Aside from bad potato salad at summer picnics and the misery it can deal the digestive system, skin—the body’s biggest organ—tends to take the brunt of warm weather ills this time of year.
Waiting rooms are filling up with patients covered in poison oak or reacting to insect stings, and doctors can only hope they don’t have to tell patients that years of tanning have turned into skin cancers.
Though the milky complexions from Scarlett O’Hara’s day aren’t likely to return to fashion any time soon, the popularity of deep tanning seems to be declining. However, hopes that the sunscreen message was finally getting through to the public were shaken when the Journal of the American Academy of Dermatology reported that the majority of Americans are not using sunscreen.
Only 14.3 percent of men and 29.9 percent of women reported that they regularly use sunscreen on both their face and other exposed skin.
“Sunscreen needs to be applied every time your skin is exposed to sun, summer and winter, even if you’re just driving in your car,” UAB dermatologist Marian Northington, MD, said. “People should also be using a lot more sunscreen than they tend to use, and they need to reapply it every couple of hours when they are outside, especially after swimming or perspiring heavily.”
The American Academy of Dermatology says most people need an ounce of sunscreen—about a shot glass full—to cover the face and other exposed areas of skin. Getting enough may take more than one layer. They also recommend a broad spectrum sunscreen that blocks both UVA and UVB rays.
Why aren’t more people using sunscreen? Perhaps they don’t fully understand the damage UV radiation can do. Life is busy, and if they haven’t made it a habit, they may forget. Some males may feel that skincare is something manly men don’t do. Those are the typical answers. However, adding to sunscreen confusion are two new topics heating up the news and the internet.
The first is the battle between congress and the FDA over the agency’s long backlog of applications for approval of next-generation sunscreen ingredients that have been available in the EU and most of the world for up to 15 years. Legislation unanimously passed in a rare show of bipartisanship was signed into law last November. The Sunscreen Innovation Act required that the FDA act on stalled applications for new ingredients within 300 days.
Act they did—they said no to all the applications. A spokesperson for the FDA stated that insufficient data had been submitted to make a judgment on the long term safety of the new ingredients, especially in vulnerable populations like pregnant women, and particularly in view of the fact that unlike in the past, when sunscreen was used occasionally, current recommendations are for daily use in larger quantities.
On the other side of the problem, are concerns about ingredients and products the FDA does allow that would not be allowed under EU safety regulations, particularly those that offer inadequate UVA protection, are frequent allergens or suspected endocrine disrupters, or are inclined to develop free radicals, increasing the chances of DNA damage to skin cells.
Perhaps the most frequently voiced objection is about nanoparticles used to block UV rays without leaving a white residue. The concern is that such fine particles with repeated use may be absorbed into the skin or inhaled into the lungs in sprays with long term effects that are unknown. Preliminary studies suggest that nanoparticles are not absorbed, but have not been sufficiently definitive to calm fears.
The concern from congress and others pushing for approval of next generation sunscreens focus on the effects of UVA radiation. SPF only measures the effectiveness of sunscreens against UVB damage. Recent research shows that UVA rays, which are far more abundant than UVB rays, do play a role in the development of skin cancer over time. They also have a primary role in the premature aging effects from too much sun.
Another frequently voiced concern is that sunscreens do not block all rays. People who use sunscreen to extend their time in the sun may be doing more accumulated damage to their skin than they realize.
This is particularly disturbing since Consumer Reports in the US and similar consumer organizations in the UK and Canada have published studies suggesting that up to a third of sunscreens on the market don’t perform as advertised. The most frequently cited problem is that their water resistance and SPF protection after water contact do not perform up to stated levels.
So with all the confusion, what does a doctor recommend to patients?
“People need sunscreen—SPF 30. Melanoma kills and sun damage ages,” Northington said. “However, don’t depend on sunscreens alone. Look for shade. Stay out of the sun as much as possible between 10:00 and 4:00. Wear UV protective clothing. Wear a hat that protects not only the front of your face, but also the sides.”
In addition to a wide spectrum sunscreen that protects against both UVA and UVB rays, some dermatologists suggest using something with antioxidants to minimize the risk of free radical damage to the DNA in skin cells.
Some moisturizers also have ingredients with naturally occurring SPF, such as red raspberry seed oil (SPF 28-50) and carrot seed oil (SPF 38-40). They are usually present in insufficient concentrations to use alone, but they could be a starting point for patients who won’t use other sunscreens.
More research is needed to clear up the confusion and make the best possible choice available to the public. In the meantime, what can be done to ease the other miseries of summer skin?
“For a bad case of poison oak, I prefer to use topical steroids. They bring relief without the side effects of other steroids,” Northington said. “To avoid heat rashes and fungal infection, keeping the skin clean and dry can help, especially drying well after showers in skin folds and between the toes.”
For patients who tend to get poison oak so severe it requires a doctor visit, prevention can be as important as treatment. They should learn to recognize and avoid poison oak. They should especially know to never burn poison oak in an attempt to get rid of it, and to avoid inhaling smoke from areas where poison oak may be burning.
One strategy is to assume whenever they are outside that they may have come into contact with poison oak and learn to remove it effectively. Most soaps are superfatted to make them more moisturizing, which makes them less than ideal for removing poison oak’s tenacious urushiol oil. This is one area where grandmother’s advice may be right—a laundry soap formulated to break up oil may be helpful in getting poison oak oil off. Old-fashioned Octagon may be impossible to find, but many artisan soapmakers make a low-superfat laundry soap, and in a pinch, a degreasing formula dishwashing detergent may help. Keep hands away from the face, and always wash hands before changing clothes to avoid waistband rash. Then wash ankles and anywhere else poison oak may have touched. Follow with lotion to replace skin oils that may have been washed away with the poison oak oil.
Since tiger mosquitoes moved into Alabama, avoiding itchy bites and the possible diseases they can bring has grown into a bigger challenge. Unlike mosquitoes that typically bite in the early morning or late in the day, tiger mosquitoes, which can be identified by the white stripes on their back legs, are hungry all day. They are so persistent, they will bite through clothing and will keep looking till they find a spot of prime skin the insect repellent missed.
For patients who can’t tolerate DEET repellants or are fearful of them, repellants containing lemon eucalyptus and/or catnip may be an option. Some people do seem to attract more mosquitoes than others. Some theories are that high blood sugar, recent consumption of high potassium foods, warmer than average body temperature, and byproduct of metabolism in perspiration after exertion tend to attract mosquitoes.
Patients who attract more than their share may also want to avoid toiletries scented with floral, fruit and food fragrance when they plan to be outside. A better choice would be plant-derived fragrances from botanicals that insects tend to avoid, such as lemongrass, lavender, tea tree, mint and eucalyptus.
