Although cumulative sun exposure increases your risk for skin cancer and causes accelerated-aging changes in the skin, only approximately 17 pecent of people apply sunscreen before going outside. And the majority of those 17 percent apply an insufficient amount and achieve only 25-40 percent of the sun protection factor promised on the label.
Studies show that the farther away the body part is from the face, the less likely sunscreen is applied. The American Academy of Dermatology recommends applying sunscreen on all sun-exposed skin. Only 50 percent of people who apply sunscreen put it on their arms, and only 3 percent on their legs.
Why is there such strong resistance to applying sunscreen? In an attempt to understand, I asked my patients their reasons for not using sunscreen daily. Some of the top reasons were that they do not like the way it feels on their skin, they believe that sunscreens are harmful to their health, they do not like the white sheen on their face and they do not like the inconvenience of having to reapply it every two hours to maintain protection.
Fortunately, there is an excellent alternative for those opposed to wearing sunscreen: photoprotective clothing.
Simply wearing clothing does not guarantee adequate sun protection against carcinogenic-inducing ultraviolet radiation from the sun. Fabrics vary greatly in their UV protection factor (UPF) measurement, depending on the type of material, weight, color, weave and construction. UPF is a measure of how much of the sun’s UV radiation is absorbed. Fabrics are tested in a lab with a spectrometer that measures how much UV radiation penetrates the fabric. For example, a UPF of 50 indicates that the fabric allows only 1/50th of the sun’s UV radiation to reach your skin.
The average cotton shirt has a UPF of 7-9, a cotton T-shirt has a UPF of 5-7 and denim and corduroy have a UPF of 1,700. Obviously, a UPF of 1,700 is not allowing any UV through, but it isn’t practical to wear denim for exercising or engaging in strenuous outdoor activities.
Synthetic and semi-synthetic fibers such as polyester, rayon, Lycra and elastane offer the greatest sun protection. Bleached cotton, gauzy silk and crepe offer the lowest protection. Unbleached cotton contains special pigments that act as UV absorbers. The tighter the weave and the greater the density of the fabric, the higher the UPF. When fabrics are wet, they lose approximately 50 percent of their UPF. A wet cotton T-shirt has a UPF of 3, hardly protective against skin cancer.
Many companies sell sun-protective clothing, including Solbari, Sun Protection Australia, Solumbra, Sun Precautions, NoZone, Patagonia, Columbia, Outdoor Research, Coolibar and UV Skinz. I encourage you to select items with a UPF of 30 or above.
The two most common places on the body to develop skin cancer are the head and neck. Wider hats tend to be floppier and can impair vision. Baseball caps are woefully inadequate for providing photoprotection – they leave the ears exposed and cover only a few inches of the top of the forehead and top of the head.
The best sun-protection hats have a drape that covers the neck and chest as well as an adjustable strap. Hats with the drape in the back provide some protection for the back of the neck, but if your movement generates a breeze, the drape blows up and the neck is exposed to the sun. Several manufacturers make hats with drapes that cover the front, back and sides of the neck.
My personal favorite is a hat with a drawstring and a longer drape in front to protect the upper chest, too. I find that hats with a face cover are too hot, and it’s annoying to have fabric constantly touching the face. The only company I could find that sells swim hats with a chin strap is Sunday Afternoons.
Not only does UV radiation cause skin cancer, it also causes sun damage in the form of brown spots, also known as solar lentigines. These spots are often mislabeled as age spots, but in fact they are unrelated to age. UV radiation also thins the skin, resulting in tendons and veins on the tops of the hands becoming more prominent and easy bruising because the skin becomes more fragile.
Wearing sunsleeves to protect the tops of hands and forearms when outside or driving in the car will help mitigate these changes. There are a variety of sungloves and sunsleeves on the market. My personal favorite comes from the brand Eclipse, which makes sunsleeves with a thumb hole that covers the upper and lower arm and hand in multiple colors and patterns. The fabric is lightweight and washes and wears well. My only criticism is that the sleeves are not long enough to cover the fingers.
I was searching for shirts and pants that looked presentable and could be worn in situations outside of going on a safari or riding a camel. My two favorite companies are Columbia and Solbari. The shirts wash well, dry quickly and have vented netting under the arms for cooling and pockets for stashing a metro ticket or credit card, but they do not look like a camping outfit. The material feels pleasant against the skin, and there are a variety of attractive colors and styles. I only wish that Solbari made its pants full length instead of a cropped style; the most common place for women to develop a melanoma is on their legs.
Dr. Patricia Wong is a Palo Alto-based dermatologist. For more information, visit patriciawongmd.com.