Surgeon General finally warns about Skin Cancer

Look how the sun hits your body while swimming and playing...

Look how the sun hits your body while swimming and playing…

This past Tuesday, the United States surgeon general issued a call to action to prevent skin cancer, calling it a major public health problem that requires immediate action.

Nearly 5 million people are treated for skin cancer each year. According to the American Cancer Society,  more cases of skin cancer are diagnosed annually than breast, prostate, lung and colon cancer cases combined and skin cancer rates are increasing.

“We all need to take an active role to prevent skin cancer by protecting our skin outdoors and avoiding intentional sun exposure and indoor tanning,” said Acting Surgeon General Boris D. Lushniak, MD, MPH.

I say this all the time, but it bears repeating as often as possible:

“Most skin cancer is 100 percent preventable.” 

Most cases of melanoma – as many as 90 percent – are believed to be caused by cumulative exposure to UV rays. UV rays are also a major risk factor for the most common curable forms of skin cancer,  basal and squamous cell skin cancers. Exposure to UV rays comes from the sun and other sources like tanning beds and sunlamps and the U.S. Food and Drug Administration (FDA) now requires that tanning beds and sunlamps carry a warning stating people under 18 should not use them. Lushniak said there is a flawed perception in the US that tanned skin looks healthy, and that needs to change. I always say,

“Tanned skin is damaged skin.”

According to the Melanoma Education Foundation, One blistering sunburn before age 20 doubles your lifetime risk of melanoma. Three or more blistering sunburns before age 20 multiplies your lifetime risk by five.


How many times have you gotten a bad sunburn?

Reduce your risk of skin cancer for yourself and your children:

-Jodi, proud owner of a lily white complexion.

Want to be 25% less likely to get age spots?

Well, I’ve been saying this to my patients for years:  Daily sunscreen use prevents the ugly results of photo-aging (spots, roughness and wrinkles caused by years of cumulative sun exposure which speeds up your skin’s natural aging process)  and finally a study published in a June issue of the Annals of Internal Medicine entitled, “Sunscreen and Prevention of Skin Aging,” has proven this to be true.

shutterstock_124869277Studies have already proven that sunscreen prevents skin cancer, but previous studies on photo-aging had always been done on mice so this new study performed on over 900 white people in Australia under the age of 55 and measured over 4 years just confirms what we dermatologists have been saying to our patients:

“If you want to keep spots and wrinkles at bay,  use sunscreen every day.”

Initially, the researchers weren’t sure exactly what effect regular comprehensive use of sunscreen would have on skin aging caused by the sun over the years and they were also curious about the effect of taking dietary antioxidants such as β-carotene supplements to delay skin aging so they tested both.

The study was broken randomly into 4 sunscreen use groups:

  1. Specific daily use of broad-spectrum (protects against both UVA & UVB rays) sunscreen of SPF 15 applied to head, neck, arms, and hands each morning and after bathing, after spending more than a few hours in the sun, or after sweating heavily and 30 mg of β-carotene.
  2. Specific daily use (as described above) of the broad-spectrum SPF 15 sunscreen and placebo.
  3. Use of broad-spectrum SPF 15 sunscreen at the discretion of the participant and 30 mg of β-carotene.
  4. Use broad-spectrum SPF 15 sunscreen at the discretion of the participant and placebo.

Photos were taken of the backs of participants’ hands at the beginning of the study and 4.5 years later and were examined for microscopic changes of skin aging by researchers without the knowledge of  which study groups the participants had been assigned.

The sunscreen use findings:

Interestingly, not all of those in the daily use group applied their sunscreen daily as directed. But more participants assigned to the daily sunscreen use group reported applying sunscreen at least 3 to 4 days each week compared to the participants in the discretionary-use group. Those in the daily-use group were 24% less likely to have increased skin aging after 4.5 years than were those in the discretionary-use group.

No overall effect of taking β-carotene supplements on skin aging was found.

My advice:  If you want to prevent discolorations, spots and wrinkles from forming due to cumulative exposure to the sun’s rays as you age, use a broad-spectrum sunscreen (and make sure it specifies so on the label) daily of at least SPF 15 whenever you are outside and exposed to the sun.  Also,  seek the shade whenever possible and wear a broad-brimmed floppy hat and sun glasses to protect facial skin and your eyes!


Allergic to sunscreen? Read labels!

Question:  My daughter is apparently allergic to many of the sunscreens I have tried on her and gets an itchy, burning rash. What is it in the sunscreens that is causing this reaction?

Answer: There could be many different chemicals causing a skin reaction.

Read those sunscreen labels!

Read those sunscreen labels!

Most commonly, allergic reactions to sunscreens are caused by one of the original UVB sunscreen protection ingredients called para-aminobenzoid acid  or PABA.

Read sunscreen labels and look for refined and newer ingredients called PABA esters (such as glycerol PABA, padimate A and padimate O) instead of the original staining, reaction-forming PABA.


New “broad spectrum” sunscreen ingredients

This year,  the FDA requires sunscreens to protect against both UVB and UVA rays (labeled “broad-spectrum”), so new sunscreen ingredients have been developed and included such as include Mexoryl SX (ecamsule) and  Parsol 1789 (avobenzone) which protect against UVA rays.

Physical sunscreens including  titanium dioxide and zinc oxide have been around for decades. Remember Zinc Oxide on the noses of lifeguards back in the day? These ingredients physically block and scatter UV rays. These singular sunscreen formulas have no other chemical ingredients and so may be a better choice for sensitive skins. They also go on thicker and appear “whiter,”  but they also stay on longer and are gentler to sensitive skins.

Despite advances in technology, formulating products with these ingredients without the skin-whitening effect has proven difficult.   Zinc oxide has recently been approved by the FDA, like titanium dioxide, in microsized or ultrafine grades as  an allowable active ingredient in sunscreen products with the ability to provide more full-spectrum protection. Zinc oxide is less whitening in this form than titanium dioxide and provides better UV protection. You  can now find sunscreen products that contain these ingredients in combination with other sunscreen ingredients to increase their stability in water and sun and decrease unwanted “whiteness.”

But remember sunscreen protection is all in the proper application.  And, a lot has changed in how we recommend sunscreen to be purchased and used, so it pays to stay up on the news about sunscreen so you don’t get burned (literally!)

Other buzz words for sensitive skin

You will notice  lots of colorful kids’ sunscreen products on store shelves you might want to stay away from. Try to  avoid any sunscreen products containing dyes or perfumes, which are known allergens. And, for acne-prone or oily sensitive skins, definitely check for specific products labeled, “non-comedogenic” or “won’t clog pores.”

I cannot stress enough how important it is to be aware of sunscreen ingredients, especially when allergic reactions are concerned, and take the time to stand in the store aisles and read those labels!


What you must know about new FDA sunscreen label rules

Courtesy FDA

Sunscreen labels are changing for the better...learn what the differences mean to you. Photo courtesy FDA.

Question: “I read about some new sunscreen labeling rules in a magazine but I don’t really know how they apply to me when I’m standing in the store aisle trying to choose sunscreen! Can you help?”

Answer:  Of course! These new FDA sunscreen label requirements are meant to clear up confusion about exactly what type of protection a sunscreen provides. There are some new terms you will see on sunscreen bottles starting this summer (although brands have until December 2012 to comply) that will help you make a more informed choice.

  • “Broad Spectrum”  This designation means the sunscreen protects against both UVA and UVB sunlight rays, and will distinguish sunscreens from those that only protect against UVB. To earn the designation, brands now need to pass the FDA’s broad spectrum test to claim they are, in fact, broad spectrum. Furthermore, only those labeled “broad spectrum” with an SPF of 15 of higher can claim that they protect against sunburn caused by UVB rays but also decrease skin cancer risk and protect against skin aging caused by UVA rays.
  • “FDA Skin Cancer/Skin Aging Alert”  For sunscreens with SPF values below 15 or those that are not broad spectrum (because they only protect against UVB rays), you will see the following new FDA alert:

“Spending time in the sun increases your risk of skin cancer and early skin aging. This product has been shown only to help prevent sunburn, not skin cancer or early skin aging.

  • “Water-Resistant”  This tells users exactly how much time they can expect to get the declared SPF level of protection while swimming or sweating, based on new standard testing. Labels will specify 40  or 80 minutes. If this term with a time limit is not on the label, the product is not water-resistant.
  • “Drug Facts”  Information such as active ingredients, usage, warnings and directions will now appear in the drug facts chart , like the one above, so you can see it at-a-glance and choose accordingly.

The following terms have been banned from labeling because they are misleading and inaccurate, according to the FDA:

  • Waterpoof
  • Sweatproof
  • Sunblock
  • Instant Protection

The biggest mistake you can make, no matter what sunscreen you choose, is not applying enough of it and not re-applying it. The general guideline is to apply a shot glass worth (about 1 ounce) to your body, but studies have shown that most people are applying only one-quarter of that amount! And, no matter what the SPF, no sunscreen protection lasts beyond two hours, so to protect skin fully, that same one ounce should be re-applied every two hours when spending the day outdoors in the sun.

I think sunscreen and skin cancer protection is really a year-round concern and sunscreen should be worn on areas exposed to the sun such as arms, neck and face every day, even if cold or cloudy. Have you seen that recent photo of the truck driver whose left side of his face looks dramatically older than the right side of his face? That’s proof of the sun’s aging power and the case was studied  by Jennifer R.S. Gordon and Joaquin C. Brieva, dermatologists at Northwestern University, with findings published in the New England Journal of Medicine.

Tell the truth:  Do you wear enough sunscreen? Will you change how you choose and apply sunscreen this summer?