PROVIDENCE, R.I. [Brown University] — Sunscreen should be simple: Apply it properly, and it will do its job shielding skin from the sun’s damaging rays. Yet despite the fact that sunscreen has enjoyed popularity for decades — and that it’s recommended for universal use by the American Academy of Dermatology — it is often misunderstood and misused.
Dr. Elnaz Firoz, an associate professor of dermatology, clinician educator, at Brown University’s Warren Alpert Medical School, and medical director of dermatology at Miriam Hospital in Providence, said she spots dozens of sunscreen use mistakes every time she goes to the beach.
“I'm always so shocked at the practices that I see,” Firoz said. “It makes me wonder how we can get more information out to people about how to use sunscreen.”
One way to educate people about sun protection is to connect them with dermatologists. Firoz is one of several Brown-affiliated faculty members who participate in free skin cancer screenings, including at the Amal Clinic at Clínica Esperanza, the Rhode Island Free Clinic and a series of skin check events held at Rhode Island beaches in partnership with the Rhode Island Department of Health.
In this Q&A, Firoz shares sun protection advice and addresses myths about the dangers of sunscreen.
Q: What are the biggest mistakes people make when it comes to using sunscreen?
It's very common for people at the beach to use aerosol bottles of “invisible” chemical sunscreen. Most of the product ends up getting sprayed into the air instead of on the skin, thereby providing less coverage than intended. People will also use the spray sunscreen on faces, where it can get in the eyes, nose and mouth, and cause stinging or a terrible aftertaste. I understand that the spray version is convenient, but it can be difficult to use it in a way that provides adequate protection.
Q: What type of sunscreen do you recommend?
I advise my patients to find a broad-spectrum — meaning it protects against both UVA and UVB sun rays — mineral sunscreen with a sun protection factor (SPF) of at least 30. There are two main product formulations: mineral sunscreens, which have ingredients like zinc oxide and titanium dioxide that sit on the top layer of your skin and block and reflect UV rays; and chemical sunscreens, which sink into your skin and act like sponges, absorbing the sun’s UV rays. Chemical sunscreens are somewhat less photostable than mineral sunscreens, which means they degrade over time slightly more quickly as they are exposed to UV radiation.
I'm a big fan of mineral sunscreen lotion, which is not only broad-spectrum but also safe, and lasts longer both in and out of the water. Mineral formulations tend to be thicker and some may leave a whitish cast on the skin, but technology has advanced to the point that there are now tinted and untinted mineral sunscreens that go on quite easily.
Q: In your practice, what implications for patients do you see as a result of not wearing sunscreen?
The main reason to use sunscreen is to prevent skin cancer. All types of skin cancer, including basal cell carcinoma, squamous cell carcinoma and melanoma, are unfortunately on the rise. Melanoma is especially worrisome because it can metastasize if not caught early and become fatal, which is why we urge people to get skin checks. Squamous cell carcinoma can also be fatal (albeit rarely), particularly in patients who are elderly or immunocompromised.
UV radiation is a carcinogen — we know that to be 100% true. Each person is going to withstand that carcinogen differently based on their genetics and behavioral practices. And there are, of course, subtypes of melanoma that are not related to the sun. But I tell patients that generally speaking, their risk for skin cancer will be lower if they practice sun safe behaviors, which includes wearing sunscreen. Wearing sunscreen also slows the process of sun damage to the skin.
