Reapply your sunscreen.
If there’s one edit worth making to the infamous Mary Schmich
commencement-speech column in the Chicago Tribune about how
wearing sunscreen was her only tip with scientifically proven benefits,
that would be it.
Although a study in the Journal of Clinical Oncology
last year found that the risk of developing melanoma was reduced by half
when participants used sunscreen every day, dermatologists say the fine
print is that you need to reapply the stuff to reap its
benefits.
“Your sunscreen could say it has a sun protection factor of
50”—meaning you should be able to stay in the sun 50 times longer than
usual without burning—“but you could barely be getting 10 if you’re not
applying it properly,” says Elizabeth Tanzi, a DC dermatologist and
assistant professor at Johns Hopkins School of Medicine. “And there are a
lot of people who don’t apply it properly.”
Make that about 80 percent of people, according to
dermatologists.
How could a city of people with an alphabet of advanced degrees
after their names mess up something so simple? First, by not putting on
enough. Your face needs a quarter-size dollop. On your body, you should be
using a shot glass’s worth—or, if you need another visual, “a golf ball,”
says Mona Gohara, assistant clinical professor of dermatology at Yale
School of Medicine. If one tube lasts you a summer, you’re flunking
Sunscreen Application 101.
You need to reapply it every two hours if you’re outside, every
four if you’re not. Working in an office all day doesn’t give you license
to skip. Think about it: If you pop out for lunch, you’re probably doing
so when the sun’s rays are strongest—10 am to 2 pm—and that’s likely to be
at least four hours after you applied sunscreen that morning. If you leave
the office for the day while it’s still light out—and the chance of that
is greater in the summer—you’ll still catch some rays on the drive
home.
If all this sounds alarmist, consider that although wearing
some sunscreen may be better than wearing none, dermatologists say that
putting it on once a day gives people a false sense of security that
they’re protected from skin cancer.
Even if it looks gloomy outside, a certain amount of
ultraviolet light gets through the clouds, says Dr. Gohara. You might not
get burned if you don’t wear sunscreen on those days, but that kind of
exposure can prematurely age you—and increase your chances of developing
skin cancer.
The car windshield and your house and office windows block out
UVB rays but not UVA rays, which are associated with aging and melanoma. A
2010 study in the Journal of the American Academy of Dermatology
found an increased prevalence of skin cancer on the left side of the head
and neck—which “may be explained by ultraviolet exposure to the left side
of the body while driving,” the authors wrote. The trend was particularly
pronounced in men, who tend to drive more often. As for sun exposure
through windows, the study cited the example of a woman with severe
photo-aging on her left cheek, the side that faced an office window for 15
years.
“People don’t realize that they need to wear sunscreen every
day no matter what they’re doing,” says Gohara. “The threat of skin cancer
and of premature aging is real even if you spend your life at the
office.”
Truth in Labeling
Let’s say you’ve been applying sunscreen correctly—the
marketing hype on the bottle could still give you false security about its
effectiveness. For one thing, there’s no such thing as “sunblock” or
“waterproof.”
“Nothing blocks out the sun 100 percent,” says Gohara. “And all
of those so-called waterproof sunscreens still have to be
reapplied”—meaning that technically they’re not waterproof.
Beginning in December, both of those terms will be banned from
labels, thanks to new guidelines from the Food and Drug Administration.
The rules will also make it easier to choose wisely from among the 1,700
sunscreens on the market.
“There will be a drug-facts box on the label like the
nutritional label on a soup can,” says Henry Lim, chairman of dermatology
at Detroit’s Henry Ford Hospital and president of the American Board of
Dermatology.
The new labels will have to establish that the product has
passed “broad spectrum” tests measuring the lotion’s ability to protect
against two key types of ultraviolet rays: UVB (the ones that SPF, or sun
protection factor, refers to—the ones that burn you) and now also UVA, the
rays that sink deeper into the skin to cause visible aging and, like UVB
rays, contribute to cancer.
In the past, most sunscreens did as they said when it came to
UVB shielding, but a sunscreen could claim it offered “broad spectrum”
protection if it included even a smidgen of ingredients that protected
against UVA rays. Not anymore. For the first time, specific sunscreen
testing is mandated by the FDA, and it’s pass/fail. “If something is even
one point below, it fails and can’t make the broad-spectrum claim,” says
Dr. Lim.
The designation “waterproof” must be replaced with
“water-resistant”—but again, only if the product passes extensive tests.
And the claim of “sweatproof” or “all-day protection” in the water is no
more: Based on a sunscreen’s test results, it can claim either 40 minutes
of water resistance or 80 minutes. If it’s neither, the label has to
advise using a water-resistant sunscreen while swimming or
sweating.
What about the actual SPF rating? Products with an SPF lower
than 15 won’t be able to claim that they protect against skin cancer.
Products of SPF 15 or higher must include the caveat that they protect
only if applied every two hours.
What SPF should you use? The FDA isn’t stepping into that
tropical storm right now. The American Academy of Dermatology recommends
SPF 30, which is 98 percent effective at shielding you from harmful rays.
Anything above SPF 30 at best reaches 99.9-percent
effectiveness.
Says Dr. Tanzi: “There’s not a lot to gain above an SPF of 30.”
(The FDA is considering a proposal to cap the SPF indicator at
50+.)
And a note to the ladies: If you’re applying moisturizer with
SPF and then a foundation with SPF, you don’t get to add up the numbers.
Says Tanzi: “You get the SPF of the most potent one you have on but, as
with any sunscreen, only if you use it properly.”
Best Sunscreens
What’s the most effective sunscreen in the world? “One that has
a formulation you’re going to use,” says Tanzi. Here’s some help in
choosing.
There are two kinds of sunscreens: chemical ones, which absorb
and dissipate UV radiation and also absorb easily into the skin, and
physical, which sit on top of your skin and deflect the sun’s rays. The
latter often are marketed as “natural” or “hypoallergenic.” The sun
protection is equally good in both.
“Physical ones are particularly good for sensitive skin because
they’re not chemicals,” says Tanzi. Most physical sunscreens contain a
combination of two minerals: zinc oxide and titanium dioxide; old and/or
cheap formulations can be white and pasty. At one point, manufacturers got
almost too sophisticated, with processes that turned the two minerals into
nanoparticles so small that they potentially could have been absorbed into
skin.
Because nobody knows the long-term effects of the skin’s
swallowing up what are essentially metals—and because both doctors and
consumers were wary—many cosmetics companies recently switched to
micronized zinc and titanium, which makes the particles small enough not
to be seen but not so small that they’re absorbed. You can’t tell from the
label if the zinc and titanium are micronized, but if a product glides
onto your skin and doesn’t look white and pasty, chances are they
are.
An expensive sunscreen isn’t necessarily more effective than a
cheap one, but it probably will look and feel better. “It does pay to
spend more money, because it costs money to be able to manufacture the
really elegant formulations,” says Tanzi. “There are some very effective
sunscreens at the drugstore, but they’ll be whiter than those at Sephora
or at the dermatologist.”
If your budget doesn’t permit smearing pricey
potions on your body every two hours, she recommends splurging for your
face and using a cheap one on the rest of your body. Her favorites for the
face include EltaMD UV Physical SPF 41 ($27) and
Intellishade SPF 45 (about $40), both of which are
tinted. Elta is at dermstore.com. Intellishade is available from
dermatologists; visit intellishadespf45.com for a list.
An inexpensive two-in-one drugstore product recommended by some
dermatologists is the non-greasy Cetaphil Daily Facial Moisturizer
for All Skin Types SPF 50 ($13.19, drugstore.com).
For the body, every dermatologist we spoke to recommended
Blue Lizard Australian Suncream Lotion SPF 30+ ($13.99,
drugstore.com). The company’s products also are recommended for
children—and the bottle itself offers a useful lesson for both them and
you: It turns blue in intense UV light, meaning you definitely should be
wearing sunscreen and reapplying it frequently.
Most dermatologists prefer physical sunscreens—Tanzi says zinc
is “the best, hands down,” at protecting against UVA and UVB rays. Another
plus for physical sunscreens is that zinc can be oil-absorbing and
slightly drying, “so it can be great for acne-prone skin,” says
Tanzi.
That doesn’t mean products containing zinc are off-limits for
dry skin, she says—just look for one labeled “moisturizing.” If you have
combination skin, try a lighter or oil-free formulation, particularly in
summer, when your skin may be greasier. If you’re applying it after the
gym or other exercise and you haven’t had time to cool down
properly—meaning you’re still sweating—you may want to try a gel
formulation; it’s a bit more drying.
More Help in Choosing
If you do opt for a chemical sunscreen, look for the UVA
blocker avobenzone (which also goes by the name Parsol 1789) on the
ingredient list. Ironically, it’s highly unstable when exposed to
sunlight—it degrades in about a half hour—so look for it paired with the
additive helioplex for staying power. Many Neutrogena sunscreens have
this.
If you’re prone to stinging eyes, the likely culprit is
avobenzone. It’s a common ingredient in chemical sunscreens, but even some
“natural” brands such as Kiss My Face contain it. One good alternative:
Mission SPF 30+ No Sting Sunscreen Facestick ($7.99,
missionathletecare.com). The company’s scientists have teamed with
athletes such as Serena Williams and Mia Hamm to find a non-sticky formula
that goes on clear, doubles as a lip protector, and manages not to taste
like sunblock. (The company is also the “on-field supplier of Major League
Baseball.”)
The Best Sunscreens? You Can’t Buy Them Here
Some of the best sunscreens are offered over the counter pretty
much everywhere in the world except the United States, says Henry Lim,
chairman of dermatology at Detroit’s Henry Ford Hospital and president of
the American Board of Dermatology. This is because the Food and Drug
Administration hasn’t gotten around to approving them.
“That is one thing the FDA could do better,” says Dr. Lim, “to
start aggressively reviewing these new UVA and UVB filters whose
applications have been sitting around in their files for
years.”
One such ingredient is Tinosorb M, which protects against a
broad range of rays and is photostable, meaning it won’t degrade in
sunlight. You can buy it in products sold abroad—including in Canada and
Mexico—or order from foreign websites such as tubotica.com, an
international online pharmacy. Some good bets: Bioderma’s
Photoderm Max, the Eau Thermale Avène line (a
top seller in European pharmacies), and sunscreens marketed abroad from
Mustela, the cult baby-products brand. Is paying
international shipping worth it? Only you can decide.
Another option: children’s sunblock. Most of these both are
avobenzone-free and absorb quickly, because kids rub their eyes a lot and
aren’t renowned for patience with sunscreen application.
Should you choose a sunscreen promising antioxidants or other
benefits? No, advises Tanzi: “Keep it simple. All the additives for other
reasons are not the main reason you’re using sunscreen.” Her pick is
Journée Bio-restorative Day Cream (about $80; visit
neocutis.com to find local doctors who carry it).
For men, Gohara recommends CeraVe Facial Moisturizing
Lotion AM SPF 30 ($13.99 at dermstore.com or area drugstores).
“You don’t smell like a piña colada,” she says.
Don’t forget your scalp. A recent study in the Archives of
Dermatology—analyzing 50,000 cases of melanoma—found that skin
cancers on the scalp or neck are nearly twice as likely to kill you as
those elsewhere. Scalp cancer is often found later than skin cancer on
other areas of the body—it may be hidden by hair—and there’s something
inherently virulent about it, the study found. Multiple dermatologists
said their top pick—besides a hat—was Shiseido Refreshing Sun
Protection Spray SPF 16 ($34.99, amazon.com).
Having dark skin doesn’t mean you don’t need sunscreen. “Many
people of color have a false sense of security,” says Gohara, who is of
Egyptian descent. “You can still get skin cancer, and it can be more
deadly,” she says, because it’s often diagnosed later due to a lack of
awareness by both the public and physicians.
Chalky white sunscreens don’t blend easily on people of color,
she notes. Her choice: La Roche-Posay’s Anthelios 50 Mineral Ultra
Light Sunscreen Fluid ($32.95, laroche-posay.us).
Reapplying Over Makeup
Once you’ve put on makeup in the morning, how can you follow
the “every two hours” advice without wrecking your face—or your
clothes?
One easy option for the face: Almost every dermatologist we
spoke to recommended Colorescience Sunforgettable Mineral
Powder Sun Protection SPF 50 ($60,
colorescience.com), which comes in a brush and can be dusted on like
pressed powder. “They are the best,” says Tanzi, a melanoma survivor. “I
don’t live without the stuff—it’s potent and effective.” It’s available in
multiple shades. (One common mistake, Tanzi says, is to forget to reapply
it to your neck and chest. Men, she notes, can get away with this because
of their shirts and ties—for women she suggests the powder.)
For on-the-go body reapplications, try Dr. Dennis Gross
Powerful Sun Protection Daily Sunscreen Towelettes SPF 30 ($18
for 20, dermstore.com). They’re individually wrapped so you can stash them
in bags, in the glove compartment, or, for a pick-me-up, in the
refrigerator. The towelettes also deliver a punch of antioxidants, green
tea, and vitamins A, C, and E—all of which fight aging.
For outdoor sports or the beach—basically, when wearing
clothing you might not mind getting sunscreen on—dermatologists like
Neutrogena Ultra Sheer Body Mist SPF 45 ($7.99,
drugstore.com).
If you’re planning to be outside for hours or are at the beach,
keep in mind that regular clothing—unless it’s dark and tightly
woven—doesn’t protect against the sun. “People, particularly men, think
T-shirts are protective, but they’re not,” says Gohara, noting that
“melanoma-on-trunk incidence is high among men.” Ideally you should
reapply sunscreen everywhere if you’re in direct sunlight for a long time,
but a good start is to apply it everywhere—not just to body parts that
will be exposed—before you get dressed.
One final tip: “Sun protection isn’t just about wearing
sunscreen,” says Gohara. You may not want to take dermatologists’ advice
about staying in the shade, but you can still create a little shade of
your own: “Do yourself a favor and wear a hat,” she says.
Babies and Kids
For children older than six months, dermatologists recommend
physical sunscreens, and you don’t have to spend a fortune. “Kids don’t
care if they’re whitish,” says Tanzi.
Gohara—a mother of two sons, ages three and six—prefers sprays,
though she acknowledges that aerosols aren’t good for the environment:
“Sprays cut down on application time by half.”
Babies younger than six months shouldn’t wear sunscreen, but
Gohara says “it’s a conundrum, because sun protection needs to begin the
moment they’re born.”
For this reason and because applying—let alone
reapplying—sunscreen to older babies and toddlers can be tough, she and
other dermatologists recommend sun-protective clothing. Gohara has a
company, K&J Sunprotective Clothing
(kjsunprotectiveclothing.com), that features kid-friendly designs approved
by her sons, Kiran and Jai.
Also recommended—for kids and adults—is
Coolibar (coolibar.com). Women looking for
fashion-forward outdoor-exercise options could try the Canadian company
Lolë (lolewomen.com).
With clothing, look for a UPF—ultraviolet protection factor,
the rating used for fabrics—of 50. That means the garment allows only
one-50th of the UV radiation, or just 2 percent, to pass through.
This article appears in the July 2012 issue of The Washingtonian.
