What is the best sunscreen to use for outdoor activities?
Individualised protection is the key to sunscreen use. What works for one person may not work for others as you need to take into consideration your activity & application method.
The key points to look for in a sunscreen for active melasma patients are-
- SPF 50+ or higher. SPF is important as it protects against UVB. The higher the number the better as most melasma patients underapply. The ones recommended below will have protection against most of UVA as well
- Tinting is essential as it protects against visible light.
- Waterproofing. Find a sunscreen that sticks to your skin.
- Convenience. Sunscreen sticks are awesome for reapplication
If you are after our top picks they are-
- Sunbum Tinted SPF Sunscreen Stick $27
- Matilda’s Tinted Organic sunscreen $32
Bang for bucks, you can’t go wrong with this brand. Cancer Council sticks at $11.
Buy half a dozen sticks & leave them everywhere.
How often do I need to apply sunscreen?
If you are engaged in outdoor activities, it’s once every 2 hours. If you swim or surf, preferably hourly. If sunscreen washes off with water or with sweat it is not effective.
Tips for reapplication: you can reapply using sunscreen lotion, sprays or sunscreen sticks. Personally, I think sunscreen sticks are best. Lotions are messy, sprays are non-tinted. A sunscreen stick applied thickly to affected areas is the most convenient way to reapply.
Sunscreen stick application
- Use tinted sunscreen sticks.
- For practical reasons apply a super thick coat over the affected areas of melasma (we’re being practical here). This means more than one layer, often 3-4 layers are required.
- Recommended brands include Sunbum & Cancer Council Tinted Zinc stick
- Colour matching is not that important when you’re actively protecting against light, it is about protection over fashion
How much sunscreen will I need to apply?
The level of sun protection is proportional to the amount of sunscreen applied; it is a linear relationship up to the point of saturation (recommended amount). The more you apply, the better the protection.
SPF (which measures burn time, not the degree of pigmentation protection) is measured when 2 mg /cm squared is applied. This equates to 2 finger lengths for the head & neck, or approximately 3-5 ml of sunscreen.
Photoprotection during activity level does not take into consideration how ‘elegant’ your face looks. When you’re walking-running-swimming-hiking-surfing, you’re not a fashion statement, hence our recommendation is that you overdo things – a super thick coat so you can actually see sunscreen on your face. This means, follow the recommended guidelines of 2 fingerlengths of sunscreen to cover the face & neck.
Tinting is essential for melasma patients as it protects against visible light.
Advice for special groups
Advice for runners
It’s not a fashion show when you run. You need a waterproof sunscreen due to sweat.
You need two layers. Layer one; tinted sunscreen (under the second layer), layer two non-tinted but waterproof. Another option is ONE layer of tinted sunscreen or sunscreen stick.
Recommended brands, Cancer Council Tinted Zinc Stick, Banana Boat Sports sunscreen SPF 50+ (downside is that it is non-tined). Matilda’s Tinted Sunscreen SPF 50+ , La Roche Posay Anthelios Wet Skin Sunscreen SPF 50+ Sustainable Tube 200ml
Application frequency: Prior to a run. Unless you run more than 2 hours, you don’t require reapplication. Ideally hats over caps.
Application frequency & amount are critical for protection. Apply a much thicker layer if you are engaged in running-swimming or in the surf.
Advice for surfers
In winter, hoodies are awesome, but they don’t protect your melasma prone areas adequately. Melasma is hard to treat in this activity sport as you may be out for hours, which may make reapplication harder. Use a neoprene cap as adjunctive sun protection.
Recommended brands; tinted- Surfmud *Though this product has no SPF rating, it can be applied as a second layer, over a primary waterproof sunscreen with an SPF rating, eg. La La Roche-Posay® Anthelios Wet Skin SPF50+ as the first layer, followed by Surfmud as the second layer.
Application frequency: Hourly. Sunscreen washes off FAST in surfers. Reapply with Sunbum as a stick is more convenient.
Stick application takes 10 to 20 seconds to reapply, even less if you only apply to melasma prone areas, however ideally, application should cover the entire face.
Advice for swimmers
Recommended brands; tinted- Sunbum Signature 40 Tinted Sunscreen
Water resistant for 80 min, tinted zinc stick by Cancer Council,
Application frequency: Hourly (ideally) or follow product application guidelines.
Do I need to wear sunscreen if I am indoors?
No, only on the condition that you don’t have natural lighting coming into the house & that you have social anxiety disorder (truly don’t leave the house for any reason).
For 99.9% of the population (chances are you), we all engage in ADLs or activities of daily living, namely going to the shops, picking up kids, hanging out the wash, going for a walk & many outdoor activities.
Every single minute of unprotected sun exposure counts if you have melasma. Hence why it’s important to wear sunscreen twice daily. It takes you 30 seconds per application. Enough said.
Buy sunscreens that you can afford
Sunscreen is expensive, especially if you use it correctly. There’s no point in buying expensive sunscreen only to use a wee bit at a time. Take for example Melan 130. Great sunscreen but it cost $90 & over. That’s for 50 ml. If you use 2.5 ml per application, twice a day, it will last 10 days. That’s 9 bucks daily on sunscreen, hence 365 X 9 = 3285 per year on SPF.
A cost effective solution is the $11 tinted stick by the Cancer Council.
Buy here.
What about sunscreen sprays?
Applied correctly, sprays are excellent, however they have 2 main downfalls-
- Convenience; are you seriously going to carry a spray with you on a run-swim or surf.
- They cost alot & take up a lot of volume given the fact that 50% of the volume is propellant.
What is the second layer of defence after sunscreen?
Topical antioxidants including vitamin C, vitamin E & ferulic acid. The most convenient formulation is by Skinceuticals known as CE Ferulic acid. Apply this under your sunscreen. A few drops go a long way. Apply in the morning.
*Don’t even think of buying this until you get your sunscreen application correct. 95% of patients who see us have not optimised their sunscreen but jump to ‘skin care’. Skin care alone, without sunscreen is a waste of time, effort & money.
**Vitamin C may not be for everyone. It is acidic (hence the name ascorbic acid). Patients with sensitive skin will develop skin irritation.
A thick layer of sunscreen is recommended. If you can SEE sunscreen on the skin, you have applied a good amount. If you can’t, chances are you underapplied. For activity, sunscreen is not meant to be fashionable.
What additional supplements can I take after learning how to use sunscreen properly?
Only after you have learned how to properly apply sunscreen, consider supplements. Supplements act as antioxidants and offer a third layer of defence (the first is sunscreen, followed by topical antioxidants). If you have not got your sunscreen application correct, you’re wasting time & money with oral supplements.
The two supplements we recommend are polypodium leucotomas (Fernblock); a natural supplement, & melatonin, another oral antioxidant. Here is the dose-
Polypodium leucotomas: one capsule (480 mg) twice daily, regardless of sun exposure. This can be useful for heat activated melasma.
Melatonin; 3 mg to 5mg at night, one hour before bedtime.
Start with melatonin at night, it is far more cost effective. After 2 months, if you require more antioxidants, you can add polypodium to the mix.
What if I am vitamin D deficient?
Pop some vitamin D pills. Yes, restricting UV can reduce your vitamin D levels, however the solution is easy, take some supplements. Most patients have no hesitation with supplementing their diet with vitamin B, C, folic acid, magnesium etc… Hence popping some vitamin D capsules is not a big deal.
Why does melasma still flare when my sun protection is adequate?
Heat, also known as IR or infrared, is another wavelength of light that stimulates pigment cells. Heat comes from the sun, heat is reflected off the pavement, heat is also radiated from stoves, ovens, & saunas.
If your melasma is heat sensitive (most are, but the amount of heat & your sensitivity varies), you’re in big trouble as this wavelength is NOT attenuated by sunscreen. There are only 3 solutions –
- Avoid heat (easier said than done, especially if you receive heat from the sun, or run outside).
- Wear an IR Mask or welder’s mask. Don’t laugh, we do prescribe this for cooks who receive lots of IR.
- Take a supplement like polypodium. This scavengers’ free radicals but does not attenuate IR heat. The effects are marginal at best.
What is the next step once I get my sunscreen application perfected?
That’s when you see us for melasma treatment. Only after you understand photoprotection & antioxidant use, you’re ready for the science of pigment removal.
At The Melasma Clinic we tailor a pigment reduction program based upon the type of melasma (early onset vs late onset, amount of sun damage- cellular aging, skin type, previous treatments, insight & genetic history). Our treatment program consists of a combination of the following-
Pigment removal: we customise a treatment plan based upon the factors listed above to remove pigment from the various layers of skin. We select the ideal laser wavelength for this job. Deeper pigment is treated with 1064 nm laser, whilst superficial pigment is addressed with 532 & 755 nm lasers.
We also perform superficial & medium depth peels, such as Cosmelan, Dermamelan & Vi Precision Peeling.
Blocking pigment synthesis: is crucial to reduce pigment rebound. This is achieved with a tailored approach of antioxidants including vitamin C, E, as well as oral supplementation. Depending on the pigment type we also prescribe topicals consisting of active ingredients such as arbutin, ascorbic acid, niacinamide & plant extracts such as licorice root & bearberry.
Enhancing your skin’s resilience: is important for ‘mature onset pigmentation’. By remodelling the deeper layers of skin, pigment protection is slowed down. We achieve this via collagen simulating injectables, polynucleotides & lasers that remodel the deeper layers of skin.
Final thoughts
Dr Davin S. Lim, Dermatologist
Brisbane | Sydney
If you’re not investing time in understanding how to use sunscreens, you’re better off buying a pair of shoes compared to investing in effective solutions for your melasma pigmentation. With effective & hypervigilant sun protection, our success rate in treating melasma is around 85% (for ‘normal’ individuals), dropping down to 75 to 80% of ‘active patients’ who enjoy outdoor activities. This figure drops down to 50% efficacy if your melasma is heat activated (Infrared activated), as sunscreens do not attenuate this wavelength. For those who don’t invest in sunscreen, the success rate drops to 20%.
Prioritise sunscreen over skin care
Spend the most amount of time & money with sunscreen application over the commercial world of skin care. Take your time finding the correct sunscreen product for your needs, with guidance from myself & my team. Once you have mastered & understood sun protection, you can move on to other skincare actives such as antioxidants (ferulic acid, vitamin E, vitamin C) & oral supplements such as polypodium.
If you are using sunscreen correctly, you will go through one 50 ml bottle of everyday sunscreen in 2 to 3 weeks, in addition to active sunscreens.
Form a habit
Twice daily, without fail. It takes 20 seconds to apply.
Dermal remodelling as stage 2
Chances are, if you have received a lot of sun exposure & or if your melasma is late onset (in your 40s), your dermal layer of your skin is cactus. This means it has a significant amount of photodamage characterised by broken collagen & elastin (elastosis), old collagen producing cells (AKA senescent fibroblasts), thin epidermis, & abnormal cells in the skin (dysplasia). Stage 2 of melasma treatment is aimed at a longer remission time between visits, this means remodelling the dermis. The concept is as follows-
- Pigment production by pigment cells (melanocytes) is secondary to a protective signalling mechanism.
- The initial message of signalling comes from deep within the dermal layer from other cells.
- Hence the pigment cells instinctively produce more pigment to protect the underlying skin from UV & visible light, which leads to accelerated dermal aging.
- The aim of stage 2 is thus aimed at dermal remodelling (as opposed to ‘pigment clearance’, i.e. stage 1).
- Dermal remodelling is part of an ‘anti-aging’ strategy or reversing cellular aging or cellular senescence
How do we remodel the dermal layer of skin?
Lasers: are the most reliable way to remodel skin. We use pico lasers in bespoke setting which differ from stage one pigment reduction. The best laser for dermal remodelling is a fractional non-ablative laser, however the disadvantage of these lasers is that they take time to work, often requiring 6 to 8 sessions over 12 months for best outcomes.
RFM devices & energy-based devices are useful in some cases. They include Sylfirm X (over-rated for melasma) & HIFU – RF monopolar devices. Much like lasers they require multiple treatments over time.
Injectables: are awesome in effectively remodelling the dermis. They include polynucleotides such as Rejuran, as well as hybrid HA complexes, PDLLA, PLLA & CAH injections. The exact type & frequency depends on your chronological age, actual skin age as well as facial shape.
Fluffy stuff including skincare: this is where skin care can come in handy. Low level collagen stimulators include retinoids, lower-level ingredients include vitamin C & retinol. These are prescribed alongside high level collagen stimulators such as polynucleotide & non-ablative lasers.
Senotherapeutic agents: m-TOR pathway agents are employed in some, but not all patients. These are beyond the scope of this page.
