging. Also, sunscreens need to be reapplied throughout the day, particularly after swimming, sweating, or exercising. Some golfers and other recreational enthusiasts prefer the “less greasy” feel of an alcohol-based sunscreen, such as Ombrelle or Coppertone Sport Spray. These products are sprayed on, and dry rapidly as the alcohol evaporates. They may interfere less with that important drive, chip, or putt! Another good option is a sunscreen such as Coppertone Sport Extra-Dry. Try to choose a sunscreen with an SPF factor of 15 or greater that provides both UVA and UVB (i.e. “broad spectrum”) protection. Look for products containing zinc oxide, titanium dioxide, and/or Parsol 1789 (UVA blockers) in addition to traditional UVB blockers such as octyl salicylate or octyl methoxycinnamate.

There are many excellent choices on the market, including Purpose, Vanicream, Eucerin, Cetaphil, Neutrogena, Lubriderm, and Blue Lizard. Sunscreen products developed specifically for lip use are also available, such as Chapstick SPF 30 (orange tube).

Please note that a sunscreen claiming an SPF of 45 or 50 is not truly 3 times as effective as one with an SPF of 15 (see chart below). In fact, the FDA has considered limiting all SPF claims to 30 or less, since they feel that higher claims may be misleading to the public.

CLOTHING
Clearly, long-sleeved shirts and pants are helpful. However, many people are surprised to learn that a typical white cotton t-shirt blocks only 40% of the sun’s harmful ultraviolet rays. This corresponds to an SPF of only 5. In general:

1. Darker hues block more sunlight than lighter colors.
2. Bleached cotton offers less protection than unbleached cotton, wool, or polyester.
3. Loose-fitting apparel is more protective than stretch fabrics that hug the skin.

Several companies offer useful, comfortable clothing specifically designed for effective sun protection, e.g. (1) Sun Precautions, 2815 Wetmore Avenue, Everett, WA 98201, (800) 882-7860, www.sunprecautions.com, and (2) Sun Protective Clothing, 2704 Leeman Road, Elginburg, ON Canada K0H 1M0, (800) 353-8778, www.sunprotectiveclothing.com

A more practical solution became available in early 2002, when “Rit Sun Guard” was released. This revolutionary new laundry additive washes UV-protection directly into your clothing. The odorless, colorless dye raises the SPF of a typical white cotton T-shirt from 5 to 30, resulting in an increase in UV blockage from 40% to 96%! According to the manufacturer, one treatment lasts for 20 washings. The prestigious, NYU-based Skin Cancer Foundation officially endorses Rit Sun Guard. More information is available at www.ritsunguard.com, or by calling (317) 231-8043. The product is available online at www.dermadoctor.com, and nationally at Eckerd Drug, Walmart, and Walgreen’s. Because it has been historically difficult to find in Lexington, we also sell Rit Sunguard at our office.

Approximately 80% of all skin cancers occur on the head and neck, so a wide-brimmed hat (3 to 4 inch brim) is very useful to shade the face, ears, scalp, and neck from the sun’s harmful rays. If a baseball cap is worn, you need to pay particular attention to applying sunscreen to the unprotected ears and neck.

“MADE IN THE SHADE”
Try to plan outdoor activities for the early morning (before 10 am) or late afternoon (after 4 pm). If outdoors, seek the shade whenever possible. Also, remember that snow, ice, and water place your face and eyes at twice the risk of UV damage because of reflected glare.

SUNGLASSES
Children’s eyes are especially vulnerable to UV radiation because their lenses are clear until about 10 years of age. Sunglasses protect the sensitive skin around the eyes and also reduce the risk of cataracts and macular degeneration. Look for sunglasses that offer both UVA and UVB protection. Polycarbonate lenses are good choices.

AUTOMOTIVE WINDOW TINT
Some UVR can penetrate automobile and residential windows, so window films are helpful.

SELF TANNING CREAMS
Gone are the days of orange, streaky skin. Modern self-tanners contain a safe sugar molecule known as Dihydroxyacetone that temporarily stains the skin an elegant tan color.

SMOKING
The 2004 Surgeon General Report states: “Smoking damages nearly every organ in the human body”. Smoking causes skin cancer, as well as leukemia and cancer of the mouth, throat, larynx, esophagus, lungs, stomach, pancreas, kidney, bladder, and cervix.

FRAGRANCES & PERFUMES
Some fragrances and perfumes can make your skin more sensitive to the sun’s UVR. Therefore, minimize use of these products when gardening or pursuing outdoor activities.

ORAL MEDICATIONS
Non-steroidal anti-inflammatory drugs (NSAIDS), such as naproxen and ibuprofen may help lessen the severity of a sunburn if taken immediately after significant sun exposure.

More information on sun protection is available at www.cdc.gov/ChooseYourCover. For reliable information on skin cancer: www.aad.org, www.cancer.gov/cancerinfo/types/Skin, www.cdc.gov/cancer/nscpep/index.htm, and www.dermoncology.com. Remember what your grandmother taught you: “An ounce of prevention is worth a pound of cure”. Thank you for allowing us to participate in your care.

* Portions of this article have been published by Dr. Dhir in the Lexington Herald Leader, and appear in interviews of Dr. Dhir on WLEX, WKYT, and WTVQ. *