Sun Exposure & Sunscreen Explained: Common Myths, SPF Basics, and Skin Cancer Facts (Part 1)

[Intro] Hey, everyone. Welcome back to Facially Conscious with myself, Trina Reneá, Esthetician, Dr. Vicki Rapaport, Dermatologist, Rebecca Gadberry, the Cosmetic Ingredient Guru, and our fabulous, overly-educated consumer, Julie Falls. 

We are gathered here together with you to talk about this crazy world of esthetics. It's confusing out there in this big, wide world. That's why we are here to help explain it to you all, subject by subject. We will be your go-to girls. And from our perspective, without giving medical advice, we will keep things facially conscious. 

Let's get started!

00:56 Trina Reneá: Good morning, ladies. How are you today? 

00:57 Julie Falls: Good morning. 

00:58 Rebecca Gadberry: Good.

00:59 Dr. Vicki Rapaport: Good morning, everybody. 

01:00 Trina Reneá: Hi.

01:01 Rebecca Gadberry: Hello. 

01:02 Trina Reneá: Welcome to our sunscreen episode. I'm so excited because this is such a hot topic in the world, because everybody's confused about sunscreen. It seems like every era we're always confused about sunscreen. And if we need it, why we need it, what kind we should use, what number we should use. I mean, there's so many questions. 

And lucky for you, you have a whole bunch of experts in this room that know about it. So we're going to deep dive right into this now. You know, the main thing I wanted to start with Dr. Vicki, because you are the dermatologist, is if we don't use sunscreens as human beings, we can get what's called skin cancer. Is that right? 

01:47 Dr. Vicki Rapaport: Yes. 80% to 90% of all skin cancers are caused by UV radiation. If people are careful about protecting their skin, the risks of skin cancer is much decreased. Truthfully, I wish we could have that for all cancers. If you could tell me exactly what to do to prevent pancreatic cancer, if you could tell me exactly what to do to prevent brain cancer, wouldn't you do it? 

02:13 Trina Reneá: Yes.

02:14 Dr. Vicki Rapaport: Hey, guess what? All you need to do is put on sunscreen or wear some sun clothes and your risks of developing skin cancer are so greatly reduced. I just don't seem to understand why this is so hard to get across to people. And that is going to be sort of like my running truth throughout this and probably my take home point later. 

02:38 Trina Reneá: I do have one thing to say. When I was working in your office many years ago, we had a doctor patient who was like a surgeon. He drove a convertible Porsche and he was balding. He would not wear sunscreen on his forehead. And he would come in to see you, and you would cut off little cancerous spots on his head and he would come in and get facials with me. 

And I'd be like, “We have a powder you could put on your forehead, like we have an SPF powder. We have like so many options for you to just put on your forehead, or you could just wear a hat while you're in your car.” 

And he refused. He was like, “I'm not doing it”

I don't know if it was ego or what the hell, but he's a doctor. He knows better and he still wouldn't wear sunscreen. And he let you cut up his damn head because of it. It's so weird to me. But it's so preventable, like you said. 

03:34 Dr. Vicki Rapaport: So preventable. And I do feel like this new generation is getting better and better about it. Like I have 10, 11 and 12-year-olds who come in for little rashes and sometimes baby acne or early acne. And they do have already a really good routine that usually includes a little bit of sunscreen. That makes me very positive and hopeful for the next generation. 

03:56 Trina Reneá: Yes. So now we know that to prevent skin cancer. And by the way, people, if you do get skin cancer, it shows up in little brown spots usually on your skin. It can be white spots on your skin. It can itch. It can bleed. They have to be cut out of your skin and leaves you scars on your ski. So if you can prevent that from happening— it can even cause death if you don't go in and get it checked out. It grows and it takes over large areas, and it can be deadly. 

So it's important that you get your monthly checks with your dermatologist. If skin cancer runs in your family, that you go and get checked more often. Really try and catch it when it's little. Do not wait for it to grow big because it can be very scary. 

04:53 Dr. Vicki Rapaport: Can I just give some quick statistics on skin cancers?

04:55 Trina Reneá: Yes, please. 

04:56 Dr. Vicki Rapaport: Okay. This is all from the Skin Cancer Foundation, and just the numbers of skin cancers. Typically, there are three major skin cancers. Basal cell is the most common. Squamous cell is the second most common. Melanoma is the third most common, but unfortunately the most deadly. There are about 3.5, 3.6 million cases of basal cell a year, one-and-a-half million of cases of squamous cell a year, and only about 200,000 cases of melanoma a year. 

Melanoma, when it's caught early, is 100% curable, but it's not typically caught early. So people do die from melanoma every single hour. There's only about 8,000 melanoma deaths per year, but it's deadly. It's preventable in some cases. There are some genetic reasons why people will get a melanoma. And people also do get melanomas, unfortunately, on non-sun-exposed areas, so it's not 100% preventable, but it is preventable. 

Basal cells and squamous cells are almost 100% preventable if sun is used with care. You can be out, you can be enjoying your outside life, but you have to just be out there with care and seeking shade and all the other things that we'll tell you guys about. 

But those numbers are really important for people to understand. 

06:20 Trina Reneá: Okay. So that being said, it's important for us to use sunscreen. So what kind of sunscreen? There's options. We have chemical sunscreens, non-chemical sunscreens. We have SPF 30, 50, 100, 15. What do we use? How often? The FDA has put new guidelines down recently that tell you you have to reapply every two hours. What does all of this mean? There's so many things in the industry that are telling us like, “Don't use this one,” and, “Don't use that,” and, “This ingredient is bad.” It's super confusing right now. There's so many questions. 

So where should we start? Like, where you live, the weather, the climate, does that make a difference? If you're in a really cold area that has gray skies all the time, like Seattle, or you live in sunny California, do you have to wear the same amount of sunscreen? 

07:24 Rebecca Gadberry: Well, sunscreens protect you from getting burned by taking longer to allow the ultraviolet light to get to the skin. So it lengthens the amount of time that you can stay in the sun without getting burned. Since UVB is the burning ray, sunscreens work on UVB light. 

But there's three different ultraviolet lights. There's UVA, which is the aging ray that's also connected with causing melanoma. There's UVB, which is the burning ray. And then there's UVC, which hopefully doesn't come in past the ozone layer because it's the sterilization ray and it would kill everybody.

08:14 Trina Reneá: But it's starting to peek through. 

08:16 Rebecca Gadberry: It is, in certain parts of the world. Kennebunkport, Maine is one area. Certain parts of the southern part of Alaska is another area. 

But with UVB, the burning ray, it is strongest at the equator and weakest at the poles. So in answer to your question, if I'm in Seattle, yes, it's going to be weaker in Seattle than it is in Los Angeles. But UVA light is the same strength whether you're in the mountains or you're at the beach, whether you're at the equator or at the pole. 

The problem is that UVB light, which is interfered with or intercepted by certain sunscreens, is our warning system to get out of the sun. So when we take away that warning system or we prolong the time that the warning system occurs, then we get higher exposure to UVA light. And we're more likely to form melanomas because that's one of the causes that's been linked to melanoma. 

So when we have UVA light and we're looking at SPF, an SPF 15 probably isn't going to be effective on UVA, but an SPF 30 would be and an SPF 50 would be. 

09:47 Trina Reneá: Then also if you look for the words “broad spectrum”, because that covers both UVA and UVB, right? 

09:56 Rebecca Gadberry: Right, but you don't know how much UVA is covered.

09:59 Dr. Vicki Rapaport: The way I like to describe it to patients is when we'll talk about specific ingredients. But yes, most sunscreens are going to protect 100% of B and about 95% to 98% of UVA. That tiny sliver of UVA that is not protective of any sunscreen, it just doesn't exist. The only thing that protects from that is clothing, which is what I'll talk about. That's my big fangirl thing to say about how to wear the best sunscreen is clothing. 

But that little 2% doesn't necessarily lead to skin cancers, but it will lead to aging. Wrinkles, brown spots, all the things you don't want when you're 60, 70, 80 years old. So if you really want to take care, it's sunscreen plus clothing. Because sunscreen alone is just not enough anymore. 

10:43 Rebecca Gadberry: And when we're talking about UVB, I know Dr. Vi just said 100% protection, but actually the highest sunscreen at SPF 99 only protects 99% of the UVB. 

10:59 Dr. Vicki Rapaport: Okay. There's our ingredient guru. She's right. Yes. 

11:03 Rebecca Gadberry: So that 1% can cause continual damage even if you're sunburned.

11:10 Dr. Vicki Rapaport: And the problem with sunburns and sun exposure is that people don't understand skin cancers come 20 to 50 years later. You could have had one sunburn on your back as a child and then were really, really good throughout your whole life. Your parents were really good and protected you and you protect yourself. And then when you're 50, you have a basal cell on your back where you've got this sunburn. It's from that sunburn you had from a long time ago. It just takes a long time for that DNA damage to really affect those cells to rapidly turn over and turn into a skin cancer. 

So being careful is the most important. As early as you can, start as early as you can.

11:47 Rebecca Gadberry: What I've heard, and could you please confirm this, let's say you've got that genetic damage that's been caused when you were younger by the sun. And the proclivity of those cells to form cancer is there, but it hasn't been tripped off yet. Then you go to Hawaii and you lay on the beach, and then it's tripped off. And within a few months after coming back, you can see a skin cancer from that.

12:16 Dr. Vicki Rapaport: That's correct. And probably also other lifestyle things, stress and other diseases and medication and drugs and alcohol and all the other things that we do as humans.

12:27 Trina Reneá: So, another thing I think that everybody should know is that if you are in your house and you have big windows or in your car and you have your car windows and they're not protected by a UV tint, you can still get UVA rays that come through windows, through the glass. So if you're sitting at a window at work and you're fully exposed to light, you can still get UVA ray through the windows and still get skin cancer from that. 

You still need to wear sunscreen even in that type of situation, because UVA rays are just as strong at sunrise as at sunset. And the same amount all day long where the UVB rays are stronger between like 10:00 and 2:00, you have UVA rays that last all through the light and come through windows. So be very careful and still wear sunscreen if you're even in front of any window.

13:30 Rebecca Gadberry: And UVA light is a thousand times weaker than UVB light, but it's a thousand times more present, so we need to protect from UVA light. Now, when sunscreens didn't protect from UVA light, this was back in the ‘70s and the ‘80s but people were starting to wear sunscreens, the occurrence of melanoma went up 36 times within like a five-year period, which shows that, some people said, “Well, it's the sunscreen that was causing that,” but it was actually the full exposure to UVA light. 

Another thing about UVA light is not only does it penetrate windows, including your car windows, but when your fluorescent lights are close to your head, they're emitted by fluorescent lights. When those fluorescent lights start to hum, you know how they'll buzz when they're getting close to the end, they're emitting UVC light. So you need to replace your fluorescents.

14:33 Trina Reneá: So just always wear sunscreen. 

14:35 Dr. Vicki Rapaport: And can I refer you to this amazing photo that you guys can find online? If you just search “truck driver face”, the left side of his face that was either the window was open or the window was closed, the point is years and years and years and years of him having more sun exposure on the left side greatly aged his face. 

Now, I don't see necessarily any skin cancers on him right now, but I can't imagine why he isn't going to grow one because that side of the face has zero elasticity. It's drooping, the collagen loss, all the damage that the rays do, either through the window or, obviously, if he wasn't protected, are intense over the years. 

15:12 Trina Reneá: Yes. And we're going to add that picture to our show notes so people can see in there. 

15:17 Rebecca Gadberry: One of the things I'd like to say about that photo, and you're going to see it if you're listening right now, you'll see it in the show notes, is that that photo was also used by a cosmetic company to state that their products work. And said that he put the product on the right side, but not the left side. So be cautious of that. 

15:37 Trina Reneá: That is so scammy.

15:39 Rebecca Gadberry: And he did put it on the right side, but he already looked like that. So be cautious of that photograph. 

15:47 Julie Falls: That’s insane.

15:47 Trina Reneá: Like, “Look what our products did to him.”

15:49 Julie Falls: Yeah.

15:48 Rebecca Gadberry: Yes.

15:49 Trina Reneá: I'm so sure. 

15:50 Rebecca Gadberry: One of the photos that I like, the before and after, is Bridget Bardot when she was in her early 20s, and Bridget Bardot today. If you look those up, or maybe we could put those on our show notes too, the sun damage is so obvious. 

16:07 Trina Reneá: Oh, I haven't seen that.

16:10 Rebecca Gadberry: And another way to tell if you have sun damage, compare the skin on your bottom, which perhaps has not been shown to a lot of sun, and the skin on your face, and see how smooth it is and how not smooth it is. That's the aging process from sunlight. 

16:26 Trina Reneá: Amazing. Okay. So let's get into the sunscreens. First of all, chemical or non-chemical, meaning zinc and titanium or oxy…?

16:41 Rebecca Gadberry: Octinoxate. 

16:42 Trina Reneá: Octinoxate, all the chemicals. They're both available to us and so does it matter which one we use? 

16:51 Rebecca Gadberry: It matters in certain instances. Some sunscreens are irritants, and octinoxate, probably the most common sunscreen in the world, is an irritant. 

17:06 Trina Reneá: Is that what's in spray sunscreens that we use at pools and the beach that you buy in the little sun stores at the hotels? You buy your sunscreen and spray? Is that what's in those? 

17:16 Rebecca Gadberry: Well, probably, because it's the most common sunscreen in the world. It's called an organic sunscreen or a chemical sunscreen, but not for the reasons that you might think. An organic sunscreen doesn't mean it was grown in a field with no pesticides. It means that it has a carbon atom in it. Anything that has a carbon atom in it is organic, meaning that it has been or is alive. 

Obviously, some portion of that molecule came from something that was alive. In this case, it was a plant. 

17:52 Trina Reneá: Do people actually try and sell that ingredient as an organic? 

17:56 Rebecca Gadberry: Yes. 

17:57 Trina Reneá: Are they allowed to do that? 

17:59 Rebecca Gadberry: No.

18:00 Trina Reneá: But they do. 

18:00 Rebecca Gadberry: But they do. Just because the industry is not well regulated doesn't mean that there aren't regulations if you don't get caught. 

The other aspect of that is the chemical sunscreen. And the way that these types of sunscreens work, what we call the organic sunscreens, the way that they work is they chemically alter light. So they'll take in the UV, they will chemically reduce the energy of the UV and emit it as heat. So when the sunscreen is working, your skin will feel a little warm. That’s how they work.

18:37 Trina Reneá: Not good for people with rosacea, I would imagine. 

18:40 Rebecca Gadberry: No, I would avoid that if you have rosacea, which is one of the places that we were leading to on that. mineral sunscreens or inorganic sunscreens or physical sunscreens are different. These are the zinc oxide and the titanium dioxide. They sit as particles, fine, fine particles on the surface of the skin. They reflect light back out into the environment. They also reflect some light to the skin. 

19:12 Trina Reneá: So most people would probably, when thinking of what you just said, think of those white-nosed surfers. 

19:17 Julie Falls: Zinc, yeah.

19:21 Trina Reneá: They have come a long way since that white, white, white blockage. 

19:25 Rebecca Gadberry: Believe it or not, the best ones were the white, white, white ones. 

19:28 Julie Falls: I have an Elta that's super, super thick. It still puts on pretty white that I use on my body. 

19:37 Trina Reneá: But most people don't want to look like that. Are there others that they could use? 

19:39 Julie Falls: Yeah, but you could rub it in. You rub it in. 

19:42 Rebecca Gadberry: Yeah, but it indicates the best protection because the thicker the sunscreen, the more protection. 

19:48 Trina Reneá: My husband was wearing that on his face the other day and I was like, “Are you sick? Are you okay? Are you pale? What's happening?” And he told me that he had put on this sunscreen that I gave him that made his skin look like he was sick, because he was so white and pasty.

20:08 Julie Falls: He didn’t rub it in. 

20:09 Dr. Vicki Rapaport: I think that's the problem with chemical versus physical. Rebecca described it perfectly that the difference between chemical, which absorbs the rays and transfers them out of the skin into heat, whereas the physical sits on the skin, almost like I describe it like a T-shirt over your skin. 

But chemical sunscreens are a little more elegant feeling and looking, because they're very thin and ultra sheer. It's hard to get an ultra, ultra, ultra sheer zinc or titanium, although they do now add a little tiny, tiny bit of tint or a brownness that some people don't like, because, oh my god, it looks like makeup. But really what it does, it just masks the whiteness of it.

20:48 Julie Falls: So which one should we be wearing? And are there certain ones that are appropriate for different times in different places? I get these questions all the time. Should I be using the expensive ones? Should I be using the ones from the department store? Should I be using the ones from the drugstore? 

21:05 Trina Reneá: And also how do I put that thick zinc stuff all over my whole body before I go in the pool? I mean, it's too much. Spraying is so much easier. Does it really matter? 

21:16 Dr. Vicki Rapaport: Ugh, spraying is the bane of my… so my answer to patients when they ask me which sunscreen should I wear, really, the sunscreen you should wear is a sunscreen that you're going to wear because that will afford them the best protection possible. 

Can I educate them if I have time to really explain the difference? Yes. And what I tell them is, probably the best protection is from a chemical sunscreen, but the healthiest and my favorite are the physical mineral sunscreens. And yes, they might be a little bit white. Yes, it might take a little bit of time to get into the skin. Yes, they might have to reapply a little more often, but I feel like it's safer.

But I also like a combination. My favorite, really, the answer to your question is a little bit of physical and a little bit of chemical sunscreen is elegant, is cosmetically elegant. It goes in nicely and it does afford really nice sun protection. 

22:05 Rebecca Gadberry: And it'll give you a higher SPF.

22:08 Dr. Vicki Rapaport: Yes.

22:08 Rebecca Gadberry: Because it's really difficult in sunscreen chemistry to hit a higher SPF, especially when you're looking at 30, 50, 60-plus, which is about as high as FDA will allow us to go now. 

22:20 Dr. Vicki Rapaport: Yes, which I think is so cool. I'm so happy that SPF 100 to me was like, oh! So much chemicals. 

22:27 Rebecca Gadberry: Ridiculous. 

22:28 Dr. Vicki Rapaport: Now, the FDA is, I think is it 50 or 60? 

22:31 Rebecca Gadberry: 60-plus. 

22:32 Dr. Vicki Rapaport: We're only allowed to say 60-plus SPF. So you're never going to see 70 SPF anymore and 100… 

22:37 Trina Reneá: And if you do, watch out, because it's not legit. 

22:39 Rebecca Gadberry: Yeah, because it's mislabeled. It's misbranded.

One thing about zinc and titanium is they don't penetrate. They're two large molecules. Unless it's a nanoparticle, which it goes on sheer. It disappears. You don't want that because those can penetrate and they can cause some problems, they've been finding. So you want something that's called micronized zinc oxide, something like Z-Cote, which you're going to find advertised in the sunscreen. 

But neither titanium dioxide or zinc oxide penetrate the skin. What they do is they adjust themselves in that layer that you just put on until they turn towards the surface and you can't see them anymore. They kind of self-adjust. Kind of like a lever on a window when it's looking straight at you. You can't see it very much as opposed to being kind of down or up.

23:40 Trina Reneá: There is a product from Color Science, and they make that really nice…

23:44 Julie Falls: Reflective, kind of?

23:46 Dr. Vicki Rapaport: Flex.

23:47 Trina Reneá: Yes. But in the beginning when they first came out, they would be like, “Put it on and then press it into the skin.” They'd say press it because your hands would heat it up and make it disappear a little bit in your skin.

24:00 Rebecca Gadberry: Make it adjust.

24:01 Trina Reneá: Adjust, like you were saying. I remember that.

24:03 Rebecca Gadberry: Yeah. So what sunscreens are best? Well, it depends upon what your concerns are and what your issues are as far as your concerns, and the environment you're using it in. The FDA in 2019 came out and said the only two sunscreens that are recognized as generally recognized as safe and effective, what we call GRASE, G-R-A-S-E, are titanium dioxide and zinc oxide. The rest of them, in what Dr. Vi has been calling the chemical sunscreens, they do not have enough data to determine that they are absolutely safe. 

So if you're worried about sunscreens that are absolutely safe, then you're going to want the physical sunscreens or the mineral sunscreens with zinc oxide and titanium dioxide. 

If you have rosacea, then you're going to want the mineral sunscreens. If you're worried about coral reefs, you're going to want titanium dioxide or anything other than octinoxate and oxybenzone.

Now, the information about coral reefs is very complicated, and maybe we can talk about it later if people are interested. But I know that we were talking about it, Julie, beforehand, and you may want to ask more questions about that.

25:34 Trina Reneá: What about Avobenzone? 

25:36 Rebecca Gadberry: Avobenzone is the only sunscreen approved in the United States to work on UVA light. It works across the entire spectrum of UVA light.

Zinc oxide also works across the entire spectrum of UVA light and goes into the visible light as well, and into infrared light, which is the heat. But it's not recognized by FDA as doing that.

26:01 Trina Reneá: So do they use avobenzone in zinc and titanium products?

26:05 Rebecca Gadberry: Yeah, they do. You can do that. 

26:08 Dr. Vicki Rapaport: That’s that combo product…

26:07 Trina Reneá: But isn't that more of a chemical? 

26:11 Dr. Vicki Rapaport: Yeah, but they combine. A lot of really good sunscreens have a little bit of a chemical and a little bit of a physical, and they're excellent sunscreens and they're elegant. 

26:18 Julie Falls: The one that starts with an E? 

26:20 Trina Reneá: With an A. Avobenzone.

26:22 Julie Falls: No, I'm talking about there's a sunscreen that you sell that I use that starts with an E. Is that one an elegant? 

26:28 Dr. Vicki Rapaport: We sell so many sunscreens. 

26:28 Julie Falls: Elta.

26:29 Dr. Vicki Rapaport: Oh, Elta, yes. We can talk about Elta.

26:31 Julie Falls: Can't we? 

26:32 Dr. Vicki Rapaport: Elta's great. Yeah. Can we talk about spray sunscreens really fast? 

26:35 Julie Falls: Sure. 

26:36 Dr. Vicki Rapaport: Last summer, there was a whole host of spray sunscreens that were found to have benzene in them, when benzene is sort of a known cancer-causing agent. And all of them that were found to have benzene, which was considered a contaminant, were taken off the market. 

26:53 Julie Falls: Was it the spray aspect?

26:55 Dr. Vicki Rapaport: It was all the sprays. All the sprays that people love. They love them because they're convenient. 

26:58 Julie Falls: But it wasn't an aerosol component. 

27:00 Dr. Vicki Rapaport: Aerosol. Yes, yes, yes, the aerosol spray.

27:02 Julie Falls: So that was the danger, the aerosol.

27:05 Dr. Vicki Rapaport: I mean, Rebecca, you're going to weigh in on this, but what's really interesting is that one of the brands that we sell in the office, they were very proud to tell us they did their own testing. They found no benzene in their spray. And so we're like, “Okay, cool.”

This is great because men love it. They love it for children. It's really convenient. And then just two months ago, they now decided to take that off the market. So I'm not sure if they now then found benzene in it or if they just realized that sprays just aren't as good chemically, maybe as stable or as safe. But I thought that was really interesting. 

So my hope is that spray sunscreens are not really used. Just get used to smearing it on and putting on. Stop being so lighthearted about your sunscreen. I think you have to really invest in a good one and spend the time putting it on.

27:59 Julie Falls: And don't be like precious and delicate. You've got to put a lot on.

[Outro] Tune in next time for Part Two of our conversation.