BLOG BY Dr Ruth Cammish

Taking Care Of Your Skin Health

What images does summer bring up for you? Socially distant evenings on a picnic blanket with a tin of your favourite cocktail, wistful memories of festivals and glowing skin or perhaps, sweaty nights with heat rash, nose streaming and feeling like a burnt lobster? Summer is a glorious time for most of us. We’re more likely to spend time outside in nature, which can boost our endorphins and lower our stress levels1. The longer hours of daylight have positive effects on our sleep hormone, melatonin and also our happy hormone, serotonin. However, our skin has different challenges to face, so here is a definitive guide to staying safe in the sun and keeping your skin healthy this summer.

Looking after our skin is the sun is the essential first step to enjoying the warmer weather. The sun emits bands of light called UVA and UVB all year round. UVA is associated with skin ageing and UVB with skin burning, but both contribute to our risk of skin cancer. These UV rays make their way through clouds and glass, therefore, our skin needs protecting even when we’re inside. The UV index tells us how strong the sun rays and when we’re at most risk of sunburn. The index is higher on sunny days and we need sun protection when it is over 3 and to avoid the sun altogether when it’s between 8 and 102.

Tip most weather apps include the UV index so use this as a guide for when your skin needs sun protection.  It’s usually high between 11am and 3pm.  Beware of UV reflectors like sand which can double your UV exposure, making burning more likely.

Culturally, darkening of the skin from tanning can be either undesirable or highly coveted; splashed over magazines as the ultimate beauty goal. Either way, tanning is a sign the skin is already trying to protect itself.  Melanin is the pigment that gives skin its natural colour which shields the skin cells from UV rays. Essentially, if you have a tan, your skin is already damaged!  The first step in sun protection is avoiding sun when the UV index is high.  Pretend you’re in the south of France with a wide brimmed hat, sunglasses and a parasol; these physical barriers keep the skin protected too.

Tip which parts of your body tan the quickest? These are the areas that you need to protect first.  Your nose, back of the neck, tops of the ears and shoulders.  Interestingly, these are the areas we commonly miss when we apply SPF! 

There are so many confusing myths when it comes to SPF and sunscreen.  Let’s keep it simple; SPF (sun protection factor) is the measure of how much UV gets through to our skin. As UVB causes burning, SPF tells us how much longer we can stay in the sun compared to if we had no sunscreen on.  However, we want to protect our skin from ageing as well as burning, so look for a sunscreen with both UVA and UVB protection. Our skin colour and type predict how quickly we can burn. Darker skins have an inbuilt SPF of around 13 but you should still aim to wear a minimum of factor 30 to prevent skin cancer and premature ageing. Generally, we are terrible at applying sunscreen and studies show we apply about half the volumes that are needed for adequate skin protection3. ‘More is better’ is a good place to start and reapplying SPF every 2 hours means you are getting the protection stated on the bottle. To cover your body, a minimum of 6 teaspoons is needed. Half a teaspoon for your face and neck, one teaspoon for your arms, one teaspoon for each leg and one for the front and back of your body.

Tip SPF should be the last product you apply to your skin 30 minutes before sun exposure.  SPF in your moisturiser or make up isn’t enough as you rarely apply the amount needed for adequate protection.  Buy new sunscreen each year as the SPF degrades over time.

Why do we want to avoid getting burnt? In the UK there are 100,000 new cases of skin cancer diagnosed every year4. Sun exposure is responsible for the vast majority and 4 out of 5 cases are preventable. More than five episodes of burning in your lifetime, increases your risk of skin cancer (melanoma) by 50%, so protecting our skin from the sun is an absolute priority. Anyone can get skin cancer and although melanoma is less common in those with darker skin, it can be much harder to recognise, so may be diagnosed much later. Skin cancer is more common on areas that are sun exposed, like the face and neck.

Tip Most moles are harmless, coloured spots on the skin but see your GP if they change in anyway.  Look out for changes in colour, a ragged border, irregular shape or if they start to grow bigger.  Bleeding, itchiness or crusting is also a sign to get them checked. 

What about vitamin D? This powerhouse vitamin regulates calcium in the body and helps keep bones, teeth and muscles healthy.  Sunlight helps the body make vitamin D and it can be hard to get enough solely from foods (oily fish, egg yolks, fortified products and cereals). There are conflicting results from studies which have examined if sunscreen blocks the body’s ability to make Vitamin D, but general consensus is SPF is essential to protect our skin5. Generally, if the skin is exposed to sun on the face and arms during the year, the body is able to produce enough vitamin D.  However, those with dark skin tones may not get enough vitamin D from sunlight alone, so current guidance is for all children over five and adults to supplement during autumn and winter and all year round for those in high risk groups6.

Tip Sunbathing for Vitamin D is not recommended because of the risk of skin cancer, so this is one of the few circumstances where supplementing with a vitamin is better than getting it from food.  10mcg a day is enough for most people.

When heat and humidity are high, the sebaceous glands produce more oil and pores open, leading to congestion and spots. If your skin feels greasier, it’s time to make some changes to your skin care. These will be different depending on your skin issues, but generally lotions and more lightweight moisturisers lie easier on our skin in the heat. Heavy or oil-based cleansers may feel too heavy. For brighter and smoother skin, exfoliation can remove debris and dead skin cells which lead to a duller complexion. Summer is a good time to try a Vitamin C product which prevents hyperpigmentation, improves the appearance of fine lines and helps collagen production.  It’s not just sun that damages our skin and accelerates the ageing process; air pollution and smoke can break down collagen too.  Vitamin C can act to neutralise this damage as a powerful antioxidant and reduce inflammation in acne and rosacea7.

Tip – make small switches to your skin care as the weather gets hotter, look for non-comedogenic makeup and consider a light-weight foundation or tinted moisturiser.  Add in a Vitamin C serum after cleansing, before moisturiser, to help protect against UV damage. 

With more skin on show, people with chronic skin conditions can feel more self-conscious. With enhanced photos in the media of ‘perfect’ skin, we can often chase an ideal which isn’t real. 13 million of us go to see a GP each year for a skin complaint, so you are not alone. These psychological effects of skin disorders are rarely discussed8 so if your self-esteem or mood is affected, please open up and see your GP. The key to managing your skin condition is preparation. Does your skin react when it's hotter? Do you notice a flare when the pollen count is high? These are your triggers and knowledge IS power.

Eczema is a chronic skin condition causing dry and irritated skin. As the temperatures rise and air conditioning is in full flow, the skin barrier can become more dehydrated, leading to uncomfortable and itchy skin. Most eczema sufferers are also atopic, meaning hay fever and asthma are common. The immune system is more allergic so common triggers in summer are pollen and new products like sunscreen. When the skin barrier is inflamed and dry, it allows irritating particles to enter the skin causing itching.  Poor sleep on warm nights can also lead to irritation.

Tip – Emollients are key to maintaining a protective skin barrier. Try switching to something lighter and keep skin cool with more natural fibres like cotton.  Patch test any new sunscreen and wash off chlorine or salt after swimming with tap water.

Acne is characterised by comodones (blackheads and whiteheads) and pustules on the skin. Although UV light reduces inflammation on the skin, sweating and higher humidity can lead to more blocked pores and more oil production.  Some antibiotics and topical acne treatments like isotretinoin, can cause skin to become more sensitive to sunlight.  Therefore, avoiding direct sun exposure and using a high SPF is advised.

Tip Switch to gels and oil free products, especially sunscreen. Shower straight after exercise if you notice your body acne flaring and consider a salicylic or tea tree body wash.   Keep up cleansing twice daily in summer as sunscreen and sweat can block pores and cause spots.

Rosacea commonly occurs on the face and is more common in women and those with fairer complexions. Common triggers are alcohol, caffeine, stress and extremes of temperature. However, UV light is the major trigger for over 80% of rosacea sufferers. Wearing an UVA and UVB SPF of over 30 all year round is essential and consider a higher SPF when the UV index is over 7.

Tip Mineral sunscreen containing zinc oxide or titanium dioxide is usually tolerated better. Reapplying every 2 hours that you are exposed to the sun ensures good protection. Taking cooler showers in the hotter months can help avoid a flare.

Even those of us without a chronic skin conditions, can experience skin changes in the warmer months from allergies to pesky bites. Approximately a third of people in the UK report hay fever symptoms, which means a large number of us spend the summer with itchy eyes and a running nose. There are 3 main types of pollen in spring and summer – tree pollen March to May, grass from May to July and weed pollen from June to September.  Keeping track of when your symptoms start, can point towards which you are sensitive to.  Starting a regular antihistamine, nasal spray and eye drops before that pollen season starts, can help reduce your symptoms.  Avoid grassy areas in the early morning or evening when the pollen count is higher and check out the pollen forecast on your weather app or on www.metoffice.com. As well as grass pollen peaking in summer, so do insect bites; leaving us with itchy bumps commonly on our legs or arms.

Tip – Pollen is sticky!  It sticks to your clothes after you’ve been outside and to washing on high pollen days.  Change your clothes and shower when coming in and avoid drying clothes and bedsheets outside, if you are sensitive. For bites, prevention is better than cure with insect repellent and covering exposed skin, especially at night.  Insects are attracted to sweet or strong perfumes.

Does drinking more water plump your skin? Well, although drinking more doesn’t necessarily lead to positive effects on skin hydration, dehydration can cause a dull complexion. There’s no good evidence that drinking more water reduces wrinkles or makes the skin smoother, but in summer we sweat more, meaning we need to drink more. Stick to the NHS recommended amounts of 6-8 glasses per day and more if you are exercising or sweating. Alcohol is a diuretic, meaning it makes you pass more urine and leads to dehydration, facial flushing and puffy eyes the next day. Although the skin can bounce back from the odd boozy day, over time it leads to the skin becoming red, inflamed and prematurely aged.

Tip – water doesn’t just come from what we drink, filling up on juicy foods like cucumber and melon adds to your water intake.  Alternate with non-alcoholic drinks and stick to no more than 14 units a week, spread over more than 3 days.

There are various vitamins and minerals that the skin needs to keep healthy, so a varied diet that’s good for your health is good for your skin.  There’s no magic bullet or one supplement for glowing skin, but ensuring your food is colourful is a great start. The antioxidants in fruit and vegetables help prevent skin damage9. Healthy omega 3 fats from oily fish, nuts and seeds are vital building blocks for the cells that make up your skin barrier.  Eating 30 different plant-based foods (fruit, vegetables, nuts, legumes) has been shown to be good for our gut health, which research shows is linked to skin conditions like eczema and psoriasis10.

Tip Summer is a great time to try new foods. All the essential nutrients the skin needs can be found from a varied and diverse diet.  See if you can get to 30 different plant-based foods this week.  Challenge yourself to ‘eat the rainbow’ with lots of red, yellow and purple foods which are packed with essential vitamins and phytonutrients, which the skin needs to function.

Summer is here to be enjoyed! The #skinpositivity movement encourages us to move away from the shame of imperfect skin towards accepting the skin that we’re in.  Trust that no-one is looking at your skin in the same magnified detail that you do.  ‘Don’t forget to drink water and get some sun; you’re basically a houseplant with more complicated emotions’ and slap on that SPF too, your skin will thank you for it.

This blog post was written by, Dr Ruth Cammish who is a GP and an eczema patient. She is the British Society of Lifestyle Medicine director for Manchester. She is passionate about holistic health and fascinated by the emerging research about the gut microbiome. You can find her on Instagram @drruthskinjourney 

References

(1)  Hunter, R. Urban nature experiences reduce stress in the context of daily life based on salivary biomarkers.  Frontiers in psychology, 2019.

(2)  World Health Organisation.  Ultraviolet (UV) index, a practical guide, 2017.

(3)  British Association of Dermatologists.  Sunscreen factsheet, 2013.

(4)  Cancer research UK, melanoma skin cancer incidence statistics, 2017.

(5)  Passeron, T.  Sunscreen photoprotection and vitamin D status.  British Journal of dermatology, 2019.

(6)  Public Health England.  Vitamin D and health report, 2016.

(7)  Pullar, J.  The roles of vitamin C in skin health.  Nutrients, 2017.

(8)  Thompson, A.  British Skin Foundation survey, 2019.

(9)  British Association of UK Dieticians. Skin health: food fact sheet.

(10)  Valdes, A.  Role of gut microbiota in nutrition and health.  BMJ, 2018.

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