"Let the Sun Shine" Beautiful Skin CHAPTER 12

Keep your face to the sunshine and you cannot see the shadow. --Helen Keller

I’ve said it before, and I’ll say it again: “There is no such thing as a healthy tan.” Please, let this be your mantra too. A tan is your body’s direct response to ultraviolet light and to skin injury. It is the skin struggling very hard to protect itself against any further damage--not a pretty picture. The greatest cause of skin damage and premature wrinkling is being caught unprotected during incidental sun exposure (like walking to your car, driving in your car, checking your mail outside, walking your dog, or sitting by a window). Many women spend their teenage and early adult years soaking up as much of the sun as possible. Later, they seem to suffer the consequences of their idle youth, when they notice age spots, dark patches, rough textures, broken blood vessels, and other results of sun exposure. They come to me seeking help, crying about their “lost beauty.” Skin that doesn’t glow with health can be devastating to a woman’s self esteem.

Sun exposure damages skin in many ways. First, it attacks the epidermis, the thin outermost layer of skin. Then, it damages the upper layers of the dermis, or the bulk of the skin, leaving them thinner, less resilient, and more susceptible to wrinkling. Over time, the collagen and elastin fibers that form the dermis also break down, causing gradual drooping and sagging.

In this chapter, I’ll give you ways to protect yourself, the right way to apply sunscreen, products to use that protect against both UVA and UVB rays, plus the newest (most natural) ingredients thought to help prevent skin cancer.

A Prescription for Sun Damage

When women come to me suffering from sun damage, I give them the facts, and the news is sobering. According to the American Skin Cancer Foundation, about a million cases of skin cancer are diagnosed in the United States each year, and it is striking at increasingly younger ages, often before the age of thirty-nine. Clearly, these numbers show that every time you go out in the sun, you are virtually taking your life in your hands--that is, unless you are taking the proper measures necessary to protect your skin. What are these measures?

According to the American Academy of Dermatology, everyone should use a broad-spectrum sunscreen having an SPF of at least fifteen and containing ingredients that screen both ultraviolet B (UVB) and ultraviolet A (UVA) rays. Ingredients that screen UVA include benzophenone, titanium dioxide, zinc oxide and butyl methoxydibenzoylmethane.

Stop Focusing On Tanning

I tell my patients to forget about focusing on getting a tan and to start focusing on preventing sun damage by using sunblock. I tell them they should assume they will naturally get some sun almost every day. In fact, most people don’t realize that sun damage from UVA and UVB rays doesn’t happen only while sunning at the beach. You can also get sun damage from incidental exposure, which is, just as it says, incidental. Incidental exposure occurs every time skin that is unprotected by sunscreen comes in contact with the sun’s rays. It occurs when you’re in your car driving and the sun gets to you through the closed window. It occurs on cloudy days, when you haven’t put anything on to protect your face. It occurs when you are out on the slopes, skiing. The effects are cumulative and can result in sun damage and eventually even skin cancer.

Myth
You’re not at risk for skin cancer if you’re rarely out in the sun.
Fact:
Regardless of your sun exposure habits today, you probably had more than enough sun exposure during your childhood to put you at risk for skin cancer. Not only that, but just running your daily errands can give you enough sun exposure to increase the possibility of skin cancer.

Skin Cancers

The sun can change the nature of melanocyte cells (the cells that cause the skin to tan), making them abnormal and in rare cases malignant. Because this process occurs over a period of ten to twenty years, the damage doesn’t show immediately. Diagnoses of skin cancer have doubled annually since 1980, according to the American Cancer Society. The Skin Cancer Foundation reports that women who rarely use sunscreens have been found to have twice the melanoma risk of women who virtually always use them. Women who reported that they tanned moderately after burning and never used sunscreens were the most vulnerable group, with approximately four times the melanoma risk as those with the same skin type who used sunscreens.

There are three forms of skin cancer:
Basal-cell: This is a nonmelanoma form of skin cancer. According to The Lancet journal, about 1.2 million cases of basal-cell carcinoma were diagnosed in the U.S. in 1998, and the incidence of skin cancer in parts of Europe has more than tripled during the last fourteen years. The most common type of basal-cell skin cancer tends to show up on your face or other sun-exposed areas. Since the growth is usually small and red, it is often mistaken for a persistent zit. The cancer rarely spreads to internal organs, but if it is left unchecked for many years (around ten), it could eat away at your skin.
Squamous-cell: This nonmelanoma form of skin cancer can kill. Between 1980 and 1989, the incidence of nonmelanoma skin cancers increased by 65 percent. Squamous-cell cancers also show up in sun-exposed areas, but usually take the form of slightly scaly or hard patches that won’t heal. These cancers pose a greater potential to spread internally than do basal-cell cancers.
Melanoma: This is the least common, but the deadliest, of the skin cancers, causing nearly 10,000 U.S. deaths per year (one American dies every hour of melanoma). Between 1980 and 1989, the incidence of melanoma in the U.S. increased by 21 percent. By the year 2000, as many as one in seventy-five Americans may develop melanoma at some time during their lifetime. However, melanoma is not automatically a death sentence. With early detection and early removal, it can be completely cured. Melanoma, is usually a dark or multicolored growth that, unlike basal-and squamous-cell cancers, which occur most prevalently on the face, can begin anywhere on the body. It is more commonly seen on the trunk: For men, the upper back is the most common area on the body; for women, the lower leg, bottom of the feet, or calves is more common. Melanoma is also tied more closely than are the nonmelanoma cancers to intermittent intense sun exposure. So, for example, sustaining a single bad sunburn in childhood or taking a once-a-year vacation to a sunny place can increase the risk of melanoma. Conversely, chronic sun exposure or cumulative sun exposure--for example, a farmer who is chronically exposed to sunlight while working in the fields--are the primary causes of basal- and squamous-cell cancers. Melanoma is striking at increasingly younger ages; 25 percent of the more than 30,000 people expected to develop melanoma this year will be thirty-nine or younger.

The incidence of skin cancer may further increase, if, as some scientists predict, the earth’s ozone layer continues to deplete. According to the Environmental Protection Agency, scientists began accumulating evidence in the 1980s that the ozone layer--a thin shield in the stratosphere that protects life on Earth from UV radiation--is being exhausted through the use of certain chemicals at a rate of 4 to 6 percent each decade. This means that increasingly more UV radiation is reaching the earth and our skin, and affecting our bodies.

Sun-Care Glossary

Here are some definitions of terms to help you better understand the language of sun protection.
Antioxidant: The fire extinguisher that diffuses, puts out, or takes the energy hit from free radicals (see below), sparing and protecting the surrounding skin cells from damaging free radicals. Some antioxidants are vitamins A, C, and E.
Free Radicals: When the skin is exposed to ultraviolet light, it forms high-energy molecules called free radicals, which cause damage to neighboring skin cells as these radical molecules discharge energy. Antioxidants can render the molecules harmless. By using products with antioxidants, you can help diminish any further harm to your skin.
SPF (Sun Protection Factor): SPF’s range from two to sixty. The number refers to the sunscreen’s ability to block out the sun’s harmful rays. The SPF amount indicates how much longer you can stay in the sun getting a sunburn while wearing the sunscreen than you could without the protection. For example, if your unprotected skin normally burns in ten minutes and you wear an SPF of fifteen, you are protected about fifteen times longer, or for 150 minutes. Keep in mind that your skin’s burning time changes depending upon the strength of the sun each day.
Sunscreen: Sunscreens get into the skin and sit there like a line of defensemen. When the ultraviolet rays hit the skin, they grab it and absorb the dangerous energy before it gets into the skin cells.
Sunblock: These sunscreen products block the ultraviolet light, causing it to reflect off the skin, so it never gets into the skin in the first place. Think of it as having a mirror sitting on the skin’s surface.
UVB rays: Short-wave, intense ultraviolet light that radiates from the sun. UVB rays penetrate the skin, causing it to show a visible burn, which is the first warning sign you are getting too much sun. Most older sunscreens on the market protect only against UBV rays.
UVA rays: Longwave, intense ultraviolet rays that can deeply penetrate the skin, even through windows and loose-knit clothing. UVA rays cause sun damage (dryness, wrinkling, discoloration) to the skin and affect the production of collagen and elastin, which give skin its structure and firmness. Unlike the burn you get from UVB rays, the effects of UVA sun damage are not immediately apparent. Failure to block UVA accounts for why the dark spots on many women’s faces get worse, especially when they use a high SPF, because the SPF blocks only the UVB.
UVC rays: You don’t need to worry about the effects of UVC rays on your skin; these ultraviolet rays of sunlight never make it to Earth, because the ozone layer blocks them.

Quick Tip
Your eye measures only visible light--where most of the light comes from the sun’s direct beam. UV light, however, is invisible to the human eye, with about 50 percent coming from diffuse sky light, which can reach you even in the shade. According to the Skin Cancer Foundation, to measure your UVB exposure, all you need to do is look up. The amount of UVB you’re getting correlates with the amount of sky you can see. If the sky is obstructed by trees or buildings, you’re getting less UVB.

An Early Problem

In the early days, we knew much more about the UVB rays than we did about UVA. The UVB rays of sunlight are much hotter and more intense than UVA rays, and older sunscreens absorbed only these rays. The problem arose when people started applying sunscreens to prevent sunburns and ended up staying out in the sun longer than they ever could before. The result? More UVA damage and an increased incidence of skin cancer. Once researchers realized what was happening, they began formulating second-generation broad-spectrum sunscreens that help block both UVA and UVB rays.

What Are The Best Sunscreens?

Many excellent products in various formulations are available for you to choose from. What’s wonderful about these products is that they block not only the short-wavelength, ultraviolet B light of the sun but also the longer wavelength, ultraviolet A rays.

Some sunscreens contain a finely milled total blocking agent, such as zinc oxide or titanium dioxide, which is sometimes called Z-Cote on labels. The older versions of these products looked opaque white. The newer products have only a tiny hint of a white hue, because the particles are so finely ground. The particles are absorbed by the skin, fending off even more of the sun’s rays. Both micronized ingredients are especially good for sensitive, freckle-prone skin, because they’re natural and don’t cause the rashes that sunscreens with PABA can. In addition, the newer Parsol 1789, also known as avobenzone, is a very good sunscreening agent, although it is not a total block like zinc oxide or titanium dioxide. Avobenzone does provide good broad-spectrum protection, however, because it screens both UVA and UVB rays.

Here are some good sunscreen products:
Ombrelle SPF 15 and 30
Neutrogena UVA/UVB sunblock, SPF 15, 30, and 45
Coppertone Shade UVA Guard SPF 30
Coppertone Waterproof Sunblock
BioSun Oil-Free Gel

Quiz: What Is Your Risk of Getting Sun Damage?

Take this test and find out your danger zone.
1. Tanning is “safe”:
A. When you catch rays only at the tanning salon.
B. If you tan only when you're on vacation.
C. Never; there is no such thing as a safe tan.

2. Which of these undesired skin conditions is NOT caused by sun exposure?
A. Wrinkles
B. Broken blood vessels
C. Leprosy

3. Most of the damage we receive from sun exposure is caused:
A. During our childhood years.
B. From using baby oil rather than sunscreen.
C. On that one day on the nude beach.

4. When is the best time to apply sunscreen?
A. In the morning only.
B. Thirty minutes before sun exposure, and again after swimming or exercise.
C. About an hour after you've arrived at the beach, just when you're just turning pink.

5. If you must be outdoors, try to limit your exposure to:
A. The hours before10 a.m. and after 4 p.m.
B. Only when the kids beg to go to the pool
C. Mowing the lawn on weekends.

6. The three main types of skin cancer are:
A. Basal-cell carcinoma, squamous-cell carcinoma, and malignant melanoma.
B. Malignant melanoma, keratosis, and warts.
C. Melanocytic nevus, basal-cell carcinoma, and eczema.

7. What can you wear to minimize sun exposure?
A. A wide-brimmed hat.
B. Long-sleeved shirts and long pants.
C. Tightly woven materials.
D. All of the above.

8. You don't need to use sunscreen:
A. On cloudy days.
B. In the winter.
C. If you don't mind developing a skin cancer or two.

9. About _________ new cases of skin cancer will be diagnosed in the United States this
year:
A. One hundred thousand.
B. Five hundred thousand.
C. One million.

10. The chance of any person developing skin cancer in his or her lifetime is:
A. Nine out of ten.
B. One out of six.
C. Limited only to George Hamilton.

Answers
1. The correct answer is C. There is no such thing as a safe tan. A suntan is the skin's response to an injury; it’s what happens as the skin tries to protect itself from further UV damage. A tan is a sign that damage has already been done.
2. The correct answer is C. Okay, this answer was pretty obvious, but did you also know that more than just wrinkles and broken blood vessels are attributable to sun exposure? Try adding dry and leathery skin texture, dull skin tone, age spots, loose skin with poor elasticity, and red blotches. Not a pretty sight!
3. The correct answer is A. Even one bad burn during childhood can set the stage for the development of skin cancer later in life. Keep infants under six months of age out of the sun completely, and apply sunscreen faithfully to all children before any sun exposure.
4. The correct answer is B. Applying sunscreen in the morning is better than not applying it at all --but applying it thirty minutes before leaving your house to go bicycling, swimming, or jogging around the block outdoors will continue your protection. If you waited until you’re actually at the beach, by the time you spread out your blanket, put up the umbrella, unpack the cooler, and stop the kids from kicking sand at each other, you’d be red as a lobster.
5. The correct answer is A. The sun's rays are strongest between 10 a.m. and 4 p.m. Whenever possible, try to schedule outdoor activities before or after these hours. When you can't avoid being outside during those hours, make sure you are well protected with sunscreen, hats, and clothing, and try to stay in the shade as much as possible.
6. The correct answer is A. Basal-cell carcinoma is the most commonly occurring skin cancer, followed by squamous-cell, and then malignant melanoma, which is the most deadly.
7. The correct answer is D, all of the above. That was a freebie.
8. The correct answer is C. You can get a serious burn on cloudy days or from the sun’s reflection off sand, snow, or even the pavement. What’s more, you can get a burn during any season or time of year. That’s why it is essential to use a broad-spectrum sunscreen every day.
9. The correct answer is C. According to the American Cancer Society’s 1997 projections, more than one million Americans will be diagnosed with some type of skin cancer each year.
10. The correct answer is B. According to the American Academy of Dermatology, at least one in six Americans will develop Skin Cancer during his or her lifetime.

Score Card
Judge your score by how many questions you answered correctly.
1-3: You probably are burned to a crisp right as we speak. Head out to the drugstore pronto and buy yourself a good sunscreen. Then use it!
4-6: You try to be a savvy consumer, but get confused about what to do, when. Often you lie outside in the sun for hours, thinking that just because you put on an SPF 30, it’s okay to soak in the rays. Wrong!
7-9: Aside from getting some incidental exposure while driving or walking, you usually wear sunscreen.
10: A perfect score. You are so health conscious that you must be a doctor.

The Best Way to Use Sunscreen

It seems simple, but you would be surprised how many people don’t know how to put on sunscreen correctly. This is how to do it:
1. Apply your sunscreen at least twenty minutes before sun exposure. This allows the sunscreen to fully absorb into the skin, completely readying the skin to screen out the first ultraviolet rays it encounters.
2. Make sure to use enough sunscreen. One ounce of sunscreen (about one-fourth of most bottles) is adequate to cover all exposed skin. If you don’t use enough sunscreen, you won’t be able to achieve the SPF rating listed on the product’s bottle. In fact, if you use only a small amount of sunscreen, you’re likely to cut the SPF rating by half or more, reducing and SPF of thirty to an SPF of twenty or fifteen, which are still acceptable. However, when a fifteen SPF effectively drops to a seven or eight, it may not provide enough protection, especially for people with very fair or sensitive skin.
3. Follow this rule of thumb: even if the label says the product is “waterproof,” “sweatproof,” or long-lasting,” still reapply it every two hours you stay out in the sun.
4. You must reapply sunscreen immediately after exercising or swimming. Despite manufacturers’ claims that certain products are waterproof or sweat-proof, no sunscreen is completely sweatproof or waterproof.
5. You also need to apply sunscreen frequently if you participate in outdoor activities, such as tennis, golf, sailing, gardening, horseback riding, etc.
6. Don’t make the mistake of using sunscreen as an excuse to lie out in the sun for long periods of time. No matter how much sunscreen you use, you can wind up with more sun damage this way than you would had you had laid in the sun for just a short period and gone inside before you started to burn. Sunscreen can be misused by allowing you to stay out for such extended periods of time without early signs of burning that you can end up with ultraviolet damage without realizing it.
7. Throw out your sunscreen after one year, the lifespan of any sunscreen/sunblock product.