A senior vice president of The Skin Cancer Foundation and his Mohs surgery fellow address five questions they hear most from their patients.
By Cheryl Janene Gustafson, MD, and C. William Hanke, MD
More people than ever are aware of the harmful effects of the sun’s ultraviolet (UV) light. Yet many still don’t protect themselves every day. One of our most important responsibilities as dermatologists is to remind our patients of the importance of year-round sun protection and early skin cancer detection. Our hope is to help people adopt daily habits that will protect and preserve their skin over a lifetime.
In that spirit, here are our responses to five key questions that our patients frequently ask:
1. Why should I start protecting my skin now, when I’ve already accumulated years of sun damage?
Don’t give up! It is never too late to incorporate sun safety into your daily routine. Sun damage adds up throughout your lifetime, and no matter what age you are, you can reduce your risk of skin cancer through daily sun protection. In a study led by the Australian researcher Adele C. Green, MD,1 1,621 people in Queensland, Australia, ranging in age from 25 to 75 years, were randomly assigned to two groups. One group used an SPF 15+ sunscreen daily; the other participants used sunscreen at their own discretion. After 14 years, regardless of their ages, the people who used sunscreen daily reduced their risk of developing melanoma by 50 percent compared with those who used sunscreen sporadically or not at all.
In addition to being the major cause of skin cancer, the sun’s ultraviolet (UV) radiation is the leading culprit behind skin aging. The visible signs of UV damage include wrinkles, age spots and the breakdown of collagen, elastin and subcutaneous fat, which causes skin to sag. Daily sun protection can slow down skin aging. In a 2013 Australian study also led by Dr. Green, people who used an SPF 15+ sunscreen daily showed 24 percent less skin aging than those who did not use sunscreen daily.2
Another way of protecting your skin is to eliminate some of the sun damage already done to it over the years. A variety of treatments not only can help reduce or undo many of the effects of skin aging, but also remove some skin precancers that might otherwise turn into full-blown skin cancers. These treatments include topical retinoids, topical exfoliants, chemical peels, laser resurfacing, photodynamic therapy and topical chemotherapies, such as 5-fluorouracil. Be especially zealous about sun protection when using any of these, since they can make the skin sun-sensitive for up to 48 hours after the treatment ends. For the benefits to last, it’s important to practice sun protection diligently even after the treatments have ended.
2. Will a light tan help protect me from UV rays?
There’s no such thing as a safe, healthy or “protective” tan, since tanning itself is the result of DNA damage to the skin. Skin damage from UV radiation, whether from the sun or a tanning bed, starts within minutes. Therefore, getting even a “light” or “mild” tan results in damage to your skin. We emphasize to patients that it takes just one damaged skin cell to start a skin cancer.
Despite efforts such as The Skin Cancer Foundation’s Go With Your Own Glow® campaign, which encourages people to embrace their natural skin color, many individuals continue to think tanned skin is more beautiful. If you still desire a tan, we recommend using topical sunless tanning products. Choose products that list dihydroxyacetone (DHA), an FDA-approved skin-coloring agent, as the main active ingredient. When applied to the skin, it interacts with amino acids in dead skin cells, subsequently producing a color change. If the product doesn’t contain DHA, it may contain a tan accelerator, which only speeds up UV-induced skin damage.
It’s important to know that the tan-colored skin produced by sunless tanners provides no protection against UV light. Therefore, it’s crucial for patients to use sunless tanners in conjunction with daily sun protection. Even when a sunless tanner includes an SPF 15 or higher sunscreen, you should reapply a separate broad-spectrum SPF 15+ sunscreen every two hours outdoors and immediately after swimming or sweating.
3. Why should I use sunscreen every day if I’m not spending more than a few minutes outside?
Skin damage can start after just a few unprotected minutes in the sun. The exposure you get from little tasks like retrieving the mail, washing the car or walking the dog adds up. It’s worth it to use sun protection daily.
You can also be exposed to skin-damaging UV rays when indoors or in your car. (That’s why dermatologists in the U.S. see many skin cancers on people’s left side, or driver’s side.) Though window glass blocks almost all of the sun’s ultraviolet B (UVB) rays, UVA rays — the main culprit behind skin aging and a significant cause of skin cancers — can pass right through. This means you can acquire skin damage while driving or in any room with windows — another good reason to find a sunscreen you like and use it every day, all year long. You can also have special window film applied to your house or car windows, which can keep out better than 99 percent of both UVA and UVB rays.
There’s new evidence that a different type of light from the sun, known as infrared A, or IRA radiation, also plays a part in skin aging,3-7though its role in skin cancer is still being investigated. Tightly woven clothing and wide-brimmed hats, already great protection against UV rays, may also offer some protection against IRA.
4. What type of sunscreen should I use?
We recommend using a broad-spectrum (UVA-UVB) sunscreen with an SPF of 30 or higher every day. While an SPF of 15 is adequate for brief, everyday exposures, SPF 30+ is better for extended stays outdoors. For extra protection when you’re swimming or exercising, use a water-resistant formula; reapply it every two hours, as well as right after sweating heavily or coming out of the water.
We often refer patients to the Seal of Recommendation Product Finder. This helpful resource lists a variety of sun protection products, from sunscreens and sun-safe clothing to umbrellas and window film.) In addition, the Foundation provides helpful brochures, newsletters and books on skin cancer and sun protection, which most dermatologists can give you during an office visit.
5. What should I do since I’m allergic to sunscreen?
A pure allergy to sunscreen is uncommon. More often it is a “photoallergy,” meaning the sunscreen causes a reaction triggered by sunlight. Whether allergy or photoallergy, if you develop a rash from one or more sunscreens, you may benefit from having “patch” and “photopatch” testing to determine which type of allergy you have.
But first, if you have a reaction to one sunscreen, it’s probably worth simply trying a different type of sunscreen. Products are categorized as either chemical screens that mainly absorb UV, or physical screens that mainly deflect the sun’s rays. Allergy to chemical absorbers is more common than allergy to physical sunscreens (sometimes labeled “mineral” sunscreen), such as titanium dioxide and zinc oxide, which remain as a physical barrier atop the skin rather than being absorbed.
If you know what ingredients cause your reaction, try a sunscreen without those ingredients. Sometimes, the problem may not be the key active ingredients, but rather an inactive or trace ingredient such as a fragrance or preservative. Allergy testing should take that into account.
Although sunscreen is important, be aware that clothing is generally considered the single most important sun protection method. The Skin Cancer Foundation recommends a comprehensive daily regimen. This includes seeking shade, especially from 10 AM to 4 PM, the hours of greatest sun intensity, and wearing UV-protective clothing, including a wide-brimmed hat and UV-filtering sunglasses. Also apply an SPF 15 or higher broad-spectrum sunscreen to all exposed areas for everyday intermittent activities and an SPF 30 or higher, broad-spectrum, water-resistant sunscreen for extended stays outdoors. Follow these guidelines, and you will slow down skin aging and substantially reduce your lifetime chances of developing skin cancer.
Cheryl Janene Gustafson, MD, is a dermatologist who is completing a fellowship in Mohs micrographic surgery and dermatologic oncology under the mentorship of C. William Hanke, MD, at the Laser and Skin Surgery Center of Indiana. She has served as a media spokesperson for The Skin Cancer Foundation.
C. William Hanke, MD, is a Mohs surgeon at the Laser and Skin Surgery Center of Indiana in Carmel, Indiana. He is a senior vice president of The Skin Cancer Foundation and a member of its Amonette Circle, and has served as president of 13 professional societies.
Published on June 5, 2016.