of skin cancers - Canadian Dermatology Association
Transcription
of skin cancers - Canadian Dermatology Association
Dangers of indoor tanning SUMMER 2013 + Choosing the right sunscreen + Your guide to summer skin health A CANADIAN DERMATOLOGY ASSOCIATION PUBLICATION EXCESSIVE PHOTOAGING Prevent and treat deep wrinkles and other effects EARLY DETECTION You’ve been diagnosed with skin cancer. Now what? T H G I sun S N I w the your Ho affect s can eye 6) e g (Pa Sun care The best of UVB-UVA protection * This product is recognized by the Canadian Dermatology Association SENSITIVE SKIN • • • • • INTOLERANT AND ALLERGIC SKIN A stable UVB-UVA photoprotection with long-lasting efficacy A potent antioxidant Photo-aging protection Water-resistant Avène thermal spring water provides soothing and softening properties * The Skin Cancer Foundation recommends the tinted compact SPF50 as an effective UV sunscreen summer 2013 A message from the president Welcome to our premier issue! The Canadian Dermatology Association is pleased to provide you with this magazine, designed to keep Canadians informed about sun safety. Our publication coincides with the 25th annual Sun Awareness Week, held this year from June 3 to June 9. The goal of the week, and the aim of our National Sun Awareness Program, is to reduce the incidence of skin cancer in Canada. Skin cancer is the most common type of cancer in Canada, with more than 74,000 new non-melanoma skin cancers found each year. More than 5,000 Canadians are expected to be diagnosed with melanoma in 2013, with more than 900 dying from it. The number of people with a skin cancer diagnosis has been rising since the 1960s, and now those born in the 1990s have a two to three times higher risk of skin cancer than those born 30 years earlier. Luckily, both melanoma and non-melanoma skin cancer are highly preventable. Prevention begins by getting informed about the dangers of excessive exposure to ultraviolet radiation, whether from the sun or tanning beds, and incorporating sun safety into your daily routine. In the following pages you will find important advice on how to protect yourself from the sun and why you should do so. You’ll also find a list of sunscreens recognized by the Canadian Dermatology Association, information about what medications may make you more sensitive to the sun, tips on how to have great skin this summer and much more. Be sure to visit our website at www.dermatology.ca for more information on healthy skin, including fact sheets on common skin issues and even colouring pages to help children learn about the importance of sun safety. As president of the Canadian Dermatology Association, I would like to wish you a happy and safe summer. Dr. Gordon Searles President, Canadian Dermatology Association Proud partners of my skin magazine A Canadian Dermatology Association publication 18 What’s inside 4 Summer skin health 6 Sun and vision 8 Excessive photo aging Six easy tips will keep your skin looking great this summer Sunglasses don’t just keep you looking cool – they protect you from serious eye issues Learn how to prevent - and treat - the signs of photoaging 12 The dangers of indoor tanning 14 Early detection of skin cancer 18 Sun and medications 20 How to choose a sunscreen 22 Final word With significantly more UV radiation than the sun, tanning beds are a dangerous risk 12 6 Learn the signs of skin cancer so you can seek treatment if needed Your medications may make you more sensitive to the sun Choose a sunscreen that offers the protection you need One woman’s story of the dangers of tanning beds 22 A publication of the Canadian Dermatology Association, my skin is produced in co-operation with RandallAnthony Communications Inc. and Globe Edge, a division of The Globe and Mail’s Custom Content Group. Inquiries: Jennifer Scott, Communications Director, jscott@dermatology.ca; Richard Deacon, National Business Development Manager, rdeacon@globeandmail.com Points of view expressed in this publication are each author’s own work. Information contained in articles should not be considered complete and should not be used in place of a visit, call or consultation with, or advice of a dermatologist. SUMMER 2013 my skin 3 up front 1 Embrace your natural hue Ditch your plans to get a tan. A tan is evidence that your skin has been damaged: your skin changes colour as a response to injured DNA in the skin cells. Over the years, all that harm will produce wrinkles, fine lines, dark spots, visible blood vessels and even purplish splotches. Some people also get sun blisters or cold sores after a day out in the sun. This is because covers the back of your neck and choose clothing that covers sun-exposed areas. Select clothes in dark or bright colours (colours that reflect some UV light) and that are made of densely woven fabric. Wear sunscreen on all exposed areas of skin, including your hands and lips (see tip 3 on how to pick your sunscreen). Take extra care if you’ll be spending time near (SPF) of 30 or greater, are broadspectrum, hypoallergenic, nonirritating, non-comedogenic and low in fragrances. A broad-spectrum sunscreen protects against both types of harmful ultraviolet rays: UVA and UVB. UVA rays penetrate deeper into the skin, interfering with your body’s immune system and causing premature aging of the skin. 6 Six tips for great skin this summer By Dr. Ian Landells Protect your skin 2 There are a few simple rules to follow to protect your skin. Wear a hat with a wide brim that 4 SUMMER 2013 my skin water, where the UV rays can be reflected back onto your skin. 3 Pick the right sunscreen On page 21 and on the Canadian Dermatology Association (CDA) website, you will find a list of sunscreens recognized by the CDA. All these sunscreens have a sun protection factor 5 Hydrate and moisturize Your skin is always thirsty. Make sure you drink enough fluids to replace moisture lost through sweating and to keep your body hydrated. A moisturizer will help prevent your skin from drying out and is best applied when your skin is moist, such as after a shower or bath. The summer months are a great time to show off your skin. Follow the six tips below to look your best both now and in the future. too much exposure to the sun can affect the body’s immune system, leaving it susceptible to infection. For great skin now and in the future, protect it from the sun. enough sunscreen. You’ll need two to three tablespoons for your body and a teaspoon for your face. Remember to reapply your sunscreen regularly, especially after swimming or sweating – sunscreen can’t protect your skin if it stays in the bottle. UVB rays affect the upper layers of skin and are the primary cause of sunburn. UVB rays are blocked by glass (like your car window), but UVA rays are not. Overexposure to either UVA or UVB rays can cause skin cancer. 4 Apply sunscreen correctly Many people don’t apply Maintain a healthy lifestyle Your skin benefits from any habits that improve your overall health. Eating a balanced diet, exercising, refraining from smoking, managing stress and getting enough sleep will all contribute to glowing skin. Exercising increases the blood flow to your skin, bringing nourishment and oxygen with it, and sweating helps flush out impurities in your skin. Keeping your skin clean is also important, and washing your face every morning and before bed with a gentle non-irritating cleanser will keep it looking fresh. Dr. Ian Landells is the Clinical Chief at the Division of Dermatology for Eastern Health, Clinical Associate Professor of Medicine and Paediatrics with the Faculty of Medicine at Memorial University of Newfoundland, Medical Director of Dermatology at Nexus Clinical Research, and past president of the Canadian Dermatology Association. Heads up from CDA Misleading marketing claims, inaccurate product information and public perception can make it confusing to select over-the-counter skin health products. That’s why the Canadian Dermatology Association is launching a program to help consumers make better and more informed decisions. In the coming months, we’ll be introducing a new program to the public that we believe will effectively fill the need expressed by consumers and industry for evidence-based information – reflecting the most recent dermatological science – to help Canadians navigate the variety of skin care products on the market. Our Skin Health Program will be led by an Expert Advisory Board of objective medical specialists who will review product formulations and independent laboratory testing to provide Canadian consumers with reliable, unbiased guidance when selecting healthy skin care products for themselves and their families. Since 1925, the Canadian Dermatology Association has remained dedicated to providing Canadians with information about maintaining optimal skin, hair and nail health. Now we’re going a step further by empowering Canadians with the knowledge they need to make informed choices about the dermatological products they use. Our experts are looking out for your family’s health. advertisement Step inside a Shoppers and explore sun safety through to August When summer finally arrives in Canada, Canadians celebrate with afternoons in the park, days at the beach, hikes in the woods – every manner of outdoor activity. It’s great for our health and our spirits, but it also brings the danger of sunburn, and with it, risk of skin cancer. Skin cancer is the most common form of cancer in Canada – more common than breast, prostate, lung, and colon cancer combined, says Victor Wong, a Shoppers Drug Mart pharmacist and owner-operator in Toronto. Unfortunately, while the incidence of skin cancer is rising, it can be prevented, he stresses. “There are no safe UV rays, but effective sun protection can be achieved.” Wong says the answer is found in just a few simple steps: 1. Cover up. Hats, sunglasses and clothing are a must. Darker clothing and denser weaves are proven to provide the best protection; clothing with built-in UV protection is also available. 2. Seek shade. Avoid the sun between the hours of 10 a.m. and 4 p.m., even on cloudy or hazy days. Remember that UV rays can pass through windows. 3. Apply sunscreen. Always apply generously 30 minutes before going out and reapply each two hours or immediately after swimming or excessive perspiration. “The most important thing to do when choosing a sunscreen is read the label,” he advises. The SPF number stands for Sun Protection Factor. SPF 30 means you will get the same amount of UV rays in 30 minutes that you would in one minute without protection. Also important is UVA protection against aging, which means looking for “broadspectrum protection,” advises Wong. “For example, at Shoppers, we offer Canadian Dermatology Association-approved Life Brand Sunthera3 broad spectrum products, which offer protection against both UVA and UVB.” To help ensure Canadians have the sun protection they need, Shoppers Drug Mart is offering a Sun Safety Pharmacy campaign from June 1st to August 9th. “If you are planning on being out in the sun, we’re here to help with tips and advice on sun safety,” says Wong. SUMMER 2013 my skin 5 up front Sunglasses offer important sun protection. Remember your eyes By Dr. Paul Rafuse W e all know about sunscreen and other protective measures to keep our skin safe, but what about our eyes? Sunglasses keep our eyes safe from the sun and can protect us from many eye issues. There are many reasons to wear sunglasses outside, on both bright days and those with cloud cover. Ultraviolet (UV) light easily penetrates clouds, particularly in the summer during midday or at altitude. progress to squamous cell malignancies, have a preference for the corners of the eyelids. The cornea, the clear domeshaped window of the eye, can get enough of a “sunburn” that dry eye symptoms can be generated or greatly aggravated. An extreme example of this is the snow blindness suffered by skiers who forget their sunglasses or goggles. The shorter UVB wavelengths are responsible for the formation of pingueculae, small fleshy nodules at the junction of the cornea and sclera 70s or 80s who develop nuclear sclerotic cataracts. The damage probably starts in childhood. The number one cause of blindness in Canada is agerelated macular degeneration, which is caused by a number of genetic and environmental factors. One of the alleged modifiable risk factors is UVA and, perhaps, blue light. The evidence isn’t conclusive, but these wavelengths can be filtered to a large extent with sunglasses. Good general-purpose sunglasses don’t have to be expen- useful for reflected light from the road, water or snow. The colour of the lens should be grey or a brownish green. Sunglasses should be large enough to cover all the lightsensitive structures of the eye. Large wrap-around styles, or sport goggles, are the best choices for those who work or play outdoors, and a broadbrimmed hat is a good idea too. Don’t forget your children – since much eye damage begins at a young age, children should protect their eyes from the sun Given our cumulative exposure to UV radiation over our lifetime, even low levels of UV radiation have the potential to affect almost all structures of the eye and its surrounding tissues. Your eyelids have some of the thinnest and most delicate skin on your body. They are subject to the same risk of cancer as any other sun-exposed skin surface: basal cell, squamous cell and melanoma. The lower eyelid is particularly prone to basal cell carcinoma. Pre-cancerous actinic keratoses, which can (white of the eye) at the three and nine o’clock positions. Pingueculae can grow across the cornea as a pterygium, which can be cosmetically unacceptable and lead to visual distortion. Clouding of the natural lens (nuclear sclerotic cataract) is a normal effect of aging, but cortical cataracts are associated with exposure to UV light without proper eye protection. These typically occur at a much younger age (to people in their 40s and 50s) rather than the usual age group of those in their sive. However, they should filter 60 to 92 per cent of visible light and UVA rays, and 95 to 99 per cent of UVB rays. They should be dark enough to be comfortable in bright light, but not so dark to reduce your vision. Winter enthusiasts, such as alpine skiers, often carry a selection of tints for various lighting conditions. Photochromic lenses, which darken with increasing light intensity, may be adequate for moderate conditions, but may not get dark enough for very bright light. Polarized lenses are particularly by wearing sunglasses as soon as they venture outside. 6 SUMMER 2013 my skin Dr. Paul Rafuse is the President of the Canadian Ophthalmological Society and an Associate Professor in the Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia. He is a past President of the Canadian Glaucoma Society and chaired the Expert Committee authoring the Canadian Ophthalmological Society’s Clinical Practice Guidelines for the Management of Glaucoma in the Adult Eye. Voted #1 Best Feeling Sunscreen by Canadian Dermatologists *NEUTROGENA® sunscreen voted brand with best texture by Canadian dermatologists. 2012 data on file. © Johnson & Johnson Inc. 2013 1 2 3 5 6 8 SUMMER 2013 my skin 4 Feature It takes more than great genes to keep your skin looking good as you get older. All those visible signs of aging that you hear about on cosmetics ads – the fine lines, pigmented spots and loss of skin tone – often have more to do with sun exposure than they do genetics. The lowdown on photoaging T wo factors determine how our skin ages. First, there is chronologic aging, or aging caused by the natural passage of time and to some extent our genetics – and there isn’t much you can do about that. Then there is photoaging, the aging of the skin caused by sun exposure – and there are ways to both prevent and treat this type of skin aging. “Photoaging is often described as premature aging because of excess sun exposure, and it’s usually responsible for the deep wrinkling, pre-cancerous By Lola Augustine Brown lesions, leathery appearance and dryness that you see on some people’s skin,” says London, Ontario dermatologist Dr. Denise Wexler. “With chronologic aging you won’t get the same extremes, and consequently those who have had a lot of sun exposure will look older than their age.” Prevention is Key Although there are several ways that you can help improve your skin, there is no way to completely undo the effects of photoaging. What you can do is make sure that you prevent any further sun damage by wearing a hat, sun-protective clothing, sunglasses that have UVA and UVB protection (and preferably ones that wrap around your face to protect as much of your eyes as possible) and, of course, sunscreen (one that is broad spectrum and at least SPF 30). Although we all know that we should wear sunscreen, it isn’t simply a case of applying a little bit at the beginning of the day and thinking you are protected. Wexler says that when applying sunscreen, the average adult needs to use two to three tablespoons of sunscreen, and they need to reapply it every two to three hours. “Especially if you are at the beach, in and out of the water, or doing a sports activity where you are sweating The deleterious effects of the sun are responsible for up to 90 per cent of skin aging. Pictured opposite, some early signs of photoaging include: (1) sun-related keratosis; (2) pigmented spots; (3) deep wrinkles; (4) freckles; (5) age spots; (6) solar lentigines. SUMMER 2013 my skin 9 Sunburn What is it? How do you treat it? Sunburn is the skin’s short-term response to ultraviolet (UV) radiation that penetrates the skin and harms the DNA within its cells. With repeated and unprotected exposure, the damage caused by UV radiation may result in sun-induced changes such as wrinkles, mottling of skin colour and skin cancer. Signs of sunburn typically include redness and swelling, tenderness and/or irritation, skin that feels hot to the touch, and varying degrees of pain, which are all proportional in severity to both the duration and intensity of exposure. In severe cases, a person may experience blistering, second-degree burns, chills and fever, dehydration, electrolyte imbalances and/ or a secondary infection. Sunburn treatment aims to provide relief from discomfort. This can be achieved with the use of analgesics (painkillers), cool baths, aloe vera lotions and moisturizers. • Hyperpigmentation What is it? How do you treat it? Hyperpigmentation is the darkening of an area of skin or nails due to excess production of melanin caused by sun damage, inflammation or other skin injuries, including those related to acne. People with darker skin tones are more prone to hyperpigmentation. Dermatological laser procedures can sometimes induce hyperpigmentation, which is why it is important to ensure the person performing these procedures is a physician, or working under the guidance of a physician, with a greater understanding of the skin, its structure and the implications of laser use on the skin. To treat hyperpigmentation, a physician may prescribe hydroquinone, topical retinoids, topical corticosteroids, glycolic acid and other fruit acids, azelaic acid and L-ascorbic acid. Skin resurfacing using chemical peels, laser, intense pulsed light (IPL) or dermabrasion may be effective, but unfortunately risks further damage to the epidermis and formation of more pigment. Cautious cryotherapy to small areas of post-inflammatory pigmentation can be effective but may potentially cause a permanent loss of pigment. 10 SUMMER 2013 my skin While the effects of photoaging like the freckles pictured here cannot be completely undone, dermatologists can apply topical treatments and services to improve skin health. a lot, then you really need to reapply.” It is also important not to assume that because you are wearing sunscreen, you are totally protected and can stay out in the sun all day. “Seek shade,” advises Wexler, “and avoid being out in the sun between 11 a.m. and 3 p.m., when the UV rays are strongest.” Treating Photoaging When it comes to repairing the damage done by the sun, a number of options are available. Usually the first course of action is to apply some sort of cream to the skin (known as a topical treatment). There are a huge number of creams available in drugstores that contain active ingredients that have been proven to reverse ? What’s the difference between UVA and UVB? “UVB is the shorter wavelength, and these rays burn the skin and are responsible for the development of photoaging and skin cancers. UVA penetrates a lot deeper, but these rays are deceiving because they don’t burn the skin, but probably cause even more damage in terms of photoaging and melanoma development,” says Wexler. This means that even if you aren’t visibly getting a sunburn, UVA can still be damaging your skin. “For example, if you are using a tanning light that only has UVA waves, you may not have visible sunburn, but you may still be at risk of damage.” photoaging in some way, and if you visit a dermatologist, you can also obtain prescription-strength creams that will have a much more noticeable impact. “The creams that are available over the counter are not thought to be as strong, but probably do have some effect,” says Wexler. Several different ingredients are used in these products. “Topically, retinol, vitamin C, glycolic acid, tretinoin and peptides like matrixyl are useful things one can apply to the skin,” says Dr. Benjamin Barankin, a Toronto dermatologist and medical director of the Toronto Dermatology Centre. (In over-the-counter preparations, these ingredients may be listed under different names – for example, Retin-A is a form of tretinoin – or they may be listed as antioxidants.) In basic terms, these creams work by lightening the skin and stimulating the creation of healthy new skin cells while preventing the build-up of dead cells. Photoaging breaks down collagen, the stuff that gives skin its strength and holds it taut, and these treatments help build up collagen in the skin. Beyond using creams, other photoaging treatments can have a very positive effect and help reverse sun damage. “We can also perform treatments using lasers and light-based devices, as well as medicalgrade chemical peels and microdermabrasion,” explains Barankin. By consulting with a dermatologist, you can find out which course of action will best suit you and provide the best possible results. “It is hard to completely undo the effects of photoaging, but the topical treatments and services that dermatologists use can definitely improve the skin significantly,” says Barankin. “Going forward, the best anti-aging thing anyone can do is to minimize sun exposure and wear a good sunscreen properly.” Lola Augustine Brown is a freelance writer living in Halifax, Nova Scotia. Her articles have appeared in Flare, Fashion, Canadian Family, Today’s Parent and various other magazines in North America. CAPITAL SOLEIL PRESERVE THE YOUTH AND BEAUTY OF YOUR SKIN HIGH UVA-UVB PROTECTION Long-lasting UV protection with our photostable filtering system, featuring Mexoryl®, a patented filter most recommended by Canadian dermatologists.1 ULTRA-COMFORTABLE TEXTURES New Bare Skin Feel Lotion SPF 45/60 with dry-touch, non-greasy, non-comedogenic and fast-absorbing textures – so comfortable, they feel like your daily skin care. For a personalized diagnostic and advice, visit vichy.ca/capitalsoleil 1 Reference: FIFG, 2012 Canadian study among Canadian dermatologists. * AC Nielsen, pharmacies, sales in $ in Canada, 2011. ** With other filters in products: Capital Soleil SPF 60 XL cream, SPF 60 XL face stick, kids SPF 50 lotion, SPF 30 XL cream, SPF 30 XL ultra-fluid lotion and SPF 20 XL lip protection stick. NEW YOUR # 1 BRAND IN CANADA* EXCLUSIVELY IN DRUGSTORES feature Some advertisers suggest it’s sexy – but it’s not. The dangers of indoor tanning By Dr. Cheryl Rosen True or False Having a tan means I’m healthy. False: A tan is evidence of damage done to the DNA of skin cells. Not all of this damage can be repaired, and it can lead to mutations that can ultimately result in skin cancer. I can safely get a tan by using a tanning bed. False: There is no such thing as a safe tan. Tanning beds may emit 10 to 15 times more UV radiation than the midday sun, which is why your skin tans in brief sessions. Indoor tanning can give me all the vitamin D I need. False: Taking a vitamin D pill and eating food that contains vitamin D are far safer ways of getting enough vitamin D, so skip the tanning bed. Most people get enough UVB radiation from incidental sun exposure in the spring and summer. 12 SUMMER 2013 my skin D o you look better with a tan? Many Canadians seem to think so, particularly when attending celebrations such as proms and weddings. Although many Canadians seek a tan because they believe it enhances their appearance, they are risking their health in their quest. Some people are aware of the devastating side-effects from using indoor tanning beds, but seem to be willing to accept the risk. Others remain unaware of the possible side-effects of tanning and do not know that a tan is actually a response to damage to the skin. The direct link between skin cancer and ultraviolet (UV) radiation is undeniable. But did you know that indoor tanning equipment can emit 10 to 15 times more UV radiation than you would be exposed to when outdoors in the afternoon sun? Not only is the tanning industry misleading its customers into believing that using artificial tanning equipment is beneficial, they are marketing their efforts directly to our children. Industry advertisements encourage people to believe that a good “base tan” will help prevent sunburn. However, the facts remain that skin is damaged when obtaining a “base tan,” which only provides you with a sun protection factor of two to four. This certainly cannot compare to the effective sun protection found in a highquality sunscreen. The ads are directed towards the youth market for good reason. Indoor tanning is very common among teens and young adults, with over 70 per cent of Canadian females between the ages of 15 and 18 having used tanning beds. Forty per cent of female tanners between the ages of 11 and 18 have used tanning beds more than 10 times in the past year. In 2009, the World Health Organization reclassified tan- ning equipment as category-1 “carcinogenic to humans.” Tobacco, arsenic and plutonium also hold court in this category. Indoor tanning before the age of 30 increases the risk of melanoma by 75 per cent. Yet young people still use tanning beds in spite of the risk. Discount multitan packages, flashy advertising and the still common belief that a tan makes you look healthy can be very persuasive. Let’s convince tanners that no tan is sexy. Talk to the tanners you know, encourage them to skip the tan and be happy with the skin colour they were born with. Indoor or outdoor, no tan is worth the risk to your health. Dr. Cheryl Rosen is the Chair of the Canadian Dermatology Association’s National Sun Awareness Program, Head of the Division of Dermatology at Toronto Western Hospital and an Associate Professor in the Department of Medicine at the University of Toronto. advertisement Skin care treatment lightens dark spots caused by sun exposure Whether we’re young or old, we’re all seeking clear, smooth complexions. But dark spots on the skin – sometimes called age spots, liver spots or hyperpigmentation – are common, especially as we age. Age is not a primary cause, however. Dark spots can often be prevented, and when they occur, effective treatments are available. The two main types of hyperpigmentation are lentigines (“sun freckles”), caused by prolonged, repeated exposure to the sun throughout life, and melasma or chloasma, which can be triggered by either prolonged sun exposure or hormonal changes (pregnancy, hormonal treatments or while taking oral contraceptives). Melasma is usually intensified by sun exposure. Chloasma is sometimes called the “pregnancy mask,” and causes dark, smooth spots, often with uneven edges, to appear on the forehead, cheekbones and cheeks. Hyperpigmentation can also be caused by skin inflammation, such as rashes or acne, says Dr. Adam Natsheh, a Toronto dermatologist. In other cases, “certain medications can cause photosensitivity, which makes the skin more prone to solar damage.” But the biggest factor is sun damage, he says. “Practicing safe sun habits can prevent or reduce hyperpigmentation. That means limiting sun exposure between 10 a.m. and 4 p.m., covering your head with a hat, wearing light, breathable clothing and using a broadspectrum sunscreen on any exposed skin.” It’s also important to consult your doctor when dark spots occur as a result of hormonal treatments, as well as to treat -81% Before After 3 months 81% less pigmentation on average, validated by the dermatologist (DPGA score) rashes early to minimize long-lasting damage, he advises. For existing spots, treatment recommendations depend on the depth of the pigmentation, says Natsheh. For those on the surface of the skin, he recommends topical treatments, such as the D-Pigment Dark Spot Lightener by Eau Thermale Avène. The D-Pigment line lightens dark spots and prevents new ones from appearing, evening out skin tone. It combines three complementary, synergistic active ingredients: melanyde, a de-pigmenting agent derived from the Scots Pine; retinaldehyde, a retinoid (vitamin A), which stimulates cell renewal to help remove excess melanin; and pre-tocopheryl, a precursor of vitamin E that slows melanin production through an anti-oxidizing action. When applied daily, the product has been proven to reduce hyperpigmentation by 81 per cent over a period of three months, with visible effects after just one month. For deeper hyperpigmentation, options include using prescription medication, chemical peels, microdermabrasion and laser treatments to remove the dark or damaged skin, says Natsheh. Meanwhile, preventing sun damage in the first place is critical, he advises, noting that planning ahead is an effective strategy. “People often find that they get caught outside unexpectedly. Many come in with sun damage that has resulted from chronic sun exposure while driving, even if they’re just spending a lot of time commuting.” Being aware that sun damage can occur even through closed windows and keeping an Eau Thermale Avène very high protection tinted compact SPF 50 in the car can help, he says. “There are also lots of great moisturizers that contain sunscreen. Apply it every morning before you leave the house, even if you don’t plan on spending a lot of time outside.” Equally important, especially for teens and young adults, is avoiding sun beds, he stresses. “That tan may look great now, but it is causing a lot of damage that will appear over the years to come.” feature Although it is the most common cancer in Canada, skin cancer is largely preventable, detectable and curable. You can protect your health by taking steps to prevent skin cancer, learning what skin cancer looks like and taking action if you find something unusual. big e th skin cancer: C Early identification is of critical importance By Dr. Richard Langley I t is estimated that one in five North Americans will develop a skin cancer over the course of their lifetime. The incidence of melanoma, the most dangerous of the skin cancers, has increased almost threefold over the past three decades. Despite these staggering statistics, if detected early, skin cancer can be successfully treated. Melanoma, if caught in its early stages, is curable, or, when minimally 14 SUMMER 2013 my skin invasive, highly curable; whereas people with melanoma that has metastasized to the brain have an average survival rate of only four months. This underscores the critical importance of early diagnosis and prompt excision of malignant skin cancer. The most common form of skin cancer, basal cell cancer, rarely metastasizes. Still, even for this form of cancer, it is important to diagnose it early as it can be locally invasive and cause significant morbidity in patients. Why is prevention important? Skin cancer is largely preventable. The most important risk factors for melanoma include light skin colour, red or blond hair, a history of sunburns (particularly blistering sunburns), a family history of melanoma in at least two first-degree relatives and a prior history of ANTHELIOS XL The advanced UVA-UVB protection most recommended by Canadian dermatologists*. OF SKIN CANCERS DETECTED EARLY ENOUGH CAN BE CURED** Use our interactive mole checker to monitor your moles at: In the lightest textures FRAGRANCE-FREE. PARABEN-FREE. *Canadian Study, IFOP 2012 **Source: French Syndicate of Dermatologists and Venereologists, 10th March 2008. feature melanoma. Some of these risk factors, such as sun exposure, can be minimized, particularly sunburns and blistering sunburns. We also know that for the most common skin cancer, basal cell carcinoma, the most significant risk factor is chronic sun exposure. Over 80 per cent of all basal cell skin cancers occur on the head and neck, occurring in areas of maximum sun exposure. Solar radiation has been identified as a carcinogen by the World Health Organization, Self-detection works: over 50 per cent of all melanomas were selfdetected by patients. and its clear link in epidemiological studies of skin cancer underscores the importance of prevention. In general, we recommend that patients avoid the midday sun (from 11 a.m. to 3 p.m.), wear a sunscreen with an SPF of at least 30, wear sun-protective clothing and avoid artificial forms of radiation. These precautions have been shown to reduce the formation of skin cancers and are an important step that we can all take to prevent skin cancer. AppearanceLocationCauses Who’s at risk?Treatment Basal Cell Fair-skinned people with blond or red hair and skin that usually burns are most at risk. Depends on tumour size and location, as well as the patient’s overall health. Incidence increases as people get older, especially over the age of 50. Therapies include: photodynamic therapy, immunemodulating creams or surgery for large recurrent lesions. A firm, flesh-coloured or reddish bump, often with a pearly border. Classification: Skin Cancer A sore or pimple-like growth that bleeds, crusts over and then reappears. Sun-exposed areas, most commonly on the face and neck, but also on the trunk, arms and legs. Frequent severe sunburns and intense sun exposure in childhood. More men get basal cell cancer than women. Organ transplant patients whose immune systems are compromised. Squamous Cell Thickened, red, scaly bumps or wart-like growths. Grows quickly over a period of a few weeks. Classification: Skin Cancer Chronically sunexposed areas such as the head and neck, arms, back of the hands and legs. Frequent sun exposure. Areas of particular concern: the rim of the ear and the lip. Malignant Melanoma Can be a new mole or frecklelike spot, or develop in an existing mole. Classification: Skin Cancer Usually dark in colour – brown and black, and can sometimes include blue, grey and red. For men: commonly on the back. For women: commonly on the legs. In darker-skinned people, it can appear on the soles of the feet, toenails and palms of the hands. Red, rough, scaling spots. Spots may sting or itch. Classification: Pre-Cancer 16 SUMMER 2013 Sun-exposed areas such as the face, ears, balding scalp, back of the hand, forearm and leg People over 40 who’ve had a lot of lifetime sun exposure. Organ transplant patients whose immune systems are compromised. Excessive exposure to UV from the sun or sunbeds. A history of severe sunburns. Fair, sun-sensitive skin that burns rather than tans, and people with freckles and red or blond hair. If confirmed by biopsy, excision or surgery is required. People with more than 50 moles or a close family history of melanoma or a personal history of melanoma. Excessive exposure to UV from the sun or sunbeds. A history of severe sunburns. Fair-skinned people. People over 40 who’ve had a lot of lifetime sun exposure. Outdoor workers. my skin Surgical excision, radiation therapy or Mohs micrographic surgery. Outdoor workers. Can also appear on the arm, scalp or face. Actinic Keratosis Fair-skinned people. Treatments include cryosurgery (freezing of the lesion with liquid nitrogen), surgical removal and creams. big e th C What are the signs of skin cancer, and what do I do if I find something? What happens if I am diagnosed with skin cancer? Look for new or changing skin lesions, monitor them and get them assessed if you are concerned. Sustained change over the course of weeks or months is a significant risk factor for skin cancer. For melanoma, a helpful mnemonic is the ABCDEs: • A: Asymmetry in the shape or colour of a pigmented lesion Remember that most skin cancers are curable or highly curable. Your treatment options depend on the type of skin cancer you have been diagnosed with. If you have a basal cell skin cancer or squamous cell skin cancer, these can typically be cured by surgical removal of the tissue along with a minimal amount of surrounding normal skin. Certain types of basal cell skin cancers (basal cell cancers around the eyes, certain locations on the nose or a specific type of basal cell cancer called morpheaform) may require specialized surgery known as Mohs surgery. This type of surgery will remove the cancer in several stages to ensure that all of the cancer cells have been removed. For melanoma, the stage of the cancer will determine your best treatment option. Most melanomas are either in the outer layer of the skin (epidermis) or have just penetrated into the skin. In this case, the thickness of the tumour (how far it penetrates into the skin) will determine how wide a margin of normal skin you need to have removed. Patients who have thicker tumours may also require a specialized biopsy of a node called a sentinel lymph node biopsy. Although skin cancer is the most common cancer, the prognosis is excellent if the cancer is diagnosed early and treated appropriately. Keep in mind that many skin cancers can be prevented by minimizing exposure to the harmful rays of the sun. As we all enjoy the warmth of summer, it is important to remember that we need to enjoy the sun in a safe and responsible way. • B: Irregular or jagged border • C: Variegation in colours, such as shades of brown, black, red or white • D: A diameter greater than 6 mm • E: Evolution or change in a lesion as noted above Self-detection works: over 50 per cent of all melanomas were self-detected by patients. If you identify a suspicious lesion, it is best to bring it to the attention of your family physician. If he or she is concerned, they may do a biopsy (remove the lesion) or refer you to a dermatologist for examination. Dr. Richard Langley is a professor and Director of Research in the Division of Dermatology, Department of Medicine, Dalhousie University, and President-elect of the Canadian Dermatology Association. He has received numerous awards for teaching, research, clinical practice and volunteer activities. sun care + ACTIVE NATURALS® oats, clinically proven to hydrate and nourish sun-exposed skin + broad spectrum UVA/UVB protection + #1 pediatrician recommended brand in Canada* + waterproof, sweatproof trusted protection for baby and mom that’s the beauty of nature+science © Johnson & Johnson Inc. 2013 *Data on file. Feature W hen taken as prescribed, medications can help address illness and relieve pain and discomfort. Many drugs also have side effects, however, and with some, you may find that your skin is more sensitive to the sun. This means that when the drug is in your body, it reacts to exposure to ultraviolet light, causing a sunburn or skin rash. Your skin can burn in less time and with less exposure to the sun, leaving you at greater risk for skin cancer. What happens if I take these medications and go out in the sun? How your skin will react depends on each individual. Some may have severe reactions, while others have a mild reaction or no reaction at all. If your body does have a reaction, it may respond in one of two ways: you could have a phototoxic reaction or a photoallergic reaction. A phototoxic reaction can occur within hours of taking the medication. It often looks like a sunburn, and it appears only in areas of sun-exposed skin. It may or may not be itchy. In extreme cases, blisters may break out. Photoallergic reactions are more rare. These appear later, up to three days after being exposed to the medication. The time lag is because the immune system needs time to ramp up an attack against the combination of the medication and sun exposure. Photoallergic reactions resemble eczema: watch for itching, red bumps, scaling and oozing lesions. These reactions occur all over the body – not just on sunexposed skin. Like other allergies, photoallergic reactions tend to happen in people who have been exposed to the medication before. They are most commonly caused by topical medications (creams or ointments) and ingredients found in cosmetics. The important thing is to be aware of the risk and take precautions. 18 SUMMER 2013 my skin A & Q Are your medications making you more sun-sensitive? By Dr. Gordon Searles If I have a reaction, what is the treatment? Treatment depends on the severity of the reaction. In many cases, you can treat the reaction using cold compresses or a hydrocortisone cream to reduce any pain or swelling. Mild phototoxic reactions are often resolved in a week or less. It is best to discuss treatment options with your dermatologist or family doctor. What kind of medications bring on this sun sensitivity? A list of some of the common photosensitizing drugs is included below. In clinical tests, medications that include heart medications, antidepressants, antimalarials and the pain reliever ibuprofen have been found to cause photosensitivity. Note that herbal medications could also cause photosensitivity. It is best Drugs to pay attention to The following drugs are some of the most common medications that cause increased sensitivity to the sun: Anti-inflammatories: Naproxen (e.g. Aleve, Midol, Naprelan) Piroxicam (e.g. Dolonex, Feldene) Antibiotics: Tetracycline (e.g. Panmycin, Sumycin, Tetracyn) Doxycycline (e.g. Microdox, Vibramycin) Nalidixic acid (e.g. Neggram, Nevigramon, Wintomylon) Antifungals: Voriconazole (e.g. Vfend) Diuretics: Hydrochlorothiazide (e.g. Apo-hydro, Aquazide H, Dichlotride) Antiarrhythmics: Amiodarone (e.g. Cordarone, Nexterone) Antipsychotics: Chlorpromazine (e.g.Largactil, Megaphen, Thorazine) Thioridazine (e.g. Mellaril, Novoridazine, Thioril) to ask a pharmacist about your medication to see if you need to take extra precautions. Is there really a heightened risk of skin cancer if I am taking one of these medications? Researchers have found that people on some photosensitizing medications had an increased risk of non-melanoma and melanoma skin cancers compared to people not taking these drugs. Can I still go outside? Yes, but if you are taking a photosensitizing medication, extra care is needed. Be sure to follow the basic precautions: • Seek shade when possible and avoid the sun from 11 a.m. to 3 p.m. when the sun’s UV rays are at their strongest. • Wear protective clothing. Slap on a broad-brimmed hat and pick clothes that have densely woven fabrics for extra sun protection. • Wear a broad-spectrum sunscreen with an SPF of 30 or greater. • Use enough sunscreen: about two to three tablespoons on your body and a teaspoon on your face. • Apply sunscreen approximately 15 to 20 minutes before going outside to give it time to properly absorb. Reapply every two hours, or after swimming or sweating heavily. Finally, be aware that you could still be sensitive to the sun after you have finished taking the medication. Check with your doctor or pharmacist about how long you should be extra vigilant about sun protection, as this varies with each kind of medication. Dr. Gordon Searles is the President of the Canadian Dermatology Association, Clinical Associate Professor of Medicine at the University of Alberta and the Managing Director of the Keystone Dermatology Institute in Edmonton, Alberta. Clim a tic a g g re ssio ns, unsuit a bl e c osm e tics... Skin recovery cream Helping my skin to protect itself Skin Recovery Cream is now enriched with Parcerine, a patented ingredient that decreases skin reactivity. By rapidly soothing the irritation and restoring the hydrolipidic film, Parcerine guarantees an efficient, long-lasting protection and comfort to the skin. Eau Thermale Avène is the only brand that offers sterile cosmetics, the innovation that truly guarantees 0% preservatives, 0% paraben, 0% fragrance, and 0% alcohol for unequalled safety and efficacy for hypersensitive and irritated skin. PA R C E R I N E ® SPECIFIC INGREDIENT • Rapidly calms irritation Everything about sterile cosmetics • Long-lasting protection resource Learning about key sunscreen features can help you make better choices for staying safe in the sun. Sunscreen 101: Everything you need to know By Dr. Anatoli Freiman W ith one in six Canadians expected to develop skin cancer in their lifetime, skin cancer is the most common type of cancer. Yet it is also one of the most preventable. The primary environmental cause of premature skin aging and most skin cancers is ultraviolet (UV) radiation from sun exposure. UV radiation is composed of three wavelengths: UVA, UVB and UVC, of which UVA (320-400 nm) and UVB (290-320 nm) rays are specifically carcinogenic. Sunscreens are an integral element for sun protection since they work by absorbing or reflecting UV radiation. There are two main types of sunscreens: organic/chemical, which absorb UV radiation, and inorganic/physical (such as titanium dioxide or zinc oxide), which physically block UV radiation. Many sunscreens combine both chemical and physical ingredients, and they are available in a variety of forms including lotions, gels and sprays. Learning about the following key sunscreen features can help you make the best choice for staying safe in the sun: 20 SUMMER 2013 my skin • SPF stands for Sun Protection Factor and indicates sunscreen effectiveness against UVB rays. There is incremental protection with higher SPF, and dermatologists typically recommend using a sunscreen with an SPF of at least 30, which blocks 97 per cent of UVB. SPF does not indicate UVA protection or that the sunscreen is broad spectrum. • Sunscreens labelled “broad spectrum” offer protection against both UVA and UVB rays and are therefore the best choice. A critical wavelength of at least 370 nm is a laboratory measure of broadspectrum protection. • The photostability of sunscreens refers to their stability upon exposure to sunlight. • Water-resistant sunscreens maintain their SPF protection level after 40 to 80 minutes of water immersion, as determined by laboratory testing. • Sunscreens should ideally be non-comedogenic (which means they won’t block pores), non-irritating, hypoallergenic and minimally or non-perfumed. The U.S. Food and Drug Administration recently adopted more stringent regulations about labelling sunscreens ! Checklist: My sunscreen should... 1. Have an SPF of 30 or higher. 2. Offer broad-spectrum (UVA/UVB) protection. 3. Be hypoallergenic and noncomedogenic so it won’t clog my pores. When in doubt: look for the CDA Sun Protection Program logo. and establishing standards for testing the effectiveness of sunscreen products. Health Canada is also in the process of revising its sunscreen monograph. The Canadian Dermatology Association (CDA) Sun Protection Program scientifically evaluates sunscreens through independent laboratory testing, and Canadians are encouraged to look for the CDA logo when purchasing sunscreens. The CDA recommends that a broad-spectrum (providing UVA and UVB protection) and high SPF (30+) sunscreen be generously and evenly applied to the skin approximately 15 to 20 minutes before sun exposure. It should then be reapplied every two hours, or more frequently if you are swimming or sweating. In general, you will need about two to three tablespoons of sunscreen to adequately cover the body’s skin surface, and a teaspoon of sunscreen is needed for the face. Dermatologists encourage the use of sunscreen for children older than six months, while using other sun protective measures for younger infants. Keep in mind that sunscreen is only one of the many ways to ensure overall sun safety. Other strategies include staying out of the sun during peak hours from 11 a.m. to 3 p.m., seeking shade and wearing sun-protective clothing and sunglasses. Including sunscreen as part of your everyday routine will not only save you from painful sunburns, it will, most importantly, reduce your risk of developing skin cancer. Dr. Anatoli Freiman is Chair of the Canadian Dermatology Association Sun Protection Program and Medical Director of the Toronto Dermatology Centre (torontodermatologycentre.com). Earned recognition The following sunscreens and other products are recognized by the Canadian Dermatology Association Aveeno Active Naturals Protect + Hydrate SPF 30 Aveeno Active Naturals Protect + Hydrate SPF 45 Aveeno Active Naturals Protect + Hydrate SPF 60 Aveeno Active Naturals Sensitive Skin SPF 30 Aveeno Baby Sensitive Skin SPF 50 Aveeno Baby Sensitive Skin Mineral Sunscreen SPF 50 Aveeno Baby Sunscreen Lotion SPF 55 Aveeno Kids Sensitive Skin Mineral Sunscreen SPF 50 Aveeno Sensitive Skin Mineral Sunscreen SPF 50 Avène High Protection Emulsion SPF 40 Avène High Protection Lotion SPF 40 Banana Boat Baby Tear Free Sunscreen Lotion SPF 60 Banana Boat Kids Tear Free Sunscreen Lotion SPF 60 Banana Boat Ultra Defense Sunscreen SPF 30 Banana Boat Ultra Defense Sunscreen SPF 60 Coppertone General Protection Sunscreen Lotion SPF 60 Coppertone Kids Sunscreen Lotion SPF 60 Coppertone Oil Free Sunscreen Lotion SPF 30 Coppertone Oil Free Sunscreen Lotion SPF 60 Coppertone Sport Sunscreen Lotion SPF 30 Coppertone Sport Sunscreen Lotion SPF 60 Coppertone Sport Sunscreen Lotion Face SPF 60 Coppertone Water Babies Sunscreen Lotion SPF 60 Exact Cooling and Refreshing Clear Continuous Spray Sunscreen SPF 45 Hawaiian Tropic Sensitive Skin Face Sunscreen SPF 30 Hawaiian Tropic Sheer Touch Lotion Sunscreen SPF 30 Hawaiian Tropic Sheer Touch Lotion Sunscreen SPF 45 Hawaiian Tropic Sheer Touch Lotion Sunscreen SPF 60 Hawaiian Tropic Sheer Touch Oil-Free Sunscreen SPF 85 IDC SPF 30 IDC SPF 50 La Roche-Posay Anthelios Dermo-Kids Velvet-Soft Lotion SPF 45 La Roche-Posay Anthelios Dry-Touch Spray SPF 45 La Roche-Posay Anthelios Melt-in Cream SPF 45 La Roche-Posay Anthelios Targeted Protection Stick SPF 60 La Roche-Posay Anthelios Ultra-Fluid Lotion SPF 60 Face La Roche-Posay Anthelios XL Melt-in Cream SPF 60 La Roche-Posay Hydraphase UV SPF 30 Life Brand Sunthera3 Baby SPF 60 Life Brand Sunthera3 Kids SPF 50 Continuous Spray Life Brand Sunthera3 Lip Balm SPF 30 Life Brand Sunthera3 SPF 30 Life Brand Sunthera3 SPF 30 Sun Protection Lotion Face Life Brand Sunthera3 SPF 60 Life Brand Sunthera3 SPF 60 Continuous Spray Life Brand Sunthera3 SPF 60 Sun Protection Lotion Face Life Brand Sunthera3 Sunscreen Stick SPF 60 Face Life Brand Sunthera3 Sport SPF 30 Continuous Spray Neutrogena Age Shield Face Sunscreen SPF 60 Neutrogena Beach Defense SPF 30 Sunscreen Lotion Neutrogena Beach Defense SPF 60 Sunscreen Spray Recognized Sun Protection Reconnu Protection solaire Category: Sensitive skin Baby/Children Sport Neutrogena Beach Defense Kids SPF 60 Sunscreen Lotion Neutrogena Healthy Defense Daily Moisturizer SPF 30 Neutrogena Healthy Defense Daily Moisturizer SPF 45 - Untinted Neutrogena Pure & Free Baby Sunscreen Lotion SPF 50 Neutrogena Ultra Sheer Dry Touch Sunscreen SPF 30 Neutrogena Ultra Sheer Dry-Touch Sunscreen SPF 55 Neutrogena Ultra Sheer Dry-Touch Sunscreen SPF 70 Neutrogena Ultra Sheer Dry-Touch Sunscreen SPF 110 Neutrogena Ultra Sheer Face Sunscreen SPF 45 Neutrogena Ultra Sheer Face Sunscreen SPF 60 Neutrogena Ultra Sheer Water-Light Daily Face Sunscreen Lotion SPF 60 Olay Complete Defense Daily UV Moisturizer Sensitive Skin SPF 30 Ombrelle Face Cream XL SPF 30 Ombrelle Face Cream XL SPF 45 Ombrelle Face Cream XL SPF 60 Ombrelle Face Stick XL SPF 60 Ombrelle Kids Protection Milk XL SPF 60 Ombrelle Kids SPF 30 Lotion Ombrelle Kids SPF 45 Lotion Ombrelle Kids SPF 30 Lotion Sensitive Skin Ombrelle Lip Balm Anti-Drying Transparent SPF 30 Ombrelle Lotion SPF 30 Ombrelle Lotion SPF 45 Ombrelle Extreme Lotion SPF 30 Ombrelle Multi-Positions Sport Clear Spray SPF 60 Ombrelle Protection Milk XL SPF 60 Ombrelle Sport Gel SPF 30 Ombrelle Sport Lotion SPF 30 Ombrelle Sport Lotion SPF 45 Ombrelle Sport Spray SPF 30 President’s Choice SPF 30 Sport Sunscreen Lotion President’s Choice SPF 30 Sunscreen Continuous Spray President’s Choice SPF 30 Sunscreen Lotion President’s Choice SPF 50 Sunscreen Continuous Spray President’s Choice SPF 50 Sunscreen Lotion President’s Choice SPF 60 Kids’ Sunscreen Continuous Spray President’s Choice SPF 60 Kids’ Sunscreen Lotion President’s Choice Sunblock Lotion, SPF 30 RoC Soleil Protexion Invisible Touch SPF 30 RoC Soleil Protexion Invisible Touch SPF 45 RoC Soleil Protexion Sun Lipstick Velvet Moisture SPF 20 RoC Soleil Protexion Velvet Moisture Spray Lotion SPF 30 RoC Soleil Protexion Velvet Moisture Spray Lotion SPF 60 Vichy Capital Soleil Sun Protection Cream XL SPF 30 Vichy Capital Soleil Sun Protection Cream XL SPF 45 Vichy Capital Soleil Ultra-Fluid Sun Protection XL SPF 30 Vichy Capital Soleil Ultra-Light Lotion SPF 50 Vichy Capital Soleil Face and Body Lotion SPF 50 Vichy Capital Soleil Sunscreen Cream SPF 60 Vichy Capital Soleil Ultra Protection Sunblock Stick SPF 60 SUMMER 2013 my skin 21 final word “I don’t recall anyone at our graduation who wasn’t tanned. I used tanning beds every other day for about four years.” A picture of health J ackie Connors, a 39-year-old nurse in St. John’s, Newfoundland, started using tanning beds in her teens because “tans were in and everybody was doing it. “I don’t recall anyone at our graduation who wasn’t tanned,” she adds. “I used tanning beds every other day for about four years. I went to two or three different salons to get as much 22 SUMMER 2013 my skin time as possible. It was definitely addictive.” At age 20, while at nursing school, Connors learned about the signs of skin cancer, including the most dangerous kind, melanoma. A very dark, irregular, raised spot on her leg that bled after shaving rang alarm bells. After the spot was removed, the confirmed diagnosis of cancer was “completely devastating,” says Connors. She underwent further surgery to remove a wide margin of skin around the cancerous lesion. The blond, blue-eyed mother of one has since undergone treatment for two more melanomas – one on her back, the other on her neck. Back at the dermatologist’s office where she now works, Connors looks for any opportunity to counsel parents and teens against sunbed use and to tell her story. “They can’t believe what I’ve been through,” she says. “I show them the scars. “My own parents really regret that they let me use tanning beds, but no one knew much about them then. Over the past five or 10 years, knowledge about the dangers of using tanning beds has really grown. It’s important that people find out the facts about indoor tanning. Don’t learn the hard way.” FEEL PROTECTED WITH SUNTHERA3 ™ Discover our line of sun care. Life Brand Platinum Sunthera3 Face protects with a broad spectrum sunscreen that’s gentle and light enough to wear on your face and neck every day. Available in SPF 30 or 60 Lotion and SPF 60 Continuous Spray. All Sunthera3 ™ products are recognized by the Canadian Dermatologist Association. Only at Protect your face and your beauty. NEW Ombrelle Ultra-Fluid Lotion Sunscreen SPF 60 Easy daily application Ultra-light texture ✓ Ideal under make-up ✓ Non-comedogenic ✓ Vitamin E** ✓ For all skin types * Canadian Dermatologists 2012 Survey. **Cosmetic ingredient: Vitamin E (tocopherol) For women by Canadian dermatologists