In a recent study reported in JAMA Dermatology, “researchers found that most consumers in a study did not understand important information on sunscreen labels. Investigators surveyed 114 patients through last summer, asking them about the labels on sunscreen products. Even though 93% of them had purchased a bottle in the last year, most people showed important gaps in their ‘sunscreen knowledge’. Just 43% of people surveyed understood what sun protection factor (SPF) means and only 7% knew how to find a product that offers protection against early skin aging. After participants were shown images of the front and back of a common sunscreen with an SPF of 30, 38% correctly identified terminology associated with skin cancer protection and about 23% were able to correctly identify how well sunscreen protected against sunburn.” “We want our patients to understand the important factors of sunscreen and what to look for on the labels. In June 2011, the FDA released new product regulations which emphasizes the importance of protection against both UVA and UVB rays”, says Dr. Jonathan Wolfe. The FDA defines SPF — or Sun Protection Factor — as a measure of a sunscreen’s ability to prevent UVB from damaging the skin. Here’s how it works: If it takes 20 minutes for your unprotected skin to start turning red, using an SPF 15 sunscreen theoretically prevents reddening 15 times longer — about five hours. Another way to look at it is in terms of percentages: SPF 15 filters out approximately 93% of all incoming UVB rays. SPF 30 keeps out 97% and SPF 50 keeps out 98%. They may seem like negligible differences, but if you are light-sensitive, or have a history of skin cancer, those extra percentages will make a difference. And as you can see, no sunscreen can block all UV rays. There are problems with the SPF model: First, no sunscreen, regardless of strength, should be expected to stay effective longer than two hours without reapplication. Second, “reddening” of the skin is a reaction to UVB rays alone and tells you little about what UVA damage you may be getting. Plenty of damage can be done without the red flag of sunburn being raised. Anyone over the age of six months should use a sunscreen daily. Even those who work inside are exposed to ultraviolet radiation for brief periods throughout the day, especially if they work near windows, which generally filter out UVB but not UVA rays. Children under the age of six months should not be exposed to the sun, since their skin is highly sensitive to the chemical ingredients in sunscreen as well as to the sun’s rays. Shade and protective clothing are the best ways to protect infants from the sun. We at Dermatology Associates of Plymouth Meeting recommend a broad-spectrum sunscreen offering protection against both UVA and UVB rays. Many after-shave lotions and moisturizers have a sunscreen (usually SPF 15 or greater) already in them, and this is sufficient for everyday activities with a few minutes here and there in the sun. If you work outside or spend a lot of time outdoors, you need stronger, water-resistant, beachwear-type sunscreen that holds together on your skin. The “water resistant” and “very water resistant” types are also good for hot days or while playing sports, because they’re less likely to drip into your eyes when you sweat. However, these sunscreens may not be as good for everyday wear. They are stickier, don’t go as well with makeup, and need to be reapplied every two hours. Many of the sunscreens available in the US today combine several different active chemical and physical sunscreen ingredients in order to provide broad-spectrum protection. Usually, at least three active ingredients are called for. These generally include PABA derivatives, salicylates, and/or cinnamates (octylmethoxycinnamate and cinoxate) for UVB absorption; benzophenones (such as oxybenzone and sulisobenzone) for shorter-wavelength UVA protection; and avobenzone, ecamsule (MexorylTM), titanium dioxide, or zinc oxide for the remaining UVA spectrum. To ensure you get the full SPF of a sunscreen, you need to apply 1 oz. – about a shot glass full. Studies show that most people apply only half to a quarter of that amount, which means the actual SPF they have on their body is lower than advertised. During a long day at the beach, one person should use around one half to one quarter of an 8 oz. bottle. Sunscreens should be applied 30 minutes before sun exposure to allow the ingredients to fully bind to the skin. Reapplication of sunscreen is just as important as putting it on in the first place, so reapply the same amount every two hours. Sunscreens should also be reapplied immediately after swimming, toweling off, or sweating a great deal. We would also like to share and dispel some myths about sunscreens, as per the American Academy of Dermatology. Wearing sunscreen can cause vitamin D deficiency. There is some controversy regarding this issue, but few dermatologists believe (and no studies have shown) that sunscreens cause vitamin D deficiency. Also, vitamin D is available in dietary supplements and foods such as salmon and eggs, as well as enriched milk and orange juice. If it’s cold or cloudy outside, you don’t need sunscreen. This is not true. Up to 40 percent of the sun’s ultraviolet radiation reaches the earth on a completely cloudy day. This misperception often leads to the most serious sunburns, because people spend all day outdoors with no protection from the sun. Eighty percent of your sun exposure comes as a child, so it’s too late to do anything now. It appears that this universally promoted idea was based largely on a misinterpretation. A recent multi-center study showed that we get less than 25% of our total sun exposure by age 18. In fact, it is men over the age of 40 who spend the most time outdoors, and get the highest annual doses of UV rays. And since adult Americans are living longer and spending more leisure time outdoors, preventing ongoing skin damage will continue to be an important part of a healthy lifestyle. Dr. Wolfe’s Final Thoughts Buy a high-quality product with an SPF of 15 or higher, making sure to check its ingredients for broad-spectrum protection. Look for The Skin Cancer Foundation’s Seal of Recommendation, which guarantees that a sunscreen product meets the highest standards for safety and effectiveness. Once you choose the right sunscreen, use it the right way. But remember, you should not rely on sunscreen alone to protect your skin against UV rays since it is just one vital part of a complete sun protection program. By following prevention guidelines – such as using sunscreens, wearing sun protective clothing, hats and staying out of high afternoon sun – you can lower your risk of developing skin cancer, while helping your skin look younger longer.