Now that we are in April, and hopefully the longest winter of memory is behind us, it is time to share questions I get asked again and again about sunscreen.
1. What number SPF should I use?
-First of all, know that the SPF refers ONLY to UVB, not UVA. In order to know you are getting protection from UVA rays, which contribute significantly to skin-aging and increase melanoma risk, the bottle needs to say “Broad Spectrum”
-The UVB number is confusing because it does not follow common sense. For example, SPF 15 is more than twice as good at blocking UVB as SPF 8, but SPF 30 blocks 97% of UVB while SPF 15 blocks 94% despite the number 30 being twice as high as 15. I generally tell people anything 30 and higher is fine. Soon, it will be illegal to label any sunscreen higher than SPF 50, which is already the rule in Australia, because there is no benefit to using anything above 50.
2. I am really not outside a lot. I am mostly in the car. Do I still need to wear sunscreen?
YES!!! While car windows block UVB, they do not block UVA
3. What do you think of the Environmental Working Group (EWG) sunscreen recommendations?
I am a big fan of the EWG’s efforts to educate consumers on the safety of products in general, including sunscreens. And I think they are scientifically rigorous about their recommendations. My only issue with them is that the sunscreens are not tested for ease of use. I live in reality; A sunscreen is no good if it is thick and goopy, or makes you look like a ghost, or takes forever to rub in. Any parent reading this knows a child will only stay still for so long in order to be sunscreened. In the summer of 2012, I did my own little experiment. I bought 10 of the highest EWG-rated sunscreens. Some were so thick, they were impossible to rub in in a cosmetically acceptable way, and you needed to use a ton in order to cover the whole body as they were not spreadable. Some separated, so you would squeeze the tube, and watery liquid would come out, leaving almost a solid behind. I reached out to the EWG and asked to partner with them to actually have a rating not just for safety, but for practicality of use, and was rebuffed 🙁 So if you follow their recommendations, know you will be getting a safe product, but in my eyes, a good sunscreen needs to be safe AND easy to use.
4. What are your favorite ingredients and what should I avoid?
-I prefer the mineral sunscreens zinc oxide or titanium dioxide. Why? First of all, they are natural, inert minerals, so you don’t have to worry about chemical exposure (Whether you have to worry or not is a whole other big controversy). Second, because they are inert, they almost never cause allergies, unlike the chemical sunscreens. Third, they are very good at blocking both UVB and UVA rays. The only downside is finding a cosmetically acceptable one, and that is easier than ever as the particles are very fine now. I like the Elta MD and MD Solar Sciences. Over the counter, Neutrogena Baby makes a good one, both for face and body.
-Of the chemical sunscreens, I think Ecamsule aka Mexoryl is the best we have available for now. It is only available in La Roche Posay Anthelios and Vichy Capital Soleil for now. I hope more products will soon have it.
-There is a very promising chemical sunscreen called Tinosorb which is available in Europe but not here yet. It appears very safe and a very good UVA blocker. FDA, please hurry and approve it. We need more safe and effective options in the US!
-After ecamsule, I think the next best is Avobenzone for UVA, but it is not very stable in sunlight (it chemically degrades) so it needs to be mixed with other chemical sunscreens in order to be effective.
-Oxybenzone - Oy Vey! It is controversial with the American Academy of Dermatology and the Skin Cancer Foundation saying it is fine, and the EWG saying it is a hormone disrupter. A study from 2004 found Oxybenzone in 97% of the participants urine, so clearly we absorb it, but the question is do we absorb anywhere near enough to cause concern. The studies that showed hormonal disruptions were in rats that got mega doses, higher than we humans would absorb. This is a good article that mentions both sides: http://www.nytimes.com/2011/06/14/health/14really.html?_r=0
I think the issue is further complicated by the fact that some of the dermatologists quoted on this issue are paid by companies that contain Oxybenzone in their formulas. Call me a cynic, but I think that needs to be noted. So what do I do personally, for me and my family. I do not use Oxybenzone. Why use it if there are so many better options available that have no even remotely possible safety issues?
-If you get skin rashes from sunscreen, the most likely culprits are ozybenzone or octocrylene. Cinnamates and PABA can cause allergy as well, but you seldom see them in sunscreens any longer.
5. I have a darker complexion. Do I still need to wear sunscreen?
YES!!! I hope my Indian husband reads this, who thinks he is immune to the sun’s rays, but often burns. I do not care what color you are, you need to wear sunscreen. Not only can skin of color burn, but skin of color is prone to hyperpigmentation, and sunscreen will help prevent it, and not allow existing hyperpigmentaion to become worse
6. Will you yell at me if I come to see you tan?
No, I will not yell at you. I believe in moderation in all things. If you get a bit of sun, it is not the end of the world. I know I differ than many of my colleagues in this, but I think living in a cave is not an option. I think it is stupid to lie out and bask, and you will look old and wrinkly and spotty, but being outside enjoying life is a good thing. I wear a hat often, and I have a swim shirt on sometimes, but I am out hiking and in the pool, and if I get a little tan, I do not freak out. I believe in pleasure and joy, and if you are so scared about getting sun that you cannot achieve those, then that is problematic.
However, I will scold you as only a Jewish mother can if you go to tanning beds. Using them substantially increases your risk of melanoma, and you look orange and icky besides. Please people, don’t do it!!!!!!!!!
7. What about Vitamin D? Don’t I need sun to make it?
-It is true that Vitamin D production in the skin is triggered by UVB rays, NOT UVA, which is what most tanning beds are. How much sun you need depends on what color your skin is, what time of year it is, how close to the equator you live, and how much air pollution there is, i.e. it is complicated!! If you are white and exposing your arms and legs on a hot summer day, you can make 10,000-25,000 units of Vitamin D3 in 15 minutes. A darker skin person may not be able to make any on a winter day in the northeast exposing just his face. Personally, since it is hard to gauge how much sun you need to get enough, and I worry people will overdo it with the sun, I recommend D3 supplements. I take 2000 IU of D3 a day. By the way, if you want to research more about Vitamin D, you should know that the Vitamin D council is supported by makers of tanning lamps, and I find it biased and unreliable as a result. You are better off reading from the NIH website, or WebMD. Just my opinion.
8. What about those sunscreen pills?
Marketed under the brand Heliocare, these pills contain Polypodium Leucotomos, which is a fern from Central America. It has antioxidant and anti-inflammatory properties. A 2004 study of only 9 patients (J Am Acad Dermatol. 2004 Dec;51(6):910-8. Oral Polypodium leucotomos extract decreases ultraviolet-induced damage of human skin) essentially showed less sun damage (measured by things called sunburn cells, and cyclobutane pyrimidine dimers, which are seen after sun exposure in the skin and can damage and mutate DNA, leading to skin cancer). Personally, I love when we can use plants to our advantage, and I do take Heliocare on beach vacations. However, it does not give you a free pass to bake out in the sun for hours upon hours. But like sunscreen, hats, and sun-protective clothing, it is another tool we can use to prevent sun damage and skin cancer.
9. What do you think of the spray sunscreens?
Overall, they are not my favorite because most of them contain oxybenzone, and I worry about inhaling the chemical propellants, which I think is hard not to do. I do think they are great for hair parts (although a hat is better!), and I found one my Elta MD (the Aero) which is zinc based, and which I use on my kids in the summer if they are being squirmy!
If there are any questions I left out, please email me at firstname.lastname@example.org, or ask on my facebook page Cybele Fishman MD Integrative Dermatology
Be well, Cybele Fishman, MD