By Leigh Ann Pansch, MSN, FNP-C, DCNP
In my busy dermatology practice, I have many opportunities to ask my patients about their sunscreen use. I’m always amazed at the answers I hear, ranging from “never” to “always” to “only on my ears.” The truth is, I think there are still many myths and inaccuracies about sun exposure, resulting in precancerous and cancerous changes to our body’s largest organ — the skin.
I wish my patients had the opportunity to follow me around for a day so they could see what I see! After viewing the countless number of skin cancers that steal skin from the nose, ears, arms, back and legs, they would always wear sunscreen — ALWAYS!
Now, I’d like to dive deeper and share some wisdom with you.
Avoid Myths … and Tanning Beds!
The most common misconception by far that I hear presumes tanned skin is somehow protective. Let’s start with the old “base tan” myth, which states, “If I get a base tan, I am protected.” The truth is, tan skin may protect some skin types from burning, but not from skin cancer. In addition, for those of you who still use tanning beds — which I liken to coffins because of their shape and risk — your chances of developing skin cancer after seven trips multiplies sevenfold! This is alarming. Please don’t ever use a tanning bed! We must remember that a tan is a natural response to ultraviolet radiation and is designed to happen over time. When you magnify the ultraviolet radiation into minutes of exposure, the likelihood of cells going rogue increases tremendously. It is simply not worth it. Your skin will still tan with the proper use of sunscreen, which acts as a preventive measure to lower the risk of skin cancer, photoaging and even some common skin rashes.
Know the Stats
The American Academy of Dermatology recommends that a broad-spectrum sunscreen with a 30 or greater sun protection factor (SPF) be applied to the entire skin surface after 15 minutes of sun exposure. Sunscreen should be reapplied every two hours. If you’re swimming or sweating, hourly re-application is recommended. Broad-spectrum indicates the sunscreen protects against ultraviolet A (UVA) and ultraviolet B (UVB) rays. UV light is associated with radiation. UVA rays induce premature aging like wrinkles and sunspots and UVB rays are responsible for burning. Exposure to these rays may cause cancerous skin changes. Understanding SPF involves a little math. For example, if you normally would start to burn in the sun within 10 minutes, application of a 30 SPF would turn that time to burn to 300 minutes (10 minutes x 30 SPF).
Many of my patients who use sunscreen are still surprised to hear about the need to apply it frequently. I am a mother of three beautiful daughters. If one of them is going to spend the day at an amusement park, I ensure they are prepared. We plan in advance to avoid the harmful effects of the sun. Planning might go like this — if I drop you off at 10 a.m., we’ll apply sunscreen before you leave, and I’ll put a small tube of sunscreen in your lunch bag so you can reapply at lunch. Let’s set an alarm on your watch or cellphone to signal that at 2 p.m. you should reapply. I’ve found these types of planning sessions are useful to avoid a bad sunburn.
I think another tip revolves around whose responsibility it is to apply sunscreen. I can’t even tell you how many times I’ve seen a mom be diligent with her family’s sunscreen, yet neglect to apply it on herself, and be miserable later with a burn. Children as young as 2-3 years of age can learn to apply sunscreen. Parents can model sunscreen application by doing it together as a family: “I’ll do this arm and you do the other while I observe.” This is a great strategy. Young, school-aged children can be fully responsible for application of their entire body once we’ve given them the skills to do so — modeling how to apply it to the entire skin surface. By the time my children were teenagers, I had exposed them to the facts about skin cancer, why we use sunscreen and sun-protective behaviors.
Know the Realities of Skin Cancer
For those of you who are still holdouts, I would encourage you to look up Mohs surgery to see some of the sobering images of skin cancer surgery. In addition, I often tell my young patients that if they use their sunscreen effectively and avoid tanning beds, they’ll look younger than all their friends when they’re my age. I find this especially motivating for teenage girls — and I hope it motivates you, as well.
Apply While Naked
Another tip for sunscreen use is to get naked! What? Sunscreen application is just easier without clothing or bathing suits in the way. Even when my family is on vacation, we slip into a bathroom stall, remove our bathing suits and ensure we’ve effectively applied sunscreen as required. This tip will help prevent a burn on that forgotten area around a bathing suit strap, etc. In addition, if you use a process (first the right leg and foot, then the left, abdomen, back, arms, face), you are less likely to forget an area. Your nurse practitioner (NP) or other health care provider can help with other questions you may have about keeping skin safe in the sun. Finally, if something suspicious develops on your skin, consult with a health care provider who is trained to distinguish the dangerous spots from the harmless ones. Parting thoughts: we use our seatbelts in the car and sunscreen in the sun!