Effective Coverage Is the Name of the Sun Protection Game

My dermatologist made small talk as she completed my yearly full body skin check. She rubbed one spot on my forehead a few times and then got her handheld instrument to examine more closely. The doctor explained that a small lesion in the middle of my forehead — what I had thought was a dry patch — was a grouping of precancerous cells. The spot, which was treated and then retreated several weeks later with liquid nitrogen, scabbed and eventually fell off.

I had been so careful to use sunscreen before going on my daily walk and sit under the umbrella at the beach. But the combination of new sun exposure and previous sun damage, possibly from my youth when I spent summers lifeguarding in the sun until I achieved a golden bronze, had caught up with me.

Recently, I added more measures, such as sun protective clothing and accessories, to protect myself. But I love the outdoors — and sunny days especially — so one thing I knew for sure is that I still wanted to be comfortable.

I am not alone in my need for more copious and varied sun protection. Anyone can get skin cancer, regardless of age, gender or skin tone. One in four Americans will develop skin cancer in their lifetime, according to the American Academy of Dermatology. 

Each year in the United States, more than 5 million people are treated for the condition. Studies show that men over the age of 50 are more likely to develop melanoma than women and they frequently do not protect themselves from the sun.

Most cases of skin cancer are found in people older than 65 years of age, but little attention has been given to ways to reduce skin cancer risk among people in this age group, according to the Centers for Disease Control and Prevention. Because older adults are living longer, the need for public health efforts to promote life-long skin health is more critical than ever.

People who reach the age of 65 can expect to live, on average, two more decades, according to research published in The Gerontologist journal. This means that efforts to improve the use of sun protection and reduce sunburn among older adults would likely help to reduce skin cancer risk in later decades of life, the researchers concluded.

"Sun protection is important at every age in life. However, as we get older, our DNA repair mechanisms become weaker. This makes older people more susceptible to developing skin cancers. It takes less exposure to cause more damage and the development of skin cancers later in life, explains Mamina Turegano, MD, a triple board-certified dermatologist, internist and dermatopathologist practicing in the greater New Orleans area.

Turegano recommends using a sunscreen labeled "broad spectrum" (protects against both UVA and UVB rays) and "water resistant" with at least a sun protection factor (SPF) rating of 30, though she prefers 50, especially if you are going to be spending more time outdoors.

It's important to find the sunscreen that you like and keep it close by. Mineral-based sunscreens (with zinc oxide) are effective but might take more take time and patience to rub in to avoid the "white cast" (the residue left behind after applying some sunscreens). "Double cleansing" the skin — starting with an oil-based cleanser and then going back in with a regular body cleanser— is an effective way to remove sunscreen, Turegano says.

Spray-based mineral sunscreen or mineral sunscreen sticks are also available. When using either a spray or stick, Turegano recommends applying more than you think you need to and reapply often. "If you're using a spray, make sure that you are spraying it close to the skin so that it doesn't all just go into the air. If you are going to be using a stick, make sure that you are applying it repeatedly to the exposed areas," she says.

Over-the-counter oral supplements, such as Heliocare, can provide additional sun protection support. Turegano says she especially likes the supplement for those who have more sensitivity to the sun or those who have a history of skin cancer.

"The main ingredient in Heliocare is polypodium leucotomos and other supplements are available that also contain the extract. Taking Heliocare [or similar] serves as a supplement and not a replacement for your sunscreen. It can work alongside other sun protective measures (sunscreen, UPF clothing, shade structures) when you spend time outside," she emphasizes.

Sometimes people over 50 develop a rash or itchiness after exposure to the sun. The rash could be caused by different factors. "Certain conditions manifest as rashes in sun exposed areas, in general, with or without sunscreen. These can include photosensitive drug reactions (when a patient is allergic to a drug, but it only shows up as a rash when they are exposed to the sun), phytophotodermatitis (when a patient is in contact with a food or plant that makes their skin more sensitive to the sun), or other photosensitive conditions, like polymorphous light eruption, solar urticaria, or autoimmune conditions like lupus. These conditions are less likely to happen with proper sun protection with sunscreen," Turegano says.

 It's also possible that the person could be sensitive to the ingredients in the sunscreen itself. "Sunscreen can be mineral or chemical. I find that if people react to sunscreens, it's usually due to the chemical sunscreens," she adds.

Treatment of the rash is dependent on the cause. An over-the-counter cortisone might help soothe some inflammation, but if the rash or itchiness persists, a trip to the dermatologist is recommended.

If more protection is needed, start shopping for comfortable sun protective clothing and accessories. When evaluating sun protective clothing like shirts, pants and cover ups look for labels that say Ultraviolet Protection Factor (UPF) 50 or higher. Darker colors are also more protective than lighter colors.

Add a wide brimmed hat and UV-blocking sunglasses to your beach bag to guard your eyes and eye area from glare and harmful rays. "Finding a source of shade is a great way to protect the skin from the sun because UPF clothing, hats and sunscreen are still not 100% at protecting the skin from UV rays," says Turegano.

Water makes sun protection tricky. You might be having so much fun or are so relaxed that you forget to reapply sunscreen. Yet when in the water consistently, sunscreen can rub or wash off more easily.

"You may also want to look for swimming suits that cover more body surface area. Long sleeve bathing suits are becoming more popular. If you can get away with wearing sunglasses and a hat while you're in the water, that would also be helpful, she says.

As the weather gets warmer, the outdoors beckon. Make sun protection part of your daily routine.

• Plan outdoor activities around the sun, avoiding peak hours between 10 a.m. to 4 p.m. when the sun’s rays are most intense.
• Bring and drink water to stay hydrated when outside.
• Read labels on your medicines (oral and topical) to see if they have photosensitivity. Be aware that some over-the-counter meds can also increase sensitivity to the sun.
• Research the ingredients in the sunscreen you choose and make sure it is healthy for you and the environment.
• Sunscreens and sun protective clothing are available in a range of price points. Test a few out to see which you like best.
• Pick your favorite products and use daily. If you like them, you will be more likely to use them. For example, I use a daily morning moisturizer with SPF 30 that feels good on my skin. I apply it every day as a base, then I add a light and fast absorbing sunscreen before I go outside.  
• Be sure to protect the often-forgotten places like the lips and region around your eyes. Use sunscreen lotion on your lips or use a lip balm with SPF 15+ and bring out the sunglasses.
• Skip the baseball cap and go for a bucket hat or wide-brim hat instead to cover your ears and the back of your neck.
• Keep an umbrella (and base) in your car along with your beach chair so you can create your own shade.

Lisa B. Samalonis is a writer and editor based in New Jersey. She writes about health, parenting, books and personal finance. Read More