(The following conversation took place more than six years ago
and was posted soon thereafter on Classic X. The material should be
required reading for anyone planning to spend time in the sun.)
by Ellington Darden, Ph.D.
The weather is getting warmer. The clothes are getting smaller. The water is getting more relaxing. It's almost summer time. It's time to hit the beaches and the pools.
It's the season when we are displaying a lot more of our hard-earned physiques for others to admire.
Those baseball biceps, horseshoe triceps, and rippling abdominals all look much more impressive with golden tan, right? A dark tan is sexy, right? A great tan has always been associated with vigorous health, right?
"Wrong, wrong, wrong!" Dr. Robert Berg says.
"Impressive? A golden tan actually thickens the skin on your arms and midsection. Sexy? A dark tan makes your skin look like an old leather shoe. Vigorous health? A great tan leads to cancer and sometimes premature death."
Wait a minute. Don't tune us out just yet.
According to Dr. Berg, you can still get out in the sun this summer, hit the beaches and pools, and be impressive, sexy, and healthy – if you under-stand what's happening and take a few simple precautions beforehand.
I've mentioned Dr. Robert Berg several times on my Web site. Robert is a board-certified dermatologist – and he's also a successful bodybuilder. I personally trained him for several months in 1998 at The Fitness Centre in Celebration, Florida. I noted in one of my articles that Robert has the best combination of intensity and formthat I've ever seen in an athlete. In the last two years, we've become great friends.
With summer just a few weeks away, I thought it was an appropriate time to interview Dr. Berg and let his skin savvy shine through.
Robert, why don't you tell me how you got started in bodybuilding?
I started working out when I was 16. I did so because I wanted to impress a girl. I thought that if I trained for six months I would get big muscles, and she would be mine. Of course, I wasn't successful. I didn't get the muscles or the girl.
What I got instead was an appreciation of strength training; plus, I learned that, eventually, discipline and consistency were required for success – not only in bodybuilding, but just about everything in life. Today, at age 40, I can't live with myself very well if I don't have my regular workouts.
Early on, I also had a vision of what I wanted my body to look like. Interestingly, twenty-fours years later I'm still trying to reach that vision or goal for myself.
I remember meeting you initially at Lou Hollesi's "Mr. Fitness" Gym in Toronto, Canada, about 15 years ago. You helped me demonstrate a Nautilus workout, didn't you?
Yeah, that was quite an experience. It must have been in 1982. Lou had all the original Nautilus equipment and he was very particular about everyone using it properly. He told me that you were coming into town for a special seminar on Nautilus bodybuilding. I was very motivated to go through a workout with you critiquing all my exercises.
There were about a hundred people at the seminar. You gave a talk, showed some color slides, answered some questions, and then asked for a workout volunteer from the audience. Man, I was up on my feet faster than fast!
I don't remember much about the exercises, except we started on that compound leg machine . . . you know that huge Nautilus machine that involved leg extensions immediately followed by leg presses. I gave it my all – 100 percent! It was the hardest workout of my life. After that I was sold on Nautilus and high-intensity training.
Here's something funny – just this last weekend, I visited my parents in Toronto and trained at Lou's old gym. It's still there, even though Lou sold it years ago and moved on. Nothing has changed much, either. All those original Nautilus machines are still being used, including that massive compound leg machine. I tried again, and you better believe I got a terrific burn.
Lou's a great guy. In fact, after he left Toronto more than ten years ago, he bought some property in Lake Helen, Florida, near where the original Nautilus headquarters were located. Eventually, he moved to Florida where he lives now. I saw Lou three months ago and he's doing well. He still trains several times a week.
So, Robert, fill me in on where you went to medical school. Were you able to continue your strength training while you studied medicine?
I went to medical school at the University of Western Ontario, which is in London, Ontario, Canada. Everyone I talked with concerning medical school told me emphatically that I wouldn't have time to train. "Just forget it, Robert," they said, "forget it for four years!"
Well, you know what? In four years, I never missed a single, scheduled workout.
After that, I did my internship in internal medicine at the University of South Florida in Tampa. The weather in Florida, compared to Ontario, was fantastic.
From there, I returned to the cold country for a three-year residency in dermatology in Buffalo, New York. By this time my training was so well ingrained that I could have figured out a way to exercise even if I would've lived in a rowboat underneath Niagara Falls.
Nevertheless, I knew I wanted to practice eventually in a warm climate. After I completed my residency, I returned to Florida. My practice today is in Stuart, which is small community on the east coast, about 100 miles north of Miami. Currently, I'm a board certified dermatologist in the United States and Canada.
Exactly what does a dermatologist treat?
A dermatologist is expected to treat 500 different skin conditions – from acne to warts, and from cold sores to poison ivy. In south Florida, however, where there is a large retirement population and plenty of sunshine, 70 percent of my practice concerns treating skin cancer.
Let's zero in on skin cancer. How wide spread is it in the USA?
Skin cancer is the number-one form of cancer in the United States. There are 1 million new cases each year – and the numbers are rising. With everyone in the United States living longer, skin cancer is a significant problem.
The best news, however, is that skin cancer is treatable. Approximately 95 percent of skin cancer, if detected soon enough, is curable.
Can you give us a little background on each of the three types of skin cancer? What it looks like? Who gets it? How is it treated?
Okay, the three types are Basal Cell Carcinoma, Squamous Cell Carcinoma, and Malignant Melanoma. Most important, they are all related to sun exposure.
Approximately 80 percent of all skin cancer is classified as basal cell carcinoma. It usually occurs on the sun-exposed areas of the body, such as the face, hands, and arms – and is in the form of a persistent sore that doesn't heal.
Squamous cell carcinoma is seen about 16 percent of the time. It is also a persistent sore, but compared to a basal cell, a squamous cell carcinoma is more crusty and scaly.
Both basal and squamous cell carcinomas are usually treated by simple surgical excision.
Malignant melanomas are much less common than basal and squamous cell carcinomas, but they are much more serious. This skin cancer has the potential to spread and can be fatal. In fact, the rate of melanoma is doubling in the United States every eight years.
Melanomas can arise from a preexisting mole or from normal skin. It usually presents itself as a lesion that has abnormal properties, such as different shades of brown or black, and uneven shapes or borders. The color and diameter may change over time.
Treatment involves excising the lesion and doing tests to search for any metastatic disease. If the cancer has spread, the patient may need chemotherapy or radiation.
In summary, here's what you need to remember concerning skin cancer:
If you notice a sore on a sun exposed area of your body that doesn't heal within two months, consult a dermatologist.
If you have a brown lesion or mole that changes in color, shape, or size – or if you have a mole that itches or bleeds – consult a dermatologist.
As you get older, after you shower, give your skin a thorough look and examination. Be sure to check your ears, the back of your neck, and the rest of your backside.
Almost all of us who are interested in strength training and bodybuilding have wanted that bronzed, tanned skin that all the champions have in their photographs. I know when I was a competitive bodybuilder in the 1960s, I spent a lot of time in the sun trying to get a dark tan. Yet, in the last 20 years, we've all read about the potential problems from sun exposure. You've given us some pointers about skin cancer and how to avoid and treat it. Personally, I've had a number of basal cell carcinomas removed from my face and arms, and that doesn't make me happy. But I still don't like having pasty white skin all the time.
Is there any way to get a "healthy" tan?
A healthy tan is a true oxymoron. A tan is an adaptive response of the skin to sun damage. So every time you tan you are damaging your skin. In fact, damage begins to occur after 10 seconds of sun exposure! The cumulative effect of all this sun exposure manifests itself 10 to 20 years later on the surface as wrinkles, sagging skin, brown spots, and skin cancers.
And from a bodybuilding point of view, a tan thickens your skin – it makes your underlying muscles harder to see, it actually reduces your muscularity or definition.
Tanning beds do not provide a safe tan either. They use light bulbs that filter out the ultraviolet B rays (UVB), which produce sun burns, and emit mostly ultraviolet A rays (UVA), which cause tanning. This is why people who use the tanning beds rarely get burned. However, UVA light penetrates deeper into the skin than does UVB light. As a result, UVA light produces more wrinkles and more skin cancers.
Tanning beds should be avoided completely. In fact, they should be outlawed.
I wish fitness-minded people everywhere would get it out of their minds that suntanned skin is healthy. A ton of research proves that untanned skin is much healthier than tanned skin.
If you must get out into the sun, cover your skin, and put sunscreen on any exposed area.
And if you don't like being pasty white, get used to it – adapt. Or try one of those sunless, self-tanning lotions.
Those self-tanning lotions seem to be getting more popular all the time. Do they really work?
Each year, they get better. Sunless, self-tanning lotions contain an active ingredient known as dihydroxyacetone (DHA), a colorless sugar that darkens the skin by staining. DHA works by interacting with the surface cells found in the skin and producing a color change. A light coat of the lotion produces a color change in approximately two hours. As the cells are naturally sloughed off, the color gradually fades – typically within five days after a single application. Thus, you have to apply it regularly to keep your color.
Many of the self-tanning products come in different DHA concentrations: light, medium, and dark. Also, sunless tanners are now being made for specific skin types, such as dry, normal, and oily. One of the best, in my opinion, is manufactured by Clinique and is called "Self-Sun." It even has a pleasant smell, which until recently, didn't seem possible.
You've got to be careful, however, of similar-sounding products on the market that rely on other ingredients – such as accelerators, bronzers, and pills – to darken the skin. They are not nearly as effective as DHA. In fact, tanning pills that contain canthaxanthin have been linked to hepatitis, skin eruptions, and severe itching. Such pills are not sold in the United States, but are available in Canada. Avoid them.
I'm for the sunless tanners. Even though they can be a bit messy, they can provide you with a nice color. And most importantly, there is no damage done to the skin in achieving this color change.
But in spite of this change to your skin, the color offers little protection against the sun. You still must use a sunscreen.
Can you simplify sunscreens for us?
Sunscreens all have a SPF number. SPF is an abbreviation for Sun Protection Factor. For example, a value of 12 means you can stay out in the sun 12 times longer before getting a sunburn than if you had no sunscreen on. I typically recommend sunscreens with a SPF of 15-30, which blocks out 93-97 percent of the sun's ultraviolet rays. Sunscreens must also block both UVA and UVB rays. Two sunscreens that do this well are Ombrelle 15 and Ban de Soleil 30.
Over 30 years ago, acne seemed to be prevalent among many young people. Today, you rarely see it. What has happened in dermatology over the last 30 years that has made such a dramatic impact on treating acne?
You're right. Significant strides have been made in the treatment of acne. There are topical products, such as Retin A, and oral antibiotics, such as Minocycline, which are both effective for mild or moderate acne. There is a medicine called Accutane, which can actually cure severe acne. It's because of these agents that acne is so less prevalent today among teenagers.
What's the best way to take care of your skin?
I'll skip all the standard stuff that centers on keeping your skin clean and moisturized. The primary thing that you can do is to protect your skin from the sun. Sun exposure is the number-one danger with me – and it's something we can all do something about.
The most important way to protect your skin from the sun is to use liberal amounts of sunscreen, with at least a 15 SPF rating. And, if possible, keep covered. Please note that I didn't say, "Do not go outside." What I'm saying is . . . "When you go outside, protect your skin."
For example, when I go to the beach (and I do often), I wear plenty of sunscreen – and – I sit under an umbrella. And don't forget to wear a hat – a big hat rather than a small one.
Also, make it a habit each morning, after you shave, to apply a cream that has a sunscreen (at least, SPF 15) to your face, neck (including the back), and even to the backs of your hands and forearms.
I know as I've aged, I've noticed that my skin is dryer and looser than it used to be. I'm sure some of the Web site readers have experienced the same conditions. Is there anything that we can do to tighten the skin?
Unfortunately, there's very little we can do for loose skin on the arms and torso. This is caused by sun damage to the elastic fibers in the skin. Also, the skin has less elasticity with time.
For loose skin on the face, however, there is treatment – namely cosmetic surgery. There's endoscopic brow lifts for sagging brows, eyelid surgery for sagging upper and lower eyelids, and a face lift for sagging cheeks.
As far as dry skin is concerned, this is a common feature of normal aging process. Dry skin can be treated by using a moisturizer after you shower. I suggest using a cream, not a lotion, because a cream is more hydrating to the skin. I recommend Cetaphil cream or any of the Neutrogena products.
Tell us about the treatment for wrinkles.
For discussion purposes, let's divide wrinkles into fine and coarse.
First, let's talk about fine wrinkles. Fine wrinkles are usually around the eyes and are known as crow's feet. They can usually be treated with a topical prescription drug called Retin A. This cream or gel is applied every night and a diminution of wrinkles is often noticed after 4-8 months of use. I've been using Retin A for 18 years and have found it to be extremely effective.
Glycolic acid cream is available over the counter and it can also be used to treat fine wrinkles. It's applied in a similar way as Retin A. Personally, I don't believe Glycolic acid cream works nearly as well as Retin A.
Vitamin A (retinol), vitamin E, and vitamin C creams have some limited effect on fine wrinkles and are available over the counter. But none of these work as well as Retin A and Glycolic acid.
Now, let's progress into coarse wrinkles.
Coarse wrinkles go deeper into the skin than do fine wrinkles and occur on the forehead, around the eyes, cheeks, and mouth. Chronic sun exposure is the blame. Coarse wrinkles usually don't appear before age 40 because it takes 20 years or more for the cumulative effects of sun damage to manifest clinically on the skin.
One treatment for coarse wrinkles involves chemical peels. Chemical peels are designed to penetrate and cause peeling of the top layer of sun damaged skin. The deeper layer underneath then moves up and fills in the peeled area. The result is that the skin now looks younger and has fewer wrinkles because it has no sun damage.
The primary peeling agents are Glycolic acid and Trichloroacetic acid. Trichloroacetic acid usually produces better results because it penetrates deeper and causes more thorough peeling.
In the last several years, the Carbon Dioxide Laser – which is actually a form of surgery – has been used to treat coarse wrinkles. It produces a peeling effect like the acids mentioned above; however, it is much more precise. The depth of penetration of the laser can be controlled to a nanometer. The Carbon Dioxide Laser applies best to wrinkles on the cheeks, around the eyelids, and especially around the mouth.
From wrinkles, let's move to sagging skin. What can we do about the skin that starts hanging from the face and neck?
Sagging or loose skin on the face and neck, as I mentioned earlier, can only be treated by surgery. The result is a more youthful and refreshed appearance. The mark of an excellent plastic surgeon is a result that is very natural looking: in other words, you cannot tell that a person has undergone surgery. A poor result is someone who looks like he just came out of a wind tunnel. Far too many patients have that wind-tunnel look.
Robert, I know that for years, many women magazines have been writing about the effects of cosmetic surgery on the faces of women. Men certainly haven't reacted favorably to cosmetic surgery to the same extent as women. Why?
Traditionally, women have been more concerned about their appearance than men. As a result, women have been more oriented to cosmetic surgery. Men have traditionally been more concerned about what their bodies looked like and less about their faces. Today, however, that trend seems to be changing. More and more men are having cosmetic surgery on their faces.
As a personal example, I've had a rhinoplasty (nasal surgery), an endoscopic brow lift, eyelid surgery, cheek implants, and a face lift. They were all done by Dr. Stephen Adler, who I consider to be the best plastic surgeon I've ever worked with. Dr. Adler practices near me in Stuart, Florida.
Furthermore, I've had all these procedures performed before the age of 40 – because the results are much better when cosmetic surgery is done early in life. This notion of waiting until you are old before you have cosmetic surgery will soon to be a thing of the past. More and more women and men under 40 are opting for cosmetic surgery – which, in my opinion, is very good.
What do some of these procedures entail and cost?
Most of the procedures I've discussed above are usually performed by a plastic surgeon. A plastic surgeon has greater surgical expertise than a dermatologist. Chemical peels, however, are often done by a dermatologist.
The procedures take place in the surgeon's office and the more complex ones require sedation. Pain and discomfort afterwards are minimal. There are side effects to each procedure and they are discussed with the physician beforehand.
In terms of costs, here are some appropriate figures:
Chemical peel $1200-2000
Laser surgery for wrinkles 3500-4500
Brow lift 2000-3500
Eyelid surgery 2500-4000
Face lift 5500-6500
As you can see, none of these procedures is inexpensive. But no amount of self-care can do what the right surgeon and correct procedure can produce.
Thanks, Robert, for this informative interview. I know you need to get back to your patients. But before you go, can you summarize your advice for the readers of my Web site?
Sure. I'll boil it down to the following:
- Understand, once and for all, that suntanned skin is not healthy.
- Be aware of the positive relationship between sun exposure of the skin and skin cancer.
- Try the new and improved sunless tanning lotions that contain DHA.
- Protect your exposed skin with the liberal use of a sunscreen of at least a 15 SPF.
- Keep covered, if possible, when in direct sunlight.
- Wear a hat outdoors, preferably with a wide brim.
- Moisturize your skin with creams, not lotions.
- Ask your doctor about using Retin A for treating fine wrinkles.
- Explore and consider using cosmetic surgery.
Finally, I'm reminded of what Groucho Marx reportedly said before he died:
"If I'd known I was going to live this long,
I would've taken better care of myself."