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What’s the Best Sunscreen for You?

Wearing sunscreen daily, rain or shine, is a must for fighting signs of aging and reducing your risk of skin cancer. But what’s the best sunscreen? Sunscreens aren’t one-size-fits-all. Picking one is like choosing a hat: You need to find one that works for you. Do you run from products that feel greasy? Prefer all-natural ingredients? Want to avoid skin irritation at all costs? Hate to reapply? 

To find the best sunscreen for your face and body, read on to learn the standards it should meet and which formulations are likely to keep you coming back for more. You may decide you want different sunscreens for different parts of your body or different circumstances. Do a little experimentation to find what works. 

The three essential requirements 

For adequate protection from the sun’s damaging rays, your sunscreen should meet certain basic requirements. Choose a sunscreen that:

• Is labeled “broad spectrum,” which means it shields you from UVA and UVB rays, both of which damage the DNA in skin cells and increase the risk of skin cancer
• Has an SPF of at least 30
• Is labeled “water resistant”  

Cream, gel, stick, spray or powder? Take your pick

Convenience and comfort matters. If you choose a sunscreen you like and find easy to apply, you’ll be more inclined to use it regularly and apply a sufficient amount. 

Sunscreen formulation is mostly a matter of personal preference. The best sunscreen for men may be a gel formulation, since these go on light and are ideal for hairy areas such as the face, chest and scalp. 

Cream sunscreens are ideal for dry skin and are often considered the best sunscreen for the face, although if your face is oily or acne prone, you’ll want a lighter, oil-free version.

Sunscreen sticks are handy to throw into a bag and are particularly useful for covering the area around your eyes, since they don’t run. If you’ve sworn off sunscreen because it stings your eyes, try a sunscreen stick.

Powder sunscreens are increasingly popular. They’re not ideal as your primary sunscreen, but they’re perfect for reapplications in the car and on the go, especially when you’re wearing makeup.  

Some people like spray-on sunscreen the best. Many parents find it the easiest formulation to apply to kids — but you need to hold it close to their body and spray generously. It’s hard to tell if you’ve missed any spots, so you should rub it in to be safe. On windy days, skip the spray and opt for a different formulation. 

Deciding between chemical and mineral

Sunscreen is sold in two varieties: chemical and mineral. Chemical sunscreens absorb UV rays before your skin can soak them up. Mineral sunscreens, also called physical sunscreens, sit on your skin and create a barrier that UV rays can’t penetrate. Both have pros and cons. 

Are you the type who never remembers to apply sunscreen until you’re already on the beach or golf course? Mineral sunscreens may not go on as smoothly, but they start working right away. Chemical sunscreens, on the other hand, don’t work until they have been absorbed into the skin, which can take 10 minutes or more.

Hate that white sunscreen cast on your skin? Choose a chemical sunscreen, or look for a mineral sunscreen that’s tinted. 

Sensitive skin? If you have a skin issue such as rosacea, mineral sunscreens may the better bet, since ingredients in some chemical sunscreens can irritate the skin. If sun exposure makes your melasma worse despite wearing sunscreen, try a tinted mineral sunscreen that contains iron oxide as an additional ingredient (look for it in the inactive ingredient list). 

Concerned about potential harm caused by sunscreen chemicals that enter the bloodstream? Choose a mineral sunscreen, since these stay on top of skin. 

Want to make the more environmentally friendly choice? Again, for go for mineral sunscreen. Some chemical sunscreens contain ingredients, including oxybenzone, moctinoxate, and octocrylene, that can be harmful to marine life and coral reefs. 

Water resistance: How much is enough?

There’s no such thing as a waterproof sunscreen, except maybe a wetsuit. But some sunscreens are more water resistant than others. If you tend to wash or sweat your sunscreen off, know that chemical sunscreens are typically more water resistant than mineral sunscreens.

The FDA requires manufacturers of water resistant sunscreens to test how long the water resistance lasts and indicate on the label how often the product should be reapplied — after either 40 or 80 minutes when swimming or sweating. If water resistance is a big concern for you, look for one that’s rated water resistant for up to 80 minutes.

Top sunscreen picks for all of your needs

Among the countless sunscreens on the market, here are 13 that make the list of dermatologist favorites. 

Best sunscreen for the body

EltaMD UV Sheer Broad-Spectrum 50+

SkinCeuticals Physical Fusion UV Defense Sunscreen SPF 50

Best sunscreen for the face

EltaMD UV Sheer Broad-Spectrum SPF 50+

COOLA Classic Face Organic Sunscreen Lotion SPF 50

Best sunscreen for men 

Supergoop Unseen Sunscreen SPF 40

Neutrogena Hydro Boost Water Gel Lotion SPF 50

Best sunscreen for sensitive skin

Neutrogena Sensitive Skin Face Mineral Sunscreen SPF 50

CeraVe Hydrating Mineral Sunscreen SPF 50 Body Lotion

TiZO3 Primer/Sunscreen Tinted SPF 40

Best sunscreen for oily or acne-prone skin

La Roche-Posay Anthelios Clear Skin Oil Free Sunscreen SPF 60

Neutrogena Clear Face Breakout Free Liquid Lotion Sunscreen SPF 50

Best sweat-resistant sport sunscreen

Neutrogena Ultimate Sport Face Oil-Free Lotion Sunscreen SPF 70+

Coppertone Sport Mineral Sunscreen Lotion SPF 50

Best tinted mineral sunscreen 

Alastin HyrdaTint Pro

Medically reviewed by Lucy L. Chen, MD

Written by Jessica Brown, a health and science writer/editor based in Nanuet, New York. She has written for Water’s Edge Dermatology, Prevention magazine, jnj.com, BCRF.org, and many other outlets.

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Hand, Foot and Mouth Disease in Adults and Kids: Get the Facts

When your child develops an itchy rash in the summer or fall, you might first suspect poison ivy or heat rash, but there’s another potential culprit to consider: Hand, foot and mouth disease. This highly contagious viral infection usually occurs in children under age 5. Hand, foot and mouth disease in adults is less common and often causes mild symptoms or no symptoms.

What is hand, foot and mouth disease?

As you can guess from the name, hand, foot and mouth disease rash affects the hands, feet and mouth. It can also appear on other parts of the body, such as the diaper area, knees and elbows. The disease is caused by viruses that are part of the enterovirus family, which usually cause mild illnesses. In the United States, coxsackievirus A16 is to blame in most cases. Young children are more susceptible to hand, foot and mouth disease than adults in part because they haven’t yet developed immunity to these viruses.

Hand, foot and mouth disease symptoms

Different stages of hand, foot and mouth disease are associated with different symptoms. During the first day or two of infection, symptoms can include a sore throat, low fever, stomach pain and reduced appetite. A sick person is most contagious at this point.

Around day three, these symptoms go away and are replaced by:

• Mouth sores. The sores can develop anywhere in the mouth, or even the back of the throat, but they often appear on the tongue. At first they look like tiny bumps or bright pink spots, but they eventually become blisters, which can be painful. Swallowing may be uncomfortable, so young children may drool more than usual, refuse to eat or want only cold drinks.
• Itchy rash. The hand, foot and mouth disease rash looks like red, flat spots that quickly give way to bumps or small, red blisters that have fluid near the surface. The blisters scab over as they heal. Some children don’t develop a rash, only mouth sores.
• Swollen glands (lymph nodes) in the neck. Some people develop these, others don’t.

How the disease spreads

There are several ways to contract the virus. These include:

• Touching the blisters of someone who has it
• Kissing, hugging or sharing utensils with someone who has it
• Touching an infected child’s feces while changing their diaper and then touching your eyes, nose or mouth
• Touching objects contaminated with the virus, such as doorknobs or toys
• Breathing droplets expelled by an infected person’s cough or sneeze

The virus is particularly common in kids who attend daycare, for reasons you can well imagine — the toilet training and countless diaper changes that happen there, as well as small children’s fondness for putting their hands and objects in their mouth.

Treatment for hand foot and mouth disease

There is no particular treatment for the virus, which typically improves on its own in seven to 10 days. Adults can relieve a fever with aspirin, but infected children and teens should be given acetaminophen (Tylenol) instead.

 These strategies can help soothe mouth sores:

• Avoid spicy, salty or acidic foods and beverages (such as orange juice and soda)
• Drink cold beverages
• Suck on ice cubes or popsicles
• Eat cold foods such as ice cream, sherbet or sorbet
• Swish warm salt water around the mouth several times day (for adults and for children who can avoid swallowing the water)

If mouth sores are particularly painful and the child is old enough to gargle, a doctor can prescribe a mouthwash that contains several beneficial ingredients, including a painkiller.

If an infected child is under six months old or has a weakened immune system, or if the symptoms are severe, go to a doctor. Contact your child’s pediatrician if the fever lasts longer than three days, symptoms don’t improve after 10 days or your child is dehydrated. Signs of dehydration in kids include dry lips, dark urine, decreased urination, and dizziness, fatigue or lightheadedness.

Any woman who gets hand, foot and mouth disease while pregnant should contact her doctor.

In very rare cases, hand, foot and mouth disease can lead to serious complications such as viral meningitis and encephalitis. Symptoms of meningitis include an extremely painful headache and neck stiffness. Encephalitis causes a painful headache and confusion. Loss of fingernails or toenails is another rare complication, but the nails usually regrow.

Medically reviewed by Andrew Jaffe, MD, FAAD

Written by Jessica Brown, a health and science writer/editor based in Nanuet, New York. She has written for Water’s Edge Dermatology, Prevention magazine, jnj.com, BCRF.org, and many other outlets.

 

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Dr. Dunnett Durando's Tips for Skin Cancer Awareness Month

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How Often Should You Exfoliate Your Face?

You absolutely love the smooth-as-a-baby’s-bottom feeling that exfoliating gives your skin. But the phrase “too much of a good thing” applies to skin exfoliation. So how often should you exfoliate your face?

The answer depends on your skin and how it reacts to exfoliation. The right frequency for you may be three times a week, once a week, every other week, or never. Read on to learn more.

What is exfoliation? 

Exfoliating means removing dead skin cells from the top layer of skin. These cells slough off on their own eventually, but sometimes they need a little encouragement.

You can exfoliate in two ways. One is by using an exfoliating scrub, sponge, brush or glove or even just a washcloth to scrape away the dead cells. The other is by using an exfoliating product that contains a chemical that dissolves the cells, revealing the living cells underneath.

“Chemical exfoliants contain acids such as salicylic acid, glycolic acid and lactic acid,” said Annie Gonzalez, MD, a board-certified dermatologist at Riverchase Dermatology.

The best exfoliating method for your face depends on your skin type, Dr. Gonzalez noted.

“Mild chemical exfoliants are a better choice if you have dry, sensitive or acne-prone skin because they’re gentler than exfoliating scrubs,” she explained. Scrubs are easy to overuse and may damage your skin.” Mild chemical exfoliants are also the best bet for mature skin, which tends to be thinner and drier than younger skin.

Physical exfoliants and stronger chemical exfoliants are more suitable for oily, thicker skin. But if your skin is dark, or if it develops dark marks after skin injuries or breakouts, you may want to avoid them, since more aggressive exfoliants can cause dark spots.

The benefits and risks of exfoliating your face

By sloughing off dead skin cells and other debris that accumulates on your face, exfoliating makes your skin looks healthier, brighter and more youthful. Over time, it can also increase the production of collagen, which decreases as you get older. Collagen is a protein naturally found in the skin that keeps it looking firm.

If your skin has age spots from sun damage, exfoliating regularly can make them less noticeable. And if you have acne, skin exfoliation can help reduce breakouts. People with acne-prone skin don’t shed dead skin cells as effectively as those who aren’t prone to breakouts. When dead skin cells accumulate on the face, they can clog pores and lead to blemishes. Exfoliation helps keep pores clear.

Exfoliating your face too often, however, can dry out your skin and worsen your complexion, causing redness, irritation and breakouts.

How often to exfoliate your face: The best schedule for you

You may need to experiment to find the exfoliation frequency that gives you all of the perks of exfoliation and none of the downsides. Start with the general guidelines below. Cut back if you develop dryness, redness or irritation or you start to break out. Take a break from exfoliating your face if you have a sunburn, rash or open cut.

Keep in mind that if you use an exfoliating cleanser such as SkinCeuticals Clarifying Exfoliating Cleanser every day, you may not need to do any additional exfoliation.

Normal skin

People with normal skin should start by exfoliating two to three times a week.

Dry, sensitive skin 

For people with dry or sensitive skin, exfoliating twice a week is the maximum frequency dermatologists recommend. You may want to exfoliate only once a week or even every other week if you use products that can cause dryness and irritation, such as retinoids.

Rosacea-prone skin

If you have rosacea, your dermatologist may recommend avoiding exfoliation so as not to cause further redness, irritation or stinging.

Combination skin

People with combination skin can typically exfoliate their face twice a week.

Oily skin

If you have oily skin, you can probably exfoliate two or three times a week, and possibly more often depending on what exfoliation method or product you use and how your skin reacts.

Medically reviewed by Annie Gonzalez, MD

Written by Jessica Brown, a health and science writer/editor based in Nanuet, New York. She has written for Water’s Edge Dermatology, Prevention magazine, jnj.com, BCRF.org, and many other outlets.

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The State of Psoriasis

Having investigated and treated Psoriasis for over 40 years now, I am writing this article to honor the millions of patients and their families who have been affected by the disease. Psoriasis is common, affecting 2.5% of the US population, estimated at over 8 million people. Psoriasis does not discriminate: it affects all races, men, women and children.

Psoriasis is not only skin-deep. Psoriasis was initially thought to be just a skin disease with rapidly dividing cells that accumulated on the surface. After decades of laboratory research using blood and skin samples donated by patients, we now know that psoriasis is a type of autoimmune disease which affects skin, joints, and almost every other organ system caused by self-made natural inflammatory substances.

In the remainder of this article, I will include questions from patients on my blog which I have updated to shed some light on some of the latest developments in psoriasis research:

Where are the most common areas to get psoriasis?

Psoriasis seems to be induced or aggravated by trauma. Thus, the most commonly involved areas are the scalp (often first to appear), elbows and knees, tailbone area, and genitalia.

Is psoriasis genetic? No one in my family has it.

Psoriasis is considered a genetic disease because many different genes have been discovered in family members that are associated with psoriasis. The gene or genes are only one part of the story, however. There also has to be trigger from the environment.

What are some of the triggers for psoriasis?

The trigger that is most well known is infection, particularly with the Streptococcus bacteria. In people who don’t have the genetics for psoriasis, the skin disease may go away after the infection, but in those who do, it may progress into chronic psoriasis.

Other triggers include severe stress, cold and dry climates, smoking, and some drugs such as beta-blockers, lithium, hydroxychloroquine, and interferon. Prednisone is more likely an aggravator of existing psoriasis rather than a trigger of new psoriasis.

What is Psoriatic Arthritis?

Psoriatic arthritis is an inflammatory arthritis that is caused by the same genes and circulating chemicals that cause the skin disease. It may affect up to 30% of patients with skin psoriasis. There are a few types of arthritis, but the most common one affects the small joints of the hands and feet and causes morning stiffness and swelling, very similar to rheumatoid arthritis.

Can children get psoriasis? Most of the people I know with psoriasis are adults.

Absolutely yes! Psoriasis is often considered an adult disease because the average age of onset is about 30 years. Here are some surprising statistics: 30% of all new cases of psoriasis start before age 15, 10% before 10 years, and 2% before 2 years. Babies can even be born with psoriasis! The incidence of psoriasis is estimated to be 3 new cases per year per 1000 children.

Besides the skin and joints, what other organ systems are affected by psoriasis?

The most important association is the “metabolic syndrome” which includes obesity, type 2 diabetes, hypertension, high cholesterol, and coronary artery disease. All of these features can be improved or prevented with weight loss, exercise, and medical management. Other less commonly affected organs may include the liver and the eyes.

How is psoriasis treated?

There are now many different ways of treating psoriasis. When I first started treating psoriasis, we only had steroid creams, coal tar, and ultraviolet light called phototherapy. We actually admitted the more severe cases to hospital for 2-4 weeks and treated daily with these modalities.

They cleared up and stayed clear for about 3 months. Then it all gradually came back, and we started over again. We still use outpatient phototherapy without the tar for psoriasis and continue maintenance to prevent flare ups.

Please tell me about some of the newer internal treatments for psoriasis.

For the last 15 years there has been an explosion of new drugs for psoriasis that have been developed to block some specific chemicals that are increased in patients and which cause inflammation in the skin and joints. The inflammation then promotes the rapid overgrowth of skin cells and damages the joints.

Most of these drugs are synthesized in the laboratory. They are injectable proteins called Biologics that block tumor necrosis factor and various interleukins. Most of these can be injected by the patient at home or at the office by us if you prefer. Some familiar names are Enbrel, Humira, Stelara, and Taltz. There are at least 8 others approved and more in development.

We use all of these drugs in the Psoriasis Treatment Center at Riverchase Dermatology.

Does psoriasis affect the nails?

Yes. As psoriasis affects the skin under the nail (nailbed) and the skin around the nail (nailfolds), it causes changes in the growth rate, color, attachment, and the surface such as ridges and pitting.

How is nail psoriasis treated?

Psoriasis of the nails is very difficult to treat. Ultraviolet or laser light helps the psoriasis around the nail but can’t penetrate into the nailbed. Topical creams and solutions also can improve the appearance of the nail. The treatments that work best for the nail are the Biologic injections discussed above or pills such as Otezla or Methotrexate which are taken internally.

I have some pain in my fingers. How do I know if I have Psoriatic Arthritis?

If your pain, swelling, and stiffness is mainly in the morning, and takes 15 minutes to an hour to loosen up, that may be a sign of psoriatic arthritis. If you have one finger that’s swollen like a sausage, that is called dactylitis which is also a strong sign. Psoriatic arthritis may also affect tendons. If you have swelling or tenderness of the Achilles tendon at the heel, that may be a sign. Nail pitting and psoriasis on the same finger with joint pain may also indicate psoriatic arthritis.

Psoriatic arthritis may be difficult to diagnose. If you have psoriasis, there is about a 1 in 3 chance that you would develop psoriatic arthritis during your lifetime, but it can be confused with or overlap with rheumatoid arthritis or osteoarthritis. For this reason, we may order blood tests, X-rays, of a consultation with a Rheumatologist.

How is Psoriatic Arthritis treated?

Some of the drugs mentioned earlier are FDA-approved, meaning safe and effective, for psoriatic arthritis. Thus, if you have both psoriasis and psoriatic arthritis, you may improve if treated with Enbrel, Humira, Cimzia, Stelara, Tremfya, Taltz, Cosentyx, or Otezla. Methotrexate is often used in combination with these medicines. Xeljanz is only approved for psoriatic arthritis.

I understand that Biologic drugs are immunosuppressive. Should I stop them during the Covid-19 pandemic?

The Biologics are targeted to specific components of the immune system that lead to inflammation of psoriasis skin and joints. Although necessary for normal immunity, these components are found in excess in psoriasis patients. They are not blocked completely by the drugs.

Therefore, the National Psoriasis Foundation has recommended continuing the Biologic that has been prescribed for you because of the risk of recurrence of the psoriasis and arthritis, while still following all of the well-known CDC recommendations for prevention of Covid-19 infection. Moreover, when a Biologic is stopped for a while, there is a possibility that some its effectiveness will be reduced.

What can I expect for the future?

Even though we have so many new drugs for psoriasis, there is still no cure. Treatments need to be continued long-term to maintain clearance of the skin and remission of the arthritis. There are many new drugs under development that work by novel mechanisms as biologic injections, pills, and creams. Be on the lookout for these in the next few years.

Charles Camisa, MD, FAAD
Director, Psoriasis Treatment Center and Phototherapy Department 

Recommended Reading:
Handbook of Psoriasis, 2nd Edition, 2005, Blackwell Publishing, by C. Camisa

 

 

 

 

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