Sunprotection and Sunscreens : All you need to know

Introduction

Sun protection is simply guarding a body from the adverse effects of sunlight. Sun light consists of visible light and Ultra Violet (UV) radiation which are of three types – A,B,C of which UVA and UVB have detrimental effects on the skin on chronic exposure:

• Acute sunburn, which can permanently damage the skin and heal with pigmentation and/or scarring.

• Premature signs of aging like sagging of skin due to loss of elasticity, wrinkling, dull and uneven texture, age spots.

• Tanning and generalized or patchy hyperpigmentation over sun-exposed areas especially face, neck, upper chest and back, forearms and lower arms and lower legs.

• Specific pigmented conditions often arise or become worse due to chronic sun-exposure like melasma , freckles , Lichen Planus Pigmentosus (LPP), post-inflammatory pigmentation due to a previous injury, burn or following procedures like chemical peel, microdermabrasion (MDA) or lasers.

• Chronic sun-exposure is also the biggest risk factor for precancerous changes in the skin and skin cancers like melanomas and non-melanoma skin cancers like basal cell carcinoma (BCC). Fortunately, the incidence of melanoma (a deadly cancer) is extremely low in Indians due to our darker complexion compared to Caucasians, however, non-melanoma cancers like BCC may still arise.

What Are the Tips to Prevent Sun Exposure?

• Limit time in the sun, especially between peak sunlight hours of 10 a.m. and 3 p.m. Use protective sunscreen with Sun Protection factor (SPF) of at least 30, preferably 50.

• Wear protective clothing, including a broad-brimmed hat.

• A shirt with sleeves that cover the arms.

• A long skirt or pants with long legs.

• Effect of fabric: Jeans, tracksuits, sweatshirts and pullovers are very photoprotective. Pale-colored 100% cotton T-shirts provide mild to moderate protection, though black-colored T shirts offer high protection.

Sunscreens should be regularly used for the following reasons:

• Should be used by all on all exposed parts of the body to avoid or delay tanning.

• To prevent and to some extent reverse any form of pigmentation like melasma, freckles (age spots), post-acne marks etc.

• To delay ageing of skin and delay appearance of wrinkles and sagging of face. Sun exposure is the single most important factor contributing to normal as well as early ageing of skin of face, neck, arms, forearms and other exposed parts.

• It is absolutely essential to start with sunscreen use prior to a procedure like chemical peel if you have never used it in the past and have background tanning.

• All cosmetic procedures like peels, MDA and all types of laser treatments make skin sensitive to sunlight. The first 7-10 days post-procedure are most crucial. You must apply the sunscreen 3 times a day for at least this duration after the procedure and in addition use physical methods to block sun exposure like scarf, shawl, umbrella.

• Avoiding outdoors in morning, noon and afternoon and other sunny periods, mechanical protection by use of umbrellas, broad-brimmed hats or use of opaque cotton cloth to cover the exposed treated parts should be done in addition to, and not as an alternative to the sunscreen.

Once again, remember, for a sensitive skin even 2 minute sun-exposure e.g. going to veranda or morning walk may result in undesirable effects. If sun protection is not followed, it may result in counter-productive effects of the peel or other procedures, specially, worsening of hyperpigmentation.

Ideal way of using sunscreens:

• The sunscreen should have an SPF of at least 30, preferably 50. SPF is a number such as 15, 26, 30, 40 or 50 that indicates the degree of sunburn protection provided by sunscreens. The amount of sun exposure depends upon a number of factors including the length of exposure, time of day, geographic location, and weather conditions. SPF is related to the total amount of sun exposure rather than simply the length of sun exposure. It indicates protection against UVB, not UVA. Ideal or "broad spectrum" sunscreens that protect against both UVA and UVB, should be used.

• Many of the sunscreens available today are a combination of several different active chemical and physical sunscreen ingredients in order to provide broad-spectrum protection. These generally include PABA derivatives, salicylates, and/or cinnamates (octylmethoxycinnamate and cinoxate) for UVB absorption; benzophenones (such as oxybenzone and sulisobenzone) for shorter-wavelength UVA protection; and avobenzone, ecamsule (MexorylTM), titanium dioxide, or zinc oxide for the remaining UVA spectrum.

• Many scientists believe that there is insufficient evidence to prove that products with SPF values higher than 50 provide greater protection for users than products with SPF values of 50.

• A common mistake is applying too little sunscreen, which can drastically reduce the effective SPF. To ensure that you get the full SPF of a sunscreen, you need to apply around two-fingers full of sunscreen for the face and 1 ounce – about a palm-full or shot glass full, to cover all parts of the body exposed to sunlight. Most people apply only half to a quarter of that amount, reducing the actual SPF they have on their body than the true SPF. During a long day at the beach, one person should use around one half to one quarter of an 8 oz. bottle.

• It should ideally be applied three times a day till sunlight is present. It could be 2 times in winters or cloudy days, but prefer thrice a day application, if possible and comfortable for you.

• A rough guideline is first (7-9 AM), second (12-2 PM) and third (4-5 PM), though the exact timings are usually adjusted as per each person’s job profile. People with outdoor work or frequent travel should carry the sunscreens in their bags in addition to keeping one tube at home and one at office.

• The re-application is to be done every 4-5 hours despite claims by certain manufacturing companies that single application suffices.

• Each coat should ideally be applied at least 20-30 minutes prior to anticipated exposure, e.g. before stepping out of the house or office or school, as it takes this much time for the sunscreen to become active and give you protection.

• Ideally, the second and third coat should be applied over the pre-existing first coat to reinforce the effect. But if you feel too greasy or uncomfortable, you may wash with a mild cleanser and then re-apply the subsequent coats.

• Suitability of sunscreens with a particular skin (pimple-prone, oily, dry, mixed, and hypersensitive) is not predictable. You may have to change the sunscreen in the initial few days and finally you would be able to identify the one that suits you the best.

• They are available in different formulations like creams, gels, aqua-gels, lotions etc. Choice of sunscreen formulation will depend on your skin type and concomitant treatments. In general, creams and lotions have a higher moisturising effect (suitable for patients with dry skin or acne patient on Oral Isotretinoin therapy (e.g. SOTRET capsules) which makes skin dry). Gels or Aquagels are preferred for patients with active acne (pimples), oily skin, open pores etc. Dermatologists at icliniq will help you to choose the optimum sunscreen for you, but it may need to be changed if it doesn’t suit you.

• The method of application of sunscreen ideally is to spread it evenly on all exposed parts (face, neck, upper back etc.) and it should ideally be applied as the first coat on your skin. In case you have been recommended concomitant creams/gels, then they may be applied half an hour to one hour prior and sunscreen may be applied over it without washing or wiping off the cream or gel.

• Some sunscreens, especially the ones with higher SPF (40 and above) often leave a temporary whitening effect over the skin and is of concern to some persons. This problem is less common with newer sunscreens. But you should be ready to accept a little whitish hue due to the sunscreen.

• If make-up is being used, the sunscreen should be applied, left to dry for 15-20 minutes and then foundation etc. may be applied.

• Newer sun-screens are water and sweat-resistant with some of them even suitable during swimming. Still it is better if sunscreen is re-applied if suspected to have been removed due to sweating, swimming or towelling off.

• Cosmetic versus Medical Sun-screens: It is true that sun-screens manufactured by cosmeceutical companies (like Lakme, Neutrogena, Loreal, Dove, Forest Essentials, Ayur etc.) with a good SPF are effective. And if they suit your skin, they may be continued. However we believe that medical sunscreens manufactured after years of research and with published clinical trials proving their effectiveness may be more protective.

• If you are going for a vacation, especially in a high-altitude area (like hill stations) or beach, the exposure may increase. Degree of exposure to the sun's radiation increases 4% for every 1000-foot increase in altitude.

Thus, follow more rigorous sun protection. Avoid getting a procedure (like chemical peel, MDA, IPL, Lasers) done if you anticipate going for vacation within a week of the procedure.

How to Remove the Sunscreen?

At the end of the day, warm water, soap and a bit of elbow grease are the best ways to get sunscreen off your skin.

What Are the Common Myths About Sunscreen?

• If I stay strictly indoors (e.g. house-wives, corporate workers with long-office shifts), I have no sun-exposure : Even if you stay strictly indoors still some exposure is inevitable, especially during summer season. Sunlight from windows, balcony etc. may affect your skin within 2-5 minutes exposure also. Corporate workers who work for more than 10-12 hours under fluorescent lights are also not spared, which they commonly assume. Even these lights have a component of Ultraviolet rays which may cause undesirable damage! So never underestimate your sun-exposure or assume “that I hardly am exposed to sun light”

• If it's cold (as in winters) or cloudy outside, I don't need a sunscreen : This is not true. UV radiation, though not as intense in the winter, still poses a threat, especially when rays reflect off snow. There is no safe time of year when it comes to UV radiation. The same applies to weather conditions. Even on a cloudy day, more than 50% of the sun's ultraviolet rays pass through the clouds and reach the earth.This myth often leads to the most serious sunburns, because people spend all day outdoors with no protection from the sun.

• “Herbal or Natural” are better than “Medicated or Artificial” Sunscreens: Sunscreens by companies like Forest Essentials, Ayur etc that claim to be totally “natural” and/or “herbal” with “no side-effects” also contain chemical ingredients like Benzophenone-3, Tinosorb-M and are only enriched with additional herbal ingredients. Though a particular brand may suit somebody’s skin (which is the case with any sunscreen for that matter), there is no additional advantage of using these so-called “herbal” sunscreens over the conventional medicated sunscreens!

• Sunscreens for ‘MEN’ versus ‘WOMEN’: There is no scientific data to prove that the skin of men requires any specific sun-screen containing ingredients different from those meant for women. All sun-screens are useful for both the sexes. It is only your skin-type (oily, dry, normal, mixed) and perhaps age that affect the choice of sun-screens. Companies manufacturing “special sunscreens for MEN” are simply using a marketing gimmick to sell their products. So don’t succumb to that!

• Sunscreens should not be used in kids due to safety issues : On the contrary, kids are more vulnerable to sun-damage and a broadspectrum sun-screen with high-rated effectiveness against UVA and UVB should be used. Special consideration for infants under six months : Their skin is too immature to tolerate the chemical sunscreens, but also highly susceptible to sun damage due to relative lack of protective melanin. The American Academy of Paediatrics recommends avoidance of sunscreens on children younger than 6 months unless protective shade and clothing are not available. In that situation one can apply a minimal amount of sunscreen to exposed skin. Pure physical sunscreens (containing titanium and/or zinc oxide) may be safer.

• Wearing sunscreen can cause vitamin D deficiency - There is some controversy regarding this issue, but few dermatologists believe (and no studies have shown) that sunscreens cause vitamin D deficiency. Vitamin-D deficiency has become a global epidemic and may occur in apparently healthy appearing young people too. But this is possibly due to evolutionary disability of our skin to form vitamin D on sun-exposure, rather than sun-protection offered by use of sun-screens. It has become commonplace for everyone with vague symptoms of lethargy, bone pains etc. to get tested for 25-hydroxy Vitamin D levels (fasting blood sample is to be given). If levels are insufficient, consult your dermatologist or physician for oral vitamin D supplements, available as powder-sachets and capsules (usual regime: 60,000 Units taken empty stomach once-a-week for 12 weeks followed by maintenance doses as per individual levels). Also, vitamin D is available in dietary supplements and foods such as salmon and eggs, as well as enriched milk and orange juice.

What Are the Adverse Effects of Sunscreens?

• Feeling of stickiness or greasiness and increased sweating is common with thicker sunscreens with higher SPFs, especially in patients with oily skins, and during humid weather.

• Skin reactions (redness, irritation, burning sensation) : They are fairly common and more common in sensitive skins. Reactions to older sun-screens were due to PABA. However, newer sunscreens are PABA-free, and contain safer derivatives. To determine the suitability of a particular sunscreen for an individual, a patch test may be conducted by applying the sunscreen to a small skin patch and exposing it to sunlight to look for any reactions. If they occur, avoid that particular sunscreen and consult dermatologists on icliniq to treat the reaction (usually with a brief application of a mild steroid) and help yourself in choosing a better sunscreen.

Conclusion

Sunscreens are essential in protecting the skin fro m permanent damage. Wearing sunscreens with SPF 50 can help to protect various UV rays and prevent skin damage.