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Dr. Amelia Warshaw is a pediatric resident at Columbia University’s New York Presbyterian Children’s Hospital (CHONY). She is a graduate of the Alpert Medical School of Brown University (MD’21).

She has written for numerous media outlets including AAMC News, Medscape, The Daily Beast, and AOA’s The Pharos and Princeton University’s Innovation Journal of Science and Technology.

Dr. Warshaw is committed to disseminating science, health, and medical information to a diverse audience, and empowering children, adolescents, and families through health literacy.

We’re Still Using Sunscreen All Wrong

We’re Still Using Sunscreen All Wrong

The sun’s UV rays are dangerous all year—which is why you should apply sunscreen every season. But please, don’t eat it.

Wearing white isn’t the only thing most people stop doing after Labor Day weekend.

While it is true that most of us spend comparatively less time out in the sun in the fall and winter months, the same ultraviolet (UV) rays that cause skin damage and skin cancer during the summer are present from September through May.

Just as you can get burned on a cloudy day in July (estimates from the American Melanoma Foundation state that on a cloudy date 80 percent of the sun’s UV rays pass through), you can still get burned in March—and not just if you’re skiing.

Ninety percent of nonmelanoma skin cancers in the U.S. can be linked to sun damage, according to estimates from the American Cancer Society. The most common kind of cancer in the nation, more than 3.3 million people are diagnosed with the disease each year.

Ultraviolet radiation (UVR) can lead to cancer by damaging the genetic material in skin cells; if enough DNA damage occurs, these cells begin to mutate and grow out of control.

Studies have shown that sunscreen is one of the best ways to protect against premature skin aging and skin cancers, including melanoma. Statistics presented by The Skin Cancer Foundation show that the regular daily use of sunscreen with an SPF of 15 or higher “reduces the risk of developing squamous cell carcinoma by about 40 percent and the risk of developing melanoma by 50 percent.”

Regular use of sunscreen can also prevent signs of skin aging. A study published in the Annals of Internal Medicine found that those who applied sunscreen every day showed 24 percent less skin aging, compared to those who only used sunscreen part of the time. The researchers also found that among subjects younger than 55 years of age, those who regularly used sunscreen were less likely to have increased skin aging after 4.5 years.

First, there are so many options. Lotions, sprays, or sticks; chemical (which sinks into the skin and contains more active ingredients) or physical (which sits on the skin to block the sun’s harmful rays); an enormous price range, which helps sustain the $1.3 billion industry; and the age-old question of which SPF to use.

Deciding between chemical and physical sunscreen is relatively easy. It comes down to whether or not you want to achieve the classic lifeguard look that comes from smearing zinc oxide on your nose.

Sunscreens work in two ways to fight both the aging and DNA-damaging effects of ultraviolet rays. There are “physical” sunscreens—literal sunblocks—that act as barriers between UV radiation and the skin, obstructing and reflecting the UV rays. Those are the visible, often messy products which contain titanium dioxide or zinc oxide.

The other variety, “chemical” sunscreens, are far more commonly used and typically contain oxybenzone, a compound that can absorb the UVA and UVB rays. A “broad spectrum” sunscreen or sunblock will protect against both kinds of UV rays.

While there are claims that oxybenzone and chemical sunscreens are linked to melanoma, this myth has been largely debunked. Dr. Jessica J. Krant, founder of the Art of Dermatology in New York City and assistant clinical professor of dermatology at SUNY Downstate Medical Center, told The Huffington Post that the rumors are just that: “Oxybenzone is one of the oldest and most used sunscreen ingredients in the world, having been in use since the 1970s, and to date there have been no human cases of hormonal disruption documented.”

Others claim that sunscreen or sunblock prevents the absorption of vitamin D, which helps the body absorb necessary nutrients, like calcium, and plays an important role in the immune system.

According to the surgeon general, it is possible to attain adequate levels of vitamin D from diet alone, “without the risks associated with overexposure to UV radiation.” But should you choose to obtain vitamin D from the sun, it won’t require a great deal of sun exposure.

The World Health Organization states that five to 10 minutes of “casual sun exposure” on your hands, arms, and face a few times a week during the summer “is sufficient to keep your vitamin D levels high.” So don’t fool yourself by thinking your high-risk sun exposure is increasing your benefits from vitamin D.

As for what kind of sunscreen to use—lotion, spray, or stick—common wisdom holds that the best product is the one you’re actually going to use. As Dr. Jennifer A. Stein, assistant professor of dermatology at NYU Langone Medical Center in New York City, told Women’s Health“Since each one works, it comes down to which type you personally prefer, so you increase the odds of using it regularly.”

The key, according to dermatologists, is not what kind of sunscreen you use, but rather to apply your cream, lotion, spray, or stick properly.

The real danger, according to the American Academy of Dermatology (AAD), is not using enough. Especially with spray sunscreen, which may be extra-thin or colorless, it is difficult to tell if you have covered all sun-exposed areas. In a mini-experiment conducted by FutureDerm, a company that studies the science behind popular beauty products, investigators found that people only got a quarter to half of the coverage with spray sunscreen (compared to lotion) because they didn’t spray themselves long enough.

Whether spray or lotion, most people only use one-third of the recommended amount of sunscreen--if they’re using it at all, the American Melanoma Foundation reports. No matter how high the SPF, if you’re not using enough product to cover exposed skin, you’re not safe from UV radiation. The AAD recommends using one ounce of sunscreen, or “enough to fill a shot glass,” for the typical adult.

Melanoma and other skin cancers can form on the lips and scalp, so sunscreen (or SPF-containing lip balm) should be applied to those areas. The AAD also emphasizes that sunscreen should be applied before going outdoors and should be reapplied frequently, especially after exercise, sweating, or swimming.

But the most important thing to remember when using sunscreen is that it’s not a magic bullet.

One of the most dangerous things about high SPF sunscreens, SPF-containing beauty products, and easy-use “sport” sunscreens, is that they give users a false sense of safety. “Just because you rub some on in the morning doesn’t mean you’re safe spending all day in the sun,” Dr. Henry W. Lim, chairman of the Dermatology Department at Henry Ford Health System in Detroit, toldTime.

In fact, even if you’re wearing sunscreen, you should still practice additional precautions, like covering exposed areas of skin with a hat, towel, shirt, orsunglasses, and avoiding too much time in the sun.

Another thing to avoid? Fads. One of the newest crazes is edible sunscreen. Yes, edible sunscreen. As reported by The New York Times, drinkable sunscreens and pills are flooding the market, attempting to convince people that UV radiation can be fought “from the inside out.”

Despite a complete lack of scientific evidence regarding efficacy or potential side effects, UVO, a “vitamin-rich cocktail,” and Heliocare, a pill made from a fern native to Central and South America, are being offered by online retailers as well as medical spas, pharmacies, and tanning salons.

The makers of UVO claim it “decreases DNA damage,” “supports [the] skin barrier,” and “increases exposure needed for sunburn,” among other effects. Heliocare’s website claims the product can “help your skin protect itself from the harmful effects of free radicals.”

Dr. David J. Leffell, chief of dermatologic surgery and cutaneous oncology at the Yale School of Medicine, told The Times that while he understood the appeal of consumable sunscreens, “there is no scientific evidence whatsoever that UVO functions as a sun protector.”

The real danger of edible sunscreens is when they’re taken in place of traditional sunscreen application, which is already insufficient. These products may also encourage the kind of “invincibility” that leads people to stay out in the sun for hours after a single spritz of sunscreen.

The bottom line is this: If a product sounds too good to be true, it probably is. Stick to tried-and-true sunscreen and make sure that you apply often and enough—even after Labor Day.

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