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Sunscreen Smarts for Every Body
by Robin Warshaw
 What's wrong with this picture?
Three friends arrive at the beach mid-morning for a day in the sun. The women plop down on a large blanket, pass around a bottle of sunscreen, then dash into the water for a swim. After enjoying the waves for awhile, they head back to the blanket, read, eat lunch, and stretch out for a nap.
Later, they slap on more sunscreen and head back to the water. They repeat that routine until after the lifeguards go off-duty; then, reluctantly, they pull on T-shirts over their bathing suits, pack up and head home.
Sounds like a perfect day, doesn't it? Yet, while the three friends were having outdoor fun, they were also putting themselves in danger of speeding the aging of their skin, suffering sunburn and causing damage that can lead to skin cancer. The simple fact is that any tan—even one gained slowly and without burning—creates skin damage from ultraviolet (UV) light rays. Tanning beds and sun lamps expose you to UV radiation that's even more intense than natural sunlight.
Each year, more than 1 million people in the United States are diagnosed with skin cancer, which disfigures many and causes nearly 11,000 deaths. About 90 percent of skin cancers come from UV radiation, through both brief daily exposures as well as longer sessions. That's why shielding your skin from the sun every day is so important.
Consider this: the percentage of women who are younger than 40 when they develop basal cell skin cancer has tripled in the past three decades; the same age group has quadrupled its rate of squamous cell skin cancer. Use of tanning beds before age 35 increases your risk of the even deadlier skin cancer, melanoma.
Because of what used to be accepted wisdom, lots of people still believe that most sun damage happens by age 18. In reality, more than 77 percent of the harm that can lead to skin cancer occurs after 18.
Put simply, what you think you know about sun protection can hurt you because that knowledge often is incorrect or incomplete. By updating what you know, you can enjoy outdoor activities year-round and avoid skin cancer risks.
Big mistakes
The women in the story above made several sun safety mistakes, including:
Relying on sunscreen (or sunblock, or suntan lotion) for protection: Too many people "erroneously think that using sunscreen will allow them to remain in the sun all day without burning," says Susan C. Taylor, MD, a Philadelphia dermatologist and the Founding Director of the Skin of Color Center at St. Luke's-Roosevelt Hospital in New York. Using sunscreen isn't enough. The friends also should have shaded themselves with a beach umbrella, closely woven brimmed hats and clothing (preferably made from fabric treated for UV protection) and wrap-around sunglasses with UV-screening lenses.
And they should have moved into the shade often during the hours of 10 a.m. and 4 p.m., when UV light is at its strongest. Learning the "shadow rule" helps: avoid the sun when your shadow is shorter than you are—that's when the sun is strongest. All sharing the same sunscreen: Unless they are triplets, it's unlikely that the three friends have the same skin type. According to the Skin Cancer Foundation, there are six main skin types, from very fair to black, and each has differing risks of enduring sun damage that can cause cancer.
Different skin types need sunscreens with varying SPF (sunburn protection factor) ratings. The American Academy of Dermatology advises, in general, choosing a sunscreen with at least SPF 15. Very fair people—who burn easily and often suffer bad sunburns—should choose higher SPF numbers such as 30 or 45. That doesn't mean, as some people think, that they can use SPF 45 and stay in the sun 45 times longer than without sunscreen coverage. A SPF 45 "probably provides 3 to 4 percent more protection than a SPF 15," Dr. Taylor says.
She also notes that skin pigment, or melanin, in the "average" African American gives protection equivalent to SPF 13, but that brown- and black-skinned people should still use sunscreen with as least SPF 15. "Although it's not exactly additive, (SPF) 13 plus 15 equals 28, or close to (SPF) 30," says Dr. Taylor, who also is the founder of brownskin.net, an online dermatological resource for women of Asian, African, Latin, Native American, Pacific and other native descents.
Using too little sunscreen: If you're lucky, you might find 8-ounce bottles of sunscreen, but many of the products sold today contain only 4 ounces or less. For adequate coverage, you need to use one ounce of sunscreen (about the amount that fills your palm or a shot glass) each time you apply it. Larger people will need more. Sunscreen needs to be reapplied every two hours. If you're swimming or playing a sweaty sport, you need to apply it immediately after drying off.
When you do the math, you'll quickly see that if sunscreen is applied correctly, one 8-ounce bottle shared by three average-sized women won't last past lunchtime, if that. The three friends also didn't put on sunscreen until they got to the beach—another mistake. The American Cancer Society (ACS) stresses the importance of applying sunscreen 15 to 20 minutes before going outside to let your skin absorb it. The ACS also recommends using sunscreen even on cloudy days. Also, use lip balm containing sunscreen.
How sunscreens fail
The three friends might have picked an inadequate sunscreen, even if they chose a well-known brand. If they're like most consumers, they purchased their sunscreen based on SPF numbers, assuming those numbers rate the sun protection provided. In fact, SPF only measures UVB (ultraviolet-B) radiation protection, not UVA (ultraviolet-A) protection. Both types of UV light lead to skin damage and cancer so it's vital that sunscreens protect from UVA as well as UVB.
Right now, the U.S. Food and Drug Administration (FDA) doesn't require that sunscreens be tested and rated for UVA protection. Products that claim to shield from both UVA and UVB market themselves as "broad-spectrum," but there's no official measure of what they can do. A proposed FDA rule change will establish a new UVA rating system to test and measure UVA safety. That system will rate products on a scale of one star (low protection) to four stars (highest). Sunscreens without UVA shielding will have to carry a "no UVA protection" statement on the label.
What should consumers do until the proposed FDA labeling goes into effect (probably in 2009)? Dr. Taylor says to pick a sunscreen labeled "broad spectrum," since many provide UVA protection. The proposed FDA rule will also emphasize reapplying sunscreen at least every two hours. Be sure to start doing that now.
Other sunscreen booby traps to know about:
Despite advertising claims, no sunscreen is "waterproof" or "sweatproof," according to the FDA. "Water resistant" sunscreens must be reapplied after 40 minutes of sweaty activity or swimming. As crazy as it sounds, certain sunscreen ingredients break down in sunlight! Some ingredients also break down over time, the FDA says, and that deterioration may be speeded by sun exposure. So throw away last year's bottles and keep your sunscreen in a shaded spot when outdoors. The Environmental Working Group, a public health advocacy organization, found that 54 percent of sunscreens contain ingredients that become unstable when exposed to light and might not offer the advertised protection. The group lists what it deems the "best" sunscreens here.
Don't look for "sunblock." The FDA states that no product completely blocks UV rays. "Sunscreen" is a more accurate term. Watch out for human error and don't be frugal with sun protection. "Most sunscreen users still get burned because they do not apply enough sunscreen to begin with," Dr. Taylor says. Slather sunscreen on thickly, covering all exposed skin. Pay attention to the areas that usually get missed: ears, around the eyes, neck (all the way around!), hands, feet and toes. Use sunscreen or wear long-sleeved clothing when driving, since side-window glass can let in UVA rays as can some windows in buildings. And remember that water, sand, concrete and snow all increase the reflection of sunlight, so put on more sunscreen and shorten your exposure time.
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