Sunscreen FAQs
by Dr Andrew Birnie
Consultant Dermatologist and Dermatological Surgeon
Altruist Dermatologist Sunscreen
Who needs sunscreen?
The simple answer is everyone. Sunscreen protects against the harmful UVA and UVB rays which can cause skin cancer and skin ageing. The fairer your skin the more essential sunscreen becomes. The risk of skin cancer is greater in those with lighter skin types, though Asian and African skins can prevent much of the changes associated with ageing (wrinkles, uneven skin tone and pigmentation) by using sunscreen year round whilst reducing further their already small risk of skin cancer.

Which sunscreen should I use?
The BAD (British Association of Dermatologists) recommends that you should use a sunscreen that provides broad spectrum protection (against UVA and B). SPF (Sun Protection Factor) refers to UVB protection and the BAD advises using SPF 30 or above. UVA protection is indicated by either an EU standard mark (UVA in a circle) or the Boots star system – 4 or 5 stars indicates very good protection.
Water resistance is a useful addition if you are likely to be sweating as it will not run and important if you are swimming. However, it is essential to reapply after swimming or towelling as it will have washed/rubbed off. There are many types of sunscreen in different formulations. Ultimately, you should use one that you feel comfortable applying generously – both from a cosmetic perspective and financial.

When should I use sunscreen?
Whenever you will be outdoors in daylight for more than about 15 minutes, but also be aware that UVA (which is the main cause of ageing) can penetrate through glass, so you will still be exposed sitting in a car.
Ideally year round as the UVA levels are fairly consistent year round and even when there is cloud cover. UVB causes burning and these levels increase with the intensity of the sun.
My personal practice is to apply Altruist SPF 30 as a post shave moisturiser every morning and then extend the coverage to include the rest of my face, my ears and my neck.
Sunscreen should ideally be reapplied every 2 hours if you are outdoors to maintain the protection. This is especially important on hot sunny days as the risk of burning is higher due to increased UVB.

How much sunscreen should I use?
Probably more than you are at the moment! Most people do not use enough to achieve the quoted SPF. Some people suggest a shot glass worth, or a teaspoon per body part such as arms, legs, face and each side of the body, but I find these difficult concepts in practice, so I usually advise people to put enough on so that the skin looks completely white before the cream goes in.
It should be applied about 20 minutes before going out and then every two hours, or after swimming or towelling.

What does it mean if the sunscreen says it’s water resistant?
It means that after 20 minutes in the water the sunscreen retains 50% of its effectiveness (labelled SPF). Some sunscreens are labelled very water resistant, which means that they retain 50% of their effectiveness after 40 minutes. Given this, you can see it’s essential to reapply afterwards. The very water resistant products tend to be less cosmetically acceptable – very sticky – and thus not the ones to use daily, but are probably the best to use if spending long periods of time in the water e.g. a long session of surfing.
It’s not correct to say that a cream is water proof.

What about spray sunscreens?
There is some concern (as yet unproven) that there may be a risk if the spray is inhaled, so you should be careful to avoid the face. However, sprays are popular. It is essential that enough is applied – a single spray onto the skin will not provide adequate coverage. Spraying into the hand and then applying is the best option, though this perhaps defeats the point of the spray. Rather apply 3 or 4 “coats” each time to ensure adequate protection.

Is it still possible to burn when using sunscreen?
Yes, though if (SPF 30 and above) used correctly (applied in sufficient quantity and frequency) it is extremely unlikely.
No sunscreen actually blocks out all UV light, so it is theoretically possible if one had no natural protection from melanin (like those with albinism) and were outdoors from dawn to dusk in the hottest conditions by water (added reflected UV). What is more likely is that insufficient has been applied, not enough time has been given for it to soak in before going into the water and an extended time has been then spent in the water with out reapplication straight after toweling.

What else can I do to protect myself from the sun?
Try and avoid the sun between 11am – 3pm, when the sun is strongest.
Wear clothes, a broad rimmed hat and sun glasses.
Never use sun beds – they have been classified as carcinogenic by WHO (The World Health Organisation).

What about vitamin D?
This is a vitamin essential for bone health and increasingly is suspected to play a role in other health aspects, too. It is very efficiently made in the skin when exposed to UVB – just 15 minutes of exposure on the arms 3 times a week in the summer is sufficient to have enough. There is no benefit in trying to get more as the body does not store it. It is not usually in high enough concentrations in food, so the best bet is to take a supplement. The NHS recommend 10 mcg a day. This is far safer than trying to obtain it from sun exposure.

I’ve heard that sunscreens can cause skin cancer. Is this true?
It has been shown that the regular use of sunscreen can reduce the incidence of skin cancer – in particular melanoma and squamous cell carcinoma (SCC).
Some population studies have shown that people who have used sunscreens seem to have a higher incidence of skin cancer. However, this tends to be the lower SPFs (below 15) and the likelihood is that the creams were used to aid tanning and thus people were deliberately seeking the sun. One Norwegian study showed that people who had used sunscreen of SPF 15 or greater on one occasion had a lower incidence of skin cancer.
The prevention of skin cancer (and skin ageing) trumps the unproven claims of harm from sunscreen.

What are the latest developments in the field of sunscreen?
Still the most important thing is to ensure that there is protection cross the UVA and UVB radiation spectrum. Thus a high level of UVA protection, in proportion with the SPF (UVB protection) is important.
The newest filter registered in the EU is Tinosorb A2B, which is in Altruist Sunscreen, this helps to ensure a more complete protection across the UV spectrum as there used to be a gap between the UVA and B peaks of absorption in sunscreens.
Nano technology is also a great innovation. Although it sounds small, in UV filters terms this actually means big! This means that they can sit on the surface of the skin and less sunscreen is actually absorbed into the skin.

-How can it be made easier for people to use a sunscreen every day? So that it is a no brainer putting it on in the morning in the bathroom?
By creating Altruist we have tried to solve this problem. Sunscreens need to be easy to apply, leave no residue and feel very much like a moisturising cream. Also, they need to be affordable, so they can be applied liberally. Personally, I use Altruist SPF30 as my post shave moisturiser and then extend the application to cover my ears and rest of face, too. this is what I advise my patients to do, too.

-What is your advice when someone has oily skin -most of our readers have oily skin. Sensitive skin comes in second-? I also have oily skin and I really hate most of the sunscreens available because of the allover shine it gives my skin, enlarging my pores even more and makes me breakout all the time.
Many susncreens, especially those that are extra water resistant, tend to be very oily; this is what gives the shine and increases the risk of spots. I advise people to use a sunscreen that is labelled “non-comedogenic” or “oil free,” this means that it tends not to cause spots. Again this was an important element in the development of Altruist – that it should be able to be used by those on treatments for acne, in particular isotretinoin.

-What is the best sunscreen for use around the eyes? Most sunscreens make the eyes cry. Can for example using a mineral sunscreen prevent this?
Tolerability around the eyes is important for many people. Of course, sunscreen is not designed to be put into the eyes, but some people don’t seem to be able to tolerate anything around the eyes and in this instance wearing sun glasses is the only option. However, these people are actually very few. Feedback from many sports people was that they didn’t like sunscreen because it ran into their eyes when they sweated. Again this was something that I’ve been delighted with Altruist Susncreen – the feedback from both golfers and cyclists has been fantastic. they say that it doesn’t run into the eyes and sting.