Sunscreen Application Should Be Thick

The best type of sunscreen to use is the kind you will wear — spray or lotion doesn’t matter, as long as you follow the directions. Applying two thick coats is recommended, and wearing a swim shirt or clothing with built-in SPF is another good option.

When’s the last time that you read the directions on a bottle of sunscreen? Did you even know there were directions?

If not, you probably aren’t as protected from sun damage and skin cancer as you’d like to think.

Although it’s recommended to wear sunscreen year-round on any exposed parts of your body, summer is the best time to get in the daily habit, whether you are headed to the pool or not. This is the time of year when people are out in the sun more often and wearing clothing that offers less protection.

The need for sun protection isn’t just about vanity and preventing sunspots or wrinkles. It can be a matter of life and death.

The number of cases of melanoma, the deadliest form of skin cancer, is on the rise, especially among young adults.

Melanoma is the most common form of cancer for young adults ages 25 to 29 and the second-most common form for adolescents, noted Dr. Jason Reinberg, a dermatologist with Mercy Clinic.

Even squamous cell skin cancer can be invasive and become deadly if left unchecked, he said. The good news is that both are treatable if caught early enough, he stressed.

However, prevention is always preferred.

There are some new guidelines out about using sunscreen, so Dr. Reinberg and Cindy Mayer, president of Melanoma Miles for Mike, a local nonprofit organization named after Mayer’s late son-in-law, who died from melanoma in 2007 just shy of his 29th birthday, sat down with The Missourian to discuss some best practices.

How Much?

The old recommendation on how much sunscreen to apply was to use as much as would fill a shot glass to cover your whole body.

Mayer admits she never liked using that reference, and never did when she spoke with children about wearing sunscreen.

The new recommendation is to apply a “thick” coat and do it twice — one before you head outdoors and a second when you get to where you are going.

But how thick is thick?

“Apply it liberally,” said Dr. Reinberg, “like you are applying moisturizer to dry skin. It has to thoroughly coat the skin for it to be the SPF that it claims to be.

“The lighter the coat, the less effective the sunscreen will be,” he explained. “So an SPF 30 may only be protecting someone like an SPF 10 if it isn’t applied thick enough.”

That brings up another question Dr. Reinberg hears a lot — what level SPF sunscreen is best? Is 30 enough? Is 50 better?

“That’s kind of a difficult question to answer,” said Dr. Reinberg, explaining how people apply the sunscreen makes a difference in how effective it will be.

When people ask him if they should be wearing SPF 100, and he points out that it certainly won’t hurt anything.

Sunscreen directions have long stated that if you are swimming or being active, you should reapply sunscreen every two hours, although many people rarely do this.

That’s one reason why Dr. Reinberg strongly suggests people wear sun-protective clothing whenever possible. Especially for kids, swim shirts with built in SPF are great. Hats, too, he said, noting wide brims are best to protect the ears.

Mayer agreed.

“Do not undervalue clothing,” she said.

In her presentations to local schoolchildren Mayer often points out that hundreds of years ago, people wore clothing that covered more.

“I tell them to think about ‘Little House on the Prairie’ and how their clothing was different from ours,” she said.

“I tell them that was the style then, but they also were protecting their skin because they were completely covered up.”

People need to be careful, however, about putting too much confidence in clothing to protect them from the sun, said Dr. Reinberg. A white T-shirt, for example, is somewhere between an SPF of 4 and 7, he said.

Two Coats, Really?

The recommendation to apply two coats of sunscreen is likely just a way to get people to apply enough, said Dr. Reinberg. Most people don’t put the first coat on thick enough, so applying a second coat makes up for that.

The directions on sunscreen also say to apply it 20 minutes before going in the sun, but Dr. Reinberg said the real goal is just to get it on, even if it’s not a full 20 minutes before heading outside.

It’s better to put it on as you’re walking out the door than not to put it on at all, added Mayer.

And of course all sunscreen will need to be reappplied throughout the day to be effective. No matter how thick the coats are applied, no sunscreen will last all day, regardless of your amount of activity.

Women also should be aware that the sunscreen built into their cosmetics, usually SPF 15, does not offer enough protection, stressed Mayer. Women should apply sunscreen first and then their cosmetics can be added protection.

Which Sunscreen Is Best?

Mayer’s response to this question is always the same:

The one that you will use is the best.

Whether that is a spray or lotion, a brand name or a generic version, expensive or cheap, sunscreen cannot work unless it’s applied. So it won’t do you any good sitting in your drawer because you don’t like it.

Following the directions on the bottle is the biggest key in making sunscreen effective.

“The spray sunscreens are convenient,” said Dr. Reinberg, “but you really have to spray it on thick for it to work.”

Here’s a helpful way to get in the habit of wearing sunscreen daily (even on cloudy days and in winter months, on your face at least) — keep a bottle of sunscreen on the vanity sink next to the soap.

And don’t think you only need sunscreen on sunny days. Even on cloudy days, 80 percent of UV light can pass through the clouds, Dr. Reinberg pointed out.

People who spend a lot of time in their cars driving should know that the car windows are no protection from the sun’s rays. They still need to wear sunscreen.

“A lot of people don’t pay any attention to this, but more skin cancers appear on the left side of the body in the United States because of driving and on the right side of the body in the United Kingdom for the same reason,” said Mayer.

Protect Your Eyes Too

Most people know that the suns rays are most intense from 10 a.m. to 2 p.m., said Mayer, but now we know the rays in the early morning hours (between 8 and 10 a.m.) and late afternoon/early evening hours can be very dangerous to your eyes because the sun is more parallel to the eyes.

This exposure can lead to eyelid cancers and things like cataracts and other eye conditions.

And it’s not enough just to wear sunglasses with UVA and UVB protection, said Mayer. The best protection comes from wraparound sunglasses that don’t allow sunlight in on the sides.

Keep It Simple, Use Common Sense

If all of the “rules” about wearing sunscreen seem too limiting and difficult to meet, Dr. Reinberg said it’s best just to use common sense when it comes to being out in the sun.

Personally he likes an ad campaign out of Australia that he’s heard:

“Slop on your sunscreen, slap on a hat and stay in the shade.”

A Tan Is a Sign of DNA Damage

Having a tan is often considered attractive and sure sign of health, but that couldn’t be further from the truth, said Dr. Reinberg.

“I hear a lot of people say that they wear sunscreen, but they still have a beautiful tan,” he commented.

“If your skin is tan, that’s a sign of DNA damage.”

Increasing Risk for Melanoma

One statistic Mayer likes to share with teenagers when she speaks with them about skin cancer risks is that having an outside job as a teenager makes them twice as likely to develop skin cancer in their 20s and 30s.

This could be working as a lifeguard, cutting grass, running children’s day camps . . .

“But the message to them is not ‘Don’t work outside.’ The message is be diligent about your skin care,” said Mayer.

Her son-in-law who died from melanoma at age 28 had been a lifeguard and taught swimming lessons when he was a teen, she noted. That set the stage for melanoma to develop later.

Although he did wear sunscreen, he didn’t reapply it throughout the day and probably wasn’t using enough in the first place.

“More intense sun exposure at a younger age as the body is still developing will lay the groundwork for DNA damage,” said Dr. Reinberg. “It will take less injury later on to switch a cell over to being malignant.”

An even higher risk of developing skin cancer comes from the use of tanning beds, said Mayer.

“You only have to go to a tanning bed 10 times in a 12-month period and you are 75 percent more likely to develop skin cancer,” she pointed out.

All tanning beds have at least two to three times the UV rays of the sun, Mayer added. Some have as much as 12 to 15 times the UV rays.

The industry is unregulated, but many states have laws that require minors to have parental consent before using a tanning bed. Just last week the Missouri Legislature sent a bill to Gov. Jay Nixon that would require anyone younger than 17 to have parental consent.

Initially the tanning industry fought this kind of legislation, but not any more, said Dr. Reinberg. The liability potential is too high. At least if there is parental consent that takes away some of their liability, he said.

New Medications for Melanoma

The good news is that there have been some pretty significant strides in developing new medications for the treatment of advanced metastatic melanoma, whereas just a few years ago there weren’t really any great options at all, said Dr. Reinberg.

“The new medications are starting to show some increased survival benefits,” he said. “They’re not perfect, and it’s still a pretty poor diagnosis, but at least there’s hope and they gained more time.”

The annual Melanoma Miles for Mike fund-raiser held in Washington each April raised enough at this year’s event to earn another $25,000 grant to the Melanoma Research Foundation in Mike Revers’ name. That makes the total amount donated by Melanoma Miles for Mike to $175,000.

“It really is making a difference,” said Dr. Reinberg.

Know Your Skin — Early Detection Is Key

People who may have already done serious damage to their skin when they were younger can protect themselves now by checking their skin routinely to look for any changes that could be a skin cancer just starting.

The key, said Mayer, is to look everywhere.

“Melanomas don’t only develop where the sun hits you,” she remarked.

It’s a good idea to know your own skin, and if possible to have a full skin scan by a dermatologist at least once, said Dr. Reinberg. That will help you know your risk for developing skin cancer, to know if it should be an annual check or how often you should be checked.

While much of this information can sound frightening, Mayer said that isn’t the point. It’s awareness.

“This isn’t meant to scare anyone or make them feel helpless,” she said. “There are things you can do. Cover up with clothing or sunscreen. Wear a hat and wear sunglasses. Anyone can do that. You can make that part of your daily routine.

“There are so many critical medical situations that you have absolutely no control over, but you can do something here. In most cases, your behavior can make a difference,” said Mayer.