Staying safe in the summer sun

By: Pat Anderson, NBC-HWC

Calling all sun-worshippers! July is high-season for catching some rays, working on that golden tan, and playing hard while the sun smiles down upon us. July is also UV Safety Awareness Month. Talk about throwing a damper on the fun…. but you can have your fun in the sun and be safe too!

July is the peak of summer in the northern hemisphere. ​

The U.S. Centers for Disease Control and Prevention (CDC) warns that:

• skin can be damaged by as little as 15 minutes of sun (UV) exposure
• skin cancer is the most common form of cancer in the U.S. 
• one in five Americans will develop skin cancer in their lifetime
• one American dies from skin cancer nearly every hour 
• unprotected exposure to UV radiation is the most preventable risk factor for skin cancer

What exactly is UV light, anyway? 

UV light is a form of electro-magnetic radiation that falls between visible light (white light and the rainbow) and x-rays. The frequency is higher than violet light (hence, ultra-violet) in the rainbow spectrum. 

“UVA,” the so-called “tanning rays” make up 95% of the UV light reaching us. These rays can penetrate deeply into our skin (including connective tissue!), causing premature aging and sometimes the more deadly form of skin cancer called melanoma.

“UVB” rays cause sunburn, and over-exposure can lead to the non-melanoma forms of skin cancer that seem to be all-too common.  

Isn’t sunlight healthy for us? 

Yes……but not always.   

In moderation and outside of the peak UV index times (see below), sunlight can be very beneficial, even critical to our wellbeing. 

Our bodies make Vitamin D, aka "the sunshine vitamin,”  with adequate sun exposure. Vitamin D is essential for immune function, bone health (rickets, osteoporosis) and for regulating many other functions in our body. 

Historically, phototherapy (sunlight & UV exposure) was a popular medical treatment for Tuberculosis and rheumatic disorders including: diabetes, gout, chronic ulcers, and wounds.

Today, sunlight is known for so much more! Sunlight: 

• is believed to assist in the release of serotonin
• is a mood booster and calming agent
• helps regulate sleep and circadian rhythms by regulating melatonin
• benefits those with premenstrual syndrome, and seasonal affective disorder (SAD)

It's also worth noting that UV light increases endorphin levels in our blood.  Endorphins are our natural opiates—the kind that make us feel good without feeling regret later. UV light is also linked to impairment of certain immune functions, which may explain why it is effective in treating skin issues, such as psoriasis. These same mechanisms may help prevent auto-immune disorders.

Too much of even a good thing can be bad...especially over-exposure to UV radiation 

Too much UV exposure is linked to:

• UVB: sunburn, non-melanoma skin cancer
• UVA: melanoma, premature aging
• All forms: cataracts, hypersensitivity to sun exposure, “sun poisoning,” eruption of cold sores caused by the Herpes simplex virus, and possibly immune system impairment.

A cautionary tale on sunburns

Just one blistering sunburn doubles the risk of melanoma.

​If that is true, I must have at least 20 times the risk!  With my pale, freckling complexion, blue eyes, and light hair, I could be the poster child for “most at risk for sunburn and the evil effects of UV exposure.” 

I spent my childhood dreaming of a Coppertone tan, but in reality I looked more like a lobster. My friends and I didn’t know any better then, although our moms warned us about getting wrinkles. When you are 13, wrinkles are the least of your worries! We were laser focused on whether that cute guy (while admiring our tan) might find the courage to ask us to the dance. So we “laid out” on a towel, sweaty and hot, periodically rotating so we would be evenly “done,” and feeling more like a chicken on a rotisserie than a “chick.”

And, guess what? Now that I care about the wrinkles, I can’t take it back. I live every day wondering whether that little bump on my back or darkish freckle on my face might be the big C.

But you, my friend. You can do better. Learning from my mistakes, so you don’t look decades older than your years would imply.

The takeaway: there is no such thing as a “healthy” tan.

---

What’s a sun-loving person to do? ​

How can you still love the sun, but keep the wrinkles, freckles, sunburns and visits to the dermatologist at bay?

Start with the basics. Let’s face it—common sense is not always common practice.
 
I know, you’ve read these basic tips a thousand times, but bear with me, and read them once more … this time, really taking them to heart:

• Wear sunscreen that provides both UVA and UVB protection with an SPF of at least 30 (but no higher than 50). Find out about the best sunscreens below.​​

• Protect those peepers. The American Academy of Ophthalmology recommends always wearing sunglasses with 100% UV protection during peak sunlight hours (5). Dark shade and mirrored glass is optional.
• Wear protective clothing such as wide-brimmed hats, pants, and long sleeved shirts, when possible. Tighter weaves and darker colors are more protective. I know, they are also hotter to wear —suck it up, save your skin! 
• The sun is at its strongest from 10 a.m. to 3 p.m., so plan to spend this time on indoor activities or in the shade.
• Avoid tanning beds.  Seriously - so not worth the risks!
• Check the UV index when planning outdoor activities to know just how intense the UV exposure is expected to be.  And yes, there’s an app for that!  If the index is above a 5, sun protection is in order.
• Remember that cloudy days are deceiving—light cloud cover does not block UV light, so these protections are still important.

What to do: “The Good, the Bad, and the Ugly”

Three year old: sun-safe from head to rump!

The Good:
​our skin is a busy organ! 
​
​We take our skin for granted, more concerned about how we look in it—joking about how well our “birthday suit” fits (or doesn’t), too often unaware of what a life-saving gift we wear every day of our life.  

In fact, our skin “suit” is the body’s largest organ, critical for life-preserving functions including:

​

• protection from pathogens and irritants
• shock absorption
• tactile sensation (what would life be like without touch?!)
• vitamin D synthesis
• temperature control
• lubrication and waterproofing 
• detoxification

 
In order to do all these amazing functions, the skin must be porous. This means, not only can things like sweat and toxins exit through the skin, but good and not so good substances can enter the body through the skin. 
 
In fact, we should care as much about what we put on our skin, as what we put in our mouths. That cosmetic, lotion, or other substance can easily enter our bloodstream through our skin.  
 
The skin is so efficient in absorbing substances that some medications and supplements are delivered this way, such as nicotine patches, hormone replacement therapy, magnesium (ever soaked in epsom salts?) and many others.  
 
What does this have to do with UV safety? As it turns out, a whole lot!

The Bad:  are sunblocks harmful?

Several recent studies concluded that when sunscreens are applied as directed, some ingredients from the sunscreen are absorbed into the body and may remain in the body for extended periods of time. These studies support a February 2019 proposed FDA rule updating sunscreen standards. 

The Environmental Working Group (EWG) publishes an annual review of sunscreens, and releases recommendations on their safety and effectiveness. Yes, they too have an app. 

The Ugly: oxybenzone is found in many popular sunscreens.

The EWG report for 2020 found oxybenzone was in 40% of the sunscreens they tested. The FDA has raised concerns about this commonly used ingredient for many reasons. 

• Oxybenzone is allergenic.
• It is easily absorbed through the skin and stays in the body a long time, and has been found in human breast milk, amniotic fluid and blood.
• Oxybenzone is a potential endocrine disruptor. Endocrine disruptors impair many of our body's most important hormonal functions starting with reproduction (infertility and birth defects), immune impairment, increased cancer risk, and nervous system disorders. Do you really want to volunteer yourself and your family as lab rats until we know for sure? 
• Children may be more vulnerable to harm from oxybenzone than adults because of the potential for higher absorption.

 
The FDA has requested studies of oxybenzone that measure potential impacts on hormone levels, reproduction and development.
 
In addition to oxybenzone, the FDA is also proposing that 11 other common sunscreen ingredients be studied for safety, including: avobenzone, homosalate, octinoxate, octisalate, octocrylene, cinoxate, dioxybenzone, ensulizole, meradimate, padimate O and sulisobenzone. 
 
Retinyl palmitate is a form of Vitamin A often added to skin care products, including sunscreens. However, studies demonstrate a potential for retinyl palmitate to cause excess skin growth and create free radicals that cause skin damage during sun exposure. European researchers have raised concerns about the potential for excess Vitamin A exposure for consumers using these skin care products and also taking supplements.
 
Recommendation:  avoid these ingredients until they are proven safe.
 
What about aerosols? Sunscreens delivered as aerosols seem so convenient—and easier to hit that spot on your back that you can’t quite reach with your hand. However, aerosol applications are often uneven and they pose a risk of inhalation of the product, which could cause permanent lung damage, so stick with the lotions and creams.

The sunscreen / Vitamin D conundrum. The American Academy of Dermatology’s 2019 position statement on vitamin D concluded, “There is no scientifically validated, safe threshold level of UV exposure from the sun that allows for maximal vitamin D synthesis without increasing skin cancer risk.” So there you have it. Weigh the risk vs. reward when your unprotected skin is in the sun. 
 
The Good: should we just slather on the SPF 100?

In short, no. In recent years, sunscreens have evolved considerably. In addition to the common sense measures previously discussed (you did read those, right?) the FDA recommends the mineral-based blockers zinc oxide or titanium dioxide that physically block both UVA and UVB rays. Look for either of these as the active ingredient, and look for an SPF between 30 and 50 for the best protection during this peak sun season.

What exactly is SPF, anyway?  SPF stands for “Skin Protection Factor” and is a measurement of skin redness (sunburn) caused by UVB exposure of protected skin versus unprotected skin.   

True or False? The SPF number times the number of minutes it takes to start developing a sunburn determines the length of time you are protected from sunburn. For example, an SPF 15 would mean you can stay out 15 times longer than if wearing no sunscreen. FALSE! Until I did my research for this article, I thought this was true and found this advice still widely prescribed throughout the universe of Google. So, put your calculators away, SPF is not that straightforward.

In truth, the length of time a sunscreen application’s protection lasts depends on the intensity of the solar energy. The SPF is a measurement of the percentage of UV rays blocked. For example, SPF 30 blocks 97% of UVB rays. This is why your actual protection time can vary significantly during the day as the sun—and UV rays—intensify. (11)

Another key to understanding SPF is that it only relates to protection against the UVB rays that cause sunburn. SPF has no bearing on protection from UVA, which has more serious long-term effects on your skin health. Many sunscreens block little, if any, UVA. 

Broad spectrum sunscreens (as defined by the EPA) protect from both UVA and UVB.  However, most do not provide nearly as much protection from UVA. This increases the potential for premature aging and melanoma— even for those faithfully applying sunscreen regularly.

The EWG recommends that consumers avoid products that claim an SPF higher than 50. The FDA has voiced concerns that higher SPF’s give consumers a false sense of security, as the incremental coverage from higher SPF’s is minimal. So unless you are using a physical blocker like zinc oxide, you are getting little or no UVA protection.

---

Slather it on! ​

Most people under-apply sunscreen, and don’t reapply often enough, if at all. Under-application can greatly reduce the SPF value received. A good rule of thumb for average sized adults is to apply 1 ounce of sunscreen, or the equivalent of a shot-glass full.  It’s a perfect excuse to bring along that Jack Daniel’s shot glass to the beach! (As long as it's not glass, of course)
​
“Lather, rinse, repeat.” Reapply sunscreen often, at least every 2 hours, especially if you are swimming or sweating. Even so-called waterproof sunscreens rinse or rub off, eroding that SPF.

What kind of sunscreen should I use on a baby? 

Baby (over 6 months) in safe sunscreen & hat, in the shade to be extra sun safe.

If you have a baby under 6 months, keep Junior out of the sun! No sunscreen product is safe for infants. For babies over 6 months old, ask your pediatrician for recommendations, or look for products designated for use in infants, which contain zinc oxide or titanium oxide. 

The American Academy of Pediatrics (AAP) suggests dressing infants in lightweight long pants, long-sleeved shirts, and brimmed hats that shade the neck to prevent sunburn. Tight weaves are better than loose. (12) And be aware, infants are more prone to overheating because their sweat glands aren’t fully developed. Babies are also more likely to become dehydrated, as their bodies are around 75% water.  Perhaps the best plan is to keep Junior home with a sitter when you plan a day at the beach.

---

Special situations increasing sensitivity to UV light:

• medications (eg, antihistamines, oral contraceptives, NSAIDS like ibuprofen, certain antibiotics, antidepressants, antipsychotics and some cholesterol-lowering drugs)
• certain supplements and essential oils (such as St. John’s wort and lavender)
• over the counter skin treatments like Alpha Hydroxy Acid peels and Retin-A
• certain medical conditions (such as lupus) may cause photosensitivity, meaning a high chance of sunburn

Remember to protect:

• Lips: Some people are sensitive to lip balms with sunscreen, and you really don’t want those chemicals literally at the tip of your tongue.  Check EWG’s sunscreen recommendations for lip protection that you can feel good about using.

• Scalp: Apply sunscreen where your hair is parted, and anyone thinning on top should give extra attention to the scalp area, which gets the brunt of the sun, or just wear a hat that makes you look (and feel) really cool!

• Ears: Even if your hair covers them.  Along with scalp, face and nose, and lips, the tops of your ears are one of the most common areas skin cancer develops.
• Feet: Keep them covered, or slather on the sunscreen. Yes, right down to the little piggy toe!

Are you protected from UV rays in your car?  One summer I did a lot of driving, and realized my left arm was noticeably more freckled and tanned than my right.  Automobile windshields do block UVA & UVB, but other car windows generally do not block UV light. You can apply film to these windows that block UV and help keep your car cooler, without it looking like a mafia get-away vehicle!

Going for a Rocky Mountain high?  If you live in or visit high altitudes, the temperature may be deceptively cooler—but UV rays are more intense, so plan (and cover up) accordingly.  Same for a visit near the equator, UV rays here travel a shorter distance so are more intense.

So, find your favorite brand of fun in the sun, use your common sense and properly applied mineral based sunscreen, and enjoy your summer!  Oh, and, don’t forget the shot glass ;) 

For a partner in your health and wellness goals, including something as "simple" as changing your summer sun habits, book a session with one of our national board certified coaches. 

To learn more about Pat Anderson, visit her website or check out her VHC profile. 

References

1. https://www.cdc.gov/cancer/skin/basic_info/sun-safety.htm
   
2. https://www.aad.org/media/stats-skin-cancer
3. https://www.ccohs.ca/oshanswers/phys_agents/ultravioletradiation.html
4. https://blogs.cdc.gov/cancer/2019/05/01/the-truth-about-sunscreen-7-facts-that-will-set-you-straight-for-skin-protection-this-summer/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2290997/
6.  https://www.aao.org/eye-health/tips-prevention/sun
7. https://www.fda.gov/news-events/fda-brief/fda-brief-fda-announces-results-second-sunscreen-absorption-study
8. https://www.cdc.gov/niosh/topics/skin/default.html
9. https://www.federalregister.gov/documents/2019/02/26/2019-03019/sunscreen-drug-products-for-over-the-counter-human-use
10. https://www.ewg.org/sunscreen/
11. https://www.fda.gov/news-events/press-announcements/fda-advances-new-proposed-regulation-make-sure-sunscreens-are-safe-and-effective
12. https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/sun-protection-factor-spf
13. https://www.fda.gov/consumers/consumer-updates/should-you-put-sunscreen-infants-not-usuall
14.  https://www.who.int/news-room/q-a-detail/the-known-health-effects-of-uv
15. https://www.aad.org/news/aad-safety-of-sunscreens
16. https://www.skincancer.org/blog/what-you-need-to-know-about-photosensitivity/