Uncovering the Facts about Sunscreen

Since I extended the offer to disburse free samples of Blue Lizard Australian Sunscreen out, many individuals across the country have taken me up on the offer. And, as such, I have received numerous questions about sunscreens (not to mention 100% positive feedback about Blue Lizard).

My recent Blog entry - Maximizing Sunscreen Efficacy, discusses what ingredients to look for, and how to ensure you're getting optimum protection. Yet, here is a list of commonly asked questions about sunscreens that many people ask:


1. Who needs to use sunscreen?
In a word -- EVERYONE~ Regardless of skin color or skin type, everyone needs sunscreen! The Food and Drug Administration (FDA) and the American Academy of Dermatology recognize six different skin types.

I. Always burns easily, never tans, is extremely sun sensitive skin. Red-headed with freckles. Irish/Scots/Welsh.

II. Always burns easily, tans minimally, is very sun sensitive skin. Fair-skinned, fair-haired, blue or green-eyed. Caucasians.

III. Sometimes burns, tans gradually to light brown, is moderately sun sensitive skin. Average skin.

IV. Burns minimally, always tans to moderate brown, is minimally sun sensitive Mediterranean-type/Caucasians.

V. Rarely burns, tans well, isn't sensitive to the sun. Middle Eastern, some Hispanics, some African-Americans.

VI. Never burns, deeply pigmented, isn't sun sensitive. African-Americans.

The American Academy of Dermatology suggests that, regardless of skin type, a broad-spectrum (protects against UV-A and UV-B rays) sunscreen with a Sun Protection Factor (SPF) of at least 15 should be used year-round. (Ideally SPF 30). Remember, everyone is at risk for skin cancer!

2. When should sunscreen be used?

Sunscreen should be used every day (even on cloudy and cold days) if you are going to be outside for more than 20 minutes, and should be reapplied every two hours. Daily, regular use of SPF 15 sunscreens actually allow some repair of surface-level damage to the skin (i.e, wrinkles and premature aging). It is important to properly apply sunscreen and to reapply it daily. The sun’s reflective powers are great – 17% off of sand and concrete; 80% off of water and snow. And remember that even on a cloudy day, 80% of the sun’s ultraviolet rays pass through the clouds.

3. How much sunscreen should be used, and how often should it be applied?
Sunscreens should be applied to dry skin at least 20 minutes before going outdoors. When applying sunscreen, pay particular attention to the face, ears, hands and arms, back of the neck, and tops of the feet, and be coat the skin liberally. One ounce (enough to fill a shot glass) is the amount needed to adequately cover the exposed areas of the body properly. Be careful to cover exposed areas completely – a missed spot could mean a patchy, painful sunburn. And don’t forget that lips get sunburned, too! Be sure to apply a lip balm that contains SPF of 15 sunscreen. Sunscreen should be re-applied every two hours, and they should be reapplied after swimming or perspiring heavily. Even so-called water resistant sunscreens may lose their effectiveness after 80 minutes in the water. Don’t forget that sun exposure occurs all the time, even while you’re taking a short walk on a cloudy day. (For children six months an older, reapply sunscreen every 1 - 1.5 hours if in the sun during the peak hours of 10:00 a.m. and 4:00 p.m.).

4. What type of sunscreen should I use, and what ingredients should I look for?

There are so many types of sunscreen that selecting the right one can be quite confusing. Sunscreens are available in many forms including ointments, creams, gels, lotions and wax sticks. The type of sunscreen you choose is a matter of personal choice. Ideally, sunscreens should be rated at an SPF of 15 or higher (SPF 30 is the best) and provides broad-spectrum coverage against both UV-B and UV-A rays. Ingredients which provide broad-spectrum protection include; titanium dioxide, zinc oxide, benzophenones (oxybenzone), cinnamates (octylmethyl cinnamate and cinoxate), sulisobenzone, salicylates,and avobenzone (Parsol 1789). (*Note: According to Australian standards, which are considered the strictest in the world, the best protection ingredients include a minimum 5% of titanium dioxide and minimum 5% of titanium dioxide).

5. Can I use the sunscreen I bought last summer, or do I need to purchase a new bottle each year? Does it lose strength?

Unless indicated by an expiration date, the FDA requires that all sunscreens be stable and at their original strength for at least three years. Though, most dermatologists and skin cancer educators recommended replacing your sunscreen every year. Keep in mind that if you are using the appropriate amount of sunscreen every day (and reapplying it) a bottle of sunscreen should not last you very long. Approximately one ounce of sunscreen (enough to fill a shot glass) is considered the amount needed to cover the exposed areas of the body properly.

6. What is the difference between UV-A and UV-B (ultraviolet) light wavelengths and will a sunscreen protect me from both?

Sunlight consists of two types of harmful rays – UV-A rays and UV-B rays. The UV-B rays are the sun’s burning rays and are the primary cause of sunburn and both basal-cell and squamous-cell carcinomas (the two more common forms of skin cancer). UV-A rays penetrate deeper into the dermis (the base layer of the skin). UV-A are the more the more dangerous, as they can penetrate through window glass, and are primarily responsible for melanoma--the deadliest form of skin cancer. Both UV-A and UV-B rays can cause suppression of the immune system which helps to protect you against the development and spread of skin cancer. Since PABA and PABA esters only protect against UV-B rays, use a broad-spectrum sunscreen that also protects against UV-A rays. Ingredients like titanium dioxide and zinc oxide extend the coverage beyond the UV-B range and into the UV-A range, thus providing broad-spectrum protection.

7. What is an SPF?


SPF stands for Sun Protection Factor. Sunscreens are rated, or classified, by the strength of their SPF. The SPF numbers on the packaging can range from as low as two to greater than 30. These numbers represent the ability of a sunscreen formula to deflect ultraviolet radiation. Yet, keep in mind, that SPF 30 is considered ideal. (Technically, sunscreens rated higher than SPF aren't molecularly more potent). If you consider that a SPF 20 is preventing 95 out of every 100 UV protons from reaching your skin, then a SPF 30 is providing about 95-98% worth of protection. The sunscreen SPF rating is calculated by comparing the amount of time needed to produce a sunburn on sunscreen protected skin to the amount of time needed to cause a sunburn on unprotected skin. Dermatologists strongly recommend using a broad-spectrum sunscreen with an minimum SPF 15 year-round for all skin types.

8. Does SPF 30 have twice as much sun protection as SPF 15?

SPF protection does not actually increase proportionately with a designated SPF number. In higher SPFs, such as an SPF of 30, 97% of sunburning rays are deflected, while an SPF 15 indicates 93% deflection. (A SPF 5 provides less than 50% protection). Note: Research reported by the AAD suggests higher SPF sunscreens (such as SPF 15 or SPF 30) are an appropriate choice for very sun sensitive individuals (skin types I and II). One study determined that skin protected by an SPF 15 sunscreen and then exposed to 15 times the minimum dose of sunlight normally required to cause redness produced 2.5 times the number of sunburn cells seen in SPF 30 protected skin with the same dose of sunlight. These results suggest that prevention of redness does not necessarily mean prevention of all sun-induced damage. More research is currently underway on the protective effects of sunscreens on different skin types.


9. What is the difference between a sunscreen and a sunblock?

Since sunscreens can now either chemically absorb UV rays, or deflect them, the term sunblock is no longer used. (The term "sunblock" is a misnomer). It’s important to find a sunscreen that offers both UV-A and UV-B (broad-spectrum) protection and includes ingredients such as titanium dioxide and zinc oxide.

10. Is sunscreen application all I need to do to protect myself from the sun?


Because overexposure to ultraviolet light is the primary cause of melanoma, dermatologists recommend the following precautions:

• Avoid the being in the sun during the peak hours of 10:00 a.m. and 4:00 p.m. when the sun’s rays are the strongest.
• Seek shade whenever possible. Remember: "No shadow…seek the shade!" If your shadow is shorter than you are, the damaging rays of the sun are at their strongest and you’re likely to sunburn.
• Apply a broad-spectrum sunscreen with a minimum SPF 15; apply it 20 minutes before going outdoors and reapply every two hours, especially when playing, gardening, swimming or doing any other outdoor activities. Sunscreens should not be used to increase the time spent in intense sunlight or instead of protective clothing.
• Wear sun protective protective clothing (rated at a UPF 50+) including a wide-brimmed hat, and wrap-around UV protective sunglasses.

Note: A number of studies have confirmed that repeated sunburns substantially increase the risk for melanoma skin cancer. This is especially true for childhood sunburns because there is more time and opportunity for subsequent sun damage to lead to melanoma.

11. Is there a safe way to tan?

There is NO safe way to tan! A tan is the skin’s response to an injury. Tanning occurs when ultraviolet rays penetrate the skin’s inner layer, thus causing the skin to produce more melanin as a response to the injury. Chronic exposure to the sun results in a change in the skin’s texture causing wrinkling and age spots. Thus, tanning to improve appearance is ultimately self-defeating. Every time you tan, you accumulate damage to the skin. This damage, in addition to accelerating the aging process, also increases your risk for all types of skin cancer, including melanoma.

12. Are tanning booths a safer way to tan?

Again, there is no such thing as a safe tan. In spite of claims that tanning booths offer "safe" tanning, artificial radiation carries all the risks of natural sunlight. Tanning booths emit UV-A radiation, which poses both short and long-term risks to the skin, including cataracts (eye damage), sunburns, skin cancer and premature aging. In addition, there can be damage to the body’s immune system and induce allergic reactions to certain fragrances, lotions, moisturizers and medications. Many tanning salons are unregulated, allowing customers access to tanning beds without supervision or even eye protection. The American Academy of Dermatology supports local and/or statewide indoor tanning legislation that bans minors from using tanning devices. In addition, this legislation usually requires that warning signs be prominently displayed in tanning salons and list the hazards of such exposure, among other possible regulatory provisions. We also support legislation regulating minors' use of tanning beds.

13. How do I treat a sunburn?

There are several types of sunburns (ranging from first to third degree burns) and burn treatments. Remember, that while you may not immediately see the effects of overexposure to the sun the cumulative effects do significantly increase your risk for skin cancer. The two most common sunburns are first-degree burns and second degree burns. First-degree sunburns cause redness and will heal, possibly with some peeling, within a few days. These can be painful and are best treated with cool baths and moisturizers or over-the-counter hydrocortisone creams. Avoid the use of "-caine" products (such as benzocaine), which may cause sensitivity to a broad range of chemicals. Aspirin taken orally may lessen early development of sunburn, but should not be used in placement of regular sunscreen use. Second degree sunburns blister and can be considered a medical emergency if a large area is affected. When a burn is severe, accompanied by a headache, chills or a fever, seek medical help immediately! Be sure to protect your skin from the sun while it healsm and everyday thereafter. That said, let it be re-stated that studies have found sunburns are linked to an increased risk for melanoma, especially if you suffered severe childhood or adolescent sunburns. Just one blistering sunburn as a child can nearly double your risk for skin cancer as an adult.

14. How much sunscreen should I apply to my skin each day to make sure I am covered?

Considered the country’s authority on the proper use of sunscreens, Dr. Elma Baron of Case Western Reserve University in Cleveland, Ohio, strongly recommends using an ounce of sunscreen (or the equivalent to the amount that would fit into the palm of your hand). With that, it is imperative to remember to apply sunscreen on EVERY part of your body that is [potentially] exposed to UV rays. Places such as your ears, behind your neck, your back, the backs of your calves, your toes, are all places that are commonly neglected. If you have trouble reaching certain parts of your body, get your spouse or your best friend to help you apply sunscreen. Make it a team effort to protect each other from the sun!

15. Which sunscreens on the market today are best for my budget?

Dr. Sancy A. Leachman, deputy director and principle investigator at the Tom C. Mathews Jr. Familial Melanoma Research Clinic at Huntsman Cancer Institute in Salt Lake City, Utah, has put together an exhaustive and accurate spreadsheet that lists every sunscreen product imaginable; lists them by the amount of essential protective ingredients each products incorporates in its sunscreen formula, the level of SPF it provides, and how much the product cost per ounce in comparison to its competitors. To reference Dr. Leachman’s An Ounce of Prevention sunscreen spreadsheet, send an email to info@cancercrusaders.org or contact Dr. Leachman at Huntsman Cancer Institute at 2000 Circle of Hope in Salt Lake City, Utah.

16. Are men or women better about regular sunscreen usage?

It is interesting to note results from a survey conducted by the American Academy of Dermatology in May 2005; the survey reported that teenage boys are the least likely of all Americans to use sunscreen. Only 32%of teenage boys aged 15-to-17 reported taking regular precautions against over-exposure to UV-rays. Similarly, the U.S. Surgeon General Richard H. Carmona, M.D., MPH, reports that another survey, recently conducted by the Sun Safety Alliance, reflects that sunscreen usage among Americans in their 20s and 30s is decreasing. It decreased from 72% in 2005 to less than 60% today. Additionally, the study reports that despite the fact 85% of middle-aged women know “the dangers of overexposure to the sun and believe skin cancer is a serious issue" they fail to properly and regularly use sunscreen. In fact, more than 60% of Americans suffer at least one blistering sunburn ever year. This is not only perplexing, but concerning especially since at least 90% of skin cancers are caused by over-exposure to ultraviolet radiation!

17. I want to remember to use my sunscreen – Do you have any ideas on how I can do that?

We have several ideas about how to incorporate a regular practice of proper sunscreen usage so as to foster a permanent lifelong habit. To mention a few:
Consider placing a bottle of sunscreen in your make-up bag or by your bathroom sink (right next to your toothbrush/toothpaste). Consider getting a bottle of sunscreen that has a key ring on it and fastening it to your house and/or car keys. Put post-it notes on your mirrors or on the front door that read: STOP! Put on your sunscreen right NOW! until it becomes so that you don’t even have to “think” about it because you are doing it all the time anyway; it becomes automatic… it becomes a habit! You can also tell your room-mates, your friends, or your loved ones, to give you friendly reminders. (Be aware that these little friendly reminders may seem annoying, but just remember you asked for it!)

18. Does sunscreen, especially sunscreen usage as a child, really reduce your risk for skin cancer?

Approximately, 80% of our lifetime sun damage is sustained during our first 18 years of life, therefore making a habit of daily, year-round sunscreen usage beginning in childhood is good common sense. And, yes, sunscreen use in children can lower one’s risk for skin cancer in the future. “Sunscreen has always been an important part of an overall sun safety regime to protect the number of sunburns, especially for children,” reports dermatologist Jason K. Rivers of the University of British Columbia Department of Medicine. Dr. Rivers conducted a study of 309 Caucasian children ages six-to-10, who were monitored for three years. “Not only did the children in the sunscreen develop less nevi, it is of some significance.” To reference this study, contact the American Academy of Dermatology.

19. Does sunscreen use cause a Vitamin D deficiency?

It is true that our bodies need Vitamin D because it helps with the production of calcium and phosphorus – two minerals necessary for the building and maintenance of strong, healthy bones. However, the sun (or any other form of ultraviolet radiation) is not a viable method of getting your daily Vitamin D. We have mentioned how ultraviolet radiation damages our skin and places at a significantly higher risk for skin cancer, so to justify use of indoor tanning beds or suntanning as a means of getting Vitamin D is not only unnecessary, but dangerous. Americans fortify a majority of their grocery products with Vitamin D – milk, for example. Therefore, if were to have a bowl of cereal every day you would get sufficient Vitamin D. Reiterating this truth is the American Academy of Dermatology. The AAD recently compiled a list detailing reasons not to seek the sun for your daily Vitamin D.


So, there you have it -- the answers to many of your questions about sunscreens. For more information check out ONLY SKIN DEEP? An Essential Guide to Effective Skin Cancer Programs and Resources, or consult a board-certified dermatologist. You can also send me an email at info@cancercrusaders.org


* This list was compiled by the American Academy of Dermatology with additions made by The Cancer Crusaders Organization.

No simple "chance meeting"

While devouring a plate of Panda Express last week, my brilliant physicist friend and fellow cancer crusader, Kathleen reminded me of a special experience that took place last year...

As you can guess from my Blog, the subject of skin cancer prevention frequently enters my conversations. Occasionally, I’m not the one who brings it up; a friend or colleague will ask me a question or share a personal story, thus spurring a lengthy discussion on the subject of Skin Cancer Awareness. I must admit, I don’t mind it all. In fact, it brings a smile to my face, even makes me chuckle a little inside and say a silent prayer of thanksgiving. I'm grateful that people feel comfortable approaching me with their questions, and I’m deeply humbled when they share their personal stories.(Remember, we're in this together!) You see, I’m an extremely extroverted person who thrives on interactions with others. I am my mother’s daughter; she planted within me seeds that have sprouted a genuine love of serving (and protecting) people. When my beloved mother passed away, I knew, deep down (though, at age 15, I was reluctant) that I would devote a significant part of my time, talents, and energy toward cancer crusading. And when I met my dear friend, Natalie, eight years later, I was reminded of this and I learned that while my roots were originally pink [breast cancer awareness] they are predominately orange [skin cancer awareness] (yet, the pink roots still remain). The following story is provides additional proof of this; it is a simple, yet profound reminder:

Every year in May, my fellow cancer-crusading friends and I participate in the Susan G. Komen Race for the Cure in Salt Lake to honor both my mother, Cindy, and Natalie’s brother, Eric. My radiant mother died from breast cancer on January 1, 1995, and Eric passed away (at age 21) due to complications associated with a malignant melanoma—the deadliest form of skin cancer, in May 1999. The event is our way of paying tribute to two beautiful people -- our angels.

So, May came along and we all gathered together for the Race. This year [2006] Natalie decided to name our Race for the Cure team “Team Maracaibo” in honor of Eric’s two-year Church mission to Maracaibo, Venezuela. (He was diagnosed with malignant melanoma just four days after returning home, and passed away exactly two months later). To surprise Natalie, a bunch of us bought Venezuelan T-Shirts (with pictures of my mother on lasso-necklaces). Unfortunately, Natalie was called out-of-town on business and was unable to attend the Race; however, her mother (also named Cindy) was deeply moved. I can still remember the look on her face, and the sound of her breathless gasp of emotion. It was such touching and tender moment.

After the Race, Kathleen and I (who walked it) met up with the rest of our teammates. After taking a few pictures and several rounds of hugs, Natalie’s family drove home and the rest of us decided to tour the sea of booths lined up around the Race course. It was then that this stranger with chesnut brown hair and a warm smile walked up to me and shouted “Who do you know from Venezuela?” I told her that my friend’s brother served a Church mission to Maracaibo, Venezuela and explained that we were wearing the T-shirts to pay tribute. “ [...] The Race always takes place right around the anniversary of his death, so we thought it would be nice to wear T-shirts honoring him and his mission.” It was then that this exuberant, but gentle lady asked me, “What's your friends’ brother’s name? I, too, served in Maracaibo.” When I told her that "his name was Eric Johnson", she immediately wrapped her arms around me in a big bear hug and squealed in my ear: “I LOVED Elder Johnson!” Then, her smile turned to a somber frown; the excitement in her voice faded and became liken to a whisper. “I was so, so sad to hear of his death. He passed away shortly after coming home, right? It was melanoma, right?”

I remember wishing that Natalie, and her family, had been present for this remarkable, even miraculous “chance meeting” with Hermana Merryweather. “I am so glad that Natalie has been able to honor Eric’s memory by creating the Skin Cancer Awareness ribbon. And I’m so glad that she has you, Danielle, to help her do that. Eric had a great love for the people of Venezuela. He was an all-around great person, and so nice and fun. Everyone liked him. Did you know that he had a perfect command of the Spanish language, too? I think I have some pictures of Eric in the mission field that I’d like Natalie to have. Can you give them to her for me?”

Oh, how I had wished that Natalie could have heard Hermana Merryweather speak so fondly of her valiant older brother; the one who inspired her to create the National Skin Cancer Awareness Symbol.

Truth be told, I never had the opportunity of meeting Eric. I only know him through stories, such as the one Hermana Merryweather shared. I only know Eric because of Natalie; the simple and quiet ways in which she serves the skin cancer community speak volumes about the love she had/has for her older brother which, in turn, tells me about the kind of person he was here in this life. I can’t make any statements about Eric, nor should I make any assumptions, but I think it is safe to say that he was a genuinely good person; a strong and courageous melanoma warrior. I'm sure he was... Just take a look at how he inspired(s) his sister, Natalie, who has since inspired(s) many others to become Skin Cancer Crusaders.

The “chance meeting” I had with Sister Merryweather is a fond memory and an experience I will always cherish. It is both humbling and bewildering. How did she spot me amid the massive crowds of literally thousands of people, and why did she choose me (there were four other people right next to me who were also wearing Venezuelan T-shirts)? Needless to say, this experience is a testament to me that we are all connected to each other. There is a saying that goes: “Coincidences are but small miracles in which God wishes to remain anonymous.” Yet, He is never anonymous. He is in every beautiful thing.

I can see Him in the faces of those I love, and see His Grace through the faces of those touched by cancer, and I can see His hand in my own life.

When I got home that day, I shared this story with my best friend [and then room-mate] Melissa (who, at the time, I had only known for a week but she ended up becoming one of my all-time favorite people and even wrote the Afterword to my book). I remember her big twinkling aquamarine eyes were immediately wet with tears. (And Melissa never cries.) Her kind, serene face glowed even brighter than the stars in Heaven. She reached out her long ballerina arm across the table and put her hand on mine. She, then, smiled and looked into my eyes. (Oh, how her eyes can see into my soul!) “You realize, Danielle, that this is no random, chance meeting […] I really believe that part of your mission here on Earth, Danielle, is to fight for those touched by cancer; to be a crusader for skin cancer and touch other people’s lives for the good. Heavenly Father is so mindful of you and He loves you…”

Honestly, I believe all of us are here to touch each other’s lives for the good. Everyone of us has the capacity, as well as the ability, to help further the cause of skin cancer prevention; to protect people and save lives from this extremely preventable disease. So often, when we hear of disease and tragedy, we are overwhelmed by its extremity that we feel crippled, if not powerless, to make a difference and stem the tide of its devastation. However, this is not the case with skin cancer. With more than 90% of skin cancers caused by over-exposure to ultraviolet radiation, this disease is largely preventable which means, WE CAN DO SOMETHING TO PREVENT IT AND PROTECT PEOPLE FROM IT; TO SAVE LIVES! That, in of itself, is a message of hope, inspiration, and empowerment. And that is exactly why the National Skin Cancer Awareness Symbol® was born; to espouse hope and inspire people to join in the fight to save lives; to touch lives for the good.

If there can be a positive side to cancer, it is that it reminds us of how precious and yet fragile our relationships are, that we are all connected to each other by a power greater than ourselves, that we have an infinite capacity for good within us, that our nature is Divine but our lives are in His Hands and, as such, life is a gift. And, as with any gift, we must embrace it humbly and graciously, and treat it with great respect and care. We are also reminded that out of tragedy, hope can be found. Hope is always alive and present; it springs Eternal [but] it waits for us to awaken; to embrace it. Hope, and love, is the part of us that lives on -- it is the part that cancer cannot kill.

So, what are you waiting for? Help us eradicate skin cancer from the earth TODAY!

Love,
Danielle.


Each life that touches ours for good
Reflects thine own great mercy, Lord.
Thou sendest blessings from above
Through words and deeds of those who love.

What greater gift dost thou bestow,
What greater goodness can we know
Than Christ-like friends, whose gentle ways
Strengthen our faith, enrich our days.

When such a friend from us departs
We hold forever in our hearts
A sweet and hallowed memory,
Bringing us nearer, Lord, to thee.

For worthy friends whose lives proclaim
Devotion to the Savior's name,
Who bless our days with peace and love,
We praise thy goodness Lord above.

(the italicized words above are an excerpt from a hymn by Karen Lynn Davidson).