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Facts
about Sunscreen
(From the American Academy of
Dermatology)
Who needs
to use Sunscreen?
In a word: everyone! More than 1 million new
cases of skin cancer will be diagnosed in the
United States this year.1 Many studies have
found an association between sunburns and
enhanced risk for melanoma, the deadliest form
of skin cancer.2 The Food and Drug
Administration (FDA) and the American Academy of
Dermatology recognize six skin categories:3,4
Skin Types
-
I - Always burns easily, never tans,
extremely sun-sensitive
-
II - Usually burns easily, tans minimally,
very sun-sensitive
-
III - Sometimes burns, tans gradually to
light brown, sun-sensitive
-
IV - Burns minimally, always tans to
moderate brown, minimally sun-sensitive
-
V - Rarely burns, tans well, sun-insensitive
-
VI - Never burns, deeply pigmented,
sun-insensitive
The
American Academy of Dermatology recommends that,
regardless of skin type, a broad-spectrum
(protects against UVA and UVB rays) sunscreen
with a Sun Protection Factor (SPF) of at least
15 should be used year-round.
What are
UVA and UVB rays?
Sunlight consists of two types of harmful rays —
ultraviolet A (UVA) rays and ultraviolet B (UVB)
rays. UVA rays (which pass through window glass)
penetrate deeper into the dermis, the thickest
layer of the skin. UVA rays can cause
suppression of the immune system, which
interferes with the immune system's ability to
protect you against the development and spread
of skin cancer. UVA exposure also is known to
lead to signs of premature aging of the skin
such as wrinkling and age spots. The UVB rays
are the sun's burning rays (which are blocked by
window glass) and are the primary cause of
sunburn. A good way to remember it is that UVA
rays are the aging rays and UVB rays are the
burning rays. Excessive exposure to both forms
of UV rays can lead to the development of skin
cancer.
The United States Department of Health & Human
Services has declared ultraviolet (UV) radiation
from the sun and artificial sources, such as
tanning beds and sun lamps, as a known
carcinogen (cancer-causing substance).5
When
should Sunscreen be used?
Sunscreen should be applied every day to exposed
skin, not just if you are going to be in the
sun. While UVB rays cannot penetrate glass
windows, UVA rays can, leaving you prone to
these damaging effects if unprotected. For days
when you are going to be indoors, apply
sunscreen on the areas not covered by clothing,
such as the face and hands. Sunscreens can be
applied under makeup, or alternatively, there
are many cosmetic products available that
contain sunscreens for daily use because sun
protection is the principal means of preventing
premature aging and skin cancer. It's never too
late to protect yourself from the sun and
minimize your future risk of skin cancer.
Don't reserve the use of sunscreen only for
sunny days. Even on a cloudy day, up to 80
percent of the sun's ultraviolet rays can pass
through the clouds. In addition, sand reflects
25 percent of the sun's rays and snow reflects
80 percent of the sun's rays.6
How much Sunscreen should be used, and how
often?
Sunscreens should be applied to dry skin 15-30
minutes BEFORE going outdoors. When using
sunscreen, be sure to apply it to all exposed
areas and pay particular attention to the face,
ears, hands and arms. Coat the skin liberally
and rub it in thoroughly — most people apply
only 25-50 percent of the recommended amount of
sunscreen.7 One ounce, enough to fill
a shot glass, is considered the amount needed to
cover the exposed areas of the body properly.
Don't forget that lips get sunburned too, so
apply a lip balm that contains sunscreen with an
SPF of 15 or higher.
Sunscreens should be re-applied at least every
two hours or after swimming or perspiring
heavily. Even so-called "water-resistant”
sunscreens may lose their effectiveness after 40
minutes in the water. Sunscreens rub off as well
as wash off, so if you've towel-dried, reapply
sunscreen for continued protection.
Also, while there are a number of combination
cosmetic products, such as moisturizers that
contain sunscreen, it is important to remember
that these products also need to be reapplied to
achieve continued UV protection.
What type of sunscreen - what ingredients should
I look for?
There are so many types of sunscreen that
selecting the right one can be quite confusing.
Sunscreens are available in many forms including
ointments, creams, gels, lotions, sprays and wax
sticks. The type of sunscreen you choose is a
matter of personal choice. Creams are best for
individuals with dry skin, but gels are
preferable in hairy areas, such as the scalp or
male chest. Sticks are good around the eyes.
Creams typically yield a thicker application
than lotions and are best for the face. There
also are sunscreens made for specific purposes,
such as sensitive skin and for use on babies.
Ideally, sunscreens should be water-resistant,
so they cannot be easily removed by sweating or
swimming, and should have an SPF of 15 or higher
that provides broad-spectrum coverage against
both UVA and UVB light. Ingredients to look for
on the sunscreen label to ensure broad-spectrum
UV coverage include:
-
avobenzone (Parsol 1789)
-
cinoxate
-
ecamsule (Mexoryl SX)
-
menthyl anthranilate
-
octyl methoxycinnamate
-
octyl salicylate
-
oxybenzone
-
sulisobenzone
-
titanium dioxide
-
zinc oxide
How do I know that the sunscreen I've selected
will provide the sun protection recommended by
dermatologists?
The American Academy of Dermatology (Academy)
recently introduced the AAD SEAL OF RECOGNITIONTM
which is designed to help consumers choose
products that will provide the sun protection
recommended by dermatologists, including
broad-spectrum, water-resistant sunscreens with
a Sun Protection Factor (SPF) of 15 or higher.
Look for the AAD SEAL OF RECOGNITIONTM
symbol and statements on product labels,
packaging and advertising.
Can I use the sunscreen I bought last summer, or
do I need to purchase a new bottle each year?
Does it lose strength?
Unless indicated by an expiration date, the FDA
requires that all sunscreens be stable and at
their original strength for at least three
years.
While you can use the sunscreen that you bought
last summer, keep in mind that if you are using
the appropriate amount, a bottle of sunscreen
should not last very long. Approximately one
ounce of sunscreen, enough to fill a shot glass,
is considered the amount needed to cover the
exposed areas of the body properly.
What is an SPF?
SPF stands for Sun Protection Factor. Sunscreens
are rated or classified by the strength of their
SPF. The SPF numbers on the packaging can range
from as low as 2 to greater than 50. These
numbers refer to the product's ability to
deflect the sun's burning rays.
The sunscreen SPF rating is calculated by
comparing the amount of time needed to produce a
sunburn on sunscreen-protected skin to the
amount of time needed to cause a sunburn on
unprotected skin. For example, if a sunscreen is
rated SPF 2 and a person who would normally turn
red after ten minutes of exposure in the sun
uses it, it would take twenty minutes of
exposure for the skin to turn red. A sunscreen
with an SPF of 15 would allow that person to
multiply that initial burning time by 15, which
means it would take 15 times longer to burn, or
150 minutes. Even with this protection,
sunscreen photo degrades (breaks down) and rubs
off with normal wear, so it needs to be
reapplied at least every two hours.
Dermatologists strongly recommend using a
broad-spectrum (UVA and UVB protection)
sunscreen with an SPF of 15 or greater
year-round for all skin types. This will help
protect against sunburn, premature aging (e.g.,
age spots and wrinkles) and skin cancer.
Does the SPF tell how well a sunscreen protects
against UVA or UVB rays?
The SPF number on sunscreens only reflects the
product's screening ability for UVB rays. At
present, there is no FDA-approved rating system
that identifies UVA protection. Scientists are
working to create a standardized testing system
to measure UVA protection.
Does SPF 30 have twice as much sun protection as
SPF 15?
UVB protection does not actually increase
proportionately with a designated SPF number.
For example, an SPF of 30 screens 97 percent of
UVB rays, while an SPF of 15 screens 93 percent
of UVB rays and an SPF of 2 screens 50 percent
of UVB rays. However, inadequate application of
sunscreen may result in a lower SPF than the
product contains.
Whatever sunscreen SPF is chosen, wearing
sunscreen should not provide a false sense of
security about protection from UVB exposure as
no sunscreen can provide 100 percent UVB
protection. While using a higher SPF provides
greater UVB protection than a lower SPF, it does
not mean that you should stay out in the sun
longer.
Is sunscreen all I need to do to protect myself
from the sun?
Sun exposure is the most preventable risk factor
for all skin cancers, including melanoma.1,
2 You can have fun in the sun and decrease
your risk of skin cancer. Here's how to Be Sun
SmartSM:
-
Generously apply a water-resistant sunscreen
with a Sun Protection Factor (SPF) of at
least 15 that provides broad-spectrum
protection from both ultraviolet A (UVA) and
ultraviolet B (UVB) rays to all exposed
skin. Re-apply every two hours, even on
cloudy days, and after swimming or sweating.
Look for the AAD SEAL OF RECOGNITIONTM
on products that meet these criteria.
-
Wear protective clothing, such as a
long-sleeved shirt, pants, a wide-brimmed
hat and sunglasses, where possible.
-
Seek shade when appropriate, remembering
that the sun's rays are strongest between 10
a.m. and 4 p.m. If your shadow is shorter
than you are, seek shade.
-
Protect children from sun exposure by
playing in the shade, using protective
clothing and applying sunscreen.
-
Use extra caution near water, snow and sand
as they reflect the damaging rays of the
sun, which can increase your chance of
sunburn.
-
Get vitamin D safely through a healthy diet
that may include vitamin supplements. Don't
seek the sun.8
-
Avoid tanning beds. Ultraviolet light from
the sun and tanning beds can cause skin
cancer and wrinkling. If you want to look
like you've been in the sun, consider using
a sunless self-tanning product, but continue
to use sunscreen with it.
-
Check your birthday suit on your birthday.
If you notice anything changing, growing or
bleeding, see a dermatologist. Skin cancer
is very treatable when caught early.
Is there a
safe way to tan?
There is no safe way to tan. A tan is the skin's
response to injury caused by UV exposure.
Tanning occurs when ultraviolet rays penetrate
the epidermis, the skin's outer layer causing
the production of melanin as a response to the
injury. Chronic exposure to ultraviolet light,
both natural and artificial, results in a change
in the skin's texture, causing wrinkling and age
spots. Thus, tanning to improve appearance is
ultimately self-defeating.
Every time you tan, you damage your skin and
this damage accumulates over time. This
accumulated damage, in addition to accelerating
the aging process, also increases your risk for
all types of skin cancer.
Consider using a spray
tan. Our office offers safe spray-tanning
which does not use UVA/UVB rays, but safe and
healthy toners and moisturizers. Ask our
cosmetic consultants for more information.
Are tanning beds a safer way to tan?
In spite of claims that tanning beds offer
"safe” tanning, indoor tanning equipment, which
includes all artificial light sources such as
beds, lamps, bulbs, booths, etc., emits UVA and
UVB radiation. The amount of the radiation
produced during indoor tanning is similar to the
sun and in some cases may be stronger.9, 10
Studies have demonstrated that exposure to UV
radiation during indoor tanning damages the DNA
in the skin cells. Also excessive exposure to UV
radiation during indoor tanning can lead to skin
aging, immune suppression, and eye damage,
including cataracts and ocular melanoma.11-15
Many tanning salons are unregulated, allowing
customers (especially those with fair skin that
tans poorly) access to tanning beds without
supervision or eye protection. The American
Academy of Dermatology supports local and/or
statewide indoor tanning legislation that bans
minors from using tanning devices. In addition,
this legislation usually requires that warning
signs be prominently displayed in tanning salons
and list the hazards of such exposure, among
other possible regulatory provisions.
In September 2007, the Tanning Accountability
and Notification Act, or TAN Act (FDA reform
bill, HR 3580), became law. This law requires
the U.S. Food and Drug Administration to
determine whether the current labeling of indoor
tanning beds provides sufficient information
about the risks associated with indoor tanning
and whether modifying the warning label required
on tanning beds to read "Ultraviolet radiation
can cause skin cancer” would more effectively
communicate the risks of skin cancer.
Consider using a spray
tan. Our office offers safe spray-tanning
which does not use UVA/UVB rays, but safe and
healthy toners and moisturizers. Ask our
cosmetic consultants for more information.
How do I
treat a sunburn?
In case you forget to cover up and apply
sunscreen, the resulting sunburn can be painful
as well as dangerous. Remember that you may not
immediately see the effects of overexposure to
the sun. It may take up to 24 hours before the
full damage is visible.
There are several types of burns and burn
treatments. The two most common sunburns are
first-degree burns and second-degree burns.
First-degree sunburns cause redness and will
heal, possibly with some peeling, within a few
days. These can be painful and are best treated
with cool baths and moisturizers or
over-the-counter hydrocortisone creams.
Avoid the use of "-caine” products (such as
benzocaine), which may cause sensitivity to a
broad range of important chemicals.
Anti-inflammatory oral medications such as
aspirin or ibuprofen may lessen the pain and
discomfort associated with sunburn.
Second-degree sunburns blister and can be
considered a medical emergency if a large area
is affected. Do not break the blisters, as they
are a natural protective mechanism to heal the
affected area and rupturing them delays the
healing process and invites potential infection.
A layer of gauze may be used to cover the area
until healed.
When a burn is severe, accompanied by a
headache, chills or a fever, seek medical help
immediately.
Be sure to protect your skin from the sun while
it heals and thereafter.
Will using sunscreen limit the amount of vitamin
D I get?
Since sun exposure is responsible for vitamin D
production in the skin, wearing sunscreen will
decrease the skin's production of vitamin D.
Individuals who wear sunscreen and are concerned
that they are not getting enough vitamin D
should discuss their options for obtaining
sufficient vitamin D from foods and/or vitamin
supplements with their doctor.
1American Cancer Society. 2008 Cancer Facts and
Figures. http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf
2Elwood JM, Jopson J. Melanoma and sun exposure:
an overview of published studies. Int J Cancer
(1997). 73(2):198-203.
3Fitzpatrick TB. The validity and practicality
of sun-reactive skin types I through VI. Arch
Dermatol. 1988. 124:869-871.
4Sunscreen drug products for over-the-counter
human use (21CFR352). Food and Drug
Administration.
5Report on Carcinogens, Eleventh Edition
(Ultraviolet Radiation Related Exposures); U.S.
Department of Health and Human Services, Public
Health Service, National Toxicology Program.
6Global Solar UV Index. World Health
Organization. http://www.who.int/uv/publications/en/UVIGuide.pdf.
7Neale, R, Williams, G, Green, A. Application
patterns among participants randomized to daily
sunscreen use in a skin cancer prevention trial.
Arch Dermatol. 2002 Oct; 138, 1319-1325.
8Hemminki K, Dong C. Subsequent cancers after in
situ and invasive squamous cell carcinoma of the
skin. Arch Dermatol 2000;136:647-51.
9Hornung RL, Magee KH, Lee WJ, Hansen LA, Hsieh
YC. Tanning facility use: are we exceeding the
Food and Drug Administration limits? J AM Acad
Dermatol. 2003 Oct;49(4):655-61.
10Miller, SA, Hamilton, SL, Wester, UG, Cyr, WH.
An analysis of UVA emissions from sunlamps and
the potential importance for melanoma. Photochem
Photobiol 68(1998), 63-70.
11Whitmore SE, Morison, WL, Potten CS, Chadwick
C. Tanning salon exposure and molecular
alterations. J Am Acad Dermatol 2001;44:775-80.
12Piepkorn M. Melanoma genetics: an update with
focus on the CDKN2A(p16)/ARF tumor suppressors.
J Am Acad Dermatol. 2000 May;42(5 Pt 1):705-22;
quiz 723-6.
13Vajdic CM, Kricker A, Giblin M, McKenzie J,
Ait. Artificial ultraviolet radiation and ocular
melanoma in Australia. Int J Cancer. 2004 Dec
10;112(5):896-900.
14Walters BL, Kelly TM. Commercial tanning
facilities: a new source of eye injury. Am J
Emerg Med 1987;120:767-77.
15Clingen PH, Berneburg M, Petit-Frere C,
Woolons A, Lowe JE, Arlett CF, Green MH.
Contrasting effects of an ultraviolet B and an
ultraviolet A tanning lamp on interleukin-6,
tumour necrosis factor-alpha and intercellular
adhesion molecule-1 expression. Br J Dermatol.
2001 Jul;145(1):54-62.
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