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Sunscreen and You

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Dr. Rachel Herschenfeld
Dermatologist
Tuesday, May 9, 2006; 11:00 AM

Dr. Rachel Herschenfeld talked about new developments in sun protection and what you don't know that could be hurting you.

The Harvard-educated dermatologist, Dr. Rachel Herschenfeld discussed sunscreens and keeping your skin safe Tuesday, May 9, at 11 a.m. ET .

washingtonpost.com: In the past few months, there have been suits against sunscreen manufacturers such as Johnson & Johnson, Schering-Plough and Playtex, accusing the companies of misleading the public with false claims concerning the effectiveness of their products. So, the question becomes what and whom should you believe. We're delighted to have Dr. Rachel Herschenfeld here today to tackle that question.

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Bethesda, Md.:

Is the SPF 15 addition to moisturizers as effective as SPF 15 sun blockers sold specifically for that purpose?

Dr. Rachel Herschenfeld: A product with an SPF of 15 should provide an equal amount of sun protection whether it is labeled as a sunscreen or as a moisturizer. The key to the SPF is the presence of active sunscreen ingredients in appropriate concentrations. The key to success with any of these products is proper application: enough to cover the area you want to protect, and reapplication as it wears off.

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Washington, D.C.:

Okay, this is a dumb question, but I'm serious: If my makeup has SPF 15 and my moisturizer has SPF 30, am I getting a total protection of SPF 45? And while we're at it, is the SPF 15 in my makeup enough? It's not like I'm a roofer or anything; I'm in an office out of the sun all day.

Dr. Rachel Herschenfeld: The SPF of your make up can't just be added to the SPF of your moisturizer. However, you certainly do get more protection by applying more sunscreen, in any form. As to whether or not the SPF of 15 is enough, well, enough for what? I recommend using at least an SPF of 30 on the face. Although you only gain a small amount of protection over an SPF of 15, even small amounts of sun exposure add up to produce big changes in terms of aging and skin cancer risk. It's just as easy to apply the product that is more effective.

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Rockville, Md.:

Are there particularly effective barrier protections? I receive a fair amount of mail from Solumbra, Solar Veil, etc. and wonder how they stack up to chemical sunscreens, each other, and so on.I prefer covering up--that stuff hurts when you get in your eyes!

Dr. Rachel Herschenfeld: The clothing that is sold by the companies that you mentioned is wonderful for sun protection. I recommend using shirts, cover-ups, hats and wraps because they don't wear off, and you know you're protected. Another great catalog is from Coolibar. If you don't want to buy clothing specifically designed for sun protection, try to wear darker colors, and choose fabric with a tighter weave- these will block more UV rays.

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Northern Virginia:

My husband is a melanoma survivor. We have two young daughters, and we are very careful about their sun exposure. They have always worn Australian-style swimsuits; we also slather them with sun screen. I've found, however, that the suits work better than any sunscreen. By the end of the summer they have some tan on the exposed areas of their arms and legs. Is there more I could be doing to reduce their risk? Perhaps a new sunscreen that is more effective at staying on and blocking all rays?

Dr. Rachel Herschenfeld: It is no surprise that they still have tan lines. Sunscreen always wears off, especially after swimming or sweating, and kids tend to do a lot of both. You should definitely use a very water resistant product, such as Blue Lizard or Blue Lizard Baby, and remember to reapply it at least every 2 hours.

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Arlington, Va.:

What remedies are recommended for sunburns that can help reduce or minimize damage to the skin?

Dr. Rachel Herschenfeld: Once you're burned, you've unfortunately done most of the damage. You can't reverse the increased risk of skin cancer and melanoma, and you can't prevent the aging changes. For acute sunburn, cool showers, gentle moisturizers, aspirin or acetaminophen for pain can all help. If there is blistering, it may be necessary to see your dermatologist for more wound dressings and to make sure there is no infection.

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So-called Base Coats:

I am going on my honeymoon in September and may end up on a nude beach. I never go tanning and I wear SPF 15 on my exposed areas (face, neck, arms) every day. Should I pre-tan before I hit the beach, or just apply large quantities of SPF 50 and reapply often?

Dr. Rachel Herschenfeld: Definitely the latter! Also stay in the shade as much as possible. Pre tanning simply damages your skin before you hit the beach!

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Charlottesville, Va.:

I know that wearing sunscreen is important and want to do so on a more regular basis. My question is this - what types of products are the best for not creating a feeling of wearing a thick layer of foundation? I have oily skin and many of the sunscreens I try (even oil free sunscreens) cause me to break out AND give me the feeling that I'm layering make-up on in the tradition of Queen Elizabeth I. Any suggestions?

Dr. Rachel Herschenfeld: So, I have a few suggestions. Have you tried the Neutrogena Ultra Sheer line yet? Not very greasy, although some people don't like the way make up goes on over it. Another option is LaRoche Posay's Anthelios- the SPF 40 gel is a very nice product.

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Pittsburgh, Pa.:

Is there any difference in sun damage between going out in the sun for 30 minutes without sunscreen and going out in the sun for four hours (or however many) with sunscreen? In terms of sun damage, is one better than the other? I was just wondering what the sun damage is equivalent to when you're wearing sunscreen. Clearly there is still some, right? How much does sunscreen actually protect you? Is there anything that sunscreen protects you against that even a small amount of time in the sun without any sunscreen would cause?I know that wearing sunscreen and a little amount of time is the true answer, but that doesn't answer the equivalency question.)

Dr. Rachel Herschenfeld: So this si the deal with sunscreen and SPF: If you use a sunscreen with an SPF of 15, it will take 15 times as long to get burned as it would if you had no sunscreen on. An SPF of 30 will provide protection for 30 times as long. BUT: this only applies to UVB rays, and sun also has a lot of UVA, which is harder to block. Though many sunscreens now contain UVA blockers, there's no standardized measure for their effectiveness yet. So, I can't give an exact equivalence for you. In terms of damage, the longer you're out, the more you get. So, use sunscreen and also minimize exposure.

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Thinning hair:

I've got thinning hair, and I'm worried about sun exposure on my head, where it's tough to check for moles, etc. I usually wear a hat, but for those times when it's inconvenient or I forget, is there something I can do for up top? Thanks!

Dr. Rachel Herschenfeld: Use a spray on sunscreen for your scalp. This is so important! Your scalp is at much at risk for sunscreen as the skin elsewhere, so don't forget it.

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Germantown, Md.:

Is it true that after a certain SPF number (like SPF 30), the protection from the sun is negligible? Can you shed some more light on this and which SPF number is optimal?

Dr. Rachel Herschenfeld: This is an interesting issue. With an SPF or 30, 1/30 of the UVB gets through, so you block about 97%. With an SPF of 50, 1/50 get's through, so you block about 98%. As the SPF gets higher, there's a smaller difference in added protection. That doesn't mean it's not worth it, because small amounts of exposure can add up to a lot of sun damage.

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Astoria, N.Y.:

Okay, so this isn't totally related, but it is related in the sense that it involves tanning. I use SPF 30 all the time and never get a tan. Last weekend I was at a spa and they did those spray-on tans. Any word on if those are safe/good for the skin? What questions should we ask since there are so many different types? As someone with extremely sensitive skin, I am always careful.

Dr. Rachel Herschenfeld: Great to hear that you always use sunscreen! I am a fan of spray-on tans for those who want some color. Self tanning products contain DHA (dihydroxyacetone), a molecule which binds to the top layer of skin cells and produces a "tan". As these cells slough off, so does the color. This is a very safe way to avoid looking very pale.

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Reston, Va.:

Hi - thanks for being here!I have 2 questions:do you have a recommendation for a body moisturizer that also contains an SPF to wear on a daily basis? I get sunburned just driving to lunch when the sunroof is opened. I often break out using the off-the-shelf suntan lotions - is there a difference in quality with the more expensive types from skin care companies or the infomercial adds?

Dr. Rachel Herschenfeld: Lubriderm makes a nice moisturizer with sunscreen in it. Wear a hat when that sunroof is open, and reapply your sunscreen before you open it! In terms of cheaper versus more expensive sunscreens, the key is in the active ingredients. Plenty of brand available at regular pharmacies are very good. One thing to look for: since there isn't yet a standard way to measure protection from UVA rays, look for a product with an SPF of 30 or higher, and then read the ingredients to make sure there's some zinc oxide, titanium dioxide , avobenzone or helioplex to provide UVB protection. In Canada, Europe and South America also look for Mexoryl- a UVA blocking ingredient not yet approved in the US.

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Washington, D.C.:

I'm extremely fair and have experienced several severe sun burns in the past. Now that I'm older and wiser, I'm careful to apply sunscreen whenever I leave the house. I recently began using a continuous spray sunscreen because it's so easy to apply. Am I okay using the continuous spray sunscreen or should I use the traditional lotion?

Dr. Rachel Herschenfeld: The spray is fine- easy to get on, so you tend to use it.

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Arlington, Va.:

So how long does it take for sunscreen to wear off if you are not sweating or swimming? I apply sunscreen every day, but I found that just this past weekend when I was out a good part of the day that by the end I had a bit of freckling on my forehead. How do I know when I should reapply if I'm not that active but am outside?

Dr. Rachel Herschenfeld: I would still recommend reapplying every 2 hours, even if you're sedentary. You'll still sweat a little bit, and the sunscreen also tends to rub off.

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Washington, D.C.:

I heard that European sunscreens include a chemical not yet added to American sunscreens because of FDA approval hold-ups. I understand this chemical provides better protection against skin cancer and sun damage. My questions are: what is this chemical? Is it safe (in your opinion)? If so, where can I get it Stateside? Thanks.

Dr. Rachel Herschenfeld: So, the ingredient you're talking about is called Mexoryl. It is actually a stabilized for of avobenzone, or Parsol 1789. It is not yet approved in the US, but you can buy sunscreens containing this ingredient on-line. One great brand is LaRoche Posay which makes the Anthelios line of sunscreens. The FDA did approve another stabilized form of avobenzone, called Helioplex, which is found in Neutrogena's Ultra Sheer SPF 55- great product available at many pharmacies. Many other sunscreen contain avobenzone, but the problem is that it breaks down quickly in sunlight, so if it isn't stabilized, it doesn't work for very long.

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Jerusalem, Israel:

So if I use a sunscreen which claims to block 100 percent of UVA and is SPF 50 (skingard), does that mean the claim of the UVA blockage is a lie? It claims the 100 percent blocking of UVA is based on an Australian norm.

Dr. Rachel Herschenfeld: It may be that there is some test that was done to show complete blockage of UVA, though this seems unlikely to me. Unfortunately, there's no standard measure for effectiveness of sunscreens at blocking UVA. An SPF of 50 is great, just read the label to make sure it contains a good UVA blocker: zinc, titanium or avobenzone (preferably stabilized).

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Washington, D.C.:

Is sunblock better than sunscreen? What about for toddler skin?

Dr. Rachel Herschenfeld: This is a labeling issue. Since nothing totally blocks UV rays, we should just refer to all of them as sunscreens. For toddlers I prefer sunscreens containing mineral blockers such as zinc end titanium. Two great brands: Blue Lizard Baby and California Baby.

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Arlington, Va.:

Can you explain how Helioplex in sunscreens, such as Neutrogena's Ultra Sheer, is supposed to increase sun protection? How does it work? It's just described as "broad spectrum uva-uvb."

Dr. Rachel Herschenfeld: Helioplex is a stabilized for of avobenzone- so it can provide long lasting UVA protection, along with the UVB protection represented by the SPF.

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Washington, D.C.:

I'm a triathlete, and I know that I need good protection from UV A & B. I get tons of sun switching from swim to bike to run, with minimal coverage from gear. And then there's the sweating that goes on! I've been using AloeGator - a thick gel type concoction with good results. Its extraordinarily expensive. What else can you recommend for water, sweat and abrasion resistance, with high SPF?

Dr. Rachel Herschenfeld: Try Blue Lizard- very water resistant and not extraordinarily expensive.

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Fairfax, Va.:

My son is allergic to DEET so I started using the Naturals OFF spray years ago. It was fine for a while. Then I found the AVON Bug Guard (with or without SPF in spray and lotions) which is DEET-free and works great and doesn't have that horrible OFF-smell. Now Avon is coming out with Bug Guard with Picardin. What is Picardin and is it better than DEET? I know kids need sunscreen more often than bug repellent - how can we not overdose on the bug repellent and make sure that SPF is doing its job and the SPF is not making the repellent ineffective or ther other way around.

Dr. Rachel Herschenfeld: I recommend using two different products; a sunscreen for sun protection, and an insect repellent for bugs. That way, when you reapply your sunscreen, you don't overdoes on bug repellent. DEET is the most effective ingredient for insect repellents, but high concentrations are toxic for children. Picardin doesn't tend to work as well.

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Washington, D.C.:

I was wondering if there are certain chemical-laden sunscreens, or chemicals (i.e. Parsol 1789?) which should be avoided because they may be linked to diseases besides skin cancer. I know there are "all natural" brands of sunscreen, but are they as effective as the traditional brands? If they are as effective, are there any you would recommend?

Dr. Rachel Herschenfeld: Great question! I tend to prefer sunscreens that contain inert particles such as zinc oxide and titanium dioxide. At the very least, these ingredients reduce the need for high concentrations of other chemicals. Also, these ingredients are effective on their own as sunscreens. Brands to look for are Blue Lizard Baby, California Baby, Lavera, and Mustela.

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Annapolis, Md.:

Re self-tanning products: I have "liver spots" on my arms and legs. Applying self-tanning products seems to emphasize the spots EVEN after the tan wears off. Am I furthering the damage to my skin by using these products. Thanks!

Dr. Rachel Herschenfeld: You're not damaging your skin by using these products. often dark spots will look darker for a long time, since more of the tanner can often stick to those spots. Try cleansing the dark areas with an exfoliating cleanser containing salicylic or glycolic acid and then rubbing gently. Examples of such cleansers are Olay Clarity or Aquaglycolic body cleanser.

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Washington, D.C.:

What is the best way to get rid of sun damage on your face?

Dr. Rachel Herschenfeld: Use lots of sunscreen, and see your dermatologist to discuss anti-aging regimens and treatments!

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Arlington, Va.:

I like to go for long runs outside and have been told how sunscreen can clog your pores and does not let your skin breathe. Is there any truth to that?

Dr. Rachel Herschenfeld: It won't do this- you'll just sweat it off. Keep using sunscreen!

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Santa Fe, N.M.:

I am wondering what you think of this: American residents use the highest amount of sun screen in the world and also have the highest rate of skin cancer. And in other parts of the world in Europe, Australia, the use of sun screen and the rate of skin cancers is very low comparatively.

Dr. Rachel Herschenfeld: I'm not sure you're right about the low rate of sunscreen use in Australia. In fact, there are very well established public information campaigns in Australia to teach kids to Slip on a shirt, Slap on a hat, and Slop on sunscreen before going outside. Many play areas are shaded, and children are required to put on sunscreen before going out for recess. These changes have probably contributed to falling rates of skin cancer in Australia.

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Grosse Pointe Park, Mich.:

Dear Doctor,I've just been diagnosed with vitiligo. The sunscreens are a bit greasy. There is a line of SPF rated clothing. Does SPF clothing worth the cost? Is there a line of clothing dermatologists or the American Cancer Society recommends?

Dr. Rachel Herschenfeld: High SPF clothing is great. Sun Precautions and Coolibar are 2 great catalogs.

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Potomac, Md.:

I see expiration dates on sunblock containers and am wondering if companies are imparting useful information or are just covering their legal rears .Does sunblock 'go bad'? Can I use sunblock within a reasonable amount of time after expiration? For example, if I didn't use up everything from last year, can I use it this year even though the dates have passed by 6 months?

Dr. Rachel Herschenfeld: It is very important to check those expiration dates. Many sunscreen ingredients do not have an incredibly long shelf life, so throw away the old stuff and replace it!

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Washington, D.C.:

This may be a silly question, but I've always wanted to know: if you apply sunscreen at 9 a.m. but don't go out of the house until noon, do you reap the full benefits of the sunscreen's protection or has some of it been "used up" during the interim, even though you haven't been outside?

Dr. Rachel Herschenfeld: Some of it is "used up". It wears off, from rubbing or sweating, and also some of the ingredients break down in light, so they just don't last that long. Reapply before you go outside.

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Waldorf, Md.:

I was given a moisturizer that doesn't have sunscreen, so the last few weeks I've been mixing a little moisturizer with a little of my sunscreen of choice (Avon, SPF 40). Am I getting effective coverage by mixing them, or should I ditch the moisturizer and just use the sunscreen? The Avon stuff isn't too heavy-feeling or greasy. Thanks

Dr. Rachel Herschenfeld: You may be decreasing the sunscreen's SPF by diluting it, but you;re probably still getting protection. In order to get the full benefit of the SPF on the label, you need to put enough on.

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Toronto, Ontario:

Is is true that most sunscreens do not filter out the rays that cause melanoma and because they prevent a sunburn that functions as an early warning to get out of the sun, actually increase the incidence of melanoma?

Dr. Rachel Herschenfeld: It is not the case that sunscreen increases the risk for melanoma. Most scientific evidence indicates that proper use of sunscreen decreases the risk for skin cancer. Sunburns and over exposure to UV rays increase skin cancer and melanoma risk.

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Arlington, Va.:

I am taking a three-week vacation to tropical Thailand in September and have been trying to figure out a strategy for the sun (and the bugs but that's not your department). I expect it to be hot so wearing lots of clothes is not a great option. Are there places I can look for a comfortable hat that doesn't look too dorky and it easy to pack? I'm a bald guy so I try to be careful about head protection.

Dr. Rachel Herschenfeld: Check out catalogs that have sun protective clothing: Colibar, Sun Precautions, Solumra are just a few. There are plenty of styles out there so you can look great and also be protected.

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Washington, D.C.:

I heard there are some vitamins or pills that might lower your risk of sunburns? They are supposed to help a little bit and somehow keep you from getting as bad a burn. A couple people in my family have died from melanoma. Do you think these pills have any effect?Also, is there any truth to the idea that the FDA is discontinuing SPF 45? I burn in fifteen minutes and prefer the higher numbers and feel like I can feel the difference and want that higher number.

Dr. Rachel Herschenfeld: There is a pill called Heliocare, that contains a plant extract that provides some sun protection. It doesn't replace sunscreen, but is reasonable to use in conjunction with it. In terms of SPF number, the FDA has considered requring labelling changes that would lump all high SPF sunscreens into the SPF greater that 30 category, but this move has been opposed by dermatologists, because we believe that there are people for whom higher SPF are imprtant. I would include you in that group, and encourage you to keep using high SPF sunscreens, as well as to avoid excessive sun exposure, and get regular skin checks from your dermatologist.

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Alternative view?:

What about the news stories a few months ago that suggested we've gone to far with sunscreen? I believe the stories suggested that we were seeing an uptick in the cases of vitamin D deficiency because we've all gotten so fastidious with the sunscreen. It seems to me that if you're not getting tan, much less burned, you probably don't need much sunscreen.

Dr. Rachel Herschenfeld: This is a great issue. First of all, it is entirely possible to get enough vitamin D from dietary sources and vitamin pills. I recommend taking a multivitamin daily, and most days I do so myself! Second of all, a few minutes of sun exposure is all you need for your body to maximize it's vitamin D production for the day. Most of us get enough sun, even through the sunscreen, to do this. As to whether or not you get sun damage without a sun burn, the answer is yes.

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Blue Lizard?:

Thanks for all your help on this important issue! I've been trying to find information on Blue Lizard. Does it have titanium dioxide or zinc oxide in it? I can't wear anything with avobenzone in it - my skin burns and I have a terrible reaction.

Dr. Rachel Herschenfeld: Blue Lizard Baby has both zinc oxide and titanium dioxide in it. Regular Blue Lizard has zinc oxide, octinoxate, oxybenzone and octocrylene as active ingredients.

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Washington, D.C.:

I'm a 38-year-old woman who has been sunburned badly many times as a child and teen (I was a competitive tennis player). I understand that the damage has been done, therefore why should I now continue to protect my skin? Skin cancer - on the off chance I won't already get it - or wrinkles or both? Hasn't all of the damage been done with respect to wrinkles and cancer?

Dr. Rachel Herschenfeld: A lot of damage has already been done, but don't fool yourself- you could still do a lot more. Continuing with excessive sun exposure will only increase your risk for skin cancer even more, and cause more aging changes. Being careful and using sunscreen can minimize ongoing damage.

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Re: thinning hair:

Not a question but a public service announcement: everyone, but especially someone with thinning hair, should ask their hairstylist to let them know if they see anything suspicious on the scalp, behind the ears, etc. The person cutting your hair is in a unique position to notice anything out of the ordinary, and I'm not sure all stylists are comfortable saying something. Maryland's former governor Parris Glendening had a melanoma on his scalp, and when I read it was THE SIZE OF A SILVER DOLLAR all I could think was, didn't his barber NOTICE something??And by the way -- everyone should wear a hat!

Dr. Rachel Herschenfeld: This is an important point- I agree with these recommendations- thank you!

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Sunshine State:

Hi.. I'm moving to Florida next week, so the sunscreen convo couldn't come at a better time! I am white and have very light skin, but I tan very easily. I also burn very easily. I've heard that your skin "gets used to" the sun after a while, and you don't need as much sunscreen. Is it important to keep wearing spf 30 after I'm tan? Or just when I go to the beach? I wear make-up with sunscreen for my face, but I'm worried about the rest of me. I don't want to be one of those leathery old ladies you see on the beach who are actually 30 but look more like 50. Advice?

Dr. Rachel Herschenfeld: Keep wearing the sunscreen! Your skin won't burn quite as easily after a little while because you'll probably get a little color, which protects you. But it comes at a price- your skin knows to get tan because it can sense the damage done to the DNA in your skin cells by UV light. The tan is an attempt to shield the DNA from further damage by putting dark pigment over it to absorb the damaging rays. So you don't want to get very dark. Let the sunscreen do the protecting!

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Falls Church, Va:

I get sun rashes and have found that many sunscreens make no difference. Parsol, for example. But ones containing micronized zinc oxide seem to work well for me. Can you talk about the possible dangers of these nanoparticles? Also, what's the deal with the sunscreen popular in other countries that's not USDA approved (Ombrelle)?

Dr. Rachel Herschenfeld: Sun rashes are often caused by UVA, which isn't blocked by many sunscreens. Zinc happens to be an effective UVA blocker. Even sunscreens containing parsol, which can block UVA, often won;t work for long because parsol breaks down quickly in sunlight if it isn't stabilized. I don't know of any medical danger from micronized zinc oxide in sunscreen. The not yet approved sunscreen ingredient is Mexoryl, which I discussed earlier.

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Germantown, Md.:

Dr. Herschenfeld,I have a four-year-old boy and a two-year-old boy. They are very active and we spend a lot of time outdoors especially in the summer. I would appreciate your advice on making sure they are well-protected from the sun. Thanks.

Dr. Rachel Herschenfeld: Make sure you use a water resistant sunscreen such as Blue Lizard Baby, and reapply it every 2 hours. Also, sun protective clothing is great: put them in swim shirts as well as swim suits. Seek the shade whenever possible, and plan outdoor activities for the morning before 10 or afternoon after 3 if you can. Also, get them some cute hats!

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Dr. Rachel Herschenfeld: Thank you for all the great questions! Keep using your sunscreen.

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