Despite our best efforts, there are some skin conditions that invariably get worse in the summer. I fully understand why many of my patients come to dread the summer as a time of frustration. Maybe you can relate? They spend fall, winter, and spring clearing their skin and then watch it worsen during the summer despite their best efforts to wear hats and sunscreen. Part of the problem is due to our busy lifestyles and the increase in sun exposure during the summer months. I tell my patients they don’t have to despair; there are actions they, and you, can take beyond sunscreen and hats that will help minimize the effects of skin conditions that worsen in the summer.
In this post, my second in a series on Summer Skin Fitness, I’m going to share information on some common skin diseases that worsen in the summer and what I recommend to my patients to minimize the effects, specifically, which topical treatments they can apply to help their skin.
First, let’s look at the diseases:
- Rosacea is a relatively common skin disorder characterized by redness and fine, but visible, blood vessels on the face along with the tendency to blush easily. Rosacea is a chronic disorder but typically involves flare-ups and remissions.
- Melasma is characterized by large dark patches on the cheeks, center of the forehead, and upper lip. These dark patches can range from mildly tan in appearance to a dark color that almost looks disfiguring. While melasma is often called the “pregnancy mask,” it’s not limited to only those who are pregnant. It’s a hormone-driven disease, so individuals on hormone replacement therapy are susceptible.
- Post-inflammatory hyperpigmentation is characterized by small dark spots that range from light to dark brown. These spots are scars from acne, scratched skin, or insect bites and can show up anywhere from head to toe. The face, back, and legs are most frustrating, particularly to women.
- Solar lentigo is the medical name for a condition commonly referred to as “liver spots.” These spots love the hands and arms. Liver spots are frustrating because a patient will work so hard to achieve a youthful appearance of the face but then they look at their hands and see brown spots.
- Sebaceous hyperplasia refers to skin-colored bumps that never go away, giving skin a “cobblestone” appearance. Essentially, these are overactive oil glands that have been irritated by the sun. Sebaceous hyperplasia appears in crops. For example, a patient may get a cluster on the face and initially mistake them for acne but notice that once they appear, they never clear despite using acne treatments.
1. Use a full-spectrum UVA/UVB sunscreen. This is seemingly obvious advice, but most of my patients are surprised by what they don’t know about SPF. When you purchase a sunscreen, the number only speaks to the protection factor for UVB rays. You want to look for broad-spectrum coverage that says UVB and UVA protection. It should say “broad spectrum” right on the bottle. There is a growing body of evidence that some of the diseases listed above are made worse by UVA as opposed to UVB. Unless you have a broad-spectrum sunscreen, you are leaving your skin totally exposed to UVA light.
Select the right number for your skin. Once you find a broad-spectrum UVB/UVA sunscreen, you need to choose an SPF of 30-55. Any less than 30 and you don’t have adequate coverage. Anything after 30 and you’re not getting that much more protection. When suggesting sunscreen SPF to my patients, I factor in skin sensitivity, as more ingredients are added to increase the number. Once you have the right sunscreen it’s important to apply a generous amount. A general rule is to apply enough so that you see a coating that your skin will soon absorb.
During the day try and come inside between 11 a.m. to 3 p.m. for a couple of hours. These are the hours the sun’s rays are the strongest. Reapply your sunscreen 15 minutes before you go back outside for the afternoon.
2. Reduce inflammation in the middle of the day. When you take your midday break from the sun, there are more actions you can take to soothe your skin. If your skin is inflamed, try and get your skin into a cooler environment. Aloe vera and milk by-products all have an immediate anti-inflammatory effect. I recommend doing this even if you don’t have a burn. Anytime you heat skin, you have inflammation. Aloe vera or something with a milk by-product will soothe and abate the skin’s reaction to the sun’s rays.
3. Incorporate topical antioxidants into your skin care routine. Antioxidants help minimize sun damage. They stabilize collagen, which reduces the aging effects that the sun promotes. Antioxidants also minimize the abnormal darkening of skin brought on by sun exposure. There are many antioxidants. My favorite is vitamin C in the form of L-ascorbic acid. To find vitamin C in this form, just read the labels. Look for the ingredient L-ascorbic acid by name. I find that vitamin C in the form of L-ascorbic acid is the most stable and effective. One interesting thing to note: copper peptides, which can be found in some anti-aging skin care products, deactivate vitamin C. Just be aware that you’re not applying one ingredient that cancels out another. If you do have a product with copper peptides, use that in the evening and your vitamin C product in the morning.
4. Use a topical product to treat skin darkening. If you have darkened skin from melasma or hyperpigmentation, there are several ingredients available for you to apply topically. Arbutin is a natural lightener. It is thought to be one of the easiest to find and most effective. It’s not a bleaching agent but gradually lightens the skin and prevents dark skin from getting darker. Kojic acid and licorice extract are also available, with licorice being the safest. These are often combined with vitamin C or soy proteins. Another benefit of licorice extract is that it also has an anti-inflammatory effect on the skin. Soy is also a natural ingredient with minimal side effects and an excellent safety profile. You can find these ingredients in over-the-counter lotions, creams, and serums. I tell my patients to literally slather them on with their sunscreen. At the very least they know their conditions won’t get any worse under the protection of these ingredients.
For those who want to be a bit more proactive, prescriptions are available. Azelaic acid in prescription strength is a nice catch-all medication to fight acne and unclog pores. It also has a natural ability to fight dark spots. New formulations are being targeted toward the treatment of rosacea. With azelaic acid there is a low risk of skin irritation. It has been around for a very long time and is quite safe in a simple prescription. It’s also sun safe, meaning the sun has no effect on it whatsoever.
With hydroquinone anything 3 percent or more is, by law, prescription strength. It’s worth mentioning that when you use hydroquinone you must use sun protection. It’s sun sensitive. Ironically, without sun protection, hydroquinone may darken the very areas you’re trying to lighten. In my opinion the biggest problem with hydroquinone is that it’s under a lot of scrutiny as a possible carcinogen. Of course, the higher the strength the more likely it will irritate the skin. If you plan to use hydroquinone, use a lower strength during the summer and be absolutely diligent about sun protection.
5. Remember that there are lasers treatments that can accompany topical treatments to reduce sun damage. Laser genesis reduces darkening and keeps skin diseases from progressing while giving skin a nice smooth appearance and glow. I covered laser genesis in more detail in my November 2010 post on Laser Therapy 101. Laser genesis is perfectly safe in the right hands during the summer.
All of these topical skin treatments will help minimize the symptoms of skin conditions that are worse in the summer. I acknowledge that applying these topicals does require a little extra effort, but you will be rewarded with skin that maintains that healthy look you worked so hard to attain during the rest of the year.