Deborah Howell (Host): Well, we've all probably done it. Fallen asleep in the sun or played too long outside and wound up with a sunburn. Or thought we'd protected ourselves pretty well with sunscreen and still got burned. So, how can we prevent sunburn from happening again? Angeline Smith is an ARNP at Pullman Family Medicine and Palouse Health Center. She's with us today to talk about sunscreen options with UVA and UVB protection, sPF 30 or higher, and whether or not water resistant sunscreen is needed. Angie's going to help us understand more about intense sun exposure and high UV areas, and we'll learn how to help an accidental sunburn and more importantly, prevent one.

Welcome, Angie.

Angeline Smith, ARNP: Good afternoon. Thank you so much for having me today.

Host: I know sunscreen is your jam, correct?

Angeline Smith, ARNP: It is very near and dear to my heart. I used to work as a melanoma research nurse at Vanderbilt Ingram Cancer Center in Nashville, Tennessee many years ago. And I was in charge of enrolling and monitoring patients on clinical trials for stage three and four melanoma.

And if you know, if you don't know what melanoma is, it is the the type of skin cancer that likes to travel and spread to other organs. And it's the one that normally is deadly if not caught quickly. So it's very important to me, but because of the clinical trial treatments, many of which are now FDA approved, a lot of my patients are still alive, but many are not.

My youngest patient, who passed from stage four melanoma was 20 years old, and her age range was not uncommon. So, sun protection is very important to me, and raising awareness of the importance of sun protection is a major goal of mine as a healthcare provider. So, thank you for having me on today.

Host: I understand that completely, so let's get to the information you so want to dispense. What are some things people should consider when purchasing sunscreen?

Angeline Smith, ARNP: First and foremost, the best sunscreen is the one you will wear. That is what everybody in dermatology and primary care, anything says that if you find one that you like and you will wear it, then that is the right sunscreen. But there are a few things to keep in mind when purchasing. So normally, getting an SPF 30 at the minimum is important.

 SPF 30 will protect you from about 97 percent of the sun's UVB rays. I am a fan of SPF 50 because it offers nearly a complete UVB block at 98%. So SPF 50 is kind of my jam. That's where I like to stay. So having SPF 30 at the minimum, also getting a sunscreen that has broad spectrum coverage, meaning it has both UVA and UVB protection.

They are both carcinogens from the sun, and too much UVA can cause the sunburn and the tan, and it gets into deep into the skin. And the UVB rays are really strong and they make up about five percent of the UV rays that come from the sun, but they're the ones that damage skin cells and can cause DNA mutations that can eventually lead to melanoma and other skin cancers. And also the last thing, I like to see that the label says water resistant. Those are the biggest things for me.

Host: Okay. Does the level of protection level change depending on where you live?

Angeline Smith, ARNP: Anytime the sun is out, you are being exposed to the sun. So even if it's cloudy, anytime the sun is out, you can get sun damage. Now it definitely varies based on the season and altitude and closeness to the equator, things like that. But SPF protection should always start at 30 at the minimum for everybody.

Host: Okay. But if you're at the top of a mountain, maybe, maybe do the 50 for sure.

Angeline Smith, ARNP: Maybe do the 50, but you know, it's not necessarily the level of protection, but the way it is applied and reapplied. So the most important part about sunscreen is making sure you're applying the right amount. First of all, getting a good base layer that is covering everything and then making sure you reapply because a lot of sunburns occur because people put on sunscreen once and they don't reapply.

They're sweating, they're toweling off, they're swimming, you know, all those things. But timely reapplication is going to keep you appropriately protected. So sunscreen should be reapplied after swimming or sweating for 40 to 80 minutes, depending on the label. And that's a water resistant sunscreen. But if you aren't swimming or sweating, sunscreen should still be reapplied every two hours.

Host: A lot of people I play pickleball with, have the spray on kind of sunscreen. And I notice they're not rubbing it in after because they don't want to get their hands dirty before they pick up their paddle. So, they really need to be rubbing that in, correct?

Angeline Smith, ARNP: They very much do. And, you know, I am all for sunscreen in whatever form, but the most important part is to make sure that you're appropriately covered. And I see a lot of people at the pool with the spray sunscreens that are trying to reapply it, or they're spraying it on themselves or their kids, but the majority of it's getting blown away in the wind.

And so you're really only getting that little part that coats your skin so it will be patchy and not evenly protected. So I'm a big fan of before you leave for the day, you know, before you even put your suit on, get a nice good base layer done with like a good lotion sunscreen. And then reapplying. If you need to reapply with a spray, that's fine. Just make sure it is, evenly coated, that you're not in the wind and it blowing the other way and then make sure it's rubbed in because you're going to have parts that are missing.

Host: Okay. And, you know, one thing that I just learned last week, as a matter of fact, I thought, okay, I'm going to do a big floppy hat and I'm going to look ridiculous, but, you know, it's going to protect my ears and such, what I never thought of is that you know, even if I have the big hat on, parts of my face are still exposed from the sunshine hitting, say, the pavement and bouncing back up.

Angeline Smith, ARNP: Yes, UV rays reflect off of surfaces like concrete, water, sand, snow, even if you're out snowboarding in the middle of winter, like we do here in the Pacific Northwest, you are still getting exposed to the sun and that reflection off of the snow and the reflection off of the water is totally intensifying the sun's rays.

So yes, it's important to always have, you know, sun protective clothing, oh my goodness. This is one of my most favorite things. Like everybody knows how much we hate to reapply, especially on little kids, on toddlers, things like that. They have amazing clothing that is UPF clothing that has sun protection in it.

They're my favorite. They make tops, and you can, they even have ones with hoods that are very lightweight that you can wear outside all day, not feel suffocated, not be sweaty. But a wide brim hat is also a really great way to protect your head from the sun, protecting those ears, your scalp, things like that.

Host: A lot of people think a visor is enough, but then that leaves the top of your head exposed, right?

Angeline Smith, ARNP: Yep. That leaves the top of your head exposed. And if you're someone like me who has very thin, fine hair, you know that a scalp sunburn is very painful and you're not always looking at your head and you can get a lot of sun damage there. Especially also the top of the ears and the back of the neck.

Host: All right. Now, something I've always wondered, maybe you can clarify this for me, is sunblock and sunscreen the same thing?

Angeline Smith, ARNP: Oh, it is not, I'm really glad you brought that up. There's actually no such thing as sunblock. There isn't any active ingredient that protects us from the sun 100%. The FDA actually made it illegal to use the word sunblock on any sunscreen labels, because that is, yeah. They made it illegal. And it can't be anywhere on the label, the word sunblock, because it's false. There's nothing that will completely block us from the sun that we can put on our skin.

Host: Got it. Thanks for that. Now, do children need different sun protectant than adults?

Angeline Smith, ARNP: Not necessarily. So young children are more vulnerable to the sun's rays. They tend to have more sensitive skin that can also become more irritated by certain ingredients. So as far as needing different sun protection, no. Sunscreen has the same function in terms of protecting the skin, but sunscreen labeled specifically for kids usually means it's formulated with sensitive skin in mind.

Host: Okay. Good to know. Now, oops, too late. You already got a sunburn. How can you help your skin heal? And two part question, is sun damage reversible?

Angeline Smith, ARNP: Sun damage is not reversible. That is something that's super important to keep in mind. Sun damage is cumulative, meaning it builds on itself over the years. So even one bad sunburn in childhood can double your risk of developing melanoma. If you do get sunburned though, it is really important to make sure you keep your skin protected from the sun.

Get out of direct sunlight as soon as possible. Seek shade, wear protective clothing, and as far as care for the sunburn itself, you can take over the counter pain relievers, such as Tylenol or ibuprofen, to reduce pain. And also, frequent cool baths or showers or cool compresses can ease some of that discomfort and warmth on the skin.

But make sure, if you do get a blistering sunburn, to leave the blisters intact, and keep your skin moisturized using a nice, thick emollient cream like CeraVe or Cetaphil, something gentle, stay super hydrated, and you can also use 100 percent aloe vera either from the plant itself or 100 percent aloe vera purchased over the counter. But while you're healing, you have to make sure to protect your skin from further sun exposure.

Host: As you're mentioning this, I was thinking of ourselves, we grew up in Minnesota, our family. My dad was a doctor, my mom was a nurse, and we'd go down to Florida in like February because it was just so cold in Minnesota, and we would just bathe in the sun.

Angeline Smith, ARNP: Yeah.

Host: And I remember having these little islands of blisters on my shoulders. I was so proud of them. This one looks like Hawaii. And boy, if I could take that back and kind of redo that portion. And we just didn't know that much back then.

Angeline Smith, ARNP: No, then. We really didn't know that much back then, and blistering sunburns are, they double your risk of melanoma as well, and so that is, it's important to prevent that from happening. And there's common misconceptions that tan is not sun damage. You know, we always talk about burn itself, but even your skin tanning, is damage.

That is your DNA changing, that is your body, your melanocytes, which are the pigment cells in the skin, they are what are trying to protect you. So when you're getting a tan, that's your skin protecting itself, saying, oh no, you know, this is not good, we need to protect ourselves. So the tan is actually damage as well.

Host: Yeah. And this goes for people of all shades, correct?

Angeline Smith, ARNP: All colors, anybody can get melanoma, and everybody who has skin can get sun damage.

Host: All right. Well, I'm glad I actually bought four new shirts that have UV protection. I'm going to probably try and just do that this week and from now on, even though it's really, really hot out, it's really time to just start protecting our skin every single day.

Angeline Smith, ARNP: It is time. It's very important and just building that up as a daily thing that is just fits into your routine is one of the most important things you can do for your kids, for yourself. It's not too late to, be diligent about sun safety.

Host: And luckily the clothes are getting a lot cuter.

Angeline Smith, ARNP: Oh, so much cuter and so much more active. Yes. Loving them.

Host: Well, Angeline, thank you so much for being on the podcast today to bring us up to speed on how to keep ourselves safe from sunburn. Is there anything you'd like to add?

Angeline Smith, ARNP: Not at all but it was my pleasure and thank you for having me.

Host: Absolutely, and you can learn more about this subject, providers and services at pullmanregional.org/PullmanFamilyMedicine. This has been The Health Podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening and have yourself a terrific day.