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Dr. Tarbox: Hello and welcome to "Skincast," the podcast for people who want to learn to take the very best care of the skin they're in. My name is Michelle Tarbox, and I'm an academic dermatologist at Texas Tech University of Health Sciences Center in beautiful, sunny Lubbock, Texas. And joining me is . . .

Dr. Johnson: Hi, everybody. This is Dr. Luke Johnson. I'm a pediatric dermatologist and general dermatologist with the University of Utah.

Dr. Tarbox: So I have to say one thing to you right now, Luke. Woo, it is hot. It is hot, and it is sunny. How about where you are?

Dr. Johnson: Oh, yeah, it was 104 degrees the other day.

Dr. Tarbox: So I thought we might talk about the unique challenges our skin face in the summer months and some things that we can do about that. Now, one of the things I like to discuss with my patients, when we're talking about summer skincare, is that we need to think about the huge job our skin has to do over the course of a long, hot summer. It has to keep us cool. It has to protect us from the environment, which includes the sun that can come to us from the outdoor exposure, the insects that we're increasingly exposed to when we're outdoors, and the plants we might come into contact as we venture out into nature. So our skin has a huge job to do. And in general, for your summer skin, you want to cleanse it gently. You want to moisturize it to restore moisture after the sun has stripped that away or the heat and the sweat has caused irritation over the course of the day.

Many people have like a summer regimen for their skin. I think simpler is often better. And using products that are hypoallergenic and gentle is generally a win-win situation, of course with a good and robust sun protection regimen, which we've discussed previously on the podcast.

And then I also want to talk about things people come in contact with uniquely in the summer. So I'm going to kind of categorize those into three things. And one will be a standalone episode by itself, because there's just so dadgum many of them. But the things we can come into contact in the summer are the three P's — plants, poisoning, which can be the sun or other chemicals, and parasites and other bugs.

So plants, we'll talk about first toxic plants, and, of course, the toxic plant that comes first to your mind is going to be poison ivy. And we talked about poison ivy a little bit before. But some things we haven't discussed is that it's actually becoming more populous because of climate change. So there are more favorable growth environments for this plant, and it's found everywhere in the United States, except for Alaska and Hawaii. Of course, it's more common in eastern and Midwestern states, and less common outside the United States, but it's found on every country, in every continent. And sprigs of poison ivy may also be present around the base of nursery plants.

So even if you live in an area that traditionally doesn't have a whole lot of poison ivy, you may still be exposed to it if you buy, say, a tree from the nursery and it came from a part of the country where it's more endemic. So exposure is relatively ubiquitous. But it also may be becoming more dangerous. So poison ivy is also potentially creating a greater concentration of the toxic oil that we call urushiol that's in the leaves that can cause the rash. So patients might have a more significant rash than they've previously experienced to poison ivy, and people who previously kind of flew under the radar might also develop symptoms.

About 80% of people will get a rash when they're exposed to poison ivy, and about 20% of people are lucky and just don't make that rash. But those numbers may change as the concentration of this toxic chemical can increase.

So leaves of three, it's better to let it be. Now, Luke, I know you've probably seen this more than I have. What does the rash of poison ivy look like, and what are the symptoms?

Dr. Johnson: Well, it actually looks a fair amount like eczema, because it's technically an allergic contact dermatitis. But it's usually just in one spot, the spot that touched against the poison ivy. And it can be a really vigorous response. So you can get blisters, or you can get little tiny, tiny baby blisters, which we call vesicles. And then you can have different reactions too if you do something like walk through a whole patch of poison ivy, or most of your body is affected, or there are reports of people who accidentally burn the poison ivy and then the smoke can cause major issues. But you want to look for a localized area that was probably brushing against the plant for some reason, especially if there's blisters in it, usually super itchy.

Also, Michelle, how come we always hear about the bad things that are getting more populous with climate change? It's always poison ivy and like wood beetles and ticks and things. How come it's not like parrots and cute animals and stuff that are expanding their territory?

Dr. Tarbox: I mean, you know, there might be some cute things that are having an easier time living in, you know, warmer climes. I'm not sure. I think we tend to notice the negative things more, and they get more attention. But, you know, it's possible that there are certain populations of daisies or butterflies or something that increase in general. But it seems like the hardier, more malicious plants always seem to benefit from adverse circumstances. And maybe that has to do with the character of the plants. They're just . . . you know, they've got grit and determination or something like that.

Dr. Johnson: Fair enough.

Dr. Tarbox: So how do you . . .

Dr. Johnson: Well, if you do get poison ivy, you might want to treat it. So our treatments are usually topical steroids. So topical means something you put on the skin. So if you don't have easy access to a doctor or somebody who can prescribe you one, then over-the-counter hydrocortisone will work all right. The ointment formulations tend to work better than the creams. So ointment is kind of gloopy, like Vaseline. So you might put that on your skin a couple of times a day. And then, if that's not cutting it, think you need something stronger, then get in touch with somebody like us.

Dr. Tarbox: Absolutely. And I think that, you know, if you've got symptoms you can't manage, sometimes patients will try unusual home remedies and things like that. It's much better to seek the advice of a medical professional early on in those circumstances.

So moving away from the plants, let's talk about some poisonings, specifically sun poisoning. So we all are probably familiar with a sunburn, where we get overexposure to UV radiation, and we can get redness or tenderness or itching. Usually lasts somewhere between 6 to 48 hours. It can cause permanent damage. It is a big deal because it can increase your risk of skin cancer. But in the acute period, it's pretty easy to manage. So you can put a little cool water or a cold compress. You can moisturize the skin using a non-petroleum or oil-based lotion. You can also take pain relievers, such as naproxen. You can take ibuprofen. Some people benefit from those things.

Sun poisoning is different. So sun poisoning is kind of an extreme sunburn that is bad enough to cause systemic symptoms. So besides the external effects of a sunburn, you can also have skin blistering. You can have headaches, nausea, dehydration, and dizziness, and it can actually last quite a long time. So unlike a sunburn, which has got a bit of a limited lifetime, sun poisoning can last up to a week, depending on the level of exposure. And so these might be treated with cold compresses, oral steroids, topical antibiotics, or lotions, depending on the severity of skin involvement. Have you ever had . . .

Dr. Johnson: It sounds miserable.

Dr. Tarbox: Oh, God, it's awful. Have you ever had a patient with sun poisoning?

Dr. Johnson: I'm honestly not sure I've ever even heard about sun poisoning before. So here, I'm learning something too.

Dr. Tarbox: Growing up in sunny Lubbock, Texas, I woke up to a personal story of sun poisoning. So my twin sister and I were at a place called Texas Water Rampage, which has a wave pool. As you might imagine, a wave pool is extremely efficient at washing sunscreen off of yourself. And when you're an enthusiastic teenager, who's having a good time, you maybe don't notice so well that you are getting severely sunburned. So both of us actually ended up with sun poisoning. So we had yellow blisters all over our poor little shoulders. I'm still waiting for the aftermath of that to show up. And we both had headaches, and nausea, and dehydration, and dizziness.

I remember it very well, because we shared a room growing up. And so we spent about three days in the summer just laying on our beds, our twin beds that were like on opposite side of the room, sort of moaning at each other across the room from the sun poisoning.

So definitely something that can happen and something that you want to avoid. And the way you avoid that is protecting your skin from the sun, making sure to stay hydrated, and using reasonable breaks from sun exposure. I like to tell my patients I don't want you in the direct sun longer than one to two hours at a time if possible and shorter if possible.

Dr. Johnson: So people often put aloe on sunburn, Michelle. Does that makes any sense?

Dr. Tarbox: That's a great question. There's some benefits to topical aloe vera straight from the plant, so long as you're not contact-allergic to that product. It does have some vitamins in it that are antioxidants, and it has some demulcent properties where it can actually help to moisturize injured and desiccated tissues.

It does get more complicated when it's a prepared aloe vera product. The proportion of aloe vera, actually, in the product varies greatly. A lot of them contain alcohol and are in gel formulation, which might actually cause more damage by stinging or by inadvertently dehydrating the skin. When you apply an alcohol-containing gel to the skin, it feels cooler temporarily because you have evaporative cooling occurring. And certainly, removing the heat from a burn is a good idea, but the alcohol potentially could cause more dehydration of the epidermis as well. So if you are an aloe vera, like, fan, I advocate straight from the plant instead of out of a bottle.

Dr. Johnson: Well, I'm not going to carry plants around with me on my cruise. Should I just be putting hydrocortisone on my sunburns?

Dr. Tarbox: I think hydrocortisone is more reliable and easier to obtain than some aloe vera preparations. But, you know, certainly you can look into being prepared ahead of time with something less complex, perhaps a prepared aloe vera that only has a few ingredients and is relatively simple and hypoallergenic.

Now, heat rash is also something that can occur, which is different than sunburn or sun poisoning. And we have seen an obscene amount of this in the past week, where our temperatures have climbed over 108 degrees.

So because of the hot and humid weather, here in Lubbock, Texas, not so humid, the skin's pores can become clogged with sweat. And so that actually causes trapping of the perspiration in the epidermis, and it makes a heat rash. This happens often in high friction areas, like underarms, elbow creases, inner thighs. I see it all the time under the breasts. The heat kind of gets also trapped in those areas. The heat rash can be treated with calamine lotion, straight aloe vera. You can also potentially use topical steroids for that. But heat rash is also something that's relatively frequent.

Do you see heat rash much where you're practicing?

Dr. Johnson: Sure. The medical term is miliaria. And it's common in little babies, because their sweat pores are such tiny, tiny little baby sweat pores, that they're easily just get blocked up. So it can happen in adults too, but it's more common, I think, if you're in a hot environment, if you're a little baby, and your sweat glands aren't working right anyway. Also, sometimes people over-swaddle or over-blanket their babies, and then they can get these little heat rashes.

Dr. Tarbox: I think that, you know, the miliaria can be in different kinds of forms. It could be miliaria pustulosa and make pustules. It can be miliaria rubra, which is red bumps around those inflamed hair follicles.

And we also can have that complicated by yeast overgrowth, which we see a lot of as well in practice, especially in skin folds, especially the groin and under the breasts. And when we have an overgrowth or a bloom of yeast, that can cause inflammation because our immune system is not fond of the yeast. It's not fond of the yeast because if the yeast gets in our blood vessels, it can be very serious for us. So our immune system is really serious about yeast. We get a lot of inflammation and erythema, which correlates to a lot of pain. It also, of course, can have that characteristic yeasty smell.

So if you have what you think is a heat rash and it smells like you're making bread, you may want to look for some anti-yeast treatments, which can be available over the counter. Products such as Nizoral shampoo can be used in the shower, or ciclopirox-containing creams can be used as a topical treatment.

Dr. Johnson: How is sun poisoning different than heat exhaustion?

Dr. Tarbox: That's a great question. You know, sun poisoning is kind of a little bit more complicated than heat exhaustion. They both overlap in a lot of ways, but there are a few things that can differentiate between the two. And I think that it really kind of is based off of the difference in the sort of skin directedness of sun poisoning.

Heat exhaustion is a more systemic presentation. The patients sweat a lot, they become very dehydrated, and they become incapable of regulating their temperature. So these patients can become lightheaded. They can actually have an increased heart rate, because their heart is basically trying to circulate the blood through their skin fast enough to dissipate enough heat to try to regulate the temperature. Thirst would typically be increased. Patients can also have even weakness with this.

This is a very important thing to look at sort of hydrating the person. The way I differentiate them is sun poisoning is like a sunburn that gets so bad that the inflammation it causes makes you sick. Heat exhaustion is a person who has lost so much water that their body is having trouble regulating its temperature, and the side effects are coming from that. Does that make sense?

Dr. Johnson: And sun poisoning is more related to actual sun exposure, whereas you could get heat exhaustion, or I suppose heat stroke, if you're not in the sun, if you're like in a hot garage or something.

Dr. Tarbox: That's true. Yeah. Sun poisoning requires the presence of actual direct sun exposure, whereas heat exhaustion and heatstroke can occur in the shade. And a heatstroke can have temperatures up to 104 or higher. The patients often have a dry, hot skin. They're confused, agitated, and may even have seizures or loss of consciousness.

Dr. Johnson: Stay in the shade, wear big hats, and drink a ton of water. I think this water thing is more important than I realized. I drink a lot of water, and I feel like I drink enough. But I feel like I actually should be drinking like twice as much water as I do, or even more than that, if I'm going to be out in the heat.

Dr. Tarbox: Especially with these extremely hot temperatures that people are experiencing, we're just not adapted for this as well. So I think that making sure that you're staying extremely well-hydrated. You want to make sure you have plenty of water available to you. Using those sun smarts, avoiding the sun from the peak hours, which is 10 a.m. to 2 p.m., and seeking shade as often as possible can help people continue to have fun in the sun, even in these hot, hot days.

Dr. Johnson: And don't push yourself. If you're feeling like it's too hot and it's time for a break, you don't need to prove to anybody that you can muscle it out for another 20 minutes in the sun. Just go sit down for a second.

Dr. Tarbox: I think that's great advice in general in life, Luke.

Dr. Johnson: Well, have a fun, healthy, and safe summer, everybody. Thanks so much for joining us today. Thanks to the University of Utah for supporting the podcast, and thanks to Texas Tech for lending us Michelle. And if you would like to learn more about dermatology, you can do so on our other podcast.

Dr. Tarbox: Our other podcast is called the "Dermasphere" podcast. It is about an hour long, and it is the podcast by dermatologists for dermatologists and the dermatologically curious. It can be found anywhere you listen to your podcasts. But also, we have our own social media pages under Dermasphere Podcast, and dermaspherepodcast.com is our website.

Dr. Johnson: All right, everybody. Stay cool.

Dr. Tarbox: Hello, and welcome to "Skincast," the podcast that teaches you how to take the very best care of the skin you're in. I'm Michelle Tarbox. I'm a board-certified dermatologist and dermatopathologist at Texas Tech University Health Sciences Center in beautiful sunny Lubbock, Texas. And joining me is . . .

Dr. Johnson: Hey, this is Luke Johnson. I am a pediatric dermatologist and general dermatologist with the University of Utah.

Dr. Tarbox: Today, what we're going to talk about are skin basics. Basically, what is the function our skin is supposed to do and how do we help our skin do those functions to its best ability? So what's one of the most important functions of skin, Dr. Luke?

Dr. Johnson: Well, the skin does a lot of stuff. It's really cool. So, obviously, Michelle and I think it's cool because we're skin doctors. And this is going to be kind of a nerdy episode, because we all like to geek out about the skin in dermatology.

One of the many things it does is regulate your temperature. So the skin has some stuff under it, fat and so on, which is also lumped in with the skin sometimes when we talk about the skin and dermatology. And that all helps you stay warm when it's cold outside or stay cool when it's hot outside, sometimes by things like sweat.

Dr. Tarbox: Absolutely. And one of the other really important functions that our skin performs is helping act as a barrier to the outside world. It's where our body and all of the things that we have contained within us come into an interface with the external environment. So it's one of the things that needs the best defense and also helps us to maintain our first line of defense against things like bacteria and viruses.

Dr. Johnson: The human body is amazing, and sometimes we don't really appreciate what it's doing until it's doing it wrong. So patients, for example, who have problems when they can't sweat, they get overheated. And patients who have a problem with the skin barrier function can get diseases like eczema.

The skin is also perhaps the biggest immune organ in the body. There's a whole bunch of immune cells in the skin, as you might guess, since it's interfacing between our bodies and the outside world.

Dr. Tarbox: Absolutely. One of the places that we actually have the sort of interplay between our primitive fast innate immune system, which is the very quick reaction our immune system can have against a general category of things like bacteria or virus, versus a very specific immune response, something more like what you get triggered when you have a vaccine.

Dr. Johnson: People who have problems with their immune system then get more infections in their skin, and perhaps elsewhere, since the skin is the first line of defense in a way.

And of course, human beings are social creatures, and so one of the main things our skin does is indicate to other people, well, various things. Other people can see our skin, and so obviously, there are big cosmetics industries and so on like that.

Dr. Tarbox: Many parts of our skin have specialized functions and things that we can do to sort of help those to act better and work better for us. Some of the very specialized organs of the skin include our hair, our oil glands, our sweat glands, our nails, and mucous membranes. So let's talk about hair first, Luke.

Dr. Johnson: Okay. I have a great set of hair. How about yourself?

Dr. Tarbox: You really do. You have lovely hair. I was blessed with very curly hair, which I really enjoy. Something a lot of people don't realize is that the hair on our body, but also on our skin, also helps us in a sensory way. So there's actually a little grouping of nerve fibers called the hair plexus or the root hair plexus that actually is a mechanoreceptor for touch sensation. So that's part, of course, of our normal skin like our arms or our legs.

But also, some people believe that you can actually have some sensations through the hair on your head. In some native communities, people feel very strongly about keeping the hair long as sort of a mechanoreceptor to help perceive the external environment.

Dr. Johnson: Dermatologists take care of the skin, but we also take care of the skin friends, like hair, and perhaps if you have problems with oil glands or sweat glands or nails or mucous membranes, dermatologists can help with that, too.

Oil glands are in a lot of places in our skin, but we often think of them primarily on the face because they can cause problems like acne. The special kind of oil that these glands have is called sebum.

Dr. Tarbox: That sebum helps to protect and nourish the skin and keep that barrier to the world waterproof. When it's not functioning properly, people get really dry skin that looks like a dry riverbed and cracks. That causes itching, it lets air in, and possibly lets in other contaminants as well. So that oil is actually very important.

Dr. Johnson: We have a couple of different kinds of sweat glands in our skin. There are sweat glands called eccrine glands and sweat glands called apocrine glands. Most of the sweat glands on your body are eccrine glands and they produce the sweat that you're probably most familiar with. But in places like your armpits and other big skinfold areas, you have apocrine sweat glands, which are a little bit different, sometimes a little bit smellier.

Dr. Tarbox: The sweat glands respond primarily to temperature stimuli, so they can actually help us to cool ourselves off if we overheat. But they also respond to emotional stimuli. So if people are getting really anxious or if they're very upset, they might sweat a little bit more.

Apocrine sweat has some fascinating functions. Some people actually believe that it's very important for pheromone signaling, which was, of course, more important before we could use conversation and lovely dialogue to convey our feelings to each other. But even in these modern times, those sorts of pheromone hormones do seem to play a role in people's attraction to each other.

Dr. Johnson: And again, we notice when things go wrong. So there are people who have a condition called hyperhidrosis where they just sweat too much. And then that's where dermatologists can help and use some medicines to make them not sweat as much. But imagine if you were just sweaty all the time what a pain that would be.

Dr. Tarbox: There are also some people who have a condition called bromhidrosis, where the sweat that they make actually smells a little bit more intensely than other people's. And there are also good treatments for those as well.

One of the fun things we share with the animal kingdom and those other creatures that live in the mammalian group like we do are our nails. So our nails are basically our version of claws. What are our nails for, Luke?

Dr. Johnson: Well, they're probably not all that relevant in the modern world, but they can be involved in picking up small objects, like when our ancestors had to pick up a nickel off of a smooth wooden table. Nails were especially helpful for that. These days, of course, they're often used to signal to other humans. So people put on nail polish and fake nails and things like that.

Dr. Tarbox: They also protect the ends of our fingers and toes, which are subject to more rough and tumble activities, and they're also helpful for some sensation. So they can actually help us to sort of feel certain types of things. And of course, we also like to express ourselves sometimes through painting them different colors or keeping them longer or shorter than other people.

Dr. Johnson: Mucous membranes include things like your mouth, and your eyes, and your nose, and your genitals. They are pink and moist and sort of related to the skin as well. They're a little bit like skin without the top layer.

Dr. Tarbox: Our mucus membranes can experience similar diseases to the rest of our skin. There are some problems when we have skin that's too dehydrated in those mucous membranes, or conversely when the skin is too wet all of the time.

We also have to worry about barrier dysfunction. For some people, they have a little bit of abnormality in the way their skin cells mature in those mucous membranes. And that can cause pain or it can potentially cause itching in those areas that can be treated.

Dr. Johnson: There are specific diseases that can affect the mucous membranes. So if you are worried that you have one of them, then a dermatologist might at least be a good place to start. Sometimes we rely on our colleagues in ENT, or dentistry, or gynecology to help us out, but we know a lot about mucus membranes, too.

Dr. Tarbox: And we're fortunate that most of our mucous-membrane-lined areas are actually self-cleaning and really take pretty darn good care of themselves. Of course, normal oral hygiene takes good care of that oral mucosa, and being gentle to the other areas is always a good strategy. You don't want to do anything too harsh or too irritating in those mucous membrane areas.

Dr. Johnson: I'd like to talk a little bit more about how to keep our skin, etc., healthy. So one thing you can do is moisturize your skin. I should say that if you don't really have any trouble and aren't bothered by something in your skin, then maybe you don't need to do some of this stuff. But a lot of people end up getting dry skin, especially if they're doing things like washing their hands a lot. It's still the coronavirus era, very sadly, so people are still washing their hands a lot. So applying a moisturizer can really help.

Dr. Tarbox: We also need to think about our exposure to the sun. One of the cool things about our skin is that it actually produces its own special sunscreen. There's a chemical called urocanic acid that's actually found in the stratum corneum, that outside top layer of the skin. And that actually comes from breakdown of other skin proteins, but it is actually able to prevent some sun damage. However, usually, it's not quite enough for much of our sun exposure, so we have to be thoughtful about our time in the sun.

Dr. Johnson: We have a whole episode on sun protection, so if you want more details, check it out. But basic story is use sunscreen and use sun protective clothing like long sleeves and hats as well.

I should say that the sun isn't all bad. One of the functions of the skin is to use sunlight to produce vitamin D, but you really don't need to be out in the sun for very long in order to get how much vitamin D you need.

So there are some medical studies that say if you spend eight minutes, three times a week out in the sun wearing shorts and a T-shirt, that's enough. So don't not use sunscreen because you're worried that it's going to inhibit your vitamin D production. You'll be fine.

Dr. Tarbox: And then of course, one of the other things that we can do for our skin is keep it clean. Now, for most of our skin surface areas, like the skin on our arms or legs, unless we've gotten into something actually dirty, we just need water running over the surface of that skin to cleanse it.

However, there are certain parts of our body that do need to have some sort of cleanser used. And those include our areas that have more oil secretions or more apocrine secretions. So that's going to be your face, the great folds of the skin, the hands, and the feet.

Dr. Johnson: Yeah. So if you, again, don't have problems with your skin, you don't really need to worry about it, but if you want to keep your skin not too dry, then what I normally recommend is no soap except in the "problem areas," which are the armpits and the groin. And then, of course, you can wash your face too.

And use gentle products. There are a lot of skincare products out there on the market, and some of them are just fairly harsh on the skin, things like astringents and scrubs and so on. They're pretty tough on the skin, so you don't really need stuff like that. Keep it gentle.

Dr. Tarbox: A gentle, nice, pH-balanced soap without too much heavy fragrance and with gentle preservatives is probably the way to go for most people.

Dr. Johnson: We aren't sponsored by anybody, but we do like to provide specific product recommendations just because I think it's helpful. So kind of the party line among most dermatologists for soap is white Dove bar soap. It's a good inexpensive option that's nice and gentle.

Dr. Tarbox: We also like a couple easy-to-find, over-the-counter products for cleansers, especially for people with sensitive skin, including the CeraVe cleansers or the Cetaphil cleansers. So how else can we keep our skin looking nice, Luke?

Dr. Johnson: So keeping it looking good is important to a lot of people, again, as evidenced by the multi-billion-dollar cosmetics industry. So I would lean on you to provide some cosmetic recommendations, Michelle, because I'm afraid I don't actually use any cosmetic products myself.

Dr. Tarbox: Well, once you have the basic groundwork of having a nice gentle cleanser that works well with your skin, as well as also having a nice sunscreen that you tolerate well and use regularly, other things that you can do to help improve the appearance of your skin include using an over-the-counter or prescription retinoid. Retinoids are vitamin-A-type products that help our skin cells turn themselves over. They help renew that skin, and they also help fight uneven pigmentation and fine lines.

Dr. Johnson: Retinoids are awesome. I do use a retinoid. So if you consider that cosmetics, then I misspoke earlier. But they're in a lot of over-the-counter products that have names like anti-aging or anti-wrinkle because, indeed, they do those things.

And the specific ingredients will be things like retinol, or retinal, or retinoic acid, or adapalene. Dermatologists can provide you with prescription-strength versions of these things as well. They're also good to help prevent acne.

Dr. Tarbox: You also want to think about good moisturizing ingredients. One of the best ingredients for skin moisturization is called a ceramide. This is sort of the lipid or fat that our skin makes to hydrate itself. And it really helps to have that kind of moisturization for our skin to look its best.

Dr. Johnson: Hyaluronic acid also a very good moisturizer because it holds a lot of water. In general, as far as moisturizers go, the thicker and greasier they are, the more effective they are at moisturizing the skin. But, of course, most people don't want to put something super thick and greasy on their face. So you've got to find the right balance.

Dr. Tarbox: Absolutely. You have to treat your skin, not somebody else's skin, not an influencer's or somebody that you aspire to be, but your skin, the way that it actually behaves. So if you have oilier skin, you may want to look for a moisturizer that's a little bit lighter and made for patients with oily skin. If your skin is very dry, you might want one that's a little bit more rich and thick that's made for more mature skin or more dry skin.

Dr. Johnson: Sometimes I have patients ask me about specific cosmetics like makeup and so on. And I normally tell them, "I'm afraid I don't actually know all that much." But I normally recommend those with the fewest ingredients because that's least likely to become irritating. So things that are mostly mineral-based. I think there's a brand called bareMinerals that I tend to recommend. Do you have any specific recommendations about makeups?

Dr. Tarbox: I do like bareMinerals. I like to make sure patients are actually getting the branded bareMinerals, or are making sure that there are not a lot of fillers in a similar product. A lot of powder-based makeups have talc as a filler, and that's actually not very good for your skin. So trying to avoid that is a good idea.

Other things you want to avoid, again, are heavy fragrance, things that have harsh preservatives, and things that are made that are just not really put together in a way that's good or safe for your skin. You can always find a label on products that are made for skin and thoughtfully that has some kind of indication of whether or not it helps or fights the formation of acne. So you want to find a product that says non-comedogenic, which is sort of the first form of acne, or non-acnegenic to make sure it's not going to make you break out.

Dr. Johnson: Keeping your skin looking good is also another reason to protect yourself from the sun, because the more sun exposure you've had over the course of your life, the wrinklier and saggier your skin.

Also, if you've been out in the sun a lot and you're in your 60s or older, you might start getting these bruise-looking things all over your arms and the backs of your hands. That's, again, mostly from sun exposure. So if you want to keep yourself looking youthful, make sure you use that sunscreen.

Dr. Tarbox: One of the other things that can tell on our age are our hair and nails. Those are really great reflectors of what's going on inside our bodies. So sometimes patients will suffer from some kind of an illness or significant stress or start a medication that doesn't agree with them and their hair will shed significantly. So what would be some reasons to see a doctor for that, Luke?

Dr. Johnson: Well, if any part of your skin, hair, nails, or mucus membranes doesn't seem like it's going right, then come see a dermatologist. We can probably help.

As far as hair specifically and hair loss, the best thing to do is to see one of us fairly quickly, because most of our treatments are pretty good at preventing further loss, but not so good at re-growing hair, though they can do that to some degree, so all hope is not lost.

We have an episode on "Skincast," I believe Episode 3, that's all about hair loss. So if you have more interest in that, check that one out.

Dr. Tarbox: So I think that we've talked about what are good ideas about taking good care of your skin. I think we talked about when to see a dermatologist. Any other pointers you want to give our listeners, Luke?

Dr. Johnson: Yeah, you should listen to the rest of our archive, which you can find through the University of Utah. Thanks to them for supporting the podcast, and thanks to Texas Tech for lending us Michelle.

If you enjoyed this very nerdy discussion about skin, then you might also enjoy a very nerdy podcast that Michelle and I do called "Dermasphere," which is really intended for dermatologists, but it's got discussions about some of the latest research in clinical dermatology. So you might find it cool whether you're a dermatologist or not. We'll see you guys next time.

Dr. Tarbox: Hello and welcome to "Skincast," the podcast that teaches you how to take the very best care of the skin you're in. I'm Michelle Tarbox. I'm an Associate Professor of Dermatology and Dermatopathology at Texas Tech University Health Sciences Center in beautiful, sunny Lubbock, Texas. And joining me is . . .

Dr. Johnson: Hey, this is Luke Johnson. I am a pediatric dermatologist and a general dermatologist with the University of Utah.

Dr. Tarbox: So today we're going to talk about skincare and kids. We really want to begin our journey towards experiencing a full and happy life living in the skin we're in, in childhood, because that's how we can protect it the best from any kind of early damage. So why is sun protection important, Luke?

Dr. Johnson: Yeah, I think we're going to spend a lot of this episode talking about sun protection, because kids are generally a lot healthier than adults and their skin is also a lot healthier than adult skin for the most part. But one thing you can do to help keep it healthy is by protecting them from the sun.

It's important for a lot of reasons. One, of course, is skin cancer prevention. So there are a lot of different kinds of skin cancer. Melanoma is the one most people know about, and with good reason because it's one that can kill people, though most melanomas don't. So protecting your kids from the sun can help reduce or prevent the development of skin cancer later in life.

Dr. Tarbox: Of course, I know parents often have questions about which sunscreens are the safest and which ones have the least probability of irritating the skin. So we do want to think about the ingredients that are in the different sunscreens and how we use those for children. I think if you focus on mineral-based products that are designed for use on children's skin you can do pretty well with this.

Now, some people got a little bit concerned about a recent study showing benzene in some sunscreens. The vast majority of the sunscreens that were contaminated with benzenes were either gels or sprays. There were a few lotions on that list, but there are many lists available that have the benzene-free sunscreens that are quite safe listed.

Some of the favorite ones that people have on this show include some of the Badger Kids Broad Spectrum Sunscreen with natural minerals in it. Some people really like the Blue Lizard products. There's Babyganics, which is organic and baby put together. That's a mineral-based sunscreen spray that's actually benzene-free. Do you have any favorites, Luke?

Dr. Johnson: So I'm a pediatric dermatologist and a general dermatologist. So being a general dermatologist means I take care of high-ranking military officials, and being a pediatric dermatologist means I take care of kids. So a lot of times I have parents ask me if I have recommendations for sunscreen for kids. And what I usually tell them is to use the mineral-based sunscreens. You've heard us say that a couple of times.

So there are two different ways that sunscreens can prevent the sun radiation from damaging your skin. There's the chemical way and then there's the mineral way. And there are medical studies that show that the chemical-based sunscreens get absorbed into your blood. We don't know that they do anything bad if they get absorbed into your blood, but to play it safe for kids, I feel like we should use the mineral-based sunscreens. Specifically, those ingredients are titanium or zinc, because we know those stay on the surface of the skin where they belong.

Modern sunscreens come in a lot of different ways. So if you don't like sunscreen or your kid doesn't like sunscreen, well, maybe we just haven't found the right one.

In addition to the standard creams and lotions and so on, there are also sprays. There are mineral-based sprays, zinc and titanium. I know Trader Joe's has one. It is about twice as expensive as the chemical-based one, but it's out there. There are also powders that you can sort of brush on with a big brush, and there are sticks and roll-on things so kids could maybe even apply them to themselves.

Dr. Tarbox: When we're talking about sunscreen, which sunscreen you use is very important but also using enough sunscreen is important as well, as important as reapplying it frequently.

So when we talk about sunscreens and their strength, they're studied in labs at a density of application that's about twice what a normal human being would put on. Now, this is important because when we talk about sunscreen application, if you're applying half as much as was studied, you're not getting half the protection. You're actually getting the square root of the protection. So putting enough sunscreen on is important.

Dr. Johnson: And then reapplying it every 90 minutes to 2 hours if you're going to be out in the sun is another hurdle that dermatologists face. Once we get our patients to actually use sunscreen, it's to use enough and to keep putting it on.

We talked about skin cancer prevention. Protecting your kids from the sun can also help prevent something called photo-aging. So the longer and more sun radiation you've had over the course of your life, the older your skin looks. And of course, there's sunburn as well that we look out for.

Kids normally don't like sunscreen. I'm sorry. That's the way it is. So they just have to wear it anyway. It's still a battle with my kids to get them to wear it. But they want to go outside? Got to wear their sunscreen.

Dr. Tarbox: Now some things that might be a little bit easier to get a kid to work with you for would be potentially sun-protective clothing. There are lots of different kinds of sun-protective clothing brands that make good quality and attractive garments that can help protect the skin from the sun. What are your favorites, Luke?

Dr. Johnson: So what you're referring to is clothing that has what's called a UPF rather than SPF. So the UPF is sort of the clothing version of an SPF. There are a lot of brands that make specific sun protective clothing including Coolibar, which is my family's preferred one. We're not sponsored, by the way. There's also a brand called Solumbra. And then if you just Google or look on Amazon sun-protective shirt or sun-protective clothing, you'll find some fine products that are very reasonably priced.

And another reason I often recommend these is that, in addition to having to not worry about sunscreen on your arms if you're wearing a long sleeve shirt, these clothes are made to be worn when it's hot and sunny outside. So initially, if somebody tells you, "Wear a long sleeve shirt out in the sun," you're like, "What? That sounds miserable." But they're made of this lightweight, breathable fabric and they feel breezy and they're really quite pleasant to wear out in the sun.

Dr. Tarbox: I love my sun-protective clothing because it's sort of a no-brainer. You put it on and you know it's going to do its job. So you don't have to think about that reapplication and you don't have to worry that something is going to wear off.

Do you know what the name Coolibar comes from, Luke? It's actually kind of funny.

Dr. Johnson: I do not.

Dr. Tarbox: It actually comes from the eucalyptus coolabah tree, which is sometimes known kind of locally in Australia as coolibah. And so they made Coolibar, which is kind of fun.

The clothes are well made. You also have lots of options in terms of shopping sales. I always shop sales because I think thrifty is reasonable.

SunGuard is another option that you might have, which is actually a detergent that washes a sunscreen called Tinosorb into clothing and then that sunscreen lasts in the clothes for about 30 washes.

Dr. Johnson: Hats are important as well. Most of these sun protective clothing manufacturers also make nice hats. You want to wear one with a wide brim if you can. Not just a baseball cap, though, of course, that's way better than nothing. But a brim that goes all the way around. My kids have these hats from Coolibar that have the flap that also goes down the backs of their necks and shades that from the sun too.

Dr. Tarbox: When I'm talking to adults, I recommend a product called Heliocare that has an extract of a tropical fern that lives on the equator in it that helps to protect the skin against the sun from the inside. But a lot of kids can't swallow capsules, so there is a product called Sundaily, which are actually gummies that can be chewed and taken that have the polypodium leucotomos extract as well as vitamin D3 in there. And those tend to be pretty darn safe ingredients. So that's something you might not have to fight the kid on as hard.

Dr. Johnson: Babies probably shouldn't have any sun exposure before 6 months of age, and after that, you can go ahead and use sunscreens and so on if you have to, though be careful about marketing techniques. Sunscreens that say baby or kids on them aren't necessarily the mineral-based sunscreens that we would want. It's just a marketing tool. So be sure to look at the ingredients for zinc and/or titanium as the only active ingredients.

Dr. Tarbox: And sometimes those kid or baby sunscreens are very heavily fragranced with that sort of obnoxious baby powder fragrance. So you do want to make sure you're not using anything that's too heavily fragranced because it could irritate the skin.

Dr. Johnson: Using sunscreen and sun-protective clothing and so on, on your kids also helps them to create a habit early in life. So hopefully, when they go forward into adolescence and adults, they will carry the importance of sun protection with them.

Dr. Tarbox: I bet you get asked every day what to do about moisturizing kids' skin, Luke.

Dr. Johnson: Well, I do. I see a lot of kids with eczema and they tend to get dry skin. So the thicker and greasier the moisturizer is, the more effective it is. So I like petroleum jelly. Vaseline is one brand. Shea butter, coconut oil, and anything that you have to scoop out of a tub or squeeze out of a tube is going to be more effective than things that squirt out of bottles.

Now, if your skin doesn't get all that dry, you can probably just be fine with stuff that pumps out of bottles. But if you've got drier skin or eczema, you want to use the thicker stuff if you can.

Dr. Tarbox: And some of our kids get eczema. Some of them will be in the care of a dermatologist. But if they have just very mild eczema, using judiciously over-the-counter 1% hydrocortisone ointment can be beneficial, especially for occasional breakouts.

Dr. Johnson: You say judicious, but really you can't overdo it with hydrocortisone 1% ointment. It's wimpy enough that dermatologists sort of sneer at it. But it can be effective if you've got fairly mild eczema. Twice a day to areas of rash. As long as you're putting it on rash, you won't get into trouble. And once again, the ointment is more effective than the cream.

Dr. Tarbox: A lot of times the over-the-counter preparations also have a whole bunch of herbs and spices and aloe and all kinds of things in there. So simpler is usually better when you have a kid with irritated skin.

Dr. Johnson: If your child also has a tendency to get dry skin or eczema, then bathing techniques can be really helpful. If they don't have a history of eczema and don't have particularly dry skin, then do whatever you want with bathing. It doesn't really matter.

But for kids whose skin has a problem, baths are better than showers. They don't really need soap. So it turns out human skin doesn't really need soap to get clean except in the problem areas. But we don't really develop problem areas until we become smelly teenagers. So, for babies and kids, I normally recommend just plain water in a bath. Soak for about 10 minutes. After that time, take them out, and while they're still dripping wet, immediately slather them with your favorite moisturizer.

Dr. Tarbox: One thing you run into a lot with little girls is they love to take bubble baths or use those bath bombs or all sorts of fragrances and oils and sodium lauryl sulfate and things like that that can cause irritation of the skin all over the body, but also in the very sensitive areas for these little girls.

So if you have a little girl that's having that kind of trouble and she's a big fan of those bath bombs and the kind of bath glitter or whatever, trying to find something kind of more fun to replace that activity, maybe some different toys or maybe some little cutout foam things that you can kind of throw around the tub to sort of give that pretty appearance but without causing skin irritation would be a good idea.

Dr. Johnson: What dermatologists refer to as wet/dry cycles are especially drying on the skin. So water follows water. Water sort of attracts more water. So if you have water on your skin, for any reason, a bath, a shower, a romantic walk in the rain, a swimming pool and then that water goes away for whatever reason, you dry it with a towel or it air dries, it just takes more water from your skin away with it.

So if you are doing something that puts water on your skin and then it dries and that happens over and over again, those are wet/dry cycles that are really tough on the skin.

So we see that in kids in swimming pools, for example, because they're often in and out of the water because they're playing. They get out of the water and it dries and that sucks the water out of their skin, they get back in the water, and they just keep doing that. And then things like sponge baths will do it too, will really dry out your skin.

Dr. Tarbox: So breaking that up with moisturizing after a good cleansing bath is a good idea. Of course, if you have a kid that's swimming, especially in a public pool, rinsing the chlorine and also any other community schmutz off of them after that experience and then maybe putting a little gentle lotion on would be a good idea.

Dr. Johnson: A lot of pools are also out in the sun. I know we've already hammered sun protection, but I want to point out that even when it's not summer and you're at the pool, it's important to use sun protection. In the winter, it's still sunny in the winter and it reflects off of snow. It's important to use sun protection even on overcast days. I mean, you still can see outside. It's not like it's black. So there's still sun radiation coming down.

And then some people with darker skin types seem to be under the misapprehension that they don't need sunscreen, but that is not true. People with darker skin types still get still cancer and so forth.

Dr. Tarbox: Speaking of things that can come up more significantly with sun and things that show up in kids, one of the focuses of my practice is pigmented skin lesions, and those of course include moles. So a lot of parents will get really worried about moles on their children, and generally in children these spots are going to be absolutely harmless. There are a few circumstances when it's a good idea for a dermatologist to take a look and maybe follow some lesions. Those can include large birthmarks, anything that's growing very quickly or unusually, or a very strong family history of melanoma.

Dr. Johnson: So, for kids and moles, what I normally tell parents is the rules are basically the same as for adults. Anything changing is the most important thing to let us know about. But kids are growing and changing and so are their moles. Plus, the incidence of melanoma is extremely low in kids, especially before puberty. So we tolerate a little bit more change in the moles of kids than we do in adults. But it still doesn't give them a free ride. So anything new or changing, it's probably safest just to have us take a look at it even though we'll probably say, "Don't worry about it."

Dr. Tarbox: Of course, if anything is bleeding, if it's come up very quickly, or it looks very unusual, it's reasonable to get it looked at by a professional.

One other thing I like to tell the parents of small children is the better you do at protecting those kids against the damage of the sun, the fewer moles they'll have to deal with in adulthood. There are well-done studies that show us that sun exposure in childhood can increase the number of moles you have as an adult and can make it more difficult to follow those things over time as well as contributing to skin aging and potential for skin cancer. So lots of good reasons to be thoughtful about sun protection in kids.

Dr. Johnson: I sometimes have parents ask me, "When is it a good time for my kid to just get checked over head to toe and have a look at their moles?" There's not really an agreed upon guideline by any governing body in dermatology, but I think maybe it's a good idea for everybody to be checked out once in young adulthood, maybe in their 20s, and if there's nothing terrible going on, then they might not need a dermatologist ever again. But if there are some funny looking moles or anything, then we'll be able to say, "Okay, I guess we should see you ever year or every few years."

Dr. Tarbox: And then, of course, when we're talking about kids, kids are growing and changing all the time, and with those changes of childhood can come some of those changes of puberty. And of course, then kids start to have acne.

Dr. Johnson: Yes, we had a whole episode of acne. I believe it was Episode 4. So see that one if you want more information. But real quickly, at least for mild acne, there are some pretty good over-the-counter products.

One is called benzoyl peroxide. It comes in a lot of different forms. I like it best as a cleanser because I figure people are washing their face anyway. Might as well put some medicine in there so you don't have an extra step to do.

So if your son or daughter or you, I suppose, have some acne, try to get one of these benzoyl peroxide cleansers. Just wash your face with it every morning. It's best if it's in the morning. Just beware that it will stain your towels afterward. So use a white towel or a towel that you do not like.

There's also a product called Adapalene, which you can also buy over the counter. It's about $12. The brand name is Differin. It's a very good product to use at night. So put a little blob on your finger, dot, dot, dot around your face, and then rub it in.

And that's probably all we have time for in terms of kids and skin for today. So thanks for hanging out with us. You can find the rest of our archive on the University of Utah's website.

Thanks to the University of Utah, of course, for supporting the podcast and thanks to Texas Tech for lending us Michelle.

If you are a dermatology nerd like we are, you might be interested in another podcast that Michelle and I do called "Dermasphere." It's really intended for dermatologists, and we discuss some of the latest research in clinical dermatology. But hey, anybody can listen to it and we hope you would find that one fun too.

Dr. Tarbox: Hello and welcome to "Skincast," the podcast that teaches you how to take the very best care of the skin you're in. I'm Michelle Tarbox. I'm an associate professor of dermatology and dermatopathology at Texas Tech University Health Sciences Center in beautiful, sunny Lubbock, Texas. And joining me is . . .

Dr. Johnson: Hey, this is Luke Johnson. I'm a pediatric dermatologist and general dermatologist with the University of Utah.

Dr. Tarbox: We had a great idea for an episode that actually came from the inestimable Lindsey Johnson, who is Luke's wonderful wife. And she suggested that we actually talk about our personal skin care routines.

Dr. Johnson: That's right. So I'm more interested in yours, Michelle, because I already know what mine is.

Dr. Tarbox: All right. So I'm going to kind of go through a weekday skin care routine. I wake up in the morning, and of course the first thing I want to do is cleanse my skin because over the night you have potentially a little bit of perspiration and it's good to start the day with a nice, fresh, clean face. So I like to wake up and kind of gently cleanse my face. One of the ways I like to do that is with my micellar cleansing water. That's much more gentle than any kind of detergent to your skin. It doesn't strip the natural oils as much, but still provides a nice, clean face.

And so I like the simple product line because they're very hypoallergenic. They don't have a lot of complex chemical ingredients. They are not fragranced. So I'll use that micellar water to cleanse the skin on either a little cotton like pad or on a little cotton ball. If I'm running late and I don't have time for my normal, I will actually grab one of their pre-moistened facial towelettes that's also made by that same company, that simple cleansing wipe and kind of cleanse my face off before I put on my morning moisturizer.

Dr. Johnson: We should say that nobody is paying us. We're not sponsored by any of these products. We just thought it would be nice for you guys to know the specific things that we used. And Michelle, I'm sorry that I don't know the answer to this, but what is micellar water?

Dr. Tarbox: Micellar water actually is water that has little tiny, micelles that help sort of encapsulate and remove particles of like, you know, soil from the face. They help to improve the skin health and cleanse sort of deep down into the pores without really chemically or severely stripping the skin of their oils. So it's a very nice, gentle way to cleanse the skin. And micellar water can be found from lots of different manufacturers.

Garnier makes a really nice one. There are, you know, different products available similarly from La Roche-Posay as well as Philosophy. But I just like the simple product because it's not terribly expensive, it's easy to find, and the ingredients are nice and well put together. So I really do like that product line. And I think it's a very nice way to cleanse the skin. Micellar water has also got some benefits in terms of leaving the normal skin barrier intact and not causing a big change in the skin's pH that could cause irritation. So I do like to use that to cleanse the face in the morning.

And then I like to put on a gentle moisturizer that contains a sunscreen. So one of my go-tos is CeraVe AM. It's a product that has hyaluronic acid as a facial moisturizer, along with some niacinamide and some gentle sunscreens.

So after all of that in the morning, sometimes I'll put on a little bit of makeup if I want to look extra special. I have a couple of different ones that I really like. But most of the time I'm using something along the lines of the bareMinerals powders. I like those a lot. They don't tend to cake or leave any kind of heaviness on the skin, and they give a nice, gentle finish.

The other products I'll use in the morning, you know, I usually use just a little bit of mascara. There's a very nice hypoallergenic one made by Neutrogena that I like quite a lot. During pandemic times, I'm not really doing a whole lot of other makeup because no one would see it. And so I'm trying not to leave a whole bunch of stuff under the mask to get sort of just pushed into my face. So my mornings are pretty straightforward and simple.

Dr. Johnson: Do you have a specific mask that you wear? Do we need to talk about mask routines and hygiene in this episode?

Dr. Tarbox: Well, the biggest thing about masks is that I use a clean one. You've got to have a clean mask every single day, because if you're reusing masks, if you're reusing a sort of paper mask, you might be putting oils and contaminants onto the face from the previous day. If you're wearing fabric masks, you want to make sure that they're clean and that you're using a gentle skin detergent.

So when I get home after wearing that mask all day long, I'll also cleanse my face again, often using that micellar water or a facial wipe, just depending on how much I need to do and how much I need to get on with my evening. After that, if I'm not going to be out in the sun again, I like to use my nice, gentle moisturizer. One of my favorite ones is by La Roche-Posay, which sounds very bougie, but it's actually a very reasonably-priced skincare line.

So it's La Roche-Posay's Toleriane Double Repair Face Moisturizer. I really like this moisturizer for a couple of reasons. It's called Double Repair because it actually has some really healthy skin ingredients in it, including ceramides and niacinamide and glycerin. So ceramides are the type of oil our skin makes to hydrate itself. It's very natural to our skin. It doesn't cause any inflammation. It doesn't alter our skin barrier in any way. It's sort of replacing what we might be missing. Niacinamide is skin healthy B vitamin that helps our skin recover from sun damage as well as decreasing redness and irritation and dyspigmentation. And then glycerin, for most people, is a great humectant. It kind of pulls moisture into the skin. It helps to retain that moisture. I like the Double Repair because it actually gives up to 48 hours of hydration. It's lightweight, and it doesn't plug your pores.

So I like to have that on, on the evenings when I'm kind of relaxing at home, and then possibly before bedtime, I'll put a little bit of night cream underneath my eyes just to hydrate those extra, especially to help them to look their best and brightest in the morning.

Now in the kind of interim, I do have to say that one of my big skin care secrets is, of course, that I have worn sunblock religiously since I was actually about 14 or 15 years old and I was actually, in my dark days, a lifeguard as well as a water safety instructor. So I got to teach people about how to be safe around a pool, and one of the modules we had for our rainy days, so if we had any rain and especially any lightning, of course, we couldn't go in the pool, so we would teach different kind of safety things. And one of those modules was about sun safety.

That's one of the reasons I'm a dermatologist was learning about that and teaching about that and kind of becoming fascinated about it. So I've actually used sunscreen every single day, anytime I'm out in the, since I was a young teenager, and that's given my skin a lot of protection over time and protected it from some of the early aging you might get in beautiful, sunny Lubbock, Texas.

My other big secret for my skin is that I do love and use Botox. I consider that as part of my like wardrobe budget and makeup budget. I would rather have four months of Botox active on my face than a pair of shoes that looks beautiful in the closet, but hurts my feet. So I use that every three to four months in areas that I make over-expressive facial expressions, especially in my forehead. I was kind of taught a young lady who is always politely and intensively listening to people expresses it on her face by raising her eyebrows constantly. So I actually had very deep, horizontal lines on my forehead back all the way when I was 10 or 12 years old. And so that is one of my can't do without products is Botox.

Dr. Johnson: So overall your routine sounds fairly simple, this micellar water a couple times a day, some good moisturizers and sunscreen, and not a lot of makeup.

Dr. Tarbox: Not a whole lot of makeup most of the time. Now, sometimes if I'm doing something like, every once in a while, I'll go on television to talk about skin cancer prevention or skin impacts of certain things that are happening in the sort of zeitgeist. And then I'll actually put on more makeup. And one of the things that I'll use for television appearances is something called HD powder. HD powder makes your skin look really good on HD camera. It's designed to sort of blur and make the skin not look terrifyingly real when you're looking at a camera that has a very intensive lens that can pick up every little detail of the skin.

But HD powder as amazing as it is at making your skin look great for short periods of time can really break you out if you leave it on for any significant period of time. So if you are using HD powder, you only should have it on for the event or whatever that you're using it for. And then you do need to cleanse your skin carefully because it's not made to sit on the skin like some other skin powders are.

Dr. Johnson: Well, my routine largely centers around the fact that I've had acne for a long time. And even though I mostly don't have it anymore, thanks in a large part to a medicine called isotretinoin or Accutane, I still get the occasional pimple. So I've got some topical products that help me not get so many pimples.

So in the morning in the shower, I wash my face with a benzoyl peroxide containing cleanser. Benzoyl peroxide comes in a lot of different strengths, about 2.5% to 10%. They all seem to be about equivalent in terms of their benefit on your acne, but the higher the percentage, the more likely they are to be irritating to your skin. My skin doesn't seem very sensitive, so I just buy the generic, like 10% benzoyl peroxide cleanser, you know, from Kroger or Kirkland or Equate or whatever. So I wash my face with that in the morning.

Once a week, in the shower, I also use an anti-dandruff shampoo because I occasionally get some dandruff. The medical term for this kind of dandruff is seborrheic dermatitis. So massage that into my scalp, let it sit for five minutes before rinsing it off once a week, just seems to be enough to keep my occasional dandruff under control.

Then after I get out of the shower, I put this medicine called clindamycin lotion on my face. Again, that's to help prevent acne. You need a prescription for that. And then I also put on a "daily facial moisturizer." Those called daily facial moisturizers usually have some sunscreen in them. I actually like the same ones that you have discovered, Michelle. So I use CeraVe AM sometimes. And then the same La Roche-Posay Toleriane Double Repair thing. There's a version with sunscreen and a version without. So I, of course, use the version with sunscreen in the morning. And that's all I do in the morning, but I do put on sunscreen every day, even if I only expect to be in the sun if I I'm walking from my car into the office or something.

And then in the evening, the only thing I do is put on this medicine called tazarotene. Tazarotene is a type of medicine called a retinoid, and retinoids are very good for the skin. They help prevent acne. They're good for scars. They're good for wrinkles. They're good for blemishes. They're good for pigment alterations. They're good for what ails you.

There's over-the-counter versions. They're called retinols and retinoic acid and adapalene, and they're in a lot of over-the-counter products that have names like anti-wrinkle or anti-aging, and then there's prescription strength versions of them as well. And this tazarotene that I use is just the strongest prescription strength that's out there to help me with, you know, acne and also all those other things.

Dr. Tarbox: Now as a dermatologist, Luke and I also sometimes do other things to our skin to help erase marks from the past or help to rejuvenate it a bit. So some of those things can sound and look a little bit scary, but help our skin to look its best by engaging something called the wound healing response in the skin. So what are some adventures your skin has been on in the past, Luke?

Dr. Johnson: Well, one of the benefits of doing a dermatology residency is you get access to a bunch of fun toys. So I think four times, over the course of my three-year residency, I was treated with the CO2 laser for acne scarring. So the CO2 laser works by punching a bunch of little holes into your skin. And then as your skin repairs, it supposedly looks better than it did beforehand, especially if you had some acne scars. And I think that's really helped out with some acne scarring. I also got some microneedling done in residency, which again works via a similar principle, except instead of using lasers to poke holes in your skin it uses needles, but otherwise kind of a similar concept.

Dr. Tarbox: So I actually have also had some focal CO2. I've never had the downtime to do my full face, but I've had some focal areas that I've treated. I have a scar on my nose from having a cyst removed there when I was a child, and I have actually used the CO2 laser on that area. Sometimes I do microneedling as well. I think microneedling is a great way to help renew the skin and utilize that wound healing response. It helps with acne scars and pigment irregularities, and it's also very helpful for fine lines and blemishes.

And after that, your post-care can be very important because you don't want use anything that's too harsh or too irritating. So one of my post-procedure products that I really like is also made by La Roche-Posay. It's called Cicaplast Baume. It's kind of fun. Cicaplast Baume, it has a B5, which is a vitamin in there that helps the skin to heal. And then sometimes I will also use a little bit of like pure hyaluronic acid potentially. Or I might use a product I really like actually called Vanicream healing ointment. That's pretty gentle and inert and doesn't cause any significant irritation. There's a French company as well that has a similar product. I'm going to probably really not do a great job of saying the name of this product, but it's called Cicalfate. And I also like that product post-procedure.

I of course, like we talked about, we do the Botox and the chemical peels, which I love. All of those things can help our skin look its best over time.

Dr. Johnson: I do like Botox. It over-performs. I know it's a little bit pricey, especially since you need like 50 units, 4 times a year, and it's whatever it is, $15 a unit or something. So it is kind of pricey. But if you have the money, it's definitely worth it, in my opinion. Again, nobody is paying us.

Dr. Tarbox: Yeah, I think that, you know, you get to try a lot of things as a dermatologist. You get to see how different topical products are made. One of the most fun things I ever got to do at one of our big meetings was actually work with some of the chemical scientists to put together some of these skincare products, where they actually show you what each different additive does, why it's a part of a lot of products, what its function is, and how things go right and how they can go wrong with that different type of product line. So all sorts of different ways that these things are put together.

Simple is always sometimes better for people, especially if you have irritated skin, and you always want to add one product at a time. So it's very tempting to go out and buy like an armamentarium of brand-new skin care. But the problem is if you do that, then you might react to something, and you won't know what product you're reacting to. So adding one product at a time can be judicious as well as cost effective.

Dr. Johnson: Sometimes people will say, "You dermatologists all have such great skin. You must know all the secrets." Well, we do, but really the secrets are fairly simple — sunscreen in the morning, retinoid at night, and occasionally stuff like Botox.

Dr. Tarbox: I love Botox.

Dr. Johnson: All right. Well, that's enough Botox love for today. Thanks for hanging out with us, guys, and thanks to the University of Utah for supporting the podcast and to Texas Tech for lending us Michelle. And if you would like to listen to more, you can certainly find our archive on the University of Utah's web page among other places. And if you would like to listen to more of Michelle and I talking about much more nerdy things, we do another podcast called the "Dermasphere," where we talk about some of the latest research in clinical dermatology with an eye toward educating dermatologists, but hopefully other people would find it cool as well. We'll see you guys next time.

Dr. Tarbox: Hello, this is Skincast, the podcast about skincare. My name is Michelle Tarbox, and I'm a dermatologist in beautiful sunny Lubbock, Texas. Dermatologists are medical doctors who specialize in the care of the skin, hair, and nails. And joining me is . . .

Dr. Johnson: This is Luke Johnson, dermatologist in Salt Lake City, Utah, with the University of Utah.

Dr. Tarbox: So we're here to talk to you about how to take the very best care of your skin. On this podcast, we will mention specific products, but we are not sponsored by any of these products. We have just found them to be useful in our clinical practice. We have no conflicts of interest with these. We just want to give you the tools to take the very best care of your skin.

Dr. Johnson: And today, we're going to be talking about how to protect your skin from the dermatologist's age-old enemy, the sun.

Dr. Tarbox: Especially living here in beautiful sunny Lubbock, Texas, I swear that the sun in our area could really be a comic book villain. It is quite strong. So we want to talk about how you protect yourself from the giant ball of heat in the sky.

So there are a lot of reasons why we should protect our skin from the sun. One of them, of course, is to reduce the risk of skin cancer. This is a very important part of our overall healthcare and it's something that we need to do all throughout our lives.

There are some statistics that are sometimes thrown around that I think sometimes discourage people, one of them being that you get something like 90% of your lifetime sun exposure by the time you're 18 years old. That is actually not true. You get about 20% of your lifetime sun exposure by the time you're 18 years old.

So if you are an adult and you're just starting to look at taking good care of your skin, you're not too late to the party. But you do want to start taking care of your skin early, and if you do have children, you wanna start them with good, safe sun habits early as well.

Dr. Johnson: I like to think that there are three main reasons you want to protect yourself from the sun. One is your skin cancer risk. Two is something called photoaging. Sunlight makes you look older. And three is, of course, sunburn, though I feel like that's a little bit tangential. Though, that's often what a lot of us think.

In terms of the skin cancer risk, dermatologists I think are pretty good about getting the word out about melanoma, which is the most dangerous kind of skin cancer. But there are other kinds of skin cancer as well, and the sunlight increases the risk of all of them.

Dr. Tarbox: Absolutely. And it does that by causing mutations in our DNA. So, unfortunately, the mutations that we get in our DNA from sun exposure, from solar radiation, don't give us superpowers like the X-men or something like that. Instead, it causes us to develop skin cancer, and it causes our skin to prematurely age.

Dr. Johnson: Yes. So your DNA sits in the cells in your skin and the ultraviolet radiation from the sun can make changes in that DNA that makes them more prone to turn the cell into a cancerous one.

Dr. Tarbox: The other thing the sun can do is it can damage the collagen in your skin. And the collagen in your skin is what gives youthful skin that kind of bounce and turgor that make it look plump and healthy and prevents the wrinkles from forming. Collagen is our best friend when it comes to anti-aging, and the sun is its mortal enemy.

Dr. Johnson: That's why people who have seen a lot of sunlight in their lives and are now older look very wrinkly. So you can minimize that by protecting yourself from the sun as much as you can.

Also, there are certain types of ultraviolet radiation that penetrate window glass as well. So even if you're planning on spending all day on a road trip driving in the car, still put on sunscreen because that UVA radiation comes right through the windshield and still causes that aging process.

Dr. Tarbox: Exactly. There are like three flavors of UV radiation that we sometimes talk about. In the news recently, you may have heard about UVC radiation. We don't actually experience that here on earth because the ozone layer filters that out, but it can be used in laboratory settings to sterilize things. And in the news, people have been talking about using certain kinds of air filters that have UVC radiation to help sterilize that.

Now, you wouldn't want to have these indoors on people because it can cause problems with your eyes. So you don't want to be exposing your eyes to UVC radiation. Fortunately, like I said, that gets filtered out by the ozone, so we don't have to deal with that one.

UVB rays do make it to the earth. We traditionally think of these as the burning rays. These are the ones that are going to have their greatest intensity at midday in full sun. And these are the ones most of us think of when we think about protecting our skin from the sun. We think about the UVB rays that cause burning.

But what about those UVA rays, Luke?

Dr. Johnson: Well, they're the ones that penetrate window glass. They also tend to be the ones that are involved in tanning beds. So it's not like a tanning bed doesn't increase your risk of anything. It definitely can increase that aging process.

Dr. Tarbox: And that UVA, I like to say it stands for aging. Because UVA actually is the flavor of UV radiation that gets the deepest into the skin. It penetrates the deepest into the skin and gets to that collagen that it can then degenerate. So that's what causes those aging changes, those UVA rays.

Speaking of tanning beds, some people think they go to the tanning bed to get vitamin D synthesis. However, because UVB rays burn you . . . most tanning salons don't like to burn their clients because their clients don't come back. And so the UVB rays are usually not in tanning beds, but the UVB rays are the ones that are necessary to make vitamin D from the sun.

Now, I'm a dermatologist. I'm a religiously sun-protected human being since the time I was about 15 years old and figured out the connection between skin cancer, sun, and aging. And I have perfect vitamin D levels because I take an oral supplement. I choose not to use my face and my skin to make my vitamin D at the cost of it increasing skin aging and skin cancer.

Dr. Johnson: So, if you're going to be out in mid-July at the beach at 2:00 p.m. with no clothes on except your swimsuit, I think most people feel like that's a good time to protect yourself from the sun. And that's true. But it's important to remember that there's always ultraviolet radiation out there because the sun is shining on the earth.

So even on overcast cloudy days, even if it's 4:00 p.m., even if it's winter or fall, there's always ultraviolet radiation out there, which can cause these changes associated with skin cancer and increase your risk of photoaging as well. So I put on sunscreen every day regardless of what I'm planning to do that day.

Dr. Tarbox: Me too. It should be part of your routine like brushing your teeth in the morning. And I actually tell patients when they're trying to get in that habit to actually keep it near something they do every day. So, if you have space, keep an extra toothbrush. You're brushing your teeth, you're looking at your sunscreen going, "After I'm finished brushing my teeth, I'll put on my sunscreen."

Dr. Johnson: Speaking of sunscreen, it's one component of a multi-component approach to protecting yourself from the sun. So, in brief, sunscreen is good. Also, stay in the shade, wear hats, wear sun-protective clothing, and wear sunglasses. And we can talk a little bit about each of those in a bit more detail.

Dr. Tarbox: I like that. I like to think of skin being protected from the sun as sort of like a team sport. So your quarterback is your sunscreen, of course. It does a lot of the hard work for you. But you have to realize that there are some limitations to sunscreen. First of all, there are places it's hard to apply, like on your scalp. And there's also a difficulty with keeping it at its highest functioning level throughout the day because you have to reapply sunscreen about every two hours. So you can add to your sun protection regimen by utilizing sun-protective clothing and, of course, sunglasses to protect your eyes.

Dr. Johnson: And the skin around your eyes. I've heard some people complain that they don't like putting sunscreen on their face because it stings their eyes. Well, just don't put it all that close to your eyes, but put on sunglasses.

A lot of my patients have questions about what specific sunscreens I recommend. So here's some of the deal with sunscreens. We usually recommend that you use SPF 30 or greater. Higher SPF is better, but it's not like 60 is twice as good as 30. It's just a bit better, but higher is better.

You also want to make sure you use enough of it. So our first challenge as dermatologists is to get people to actually use sunscreen, and our next challenge is to get them to use enough.

Dr. Tarbox: That's absolutely right. So you have to use about a shot glass full of sunscreen to apply to the areas that are usually exposed to the sun. One thing you don't necessarily want to mix though is sunlight and a lot of alcohol, because there have been some studies that showed that that potentially can increase the harmful effects of the UV radiation. So we like to say here on Skincast, “Don't Titos and tan.”

Dr. Johnson: So that shot glass should be full of sunscreen and not something else if you're planning to be out in the sun.

And you mentioned to reapply every couple hours, and that's true. So another challenge we have as dermatologists is to get people to keep using the sunscreen. So it just sort of wears off in a couple of hours because the chemical components in it get used up because they're doing their thing protecting you from the sun, or the physical blockers get washed or sweated or wiped away.

Dr. Tarbox: Absolutely. And one pro tip that I like for people who are active outdoors, who have trouble with the sunscreen kind of getting in their eyes when they sweat, is you can actually get the little wax sticks that are kind of like a Chapstick that have sunscreen on them, which are also a nice thing to use if you have to put sunscreen on a child's face because they can't get it in their eyes on accident.

And if you put a little bit of that wax-based sunscreen over each eyebrow and leave the space between the eyebrows uncovered with that kind of sunscreen and use the other one everywhere else, it'll keep the sweat from dripping down into your eyes and carrying the sunscreen with it.

Dr. Johnson: I think it's a good point to mention that there are different products available. A lot of people think about sunscreens just as sort of the standard lotion-y, creamy stuff that they slather on themselves. But these days, the sunscreen manufacturers have developed a lot of different ways to put this stuff on your skin. And a lot of people might feel that it's more convenient or it feels better for them.

Dr. Tarbox: Yeah, I think the most important thing is to find a sunscreen that you like using, because if you get the very best whatever highest SPF sunscreen but you hate applying it, and you don't like the way it smells, and you don't like the way that it feels, you're not going to use it. So you need to get one that you like to use and that you're comfortable using.

Dr. Johnson: And they all seem to be fine. So there are spray sunscreens, which I find quite convenient. They're a little bit tricky because you've got to keep your eyes closed if you're putting them on your face. Or you spray them on your fingers and hands first, and then put them on your face. You've got to watch out putting them on children because children will sometimes breath in at the wrong time or keep their eyes open.

They're also technically flammable. So sometimes people are having campfires, and that's when they're putting on sunscreen, so watch out for that. But otherwise, sprays are a fine way to apply sunscreen to your body if you find them convenient.

Dr. Tarbox: Yeah, that's definitely a good thing to bring forward there. So just like you wouldn't go near an open flame and spray a can of hairspray, you wouldn't want to use any kind of spray sunscreen that has an accelerant in it. So once that does dry, you are no longer highly flammable. Just make sure the sunscreen is dry before you go near any heat sources.

Dr. Johnson: There are also sunscreen sticks. I think you mentioned these. They look a bit like deodorant sticks, but you can just sort of rub them on your arms and they're pretty convenient. I know Neutrogena makes a good one. I think it's called Sport Stick or something like that.

And then there are also powders. So I've had some big, strong, tough, manly men who just don't feel like they want to put lotion on their skin. So I say, "Well, some of my patients like these powders, because you can just sort of brush them on your face easily and then throw them on the back of your pickup truck and be off to your manly man duties."

Dr. Tarbox: I like that. That should be a brand. There should be manly men sunscreen. What do you think?

Dr. Johnson: I think we should make it.

Dr. Tarbox: It should be non-fragranced and it should not have any kind of color to the skin. I like the idea of a powder.

Dr. Johnson: And it should have a picture of me flexing on front.

Dr. Tarbox: I think that would be perfect.

Dr. Johnson: So, last year, there was also a medical study that showed that the chemical components of sunscreen get absorbed into your blood. It didn't show that anything bad happens when they get absorbed into your blood. And my personal feeling is that probably nothing too horrible happens because we've been using them for decades and nothing too horrible has happened to the general public. But it does show that they get absorbed into your blood and we probably need more medical studies that look into what that means.

So, because of that concern, I usually recommend just the mineral-based sunscreens. Those are sunscreens containing zinc or titanium as the only active ingredients. I recommend those for children specifically. For adults, I don't think it matters quite so much. If you are worried about sunscreen chemicals being absorbed into your blood, then stick with zinc or titanium sunscreens because we know those stay on the skin.

Dr. Tarbox: They have some really good sunscreens that are actually zinc only that are very gentle. Neutrogena makes a good one. Some of them are also produced with a process called micronization, which makes the particles of the physical sunscreens, which are both metals, zinc and titanium, very much smaller so that they don't leave a sort of gray cast on skin, especially skin that's got a darker color.

Dr. Johnson: I like the Neutrogena . . . I think it's called Clear Touch or something like that. It's just zinc or titanium. It rubs on easily. I find it some of the mineral-based sunscreens kind of muck up clothing a bit, but this one seems to be good.

Dr. Tarbox: And some people are sensitive to sunscreen ingredients. The ones that I think are the best for people who have sensitive skin are a product line called Vanicream, which you can get most Walgreens drugstores. Vanicream is made to be very hypoallergenic. They have a really good sunscreen, their Vanicream Sports sunscreen, which is SPF 35.

I also really like CeraVe's sunscreen. It's a nice sunscreen for people who have sensitive skin as well. And it's made to be sort of like a nice little extra skincare product. So there's actually some niacinamide in there, which is a B vitamin that's an anti-inflammatory and it's a skin healthy ingredient. Additionally, they also have some hyaluronic acid in that sunscreen.

Dr. Johnson: CeraVe is a good brand. I like it for my daily facial moisturizer that has sunscreen in it. So CeraVe AM is what I put on every day. It has some SPF 30 and protects my skin from those photo-aging effects of that radiation.

Dr. Tarbox: I like that. And earlier we were talking about the fact that some of the mineral sunscreens can leave a little bit of a cast on skin of color. I think it's also important to mention that everybody needs to protect their skin from the sun.

So there is not a person of any skin color that's 100% without risk for developing skin cancer. And sometimes people have gotten that information either through the media or unfortunately sometimes even through medical practitioners. So it is important to protect your skin from the sun no matter what color your skin is as a baseline. You wanna make sure that you're keeping yourself healthy and taking good care of yourself.

If you are a person of color, you do need to work harder to supplement the vitamin D, however, because that or that turns to be a little bit of a greater percentage of vitamin D deficiency in patients of color.

So very important to protect your skin from the sun. We talked about also seeking the shade, which is important. The middle of the day is really when the sun's rays are at its most intense. So that's usually between about 10:00 a.m. to 2:00 p.m., with the noon hour being sort of the witching hour when you get the most UV radiation on the earth's surface. So trying to stay out of the sun if you can during those times is a good idea. But what if you can't stay out of the sun right then?

Dr. Johnson: Well, I like hats. We like hats with wide brims. I have a nice wide-brimmed hat that makes me look super cool when I'm walking around outside with my kids and my kids are all wearing big wide-brimmed hats and everyone thinks, "That must be a dermatologist walking by."

Dr. Tarbox: Yeah, I feel like you can always pick out the dermatologist's kids at the beach. So you can do that. You can do that sun-protective clothing. Sun-protective clothing has something called a UPF, and it's UV Protective Factor. And that will actually be on the label typically. Most sun-protective brands have a UPF of 50 and it's analogous to an SPF.

The companies that we like that do that include Coolibar, which is a sun protection clothing manufacturer. They have awesome clothes, and they go on sale frequently. There's also one called Sunday Afternoons, which is very cute. And then there's UV Skinz, and Skinz is spelled with a Z, which I thought was fun.

Dr. Johnson: There are also some generic brands, if you will. So, if you just look on Amazon or Google for sun-protective clothing, you can find some. And they're light and breezy and they're meant to be worn when it's 90 degrees outside. So it might sound miserable to wear long-sleeve shirts when you're out in the summer, but that's what these are intended for and they're pretty good. I have a number of them myself, and I don't feel miserable wearing them outside,

Dr. Tarbox: I actually find them less hot when I'm wearing them. There are some products that are made that are in sun-protective line that are actually made from bamboo fiber. And bamboo fiber is naturally a couple of degrees cooler than the ambient temperature. So it's a very comfortable thing to wear.

So, Luke, what are some sun myths that sort of circulate?

Dr. Johnson: We mentioned a few of the myths, like that SPF 60 is twice as good as SPF 30, or that if you're old, it's too late to protect yourself from the sun. Not so. There's also this myth about having a base tan. So I've had some people tell me that they're going to go to the tanning salon to get a base tan before their trip to Hawaii or something. Don't be fooled. That doesn't help.

Dr. Tarbox: Yeah, the base tan might make you feel more comfortable in your swimsuit, but spray tans are a good alternative. Spray tans are actually just made out of a three-carbon sugar that gets sprayed on or applied on the outside levels of the skin. This chemical does not absorb it all into the bloodstream. And it basically goes through the same reaction that bread goes through in the oven that causes it to brown. It's called the Maillard reaction, and that's what gives that color.

The newer products have actually been very elegantly composed to remove sort of the traditional fake tan smell, which is very nice. And a lot of products can also be used kind of gently and daily to build up gradual color in a nice even way.

Dr. Johnson: Well, listeners, I hope that that gives you some ideas about why it's important to protect your skin from the sun and some good ways to do it.

Dr. Tarbox: We are very happy to be able to educate you about how to protect yourself and we're very grateful for this opportunity to visit with you. We want to thank our institutions for giving us support to do this podcast and encouragement to help people take better care of their skin.

Dr. Johnson: Yes, Texas Tech Dermatology and the University of Utah Department of Dermatology. And if you consider yourself a real dermatology nerd, Michelle and I have another podcast called "Dermasphere," where we cover some of the latest research in dermatology. We'll see you guys next time.

Interviewer: All sunscreens are not created equal. There are actually some that are better than others. We're going to find out more about that next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Doug Grossman is an expert in early diagnosis and treatment of skin cancer at Huntsman Cancer Institute. All sunscreens are not created equal and I think I'm a little stressed out because I don't think I'm using the right sunscreen. Let's talk about that for a second. From my understanding, there are two different kinds of sunscreens.

Dr. Doug Grossman: There are actually a variety of products. A lot of patients like the sprays because they're easy to apply. The problem is you don't get enough of the material on the skin and so I also worry about if you're spraying a lot and inhaling.

Interviewer: I know. I was at the pool the other day and somebody was spraying and I was getting more in my lungs. My lungs were not sunburned after that.

Dr. Doug Grossman: Right, and some of these that have alcohol could also potentially be flammable, so that could be a risk as well. So I don't like the spray-ons. I do like the lotions that can be applied and as you indicated there are two basic types. The first are the mineral containing products that have either zinc oxide or titanium dioxide and these work as a physical UV blocker. The UV rays just bounce of these minerals and they stay on the skin, so they're very long lasting.

Interviewer: So kind of like a mirror?

Dr. Doug Grossman: Yeah and they block the entire UV spectrum. The other class of products which tend to be more popular because they tend to be less expensive and not leave as much of a white-ish residue on the skin are the chemical sunscreens and these work by absorbing the highest energy UV rays, so they prevent sunburn but some of the lower energy rays still get through and cause damage and they work again by absorbing so one they get saturated, then they loose their effectiveness, so they wear off very quickly, so you have to keep reapplying them.

Interviewer: So that's why you have to keep reapplying? So it's like if I tried to mix a lot of salt into water, eventually it can't absorb anymore. Is that kind of like the same thing?

Dr. Doug Grossman: Yeah.

Interviewer: Interesting. So if I don't know what kind of sunscreen I have, likely I have the chemical kind.

Dr. Doug Grossman: Yeah, most products in stores are the chemical base. There are a few products that contain the minerals that I recommend. My favorite product is Blue Lizard, it contain 15% zinc and titanium dioxide. I think that has the highest concentration of any product that I've found. It's made in Australia where they have the highest rates of skin cancer and it goes on a little white, but then it turns clear and I find that to be the most effective. There are several other products, Vanicream that has these sun blockers as well. And I know this from personal experience, these are the products that I use and I don't have any financial interests in these products?

Interviewer: You don't have stock, huh?

Dr. Doug Grossman: Correct.

Interviewer: I find that fascinating that the Blue Lizard that you talked about is from Australia where they have the highest incidences of skin cancer, so obviously they know what they're doing I guess.

Dr. Doug Grossman: I think so.

Interviewer: Yeah, so the other advantage to this from what I understand is you don't have to apply it as much either. It's like once on and you're good.

Dr. Doug Grossman: Right. Unless you're perspiring a lot and the skins getting wet and you're toweling it off, it stays on the skin and so you don't have to apply it nearly as often as the chemical based products.

Interviewer: So at the end of the day, these mineral based products may be a little bit more expensive, but you think they're well worth it.

Dr. Doug Grossman: Right, they definitely are more expensive, but you get what you pay for.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

Interviewer: It's summertime, and pool safety can be a big enough challenge, let alone if you have a child with developmental disabilities. We're going to find out what you need to look out for coming up next on The Scope.

Announcer: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Pool safety. We're with Dr. Kyle Bradford Jones. He's at the Neurobehavioral Home Program here at the University of Utah, Family Medicine doctor. And for a parent that has a child with developmental disabilities, pool safety is a little bit more of a challenge. Let's talk about some of those things. These are conversations you have with most of your patients?

Dr. Kyle Jones: Absolutely. All the time. You know, individuals with developmental disabilities such as autism or intellectual disabilities, etcetera sometimes have a harder time around the pool. They need to be watched a little bit more closely because sometimes they don't understand the risks. They don't understand the dangers. So, it makes it much more important to keep a close eye on them as they're playing around the pool. Do your best to either avoid the deep end or to stay close by them when they are there.

Interviewer: What about even the shallow end?

Dr. Kyle Jones: You know, even the shallow end, it's true. Make sure that they're playing appropriately. What I mean by that is that they're playing safely. They're not continually hitting other children. They're not causing problems in that sense. They are able to play with others and play safely within the water environment.

Interviewer: Gotcha. What's one of the hidden dangers that a parent might not realize?

Dr. Kyle Jones: Individuals with autism, specifically, have difficulty with sensory issues. So they may not want to wear a floatation device or a life preserver. So you may put it on them and they go out to play, and then they don't like the way it feels, so they take it off.

Interviewer: That's pretty common?

Dr. Kyle Jones: Exactly.

Interviewer: Yeah. Excuse my ignorance. Is it an inability to swim that makes it a big danger for individuals with developmental disabilities around the water?

Dr. Kyle Jones: That's part of it. Especially at large pools where there's lots of other kids or lots of other people, sometimes they don't understand exactly how to interact with others. They can sometimes get into trouble in that sense.

Interviewer: So, for example, they don't understand the dangers of water, so they might put somebody under the water?

Dr. Kyle Jones: Exactly.

Interviewer: And not even realize that, that could be a dangerous situation?

Dr. Kyle Jones: Exactly.

Interviewer: Okay. Other situations like that?

Dr. Kyle Jones: Beware of the diving board or the slides for the same reasons: to watch out for other people but also make sure they can swim so that they can do OK once they're in the water.

Interviewer: What other concerns?

Dr. Kyle Jones: Obviously, sun safety, so making sure they're wearing sunscreen, keeping the skin covered up as much as you can while still allowing them to go out and have fun.

Interviewer: What's one of the most common injuries you see as a result of individuals with developmental disabilities at the pool?

Dr. Kyle Jones: One other safety thing to watch out for is it being slippery around the pool. Sometimes they don't understand that they need to slow down in order to keep from falling. And sometimes you see them come in with anywhere from a scrape to falling and hitting their head and having a head injury. So that's something to be very careful with.

Interviewer: What's the one take away that you would want to have somebody after they heard this walk away from?

Dr. Kyle Jones: If you have a child who has a developmental disability such as autism, keep a close eye on them and try to be as patient as you can with them in the pool so that they can play safely. If you don't have a child with a developmental disability and you're at the pool with one, again, please be patient and do the best you can to let them have some fun, too.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.

Interviewer: How dangerous is skin cancer, really? We'll examine that next on The Scope.

Man: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Let's face it, we all love the feeling of the sun on our skin and maybe even a little bit of a golden tan, but then we hear things like skin cancer and you should wear long sleeves and big hats. We're with Dr. Glen Bowen at Huntsman Cancer Institute. How do I balance that kind of desire to want to be out in the sun and yet the desire to do what guys like you tell me I should do?

Dr. Glen Bowen: Well, the first thing I would say is somebody dies every hour in the U.S. from skin cancer. It is an epidemic problem, so you can't really minimize that fact, not to mention the fact that there are people every day that come to the Huntsman Cancer Institute. I'm removing either part of their nose or most of their nose or eyelids or lips or ears. It's very devastating for people. Almost all of them, not all of them, but almost all of them are avoidable.

Interviewer: Yeah.

Dr. Glen Bowen: So, yeah, the sun's okay, but, you know, people just aren't really exposing themselves to the sun in what I would say moderation.

Interviewer: Okay. So it's just a matter of people are trying to get too much, laying out there for hours on end or going into the swimming pool without any protection. Bad idea.

Dr. Glen Bowen: That's right. And a really, really bad idea are peeling sunburns. There's no question that peeling sunburns have a very big impact on our risk for skin cancer. The interesting thing about swimsuits is that they used to cover the torso. If you look at photographs of Saltair, the swimsuits for both men and women covered the torso. Well, most melanoma occurs on the torso.
So when the swimsuit style changed, there was an incremental jump in melanoma incidence because they tend to occur in areas where we get peeling sunburns, which is usually the torso. They're spring break cancers.

Interviewer: And it's really young people that really need to be the most careful, right?

Dr. Glen Bowen: Yeah. So it's thought that about 80% of the sun damage to our skin that causes skin cancer probably happened before we graduated from high school. And it doesn't mean that the sun after high school doesn't matter. It just means that most of the switches that were flipped to cause cancer happened when we were young. So it's critically important that young people try to avoid peeling sunburns.

Interviewer: Yeah. Tell me about the genetics of skin, because what the sun does is it actually genetically alters a cell, and these peeling skin cancers are some of the worst at doing that.

Dr. Glen Bowen: That's right. You could think in a way of the ionizing radiation from the sun like bullets from a machine gun. I mean they literally are. They pass through the skin, and they poke holes in the DNA. The DNA has a beautiful spellchecker like our word processors that can kind of correct for the mistakes, but the problem is you can simply overwhelm it, and that's exactly what happens particularly in light-skinned people, Caucasians. With chronic sun exposure, the spellchecker simply can't correct the mistakes in the DNA as fast as the mistakes are being made, and the result is skin cancer.

Interviewer: So tell me how do I balance then this desire to want to be out in the sun and maybe get a little color to my skin in the summertime versus the dangers of melanoma.

Dr. Glen Bowen: So what is it? Well, people don't dress like they used to, and if you want to do an interesting experiment, just look at the photograph of the Golden Spike when it was pounded in, and you look at the people in that photograph. They all have long-sleeved shirts. They all have trousers, and they all have hats. And that's how people used to dress.
Of course, the style of the swimsuit as it went from one piece to two piece, there's a very direct correlation of increased melanoma rates. So the trick is to go ahead and enjoy yourself outdoors but dress the part. You know, wear clothes. It's not a good idea to go trouncing around in a speedo with nothing else.

Interviewer: For a lot of reasons.

Dr. Glen Bowen: Yeah, it's a great idea to wear a hat, especially a hat with a brim. I remove a lot of portions of men's ears because we don't have hair that covers our ears. So hats with a brim on the side. A baseball cap won't help you in that regard, but a hat with a brim is hugely helpful, and, of course, sunscreen.

Interviewer: So what type of sunscreen should I be wearing?

Dr. Glen Bowen: Well, sunscreen, in general, if you get to a sun protection factor, SPF, 30 or higher, the incremental gains from a higher SPF are pretty small.

Interviewer: Okay.

Dr. Glen Bowen: But there's a huge difference between a 15 and a 30. So, in general, you want to be wearing something 30 or higher. The other problem with a sunscreen is people kind of see it as the seatbelt. It's not. It's the airbag.

Interviewer: Okay.

Dr. Glen Bowen: So clothing is really your seatbelt.

Interviewer: Okay.

Dr. Glen Bowen: But sunscreen in addition to that is very effective. It has to be reapplied, and that's another problem. People tend to put it on once. But golfing, for example, you need to apply it before the first nine, and then you want to reapply it after the first nine because after about two hours, the particles are pretty much dissipated on the skin and it's dilute enough where it's not working very well.

Interviewer: And that's very effective in preventing melanoma, is that correct?

Dr. Glen Bowen: Yeah, it's thought to be.

Interviewer: Okay.

Dr. Glen Bowen: The science is really difficult to do in that case, but we just think that it'd be like a filter on a cigarette, you know . . .

Interviewer: Sure.

Dr. Glen Bowen: . . . the more you filter out the tar and nicotine, the less likely you're going to get lung cancer, and the same with ultraviolet light. The less that gets through to the DNA within your skin cells, the less likely you are to get skin cancer.

Interviewer: Prevention's also important, meaning like to examine yourself. What would I be looking for?

Dr. Glen Bowen: Yeah, that's a great question, and the answer is you look for exactly two things. One is a sore that doesn't heal. So most of the skin cancer is not melanoma. It's called a basal cell carcinoma or a squamous cell carcinoma. Most people, especially young people, they will dismiss it as a zit.

Interviewer: Really?

Dr. Glen Bowen: So it's a little blemish on the skin that does not go away after about a month.

Interviewer: Okay.

Dr. Glen Bowen: So I just had three patients this morning that I operated on. They said, yeah, it was a sore that wouldn't heal. So little sores on the skin, especially the face, that don't heal after about a month, they could be a skin cancer.

Interviewer: Okay.

Dr. Glen Bowen: Sometimes they'll heal temporarily and then they'll break down again like a rollercoaster. So if a sore seems to get better but then it breaks down again, gets better, breaks down again, that's another warning sign that it might be skin cancer. The melanoma is almost always from a mole, and it's simply going to be an ugly duckling. So if you look at the moles on your skin and there's one that just stands out from the others, it's the ugly duckling, it's the black sheep, it doesn't look like the other ones, that's the one to be concerned about.

Interviewer: How important is early diagnosis? How big of a difference does it make?

Dr. Glen Bowen: It's everything. I mean, it's everything. Just to give you an example, I had a patient today with a melanoma that was what we call in situ, which means it's very superficial. Their survival is predicted to be close to 100%. Whereas another patient with one that, say, is down to the fat, they have less than 50% chance of surviving their cancer.

Interviewer: Wow.

Dr. Glen Bowen: So it's like Charles Dickens-it's the best of times and the worst of times. If it's caught early, it's one of the best cancers to have. If it's caught late, if not the worst cancer, it's certainly one of the worst cancers to have just because there are very few good treatments for melanoma that has got into the internal organs.

Interviewer: So it can spread to other organs?

Dr. Glen Bowen: Melanoma is a terrific hitchhiker. It's incredibly good at getting into the bloodstream or the lymph vessels and traveling to internal organs. A lot of cancers, they don't do well out of their neighborhood. Melanoma does exceedingly well. It can set up shop anywhere it wants to-bone, brain, liver, lungs, small bowel. I've seen it in every organ in the body. It's kind of amazing that way.

Interviewer: And once that happens . . .

Dr. Glen Bowen: It's very tough to treat. I mean, we do have some newer treatments at the Huntsman Cancer Institute that are very promising, but you just don't want to be one of those patients on experimental therapy.

Interviewer: Sure. And why go that way, because it sounds like this is a totally preventable cancer.

Dr. Glen Bowen: Well, you know, there are cancers out there, pancreatic cancer, for example. There are these terrible cancers out there that there's not much you can do. It's a little bit of the lottery. Most skin cancer is very easily preventable. That's the tragedy of it, but it's also the good thing about it. You could easily prevent most of the skin cancers that I operate on every day at the Huntsman Cancer Institute.

Interviewer: Is there a takeaway message that you would have our listeners leave with?

Dr. Glen Bowen: I would say for the parents, concentrate on your kids because it makes a huge difference. Those peeling burns we got as children, they make a huge difference for when we're adults and getting skin cancer.
Get a rash guard, you know, those little swimsuits that are spandex or Lycra that they just wear as a T-shirt. It'll protect their skin. It's got a tight weave. They're comfortable. They dry quickly.
So I would say, you know, just be careful to avoid those sunburns. And then it's a good idea for any person to just look at their birthday suit the first day of each month and make sure that there's not an ugly duckling or a nonhealing sore.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.