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Ep. 4: Sun Protection & Skin Care

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Ep. 4: Sun Protection & Skin Care

Jun 24, 2021

Summer's here but sun protection is important for skin health all year-round! In the Episode 4, Luke Johnson, MD and Michelle Tarbox, MD break down the benefits of SPF 30+, the differences between mineral and chemical sunscreens, and more.


Dr. Tarbox: Hello, this is Skincast, the podcast about skincare. My name is Michelle Tarbox, and I'm a dermatologist in beautiful sunny Lubbock, Texas. Dermatologists are medical doctors who specialize in the care of the skin, hair, and nails. And joining me is . . .

Dr. Johnson: This is Luke Johnson, dermatologist in Salt Lake City, Utah, with the University of Utah.

Dr. Tarbox: So we're here to talk to you about how to take the very best care of your skin. On this podcast, we will mention specific products, but we are not sponsored by any of these products. We have just found them to be useful in our clinical practice. We have no conflicts of interest with these. We just want to give you the tools to take the very best care of your skin.

Dr. Johnson: And today, we're going to be talking about how to protect your skin from the dermatologist's age-old enemy, the sun.

Dr. Tarbox: Especially living here in beautiful sunny Lubbock, Texas, I swear that the sun in our area could really be a comic book villain. It is quite strong. So we want to talk about how you protect yourself from the giant ball of heat in the sky.

So there are a lot of reasons why we should protect our skin from the sun. One of them, of course, is to reduce the risk of skin cancer. This is a very important part of our overall healthcare and it's something that we need to do all throughout our lives.

There are some statistics that are sometimes thrown around that I think sometimes discourage people, one of them being that you get something like 90% of your lifetime sun exposure by the time you're 18 years old. That is actually not true. You get about 20% of your lifetime sun exposure by the time you're 18 years old.

So if you are an adult and you're just starting to look at taking good care of your skin, you're not too late to the party. But you do want to start taking care of your skin early, and if you do have children, you wanna start them with good, safe sun habits early as well.

Dr. Johnson: I like to think that there are three main reasons you want to protect yourself from the sun. One is your skin cancer risk. Two is something called photoaging. Sunlight makes you look older. And three is, of course, sunburn, though I feel like that's a little bit tangential. Though, that's often what a lot of us think.

In terms of the skin cancer risk, dermatologists I think are pretty good about getting the word out about melanoma, which is the most dangerous kind of skin cancer. But there are other kinds of skin cancer as well, and the sunlight increases the risk of all of them.

Dr. Tarbox: Absolutely. And it does that by causing mutations in our DNA. So, unfortunately, the mutations that we get in our DNA from sun exposure, from solar radiation, don't give us superpowers like the X-men or something like that. Instead, it causes us to develop skin cancer, and it causes our skin to prematurely age.

Dr. Johnson: Yes. So your DNA sits in the cells in your skin and the ultraviolet radiation from the sun can make changes in that DNA that makes them more prone to turn the cell into a cancerous one.

Dr. Tarbox: The other thing the sun can do is it can damage the collagen in your skin. And the collagen in your skin is what gives youthful skin that kind of bounce and turgor that make it look plump and healthy and prevents the wrinkles from forming. Collagen is our best friend when it comes to anti-aging, and the sun is its mortal enemy.

Dr. Johnson: That's why people who have seen a lot of sunlight in their lives and are now older look very wrinkly. So you can minimize that by protecting yourself from the sun as much as you can.

Also, there are certain types of ultraviolet radiation that penetrate window glass as well. So even if you're planning on spending all day on a road trip driving in the car, still put on sunscreen because that UVA radiation comes right through the windshield and still causes that aging process.

Dr. Tarbox: Exactly. There are like three flavors of UV radiation that we sometimes talk about. In the news recently, you may have heard about UVC radiation. We don't actually experience that here on earth because the ozone layer filters that out, but it can be used in laboratory settings to sterilize things. And in the news, people have been talking about using certain kinds of air filters that have UVC radiation to help sterilize that.

Now, you wouldn't want to have these indoors on people because it can cause problems with your eyes. So you don't want to be exposing your eyes to UVC radiation. Fortunately, like I said, that gets filtered out by the ozone, so we don't have to deal with that one.

UVB rays do make it to the earth. We traditionally think of these as the burning rays. These are the ones that are going to have their greatest intensity at midday in full sun. And these are the ones most of us think of when we think about protecting our skin from the sun. We think about the UVB rays that cause burning.

But what about those UVA rays, Luke?

Dr. Johnson: Well, they're the ones that penetrate window glass. They also tend to be the ones that are involved in tanning beds. So it's not like a tanning bed doesn't increase your risk of anything. It definitely can increase that aging process.

Dr. Tarbox: And that UVA, I like to say it stands for aging. Because UVA actually is the flavor of UV radiation that gets the deepest into the skin. It penetrates the deepest into the skin and gets to that collagen that it can then degenerate. So that's what causes those aging changes, those UVA rays.

Speaking of tanning beds, some people think they go to the tanning bed to get vitamin D synthesis. However, because UVB rays burn you . . . most tanning salons don't like to burn their clients because their clients don't come back. And so the UVB rays are usually not in tanning beds, but the UVB rays are the ones that are necessary to make vitamin D from the sun.

Now, I'm a dermatologist. I'm a religiously sun-protected human being since the time I was about 15 years old and figured out the connection between skin cancer, sun, and aging. And I have perfect vitamin D levels because I take an oral supplement. I choose not to use my face and my skin to make my vitamin D at the cost of it increasing skin aging and skin cancer.

Dr. Johnson: So, if you're going to be out in mid-July at the beach at 2:00 p.m. with no clothes on except your swimsuit, I think most people feel like that's a good time to protect yourself from the sun. And that's true. But it's important to remember that there's always ultraviolet radiation out there because the sun is shining on the earth.

So even on overcast cloudy days, even if it's 4:00 p.m., even if it's winter or fall, there's always ultraviolet radiation out there, which can cause these changes associated with skin cancer and increase your risk of photoaging as well. So I put on sunscreen every day regardless of what I'm planning to do that day.

Dr. Tarbox: Me too. It should be part of your routine like brushing your teeth in the morning. And I actually tell patients when they're trying to get in that habit to actually keep it near something they do every day. So, if you have space, keep an extra toothbrush. You're brushing your teeth, you're looking at your sunscreen going, "After I'm finished brushing my teeth, I'll put on my sunscreen."

Dr. Johnson: Speaking of sunscreen, it's one component of a multi-component approach to protecting yourself from the sun. So, in brief, sunscreen is good. Also, stay in the shade, wear hats, wear sun-protective clothing, and wear sunglasses. And we can talk a little bit about each of those in a bit more detail.

Dr. Tarbox: I like that. I like to think of skin being protected from the sun as sort of like a team sport. So your quarterback is your sunscreen, of course. It does a lot of the hard work for you. But you have to realize that there are some limitations to sunscreen. First of all, there are places it's hard to apply, like on your scalp. And there's also a difficulty with keeping it at its highest functioning level throughout the day because you have to reapply sunscreen about every two hours. So you can add to your sun protection regimen by utilizing sun-protective clothing and, of course, sunglasses to protect your eyes.

Dr. Johnson: And the skin around your eyes. I've heard some people complain that they don't like putting sunscreen on their face because it stings their eyes. Well, just don't put it all that close to your eyes, but put on sunglasses.

A lot of my patients have questions about what specific sunscreens I recommend. So here's some of the deal with sunscreens. We usually recommend that you use SPF 30 or greater. Higher SPF is better, but it's not like 60 is twice as good as 30. It's just a bit better, but higher is better.

You also want to make sure you use enough of it. So our first challenge as dermatologists is to get people to actually use sunscreen, and our next challenge is to get them to use enough.

Dr. Tarbox: That's absolutely right. So you have to use about a shot glass full of sunscreen to apply to the areas that are usually exposed to the sun. One thing you don't necessarily want to mix though is sunlight and a lot of alcohol, because there have been some studies that showed that that potentially can increase the harmful effects of the UV radiation. So we like to say here on Skincast, “Don't Titos and tan.”

Dr. Johnson: So that shot glass should be full of sunscreen and not something else if you're planning to be out in the sun.

And you mentioned to reapply every couple hours, and that's true. So another challenge we have as dermatologists is to get people to keep using the sunscreen. So it just sort of wears off in a couple of hours because the chemical components in it get used up because they're doing their thing protecting you from the sun, or the physical blockers get washed or sweated or wiped away.

Dr. Tarbox: Absolutely. And one pro tip that I like for people who are active outdoors, who have trouble with the sunscreen kind of getting in their eyes when they sweat, is you can actually get the little wax sticks that are kind of like a Chapstick that have sunscreen on them, which are also a nice thing to use if you have to put sunscreen on a child's face because they can't get it in their eyes on accident.

And if you put a little bit of that wax-based sunscreen over each eyebrow and leave the space between the eyebrows uncovered with that kind of sunscreen and use the other one everywhere else, it'll keep the sweat from dripping down into your eyes and carrying the sunscreen with it.

Dr. Johnson: I think it's a good point to mention that there are different products available. A lot of people think about sunscreens just as sort of the standard lotion-y, creamy stuff that they slather on themselves. But these days, the sunscreen manufacturers have developed a lot of different ways to put this stuff on your skin. And a lot of people might feel that it's more convenient or it feels better for them.

Dr. Tarbox: Yeah, I think the most important thing is to find a sunscreen that you like using, because if you get the very best whatever highest SPF sunscreen but you hate applying it, and you don't like the way it smells, and you don't like the way that it feels, you're not going to use it. So you need to get one that you like to use and that you're comfortable using.

Dr. Johnson: And they all seem to be fine. So there are spray sunscreens, which I find quite convenient. They're a little bit tricky because you've got to keep your eyes closed if you're putting them on your face. Or you spray them on your fingers and hands first, and then put them on your face. You've got to watch out putting them on children because children will sometimes breath in at the wrong time or keep their eyes open.

They're also technically flammable. So sometimes people are having campfires, and that's when they're putting on sunscreen, so watch out for that. But otherwise, sprays are a fine way to apply sunscreen to your body if you find them convenient.

Dr. Tarbox: Yeah, that's definitely a good thing to bring forward there. So just like you wouldn't go near an open flame and spray a can of hairspray, you wouldn't want to use any kind of spray sunscreen that has an accelerant in it. So once that does dry, you are no longer highly flammable. Just make sure the sunscreen is dry before you go near any heat sources.

Dr. Johnson: There are also sunscreen sticks. I think you mentioned these. They look a bit like deodorant sticks, but you can just sort of rub them on your arms and they're pretty convenient. I know Neutrogena makes a good one. I think it's called Sport Stick or something like that.

And then there are also powders. So I've had some big, strong, tough, manly men who just don't feel like they want to put lotion on their skin. So I say, "Well, some of my patients like these powders, because you can just sort of brush them on your face easily and then throw them on the back of your pickup truck and be off to your manly man duties."

Dr. Tarbox: I like that. That should be a brand. There should be manly men sunscreen. What do you think?

Dr. Johnson: I think we should make it.

Dr. Tarbox: It should be non-fragranced and it should not have any kind of color to the skin. I like the idea of a powder.

Dr. Johnson: And it should have a picture of me flexing on front.

Dr. Tarbox: I think that would be perfect.

Dr. Johnson: So, last year, there was also a medical study that showed that the chemical components of sunscreen get absorbed into your blood. It didn't show that anything bad happens when they get absorbed into your blood. And my personal feeling is that probably nothing too horrible happens because we've been using them for decades and nothing too horrible has happened to the general public. But it does show that they get absorbed into your blood and we probably need more medical studies that look into what that means.

So, because of that concern, I usually recommend just the mineral-based sunscreens. Those are sunscreens containing zinc or titanium as the only active ingredients. I recommend those for children specifically. For adults, I don't think it matters quite so much. If you are worried about sunscreen chemicals being absorbed into your blood, then stick with zinc or titanium sunscreens because we know those stay on the skin.

Dr. Tarbox: They have some really good sunscreens that are actually zinc only that are very gentle. Neutrogena makes a good one. Some of them are also produced with a process called micronization, which makes the particles of the physical sunscreens, which are both metals, zinc and titanium, very much smaller so that they don't leave a sort of gray cast on skin, especially skin that's got a darker color.

Dr. Johnson: I like the Neutrogena . . . I think it's called Clear Touch or something like that. It's just zinc or titanium. It rubs on easily. I find it some of the mineral-based sunscreens kind of muck up clothing a bit, but this one seems to be good.

Dr. Tarbox: And some people are sensitive to sunscreen ingredients. The ones that I think are the best for people who have sensitive skin are a product line called Vanicream, which you can get most Walgreens drugstores. Vanicream is made to be very hypoallergenic. They have a really good sunscreen, their Vanicream Sports sunscreen, which is SPF 35.

I also really like CeraVe's sunscreen. It's a nice sunscreen for people who have sensitive skin as well. And it's made to be sort of like a nice little extra skincare product. So there's actually some niacinamide in there, which is a B vitamin that's an anti-inflammatory and it's a skin healthy ingredient. Additionally, they also have some hyaluronic acid in that sunscreen.

Dr. Johnson: CeraVe is a good brand. I like it for my daily facial moisturizer that has sunscreen in it. So CeraVe AM is what I put on every day. It has some SPF 30 and protects my skin from those photo-aging effects of that radiation.

Dr. Tarbox: I like that. And earlier we were talking about the fact that some of the mineral sunscreens can leave a little bit of a cast on skin of color. I think it's also important to mention that everybody needs to protect their skin from the sun.

So there is not a person of any skin color that's 100% without risk for developing skin cancer. And sometimes people have gotten that information either through the media or unfortunately sometimes even through medical practitioners. So it is important to protect your skin from the sun no matter what color your skin is as a baseline. You wanna make sure that you're keeping yourself healthy and taking good care of yourself.

If you are a person of color, you do need to work harder to supplement the vitamin D, however, because that or that turns to be a little bit of a greater percentage of vitamin D deficiency in patients of color.

So very important to protect your skin from the sun. We talked about also seeking the shade, which is important. The middle of the day is really when the sun's rays are at its most intense. So that's usually between about 10:00 a.m. to 2:00 p.m., with the noon hour being sort of the witching hour when you get the most UV radiation on the earth's surface. So trying to stay out of the sun if you can during those times is a good idea. But what if you can't stay out of the sun right then?

Dr. Johnson: Well, I like hats. We like hats with wide brims. I have a nice wide-brimmed hat that makes me look super cool when I'm walking around outside with my kids and my kids are all wearing big wide-brimmed hats and everyone thinks, "That must be a dermatologist walking by."

Dr. Tarbox: Yeah, I feel like you can always pick out the dermatologist's kids at the beach. So you can do that. You can do that sun-protective clothing. Sun-protective clothing has something called a UPF, and it's UV Protective Factor. And that will actually be on the label typically. Most sun-protective brands have a UPF of 50 and it's analogous to an SPF.

The companies that we like that do that include Coolibar, which is a sun protection clothing manufacturer. They have awesome clothes, and they go on sale frequently. There's also one called Sunday Afternoons, which is very cute. And then there's UV Skinz, and Skinz is spelled with a Z, which I thought was fun.

Dr. Johnson: There are also some generic brands, if you will. So, if you just look on Amazon or Google for sun-protective clothing, you can find some. And they're light and breezy and they're meant to be worn when it's 90 degrees outside. So it might sound miserable to wear long-sleeve shirts when you're out in the summer, but that's what these are intended for and they're pretty good. I have a number of them myself, and I don't feel miserable wearing them outside,

Dr. Tarbox: I actually find them less hot when I'm wearing them. There are some products that are made that are in sun-protective line that are actually made from bamboo fiber. And bamboo fiber is naturally a couple of degrees cooler than the ambient temperature. So it's a very comfortable thing to wear.

So, Luke, what are some sun myths that sort of circulate?

Dr. Johnson: We mentioned a few of the myths, like that SPF 60 is twice as good as SPF 30, or that if you're old, it's too late to protect yourself from the sun. Not so. There's also this myth about having a base tan. So I've had some people tell me that they're going to go to the tanning salon to get a base tan before their trip to Hawaii or something. Don't be fooled. That doesn't help.

Dr. Tarbox: Yeah, the base tan might make you feel more comfortable in your swimsuit, but spray tans are a good alternative. Spray tans are actually just made out of a three-carbon sugar that gets sprayed on or applied on the outside levels of the skin. This chemical does not absorb it all into the bloodstream. And it basically goes through the same reaction that bread goes through in the oven that causes it to brown. It's called the Maillard reaction, and that's what gives that color.

The newer products have actually been very elegantly composed to remove sort of the traditional fake tan smell, which is very nice. And a lot of products can also be used kind of gently and daily to build up gradual color in a nice even way.

Dr. Johnson: Well, listeners, I hope that that gives you some ideas about why it's important to protect your skin from the sun and some good ways to do it.

Dr. Tarbox: We are very happy to be able to educate you about how to protect yourself and we're very grateful for this opportunity to visit with you. We want to thank our institutions for giving us support to do this podcast and encouragement to help people take better care of their skin.

Dr. Johnson: Yes, Texas Tech Dermatology and the University of Utah Department of Dermatology. And if you consider yourself a real dermatology nerd, Michelle and I have another podcast called "Dermasphere," where we cover some of the latest research in dermatology. We'll see you guys next time.