Skin Care Myths: Separating Fact from Fiction Vivianne C. Beyer, MD Dermatology

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Skin Care Myths: Separating Fact from Fiction Vivianne C. Beyer, MD Dermatology

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Disclosures I have no conflicts of interest to declare

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Objectives Discuss common myths, misconceptions, old wives’ tales Discuss the evidence that separates fact from fiction The following topics will be discussed: Skin cancer and prevention Tanning Vitamin D controversies Skin care and beauty tips Acne myths

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Your Skin: A Vital Organ The largest organ Regulates body temperature Stores water and fat Is a sensory organ Prevents water loss and entry of bacteria It is essential to take care of this vital organ!

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Myth # 1 Skin cancer only happens in older people

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Fact: Melanoma is the most common form of cancer in young adults 25-29 years old Second most common form of cancer for 15-29 year-olds The incidence of nonmelanoma skin cancers, especially basal cell carcinoma, is rapidly rising in young adults Source & photo: skincancer.org

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Skin Cancer Skin cancer is the most common form of cancer in the US More than 3.5 million skin cancers are diagnosed annually  There are more new cases of skin cancer each year than there are cancers of the breast, prostate, lung and colon combined One in five Americans will develop skin cancer in the course of a lifetime   Source: skincancer.org

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Basal Cell Carcinoma Basal cell carcinoma is the most common form of skin cancer Main risk factor is cumulative and intense bursts of sun exposure About 2.8 million cases are diagnosed per year in the US  Rarely metastasize but can be locally disfiguring/destructive Photo: skincancer.org

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Squamous Cell Carcinoma The second most common form of skin cancer Main risk factor: cumulative UV exposure over the course of a lifetime An estimated 700,000 cases of SCC are diagnosed each year in the US  Look like open sores, wart-like nodules, scaly red patches Have higher rate of metastasis than BCC (5%)

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Melanoma One person dies of melanoma every 57 minutes About 76,000 cases of invasive melanoma are diagnosed every year in the United States  More than 9,000 people died of melanoma in 2013?  Melanoma accounts for less than five percent of skin cancer cases, but the vast majority of skin cancer deaths (75 percent) 1 in 50 men and women will be diagnosed with melanoma of the skin during their lifetime Source: skincancer.org   

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Myth # 2 Indoor tanning does not increase your chance of developing skin cancer Photo: skincancer.org

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Tanning Ultraviolet radiation (UVR) is a proven human carcinogen One indoor UV tanning session increases risk of developing : squamous cell carcinoma by 67% basal cell carcinoma by 29% melanoma by 20%   76% of melanoma cases among 18-to-29-year-olds are due to tanning bed use People who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent     Source: skincancer.org

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“Whoa: Tanning beds cause more cancer than cigarettes!” -Headline from msn.healthyliving.com

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Results from a study published in JAMA Dermatology in January 2014: Roughly 450,000 cases of skin cancer each year are due to indoor tanning 360,000 cases of lung cancer are secondary to smoking In the US, 35% of adults and 55% of college students have tanned On an average day, more than one million Americans use tanning salons Wehner MR, Chren M, Nameth D, et al. International Prevalence of Indoor Tanning: A Systematic Review and Meta-analysis. JAMA Dermatology. 2014 Jan 19

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Myth # 3 It is a good idea to get a “base tan” before a sunny vacation

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There is no “healthy” tan Any tan is a sign of sun damage Base tan only offer SPF 3-4 Will not protect against burning Photo: skincancer.org

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UV radiation facts UVA light penetrates deeper and causes photoaging (wrinkling, solar lentigines, large pores, blood vessels) Also contributes to development of skin cancer Intensity is constant throughout the day UVB light causes sunburn Strongest from 10AM to 2PM Tanning is induced by UVA (mostly) and UVB light Source & photo: skincancer.org

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Source: skincancer.org

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Myth # 4 You don’t need sunscreen on a cloudy day

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Don’t learn this the hard way! Clear skies: 100% of UV light reaches Earth’s surface Scattered clouds: 89% Broken clouds: 73% Overcast: 31% UVA light is not affected much by cloud cover In addition, 50% of exposure to UVA occurs in the shade Jansen R., Wang S., Burnett M. et al. Photoprotection: Part I. Photoprotection by naturally occurring, physical, and systemic agents. J Amer Acad Derm.69(6):853.e1-853.e12.2013 Dec.

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Myth # 5 Sunscreen only needs to be reapplied after sweating or swimming

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Reapply! Every 2 hours After sweating, swimming, toweling off Regardless of how high the SPF is

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How sunscreen works Chemical sunscreens absorb UV rays before they affect the skin Physical sunscreens reflect UV light away from skin zinc oxide and titanium dioxide Photo: skincancer.org

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Sunscreen Facts SPF value refers only to protection gainst UVB (and small amount UVA) To achieve the full advertised SPF, must use 2 mg/cm2 (shot glass for entire body) 1 teaspoon for face/head/neck 1 teaspoon to each arm 2 teaspoons total to trunk 2 teaspoons to each leg Most people only use 25-50% of required amount Source: skincancer.org

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Myth # 6 Using a higher SPF sunscreen means I can stay out in the sun longer

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Chart of Sunscreen Efficacy An SPF 15 sunscreen blocks 93% of UVB radiation SPF 30 sunscreen blocks nearly 97%  SPF 50 blocks 98% No suncreen blocks 100% of UV rays http://mycpss.com/sunscreen/spf-rating-system

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Sunscreen Buying Tips Look for broad spectrum (UVA/UVB protection) For UVA protection, look for one of the following ingredients: avobenzone, titanium dioxide, ecamsule, oxybenzone, and zinc oxide  SPF 30 Water resistant Do not use if past expiration date Store in cool space Source: AAD.org

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Myth # 7 Sunscreen causes Vitamin D deficiency

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Facts about Vitamin D Vitamin D is important for skeletal health Current evidence does not support its role in the prevention of breast cancer, colorectal cancer, heart disease and stroke Institute of Medicine, 2010 There are 3 sources of Vitamin D: Diet Foods: fatty fish (salmon), cod liver oil, and fortified milk, cereal, and orange juice) Supplements UVB radiation Source: skincancer.org

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Vitamin D Controversy Scientific evidence has NOT shown that sunscreen use prevents adequate vitamin D production Indoor tanning beds are primarily UVA, which does not increase Vitamin D production Vitamin D production reaches its maximum after 5 minutes in summer midday sun Source: aad.org, skincancer.org

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Vitamin D Studies have shown that people with sun-seeking behavior (Australian surfers) still have suboptimal Vitamin D levels (under 50nmol/l) There is a significant genetic influence on Vit. D levels Photo: skincancer.org

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Vitamin D Guidelines 400 International Units (IU) for infants under 12 months old 600 IU for children and adults younger than 70 800 IU for those 70 and older Source: AAD.org

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Myth # 8 Sunscreens cause cancer

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Do Sunscreens Cause Cancer? Oxybenzone, retinyl palmitate, and nanoparticles have come under scrutiny No studies have shown a cause and effect relationship Source: skincancer.org

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Myth # 9 A product that combines sunscreen and insect repellant makes sense Photo: AAD.org

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Buy 2 Separate Products Combination products are problematic for a few reasons: 1) The sunscreen ingredient is less effective (for example, when combined with DEET) 2) The insect repellant is more toxic and more readily absorbed 3) Application instructions differ for the 2 products Source: skincancer.org

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Myth # 10 My makeup has sunscreen in it, so I do not need additional sunscreen

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Makeup and Sun Exposure Facial foundations without sunscreen provide SPF of 2 to 6 Better to layer foundation after sunscreen

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Myth # 11 People with dark skin do not develop skin cancer

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Photo: Billboard.com

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Bob Marley Acral lentiginous melanoma Was dismissed as a soccer injury under his toenail Metastasized to his brain and caused his death at age 36 Source: skincancer.org Photo: Bolognia Dermatology, 2nd edition

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Skin Cancer Affects Everyone Dark-skinned patients who develop skin cancer have a higher mortality Why? Delay in diagnosis Melanomas more likely to appear in mouth, on palms/soles, or under nails So while skin cancer is much more common among lighter-skinned people, it tends to be more deadly among people of color Source: skincancer.org

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Myth # 12 UV light does not go through windows

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Unilateral Dermatoheliosis Jennifer R.S. Gordon, M.D., and Joaquin C. Brieva, M.D. N Engl J Med 2012; 366:e25April 19, 2012

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Myth # 13 Self tanners protect from burning

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Not a True Tan! Most self tanners contain the active ingredient dihydroxyacetone (DHA), a sugar molecule that darkens the skin Does not increase melanin pigment in skin, so MINIMAL protection from UV light Source: skincancer.org

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Myth # 14 Acne is caused by greasy foods and chocolate

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Diet and Acne Controversial Recent studies have implicated: Skim milk High glycemic index foods Photo: skincancer.org

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Myth # 15 Acne is due to dirty skin, so skin must be scrubbed clean several times daily Photo: aad.org

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Skin Washing Tips Overzealous washing can make acne worse! Use a gentle, alcohol-free cleanser Use your fingertips to apply cleanser; avoid hot water Do not scrub your skin  Rinse with lukewarm water; pat dry with a soft towel Apply moisturizer if your skin is dry or itchy (oil-free) Even oily skin needs moisturizer Limit washing to twice daily and after sweating Source: aad.org

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Myth # 16 Only teenagers have acne

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Acne Contributors Hormone fluctuations Stress (increased androgens) Family history Hair and skin care products Certain medications Certain medical conditions 

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Myth # 17 Anti-aging products can erase all signs of aging Photo: aad.org

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Skin Care Products If it sound too good to be true, it probably is! For a product to truly be anti-aging, it MUST contain UVA and UVB protection

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Anti-Aging Tips Protect your skin from the sun every day Avoid repetitive facial expressions Sleep on your back Eat a healthy, well-balanced diet Stop smoking, and drink less alcohol Exercise Cleanse your skin gently (twice daily and after sweating) Avoid irritating skin care products Be patient!! aad.org

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Source: skincancer.org

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Myth # 18 When it comes to skin care products, “you get what you pay for”

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Not True! More affordable drugstore products often work just as well, if not better than expensive “luxury” brands Often paying for package, smell, feel of product- but not active ingredient and efficacy

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Budget Skin Care Sunscreen, sunscreen, sunscreen! Apply moisturizer to damp skin to lock in moisture Petroleum jelly is a great moisturizer for rough, cracked skin Don’t overdo it Consider a moisturizer WITH sunscreen Look for key ingredients

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Ingredients Look for products with Vitamins A, C, or E Antioxidants- prevent formation of free radicals that can lead to skin aging and skin cancers Vitamins C and E can decrease sun damage and improve skin texture Vitamin A derivatives (retinoids) soften fine lines and correct uneven skin tone Source: AAD.org

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Other Ingredients Alpha hydroxy acids Glycolic acid For dark spots: hydroquinone, retinol, kojic acid, soy, niacinamide, ellagic acid, lignin peroxidase, arbutin, licorice Source: aad.org

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Take Your Vitamins! Vitamins A, B, C, D, E, and K Essential fatty acids (alpha-linolenic and linoleic acids) Folic acid Zinc and selenium Biotin for hair and nails Source: aad.org

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Myth # 19 Cocoa butter prevents stretch marks

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Sadly, no Genetics play a huge role Hormonal changes during puberty and pregnancy contribute

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Myth # 20 Smoking is not a major cause of wrinkles

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This photo says it all… Facial changes caused by smoking: a comparison between smoking and nonsmoking identical twins. Okada HC1, Alleyne B, Varghai K, Kinder K, Guyuron B. Plast Reconstr Surg. 2013 Nov;132(5):1085-92.

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Myth # 21 If the label says “all natural” or “botanical” ingredients, it must be good for my skin

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Not Always True Heavily fragranced products can be very irritating Allergies can develop over time “Natural” or “botanical” does NOT mean hypoallergenic “Unscented” is not the same as “Fragrance-Free”

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Conclusions Sunscreen, Sunscreen, Sunscreen! You do not need to break the bank to take care of your skin Don’t believe everything you hear Take care of yourself and your skin will thank you See you dermatologist for any concerning lesions and annually for skin exams

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References Skincancer.org AAD.org Springfieldclinic.com Bolognia et al. textbook of Dermatology 2nd edition Journal of the American Academy of Dermatology JAMA Dermatology msn.healthyliving.com

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Thank you! Questions?