Sun Safety Blog
My mom was the chief of the sun police. She made sure that my brother and I were always covered, in the shade, or showered in sunscreen. She even made me wear a T-shirt over my swim suit in the pool! One day, the smart seven-year-old that I was, decided I could lounge in the sun with the other little girls in our bikinis, without my T-shirt. What did I get to show for it? I got a second degree burn on my shoulder with a blister the size of a quarter! Thus began my education on the importance of sun protection and also in listening to my mother.
But there’s a lot more to sunscreen than just preventing sunburns of course. As dermatology providers, we see first-hand we are finding multiple skin cancers every day! Skin cancer is the most common type of cancer in the US, and using sun protection can help to prevent it. It can also help to lessen and prevent dark spots, fine lines and wrinkles and other signs of aging. In fact, studies have shown that using sunscreen daily, on its own can help to improve the appearance of the skin!
I get a lot of questions about sun protection and what to wear and when, so let jump in and go over what you need to know
First of All, Who Exactly Needs to Care About Sun Protection?
Simple-everyone! Skin cancer does not discriminate based on age, sex, race, or skin tone. (Neither do dark spots!)
What about babies? The best way to protect infants is to keep them covered in protective clothing and in the shade. Try to avoid sunscreen in children younger than 6 months. Make sure they don’t over heat and get plenty of fluid!
What counts as sun protection? We know that the sun’s rays are strongest between the hours of 10AM and 4PM, so try to avoid the sun during these times or seek shade when outside. For all of those golfers, pickle ball players and other outdoor enthusiasts that may be a little difficult, so it’s important to wear protective clothing. This can include lightweight long sleeve shirts and pants, wide brim hats, and UV protective sunglasses. There are even companies that make clothing specifically designed for sun protection! They are called UPF clothing which stands for Ultraviolet Protection Factor. When choosing clothing, note that darker colors can offer more protection than lighter colors. Additionally, loose or open weave clothing with holes like mesh or lace don’t offer much protection. For your beach and pool days, you should know that dry clothing is more protective than wet clothing too! Make sure that when you are shopping for sunglasses that the label states UV protective. Just because the lenses are dark, doesn’t necessarily mean they are better protection. Hats with a wide brim can help protect your face, ears and neck! Hats are superior to visors! Visors don’t protect your scalp and yes you can get sunburns and skin cancer there! Straw hats may appear protective, but just like the loose weave clothing, are not fully keeping you covered! Then of course after you have covered up, apply broad spectrum sunscreen to all those areas of skin that are still exposed.
Do We Really Need to Wear Sunscreen Every Day?
What if I don’t really go out that much? What if it isn’t sunny? Excuse me while I step onto my soap box. YES! Although in many places around the country and the world, people believe they only need to worry about the sun in the summer months because that is when it is the strongest. This is a misconception! The sun’s UV rays are powerful and they don’t take days off! Especially for us Floridians and others living in tropical areas close to the equator, daily sun exposure is inevitable. We still walk to and from our cars, into and from the store, we check the mail, we walk our dogs, we are seeing some sun every day! And while glass windows can block UVB rays, UVA rays can still penetrate. So if you spend a lot of time in direct sunlight next to a window or driving around in your car, you can still have sun damage! According to the World Health Organization, sun damage occurs even on cloudy days as the global UV index shows 80% of the sun’s rays can still penetrate your skin. AND being near water, sand and even snow calls for extra caution because they can reflect the sun’s rays and increase your risk for damage. If you are really spending all day indoors, it is much less likely you are exposed to enough UV to cause harm, but wearing sunscreen every day keeps you in the habit!
What Type of Sunscreen is The Best?
This is a tough one because everyone seems to want a specific choice but it really is subjective! The best sunscreen for you may be different than the best one for me! If you buy my favorite and you don’t like it, it may sit on your bathroom counter for ages and never get used. So you should find one that you enjoy or at the very least don’t mind wearing and reapplying. What you should look for is a few things on the label. You want a sunscreen that is broad spectrum. This means that it provides protection against both UVA and UVB rays, both of which can cause damage and lead to cancer. The next thing to look for is the SPF, 30 or higher is the recommendation from the AAD. (American Academy of Dermatology). My personal preference is SPF 50 or above for long periods in the sun but at least SPF 30 for daily wear. “Water resistant” is another preferred selection as it will still work on wet or sweaty skin, at least for a while! Keep in mind that water resistant is not equal to water proof! If you are in the water, the sunscreen must be applied more frequently to maintain its protection!
What about moisturizer or makeup with SPF? While wearing some protection is better than none, it’s important to look at the labels! Many cosmetics contain very low SPF, and even if it is higher, they will still need to be reapplied for prolonged sun exposure. Some companies sell combination products of sunscreen and bug spray. The AAD actually recommends that we should not use these combo products but apply sunscreen and bug spray separately as you will likely need more liberal and more frequent application of sunscreen.
How Should Sunscreen be Applied?
You should apply sunscreen to all areas of skin that are exposed to the sun and not covered by your clothes. Don’t forget the tops of your feet and your ears! For most people one ounce of sunscreen, or enough to fill a shot glass, should be enough to cover these areas. About a quarter tea spoon size of that should be used for your face. Sunscreen should be the last step in your morning skin care routine. Make sure you also protect your lips with a lip balm with SPF. Sunscreen should be applied about 15 minutes before you head outside to give it a chance to settle into place. Sun screen doesn’t last all day and should be regularly reapplied. A good general rule is every two hours if you are in the sun and every hour if you are in the water. I have had several patients tell me that they don’t bother with sunscreen because they burn even if they wear it. This is likely because they are not wearing enough, or not reapplying. It can be especially difficult with spray on sunscreens to make sure that you are getting enough coverage and not missing any spots.
What Does SPF Mean Anyways?
SPF stands for Sun Protection Factor and it can be confusing. It supposedly tells you how long your sunscreen allows you to be outside in the sun before burning. However, this is only if you use the product EXACTLY as indicated. So in a perfect world, wearing an SPF 50, it would take 50 times as long for the sun to cause you to burn than it would if you weren’t wearing any sunscreen at all. SPF 30 can filter about 97% of the sun’s UVB rays while SPF 50 can filter about 98%. While this doesn’t sound like a big difference, it actually is if you think about it in terms of the percentage of rays allowed to pass. SPF 30 allows 3% or 1.5 times as much of the sun’s rays as SPF 50! Although the recommendation is 30 or higher, it’s not really a one- size fits all situation. Base your SPF choice on your personal skin type, tendency to burn and history of skin cancer. There is another number you may notice on the bottle that is PA +. This stands for Protection Grade of UVA. PA+ can block UVA rays at 40-50% while PA++++ it up to 95%. Remember both UVB and UVA rays can cause harm.
What is the difference in the types of sunscreen? Sunscreens are commonly classified by their ingredients. Physical (or mineral) sunscreens contain zinc oxide or titanium dioxide. They are called “physical” because they sit on the surface of the skin like a shield rather than absorb into the body and are considered to create a physical barrier between you and the sun. They work both by absorbing the sun’s rays and also reflecting them. Because they aren’t absorbed, many people with skin sensitivities do better with them. Although sometimes they can be very thick and leave a white cast that is difficult to rub in. Newer technologies are improving this texture as well as hybrid sunscreens. Chemical sunscreens contain one or more of the following: oxybenzone, avobenzone, octisalate, octocrylene, homosalate, and octinoxate. They work by a chemical reaction that absorbs the sun’s rays and converts them into heat that is released. Chemical sunscreens have potential for higher SPF and are more effective for water resistance. They may have a lighter consistency and are easier to rub in without as much white residue.
But is it safe to use those chemicals on my skin? The FDA is the regulatory body that determines the safety and efficacy of these products. Based on current scientific knowledge, the FDA reports there is no evidence that the ingredients in sunscreen products available currently in the US cause harm to human health. Many of these ingredients have been widely used for over 20 years. There was a finding that some of the chemicals in sunscreen are absorbed into the blood more than originally thought, but the FDA clarified that just because an ingredient is absorbed in the blood, doesn’t mean that it is harmful. Even water is technically considered a chemical, right? As of 2019 the FDA called for further investigation and data on these ingredients. To be fair, the US is definitively behind our European counterparts when it comes to advancements in sunscreen technologies. This is because the FDA approval process is rigorous, expensive and time consuming, sometimes taking several years!
What About Vitamin D?
It’s true that wearing sunscreen can decrease your skin’s production of vitamin D. But most of us aren’t going outside covered head to toe in sun protection every day. The AAD recommends that we consume more vitamin D. We should maintain a diet with food and beverages naturally higher in vitamin D in order to prevent deficiency. This way we still obtain appropriate amounts of vitamin D without increasing the risk for skin cancer.
What Was The Deal With The Sunscreen Recalls a Few Years Ago?
In 2021 an independent pharmaceutical company called Valisure decided to test a bunch of sun screen and after sun products before they would sell them. Their studies found that this chemical called Benzene was showing up in some higher quantities than what the FDA allowed. Benzene is naturally found in cigarette smoke, crude oil and gasoline. Benzene has also been used in manufacturing of some plastics, synthetic fibers and pesticides. It is considered a “known cancer causing agent”. This is a scary term that means that exposure can increase the risk of developing cancer. However, it is not known exactly how much it increases that risk. The amount of benzene they were finding could change significantly from batch to batch, even within the same branded products. So they realized that it must have been a contaminant or by-product of the manufacturing, which continues to be investigated. Chemical spray sunscreens appeared to be most frequently effected but no specific ingredient seemed to be associated with the contamination. So many of those products got recalled. In repeat testing in 2022, majority of products were found to be free of benzene or below the allowed level. Technically there isn’t a level of benzene considered “safe” but the amount of exposure from these levels is considered relatively low risk. Exposure of benzene into the blood stream through skin contact has been less studied than through inhalation, but there is little evidence that the application of the contaminated sunscreens caused absorption of benzene. As vehicle exhaust is the number one source of benzene in the environment, exposure to benzene in day to day life is likely unavoidable. The largest concern for benzene exposure is for industrial workers who are exposed and inhaling benzene throughout the day, every day, for decades. Although the presence of benzene in personal care products is a concern, it seems media attention may have rung the alarm a little more than necessary.
What About the Coral Reefs?
Another controversy you may have heard about is certain places like Hawaii banning sunscreens with specific ingredients thought to be causing coral bleaching. While they did find that these ingredients can cause coral bleaching, marine scientists tested these ingredients on isolated pieces of coral in a lab with much higher doses of the ingredients than are likely to actually be present in the ocean. The worst of the coral bleachings are occurring in areas with higher temperatures of water, many in locations where tourists don’t frequent. Although it can’t be proven that sunscreen doesn’t have any effect on the coral, the bigger culprits are climate change and agriculture. If you are concerned, the best thing you can do is avoid the sun during midday hours, wear more sun protective clothing and avoid sunscreens containing oxybenzone and octinoxate when visiting beaches with coral.
Does Sunscreen Go Bad?
Yes! Over time sunscreen will degrade and lose its potency. The FDA regulates that sunscreens must retain their original potency for 3 years. Mine don’t usually last that long but if you’ve had a bottle for more than a few years, it’s time for a new one! Some sunscreens will have an expiration date on them, but if not, you can always write your purchase date on the bottle. If you notice the color or consistency of the product has changed, it’s probably a good sign to get rid of it. Also storing sunscreen in direct sunlight or in a hot car can cause it to degrade a lot sooner!
I think that covers most of my FAQs about sunscreen and sun protection. Let’s reiterate that exposure to the sun’s UV rays is a substantial factor in development of skin cancer and preventable with proper sun safety! I still say we should enjoy the sun, as long as we protect ourselves too!
References
Sunscreen FAQs American Academy of Dermatology https://www.aad.org/media/stats-sunscreen
FDA alerts drug manufacturers to the risk of benzene contamination in certain drugs US Food And drug Administration https://www.fda.gov/drugs/pharmaceutical-quality-resources/fda-alerts-drug-manufacturers-risk-benzene-contamination-certain-drugs
James, K (2022, July 20) Benzene Contamination in Sunscreen: Not Worth Getting Burned National Collaborating Centre for Environmental Health https://ncceh.ca/resources/evidence-briefs/benzene-contamination-sunscreen-not-worth-getting-burned#:~:text=Benzene%20is%20not%20a%20standard,of%20%E2%80%9Csignificant%20therapeutic%20advance%E2%80%9D.
Hall, D (2022, September) The Truth About Corals and Sunscreen Smithsonian National Museum of Natural History https://ocean.si.edu/ecosystems/coral-reefs/truth-about-corals-and-sunscreen
Jessie Richie, PA-C
About the Author
Jessie is a graduate of the University of Central Florida with a bachelors degree in theater arts and biology. She went on to obtain her masters degree in physician assistant studies from Nova Southeastern university after spending a few years working in a dermatology clinic in northern Virginia. Jessie is Florida licensed and a member of the Society of Dermatology physician assistants. Practicing since 2018, she has experience in general dermatology and laser treatments. In her free time she loves to sing, travel and spoil her dogs.
MEDICAL ADVICE DISCLAIMER
The information provided on this site is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. OnSpot Dermatology is not providing personalized medical assessments or recommendations for individual cases in this post. The content presented here is based on general knowledge and should not be considered a substitute for a consultation with a qualified healthcare professional. The use of information provided is solely at your own risk. OnSpot Dermatology and the author make no representations or warranties, express or implied, regarding the completeness, accuracy, or usefulness of the information presented. By reading this post, you agree to the above disclaimer and understand that any action you take based on the information provided is at your own discretion. If you have specific questions or concerns about your skin or any medical condition, please consult a healthcare professional for a personalized assessment and recommendations.