A General Guideline on Sun Protection

Sun protection is one of the most discussed topics when it comes to skincare. I think the reason there is no clear cut guideline for sun protection is because there are so many lifestyle and personal variables involved. Despite the best advice and research, it's ultimately up to each person to figure out what works best for them and their lifestyle. A few general things to get out of the way first:

1. Sun protection is important and necessary. Cancer is the second only to heart disease as the leading cause of death in the United States. Skin Cancer is the most common form of cancer.  All skin cancer prevention revolves around sun protection.

2. Even if that alone doesn't convince you, prolonged sun exposure significantly ages skin.

3. No, the sun is not bad for you. When it comes to personal health, we have the tendency to group things into the "good" and "bad" category. However, it's not that simple. The sun is necessary for sustaining life, plants require sunlight for photosynthesis, which in turn fuels the food chain. Sunlight triggers the synthesis of Vitamin D and has been shown to be effective as an anti-depressive stimulant.

With that out of the way, let's approach the following recommendations with the open mind of cultivating a healthy relationship with the sun rather than one that gravitates toward either extreme of complete fearful avoidance or unrestrained acceptance.

• Sunscreens offer chemical protection. Chemical sunscreens are often thinner and more quick to absorb into skin however sunscreens must be applied 15-30 minutes before exposure for any significant protection and mostly - some ingredients provide questionable levels of protection and may themselves become volatile under sun exposure. 
• Sunblocks offer physical protection. Sunblocks are heavier and require more work to absorb into skin. If you're looking for natural/green sun protection, this is where you'll need to look. Newer formulas are getting around the thick/visibility issue by offering tinted formulas that function almost like a BB cream/tinted moisturizer. 
• It's not just about the sunscreens/blocks: Avoiding direct sunlight by staying in shaded areas, wearing UV deterrent clothing along with sunglasses and hats all help shield skin from potential sun damage.
• Consider the areas you are most exposed: many men forget to apply product to their ears while women tend to forget ankles. Remember that burns can occur anywhere under prolonged exposure so no area is insignificant.
• Wear an SPF 15+ when indoors and under low exposure while SPF 30+ is ideal for anything else. There are higher SPFs but the pay-off dramatically decreases beyond SPF 30. The numbers are not on a consistent scale and a SPF 15 will absorb around 93% of UV radiation while SPF 30 increases this to 97%. 
• Re-apply. Apply your product 30 minutes before going out. Rather than crunching numbers with how long you're outside, the time in between exposure and your SPF -- even the best laid plans are useless if they're hard to follow. I have an easier way to think about re-application. For those in the office with a 9 to 5, once in the morning and once before going out for lunch. Active? Apply again after showering or heavy perspiration. 
• Waterproof vs Water-resistant. Unless you're planning to swim, opt for the Water-resistant formula which is easier to rinse off in the shower. Water-resistant formulas are designed to withstand exposure to water for 40 minutes whereas waterproof formulas are designed to withstand exposure to water for 80 minutes. 

Top questions:

• I am Vitamin D deficient, do I still need sun protection? Yes you do. A lot of people are Vitamin D deficient and that is an issue because Vitamin D is important for maintaining cell immunity. If you fall into this camp, I recommend speaking to your primary care physician about adding a Vitamin D supplement. Based on your blood work, they'll be able to work out a dosage with you. The supplement may not be as "natural" as getting your Vitamin D through sunlight synthesis however it outweighs the risks of deliberate sun exposure for this purpose.
• I live in a cloudy area, do I still need to apply SPF? Yes, 80% of UV radiation is able to penetrate through that layer so while it may not seem like you'll get a burn, the danger is still very much present.
• Is sun protection more important if my skin is pale? Well yes, because you're more prone to getting a burn which in turn increases the likelihood of melanoma. However it's a misconception that those with darker, more pigmented skin tones do not need as much protection as one of the fastest growing demographics for skin cancer are African-Americans. 
• What is the best active ingredient to look for in sun protection? There are many active ingredients and you want to look for a product that offers broad spectrum protection. The single most effective active ingredient is Zinc Oxide, which (good news!) is a staple in nearly all natural/green sunblocks and can be found in many broad spectrum sunscreens as well.  Zinc Oxide is one the only ingredients that covers UVA and UVB damage. Nano-particle Zinc Oxide was shown to be potentially harmful but most companies stopped using this form of Zinc Oxide. There are some environmental concerns but if you avoid going into the ocean/sea - you should be fine for the most part.
• I don't use SPF because it's too heavy and my skin is oily and prone to acne, I know I'm supposed to use SPF so what should I do? On the priority scale, it should be skin cancer > acne right? So let's always make SPF necessary regardless of skin type. Next, experiment with products by going into your dermatologist and asking for light formulas. Often times this doesn't need to be a "oil-free" as even liquid sunscreens can clog pores. Your dermatologist will be able to recommend some good products for you (most of us even have samples on hand). As a general rule, chemical sunscreens are lighter and fast-absorbing compared to sunblocks. For those who adhere to natural/green products, the good news is there are some newer products out that do a pretty good job of being as light as possible for a physical block - also Zinc Oxide can be beneficial for some acne sufferers due to its anti-inflammatory properties.
• My eyes are very sensitive, should I apply SPF around my eyes? Yes - the skin around your eyes are the thinnest which makes it more susceptible to UV radiation penetration. Most of the time when there is sensitivity to SPF there, it's actually due to the product getting into the eyes which can come from sweat/perspiration and rain so I recommend looking for a water-resistant formula.
• I know I should protect my lips but I also don't want to ingest the chemicals that I put on my lips, is there any way to get around this? You should protect your lips as they're very much exposed to sunlight. What I'm about to say may come across strange but stay with me: to avoid ingesting your SPF, physical blockers should be avoided because they're meant to stay on skin surface which makes them not very ideal for lips. Instead what I suggest is choosing a chemical sunscreen that you can apply when you know you won't be eating/drinking for the next 30 minutes. Once the SPF absorbs into your skin, you're clear.
• Are there other products I can apply to help my SPF? Yes! A lot of foundations (especially mineral based formulas) offer SPF. Antioxidant serums are also good at boosting due to their ability to neutralize free radical damage. Look for face oils that have sun protection such as raspberry seed oil, carrot seed oil, sea buckthorn oil, etc. and avoid ones that use photo-sensitizing oils such as citrus oils. 

What products do you recommend?

I like these brands: Elta MD, Coola*, Suntegrity*, Mustela*, Skinceuticals, Avene, La-Roche Posay, Pratima*

*Denotes natural/green options available

If you're purchasing a green physical block, be sure the packaging is air tight as the formula tends to be prone to drying over time, resulting in wasted product. I've seen this happen with sunblocks from John Masters, DeVita and Osmosis. 

I personally use Elta MD Physical sunblock because it's a well-balanced formula although not green as there are some chemicals that help with the texture to make it more easily absorbed. I don't believe these chemicals, used in the amounts presented will harm skin and I think they carry significant benefit in helping the sunblock bond with skin to be more effective. For days when I'm mainly indoors, I like Pratima's Neem Rose Sunscreen which is a very simple formula.

MARCH Reader Questions

I've been getting more questions lately and if you have any you want me to look at, feel free to drop them in the comments. Some of the most frequently asked are compiled together.

What is an essence and how should I use it?

Essences are being introduced into the American market and like BB creams before them, seem to be influenced from Asia. When purchasing products I think it is important to look at ingredients and see how products work with your skin rather than buying simply into labels like toners, essences, serums. Some serums are thick enough to work as moisturizers, some toning lotions are actually fluid lotions, you'll find a lot of overlap with the definition.

Essences are meant to be used after toning and before serums. The classic cleansers were primarily soap based which damaged skin's acid mantle so acidic toners were necessary to restore the balance while conveniently sloughing off dead skin cells to allow serums to better penetrate. Essences would figure into priming the skin for serums. Now there are good cleansers that are not soap based so a lot of toners already do the job of essences especially green facial mists that are concentrated in botanicals (look for products whose first ingredient is not water).

A lot of essences in Asia are actually a lot like serums in that they're light, fluid creamy products. As to actual benefit, a well formulated product can always benefit skin but whether it's a toner, essence or serum will not matter as much as the individual product's ingredients and what it is meant to do.

How often should I exfoliate my skin?

As often as it's good for your skin. Everybody's skin is different, I'm not telling you anything new here. So you shouldn't exfoliate your skin based on a set formula but rather adjust as you see fit. One of the things I think a lot of people often overlook is they don't realize when they exfoliate. Exfoliation isn't just a chemical peel or abrasive scrub, you exfoliate a little with every cleanse (citrus oils, enzymes and acids often do this task), most non-hydrating masks carry some sort of exfoliation whether chemical based or physical, your Vitamin C and Retinol treatments exfoliate skin, etc.

If you're seeing clogged pores, dull complexion then go for some gentle exfoliation. Those who wear heavier products like make-up, thick moisturizers and chalky sunscreens may find they need to exfoliate more frequently. On the other hand if your skin is frail, easily reddens and feels really sensitive to the touch it's a sign you've went a little overboard.

One of the precautions I want to share is not to go overboard. This isn't only because of potential irritation. Scientifically, our cells will reach a hayflick limit which is the number of times a cell will divide until it stops. This is because each division shortens the cell DNA's telomeres. It's really difficult to actually identify when this is reached but you might notice some people who really advocate daily Retinols and exfoliating acids have really beautiful and smooth yet thin and crepey skin that kind of looks strained the moment they move a facial muscle. When skin reaches that point, there really aren't many viable treatment options.

What is double cleansing and when/why should I do it?

I had no idea cleansing was going to be such a heavily discussed topic. Firstly, cleansing is super important. When someone tells me they don't 'believe' in cleansing or simply don't cleanse, in my mind I'm already silently panicking before they go on to tell me about their skin troubles. In fact, a lot of times when patients say they don't cleanse or aren't doing it properly then tell me they have very very irritable, weak or compromised skin, I always tell them to get on a recommended cleanser and follow-up if the issue persists. That's how important cleansing is for skin health.

You might be reading this and thinking "but I don't really cleanse or I just use an oil and my skin is fine" - more power to you! But I'm going to burst your bubble and let you know that the expensive serums you use are essentially useless as they're most likely sitting on your skin since you haven't cleared the way for them to properly be absorbed into your skin.

Caroline Hirons explains this in more detail and I recommend reading her post.

Essentially: mornings, cleanse with something light. Evenings make-up remover to remove make-up/oil/sunscreen, follow with a proper cleanser to get to work on your skin after you've removed all that stuff off the surface of your skin.

Need recommendations, have questions? Drop them in the comments.