By Dr. C.H. Weaver M.D.
As summer arrives each year, I’m often asked about the balance between spending time outdoors enjoying all that summer has to offer and avoiding sun damage. My standard answer: know the rules to staying sun safe and then enjoy the season! The key to finding that balance is acknowledging a few basic facts that should guide our time outside this summer.
First, it is a myth that exposure to ultraviolet (UV) rays is justifiable in the name of vitamin D metabolism. The fact is we can get appropriate and healthy vitamin D through 15 minutes of direct sun exposure over the surface area of our hands.
Second, the incidence of skin cancer (cumulative sun exposure being the biggest risk factor) is on the rise. Basal and squamous cell carcinoma are now more common than all other cancers combined. They can be life threatening but are more commonly quality-of-life threatening—capable of destroying and deforming our skin if left untreated. If you have fair skin and live long enough, you are likely to get one of these cancer types.
So should we dive under a tree every time we see the sun? As an expert in the field, I say no. Most would argue—and I agree—that we should live life to the fullest and enjoy outdoor activities. Indeed, that is where many of our fondest experiences and memories occur.
That said, the key to living fully under the sun is to be smart. Be outdoors and be “sunsensical” at the same time. That means moderation and common sense. To that end here are five key lessons to live by.
1.Say No Tanning Beds.
Tanning beds are to skin cancer what cigarettes are to lung cancer. A recent study estimated that regular use of tanning beds increased the risk of melanoma by 75 percent. Tanning beds deliver radiation— varying degrees of UVA and UVB rays, depending on the machine. Both forms of radiation cause skin cancer (and premature aging). Avoid them.
2.Say Yes to Sunscreen.
Put sunscreen on your body every day. Don’t forget your scalp and under your bathing suit. There is no evidence that one brand or product is better than another at preventing skin cancer. The best sunscreen out there is the one you will actually wear. If it is too expensive, too greasy, or too fragrant, you won’t wear it. My recommendation is to select a sunscreen with a sun protection factor (SPF) of 30 or greater and apply it every day (and reapply every two to three hours if you are outdoors because UV radiation will destroy the sunscreen on your skin over time). If you get in the water, assume the sunscreen is gone from your skin and reapply; if you can’t reapply to your whole body (the SPF of regular clothing is only 5 to 6), at least reapply to your face and hands, which are the most common body parts affected by skin cancer and the most cosmetically sensitive. Try several brands, and choose one that you like that is affordable and that you will use.
Are chemicals in sunscreens dangerous? Parabens, triethanolamine, and para-aminobenzoic acid (PABA)—all have been shown in mice studies to have some adverse effects. The risk in humans is unclear, however, and the risk of direct and cumulative UV exposure far outweighs the unclear and very small risks associated with the use of any sunscreen. Please wear it.
3.Benefit from Early Detection.
Examine your own skin every month on your birthday for an extra 10 minutes in the shower. A wound that bleeds with minimal trauma (like toweling), a wound that won’t heal over the course of a few weeks, a skin lesion that grows larger—all are signs of skin cancer. Additionally, any brown or black spot on the skin that is changing (shape, color, or size) is a red flag. Change is the most sensitive indicator of something you should have checked. At least once a year, have your skin checked by a dermatologist or primary care doctor.
4.Don’t Cut Corners on Treatment.
If you’re diagnosed with skin cancer, treat it right the first time. Be your own advocate, ask questions, and make sure you are treated by an expert in the removal of skin cancer (certified by the American College of Mohs Surgery) and an expert in reconstructive surgery (board certification by the American Board of Plastic Surgery or the American Board of Facial Plastic and Reconstructive Surgery).
5.You Can Be Sun Safe and Still Look Great!
For a variety of reasons, our society sees pale skin as less attractive than tan skin. As a board-certified plastic and cosmetic surgeon, I understand and appreciate the importance of cosmetics and looking attractive, youthful, and rejuvenated. But the reward has to justify the risk. Radiating your skin to look temporarily better is not worth the increased risk of cancer that prolonged and repeated intense sun exposure carries. If you feel more attractive with a tan complexion, keep in mind that there are several very effective and very safe spray-tanning options on the market today that do not increase the risk of cancer and that give fantastic cosmetic results.
Protect Your Skin from Phytophotodermatitis
Margaritas and sunshine just belong together, don’t they? It sounds delicious, but if you’re not careful, it could result in a condition called “margarita dermatitis.” It turns out that when certain plant compounds come into contact with the skin they make the skin mores sensitive to sunlight. Lime juice is one of those compounds—hence the moniker, margarita dermatitis.
The real name is actually phytophotodermatitis and refers to a chemical reaction that makes skin hypersensitive to ultraviolet light. The result is a burning rash that commonly appears on the hands, wrists, forearms, or lower legs. Sometimes phytophotodermatitis results in blistering, and its key characteristic is that it burns rather than feeling itchy.
Phytophotodermatitis happens in two steps: first the skin is exposed to a photosensitizing substance, and, second, that skin is exposed to UV light from the sun. When phytophotodermatitis occurs, a red, swollen rash develops about 12 to 36 hours after contact and is then replaced by an area of discoloration that can last for months or years. Phytophotodermatitis can be mistaken for several other conditions, but the key clue is that the rash often appears in the shape of drip marks or handprints. (In fact, the bruise-like marks in the shapes of fingers are sometimes mistaken for child abuse.)
Phytophotodermatitis is the result of photosensitizing chemicals called furocoumarins that are found in certain plants and fruits. These compounds are at their highest levels in spring and summer, which increases the likelihood of exposure. They are found in celery, parsley, citrus fruits, parsnips, figs, Queen Anne’s lace, bergamot, and more.
Exposure can result from fruit drippings, airborne particles, or scratches from branches. Phytophotodermatitis is more common in people who handle fruits and vegetables, such as bartenders, grocers or farm workers. Sometimes kids who play in grasses that come from the same family as Queen Anne’s lace will develop the condition. In addition, some natural perfumes or essential oils contain oils that come from wild plants containing the compound that causes phytophotodermatitis.
To avoid contracting phytophotodermatitis, be careful to thoroughly wash your skin after coming into contact with lime or lemon juice or other plant compounds associated with the condition. In addition, it’s important to apply sunscreen and limit sun exposure for healthy skin.
Phytophotodermatitis isn’t cause for alarm and shouldn’t stop you from enjoying that margarita or spending time in the sun (having applied sunscreen, of course). Just exercise a little caution.
Most cases of phytophotodermatitis are mild and don’t require a trip to the doctor. Treat the rash as you would treat a poison ivy rash—with cool compresses, hydrocortisone creams, and oral antihistamines. In severe cases, treatment might involve steroid pills.
So, get thee outside and enjoy summer—just make sure the lime stays in the glass.