Avoid Sun Harm

By Emmanuel R. Loucas, MD
May 14, 2013

There’s no upside to a lack of sun protection. Exposure increases your cancer risks and decreases your attractiveness.

Although smoking, genetics, and the normal aging process all play a role in skin changes, they are not the most significant factors. There is no dispute that chronic sun exposure is the most common cause of unwanted skin changes that occur in most people as they age. Take it from a doctor who has been examining people’s skin for over 20 years— those aged far north of 65 have minimal wrinkles and signs of sun damage if they have practiced strict sun avoidance over their lifetimes or protected their skin properly, while those south of Medicare age may look far older if they have disregarded proper skin care.

There are three major wavelengths of light that affect your skin: UVA, UVB, and UVC. UVA and UVB rays are the primary wavelengths that affect your skin in a negative way.

UVB rays are the shorter wavelengths, which do not penetrate deeply into the skin; these are the primary rays responsible for sunburns. They also are the major cause of squamous cell carcinomas, an aggressive type of skin cancer. The “good” thing about UVB rays? They can be effectively blocked by most sunscreens.

UVA rays, the longer and more dangerous rays, penetrate deeply into the skin and are very difficult to block with conventional sunscreens. Although UVA rays are not the major cause of sunburns, they are responsible for sun-induced skin damage, and may be the primary cause for a common form of skin cancer, basal cell carcinomas, as well as the most deadly and dangerous skin cancer, melanoma.

Chronic sun exposure causes both a significant decrease in the production of collagen and a breakdown of whatever collagen exists; it also destroys skin’s elastic tissue. The result is a loss of elasticity and bounce in your skin. This is the most common reason why people seek out facial volume restoration by utilizing fillers or surgical means (such as face lifts).

When elasticity is lost, fine lines and deep wrinkles increase. Other common but unappealing changes are an increase in brown spots (lentigines), brown patches (melasma), yellowing, and unevenness and roughness in skin texture.

The only ways to prevent the sun from causing unsightly changes in your skin are sun avoidance or the regular use of sunscreens. Since most boaters love to be in the sun, they should choose the second option and select broad spectrum sunscreens that help block both UVA and UVB rays (most sunscreens on the market today are broad spectrum). If you’re someone who has trouble remembering to use your sunscreen before heading out on the boat, I’d advise you to start applying sunscreen on a daily basis, regardless of the forecast or your outdoor activities. I’d even encourage you to use a moisturizer that contains a sunscreen in the fall and winter months so that it becomes a regular behavior and a good habit.

Another good habit to adopt is applying sunscreen in the morning, giving it a chance to absorb into your skin; this improves its effectiveness before you start sweating. Always re-apply sunscreen if you are outside for more than two hours, and pick a product that you don’t mind putting on— if you hate the feel of it, you won’t use it! I suggest trying to find sunscreens that contain both zinc oxide and titanium dioxide (physical blockers), because these ingredients tend not to sweat off as easy.

Enjoy your summer and have fun, but be responsible. Skin cancers are one of the few cancers still on the rise. In particular, melanoma is a disease affecting both the young and old, and its incidence has reached epidemic proportions. Besides applying sunscreen, perform skin self exams on a monthly basis, looking for beauty marks or growths that are changing in color, shape, or size, or are bleeding. It is also essential that you see a health care professional who is well versed in skin cancer detection and prevention. Schedule your appointment for before or after boating season, but make this a yearly life-prolonging skincare habit. You’ll look great and feel even better!

Emmanuel R. Loucas, MD is the Director of the Loucas Dermatology & Laser Center, 69 East 76th Street in New York www.loucasdermatology.com and is also Assistant Clinical Professor of Dermatology at the Mount Sinai School of Medicine.

By Emmanuel R. Loucas, MD
May 23, 2012

Last year an estimated 68,130 people in the U.S. were diagnosed with melanoma– the most dangerous form of skin cancer– and an estimated 8,700 died, according to the National Cancer Institute. After 33 years of consideration, the Food and Drug Administration (FDA) recently released their new rules for labeling sunscreens, which will take effect in June 2012. Here are some of the changes:

Sunscreens may no longer claim to provide protection for longer than two hours.
Sunscreens wear off, sweat off, and wash off, so it’s a must that they be applied every two hours– at a minimum.

Products are prohibited from using the words “sweatproof” or “waterproof.”
These claims have always been false, so this new rule may create more awareness of the need for frequent re-application after swimming and sweat-inducing activities. Products may claim to be “water resistant,” but they must specify a time period (e.g. 45 minutes).

Using “sunblock” is no longer allowed.
When Zinc Oxide and Titanium Oxide sunscreens became popular due to their compatibility with oily, acne prone and sensitive skins, they were referred to as “sunblock.” The FDA never liked the term sunblock, however, and I know why: there isn’t a product on the market that can fully block out the sun’s rays.

“Broad spectrum” sunscreens must make their defense against UVA and UVB radiation proportional.
The FDA requires sunscreens to protect equally against two kinds of the sun’s radiation, UVB and UVA, to earn the coveted protection designation of “broad spectrum.” UVB rays cause burning, UVA rays cause wrinkling, and both cause cancer. If a product fails to offer this dual protection, it will have to carry a warning label: “This product has been shown only to help prevent sunburn, not skin cancer or early skin aging.”

There are other changes proposed for sunscreen as well:

Eliminating sunscreens above SPF 50
The FDA is proposing to limit the maximum SPF on labels to 50 because there isn’t enough information to prove higher SPFs offer any greater protection for users. An SPF 50 or higher certainly gives people a false sense of security.

Caution for spray sunscreens
As sprays are applied differently from other sunscreen dosage forms, such as lotions and sticks, the FDA has requested additional data to establish effectiveness and to determine whether they present a safety concern if inhaled unintentionally.

The FDA’s new regulations and proposals are certainly a step in the right direction to increase sun safety awareness and sunscreen education. However, the new regulations will do nothing to prevent the most common problem with sunscreens, which is that consumers fail to use enough of them. Ultimately, it will be the consumer’s choice to read the sunscreen labels and follow the directions accurately to protect her or his skin from the dangers of the sun.

Turn Back The Hands Of Time
April 30, 2012

We would all like our skin to look its best, and certainly want to decrease our chances of developing skin cancer. If you’ve tried creams, lotions and gels and been unsatisfied with the results, discuss topical regimens and procedures with your dermatologist. Treatments exist that can enhance both your looks and your health.

If you have been diagnosed with early pre-cancerous skin changes, there are topical preparations that contain imiquimod, diclofenac, and fluorouracil which, when applied under your dermatologist’s supervision, can effectively reverse some of this damage. In addition, chemical peels are an excellent choice. This treatment has been around since Cleopatra’s time, and for something to be in use that long, it must be good!

On the strictly cosmetic front, I have seen numerous topical agents and lasers come and go over the years. These are often done in a series of treatments and do have some risks, but can be very effective when done by a competent physician (not by an assistant or an aesthetician). PDT (photodynamic therapy) is a newer therapy where an agent is applied to your face for one to three hours before undergoing a treatment with either a pulsed-dye laser or blue light. While shown to be an effective treatment, expect some down time as your skin will be red and flaky for one to four days. Another effective option is the more aggressive ablative laser resurfacing, which uses either a traditional carbon dioxide or Erbium laser. Often only one treatment is required, but the big hindrances are the one to two weeks needed to heal and the possible side effects of infection, persistent redness, or scarring. Newer fractional ablative lasers have been developed which decrease the chances of these side effects; the downside is that multiple treatments may be required. Furthermore, the results do not always meet patient expectations for such a costly procedure.

If you just want to get rid of sun damage such as fine lines, broken blood vessels, and discoloration, there are less aggressive measures that are effective. Again, the chemical peel is a great option, despite the scary misinformation in an episode of Sex in the City. I don’t have much faith in micro-dermabrasion as a very effective option for reversing sun damage, though it may be good to rid your face of blackheads or to just “freshen up” your skin a little. A pulsed- dye laser can be used to improve skin texture, decrease visible blood vessels and lessen the persistent redness that sun damage often causes. Other procedures include the diode laser, which improves overall skin texture and quality, and IPL (intense pulse light) machines that can be used to reverse sun damage.

Once more, I would recommend that these procedures not be done at your local spa by a friendly aesthetician. I firmly believe that laser surgery should only be performed by a qualified board certified dermatologist or plastic surgeon. I have seen too many avoidable “mishaps” that were referred to me for correction.

It is never too late to try and reverse the damaging effects that sun has on your skin. Start slow and consistently follow a steady course with a simple but effective topical regimen. Discuss effective and proven treatments with a knowledgeable dermatologist who practices evidence-based medicine. And when considering various procedures, always ask questions about the risks and the benefits of each. Most importantly, take continuous care of your skin: have your doctor instruct you on performing self skin examinations on a monthly or bi-monthly basis, get a complete body examination on a yearly basis, see your dermatologist if you notice any new or changing skin lesions, and apply generous amounts of sunscreen.

Emmanuel R. Loucas, MD, is the Director of the Alpha Aesthetic Dermatology and Laser Center of Manhattan at 69 East 76th Street and an Assistant Clinical Professor in the department of Dermatology at Mount Sinai School of Medicine. He has been in private practice for 15 years.

Screening Out The Sun’s Rays
January 1, 2012

As water reflects and amplifies the sun’s rays, boaters of every age should beware of the hazards of unprotected exposure. Current estimates are that one in five Americans will develop skin cancer during their lifetime; more than one million new cases of skin cancer will be diagnosed in the U.S. this year. Malignant melanoma- one of three types of cancer directly related to excessive sun exposure- is the number one cancer in those aged 25-29, and second most prevalent in those aged 15-29 years old. The chilling reality is that one person dies from melanoma every hour.

The American Academy of Dermatology (AAD) recommendations, regardless of skin type or color, are for a broad spectrum sunscreen with a minimum Sun Protection Factor (SPF) of at least 15 that protects against UVA rays & UVB rays. UVA rays pass through window glass, causing premature skin aging, wrinkling, and age spots; UVB rays do not penetrate glass and are the cause of sunburn. Don’t let sunshine be your guide: up to 80% of the sun’s ultraviolet (UV) rays can pass through clouds and damage skin.

Make-up, lotions, and hand creams may have added sunscreens; such protection is often adequate for routine daily activities, but on the high seas, never be without full sunscreen. Though there are many high SPF products, you are likely to find a sunscreen with an SPF of 30 more aesthetically pleasing than one with an SPF of 70. Don’t be mislead by high-SPF products: an SPF 45 will not provide three times the protection of an SPF 15; an SPF of 30 screens 97% of UVB rays, and a SPF of 15 screens 93% of UVB rays.

Sunscreens should be applied to dry skin 15-30 minutes before going outdoors. Though the AAD recommends that people apply a generous shot glass (one ounce or more) of sunscreen to protect the body, most studies show people use only 25-50% of the recommended amount. Don’t be afraid to apply larger amounts, and be mindful of using spray-on sunscreens. While I love the ease and convenience of the spray, it is easy to miss spots and apply too little sunscreen, so make sure you apply a liberal coating with a systematic approach.

Sunscreen should be generously re-applied every two hours to maintain protection. If you’ve been swimming or perspiring heavily, apply even sooner, as even so-called “water-resistant” sunscreens may lose their effectiveness after 40 minutes in the water.

When it comes to finding an effective sunscreen, I find that store brands are often as effective, but less aesthetically pleasing, than expensive brand name products (you may wish to apply a store brand on your body and a brand name on your face). Look for the AAD SEAL OF RECOGNITION® on labels to help choose products that provide the sun protection recommended by dermatologists.

If you have very sensitive skin, sunscreens containing titanium and/or zinc oxide are best; if you develop a reaction, “cinnamates” may be the ingredient to avoid. Fragrances in sunscreen may also irritate your skin, and avoid combination products like sunscreens with insect repellent.

No matter how conscientious you are about applying sunscreen, I recommend that everyone undergo a yearly full body skin examination by a board certified dermatologist, who will also teach you how to do self-examination.

Dr. Loucas’ perspective on news reports concerning sunscreens:

There has been a lot of controversy in the lay media as to whether sunscreens promote changes in the skin cells that result in increased risks of skin cancer. There have been some recent news articles touting the dangers of using sunscreens, suggesting that sunscreens contain dangerous chemicals that accelerate the growth of skin tumors, disrupt the intricate workings of your hormonal system, or just plain don’t work, giving people a false sense of security so they stay in the sun longer, resulting in an increased risk of skin cancer.

While there may be the smallest bit of merit to claims that applying any “chemical” to your skin may result in some sort of toxicity to your skin, the American Academy of Dermatology (AAD), scientists, and the majority of scientific data unequivocally support the use of sunscreens.

Besides sun avoidance, which almost impossible for most of boaters, sunscreens are your best bet to avoid skin cancer. Some helpful tips:

1) Believe that Sunscreens Work. In the past, sunscreens were only regulated for UVB protection, but now there are controls and regulations for the UVA component of sunscreens. Always pick a sunscreen that is broad spectrum. Until a final verdict is in, choose a sunscreen that contains only physical blockers (titanium dioxide and zinc oxide), and avoid sunscreens with chemical blockers.

2) Don’t Be Afraid to Apply Larger Amounts Frequently. Although the AAD recommends that people apply a generous shot glass (one ounce or more) of sunscreen to protect the body, most studies show people use much less.

3) Don’t Be So Concerned About the Chemicals…Yet. In a perfect world, we wouldn’t eat anything that is processed, and avoid any drugs or chemicals that we don’t need. Unfortunately, this is a very difficult task. The Environmental Working Group, an organization that specializes in environmental research and advocacy, cites two chemical “culprits” as targets

~~Retinyl Palmitate is a Vitamin A compound found in 40% of sunscreens.

~~Oxybenzone accused of being a hormone-disrupting compound only in mice.

Until the picture becomes clearer, try to pick sunscreens that are either purely physical blockers, or if you pick one that contains both physical and chemical blockers (most sunscreens contain both), try to avoid these possibly suspect compounds.

4) There is No Substitute for Covering Up and Sun Avoidance When Possible. Always try to wear clothing that is light and has built-in UV protection (there are several good clothing lines on the market). Many hats and caps have been lost at sea from gusts of wind, but keep buying them and wearing them!

Story by Emmanuel R. Loucas, MD

Supple Summer Skin
June 1, 2011

While cooler months are behind us, our skin’s need for softening is still present. Moisturizers improve skin’s barrier function, minimize surface water, and keep the skin’s top layer softer and suppler. Though hot days may make us want to skip some grooming steps, moisturizing remains important. If the skin loses too much water, it becomes dry, flaky, and prone to both infection and inability to regulate body temperature.

Though one of the most prescribed products in dermatology, moisturizers contain so many different ingredients and make so many antioxidant, anti-aging, and other “anti-” claims that their therapeutic effects have come under scrutiny in recent years (the lack of well controlled studies has confused dermatologists as well as consumers). One exciting development is the addition of naturally occurring skin fats and other barrier elements (sterols and ceramides) to over-the-counter moisturizers. There are also new anti-inflammatory prescription moisturizers (primarily used for dry skin conditions such as eczema) which are extremely effective for dry skin under the guidance of a dermatologist.

The moisturizer you choose depends on your skin type. Those with dry, sensitive skin may choose a moisturizer that is cream based, with a physical (titanium dioxide and zinc oxide) sunscreen component rather than chemical blockers. More oily skin types should pick less-greasy moisturizers such as lotions or gels. Your dermatologist may make specific recommendations.

In cooler weather, I often recommend a daily routine that includes applying cream based moisturizers with sunscreen SPF (Sun Protection Factor) of at least 15, but preferably 30. As days turn hotter, switch to less-thick moisturizing lotions in SPF 30 or higher (lotions are more elegant and dry faster during hot, humid weather). If you’re on the boat or at the beach, change up the moisturizer for a sunscreen with an SPF of 50 or more.

While there is no set rule, I advise applying moisturizer with sunscreen before make-up, unless you are using topical medicines for conditions such as acne or dermatitis (then apply the medicine before anything else). Most moisturizers are water based and won’t block the pores of those with acne. In fact, you will be more likely to tolerate acne medications and improve compliance.

If you apply a high SPF sunscreen on hot humid days, bypass the moisturizer in the morning. As sun exposure for even short periods tends to dry out skin, apply your moisturizer after returning home and washing your face. Don’t use a moisturizer with sunscreen twice a day, as it may lead to skin irritation—the wrong result of a good skin care routine!

Story by Emmanuel R. Loucas, M.D.

Sunscreen Basics
September 1, 2010

Boaters beware: water reflects the sun’s rays, amplifying the risks of exposure.Current estimates are that one in five Americans will develop skin cancer during their lifetime; more than one million new cases of skin cancer will be diagnosed in the U.S. this year.Older boaters don’t bear all the risk, as malignant melanoma- one of three types of cancer directly related to excessive sun exposure- is the number one cancer in those aged 25-29, and second most prevalent for those 15-29 years old.The chilling reality is that one person dies from melanoma every hour.

The American Academy of Dermatology recommendations, regardless of skin type or color, are for a broad spectrum sunscreen with a minimum Sun Protection Factor (SPF) of at least 15 that protects against UVA rays & UVB rays.UVA rays pass through window glass, causing premature skin aging, wrinkling, and age spots; UVB rays do not penetrate glass and are the cause of sunburn. Don’t let sunshine be your guide: up to 80% of the sun’s ultraviolet (UV) rays can pass through clouds and damage skin.

Sunscreens should be applied to dry skin 15-30 minutes before going outdoors.Most people apply only 25-50% of the recommended amount of sunscreen: one ounce, enough to fill a shot glass, is considered the minimum amount needed to properly cover the exposed areas of the body (double that amount if you’re wearing a bathing suit).Sunscreen should be re-applied at least every two hours, sooner after swimming or perspiring heavily.Even so-called “water-resistant” sunscreens may lose their effectiveness after 40 minutes in the water.

Make-up, lotions, and hand creams may have added sunscreens; such protection is often adequate for routine daily activities, but on the high seas, be sure to also apply sunscreen. Cream sunscreens are best for individuals with dry skin, while gels and sprays are preferable in hairy areas.In my experience, spray sunscreens improve compliance, as people are more likely to re-apply these, especially on very hot days.The ideal sunscreens are water-resistant and have a minimum SPF of 30.

Though there are lots of high SPF products, you are likely to find a sunscreen with an SPF of 30 more aesthetically pleasing than one with an SPF of 70.Don’t be mislead by high-SPF products:an SPF 45 will not provide three times the protection of an SPF 15; an SPF of 30 screens 97% of UVB rays, and a SPF of 15 screens 93% of UVB rays.Just remember to re-apply every couple of hours to maintain protection.

When it comes to finding an effective sunscreen, you don’t need to buy the most expensive brand name products.I find store brands are often as effective, but less aesthetically pleasing, so you may wish to apply a store brand on your body and a brand name on your face. The American Academy of Dermatology (AAD) recently introduced the AAD SEAL OF RECOGNITION®, which is used to help consumers choose products that will provide the sun protection recommended by dermatologists; look for this seal of recognition on product labels.

For those with very sensitive skin, sunscreens containing titanium and/or zinc oxide are best.If you develop a reaction, “cinnamates” may be the ingredient to avoid.Fragrances in sunscreen may also irritate your skin, and avoid combination products like sunscreens with insect repellent.

A final caution:no matter how conscientious you are about applying sunscreen, I recommend that everyone undergo a yearly full body skin examination by a board certified dermatologist, who will also teach you how to do a self examination.

A hot topic lately is the controversy over some chemical sunscreens containing benzenes, which MAY be associated with cancer risks.

Some sunscreens contain chemical blockers, and others contain physical blockers. The physical sunblocks contain zinc oxide and titanium dioxide. In years past, these ingredients were undesirable, as their opaque nature made them aesthetically unpleasant for users. In recent years, these products have been refined using nano (like nano particles from your physics class) technology to make them more aesthetically acceptable.

There are many chemicals in the other category, from the original PABA to some of the more popular ones such as avobenzones and cinnamates. Most sunscreens contain these chemical blockers alone or in combination with physical blockers.

With the recent findings that some of the chemical blockers may increase rather than decrease your risk of skin cancer, the push is towards finding effective sunscreens that only contain zinc oxide or titanium dioxide. Locating a sunscreen that only contains these two ingredients requires a little extra time reading labels at your local drug store, or asking your pharmacist for guidance. You can also call your local friendly dermatologist’s office to see if they have any suggestions or sell a good product.

Remember, all of this has not been proven. There have been many controversies in medicine over the years that have not panned out, and many recent articles have been sponsored by companies who have something to gain by changing consumers’ habits. The bottom line is that for me, many of my colleagues, and the American Academy of Dermatology, the risk/benefit ratio of not wearing a sunscreen even with purely chemical blockers is worth it over experiencing sunburn and skin damage.

The bottom line: don’t throw away that bottle of sunscreen–use it! My personal point of view is that until more valid scientific evidence can demonstrate a true association between the use of chemical blockers and skin cancer, the risk of getting skin cancer is much, much, much higher for those people avoiding the use of sunscreen than for those using them.

By Emmanuel R. Loucas, MD

Reversing Sun Damage Cosmetically
April 7, 2010

Despite popular belief that the majority of skin damage occurs before we turn 20, we now know that safe skin practices at any age can prevent and even reverse sun damage. The best way to prevent sun damage is to liberally and regularly apply sunscreens that contain both UVA and UVB protection and wear clothing from one of the excellent lines that offer UV-protective clothing. Prevention is important, as exposure to UVA and UVB rays account for over 85% of the symptoms of premature skin aging, such as wrinkles, discolorations, decreased elasticity, thinning skin, and lesions that may be cancerous. But if the harm has already been done, there are ways to reverse some of the damage caused by excessive sun exposure. Whether your goal is to reverse the visible signs of photo aging or to prevent the development of skin cancers, start by meeting with a board certified dermatologist. Begin by requesting a complete body assessment: this simple five minute exam can literally save your life. If your dermatologist delivers the good news that you have no precancerous or cancerous lesions, then you could discuss erasing evidence of sun damage.

As a physician, I look to evidence based medicine to guide me in making recommendations for patients who want to reverse the signs of sun damage in a cost effective way. Hydroxy acid products and retinoid have a lot of science showing their effectiveness. I often recommend an over the counter alpha hydroxy acid, and/or a retinoid three times a week to be increased gradually over several weeks to daily. As over the counter products have a lower concentration of the effective ingredients, they may not yield the results you want. Your doctor can then dispense a prescription strength hydroxy acid and prescribe one of several prescription strength retinoids, based on the sensitivity of your skin and the season (e.g. starting in the winter, when skin is dry, may be more challenging). I advise patients to use a mild cleanser and wait until the face is completely dry before applying any product. Wait another 10 to 15 minutes before applying moisturizer.

What about antioxidant creams containing ingredients such as green tea, copper peptides, kinetin, soy, vitamin C or pomegranate? There has been some credible research to indicate that green tea and copper peptides are effective, and so I dispense antioxidant products in my office, with some positive feedback (these are often a good alternative for those with sensitive skin). But when it comes to most advertised antioxidant, anti-aging products, keep in mind that this is a huge money making industry based on claims not backed up by well-controlled clinical trials. Some products containing growth factors in combination with various antioxidants also have some good science behind them, and I find they are effective to reverse photo aging to a certain degree (though they are too expensive for some patients).

Taking care of your skin is like exercising to stay in shape. I tell my patients that someone who exercises three times a week on a regular basis is better off than the person who exercises for two weeks straight then skips the gym for three months. And the same holds true if you want to reverse the effects of sun damage: applying one or two effective topical agents on a consistent daily basis yields better results than burning and over-drying your skin by slathering on six different over-hyped cosmetic creams. Many times patients come in with bags of creams that cost hundreds of dollars, all of which end up in the garbage can once they start effective treatments.

Emmanuel R. Loucas, MD, is the Director of the Alpha Aesthetic Dermatology and Laser Center of Manhattan at 69 East 76th Street and an Assistant Clinical Professor in the department of Dermatology at Mount Sinai School of Medicine. He has been in private practice for 15 years.