Meet the Skin Doc
We are excited to have distinguished dermatologist Dr. Heidi Waldorf as this week’s Beauty Guru to kick start Skin Cancer Awareness Month. If the rising temperature inspires you to shed layers and emerge from winter hibernation, you aren’t alone; but as you enjoy the long-awaited warmth, we encourage you to do so safely. Dr. Waldorf is a highly regarded researcher and educator, who currently serves as Director of Laser and Cosmetic Dermatology at The Mount Sinai Medical Center in New York City, and Associate Clinical Professor in the Department of Dermatology at The Mount Sinai School of Medicine. She also practices at Waldorf Dermatology & Laser Associates, P.C. Dr. Waldorf graduated magna cum laude from Harvard University and received her medical degree from the University of Pennsylvania School of Medicine. In the following interview, she separates fact from fiction to debunk some of the myths associated with sun exposure, and shares practical tips for skin salvation.
How worried should the average person be about incidental sun exposure?
The average person should be concerned. Skin cancer is the most common form of cancer in the United States: more than 3.5 million cases are diagnosed every year including over 68,000 melanomas. In addition, for the aesthetically conscious, most say even 90% of the signs of ‘aging’ skin are actually due to ultraviolet exposure. Happily, air conditioning and UV protective glass are now commonplace in cars. Not so long ago, we saw driver’s side accentuation of sun damage from open car windows. However, we’re exposed whenever we’re outdoors, all year round. In fact, most of my patients report their worst sun exposure when they least expected it and were unprepared.
Some proponents of tanning will argue that sun exposure helps the body to produce vitamin D and also dries up acne. How do you respond to these and other claims?
Vitamin D is important for our health but is readily available in oral supplements. I tell patients to discuss getting vitamin D levels checked with their internist to determine if supplements are needed, and, if so, how much to take. Most patients will discover that their vitamin D level is fine. It actually only takes 5 to 30 minutes of sun on the skin of the arms or legs twice a week to have adequate vitamin D conversion. In terms of acne, the benefit of ultraviolet light is a myth. It may temporarily decrease the appearance of inflammatory acne, but then bounces back worse. In fact, chronic sun exposure leads to a condition known as solar comedones, large open comedones (blackheads) along the cheekbones and temples.
What are some of the most common myths and misconceptions your patients share with you about their skin/skincare habits?
One of the most common and hard to break myths is that a base tan is protective before heading to a sunny climate. It’s the myth on which tanning salons flourish. I even had a patient who came to my office for a cosmetic consultation right from the tanning salon – she was shocked at my surprise and said “but I’m going to Aruba next week.” I liken it to smoking a lot of cigarettes before going to a bar where there would be smoking – just adding damage to damage. In the case of tanning, you may be less likely to burn if you are already tan, but that’s because your skin is damaged. In the long run, it is better to go on your vacation and be sun smart: use plenty of sunblock; wear a hat, sunglasses and sun protective clothing and seek shade midday when the sun’s rays are strongest. I also don’t understand the logic of applying SPF 50 to your face and 15 everywhere else, but so many people do it. Clearly my logic must be distinctly dermatologic. I explain that you are just as, if not more, likely to burn on your chest, back and ears. And besides the risk of skin cancer, hands, neck and decolletage are tell tale spots that can reveal a woman’s true age.
When it comes to preventing skin cancer, most of us know to apply SPF, but what other steps should we take?
I am a big fan of sun protective clothing. Modern sun protective fabrics can be light and attractive and there are lots of flattering wide brim hat options. Patients are always concerned that the clothing will hold in the heat or disrupt a golf or tennis swing. Actually, light colored, light weight breathable fabrics will reflect the ultraviolet rays rather than absorbing them as heat like our skin does. Think of the Bedouins in the desert, swathed in white robes. For the latter issue, I can’t comment on how it will affect the game of someone used to the freedom of sleeveless, but we have to have some priorities. For activities like swimming and on the beach, try a ‘rash guard’ or surf shirt. Surfers have worn these forever – the snug short or long-sleeve shirts made of bathing suit material. They are great for all water activities and protect two areas that are directly targeted by the angle of the sun’s rays – the chest and the upper back.
What is the proper way to apply SPF?
For routine use in the Northeast (I’m in NY), daily use of an SPF 15 containing good UVA ingredients (titanium dioxide, zinc oxide, avobenzone, mexoryl or tinosorb) is adequate. For outdoor activities or during spring and summer months, I recommend increasing the SPF to a 30 or higher. For swimming or sweating, be sure it is also water resistant. Apply your sunblock at least 30 minutes before sun exposure and before you get dressed – you are less likely to have skin areas if you aren’t worried about getting it on your clothes. Right after the shower is a good time. On beach or other outdoor days, reapply within an hour of being outside and then every 1 to 2 hours. For reapplication, a spray, powder or stick are often easier – and the easier it is to reapply, the more likely you are to do it.
Which brands do you recommend for sunscreen for face and body and why?
The Anthelios line is great: the SPF 15 Daily Moisturizing Cream is a cosmetically elegant moisturizer for daily use and works well under makeup; patients with oily skin love the Ultra Light Sunscreen Fluid SPF 60, which is also water resistant; the Melt-in Sunscreen Milk SPF 60 is moisturizing, water resistant and comes in a large (5oz) tube which is practical for face and body. For heavy duty swimming or sweating activities or travel to strong ultraviolet exposure, I love Blue Lizard Australian Sunscreen SPF 30+ Sport. It is very water resistant and contains both chemical sun protective ingredients and 6% zinc oxide, yet rubs in clear. For sprays, I like Kinesys, Aveeno and Neutrogena, the first being the most moisturizing, the last the driest feel. My latest addition to the sunblock armamentarium for me and my patients is Colorescience Sunforgettable SPF 30. I love that it comes in sheer tones in a pre-loaded brush. Men like the dry feel. Women like that they can reapply it during the day over their makeup without smudging. Kids like that it doesn’t sting their eyes. And it’s very water resistant. (Note that there are FDA definitions for labeling for water resistant vs. very water resistant). I’m also all about lip protection: the Colorescience lip shine SPF 35 is very easy to get women to use and reapply. For men, the Kinesys solid sunscreen stick works for lips, eyes and ears.
How often do you recommend getting a full body scan from a dermatologist?
Start by getting a baseline exam. Sometime in the week after the exam, do a self exam so you know you’ve seen everything the dermatologist has. Then, once a month, recheck yourself. Depending on your skin type, family history, personal ultraviolet exposure history and the findings at the first exam, the dermatologist will recommend how often to return. Patients with a history of dysplastic nevi or melanoma, actinic keratoses, basal cell carcinoma or squamous cell carcinoma may need exams at intervals ranging from 3 months to a year depending on the number of neoplasms, severity and when they were most recently diagnosed. Anyone diagnosed with colon or breast cancer should also have a total body skin examination because of a statistically increased risk of melanoma. Immunosuppressed transplant patients have a higher risk of aggressive squamous cell carcinoma and need to be watched closely.
Is there any way for former sun-worshipers to erase the sins of their past, both from a cosmetic and a health perspective?
Number one – wear sunscreen. Classic large population studies done in Australia showed that sun protection can keep some sun damaged skin from progressing from pre-cancerous to cancerous. Patients with lots of actinic damage may benefit from a topical chemotherapy or immunotherapy agent like Carac, Efudex or Aldara or from photodynamic therapy to seek out and destroy premalignant cells before we can see them. Regular use of a topical retinoid promotes cell turnover and can improve the skin medically and cosmetically (as can the prior agents noted). Other cosmeceutical ingredients that may help repair damage include topical antioxidants, peptides, growth factors, alpha hydroxy acids and beta hydroxy acids. In terms of procedures, the newest Fraxel re:store dual allows us to improve both texture and pigment with minimal downtime. For the patient with less damage, a series of traditional Jessner’s or the modified Vitalize peels and/or microdermabrasion helps directly and by improving penetration of the topicals.
Are you a mom?
I am not a mom, but am a very happy and involved aunt to my young niece in California. I took her on her first trip to Disneyland at age 5 and Paris last summer at age 6. We spend lots of time outdoors and in various climates, so needless to say when I’m in charge, moisturizers and sunscreens are common discussions…and occasionally debates. But as both the niece and the grand-daughter of dermatologists, she already recognizes the importance of the skin.
What’s in your bag?
I never go anywhere without either Vaseline or Aquaphor. Great for lips, cuticles, cuts, irritation and, in a pinch, as a makeup remover. I can use Vaseline as my lip gloss, but generally have at least one sheer or light berry sun protective gloss. Then of course I must have sunblock – I always have a sample of some sun protective moisturizer and recently a Sunforgettable brush (which thank you for reminding me, I need to replace – left mine with my niece in CA two weeks ago). Since I am constantly washing or using Purel on my hands while seeing patients, hand cream is critical for me. My favorite is Dermatopix Intensive Hand Cream. It’s the reincarnation of the original RoC dermatologic line hand cream that was discontinued several years ago. It’s silky instead of sticky and repels water well.
What’s your favorite bag?
It’s probably dermatologic sacrilege, but I do not carry Hermes or Louis Vuitton to work. I prefer something very lightweight for every day – no chains, buckles or embellishments – I already carry so much inside the bag. My favorite everyday bag is a super soft leather oversize tote by M0851. I collect M0851 bags in various sizes and colors because they are just so useful and travel friendly – I can also always find my passport, wallet, Blackberry, lipstick and the like by throwing a smaller bright colored purse size into a larger tote. I love that the leather gets even better over time. I’m also a ‘when your own initials are enough’ kind of gal – get that from my mom who carried Bottega as her everyday bag – and I also carry a few of her classics.