Yes, You DO Need Sunscreen Indoors

The importance of sunscreen

When I was a teen, it was considered an outrage to have pale skin after Memorial Day. Skin needed to be tanned, and tanned promptly, no matter the means required to do so. Teens would line up for hours, bored beyond measure, misting themselves with water, basting their pasty skins with baby oil or suntan lotion, waiting for a tiny hint of color to appear. Blisters? No problem! Burning? Hey, that was the price we paid for hours in the sun. We flaunted the burn, proud of our discomfort, never realizing those hours in the sun’s rays could result in skin damage we would regret down the road. Now, we have learned our lesson. Now, we wear sunscreen.

As years passed, and reunions go by, it is remarkably easy to determine who has befriended the shade, and who has retired to sunnier climates for several rounds of golf/day. But what most of us tend to forget, as the past months of lockdown have gone by, is that we need to apply sun protection indoors as well as out, so while we are staying home, we still need to protect our complexions from harmful UVA/UVB rays.4

The Rationale

New York based dermatologist Dr. Hadley King states that UVA rays tend to be the ones responsible for the wrinkling, aging, sunspots, and other signs of skin damage we want to avoid. These rays can penetrate through a window, particularly indoors on a sunny day. UVB rays, on the other hand, damage DNA in skin cells and are the ones likely to cause skin cancers, although UVA rays are the culprits causing most of the damage from tanning beds. The glass in cars, homes, and offices will typically protect the skin from UVB rays, but not UVA, so even if you are indoors or in a car, your skin is not completely protected from harmful rays.1

One of the easiest ways to determine how the skin ages is to assess a part of the body that rarely sees the sun, such as the buttock, versus the skin on a patient’s neck, that is nearly always exposed, especially the side of the neck not protected by a woman or man’s hair. The skin on the buttock should be soft, with a texture like satin, whereas the skin on the neck may feel “unrefined” and aged. The same can be said of a woman’s décolleté, where sunscreen is rarely applied. Sunspots and lined skin tend to appear in this area first.

High energy visible light (blue light) emitted from phones, laptops, TV’s, and even LED lightbulbs also can penetrate the skin and cause premature photo-aging, hyperpigmentation, and possibly age spots and melasma. Fortunately, this type of lighting is not known to cause skin cancer.

Prevention

Dr. Chris Adigun (Spokesperson for the Skin Cancer Foundation) and a practicing dermatologist based in North Carolina, says choosing the appropriate sunscreen is an important first step for skin protection. First, make sure the product says, “broad spectrum” and that it has the Skin Cancer Foundation’s seal of approval, so it has been approved for protection against both UVA and UVB rays. Additionally, she recommends using a product that appeals to the consumer, e.g. one that has an enticing smell and texture so using the product is “not a chore”. The product should be used to cover all exposed areas of the skin: the ears, backs of the hands, and the entire face. Also recommended is utilizing a dual product: sunscreen in a foundation for women, or a moisturizer or bronzer product for men who may want a bit of color.3

The amount of product that should be used is estimated to be a shot glass/day.

Skin Cancers

Skin cancer can appear as one of the following three types: basal cell (the most common form), squamous cell, or melanoma. BBC (basal cell skin cancer) is so common that over 5.4 million cases were diagnosed and treated in the United States in 2012, which is the last year statistics were documented. The annual cost of treating all skin cancers in the United States has been estimated at ~ $8.1 billion, approximately $4.1 billion for nonmelanoma cancers and $3.3 billion for melanoma.5

As with any cancer, the odds of developing skin cancer depend upon your risk factors, but age and ethnicity are an important part of the equation. Skin cancer is the most common cancer in the United States and worldwide. Fair complexion and light eyes tend to increase risk, as do the following factors:

    • Having five or more sunburns in a lifetime
    • Having a history of excessive indoor tanning
    • Lengthy exposure to sunlight, unprotected by sunscreen

By age 70, 1 of every 5 Americans will have been diagnosed with skin cancer. More than 2 people will die of skin cancer every hour in the United States this year as they have in previous years. The risk for skin cancer continues.5

The Bottom Line

Nonmelanoma skin cancers are classified as basal cell skin cancer and squamous cell skin cancer. Although basal cell skin cancers are more common, they may occur in “patches” or reoccur in the same place (i.e. nose, ear, or cheek). Many of us might remember Hugh Jackman performing a PSA with a bandage on his nose discussing the importance of early diagnosis/treatment for basal cell carcinoma. Basal cells may appear as a red patch, a shiny bump, or a small pink growth. These lesions rarely metastasize, and treatment is determined by size. A dermatologist will either remove the growth layer by layer, utilizing a microscope to examine each cell layer (called Moh’s surgery), use cryotherapy, or perhaps one of two 5-FU creams. Your dermatologist will be the best person to decide treatment options and follow-up.

Squamous cell skin cancer is the second most common type of nonmelanoma skin cancer. It arises in the squamous layer of the skin, hence the name. This type of cancer occurs from lengthy exposure to the sun’s rays or from prolonged use of tanning beds. Squamous cell skin cancer usually does not metastasize unless it is left untreated for long periods of time. The lesions appear as crusty red sores that may break open or bleed.  The sores are often located on areas that the sun reaches the most: ears, lips, face, scalp, arms, and legs. Treatment is the same as for basal cell carcinoma.

Melanoma

The most alarming skin cancer is melanoma. It is estimated that 192,310 cases of melanoma were diagnosed in the United States in 2019, which was an 8% increase from 2018. Fortunately, the mortality rate for melanoma is decreasing, by as much as 22% (!), but prevention and early diagnosis remain key to success with this deadly disease. For people with a primary sibling with melanoma, they have a 50% greater risk of developing this skin cancer, so they must be on the alert for detecting the disease.2

Melanoma identification remains the “mole assessment” of ABCDE: asymmetry, irregular borders, changes in color, diameter (anything larger than ¼ inch is suspect), and evolving, meaning it changes in appearance over time. Unfortunately, melanoma can also develop in the fingernails, in the vagina, in the mouth, or in the eye, so for people at risk, a full assessment by a primary care provider is pivotal.2

If melanoma is caught early enough, it can be treated with Moh’s surgery or excision. However, if it has spread (Stage III or Stage IV), other therapies will be utilized. There are new medications and therapies that are available to assist the immune system to fight melanoma, with very encouraging results.

It Begins and Ends with Prevention

Whether your interest is one of preventing wrinkles, brown spots, and leathery skin, or avoiding a visit to the dermatologist for a potential diagnosis of skin cancer (!), skin fitness begins and ends with a dose of sunscreen. The easiest way to apply sunscreen is to make it part of your daily routine, as simple as brushing your teeth. Utilize a two-in-one product, so sunscreen and a bit of color are completed in one step. If you use a shot glass size of product every day, even while staying indoors or driving to events, you will be standing tall at the next reunion, looking younger than your years, no bandages on the nose, zero indications of sun damage in sight.

Websites:

  1. Amp.cnn.com “Yes, you still need to wear sunscreen indoors, here’s why.”, Saunders, N., May 13, 2020, CNN.
  2. Health.com “Here’s what you need to know about the 3 types of skin cancer.”, Levine, H., May 19, 2019, Meredith Health Group.
  3. Health.com “Should you wear sunscreen inside? Here’s what a dermatologist says.”, O’Neill, M., May 11, 2020, Meredith health Group. 
  4. Insider.com “7 scary reasons you should be wearing sunscreen daily-even if it’s cloudy out.”, Greenwood, Chelsea, June 21, 2018, Insider, Inc.
  5. Skincancer.org “Skin cancer facts & statistics.” Updated April 16, 2020.

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