To use or not to use a sunscreen, that is the question. This topic has been discussed, debated and dismissed with alarming apathy. But the verdict is in.
The skin is the largest organ of the human body, so it deserves special attention — especially as skin cancer rates are frighteningly high. Skin cancer accounts for nearly half of cancer cases in the US, according to the American skin cancer website (www.skincancer.org). Data published by Australia's Cancer Council (www.cancer.org.au) is equally alarming: two in three Australians are likely to develop skin cancer by the time they are 70. Over the past 30 years, incidence of malignant melanoma (the deadliest form of skin cancer) has more than quadrupled in Britain (http://info.cancerresearchuk.org).
Protection, therefore, is mandatory, and sunscreen which protects the skin from the harmful ultraviolet (UV) rays of the sun is the key.
Dr Ikramullah Al Nasir, specialist dermatologist at Dermacare Skin Centre, says: "Sunscreens are a preventive aspect of skincare. It's a real science; there is evidence to prove that they are an effective means of sun protection."
So how serious is the situation in a city such as Dubai, where sunshine is perennial and the average daytime temperature hovers around 40°C during summer?
Dr Fatma M. Mostafa, dermatologist and skin laser specialist at Dr Rustoms Medical Centre, says: "Sun exposure without thorough protection in a place such as Dubai may lead to skin cancer, especially for people with white skin, whereas people with dark skin will have a greater tendency to develop melasma (discolouration of skin) and blemishes. It is essential to apply a broad-spectrum, purpose-built sunscreen from a reputed company daily to minimise sun-induced skin problems. This is as important as protecting our vital organs from cholesterol, sugar or hypertension."
Sun-induced skin damage
Having dealt with skin cancer cases in the region for 14 years, Nasir adds: "Among the white population, there has been an increase in cases of skin cancer in Dubai."
Apart from the risk of cancer, pigmentation, dryness, early wrinkling, freckles and sagginess are all signs of sun-induced premature skin ageing. These can also be delayed or effectively prevented with the use of sunscreens.
Though there has been an increase in sunscreen products developed to offer long-lasting protection, a study conducted by Vichy Cosmetics' public health mission indicates the use of sunscreen is still low.
Dr Najwa Khalife, scientific director of L'Oreal Middle East, explains. "Definitely, with the leveraged level of awareness these days, more people are keen to protect their skin from the harmful rays of the sun.
"However, our research shows that seven out of ten women still don't protect their skin sufficiently. And one out of five children are not correctly protected. So while there is growth in demand for sun-protection products, people still need to be educated on how to use them properly."
Sunscreens and the Sun Protection Factor
Sunscreens have transformed over the years, from an oily, thick cream to non-greasy, slick formulas available in lightweight tubes and sprays that suit every budget. In the past couple of years, as Elie Abrass, brand manager for Nivea Sun, Middle East, informs us, sunscreen sales have gone up.
"Protection sprays and kids' products show the highest growth. There is also increasing demand for higher Sun Protection Factor (SPF 30 to SPF 50+) products," she says.
However, using a sunscreen with high SPF does not translate into better protection. What really matters is the duration of exposure to the sun and the method of application. Sunscreen should be applied half an hour before stepping out in the sun.
This allows enough time for the chemical in the cream to be absorbed by the skin tissue to form a protective shield against damage-inducing UV rays. Higher SPF does not necessarily mean quicker absorption, Nasir says. "People will apply a high SPF sunscreen five minutes before leaving the house, they will go to get their child from school and come back in half an hour and feel they are adequately protected, but they are not. This is not the proper way to achieve effective sun protection".
Prevention is better than cure
Almost all cosmetic brands have introduced special products to cater to the delicate and sensitive skin of children. Though sunlight provides the human body with essential vitamin D, which is good for the growth of teeth and bones, saving skin from harmful ultraviolet A and B rays should begin as early as possible.
"Sun protection should start from early childhood as the damage is usually due to a cumulative result of harmful exposure to ultraviolet rays of the sun over the years," Nasir says. Parents can also keep children safe from sun damage without using sunscreens, he explains. "Make them cover up, avoid the midday sun, use a hat to protect the face and ears. Reduce the hours of exposure by not spending a whole day at the beach."
Pre-schoolers usually do not require sunscreens as they remain mostly at home. However there is a range of effective suncare products on most market shelves that cater to children of all ages.
As part of their SunSmart programme, the Australian Cancer Council creatively launched the "Slip, Slop, Slap" campaign for children. "Slip on a shirt, slop on sunscreen and slap on a hat." The slogan has been modified to "Slip Slop Slap Seek Slide" to endorse the importance of seeking shade and sliding on sunglasses to prevent sun damage.
Don't leave the lips out
Just like the nose, ear lobes, temples and cheekbones, lips are more at risk of sun damage than the rest of the face. These are the prominent areas that get easily sunburnt. Applying any sunscreen of a reputed brand on the lips is especially important, says Mostafa, "if there is any inflammation, infection or if the patient has a tendency to develop lip pigmentation. It should be applied before sun exposure and after it is wiped out by eating or drinking."
Though there is no special sunscreen for any particular type of skin, Mostafa advises people with fairer skin tones (who fall within the higher-risk category of sun-induced skin damage) to consult a dermatologist before choosing a suitable sunscreen. Other than that, individual suitability depends on the user and what texture works best for them.
Remember, to use or not to use a sunscreen is no longer the question.
Myth vs reality
There are quite a few grey areas associated with using sunscreen. Dr Ikramullah Al Nasir, Specialist Dermatologist at Dermacare Clinic, tackles some of them.
Myth: Sunblocks are for older people or those with fairer skin.
Reality: A big No. "Sun protection should start from early childhood, as skin damage is usually a cumulative result of exposure to UV rays over the years."
Myth: Men do not need to use sunscreens. They need a special sunscreen developed for the male skin type.
Reality: Discouraging this myth, Dr Nasir says, "Sun-related skin risks are not gender-dependent. Both men and women can apply the same sunscreen. Product selection should not be different, because sunscreens are not cosmetic items."
Myth: Using a moisturiser with SPF provides sufficient sun protection.
Reality: For a minimal duration of exposure, yes. But avoid using two-in-one products. "Each product should be purchased for its specifically targeted action with exclusivity of its formulation. So-called multipurpose single products, in many instances, fall in the category of a marketing gimmick."
Myth: Using a higher-SPF sunscreen even for short spurts of activity will provide better sun protection.
Reality: A high-potency SPF should be used according to the duration of exposure in sunlight, the type of activity (for example, when playing water sports or swimming) and according to the skin photo type of an individual (people with fairer skin, are potentially at a higher risk of sun-induced skin damage). For minimal sun exposure of, say, half an hour, applying very high SPF creams is not necessary.
Dr Al Nasir's advice
- Phobia should not be associated with sun protection. Forgetting to apply sunblock one day should not be looked upon as a grave mistake.
- Sunlight also produces harmful infrared radiation. This cannot be minimised by the use of sunscreens. The only way is to stay out of the midday sun, select shaded areas when outside and cover up.
- Sunscreens are just one of the primary preventive means of protecting against harmful UV rays. Sun protection guidance has two distinct components.
a) Guidelines for people with a higher possibility of acquiring sun-induced skin damage, including cancer. The potential risk of this group is medically calculated based on skin photo type, which is subdivided into six classes:
- Photo types 1, 2, 3 include fair skinned people, particularly of Irish, Caucasian and Scandinavian origin, from Western Europe or the Mediterranean region. This group requires customised advice by an expert dermatologist.
- Photo types 4, 5 are individuals from the Middle East and Asia.
- Photo type 6 deals with people of African descent.
b) General rules that apply to everyone, such as:
- Minimise exposure duration. Perform sun-exposed activities in breaks. Unnecessary over-extended exposure such as spending a full day at the beach, should be avoided.
- Time the exposure: Avoid the midday sun (between 11am and 4pm), especially in the summer months.
- Personal/cultural clothing habits: Wear tightly woven cotton that covers the whole body.
The doctor advises people in the higher-risk groups (Photo Types 1, 2, 3) to visit a dermatologist, preferably a skin cancer specialist, annually, after the age of 25.
How to use a sunscreen
- Dermatologists advise that sunscreens should be applied to all exposed areas of the skin half an hour before stepping out in the sun.
- Don't be stingy. Apply a sufficient amount (half a teaspoon for the face is recommended) and do not forget to cover the ears, neck, back and hands.
- Reapply sunscreen every two hours especially when swimming, as the effect will be washed away, even if it's a waterproof sunscreen.
- It is advisable to apply a sunscreen in cloudy weather and even in winter. Snow is an extremely powerful reflector of sunlight.
- Protect eyes from sun damage by wearing shades and seeking the shade.
Choosing a good sunscreen
- Look for the active ingredients when selecting a sunscreen and choose the texture that suits your skin best.
- Purchase a broad-spectrum cream (which protects from both UVA/UVB rays) of a well-known brand. The American Skin Cancer Society, suggests looking for a product with The Skin Cancer Foundation's Seal of Recommendation on it. Visit www.skincancer.org for details.
- Both clear sprays and cream applications work well as they are both sunscreens. Sprays are convenient, but difficult to apply on windy days. Creams take longer to apply, but provide thicker applications.
- Choose a high enough SPF according the duration of exposure and the time spent in the sun.
— Shahana Raza is a UAE-based freelance writer
