Question: I recently went out for a day on a boat with friends and even though I used SPF 50 sunscreen all day, I still got burned. What did I do wrong? Answer: There's a lot of news in sunscreen ingredients and thinking these days so lets update how you buy, use and apply sunscreen so you don't get burned again (or needlessly exposed to the rays that cause aging, wrinkles and skin cancer): Mistake: Not applying enough sunscreen The current guideline is to apply a shot glass-worth, one full ounce, of sunscreen to your body when spending the day in the dun. And, the most important part, you should reapply this amount of sunscreen every two hours regardless of the SPF noted on the bottle, so you could go through half of an eight-ounce bottle in one day in the sun! Mistake: Believing that sunscreens are "water-proof" The FDA, in its new labeling guidelines, has declared that the use of the term "water-proof" misleading and banned brands from using it. The word will need to be removed from labels by December 2012. Now, the guideline is that sunscreen is "water-resistant" and only for a tested time limit of 40 or 80 minutes when spending time in the water, after which the product will need to be re-applied. Mistake: Applying the sunscreen when you get there The best way to allow sunscreen to do it's work is to apply it a full 30 minutes before going into the sun, so it has time to bond to skin, instead of getting immediately rubbed off by a towel you lay on or washed off by jumping directly into the water. Mistake: Not protecting your skin from UVA rays It used to be that sunscreens only protected against UVB (the burning rays) but now a slew of new chemicals can absorb UVA rays (the ones that penetrate deeper to cause aging, wrinkles and skin cancer). Choose a sunscreen with the new designation "broad spectrum" because these have been tested by the FDA to provide protection against both UVB and UVA rays. Consumer Reports recently tested and rated sunscreens according to the new FDA labeling requirements and found these three top-rated choices:
- All Terrain AquaSport SPF 30 (for athletes and outdoor workers)
- Coppertone Sport High Performance Ultra Sweatproof SPF 30 (for athletes and outdoor workers)
- No-Ad with Aloe and Vitamin E SPF 45 (for the budget minded, every-day body user)
Mistake: Thinking the higher the SPF, the better the protection… According to Consumer Report's recent ratings, top-rated sunscreens are between SPF 30-45. The new thinking is that higher SPF does not really not afford more protection. Here's why: an SPF 15 filters out approximately 93% of all incoming UVB rays, SPF 30 filters out approximately 97% and SPF 50 filters out approximately 98%. No sunscreen can block out 100% (which is why the FDA has also banned the use of the word "sunblock" on labels) of all UV rays so after an SPF 30, you can see the difference in filtering is negligible. The old thinking: If your skin starts reddening in 20 minutes when exposed unprotected to sunlight, using an SPF 15 should prevent your skin from turning red for 15 times longer (approximately 5 hours). The new thinking: No sunscreen protection lasts more than 2 hours. Choose an SPF 30-45 and reapply one ounce every two hours for real protection. Mistake: Ignoring your scalp Most people protect their eyes with sunglasses and slather on the sunscreen but completely ignore their scalp. This is very dangerous, especially if you have any hair loss or thinning issues. Apply sunscreen to any areas experiencing hair loss (a widening part-line, bald spot or receding hair line) and definitely wear a hat! Mistake: Believing that the sun does not affect your face every day I advise everybody to apply a basic "broad-spectrum" sunscreen every day to face, underneath makeup or in makeup for women, especially to protect against photo-aging and skin cancer that you cannot see happening. One that I personally recommend, that was also recommended by the Consumer Reports Ratings, is La Roche-Posey Anthelios 40 with Mexoryl SX SPF 40. Have you made any of the mistakes on this list recently? Tell us your worst sunburn story in the comments!
Question: "I read about some new sunscreen labeling rules in a magazine but I don't really know how they apply to me when I'm standing in the store aisle trying to choose sunscreen! Can you help?" Answer: Of course! These new FDA sunscreen label requirements are meant to clear up confusion about exactly what type of protection a sunscreen provides. There are some new terms you will see on sunscreen bottles starting this summer (although brands have until December 2012 to comply) that will help you make a more informed choice.
- "Broad Spectrum" This designation means the sunscreen protects against both UVA and UVB sunlight rays, and will distinguish sunscreens from those that only protect against UVB. To earn the designation, brands now need to pass the FDA’s broad spectrum test to claim they are, in fact, broad spectrum. Furthermore, only those labeled "broad spectrum" with an SPF of 15 of higher can claim that they protect against sunburn caused by UVB rays but also decrease skin cancer risk and protect against skin aging caused by UVA rays.
- "FDA Skin Cancer/Skin Aging Alert" For sunscreens with SPF values below 15 or those that are not broad spectrum (because they only protect against UVB rays), you will see the following new FDA alert:
"Spending time in the sun increases your risk of skin cancer and early skin aging. This product has been shown only to help prevent sunburn, not skin cancer or early skin aging.
- "Water-Resistant" This tells users exactly how much time they can expect to get the declared SPF level of protection while swimming or sweating, based on new standard testing. Labels will specify 40 or 80 minutes. If this term with a time limit is not on the label, the product is not water-resistant.
- "Drug Facts" Information such as active ingredients, usage, warnings and directions will now appear in the drug facts chart , like the one above, so you can see it at-a-glance and choose accordingly.
The following terms have been banned from labeling because they are misleading and inaccurate, according to the FDA:
- Instant Protection
The biggest mistake you can make, no matter what sunscreen you choose, is not applying enough of it and not re-applying it. The general guideline is to apply a shot glass worth (about 1 ounce) to your body, but studies have shown that most people are applying only one-quarter of that amount! And, no matter what the SPF, no sunscreen protection lasts beyond two hours, so to protect skin fully, that same one ounce should be re-applied every two hours when spending the day outdoors in the sun. I think sunscreen and skin cancer protection is really a year-round concern and sunscreen should be worn on areas exposed to the sun such as arms, neck and face every day, even if cold or cloudy. Have you seen that recent photo of the truck driver whose left side of his face looks dramatically older than the right side of his face? That's proof of the sun's aging power and the case was studied by Jennifer R.S. Gordon and Joaquin C. Brieva, dermatologists at Northwestern University, with findings published in the New England Journal of Medicine. Tell the truth: Do you wear enough sunscreen? Will you change how you choose and apply sunscreen this summer?
Take an extra moment today to check your moles because today is Melanoma Monday®. Have your skin checked at least once per year with a dermatologist to avoid any type of skin cancer, especially if your skin has been or is overexposed to the sun or UV radiation from outdoor activities or indoor tanning. Check for any moles with the following characteristics and remember these warning sign ABC's in between: Asymmetry: Half of the mole does not match the other half. Border irregularity: The mole’s border is irregular or jagged. Colors: The mole has a variety of colors such as shades of brown, tan, black, red or blue. Diameter: The mole is 6 millimeters wide (about the width of a pencil eraser) or larger. Evolution: The mole has either changed color or growth in width or height or the mole has become bloody, crusty or itchy. If a mole anywhere on your skin or scalp displays any one or more of these warning signs have it checked and possibly biopsied by your dermatologist as soon as possible.
The primary purpose of hair conditioning products is to reduce the resistance that occurs when hair (particularly wet hair) is combed or brushed. Conditioning agents lubricate the hair fiber so that surface friction is diminished and hair becomes easier to comb through. The hair feels softer, more moisturized, more manageable, and “flyaway” hair is tamed. In addition, increased ease-of-combing means that hair fibers can be aligned in a more parallel configuration, thus improving the appearance of hair shine. Hair conditioners work by protecting the hair’s structural elements, especially the cuticle, from grooming damage, which is probably the most significant source of damage to the hair surface. Excessive combing and brushing without conditioning can chip and tear away the cells of the hair cuticle. The ends of the hair fiber are subject to greatest damage because the tips are older and have been exposed to more combing, brushing and stress as a result of the detangling process. Without sufficient conditioning, the cuticle layer, particularly on hair tips, is eventually lost, causing split ends. Keep in mind that hair is at its most fragile when wet, and combing wet hair can cause maximum damage to the cuticle cells; therefore it is particularly important to condition hair at this stage of grooming. Conditioners also help combat another prevalent cause of damage to the hair: the use of grooming appliances such as blow dryers, curling irons and heated rollers. Some appliances reach temperatures of 200 to 400°F and can cause steam to be released from the hair fiber, resulting in bubbling and buckling of the cuticle, especially if hair is not completely dry while being styled. Conditioners protect the hair from heat damage, and certain conditioning polymers can provide extra protection from heat and increase the life of a hair fiber. Finally, regular use of conditioner helps maintain the integrity of cuticle cells in hair that has been chemically processed. In healthy “virgin” hair (i.e., hair that has not been chemically processed), the cuticle surface is hydrophobic, because there is a layer of fatty acids covalently bonded to the outermost surface (epicuticle) of the hair. On the other hand, hair that is chemically treated (e.g., with bleaching, dyeing, perming or straightening agents) is compromised because these chemical treatments include oxidative steps that modify and strip the surface of the hair. Chemical treatments increase surface friction, causing greater resistance to combing and making hair feel rough and dry. Because of this increased likelihood of grooming damage, treated hair generally requires more conditioning than “virgin” hair. I hope you find this information useful. Often patients come into our office with hair loss. Sometimes, there is significant hair breakage which can be easily remedied if you smooth hair’s outer cuticle. Conditioning your hair will help your hair look healthy and shiny. It is worth doing! Happy Easter! Happy Passover!
Suffer from dry eyes? There is help! See below for some useful tips: Artificial Tears are beneficial for the stinging or burning associated with dry eyes. Made of ingredients that temporarily restore moisture to eyes (e.g., glycerin and oils), you can use one or two drops in each eye when they feel uncomfortable. If you need to use more than 3 or 4 times a day, see your ophthalmologist; and if you use drops frequently, try switching to preservative-free drops. Omega 3’s help reduce the inflammation that can contribute to dry-eye syndrome (DES). Studies have shown that patients who take daily supplements of omega-3 fish-oil supplements plus flaxseed oil produce more tears. You can increase your intake byadding a few servings of salmon to your weekly diet or by taking fish-oil and flaxseed supplements after discussing them with your practitioner. There are prescription medications for treating chronic DES. Restasis® is a prescription eye drop that contains cyclosporine, which can help increase natural tear production. Use it twice a day as directed by your ophthalmologist. Warm Compresses are helpful for when your eyes just don’t have enough tears! Tears are your eyes’ lubrication and are made up of water and oil. The oil is produced by glands along the eyelid; if the cells in the glands harden and the openings of the glands become plugged, the oil in the tears may be reduced. Without the oil, the water in tears evaporates too quickly, leaving your eyes feeling dry. Warm compresses can liquefy the plugs so the oil can flow into the tears. Eyelid Washes are helpful when dry eyes have accompanying flaking along the eyelids (a sign of blepharitis--“dandruff” and inflammation of the eyelash follicles). Because of the overproduction of oil (the same concept as dandruff on the scalp), cells near and around the eyelids stick together, causing inflammation. Too much oil can clog the glands and cause tears to evaporate too rapidly. An OTC eye wash contains mild cleansing agents to dissolve the oil and remove the flakes (as well as irritants and allergens). If the symptoms persist for more than 2-3 days, see an ophthalmologist. Eye Inserts are a new treatment option that can be used when all other remedies fail. Available only by prescription, Lacrisert®ophthalmic inserts are tiny cellulose beads that you place within the pouch of your lower lids. These beads dissolve slowly and mix with your own tears and provide ongoing lubrication throughout the day. Use once or twice a day as directed by your ophthalmologist.
As healthcare professionals, we are expected to do a thorough review of systems, assess your medication, evaluate your past medical and family history, equip you with health maintenance and, of course, conduct a physical exam. Examining the skin is the focus in dermatology, but this kind of exam should be part of any internal medicine visit. Often people ask me, how do you do an effective skin exam and identify a mole that is suspicious? When I examine a patient’s skin, I am very methodical, often starting at the head and working my way down a person’s body. Additionally, I am always looking out for the “ugly duckling”--the mole that stands out and looks different from the rest. Don’t forget the ABCDE’s: Asymmetry--is there a lack of symmetry in the color or shape of the lesion? Border--is the edge irregular or jagged? Color--what color is the lesion? Is it brown, black, gray, blue, red or a mixture? Diameter--is the lesion larger than the size of a pencil eraser (> 6mm) or changing in size? Evolving--is the lesion new, growing, spreading or changing? Can you affirm for its changelessness? Most moles on an individual have a pattern, a “look”. The patterns or arrangement of moles on an individual’s skin are good; they serve as an example or point of reference when examining a patient’s skin. When a mole doesn’t fit the pattern, it deserves further investigation (e.g., biopsy, etc.). When a patient says that a lesion is changing, I believe them, even if I am not alarmed by the way it looks. After all, you see your body every day. If you notice something is different, if some aspect about the mole seems to be evolving, say something. Get it checked. And always question an inflamed lesion, with or without pigment. My rule of thumb is one month. If something you notice does not resolve within a month, if the mole looks different and those changes last one month, get yourself to a dermatologist for a full skin check-up and have the lesion examined. If you live in an area where access to a dermatologist is restricted, get to your primary care giver or internist, who may be able to do a biopsy or refer you to a surgeon who can. As part of health maintenance (this goes for everyone), you should have a full skin exam by a dermatologic practitioner yearly. If you have more than 50 moles, have had skin cancer or pre-cancerous/suspicious moles or growths, have a family history of atypical moles or melanoma, you should have a skin exam performed more frequently.
Have you (yes, YOU!) had your cancer screenings? I feel like my dog means business when he gives me THAT face, so I thought it would be appropriate for today’s blog on cancer screenings. I know we all become somewhat lax about taking care of ourselves and I am no exception. Sometimes we need a gentle reminder... Cancer Screenings
- yearly mammograms starting at age 40 - clinical breast exams during routine check-ups beginning around age 20
- ★Colon and Rectum
- age 50 for both males and females
- digital rectal exam (DRE) and prostate-specific antigen (PSA) should be done annually for men at age 50 - men at high risk, particularly African American men, should begin testing at age 45
- screening should begin about 3 years after a woman starts having vaginal intercourse - screening should begin in the abstinent by age 2 ...remember (I often need a aide-mémoire myself...) early detection means early cure...so, don’t delay and start screening! - Jodi