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What do you get when you combine your love of the sun-kissed look with gobs of new information and products? A little confusion. A little rationalizing. And a high rate of melanoma. Currently, one person dies from it about every hour in the United States. We've done the leg (and arm and face) work to give you everything you need to protect yourself.
1. Stop trying to get a "healthy" tan from the sun. "I tell my patients there's no such thing,' says Chicago-based dermatologist Scott B. Phillips, MD, an American Academy of Dermatology expert on skin and endurance sports. "Exposure of any kind does some damage to your skin," he says. Any time you go outside without sufficient skin protection you risk absorbing enough harmful rays to increase your chances of getting melanoma -- even if you don't get an ounce of color. If you want a bronzed look, use a self-tanning product.
2. Know when to stay out of the sun completely. Your vulnerability to the sun skyrockets after any kind of intensive facial. "Many of the treatments remove the top layer of your skin, at a minimum. Without it, you are more likely to burn," says Kelly Cordoro, MD, a professor of dermatology at the University of Virginia. "So avoid the sun entirely afterward." Just how long you should wait depends on the kind of treatment you've had. "After noninvasive laser treatments such as microdermabrasion and light glycolic peels, don't get any direct sun for a week," advises dermatologist Christine Lee, MD, director of the East Bay Laser & Skin Care Center in Walnut Creek, California. (The same advice holds true if you've had laser hair removal.) "And if you're doing microderm or glycolic treatments at home, avoid the sun as much as possible for two or three days afterward."
Dr. Lee explains that more invasive procedures -- such as laser resurfacing and deep chemical peels -- require patients to stay indoors for two weeks; after that, exposure to direct or indirect sunlight should be limited as much as possible for three to six months. When you must go out, pour on the lotion and wear a wide-brimmed hat. Otherwise, you could cause serious damage. To be on the safe side, talk to your dermatologist about how careful you should be after any kind of facial treatment.
3. Learn the truth about UVA and UVB rays. "For years, we thought UVB were the only kind of rays we had to worry about," says Susan H. Weinkle, MD, an assistant clinical professor of dermatology at the University of South Florida. But now experts know that while only UVB is responsible for burning, UVA is a major problem too. Like UVB, it causes premature aging -- think sun spots and wrinkles -- and increases cancer risk, but UVA is actually scarier than UVB in the sense that there's no visible short-term way to gauge how much of it we've soaked in; only time will tell.
These days, most sunscreens are made with UVA-absorbing chemicals (such as avobenzone, octocrylene, oxybenzone, and a new one, Mexoryl), but not all of them contain these. And buyer beware: The phrase "broad-spectrum sunscreen" can be misleading -- sometimes it indicates that a product will prevent you from soaking in the full spectrum of UVB rays only. Don't buy it unless the label says it protects against both UVA and UVB.
One last frightening fact about UVA: Unlike UVB, they can easily penetrate car windows, according to a report recently released by the Skin Cancer Foundation. So protect yourself during road trips just as you would at the beach -- or get your glass professionally treated with UV-protective film. (Check the Yellow Pages under "glass tinting" or "glass coatings" for a dealer near you.)
4. Know the limits of your SPF. Okay, we all get that a lotion with a sun protection factor of 30 will give you more protection than a 15 -- but have you ever wondered what SPF really means? You're not the only one. Brian Adams, MD, director of the Sports Dermatology Clinic at the University of Cincinnati, explains: "A lotion with an SPF of 10 lets you stay in the sun 10 times longer than you normally would without burning." By the same token, SPF 15 lets you stay out 15 times longer, and so on. In theory, that would mean if you can be in the sun for 10 minutes without burning when you've got nothing on your skin, a cream with an SPF of 30 would allow you to stay out for a whopping 300 minutes without turning into a lobster.
But wait a second: Plenty of people have used SPF 30 and burned before spending anywhere near 300 minutes in the sun (or at least, we have). What gives? The problem's not the product so much as the application of it, according to Dr. Phillips, who says you need to carefully cover all exposed areas and reapply regularly. (For the how-to, see No. 6.)
5. Try the new-and-improved sun-protection ingredients. But first know this about sun-protective lotions: No matter what they're called, some of them "block," while others "screen." Any product made with titanium dioxide or zinc oxide physically blocks both UVA and UVB rays, points out Dr. Adams. In other words, it forms a layer on the surface of the skin that repels the sun like an umbrella repels water. All others are made with chemicals that act like sponges, absorbing the sun's rays before your skin does. Although screens are popular because they feel creamier and don't look white on your skin, they're inferior to blocks when it comes to warding off damage, because they can break down and stop working even before they've been washed off.
There's some good news about screens, though: The next generation, recently approved by the FDA, stays effective longer than its predecessors -- and so keeps your skin safe for greater periods of time. Some Neutrogena products are now being made with helioplex, a stabilizer that keeps UVA-protective sunscreen from breaking down. And the new UVA protector Mexoryl works longer than other chemicals of its kind, says Dr. Phillips. Still, sunblocks made with titanium dioxide or zinc oxide are your best bet. You can buy them in stores or online at coolibar.com. (Click on the sunscreen tab, then look for the link that will take you to "Sunscreen by Ingredient.")
6. Remember when to apply -- and reapply -- sunscreen. "It takes 20 to 30 minutes for sunscreen to be properly absorbed by the skin -- and it won't be effective till it sinks in," explains Dr. Cordoro. So put on lotion half an hour before you leave the house. Blocks win in this category too: "They take effect almost immediately," says Dr. Cordoro.
Should a sun-protective lotion go over or under your makeup? If you're applying several skincare products, the general rule is that the first item you put on should be the sunscreen. And most cosmetics, as long as they're not too watery, won't affect the sunscreen underneath too much. "It will look better to have your foundation and powder on top," Dr. Weinkle points out. To help protect yourself and still look beautiful, choose cosmetics, moisturizers, and eye creams with a built-in SPF.
Just as important as getting it right before you walk out the door is making sure you're covered throughout the day. "Reapply every hour if you're doing anything more than moderate exercise -- even if your sunscreen is waterproof and regardless of the SPF," says Dr. Adams. Why? To be declared "waterproof," sun lotions usually only have to be tested on people doing things like lounging around the pool or spending time in a whirlpool, rather than on those who are running, biking, or swimming vigorously -- which means these products are not hard to wash or sweat off. And SPF is irrelevant if there's no sunscreen left on your skin! (By the way, waterproof products will generally stay on longer than anything labeled water-resistant.)
7. Figure out how much sunscreen you need. We've heard the shot-glass rule, and that you're supposed to use a tennis-ball-size glop of sunscreen to cover your entire body. But lotions don't come out of the bottle looking like something you're supposed to hit over the net! Dr. Cordoro has helpful advice: "Use a tablespoon of cream on your face, neck, and chest to get the amount of protection the bottle claims to give." The same proportion goes for the rest of your body: Use two tablespoons for arms and about three for legs, for a total of six tablespoons. Don't forget to put lotion on the tips of your ears, the part of your hair, and between your toes.
8. Wear a hat. So you've done everything right -- you're using the proper sunscreen and you've put it on perfectly -- and now you're wondering if a hat is pointless. Not at all. A hat with a brim that's more than 4 inches wide can reduce head and neck exposure to ultraviolet light by an impressive 70 percent, according to the Skin Cancer Foundation. The best ones shield your ears and your neck as well as your face -- so bucket hats trump visors and baseball caps.
9. Wear clothes with built-in protection. All the dermatologists we spoke to raved about clothing that's specially made to provide sun protection. "It's well worth the money," says Dr. Adams, whose kids wear sun-protective bathing suits. The clothes are effective for one of two reasons: Either they're made of tightly woven fibers or the fabric has been treated with a sun-blocking chemical. Companies that sell them include Lands' End, Reebok, Nike, The North Face, and Under Armour.
Dr. Weinkle also loves a new laundry product that allows you to sun-proof your favorite clothes simply by washing them in a special solution. That's great news, because an untreated white T-shirt has an SPF of only 7 -- and when it gets wet, it drops to 3, she points out. Try SunGuard, which you can buy online at sunguardsunprotection.com.
10. Use Retin-A to repair sun damage. If the sun has already wreaked some havoc on your skin, there's one thing that can help: prescription Retin-A. Sure, you know it's great for smoothing out fine lines and reducing sun spots, but what you probably don't know is that it also reduces the likelihood that you'll get skin cancer. Bonus! "Retin-A helps reverse ultraviolet damage to the skin," says Dr. Weinkle. "Most of the products on the market made with retinol, its nonprescription sister, are good too, though not as potent or effective as Retin-A." If you don't want to schedule an appointment with the dermatologist, Dr. Cordoro has some good advice on what to look for at the drugstore: "Find something that lists retinol or retinoic acid as one of the active ingredients."
The hottest development in skin cancer prevention is a new dietary supplement that makes your skin less susceptible to the sun by mopping up free radicals -- molecules that collide with cells, causing premature aging and DNA damage that leads to cancer. The pill, called Heliocare, is made from natural antioxidants -- beta-carotene, along with extracts from a tropical fern and green tea. It hasn't been extensively tested yet in the United States, but Heliocare has been available in Europe for about 30 years. The dermatologists FITNESS spoke to were cautiously optimistic about its potential. "In small U.S. trials, Heliocare seems to be an effective way to protect your skin against UVA light," says Dr. Cordoro. "I wouldn't go out and buy it just yet, but I would stay tuned."
If you decide to try it, you'll need to swallow your first pill at least half an hour before going out the door -- and Dr. Weinkle advises taking another dose every two to three hours while you're outside. What's more, the manufacturer recommends that it be used in combination with sunscreen and other protective measures -- not as your only defense. Heliocare is available in major pharmacies, as well as at select dermatologists. For more information on where to buy, log on to heliocare.com.
Originally published in FITNESS magazine, May 2007.