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.”
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.