How to choose a sunscreen – SPF myths and misconceptions

 

 

UV radiation from sun exposure is the greatest risk factor for developing skin cancer.  Here in Australia dangerous melanomas are the third most common types of cancer diagnosed. 
Simple sun protection measures including daily use of a broad-spectrum sunscreen can reduce you and your family’s risk of developing skin cancers later in life.  If this is not compelling enough to encourage you to protect yourself, see our earlier post on UV photo ageing.  Wrinkles! Argghhhh

 

 
Our Cosmetic Nurse Kristie breaks down the jargon and myths surrounding sunscreen use.
 
“What does SPF even mean?”

SPF is an acronym for Sun Protection Factor and is a measurement of how effectively a sunscreen will protect the skin from UVB rays (it does not measure UVA, this is important! More on this later).

Confusingly, it talks about time e.g. if it takes 10 minutes to burn without cream, applying an SPF 15 means it will take approximately 150 minutes to burn (a factor of 15 times longer).  THIS DOES NOT MEAN YOU CAN STAY IN THE SUN LONGER OR THAT YOU CAN GO LONGER WITHOUT REAPPLYING.  Sunscreen should always be reapplied after 2 hours to ensure continuous protection.

Misleading I know.

“So, what SPF should I be using?”

The SPF (Sun Protection Factor) scale is not linear, in that an SPF 30 is not “twice” as protecting as an SPF 15.  In fact, SPF 15 blocks 93% of UVB rays, SPF 30 blocks 97% of UVB rays and SPF 50 blocks 98% of UVB. The difference from an SPF 15 to SPF 30 is only 4%.

“So why do I need a higher SPF?”

Flip it around and think about what you are letting through.

SPF 15 (93% protection) allows 7 out of 100 photons through. SPF 30 (97% protection) allows 3 out of 100 photons through. That’s twice as many skin damaging photons!

“I don’t need sunscreen because I’m not outdoors?”

Not true.  UVA, which is responsible for ageing of the skin and contributes to skin cancer formation can pass through glass.  And incidental sun adds up.  Walking to the train, sitting in the window, driving.  So you don’t need to be “outside” to be exposed.

I always tell people to invest in a broad-spectrum product containing SPF 30-50 that they like enough to wear every single day.

Why?

The Anti-Cancer council recommends that sunscreen is required on days when the UV index is 3 or greater (typically in the warmer months between 11-3 pm), which is the threshold at which the UV is strong enough to damage the skin.  HOWEVER, we are creatures of habit and I find in myself and many of my patients that if your skincare routine is not just that, a ROUTINE, then things go to the wayside and before you know it, it’s mid-September, 12 noon and you find yourself in a café without sun protection!

A broad-spectrum sunscreen is important as SPF measures only UVB and we know UVA is a big culprit in causing skin damage.  A broad-spectrum sunscreen will protect against both UVA and UVB.

“What is the UV index?”

It’s “sciency”.  There are a LOT of variables that can influence the amount of UV reaching us.  But scientists are all over this and we highly recommend everyone download the Sun Smart App which will tell you what the maximum UV index for the day is forecast to be and when it is at its highest.

Thank you science!

“Do I need to reapply?”

Yes. All sunscreens need to be reapplied after two hours to maintain their SPF role. Are you going to reapply your sunscreen over your makeup at lunchtime in the middle of winter when you’re in the office? Probably not. And that’s ok.

1/ Because the UV index is low then

2/ Most of the damage from UV comes from accumulated exposure. Our skin is like a data bank for sun damage! So having your base SPF on for incidental sun when you leave the house helps reduce your lifetime UV exposure and associated damage. Unless your office desk is next to a window. Then see my earlier point about UVA passing through glass.

The reason to reapply is often unclear?  Is it wiping off? Does it have a time-limit of efficacy? Does it breakdown?

The answer is all of those things.  You will touch, rub, wipe, smear, and remove some of your SPF protection without noticing.  If you are sweating, exercising, swimming, etc we are pretty clear on the fact that your sunscreen will not withstand that.  Reapply.

Some chemical sunscreens do break down when exposed to sunlight. This is less of a concern with mineral (zinc or titanium oxide) sunscreens but this does mean that if you are outdoors, in the sun, your sunscreen DOES have a lifespan and it DOES breakdown.  It lends merit the argument that if you are in an office, away from all windows and will have minimal incidental sun (and don’t touch your face AT ALL) then your sunscreen MAY last longer.  I would definitely encourage you to reapply if you are planning on spending significant time (>1 hour) outdoors.

“I heard Nanoparticles were dangerous?”

They’re not.  The worry here was that the smaller nanoparticles which allow higher concentrations of our physical blocks containing zinc and titanium dioxide to be used in creams and still feel lovely and light on the skin were able to be absorbed though the skin and enter our bodies and cause harm.

This is not proven. The current evidence is that these particles do not penetrate the skin and remain on the surface as intended so the risk is negligible.  If applied to damaged or compromised skin there can be some penetration of the outermost layer of skin but they are not absorbed systemically (i.e. they don’t circulate throughout the body).   Be more concerned about inhaling spray sunscreens! Stay away from light sprays that flow with the wind and avoid these on the face.

“But what about Vitamin D?”

According to the Cancer Council sensible sun protection does not put people at risk of vitamin D deficiency and several studies have shown that sunscreen use has minimal impact on Vitamin D levels over time.  Incidental exposure, a few minutes most days is all most people require for adequate Vitamin D production.  If you are deficient in Vitamin D increasing UV exposure is not recommended and you should speak with your GP regarding supplementation.

We hope this clears up some common excuses people use for NOT applying sunscreen every day.  There are no excuses!  We KNOW skin cancer is directly related to UV exposure and we KNOW sunscreen protects us from this.  

 

There are so many nice, easy-to-use sunscreens available these days for every budget.  If you need a hand choosing one, call us today on 9039 5644 and book a consultation with our Cosmetic Nurse Kristie and we will get you on the right track.

UVA and PHOTO DAMAGE

This image has been doing the rounds in the cosmetic world since it was first published in the New England Journal of Medicine in 2012.

This gentleman was a truck driver who over his career was exposed to consistent, daily UV exposure to the left side of his face.

Ageing is inevitable and dependent on time and genetics. However it is thought that 80% of age-related changes in our skin are the result of extrinsic factors, namely UV photodamage.  Extrinsic ageing (vs intrinsic, chronological “just getting old” ageing) is the result of external factors such as excess sun exposure (photo-damage) and other lifestyle habits such as smoking.  Photoaging can be avoided with good sun protection habits and in this blog we hope to clear up many misconceptions that we commonly find amongst our patients with regards to sun exposure and protection.

The first question I ask during a skin consultation is whether the patient uses SPF on a daily basis and what that SPF is.  If it’s not an immediate yes then I know I’m going to hear “I don’t really go outside”, “Only when I know I’m going to be outside”, “Only in summer” or a flat “no”.

UVA radiation in particular plays a significant role in photo-ageing as it is able to penetrate more deeply in the skin than UVB affecting the deeper dermal layers.  Here it can damage collagen and elastin – leading to deep wrinkling and reducing the skins’ resilience; damage vascular structures causing telangiectasia (visible blood vessels at the surface of the skin); and more superficially causes pigmentation irregularities and lesions.

What you may not know about UVA

  • UVA is present in equal strength all year regardless of season.
  • UVA accounts for 95% of the UV radiation we are exposed to with sun exposure
  • UVA can penetrate through both clouds and GLASS e.g. your office, bus, car, café window
  • Incidental sun adds up. Waiting for the bus, ducking out for your morning coffee, hanging out the washing.

We live a very long life and here in Australia our winters are relatively mild. We aren’t snowed in 3months of the year and we’re showing it on our faces (and necks, chests, hands…)

As well as this, UVA has been shown to cause damage in the more superficial layers of the skin in the epidermis where most skin cancers such as basal cell carcinomas (BCC’s) and squamous cell carcinomas (SCC’s) occur.

So how can we prevent photo ageing?

If you want to slow down your extrinsic ageing process the use of a DAILY high protection, broad spectrum sunscreen is a MUST, year-round.

Be aware of the daily UV index! Download the Sun Smart app to find out what the expected UV is for the day and how much protection you may require. UV levels are typically highest between 11am-3pm.

Wear sun-protective clothing such as a broad-rimmed hat, sunglasses, long-sleeved clothing and seek shelter during this time where you can. Sit under a tree, veranda, stay indoors.

Is it too late for me?!

Don’t panic. We’ve got you.

What you can do
  • Start wearing SPF 30+ – SPF 50+ EVERY DAY. Face, neck, chest and hands.
  • Active skincare such as AHA’s (alpha hydroxy acids), Vitamin C serums, topical retinoids (Vitamin A) will help to increase skin cell renewal, brighten dull skin, reduce and prevent pigmentation changes
  • Vitamin B products and moisturisers will help improve dry and flaky skin and restore the skins’ natural barrier protection.

Can we turn back the clock?

Treatments to reverse the damage
  • Dermal filler to re-volumise and plump any areas of deficit and soften deep furrows
  • Anti-wrinkle injections to reduce dynamic facial lines (expressive lines) and prevent existing lines from becoming deeper
  • Vascular and Pigment laser for colour irregularities
  • Resurfacing procedures such as peels, micro-needling, RF, RF needling, ablative lasers
  • Tightening and lifting treatments such as Rf, RF needling, Micro-focused Ultrasound

Are your days of tanning catching up with you?

Call us on 9039 5644 for a consultation with our Cosmetics Nurse for skin assessment and treatment plan.

Scar reduction treatments

Actual patient Hope Dermatology

 

This is a common question from patients.  Firstly in our assessment of scars, we have to assess the patient as a whole. Every scar in every patient is managed differently and there are lots of variables to consider.

These are the types of questions we need answers to before prescribing a scar reduction plan.

  • How old is the patient? If the patient is a young child, the scar may enlarge with their natural growth and can stretch. Older patients tend to heal up better from surgical scars as there is less tension in the skin.
  • What is the scar from? A traumatic fall? a burn? an acne scar? or a surgical scar? Each of these types of injuries will result in different types of scars. If the scar is from acne (for example), there needs to be complete control of any breakouts of acne before we then tackle the scarring. There is no point addressing the scarring without treating the new bouts of acne.
  • Where is the scar? Certain areas on the body will scar more severely than other areas. In general, areas of poor scarring include the chest, upper arms/shoulders and upper back as these are areas where there is the most tension on the skin and these areas can be prone to keloid or hypertrophic scarring
  • What skin phototype is the patient? Typically patients with darker skin types will scar worse than people with fairer skin types. However, a true scar is not to be confused with post inflammatory hyper-pigmentation (PIH). This PIH is more common in darker skinned people and PIH should resolve without scarring but it can take 6 months or more to resolve in darker skinned people. Hence PIH differs to scarring as often with PIH there is no need for any treatment other than waiting for spontaneous resolution.
  • How long has the scar been present for? Scars can take about 2 years before they fully mature and transition from the acute red/pink colour to the long-term pale/white colour. So if a scar is only recent, it should be explained to the patient that there is a fair chance the scar will improve naturally without any treatment.
  • Could the scar actually be a skin cancer? There are some types of skin cancers that can mimic scar and for this reason, patients ignore the lesion. If there is a scar area or an ulcer that is worsening with time, we should alway consider scar-like skin cancer. The most common one would be sclerosing basal cell carcinoma. This type of skin cancer can be difficult to treat; particularly as patients may not seek treatment quickly.
  • Is the patient taking any medication? Some medications can delay wound healing and hence continuation of such medication needs to be carefully considered in the context of scarring.
  • Is the patient using sunscreen?  UV exposure not only increases the risk of and darkens any existing PIH in a scar, it also impedes our natural wound healing response leading to a poorer cosmetic outcome.
  • Is the patient allergic to any wound dressings? Avoiding irritants in the area, whether it be a traumatic or surgical scar,  will enable better healing without causing additional inflammation in the surrounding skin. If the wound is carefully looked after in the early stages of healing, the risk of a scar, or the extent of scarring can be minimised.
  • Is the patient using any medical grade skin care? This is particularly relevant to facial scars or acne scars and depending on the evolution of the scar (i.e. new, old, currently being treated) active skincare such as Vitamin A creams or prescription fading creams such as Hydroquinone preparations can either aid or hinder healing and must be used under the supervision of an experienced practitioner.

Treatments for scarring

Effective treatment for scarring involves accurate assessment of the scar.

  • Is it tethered to the underlying tissues? If so, subcision, where there is manual release of the tethered tissue could be appropriate.
  • Box car, rolling, ice pick – these are all terms for the different types of scarring in acne. Acne scarring can be treated by a number of modalities including Fractionated laser, Radio frequency, Fractional radio frequency or Skin needling.  Each of these vary with respect to downtime, discomfort, cost, result and suitability of skin type.
  • Keloid scar? Intralesional steroid injections could be appropriate to flatten the areas and improve the pain of the scar for patients, as often patients often have exquisitely sensitive skin over their keloid area. The dermatologist will decide on the strength of the steroid injection needed. This is important as too weak a strength will result in no change in the keloid scar; and too concentrated an injection will mean skin dipping where the injection is. Hence injections should be performed carefully by experienced doctors. These injections are usually performed every 4-6 weeks until good cosmetic result is seen.
  • PIH or post-inflammatory erythema?  As mentioned, assessment is important to not only ensure the correct treatment is selected but in some instances, no treatment is in fact the best treatment.  Patients often present looking to improve their self-perceived acne scars when in fact the skin is still healing from recent breakouts and any post-inflammatory redness will fade with time without intervention as will PIH.  In saying this, we can often speed up this process with vascular laser (for a red scar) and prescription fading creams/skin needling/laser for pigmented scars.

We offer a variety of treatments for many types of scars here at Hope Dermatology and encourage you to book with our team of Specialist dermatologists and cosmetic team to discuss the most appropriate treatment plan for you and your skin.

Call us on (03) 9039 5644 for a consultation. 

 

Treating freckles and pigmentation

Autumn is officially here! And with the cooler weather, lots of our patients are wanting laser and treatment for their pigmented and blotchy skin. Our laser nurse Kristie gives us an overview of pigmentation…Freckles, pigment, sunspots…

What’s the difference!?

 

Kristie Phillips - Hope Dermatology

“In my 18 years of lasering I have often been asked this very question, and frequently in general conversation the terms “freckle”, “pigment” and “age spot” get bandied around interchangeably.

Whilst as a consumer, you probably don’t need to know the ins and out of what constitutes a freckle versus a sun spot, or whether you have sun damage or melasma it is important to understand there IS a difference and this can be VERY important when it comes to treatment”.

 

PIGMENT essentially refers to the colour of the skin and is determined by the level of melanin, produced by melanocytes. Melanin production is determined by racial origin and sun exposure. People with dark skin produce more melanin than those who are fair skinned, and exposure to sun and UV stimulates our melanocytes to produce more melanin, resulting in a tan. Generally when people are seeking treatment for their pigmentation, we are referring to excess and uneven pigment.

MELASMA is a chronic skin disorder that results in a symmetrical, blotchy, darkening of the skin that can be both difficult to treat and distressing for sufferers. It commonly affects women more so than men, manifesting around the ages of 20-40. It results from the production of melanin by melanocytes, as with a tan, but is an overstimulation of melanin that persists long term (often despite our best efforts!) The cause of melasma can be complex and can have a genetic predisposition. Common triggers can include sun exposure, pregnancy, hormone therapy such as the oral contraceptive pill, other medications and inflammation from cosmetics such as perfumes or soaps and so strict avoidance of these is vital in treatment.

FRECKLES (medically we call them ephelides just to add another term into the mix) present as small, flat brown lesions on sun exposed areas of the body such as the face, shoulders, arms etc and are common in people with fair skin and red heads. Freckles are the result of sun exposure which again is stimulating our melanocytes to produce melanin, which then accumulates locally in the superficial skin cells (keratinocytes). They typically darken in summer (with sun exposure) and fade in winter (due the natural exfoliation and replacement of the keratinocytes).

SUN SPOTS / AGE SPOTS / LIVER SPOTS etc etc are all terms used to describe SOLAR LENTIGINES. Like freckles, solar lentigines are benign dark patches in the skin, as a result of sun induced melanin production and localised proliferation within the keratinocytes.   Unlike freckles, they do not fade in winter and tend to present in people over the age of 40 and accumulate with continued sun exposure, hence the terms “sun damage” and “aged spots”. They have NOTHING to do with your liver.

So how do we treat them? Well first I would always suggest a skin check with the dermatologist to diagnose your skin condition and rule out the myriad of OTHER brown spots and skin lesions and potential skin cancers.

Beyond that…

Prevention – with daily (rain, hail or shine) use of an SPF 50+.

Repair  – with good quality, cosmeceutical skincare (think AHA, Vit A, Vit B, Vit C etc etc).

Remove – generally with laser. There are a variety of lasers available to treat various types of pigment irregularities and a consultation is a must.

 

Kristie Phillips, RN