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Summer skin protection checklist

While our skin needs protection from the sun throughout the year, the increased time spent in the sun during the summer can raise the risk of skin damage and skin cancer.

Most skin cancers are caused by exposure to ultraviolet (UV) rays from the sun, tanning beds, or sunlamps that can damage skin cells, initially causing a sunburn. Over time, this damage can lead to skin cancer.1 Protecting yourself from the sun can help prevent skin cancer (as well as premature aging that can come with sun exposure!).

Here is PHM’s recommended checklist on the best ways to protect yourself from the sun’s damaging UV rays and reduce your risk of developing skin cancer.

Sun protection strategies

  • Cover-up
    When outdoors, especially during peak hours when the sun’s rays are strongest (10am-4pm).3 In cooler weather, wear long sleeves and pants (specifically clothing that is dry, darker colored and with tighter weave fabrics),4 wide-brimmed hats, and sunglasses that wrap around and offer UV protection.

  • Avoid peak sun time
    Stay in the shade, when possible. Avoid outdoor activities between 10am-4pm, and move outdoor activities to the morning or evening, even on cloudy days. You can still get a sunburn when it is cloudy.3

  • Combine the above with sunscreen
    Sunscreen is intended to be combined with other sun protection strategies, and it is important to use a combination of steps for effective sun safety.

Sunscreen checklist
Exposure to UV radiation is estimated to be associated with 80%–90% of skin cancers.5 Sunscreen is an important part of skin protection, as it blocks ultraviolet radiation and has been shown to reduce the incidence of both melanoma and nonmelanoma skin cancers.5

Sunscreen application recommendations
For sunscreen to work to be effective, it must be applied properly. Research suggests that sunscreen users get burned frequently because they do not use it correctly.5 Here are some tips for proper sunscreen use:

Sunscreen amount (you need a lot more than you think!)

  • The American Academy of Dermatology (AAD) recommends using at least a full ounce of sunscreen, equivalent to a shot glass, to adequately protect the body;7 this breaks down to about a teaspoon per body part.

Timing and re-application

  • Apply sunscreen to dry skin 15 minutes before going out,7
  • Reapply every two hours in the sun or immediately after swimming, sweating, toweling off, or any immersion in water or sand.5,8
  • To help remind you when to reapply sunscreen, there are a variety of apps for your smartphone or wearable device, including the SunSmart app, designed by the World Health Organization.

Spray-on vs. lotion

  • To ensure that the adequate amount of sunscreen needed is used and that it is rubbed in properly, cream-based sunscreens are more desirable than spray-on.5
  • If opting for spray-on versions, the AAD recommends applying four passes back and forth, and rubbing it in with your hands for even coverage.

Sunscreen for children:

  • The American Academy of Pediatrics recommends broad spectrum sunscreen of at least 30 SPF for all children older than 6 months.
  • Mineral sunscreens may be less irritating to children’s skin.
  • Sunscreen is not recommended for babies who are 6 months old or younger. The U.S. Food and Drug Administration recommends keeping infants out of the sun during midday and using protective clothing if they have to be in the sun.5

Sunscreen and makeup

  • Apply sunscreen under your makeup, even if the makeup has an SPF. Research has shown that the SPF of makeup products is lower than labels indicate and does not offer adequate sun protection.6
  • After washing and moisturizing your face, apply sunscreen, wait a few minutes for it to dry, then apply makeup.

Understanding sunscreen options

Broad spectrum: UVA and UVB

Ultraviolet A (UVA) rays make up 95% of the sun’s rays and can penetrate deep into the skin, causing premature aging and wrinkles by harming collagen and elastin.10 Ultraviolet B (UVB rays do not penetrate as deeply as UVA, but are responsible for sunburns and can greatly damage the upper layer of skin and cause DNA mutations. This can eventually lead to melanoma and other types of skin cancer.10
Recent research shows that UVA and UVB rays may partner together to cause skin cancer.9

Always use sunscreen with a label saying it is “broad spectrum,” meaning it filters out both UVA and UVB rays. UVA (Ultraviolet A) and UVB (Ultraviolet B) radiation affect the skin differently, but both do harm by damaging skin cells.

SPF

It is a general misunderstanding that the SPF number relates to how long a person can stay out in the sun without reapplying sunscreen. Rather, sunscreens are assigned a sun protection factor (SPF) based on how well they filter out UV rays, with higher numbers indicating more protection. The AAD recommends using an SPF of 30 or higher.7 Regardless of the SPF number, the same guidelines on timing, amount, and using concurrent sun protection strategies should be followed.

Chemical vs. mineral sunscreens

The active ingredients in sunscreens are divided into two categories based on how they work: chemical and mineral (or physical). Both types of sunscreens are effective at protecting skin from sun damage.5

Chemical sunscreens
  • Work by absorbing the sun’s UV rays
  • Some of the chemicals used include: oxybenzone, octinoxate, and octoerylene, octisalate, homosalate, and trolamine salicylate
    Advantages:
  • Easy to apply and last longer than mineral sunscreens

    Disadvantages:
  • May be absorbed into the skin at levels above the FDA threshold, but
    these findings do not indicate that people stop the use of sunscreen.11

Mineral sunscreens
  • Often referred to as natural or organic sunscreens
  • Common active ingredients include zinc oxide and titanium dioxide
  • They work by creating a barrier on your skin that reflects UV light
    Advantages:
  • Classified as safe by the FDA; no issues with skin absorption12
  • Less likely to cause rash or irritation for people with sensitive skin

    Disadvantages:
  • Less likely to be waterproof and require more frequent reapplication
  • Take longer to apply than chemical sunscreens

Considerations while traveling abroad:

  • Several destinations, including Hawaii, Key West, the U.S. Virgin Islands, Palau, Aruba, and some areas of Mexico have recently banned sunscreens containing oxybenzone and octinoxate. Visitors can opt for mineral sunscreens to protect themselves in these locals.
  • European regulators have approved several effective chemical sunscreens that are not yet approved in the U.S., so there are additional options if you are traveling Examples include: Tinosorb S, Tinosorb M, Mexoryl SX, and Mexoryl XL.

Protection for people at high-risk:
It is particularly important to use the above strategies to protect your skin if you are more sensitive to the sun or in a high-risk group.13 You may be at higher risk if you:

  • Have fair skin, blue or green eyes, blonde or light brown hair, or freckles
  • Have had skin cancer or have a family history of skin cancer
  • Have certain autoimmune diseases, like lupus erythematosus
  • Are taking a medication to suppress your immune system
  • Have an inherited condition that increases skin cancer risk
  • Are taking medications that make your skin sensitive to sunlight. It is important to read the package that comes with your medication for warnings about sun sensitivity.14 If you are not sure if a medicine increases sun sensitivity, ask your doctor or pharmacists.
  • Some commonly used medications that have been shown to increase sun sensitivity include:
    • Certain antibiotics (tetracycline, doxycycline, ciproflaxin)
    • Certain non-steroidal anti-inflammatory drugs (NSAIDS), like naproxen (Aleve)
    • Oral acne medication isotretinoin (Accutane)
    • Topical acne medication isotretinoin (Retin-A)
    • Certain diuretics, like hydrochlorothiazide (HCTZ)
    • Some diabetes drugs, including glipizide (Glucotrol) and glyburide (Diabeta)

REFERENCES

  1. What Is Skin Cancer? | CDC. https://www.cdc.gov/cancer/skin/basic_info/what-is-skin-cancer.htm (2023).
  2. Skin Cancer (Including Melanoma)—Patient Version – NCI. https://www.cancer.gov/types/skin.
  3. US EPA, O. Ultraviolet (UV) Radiation and Sun Exposure. https://www.epa.gov/radtown/ultraviolet-uv-radiation-and-sun-exposure (2018).
  4. Sun Protective Clothing – The Skin Cancer Foundation. https://www.skincancer.org/skin-cancer-prevention/sun-protection/sun-protective-clothing/.
  5. The efficacy and safety of sunscreen use for the prevention of skin cancer – PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759112/.
  6. Kim, M. A., Jung, Y. C., Bae, J., Ha, J. & Kim, E. Layering sunscreen with facial makeup enhances its sun protection factor under real-use conditions. Skin Res Technol 27, 751–757 (2021).
  7. Sunscreen Facts. http://www.aad.org/media/stats-sunsreen.
  8. Sun Safety | Skin Cancer | CDC. https://www.cdc.gov/cancer/skin/basic_info/sun-safety.htm.
  9. UV Radiation – The Skin Cancer Foundation. https://www.skincancer.org/risk-factors/uv-radiation/.
  10. What’s the difference between UVA and UVB rays? | MD Anderson Cancer Center. https://www.mdanderson.org/publications/focused-on-health/what-s-the-difference-between-uva-and-uvb-rays-.h15-1592991.html.
  11. Matta, M. K. et al. Effect of Sunscreen Application on Plasma Concentration of Sunscreen Active Ingredients: A Randomized Clinical Trial. JAMA 323, 256–267 (2020).
  12. Research, C. for D. E. and. An update on sunscreen requirements: The deemed final order and the proposed order. FDA (2022).
  13. Are Some People More Likely to Get Skin Damage from the Sun? https://www.cancer.org/cancer/risk-prevention/sun-and-uv/sun-damage.html.
  14. Research, C. for D. E. and. The Sun and Your Medicine. FDA (2018).

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