As a family physician with a special interest in skin diseases and skin cancers, I frequently examine patients with sun-damaged skin and operate on skin cancers caused by the sun. Skin protection and prevention of skin cancers is of special interest to dermatologists like my father was and to family physicians like myself.
However, we often get conflicting health advice. One week we hear that tanning causes skin cancer and another week we read that Vitamin D deficiency from lack of sunlight causes osteoporosis!
So what are we to do? Here are my present conclusions based on long experience and recent evidence.
1. Whatever you do, try to never, ever get sunburned! Sunburns are not just painful -- they're dangerous. Sunburns in childhood are a major predictor of ugly keratoses, skin cancers, and life threatening melanomas.
2. Use hats and long sleeves to protect skin from excessive sun. Get your child a sun suit (also called surf suits or rash guards) to swim in. Consider summer shoes that protect the tops of your children's feet and toes.
3. Use the clock to protect your skin. Before 10 a.m. and after 3 p.m. are good times to be out in the sun. You are much less likely to get sun damage during these hours.
4. Use sunscreen. For adults any sunscreen is better than none. Higher SPF numbers don't provide more protection but are supposed to last longer. For children (or younger adults of child-bearing years) stick with safer, less absorbable sunscreens including those based on finely ground up minerals like zinc and titanium oxides. These aren't like the old sticky white zinc oxide paste that climbers used to paint on their noses, but the protection is just the same, and good against both types A and B ultraviolet rays.
5. Which sunscreen? The Environmental Working Group 2010 has published a good list of recommended brands. The site also explains what to look for and what to avoid in a sunscreen. I have reorganized some of those ingredients into Best, OK and No Thanks lists.
- Mexoryl SX/ecamsule
- Tinasorb M (coming soon)
- Tinasorb S (coming soon)
- Nano/micro-sized zinc oxide or titanium oxide
You may wish to avoid these for children or adults in child bearing ages because of some questions about their absorption into the body and possible side effects.
(But remember that any sunscreen is safer than a sunburn, so in an emergency use what you have!)
- Octyl methoxycinnamate/OMC
- Methylbenzylidene camphor (4-MBC)
- 3-Benzylidene camphor
What about vitamin D?
To get Vitamin D the natural way, expose skin that is not normally in the sun to mid-day sunlight for 10-30 minutes once a week. (Exposure to your face or hands doesn't count!) It would probably be safer to take a capsule each day with 2,000 units or more of Vitamin D3 for teens and adults, and 1,000 units for weaned children.
The bottom line is that if you want to live long and healthy, you have to "live a shady life."
Dr. John Hoehn is a family practice physician with a special interest in skin disease and cancer at Adventist Health/Medical Group.