It\’s officially summer, and with this season comes a more relaxing pace for you (hopefully), an increased variety of fresh fruits and vegetables, water sports, beach reading, and of course more exposure to the sun. Regardless of how much is out there about sun protection, I still find the topic, and the array of products, confusing.

First, what we do know. Skin cancer is the most common type of cancer in the United States, with over one million cases diagnosed each year. The most common type of skin cancer, squamous cell carcinoma (scc), has been proven to be caused by sun exposure so that obviously, sun block will protect against this cancer. However, and this may surprise you as it did me, sun block has not been proven to protect against the most deadly form of skin cancer, melanoma, as well as another common form, basal cell carcinoma (bcc). So, if that\’s the case, why wear sunblock at all?

Good question, though easily answered. These are the reasons: 1) sun block does protect against the most common form of skin cancer, squamous cell, 2) studies are ongoing to prove that sun block can protect against melanoma and bcc, and we don\’t know that it does not protect yet, 3) sun block definitely protects against those dreaded signs of aging skin – such as wrinkles and discoloration. (For a more in depth discussion of the damage caused by the types of ultraviolet rays of the sun, see my column from November 2006.)

So what about all those different sun block products? Which should you use? The types of ingredients which are protective against the sun are divided into two categories: chemical and physical blockers. What this means is that the “chemical” block ingredients actively react with your skin to prevent the damaging ultraviolet rays of the sun from being absorbed. A few examples of chemical sunblock ingredients are PABA, avobenzone, and the newest, just available in the US, and considered by many to be the best, mexoryl. Currently this last ingredient is only available in one brand here: Anthelios, available at most drugstores. (I recently saw it at my local CVS.) The downside of sun blocks with these chemical ingredients is that they can cause a variety of bad reactions once in contact with your skin (or inadvertently, your eyes), from irritating rashes to allergic swelling to severe burning of the eyes. I\’ve had severe reactions to all of the chemical sun block agents so far, and am just now cautiously trying the newest one.

What about the ingredient that is a “physical” blocker of the sun? It does exactly what it says: you put it on and it blocks the ultraviolet rays from being absorbed by your skin, like a shield. No chemical reaction at all; the UV rays simply cannot penetrate through it. You\’re very familiar with examples of this type of sunblock ingredient – remember those hunky lifeguards at the beach or the pool with the heavy coating of thick white cream on their noses? Yes – the old tried and true zinc oxide, and its more modern sister, titanium dioxide. I wear this type of sun block all the time, and it works. No burn, no dark marks from the sun, and fewer wrinkles (I hope).

So, it\’s important that you look at the ingredients in the sun block you\’re thinking of buying. Be aware that some products contain a combination of physical and chemical blockers. Also important to know is that some brand names, like Neutrogena and Coppertone, make several different types of sun blocks with different ingredients. If you have sensitive skin, I would go with the ones which only have zinc oxide or titanium dioxide, like “Neutrogena for Sensitive Skin”, which I\’ve used for years. If your skin isn\’t especially sensitive, I would try the newest kid on the block with the ingredient mexoryl, as mentioned above.

As to which brand or formulation – that\’s entirely up to you. If you want sun block combined with your makeup or your moisturizer, that\’s fine, as is a plain sun block formulation, as long as it is labeled with at least an SPF (sun protection factor) of 15. And please don\’t forget about your lips. You\’re better off getting a lipstick type product formulated with sun block because it will stay on longer, and probably have a better taste. I love one made by Avon called “Beyond Color.” One thing to know – more expensive is not necessarily better. I\’ve used drugstore-bought sun block successfully for years

And what about all those “SPF” numbers? There\’s lots of debate about how effective the higher SPFs (over 30) really are, but the important thing is to use a sun block with an SPF of at least 15, and to use enough – at least 2 tablespoons per application – and reapply often – at least every two hours, no matter what the SPF.

If you really want to protect yourself from the sun, say if you\’ve had skin cancer before or if there\’s a family history of it, there\’s good news for you. These days there\’s a wide variety of specially-manufactured clothing that has high ultraviolet protection value. My personal favorite is made by the company “Solumbra,” (http://www.solumbra.com/). I wear one of their hats all the time, and their track suits for long summertime walks. Again I can tell you that these specially treated clothes really work, even after many washings. Alternatively, some dermatologists feel that densely woven fabrics, such as denim, wool, or polyester materials, especially in dark colors, can be as protective, even without being specially treated.

And what about you dark skinned beauties? Think you don\’t have to worry about blocking the sun? Think again. Although it is true that skin cancer is the most common in lighter skinned people, those of you with darker skins, whether you are of Asian, Hispanic or African American backgrounds, are susceptible to developing skin cancer too. And, in darker skinned people when skin cancer is found, it is usually more serious because it has advanced to a later stage before being diagnosed.

One more thing: don\’t forget about your eyes! Did you know that overexposure to the ultraviolet rays of the sun is a risk factor, and can lead, to two serious eye conditions? Both cataracts and macular degeneration, both leading causes of blindness which occur predominantly in people over the age of 50, have as one of their risk factors overexposure to the sun. How can you protect your eyes? Sunglasses – but not just any pair of sunglasses.

Although we all love those designer sunglasses, they may not give you adequate protection, no matter how much money you spent on them. You must notice on the label of the glasses if they are coated with UV light-absorbing material, and even if they are, most do not block enough of the UV light to prevent cataract formation. You should particularly look for a label which says “Meets ANSI Z80.3 General Purpose UV Requirements” and which indicates that the sunglasses block UV radiation up to 400nm. These are known as “general purpose” sunglasses.

If you are at special risk for cataracts by having diabetes or smoking, or if your eye professional has told you that you have early cataracts, you should only wear “special purpose” sunglasses which fit snugly on the nose, wrap around the head, and block light from below, above, and both sides of the glasses. These glasses should also have on their label the Skin Cancer Foundation\’s Seal of Recommendation for Sunglasses. You should also know that polarized glasses cut glare, but do not protect against UV radiation. In addition to special purpose sunglasses, a large sun hat should be worn to take care of those extra rays.

That\’s a lot of stuff to remember for a simple day on the beach so here are the main points:

  • Do not allow yourself to burn. Avoid tanning.
  • Look for shade, especially between the hours of 10 AM and 4PM. (Don\’t forget to

factor in Daylight Savings Time!)

  • Use a sun block with an SPF of at least 15 or higher everyday.
  • Apply at least 2 tablespoons of sun
  • block to all exposed parts of the body at least one half hour before going into the sun.
  • Reapply immediately after swimming, excessive sweating, or at least every two hours.
  • Consider using sun-protective clothing. Always wear a broad brimmed hat.
  • Get sunglasses with the proper UV protection – look at the label.
  • See your dermatologist every year for a routine full skin evaluation, and as needed for new or changing skin lesions.
  • Get into the habit of examining your own skin regularly, just as you do for your breast self-exam.
  • Drink plenty of fluids and ENJOY!
Janet Horn, M.D. Physician