Maggie McKay (Host): Welcome to Total Health Talks, your Cook County Health podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with the chair of the Division of Dermatology at Cook County Health, Dr. Vesna Petronic-Rosic, about skincare and skin health. Thank you so much for joining us today.

Vesna Petronic-Rosic, MD: Oh, thank you. It is my pleasure.

Host: So, how should a skincare routine change between winter and summer? What are the most important seasonal differences we should consider?

Vesna Petronic-Rosic, MD: So, it's really all about the temperature and the humidity. So when it's warmer and more humid, we tend to sweat more and our oil glands produce more. So, it should be on the lighter side of skincare. Using lighter moisturizers that are more hydrating, those that have hyaluronic acid that are water-based. Whereas in the winter when the air is dry and cold, we need richer moisturizers that can help kind of seal the surface of the skin to stop our own water from leaving it.

Host: Oh yeah, that's interesting. So, what are the most common skin concerns you see In summer months?

Vesna Petronic-Rosic, MD: In the summer months, patients are most concerned about sunburn, but there are diseases that get worse in the summer because of the heat and humidity, such as acne or hidradenitis. Also, if the skincare routine is not optimal, it is easier to get clogged pores in the summer because of very heavy moisturizers or sunscreens that are not appropriate for the skin type.

Host: What about gel sunscreens?

Vesna Petronic-Rosic, MD: Gel sunscreens would be chemical sunscreens, which is absolutely fine. They work well. The main thing about sunscreens is to apply the appropriate sun protection factor and the appropriate amount, and then to reapply if you're going to be in the sun all day or you are going out multiple times during the day.

Host: What are your go-to skincare products for summer? Are there any essentials everyone should have?

Vesna Petronic-Rosic, MD: well, that's a great question. Kind of baseline skincare throughout the year is really sunscreen. So during the summer, I tend to use a tinted moisturizer sunscreen that helps even out the tone of my skin. It's a mineral sunscreen, so it's a little bit thicker, not quite like a gel or a liquid, which you can easily spread on the skin, but it gives more even coverage. And it's an SPF 50. I actually don't use sunscreen that's less than SPF 50, even though the general recommendation is 30. And the reason is that nobody applies the amount you're supposed to apply. So if you apply a 50, you'll get more out of it. We all apply less than we're supposed to, otherwise we would look like we're putting on makeup for like the theater or something.

But yeah, I do, I use a very mild cleanser. I wash my face in the morning. If I applied a tinted sunscreen or makeup, I do that in the afternoon or evening as well. And then, I apply a light moisturizer and my tinted sunscreen. I have several. And they're all mineral. And I really think it's personal preference, whether you like it to be a cream or a lotion or a gel. Sprays, I'm not crazy about because environmentally they're not as good. And also, if you're out and about and applying a spray, if you're outdoors, the wind will basically take 90% of it down the street. So, you're not really getting a good bang for your buck.

Host: Of course. You know, I just ordered two and they came yesterday-- spray. I thought, "Oh, that'll be a lot less messy."

Vesna Petronic-Rosic, MD: It is. It is less messy. It is totally less messy. What I can suggest is that you apply them before you go outdoors.

Host: Exactly. What's your advice for helping people make sunscreen a daily habit? We all know we're supposed to do it, but a lot of times we're in a rush or we're not going to be spending the whole day outside, so we think, "Ah, we can skip it."

Vesna Petronic-Rosic, MD: That's a great question and one that I've certainly struggled with personally in the past because I would be in a rush, getting ready, I need to go. I'm late. And I not only apply sunscreen to my face, but I want to do it to my neck. I want to do it to the tops of my hands because I drive a lot. So, I don't want to get dark spots on my hands. The routine I came up with is I have sunscreen at every point where I could possibly put it on. So, I have it next to my toothbrush and my toothpaste. So when I brush my teeth and I wash my face, I apply it to my face. And then, I have a dog that I walk several times a day. So, I have sunscreen that sits where the dog leash sits. So, I use that. And then, in my car, I actually have a stick sunscreen that I keep in the console. So when I'm driving, I can apply it to the tops of my hands.

I guess the bottom line is put it where you are going to see it, and make it so that it's easy to use. Stick sunscreens are very easy to use. And you can keep them anywhere. You can keep them in your purse, in the car. They're not messy at all. And they also come in SPF 30, 50 and above, so you would get very good use out that.

Host: My son swears by that, and he's a rock climber, so I trust him because if it works way up there...

Vesna Petronic-Rosic, MD: Well, another thing-- sorry to interrupt-- is that it's like why you would like the spray, you'll also like the stick because you don't have to put it in the palm of your hand to apply it. So if he's a rock climber, he does not want greasy palms, so a stick works really well.

Host: Totally. How often should sunscreen be reapplied throughout the day And does it depend on the type of product or the activity? Like if you're just at work or if you're at the beach, it's got to be different, right?

Vesna Petronic-Rosic, MD: Yeah. It's very different. If you're at the beach, you need to be using water-resistant sunscreen that can last up to 80 or 90 minutes in the water, and then you need to reapply it when you get out of the water. Generally, we recommend applying every two hours. But if you're swimming or sweating a lot, you could do it more often. And then, for every day, I go to work, I put it on. If I'm going to go for a 30-minute walk during lunch, I will reapply my sunscreen. So if you're sitting next to a window, the UV rays do go through glass. Newer cars actually have UV filters that prevent that. So, newer cars are a little safer in that sense. But if you are sitting next to a window or next to a source of blue light, you will be exposed to the rays throughout the day. So if getting too much ultraviolet radiation is a concern for skin cancer reasons or for aging reasons, then reapplying every two hours is a must.

Host: Is there such a thing as a "better sunscreen" or are most products equally effective if they're used correctly?

Vesna Petronic-Rosic, MD: I would say a reputable sunscreen brand, which means that they come from a manufacturer that puts in a lot into quality and to make sure that their products keep getting bought and that there are no issues with them. So, a reputable brand, whether you're getting chemical or physical, it's really a personal preference. They deflect radiation from the sun in different ways. So, chemical are more absorbing and then degraded, whereas physical are both reflective and absorbing. The physical ones give you more of a cast. Now if you use a tinted one, it can double up as foundation. So, there's a benefit to that. But if you have dark skin and you're using non-tinted mineral sunscreen, it's going to make you look ashy. And many patients prefer alternatives to that. Chemical sunscreens are usually very easy to apply. They come in a gel, lotion, cream, and they don't leave any kind of residue at all. If a sunscreen that is chemical is leaving residue, there's something wrong with it, get rid of it. Get a new one.

Host: I have to say I am pretty good about that. Usually, after a year, the date, it's gone. So, don't use old sunscreen, right?

Vesna Petronic-Rosic, MD: Yeah. Don't use. There's an expiration date on each product, so you want it to be within the expiration date.

Host: So, just to wrap up the physical or mineral versus the chemical sunscreens. Is one better suited for summer or either is fine?

Vesna Petronic-Rosic, MD: Either is fine.

Host: Okay. Can sun damage occur even on cloudy days or when you're mostly indoors? What should people know about less obvious UV exposure? You mentioned being at work next to a window. I wouldn't have even thought of that.

Vesna Petronic-Rosic, MD: Definitely. Cloudy days are a big perpetrator of sun damage because 80% of the UV rays will go through. And many people when they don't actually see bright sun, they're like, "Oh, I don't need sunscreen." But that is in fact incorrect. And if you think about it, those of us who have glasses that are the ones that get darker in the sunlight, they get very dark when it's cloudy out there, as long as it's daytime. So, that is an indicator of how much of the sun's rays are coming to the surface. So, you should always apply sunscreen. Whether it's cloudy or sunny, whether it's summer or winter, it should be part of your routine for the prevention of skin cancer and for the prevention of premature aging.

Host: And this may be an obvious question, but I do always think like the order of putting on. Like, some people wear serum and then they put on foundation, and then they put on sunscreen. Should sunscreen be the last thing you put on?

Vesna Petronic-Rosic, MD: It doesn't. Matter that much, unless you're putting something on that can dilute it. So for example, if you're using a serum, definitely put the sunscreen on afterwards. But if you are using a sunscreen and then you put on powder blush and a powder mattifier on the face, that's fine. But you should not put anything liquid over a sunscreen because it's just going to dilute it.

Host: What are some persistent myths or misconceptions about skin health that you wish more people understood? For example, is it true that darker skin tones are more prone to UVA- induced hyperpigmentation?

Vesna Petronic-Rosic, MD: That is absolutely true. So, anyone who has more of the pigment-producing cells in their skin will be prone to hyperpigmentation when they're exposed-- not just exposed to sun, but trauma, anything that damages the skin-- because these cells that live in our skin produce pigment. And if you irritate them, they get angry and produce more pigment. And basically, you can think of tanning as constantly irritating those cells. So, not a good thing to do. Tanning is not healthy. Actually, there are many, many states in the United States that do not permit anybody less than 18 years of age to go to tanning salons. It's for their own protection. They're directly linked to skin cancer down the road.

But a common myth is that dark skin doesn't need sunscreen. It is true that we have a much lower incidence of skin cancer in dark skin, but dark skin can also burn. And the sun protection factor inherent to dark skin obviously depends on the skin tone, but it is no more than at the most 10 or so, and we recommend minimum SPF 30. So, even the darkest skin doesn't have the natural SPF that we hope people will use to prevent aging and skin cancer.

Host: Any other myths or misconceptions about skincare that you want to clear up?

Vesna Petronic-Rosic, MD: Well, as I mentioned, tanning is very unhealthy. It causes DNA damage. People often ask me, "Well, can I tan a little?" And the answer to that is as long as you don't get red. So, some people believe that they should burn at the beginning of the summer to kind of harden their skin and get a base tan. That is the absolute worst thing they can do. It's a total myth. If you do love to be tan, either do a fake tan or if you have to do it, do it in a way where you actually never get red because redness is an inflammatory response to injury. So if you're red, something got injured. Think of it as like when you scrape your skin, the first thing that happens is it becomes red. So, it is a sign of skin injury. So, please don't do it.

Host: And there's a lot of conflicting advice about the "perfect skincare routine." We've talked about it a little bit here, but in your view, what actually matters for maintaining healthy skin over time? Are there specific vitamins or ingredients people should maybe be prioritizing?

Vesna Petronic-Rosic, MD: As far as maintaining a good routine for healthy skin, I think nutrition is very important. So, having a well-balanced diet is really important. And if you're eliminating certain food groups, you may become deficient in some vitamins that are important for skin health, like vitamin A, vitamin C, vitamin D. So, make sure you have a healthy diet.

As far as daily skincare, the number one most important thing you can put on your skin is sunscreen. Everything else is temporary results. So if you put on a moisturizer in the morning, if you wash your face, that moisturizer's gone. The effect is gone. If you are using serums or tonics or anything else, again, the effects are very temporary. The only long-lasting preventative effect to maintain healthy skin that you can put on your face is sunscreen.

Now, that said, some people have naturally dry skin or naturally oily skin, and there are skincare regimens that would benefit them. If someone has very dry skin, using a rich moisturizer will not only make their skin healthier, but it will also make them feel better. Because when skin is very dry and tight and cracked, it's itchy and uncomfortable.

Another very important element to remember is that if you put something on your skin and it doesn't feel good, remove it and don't put it on again. Like if it burns or stings or makes you turn bright red, do not use that because that is causing injury to your skin. Like if you're feeling burning or stinging, it's doing something. What it is doing is it damaging your skin. So, don't do it.

Host: And just real quick, what about drinking water? How crucial is that for good skin?

Vesna Petronic-Rosic, MD: Well, water is critical to maintain the skin's turgor, which is the hydration of the skin. And if you're dehydrated, your skin will become very dry. And if you pull your skin like this, if it has good turgor, it'll snap right back. But if it has poor turgor, it'll kind of stay like tented, and that means that you're dehydrated. So, that's not healthy. Not just for the skin, it's bad for the kidneys, it's bad for everything. So, please stay hydrated. You should not water log yourself. There's no specific recommendation I have for, like, whether you should drink eight glasses of water or a gallon of water. It really depends how thirsty you are, what you're eating. If you eat salty foods, you need more water. But you can check whether you're hydrated enough by pinching yourself and seeing if the skin snaps back into place quickly.

Host: So, I think you already answered this, but let's just go over it one more time. What does an ideal skincare regimen look like for the average person? I know everyone's skin type is different, but sunscreen, moisturizer, wash your face at night.

Vesna Petronic-Rosic, MD: You should wash your face at night to remove whatever makeup or products you had on. And also, if you were out and about, you probably have some environmental Contributions on your face. So, you should wash your face and apply a moisturizer. Same thing in the morning when you're getting ready. If you have dry skin, you don't have to use soap every time, just water. And then, apply moisturizer and sunscreen. And that's pretty much all you really need to do.

Now, you can try different moisturizers to see which one you like better. But remember that moisturizers themselves only rehydrate the surface of the skin. They're not going deep down into your body. So, there's no long lasting benefit. The benefit you get from using it is for the next six to eight hours, and then you have to put it on again. are my recommendations. And then, all these trends and, you know, snail mucin, salmon sperm, and all this stuff, I mean, it's very trendy, it's very expensive, and there is almost no data to support using any of it. So if you can financially tolerate it and you like to experiment, go for it, but you really don't need to do that.

Host: The latest is beef tallow. That's the latest one I've heard.

Vesna Petronic-Rosic, MD: So, beef tallow will clog your pores and cause blackheads.

Host: Oh, no.

Vesna Petronic-Rosic, MD: That's all I'm going to say.

Host: Oh no. Okay. I'll pass that on. So if you could give just one piece of advice to someone looking to protect their skin long-term, what would it be?

Vesna Petronic-Rosic, MD: Use sunscreen every day.

Host: Anything else you'd like people to know when it comes to taking care of their skin during summertime?

Vesna Petronic-Rosic, MD: Just be kind to your skin and don't do things to it that are not well-researched or standard of care or known to be beneficial. Don't experiment with your skin.

Host: Thank you so much for sharing your expertise. This has been so educational and fun.

Vesna Petronic-Rosic, MD: Thank you. It's a pleasure to be here.

Host: Again, that's Dr. Vesna Petronic-Rosic. To learn more, please visit cookcountyhealth.org/podcast. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.