SUSAN CINGARI: Hello, I’m Susan Cingari, and welcome to our web cast from Miami.
Many of us think of sunbathing as enhancing our beauty. There’s nothing better than a good tan, right? Well, as it turns out, sun exposure can have negative effects on your skin in the long run if you don’t take care of yourself. And we all should, so that’s why we’re here to talk to two University of Miami dermatologists about keeping our skin beautiful.
Dr. Mariano Busso to my right, thank you for joining us, Dr. Steven Shapiro to my left.
Let’s start with UVA and UCB rates, there’s a lot of confusion about them. You hear about it, you don’t really know what they mean. Talk to me about that.
MARIANO BUSSO: Sure. The sun has visible light and invisible light. Within the invisible light we have the ultraviolet light A and ultraviolet light B, UVA and UVB. They both produce suntan, sunburn, premature aging, skin cancer, and also allergies and deterioration of the immune system. The UVA penetrates the skin deeper, so it can be harmful, and it’s more related to premature aging. UVB can be filtered out through glass windows, whereas UVA not as much. Therefore we see a lot more aging or even skin cancers on the left side of our body because of our driving habits, we get more sun through the windows in our cars.
SUSAN CINGARI: So essentially, should we wear sunscreen in the car?
MARIANO BUSSO: We should wear sunscreen before we leave home. As a matter of fact, we receive about one to two hours per day of indoor tanning without even noticing it. So first thing in the morning we should apply sunscreen.
STEVEN SHAPIRO, MD: One thing about damage to the skin and skin cancer, most people feel they have their sunburn and the sunburn goes away and the skin goes back to normal. But the skin actually has memory in it and it can remember that damage, and years later it can cause skin cancer.
SUSAN CINGARI: Speaking of UVA and UVB rates, a lot of people are saying, “Okay, we know we’re not supposed to gout in the sun so we’re going to go to a tanning salon.”
What about tanning salons? Talk to me about UVA and UVB rates, if there are any, in the tanning salon.
STEVEN SHAPIRO, MD: I’d like to start with this one. Years ago we thought that UVB caused skin cancer, and we remember UVB for bad. And the tanning salons, to that point, were about 98%. So what happened is they switched to UVA and now they’re about 98% UVA. Later on we found out that UVA caused skin cancer, as well. So what happened is that we know that tanning salons contain about 98% UVA, 2% UVB, both rays cause skin cancer, therefore the tanning salons cause skin cancer. In fact, I believe it was this week, the FDA listed sunlamps on their list of carcinogens. So we do know that tanning salons do cause skin cancer.
MARIANO BUSSO: People need to understand that when you have a tan, the skin is sending is sending you a messaging, which is, “I’m getting darker to protect from radiation.” So it’s a protective mechanism as opposed to a health mechanism. So every time you have a suntan, that’s bad.
STEVEN SHAPIRO, MD: One of the things I tell my patients in the room, most people say, “I don’t go out in the sun, I don’t have any skin cancer, I don’t have any sun damage,” and I tell people, “Look at the outer part of your arm.” And on the outer part of their arm you’ll see freckling, you compare it to the inside of your arm, you don’t see quite as much, that’s a measure of your own sun damage. That will also show people, too, that they do have some background sun that they’re getting, and it’s the same sun walking down the street that it is at the beach. Most people feel you have to be at the pool or the ocean to get sun, that’s not true.
MARIANO BUSSO: Yes, that’s not true. I see people with major suntans, I say, “You’ve been in the sun?” “No.” “But you have a suntan.” “Well, I run from eight to nine.” Right. People think that the bad rays are between ten and four.
All the sun exposure is going to harm your skin, it doesn’t matter the time of the day. Of course, you’re going to get a lot more harmful radiation at noontime, it has the highest index value, but at seven o’clock at night or in the morning, you’re still going to have harmful rays.
STEVEN SHAPIRO, MD: I’d like to tell this funny story. Years ago I was sent out to give a skin cancer lecture to a yacht club. And it was twelve o’clock, there wasn’t a cloud in the sky. And I walked in there and I sat there, I had this beautiful lecture put together on staying out of the sun. And I sat there and said, “These people don’t want to hear this.”
So what I did is I walked in the room and off the top of my head I changed the entire lecture to what I call Principles of Sensible Sun Exposure, to talk to these people about ways to be more sensible about the amount of sun that they get. One of the best ways to do it is put your sunscreen on before you even go out in the sun so it has a chance to dry and set first. Make sure the sunscreen blocks both UVAS and UVB, and it should say All Day on the label, all Day means eight hours worth of protection. If it doesn’t say All Day, you need to reapply it about every two or three hours. Recognize that on a cloudy day you get 70% to 80% of the sun, so you still need the sunscreen on a cloudy day.
As a dermatologist, most of the sunburns I see are on Monday morning after a cloudy weekend. I try to tell people that it’s the same on that weekend, some of it’s filtered, only about 20% or 30% if filtered.
Other things to understand that in the water, you get 85% of sunlight in up to three feet of water. So if you’re going to be in the water all day, you still need your sunscreen as well. In fact, try to find a waterproof or a water resistant sunscreen. These are ways to be more sensible about the amount of sun you get.
I also told the yacht club to try to do their races early in the morning or late in the day. I also told them too, if you’re going to be out on a boat or outdoors, try to go indoors for lunch. Again, that’s not going to eliminate your risk of skin cancer, it’s only going to reduce your risk of skin cancer.
SUSAN CINGARI: What about if I decide to take your recommendations to heart. I say, “Okay, I’m not going to go jogging till after five, I’m not going to ride my bike to 5:30, the sun is going down, and I’m wearing a hate.” Is that going to protect me?
MARIANO BUSSO: Well, you should wear a hat, protective clothing and also the sunscreen. One issue about sunscreen is compliance. Usually the question that’s asked is, “What do I apply first, my makeup or the sunscreen?” There are so many good products out there that are makeups with a good sunscreen that you can have both, so in one application, you can have both, the same with moisturizers. If you’re going to apply a moisturizer, you can apply a moisturizer that contains some form of UV protection. It’s not going to be as good probably as a good sunscreen, but at least will give you some degree of protection.
One of the major issues it that those products are washable, whereas the good sunscreens are going to be waterproof. So if you sweat, you won’t run them off. And so if you’re not going to be exposed directly in the sun, you’re just driving, doing your usual activities, you can apply makeup which contains sunscreen, 15 or more, at least. But if you’re going to go in the sun or change your routine, yes, you do need to apply a sunscreen which will not rub off as easily, like waterproof or sweat proof, at least.
STEVEN SHAPIRO, MD: In my experience, too, with makeups and sunscreen, it seems like people don’t look for the same thing in a sunscreen that they look for in the makeup. And they’ve got to again look for those principles, it’s got to block UVA, it’s got to block UVB, and it should say All Day, and a lot of those will block UVA or UVB, and they may not have protection for both.
What I’ve noticed with the good makeups is they’ll say it blocks UVA and UVB or you have to know the ingredient that you’re looking for, it should say it on the label. If it doesn’t say UVA and UVB protection, it probably does not have it.
SUSAN CINGARI: Which brings us to an important point. Most people, like myself, we probably wear a moisturizer, we’re wearing makeup. In my case, I’m trying to wear something to make me look young and thin, but that’s beside the point. What about sunscreen under makeup? Can you use your sunscreen under makeup, and what order should you apply it? And what about if you’re wearing a moisturizer? Where does that fit into the whole scheme of things?
MARIANO BUSSO: It’s easier to have a product that contains both. But if you don’t, you first apply your sunscreen, allow your sunscreen to penetrate your skin at least twenty minutes, and then you’ll apply your makeup or your moisturizer. But again, there are so many good products that contain both that most likely you just look for protection that’s broad spectrum, fifteen or more, within your makeup.
STEVEN SHAPIRO, MD: In general, working with the skin, try to cleanse the skin first. Try to use any of your liquids first before you put in your creams or your makeups. I tell people if you do it in reverse, you make soup. But basically, you want to use your toner, your liquid products first. So if it’s a gel sunscreen, you’ll cleanse first, use your gel sunscreen, let it dry; you might use a moisturizer on top of it, and then you would use your makeup.
If it’s the other way around where you’re using a cream based sunscreen, you may cleanse first, put on your cream based sunscreen, and then your makeup on top of it, you won’t have to use the toner or the gel if you’re not applying it at that time.
SUSAN CINGARI: Now you just mentioned gels. Which type of product works the best? I know there’s lotions, gels, pads, there are a ton of different kinds out there. Which type of product do you think works the best?
STEVEN SHAPIRO, MD: Number one, people have to find one that they like and they’re comfortable with it. For an acne patient who has a lot of oil in their skin, they may prefer the gel sunscreen or a liquid sunscreen, one that’s not going to feel greasy or oily. If somebody is older or if they have dry skin, they may want to use a cream based or a lotion based.
And again, I tell people if they don’t’ like to use a sunscreen they’re probably not going to use it. If they like to use it they’re more likely to use it, and just make sure they’re aware of what product and what it says on the label, and they have to read the labels.
MARIANO BUSSO: One thing I would like to add, one of the main causes of wrinkling is sun, as an exterior factor; the second one most common is smoking; those we can control. One interesting thing is that, of course, wrinkling is due to the sun, you avoid the sun and apply sunscreen.
But there are some other products that have the capacity and have shown over the years with research studies and a big body of evidence that they can also undo sun damage and also prevent sun damage, such as Retin-A or Tretinoin-A, or some of the Retinols that are available in the stores. So those products can undo sun damage and prevent sun damage, a good complement perfectly with sunscreen. You apply sunscreen in the morning during the time of sun exposure and Retin-A at night before you go to sleep.
STEVEN SHAPIRO, MD: I love to use an analogy for Retin-A as like toothpaste and cavities. I think a lot of people use a product like that, they put it on, they run to the mirror the next day to see what’s going. And really, your good sunscreen will stop future sun damage, and then you’ll use products to get rid of old sun damage, like a derivative Vitamin A, as Dr. Busso said, Vitamin C, to get rid of the old sun damage. But they’re not vanishing creams, they might only give you a small percentage improvement per year. And I told people if they come back in twenty years and they look exactly the same, the products worked.
So they’re more for long term. And the analogy that I use is like brushing your teeth with cavities. You may still get two or three cavities, but it’s better than what it would have been; those are the home products.
Then there are other things that can be done in an office. There are chemical peels, microdermabrasion, laser treatments that can be used to get rid of the damage that’s there now.
SUSAN CINGARI: So the main thing is we should definitely wear the sunscreen, but what about if people are allergic or have sensitivity issues? You’re ready about PABA and you’ve read about some of these other things that can cause a reaction. Talk to me a little bit about that.
MARIANO BUSSO: As long as you find a sunscreen that contains the basic properties as we said, broad spectrum, fifteen or more, and waterproof, then it doesn’t matter if it’s a gel, a cream or an ointment, so you take the one that fits you better. If you have an oily skin you’re going to use a water-based or alcohol-based product; if you have more of a dry skin, you’re going to use probably a cream. On the face, ointments tend to block the pores and produce acne, so we try to stay away on the face. But usually products that are safe to be applied to the face would say on the label. It would say either non-comedogenic or that’s not going to clog the pores; it would make a reference to it.
One of the originally chemicals used for sunscreen was PABA, and a lot of people that had allergies to that chemical. So many of the newer sunscreens say, “PABA free,” and they use other chemicals.
Many times what we believe is to be an allergy is just irritation from applying too many products. Some of them may contain alcohol, or if you use an alcohol-based sunscreen and you apply everything at night or you didn’t do it very carefully, you can have some irritation. And so one way to know whether you are allergic or not to a specific product is very simple. You apply on the surface here on your elbow twice a day for a week, if you do not develop any reaction then you can safely apply on the face.
STEVEN SHAPIRO, MD: One of the other things about that. If you do have sensitive skin and you have had problems with sunscreens in the past and you’re looking for one that’s safer, those are the chemical-free sunscreens, and that’s whole other category of sunscreens. They’re basically sunblocks, they sit on the outer layer of the skin, and basically, the ones contain zinc oxide, titanium dioxide, those are great chemical-free sunscreens.
SUSAN CINGARI: Quickly, we have time for just one more little bit of information for you, self-tanners. Everybody is out there marketing them, everybody is using them. Do they work, are they safe, how should we use them?
STEVEN SHAPIRO, MD: I’d like to answer that one. The active ingredient you’re looking for in a self-tanning cream is dihydroxy acetone, and I tell people it’s the equivalent of using nail polish. And basically it sits on top of the skin, gives color to the skin.
When they first came out they were more orange in color and it didn’t look that natural. There are great ones out there now that are very natural looking. You only have to apply them every two or three days once you reach the color that you like, and there are some now that have sunscreens in them. The biggest myth about self-tanning cream is that it does not give protection from the sun.
SUSAN CINGARI: Dr. Mariano Busso, Dr. Steven Shapiro, thank you so much. That’s some great information. I’m going to go run out and buy some more sunscreen now.
Thanks for joining us for this web cast, I’m Susan Cingari.