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Skin games: Sun protection should be used early and often
By Jackie R. Broach
A matter of minutes is all it takes for the blazing summer sun to do serious damage to unprotected skin.
The redness and pain fade away after a few days, and then when the peeling is over it’s easy to forget the discomfort that was caused. But the damage resulting from that kind of sun exposure lingers long after the visible effects are gone.
“I find many patients haven’t been in the sun for 20 years, but I’m treating them for skin cancer now at 50 and 60,” said Dr. William Jackson “Jackie” Epperson. A physician partner of Roper St. Francis Hospital, he has a practice in Murrells Inlet and specializes in skin care.
Most of the damage he deals with is the result of intense sun exposure received between the ages of 10 and 30, he said.
Jenifer Lachicotte, a family nurse practitioner for 15 years, said about 70 percent of the people she sees at Visible Results, a Pawleys Island area medical spa specializing in aesthetics and prevention, come in looking for correction of pigment changes caused by sun exposure. The problem is usually dark spots or red, broken capillaries.
“Most of those are the baby boomers who didn’t use any sunscreen. It’s really only been in the last 20 years we started to apply sunscreen and now we’re seeing the affects of when someone was 16 and went to Pawleys Island for the week and got sunburn.”
She preaches sun protection to all her clients, whether they came in because of sun damage or not.
“If they come in for any kind of service, they leave with sunscreen on,” she said.
If people are lucky, aesthetic damage is the worst effect of any unprotected sun exposure they’ve received and Lachicotte can take care of that with a laser treatment. If anything looks suspicious, they get referred to a dermatologist and the treatment could become a lot more frightening.
Epperson said he sees many patients who end up having to undergo “very disfiguring treatments” for skin cancer.
Yet despite more warnings these days about the dangers of sun exposure and tanning, he said the number of skin cancer cases is on the rise.
“People are still tanning,” Epperson said. “But there is no safe tanning with UV light, period.”
The reason tanning occurs is because the complex array of cells that make up the skin detect significant damage. That damage triggers a release of activating factors in which pigment is produced and deposited in the skin’s immune cells. They pile up in an effort to form a barrier to UV radiation.
For those who have to have that bronzed look, Epperson said he’s a proponent of spray tanning. Lachicotte points out that people can still get “a little bit of color,” even wearing sunscreen, but without the pain and danger of too much exposure to harmful UV rays. She frequently hears from people concerned about “looking white as a ghost.”
“You can still get a little bronzing with a broad spectrum sunscreen protecting you against the burning and aging rays of the sun,” she said. “The sunscreens out today are lovely.”
Some even come in a mineral form that doesn’t clog pores and can be applied (or reapplied) over makeup.
“You take that and dust it on as you would a compact powder and it gives you great protection,” she said.
When in the sun, Epperson recommends common sense practices including always wearing sunblock, covering up with clothing and using hats to protect the head.
Sunblock is the first step in skin protection, according to Epperson. An SPF (sun protection factor) of at least 30 should be used, but “there is no reason to use a sunscreen higher than 30.”
SPF is based on a logarithmic curve and can be misleading. The farther out one goes, the smaller the difference between the numbers, he explained.
An SPF of 4, for example, offers about half the protection of SPF 8, as one would expect. But SPF 50 is only about 5 percent stronger than SPF 30. It doesn’t hurt to buy sunblock with higher numbers, he said, but it doesn’t help much either.
He said the same for sunscreen touted as made for children. The only significant
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From Second Front
difference is in the packaging and marketing. Otherwise, it’s the same as what’s used for adults.
He doesn’t put much faith behind special SPF clothing either, pointing out that any item of clothing has some SPF. Again, using it doesn’t hurt anything, but the amount of extra protection probably isn’t worth the price.
A person can still get sunburned through thin clothing. A regular T-shirt is good and a shirt with a collar is better than that, because it protects the neck.
“Just wear your Izod or polo shirt and as long as it’s a good, thick weave, it’s the same as an SPF 30.”
Epperson also reminds folks that sunscreen needs to be reapplied periodically.
“Most companies put in something so it stays on pretty well,” he said. But if someone is swimming or sweating, a reapplication is probably a good idea.
“The whole secret with sunscreen is finding a product you like and reapplying,” Lachicotte said.
The FDA recently issued new requirements for sunscreens that will make it easier for consumers to understand the effectiveness of the products and use them correctly.
Among the requirements, companies won’t be able to label sunscreens as “waterproof” or “sweatproof,” or identify their products as “sunblocks,” because these claims “overstate their effectiveness,” according to the FDA
Sunscreens also won’t be able to claim to provide sun protection for more than two hours without reapplication or to provide protection immediately after application without submitting data to support those claims and obtaining FDA approval.
For water resistance claims, the front label will have to state how long the sunscreen remains effective while swimming or sweating, based on standard testing.
Men need to be especially careful to make sure they protect their ears and noses from the sun. They tend to get cancer in those areas more than women, Epperson said. Women have a higher incidence of cancer on their chests.
Kids should be kept out of the sun during the hours when the sun is at its most intense — between 11 a.m. and 3 p.m.
Epperson discourages natural tanning and he most definitely advises against tanning beds, which allow people to get the equivalent of six to eight hours of natural UV exposure in a matter of minutes.
“It leads to pretty significant damage related to UV light exposure,” he said. “People who use tanning beds, some develop horrendous multiple skin cancers — as many as 17 to 20.”
People don’t brag about going to tanning beds like they used to now that tanning beds are falling out of favor, much like cigarettes, due to health risks. But as Epperson said before, people are still tanning, and they’re still using tanning beds. Some people even have them in their homes and use them in “massive amounts.” They’re just quieter about the activity.
“Now they sneak around and go,” he said.
Prevention is the best medicine for sun damage, but once it’s too late for that, there are simple steps to take to help alleviate the pain of sunburn.
Epperson recommends staying well hydrated and taking aspirin or ibuprofen in “fairly high doses” to decrease inflammation of the skin.
“It’s important to remember many people who are badly sunburned are also dehydrated and dehydration can also lead to sunstroke,” Epperson cautioned.
If there is blistering as a result of sunburn, especially on the face, it’s time to see a doctor, he said. He sees a lot of sunburn cases every year, as do emergency rooms.
“When you’re crying and you can’t move and you look like a lobster,” there’s not much else to do but seek medical attention, he added.
The earlier a severe sunburn is treated, the better.
Regular skin checks are also highly recommended.
“If you have any lesion on the body that’s not healing or you’re just concerned, it’s a good idea to set up an appointment for a skin check. I do those all day long one after another,” Epperson said.
While he’s a family physician, there’s a nationwide shortage of dermatologists, meaning his skills as a skin care specialist are in high demand.
If there’s anything suspicious on the skin, whether it’s an area that isn’t healing or pigmentation has changed, it needs to be checked out, Epperson said.
“I often find melanomas on patients who have no clue,” he said. It’s not their fault, he adds. “The problem is the public doesn’t know what to look for.”