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Atopic Dermatitis

Atopic Dermatitis (Eczema) Treatment

atopicdermatitis.jpg

Atopic Dermatitis (Eczema)

Atopic dermatitis (AD) is a chronic skin disorder that that causes dry, itchy, and inflamed skin. The rash of AD comes and goes in cycles. The worsening of AD (“flares”) can be brought on by a variety of triggers.

AD is very common, affecting 10-15 percent of people. It is not contagious. However, the severe itching and irritation during flare-ups can be extremely bothersome and even painful. The rash can also be unsightly.

Fortunately, most cases respond well to treatment.

The term “eczema” is sometimes used to describe atopic dermatitis. Eczema refers to inflamed, itching skin from a variety of causes. Atopic dermatitis is the most common type of eczema.

The appearance of AD varies tremendously from person to person. Most people with AD experience a short-term flare for a few weeks (acute), during which the skin looks red, raised, and cracked. Between flares, the skin may appear normal or slightly dry. If the rash lasts a long time (chronic), the skin may start to change appearance, becoming thicker and darker. These patches of thickened skin take longer to respond to treatment

What Causes Atopic Dermatitis?
The exact cause of AD is unknown, but the tendency to develop AD runs in families. People with atopic dermatitis are more likely to suffer allergies and/or symptoms of asthma. The connection between these disorders appears to be an overactive immune system.

T-cells, a type of white blood cell that fights infections, appear to be more active in people with AD. Changes beneath the skin make the skin of people with AD more susceptible to losing water quickly, leading to dry, cracked skin.

Although the immune system is overactive in people with AD, it is not always effective at fighting infections. In fact, people with AD are more susceptible to skin infections, such as impetigo.

What Are the Signs and Symptoms of Atopic Dermatitis?
The most obvious symptoms of AD are intense itching, along with red, dry skin that is sometimes scaly. 

Infants - Children less than one year old often have AD widely distributed over their body. The skin is usually dry, scaly, and red. The baby may scratch the skin, leading to scratch marks. The cheeks of infants are often the first place to be affected. The diaper area is frequently spared because the moisture retained by the diapers prevents the skin from drying.

Atopic_DERMATITIS_1_070703.jpgatopic_dermatitis_face_1_051214toddler.jpg

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Toddlers - As children reach 2 to 3 years old, AD becomes more localized to areas such as the outer part of the joint, including the front of the knees, outside elbows, and top of the wrists. Older children are also more capable of a vigorous scratch, creating very red and inflamed areas.


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School-age children
As children reach school age, AD tends to migrate to the part of the joint that flexes, such as the insides of the elbows and knees. AD may also start to appear on the eyelids, earlobes, neck, and scalp. School-age children may develop itchy blisters on the fingers and feet known as dyshidrotic or vesicular dermatitis (pompholyx).

dyshidrosis_2_030903.jpg

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Adults - Adults with AD tend to have the rash localized to specific areas, particularly the hands, feet, eyelids, back of the knees, and insides of the elbows. However, the skin elsewhere on the body may feel dry and prone to itching.

Atopic_Dermatitis_1_070403legs.jpg

 Atopic dermatitis that starts in infancy often improves by the time the child is 5 years old and usually resolves by the teenage years. However, many people endure atopic dermatitis and need to manage it throughout their lives.

What Are the Treatment Options for Atopic Dermatitis? 
The goals of AD treatment are to heal the skin, prevent new flare-ups, and reduce the urge to scratch, which can further irritate and prolong symptoms.

AD treatment may last for many months, and treatments often need to be repeated.

There are several treatment options available. Your doctor will recommend a treatment plan based on several variables, including:

  • Your age
  • Location (face vs. knee)
  • Severity
  • Acute vs. chronic (long-lasting symptoms may require more potent medications)
  • Results of past treatments
  • Your personal preferences

Treatment mainstays include trigger avoidance and frequent moisturizing.

Additional treatment options include:

  • Topical corticosteroids
  • Topical immunomodulators (Elidel, Protopic)
  • Antihistamines
  • Antibiotics
  • Oral corticosteroids (prednisone)
  • Immunosuppressants (cyclosporine)

Moisturizers and AD
One of the most important steps for treating and managing AD is to use a moisturizer. Moisturizers provide a layer of protection from irritants, trap moisture in the skin, help restore the skin barrier, and improve the skin’s appearance.

Regular use of a moisturizer may reduce the need for other medicines.

Moisturizers are best applied at least twice a day within 3 minutes after a bath, shower, or swim.

When choosing a moisturizer, look for a hypoallergenic and ointment-based product. Thicker moisturizers will protect the skin longer than lighter lotions. Avoid moisturizers containing alcohol, fragrances, or other chemicals that can irritate the skin. Even seemingly harmless substances like glycerin can dry the skin of people with AD.

Possible moisturizers include:

  • CeraVe
  • Cetaphil
  • Eucerin
  • Aquaphor
  • Vaseline Petroleum Jelly—-though thick, it is quickly absorbed by very dry skin

Before applying the moisturizer, use tepid water and a gentle cleanser to remove dead skin cells. Do not scrub or rub excessively. Apply the moisturizer immediately afterward while the skin is still damp.

Remember to use plenty of moisturizer to keep AD at bay, especially in children. Keeping a child’s skin sufficiently moisturized could require as much as 1-2 bottles of moisturizer per week. Adults will need even more.

Topical corticosteroids
Topical corticosteroids are commonly used to calm the irritation from an AD flare. They are available in various strengths, with “super potent” being the strongest. The more potent, the greater the risk of side effects. Mild or acute cases of AD usually respond well to mild steroids. Severe or chronic AD, with skin thickening, or on the palms or soles, may require more potent steroids.

If topical steroids are used for too long or inappropriately, they can cause side effects such as thinning of the skin, or become absorbed into the blood.

Use only mild steroids on delicate areas like the face, groin, underarms, and genitals. Potent formulations should only be used for a few weeks at a time and never on wounds or skin that is thinned from overuse. Potent steroids should be used with special care in children.

In general, moderate-to-potent steroids are recommended for use on thick lesions for a limited time.

Topical immunomodulators (Elidel, Protopic)
Topical immunomodulators (TIMS), or calcineurin inhibitors, are a type of medication applied to the skin that can help control the symptoms of AD and reduce the need for topical steroids. They are a useful alternative for sensitive locations, such as the face and skin folds. They are generally effective and well tolerated.

There are currently two FDA-approved topical immunomodulators for treating AD: Elidel (pimecrolimus) and Protopic (tacrolimus). Both work by reducing inflammation and other symptoms of AD.  These medicines have fewer side effects than topical corticosteroids, but it has been theorized that they may lead to an increase risk of skin cancer.

This risk is not fully known and is still being evaluated. You can read a full statement from the National Eczema Association (NEASE) here.

Antihistamines (Benadryl, Atarax)
Oral antihistamines help reduce the itching and scratching that can further damage the skin. They are often recommended for use at night to help prevent scratching during sleep, and some people find them too sedating for use during the day.

Antibiotics
Bacteria, such as staph, can live on the surface of skin without causing any problems. However, at times, these bacteria can trigger AD flare-ups or prevent inflamed skin from healing.

Topical antibiotics are useful because they can be applied directly to an inflamed area. However, an oral antibiotic, such as cephalexin or erythromycin, may be recommended if larger areas are inflamed or appear infected,

Oral corticosteroids
Short courses of oral corticosteroids, such as prednisone, may help control a severe case quickly. Risks of this treatment include a rebound of symptoms and side effects such as dizziness or fatigue. The medication is usually limited to a few weeks and the dosage is often tapered off.

Immunosuppressive drugs
When AD fails to respond to any other therapies, immunosuppressive drugs may be recommended to calm the immune system. These include cyclosporine, methotrexate, azathioprine, and mycophenolate (Cellcept). However, because of their side effects, they are usually prescribed for a short duration.

What Triggers Atopic Dermatitis? 
Not everyone with AD will have the same triggers, so people with the disorder will have to keep track of their particular sensitivities. Because identifying triggers can be tricky (for example, sometimes there is a delay between eating a certain food and seeing a resulting flare-up), it’s a good idea to keep a journal of any AD symptoms and possible causes. 

Some commonly reported AD triggers include:

  • Irritants—These are substances that contact the skin directly, causing redness and inflammation. They include wool or other synthetic fabrics, soaps and detergents, perfumes and makeup, cigarette smoke, and chemicals (such as chlorine).
  • Allergens—This is a more indirect trigger, where the skin becomes inflamed and itchy because of an allergic reaction, such as from pollen, mold, or animal dander.
  • Stress—While stress isn’t a known cause of atopic dermatitis, it can aggravate flare-ups.
  • Temperature—Many people with AD have chronically dry skin that is sensitive to certain climate conditions, such as cold winter weather, indoor heating, or warm baths. Humid environments, such as a sauna, may cause sweating that could trigger a flare-up.

What About Atopic Dermatitis Self-Care? 
These tips may help to prevent AD flare-ups:

  • Moisturize frequently. Choose thick, greasy ointments over lighter lotions, when possible, and apply them right after bathing or cleansing the skin to lock in moisture. Choose fragrance-free moisturizers and avoid those with alcohol or other irritants. 
  • Try not to scratch. Resisting the urge to scratch itchy skin is a huge challenge for many people with AD. While medications and moisturizers can curb the itch, they don’t eliminate it entirely. Pay attention to situations where itching is the worst; if you can’t avoid such situations, try to distract yourself with an activity that will keep you busy and involve the use of your hands.
  • Avoid sudden changes in temperature or humidity.
  • Avoid getting overheated or sweaty.
  • Wear comfortable clothing. Choose cotton or other natural fibers over scratchy wool and synthetic fabrics.
  • Avoid harsh soaps, detergents, or heavily scented cosmetics.
  • Avoid common environmental allergens, such as pollen, mold, dust, and pet dander.
  • Vacuum carpets and curtains at least weekly, and dust frequently.
  • Wash bedding weekly in hot water.
  • Increase humidity in the home by using a humidifier or placing trays of water near heating sources.
  • Keep your bedroom cool at night.
  • Wear gloves when using water and detergents (such as when washing dishes).

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Images courtesy of DermAtlas, ©2001-08

This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

Dear Friends
 
Our goal at NYC Dermatology is to be the Tiffanys of Skin
Care. I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified DermatologistMy goal is, quite simply, to provide the type of dermatologic care which I  would seek for my own family. This is a very important point, since physicans often use the phrase "Doctor's Doctor" to refer to those individuals who typically are selected by physicians themselves for personal care. I am confident that my practice fully meets that definition. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with courtesy, dignity and respect. I carefully listen to their skin-care concerns and offer a variety of options including a treatment plan that I believe will give them the best results and the best dermatologist. We also support our patients with a very fine medical staff . Please take a moment to explore our top of the line winning website. My philosophy is simple…Experience Counts and Quality Matters. Please allow me to solve your skin problems.  After all, at NYC Dermatology , our philosophy is if you look great you will feel great with gorgeous skin.”
 
Best Regards,
 
Dr. Rothfeld
 

  
 
 

 Dr. Gary Rothfeld possesses the special knowledge, skills and professional capability that distinguishes him as an outstanding  Dermatologist in NYC , Manhattan , New York at NYC Dermatology by Board Certified Dermatologist. Top New York City Dermatologist, Dr. Rothfeld  in Manhattan treats the most difficult cases until the problem clears.  Dr. Rothfeld, a Board Certified Dermatologist at NYC Dermatology in Manhattan, New York is caring, detailed, and meticulous and will never give up until the problem is cleared.  Dr. Rothfeld, a board certified dermatologist in nyc who practices Dermatology in Manhattan, New York has treated many patients in the entertainment and music industry is caring, detailed and meticulous and will not give up until the condition resolves.  Dr. Rothfeld is recognized as one of the best Dermatologists in NYC by the entertainment industry.

NYC Dermatology is under the medical supervision of Dr. Gary Rothfeld, a Board Certified Dermatologist. 
To enhance every aspect of your skin care, Dr. Rothfeld has personally created a superb line of cosmetic procedures..

NYC Dermatology by Board Certified  Dermatologist Dr. Gary Rothfeld  is a board certified NYC  Dermatologist with a  New York City office in Manhattan, New York  providing expert skin care, dermatology, and cosmetic dermatology services.

A board certified dermatologist in NYC specializing in dermatology and dermatologic surgery including state-of-the-art cosmetic surgical procedures, Dr. Gary Rothfeld  is known for his attention to body symmetry and his dedication to meeting patients’ personal goals. His specialties include full body liposuction using the tumescent technique, facial fat transplantation, Botulinum injection into facial lines and laser resurfacing. NYC dermatology  specializes in chemical peels, vein injections, laser, restylane, Perlane, Botox injections, JUvederm, non-surgical facelifts, collagen implantation and treatment of skin cancer.
 
As an expert in the field of dermatology and cosmetic dermatologic surgery, Dr. Rothfeld is has appeared on national television shows. Dr. Rothfeld has also been quoted in many high profile national magazines.
Our goal at the manhattan office of Board Certified  Derrmatologist , Dr. Gary Rothfeld is to create an atmosphere of professionalism, trust and complete patient satisfaction at the NYC Dermatology and Cosmetic Surgery Center in Manhattan, New York.  Dr. Rothfeld, Dermatology Director of NYC Dermatolgy is a Board Certified  Dermatologist at NYC Dermatology who has treated many patients in the  entertainment industry.
   Schedule an appointment at our office which provides top of the line  expert skin care, dermatology, cosmetic dermatology services, and advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer a full range of services including surgery for skin cancer, laser hair removal, Botox®, the Fractionated Resurfacing laser, Titan laser, and acne photodynamic treatments. Our main goal is to provide you with the most effective and advanced treatment. Join the NYC Laser Center NYC Dermatology Mailing List Our periodic newsletters include exclusive offers, educational articles, as well as free treatment & product drawings! Email: nycdermatologist@aol.com in our Media  office and   including different offers and many more. We offer a variety of services from Botox® to Liposuction . Please contact us with any questions you may have or schedule an appointment online or by phone for a consultation.   Beauty Is Forever!  and Dr. Rothfeld  at NYC Dermatologist has over 20 years of experience with his beauty tips.  
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During your office consultation  and examination you will be provided with a detailed plan of the treatments that will benefit you most.  NYC Laser Center NYC Dermatology top laser dermatology center offering skin care, dermatolgy,cosmetic dermatology services, and laser treatments for sun damaged skin, acne, acne scars, rosacea, pigmentation, laser hair removal, broken blood vessels, as well as superficial and deep wrinkles. We offer patients in Manhattan,  services including general dermatology, wrinkle fillers such as Restylane®, Captique,  Perlane,Cosmoderm and Cosmoplast, Radiance® (radiesse) and Sculptra. We also offer Botox®, Cosmelan, Velasmooth, Fotofacial, Titan laser, Refirme, and the Fractionated Resurfacing laser. in the treatment of acne, rosacea, skin cancer and  surgery.  Dr. Rothfeld has taught numerous other physicians on the proper use of Botox®, medical hair transplants, and lasers in  the country.   Acne Photodynamic Treatment - Botox® - Botox® for Hyperhidrosis - Cellulite - Cool Laser  - Cosmelan Depigmentation Treatment - Glycolic Acid Peel - Fat Transfer - Fotofacial / IPL Fractionated Resurfacing Laser - Hair Loss - Laser Hair Removal - Liposuction -  - Surgery - Minimal Scar Technique -  Photodynamic Rejuvenation Radiance® - Restylane® - Sclerotherapy - Sculptra - Smoothbeam - Stretch Marks - SunFX - TCA Peel - Tattoo Removal - Titan Laser Facelift - V-beam Laser Treatments - Velasmooth Our cosmetic surgeon includes Dermatologist  Dr. Gary Rothfeld Board Certified Dermatologist  at NYC Dermatology.  Our NYC dermatologist offers advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer our services to Manhattan , Brooklyn, Bronx, Queens locations through our Manhattan office in NYC

 

Sun Protection

 

Ultraviolet radiation is the major cause of skin cancer, including melanoma. It is important for everyone to be aware of its damaging effects and take measures to avoid overexposure.

 

Although many people enjoy the appearance of tanned skin and think it looks "healthy," tanned skin is damaged skin. The ultraviolet radiation in sunlight penetrates the deepest layers of the skin where it harms the cells. The body responds by making more pigment (melanin) to try to protect itself, but the damage has already happened and may be permanent. The more exposure you have to the sun, the more likely you are to develop skin problems later in life.

Ultraviolet Radiation

The damaging part of sunlight is called ultraviolet radiation, or UV rays. It is categorized into three types:

  • UVC rays (wavelengths = 200 nm to 290 nm) are the shortest and most powerful of the UV rays. UVC is the most likely to cause cancer if it reaches skin. Fortunately, most of it is absorbed by the ozone layer in our atmosphere. However, there is concern that a thinning of the ozone layer may be causing more UVC to reach the earth's surface.
  • UVB rays (wavelengths = 290 nm to 320 nm) are less damaging than UVC, but more of it penetrates to the earth's surface. It is the most common cause of sunburn and skin cancer. UVB is particularly strong at the equator, at high elevations, and during the summer.
  • UVA rays (wavelengths = 320 nm to 400 nm) are the least powerful of the UV rays, but they are present all year and can penetrate windows and clouds.

Sun Protection

The first and more effective way to avoid sun damage is to stay out of tthe sun as much as possible.

If you cannot avoid being exposed to sunlight, there are five basic defenses that you should keep in mind when you go outdoors:

  • Avoid peak hours of sunlight
  • Sunscreen
  • Clothing
  • Sunglasses
  • Shade

Avoid Peak Hours of Sunlight (UV Index)

In general, UV rays are the greatest between 10 a.m. and 4 p.m. It is best to avoid the outdoors during these hours without protection, particularly during summer, in tropical regions, or at altitude. During this time, you should pay close attention to the appropriate use of sunscreen, clothing, sunglasses, and shade.

You can obtain an accurate measure of the amount of UV rays in your area by looking up the Ultraviolet (UV) Index. The UV Index is like a weather forecast. It provides a report on the amount of damaging UV rays that are expected to affect a region on a particular day. The UV Index changes day to day according to time of year, cloud cover, atmospheric ozone, and other factors.

The following table is a breakdown of the UV Index. A high UV Index number means that you are at greater risk of being exposed to ultraviolet radiation. You should take special care to avoid outdoor exposure to sunlight when the UV Index is moderate or greater.

  • 0 to 2 = Minimal
  • 3 to 4 = Low
  • 5 to 6 = Moderate
  • 7 to 9 = High
  • 10 or more = Very high

The UV Index can be found on our Website or in local papers, usually in the weather section.

Sunscreen

There are several factors to consider when selecting the right sunscreen. (See the Sunscreens handout for more information.)

Sun protection actor (SPF) - Sunscreens are rated by the amount of protection they provide from UVB, measured as the "sun protection factor" or SPF. Sunscreens with higher SPF provide greater protection from the sun. It is best to use sunscreens that offer a minimum SPF of 15.

Broad-spectrum sunscreens - It is best to use a sunscreen that can protect you from both UVA and UVB rays. These are called "broad-spectrum" sunscreens. 
Most of the original sunscreens blocked only UVB, but increased awareness of the damage caused by UVA has lead to the development of ingredients that protect against UVA too. Broad-spectrum sunscreens combine ingredients to provide a product with greater protection.

Common sunscreen ingredients that  provide protection from UVB rays:

  • Cinnamates
  • Octocrylene
  • PABA (para-aminobenzoic acid)
  • Padimate O and Padimate A (Octyl Dimethyl PABA)
  • Salicylates

Common sunscreen ingredients that  provide protection from UVA rays:

  • Avobenzone (Parsol 1789)
  • Benzophenones (oxybenzone, dioxybenzone, sulisobenzone)

Sunblocks - "Physical" sunscreen ingredients lie on top of the skin and work by reflecting or scattering UV radiation. They are particularly useful for people who are sensitive to the ingredients found in other sunscreens. Sunblocks often contain one or more of these ingredients:

  • Zinc oxide
  • Titanium dioxide
  • Iron oxide

Although past formulations were unsightly (often leaving a white film on the skin), newer "microfine" formulations are invisible after being applied. Microfine titanium dioxide is effective at protecting from both UVA and UVB rays.

Water resistance - Sunscreens are classified as "water-resistant" if they maintain their protection after two 20-minute immersions in water. They are classified as "waterproof" if they maintain their protection after four 20-minute immersions. You should seek a water-resistant or waterproof sunscreen if you will be participating in water sports, such as swimming or water skiing, or will be actively sweating.

However, independent testing has shown many products do not perform well in the real world. So it remains a good idea to apply sunscreen every time you leave the water, or frequently if you are actively sweating.

Using a Sunscreen

Sunscreen should be applied evenly and liberally on all sun-exposed skin within 30 minutes before going outside to give sunscreen time to take effect. (Sunblocks are effective immediately after being applied.) Sunscreens should be reapplied every two hours or following swimming or sweating. Apply sunscreen generously and reapply frequently at least every two hours.


The chemicals may lose effectiveness over time, so it is important to throw away sunscreen that is past its expiration date or is over two years old.


No sunscreen is 100% effective; take additional measures to avoid the damaging effects of the sun's rays.

Clothing

Clothing can provide excellent protection from the sun. However, not all clothing is protective. A thin, wet, white t-shirt will provide almost no protection from UV rays. When selecting clothes for sun protection, consider the following:

  • Cover your head, shoulders, arms, legs, and feet.
  • Use a hat that is broad-brimmed (brim should be at least four inches wide).
  • Wear fabrics that are thicker or with a tight weave; these allow less sunlight to penetrate the skin.
  • Wear darker-colored clothes that absorb more UV rays.
  • Wear clothing made from nylon or Dacron because it is more protective than cotton.
  • Avoid remaining in wet clothes because wet fabric may allow more UV rays to penetrate the skin.
  • Wash clothing with chemical absorbers to increase their protectiveness.
  • Some clothing comes with a UPF rating that stands for "Ultraviolet Protection Factor." This measures the ability of the fabric to block UV radiation from penetrating to the skin. A fabric with a UPF 15 allows only 1/15th (6.66%) of the UV radiation to penetrate your skin as compared to uncovered skin.

Garments fall into 3 categories:

  • Good protection: UPF = 15 to 24
  • Very good protection: UPF = 25 to 39
  • Excellent protection: UPF = 40 to 50+

Choose clothing with a UPF rating of at least 15. Keep in mind that the UPF of a garment will decrease over time as the fabric wears.

Sunglasses

Overexposure to sunlight can cause cataracts and macular degeneration, a major cause of blindness. Sunglasses can provide protection. However, not all sunglasses are of value. A darker lens itself does not guarantee protection. Look at the label to ensure that the glasses provide UV protection. Sunglasses should be large enough to shield your eyes from many angles. Look for sunglasses that are described as blocking 99% or 100% of UVA and UVB. The glasses may also be described as providing UV absorption up to 400 nm.

Shade

If possible, remain in the shade when outdoors. Keep in mind that shade does not provide full protection from the sun because UV rays can bounce off reflective surfaces, such as sand, snow, water, concrete, or even porch decks. In addition, some fabrics used as shade devices, such as parasols or umbrellas, may not provide sufficient protection. If you seek shade under a cloth, look for a fabric that is thick, tightly woven, and dark-colored.

Clear window glass provides protection from UVC and UVB, but not UVA rays. If you are frequently exposed to sunlight while driving, the plastic interleaf of your windshield (which prevents it from shattering) can help block the light, but side windows have no such protection. Non-drivers can make use of additional window shade devices. Drivers in some states may be able to use darkly-tinted glass in the side windows, but this is illegal in some states.

Summary

  • Avoid the sun when its UV rays are strongest, between 10 a.m. and 4 p.m.
  • Use a broad-spectrum sunscreen with SPF 15 or greater. Apply it 30 minutes prior to being exposed to the sun and reapply every two hours. Consider using a water-resistant sunscreen if you will be active (sweating) or in the water.
  • Use a sunblock on your lips.
  • Wear a broad-brimmed hat when outdoors.
  • Wear sunglasses.
  • Wear tightly woven, dark clothing to cover your arms, legs, and feet.
  • Stay in the shade when possible.
  • Avoid reflective surfaces, such as water or snow.
  • Avoid sunbathing.
  • Don't be fooled by cloudy days since damaging rays can penetrate clouds.

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