Dermatologists Take Cover, Shun a Place in the Sun

At picnics, Dr. Lorrie J. Klein passes out vials of sunscreen.

At his back-yard pool in San Juan Capistrano, Dr. Richard Klimkowski has trained his children to swim with T-shirts over their bathing suits. When he and his wife watch the children play, it’s from lounge chairs strategically placed in the shade.

On rare visits to the beach, Dr. Nancy Silverberg and her two small children take shelter beneath an umbrella. And when they do venture into the sun, they stay protected, wearing not only sunscreen, but also long-sleeve coverups.

“The children don’t look that strange,” the Newport Beach dermatologist said of her caftan-clad youngsters, ages 3 and 6. “At least they’re not wearing wool sweaters.”

These are the some of the tactics Orange County dermatologists use to shield themselves, their families and friends from the summertime sun.

Party poopers? No, these professional shade-bathers said. Just prudent.

“I think dermatologists are the most careful people on earth. Every day they see what can happen to your skin,” said Klein, a Laguna Niguel dermatologist who diagnoses new skin cancer cases each week.

She and other dermatologists are acutely aware that sunburned or suntanned skin can lead to cancer 10 or 20 years down the road. And they recommend applying sunscreen every morning of the year, using it “just as you would brush your teeth,” Klein said.

“Half of a person’s sun damage is done by the time a person is 18,” noted Dr. Gerald Weinstein, chairman of dermatology at UC Irvine’s School of Medicine. He recommends minimizing additional damage by regular use of protective creams--and, where feasible, staying out of the sun.

Lately, Weinstein is seeing cancers in younger and younger patients, he said. Products of an outdoorsy, Southern California lifestyle, they have skin cancers or blotchy, wrinkled, sun-damaged skin before they turn 40.

Of course, the dermatologists readily admit, 10 or 20 years ago, when a golden tan was in fashion--and its connection to skin cancer was not widely known--they soaked up the rays just like anyone else.

“When I was younger, I used to lie out in the sun. Sometimes I got blistering sunburns,” Silverberg acknowledged. “The only thing that may have saved me (from skin cancer) is that I grew up in Philadelphia,” where serious tanning was limited to three months of the year.

But in Southern California, Arizona and Florida, where tanning enthusiasts can bathe in the sun almost year-round, there is a higher rate of skin cancer than the northeastern states. The risk of getting skin cancer increases with proximity to the Equator, where ultraviolet radiation from the sun is greatest, Silverberg said.

In high school and college, Klimkowski, now chairman of dermatology at Samaritan Medical Center in San Clemente, used to work on his tan by spending Easter break at Ft. Lauderdale, Fla., and spending summers playing baseball or at the beach.

And Dr. Ron Cotliar, chief of pediatric dermatology at Children’s Hospital of Orange County, recalled that just before he entered medical school, he honeymooned in the Bahamas and “my wife got so sunburned, we had to sleep in separate beds.”

But that was before sunscreens were plentiful and the research findings were clear--sun damage can lead to skin cancers, including a deadly, fast-moving cancer called melanoma. Characterized by dark, irritated or itchy lesions, its malignant cells spread quickly to other parts of the body, including the kidneys and brain.

Now, the dermatologists say, they work hard to protect their skin and to persuade patients, children and spouses to do the same.

That means applying sunscreens often, wearing a long-sleeve shirt, a hat and sometimes sunglasses while in the sun--and staying out of the ultraviolet rays altogether when they are strongest, from 11 a.m. to 2 p.m. (Silverberg recommends staying in the shade a longer period, from 10 a.m. to 3 p.m. every day.)

Dermatologists with young children say that so far they’re winning the battle.

“Ever since they were little, they’ve been wearing sunscreen,” said Silverberg who has made this a family habit, as important as “putting on seat belts when we go in the car. . . .” “They come to me with a bathing suit in one hand and sunscreen in the other and say: ‘Mommy, let’s go to the pool.’ ”

Conceding that “I’m a fanatic,” Silverberg also noted that every morning, before her 6-year-old leaves for camp, “I put sunscreen all over him. And there’s a little note in his backpack for the counselor to reapply it after he goes swimming.”

Klimkowski has also taught the older of his five children, who range in age from 2 1/2 months to 10 years, to apply sunscreen every day. “They know if they don’t wear sunscreen, they don’t go anywhere.” he said.

But spouses and teen-agers can be difficult, the dermatologists conceded. Silverberg noted that her husband is “not too good about using (sunscreen),” so when she can, she applies it for him.

Cotliar has “a great problem” with his 16-year-old son, he said. An avid baseball player, the youth uses sunscreen every day, but during a game or practice, “he tends to sweat and his nose gets red. I’ve been on his case all spring. If he were a cardiologist’s son, I’d have to listen to his heartbeat to detect a problem, but with skin, you can just sit there at dinner and tell.”

Cotliar said he went through a similar battle with an older son, now a 20-year-old college student. “It’s a constant conflict. The kids want to look as good as they can by being tan. They want to lie out. And there’s me yelling (about cancer). And they don’t want to understand.”

Weinstein is also trying to persuade his 18-year-old daughter to be careful in the sun. “I don’t go to the beach. My wife doesn’t go to the beach. My daughter loves the beach,” he said with a sigh. “It’s a constant problem with young people who want to be out in the sun. It causes interesting discussions in the home.”

The outcome of these “interesting discussions,” Weinstein said, is that his daughter uses sunscreen most of the time. “I can’t say what was most persuasive,” he reflected. “Her mother and father tried to educate her to the later difficulties, including the cosmetic difficulties. We think she’s a pretty girl, and we want her to stay that way.”

One major problem, Weinstein said, is that his daughter tans easily, without burning. So she doesn’t feel pain when she gets too much sun. Also, he said, “I think the kids still think that being tan is the healthy look.”

But tanning causes subtle skin damage, “at a molecular level,” Weinstein said. Though he recently led a major study showing that the drug Retin-A can reverse some of the wrinkling and roughness of sun-damaged skin, he recommends avoiding that damage in the first place.

“The less sun on the face the better,” said Weinstein, who wears sunscreen and a hat when he plays golf and tennis.

At the Cotliar household, the family wears sunscreens winter and summer, Cotliar said. And though some dermatologists avoid it like the plague, they do like to go to the beach. When they do, the boys wear zinc oxide ointment on their noses.

But Cotliar draws the line at completely covering up. He said he never wants to look like a dermatology colleague from Milwaukee--”a wacky guy who wears long-sleeved pants and a long-sleeved shirt” to the beach. “I don’t want to look like a fool,” Cotliar said.

Learn Not to Burn

The summer sun is no friend to your skin, dermatologists say. Following simple tips can prevent sunburn and more serious consequences of exposure.

Wear sunscreen every day of the year. Make using sunscreen a habit, Orange County dermatologists say--applying it each morning about the time you brush your teeth.

Sunscreen should have a sun protection factor of at least 15. The SPF ranking, devised in 1978 by the U.S. Food and Drug Administration, refers to a product’s ability to block ultraviolet radiation. For example, someone whose unprotected skin turns red after 10 minutes in the sun can remain there 150 minutes--15 times longer--when wearing an SPF 15 sunscreen.

Swimmers should wear waterproof sunscreen. And they should reapply it after coming out of the water. Anyone who engages in outdoor sports should reapply sunscreen because perspiration may remove it.

Minimize exposure to the sun. Try to avoid being out in the sun for extended periods between 11 a.m. and 2 p.m., when ultraviolet rays are strongest. Some dermatologists suggest extending the time frame from 10 a.m. to 3 p.m. If you have to be in the sun during those hours, wear sunscreen, a hat, sunglasses, and perhaps a long-sleeved shirt.

Avoid sunbathing at all times. At the beach, when you’re out of the water, sit under an umbrella; at a picnic or barbecue, find a seat in the shade.

Check yourself and your family monthly for skin lesions. If a new lesion remains for two months, see a dermatologist.

Source: various Orange County dermatologists