In all my years as a beauty editor, I've been confounded by many, many things. Isn't an essence the same as a toner? Why does natural looking" makeup still require 15 different steps? How have we managed to discover penicillin yet can't create a matte lipstick that doesn't feel like you're wearing a plaster cast on your mouth?

Sunscreen, on the other hand, has always seemed like the most clear-cut concept. UV rays can damage your skin and potentially cause you to develop skin cancer. Wearing a product with sun protection factor (SPF) protects against these ills. Case closed. Lately, not quite.

Consumers are more confused than ever about what products are safe and effective and how to use them properly. And a steady stream of misinformation may explain why only 43% of women report using an SPF of 15 or higher regularly, according to the Centers for Disease Control and Prevention.

For dermatologists, there's no confusion on the subject. They want you to use sunscreen regularly and take other defensive measures like seeking shade throughout the day and wearing sun protective clothing. "The key to aging well and preventing skin cancers is to get in the habit of putting on a product with SPF every single day," says Abigail Waldman, M.D., clinical director of the Mohs and Dermatologic Surgery Center at Brigham and Women's Hospital in Boston. "Wake up, brush your teeth, put on sunscreen."

Here, Waldman and other top doctors debunk the SPF myths they hear most often from their patients, and offer commonsense strategies for proper sun protection.

Myth #1: "I tan, so I don't need to wear sunscreen."

If you're someone who loves to greet summer with a golden glow, know this: When used properly, sunscreen prevents tanning—and that's a good thing. "Nothing about a tan is healthy—it's essentially your skin sending out an SOS," says Mona Gohara, M.D., associate clinical professor of dermatology at Yale University. "If a person is having a heart attack, the first sign might be chest pain. A tan is the same thing; it's telling you that your skin is being damaged."

A tan is essentially your skin's melanocytes reacting to UV exposure by churning out more pigment in an effort to protectively reflect away some of those damaging rays. "But a tan is only the equivalent of basically an SPF 2," Waldman says. "So the idea that getting a ‘base tan' allows you to lay out in the sun for hours is a false sense of security."

In fact, even the darkest skin tones only have a natural SPF of about 13, which is why the American Academy of Dermatology recommends that everyone, regardless of skin color, use an SPF of 30 regularly. While less common than in Caucasians, Black and Hispanic women are diagnosed with all forms skin cancer. "I've personally seen skin cancers growing on the faces of those who have the darker type four or five skin, and it's usually a shock to them," says Alison Avram, M.D., a dermatologist specializing in skin cancer at Massachusetts General Hospital (MGH). Bottom line: Skin color alone ain't cutting it—you've got to slather on that SPF.

Myth #2: "The higher the SPF number, the better the protection."

You're at the drugstore and you see a bottle of sunscreen with SPF 30 and another with SPF 100—you should go for the 100, right? Maybe not. "The idea that the SPF number is the most important variable in the sunscreen equation is a huge misconception," says Orit Markowitz, M.D., Director of Pigmented Lesions and Skin Cancer at Mount Sinai Hospital in New York City.

While one study in the Journal of the American Academy of Dermatology did find that participants wearing an SPF of 100 experienced fewer sunburns than those wearing the same amount of a product with an SPF of 50, Markowitz insists that there are other important factors to consider, such as the type of product and how much water resistance it has. "A patient wearing a thick physical blocker that only has an SPF of 30 will be better protected than a person who has sprayed on an SPF 100 aerosol," she says.

And don't think that SPF 100 protects you from 100 percent of the sun's damaging rays—that's not how it works. The number merely calculates how long a product keeps you from burning (SPF 15 protects you 15 times longer and so on up). And in order to get the protection advertised on the bottle, you must apply it regularly (every two hours) and amply (a shot glass for the entire body). This last part is key since most people use less than half of the recommended amount, according to the Skin Cancer Foundation.

Myth #3: "I don't need to wear sunscreen indoors."

Particularly relevant in these times of stay-at-home orders and social distancing, many patients automatically assume that holing up indoors is a free pass to skip the sunscreen. Not true. Research shows that up to 72% of UV rays can penetrate clear glass windows, so get in the habit of applying your SPF of choice every morning, whether you'll be inside or out.

And the same goes for cloudy days. "Cloud cover doesn't even block the majority of the sun's rays," says Mathew Avram, M.D., Director of the Dermatology Laser and Cosmetic Center at MGH. "You're still getting significant exposure." Do you need to be reapplying as fervently as you would be if you were, say, at the beach swimming? Probably not, but that doesn't mean some vigilance isn't required. "I'd be shocked if the sunscreen you applied at eight o'clock in the morning is still active at noon, whether you're outdoors sweating or not," adds Alison Avram. So be sure to break out that bottle at least twice a day, every day.

Myth #4: "I'm allergic to sunscreen."

You put on SPF. You break out. Your skin must be sensitive to sunscreen. It seems logical, but adverse reactions to active sunscreen ingredients are extremely rare—and usually oxybenzone is the culprit. Far more common, says Waldman, are allergies to other ingredients that make up the formula, including fragrance, preservatives and formaldehyde releasers—and those are found in many different skincare products, not just sunscreen.

The good news is that there's a product out there for everyone, so if your skin reacts poorly to one, you'll likely find another that works beautifully—even if it takes a little trial and error. To help, Waldman recommends the following, all of which eschew the common allergens she details above: EltaMD UV Elements Tinted Broad Spectrum SPF 44, Tizo 3 Facial Mineral Sunscreen SPF 40 or CoTZ Face Prime & Protect SPF 40 Tinted Mineral Sunscreen.

Myth #5: "I don't need sunscreen if I'm wearing clothes."

When it comes to adequate sun protection, all of the experts I spoke with for this story recommend a multi-pronged approach. No single protective measure, including clothing, can give you 100 percent security, especially if you plan on spending a full 8 hours outdoors. So wearing sunscreen underneath fabrics with UPF (ultraviolet protection factor) and seeking shade during peak sun hours is the smartest strategy. "The more you layer, the less chance the sun has of getting at you," says Markowitz.

Myth #6: "Chemical sunscreens are bad for you."

For years, sunscreen detractors have used small preliminary studies, many of which were performed on animals in conditions that would be nearly impossible to replicate in people, to establish a link between certain chemical UV filters and myriad health concerns, from hormone disruption to birth complications to cancer. Things came to a head last year when the Food & Drug Administration issued new sunscreen recommendations that suggest 12 commonly used chemical UV filters do not meet the criteria to be considered generally recognized as safe and effective (GRASE).

What's important to note is that the FDA isn't saying that these ingredients are unsafe. The agency is merely requiring manufactures to provide more information on their safety. And while people—yours truly included—applaud the agency's efforts to safeguard consumers against potential danger, the American Academy of Dermatology still recommends that people use a broad spectrum sunscreen with an SPF of 30 regularly and "has not found a toxic association with the sunscreen ingredients that are currently being used," says Mathew Avram.

Further complicating things is a recent study that found that many of the sunscreen ingredients the FDA is evaluating for safety are absorbed into the bloodstream when used as directed. It's not an altogether surprising finding, and simply because these ingredients are absorbed doesn't mean they are harmful. "Thus far, there hasn't been data that has created concern scientifically among dermatologists," Gohara adds. If you want to exercise an overabundance of caution, fair enough. The solution is simple: Choose a mineral-based sunscreen.

Myth #7: "Sunscreen doesn't protect against melanoma."

Because the deadliest form of skin cancer can pop up on areas where the sun don't shine—melanomas have been identified on the soles of the feet, the palms of the hands and even the genital area—some suggest that melanoma isn't caused by the sun and, therefore, sunscreen would offer little protection against it.

While it is true that not all melanomas are sun-related, our dermatologists are unanimous in saying that there is sufficient evidence of a clear association with UV exposure. "It's a very black-and-white issue to me," says Gohara. "Sun exposure is to melanoma what cigarette smoking is to lung cancer."

The research here is complicated: While some studies have found an association between sunscreen use and increased rates of melanoma, Waldman, and the study authors themselves in some cases, point out that this research often doesn't control for actual sun exposure. "If you're using sunscreen, for example, it's likely you might actually be going out in the sun more and therefore putting yourself at a higher risk," she says.

One of the best pieces of data we have, Waldman tells me, is a study of more than 600 Australian patients published in JAMA Dermatology, which found that regular sunscreen use is significantly associated with a reduced risk of melanoma. Just make sure to choose your product wisely. You must use one labeled "broad spectrum," meaning it protects against both UVB rays (the sunburn-causing kind) and UVA rays (those that penetrate deeper, and are most associated with skin cancer). And, to be clear, using sunscreen won't give you carte blanche to bake on the beach all day. Try to get inside as much as possible too.

Read the original story here: Sunscreen Myths That Drive Dermatologists Crazy


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