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In a previous post, we discussed sunscreen safety but did not address sunscreen efficacy. A recent study of top-rated sunscreens sold on Amazon.com revealed that 40% of the 65 top-rated products didn’t meet all three of the American Academy of Dermatology’s (AAD) recommended criteria:

1. Sun Protection Factor (SPF) of 30 or greater2. Broad Spectrum (UVA &UVB) protection3. Water and/or sweat resistanceThese components are particularly important when spending a significant amount of time outdoors.

It’s advisable to check your sunscreen’s label to confirm it satisfies the AAD criteria. In addition, The Skin Cancer Foundation’s website, www.skincancer.org, has lists of safe and effective sun protection products including sunscreens that carry its “seal of recommendation.”

It's important to apply enough sunscreen to optimally protect your skin. This means applying the equivalent of a shot glass (two tablespoons) of sunscreen to the exposed areas of the face and body –a nickel-sized dollop to the face alone. Finally, sunscreen should be reapplied every two hours, or more frequently after swimming, heavy perspiration, or toweling off.

Biotin, also referred to as Vitamin B7 or Vitamin H, is one of the B complex vitamins, important in the metabolism of carbohydrates, proteins, and fats.While there is no recommended daily allowance of biotin in the United States, most people ingest enough biotin through their diet. Biotin is found in brewer's yeast; cooked eggs (especially egg yolk), sardines, nuts (almonds, peanuts, pecans, walnuts) and nut butters, soybeans, other legumes (beans, blackeye peas), whole grains, cauliflower, bananas, and mushrooms. In addition, bacteria in our intestines produce biotin. Biotin deficiency is usually recognized by its symptoms, including hair loss, dry scaly skin, cracking in the corners of the mouth, swollen and painful tongue, dry eyes, loss of appetite, fatigue, insomnia, depression, and tingling of the arms and legs. Aside from certain medical conditions/medications (alcoholism, some epileptic drug therapies, individuals with kidney failure who are on dialysis, individuals with Crohn’s Disease and overconsumption of raw egg whites which binds biotin), biotin deficiency is rare. Regarding its use in healthy individuals, there is weak evidence to suggest that biotin supplements may improve thin, splitting, or brittle toe and fingernails, as well as hair. According to the National Institutes of Health, there is not enough evidence to recommend biotin for hair loss.

Summer travel may take you to areas where mosquitos are carriers of disease-inducing viruses including Zika, Dengue, or Chikungunya. To minimize the risk of mosquito bites, it's important to choose an insect repellent that works well and that you are comfortable with. Use an Environmental Protection Agency (EPA)-registered insect repellent with one of the following active ingredients. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breastfeeding women.

• DEET: Some brand names: Off!, Cutter, Sawyer, Ultrathon
• Picaridin, also known as KBR 3023, Bayrepel, and icaridin : Some brand names: Skin So Soft Bug Guard Plus,
• Oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD): Brand: Repel
• IR3535 : Some brand names: Skin So Soft Bug Guard Plus Expedition, SkinSmart

Additional protective measures include:

• Covering up: Wearing long-sleeved shirts and long pants.
• Keep mosquitoes outside: Stay in places with air conditioning or that use window and door screens. If you are not able to protect yourself from mosquitoes inside your home or hotel, sleep under a mosquito bed net.
• If you're bitten, try to avoid scratching. For itch relief, apply hydrocortisone cream or calamine lotion to the bite several times daily. Ice or cold pack applications may be helpful as well as oral antihistamines such as diphenhydramine (Benadryl and Cetirizine (Zyrtec). If mosquito bites are associated with more serious warning signs including fever, headache and body aches, contact your doctor.

Adapted from https://www.cdc.gov/mosquitoes/mosquito-control/community/

We’re often asked how much sunscreen should be applied to protect the skin from the damaging effects of ultraviolet (UV) exposure. To achieve the SPF (Sun Protection Factor which protects against the sun’s UV radiation) listed on a bottle of sunscreen, an average sized adult should use the equivalent of a shot glass (two tablespoons) of sunscreen to the exposed areas of the face and body – a nickel-sized dollop to the face alone.Remember that sunscreen needs to be reapplied every two hours, or more frequently after swimming, heavy perspiration, or toweling off. The SPF should be 30 or higher for extended time spent outdoors and there is no evidence that using a sunscreen with an SPF higher than 50 conveys more protection. Newborns should be kept out of the sun and it is advisable to apply sunscreen to children over 6 months of age.In addition to using sunscreen, seek shade whenever possible, minimize the hours spent in the sun (especially between 10 am and 4 pm), wear sunprotective clothing, broad-brimmed hats, and UV-blocking sunglasses.

May is skin cancer awareness month. In addition to periodic examinations by your dermatologist, monthly self skin exams can also pick up early signs of skin cancer. Our patient's often comment that they have difficulty recognizing the particular features of skin cancer (see www.skincancer.org for photos and descriptions of melanoma and the more common and generally less serious non-melanoma skin cancers.)

Here are a few simple tips:

1. If a skin lesion is new or changing, schedule an appointment with your dermatologist for evaluation.
2. Skin lesion(s) that appears significantly different from your other skin lesions should be evaluated by your dermatologist. This is commonly referred to as the "ugly duckling sign" or "funny looking mole sign."
3. Any skin lesion with bleeding, crusting, scaling, or irritation that doesn’t heal within a couple of weeks should be evaluated by your dermatologist.

We also recommend that you protect your skin from the damaging effects of the sun’s ultraviolet radiation by using sunscreen (more on this next month), seeking shade whenever possible, minimizing the hours spent in the sun (especially between 10 am and 4 pm), wearing sun-protective clothing, broad-brimmed hats, and UV-blocking sunglasses.

Hypertrichosis is excessive hair growth over and above the norm for the age, sex, and race of an individual, in contrast to hirsutism, which is excess hair growth in women and children following a male distribution pattern. The latter is caused by the presence of excessive male hormones. Hypertrichosis can develop all over the body or can be isolated to small patches. Rare forms of hypertrichosis are present at birth in contrast to acquired hypertrichosis which develops later in life.There are various causes of acquired hypertrichosis including localized irritation of the skin, medications, underlying malignancy, and possibly anorexia. New onset of hypertrichosis or hirsutism should be evaluated by a physician. Treatments for hair removal include bleaching, trimming, shaving, plucking, waxing, chemical depilatories, electrolysis, and laser hair removal.

It's been said that beauty emanates from the inside so it's not surprising that the foods we eat affect our health and the appearance of our skin. The signs of aging skin are influenced by internal factors related to maturity and external factors including ultraviolet (UV) radiation from sun exposure, smoking, pollution, sleep deprivation, and poor nutrition. These items stimulate the formation of damaging free radicals that can harm skin cells and cause signs of aging. Antioxidants such as beta-carotene and vitamins C, E, and A can curb the damage caused by free radicals.The best defense is a health-oriented lifestyle with caloric restriction, exercise, low-stress conditions, and a nutritionally balanced diet that includes antioxidant-rich foods. Eating a wide variety of multicolored fruits and vegetables such as blueberries, strawberries, grapefruit, kale, spinach, different kinds of peppers, and cooked tomatoes is good for your whole body, including your skin. Foods that are high in omega-3 fatty acids, including wild salmon, sardines, fortified eggs, and walnuts are also beneficial. What about supplements? To date, the evidence isn't available to support the ingestion of supplements to maintain a youthful appearance.Bottom Line: Eat healthy foods to stay fit and look your best.

Good news for everyone who put "more exercise" on their new year’s resolution list. While we have long known about the salutary effects of exercise, there is now compelling evidence that sustaining exercise can help maintain youthful skin and hair. It appears that certain chemicals released by skeletal muscles during exercise directly affect skin cells as well as muscle cells.The studies show that greater than 4 hours/week of high-intensity aerobic exercise can keep skin younger and even reverse some aging changes. Of course, sun protection is critical to avoid damage from ultraviolet rays and protect the exercise-induced benefits. Until the technology is available to put these chemicals in a pill, keep exercising!

Thin skin with brown spots, less elasticity, and loss of underlying fat are characteristic features seen with the passage of time. Causative factors include long-term ultraviolet exposure from the sun, aging, and, in some cases, medications such as chronic use of topical and/or systemic steroids. Fortunately, the appearance of the hands can be improved. Brown spots fade with photo rejuvenation using intense pulsed light or lasers.The volume loss of the back of the hands can be replenished with fillers such as Radiesse, Juvederm, or Restylane Lyft. This also helps to diminish the prominence of underlying veins and tendons. Finally, the skin can be nourished with emollients and sunscreens to moisturize and protect the skin from further sun damage.