Heidi H. Cole, M.D.
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Why do you need protection?


· Sunburn - this is the most obvious and most immediate sign of too much sun. Your skin will be red and tender, and it may swell and blister. You may even run a fever and feel nauseous from a sunburn.

· Premature wrinkling - over time, too much sun exposure will cause your skin's texture to change. The skin can become tough and leathery and you may notice more wrinkles. In addition, the sun can cause sun spots-discolorations in the skin's tone that may be red, yellow, gray, or brown.

· Skin cancer - this is the most serious result of too much sun. Check your skin regularly for any changes in the appearance of moles or freckles.

Protecting your skin:

In addition to eating healthful foods, there are other things you can do to protect your skin from damage and wrinkling. The American Academy of Dermatology offers some tips to help keep your skin healthy and young looking.


· Stop smoking-smoking causes premature aging and wrinkling of the face.


· Wash your face every day and always use a moisturizer. The best time to apply a moisturizer to the skin is immediately following a bath or shower.

· Drink at least 6 to 8 glasses of water a day. This will help keep your skin hydrated.

· Stay out of the sun between 10 a.m. and 4 p.m.-the sun's rays are strongest during these hours. When in the sun, wear a 4-inch-wide broad-brimmed hat and sunglasses with UV protective lenses.

· Use a sunscreen with an SPF of 15 or greater, even on cloudy days. Apply the sunscreen 20 minutes prior to sun exposure and reapply every two hours.


To help protect your skin when you are in the sun, follow these simple tips:

· Always wear sunscreen with a sun protection factor (SPF) of at least 15. Use a "broad spectrum sunscreen"-this type absorbs at least 85% of the UVA and UVB rays of the sun.

· Apply sunscreen to all exposed areas approximately 20 minutes before sun exposure. Don't forget the back of the neck, rims of the ears, and tops of the feet. Reapply after swimming and every couple of hours.

· Try to avoid sun exposure between 10 a.m. and 4 p.m. This is when the sun's rays are most damaging.

· Wear a wide-brim hat, sunglasses, and other protective clothing.

· Don't deliberately sunbathe.

· Stay away from artificial tanning devices, such as tanning booths or tanning lamps.

UV radiation:

Despite the overwhelming brightness of summer days, only about 48% of sunlight is visible to your eyes. An additional 46% is invisible infrared radiation. The remaining 6% consists of two types of invisible ultraviolet radiation--UVA and UVB. UV radiation is the dangerous component of sunlight. UVB causes sunburn, premature aging, and skin cancer. UVA also is involved in sunburn and skin cancer, and both UVA and UVB suppress your immune system. Although you are more susceptible to damage from UV radiation if you are light skinned or you live at higher altitudes or near the equator, no one is immune to harm from UV. The key to UV protection is to keep that sinister 6% from getting to your skin.

There are three ways to protect yourself from UV radiation: block it, absorb it, or reflect it away. Sunscreens primarily block or absorb UV radiation, but clothing can protect you all three ways. The fabric blocks, the color absorbs or reflects, and special chemical treatments also absorb UV radiation; some even convert it into harmless visible light. Unfortunately, there currently is no UV protection rating system for clothing similar to the familiar SPF system for sunscreens, although there will be soon.


There are two types of damaging wavelengths that beam down on us from above: short, ultraviolet B (UVB) rays and the longer ultraviolet A (UVA) rays. The UVB rays cause superficial and immediate reactions in our skin.  When they are mildly irritated, they produce brown pigment and cause a tan. When the damage is more extensive, they are overwhelmed and we end up with a sunburn. This more severe damage, which we see and feel as a burn also, unfortunately, demolishes the skin’s immune system, and subsequently increases the likelihood of malignant melanoma, which now occurs in one out of ninety Americans. UVA rays have a longer wavelength, which allows them to penetrate even deeper than UVB. These radiate down on us all day, every day, whenever natural light strikes our skin, through window glass, clouds, smog and some sunscreens. UVA rays are also the rays used in tanning salons, which should advertise a promise that “you will look tanner now — and prunier later.”


THERE’S MORE TO UV DAMAGE THAN AN INCREASE IN CANCER RISK.

Both forms of UV radiation stimulate production of hydrogen peroxide in the skin cells and this triggers a breakdown in collagen. It’s this ongoing collagen damage that is the cause of our skin’s aging. The “upset” collagen loses its form and causes tiny amounts of scar tissue to build up. Over time this causes wrinkles, and to add insult to injury, UV also impairs the synthesis of new collagen, so the skin’s elasticity decreases. Combined with this collagen loss there is damage to the underlying blood vessels and the pigment cells so that the following skin changes typical of photoaging occur:

Photoaging (extrinsic):
Uneven pigmentation
Course and leathery skin
Deep wrinkles
Loss of elasticity (sagging)
Age spots
Dilated blood vessels
Spider veins
Red bumps
Keratoses (raised, rough, red, brown or black spots)

HOW DOES THIS DIFFER FROM CHRONOLOGICAL AGING OF THE SKIN?

Damage in the skin cells with age occurs from the ongoing metabolism of oxygen in the cells’ energy units (mitochondria). The oxidative byproducts also damage DNA, proteins and fat in the membranes of cells, and as a result, skin thins, fine wrinkles occur and fat under the skin disappears. Blood vessels become more fragile and bruise easily. This intrinsic aging results in:

Age changes in the skin (intrinsic):
Fine wrinkling
Thinning
Fragility
Loss of underlying fat
Purple-red spots

These develop much more slowly than photo damage changes and accounts for less than twenty percent of the aging appearance of our skin.




WHAT CAN WE DO TO PREVENT PHOTOAGING?

Prevent further damage. At any age, we can and should protect ourselves from sun damage. First, remember when it comes to maintaining youthful skin, there is no such thing as a safe tan. Even the slightest change in pigment is accompanied by skin cell injury. Think brown (and certainly red) = collagen destruction. And UVA rays hit us at all times, even when we think the sun isn’t strong, we’re in a car, or heaven forbid we’re in a tanning booth. If you want a self-bronzed look, use self-tanning creams that contain Dehydroxyacetone (DHA), which interact with proteins in the cells of the outer skin layer and stains them brown. This doesn’t penetrate the deeper skin layers and doesn’t inflict damage.

The other advice is that which you already know for skin cancer protection:
-Limit exposure and stay out of the sun from ten to three.
-Cover up if you must be outside, not just a white T-shirt (it offers very little UV protection) but with specially treated fabrics. There are more and more companies offering sun protection clothing (Solumbra, REI, Sunveil and UV Aguawear are just a few). The fabrics are rated according to an Ultraviolet Protection Factor (UPF). Anything over thirty is good. This means only 1/30 of UV rays can penetrate the fabric to reach the skin. (An ordinary polo shirt rates a mere 6!)
-And of course you need a hat as wide-brimmed as possible to protect the most looked-at portion of your exterior, your face.

What type of sunscreen should I use? 
 


In general, sunscreen begins to work thirty minutes after it goes on, and even waterproof screens lose effectiveness within ninety minutes if you perspire or swim. (Water resistant screens may last only forty minutes.) Because we now know UVA rays cause just as much or more skin aging as UVB, we need to make sure we have a block for both. The best protection reflects rather than absorbs UVA and B and contains zinc oxide or titanium dioxide. In the past, these creams were greasy and white, but new versions are now transparent. If you don’t like wearing this constantly, use a sunscreen with a label “broad spectrum”. This usually has Parsol 1789 (also called azobenzone).

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