Doc’s Corner


After being advised to stay inside during much of the spring related to COVID-19, many of us are enjoying the wonderful sunny days of summer. Exposure to sunlight has many health benefits in addition to lifting our mood just by being outdoors on a sunny day.
It is prudent however to take precautions. Each year there are more new cases of skin cancer than new cases of breast, prostate, lung and colon cancer combined. About one in every five Americans will develop skin cancer during their lifetime. The underlying cause is well known: 90% of basal cell and squamous cell cancers and 86% of melanoma cases are linked to sun exposure.

Living in beautiful, sunny Southern California, what is a fun loving person to do? The obvious response is to use sunscreen, but how much, how often and what type and are there any risks?

Each of us has a different risk profile based upon skin type, prior exposure and even inherited genetic predisposition. This is because those with more pigmentation have more natural protection from the sun. However, people with darker skin can nonetheless get skin cancer. Most people have a UV radiation resistance-associated gene (UVRAG for short), that rushes into repair as much of the damage as possible, while others lack this protection. We now know this gene plays a role in everyone’s odds of getting skin cancer. Skin damage can begin within 15 minutes of sun exposure. It is generally best to consider each of us to be at risk.

We should apply sunblock to exposed skin areas whenever we are outdoors, regardless of the weather and your skin tone. Apply an ounce of sunblock (about a shot glass) 30 minutes before going outdoors, as recommended by the American cancer society. As much as 40% of the sun‘s UV rays reach the earth even on overcast days. Skin cancer doesn’t discriminate, but our risks are varied. Melanoma survival rates among African Americans tends to be significantly lower than white Americans, according to a recent study published in the Journal of the American Academy of Dermatology.

Not all sunblocks protect you from UVA and UVB rays. UVA rays age your skin, weaken the immune system and damage DNA. UVB rays are linked with skin cancer. Many sunblocks provide protection against UVB rays but not UVA. Only products labeled as “broad-spectrum“ can protect you from both because they have either zinc oxide (expert ingredient of choice), titanium oxide or 3% avobenzone with octocrylene in its ingredients.

Aerosol spray-on sun blocks often don’t provide the same level of protection as a lotion. It’s very difficult to gauge the amount of spray you’ve used and if you’re thoroughly covered. Inhaling fumes also is a concern.

Read sunblock labels. Begin by checking the expiration date. Most sunblocks are only effective for two or three years. Next, check the SPF level. Many people are willing to spend a lot of money on sunblocks with high levels of SPF thinking they’ll get significantly more protection from UVB rays. That’s not quite accurate. A block with SPF 15 screens out about 93% of UVB rays; SPF 30 filters about 97%, SPF 50 protects 98% and SPF 100 blocks about 99%. Select the SPF level that best suits your needs and wallet. Usually use SPF 15-30 or higher, SPF 50 if fair skinned.

1 Broad Spectrum: It’s essential for your sunscreen to offer broad spectrum protection, which means that it offers effective protection against both UVA (ultraviolet A) and UVB (ultraviolet B) rays, the solar wavelengths proven to damage the skin. UVA rays penetrate the skin more deeply than UVB, and are the chief cause of wrinkles, sagging and other signs of aging. UVB rays damage the skin’s upper surface and are the main cause of sunburn. Both cause skin cancer.
2 Sun Protection Factor (SPF): SPF is a measure of how long a person can stay in the sun before its UVB rays start to burn the skin.  Let’s say with no sunscreen, your skin starts to redden in 20 minutes. An SPF 30 will theoretically allow you to stay in the sun 30 times longer without getting burned.  But keep in mind that SPF numbers are determined in a lab. In the real world, no matter what the SPF, sunscreens start to lose effectiveness over time, so it’s important to reapply every two hours and after swimming or heavy sweating. Also note that above SPF 50 the amount of additional sun protection is negligible. The Skin Cancer Foundation recommends always using a broad spectrum sunscreen with an SPF of 15 or higher – SPF 30 or higher for extended stays outdoors.
3 Water-resistant: The terms “water-resistant” and “sweat-resistant” indicate whether the sunscreen remains effective for 40 minutes or 80 minutes when you are swimming or sweating. Since no sunscreen is fully “waterproof” or “sweatproof,” the FDA prohibits these terms.
4 Active ingredients:  This area of the label, often on the back of the bottle, lists the main ingredients in sunscreens that protect your skin against UV rays. There are two main types of active sunscreen ingredients: chemical and physical. Chemical ingredients such as avobenzone and benzophenone, work by absorbing UV, reducing its penetration into the skin, whereas physical ingredients such as titanium dioxide and zinc oxide stay on top of the skin and deflect UV rays. Many sunscreens available today combine chemical and physical ingredients.

Lastly, consider selecting a brand without vitamin A and forms of it such as retinyl palmitate, retinyl acetate, retinyl linoleate and retinol. The sun block industry uses this antioxidant to moisturize skin. But topical vitamin A has been linked to skin tumors and lesions when exposed to sunshine.

In early 2020 the FDA reported testing of sunscreens showed that six common active ingredients are absorbed into the body and may linger for days or even weeks, in some cases, with levels high enough to raise health concerns. Until more studies are completed, the FDA concludes that while UV filters in chemical sunscreens “can’t be considered safe, that doesn’t mean they’re unsafe”.
Of course, sunblock is not your only means of sun protection. Tightly woven, loosely fitted long shirts and pants can reduce up to 27 percent of your sunburn risk. If you spend a lot of time in the sun, consider investing in sun-protection clothing with a UPF factor built-in sold at many sporting good and outdoor stores. Additionally, hats with two to three-inch brims, UV blocking sunglasses and contact lenses also can help. Whenever possible, avoid planning outdoor activities between 11 am and 4 pm, when the sun is the strongest. And when outdoors, seek shade, i.e.. trees, umbrella, tent, other.

Be sure to scan your body each month to keep track of new or changing moles and lesions that should be reported to your doctor. If you’re concerned about vitamin D deficiency, talk to your physician. Sun exposure has long been touted to help prevent vitamin D deficiency; however, many experts no longer consider it to be the safest or most reliable source of vitamin D. Vitamin D supplementation is now readily available.

In Summary:
Seek the shade, especially between 11 AM and 4 PM.
Avoid sunburn.
Avoid tanning and UV tanning booths.
Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating. (In view of recent studies, reduce the sun exposed area by use of sun protected clothing to reduce the amount of sunscreen necessary.)
Keep newborns out of the sun. Sunscreens should be used on babies only over the age of six months. Limit exposed areas and prefer physical to chemical sunscreens.
Examine your skin head-to-toe every month.
See your physician every year for a professional skin exam.
Nonsteroidal anti-inflammatory medications like aspirin, ibuprofen (Advil and Motrin) and naproxen (Aleve) make you extra-sensitive to the sun. If you use such medications for your aches and pains, be vigilant about protecting your skin. Be aware that some prescription medication, including some antibiotics and others, may sensitize the skin to burn more readily.

Comments and questions are welcome:
Paul R. Block, MD, FACP, FCCP

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