Q1. I've always had freckles, but I've noticed that an alarming number of new ones have popped up all over my face and chest. Could this be a sign of sun damage or skin cancer?
Freckles (“ephelids”) are a sign of previous sun exposure. While most freckles are not dangerous, they are an indication of sun damage. Freckles develop when the skin produces more melanin pigment in response to the sun’s ultraviolet (UV) rays. Think of this process as your skin’s attempt to protect itself from further sun damage. This is why freckles often fade in the winter, then darken in the summer, when there’s more sunlight.
Freckles are more common in fair-skinned individuals, who tend to sunburn easily and have difficulty tanning, while those with olive or darker skin tones can tan easily and have fewer freckles. Freckles usually begin appearing in childhood on areas of the body that are most exposed to sunlight (like the face, chest, and arms), and gradually accumulate over a lifetime of sun exposure.
A recent sunburn or visit to a tanning bed could trigger the onset of new freckles. In fact, freckles that appear after a sunburn (“sunburn freckles”) have been associated with an increased risk of melanoma skin cancer. These are most often found on the chest and shoulders, and are larger and darker than the light brown freckles seen in childhood.
Any change in your freckles or moles could be a sign of skin cancer or a precancerous condition, so I recommend a visit to your dermatologist, who can examine your new freckles and determine whether they need to be removed. In my office, I encourage my patients to have a complete skin examination at least once a year for a baseline, and to come in sooner if they notice any changes in their skin, such as new growths or existing growths that are getting larger, darker, or itch and/or bleed. Freckles or moles that show these changes may need to be removed and sent to a lab for a biopsy to determine whether they are cancerous.
Q2. I need to buy sunscreen, but I'm confused by all the options. How high an SPF do I really need to protect my skin?
It's more important than ever to use the right sun protection. Like you, a lot of my patients are confused by the many available sunscreens. Pricier department store products aren't necessarily better than drugstore brands — luckily, there are good options at any price, but you should know what features to look for.
First, a quick lesson on SPF: SPF stands for sun protection factor, which is a measure of the amount of time you can spend in the sun before getting a sunburn. For example, if you would normally burn after 10 minutes, a sunscreen with SPF 15 should allow you to stay out for 150 minutes before burning. However, these numbers are measured in the lab, and there are many variables that reduce the actual amount of protection that most people get when they apply sunscreen in the real world. For instance, most people don't apply enough (see number 3, below, to learn how much you should be using). Also, sunscreen can rub off on clothing, when you perspire, and of course, when you go in the water.
One popular misconception is that a higher SPF guarantees you're getting a stronger sunscreen. In fact, SPF only measures protection against UVB (burning) rays. For the best protection, your sunscreen should also protect against UVA (aging) rays, which have been linked to melanoma skin cancers as well as wrinkles and other signs of sun damage.
Another myth is that using a sunscreen with twice the SPF gives you double the amount of sun protection. Actually, a sunscreen with SPF 30 only gives you 4 percent more UVB (burn) protection than one with SPF 15. One study showed that people who reapplied an SPF 15 sunscreen every three hours were less likely to sunburn than those who used an SPF 30 sunscreen and stayed out all day but didn't reapply.
To make sure you're adequately protected, you need to:
- Choose a sunscreen with an SPF of 15 or higher.
- Look for ingredients such as zinc oxide, titanium dioxide, or Mexoryl, which protect against UVA rays. Mexoryl, the newest FDA-approved sunscreen ingredient, can be found in Anthelios SX Daily Moisturizing Sunscreen Cream (available at drugstores) and Lancome UV Expert SPF 20 Sunscreen (sold in department stores). Helioplex, a patented combination of two ingredients that protect against UVA rays, is found in Neutrogena brand sunscreens. My patients with oily or acne-prone skin really like Neutrogena Ultra Sheer Dry-Touch Sunblock SPF 55, which dries invisibly. If you have normal to dry or sun-damaged skin, try Neutrogena Age Shield Sunblock SPF 30, which doubles as a daily moisturizer.
- Make sure you apply enough sunscreen. You need a tablespoon to cover your entire face (including ears), and a shot glass–sized amount to cover the exposed areas of your body.
- Reapply sunscreen every three to four hours, as well as after bathing or swimming.
Q3. My skin seems to break out more in the summertime. Why is that, and is there anything I can do about it?
— Gia, Texas
Summer heat, sweat, and humidity — combined with makeup and your skin’s natural oils — can clog pores, leading to more breakouts than usual. If you usually use a creamy cleanser, this is a good time to switch to a gel face wash, which will leave your skin cleaner.
As always, be sure to wash your face at night, especially if you’ve been wearing makeup and sunscreen all day. Look for a cleanser that contains salicylic acid, which gets into the oil glands and helps unclog pores. Try L’Oreal Go 360 Clean Deep Facial Cleanser, which comes with a soft “scrublet” to help remove sunscreen, makeup, and dirt.
Warmer weather is also a good time to switch to lighter makeup. For a fresh summer look, try swapping your heavier foundation for a tinted moisturizer, which helps even out your skin tone but won’t look or feel like a mask on a hot, humid day. I like Laura Mercier Tinted Moisturizer SPF 20 and Clinique Moisture Sheer Tint SPF 15.
Summer is also a good time to re-evaluate your sunscreen routine. Some heavy, greasy sunscreens can aggravate breakouts, so try a sheer, lightweight formula like Neutrogena Ultra Sheer Liquid Daily Sunblock SPF 70 or Clarins UV Plus Day Screen High Protection SPF 40, both of which dry invisibly, leaving a matte finish. They’re also both water-resistant, so they’re perfect for active lifestyles and humid climates.
Heat and perspiration can also cause breakouts on your body as well as your face. If you’ve been sweating more than usual and have itchy red bumps on your chest and back, you may have a condition called “miliaria” (also known as “prickly heat”). These bumps are caused by clogged sweat glands, and typically go away on their own after a week or two if you keep your skin cool and dry. In the meantime, try a mild over-the-counter cortisone cream (like Cortaid or Cortizone 10) or a soothing lotion like Caladryl Clear Anti-Itch Lotion to help soothe the itch.
Stay cool this summer!
Q4. I am 67 years old, and because I spent a lot of time in the sun, my skin looks like an orange peel. Is there any vitamin or skin cream I can use to improve my skin? I am not looking for a transformation, just a slight improvement.
— Marilynn, Illinois
First and foremost, you should apply a sunblock, with an SPF of 15 or greater, every day. I believe that the higher the SPF factor, the better. Though most sun damage occurs in our youth, we are still susceptible to skin changes as we age. Clinical studies have shown that the number of precancerous lesions among your age group can be reduced by daily application of sunblock.
Depending on the degree and type of sun damage to your skin, you might want to consult with a dermatologist about possible treatment with 5-fluorouracil cream, which can treat precancerous changes of the skin and, an extra benefit, may result in a rejuvenated facial appearance.
The gold standard of treatment for the reversal of photoaging (aging of the skin due to sun exposure) is the use of vitamin A acid derivatives, such as retinoic acid and adapalene, in prescription preparations such as Retin-A, Renova, Tazorac, and Differin creams and gels and in over-the-counter preparations with retinol. Using these products may help reduce fine wrinkling and pigmentary changes and result in an overall brightening and smoothing of the skin. Glycolic acids have also been shown to improve skin texture and fine wrinkling.
Now, with the advent of antioxidants such as vitamin C, green tea, berry extracts, coenzyme Q, peptides, and growth factors, a new generation of products is available for skin rejuvenation. Products containing these ingredients may be obtained in higher concentrations from your dermatologist. Cosmetics containing lesser concentrations are available in drugstores and department stores — for example, RoC Deep Wrinkle Serum, Oil of Olay Total Effects and Regenerist products, and Eucerin Q10 Anti-Wrinkle Cream.
Learn more in the Everyday Health Skin and Beauty Center.