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Sun Exposure and Skin Damage: Ask the Dermatologist

Dermatologist Doris Day answers your questions about sun exposure and skin damage.

Question:
I'm fair skinned and a model. I like to lay out in the sun and don't really use protection. Any advice you can offer to help me to maintain my youthful appearance?
Answer:

Sun exposure is the No. 1 (and 2 and 3) cause of aging of the skin. Sun-smart behavior is essential. Avoid midday sun, never go to a tanning salon, wear sun-protective clothing when possible, and use a high SPF sunscreen and reapply it every two hours when you are out. If you would like the look of a tan, try a sunless tanner. These have come a very long way and are safe.

Question:
What product must I use to have a clear and smooth skin?
Answer:

Sunscreen every day all year round, along with proper sun protection. I also really like retinoids for those who tolerate them. Other ingredients are niacinamide, vitamin C, and other antioxidants.

Question:
Is it correct that anything over an SPF 25 really doesn't decrease UVA and UVB sun exposure? I have heard that it "MAY" add only 2% more protection, but the costs of a higher SPF is not worth the price point.
Answer:

While it is true that you don’t double your protection when you double the SPF number, you do get an added benefit. SPF numbers are determined through testing under very controlled environments using an amount of product that no one uses in the real world. By using a higher SPF sunscreen, and reapplying it every two hours or so, you are getting closer a reasonable amount of protection. I see patients every day who used sunscreen and yet they are still suntanned, or sun burned, which means they were not getting the SPF they thought they were.

Question:
I am 65 and concerned about the sun spots on my face because they are getting larger and darker. Will a Blue Peel be strong enough to remove these spots and even out my skin tone? Or would it be more effective to have the spots removed with a laser? Also, several years ago while visiting my dermatologist I mentioned the dark spot on my face and hands, and he sprayed something on me. First it felt cold, then burned like "freeze wart remover." The area turned brown, scabbed over and a week or so later spots were gone. Do you have any idea what might have been in that “magic can?” I would ask him but he has retired. My budget is tight at the moment, but I am going to a class reunion in three months and need all the help I can get.
Answer:

The "magic can" contained liquid nitrogen and is one of the oldest and often highly effective treatments for sunspots, warts, and other skin issues. It is also one of the least expensive of the treatments dermatologists offer to remove sunspots. There is a risk that all the pigment may be removed as the skin heals, and that can leave a white spot at the site of treatment and that is permanent, so it does need to be done carefully and you do need to be aware of the risks.

The Blue Peel is effective for some people, but usually not if the spots are raised or have any depth to them. Laser peels are highly effective, but must be done by a qualified trained aesthetic physician (dermatologist/plastic surgeon).

Question:
How can you get rid of sun damage on your décolletage?
Answer:

There are excellent chemical peels or laser peels your dermatologist can offer you to help treat this very sensitive area. My preference is the fractional CO2 laser.

Question:
I have small red bumps on my upper inner thigh, and on the lower part of my butt. I read somewhere to try a cortisone cream and that didn't work. I have also tried some benzyl peroxide cream from the doctor. I don't know what else to try but it is very embarrassing!
Answer:

This might be a form of a genetic condition called keratosis pilaris. It can also occur on the upper outer arms. Some people grow into it over time, others are lucky and grow out of it over time. You can control it but not cure it. Products containing lactic acid, salicylic acid, and glycolic acid, alone or in combination, can be very helpful.

Question:
I use a high SPF lotion on my face daily, especially when going outdoors. Why do I still get sun spots? I even have white "freckles" on my body. I have oily skin that is very sensitive.
Answer:

Both the dark spots and the light spots are due to cumulative sun exposure over years. What you do now may help prevent the spots from getting darker and will make it so you get fewer new ones over time, but they are really markers of what happened 10-20 years ago. There are excellent sun protection products that are oil free or are designed for oily skin, and I would recommend looking for those in particular if your skin is oily.

Question:
What are the risks of sunbathing or by means of tanning beds?
Answer:

The World Health Organization recently issued a report that states and acknowledges that excess exposure to all ultraviolet rays, from natural sunlight or tanning beds, are what we call known carcinogens. This means than anyone exposed to enough of these rays over time will ultimately develop skin cancer. It may take longer for some than others depending on genetics and the amount of sun exposure, but tanning beds are stronger than natural sunlight and should be avoided.

Question:
I have had two children and am left with a wrinkly old-lady belly. I have a small amount of extra skin and lots of old stretch marks. I am only 23. How effective is Thermage and microdermabrasion? Are there other processes that are better, or is the knife my only option?
Answer:

Microdermabrasion will most likely have little to no effect. I have seen good results from Thermage, but it can take more than one treatment and is not always effective. Your dermatologist will help you determine if you are a good candidate for this procedure.

Question:
What is the best way to remove or lighten a dark spot that was caused by the sun and estrogen?
Answer:

The first thing to do is to have a skin cancer screening to make sure that the spots are OK. Your dermatologist can then recommend a variety of treatment options depending on the location, number, and size of the spots. If you are describing the patchy darkness that occurs on the forehead, cheeks, and upper lip from hormones and sun -- that is usually a form of melasma and for that, typically we recommend products that contain hydroquinone, retinoids, sepi-white, as ingredients to look for. Other treatments include chemical peels that more dramatically help even out the skin tone and lighten and sometimes even erase the dark spots. If you go in the sun, the dark patches will quickly return.

Question:
My daughter, age 17, has severe itching in her hands and feet primarily at night. It is so intense that she cannot sleep. Two days ago her doctor gave her a steroid shot and XYZAL tablets. They do not seem to work. We have also given her 2 Advil PM -- they do not help her sleep. She has missed six days of school as she only finally falls asleep at 5 a.m. There is no visible rash.
Answer:

The source of the itch may be neurologic and not from the skin. I would recommend seeing an internist or possibly a neurologist to evaluate further.

Question:
I am 49 years old and I have been out in the sun most of my life. I'm watching a freckle that is the size of a pencil eraser. It is round and recently it changed colors on the outer edge resembling a 1/2 moon. Do I need to worry about it?
Answer:

Any new or changing lesions should be evaluated by your dermatologist.

Question:
How can I overcome the dryness caused by natural products?
Answer:

Use a rich moisturizer. Look for ones that contain shea butter or ones designed for dry skin. Apply the product after washing the face when the skin is still damp to allow for maximal penetration.

Question:
Three days ago, my husband's skin started to hurt. It started with a patch on the small of his back and now it's on his on his chest. No rash just pain. What would you recommend?
Answer:

If the rash is on the same side of the back as on the chest, and is only in that one area, it could be an early sign of shingles, medically know and varicella zoster virus. This is a reactivation of chickenpox. It occurs in the distribution of one given sensory nerve, can be painful, and is often followed by a blistering rash in the same location. It should be treated as early as possible in order to avoid longer-term pain after the rash resolves. I would recommend an immediate visit to your dermatologist for an evaluation.

Question:
I have a lot of sun damage on my neck. It’s very splotchy and I would like to get rid of it. Would it be better to do a chemical peel, laser resurfacing, or do you recommend something else?
Answer:

There are excellent chemical peels or laser peels your dermatologist can offer you to help treat this very sensitive area. My preference is the fractional CO2 laser.

Question:
What can I do to take off the wrinkles on my feet?
Answer:

Often, proper hydration alone can make a very big difference in the smoothness and softness of the feet.

Question:
Are the chemicals contained in sunscreen safe for daily use?
Answer:

Yes. These chemicals have undergone many tests to determine safety and efficacy and designed to be used on a daily basis. The OTC review program, through which FDA requires significant safety and efficacy data on every active ingredient that is used in a sunscreen product, is the most rigorous in the world for ensuring the safety and efficacy of sunscreen products and is conducted in an open, transparent manner. The law gives the agency broad authority to inspect manufacturing facilities, to require adherence to strict good manufacturing practices, and to enforce the stringent, science-based regulations that ensure sunscreen products are safe and effective for consumers. FDA also relies on independent experts in the science of sun protection to help advise them in their assessment of safety and efficacy.

Question:
Treating a flea infestation in my hair with kerosene caused skin irritation that water doesn't seem to mitigate. Is there a more effective treatment than water, soap and water, or hair shampoos for reducing skin irritation from kerosene?
Answer:

I would not recommend applying kerosene to the skin. I would recommend you see your dermatologist to evaluate the extent of the irritation and determine the right treatment plan for you.

Question:
The sides of my nose and top of my nose keep peeling and it is not sun burnt. I don’t know why.
Answer:

I would recommend evaluation by a dermatologist.

Question:
What is the best thing for itching skin?
Answer:

Products that contain menthol are cooling to the skin and can distract from the itch. You can also leave your regular moisturizer in the refrigerator and applying it when it is cool can also be soothing. Otherwise it is important to get to the underlying cause. I am amazed at how often it is simply due to dry skin, even if it is only a little dry, and that just by proper moisturizing on a regular basis the problem resolves. You should look for a cream rather than a lotion, and apply it right after the bath or shower. Also avoid excessively hot showers and keep the shower/bath to no more than 10-15 minutes. If that does not help, it’s time for a checkup with your internist and dermatologist for further evaluation.

Question:
I'm a female, all my life have had hair on the sides, upper lips, under chin. What can I do to stop the waxing? It costs a little too much for my budget. I am 51 years old female also wonder if this is for life.
Answer:

If the hair is dark enough, laser hair removal, otherwise electrolysis can be very helpful. There is also a prescription product you can discuss with your dermatologist that is effective; however, you need to keep using it in order to maintain the effect.

Thank you for joining us for WebMD Ask the Dermatologist. Be sure to come back on Jan. 6, 2010, at 11 a.m. ET when we will discuss skin problems, From acne to rosacea. Sign up if you'd like an email reminder the day before our next event.

WebMD Ask the Specialist Transcript

Reviewed by Doris Day, MD on December 09, 2009

The opinions expressed in this section are of the Specialist and the Specialist alone. They do not reflect the opinions of WebMD and they have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance or objectivity. WebMD is not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your doctor or other qualified health provider because of something you have read on WebMD. 

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