Skin Cancer Awareness Month – Time For a Safe Sun Behaviour Refresher Course #SSB

pig-no-sunscreen-baconAs a cosmetic dermatologist, my day-to-day focus on sun exposure relates most commonly to the ageing consequences of ultra-violet rays. But let us not forget that an altogether more serious reason for Safe Sun Behaviour is prevention of skin cancer. May is a good time to refresh the facts.

 

1)   Malignant melanoma is the commonest form of cancer in young adults age 25-29 and the 2nd commonest in 15-29 year–olds.

2)   Frequency of melanoma in women has increased 8-fold since the 70s and likely reflects the increased use of tanning beds and intense sun exposure, such as severe sunburn in childhood.

3)   Regular tanning bed users have a 74% increased chance of developing melanoma.

4)    A person’s risk for melanoma doubles if he or she has had more than five sunburns at any age. 

5)   One or more blistering sunburns in childhood or adolescence more than double a person’s chances of developing melanoma later in life.

6)   But with early detection, cure rates can be as high as 98% – so it’s never too late to start making changes and developing Safe Sun Behaviour.

 

So with these sobering facts in mind, let’s review the basics.

 

1)   There is no such thing as a safe tan (she says, banging her drum). But it’s true. A tan means UV rays are messing with your skin’s DNA, creating mutations which trigger a melanin defense response. Thinking this is a good thing is insanity.

2)   With this simple fact in mind, think about protecting yourself with the holy trinity of shade/clothing/sunscreen – in that order of importance. Especially important for peak hours of UV, between 11am and 3pm.

3)   Remember that sunscreen is only effective when you put it on right. When applied incorrectly, it leaves you vulnerable to sunburn ( a very bad thing – see above) because you are under the illusion you’re protected. PUT IT ON GENEROUSLY AND FREQUENTLY.

4)   Think of sunscreen like a medicine – you wouldn’t decide to take a ¼ of the dose of antibiotic your doctor prescribes, but this is a common occurrence when it comes to applying sunscreen. You need 30ml (a shotglass-sized amount) to cover an average adult top-to-toe and you need to put it on at least every 2 hrs. Watch out for bits that often get missed, like sides of the neck, ears hairline and scalp.

5)   Examine yourself regularly for changes on your skin, such as new moles or changes to old moles, and talk to your doctor if you’re concerned.

Image: courtesy of cafepress.com

Sunscreen + Antioxidants: A Belt’n’Braces Approach to Ageing Prevention

ashtonI was recently asked at a consumer event if sunscreen was really a daily skincare necessity (sunscreen is so boring, after all; serums seem much sexier).

They can be messy, greasy in finish, they can make your make-up vanish before lunch and they can block your pores.  They might even stop you getting your necessary vitamin D.  What’s to like?

My view on this is simple. 1) You haven’t found the right sunscreen yet. 2) You can get vitamin D from a foodstuff or supplement (and anyway, its such an important vitamin, why would you rely on unreliable, potentially carcinogenic UVB for your supplies anyhoo?)  3) Yes, it’s utterly essential-the belt that holds it all (and by all I  mean the ageing skin) together. As is an antioxidant ‘pair of braces’. Surprisingly hard to find a pic of both as in fashion, both are generally considered de trop (sorry Ashton). But not in skin…..oh no.

I think part of the resistance to acceptance of this simple notion is the confusion that surrounds what ingredients to look for.  You need protection against both UVB and UVA all year-round, so tinted moisturiser with an SPF 15 and no UVA filter is not enough. Bear in mind that UVA is present in winter and travels through glass. UVB is fairly easy to block. Good ingredients include titanium dioxide (physical block), the salicylates (like octisalate) and the cinnamates (like octinoxate). Harder is to get full UVA protection. Zinc oxide (physical blocker) and titanium oxide both protect well, as does avobenzone and ecamsule (both chemical blockers).

I’m a big fan of physical blockers. That makes some people nervous-a white-ish, hint-of-death, chalky finish comes to mind. But the beauty of modern sunscreens is that the particles are so fine, you lose the nasty pallor but you are beautifully protected.  There are also plenty of choices in the all-important non-comedogenic camp- breakouts need not be a concern. So that’s my take on the belt. Buckle up. Apply enough (a generous teaspoonful) daily, and use a minimum of SPF30 broad-spectrum protection. And while you’re at it, protect your neck, chest and hands. And don’t even ask yourself the question ‘do I need sunscreen today?’ Take my advice, you do. Once you engage in that inner dialogue, game over-you haven’t found the right sunscreen.

But we don’t reapply sunscreens through the course of the typical working day-I know I don’t. So practically, what can we do to minimize any breakthrough UV (and indeed infrared radiation, of which we are learning more) that doesn’t get deflected and reaches our precious dermis? Adopt the braces-which means utilizing a smartly formulated antioxidant preparation.  Vitamin C in its L-ascorbic acid form (otherwise it doesn’t get to the dermis) and Vitamin E make a great, synergistic combination. They mop up those nasty little free radicals-and Vitamin C has a multitude of other benefits too, so it suits almost every skin-type.

If you’re smart, you’ll start doing these simple steps daily before you even think about heading into a doctor’s office for something more invasive . It’s just common sense.

The Secret to Bare-Faced Chic or ‘Bien Dans Sa Peau’

Image

Leaving the house without make-up…a challenge that leads many women to suggest they’d rather chop their arm off than contemplate. But the reality of busy lives, whether it’s getting the kids to school on time or squeezing in a quick gym session before work, frequently necessitates being confident enough in our own skin to face the world sans slap. It’s also not such a bad idea to give ourselves a day off every so often, for the sake of skin health, as Jesse J and Kelly Brook demonstrated recently on Twitter.

The keys to looking great bare-faced are:

1) Skin radiance

2) Minimise under-eye problems

3) Banish blemishes

4) Killer brows

5) Well-moisturised lips

If these 5 things are in place, you’ll be able to project a clean, groomed kind of nude beauty that’s highly desirable and actually very youthful.

Steps 1 and 3 are best accomplished with morning application of AHAs and BHAs and night-time use of vitamin-A derivatives. Follow up with daily sunscreen all year-round. I like Obagi Exfoderm Forte, Tretinoin 0.1% and Sunshield SPF 50 on prescription, which I could not function in clinic without. Over-the-counter I love Medik8 Betagel, Retinol 40 Boost and Heliocare SPF 50 gel. Combine with a home-use dermaroller for extra impact and support with a non-comedogenic cleanser and moisturiser.

2) The under-eye area is a hard one to tackle without make-up, I fully admit. Dark circles are tricky. Sleep is critical. January is a good time to catch up on much-needed slumber as lots of people are cutting back on alcohol and hitting the gym. Keep salt to a minimum to reduce under-eye puffiness due to fluid retention. And utilize skin-care products containing high-potency vitamin C for hyperpigmentation  and collagen production. I like Obagi Professional C serum 15% (again, a clinic staple of mine) and over-the-counter Skinceuticals Phloretin CF serum.

4) Brows frame the face. So important. A thicker brow looks right at the moment. So get professional input and have them threaded-Shavata Brow Studio  fantastic.

5) Dry lips in winter are uniquitous-a supple, moisturized lip is crucial for a healthy appearance so keep them juicy and low-maintenance with regular lip balm usage and do not lick! Saliva irritates the delicate lip area, which naturally lacks sebaceous glands and  Vitamin E, hence the lip’s tendency to age; this dries lips out, so break the cycle by being aware of your behaviour. I love Elizabeth Arden 8-hour Cream, which is now available in an unfragranced version. 

So hopefully these simple steps take you a little closer to comfort in your own (glowing) skin….’bien dans sa peau’.

Talking live on Channel 4 News on the dangers of the ‘Barbie doll’ drug Melanotan

In-flight Skincare-or how not to have a Break-out after Long-Haul Travel

ImageWhen I get on a plane these days, I treat it like a military operation-I’ve had too many instances where I’ve arrived at the other end crispy dry, broken-out and red-eyed (aka jet-lag acne….sounds so glam ironically). Not the best thing if you’re travelling for business and expected to ‘perform’ at the other end. So I’ve devised a kit of products, which I know will maintain the status-quo-and mean that I get off the plane looking fresh, hydrated and ready to work.  You will need to go to a store like Muji to get some of those small travel-sized pots to decant the bigger products into, in order to keep the powers that be happy re the 100ml threshold.

Remember what you’re battling against is a) horrendously low humidity, meaning skin WILL get dry and b) stress; air-travel is inherently a stress on our systems, particularly if it’s long-haul, and disrupts sleep. For those who are acne-prone and already teetering on the brink of a fresh break-out because their skin is clogged, this combination is enough to send the process into freefall and trigger a fresh flurry of lovely, bumpy red numbers.

So once you’ve boarded, settled and the seat-belts sign is off, get thee to the bathroom with your kit.

1)   Remove  make-up. I recommend using a micellar lotion with a cotton pad-I like Avene Micellar Lotion as it’s non-comedogenic (I know I sound like a broken record but this is SO important) and take all your make-up off. Wash-off cleansers are not practical on airplanes-I know, I’ve tried (and flooded the bathroom floor, resulting in unpleasant wet socks. Nice.)

2)   Problem-solve. Apply a gentle-but-therapeutic product to bare skin, targeting all trouble-prone areas to suppress any imminent ruptures. I like La Roche Posay Effaclar Duo particularly in this context because the gentle BHA works as an an anti-inflammatory, exfoliant and clog-clearer; whilst niacinamide has anti-acne benefits but will also help fortify your skin’s barrier function, helping to prevent moisture loss and keep skin supple.

3)   Hydrate. This is something all acne-sufferers are terrified of. I see it in their eyes when I tell them they will need moisturiser to manage the side-effects of their acne meds. But have faith-there are products out there which will not make acne flare-and, yes, you guessed it, they’re non-comedogenic. If you let acne-prone skin dry out, not only will it get dry (doh!), it will revert to its ‘stressed state’ response and break-out. So: the products I will happily spoon on to an acne sufferer’s skin are: anything Cetaphil-the Moisturising Lotion is great for most, but if very dry especially in winter, then it’s good to have the Cream too. And they come in really handy 14g samples sized tubes-perfect for air-travel. I also love Effaclar H Compensating Moisturiser from La Roche Posay.

4)   Soothe. Areas like the lips and hands really suffer, so be sure to apply a lip balm regularly and pamper your hands and cuticles. Elizabeth Arden 8-Hour Cream cannot be beaten for lips and cuticles. Cetaphil Moisturising Cream will serve double-duty for hands too.

Depending on the length of the flight, I will repeat steps 2 and 3 every so often (3 especially). Take your own eye-mask, cashmere wrap and socks (even in Economy, this brings a touch of First-Class to the whole experience) and try to relax/sleep.  Minimize alcohol and drink lots of water.

Before landing, I will cleanse and apply a light layer of moisturiser. Then conceal any areas of redness  and dark circles with a little Vichy Dermablend Liquid Foundation. Add a pop of blush to the cheek, a layer of gloss (Nars Pillowtalk is my current fave) and a touch of mascara and I’m ready to get things done.-just add a  well-cut navy blazer for polish a la Elle Macpherson and feel……well, a little bit smug.

Extinguishing the Fire of Rosacea (the most-searched tag on my blog)

Rosacea is probably one of the commonest and most annoying conditions-it can render the sufferer beetroot red at a moment’s notice, and usually when least convenient. Unpredictable and terribly self-conscious making.

Treatment works best on the spotty papulo-pustular type; treating the flushing, fixed redness and broken capillaries is harder. But the key to developing better treatments is a more detailed understanding of the processes behind the disease, and how current therapies modify it. I think we can now safely say we we’re closer to understanding this capricious condition.

The key to understanding rosacea is to appreciate how the skin senses the environment, in it’s bid to keep our insides safe. The innate immune system is a primitive-but-useful part of this protective mechanism that serves as a warning system, which responds to dangers in the environment. Like the sun. But in rosacea, this system is hyperactive and over-anxious.

Think of it like a fire-alarm-designed to ‘go off’ when there is a significant hazard. Like the oven has caught fire. Instead, it goes off when the kettle boils. The premature alarm generates pro-inflammatory changes, which are disproportionately strong. This leads to leaking from capillaries, weakening of capillary walls leading to inflammation and visible surface blood vessels. And, through the release of nerve-stimulating peptides, can cause burning, stinging and sensitivity. And all of this is compounded by sun exposure, with the associated damage to elastin and collagen fibres that can further weaken blood vessels and strength of the skin’s scaffolding.

Finally, if this goes on unchecked, the chronic, ongoing inflammation can recruit white cells and overwhelm lymphatic vessels, leading to fibrosis and distortion of facial features, like the nose.

Much of this process is due to genetics with environmental triggers. People are probably bored of hearing about sun protection, but I think the above explanation makes it clear that first-line therapy for rosacea sufferers is to know your environmental triggers and use daily sun protection. I find patients tolerate a well-formulated sunscreen with broad-spectrum filters-I like both Obagi and Skinceuticals sunscreens for this reason, as they really are compatible with daily wear.

The treatments that I think work best have been shown to influence the innate immune system-oral tetracyclines turn down the over-active response pathways generated by the alarm going off, as do effective topical agents like azelaic acid.

In the future we will have better treatments to target the premature alarm bell itself-receptors called Toll-like receptors. We think azelaic acid may well do this too. And we will also be better able to target the family of response molecules called cathelicidins which have a specific action on the blood vessels themselves.

A complex disease with complex mechanisms-but I think we’re getting thereJ

Bank-Holiday Break? Remember, A Safe Tan Is An Urban Myth

Image

This summer, I’ve been asked an exceptional number of times for my tips on safe-tanning. And every-time someone asks me this, I have to search for ways to sugar-coat the fact that, well, there simply isn’t one and that the mere expression causes me consternation.

A (real) tan means you’ve caused enough damage to your skin’s DNA to activate the fire alarm and start up the hose-your skin’s melanin factory.  And in some this will prove an effective defense mechanism (but know that your skin is like an elephant and will not forget this insult); others (fellow Casper-like Celts, you know who you are) will see their somewhat impotent melanocytes  gasp and splutter to produce a bit of extra protection, but ultimately they will fail  them-and the inevitable sting and soreness of sunburn will ensue.

Why go through this ritual of burn-then-tan (badly) when your skin is simply not designed for this function very well? Take the following steps and  your lovely white epidermis will thank-you for decades to come:

1)   Apply lashings of Xen-Tan Gradual Self Tan after exfoliating-and use one of those nice, velour mits for a streak-free finish. See, you too can look good in a white Heidi Klein bikini.

2)   Develop a vacation ritual of late nights, lunch-for-breakfast and enjoy the beach from 3pm onwards (Mykonos and Ibiza lend themselves very well to this custom). This minimises sun exposure at the peak hours, without killing your buzz from the great weather.

3)   Find a broad-spectrum sunscreen that you like, minimum SPF30 and USE IT PROPERLY.  Use a shot-glass full amount to cover the average adult, let it dry before going outside to avoid it rubbing off and reapply at least every 2 hours, or after sweating/towelling.

4)   Get a sunscreen for the face that’s non-comedogenic, so you don’t have the excuse that it ‘makes you break out’ for under-applying. A generous teaspoon here please. And don’t miss bits, commonly along the hairline, nose and ears.

5) A good-quality antioxidant facial serum will give you a ‘belt-and-braces’ type extra layer of protection against any pesky UV that does get through your sun-screen, neutralising ageing free radicals-try Obagi Professional C serum or Skinceuticals CE Ferulic.

5)   Finally, please do not ask me for Botox whilst lobster-red from yesterday’s sunbed in preparation for going on holiday (this really happened) …..I don’t have words…..