An Unexpected Life
An Unexpected Life
Up Your Skin Game! Guest: Dr. Eva Simmons-O'Brien
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UV damage is sneaky! Even with daily sunscreen use, you could be exposing your skin to sun damage and increasing your risk of melanoma in ways you never imagined!
For instance, did you know that your mode of travel, that refreshing margarita or even your over-the-counter painkiller can cause damage in the sun? How about the fact that you can burn through your clothes? Class is in session! Dropping today, our latest episode of An Unexpected Life Podcast.
Claire Marie Foundation Chief Medical Advisor and Dermatologist Eva Simmons-O’Brien joins us with insights and simple solutions to make sure you are sensationally sun-safe!
What You’ll Learn in This Episode
✅ How to find the UV Index for your area
✅ Hidden Travel Sun Risks
✅ How to Keep From Burning Through Your Clothes
✅ Reality of “Margarita Burn” and Other Food Risks
✅ Drugs That Enhance Sun Sensitivity.
✅ Benefits of UPF 50 Clothing, Heliocare & SunPowder
✅ Melanoma Does Not Discriminate: Why Everyone is at Risk.
✅ Hormones and Genetics; Other Factors That Put You At Risk
Links
🔶 The Margarita Burn and Other Risks bit.ly/4usJ9bf
🔶 People of Color Do Get Melanoma bit.ly/4dS73qx
🔶 Why is Melanoma Striking So Many Young Men? bit.ly/42KhSF2
🔶 Risk of Tanning Beds: bit.ly/4t280kr
🔶 Heliocare https://heliocare.com/
🔶 SunPowder https://drinksunpowder.com/
🔶 The Risks of Spray Sunscreen bit.ly/4cmxTEi
🔶 Teen Cancer America; Support for Teens and Young Adults: https://teencanceramerica.org/
🔶 Ulman Foundation; Support for Teens and Young Adults: https://ulmanfoundation.org/
Claire Marie Foundation Mission
“ The Claire Marie Foundation provides clarity and hope in the fight against adolescent and young adult melanoma through awareness, education and prevention.
Follow and Connect
🔶 www.clairemariefoundation.org
🔶 LinkTree
Hello, June. Summertime is here and the living is easy. It's time to get out, enjoy all those outdoor activities, soak up the sun, and just celebrate life as we like to do. But of course, we want you to be sensationally sun safe while doing it. Obviously, you need to protect your skin every day, every season. But let's be honest, this time of year, your skin's going to see a lot more sun than it would in January. So that's why we want to today jump into a conversation. Make sure you know how to take care of yourself in the best way possible. Because you might not realize this, but sunscreen alone will not prevent skin cancers and melanoma. Yep, it takes a lot more than that. Class is in session with one of the best experts. Today, we are going to be talking with dermatologist Dr. Eva Simmons O'Brien to make sure you know how to avoid any bumps in the road that could lead to an unexpected life. When my daughter Claire Wagenhurst was diagnosed with melanoma, she was 14 years old. We lost her at the age of 17. And to our knowledge, what we knew about sun prevention, she was doing everything right. She wore sunscreen, she never tanned. She even got checked out, had her skin analyzed to see if there was any problems. But what we didn't realize is that for young people, there are other risks as well. And she happened to be one of those who drew the unlucky card. Genetics and hormonal changes related to puberty all conspired to create melanoma in her body. It blew us away, it blindsided us, and it was something that we decided we need to share with other people. And we soon found out that other young people are at great risk as well for those same reasons. It's kind of the trifecta of melanoma risk. So before I scare you into wrapping yourself into bubble wrap and saying I'm going to hide in my basement and I'm not going to come out till winter, no, you do not need to do that. What we're going to do is empower you today, teach you all the little details that you need to know to make sure you can live a full and vibrant life. Joining us today is our chief medical advisor at the Claire Murray Foundation, Dr. Eva Simmons O'Brien. It's been a minute. So good to see you again. Nice to see you as well. You know, I could uh take a half hour just to list all your credentials, but let's just, you know, take a whip trip through them all. Of course, you are a board-certified dermatologist and assistant professor of internal medicine at Johns Hopkins University School of Medicine, and also a fellow of the American Academy of Dermatology. And I also just want to mention that I know you so well because you became Claire's dermatologist once she was diagnosed and we knew we had this disease that we had to deal with. And it's been about 15 years now since all that happened. A lot has changed, but wow, I've learned so much from you. And you've always, and again, with your partner, Dr. Diana Rlinsky, and all the others on our medical advisory have always been there to help us make sure we're getting the most accurate and up-to-date information out. And um really just help us put a focus on melanoma in in young people because they really don't get basal cell and squama cells too often, correct?
SPEAKER_01That's correct. We don't see the sun-induced skin cancers that we refer to as basal cells and squamous cells. We do not see them as often in the young, the teenage and young adult population. But I have to tell you, we we do see them.
SPEAKER_00In young people, um, everybody, we've had this discussion many times that yes, in causes of skin cancer from birth to 100, the majority will be in an older population, probably lighter-skinned people, you know, over what, 40 or 50. But in cancer, it's because young kids don't get cancer set so often, melanoma is one of the more prevalent cancers. And that's why we try to say, if you look at it in the scope of the age demographic. And there's a multitude of reasons, as I was mentioning. But you add to it the sunshine, which young people are out so much and they're autonomous. And what we try to do is educate them that if they're 16 and they're off on their own, let them understand mom's not going to be there to remind them to wear the UPF-50 and the sunscreen. But we we try to educate them, and it's been so interesting over the years to learn how sneaky UVA and UVB can be. Because we know if you're going to the beach or if you're going to the pool or you're going hiking or you're out on a court playing sports, sure, you can feel you can feel the sun. But where are some other ways that it comes in? Even when you travel.
SPEAKER_01Oh, absolutely. You can get um very strong UV rays in the car. Uh, being a driver, a passenger, even in the the back seat. Uh, you can definitely get the UV rays in an airplane. Uh, so we advise people to keep that window closed. Uh, you know, if they like to sit by the window. Um, you can get them trains. I mean, again, they come, UV rays come through glass. So you can be sitting closer than six feet in from a sofa on your sofa couch in the living room and actually get UV rays coming through, you know, your your windows in your own home. So that's why we tell people sun, sun protection, sunscreen, sunblock uh is important to wear every single day and to reapply it because it doesn't matter whether it's an SPF 30, 50, 70, 100, it's only good for two hours.
SPEAKER_00Okay, so kind of explain the SPF number differences for us because people think, oh, if I put on 60, I don't have to reapply every two hours because it's stronger.
SPEAKER_01Okay. So a sun protection factor number means uh the amount of time that you have wearing that product before typically you would burn. So the studies used to be if you would to put someone in an artificial setting like a light box and you could make that their skin burn uh in two minutes, then that sun protection factor number, SPF of 30, would mean that you would have 30 times two or 60 minutes before you would burn. If it was an SPF of 50, you would have 100 minutes before you would burn. But there's more to it than that. It depends on where on the planet you are, uh, the demographics, the geographics of where you happen to be, that it could happen sooner or it could happen later. And it also depends on your skin type. So that's where it's a wonderful thing to check the UV index. So there are lots of things that can um help you to stay safe and empower you and give you knowledge. And uh, and Marianne, I just wanted to back up and let young people know that we're not telling them that they can't enjoy and be outdoors. We're trying to, as you said, empower them and make them understand, however, that UV rays are the, you know, the biggest driver, you know, when it comes to melanoma, you know, in terms of all of it, uh all over genetics, uh, you know, environmental, everything. It's the UV light that uh the youth really can have control over and and uh you know and use precautions.
SPEAKER_00Well, and it's and it's getting more intense environmentally. We know that. So just depending on so there's these apps that show your UV uh intensity. Is that something good to engage with?
SPEAKER_01Absolutely. But even if you don't, even a lot of people don't want to have to put another yet another app on their phone. Uh you can just basically look up the UV index on on uh, you know, on the web browser and put in your age, your sex, um, estimate your skin type, what time of day it is, and where you are. And it'll give you the UV index for that particular uh place in terms of how strong the sun is and when it peaks and when, you know, and and when it's beginning to set and when it isn't as strong. And it'll give you an idea of if you have no protection on no SPF factor product on how quickly you would burn in that setting.
SPEAKER_00Well, and even like taking like road trips, because everybody's gonna be, you know, out doing more of that this summer with the economics. Well, we think it's cheaper to drive, maybe not, but you can put UPF sleeves on. Um, so I think people get confused with SPF and UPF. So SPF is sun protection factor. Yes.
SPEAKER_01And then UPF is the UPF is basically uh um basically is for clothing. Um, so it's how the sunscreen material has been woven into the fabric to make the fabric uh uh something that can protect, you know, protect the individual, whether it's a cloth, whether it's hats or visors or uh the sungloves, as you said, or jackets or pants. So um they refer it to as oh I think the use stands for ultraviolet light protection factor. And a lot of clothing is at like a UPF 38. Sometimes it's a little bit higher depending on the brand.
SPEAKER_00And just to explain to listeners, a lot of people think, well, I I I put on a long sleeve t-shirt, I was good. It's like, no, that only blocks 6% of the sun. You can burn through your clothes.
SPEAKER_01You will, which is they've estimated that a professional baseball player's cap is about an SPF of seven. So if you go back to what I said about putting that person in a light box, and if you can make their skin turn pink in two minutes, then a baseball cap might just give you 14 minutes of protection, which is nothing.
SPEAKER_00So what we ingest can help or can hurt us as well. So let's talk about some over-the-counter medications, makes your skin more sun sensitive, like if you take a leave or advil or a painkiller, right? Some of those can affect what else?
SPEAKER_01Antibiotics. And we know that a lot of our teens and young adults uh might be being treated for acne or or Lyme disease or some condition that requires an antibiotic. So uh there are the tetracycline class of antibiotics, the doxycyclines, the minacycline, tetracycline itself, although it's less given these days, but it does make people, all of those medications make people uh photosensitive. Um, so that that's a big one. Um, ciprofloxicin actually can. So the antibiotic class is probably the most common. And then, like you said, the non-steroidals uh can also do that. Um, I believe some of the anticonvulsants, but you know, less commonly used. But the antibiotics are pretty commonly used. So that that would be of concern in terms of medications.
SPEAKER_00And and even if if somebody's fighting cancer, that cancer therapy can so anything you're ingesting in that nature, you should be asking your pharmacist, your doctor, if it has an impact before you go out in the sun. Not again that it keeps you from it. Yeah, just maybe wear sunscreen and UPF, right? Just to make sure double protection.
SPEAKER_01Sulfurs can as well. But foods, there are certain foods that you can eat that can make you more photosensitive. So give us some ideas, celery. Uh there they're called fumo coumarin plants. Okay. Uh, and they're plants that if you ingest them, um they activate the light, they can be activated by light rather, and make you more photosensitive. So that can be celery, that can be uh from the yucca plant, um, it can be parsley, fig. That is probably what is going to be more common in this country. If you go to the islands, um cashew uh fruit, uh, you know, from the from the tree that they actually get cashew nuts. Uh so ingesting some of these uh things can uh lemons, limes, limes more so than lemons, uh can make you photosensitive. Uh, Dr. Alinsky and I always see people with blisters on their chest after they've been to Mexico. And they've they've they've enjoyed a little bit too much tequila and in lime. I'm not saying that the adolescents at all, but we do see young adults too, or adults.
SPEAKER_00And all the stuff we talk about, we always put our focus on young people because nobody else was. But all this information applies to everybody who has skin, which is that but on the point, hey, margarita time, but cocktails, drinking alcohol in the sun can also make you more sun sensitive, correct?
SPEAKER_01Yes, it absolutely can. These are all the things, again, just to be aware of. And and I think that, you know, people uh oh, but I wanted to mention the polypodium leucatonus, if that's not jumping the gun. Uh, that there is something you can ingest that is a supplement that actually has very good science behind it, uh, that's been around now, I'd say, probably at least 30 plus years. Uh, it's a fern that was initially discovered in the Amazon that has shown to be a very powerful uh um antioxidant in that it helps with uh getting rid of oxygenated-free radicals and helping to make your experience in the sun a safer one. So in other words, people can get it, uh product called heliocare. Yeah. Heliocare. And there are other products that are um that have this fern, which is polypodium leucatonis, in it. But heliocare is one of the is the go-to for us. They have two formulas. They have a plain and an advanced for uh older adults that have uh that has niacinamide in it, which has been shown a B vitamin to help prevent uh squamous cell carcinomas. But there are other formulations.
SPEAKER_00Yeah, you can just get that over the counter at the pharmacy. Yes, where you and then so can you consider it an internal sunscreen? Not that it negates wearing sunscreen, but is it a tandem approach to sun protection?
SPEAKER_01Yeah, I I think one should really consider it as an antioxidant that really helps to protect you from UV exposure. Okay. And again, it helps. It's one of the tools in the toolbox, as my partner says. It's not the only, it's not the only thing because some we don't ever want to give people the false sense of security. Just take the supplement and you don't need your sunscreen, you don't need your uh UPF clothing. No, you need all of it.
SPEAKER_00Yeah, absolutely. So it is, it is it is understanding everything, getting that tool chest full, as you said. The FDA opened the door to some new sunscreens in the last year. So, what you know, yes, you should choose a mineral based. There's all this discussion, particularly with the Gen Zers, who for some reason think they need to listen to TikTok rather than you guys, uh, that suggests you shouldn't wear sunscreen, that it's toxic, but we know cancer is toxic, not sunscreen. Can you explain that and how that all works in with these new uh sunscreens that are now available? What should we look for? What's a good choice?
SPEAKER_01Well, that's a very good question. And in our practice, we still favor the micronized zinc preparations, uh, preferably micronized zinc alone, but some of them still contain a little titanium. And not that that's a problem. It's just that those products might be thicker and might have a cast. But micronized zinc now can be formulated that can really work on any skin type from type one through six. And you want a zinc oxide percentage that is at least 10% or higher. Um, the newer sunscreens that, well, it's it's not so much the newer sunscreens, but there are newer filters that have been approved by the FDA that can be put in sunscreens that have been widely available in Europe and in Asia, just not in the United States. So they're gonna allow manufacturers in the United States to start making um, you know, these sunscreens that have these particular filters in them, which a lot of my colleagues believe are superior than the ones we have. Um, however, they're still chemicals, that's my understanding. And we have yet to see whether or not they um will be uh irritating or not, possibly less irritating, because that's our personal biggest beef, uh, Dr. Linsky and I, with sunscreens, chemical sunscreens, and we'll be the first to say, look, wear that, that's better than nothing if that's all you have. But if you have the choice, we prefer the uh the mineral blocks over the chemical sunscreens, because chemical sunscreens are absorbed into the skin. And for some people, uh they can be very irritating. So people who are uh genetically predisposed to eczema, uh, they can also be acneogenic. They can make acne worse, and we have seen this. Whereas the zinc products uh hover over the skin, they don't fall into your pores.
SPEAKER_00Okay. All right. So again, consumer buyer, beware if you have questions. Ask dermatologist, what do you recommend? But again, go to a medical expert, don't take it off of an influencer uh who's trying to, as I say, get followers and get paid. That's not quite what it works. There's other aspects um in young people in particular, and again, this applies to everybody that that I really want to touch base with you because, for instance, men, young men in particular, think this is a chick thing, that uh that their skin doesn't need to be protected, and and they're seeing elevated levels in young men um as well as women. What be combined with that, and then people of color who think they're invincible because they have uh more melanin in their skin, can you address those concerns?
SPEAKER_01Yeah, we have always said that melanoma doesn't discriminate and uh in any way, shape, or form. So everyone, if you're a living, breathing human being, uh everyone is at risk, uh, whether you are an infant or whether you're a centurion. So they really should not feel that way. Uh, I think maybe it's, you know, the thought used to be that possibly women might have had more melanomas than men, but I don't think that's that's ever, you know, should proven at all. Um, and I don't think anyone can ever say that. In fact, uh, I don't know if those studies were originally from Australia or not, but I think men and women can uh and children, you know, everyone can get melanoma. So we we know that. And I think if you're fairer skin, lighter eyed, lighter hair, uh you could be at increased risk because of that in terms of how UV exposure affects you in that way. But again, it's it's about uh, you know, cumulative light exposure and where you've been living and what you've been doing, that it doesn't matter if your skin is darker, you could still definitely be at risk because if the skin has been burned and the skin has formed abnormal DNA cross-linking, and that is what happens when the skin is burned, it can go on from there and can affect the moles that you have on your skin adversely. Or as we know all too well, melanoma can just show up, you know, as a brand new mole, a mole that you've never had. You might be a person who really doesn't have many moles, and all of a sudden you you get a get and see a melanoma on your body.
SPEAKER_00And morbidity in people of color, because perhaps they think they're not at risk, they don't notice it, they don't get screened, and then by the time it's found, it's more advanced. Is that not?
SPEAKER_01Yeah, that's correct. So a lot of it's education and awareness, not realizing that you know they are at risk. And then even if they are aware that they can get melanoma, it's it's unlikely because they are uh they have more, uh, they have melanated skin. But we encourage our patients to uh to wear sunscreen, to reapply sunscreen, uh to really um you know cling to those. Sun safety, good habits of using SPF protected clothing. I was glad to see that sun powder, which I think is a version of Sunguard, is back out on the market where you can actually put this, sprinkle this powder into your laundry detergent and have it convey photo protection just to your normal clothing, because we know that not everybody has, you know, the finances or the or the availability or accessibility to get the um you know the UPF clothing. So that's something that's um now being sold online and in um grocery stores like it used to be. Um the old product was called Sun Guard and now it's called Sun Powder. And you can just put it into your wash. And I think it the clothing is good for four wearings before you need to do that again. That's fantastic. But to get back to your point, everyone is at risk. So there really shouldn't be that thinking. I don't know, maybe it's uh young men feel that we do know women go to tanning beds more than men do.
SPEAKER_00I'm just trying to think conversation um that just came out uh with Kennedy saying that it should be a personal choice and that young people should not be limited. Uh to clarify with the science, it it can you explain uh how the damage in a tanning booth one time increase your risk 75% of development. One time. That's if you, you know, if it just and again, some people can go many times and it doesn't happen, but that doesn't mean you should take the risk. But how do you the color comes out so quickly because the epidermis damage is so intense? Is that correct way to put it?
SPEAKER_01Well, it's it's actually the color doesn't come out as quickly, and I think that's what makes it even more damaging. It's it's a slow bake. What saves us when we go outside from from more catastrophic skin changes is the actual heat uh that we get from the UVB, you know, the temperature and the UVB light. That's your immediate light. That's what makes you dark immediately. Like you've spent 10 minutes in your garden and you come back and you see you're already brown or pink or what have you. Um, that's the light that peaks in 24 hours. It's the UVA light that is the wavelength that peaks over 48 hours and actually is a what we call a slower bake. And what you can fool yourself into thinking, oh, I did not get that much light. But you can come home from a vacation where you've been in a very sunny place for a week and continue to get darker while you're at home, at work, and school, because you're you're you're you're what's basically happening is all those days that you spent on vacation are now peaking at their 48 hours with that UV exposure. So uh so getting back to tanning beds, tanning beds are UVA lights. Uh so they are what I think are the the more dangerous lights because they're the ones that are more tolerable temperature-wise, but they're the ones that are more like a slow cooker.
SPEAKER_00And you're not going to wear sunscreen if you're going in. So you're doing nothing to protect your skin.
SPEAKER_01Well, I have never been to one, and uh my my children have never been to one. Um, and uh, you know, most likely are they not wearing sunscreens when they when they're gonna be able to do it.
SPEAKER_00No, that's that's the process. They don't wear sunscreens and it it it causes addiction in the sense that uh the brain responds to the feel-good and it brings them back, and um it's just so damaging. And it just, you know, we just urge people, uh, your personal choice should be a wise one and and and not take take a risk on on that.
SPEAKER_01And uh Dr. Alinsky and I feel that many of our patients, you know, uh when we've had those pay, I shouldn't say many of our patients, when we've had patients who really are want to tan and be in that tanning bed, we always wonder if maybe they are uh suffering from seasonal affective disorder and they actually, you know, would have done well if someone had talked to them about that and got more of an understanding about why it makes them feel good, because you're absolutely right. People will say more than the color of their skin and how they look, it makes them feel good. So what is it about that? And and maybe these are people who would do well with, you know, different lights in their home because this is what they call sad lights, you know, because they really do suffer uh, you know, from you know, uh not feeling like they're getting enough light in their life.
SPEAKER_00Are you gonna get vitamin D from a tanning booth or from outside? Do you know?
SPEAKER_01Um that's a good question. I don't know. I I would think that you probably get D from direct sunlight. Right. Because I think it it I I believe that the mechanism takes all of the wavelengths, but especially B to help to uh for help one to make it in their skin if they are of you know uh a certain skin type, because I would say skin types four on five and six uh really don't make vitamin D in their skin. Uh the sun drives, you know, uh the sun effects go straight down into the dermis and bypass the top part of the skin, which we call the epidermis, and that's where the vitamin D is made. So that's why so many individuals who have uh of color or melanated skin are vitamin D deficient.
SPEAKER_00Right, right. And you can also get supplements for that. Yes. And you don't have to be tanned to absorb it from the sun either. You just need to be outside safely, and that that takes care of it all in all. One last topic just to to to dance around and to address a bit. And again, I always say this cautiously, that the factor that Claire went through and the fact that we know and and we've profiled young women who have developed it while pregnant, doesn't mean every pregnant woman is going to develop melanoma. It doesn't mean that every child going through puberty will have an issue, but it is something to understand as a possibility and a consideration, right? That if you have a history in the family, maybe if you're pregnant, get screened at the beginning, keep an eye on your body. What do you advise about that?
SPEAKER_01Well, we encourage people to learn as much as they can about their family history in general and and and know whether or not there has been a history of uh sun-induced skin cancers and um melanoma in their family. All you know, all of that's super important. And if they don't know, we we encourage them to talk to members on both sides of their family and find out. Because, yes, your your genetics can put you at risk. And even if you don't, even if you haven't had a family history of melanoma, thankfully, but you are an individual who has a lot of moles, because we know that just more than 50 moles can put you at risk for melanoma, that uh say being an expectant mom, estrogen is is a hormone that can uh increase melanogenesis. So it's it's not uncommon to see, you know, women when they're pregnant to get even more moles. So they had a lot to begin with, and they got pregnant and they got more, and they've had two, three, four, you know, kids. So they continue to get moles. Well, that and that continues to increase their risk just by having you know more moles, which means that they need to, you know, be thoroughly examined by their board-certified dermatologist, you know, on a yearly basis and sometimes twice yearly, depending on whether or not they've ever had biopsies and where the moles, even though benign, were beginning to look a little bit what we refer to as atypical or dysplastic.
SPEAKER_00Right. So just know your body, know your family history, know it's more than just wearing sunscreen that you have to enhance that. But you don't have to, as we said, just hang out in the basement and bubble wrap. You can go out, you know, you play tennis, you're active, go out, have a wonderful, happy life, but just and get skit checked once a year. That's really, really essential to do.
SPEAKER_01Very, very important. And and and like I'm sure you've said with many of your other guests, make sure that your dermatologist is uh using a dermatoscope. Um, the field of dermoscopy has been a breakthrough, and we continue to learn and it continues to evolve in terms of us learning uh pigment patterns in the skin. So that is a not a magnifying glass, it's not magnifying head loops, it's actually a handheld device that is pressed to your skin that the dermatologist should be looking through and should be saying that they're looking to see the pattern that the pigment is leaving in the mole, not if that not how big the mole looks or not the texture. It's the pattern of the pigment or the lack of a pattern.
SPEAKER_00So if your dermatologist doesn't use dermoscopy, then find a new derm, right? Absolutely. Okay, yeah. Advocate, be in control, don't be afraid to question and challenge, you know. Dr. Simmons or Brent, thank you so much for all of this. You're always such a wealth of information. And I just appreciate it.
SPEAKER_01Thank you for asking me. Thank you for all of what you do to educate people and to make them aware of this, you know, horrible, uh, potentially deadly cancer that we can prevent. Your daughter was an angel.
SPEAKER_00Thank you. Yeah, I'd like to say Claire's still out there doing her. Still is an angel. Thank you so much. Uh, for more information on what we've discussed here a day, of course, please go to our website, ClaireMarieFoundation.org. There'll also be a lot of links in the notes to this podcast. You can find it there. And just a quick word of thanks to Castle Biosciences and Children's Cancer Foundation for supporting this podcast and our mission. We simply could not do it without you. Till next time, have a fabulous day. Adventure awaits. Go have a wonderful summer and live life like Claire. Thanks so much. See you next time.
