Doctors debunk 12 myths about sunscreen, sunburns, and tanning

• Dermatologists Jeremy Brauer and Michelle Henry debunk 12 myths about sunscreen and sun care.
• They talk about the effects of getting sunburned and what to look for in a good sunscreen.
• They also explain how protecting your skin is a comprehensive plan that requires more than SPF.

Following is a transcript of the video.

Michelle Henry: "Getting a base tan will protect you from a sunburn later on."

You know, a tan is temporary, but your skin never forgets.

"I'm covered -- I applied sunscreen on my face, arms, and legs."

Jeremy Brauer: You're not covered.

"Getting sunburned once is harmless."

All it takes is one blistering sunburn. One.

Hi, my name is Jeremy Brauer. I am a board-certified dermatologist and a fellowship-trained Mohs surgeon. I have a new practice in Westchester, New York, called Spectrum Skin and Laser as well as practicing in Manhattan for about a decade.

Henry: Hi, I'm Dr. Michelle Henry. I'm a board-certified dermatologist and skin-cancer surgeon. I have a practice called Skin & Aesthetic Surgery of Manhattan. I specialize in high-risk skin cancers, lasers, aesthetics, and general dermatology, and today we'll be debunking myths about sun care.

"A higher SPF is always better."

Brauer: So, that, I would have to say, is a myth. SPF is great when we think about UVB, or ultraviolet B, rays, but we also have to worry about our ultraviolet A rays, which also cause sun damage and skin cancer. So in that regard, you're looking more for a broad-spectrum, UVA/UVB-protective sunscreen. The other part of this that makes it a myth is higher is not always better. Yes, 30 is better than 15, 50 is better than 30, but at some point, roughly around 50, you're already at 98% blocking of your UVB rays.

Henry: And SPF 100 only takes you 1% more, to 99%, and is that really significant? Likely not. What's most important to me is that you're wearing 50 when you're outdoors, but you also want to make sure you're wearing sunglasses, utilizing shade structures, you're wearing a hat, you're paying attention to your skin.

Brauer: "You can have a 'healthy tan.'"

Henry: Absolutely not. So, this is complete fake news. We know that UV light is a known carcinogen, so there really is zero safe dose of UV light.

Brauer: I would agree. Healthy and tan do not go together, by definition. When your skin is tanned, it's damaged. And when you have damaged skin, you increase your risk of skin cancer. We know that approximately 90% of all skin cancers are directly related to exposure to ultraviolet A and B rays, and guess what? Those are what causes a skin to tan.

Henry: Exactly. You know, a tan is essentially just your skin's stress response. So your skin is distressed when it's tan. If you want tan skin, A, understand that your skin is OK and beautiful the way it is. But if you for the summer want to look a little bit tanner and you want to do that in a safe way, there are many companies that provide very safe sunless tanning creams, lotions, and sprays that can give you the look that you want but also keep you safe. And that is my singular recommendation for being tan.

"Getting a base tan will protect you from a sunburn later on."

The tanning salons will tell you that if you get a base tan before you go out into the sun, it's going to protect you. So, a base tan probably gives you about an SPF of 3. So if you burn in 20 minutes, now you're going to burn in 60 minutes. That's nothing. It doesn't really help you significantly. But what it has done is increase your risk for skin cancer, increase your risk for accelerated aging. And, you know, a tan is temporary, but your skin never forgets. So what I tell my patients is that skin cancer is like the straw that broke the camel's back. You never know when you're getting that one last exposure that is now going to tip your skin cells over into being cancerous. So there really is zero safe level of UV.

Brauer: "You can't get sunburned in the shade."

Henry: Incorrect. So, you can absolutely get sunburned in the shade.

Brauer: Are you skiing? Are you at the beach? Is there sand? Are you sitting right next to an aluminum garbage can?

Henry: No matter where you are, the sun can reflect off of the concrete, the sand, the snow especially. With snow, about 80% of the sun's rays actually reflect. So you're actually still at risk and still quite vulnerable, even if you're under a shade structure.

"You only need sunscreen if you're going outside."

Brauer: That is definitely a myth. We know for sure that whether you're indoors sitting by a window or if you're in a car driving, you are going to get exposure to ultraviolet light. Primarily it's ultraviolet A, but as we've been talking about, ultraviolet A is just as dangerous as ultraviolet B. And even then, while these windows do protect you against most of ultraviolet B, it's not all of ultraviolet B.

Henry: Curtains aren't perfect, because, you know, clouds aren't even perfect, right? So UVA makes its way completely through the clouds. So curtains alone won't do it. You know, sunscreen alone won't do it. It is a comprehensive plan to keep your skin safe.

"I'm covered -- I applied sunscreen on my face, arms, and legs."

Brauer: You're not covered. We also think about arms, but what about the backs of your hands? And if you're outside wearing flip-flops or open-toed shoes, sandals, the tops of your feet as well need to be protected with sunscreen.

Henry: The lips. That's an area that's really high risk for skin cancer, and as skin-cancer surgeons, we know that's one of the areas where skin cancers can metastasize. Another area: the part. When men lose their protective covering on the scalp, you want to make sure that you're protecting those areas. The chest, behind the legs, underneath the chin. I treat skin cancers underneath the chin all the time. So even if you're just out on a patio having lunch with a friend, that light is getting reflected. So don't forget underneath the chin as well.

Brauer: "Getting sunburned once is harmless."

Henry: No. This is absolutely incorrect.

Brauer: All it takes is one blistering sunburn in your lifetime to increase your risk of skin cancer. One. Henry:

Henry: Those young formative years, not only are they psychologically important, but they're clinically important to keeping you safe. We know that five sunburns before the age of 18 can double your risk for melanoma. So it's really important that you're protecting your skin early.

Brauer: I would say the best way to stay away from us is actually coming to see us.

Henry: Oh, yes, I like it!

Brauer: Everyone, as you said, everyone is incurring sun damage. Everyone should have a skin check by a board-certified dermatologist. And the idea is not just for the dermatologist to take a look at your skin, but also have a conversation with you about what your skin looks like and how you can prevent future sun damage, prevent development of skin cancer, what sunscreens might be appropriate for you.

Henry: Once you've had one skin cancer, you're at an increased risk of having another one in the next year. And so it's just, once you've accumulated that damage, you continue to have them, and you continue to have them. And so it's really important that you take every sun exposure seriously, because you never know when you're near your tipping point.

Brauer: And so, yes, what has happened has happened, but it doesn't mean that it's too late, and we absolutely can do things for you to help minimize the risk of development of skin cancer in the future.

Henry: "The sun is strongest when it's hottest."

Brauer: This is not necessarily true. The heat that you feel over the course of the day is actually cumulative, so for most of us, we actually feel the hottest a little later in the day, usually about 3 o'clock. So if you're out at 10, 11 o'clock and you don't feel it's all that hot outside, guess what? That's when the UV is actually strongest. There are certain times of the day where the sun is at the highest in the sky. And at that period of time, we believe that the ultraviolet light that we've talked about, UVA/UVB, is at its strongest and most damaging. In general, we talk about 10 a.m. to 3 p.m. It can vary slightly, maybe 11 to 4, but that doesn't necessarily mean that's when it's hottest during the day.

Henry: A little trick that I often use is the shadow trick. If your shadow is shorter than you, the sun is higher in the sky. If your shadow is a little bit longer or taller than you, so in the late morning or the late afternoon, then the sun is likely not at its peak.

Brauer: The other thing to think about is on a cool day, on a cloudy day, even on a winter day high up in the mountains, when you're skiing, you're getting ultraviolet damage occurring.

"People with darker skin don't need sunscreen."

Henry: So, everyone needs sunscreen. It does not matter your skin type. So we know that melanin is protective, but melanin is not perfect. So even the deepest, darkest skin ranges from an SPF, let's say, 4 to SPF 13. And what do we recommend? SPF 30 and above. So even dark skin is not 100% protective. We know that we see skin cancers in darker skin types. What's also important is that in darker skin types there's often a lower index of suspicion, so we find them later. And because of this, the outcomes can be quite worse. So in darker skin types, we see that the five-year survival for melanoma is about 65%. In lighter skin types, it's about 90%. And part of that is because of that lower index of suspicion. The thing about skin of color is that redness looks different, sun damage looks different, but it's still there. Skin cancers look different. So some of the most common skin cancers, like basal cell skin cancers, which we classically describe as a pearly pink papule, in a darker-skin patient might look brown. It might, instead, it's a pearly brown papule. And so, you know, it's not that it doesn't happen. It's about being trained in a way to read those changes, because they're there, they're present, and it's critical to find them.

Brauer: "All sunscreen works the same."

Henry: Fortunately, they do not, because variety is really important, because different skin types have different needs. And so the two broad categories of sunscreens are your physical sunscreens and then your chemical sunscreens. So, chemical sunscreens work by bonding with your skin, and they convert UV light to heat. Physical sunscreens lay on top of the skin, and they reflect UV light.

Brauer: When we're talking about physical sunscreens or physical blockers, those are the mineral sunscreens. In general, we think of titanium dioxide and zinc oxide as the two prominent ingredients found in those sunscreens.

Henry: If someone has really sensitive skin, they may not want to use a chemical sunscreen, not only because of the chemicals, but because of that release of heat.

Brauer: In the news, very recently, there's a lot of talk about contaminants, such as benzene, as well as the concern about whether or not, yes, are we getting that SPF protection? Are we getting that sun protection that the label is claiming that we do? We definitely need stronger regulation by the FDA. We need more consistency and standardization in the industry, but that being said, applying your sunscreen and using your sunscreen as directed is definitely better than not using it at all.

Henry: Absolutely. The best sunscreen for you is a sunscreen that you will use. It's a wonderful thing that we have different variations. Creams for those who may have drier skin and enjoy that feeling of a richer cream. Lotions for those who don't. Gels for those who may have oilier, acne-prone skin. Powders for those who want to reapply on their makeup. Sprays for those who are looking to catch their kids running away on the beach.

Brauer: But don't inhale.

Henry: But don't inhale. But don't inhale.

Brauer: The important point to make is there is no waterproof sunscreen. So while it's great that if you feel like you're either going swimming or you're going to be sweating or very active, you want to use a water-resistant sunscreen, I think it's just as important that you realize once you get out of that pool or once you're ready to towel off after a lot of sweating, you reapply.

"You don't need sunscreen if your makeup has SPF."

Henry: No. And this is a common question I get in the office. Frankly, we don't apply our foundation the same way that we apply our sunscreen. Our sunscreen is a much more even application. If you're applying, let's say, eye shadow with SPF, most of us aren't applying a thick sheet of eye shadow over our eyelid, and so there are going to be areas of vulnerability.

Brauer: And as we've spoken about before, it's not just about that SPF number. You want to make sure that it's UVA protective too. And that's going to be found in your sunscreen, most likely not in your moisturizer. For physical blockers, I usually tell people that will go on last. But the chemical sunscreens, you maybe want to put that on prior to any other makeup that you'll be using.

Henry: A big problem that happens is that we've become these mad scientists and these chemists that we're not. And so when you start mixing formulations and you don't understand how to formulate, frankly what you're doing is you're diluting your sunscreen. And so if you're mixing your SPF with your moisturizer, now you have less protection. And we don't even know how these formulations work together. Maybe it's less than half. It's just far too risky.

"You won't get enough vitamin D if you use sunscreen."

There are more than enough ways to get vitamin D that don't cause skin cancer. So, I recommend supplementation, or, you know, dairy products also have vitamin D. So there are many ways you can get adequate vitamin D that's not a carcinogen.

Brauer: And if what Michelle said is not enough, sunscreen, sunblock is not perfect. So you're still getting sun exposure even when you apply sun protection perfectly. So it's not as though you're completely blocking the sun and you're not making any vitamin D. You are making vitamin D. You do not need much sunlight to make vitamin D. So, if I had to say three things to leave you with, start young, reapply -- it's not just about that first application first thing in the morning -- and it's not just about sunscreen. We've talked about all the other things that are involved in a comprehensive plan for skin care and sun protection.

Henry: We're excited about going outdoors. Our beaches are going to be busy. We want to make sure that while we're having fun, we're still being responsible. So sunscreen to me is an evergreen topic. We should talk about it year-round, but it's particularly important right now.