Sun's Out! FAQ: Sun Safety Edition

Edited by Mirabella Chan



Summer is one of the best times of the year. The sun is shining, birds are chirping, and it’s finally warm enough to enjoy the outdoors. Amidst these happy sunny days, it is important to remember to protect your skin from the sun. More than 1 in 3 Americans report getting sunburned every year, and while this may seem like a minor inconvenience, it can have drastic consequences on your health. Luckily, these consequences can be prevented! Let’s answer some of the burning questions regarding sun safety.



Why is it important to protect myself from the sun?


The sun gives off harmful ultraviolet (UV) radiation. The types of UV radiation which primarily affects our skin is called UVA and UVB rays. UVA rays are present all day long and can even pass through windows, while UVB rays are strongest between 10AM – 4PM and are intensified by high temperatures. When exposed to the skin, UVA rays penetrate the deep layers of the skin, while UVB rays act on the surface.


UVA and UVB rays can drastically affect the health of our skin. Sun rays can penetrate deep into the skin layers, thereby damaging DNA within the skin cells. This leads to the progression of photoaging thus leading to the appearance of wrinkles, fine lines, and pigmentation on the surface of the skin. Photoaging starts at any age and can begin to show in the early 20’s. Furthermore, photoaging can lead to more serious conditions, such as skin cancer.

Excessive or prolonged exposure to UV rays can also cause sunburns. A sunburn is an inflammatory reaction and is recognizable by redness, blistering, and tenderness of the exposed skin. Sunburns can lead to photoaging of the skin, which can ultimately lead to skin cancers.


Adequate protection of the skin from UV rays can prevent photoaging and sunburn. Taking the proper steps to ensure that your skin is not damaged by the sun can drastically reduce the risk of developing skin cancer.



What can I do to protect myself from the sun?


There are various ways to protect yourself from the sun, and it is recommended to practice a combination of strategies to best combat UV rays. Firstly, wearing protective clothing such as long-sleeved tops, long pants, clothing made with a sun protection factor, wide brimmed sun hats, and sunglasses will protect your skin. Additionally, avoiding the sun when possible will dramatically prevent sun damage. Therefore, try not to plan outdoor activities during times when the sun is at its peak between 10 AM and 4 PM. If you are outdoors, try to stay in a shady area and out of direct sunlight. Avoid tanning salons and artificial tanners as they use UV radiation to achieve a tanned skin tone and result in the same damage as sun exposure.


Finally, one of the mightiest fighters of sun damage is sunscreen. Sunscreen should be used with other methods of sun protection, not instead of them. It reduces the risk of burns, tans, photoaging, and pigmentation. An effective sunscreen should be free of irritants, contain an SPF of at least 30, and offer broad spectrum protection from both UVA and UVB rays. It is also important to remember to reapply sunscreen throughout the day to get consistent protection.



What is “SPF”?


SPF stands for sun protection factor. It is a way of measuring how effectively sunscreens protect against UVB rays (UVA rays are typically not measured due to their abundance). Generally, as the SPF value increases, the sun protection factor increases as well. A sunscreen with at least SPF 30 is recommended, as SPF values below this provide insufficient protection against the sun, while SPF values above this may not provide much more protection. However, since sunscreen is usually applied in an amount lower than recommended, a higher SPF sunscreen may be used to ensure that proper protection is still achieved.



Do I really need to wear sunscreen all the time?


Yes! Even on rainy days, the sun still radiates UVA and UVB rays. As a result, your skin is still susceptible to sun damage on days when the sun is not shining. In addition, UVA rays can also penetrate windows, so it is still important to wear sunscreen while staying indoors.


Sunscreen should be applied 15-30 minutes before sun exposure, and should be reapplied at least every 2 hours or after swimming, sweating, or other water exposure. Sunscreen should be applied generously and evenly all over the body, including the face, neck, ears, lips, feet, legs, arms, and torso. A common method of sunscreen application is the “teaspoon rule.” This rule states that ½-1 teaspoon of sunscreen provides adequate protection for the face and neck, 1-1 ½ teaspoons provide adequate protection to the arms, shoulder, and torso, and 2-2 ½ teaspoons provide adequate protection to the legs and feet. As a rule of caution, it is better to apply too much sunscreen than too little sunscreen. If approximating the amount of sunscreen in teaspoons is difficult, try over-estimating when applying to ensure that you are not sacrificing the benefits of sunscreen.



Are some people more susceptible to sunburn and/or sun damage than others?


Yes! Children, young adults, and outdoor workers tend to have more exposure to the sun, and therefore have a higher incidence of sunburn. However, age and occupation does not directly make an individual more susceptible to sun damage – it just statistically increases the likelihood of skin damage due to sun exposure.

Certain drugs can increase photosensitivity of the skin – that is, they make the skin more susceptible to damage from the sun. These drugs include, but are not limited to:

  • Antimicrobials (tetracycline, ciprofloxacin)

  • Antifungals (itraconazole, voriconazole)

  • Non-steroidal anti-inflammatory drugs (aspirin, voltaren, naproxen, Advil)

  • Oral and topical retinoids (Accutane, tretinoin, isotretinoin)

  • Diuretics (hydrochlorothiazide, furosemide)

  • Psychiatric medications (alprazolam, desipramine)

  • Cancer therapies

  • Acne medication

  • Sulfonylureas

  • Antimalarial drugs

Anyone taking the above medications should take extra care to protect their skin from sun damage.

Further, using a tanning bed and/or artificial tanner also increases the risk of sun damage, as mentioned previously. The World Health Organization recognizes a direct link between artificial tanning and skin cancer. Although there is generally no direct exposure to the sun, artificial tanning relies on exposure to high amounts of UV radiation to achieve the desired tanned skin colour. This exposure damages the skin in a similar way as the sun.


Individuals with lighter skin tones (Fitzpatrick skin type 1-3) are more susceptible to sunburn due to lack of melanin in the skin. Melanin contributes to a darker skin tone, but also plays some role in blocking UV rays. Individuals with darker skin tones (Fitzpatrick skin type 4-6) are less susceptible to sunburn due to increased melanin levels; however, this does not mean that individuals with darker skin do not burn in the sun – it simply takes a larger degree of UV radiation exposure. Additionally, lower susceptibility to sunburn does not mean that sun damage is not possible, and it certainly does not mean that these individuals are not at risk of developing skin cancer. Although individuals with lighter skin tones are more susceptible to photoaging and pigmentation due to sun damage, those with darker skin tones are still at risk and it is crucial they take adequate precautions to protect themselves from the sun.




I got sunburned. What can I do to help this get better?


It happens, and it’s a lesson for next time! A sunburn is usually a burn on the surface of the skin and can be managed at home. However, if the sunburn is extremely painful, charred, or is bleeding, it is advised to seek medical attention to ensure the burn is not deep in the skin.


Sunburns take about a week to heal. However, there are some strategies to ease the healing process such as cool baths or cold compresses placed on the burn to help relieve discomfort. Calamine lotion, moisturizers, and colloidal oatmeal may also soothe the area. For painful sunburns, Advil or Tylenol may be used to relieve the pain.


It is important to note that sunburned skin should not be exposed to the sun for at least one week. Use clothing to cover sunburns, if possible. If sun exposure is unavoidable, apply a generous amount of sunscreen to the area.



Don’t I need the sun to make Vitamin D in my body?


Yes, you do. UVB rays are needed to convert cholesterol in skin cells into vitamin D. However, using sunscreen to protect the skin from sun damage does not significantly affect vitamin D production.



There are so many sunscreens at my pharmacy – which one is the best?


Sunscreens can be divided into 2 categories based on the way that they protect the skin from the sun:

  1. Physical sunscreen (also known as sunblock or mineral sunscreen): Sits on top of the skin and prevent sun rays from reaching the skins surface by deflecting them. Common ingredients include titanium dioxide and zinc oxide. These sunscreens are thick and often leave a white cast on the skin.

  2. Chemical sunscreen: Absorbs UV rays and converts them to heat, which is then released from the body. Common ingredients include oxybenzone, mexoryl, octocrylene, avobenzone, and octisalate. These sunscreens are runnier and are generally transparent when rubbed onto the skin.


Neither sunblock nor sunscreen is superior to the other. Rather, it comes down to your skin type and personal preference when selecting a sunscreen. If the sunscreen you select is at least SPF 30, protects against both UVA and UVB rays (also known as “broad spectrum protection”), and has passed all health regulations, it is perfectly safe to wear. Ultimately, the best sunscreen is the one that you want to wear every day!


Some sunscreen recommendations:


FOR ACNE-PRONE SKIN

Choose a sunscreen that is labelled as “acne safe” or “non-comedogenic.” Some options include Dermalogica, La Roche-Posay, and Neutrogena.


FOR DARKER SKIN TONES

A big problem with many sunscreens, especially physical sunscreens, is that they leave a white cast on the skin. This is especially a problem for individuals with darker skin tones, as a white cast may stand out too much and deter individuals from wearing sunscreen. However, there are many sunscreen options that do not leave a white cast or are formulated to avoid a white cast. Some sunscreens are tinted to prevent a white cast, such as La Roche-Posay, Elta MD, and Clarins. Chemical sunscreens, such as Neutrogena Hydroboost, do not leave a white cast on the skin either.


FOR DRY SKIN

Creams and lotions are a good option for dry skin as they are often formulated with moisturizing ingredients and are easy to apply on the skin. Ombrelle, Paula’s Choice, and Supergoop are formulated with moisturizing ingredients.


FOR OILY SKIN

Some chemical sunscreens can be greasy and leave a shine. For individuals with oily skin, this shine can be a concern. Sunscreens such as Vichy, Neutrogena Dry Touch, Clarins, and Biore UV Essence have a matte finish and are suitable for individuals with oily skin.


FOR CHILDREN

Sunscreens that are formulated for adults are generally safe to use on children as well. If applying sunscreen on your child is difficult, try a spray sunscreen, such as Bioderma or Ombrelle, and ensure that it is rubbed in adequately. Make sure your child is not inhaling any of the sunscreen while it is being sprayed.



 


References

  1. Canadian Dermatology Association. Photoaging. Updated 2021. Accessed July 26, 2021 https://dermatology.ca/public-patients/skin/photoaging/

  2. Guenther, L. Sunburn. In: Compendium of Therapeutics for Minor Ailments. Canadian Pharmacists Association. Updated April 12, 2021. Accessed July 26, 2021. https://www-e-therapeutics-ca.login.ezproxy.library.ualberta.ca/search#Medicationsthatmaycausephototoxicreactions

  3. Mayo Clinic Staff. Best Sunscreen: Understand Sunscreen Options. Mayo Clinic Healthy Lifestyle: Adult Health. Updated May 21, 2019. Accessed July 26, 2021. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/best-sunscreen/art-20045110

  4. Neale, RE. Khan, SR. Lucas, RM. Waterhouse, M. Whiteman, DC. Olsen, CM. The effect of sunscreen on vitamin D: a review. British Journal of Dermatology. 2019; 181(5): 907-915. https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.17980?casa_token=BEogzW5sLaMAAAAA%3AaFKUKtRJn40UCLods9KzMGxiv4-kWoHrcZXi2jGCVMnuQT4y52187L4jiEENk5l4gItYXiWb8f2xGw

  5. Office of the Surgeon General. Skin Cancer: Quick Facts from the Surgeon General. US Department of Health and Human Services. Updated August 8, 2014. Accessed July 26, 2021. https://www.hhs.gov/surgeongeneral/reports-and-publications/skin-cancer/fact-sheet/index.html

  6. Schneider, J. The Teaspoon Rule of Applying Sunscreen. Arch Dermatol. 2002;138(6):838-839. https://jamanetwork.com/journals/jamadermatology/article-abstract/478840?casa_token=C1G-FhuXiYMAAAAA:GNz6wTeqwGrTIm3ZMOIPY5ZSATwoHOUQmgCmZMmi3DqjhAFEW1w0lJgVPeOBjgpH5BwGt35ZEg

  7. US Food and Drug Administration. Sun Protection Factor (SPF). Updated July 14, 2017. Accessed July 26, 2021. https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/sun-protection-factor-spf