I’m a Dermatologist & This Is What I Want You to Know About Winter Skin Protection
When we move from the spring to summer months and temperatures begin to rise, retailers often push their sunscreen displays to the front of the store. Feeling the heat of the sun on your skin and squinting in its sunny rays are constant reminders of the damage sun exposure can do to your skin, but come wintertime when the temperature drops and you haven’t seen the sun in days, don’t think you no longer have to worry about skin protection. Harmful ultraviolet (UV) rays are present year-round, and in addition to being the main cause of skin aging, around 90% of nonmelanoma skin cancers –the most common type — are associated with exposure to ultraviolet radiation from the sun. These rays have the ability to penetrate through clouds and shade, reflect off of the snow, and even make it inside through windows, meaning just because you can’t feel the heat of the sun or see it turning your skin pink doesn’t mean you are protected.
I work in a warm southern climate where temperatures rarely travel below 70 degrees even in the winter, but in my career I have seen a lot of patients who moved from further north. It used to shock me that many of them believed they weren’t at a risk for skin cancer where they used to live, but I have come to realize in my twenty years practicing that it is a fairly common misconception. Skin cancer is the most common type of cancer in the United States, but even though it is one of easiest to prevent, one in five Americans will develop some form of it before the age of 70. Damage to your skin cells is cumulative, so even if you are ultra-vigilant during the summer months, by ignoring the winter months you are still leaving yourself vulnerable for the majority of your life.
Learn why the winter sun and cloudy days matter and how to protect your skin.
How the sun damages your skin
Dark spots, sagging skin, wrinkles — all of these traits considered to be a part of the natural aging process are actually caused by the skin’s exposure to ultraviolet (UV) radiation. The sun emits ultraviolet rays, and when they hit our skin they damage the elastin fibers within it, which is what causes the skin to lose its elasticity, sag, and stretch. With sustained damage, it will eventually cause the skin to bruise and tear more easily and heal at a much slower rate. The “sunburn” you know of that produces the characteristic pink and red skin that is tender to the touch is your body having an inflammatory response to UV rays damaging the DNA within its cells.
The sun emits three types of ultraviolet rays, but the two that are able to reach the Earth’s surface are UVB rays and UVA rays. UVB rays are the primary cause of sunburn and skin discoloration, and the longer wavelengths of UVA rays mean they penetrate deeper into the skin, causing wrinkles and age spots. However, both are types of skin damage that cause the DNA within the skin cells to mutate which leads to the uncontrolled growth of abnormal skin cells known as skin cancer.
During the winter, the Earth’s Northern Hemisphere is pointed away from the sun, leading to a drop in temperatures as the sun’s rays are hitting there less directly than they do in the summer. However, even though the overall amount of UV rays decreases slightly in the winter because of the angle that the sun’s rays hit the Earth, If you’re outside, you’re still at risk for skin damage. High altitudes and reflective surfaces such as snow or ice can even increase the risk further, two factors consistent with winter sports such as skiing or snowboarding.
Protect your face on the slopes
Winter is the time to head to the mountains and hit the ski slopes, do some hiking, or just cozy up by a yule log, but those higher altitudes also mean an increase in the intensity of UV rays. The higher you go above sea level, the less of the earth’s atmosphere there is to block the sunlight, and UV exposure increases by around 4% for every 1000ft in elevation you gain. This means that in a ski town like Aspen which has an elevation of 8,000ft, your UV exposure is 32% higher than in a coastal city like Miami. On top of that, snow reflects up to 80% of the sun’s rays, meaning that already higher exposure is again nearly doubled during a day on the slopes as you get UV rays from both the sky and the ground. In this way, a winter’s day in the mountains can potentially do just as much damage to your skin as a summer’s day at the beach. As I said before skin damage is cumulative, and while even just one blistering sunburn increases your skin cancer risk, after five your risk for melanoma doubles.
Go beyond sunscreen
Clothing can often be a better barrier from UV rays, as it is more consistent in its coverage and doesn’t require constant application to remain effective. Cover up by wearing earmuffs or a stocking cap to cover your ears in the cold, or a ski mask in the cold and wind. Adding a scarf can provide valuable protection to your neck and chin, gloves will do so for your hands. All of these have the benefits of keeping you warm while also keeping the sun’s harmful rays at bay, which can damage any and all parts of the skin.
However, while your face may be the only part of your body that is exposed to the sun when it’s cold, it is also the most common area for skin cancer to occur, so using sunscreen in any area that remains exposed is still incredibly important. You should be using at least one teaspoon of sunscreen to cover your face, neck, and chin, and because dry conditions and wind can wear away your sunscreen you should look for one that also contains moisturizing ingredients such as lanolin or glycerin. Finally, regardless of what your sunscreen label says you should be reapplying at least every two hours, and even more often if you are sweating or it gets wet.
Heading for warmer climates? Skip the “base tan”
One of the many myths that continues to baffle me with its prevalence is the idea that getting a “base tan” will help prevent sunburns. While you may love the golden glow indoor tanning beds can provide, a tan is a physical and biological sign that your skin is being damaged by UV radiation — which all types of indoor tanning exposes you to. In fact, indoor tanning actually gives you more UV radiation than the sun in the same period of time, greatly increasing your risk for skin cancer. The International Agency for Research on Cancer — a branch of the World Health Organization — includes UV tanning devices in its Group 1 list of agents that are cancer-causing to humans, joining the likes of plutonium and cigarettes, and more people develop skin cancer because of indoor tanning than develop lung cancer because of smoking. Whether you’re wanting to get ready for a beach vacation or just looking to add a little color to your winter skin, opt for a spray tan or bronzer and please, please skip the tanning bed.
Don’t neglect the smaller areas
We’ve already established that your face is one of the most common areas of the body for skin cancer to occur, and while you may be good about getting sunscreen on your forehead, nose, and chin, it’s important to remember that any and all parts left exposed have the potential to develop skin cancer. The lower lip is a common area for squamous cell carcinoma to occur, so you need to provide them with extra protection from the strong winter sun. Making a habit of carrying and frequently applying a lip balm with an SPF rating, providing them with protection along with preventing them from getting burned, chapped, and cracked from the snowy and windy conditions.
Your nose and ears are also often left uncovered in cold weather, giving the wintertime sun good landing spots. The nose is the most common site for basal cell carcinoma, and the sun can cause growths called actinic keratosis to appear on your ears, which can turn into squamous cell carcinoma. Remember the 1980’s when lifeguards smeared the thick white zinc oxide on their nose to protect the delicate area from the sun? These days you can find the same thick sun protectant in a more subtle transparent formula, so investing in it for your most sensitive areas is a year-round solution.
Your eyelids and the skin around your eyes are also areas where skin cancer can form, and melanoma can even form in the pigmented tissues of the eye itself. Using sunglasses will have the benefit of protecting your eyes while also fighting glare from the snow and ice. Ideally, you would be able to find sunglasses that have UV protection against both UVA and UVB rays, fit tightly, and are large enough to cover the skin around your eyes. A wraparound model would provide the most protection in this case.
Stay protected even if you can’t see the sun
Yes, the sun can damage your skin even on those days when it feels like you haven’t seen the sun in years. Although clouds do block some radiation, UVA rays have the ability to pass through them and reach the Earth’s surface — as well as your skin’s — and some studies have even shown an effect called cloud enhancement of UV radiation, in which the sun’s beams reflect off the sides of clouds and cause the radiation to become more focused as well as more dangerous. Often, you are more likely to get sunburnt on a cloudy day because the false sense of security the clouds provide cause you to be lazy with your sunscreen application as a result.
On the topic of sunscreen, the plethora of options available today can make it difficult to know where to start. When reading labels, negate factors such as price or packaging and instead look for one that has a four or five star UVA rating in addition to a high SPF. Products that are marketed towards children are often a good place to start, as they tend to provide protection that is both powerful and long-lasting. People also tend to apply less sunscreen to their bodies than lab tests, meaning they are getting less protection than the SPF rating describes. In order to fully cover the body effectively, most adults need enough to fill a shot glass, or one fluid ounce. Sunscreen should be applied 20 minutes before sun exposure, and reapplied at a minimum of every two hours.
In general, whether it’s the summer or the winter there are some consistent rules that can be followed for skin cancer prevention. Stay in the shade where UV radiation is reduced whenever possible, but especially during the brightest hours of the day between 10AM and 4PM. Avoid getting sunburned or tanning, and never use UV tanning beds. Cover up as much of your skin as possible with clothing, and use a sunscreen that protects against UVA and UVB rays with an SPF of 15 or higher on every inch of skin left exposed. Protecting your skin from the damage of the sun doesn’t take a lot of effort, and whether it’s on a tranquil beach in the summer or a pristine mountainside in the winter it’s well worth your time to get educated and stay safe.
— — — — -
Tim Ioannides, M.D. is the founder and head physician at Treasure Coast Dermatology, a dermatology practice in eastern Florida that focuses on the prevention and treatment of skin cancer. He is a voluntary faculty member at his alma mater the University of Miami School of Medicine, and was recently a senior author on two papers in the Journal of American Medical Association of Dermatology which earned one of the “Most Talked About” honors for 2018. Dr. Ioannides is board certified by the American Board of Dermatology, as well as a fellow member of the American Academy of Dermatology, the American Society for Dermatologic Surgery, and the American Society for Mohs Surgery. Dr. Ioannides is also a member of the American Medical Association and Florida Society of Dermatology and Dermatologic Surgery.