The days of people using baby oil to ‘tan’ their skin are, thankfully, long gone. But from what I see as a consultant dermatologist (in the NHS and private practice), many people are still not doing nearly enough to protect their skin in the sun.
On a recent holiday in Cornwall, it was amazing – if alarming – to see how many people had moderate to severe sunburn by 4pm.
The lovely warmer weather of this Bank Holiday weekend means lots of people will enjoy the sun without appreciating the risks from the UV radiation, even in the UK – sadly, I’ve treated patients for skin cancer, including malignant melanoma, who have rarely travelled abroad for a holiday or who’ve never actually left the country.
Read on for the common mistakes people make in the sun – and my guide to the risks for every body part, as well as how to get it right.
Protected? Not all SPF products are created equal, as some fail to protect against ageing UVA
Youthful: Consultant dermatologist Dr Justine Hextall, 54, has worn sunscreen every day for 30 years
Seven people die from malignant melanoma every day in the UK, and cases are rising, with a record high number reported last week by Cancer Research UK. Yet skin cancer is largely preventable.
The clearest sign of sun damage is sunburn, which in turn raises your risk of skin cancer – the more you get sunburnt (especially in childhood), the greater your chances are of developing it.
Each additional blistering sunburn before the age of 15 increases the relative risk of melanoma by 3.2 per cent, according to a major study of over 44,000 participants published last year in the Journal of the American Academy of Dermatology.
And whatever is being said on social media by influencers, you really cannot ‘train your skin’ to build protection against sun damage by slowly tanning.
It’s true that skin builds up a degree of tolerance to the sun, as light triggers cells in our skin to release melanin, the dark pigment that causes a tan. This is the skin’s attempt to protect itself, as melanin absorbs more of the UV radiation that damages skin.
But chronic sun exposure will still cause damage over time. A tan is a warning sign that the skin is already damaged.
(The idea that a pre-holiday sunbed will protect against sun damage is also rubbish – the levels of UVA, the type of ultraviolet radiation used in sunbeds, are up to ten times the sun’s and even one use before the age of 35 increases your risk of melanoma, reported the Journal of the European Academy of Dermatology and Venereology last year.)
Sunscreen is vital. And not ‘just’ to prevent skin cancer.
I have worn sunscreen every day since I was 23, even before I started training as a dermatologist. At the age of 54 I’m told I look younger than my years – and I think this is largely to do with protecting my skin from UV.
How much do you really need? Read on for our top-to-toe application guide
Young women in their 30s and even their 20s often come to my clinic asking for Botox and other anti-ageing treatments.
But there is one, much more effective, and cheaper preventive: wearing SPF50. This applies to men, too.
Skin conditions such as rosacea are also affected by UV exposure. Studies suggest sun exposure is the top trigger in more than 80 per cent of sufferers (rosacea causes an angry rash, a red, inflamed nose and spots). I advise many of my rosacea patients to wear sun cream on their face year round.
But of course, what’s important is applying enough sunscreen to get the sun protection promised on the label, choosing a product that protects against both UVA and UVB (the main cause of sunburn).
Here are my top tips on what to pick, how to wear it – and the mistakes to avoid:
- You need to apply 2mg of cream per square centimetre of skin. Yet research shows, on average, we apply less than half of this. For a week’s holiday you should pack at least a 200ml bottle of sun cream per person.
- The SPF (sun protection factor) on the label shows the UVB protection, i.e. how much more UVB radiation your skin can absorb before burning compared to unprotected skin. UVA rays penetrate deeper into the skin – protection is measured in stars, so choose at least four-star protection.
- I would recommend always wearing SPF50 – and in the UK, apply it to all exposed skin once the UV index is above 3. (For darker skin tones allow for some sun exposure – though not extended – as there is a risk of not getting enough vitamin D.) I apply SPF50 to the face, neck and hands all year round, mostly to protect against UVA and visible light in winter.
- Don’t assume that a moisturiser that has an SPF is enough protection – swap your face cream with SPF for a proper sunscreen, at least in the summer. (Not least as while a face cream might have SPF, it doesn’t always offer protection against UVA too.)
- While it’s really important to protect your skin at home, the most dangerous pattern of sun exposure is if your skin has been covered for most weeks of the year then is suddenly exposed to high UV levels on a two-week holiday, with subsequent sunburn – this pattern is linked to the development of melanomas.
- Even really good, well-applied sunscreen is no substitute for covering up and staying in the shade – but you will still need sunscreen, as the UV rays can bounce off surfaces, such as water, sand and even grass.
- Try to apply before you go out, because this allows even coverage and film formation for maximum protection.
Now use my top-to-toe guide to work out how much protection you actually need…
BACK
2 x 50p blobs of sunscreen
When the sun comes out, many men are quick to take off their tops, and the back is the most common area of the body where we see melanoma in men (in women, it’s their legs). It is therefore absolutely critical that men apply regular high factor sun cream to their backs.
CHEST
1 x 50p
A lot of women who have protected their face from the sun don’t do the same for their neck and chest and sun damage really shows up in this area, with dark sun spots and paler patches that have lost their pigmentation, thread veins and texture changes. As a result, the skin on the chest often becomes crepey and quite rough to touch.
ARMS & LEGS
2 x 10p blobs for each limb
Legs are the most common site for melanoma in women. The backs of the thighs in particular are prone to burning, as not only are they harder to put sun cream on yourself, but they’re covered up for a lot of the year. I treat a lot of people in their 40s wanting to get rid of sunspots on their lower legs.
STOMACH
1 x 10p blob
SCALP
1 x 50p blob
I see a lot of sun damage and skin cancer on scalps of men who have lost their hair so you must use sunscreen here, too. Better still, wear a hat.
SHOULDERS
2 x 10p blobs
Like the back this is an area that’s often missed and they’re also vulnerable as like your back, legs and stomach, they’re covered up for much of the year.
NOSE, EARS AND HAIRLINE
A 5p blob for each area
I always recommend applying two layers to the face a few minutes apart to prevent gaps in application.
NOSE: This is a very common area for skin cancers as it protrudes from the body, and gets more direct sunlight. It’s important to protect it – not least as surgical treatment of skin cancers on the nose can be quite disfiguring as there isn’t much skin to play with here.
You need to apply SPF more regularly – around two hourly – as we sweat quite a lot in the centre of the face, and the skin there tends to be oilier.
I recommend a two-pronged approach – a standard chemical sunscreen (common ingredients in these include octocrylene and avobenzone) – plus a decent application of zinc oxide paste. As for amounts, you want the skin to visibly white which suggests adequate cover. If you’re doing water sports, think white nose and ears!
EARS: This is a common site for skin cancers, especially in older men – probably because men are more reluctant to use sun cream and they’re also more likely to have short hair or a bald scalp. Skin cancer here is often at higher risk of spreading.
HAIRLINE: Few people put sun cream in their parting – but it is very vulnerable. There are some very good sprays now available that are less greasy.
FOREHEAD AND BACK OF NECK
A 10p blob for each area
FOREHEAD: Skin cancer is also common here, but I find some people are reluctant to use sunscreen in the upper part of their forehead – especially if they play sport – as it runs when they sweat and irritates their eyes. To get around this, try a zinc oxide sunscreen or cream stick as this tends not to run as much.
BACK OF NECK: Again, a classic place to burn, especially for those with short hair.
REST OF THE FACE
2 x 10p blobs for each side
The tops of the cheekbones, just below the eyes, are common areas for sun damage and skin cancers – people tend to miss these areas because they don’t like to get sun cream too close to their eyes. Use a mineral sun cream like zinc oxide around your eyes, as this tends to be less irritating. And wear sunglasses.
Dr Justine Hextall is a consultant dermatologist at Tarrant Street Clinic in Arundel, West Sussex.
Additional reporting: Jennie Agg