The Great Sunscreen Controversy

The title of this post is a bit misleading because in my mind there really is no controversy. Based on the available evidence, sunscreen is not a danger to your health. But we know that not wearing it is!

There has been a great deal of media attention recently following the release of the Environmental Working Group’s (EWG) annual sunscreen guide, which called out several brands for “inferior sun protection” or worrisome ingredients. While I believe EWG is trying to work in the public interest, unfortunately the way this information is often reported can be counter-productive to public health when it leads to people exposing themselves to harmful UV rays because they are unnecessarily worried about the sunscreen they’ve been using.

One of EWG’s favorite targets is the chemical oxybenzone, which they claim can be carcinogenic. A study in rats showed possible estrogenic and antiandrogenic effects with exposure to a high dose of oxybenzone. However, it was estimated that it would take 277 years of daily application of sunscreen to reach the same level of exposure in humans. The safety profile of oxybenzone is supported by both the US FDA and Health Canada.

Unfortunately the EWG test methods lack the rigor of peer-reviewed, scientific evaluation. Oxybenzone has been used in the US since the 1970’s with prevalence of exposure estimated to be 96% of the population. And the Canadian Cancer Society has already issued a statement refuting the cancer-causing claim.

EWG also makes the claim that sunscreens labeled with SPF values higher than 50 do not provide additional protection. The fact is that most consumers do not apply sufficient sunscreen, generally applying only 25-50% of the amount used for SPF testing. This results in an effective SPF that is about 33% of the labeled SPF. As such, higher SPFs can help counteract the under application effect.

I wrote this to help address inquiries I get from patients and ensure people are properly protecting themselves from sun damage. I invite you to take a moment to review my Top 10 Sun Protection Tips. 

Rosacea: Facts and Myths

This April is the first ever Global Rosacea Awareness Month and I am pleased to support it. Rosacea is one of my sub-specialties and my interest in this area led me to co-found the Vancouver Acne & Rosacea Clinic with Dr. Shannon Humphrey. Millions of people suffer from rosacea, a chronic skin disorder that primarily affects the face, and the most important first step in dealing with it is knowledge. 

The onset of rosacea is typically after age 30, with symptoms appearing as redness or blushing that comes and goes initially. Over time, the redness tends to become persistent, and visible blood vessels may appear. Rosacea always includes at least one of the following primary signs: flushing, persistent redness, bumps and pimples, and/or visible blood vessels. Various secondary signs and symptoms may also develop. These include eye irritation, dry skin, thickening of the skin, red patches or plaques, and swelling.

The severity of rosacea can vary significantly from one person to another, and in most cases some rather than all of the potential symptoms appear. Many people with rosacea have a history of blushing or flushing. This is often the earliest sign of the disorder.

Rosacea may be mistaken for acne but while the two may look similar acne has a different underlying cause and needs to be treated differently. The cause of rosacea remains unknown, and while there is no cure, medical therapy is available to control, and sometimes reverse, the symptoms.

Prescription oral and topical medications are often used to treat the bumps and pimples associated with rosacea. Treatments with lasers, intense pulsed light sources or other medical and surgical devices may also be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose.

Topical ivermectin is a new treatment for rosacea that has shown promising results for treating inflammation in papulopustular rosacea. There are two other relatively new medications on the market as well. Onrealtea is a topical prescription specifically designed to treat the facial redness of rosacea. Apprilon is an oral, once-daily treatment designed to treat the bumps and pimples associated with rosacea. To find out whether any of these treatments may be right for you, speak with your dermatologist.

Rosacea is not related to hygiene but it is important to treat skin affected by rosacea gently. I recommend using a mild skin cleanser and products that are non-drying and free of alcohol or astringents. When washing your face, do not scrub, rinse with lukewarm water and pat dry. It is a good idea to moisturize your skin and use a sunscreen (SPF 30 or higher) every day.

A number of lifestyles factors may cause rosacea to flare up. Research has disproven some myths, such as caffeine and coffee causing flare ups (it was determined that it was in fact the thermal temperature of the beverage). Common triggers thought to affect rosacea include hot and cold weather extremes, sun exposure, mental stress, spicy foods and hot beverages. These triggers vary from person to person, so it is important to find out which ones make your rosacea symptoms flare up. This can help you to better manage your condition by avoiding things that may potentially aggravate your skin. 

If you have other questions about rosacea the National Rosacea Society is a great resource.

April is Global Rosacea Awareness Month

As part of its Act on Red rosacea awareness program, Galderma has supported the creation of Global Rosacea Awareness Month and the world's first Global Rosacea Coalition supported by many leading rosacea experts. The goal is to provide greater access to information to help the millions of people with rosacea. 

I am honoured to have been invited to be a part of the Global Rosacea Coalition in Canada. Rosacea is one of my sub-specialties and a topic I have done significant research on. It is an extremely visible condition that can create anxiety and potential embarrassment for sufferers. Global Rosacea Awareness Month is important to help people understand their options for living with the condition and for getting help and support. 

Many people who suffer from rosacea may assume that they just blush easily and/or that they might be sun-sensitive. Facial redness associated with rosacea is often mistaken for acne, eczema, excessive sun exposure, or a skin allergy. For almost half of the estimated 40 million rosacea sufferers who remain unaware that they have a medical condition, finding accurate information and access to healthcare professionals are critical steps to understanding the disorder and finding the right solutions.

Global Rosacea Awareness Month activities culminate in the world's first ever Global Rosacea Tweetathon (#ChatRosacea) on Monday, April  27th. I am looking forward to taking part in this and hope you will join me!

New Psoriasis Treatments

I recently returned from the American Academy of Dermatology (AAD) Annual Meeting in San Francisco, where I had an opportunity to collaborate with and learn from many leaders in the field of dermatology. One of the areas I was interested to hear more about was the latest in treatment for psoriasis. This was a popular topic due in part to Novartis recently receiving approval from the FDA for its new treatment called Cosentyx (secukinumab). Secukinumab is the first in a new line of psoriasis drugs called interleukin inhibitors, which block interaction with the IL-17A receptor that triggers the inflammatory response in psoriasis.

Older treatments such as Enbrel, Remicade and Humira block a protein called TNF that signals the body to create inflammation. Stelara (ustekinumab) targets proteins known as IL-12 and IL-23, while secukinumab goes after IL-17A, which only recently has been linked to psoriasis. Similar IL-17 drugs are in development at Eli Lilly & Co. (ixekizumab) and in a partnership between Amgen and AstraZeneca (brodalumab). These IL-17 therapies are expected to be more effective for patients with moderate to severe psoriasis.

Dr. Mark Lebwohl presented summary data on all three IL-17 targeted therapies – secukinumab, ixekizumab, and brodalumab. Studies show a high response rate and improvement in plaque, scalp and nail psoriasis for all of these new class of drugs.

Data on secukinumab showed superior results to ustekinumab in delivering clear skin to subjects with moderate to severe plaque psoriasis over 16 weeks. Secukinumab has previously shown greater efficacy to placebo and to Etanercept. The study is ongoing and 52-week data will be reported at a later date. It will be interesting to see if the results hold but the early results are certainly encouraging.

Dr. Andrew Blauvelt presented additional data on the long-term benefits of secukinumab, showing sustained efficacy to two years with a favorable safety profile.  

With approximately 9 million psoriasis sufferers in the US and Canada, it is exciting to see these new treatments coming to market. Like any systemic medication there are potential side effects, but if you are suffering from psoriasis and are interested in further treatment, consult your dermatologist.