skin care myths
TRANSCRIPT
Skin Care Myths:Separating Fact from Fiction
Vivianne C. Beyer, MDDermatology
www.SpringfieldClinic.com/DoctorIsIn
Disclosures
• I have no conflicts of interest to declare
Objectives• Discuss common myths, misconceptions, old wives’ tales• Discuss the evidence that separates fact from fiction• The following topics will be discussed:
– Skin cancer and prevention– Tanning– Vitamin D controversies– Skin care and beauty tips– Acne myths
Your Skin: A Vital Organ• The largest organ• Regulates body temperature• Stores water and fat• Is a sensory organ• Prevents water loss and entry of bacteria
• It is essential to take care of this vital organ!
Myth # 1
• Skin cancer only happens in older people
Fact: – Melanoma is the most common form of cancer in
young adults 25-29 years old • Second most common form of cancer for 15-29 year-olds
– The incidence of nonmelanoma skin cancers, especially basal cell carcinoma, is rapidly rising in young adults
Source & photo: skincancer.org
Skin Cancer• Skin cancer is the most common form of cancer in the US• More than 3.5 million skin cancers are diagnosed annually
– There are more new cases of skin cancer each year than there are cancers of the breast, prostate, lung and colon combined
• One in five Americans will develop skin cancer in the course of a lifetime
Source: skincancer.org
Basal Cell Carcinoma• Basal cell carcinoma is the most
common form of skin cancer– Main risk factor is cumulative and
intense bursts of sun exposure– About 2.8 million cases are
diagnosed per year in the US – Rarely metastasize but can be locally
disfiguring/destructive
Photo: skincancer.org
Squamous Cell Carcinoma• The second most common form of skin cancer
– Main risk factor: cumulative UV exposure over the course of a lifetime– An estimated 700,000 cases of SCC are diagnosed each year in the US – Look like open sores, wart-like nodules, scaly red patches– Have higher rate of metastasis than BCC (5%)
Melanoma • One person dies of melanoma every 57 minutes
– About 76,000 cases of invasive melanoma are diagnosed every year in the United States
• More than 9,000 people died of melanoma in 2013 • Melanoma accounts for less than five percent of skin cancer cases, but the vast majority of
skin cancer deaths (75 percent)
• 1 in 50 men and women will be diagnosed with melanoma of the skin during their lifetime
Source: skincancer.org
Myth # 2• Indoor tanning does not increase
your chance of developing skin cancer
Photo: skincancer.org
Tanning• Ultraviolet radiation (UVR) is a proven human carcinogen
• One indoor UV tanning session increases risk of developing :– squamous cell carcinoma by 67%– basal cell carcinoma by 29%– melanoma by 20%
• 76% of melanoma cases among 18-to-29-year-olds are due to tanning bed use
• People who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent
Source: skincancer.org
• “Whoa: Tanning beds cause more cancer than cigarettes!”
-Headline from msn.healthyliving.com
• Results from a study published in JAMA Dermatology in January 2014:– Roughly 450,000 cases of skin cancer each year are due to indoor tanning– 360,000 cases of lung cancer are secondary to smoking
– In the US, 35% of adults and 55% of college students have tanned– On an average day, more than one million Americans use tanning salons
Wehner MR, Chren M, Nameth D, et al. International Prevalence of Indoor Tanning: A Systematic Review and Meta-analysis. JAMA Dermatology. 2014 Jan 19
Myth # 3
• It is a good idea to get a “base tan” before a sunny vacation
There is no “healthy” tan• Any tan is a sign of sun damage• Base tan only offer SPF 3-4
– Will not protect against burning
Photo: skincancer.org
UV radiation facts• UVA light penetrates deeper and causes
photoaging (wrinkling, solar lentigines, large pores, blood vessels)– Also contributes to development of skin
cancer– Intensity is constant throughout the day
• UVB light causes sunburn– Strongest from 10AM to 2PM
• Tanning is induced by UVA (mostly) and UVB light
Source & photo: skincancer.org
Source: skincancer.org
Myth # 4
• You don’t need sunscreen on a cloudy day
Don’t learn this the hard way!• Clear skies: 100% of UV light reaches Earth’s surface• Scattered clouds: 89%• Broken clouds: 73%• Overcast: 31%
• UVA light is not affected much by cloud cover– In addition, 50% of exposure to UVA occurs in the shade
Jansen R., Wang S., Burnett M. et al. Photoprotection: Part I. Photoprotection by naturally occurring, physical, and systemic agents. J Amer Acad Derm.69(6):853.e1-853.e12.2013 Dec.
Myth # 5
• Sunscreen only needs to be reapplied after sweating or swimming
Reapply!
• Every 2 hours• After sweating, swimming, toweling off• Regardless of how high the SPF is
How sunscreen works• Chemical sunscreens absorb UV rays before they
affect the skin
• Physical sunscreens reflect UV light away from skin– zinc oxide and titanium dioxide
Photo: skincancer.org
Sunscreen Facts• SPF value refers only to protection gainst UVB (and small amount
UVA)• To achieve the full advertised SPF, must use 2 mg/cm2 (shot glass for
entire body)– 1 teaspoon for face/head/neck– 1 teaspoon to each arm– 2 teaspoons total to trunk– 2 teaspoons to each leg
• Most people only use 25-50% of required amount
Source: skincancer.org
Myth # 6
• Using a higher SPF sunscreen means I can stay out in the sun longer
Chart of Sunscreen Efficacy
•An SPF 15 sunscreen blocks 93% of UVB radiation • SPF 30 sunscreen blocks nearly 97% • SPF 50 blocks 98%
– No suncreen blocks 100% of UV rays
http://mycpss.com/sunscreen/spf-rating-system
Sunscreen Buying Tips• Look for broad spectrum (UVA/UVB protection)
– For UVA protection, look for one of the following ingredients: avobenzone, titanium dioxide, ecamsule, oxybenzone, and zinc oxide
• SPF 30• Water resistant• Do not use if past expiration date • Store in cool spaceSource: AAD.org
aad.org
Myth # 7
• Sunscreen causes Vitamin D deficiency
Facts about Vitamin D• Vitamin D is important for skeletal health
– Current evidence does not support its role in the prevention of breast cancer, colorectal cancer, heart disease and stroke
• Institute of Medicine, 2010• There are 3 sources of Vitamin D:
– Diet• Foods: fatty fish (salmon), cod liver oil, and fortified milk, cereal, and orange juice)
– Supplements– UVB radiation
Source: skincancer.org
Vitamin D Controversy• Scientific evidence has NOT shown that sunscreen use prevents
adequate vitamin D production
• Indoor tanning beds are primarily UVA, which does not increase Vitamin D production
• Vitamin D production reaches its maximum after 5 minutes in summer midday sun
Source: aad.org, skincancer.org
Vitamin D• Studies have shown that people with sun-seeking
behavior (Australian surfers) still have suboptimal Vitamin D levels (under 50nmol/l)
• There is a significant genetic influence on Vit. D levels
Photo: skincancer.org
Vitamin D Guidelines• 400 International Units (IU) for infants
under 12 months old• 600 IU for children and adults younger
than 70• 800 IU for those 70 and older
Source: AAD.org
Myth # 8
• Sunscreens cause cancer
Do Sunscreens Cause Cancer?• Oxybenzone, retinyl palmitate, and nanoparticles have come
under scrutiny – No studies have shown a cause and effect relationship
Source: skincancer.org
Myth # 9 • A product that combines sunscreen
and insect repellant makes sense
Photo: AAD.org
Buy 2 Separate Products• Combination products are problematic for a few reasons:
– 1) The sunscreen ingredient is less effective (for example, when combined with DEET)
– 2) The insect repellant is more toxic and more readily absorbed– 3) Application instructions differ for the 2 products
Source: skincancer.org
Myth # 10
• My makeup has sunscreen in it, so I do not need additional sunscreen
Makeup and Sun Exposure
• Facial foundations without sunscreen provide SPF of 2 to 6• Better to layer foundation after sunscreen
Myth # 11
• People with dark skin do not develop skin cancer
Photo: Billboard.com
Bob Marley– Acral lentiginous
melanoma• Was dismissed as a
soccer injury under his toenail
• Metastasized to his brain and caused his death at age 36
Source: skincancer.orgPhoto: Bolognia Dermatology, 2nd edition
Skin Cancer Affects Everyone• Dark-skinned patients who develop skin cancer have a higher mortality
– Why?• Delay in diagnosis• Melanomas more likely to appear in mouth, on palms/soles, or under nails
• So while skin cancer is much more common among lighter-skinned people, it tends to be more deadly among people of color
Source: skincancer.org
Myth # 12
• UV light does not go through windows
Unilateral DermatoheliosisJennifer R.S. Gordon, M.D., and Joaquin C. Brieva, M.D.N Engl J Med 2012; 366:e25April 19, 2012
Myth # 13
• Self tanners protect from burning
Not a True Tan!• Most self tanners contain the active ingredient
dihydroxyacetone (DHA), a sugar molecule that darkens the skin• Does not increase melanin pigment in skin, so MINIMAL
protection from UV light
Source: skincancer.org
Myth # 14
• Acne is caused by greasy foods and chocolate
Diet and Acne• Controversial• Recent studies have implicated:
– Skim milk– High glycemic index foods
Photo: skincancer.org
Myth # 15• Acne is due to dirty skin, so skin
must be scrubbed clean several times daily
Photo: aad.org
Skin Washing Tips• Overzealous washing can make acne worse!
– Use a gentle, alcohol-free cleanser – Use your fingertips to apply cleanser; avoid hot water – Do not scrub your skin – Rinse with lukewarm water; pat dry with a soft towel– Apply moisturizer if your skin is dry or itchy (oil-free)
• Even oily skin needs moisturizer– Limit washing to twice daily and after sweating
Source: aad.org
Myth # 16
• Only teenagers have acne
Acne Contributors• Hormone fluctuations• Stress (increased androgens)• Family history• Hair and skin care products • Certain medications • Certain medical conditions
Myth # 17 • Anti-aging products can erase all signs of aging
Photo: aad.org
Skin Care Products
• If it sound too good to be true, it probably is!• For a product to truly be anti-aging, it MUST contain UVA
and UVB protection
Anti-Aging Tips• Protect your skin from the sun every day • Avoid repetitive facial expressions
– Sleep on your back• Eat a healthy, well-balanced diet• Stop smoking, and drink less alcohol• Exercise • Cleanse your skin gently (twice daily and after sweating)• Avoid irritating skin care products• Be patient!!
aad.org
Source: skincancer.org
Myth # 18
• When it comes to skin care products, “you get what you pay for”
Not True!
• More affordable drugstore products often work just as well, if not better than expensive “luxury” brands– Often paying for package, smell, feel of product- but not
active ingredient and efficacy
Budget Skin Care• Sunscreen, sunscreen, sunscreen!• Apply moisturizer to damp skin to lock in moisture• Petroleum jelly is a great moisturizer for rough, cracked skin• Don’t overdo it• Consider a moisturizer WITH sunscreen • Look for key ingredients
Ingredients• Look for products with Vitamins A, C, or E
– Antioxidants- prevent formation of free radicals that can lead to skin aging and skin cancers
– Vitamins C and E can decrease sun damage and improve skin texture
– Vitamin A derivatives (retinoids)• soften fine lines and correct uneven skin tone
Source: AAD.org
Other Ingredients
• Alpha hydroxy acids– Glycolic acid
• For dark spots: hydroquinone, retinol, kojic acid, soy, niacinamide, ellagic acid, lignin peroxidase, arbutin, licorice
Source: aad.org
Take Your Vitamins!• Vitamins A, B, C, D, E, and K• Essential fatty acids (alpha-linolenic and linoleic acids)• Folic acid • Zinc and selenium• Biotin for hair and nails
Source: aad.org
Myth # 19• Cocoa butter prevents stretch marks
Sadly, no
• Genetics play a huge role• Hormonal changes during puberty and pregnancy
contribute
Myth # 20
• Smoking is not a major cause of wrinkles
This photo says it all…
Facial changes caused by smoking: a comparison between smoking and nonsmoking identical twins. Okada HC1, Alleyne B, Varghai K, Kinder K, Guyuron B. Plast Reconstr Surg. 2013 Nov;132(5):1085-92.
Myth # 21
• If the label says “all natural” or “botanical” ingredients, it must be good for my skin
Not Always True
• Heavily fragranced products can be very irritating• Allergies can develop over time• “Natural” or “botanical” does NOT mean hypoallergenic• “Unscented” is not the same as “Fragrance-Free”
Conclusions
• Sunscreen, Sunscreen, Sunscreen!• You do not need to break the bank to take care of your
skin• Don’t believe everything you hear• Take care of yourself and your skin will thank you• See you dermatologist for any concerning lesions and
annually for skin exams
References
• Skincancer.org• AAD.org• Springfieldclinic.com• Bolognia et al. textbook of Dermatology 2nd edition• Journal of the American Academy of Dermatology• JAMA Dermatology• msn.healthyliving.com
Thank you!
Questions?