I think about sun protection and the long-term risks of being lazy about sunscreen all the time. I’m serious, rarely does a day go by that something about sun protection and UV damage and cosmetic long-term effects or the likely development of skin cancer doesn’t cross my mind. Now I realize how that sounds but I’m willing to admit it here.
Why Sun Protection is Important?
Being a dermatologist, I have the opportunity to see patients of all ages:
So please don’t quiz me on “What any of the generation ages are?” because I don’t know. I even looked it up last week but have since forgotten and I don’t plan to try again. Maybe I should make a chart.
Anyway, my point is that I have a unique perspective, that I talk to many people all day long and inspect their sun damage. We discuss:
- approaches
- methods of sun protection
- attitudes towards protection against the sun
Even when the visit is about a different type of skin issue
A Dermatologist's Perspective
As a dermatologist, I am supposed to say to everyone that you must apply all day every day:
- 2 layers of high SPF sunscreen zinc oxide
- a hat
- long sleeves
Just believe it's best to wear SPF in the shower or before bed.
However, over the years, I’ve realized that everyone is an individual and each person’s specific use of sun protection needs to be adjusted based on his or her personality and abilities. In medical school, we are taught that it’s our job to protect people and convince and even force them to do what is best for them. We are taught to intrude on patients’ lives and it’s our right and responsibility to invade their privacy for the greater good of helping them and saving their lives.
Prioritizing Sunscreen as a Doctor's Duty for Patient Well-being
We are supposed to ask people: If they wear seat belts, What kind of paint they have in their house, and If they have a balanced meal that is low in fat. We must remember about sunscreen, it is our most important duty to make sure that people wear dermatologist-recommended sunscreen.
If you don’t, as a doctor, you are committing terrible malpractice and your medical license should be voluntarily given back. You should start working as a lawyer or an evil drug company that buys doctors coffee to make them corrupt and immoral. Congress even made laws against buying coffee!
Individuality in Patient Care and Beyond
My medical school experience provided me with invaluable training and laid a solid foundation for my medical education. Since then, I have continued to expand my knowledge and skills, building upon those initial lessons. I have learned about being realistic when approaching a patient.
Everyone is very different from one another, and my approach to each of them is key to success in improving their health and maintaining a relationship. So, I can help them with long-term skin health and prevent important things like skin cancer and wrinkles, both equally important.
I still remember an experience from medical school that alerted me to the fact that I still have a lot more maturing to do regarding my approach to each patient as a unique individual with unique life experiences and specific thought processes. A better understanding of who I was dealing with, could help me be successful in helping the person in front of me.
Lessons Learned in Medical School
So, back in med school, I was participating in an urgent care clinic, something I enjoyed and learned so much from the experience. I was evaluating a 90-year-old woman who came in for a cough. I listened to her lungs, they had some faint sounds of crepitus.
I had a 90-year-old woman that I was helping to care for, I believed that my participation in her care was going to make a difference, med students are so funny. I asked about her smoking history, and it turns out she smoked half a pack a day and has been smoking since she was in her 20s, about 70 years, three times longer than I was alive. So, of course, as a good and well-trained almost doctor, this was my cue to save this woman.
This is what I’ve been waiting for! A 90-year-old woman, who lived a long and pretty healthy life and had some abnormal lung sounds. I was going to change her life by convincing her to stop smoking.
I said, “Miss, you need to stop smoking.” I hope everyone is appreciating the hilarity of this situation. She looked at me and honestly didn’t understand what I just said to her. She looked over at her daughter, a woman in her 60s, and asked what I said. Her daughter told her that I said she should stop smoking. The patient looked at me, with what appeared to be a grin, and said, “Son, I’m not going to stop smoking.” She wasn’t upset, I think she may have found it very funny. At that time, I didn’t understand why she would not listen to my important advice.
It took many years to learn how to be a successful and helpful physician in my specific field of medicine. I should better understand each person to know what they want from me and what I can offer them.
Educating Patients on Sun Protection
My role as a dermatologist is to help people understand the importance of sun protection so that each person can use it to the best of their abilities. There are many factors to consider. It’s important to understand what SPF means:
- Why do we use it?
- The different formulations of sunscreen: lotion, cream, stick, spray
- The difference between physical and chemical sunblock.
Then, you can decide how you want to use it and which sunscreen to use to help protect your skin. Some of my patients are aggressive, they apply sunscreen to their faces every day as part of their normal routine. Other patients come in for yearly skin exams so that I can help identify pre-cancerous moles and remove them before they become a problem.
Patient Behavior to The Sun
People come into the office when they see a spot that looks concerning to them, they wait until their judgment tells them they need me to participate in their care. Some people tell me that they use sunscreen all the time every time they are in the sun and never go outside and never experience sun but yet come to the office fully dark tan with a distinct tan line at their bathing suit outline, but insist they use sunscreen and it doesn’t work.
And one of my favorite patients is a 60-something-year-old, who comes in every 3 months, with leathery tan skin and outright says to me, he sits in the sun and loves it and won’t live without it. He has many skin cancers that I remove several times a year, and he tells me “Doc, I’m not changing my sun exposure habits, but I will come in every 3 months for you to help me.” He’s honest and I appreciate that, and I never lecture him on skin cancer risks because he doesn’t want to hear it.
So, let me help you understand the components of sunscreens and which you can choose for yourself.
Chemical vs Physical Sunscreens
First of all, both physical and chemical sunscreens work to protect against the sun. This is a multi-billion dollar industry, so significant resources and time have been spent on the development of these products. And they do work.
It’s another great example of how the brilliant human mind can address a limitation of the human body and find an effective solution to overcome our evolutionary selection process. This is what separates us from all other animals.
BASIC CONCEPT
1. PHYSICAL SUNSCREEN
These simple elements – zinc and titanium (review your periodic table please) sit on top of our skin, like clothing, and block UVA and UVB from coming in contact with our skin cells (keratinocytes). Thus, preventing these potentially harmful components of the sun from causing DNA damage to our skin cells. The goal of this type of sunscreen is to be a physical barrier on top of the skin, similar to clothing.
2. CHEMICAL SUNSCREEN
These are lab-developed organic chemistry molecular structures composed mainly of hydrocarbons. If you were lucky enough to take organic chemistry in college, these structures will be familiar, but please remain calm, there is no test on this material. Here is an example:
So, the basic approach to this type of sunscreen is that these chemical structures, much more complicated and interesting than zinc or titanium, get absorbed into the top layer of the skin.
How Chemical Sunscreens Protect Your Skin from UV Damage
These molecular structures then absorb UV light, cause a chemical reaction to absorb the harmful UV sunlight, and produce heat and a new chemical structure. The result is the skin cells don’t ever see the UV and the energy, that is heading towards DNA damage to your cells is redirected to the chemical sunscreen and using the energy for a benign chemical reaction.
This can help you understand why the recommendation is to apply sunscreen 20 minutes before sun exposure because these need time to be absorbed into the top layer of skin, the epidermis. Also, this explains why there is a recommended re-application time because these chemical structures are being used up every time they are exposed to light. Compared to the physically blocking sunscreens that are inert and remain on the skin regardless of how much sun exposure they experience.
SPF
SPF is an abbreviation for SUN PROTECTION FACTOR. This gives a concrete measurable number to the effectiveness of the sunscreen. I’m a data-driven numbers guy, so this quantifiable description of sunscreen helps me understand the different products. Typical “amounts” of SPF are:
- SPF 15
- SPF 30
- SPF 50 and even higher
So, what do the numbers mean?
The number is a quantifiable amount of protection. SPF 15 protects your skin 15 times or another way your skin is 15 times less affected by a given amount of UV sun exposure. For example, if a person is outside and usually it takes 30 minutes for a sunburn to develop, with SPF 15 sunscreen on, it would take 30 minutes x15 = 450 minutes or 7.5 hours to now develop a sunburn. The sunscreen extends the amount of time you can stay in the sun.
Another way to understand the SPF value is to quantify the amount of sun it blocks. Take a look at this chart:
This can help you understand what these numbers mean. My usual advice, that I practice myself, is for a daily face lotion with sunscreen, I aim for SPF 30, which blocks 97% of the UV that I see daily. To me, that’s good. So over 40 years, I decreased the amount of UV I’ve seen which, I think about it, will significantly decrease my risk of skin cancer development and will also reduce the aging process of my skin. When people are spending a day at the beach or going to be outdoors for several hours, my advice is to target SPF 50. This blocks 99% of the UV that you are going to encounter.
Daily Sun Protection Habits
Here is how I approach sun protection and my advice to patients. It’s important to live your life healthily and enjoyably. It’s unfair and short-sighted to expect people to make major changes in their sun protection habits. A person should make changes that fit into his/her lifestyle, especially the easy changes.
My first and primary advice is to apply a daily face lotion with sunscreen. It’s so easy. Almost everyone, except maybe my kids, brush their teeth every day, so it’s simple to add a 30-second application of a face lotion to the already existing routine.
Long-Term Benefits of Consistent Sun Protection
I joke that if you can’t handle brushing your teeth and applying a face lotion, for a total of 2.5 minutes, then the face lotion is more important and you should stop brushing your teeth. My thought process is that chronic sun is a major culprit for skin cancer development decades later in your life and 30 minutes of sun a day over 20 years, is a lot of sun, much more than a few sunburns as a child.
If you apply a daily face lotion with sunscreen, the baseline level of sun and chronic sun damage will be eliminated by proactive sun protection that will decrease significant sun damage that takes place over many years. Other easy, low-hanging fruit, wear a hat when outside for several hours.
When you are watching your kid’s baseball game, which is scheduled for 1.5 hours but lasts 3 hours, we are talking about 10-year-old baseball, get that hat on and you don’t have to worry about re-application or sunburn, you are safe under your wide brim hat which will make you much more comfortable to curse out the umpire at the end of the game when your 10-year-old is crying because he took a strike that ended the 1 run game, it doesn’t matter that it was the correct call and your kid just isn’t that good at baseball.
Conclusion
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