Dr. Dosal Featured in Harper’s Bazaar

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Dr. Jacquelyn Dosal was featured in this month’s Harper’s Bazaar Australia.  Journalist Amy Molloy consults with Dr. Dosal about over-stretched concerns regarding sunscreen safety.

Molloy writes that women are skipping daily sunscreen use for fear of putting chemicals on their skin. This “chemophobia” is largely internet and celebrity driven, in contradiction to scientific studies that demonstrate safety and effectiveness of sunscreens.

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Dr. Dosal explains that the many of the assertions of toxicity come from lab animals that were fed sunscreen.  According to Dr. Dosal,

“There is a monstrous difference between eating super-high doses of sunscreen and applying it to your skin daily.”

To put it in perspective, it would take 200 years of daily sunscreen application to reach any amount of concern such as the scenarios found in the often cited rat studies.

If one has concerns, there are certain ingredients, such as zinc and titanium dioxide based, that are marketed as “chemical free,” (which really is a misnomer – everything is a chemical…. even water – remember H2O anyone?).

In summary, sunscreen not only prevents skin cancer, but it is also the best anti-aging ingredient on the market.  Don’t waste your time with fancy La Mer products if you aren’t wearing sunscreen every day!

Full article can be found here: harpars-bazaar-au-oct-16-health-sunscreen-new

Dr. Jacquelyn Dosal is a Board-Certified Dermatologist practicing dermatology in Miami, FL at Skin Associates of South Florida and is a voluntary Assistant Professor at the University of Miami.

 

My Homemade Sunscreen Experiment

Why, might you ask, did I attempt to try to make my own sunscreen?  Boredom on vacation?

I think many of us are attracted to do-it-yourself home remedies.  They seem cheaper and it might make sense to use things that are already in the cupboard. For instance, apple cider vinegar seems to be the internet/Facebook “cure-all” – it can fix everything!  Pretty soon I started noticing links for how to make your own sunscreen.  I haven’t tried apple cider vinegar yet, but had to try this one.

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My homemade sunscreen experiment.  Can anyone spot the most essential ingredient in the realization of this blog?  Hint – it’s in blue (baby monitor a.k.a nap time).
But does it really work?  In the case of sunscreen, I wanted to find out for myself.

Those looking for natural or organic solutions are particularly ripe for getting misinformation or potentially dangerous advice.  There are MANY excellent natural solutions, but usually those giving advice  (i.e. your friend on Facebook) don’t have any medical background, making it hard to vet what is SAFE and effective.

As many of you already know, I’m very passionate about sun protection, and wanted to make sure that people weren’t getting bad information.  I was optimistic, hoping to be surprised!  With this in mind, I set out to make my own sunscreen.

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Zinc oxide powder ready to be added to the base.
Here were the pros:

  • It was relatively easy and fast to make.
  • There were only a few ingredients, which should please simplistic and naturally oriented people. (Ingredients: coconut oil, shea butter, zinc oxide, pomegranate oil, and lavender oil).
  • I did not burn while wearing it for 2 hours in the noon Florida summer sun.

Here were the cons:

  • It cost me $57.70 to get all the materials!  
  • It was messy to apply.  Commercially formulated containers exist for a reason. Next time I would transfer it to a squeeze bottle.
  • Forget re-applying (one of the most common mistakes people make is not reapplying their sunscreen) – it would be way too messy to transport this DIY sunscreen.
  • I felt like a human version of “Slip-N-Slide” after applying.  The texture was way too greasy for my taste.
  • The true SPF of the concoction is unknown – a major no-no for me.
  • The stability and expiration date is unknown – I would guess that you could keep this mixture for 60 days, and then have to repeat the process. (I have absolutely no data to support this, which is the point… how do you know if it’s still good?)
  • The ingredients separated after mixing – not a big deal – just required mixing again before applying. A few days later the mixture was more consistent and paste like.
  • I would not recommend using this on your face if you are break-out prone. The oils might cause an acne flare.

My conclusions:

Save the $57.70, buy a $15 sunscreen with SPF 30+ and UVA protection, and use the rest of the $$ for a good sun shirt!  (Find my sun shirt picks here!)

And a last few words.  Some websites advocate using coconut oil alone as sunscreen – this is NOT OK!  Coconut oil has an SPF of about 4-6.  Would you ever consider buying a sunscreen with SPF 5?  No, so don’t consider it adequate protection for your skin.  The American Academy of Dermatology recommends a broad-spectrum sunscreen with an SPF of at least 30.  We are talking about a serious cancer risk (1 in 5 Americans will develop a skin cancer in their lifetime), as opposed to any hypothetical concerns about ingredients – see my in-depth post about sunscreen safety here.  The mixture above includes zinc oxide powder to beef up the SPF.  Even easier, you can also very easily find some simple commercial sunscreens with zinc oxide.

While my experiment “worked” in that I didn’t get burned, the practical aspects of the homemade sunscreen made it a no-go for me.  It was too expensive, too greasy, too messy, and in my humble dermatologist opinion, a little too risky for me.  I’m ok with using a homemade milk mask, but I don’t like risking DNA damage to my skin cells because I messed up the SPF formulation.  I’ll leave that to the experts.

It takes just two painful sunburns to increase your risk of melanoma, so for me, it’s really not ok to experiment with sun safety.  I did it for you, so that you won’t have to!

In the end, my main message is to use something that you know has an SPF of over 30, reapply every two hours, and practice sun safe behaviors.

Dr. Jacquelyn Dosal is a Board-Certified Dermatologist practicing dermatology in Miami, FL at Skin Associates of South Florida and is a voluntary Assistant Professor at the University of Miami.

Can you use diet to help protect against skin cancer?  

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Can you use diet to help prevent against skin cancer?

The answer is No.  

And Yes.

The reason why I say “no” first is that there are no superfoods in the world that can fully protect against any cancers, and NOTHING replaces sun-safe behavior as the single most effective strategy against skin cancer.  We are all looking to take back some control against the scariness and sometimes unfair nature of cancer.  Diet can seem like the most obvious choice, but let’s not let diet overshadow the most important factors in preventing skin cancer, in this order:

  1. Sun protection
  2. Sun protection
  3. Sun protection
  4. #4 through #100 – Sun protection 

    woman on beach

The use of sunscreen, sun clothes, sunglasses, wide brimmed hats, and seeking shade is far more important than what you eat.  Over 80% of skin cancers are due to UV radiation.  Just like quitting smoking is one of the best things you can do to prevent lung cancer and heart disease, sun protective measures will always trump nutrition as a cancer prevention strategy.

Now why, “yes?”

I’m fascinated by how our nutrition might affect the overall health of our body.   Apparently, so are a lot of other people.  You can find a nutrition study for just about any nutrient, and just about any disease state.  After reading Michael Pollan’s  In Defense of Food, I now understand how difficult it is to isolate a single nutrient with regards to health, since nutrition does not exist in a vacuum.  Nutrition is much more than the sum of its nutrient parts.  It depends on the human host that consumes it, vitamins and cofactors consumed simultaneously, the soil/environment in which it was grown, etc.  It is very difficult to prove causation (and not just association) in nutrition studies.

That being said, I am still very interested in what has been published with regards to skin health and skin cancer prevention.  At this point, evidence is still only suggestive of certain foods being beneficial in preventing skin cancer.  However, most of these foods are known to be beneficial for other reasons, such as preventing heart disease, diabetes, obesity, etc, so I see no difficulty recommending them– in addition to rigorous sun protection.

The Highlights…

mediterranean diet

  • The overall direction of the medical literature roughly supports something similar to the Mediterranean diet, with emphasis on vegetables and good fats.
  • Prudence should be taken with alcohol and possibly citrus fruits (while in the sun).
  • Supplements do not replace whole foods, and in my opinion should not be used as a substitute for getting the nutrient du jour.  See below for the dangers in “nutritionism.”
    • In some cases supplements might increase your risk of skin cancer.
    • There is also the issue of pervasive supplement contamination with “yucky stuff” (hormones, heavy metals, or undetectable levels of the actual product that is being sold).

So let’s look at the specific foods that can be helpful (and a few words about supplements):

    • Fish high in omega-3 fatty acids (sardines, anchovies, tuna, salmon, shellfish)
    • Regular tea drinking (green and white tea)
    • Veggies (especially dark leafy greens like kale, carrots, broccoli, cabbage, brussel sprouts)
    • Tomatoes
    • Herbs and spices – rosemary and turmeric
    • Olive oil
    • Coffee
    • Fruits
    • Soy

Foods to avoid (foods that are pro-inflammatory)

  • Trans-fats
  • High amounts of omega-6 polyunsaturated fatty acids
  • Pre-prepared meals or snacks in a package
  • Too much red meat
  • Controversial: dairy

This is the way I think of it…  Skin cancer generally happens for a combination of three reasons.

  1. Genetics – red haired, light skinned individuals have genetics that make them susceptible to skin cancer and UV damage, partly because of their lack of pigment leaves them vulnerable to the sun.
  2. DNA damage, predominantly from UV rays –  The sun actually damages our DNA – the tan and sunburn you see are your body’s reaction to all the bad stuff that is happening on a cellular level.  With enough DNA damage comes uncontrolled-immortal-damaged cells (a.k.a. – cancer).
  3. Bad luck – There are some instances where skin cancer develops in sun-protected areas or in dark-skinned individuals – this is a combo of a spontaneous mutation in their cells, maybe a genetic predisposition, but probably just bad luck!

The only factor in our control is to avoid #2 – seek sun protection to avoid DNA and oxidative damage that comes from UV rays.  However, unless you live under the ground, you will probably have your fair share of sunny indiscretions.

Nutrition comes in as a way to keep your bodily defense reserves high against DNA damage from UV radiation.  Think of it as ROTC (Reserve Officer Training Corps for the US Military) for your body.  You will have highly trained soldiers ready to come to action should there be some cellular stress on your body. By keeping those soldiers ready, you are more likely to protect against the waxing and waning onslaught of stressors on the body whenever needed.  It helps protect against damage from UV rays, smoke, environmental pollutants, even stress (and can help regulate stress response).

The key to this is keeping anti-inflammatory foods high, and pro-inflammatory foods low.  It is also helpful to keep a diet full of antioxidants.  By fighting inflammation and oxidative stress (hence the terms anti-inflammatory and antioxidant), you keep the body functioning at its best, ready to fight off any DNA-damage-causing forces.


 

Here is a little more detail for those interested:

grean tea bestGreen Tea – Frequent tea consumption was protective against melanoma in an Italian study (in a dose dependent relationship) (Fortes).  Green tea contains polyphenols (epigallocatechin-3-gallate or EGCG) and catechins. These antioxidants help prevent DNA damage from UV radiation, help repair DNA damage, prevent the progression of DNA damage into cancer, they block immune suppression that can allow cancer to grow.  Of note, there are studies that show no benefit of drinking tea in the prevention of skin cancer, so like almost everything, the data is mixed.

Tomatoes and carrots – Carrots and tomatoes contain carotenoids such as beta-carotene, lutein, and lycopene which are excellent antioxidants.  Increase beta-carotene intake has been associated with decreased risk of melanoma, as documented in a retrospective dietary analysis in a case control study of melanoma patients.  In a placebo-controlled clinical study, sunburn intensity after UV irradiation was lower in subjects receiving carotenoid supplements.  Of note, lycopene is better absorbed with olive oil, which is why tomatoes and olive oil pair so well, and is a hallmark of Mediterranean cooking.

Cruciferous and green leafy veggies – (broccoli, brussel sprouts, cauliflower, kale, spinach) – The same study done by Fortes et al showed a protective effect of high consumption of vegetables (>5 times weekly) and more than one fruit a day.  Cruciferous vegetables (cauliflower, broccoli, bok choy, brussel sprouts) and dark green vegetables are best on the list, as they are all rich in polyphenols, which have many anti-cancer properties including: photo-protection, protection from ROS (reactive oxygen species, a big promoter of oxidative damage), reducing sunburn, stimulation of the immune system, and cell regulation which is important in cancer prevention.

Herbs and spices (especially rosemary and turmeric), which are central to the Mediterranean diet.  Curcumin (turmeric and curry) strongly inhibits tumor production in mouse skin and inhibits inflammation in mice (Huang et al., 1991; Stoner & Mukhtar, 1995). Fortes et al found an inverse relationship between consumption of Mediterranean herbs such as rosemary, sage, parsley, and oregano and certain types of cancer.  Carnosol (extract from rosemary) has been evaluated with promising anti-cancer properties (Johnson, 2011).

Extra virgin olive oil, which is rich in phenolic antioxidants, squalene, and oleic acid, may help to protect against skin cancer and aging by inhibiting oxidative stress (Owen at al, 2000).

Soy – Recent research has illustrates the antioxidant and DNA-protective effects of soy isoflavones on the skin.  The antioxidant and phytoestrogen genistein found in soy is believed to block UV-induced cellular damage (Accorsi-Neto et al., 2009).

coffee happy faceCoffee – yes, coffee.  Higher consumption of coffee was associated with a lower risk of basal cell carcinoma, the most common type of skin cancer (Loftfield E, et al).  It may also have an effect at lowering the risk of melanoma as well.  It is believed to be related to the caffeine content, so decaf doesn’t cut it.  And the effects were seen at multiple cups (4 or greater) per day, so as long as your doctor says it’s OK, brew happy!

The complicated story of Polyunsaturated Fats (PUFAs): PUFAs stand for polyunsaturated fats.  Often thought of as an alternative to saturated fats, the modern American diet has adopted too many of PUFAs due to the industrial reliance on corn oils and soybean oils for cooking.  The story is complicated, and there is a good summary here.  Many of you might have heard about omega-3 polyunsaturated fatty acids as being good for the body.  It’s the new dietary fad, and omega-3s are the “good fats,” found in salmon, cod, avocados, and flax seeds, among others.  The most important part of the PUFA story is the ratio of omega-6 (O-6) to omega-3 (O-3) fatty acids.  The idea ratio is somewhere between 4-6:1 of O-6 to O-3.  The typical American diet has somewhere around 10:1 or 16:1 ratio, which is waaaay too in favor of the omega-6 fatty acids.  This is because of all the vegetable oils that are used in cooking and our processed foods (i.e. canola oil, soybean oil, vegetable oil, crisco) and because of our heavy red-meat consumption (omega-6s are also found in conventional, non-grass-fed red meats).   Omega-6s contain arachidonic acid, which has a pro-inflammatory effect on the body and skin (hint: aspirin inhibits arachidonic acid, which is a main contributor of pain, and why aspirin works on pain).  Fish oils rich in omega-3 fatty acids contain eicosapentaenoic (EPA) and docosahexaenoic acids (DHA) which inhibit the formation of inflammatory molecules and generates anti-inflammatory and anti-proliferative metabolites.  The data on skin cancer prevention and PUFAs is mixed, probably because the story of PUFAs is complicated.   Again, the Mediterranean diet, which emphasizes omega-3 PUFAs (fish) found positive benefits with diets high in PUFAs, while others have found even an increased risk of skin cancer.  The important question is: “what was the omega-6 to omega-3 ratio?”  Without that information, the discussion of PUFAs is too muddy. Of note, there was no effect of a low-fat diet on the risk of two of the most common types of skin cancer (basal cell and squamous cell carcinoma), therefore a fat restricted diet is not recommended for skin cancer prevention.

Foods that may INCREASE the risk of cancer

drunkA word about alcohol:  multiple studies have found an increased risk of skin cancer with higher consumption of alcohol, while others have not (Murzaku, et al).  Of course, the possible confounding factor here is that those who regularly consumed alcohol might be higher risk-takers, increasing the risk of sunburn behavior. An exception was found with the Mediterranean diet, where no increased risk was found with alcohol consumption, probably because the drink of choice was likely red wine.  Red wine is rich in polyphenols (similar to chocolate and green tea), which might neutralize the alcohol-induced oxidative stress.  Similar beneficial compounds are not found in beer or hard liquor, so choose your drink wisely!

citrus drinkOf note, citrus consumption was associated with slightly higher risk of skin cancer (Wu S, et al).  Citrus contains psoralens, which can make your skin more sensitive to the sun.  A large prospective study correlated citrus consumption with an increased risk of basal cell and squamous cell carcinoma risk of skin cancer, and another study found increased risk with melanoma.  Highest incidence of skin cancers associated with the highest consumption of citrus fruit, especially grapefruit, which has the highest concentration of psoralens.  Hold on… citrus has a lot of other beneficial components, including Vitamin C (an antioxidant), so it isn’t time to give up your OJ yet.  Just use caution when being in the sun and don’t skimp on sun protection, especially when accompanied by a tropical drink.  Also, think twice where you put that lime…. lime burns, also known as phytophotodermatitis (say that 3 times fast), can give a bad burn and leave a stain for many months.  If eating/drinking citrus, think sunscreen!!!

Supplements  

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Disclaimer:  This section on supplements is only in regards to the prevention of skin cancer, not any other disease state, and is meant as educational only.  Please consult with your doctor with any specific questions.

In general, I usually don’t  recommend taking a supplement over getting the nutrient in question from whole foods.  While there are some studies supporting benefits of supplements, there are also many others that show no benefit or actual harm being done to patients, including an increase in mortality!  Eat a diverse, colorful diet, and you won’t need to pop any pills!

BUT… I still like to know what’s out there… so here it is!

Aspirin, ibuprofen, naproxen – also known as non-steroidal anti-inflammatory drugs (NSAIDs). Epidemiological studies have shown a protective effect for the regular intake of NSAIDs on the development of melanoma (Harris, 2001). Of course, these medications should not be taken to prevent melanoma, but it feeds into the theory of “anti-inflammation” being helpful in fighting/preventing many diseases, including cancer.  NSAIDs have other serious side effects with prolonged use, including stomach ulcers, so again, you should not take this without your doctor’s oversight, and certainly not for skin cancer prevention until we get more data.

Selenium is an antioxidant.  Originally selenium supplementation was thought to be beneficial in preventing skin cancer, however, one study did find that selenium may increase the risk of certain types of skin cancer and a review from the JAAD concluded that selenium supplements should be avoided. (Murzaku EC, et al.).

Vitamin D: Data is conflicting (Reddy et al, Tong et al).  While Vitamin D shows excellent properties in the lab, clinical trials with 36,000 patients did not show any improvement in melanoma rates with modest vitamin D supplementation (calcium + 400 IU daily) compared to placebo.  There is some data that in high risk patients with a history of non-melanoma skin cancer, supplementation results in a significantly lower melanoma risk.  But for the average person, vitamin D does not seem to impact skin cancer risk.  It is important to note that these studies are looking at vitamin D supplements… getting vitamin D from the sun is automatically accompanied by DNA damage that can cause skin cancer, as shown by this study.  There is no safe way of getting vitamin D from the sun!

Vitamin E (and C): Topical vitamin E works well in combination with topical vitamin C as an antioxidant.  However, oral vitamin E studies are mixed.  Multiple studies show no association between vitamin E and melanoma risk.  The safety of vitamin E supplementation is also unclear, because increased all-cause mortality has been found in patients receiving high-dose >400 IU daily vitamin E (Bjelakovic G, et al, 2014).

red wine

Resveratrol is a naturally occurring polyphenolic compound in grapes, red wine, some berries, and peanuts.  While the purported benefits are large (photoprotective, antioxidant, anti-inflammatory, and anticarcinogenic), there are no good studies looking at oral supplementation with the exception of a study showing better skin outcomes after radiation for breast cancer in those taking a combination antioxidant supplement containing resveratrol (Murzaku EC, et al 2014).

Lycopene: is a carotenoid found in red fruits and vegetables.  Tomatoes and tomato paste are a great dietary source of lycopene.  Lycopene is a potent antioxidant and free radical scavenger that protects against UV photo-damage (Murzaku EC, et al 2014).  Topical application of lycopene before UV irradiation decreases the inflammatory response, diminishes the generation of enzymes that damage the skin (MMPs), decrease how fast the skin becomes red to UV, and preserves DNA integrity and normal cell proliferation.  Human studies of oral lycopene are conflicting.  When dietary lycopene was stratified into the highest 20% of consumption, one case control study found that these patients had a significantly lower melanoma risk. It was shown that it was possible to protect against UV light-induced erythema (sunburn) by 40% after eating 40 grams of tomato paste a day for 10 weeks (Stahl et al., 2007). However, 3 case control studies found no significant association between serum lycopene levels and risk of subsequent melanoma.

Two supplements that I think is worth highlighting in particular….

Heliocare (Polypodium leucotomos) – Heliocare is an oral dietary supplement derived from the fern species Polypodium leucotomos, which has been used for centuries in Central and South America to help protect the skin from the sun.  It is an excellent adjunctive to externally applied sun protective measures.  It takes more UV exposure to cause a sunburn in someone taking Heliocare than someone that does not.  Of note, a similar product has also come to market, called UVO, which instead of a pill, is a powder packet that also contains other antioxidants that you can dissolve in water and drink daily.  Polypodium leucotomos is never a replacement for sun protection, but I think they are an excellent adjunctive.  To date, no adverse events or side effects have been reported with this supplement to my knowledge.  The major caveat is that since it is not a medication, it has the same loose oversight (and lack of FDA oversight) as any other vitamin or nutritional supplement.

Nicotinamide – A randomized, double-blinded, controlled trial found that supplementation with twice daily 500 mg of nicotinamide significantly decreased the number of precancerous lesions and all types of skin cancer.  (Chen A et al, N Engl J Med 2015).


Again, as a reminder, I would like to reiterate that nutritional studies are notoriously fraught with research biases, making them difficult to interpret.  Many studies show a correlation, which is very different from causation.  Here’s a nice example of this error from Wikipedia:

Sleeping with one’s shoes on is strongly correlated with waking up with a headache.

Therefore, sleeping with one’s shoes on causes headache.

sleeping w shoes

The above example shows why one should not confuse correlation with causation.  This example prematurely concludes that sleeping with shoes causes a headache, rather than the more likely factor, which is going to bed drunk causes both the headache and sleeping with shoes on.

In summary, I think the most extreme example of how nutrition can be a form of sun protection would be when you’re on vacation. You are probably getting more sun exposure than usual, and maybe a little loose with your diet.  Now would be the time to pass on the cheeseburger – full of grease and lacking any beneficial antioxidants, and opt for a green salad and fruit, or a caprese salad with tomatoes and olive oil!  Keep your reserves of anti-inflammatory and antioxidant powers high, and no matter what, don’t forget your sunscreen!!

 


 

References

Accorsi-Neto A, et al.  Effects of isoflavones on the skin of postmenopausal women: a pilot study.  Clinics (Sao Paulo) 2009;64(6):505-10.

Aguilera P, et al.  Benefits of oral Polypodium Leucotomos extract in MM high-risk patients.  J Eur Acad Dermatol Venereol 2013;9:1095-100.  

Bjelakovic G, et al.  Antioxidant supplements and mortality.  Curr Opin Clin Nutr Metab Care 2014;12(1):40-4.  

Bronsnick T, et al.  Diet in dermatology: Part II. Melanoma, chronic urticaria, and psoriasis.  J Am Acad Dermatol 2014;71(6):1053

Chen AC, et al.  A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention.  N Engl J Med 2015;373(17):1618-26.  

Ferrucci LM, et al.  Tea, coffee, and caffeine and early-onset basal cell carcinoma in a case-control study.  Eur J Cancer Prev 2014; 23(4):293-302.

Fortes et al. A protective effect of the Mediterranean diet for cutaneous melanoma.  Int J Epidemiology; 2008: 37(5):1018-29.

Harris RE, et al.  Inverse association of non-steroidal anti-inflammatory drugs and malignant melanoma among women.  Oncol Rep 2001;8(3):655-7.

Huang MT, et al.  Inhibitory effects of curcumin on in vitro lipoxygenase and cyclooxygenase activities in mouse epidermis.  Cancer Res 1991 51(3):813-9.

Jensen JD et al.  Nutrition and melanoma prevention.  Clinics in Dermatology 2010;28:644-649.

Johnson JJ.  Carsonol: a promising anti-cancer and anti-inflammatory agent.  Cancer Lett 2011;305(1):1-7.  

Loftfield E, et al.  Coffee drinking and cutaneous melanoma risk in the NIH-AARP diet and health study.  J Natl Cancer Inst 2015;107(2).

Murzaku EC, et al.  Diet in dermatology: Part I.  Atopic dermatitis, acne, and nonmelanoma skin cancer.  J Am Acad Dermatol 2014:71(6):1039

Peterson B, et al.  Sun and ski holidays improve vitamin D status, but are associated with high levels of DNA damage.  J Invest Dermatol 2014;134(11):2806-13.  

Pollan M.  In Defense of Food.  2009 Penguin Books.

Reddy KK, et al.  The role of vitamin D in melanoma prevention: evidence and hyperbole.  J Am Acad Dermatol 2014;71(5):1004-5.

Smith SG.  How diet impacts your skin.  March 22, 2016 https://www.md.com/blog/how-diet-impacts-your-skin

Stahl W, et al.  Carotenoids and flavonoids contribute to nutritional protection against skin damage from sunlight.   Mol Biotechnol 2007;37(1):26-30.

Stoner GD, Mukhtar H.  Polyphenols as cancer chemopreventive agents.  J Cell Biochem Suppl.  1995; 22:169-80.

Tong LX, et al.  Nutrition: the future of melanoma prevention?  J Am Acad Dermatol 2014;71:151-60.

Wu S, et al.  Citrus consumption and risk of basal cell carcinoma and squamous cell carcinoma of the skin.  Carcinogenesis 2015;36:1162-1168.

Wu S, et al.  Citrus consumption and risk of cutaneous malignant melanoma.  J Clin Oncol 2015;33(23):2500-8.  

Zeng W, et al.  Tea consumption and cancer incidence in a prospective cohort study of postmenopausal women.  Am J Epidemiol 1996;144:175-82.

The Best Sun Protective Clothing – and why you should wear it!

After many years of battling with unpleasant sunscreens, I have finally come around to the notion that sun clothes (clothes that have built in SPF, or more technically, UPF) are much more convenient and more effective and protecting from UV damage.  And most surprisingly, I am MUCH COOLER in the sun when I wear a long sleeve sun shirt!  New technology has made sun protecting clothing the ultimate multi-taskers; protecting from UV rays, cooling down the skin, wicking away moisture, and ventilating at the same time.

I think it would have been tough if I was still a teenager, dealing with the peer pressure to sunbathe in an itty bitty bikini, to instead wear a full coverage sun shirt.  But I should give our society more credit.  More and more people are starting to realize that the sunbathing you do as a youngster to “look good,” or “have a base tan,” is passé.  Pale is beautiful, and the very sunbathing done for aesthetic purposes has very ugly consequences even as short as 15 years later (think sun spots, wrinkles, blotchy skin).

Here are some benefits of UV clothing:

  1. You feel COOLER in the sun!  Amazing, but true.
  2. You don’t need to reapply sunscreen!  Who wants to reapply every two hours?
  3. You won’t miss any spots and have awkward geometric burns on your back.
  4. Prevention of skin cancer and skin aging.

So, here are my reviews and recommendations of some of the best sun protecting clothes that are cute and fashionable.

Coolibar – the company performs vigorous testing on all lots of clothing to ensure excellent UV protection. These were my first sun shirts.

Columbia – OmniShade and Omni-Freeze Zero – One of my personal favorites.  The Omni-Freeze Zero technology cools down a person when exposed to sweat.  We find it most commonly in their Performance Fishing Gear.  Great for the beach or any hot day.  My family knows that if it’s hot out, my hubby will only be wearing this shirt.  It’s now a joke that he doesn’t own any other clothes.

IMG_4899
Good dermatology family!  We are covered up and cool (both temperature-wise and figuratively). My hubby is sporting his favorite Columbia shirt.

UV Skinz – nice selection of outerwear for the family (nice kids selection), plus sun “sleeves” which are great for driving, gardening, golfing, etc.  I just bought some of the sleeves for myself and my husband!  Plus I LOVE their May Skin Cancer Awareness campaign – any purchase comes with a free baby sun shirt!

banner-saveababysskin
UV Skinz Save a Baby’s Skin Campaign – free baby sun shirt with any purchase during Skin Cancer Awareness Month (May).

Lands’ End – I was surprised myself, but after seeing a tweet by Deborah Messing, I checked them out.  They have surprisingly cute swim wear!

SwimZip – As seen on Shark Tank.  This company makes it easy to find cute swimwear with zippers – we all know how hard it is to take off a wet bathing suit from a squirmy toddler!  SwimZip makes it super easy.

Mott50 Sun Protective Fashion – Co-founder Anne Reilly wanted to capitalize on the more noticeable trend of young ladies covering up.  Nice variety of casual and swim wear for women and kids.

IMG_4045
Dr. Dosal modeling a Bloxsun scarf at the Miami Open 2015

BloxSun – a local Miami company, offering beautiful UPF scarfs to cover you up in any occasion.  Check me out modeling my scarf at the Miami Open, where the sun can be unbearable.  This beauty kept me cool!  I also use their sun gloves while driving and gel manicure to keep my hands looking young.

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SunSoaked – Australian beach outwear line.  Designed to offer more fashionable, feminine, elegant sunwear.

Cover – Founded by the sister of a melanoma survivor and former investment banker, founder Lisa Moore offers luxury sun protective clothing that is runway worthy.

SanSoleil – makes golf, tennis, and other sports apparel out of Newport Beach, CA.

BloqUV – Excellent beach and sporting apparel. Great selections for golf, tennis, running, yoga, swim.

Any clothing with “Coldblack” – coldblack is a special dye added to clothing to reflect light and infrared heat.  Used to keep men cool in dark suits, it also provides a UPF factor of 30 to its clothing.  It can notably be found in Ermenegildo Zegna suits and in Under Armour golfing wear.

These retailers have earned the Skin Cancer Foundation’s Seal of Recommendation for sun protective clothing and hats.

  • Boys Scouts of America
  • Columbia Sportswear
  • Coolibar
  • J. Crew
  • Lands’ End
  • O’Neill Wetsuits
  • Quiksilver
  • Roxy
  • Specialized Bicycles
  • Sundrive
  • Wollaroo Hats Company (I like their hats a lot)
  • Whitworth Hats

I encourage you to pack (and wear) a sun shirt the next time you are going to be somewhere sunny.  I think you will be pleasantly surprised how much you like it!

References

The Skin Cancer Foundation Journal, Vol XXXII, 2014.  skincancer.org

Dr. Dosal is a practicing dermatologist at the Skin Associates of South Florida in Miami, FL.  She is also on voluntary faculty at the University of Miami.

I LOVE my Gel Manicures! But should I worry?

I LOVE my gel manicures!  Lasting at least two weeks, gel manicures have finally made my pincers look pretty!  Like many of you, I had been wondering about the safety about the UV lamps that are used to cure the gel manicures.  They seem fairly benign, but there has been some press questioning its safety. nail polish

When I read a recent issue of JAMA Dermatology, I was relieved to read that the authors concluded that the risk of skin cancer was very very low with gel/UV manicures, even with regular use.  This is what I suspected, so I stopped worrying.  Additionally, my salon recently introduced an LED nail lamp, which also seemingly solved the issue of the UV lamp.

Well, imagine my surprise when this topic came up again at the most recent American Academy of Dermatology Annual Meeting.  Nail expert Dr. Chris Adigun reopened my concerns about the safety of UV lights. She argued that the lamps are notoriously variable in their UV exposure, nail salons hardly ever follow manufacturer recommendations, and that the UV exposure is more than we previously thought.

This really left me conflicted, since I adore my gel manicures, and I really hadn’t prepared myself to abandon them anytime soon. So I took it upon myself to read through all the relevant articles on the subject (I hate taking someone else’s word for it).  Luckily, several groups have studied a variety of nail lamps, with a variety of hand positioning and exposure times.

Here’s the summary:

The amount of UV exposure is WAY below anything close to skin-cancer-causing levels.  

Here are a few other important take-away points:

  • Out of 72,709 women getting regular manicures for 60 years (assuming generous exposure times), only one woman would develop skin cancer who wouldn’t otherwise (in statistics, this is called the “number needed to harm”).
  • It would take 250 years of weekly gel manicures to equal that of a therapeutic phototherapy session that I commonly prescribe for psoriasis (15–30 treatments over 5–10 weeks).  (Yes, phototherapy is often UVB, rather than UVA, but this JID study measured UV dose in J/cm2, and gives a risk comparison to something we already know to be safe).

From a skin cancer perspective, the risk of skin cancer from nail curing lamps is very low.  However, it is important to note that ALL lamps used to cure gel manicures emit UVA radiation, even the LED lamps.  Despite the lack of “UV” in the name, LED lamps are actually more intense than UV lamps and emit more UVA.

As a quick review: UVB rays cause sunburn and skin cancer, while UVA rays penetrate deeper into the skin, causing skin aging, cell damage, sun spots, and wrinkles by breaking down collagen and elastin (and to a lesser degree than UVB, also contribute to skin cancer).

UVA UVB infographic
UVA penetrates deep into the skin to affect collagen and elastin, causing wrinkling, blotchiness, and poor skin tone.
UVA radiation is responsible for the brown spots (“liver” spots or “sun” spots) on your grandmother’s hands, as well as the wrinkles and crepiness of the skin.

There’s nothing worse than a youthful face that has been preserved with good skin care, but “old” looking hands.  

While the risk of skin cancer is much less than ambient exposure to natural sunlight, the cumulative effects of UVA exposure can result in discoloration and premature aging of the skin.

 

Aging hands
The typical appearance of a photoaged hand.  Note the blotchy appearance of the skin, brown spots, and thinned skin overlying the veins and tendons of the hand.  This occurs with regular exposure to UV light, especially UVA, which is emitted in all nail curing lamps and penetrates windows.
So your gel manicure won’t significantly increase your risk for skin cancer, but why risk any UV exposure?

For the very sake of preserving the youthful appearance of your hands, I recommend at least the application of a broad-spectrum sunscreen with an SPF of 30+ (see here for recommendations), or sun gloves while having your hands in the lamp.  My feeling is the gloves are better.

  • I use these sun gloves made by BloxSun– I wear them driving and bring them to the salon. 
  • Screen Shot 2016-02-08 at 1.14.25 PM
  • YouVee sunshields are currently crowdfunding – they are very cheap disposable hand protectors that block 99% of all UV radiation.  Wouldn’t it be great if salons started carrying these?
    2e0973_49bb9c8432144cb7809de96894bdcdf2

 

In summary, I’m going to keep getting my gel manicures (thank goodness)!

For many of us women on-the-go, the gel manicure is here to stay!  Just be sure to protect those hands! And as with anything, it’s good to take a break once in a while from manicures to give your nails a breather.

Dr. Jackie Dosal is a practicing dermatologist in Miami, FL at the University of Miami and Skin Associates of South Florida.  

 

References

Shipp et al.  Further investigation into the risk of skin cancer associated with the use of UV nail lamps.  JAMA Dermatology 2014;150(7):775-6.
Diffey BL.  The risk of squamous cell carcinoma in women from exposure to UVA lamps used in cosmetic nail treatment.  British Journal of Dermatology 2012;167:1175-1178.
Markova A, Weinstock MA.  Risk of skin cancer associated with the use of UV nail lamp.  Journal of Investigational Dermatology 2013;133:1097-1099.
Macfarlane DF, Alonso CA.  Occurrence of non melanoma skin cancers on the hands after UV nail light exposure.  JAMA Dermatology 2009;145(4):4479.
Curtis J, Tanner P, Judd C, Childs B, Hull C, Leachman S.  Acrylic nail curing UV lamps: High-intensity exposure warrants further research of skin cancer risk.  J Am Acad Dermatol 2013;69(6):1069-70.
Dowdy JC, Sayre RM.  Nail curing UV lamps: Trivial exposure not cause for public alarm.  J Am Acad Dermatol 2015;6(64):e185-6.

How to select the best sunscreens

Summer is the time where I get alot of questions regarding sunscreens. It’s no wonder… the flood of information out there can be very confusing. I offer up a fairly comprehensive summary of what you need to know this summer to protect your skin. Here are some basics:

Considering that SPF was determined using experiments with 2 mg/cm2 of sunscreen, which is way more than anyone uses in real life (we generally use less than 1/3 of what we are supposed to), we are all getting less protection than we think. For that reason, I usually recommend an SPF of 30 or more (the sun laughs at less than SPF 30, especially here in Miami), one with the label “Broad Spectrum,” and to reapply every two hours. UVB rays cause sunburn and skin cancer, while UVA rays penetrate deeper into the skin, causing skin aging, cell damage, sun spots, and wrinkles by breaking down collagen and elastin. It is important to block both of them, and SPF only indicates the UVB protective power. “Broad Spectrum” indicates that the particular brand also blocks UVA. See this lovely infographic by Dr. Michelle Levy that illustrates how UVA and UVB damage the skin.

UVA UVB infographic

Why not use SPF 100? There is a miniscule incremental benefit in protection above SPF 50, so much that the FDA proposed banning the labeling of higher SPFs, as it can be misleading to the public. SPF 100 blocks 99% of harmful UVB rays, while properly applied SPF 50 blocks 98% of the same rays. Something about an SPF of 100 gives people a false sense of security, and they are more likely to improperly use it or expose themselves to the sun for longer. Additionally, there is some evidence that having the very high SPF makes it more difficult to chemically formulate a sunscreen with great UVA protection, which is just as (if not more) important as UVB.

sunburn lines small

Reapply! The most common reason for sunburn is missing an area of your body and forgetting to reapply every two hours.

There are so many sunscreens on the market, how do I know which one to use?

I classify my sunscreens by the type of use: everyday useintense sun exposure (like going to the pool or beach), athletic use, and those for babies. Let’s start with babies:

Babies: Baby’s skin at less than 6 months of age hasn’t yet developed the same type of barrier protection as an adult. For that reason, the American Academy of Dermatology will generally recommend sun avoidance or sun protective clothing (look for clothes labeled with UPF- iPlay makes great ones). When sunscreen is needed, a physical sunscreen is best. Physical sunscreens bounce UV rays off the skin, as opposed to chemical sunscreens which are excellent at protecting the skin, but baby is more likely to be sensitive to these products (note: most sunscreens are chemical sunscreens). You can recognize a physical sunscreen because it only has one or two active ingredients: zinc oxide or titanium dioxide. These are some of my favorites: CeraVe BabyNeutrogena Pure and Free Baby SunscreenBlue Lizzard Baby. (I don’t like the one made by the Honest company — I find it very hard to rub in and sticky).

Beach or pool use: As mentioned earlier, a Broad-Spectrum sunscreen with an SPF of at least 30 is best. Water-resistant (now labeled as 40 or 80 minutes) is also a must. The key is to reapply every 2 hours! Pick your favorite and go with it… Sunscreen only works if you use it! Here are some of my favorites: La Roche Posay Sunscreen MilkNeutrogena Ultra SheerCoppertone Oil-Free FacesNeutrogena Beach Defense.

Everyday Use: Yes, you should be wearing sunscreen every day!!! It’s not only to protect yourself from skin cancer, but if you want to look young, the MOST important intervention is sunscreen! See the difference between these twins, one who practiced sun protective measures, and the other who didn’t. The twin that protected herself from the sun looks at least ten years younger than her twin sister. Having a tan can be nice in the short term, but your skin will pay for it. By the time most people hit age 30, their skin can start to show their prior indiscretions! Time to embrace your inner Anne Hathaway. Pale is beautiful.

The sunscreens I like for everyday use are those that feel like a moisturizer, are very light and sheen, and layer well under makeup. Sunscreen should be layered under your makeup, even if your makeup contains SPF…. it’s not enough. Here are my favorites: Elta MD UV ClearLa Roche Posay AOX SerumNeutrogena Healthy DefenseCeraVe AM.

Athletic Use: This is a tough one. Intense exercise or very hot conditions cause you to sweat like it’s raining. Even water resistant sunscreens can be tough to keep on, and forget reapplying on that wet skin. I’m still in search for a good one, and would love to hear your comments/recommendations below! I would definitely recommend UPF moisture-wicking clothing for tennis, fishing, or other activities, as these actually keep you more cool than tank tops and have consistent sustainable sun protection.

Sprays: Personally, I love the convenience of sprays. However, it seems like people are more likely to under-apply or miss certain areas of their body, potentially leading to sunburn. There are also some questions about the possibility of inhaling the aerosolized chemicals, and we don’t yet know the dangers of this. I still use sprays sparingly when I need the convenience, but the jury is still out as to their proper role.

When should I be using a non-chemical (a.k.a. physical) sunscreen?

The majority of sunscreens on the market contain excellent scientifically developed chemicals that block a combination of UVB and UVA rays. For the vast majority of people, chemical sunscreens are perfect. In some cases, a physical blocker is preferred. For instance, in babies less than six months of age, I recommend a physical blocker for reasons stated above. There are 3 other scenarios where I prefer physical sunscreens: sensitive skin, rosacea, and melasma.

I know many people who tell me they are allergic to every sunscreen that they have tried. My bet is that they have not yet tried a purely physical sunscreen, as they can be difficult to find. While regular sunscreens have a fairly high rate of allergic contact dermatitis, physical blockers have almost no reactive potential. These are my favorites for non-facial use: Neutrogena Sensitive SkinNeutrogena Pure and Free Baby SunscreenBlue Lizzard. See below for facial sunscreen recommendations.

Do you suffer from flushing, red pimple bumps, skin burning, and/or sensitivity to most products? Well then you might have rosacea, and I definitely prefer for you to wear a physical sunscreen. Rosacea and melasma (those brown patches on the face that come with sun or pregnancy) are very sensitive to heat, and chemical sunscreens produce an imperceptible amount of heat, potentially flaring the skin. In order to minimize anything that can exacerbate rosacea or melasma, I recommend a pure physical sunscreen for these heat sensitive conditions. Physical sunscreens bounce the UV rays off the skin, and are inactive on the skin. In both rosacea and melasma, sunscreen is mandatory. You will find with changing sunscreen alone, your skin may dramatically improve. These are my favorite physical sunscreens for daily facial use: La Roche Posay Anthelios Mineral SPF 50Elta MD UV Physical SPF 41SkinCeuticals UV Physical DefenseCeraVe SPF 50 Facial Sunscreen LotionAvene Mineral SPF 50. And don’t forget to reapply. For the sake of convenience, I like the following two products to help women reapply sun protection after they have applied their makeup. No one wants to put on a lotion sunscreen to a freshly painted (ahem, made-up) face. Use these products to layer on top of your pretty face throughout the day: Avene compactColorescience Sunforgettable Mineral Powder Brush.

In conclusion, don’t forget to practice other sun safe behaviors, such as wearing polarized sunglasses, protective clothing such as hats, UPF clothing, UPF scarves (see these great ones by Blox Sun), and seeking shade during peak hours of UV intensity, 10 am to — 4 pm.

I’d love to hear your thoughts and invite you to comment below!

Stay tuned for my take on the topic of Vitamin D and the Environmental Working Group’s rankings of sunscreens.

Photo credit: Shutterstock

Dr. Jacquelyn Dosal is a board-certified dermatologist practicing in Miami, FL.  About Dr. Dosal: http://goo.gl/hbgqZW

The dangers of sunscreen – A dermatologist’s perspective.

Is my sunscreen going to kill me? Perform a search on sunscreen safety and some scary stuff shows up! Retinyl palmitate causes skin cancer. Oxybenzone causes estrogen-like effects on the body. I have seen these statements repeated over and over again all over social media and in real life. I recently heard from a patient, “I was using Neutrogena but then stopped because I heard it wasn’t so good for you.” How do we protect ourselves and our families from skin cancer without any nasty side effects?

avocado organic

I’d like to offer up my take — from a organic-loving, Whole-Foods-shopping, yoga-practicing, green-tea-drinking MD (dermatologist), with an eye for interpreting both media and science…

For those not able to read the whole post (we are all busy, I know!), here’s the quick summary of my findings. You can read on for more info too!

Sunscreen won’t cause hormonal disruption — it would take 200 years of application to even reach questionable levels of exposure.

Sunscreen won’t cause skin cancer — the use of sunscreen is directly correlated to the prevention of skin cancer. Retinyl palmitate is an anti-oxidant that occurs naturally in the skin.

Nanosize sunscreens are safe for use, as they clump in real life, preventing them from being absorbed.

I’ve researched the issues of sunscreen safety personally, and WOW! It’s confusing and contradictory. I’ll at least say this— we always need to critically and scientifically analyze the sunscreen ingredients we use for both efficacy and safety. And just as important, let’s not perpetuate myths that are based on unsound science. If you are interested in sorting through the muddy waters of sunscreen information — read on!

—-

Environmental Working Group’s Rankings of Sunscreens.

Most of the information about safety stems from the Environmental Working Group’s sunscreen rankings. The Environmental Working Group is a not-for-profit organization that searches to identify harmful chemicals in our environment. While I applaud the intentions of the EWG to find safe and environmentally responsible materials, we need to be fair and look at these issues seriously, and not just solely how presented by the EWG.

Do sunscreens cause hormonal disruption?

The EWG advises avoiding any products with oxybenzone (an excellent UVA and UVB blocker) as it may cause effects similar to estrogen. The concern comes from a study performed in rats, where the rats were fed supratherapeutic doses of sunscreen (let me say that again, the rats ATE sunscreen at megadoses), and the size of their uterus enlarged.

graph from oxybenzone study 4
Edited graph from PMID 11333184

There is a monstrous difference between eating super high doses of sunscreen and applying it to your skin daily — and concluding that topical use in human sunscreen causes estrogenic effects is an unrealistic stretch. A study in 2011 in JAMA Dermatology showed that it would take 200 years of daily sunscreen application to reach the same amount of exposure as the rats in this study. To the author’s credit, their word-for-word conclusion in the abstract was: “Our findings indicate that UV screens should be tested for endocrine activity…” The authors do not say that the UV screens cause hormone activity in humans… they can’t. In order to substantiate their EWG’s claim, you would need to show hormone disruption in real live humans.

Luckily, such a study was performed. Human patients applied more than 3 times the real-life quantity of a high percentage oxybenzone sunscreen (10% oxybenzone, compared to the commercially available 6% oxybenzone) to their whole body daily for one week. Oxybenzone was in fact detected in the urine of the volunteers (as have some other sunscreen agents). Sound the alarm bells! — this is concerning. It indicates that there is some absorption from topical use (medications that are applied directly to the surface of the skin). However, the body quickly excreted it through the urine (which is a good thing). Much can be said about the fact that it was absorbed, but the take-home message was that the researchers were UNABLE to show a hormone disruption despite this absorption (again, this was at 3 times real-life dosage). There was no accumulation of the ingredients over time.

So we have a study in humans of real-life sunscreen use that shows no hormonal effect, or a study where rats ate sunscreen — which do you believe?

To be fair, when researching this blog post, I did come across an alarming number of lab and animal studies showing absorption of various sunscreen agents, with some experiments suggesting hormonal disruption. There were almost as many studies that showed no absorption nor hormone disruption. A good summary of those studies can be found here. But we have to look at what’s important… no human studies have shown hormonal disruption, and that is what counts.

Of note, it is important to mention that oxybenzone can cause allergic skin reaction in a fair percentage of people, so there should be some caution with its use.

And by the way, soy is weakly estrogenic. Where are the cries for banning or avoiding soy milk because of hormonal activity? There are many natural skin care products on the market containing soy, several of which I recommend and are excellent. A little perspective is important, and we need to remember that topical use is very different from ingestion.

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Let’s move on to sunscreen and skin cancer.

sunscreen bottle

Does my sunscreen increase my risk of skin cancer?

A few years ago there was media buzz about a toxicology study that suggested that retinal palmitate, a common inactive ingredient in sunscreens, may actually increase your risk for skin cancer by increasing oxidative damage, or reactive oxidative species (ROS). Oxidative damage is like rust on metal — it corrodes our body and makes us more prone to inflammation and cancer. Let’s dive into this deeper.

Retinyl palmitate is an interchangeable form of retinol that is present naturally in our skin, and this should already be a clue that it’s not dangerous. Retinyl palmitate is not just in sunscreens; is approved by the FDA for use in prescription and over the counter medications, as well as a food additive in dairy products and cereals. It was selected for testing due to its prevalent use in common agents, not for any concerns of safety up to that point.

Once again, we have to look at the details of the study that created the buzz. It was never published in a peer-reviewed journal (the standard for medical literature — data needs to be vetted by people in-the-know), and was not performed in humans (also a huge red flag). It was performed in hairless mice, known to have an already increased risk of skin cancer, and these mice were burned with and without retinyl palmitate (RP). The studies showed the production of oxidative damage and increased risk of malignancy. However, these studies take RP out of human context, which is a very complex interactive antioxidant system. According to Dr. Steven Wang, the lead investigator in the study, “when a sunscreen with retinyl palmitate is applied to the skin, a number of antioxidants work together to alleviate the risk of free radical formation seen in these in vitro experiments. If studied on its own — outside of this environment — its antioxidant properties can rapidly be exhausted, allowing the production of oxygen radicals. In these non-human studies, retinyl palmitate was the only compound studied — making the biological relevance of these findings to humans unclear.” Even the lead investigator is not ready to recommend avoiding retinyl palmitate.

The final and probably most convincing evidence of the safety of retinyl palmitate comes from real life use in humans. We often use the family of retinoids (of which retinyl palmitate is a member), as a pill for the prevention of skin cancers in those most at risk (immunosuppressed organ transplant patients). We also have decades of experience using retinoids in acne medications; and topical retinoids are one of the best anti-aging creams on the market — I personally use one (Retin-A) every night. Undeniable human research shows it can reverse oxidative damage and signs of aging, keeping the skin healthy and youthful.

If you are interested in more, I encourage you to read this summary by the Journal of the American Academy of Dermatology detailing the properties of retinyl palmitate and discussing its safety.

—-

What are nano particles, and are they safe?

Nanoparticles are molecules that have been divided into nanometers (one billionth of a meter). By making the molecules small, it makes sunscreens more cosmetically acceptable and elegant, thus making it more attractive for people to use (i.e. not thick, sticky, or opaque like the old sunscreens found on lifeguards’ noses).

lifeguard troll nose
Photocredit: http://etsy.me/1D3PcyJ

Concerns arose that these molecules might be small enough to penetrate through the skin into the bloodstream. Time and time again, human studies have shown that these particles are unable to penetrate through the skin because, in nature, these nanoparticles aggregate into clumps that are too large to penetrate the skin. There was also some thought that these ingredients could increase reactive oxidative species (ROS). We now know that this is meaningless if tested outside of the complex human antioxidative system. With this in mind, we should all embrace these new technologies that makes sunscreens less opaque, pastey, and more consumer friendly!

nanoparticle aggregates
Nanoparticles clump on the skin.  Photo credit: PMID 22123418

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Be Cautious of Media Sound Bites

mediaThe EWG extrapolates data (usually from animal studies, not humans), and uses scare tactics to make us feel like we are hurting our children if we use certain products. What I don’t like is that they ignore actual sound studies that show safety in humans. Their sound bites are alarming and catchy for headlines. I’ve actually seen website titles citing the EWG reading: “The Most Dangerous Sunscreens For Kids (And They’re Probably Hiding in Your Beach Bag).” Talk about mommy guilt!

I love this story which explains why we need to critically interpret how the media presents headlines: Chocolate Causes Weight Loss!

chocolateweightloss
http://io9.com/i-fooled-millions-into-thinking-chocolate-helps-weight-1707251800

Background: A scientist wanted to show just how easy it was to convince the media to pick up a poorly designed faux scientific experiment that was catchy for headlines. It was a completely fake, but intriguing idea — eating chocolate can help loose weight. It turns out, it was really easy to get experienced journalists to pick up the headline! Read here: I Fooled Millions into Thinking Chocolate Helps Weight Loss. A critical eye is really needed in these days of rapid information sharing.

—-

What does this all mean?

I don’t agree with the EWG rankings. Many of the poorly ranking sunscreens are very reputable and excellent brands. You can’t take the data from one animal or lab study and ignore other science and human experiments that are in disagreement. That’s not how science works. That’s the reason why thousands of drugs that work in animals never get to the market — because animal studies and in vitro studies often don’t translate into efficacy in the complex environment of the human body.

While in general, I’m in favor of the organic movement, real foods, and responsible farming practices, I often laugh when I see websites recommending chemical-free everything, including sunscreens. Chemicalsare in everything, and there is no such thing as a purely chemical-free susncreen. Of course, live in moderation — extreme use of any susbtance can lead to some bad effects, but to say that normal day-to-day use of products causes the same effect seen with extreme use or oral ingestion doesn’t make any sense.

As this EXCELLENT video describes, the dose is the poison, not the chemical itself. Almost any substance, including natural or beneficial substances, can be toxic under certain conditions, such as high temperatures, pH, concentrations, or when in the presence of other chemicals. Even too much Vitamin C can be lethal to skin cells at certain doses. The age-old mantra still holds true — everything in moderation.

Let’s thank the EWG for their laudable efforts in keeping us safe, but ask them not to demonize valuable products when the science shows otherwise. I completely agree that more testing needs to be done on household and cosmetic ingredients, but I wish they were a little more unbiased when it came to promotion of their agenda. And the media perpetuates these news snippets with negligible investigation into the validity of the EWG claims. It serves our society poorly.

Feel good about protecting your family — and apply that sunscreen this summer!

This article was originally posted on http://www.medium.com/@jackiedosalmd on July 29, 2015.

Dr. Jackie Dosal is a board-certified dermatologist practicing in Miami, FL.  About Dr. Dosal: http://goo.gl/hbgqZW

References

www.EWG.org/2015sunscreen

Hayden CG, Roberts MS, Benson HAE. Systemic absorption after topical sunscreen. The Lancet. 1997;350:863–4.

Janjua NR, Mogensen B, Andersson AM, et al. Systemic absorption of the sunscreens benzophenone-3, octyl-methoxycinnamate, and 3-(4-methyl-benzylidene) camphor after whole-body topical application and reproductive hormone levels in humans. J Invest Dermatol. 2004 Jul;123(1):57–61.

Janjua NR, Kongshoj B, Andersoon Am, Wulf HC. Sunscreens in human plasma and urine after repeated whole-body topical application. J Eur Acad Dermatol Venereol. 2008 Apr;22(4):456–61.

Krause M, Kilt A, Blomberg Jensen M, et al. Sunscreens: are they beneficial for health? An overview of endocrine disrupting properties of UV-filters. Int J Andrology. 2012:35:424–436.

Schlumpf M, Cotton B, Conscience M, et al. In vitro and in vivo estrogenicity of UV screens. Environmental Health Perspectives 2001;109: 239–244.

Wang SQ, Burnett ME, Lim HW. Safety of oxybenzone: Putting numbers into perspective. Arch Dermatol 2011;147(7):865–866.

Wang S, Dusza SW, Lim HW. Safety of retinyl palmitate in sunscreens: A critical analysis. J Am Acad Dermatol 2010; 63;903–6.

Wang SQ, Tooley IR. Photoprotection in the Era of Nanotechnology. Semin Cut Med & Surg. 2011;30:210–3.

http://www.cosmeticsandtoiletries.com/regulatory/uvfilters/49695482.html

#Getnaked. Check your skin!

I diagnosed two melanomas last week. My partner diagnosed another one the same week. Three melanoms in one week!!! Much to your surprise, here was the order of the most dangerous:
#1 most deadly case last week — melanoma on the bottom of the foot.
#2 most deadly case last week — melanoma on the lower leg.
#3 most deadly case last week — melanoma on the face.
Now, most of this has to do with how advanced the melanoma was when it presented, but there is an important lesson here. Alot of people will poo-poo a dark or unusual lesion on the lower body, since they don’t feel like the lower body gets alot of sun exposure.
Melanoma can happen ANYWHERE! The most common location for women to develop melanoma is the legs (as illustrated above — patients #1 and #2 were women).
I’ve said it before:

Screen Shot 2015-10-12 at 5.45.48 AM

If your dermatologist doesn’t make you #getnaked, find another one.

When you come to me for a full body skin examination, I check everywhere (unless you absolutely decline, I will respect your privacy!). But seriously, your dermatologist should be checking in between your toes, looking through your scalp, and checking where the sun doesn’t shine! I used to have a teacher in dermatology residency that would drill into us that if we weren’t checking the buttocks, we had not finished our full body exam. It was a little embarassing when she asked in front of the patient, but the point was well taken.
Bob Marley died of melanoma on his foot.
In truth, some melanomas are not sun induced (how would sun get to the bottom of your foot?), and these melanomas are more similar to other cancers that happen spontaneously. Therefore, everyone should come in for an annual skin exam, even people with dark skin.
I also strongly urge all of you to take a look at your skin regularly. Take a hand mirror and look ALL around before you get in the shower. Look at your spouse’s and your children’s skin. Become a “skin checker.”

What should I be looking for?

Dermatologists will often talk about the ABCDE method of detecting of melanoma. This is a great tool to help identify potentially suspicious lesions. Each letter corresponds to a characteristic of a mole that may signal an issue:

A stands for asymmetry — if a mole is asymmetrical. One half is not like the other half.
B stands for border — if the edges are ragged, not smooth.
C stands for color — if there are more than 1 or 2 colors present.
D stands for diameter — if it is more than >6 mm or the size of a pencil eraser.
E stands for evolution — if any mole is changing.

https://www.aad.org/spot-skin-cancer/learn-about-skin-cancer/detect-skin-cancer/what-to-look-for
https://www.aad.org/spot-skin-cancer/learn-about-skin-cancer/detect-skin-cancer/what-to-look-for

If you feel that any of your moles have met these criteria, don’t panic, but please do see your dermatologist for a professional evaluation.
As an aside, you should never feel funny going to the dermatologist to check any spot on your skin. The spot in question may be benign, but just being in the office may help identify other problem areas. More often than not, the worrisome spot is fine, but I may subsequently locate an inconspicious lesion that is a problem (potentially a skin cancer). This was the case in patient #3.
90% of melanomas are curable if caught early. Take care of yourself and your family — #getnaked and check your skin!