QUESTION: “Hello Dr. Neal, I listen to your podcast every day. I find the information helpful and intriguing, not to mention thought provoking. Thank you for sharing this life-changing information with us. I am a 57-year old male living in Southern California. Last year, a very good friend of mine was diagnosed with Melanoma skin cancer on his neck and he is working through his treatments now. My wife is very concerned that I may a candidate for this type of cancer because I rarely put on sunscreen when I work and play outside. I am willing to apply a preventative lotion on my neck daily, but I don't want to smell like a coconut. What preventative application do you recommend and is a one-time daily application, like Supergoop-brand sunscreen, adequate to hedge against skin cancer? Thank you in advance for your response.”
DR. NEAL: Thank you for taking the time to send your question.
First, I’m very sorry to hear about your friend and his diagnosis. I’m sending healing thoughts his way.
I recently had some suspicious moles removed from the middle of my back. I’ve always had moles, so getting one or two removed here and there is nothing new.
Even though I am darker-skinned, I’ve always been good about wearing sunscreen and have been lucky enough to have only experienced one instance of getting sunburned. When I’m not wearing a hat outside, I’ll even put sunscreen in my hair to protect my scalp!
But at a recent routine visit to my dermatologist (a doctor that specializes in skin health and skin conditions), they expressed some concern about a little mole cluster in the middle of my back.
Again, I’ve had moles removed before and usually the doctor will say something to me like, “It’s probably no big deal, but let’s remove these moles just be safe so that they become cancerous later.” Instead, this time, as the doctor was examining this particular mole cluster, they said things like: “Hmm… how often do you wear sunscreen? How many times have you been sunburned? How often have you been sunburned in this area of your back where these moles are?”
Luckily, the moles turned out to be benign – meaning, they were harmless.
But it served as a reminder that I need to stay vigilant about wearing sunscreen and not get sunburned.
Sunburns and Skin Cancer
Now, I keep mentioning sunburns. This is because researchers have found that sunburns dramatically increase risk for skin cancer. More sunburns lead to a potentially higher risk for skin cancer later in life.
But, we’re learning that sunburns aren’t the only potential problem. Long-term sun exposure in general, without sunburns, can increase our risk for skin cancer… especially among those that have fair skin. So, doctors recommend that we wear sunscreen anytime we’re going to be outside. Which brings as back to your question.
Are there sunscreen options that will help prevent skin cancer but that are, first, easy to apply and can last all day without reapplication, and second, don’t make you smell like you just bathed in coconut water.
Luckily, there are.
When to Wear Sunscreen?
Here are some recommendations according to the American Academy of Dermatology Association:
First, as I mentioned before, they recommend we wear sunscreen anytime we’re spending time outside… even on cloudy days. The purpose of wearing sunscreen is to protect our skin from harmful ultraviolet rays (sometimes referred to as UV rays). It is these UV rays that increase our risk for skin cancer. But, how much sunscreen do we need to apply and how often?
It’s recommended that we apply sunscreen to any area of the body that’s being exposed to the sun. No duh, right? But, there are areas we tend to forget about. Art, you mentioned applying sunscreen to the back of your neck. That’s great, but don’t forget your ears, forehead, nose, cheeks, and lips. Now, applying sunscreen to the lips wouldn’t be all that pleasant, so it’s best to find a lip balm that contains sunscreen.
The goal should be to apply sunscreen that protects from both ultraviolet A and ultraviolet B rays (abbreviated UVA and UVB), with an SPF of 30 or higher, and is water resistant. And, be sure to apply it at least 15 minutes before going outside.
When it comes to types of sunscreen, I have to quote the American Academy of Dermatology Association here:
“The best type of sunscreen is the one you will use again and again.”
In the U.S., sunscreens are regulated by the Food and Drug Administration and are considered over-the-counter drugs. It’s unlikely that you’ll end up purchasing one that is completely ineffective. Instead, the type of sunscreen you prefer to use is a matter of personal choice.
If you prefer unscented varieties, that’s fine. Whichever you end up choosing, the trick is to look at the instructions on the bottle and follow them. If it says to reapply every 2 hours, be sure to do so. If it says to reapply after exposure to moisture, do it.
Again, the most important thing is regular use and to be sure to apply it to all areas of the body exposed to the sun.
Which Sunscreens Are Safe?
QUESTION: “Hi Dr. Neal, I'm a menopausal woman who has lived in Florida most of my life. I know sunscreen and moisturizers are extremely important, but I worry about using the right brand. I've heard of FDA doesn't regulate topical products much and the labels are impossible to understand. I don't want to do more harm than good when I apply skin care products. What do you recommend me? Thanks in advance for your help.”
DR. NEAL: Thank you for your question. We know that certain chemicals can be absorbed through the skin. We’re learning more and more about which chemicals are more likely to be absorbed and in what forms.
Sunscreen comes in many different forms – it can be applied as a lotion, a cream, or sprayed on.
Chemical vs. Physical Sunscreens
Plus, there are different categories of sunscreen: there are chemical sunscreens and physical sunscreens.
Within chemical sunscreens, there are some common compounds typically found in these products: oxybenzone, avobenzone, octocrylene, and ecamsule. These chemicals are great at absorbing the harmful UV rays. Physical sunscreens are often made up of zinc or titanium dioxide. Instead of absorbing UV light, these compounds reflect it.
The trick with using physical sunscreens is it needs to be visible on the skin. Both zinc and titanium dioxide should appear white when applied to the skin. I’m sure you know what this looks like.
If you need a visual think Sean Penn’s character Spicoli from the movie, Fast Times at Ridgemont High. He sported that white, physical sunscreen on his nose in those beach scenes.
In a more recent example, Mark Zuckerberg also sported the white physical sunscreen look.
— New York Post (@nypost) July 19, 2020
Many folks don’t want that to be visible on their faces, let alone the rest of their body.
FDA and Chemical Sunscreen Safety
You are correct that here in the States, the Food and Drug Administration (FDA) is supposed to regulate the safety of ingredients found in sunscreens. But they’ve been a bit lax on this.
More recently, the FDA has come under scrutiny for being less vigilant about the safety of chemical sunscreens. So, they are asking sunscreen manufacturers to provide more safety data about these products.
For now, the Harvard School of Public Health and the FDA state that there is no relationship between the chemicals commonly found in these products and any negative health effects. But both agree that more studies would be helpful.
Which Sunscreen Ingredients Are Not Safe?
There are, however, two ingredients that are not recognized as safe.
These are para-aminobenzoic acid (also known as PABA) and tolamine salicylate. But, you can rest easy because products that contain these chemicals are no longer sold in the U.S.
When it comes to moisturizers, we likely only need to concern ourselves with one chemical ingredient: phthalates. Pthalates act as skin softeners and moisturizers. But, phthalates aren’t just found in self-care products. They’re basically everywhere. They’re often used to preserve food and even found in our food packaging. It is for this reason that, back in 1999, the European Union restricted the use of 6 different types of pthalates.
So, the question now is: how much exposure to parabens and phthalates, in particular, is too much exposure? Sadly, we don’t know. This is why many toxicologists will advise us that we limit our exposure just in case.
So if you can find phthalate-free moisturizers that would be ideal. Most products will clearly state they’re phthalate-free right on the packaging.