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Gladys Tse, MD

Belleville native, Gladys Tse, MD, a specialist in obstetrics and gynecology, enjoys developing long-lasting relationships with her patients. One of the best pieces of advice she ever received was to “treat every patient as if she were your mother”.

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NOT ALL SUNSCREENS CREATED EQUAL

From Washington University Physicians by Mary Jo Blackwood, August 2008

The rate of skin cancer is rising. Perhaps more distressing are the age-related changes caused by long-term sun exposure. Choosing the right sunscreen, along with the judicious use of protective clothing can ensure that our fun-in-the-sun activities are also safe.

Dermatologic surgeon Eva Hurst, M.D., assistant professor in the Division of Dermatology at Washington University, is an expert in Mohs micrographic surgery for skin cancer, which removes skin cancers effectively, while taking the least normal tissue, for both a good clinical and cosmetic outcome. However skilled, our skin cancer surgeons would prefer prevention.

“We continue to learn more about how ultraviolet light from the sun affects our skin. Historically, we’ve known that ultraviolet B rays (UVB) contribute to skin cancer. More recently, we’ve gained a better understanding that the ultraviolet A rays (UVA) also cause skin cancer, and are the main contributor to wrinkling and aging changes.

The term broad-spectrum coverage means a preparation protects across the spectrum, against both UVA and UVB rays. Sunscreen makers are challenged to formulate sunscreens that give the best coverage and at the same time are aesthetically pleasing so people will use them consistently.”

She says sunscreens can be divided into two types: physical blockers and chemical blockers.

“Physical blockers include preparations with zinc oxide or titanium dioxide. These reflect and block the sun’s rays. We used to associate these with lifeguard white, but newer preparations are micronized and rub in colorless. They are still the best for children, people with sensitive skin, and those with skin allergies because they don’t contain a lot of preservatives. Physical blockers protect against both UVB and UVA.”

Chemical blockers work differently. They deactivate ultraviolet light but tend to degrade over time. They are also thinner so people like them better. Most chemical blockers protect against UVB rays. What we need to check, says Hurst, is that they also protect against UVA. When selecting a sunscreen, read the bottle and check for the presence of one of three UVA protective ingredients: oxybenzone, avobenzone (also known as Parasol 1789), or mexoryl.

Some sunscreens feature a combination of physical and chemical blockers. The sun protection factor (SPF) rating is based on UVB protection, but if one of the three ingredients above is included, the rating is broad-spectrum. “As far as SPF goes, you can’t go too high. SPF 15 may be adequate, but the problem is that most people don’t put enough on or cover all areas thoroughly. So we recommend an SPF of at least 30. If you’ve had a history of skin cancer or other sun exposure problems, go with an SPF of 45 or higher.”

Another important part of sun protection, she says, especially for children, is sun-protective clothing.

“The average white tee shirt has an SPF of 4-8. Most people don’t know that. A better idea is for sun exposure protection with lightweight UV clothing. It’s available in bathing suits, shirts, pants, hats, and for babies through adults. Using that for small children allows parents to apply sunscreen only to exposed areas. These outfits are available on-line for reasonable prices and make great baby gifts.” Another option she recommends is washing clothing that will be worn outside, like shirts and pants, with a special detergent, also available on-line. “There is one product available called RIT Sunguard Laundry Treatment. It lasts for 25 washes.”

Other sun protection tips Hurst wants to share:

• On water, sand, or snow, use extra protection and don’t forget under the chin and ears. Your exposure is greater because of reflected sun.
• Even cloudy days yield significant UV exposure.
• Put sunscreen on 30 minutes before exposure, and preferably before you put on the swimsuit or shirts, so you don’t miss spots.
• Don’t forget lips. Lots of skin cancers occur on the lips, so use lip balm with at least an SPF 15.
• Don’t forget the scalp and head, especially with thinning hair. We get a lot of skin cancers in part lines.
• Eyelids are a common location for skin cancers. She removes one a week around the lashes. Sunglasses for all ages are key to prevent eyelid cancer and also cataracts. Make sure sunglasses say they block UV rays. Some don’t.

“Avoid tanning beds altogether. They amount to cancer in a box. There is no such thing as a protective tan. Tanning is a precancerous condition. Self-tanners are fine, but you still need sun protection on top. Stay safe so sun can stay fun.”

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