Skin Cancer xxix, 2011 : Page 28

LIFESTYLE SUN PROTECTION AS A WAY OF LIFE . . . . . . . . . . . . . . . . . . 28 140 MILES IN THE SUN A Q&A with Robert Nossa, MD . . . . . . . 32 SUN HAZARDS IN YOUR CAR: Watch Out for Skin Cancers And Photoaging on the Left Side Of Your Body . . . . . . . . . . . . . . . . . . . . 36 RUNNERS IN THE SUN . . . . . . . . . . . . 38 THE GLARING NEED FOR SUN SAFETY IN SCHOOLS . . . . . . . . . 42 Subjects who regularly worked indoors with one side of the face directly exposed to a window developed noticeably more wrinkles, brown spots, and sagging skin on that side of the face. — SUN PROTECTION AS A WAY OF LIFE (P.28) Sun Protection As a Way of Life than one product, follow the correct application order: 1 Medication. If you use a prescrip-tion topical medication, this should always be the fi rst product applied to a clean, washed face. Moisturizer. A moisturizer worn on top of medication will not interfere with the topical treatment and could actually enhance its penetration. A moisturizing sunscreen will save you a step, but if you prefer using sepa-rate products, apply the moisturizer before the sunscreen. Sunscreen. Your sunscreen should be broad-spectrum , protecting against both UVA and UVB rays. Its sun protection factor (SPF), which measures protection from the sun’s UVB rays, should be at least 15. For UVA protection, make sure it con-tains some combination of stabilized avobenzone, ecamsule (a.k.a. Mexoryl™), oxybenzone, titanium dioxide, and/or zinc oxide. Makeup. Apply foundation fi rst, then powder and blush. An SPF 15+ lip balm is also a good idea. Loose or pressed powder mineral makeup is a great addition, since it contains sunscreens like titanium dioxide and zinc oxide — insoluble minerals that block or refl ect UVR away from the skin. The powder should catch any spots you have missed, and will make sunscreen touchups easier. 2 T he vast majority of skin cancers, as well as most of the visible signs of aging, are caused by the sun’s harmful ultraviolet (UV) light. Since UV damage is cumula-tive over our lifetime, it is something we have to be concerned about on a daily basis. Fortunately, incorporating sun protection into your everyday routine is easy. Whether you’re at work, on vacation, out exercising or with friends, Linda K. Franks, MD; Bruce Katz, MD; Jordana Gilman, MD, and Doris Day, MD, have the answers you need to stay sun-safe. At Work by Linda K. Franks, MD Sun protection should be a prior-ity at work, even if 28 your offi ce is indoors. That’s because the sun’s UV radiation reaches us as both long-wave UVA rays and short-wave UVB rays, and while window glass largely blocks UVB, UVA can pass right through. In a recent study, subjects who regularly worked indoors with one side of the face directly exposed to a window developed notice-ably more wrinkles, brown spots, and sagging skin on that side of the face. It’s not just people who sit at a desk (or work outdoors) who are at risk: If your job requires much time in a vehicle, UVA can reach you through the side windows there, too. [See Sun Hazards in Your Car , page 36.] Pre-Work Prep When you prepare for work in the morning, you may apply moisturizer or makeup along with sunscreen. If your AM routine involves more 3 4 S K I N CA N C E R F O UND A T I O N J O URN A L

Sun Protection As A Way Of Life

Linda K. Franks, MD; Bruce Katz, MD; Jordana Gilman, MD, and Doris Day, MD

The vast majority of skin cancers, as well as most of the visible signs of aging, are caused by the sun's harmful ultraviolet (UV) light. Since UV damage is cumulative over our lifetime, it is something we have to be concerned about on a daily basis. Fortunately, incorporating sun protection into your everyday routine is easy. Whether you're at work, on vacation, out exercising or with friends, Linda K. Franks, MD; Bruce Katz, MD; Jordana Gilman, MD, and Doris Day, MD, have the answers you need to stay sun-safe.<br /> <br /> At Work<br /> by Linda K. Franks, MD<br /> <br /> Sun protection should be a priority at work, even if your offi ce is indoors. That's because the sun's UV radiation reaches us as both long-wave UVA rays and shortwave UVB rays, and while window glass largely blocks UVB, UVA can pass right through. In a recent study, subjects who regularly worked indoors with one side of the face directly exposed to a window developed noticeably more wrinkles, brown spots, and sagging skin on that side of the face.<br /> <br /> It's not just people who sit at a desk (or work outdoors) who are at risk: If your job requires much time in a vehicle, UVA can reach you through the side windows there, too. [See Sun Hazards in Your Car, page 36.]<br /> <br /> Pre-Work Prep<br /> When you prepare for work in the morning, you may apply moisturizer or makeup along with sunscreen. If your AM routine involves more than one product, follow the correct application order:<br /> <br /> 1 Medication. If you use a prescription topical medication, this should always be the fi rst product applied to a clean, washed face.<br /> <br /> 2 Moisturizer. A moisturizer worn on top of medication will not interfere with the topical treatment and could actually enhance its penetration. A moisturizing sunscreen will save you a step, but if you prefer using separate products, apply the moisturizer before the sunscreen.<br /> <br /> 3 Sunscreen. Your sunscreen should be broad-spectrum, protecting against both UVA and UVB rays. Its sun protection factor (SPF), which measures protection from the sun's UVB rays, should be at least 15. For UVA protection, make sure it contains some combination of stabilized avobenzone, ecamsule (a.k.a. Mexoryl™), oxybenzone, titanium dioxide, and/or zinc oxide.<br /> <br /> 4 Makeup. Apply foundation fi rst, then powder and blush. An SPF 15+ lip balm is also a good idea. Loose or pressed powder mineral makeup is a great addition, since it contains sunscreens like titanium dioxide and zinc oxide – insoluble minerals that block or reflect UVR away from the skin. The powder should catch any spots you have missed, and will make sunscreen touchups easier.<br /> <br /> At Play<br /> by Bruce Katz, MD<br /> Sunny vacations can easily damage your skin. It's not just the amount but also the type of sun exposure you receive that's a problem. Whether you're headed to the shore or the slopes, take precautions.<br /> <br /> On the Beach Intermittent, intense sun exposure – the kind you might experience on a beach vacation, resulting in sunburn – has been linked to both basal cell carcinoma, the most common form of skin cancer, and melanoma, the deadliest skin cancer. In a recent study, researchers found that young, white English women who vacationed in hotter countries had 74 percent more moles than women who had not. The more moles you have, the higher your melanoma risk. Minimize risk by applying a full ounce (two tablespoons) of a water-resistant, SPF 30+ sunscreen to your entire body 30 minutes before heading to the beach. Reapply every two hours or immediately after swimming or sweating heavily.<br /> <br /> UV exposure does not have to be direct to damage the skin. Indirect UV rays also pose an often-overlooked risk, since they can bounce off reflective surfaces and hit the skin a second time. On the beach, sand reflects 15 percent of UV light; water reflects up to 10 percent, and sea foam 25 percent. You can minimize exposure by hitting the beach before 10 AM or after 4 PM–the sun (and heat) will be less intense, and you'll miss the crowds.<br /> <br /> Many beachgoers wear nothing but a swimsuit, but studies show that clothing is the single most important factor in sun protection. It's advisable to cover as much skin as possible before and after you go in the water. Loose-fitting, long-sleeved shirts or blouses and long pants will shade your arms and legs, while UV-protective glasses and a hat with a broad brim (at least 3 inches all the way around) will go a long way to keep your head and face sun-safe. Tunics can be a happy medium for women, with long, loose sleeves and hems that reach the knees, covering more of the torso than the usual shirt. Wraparounds such as sarongs are also a light and comfortable form of protection. And three-quarter-length pants (a.k.a. clam diggers) will give men more leg coverage than standard shorts.<br /> <br /> Beachgoers can also benefit from specially made clothing. Look for clothes with a UPF (Ultraviolet Protection Factor) label. UPF indicates what fraction of the sun's ultraviolet rays can penetrate the fabric. For instance, a swimsuit with a UPF of 50 lets just 1/50th of the sun's UV radiation penetrate the fabric. The Skin Cancer Foundation recommends clothing with UPFs of 30 or more.<br /> <br /> Surfers and swimmers should have no trouble finding sport-specific protective gear. Synthetic and semisynthetic fibers like nylon and Lycra offer great UV protection for beach basics such as wetsuits, rash guards, and swim shirts. <br /> <br /> In the Snow<br /> While "sunny vacation" usually suggests a beach holiday, the sun in cold weather getaways can be every bit as intense as summer exposure. Again, reflection can be a serious problem, since snow reflects up to 80 percent of solar UV rays and can nearly double UV exposure. Skiers and snowboarders beware: UV exposure increases 8-10 percent with every 1,000 feet above sea level. Plus, both snow and strong wind can wear away sunscreen and reduce its effectiveness, so reapply a moisturizing sport sunscreen regularly.<br /> <br /> When you're on the slopes, cover as much of your face as you comfortably can, with close-fitting wraparound sunglasses or goggles that block 99-100 percent of UV radiation. This will help cut down glare, and also protect your eyes, the second most common site for melanomas. A ski cap or a hat with ear flaps will go a long way towards protecting the ears and scalp, two common sites for skin cancer.<br /> <br /> While Exercising<br /> by Jordana Gilman, MD<br /> If outdoor exercise is a priority for you, make sure sun protection is also on the agenda!<br /> <br /> Sunscreen<br /> A broad-spectrum (UVA/UVB) sunscreen is a must, and for extended periods outdoors, a water-resistant or very water-resistant sunscreen with an SPF of 30+ is recommended. Active people have numerous sunscreen options, since current sport sunscreens are water-resistant, lightweight, easily absorbed, and don't run into the eyes or sting. There are also an array of delivery options, from lotions and gels to wipes, which makes reapplication a breeze. For instance, you may want to apply a spray sunscreen before you leave the house and carry a stick with you for quick reapplication after two hours.<br /> <br /> Immunosuppression<br /> Excessive UV exposure and high-intensity exercise can harm the immune system, making athletes particularly vulnerable to illnesses, including skin cancers. Schedule outdoor exercise before 10 AM or after 4 PM, when the sun is less intense.<br /> <br /> Photosensitivity<br /> Some over-the-counter pain relievers (like ibuprofen and naproxen) can increase sun sensitivity, causing the skin to burn in less time and in response to less sun exposure. If you regularly take pain relievers to ease your aches and pains after a vigorous workout, be extra careful in the sun. Other common medications that can increase sun sensitivity include antibiotics, diuretics, topical retinoids, oral contraceptives, and antidepressants.<br /> <br /> Clothes<br /> The heat can tempt athletes to shed clothes, sacrificing sun safety for comfort, but today's sportswear is made of lightweight, high-tech fabrics specially treated to be "breathable" and "sweatwicking."<br /> <br /> Tightly woven athletic tops and shorts keep out more UV radiation than those made of fabrics with loose or open weaves (like mesh).<br /> <br /> Remember to keep your head covered. While a broad-brimmed hat (such as an outback or bucket hat) offers the most protection, it may not be feasible in certain sports; however, even a cap will protect the vulnerable scalp. Foreign legion-style hats are another option, offering extra protection for the back of the neck. <br /> <br /> Socializing<br /> by Doris Day, MD<br /> When you're spending time outdoors with friends and family, follow these tips to maximize fun while minimizing sun damage:<br /> <br /> Accessorize<br /> 99-100 percent UV-blocking sunglasses can make a chic fashion statement while also protecting you from eyelid cancers, which account for five to 10 percent of all skin cancers. While few are lethal, they can cause significant tissue damage, leading to disfigurement and even blindness. The bigger the lenses, the better.<br /> <br /> Fedoras and other wide-brimmed hats are another great way to protect from the sun and make a fabulous fashion statement. Hats made of darkor bright-colored fabrics provide more protection than light-colored hats, and those made of densely woven, opaque material (like canvas) are preferable to those made of straw.<br /> <br /> Put Your Best Face Forward<br /> If you wear makeup when you go out with friends, take the opportunity to add an SPF15+ mineral powder. Not only will mineral powder give your skin a glamorous matte finish, you'll be augmenting the sunscreen you've already applied. For more information on sun protection and makeup, see "At Work," page 28.<br /> <br /> Seek the Shade<br /> Sometimes, you can increase sun safety just by moving a few feet. Shade is an important element of sun protection: Look for trees with large spreads of dense foliage, and ones near other trees or buildings, to further block out the sky. Also use parasols or sun umbrellas whether you're walking, lying in the sand, or sitting at a picnic table.<br /> <br /> Remember, it is vital to protect your skin on a daily basis. Go to www.SkinCancer.org/Guidelines for a concise list of The Skin Cancer Foundation's everyday sun safety strategies.<br /> <br /> DR. FRANKS was named by New York Magazine as one of America's Best Doctors six years running, and is the Medical Director of Gramercy Park Dermatology and Assistant Professor of Dermatology, NYU School of Medicine. Her articles have been published in numerous dermatological medical journals and consumer periodicals, and she has presented many papers at medical conferences.<br /> <br /> DR. DAY is Clinical Assistant Professor of Dermatology at New York University's Langone Medical Center. She is Director of Day Dermatology and Aesthetics, New York City, author of Forget the Facelift and radio talk show host for the dermatology show on Doctor Radio.<br /> <br /> DR. KATZ is Clinical Professor of Dermatology at The Mount Sinai School of Medicine, Director of the Cosmetic Surgery & Laser Clinic at Mount Sinai Medial Center, and Director of the Juva Skin & Laser Center in New York. Dr. Katz, who has been named frequently by New York Magazine as one of the best doctors in New York, is Past President of the Dermatologic Society of Greater New York.<br /> <br /> DR. GILMAN is an Assistant Clinical Professor of Dermatology at Mount Sinai Medical Center in New York City and has a private practice in Manhattan. Dr. Gilman has extensive experience in medical, cosmetic and aesthetic dermatology.<br />

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