Kenneth Beer, M.D. is a board-certified dermatologist and dermatopathologist in Palm Beach, Fla., and the director of scientificskin.com, an online skincare company. He is also the director of The Cosmetic Bootcamp, which trains physicians in best practices for cosmetic medicine. Dr. Beer is an instructor in dermatology at the University of Miami, and he is an A.B. Duke Scholar at Duke University. He obtained his medical degree from the University of Pennsylvania School of Medicine, and received his dermatology and dermatophathology training at the University of Chicago. Visit Dr. Beer's office at palmbeachcosmetic.com.
 
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Sunscreen and Vitamin D Facts

Monday, 26 Mar 2012 10:52 AM


More and more studies show that people don’t have enough vitamin D, which is produced when sunlight hits our skin. Does this mean we should stop using sunscreen? Should we decrease the SPF (sun protection factor)? Or should we continue using sunscreen and take vitamin D supplements?
The truth about vitamin D and sunscreen is complicated. I don’t believe the heated rhetoric of this debate, and I believe that moderation is the best approach. Humans have evolved to live outside and get sun. The problem is that our skin has evolved in several parallel pathways so that it can get more or less sun depending on the latitude it has adapted to live in. Darker skin has evolved for more sun exposure, while lighter skin has evolved for more northern latitudes. If a light-skinned person is put in a sunny environment, their skin won't have the protection it needs and will tend to get burned. Over the long term this exposure will manifest as skin cancers, precancers, and premature aging including wrinkles.
Very few light-skinned Americans are getting enough vitamin D. This can and should be measured on an annual basis, especially for those that live in a climate that does not expose them to much sun light. If you have a low vitamin D level, you can plan a strategy that supplements it with oral vitamin D, and this can be done with your physician. There are a few different forms of vitamin D, and the one that you should monitor is called 25 (OH) D. According to the National Institute of Health, a level of about 20 ng/ mL is appropriate for most people. Having a level higher than this can predispose to formation of kidney stones because vitamin D will increase calcium absorption. Less than this level can affect bones and other vital structures.
Vitamin D levels are controlled by levels of calcium and phosphate in the blood. Each of these can cause vitamin D levels to change. In addition, a hormone called parathyroid hormone will also affect the levels of vitamin D. Finally, the amount of sun exposure governs how much active vitamin D is produced by the skin. Thus, there are many different factors governing what vitamin D levels will be and any discussion that does not mention these is overly simplistic.
Patients frequently ask me how much sun protection they should use because they are concerned about not getting enough vitamin D. My advice is that unless they work outside, they don’t need daily sun protection. I think that telling people to routinely put on sun protection every day is simply not realistic and can actually do people harm. Putting it on daily means that you are most likely using one of the products that has a low number “daily wear” sunscreen. These are not stellar for long duration sun exposure, but many people get into the habit of using these products as their sole source of sun protection. While this is adequate for walking to the car in the morning, it is not adequate for spending a day at the beach when you should use a waterproof 60 SPF. Another potential problem with the use of these products on a daily basis is the exposure of the skin to potential irritants. Finally, I simply believe that dermatologists that advise people never to get sun exposure are not taken seriously. As with every "rule" there are exceptions, and if you have a history of melanoma or risk factors for skin cancer, you should develop a sun protection strategy for your situation.
There is so much conflicting information regarding sun exposure and vitamin D. My advice is to read about it and to look at sites like the National Institutes of Health for objective information. Avoid sunburns and try to get moderate sun exposure, measure your vitamin D levels, and guide yourself according to your risk for developing skin cancer and your skin type. Speak with your internist about your vitamin D levels and your dermatologist about a sun protection plan that makes sense for your skin type and location.











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Monday, 26 Mar 2012 10:52 AM
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