May is Skin Care Awareness Month and today is Melanoma Monday. As the sun starts to get stronger and we begin spending more time outdoors, we wanted to get an expert's opinion on what we need to be doing for sun-care safety. Manhattan dermatologist Cybele Fishman of Integrative Dermatology gives us the 411.
Sunscreen labels are getting confusing. Can you tell us what to look for? Does the number matter the most? What about "broad spectrum" or UVA/UVB?
I tell patients SPF 30 or higher. But in truth, SPF 45 is so similar to SPF 30 in terms of how much UVB it blocks that it does not really matter. A few more tips: The SPF only tells you the UVB protection, it says nothing about the UVA protection. For UVA, it needs to say "broad spectrum" or "UVA/UVB protection." To me, an SPF 30 with a good sunscreen is better than and SPF 45 with less effective sunscreens.
How do you address concerns about putting too many harsh chemicals on your skin? What is the alternative?
I am a fan of using zinc oxide or titanium dioxide. They are inert minerals. They are great because (1) they do not cause allergy—sunscreen allergy is becoming more and more of an issue, (2) zinc and titanium block both UVA and UVB, (3) the new formulations are much more cosmetically acceptable, so you don't have the white pasty look, and (4) there is no controversy on their safety.
If you cannot find a zinc or titanium sunscreen you like, my favorite chemical sunscreen is Ecamsule (aka Mexoryl), which is available in La Roche Posay Anthelios ($29.99 at laroche-posay.us). I think it is right now the safest and most effective UVA blocker of the chemical sunscreens. Also, look out for Tinosorb, a sunscreen available in Europe. The FDA is reviewing it, and I hope it gets approved here because it is a good one, and we need better options.
We hear that you must wear sunscreen every day—not just at the beach. But if you're just driving to work and sitting inside most of the day, does it really matter? How many harmful rays are you really getting on a cloudy winter day in an office.
A common mistake is to not wear sunscreen in the car. Car windows block UVB, but not UVA, and UVA contributes to photo-aging and increases melanoma risk. Same if you have a window in your office. The UVA is coming in. If I had a dime for every patient who said "I didn't wear sunscreen because it was cloudy, and I burned," I would retire. I think the best thing is to get in the habit of wearing moisturizer with sunscreen daily on your face. If you do it only when you think you are going to get sun, you won't be consistent. And don't forget sunscreen on your hands, especially when driving, and on the V and sides of the neck. Those are two areas that give age poorly, are harder to rejuvenate than the face, and are common sites of skin cancer in women too.
Can you also give us some red flags for moles? What should we be on the lookout for?
The ABCD's of moles are an old, but good guideline:
A – The mole is asymetrical (if you fold the mole in half, the halves don't align).B – The borders are irregular (instead of consistent all the way around).C – There is more than one color.D – The diameter is more than 5 mm (size of a pencil eraser).
I tell patients that looking for changes is most important. A changing mole should send you to the dermatologist. I also tell patients that raised moles can be benign, and flat ones can be deadly, so don't assume a flat one is fine, and a raised one is definitely bad.