Everybody's Free to Wear Sunscreen

(Do you remember that song, btw? I do because I actually was Class of '99. Was it not so embarrassingly fake-deep and horrible that you shuddered and had to change the station every time it came on? I'm pretty sure the only good thing that came of it was Chris Rock's parody "No Sex in the Champagne Room.")

So Runner's World posted this article recently that had to do with wearing sunscreen when you run outdoors. In the article, it said that a 2005 study reported that 85% of outdoor athletes didn't use sunscreen at all.

WHAT??? Seriously??

This was as flat-out unbelievable to me as when I heard that the average American wedding cost $28,000. (Then I talked to a bunch of my recently wedded friends who all shrugged & were like, "Sounds about right." I guess we're having cocktail weenies for dinner at my wedding.)

I mean yes, I know that there will always be people who for whatever reason refuse to take basic health/safety precautions no matter how quick and easy they are (ie seat belts, bike helmets, etc.). But I really expected this number to be more in the 15-20% range. 85%, not just of average people, but outdoor athletes, don't use sunscreen at all?

The mind boggles. Or mine does at least.

So this is my mama hen sunscreen post, on the off chance that any of the seven people who read my blog are among that 85%.

Now, you may be asking, "What makes YOU such a smarty-smarterson about sunscreen?" A fair question. Nothing super-formal, I'll admit; the majority my knowledge of all things sunscreen / skin damage comes from a few sources:

• Truly ludicrous levels of paranoia. I do this about most things health-related. Sometimes I can't sleep at night because I think about all the different types of cancer in the world and I feel sure that statistically one of them must be eating me from the inside out & I won't know about it until it's too late. Skin cancer, on the other hand, seems like something I can actually do something about and mostly prevent with enough vigilance. So I've done a lot of anxiety-driven research on my own
• I have some nasty skin allergies, which has resulted in learning a lot about skin care in general from doctors / allergists / the internet. Some of that is relevant to sunscreen use.
• Don has a chemist friend from school who started his own organic skin care business some years ago, and he has educated us both substantially, particularly around sunscreen & skin damage. We use a lot of his products, which are especially good for me given my super sensitive skin. Also they are apparently in Whole Foods now, which is exciting!

Running & Sunscreen

(You can probably skip this part if it is painfully obvious to you why you should slather yourself in sunscreen before running outdoors.)

There are nearly 1,000,000 new cases of skin cancer and 60,000 new cases of melanoma diagnosed each year. Statistically, probably a lot of those people spend more time outdoors than average. But plenty of them, like most people, are folks who get the bulk of their sun exposure casually, while out running errands, driving, etc. Contrary to what a lot of people think, you don't have to be a sun worshiper to develop skin cancer. The cumulative effects of normal exposure over time are absolutely linked to melanoma and other forms of the disease. Even people who spend most of their time indoors can be at risk if they don't wear sunscreen regularly when they are out.

As runners, most of us spend many additional hours out in the sun every week, putting us at an elevated risk. (Those of us running between 10am - 4pm have it the worst.) Deena Kastor once wrote on her blog that in six years of dermatologist visits, she had only walked out of the office once without having some form of cancer biopsied or removed. (Deena has extra-fair skin & so has been in the habit of getting regular skin cancer screenings.) Sweating makes us even more susceptible to UV rays. An Australian study also found marathoners to be at higher risk for "atypical moles, age spots, and other lesions that increase the risk of developing skin cancer."

Choosing a Sunscreen

Come down to it, sunscreen is a little like birth control -- whatever you're most likely to use consistently is the best, and something is better than nothing. That said, they're not all created equal. When you shop for sunscreen, look for...

Broad spectrum. UV rays come in two flavors, UVA & UVB. Look for one that protects against both. UVB causes sunburn; UVA causes premature wrinkles / aging. Both play a role in the development of skin cancer. These days more and more screens are broad spectrum, but it's still smart to double check before you buy.

SPF 20-30. SPF or Sun Protection Factor is a measure of the amount of UV your skin absorbs. For example, wearing SPF 15 means that your skin will absorb 1/15th (or 6.7%) of what it would absorb without any sunscreen at all, so 93.3% of UV rays are blocked. SPF 30 means your skin absorbs 1/30th or 3.3% of what it would bare, meaning 96.7% of rays are blocked. Most dermatologists say that if you apply SPF 20-30 correctly and re-apply as necessary, you're doing just fine. Yes, SPF 50 and 60 screens are out there, but since the functional difference between blocking 96.7% of UV rays and 98% is negligible, this is usually more of a marketing gimmick than anything else. In fact, SPF factors this high can actually cause people to suffer more skin damage sometimes by giving them a false sense of extra security (so they apply less, re-apply less often, etc.).

Here is a graph from Erik's site that shows SPF vs UV rays blocked:

Look for a physical sunscreen. Sunscreens come in two types: physical and chemical. Physical sunscreens sit on the top layer of your skin and deflect or block the sun's rays. Chemical ones actually bond chemically with your skin and absorb rays. (Some chemical filters do some amount of scattering, but mostly it's just absorption/filtering.) You want the physical ones. Once physical sunscreen is on your skin, it is effective until it is removed (by washing, sweating, rubbing/toweling off, etc.). Because absorbing UV rays breaks down chemical sunscreens, they must be re-applied periodically, even if they haven't come off.

Chemical sunscreens are also more likely to irritate skin & cause allergic reactions, and (ironically) some generate free radicals which can actually cause UVA sensitivity and skin damage (PABA was one, but the jury's still out on several others that are still in use). Some (like oxybenzone) are endocrine disruptors that mimic estrogen, which can have all kinds of nasty effects. Finally, physical sunscreens are more environmentally friendly because they are basically inert, whereas some ingredients in chemical ones (cinnimate, benzophenone, parabens, and camphor derivatives, mainly) have been found to harm ocean life, particularly coral.

Determining whether a sunscreen is a physical one is quite easy, since there really are only two. Under 'active ingredients,' look for Titanium dioxide (TiO2) or Zinc oxide (ZnO). Common chemical screens include avobenzone, octinoxate, octisalate, oxybenzone, and uvinul, but if it's not TiO2 or ZnO, it's a chemical screen. Zinc oxide is preferable because it offers broad spectrum protection on its own, whereas Titanium dioxide protects mainly against UVB rays and needs to be paired with a chemical like mexoryl, helioplex, or avobenzone in order to provide UVA protection.

Green Screen (zinc oxide) with a bit of bronzer (powder) on top. Look ma, no ghostly white film!

Some people don't like to use physical sunscreens because they tend to be thick, harder to wash off, and due to the white color of the active ingredients, can give you kind of a ghostly-white pallor. (Chemical screens can be thinner, invisible, and more lotion-like.) However, physical screens with various shades of skin-colored tinting are becoming more popular. Erik's company makes a tinted one which is my go-to screen, and although on its own it can still make me look a little paler than, for example, tinted moisturizer, it looks pretty decent with a little powder or bronzer on top. (Obviously I don't bother with that when I'm just going out for a run, but at, say, a picnic or BBQ, this works great in place of actual make-up.) They also now have one made to match darker skin tones.

Avoid carcinogens, neurotoxins, & endocrine disruptors. This is less about sun protection & more about keeping nasty substances out of your body. Some of the most common ones you want to steer clear of include oxybenzone, homosalate, octinoxate, PEGs / polyethylene / polyethylene glycol, propylene glycol, retinyl palmitate, quaternium-15, triethanolamine, diazolidinyl urea, methylparaben / propylparaben, disodium EDTA, & anything with the generic ingredient 'fragrance.' Looking into why these chemicals are maybe not things you want to be smearing all over your skin is left as an exercise for the reader as that is a whole other bucket of worms.

Applying Sunscren

Did you know most people do it wrong? This is something else I learned from Erik.

Every day, year round. Yes, UVB rays (which cause burning) are strongest during the summer and in the middle of the day. Don't fall into the trap of thinking that if you're not at risk of burning, you're not accumulating UV exposure, though. UVA rays (the wrinkle/aging rays) are present all day and year-round, even on cold or cloudy days. Even 10 minutes of UVA exposure a day can cause significant damage in as little as 12 weeks. Most of us get that simply running our daily errands. Yes, it's an extra step in your morning, but it's such a small trade off to make in terms of your health & peace of mind (just ask Deena Kastor).

2 tablespoons, head to toe, & 1 teaspoon for your face. One of the main problems with sunscreen is that people generally don't use enough. If you're using SPF 30 and you spread it on too thin, you can end up only getting SPF 5-6 protection. So don't be shy! Apply liberally. You'll go through it faster, but again, it's such a small price to pay.

Be thorough. Most of us are pretty good about slathering up our faces, backs, chests, and shoulders. Don't forget commonly overlooked areas like ears, forehead, backs of hands & arms, lower legs, and lips (I have Erik's SPF lip balm, which I need to be better about remembering to use).

Apply chemical screens 15-20 minutes before exposure. Because physical screens sit on top of the skin and actually block UV rays, they are effective immediately. Chemical screens must bond with your skin before they are effective, though, so they will not offer protection until 15-20 minutes after you put them on.

Reapply, reapply, reapply. If you're doing something relatively tame, not sweating, and not touching your skin, a physical sunscreen will last you all day. The reality is, though, that we're active, we sweat, touch our faces, wipe/towel off our skin, etc. Some sunscreens are water/sweat resistant, meaning they retain their UV protection when wet, but there is no such thing as water/sweat PROOF sunscreen, and in fact as of June 2011 the FDA does not allow sunscreens sold in the US to be labeled as such. Even so, as soon as you wipe or towel off, all bets are off.

Pre-2011 sunscreens I have stopped using because of the many possible carcinogens / neurotoxins / endocrine disruptors they contain.

Reapplying at least once every two hours is recommended; when I am running and sweating a lot I probably reapply more like every half hour or so, but as I mentioned, I am super paranoid about these things. (I know this can be tricky with running -- I'm better about reapplying when I'm at the track & I can just dump my bag in the stands, but if I'm going on a longer run, I try to do loops past my house or car where I can reapply, or carry a travel-size bottle with me. Erik makes 1 oz bottles that are perfect for this. At this point he should probably be paying me for this post, don't you think? ;) )

If you're using a chemical sunscreen, reapply every 1-2 hours no matter what, because the protection will break down as it absorbs UV rays, even without wiping/toweling/etc. Also do your best to dry your skin before reapplying -- both physical & chemical screens are more effective on dry skin, but chemical screens in particular really need skin to be dry in order to bond with it.

Consider applying under clothes. Many people erroneously believe that clothing protects your skin like sunscreen. Generally it doesn't; a light-colored shirt, for example, probably offers ~SPF 5 protection. If you're going on a sunny run and you aren't wearing SPF-rated clothing (which is AWESOME, by the way!), applying underneath is a smart move. (The RW article I mentioned up top talked about a guy who used to never wear sunscreen, got skin cancer, & now religiously wears sunscreen under his clothes every day.)

A Few More Tips

Personally, I think wearing a good sunscreen regularly & applying it correctly is a HUGE step in terms of sun protection. But there are even more things you can do if you're so inclined.

Sun protective duds. I love this stuff! I will admit to not having a ton of it, but still. I love that it exists. I just did a quick google search & found this, this, and this.

Wear a hat. Exposed parts of the scalp are another oft-overlooked spot when it comes to sun damage. Wearing a hat is easier than sunscreening your part! A hat with a visor will also provide additional protection for your face.

Avoid peak UV hours. Those of us who are not professional runners don't always have a ton of flexibility about when we run, but if you're able, try to run before 10am or after 4pm in the summer when UVB rays are at their worst.

Wear sunglasses. It's not your skin, but UV rays can still damage eyes and even cause cataracts.

Alright -- I am done nagging you for the day. Go forth and run (or whatever) in health!!