Being a dermatologist doesn't mean I hide indoors during the summertime to avoid all of those threatening UV rays. But whenever I go to "preach" the need for sensible sun savvy behavior, everyone anticipates I'm going to say "don't go outdoors." I believe that everyone should be able to go have a fun, active outdoor lifestyle during the summertime, but all too often, too much fun in the sun can lead to sunburn. If you haven't taken the appropriate precautions you may be sorry. Play it safe and learn what to do just in case.

Risky Business?

Exactly what does the sun do to the skin? There are 2 forms of ultraviolet (UV) rays produced by the sun that can be harmful. The first is UVB, the light that actually causes the sunburn, redness, blistering and pain we are all familiar with. But UVA is equally dangerous to our skin. It is a longer wavelength capable of penetrating deeper into the skin, and causing damage that leads to the development of skin cancer and aging skin changes (aka wrinkles).

Common sense tells us that the sun is strongest during the hours of 12-3pm (or 1-4 pm for those on Daylight Savings Time). If you are able to alter your schedule, skip the pool or the beach for some other activity during that time. Such a simple change can make a huge difference in limiting your exposure to UV light.

There are many prescription medications that can cause increased sun sensitivity. While there is no guarantee that you are going to fry if exposed to the sun, it is important to take a proactive approach to avoiding sunburn. Medicines that fall into this category include tetracyclines, thiazides, methotrexate, oral vitamin A derivatives such as Accutane and Soriatane, topical vitamin A products such as Retin A, etc., topical glycolic acids and retinols. Use common sense and pay attention to what your skin is doing while out in the sun and wear sunscreen. Just because you are on one of these medications doesn't automatically mean you have to stop or use a substitute during the summer.

Reapply your sunscreen when you get out of the water. Contrary to whatever label you're reading, there is no such thing as a waterproof sunscreen. And don't forget to reapply your sunscreen every 2 hours when you're outdoors. The heat and humidity cause you to sweat your sunscreen off.

Come in out of the sun when you first start to notice your skin getting pink. Paying attention to what your skin is telling you will go a long way to avoiding ruining a highly anticipated trip or weekend.

Wear clothing! How simple is that? For all of us who strip down during the summer to skimpy little outfits or for those men who don't seem to own a shirt during the summertime, it is important to apply sunscreen with a minimum broad spectrum SPF 15 to all of that exposed skin. The light isn't going to hit just your face and ignore your belly, after all. And remember, cloth only has an SPF of 4, so while it may help cut down on getting sunburned, it isn't protecting against those UVA rays. Try Sun Guard Laundry Treatment UV Protectant that will make it easier to have SPF 30 on those clothed areas without having to always coat every square inch of your body with sunscreen.

Make sure that you are protecting babies and very small children with an SPF 30 that contains an active ingredient of Zinc Oxide and/or Titanium Dioxide. Some of our favorites are Cellex-C Mother & Child Skin Care - Baby Sunsafe Cream SPF 30 and California Baby SPF 30+ No Fragrance Sunscreen Lotion.

Are you a little thin on top? My own father has finally learned the importance of wearing a hat despite the family tendency toward early hair loss. If you have thin hair, by all means, wear a hat, preferably one that has sun protective cloth like Sunday Afternoons Men's Fairway or Sunday Afternoons Riviera Women's Hat. Don't forget this area, a sunburned head is simply no fun!

Another area that seems to be overlooked is the eye area. Wear a product with SPF made specifically for the eye area (think Murad Essential-C Eye Cream SPF 15) and be sure to wear UV protectant eyewear. Physician Endorsed makes some fantastic sunglasses!

FEEL THE BURN, OUCH!

You just know when you have gotten burned. The skin becomes exquisitely tender to the touch. A sunburn can show up as late as 24-48 hours after the initial exposure, which surprises many people.

Steps to take once you've burned:

• Apply cool moist compresses frequently to the burned skin. Plain tap water is fine, but if you want to be fancy, saline solution used for contact lenses is good, too.
• Ole Henriksen All Purpose Aloe Vera Gel is a cooling oil-free gel that helps sooth skin irritations with chamomile. A refreshingly, light as a feather gel for skin that "acts up" caused by a rash, cut or sunburn.
• I have read that compresses made with green tea are also helpful in relieving some of the pain. Green tea acts as an antioxidant and helps reduce inflammation. The active ingredient in green tea is epigallocatechin gallate (EGCG). To be honest, this is one remedy I haven't personally tried, but it certainly makes sense. Brew up a pot of green tea using loose tea leaves or the bags, strain and compress with CHILLED tea for best results. DERMAdoctor Body Guard Exquisitely Light SPF 30 For Face & Body, high in Japanese green tea, also does double duty as a post sun treatment, helping reduce the red.
• Take a pill if you can. Oral NSAIDs (nonsteroidal anti-inflammatory drugs) like Advil or Motrin (ibuprofin), or Aleve (naproxyn) truly help control not just the pain, but also help reduce some of the local inflammation that the burn has caused. If you think you've had a little too much sun and haven't yet developed the burn (many people don't feel the burn until night time), take one of these medications. The earlier the better to help reduce some of the severity of the burn symptoms.
• Drink plenty of water. Rehydration is important as you will lose necessary fluids and nutrients through burned skin.
• Apply an emollient to reduce further water loss. One with an antioxidant such as Vitamin E or C and copper peptides like Vitec Vitamin E Lotion and Neova Body Therapy have been shown to help reduce the severity of the sunburn up to 8 hours after getting out of the sun. Choose an emollient that is not too occlusive.
• Soothe your skin by soaking in a baking soda bath (1/3 box) or use AHAVA Bath Salts.
• Relieve the pain with topical anesthetics like Caladryl Clear Lotion or PrameGel
.
• Consider the benefits of vinegar. My mother chose this rather smelly option when I was a kid. And while I never appreciated smelling like a salad wherever I went, it was amazing how the distilled white vinegar immediately stopped the pain.
• Avoid the use of products that contain known skin sensitizers. When skin is inflamed, these ingredients are more likely to cause an allergic reaction. Active ingredients such as neomycin, silver sulfidine and topical lidocaine and benadryl are things to avoid when you have a sunburn.

PEEL THE BURN

Burned skin will become dehydrated and ultimately is going to peel. Peeling and the inflammation that has been caused from the burn are going to lead to itching. Once you have dealt with the initial pain and redness it's not quite time to forget about the consequences.

• Do NOT apply glycolic or lactic acid moisturizers to freshly peeling sunburned skin. It causes stinging. Seems like a simple thing, but will it hurt if you do this. Stick with a bland emollient cream. It won't stop the peeling, but it will help rehydrate the new underlying skin and help control some of the itching. Products like Vanicream Moisturizing Skin Cream and Cetaphil Moisturizing Cream are helpful. You'll probably need lots, so don't waste money on expensive tiny jars of specialty moisturizers.
• Lotions will not provide the amount of hydration your skin is craving. Select a cream or ointment.
• You can speed up the exfoliation process by the use of gentle scrubs like DERMAdoctor KP Duty Dermatologist Body Scrub with Chemical + Physical Medi-Exfoliation or Peter Thomas Roth Botanical Buffing Beads used daily in the shower. For those who don't mind further physical exfoliation, lightly use the Ole Henriksen Rub n' Buff Salt Scrub on trouble zones before showering.

SUN STROKE/HEAT STROKE

One in the same, Heat Stroke is a serious, life-threatening condition. Heat stroke is the consequence of a series of events that begin with dehydration, the loss of significant volume of body fluids and electrolytes. On the beach, this is typically due to profuse sweating and inadequate intake of water. Alcohol consumption will aggravate dehydration. Dehydration leads to heat exhaustion. Symptoms of heat exhaustion include headache, nausea and/or vomiting, fainting, and blurred vision. As the core body temperature rises, heat exhaustion becomes more serious. If not rectified quickly, heat stroke is the final shut down of the organs from lack of these vital fluids and nutrients and can lead to delirium, coma and death.

If dehydration is suspected, rehydration is key to preventing further complications. If heat exhaustion is suspected, immediate emergency medical attention is important.

AN OUNCE OF PREVENTION

Wear sunscreen. It comes in all forms, all colors, oil-free and moisturizing, liquid, spray on, stay on, etc. By all means, purchase a sunscreen (and wear it daily) if you don't already own one. An SPF of 15 is an entry level, appropriate for normal outdoor activities. If you are going to be outdoors, apply a 30 like DERMAdoctor Body Guard Exquisitely Light SPF 30 For Face & Body. There really is a big jump in protective value between a 15 and 30. Remember to read the label to verify that it protects against both UVA and UVB. If you are taking one of those medicines that make you more prone to sun burning, have medical concerns like lupus, vitiligo, or skin cancer, you may want to wear Total Block UVA/UVB SPF 65. They can list the SPF 65 because this product contains ingredients meant to protect you not only from UV rays, but also against visible light that comes from fluorescent lights, TV and computer screens.

It has been shown that oral vitamin E and C work as antioxidants, reversing the cellular damage the sun produces. While this is somewhat controversial, you may want to take the daily-recommended allowance of these vitamins before you hit the beach. Pay attention to the package instructions. You may also want to protect the skin with an antioxidant layer underneath your sunscreen. Vitec Vitamin E Lotion contains Vitamin E and may help those who are particularly prone to sunburn. Cellex-C Body Smoothing Lotion is another option particularly anyone looking to look better in a bathing suit and looking for an antioxidant (vitamin C) at the same time. Consider one of these products next time you get ready for the sun.

Routinely, I find that patients with darker skin feel a false sense of security with regards to the sun. While it may be true that someone who has a Mediterranean background and has an olive complexion may "tan" when exposed to the sun, that doesn't mean they are not going to develop skin cancer and/or wrinkles down the road. The same is true for my African American and Hispanic patients. And, while "normal" amounts of sunlight here in the U.S. may not cause a sun burn, I can't tell you how many patients have called me upon their return from the tropics because they're puzzled as to the cause of their skin condition and are often surprised to hear the diagnosis. The mix of skin and sunlight is relative to one's normal lifestyle. Exposure to higher levels of concentrated sunlight can and do cause sunburns regardless of race or ethnic background. And skin cancer does not recognize these factors either. I urge everyone to apply his or her sunscreen daily.

There has been a lot of hype about taking large doses of beta carotene prior to getting out in the sun to help prevent burning. There is simply no documented evidence to show this has any validity. Other than the possibility of turning orange from carotenemia, I don't think this is going to be of help.

For those rare individuals who have a true history of serious sun allergy/sun stroke, the use of oral antimalarial drugs such as Atabrine may be of help in cutting down on excessive sun sickness. These medications are available only by prescription.

I'VE GOT A GENIE IN A BOTTLE

All the sunscreen in the world will likely still allow you to get some baseline color if you lead an active enough outdoor lifestyle. But what you should not be doing is baking to a golden brown. If looking like you just stepped out of a Hawaiian Tropic ad is what you have been wishing for, then you should look to a self tanner. Did you know that the Bay Watch actors use self tanners to get that golden glow? Apparently some of them have suffered with skin cancer and they lead a sun-aware existence. Follow their lead and look to that tropical feel from such great self tanners as the GlowFusion Micro-Nutrient Face & Body Natural Protein Tan - Medium, Cellex-C Bio-Tan Sunless Tanning Gel or Rodial Brazilian Tan - DARK.

Tanning beds continue to be the bane of my existence. How many times have I heard someone tell me that they go to the tanning beds in order to PREVENT sunburn? Don't they realize that they are damaging their skin far worse with these concentrated forms of UV light? Tanning beds are out. If you want to look tan, get it out of a bottle.

Have a terrific summer and keep your skin healthy!

Thank you for taking the time to read through this important information. I hope you have found this article informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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