Protecting Skin From UV Rays

By Dr. Bradley Lau
Interviewed by Melissa Moniz
Wednesday - April 09, 2008
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Dr. Bradley Lau

Dr. Bradley Lau
Dermatologist at Kaiser Permanente

Where did you receive your schooling?

I was born and raised in Hawaii and graduated from Kalani High School. I was away from Hawaii for 12 years because there’s no dermatology training locally. I went to the University of Colorado at Boulder for my undergraduate and then University of Chicago for medical school. I did my internship at Northwestern University in Chicago, then I went to Los Angeles to Martin Luther King General Hospital for my dermatology residency.

What are some simple tips for healthy skin?

One of the most important things that we encourage people to do is prevent getting extensive sun exposure in their early years. For people less than 25 years old, I ask them to do their outdoor activities either earlier or later in the day, before 10 a.m. or after 4 p.m., when the sun is less intense. Furthermore, I advise daily use of a SPF 30 or higher sun block before going outdoors. SPF is a measure of ultraviolet B protection. Right now there isn’t a really good scale for ultraviolet Aprotection. I recommend about one full ounce of waterproof broad spectrum sunblock per application, one that protects against both ultra-violet A and B. For general skin wellness, I do recommend a decent amount of rest, a little bit of regular exercise and to eat healthy, less-processed foods.

Is skin cancer an increasing problem?

Skin cancer is a very large problem and it’s getting worse each year. The most-common skin cancer is called basal cell carcinoma, and our best estimate is that this year in the U.S. we’ll treat more than 1 million Americans with that problem. But the most important skin cancer is not the most common. We expect to see about 100,000 cases of malignant melanoma in the country this year, which is the highest number it’s ever been. It is the most deadly, but if caught early it can be completely removed and the person will be fine. If it’s caught late, even as little as 1.5 millimeters thick, it can be fatal and difficult to treat. So the key is early detection and early surgical removal. Hawaii leads the country in skin cancer incidence.

Dr. Bradley Lau checks a patient's arm with the dermascope
Dr. Bradley Lau checks a patient’s arm with the dermascope

Why do you think the problem is getting worse and not better?

We think it’s two-fold. One is the popularity of outdoor activities and lifetime overall exposure to sunlight, and the other is that the population is getting older. So as the baby boomers are aging, we’re seeing a lot of changes in the skin from their early years of sun exposure. We expect that the population of those over age 60 will increase by 8 percent due to aging baby boomers over the next decade.

What are some things to look for when checking for malignant melanoma?

What we’re looking for is dark skin lesions with asymmetry, border irregularity, variation in color and a size roughly the size of a pencil eraser. If it’s changing, bleeding or unstable, it’s something to have checked. Melanoma can arise in an existing mole or appear on otherwise normal skin. Aconsistent self-check exam each month is usually helpful with early detection.

Are indoor tanning booths safe?

Dermatologists don’t recommend indoor tanning booths. It’s an extremely common practice, especially for young people and teenage girls. What we don’t like is that the booths are unregulated businesses that don’t necessarily keep track of how much ultra-violet light you are getting. The amount of ultraviolet light that you get from one of the tanning booths is based on the “freshness” of the bulbs that are installed and the time spent. So if the bulbs are new, you’ll risk getting a higher dose of ultraviolet light. All of that may lead to burning or chronic sun damage of the skin, and that adds up with all the other damage you get from sunlight over your lifetime.

With infants and children, what are the more common skin problems?

We see more rashes and infections in the young age groups. These usually include eczema, seborrhea or diaper rash and yeast, bacterial or viral skin infections.

What are some things that parents can do to avoid some of the rashes that you see in children and infants?

A common problem that I see is overbathing in children who have a dry or sensitive skin trait. Overbathing often leads to more dryness and itching resulting in scratching, then rash areas spread and get out of control. Usually I suggest a five-minute lukewarm bath or shower with no scrubber or washcloth, and refrain from lathering with soap. Only use a very gentle soap like Cetaphil, Oil of Olay or Dove for sensitive skin. Another is children with sensitive skin will do best when small areas of rashes are treated early and effectively, never letting them be severe.

Do you see a lot of rashes in children as a reaction to medication?

We do. Severe reaction to the skin from any medication or allergy is a skin emergency and we are often called to the emergency room or ICU to help manage those cases. We can prevent some of the worst blistering reactions by catching the problem early and withdrawing the medication, hopefully resulting in a less severe reaction.

Are there new technologies that are helpful in your field?

One is the dermato-scope. It’s a fairly new device that has LED lights and a magnifier built into a hand-held unit, which you can use to look at skin lesions. This helps us diagnose skin cancers earlier. The second is TeleMedicine cameras. I got a urgent telephone call from a nurse in Kona recently who had an 18-month-old infant who had an extensive painful and itchy rash that was out of control, even though the patient was already on medications. We made arrangements very quickly for that patient to be seen at the Kona clinic, and using TeleMedicine cameras available at the Kona Clinic and a similar camera that we have here at Moanalua Clinic, I was able to talk to the patient’s mother and examine the patient using the TeleMedicine camera. I saw the patient and decided on what treatment plan needed to be done. We started the plan a few days ago and the little boy is doing much, much better today. So that is a very good example of TeleMedicine, or what we call TeleDermatology.



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