Skin Care Treatment Article
The Frying Game
San Francisco Bay-area dermatologist Katie Rodan does everything she can to keep her family a healthy shade of pale. SPF 32 sunscreen is a daily essential - rain or shine. Hats and long-sleeved shirts are a must on sunny days outdoors.
Open-air athletics are scheduled for early mornings or late afternoons to avoid peak sun hours of 10 A.M. to 2 P.M. "We're a pretty active family," says Dr. Rodan. "We just try never to be out in the midday sun."
Overkill? Not at all, contends Rex Amonette, M.D., co-chair of the National Coalition for Sun Safety, an organization dedicated to raising public awareness. For Dr. Rodan, Dr. Amonette, and a growing number of others, the best model of sun protection is Australia, which in 1980 launched the "Slip! Slop! Slap!" campaign featuring an animated seagull urging citizens to "Slip on a shirt/Slop on sunscreen/and Slap on a hat" to prevent skin cancer. Since the campaign first began, Australians, who have the highest rate protection now put on their Persol. They have found that "The future of sun protection is looking you in the eye."
Signs of sun damage include brown spots, uneven coloring, sallowness, sagging, wrinkling, Rosaecia, and pre-cancers.
"Skin turns to leather with all the sun they get," notes Miami-based dermatologist Fredric Brandt, M.D. who says he cringes when he sees bikini-clad vacationers basking on Florida beaches, or when he drives past a schoolyard where children are romping at midday in the shade-free play areas typical of American schools. Dr. Brandt urges friends, patients - anyone who will listen - not to spend extended time outdoors during the day, to shop at indoor malls, to park in indoor garages, and to build houses with verandas. Here's what else he and others now tell Americans in response to common questions.
Q: Is burning the only major sign of sun damage?
A: Far from it. Over the long run, signs of damage include brown spots, uneven coloring, sallowness, sagging, wrinkling, Rosaecia, and pre-cancers. "Tanning and burning are only the most immediately visible, and passing, marks of injury from the sun," says Vincent Genes, and can eventually cause skin cancer. Exposure that results in a tan is a direct sign of DNA damage to pigment cells; long after the tan fades, the genetic damage remains, showing itself as mottling, brown spots-even malignant moles, or melanoma. Sun avoidance and sunscreen are the prime ways to stave off this damage.
Q: What kind of sunscreen is best?
A: Best by a mile is what's called "broad spectrum" sunscreen, which blocks both ultraviolet B light (the sun's burning rays) and longer-wave ultraviolet A light, which penetrates the skin more deeply, causing a breakdown of collagen and elastin. (Think "A" for aging.) To find a good broad spectrum sunscreen that guards against both UVB and UVA rays, check the label under "active ingredients" for zinc oxide, titanium dioxide, or avobenzone (also called Parsol 1789)- the only full-spectrum ingredients approved by the FDA. According to dermatologists, The latest DV prescription: Wear SPE 15 only if you plan to be indoors for most of the day. Outdoors, SPF 30 is the new minimum.
Australians have become arguably the earth's sun savviest people on skin cancer in the world, wearing full-body bathing suits and learning to check every day for changes that might signal early malignancies. Cities are crisscrossed with arcades and covered walkways; parks and playgrounds feature large sections shaded by canopies and trees. Ice cream vendors to dispense sun block alongside the jimmies and cones. Today, in what is widely regarded as a public health triumph, the number of deaths from melanoma has declined in Australia.
In the U.S., skin cancer rates seem to be rising. "Not to mention the fact that people are turning their skin to Dr. DeLeo, M.D., chairman of dermatology at New York's St. Luke's Roosevelt Hospital.
Permanent underlying damage to both the cells and the genes occurs every time skin absorbs direct rays of ultraviolet sunlight. Some cells are killed outright. Others, wounded, spew out chemicals that irritate tiny blood vessels, causing inflammation and, if exposure continues, the redness of a burn. UV exposure leads to a breakdown in collagen and elastin fibers, resulting in drooping and sagging, and weakens blood vessels, lacing the skin's surface with spider veins. And UV rays produce free radicals, corrosive little molecules that alter cellular DNA damage, the zinc oxide is now thought to give the most complete protection of the three; and zinc has the added benefit of soothing the skin, it's the major active ingredient in most diaper-rash ointments. All UVA absorbing ingredients should be used in a product that contains a high-number SPF.
Q: What is SPF-and what's the current thinking about it?
A: The best thinking is: "The more SPF the better, and apply it several times a day," says dermatologist and University of Oklahoma molecular biologist Mark Naylor. SPF itself is a rating system that measures a sunscreen's effectiveness in protecting against burning UVB rays. (An SPF 10 allows you to stay in the sun 10 times as long without getting a burn as you could wearing no protection; SPF 15 lets you stay out 15 times as long, and so on.) Until recently, dermatologists assumed that an SPF of 15 to 20, which prevents burning in most people for hours, was adequate. Today, in light of mounting evidence that major sun damage can occur long before a burn appears, doctors have revised their SPF recommendations sharply upward.
Many now suggest an SPF 15 only if you plan to be indoors for most of "SPF 30 should be the minimum for most people," says Dr. Naylor. Last fall the FDA, which only a few months earlier had proposed capping manufacturers' SPF claims at 30, postponed implementing the new requirements until 2002 to allow further review of the SPF issue. Meanwhile, most sun specialists recommend slathering on sun block two to three times a day- even if you aren't going to shower, swim, or exercise vigorously enough to sweat. And make sure you use enough-at least a teaspoonful for the face.
Q: So SPF 30 must be twice as protective as SPF 1.5. Right?
A: Not exactly, says Andrew Scheman, M.D., of the Northwestern University Medical Center in Chicago Although an SPF 30 sunscreen keeps you from burning for twice as long as an SPF 15 does, it does not block twice as many of the ultraviolet B rays that are principally responsible for sunburn. Nevertheless, it's worth using.
"An SPF 15 allows about one-fifteenth, some 6 percent, of UVB to get through to your skin. An SPF 30 lets in one-thirtieth, or just about 3 percent," explains Dr. Scheman. "So while SPE 15 blocks about 94 percent UVB, SPF 30 blocks around 97 percent - only a few percentage points more." But those extra points can make a big difference, says Elizabeth McBurney, M.D., of Louisiana's Tulane University and LSU Medical Schools. Those who have very pale skin or who are very sensitive to the sun need the extra protection," she notes, adding that she wears an SPF 60 when she goes out in midday sun.
Q: What kind of sunscreen is best for sensitive or allergy-prone skin?
A: Doctors say you should go for a "non-chemical" sun block, i.e., one that contains zinc oxide or titanium dioxide as its main active ingredient, and avoid irritating non-active ingredients labeled "hypoallergenic" and "non-stinging." The best bet may be to shop for a sunscreen designed for children. "Manufacturers try to eliminate anything even remotely irritating from those products," says Dr. DeLeo.
Q: Can sunscreen prevent melanoma?
A: No one is sure. "Though there's strong evidence that faithful use helps prevent basal and squamous cell cancers," says Lynn Drake, M.D., of the University of Oklahoma Health Sciences Center, "more studies are needed about melanoma." Dr. Drake advises women with very pale skin that burns and freckles easily, women with numerous moles, and women who have had severe sunburns as children - in other words, those statistically at high risk for melanoma - to be especially careful about wearing sun protective clothing, avoiding direct sunlight, and seeking regular skin checkups.
And yes - use sunscreen every day; it can't hurt and it will reduce your risk of other skin cancers and prevent that mottled leathery look we all want to avoid.
Q: Can you go outside in the sunlight after putting on Retin-A?
A: Yes - but take precautions. Tretinoin, the prime ingredient in Retin-A, is not only inactivated by sunlight, but also tends to thin the stratum corneum, the outermost layer of the skin-at least until you've built a tolerance to this drug (Which can occur according to Dr. Terezakis, M.D., of Tulane University in New Orleans.) So apply your retinoid at night and be fastidious about sun protection during the daylight hours.
Q: How will sun protection get better over the next few years?
A: Look for lots of cheaper, creamier, more efficient sunscreens, predicts Ken Klein, a chemist in Fairfield, New Jersey. "There are new additives in the works that should help us get higher blocking performance at lower prices from active ingredients Parsol 1789," says Klein. "We may also soon see the introduction of really effective antioxidant protection in sunscreens," adds Dr. Scheman. "Most of the vitamins and AHAs you see on labels are not chemically stable in sunscreens - right now, they work in just a small number of stand-alone products.But when chemists solve that problem, we may have sunscreens that truly can do two jobs at once: block out the sun and fight free-radicals." Perhaps further down the road: sun block in easy-to-swallow pill form, taken with our daily vitamin; drugs that stimulate production of natural protective melanin (and a slight tan) without exposure to the sun; and a sunscreen soap that lathers on complete protection, according to Mary Buller, director of the American Sun Protection Association in Denver.
"This may sound very futuristic, but there's huge potential," remarks Stanley Levy, M.D., director of medical affairs for the Revlon Research Center in Edison, New Jersey. The most significant twenty-first century advance of all? "That would be getting people to change their behavior and be sun-safe," says Dr. Drake. Adds Dr. Rodan, "Say yes to sunscreen. People should wear it rain or shine."
by Lydia Preston Sun 2001
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