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For more information about skin conditions and treatment, contact:



Elizabeth H. Hamilton, MD, PhD
Amy Stein, MD
Julie Dodge, PA-C
4321 Medical Park Dr., #102
Durham, NC 27704
Telephone: (919) 220-7546 (SKIN)

Pale Is the New Tan:
The Beauty of Burn-Free Skin

As is true for most of us, Dr. Elizabeth Hamilton of Regional Dermatology in Durham loves to spend time in the great outdoors—a treat she allows herself with an equal measure of pleasure and caution.

Dr. Hamilton encourages all of her patients to care deeply about the health and beauty of their skin—which means limited and controlled exposure to the sun.

“The most toxic effect of the sun,” she notes, “is the tan we get either purposely or accidently. Throughout the ages, people were aware that the sun damages the skin making one look older and wrinkled. Famous clothing designer Coco Chanel popularized tanning in the 1920s and it became the new norm. Rapidly tanning became synony-mous with relaxation, leisure, health, and wealth. Fast forward to 1978 and UVA tanning beds became a new (and dangerous) trend in the USA.

“Most people think that a tan looks attractive but don’t realize that it was introduced to make us a slave to fashion,” notes Dr. Hamilton. “Today a new phrase is being coined—Pale is the new tan. We’re trying to reverse the notion that tanning is healthy. Our new mindset is that skin, with proper care, is beautiful without the discoloration of a burn.

“Because the simple fact is: a tan is the result of toxic sun assault—ultraviolet light damage to skin cells. If the assault is sufficiently severe, the skin is burned and painful.

“Skin can tolerate only a certain amount of ultraviolet light,” she explains. “I compare it to a bucket that gets filled with sun damage over a lifetime, and once it’s full, you’re done. Many fill that bucket in their youth. Then additional rays are added until the bucket is overflowing and we start getting wrinkles, aging skin, brown spots, bruising, pre-cancers, and skin cancers. The lighter skinned you are, the smaller your bucket; the darker skinned, the larger the bucket. Once your personal bucket is full, we all experience the same problems, and the possibility of getting skin cancer.”

The sun has two very toxic effects, Dr. Hamilton explains. “It causes skin damage from UV light, and it also inhibits the immune system, which protects against abnormal skin and cancer cells. There are certain cells in our body—specifically the squamous cells—that are controlled by the immune system.”

Protecting Yourself From the Sun

When you protect yourself from the sun, notes Dr. Hamilton, not only do you reduce damage, but you allow your immune system to do its job of screening skin cancers. The alternative to use of effective sunscreens is to avoid all sun exposure or wear sun-protective clothing. “And, unfortunately,” she notes, “most people avoid either choice.”

Dr. Hamilton explains that there are basically two broad categories of sunscreens: chemicals and blocks. “Chemical sunscreens absorb light in a certain wavelength spectrum. For adequate protection there have to be multiple ingredients with overlapping absorptions. There can be side effects such as irritation or allergic reactions. The higher the SPF protection number, the higher the chemical concentration, and the greater the potential for irritation. Sunscreen sensitivities are hard to precisely determine because there are so many factors involved.

Skin Cancer
Facts and Figures

  • More than 5.4 million cases of non-melanoma skin cancer were treated in over 3.3 million people in the US in 2012.
  • More people are diagnosed with skin cancer each year in the US than all other cancers combined.
  • One in five Americans will develop skin cancer by the age of 70.
  • Actinic keratosis is the most common pre-cancer affecting more than 58 million Americans.
  • Regular daily use of SPF 15 or higher sunscreen reduces the risk of developing squamous cell carcinoma by about 40% and developing melanoma by 50%.
  • In the past decade the number of new melanoma cases diagnosed annually has increased by 53 percent, the vast majority caused by sun exposure.
  • It’s estimated that 90 percent of skin aging is caused by the sun.
  • Sun damage is cumulative and any amount is damaging to the skin.
  • UVA (Ultraviolet A) are long wave rays that penetrate deep into the thickest skin dermis; UVB (Ultraviolet B) rays burn the superficial layers of skin.
  • Tanning Beds emit mostly UVA rays.

“The other type of sunscreen is a block—titanium and zinc oxide. Blocks act like a glove, physically blocking the light. They are not absorbed by the skin. People don’t like them because they make their skin look white—like the lifeguard with the white nose. However, they tend to be less irritating, so if you’re concerned about sunscreen sensi-tivity, a chemical-free sunblock is a good choice.”

Sunscreens come in many formu-lations—lotions, sprays, creams, and gels. “Sprays are especially popular,” notes Dr. Hamilton, “because they’re easy to use. But if you watch how the sunscreen is applied when sprayed, you’ll see that most of it is airborne and not giving good coverage. The American Academy of Pediatrics has advised against using sun-protective spray on children because of concern for toxic chemical propellants being inhaled. If a spray is used, I advise using it at close distance, so it puddles, and then rub it in, or spray it in your hand and rub it on. As a primary protectorate, sprays are not as effective.”

Tanning Beds:
Toxic Light at Its Worst

“Perhaps the most dangerous myth about sun exposure is the myth about the value of a ‘base tan,’” says Dr. Hamilton. “The idea that you can protect yourself from sunburn and sun damage by getting a ‘base tan’ is utterly false. Tanned skin is damaged skin and doesn’t protect you. And the choice to use a tanning bed to get that ‘base tan’ is particularly troublesome. Tanning beds emit the worst kind of UVA light, penetrating the skin more deeply, and are likely to affect the connective tissues, collagen and elastin, eventually making damaged skin as thick as leather. Using a tanning bed because you don’t want to burn outside is like getting a brand-new car and taking a sledge hammer to it so when you’re in a wreck someday, nobody can see the nicks and dings.”

Other Myths and Misunderstanding About Sun Exposure

Because the sun is a source of vitamin D, notes Dr. Hamilton, “many people believe they need to risk sun damage to get their fix of Vitamin D. But there are so many better sources of vitamin D, such as food and supplements. Why would you ever tell someone to go out and expose themselves to ultraviolet rays?”

Misconceptions also exist about the effects of the sun on different skin types. “The truth is,” says Dr. Hamilton, “while darker skin offers more protection than lighter skin and the incidence of skin cancer in darker skinned individuals is lower, the sun damages all skin. The resulting damage may vary with skin types—producing blotchy skin, hyper-pigmentation, irregular darkening, and skin aging.

“Skin that’s chronically exposed to the sun doesn’t function well as you age. Aging skin often looks bad, is dried out and more sensitive, and is far more likely to develop brown spots and bruises, and to tears easily. The skin is more prone to bruising because it no longer has the same insulation or protective covering around the blood vessels.

“Sun-damaged skin has some capacity to heal, but it’s very unlikely to regain its earlier appearance and beauty. When people who are chronic tanners stop the practice because they’ve had skin cancer, their skin gets better with time, reversing somewhat. There are things you can do, like retinoids, tretinoin, and 5 Fluorouracil, which have a long science of helping reverse damage from chronic sun exposure. You can also cosmetically help your skin.”