Debunking myths, misconceptions and misinformation about sunscreens: no evidence they cause cancer, but they do expire

Photo illustration from M.D. Anderson Cancer Center

By Gina Van Thomme and Kellie Bramlet Blackburn

MD Anderson Cancer Center

Sunscreen is a hot topic – and not just because it’s a summertime staple!

There are also many myths and misconceptions surrounding sunscreen’s safety, effectiveness and usefulness.

So, if you’ve ever been confused about when – or if! – to use sunscreen, you’re not alone.

We asked MD Anderson Cancer Center dermatologist Anisha Patel about common sunscreen myths. Read on for her answers.

Myth 1: All sunscreens work the same way.
False. Sunscreens can prevent sunburn in different ways:

• Chemical sunscreens: The active ingredients in chemical sunscreens absorb ultraviolet (UV) rays as they hit the skin, Patel explains.
• Physical blocker sunscreens: Physical sunscreens, which are also called mineral sunscreens or sun blocks, use ingredients such as zinc oxide and titanium dioxide to form a barrier on the skin’s surface that reflects UV rays.

Not sure whether to use a chemical or physical sunscreen? Hybrid sunscreens contain both chemical absorbers and physical blockers.

When selecting a sunscreen, Anderson dermatologists recommend choosing a broad-spectrum product with at least sun protection factor (SPF) 30. 'Broad spectrum' means the product protects from both UVA and UVB rays which can lead to sun damage and skin cancer. SPF refers to the amount of UVB rays it blocks.

Myth 2: It doesn’t matter what kind of sunscreen I choose.
False. While wearing sunscreen is always a good choice, each type of sunscreen has instructions that must be followed to ensure your skin is protected.

Sunscreen comes in formats including cream, lotion, spray, powder and stick.

Each type of sunscreen has benefits and limitations. For example, many spray sunscreens are clear and absorb into the skin quickly, but this feature can make it challenging to see if you’ve missed a spot.

Overwhelmed by options? Anderson dermatologists recommend physical blocker sunscreens. Patel says this is because they have the broadest range of UVA and UVB protection.

Whatever type of sunscreen you choose, always review its instructions for information on how – and how frequently – to apply and reapply.

Myth 3: Sunscreen causes cancer.
False. There is no medical evidence that sunscreen causes cancer. However, there is a lot of evidence that UV rays from the sun and tanning beds do.

In the past, some sunscreens were recalled for being contaminated with a chemical called benzene. Benzene is not normally found in sunscreen. This recall doesn’t mean you should stop wearing sunscreen, dermatologists say.

Still, some may feel more comfortable using sunscreens that don't absorb into the skin – that is, those physical blockers sunscreens described above.

Additionally, sunscreen isn’t the only way you can practice sun safety. “There are a lot of sun protective options outside of just the creams and sprays,” Patel says.

Other ways to protect yourself from sun damage include:

• Wearing protective clothing that is dark and tightly woven, with ultraviolet protection factor (UPF) 50+
• Wearing a wide-brimmed hat
• Wearing sunglasses with UVA and UVB protection
• Seeking shade between 10 a.m. and 4 p.m. when sun rays are strongest

Myth 4: I have dark skin. I don’t need to wear sunscreen.
False. Dark skin is susceptible to sun damage.

It takes more sun exposure for darker skin types to get sun damage, Patel says. She explains this is because melanin, which gives skin its color, provides DNA with a small amount of sun protection. Still, this small amount of protection doesn’t prevent sun damage altogether.

“Darker-skinned people can still get a sunburn, still get skin cancers and definitely still get photoaging from UV exposure,” Patel says.

Regardless of your skin color, apply sunscreen liberally 30 minutes before going out in the sun, and don’t forget to reapply every two hours or after swimming or sweating.

Myth 5: My sunscreen is waterproof, so I don’t need to reapply it after swimming or sweating.
False. According to the Food and Drug Administration, there is no such thing as waterproof sunscreen.

There is, however, water-resistant sunscreen. The FDA says these products offer water-resistant sun protection according to the time and SPF level specified on each product.

Heading for a beach day or outdoor workout? Choose a water-resistant sunscreen and follow the product instructions on how often to reapply.

 
Myth 6: My sunscreen is SPF 50, so I don’t need to apply it as often.
False. No matter the SPF number, chemical absorber sunscreens only work for about two hours and should be reapplied after swimming or sweating.

Regardless of the SPF level you choose, you need to reapply with the same frequency, Patel says.

If you have trouble remembering to reapply, Patel suggests using a physical blocker sunscreen. These products don’t rub in or disappear into the skin, so it is easy to determine when to reapply.

“If you can see the white on your face, it's still working,” she says.

Myth 7: There is SPF in my makeup. I don’t need to wear sunscreen.
False. While Patel says that sunscreen in makeup counts, it usually doesn’t provide the recommended SPF levels.

“It's typically only 5 to 15 SPF, and we recommend 30,” she says.

Check that your makeup offers at least 30 SPF, and supplement with additional sunscreen as needed. Finally, don’t forget to apply sunscreen to other exposed areas of your body, and make sure you reapply sunscreen as directed throughout the day.

Myth 8: I only need sunscreen when it is sunny.
False. Sunburn and sun damage may be associated with hot, sunny weather, but they can also occur in cold, cloudy conditions.

“Even when it's cold, sun is getting through the clouds,” Patel says.

While clouds filter some UVB rays, they don’t block UVA rays which are a risk factor for melanoma, she adds.

So even if it’s cloudy or cold, you need to apply your sunscreen the same way you would if it were a warm sunny day.

Myth 9: Sunscreen doesn’t expire.
False. “You cannot rely on expired sunscreen,” Patel says. “Nothing bad is going to happen if you use an expired one in terms of increased toxicity. It just won't work.”

It is also important to store sunscreen properly. Specific storage instructions can be found in the product’s ‘Drug Facts’ section.

For example, if you store your sunscreen in a hot car or in direct sunlight, Patel says the product could degrade earlier than its expiration date.

"You have to look at the storage recommendations. Sunscreen will only last until the expiration date if you keep it within those temperature ranges," she says. "If you go outside of those temperature ranges, the molecules that are protecting your skin will degrade faster.”

How to use sunscreen to protect your skin, reduce cancer risk

Photo from Harris Dermatology

By Penn State Health

Summer has arrived and with it so have dreams of beach vacations, trips to the waterpark and outdoor activities. After months of winter’s colder temperatures, you’re ready to get outside in search of that warm feel of sun on your skin and the resulting “healthy glow.”

Sure, the sun feels good, but while everyone needs limited sun exposure to produce vitamin D to strengthen bones, unprotected exposure to the sun’s ultraviolet rays can damage skin and increase the risk for skin cancer.

But there’s no need to be a recluse, says Dr. Charlene Lam, a Penn State Health dermatologist. Just be smart about your time in the sun and protect your skin by taking a few preventive steps, including routinely using sunscreen.

How sunscreen keeps you safe

“It is not just the day out at the beach or waterpark when you need sunscreen, but every time you go out – when you get the mail, walk the dog – all of that exposure to the sun can add up to damage and lead to skin cancer, aging skin, dark spots and wrinkles,” she said. “Although there is no single method that protects you perfectly, there are different modalities we can be smart about and adopt into our lifestyle as daily habits.”

One is the regular use of sunscreen, which protects your skin by absorbing or reflecting the sun’s ultraviolet (UV) rays that damage skin cells.

“There are two types: UVB rays, which cause sunburn and play a key role in skin cancer, and UVA rays, which cause skin damage that leads to tanning, aging of skin and wrinkles,” Lam said. “That’s why it’s important to choose a broad-spectrum sunscreen that protects you from both.”

She also recommends choosing a sunscreen with a sun protection factor – or SPF – of 30 or higher. Although high SPF sunscreens protect from burning for longer periods of time than those with lower SPF, they can give the user a false sense of security.

“Sometimes what I see are people who use an SPF 50 will stay in the sun longer and won’t reapply. They end up getting more sun damage, and it defeats the purpose,” Lam said. “If you use a 30, know that you need to reapply every two hours, more if you get wet or wipe it off.”

How to properly apply sunscreen

The best type of sunscreen is the one that you’ll use regularly. Whether you prefer a cream or an aerosol, there are a few tips when it comes to application that can make the difference in its effectiveness. In addition to applying it 30 minutes before you go outside, remember that coverage counts.

“The big thing is to make sure you are using enough. On average, an entire body requires about an ounce or shot glass full for full coverage. A nickel-sized dollop is required for the entire face alone,” Lam explained, adding that with a spray sunscreen, it is important to get an even sheen across the skin and to spread it out. “Typically, a family of four should use one four-ounce bottle per person for a day-long event.”

Don’t forget those sensitive areas, such as the top of your ears, back of the neck, the scalp along the part, tops of your feet and behind your knees.

All skin types deserve sunscreen

Despite what you may have heard, everybody can get sunburned, no matter what type of skin color they have. Men, women and children over six months should use sunscreen, including those who tan easily. The best defense is to use multiple modalities of sun protection, Lam said.

“Protective clothing, hats, sunglasses, avoiding mid-day sun from 10 a.m. until 2 p.m. and seeking shade are all good ways to protect yourself from the sun,” she said. “But shade isn’t a perfect shield. Some UV rays can still reach out, reflecting off water, sand, glass, concrete and snow.”

But protection from sunburn isn’t the most important reason to wear sunscreen.

“Your skin is damaged by sun exposure over your lifetime, not whether or not you burned. If you have skin, you can get skin cancer,” Lam said. “Once you burn, it is a clear indication that you’ve had too much sun. The burn will heal, but the damage is done. The thing is to learn from that burn, and make it your last.”

What are the best sunscreens for children? Los Angeles Children's Hospital has advice.

After receiving 600 public comments, health cabinet removes proposal to ban tattoos on scarred skin in updated regulation

By Melissa Patrick
Kentucky Health News

The state Cabinet for Health and Family Services has updated its requirements for tattoo studios in Kentucky, and they no longer prohibit tattoos on scarred skin, as first proposed.

WFPL photo

The cabinet said in a news release it had received more than 600 public comments on this proposal. In addition, WHAS-TV reported that almost 100 people from all over the state attended a public hearing about the issue May 28 in Frankfort.

"Based on comments received, we elected to remove the language relating to scar tissue," Dr. Jeff Howard, commissioner of the state health department, said in the release.

Opponents of the proposal have said there is no medical reason to ban such tattoos. Others have said such a ban is a violation of their civil rights, and there are already industry rules around this issue. Still others pointed out the many reasons people want to cover their scars, including cancer survivors who want to cover their mastectomy scars.

The state announced the original amendment to the regulation in April, which simply said "tattooing over scarred skin is prohibited." The proposal did not give any reason for adding this language; when asked about it, a cabinet spokesman said only that the proposal was made in an effort to update a regulation that hadn't been updated in 15 years.

In May, the health commissioner issued another release, saying the proposal to ban tattooing on scarred skin in the regulation "had some unintended consequences" and that the language regarding this issue would be addressed once the public comment period ended on May 31.

On Tuesday, July 16, the cabinet announced that the ban had been removed, citing a "a lack of available evidence to support this prohibition." It said the intent of the first revision was to prohibit the tattooing of freshly scarred skin, but "freshly" was left out.

Under the new rule, which next goes before the Administrative Regulation Review subcommittee, a person registering as a tattoo artist will have to complete training about blood-borne pathogens. The rules also outline a registration process for tattoo studios and increased fees to offset inspection cost.

The regulation also updates requirements for disinfecting and sterilizing equipment and adds a new rule to require a notarized statement of parental consent for a minor who is seeking a tattoo without a parent or legal guardian present.

Summer's here, which means it's time to protect our skin from the sun and keep a regular watch for skin cancer

Chart from Great Plains Center for Agricultural Health; click on it
to view a larger version; to download a full-size version, click here.

Friday, June 1 is the start of meteorological summer, which is a great reminder to make sure you have enough sunscreen on hand and to remember to check your body for skin cancer.

The American Cancer Society says the top cause of skin cancer is exposure to ultraviolet, or UV, rays from the sun or other sources like tanning beds.

To protect yourself from the sun, the ACS recommends wearing clothing and a wide-brim hat to protect as much skin as possible; using a broad-spectrum sunscreen with a SPF of 30 or higher, and to reapply every two hours, as well as after swimming or sweating; staying in the shade if possible; and avoiding tanning beds and sunlamps.

But it's also important to be careful when using sunscreens on children.

Brenda Goodman of WebMD reports on a 14-month-old child who is recovering from a "painful, blistering rash that spread over her cheeks and nose, right where her mom had spread a palmful of Banana Boat Kids Free spray sunscreen."

The U.S. Food and Drug Administration is investigating the case, and told WebMD that it is aware of three other Canadian children who had reactions to the same product.

Dr. Alok Vij, a dermatologist at the Cleveland Clinic, told WebMD that he thought the reaction was something called a photoallergy, which happens when the sunlight combines with a chemical to cause a chemical reaction.

His advice to parents includes: Keep kids out of the sun during the brightest parts of the day, 11 a.m. to 4 p.m.; use sun-protective clothing; use mineral-based sunscreens, like those with zinc or titanium; and avoid spray sunscreens. 

The American Academy of Dermatology reports that one in five Americans will develop skin cancer in their lifetime.

 The doctors at University of Louisville Physicians – Surgical Oncology, in a U of L news release, recommends regular skin self-exams after a shower or bath.They note that it's important to learn where your birthmarks, moles and blemishes are located, and to take note of how they usually look and feel. Family members can examine areas that are hard for an individual to see.

"Using a full-length mirror and a hand-held mirror, check for anything new such as a mole that looks abnormal, a change in size, shape, color or texture of a mole or a sore that doesn’t heal," the doctors advice. "Check yourself from head to toe, including all areas and crevices of the skin."

They also offer these "ABCDE" tips to help you remember what to watch for:

• Asymmetry – The shape of one half does not match the other.
• Border – The edges are often jagged, uneven, distorted or atypical in outline; the pigment may spread into the surrounding skin.
• Color – The color is uneven. Shades of black, brown and tan may be present. Areas of white, gray, red, pink or blue also may be seen.
• Diameter – There is a change in size, usually an increase. Melanomas are usually larger than the eraser of a pencil (1/4 inch or 5 mm).
• Evolution – Anything that changes over time. It is important to call a dermatologist if you find one of these suspicious characteristics.

And just because you have dark skin doesn't mean you shouldn't check yourself. A 2016 American Academy of Dermatology study, “Racial Disparities in Melanoma Survival,” found that while melanoma incidence is higher in whites, death rates are relatively higher among people of color.

 “Far too often, black, Hispanic, and Asian patients with melanoma cancer tell us they believed that melanoma was only a danger for sun-seeking whites,” says the study report. “But anyone – regardless of skin color – may develop melanoma, in both sun-exposed and sun-protected sites. Not noticing or ignoring a new or changing mole in a sun-protected site can be fatal.”

Many Americans still don't use sunscreen, which has been proven to prevent skin cancer, the most common cancer in the U.S.

Sunscreen has been proven to reduce the risk for all types of skin cancer and to prevent or delay signs of aging, but most Americans still don't use it regularly, according to a new study by the federal Centers for Disease Control and Prevention.

The study, published in the Journal of the American Academy of Dermatology, found that only 14 percent of men and 30 percent of women regularly use sunscreen both on their face and other exposed areas. It also showed that more than 40 percent of men and 27 percent of women never use sunscreen on their face or other areas of exposed skin when outdoors for an hour or more, Carrie Myers reports for HealthDay News.

"The overwhelming majority of melanomas -- the deadliest form of skin cancer -- and non-melanoma skin cancers are associated with exposure to ultraviolet radiation from the sun," Dr. Deborah Sarnoff, senior vice president of the Skin Cancer Foundation, told Myers. "That's why daily sun protection is critical," she said.

The foundation recommends that when you are out in the sun you should seek shade, wear protective clothing, including a broad-brimmed hat, wear UV-blocking sunglasses and wear a broad-spectrum daily sunscreen that has an SPF of 30 or higher and is water-resistant,of which you should check the expiration date, Sarnoff told Myers.

The study also found that nearly 40 percent of sunscreen users didn't know whether their sunscreen provided broad-spectrum protection.

"Broad-spectrum means that the sunscreen protects the skin from both UVA and UVB rays. UVB rays are responsible for sunburns, while UVA rays go deeper into the skin, causing sagging and wrinkling. It is believed that both UVA and UVB rays play a role in skin cancer," Myers writes.

"To take advantage of the full protection your sunscreen offers, it should be applied thickly to all exposed skin and reapplied every two hours and after swimming, sweating, and toweling off," Dawn Holman, lead author of the study, told Myers. "Sunscreen is most effective when paired with other forms of sun protection."

Holman recommended products with physical blocks, such as titanium dioxide and zinc oxide, for those who shy away from sunscreens because they fear the chemicals in them. She also told Myers that everyone should avoid midday sun exposure because that is when the UV rays are most intense and encouraged people to check the UV index before going outdoors, saying, "The higher the UV index, the more sun protection you will need."

Skin cancer is the most common cancer in the United States, according to the CDC. The most severe form, melanoma, causes more than 9,000 deaths a year in the United States, Myers reports.

FDA issues warning label for tanning bed use by minors; sponsor of bill for a state ban says he will try again

Soon tanning beds will have a "black box" warning that those younger than 18 should not be using them, but some doctors, tanning companies and legislators do not think this will be sufficient to keep minors from tanning. "Consequently, some want a new Kentucky law prohibiting bed use by minors," Annie Garau writes for the Lexington Herald-Leader.

Lexington Herald-Leader graphic

The U.S. Food and Drug Administration announced May 29 new regulations that moved sunlamps from the category of low-risk devices—like dental floss and tongue depressors—to moderate-risk devices. Tanning beds are dangerous because they emit ultraviolet rays like the ones from the sun. These ultraviolet rays not only cause wrinkles and eye damage but also cause skin cancers, including melanoma, which is the most deadly kind of skin cancer, according to the FDA and local doctors.

"There's really no way to get a tan right now without incurring the risk of cancer," said Dr. John D'Orzio, a researcher and pediatric oncologist at Kentucky Children's Hospital. "I don't want to tell people not to go outdoors at all because that would be ridiculous, but the actual ultraviolet radiation from the beds can be up to 10 times more than from standing in the sun." D'Orazio said his biggest concern is that children under 18 have access to the tanning beds. Currently Kentucky only requires "signed parental consent for teens ages 14 to 17 and in-person parental consent for anyone younger than 14," Garau writes.

Mark Wells and Cheryl Ledford, co-owners of Southern Rays Tanning, do not think the new warnings will turn customers away. "There has always been some kind of warning on the beds," Ledford said, "and they haven't stopped people from tanning."

Wells said there are health benefits to tanning, such as increased Vitamin D, the fading of acne and getting a "base tan" indoors to prevent burning outside. D'Orazio disagreed. "A base tan is not going to help you avoid the risks," he said. "You're still getting ultraviolet radiation while you're getting that base tan. Also, it really only takes about one minute of standing in the sun to get enough vitamin D. . . . This is a multibillion-dollar industry. That's a lot of money going into downplaying the negative consequences."

American Academy of Dermatology President Dr. Brett Coldiron said that although sometimes dermatologists prescribe phototherapy as a treatment, "The difference between phototherapy and indoor tanning is that phototherapy is closely monitored and supervised by a dermatologist. This type of medical care isn't provided at an indoor tanning salon, where operators have minimal knowledge about the potential side effects of UV light, and tanning bed lamps have variable amounts of UVA and UVB light."

State Rep. David Watkins, a Democrat and retired physician from Henderson, wanted to prevent Kentucky minors from using tanning beds without a medical prescription, but the Senate Health and Welfare Committee killed his House-passed bill. "I think I'm going to have to work a little harder and make sure my colleagues in the Senate understand that I'm not trying to limit freedoms," Watkins told Garau. "I'm trying to protect some of our most vulnerable constituents." (Read more)

Season has arrived for poison ivy, oak and sumac; here's plenty of advice on how to deal with them and their rashes

Leaves of three, let them be.

This old childhood rhyme still holds true today,well at least for poison oak and poison ivy. Poison sumac has seven to 13 leaflets on each leaf. But the result is the same: If you come into contact with the oil from their leaves, you are likely to end up with a an itchy rash that can last from one to three weeks.

About 85 percent of people will develop an itchy, blistering rash when they come in contact with the oil from these plants, says the American Academy of Dermatology in a news release.

The rash itself isn't contagious, but the oil is, and it can linger on just about any surface: skin, clothes, under fingernails, tools, pets -- you get the picture. It can even come through the air if someone is burning brush. So, you can get poison ivy, poison sumac or poison oak without stepping one foot into nature.
Avoiding the plants and wearing protective clothing are the two proven ways to avoid getting a rash from these plants.

“If you are absolutely certain that your rash is due to poison ivy, poison oak, or poison sumac, and if the rash appears on a small section of your skin, you may be able to treat the rash at home,” Seemal R. Desai, dermatologist from Texas, said in the news release. “However, if you have difficulty breathing or swallowing, you experience swelling, or you have many rashes or blisters, go to the emergency room right away.”

The association also recommends going to the emergency room if the rash covers most of your body, if your eyelid swells shut, if the rash develops anywhere on your face or genitals, if much of your skin itches, or nothing seems to ease the itch.

Fortunately, there are simple steps people can take to safely treat a mild rash at home. Here are the association's recommendations for treating mild cases of poison ivy, poison oak or poison sumac:

1. Immediately rinse your skin with lukewarm, soapy water. Initially take a shower, not a bath, to get the oil off of your body.
2. Wash your clothing.
3. Wash everything that may have come in contact with the oil from the leaves.
4. Do not scratch. Scratching can cause infection.
5. Leave blisters alone. If blisters open, do not remove the overlying skin, as the skin can protect the raw wound underneath and prevent infection.
6. Take short, lukewarm baths to relieve the itch. Add colloidal oatmeal from the drugstore or one cup of baking soda to the running water for additional relief.
7. Consider using calamine lotion or hydro-cortisone cream.
8. Apply cool compresses to the itchy skin.
9. Consider taking antihistamine pills. These pills can help reduce itching, however use with caution. Call your doctor if you are uncertain if you should take an antihistamine.
10. Do not apply a topical antihistamine to your skin; doing so can worsen the rash and the itch.
11. See a dermatologist if the rash has not improved within 10 days.