It's More Sun in the Philippines with Dermatologists Dr. Mara, Dr. Chesca, and Dr. Jaja

Does sunscreen really prevent skin cancer? The higher the SPF, the better? Do oral sunscreen and UPF clothing actually work? Does the sun cause melasma and hyperpigmentation? Does one still need to apply sunscreen during the winter or if staying inside the house? We are joined today, not by one, not two, but three expert board-certified dermatologists all the way from Manila, Philippines, to talk about all things sun exposure, damage, and protection, especially within equatorial regions, where UV exposure is known to be at highest risk.

Dr. Mara Evangelista-Huber, also known as "Dermomtology," is a dermatopathologist with expertise in dissecting clinical research. She received her BS in Biology from the University of the Philippines, MD from the University of Santo Tomas Faculty of Medicine and Surgery as Cum Laude, Chief Dermatology Residency at Jose R. Reyes Memorial Medical Center, Dermatopathology Fellowship at the University of California San Francisco, and Masters in Clinical Research Trials from the University of London with distinction. Dr. Mara is the Managing Editor of the Journal of the Philippine Dermatological Society, Secretary of the Dermatopathology Society of the Philippines, and Co-Chair of the Philippine Dermatological Society Research Committee. She is the first Asian and Filipino to win the Everett Fox Award for Outstanding Clinical Research by the American Academy of Dermatology for her investigation of the use of simvastatin for venous ulcers.

Dr. Francesca "Chesca" Sy-Alvarado, also known as "Go Lightly MD," is an expert in dermatologic surgery, lasers, and cosmetic dermatology. She received her BS in Psychology from the University of the Philippines, MD from the University of Santo Tomas Faculty of Medicine and Surgery, Dermatology residency at the Philippine General Hospital, and Dermatologic Surgery Fellowship at the Faculty of Medicine Siriraj Hospital of Mahidol University in Bangkok, Thailand. Dr. Chesca is the Owner and Medical Director of QuAD Clinic in Makati, which focuses on positive aging.

Dr. Jarische "Jaja" Lao-Ang, also known as "The Derma Mama PH," is a master of science communication on healthy hair, skin, and nail habits. She received her BS in Human Biology from De La Salle University as Cum Laude and MD from St. Luke's Medical Center College of Medicine William H. Quasha Memorial, where she also completed her Dermatology residency. Dr. Jaja now stands as an attending dermatologist at St. Luke's Medical Center and Skin 101 Shangri-La Plaza, where she tackles acne, cosmetic procedures, and starting a skincare routine.

Livestream Air Date: May 23, 2023

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Episode Transcript

(00:00):
Hi friends, happy Friends of Franz Friday.

(00:07):
Well, to be honest with you, I haven't really had a super happy day the past week because
it's been so cold here in New York City.
There was a torrential rain one night, uprooting winds the other, and just freezing evenings
every day of the week.
Or as New Yorkers say it, it's brick.
But despite the changing temperatures and weather, there is one thing that remains the

(00:30):
same for me every day, and every week, and every month of every year since I was 17 years
old.
I apply sunscreen.
I know, I know, the derm gods are clapping for me right now.
The reason I'm randomly mentioning this is because this is the core of today's episode.
Sunscreen, sun protection, and everything in between.

(00:51):
As you know, the internet and even social media are fountains of so much information,
many arriving on people's phones and gadgets through shared posts.
However, the truth is, when there are so many sources and contents of information, misinformation
is also in abundance.
The fields of science, healthcare, and medicine are common arenas of misinformation because

(01:12):
anyone can say anything about a certain topic, even by those who are not educated or trained
in those respective subject matters.
The general public will believe it.
Interestingly, the fields of dermatology, skincare, cosmetics, and beauty abound in
so many myths and erroneous information.
You name it.
This ingredient is toxic, this brand will cause cancer, this fruit will cause acne,

(01:34):
and one of the big things, sunscreen is bad and toxic.
When in fact, sunscreen prevents skin cancer.
Sunscreen and sun protection are often tested by so many groundless myths and questions.
Conversations about UV radiation, chemical vs. mineral sunscreen, which SPF to use, whether
one should use sunscreen during the winter.

(01:55):
You name it.
The list never ends.
Going back to my introduction of wearing sunscreen every day, yes, even during the winter, this
may not be a common thought because truly, we sometimes may not see or feel the sun's
rays in the darkest frozen mornings and early sunsets.
So do we still need to apply sunscreen?
Would I still be worried about sun protection and skin cancer when I'm inside the house

(02:18):
during a wintery day?
To answer this question, ironically, I call on not one, not two, but three skin and sun
protection experts all the way from a land that experiences no winter.
In a land of sun, where one would believe that they would need sunscreen every day.
From over 8,000 miles away, we'd take a quick trip to my motherland, the islands of

(02:39):
the Philippines, to speak to three board-certified dermatologists to talk about all things sun
protection.
There's a national slogan in the country that goes, it's more fun in the Philippines.
Well, today, we'll take a fragment of that for our today's episode title.
It's more sun in the Philippines.
Because this is the absolute truth.
The Philippines is a hot and humid and sunny empire.

(03:03):
Each time I visit, I just melt into water.
Period.
Sitting along the equator, where these three derms thought on sun protection, not only
in a sunny land, but also the interior of homes that may not see the sun.
First, we have Dr. Mara Evangelista-Huber, also known as Dermomtology online, who is
a dermatopathologist with expertise in dissecting clinical research.

(03:26):
She received her master's in clinical research trials from the University of London with
distinction.
Dr. Mara is the managing editor of the Journal of the Philippine Dermatological Society,
secretary of the Dermatology Society of the Philippines, and co-chair of the Philippine
Dermatological Society Research Committee.
She is the first Asian and Filipino to win the Everett Fox Award for Outstanding Clinical

(03:48):
Research by the American Academy of Dermatology for investigation of the use of cholesterol
medication simvastatin for venous ulcers.
I love Dr. Mara.
When I visited back home in the Philippines last June of 2023, we had brunch in the middle
of the BGC and the conversations were just mm-mm-mm.
So much passion, so much wisdom, and so much love for her.

(04:11):
Then we have Dr. Francesca or Chesca Sy-Alvardo, also known as GoLightlyMD, who is an expert
in dermatologic surgery, lasers, and cosmetic dermatology.
She completed her dermatologic surgery fellowship at the Faculty of Medicine in Majidol University
in Bangkok, Thailand.
Dr. Chesca is the owner and medical director of Quad Clinic in Makati, which is actually

(04:32):
my personal derm clinic back home, which focuses on positive aging.
And lastly we have Dr. Jarische or Jaja Lao-Ang, also known as The DermaMamaPH, who is a master
of science communication on healthy hair, skin, and nail habits.
Dr. Jaja now stands as an attending dermatologist at St. Luke's Medical Center and Skin 101

(04:52):
Shangri-La Plaza, where she tackles acne, cosmetic procedures, and starting a skincare
routine.
Now, what's funny is, and timely with this episode, when I went home to the Philippines
last June again, I also met with Dr. Jaja and she actually gifted me a sunscreen from
Japan.
And guess what?
I have restocked this sunscreen.
Thankfully we have one in New York City.

(05:14):
I'm not tearing where.
It's a secret.
And I have been using it since June.
It's my go-to sunscreen.
It's my everyday sunscreen.
We touched on so many topics in this episode, SPF, melasma, antioxidants, vitamin D, EPF
coating, blue light, skin cancer, and so much more.
Get ready for an adventure around the sun.

(05:36):
There's not one, there's two, there's three of us today, oh, four of us today here.
Hi, dogs.
Thank you so much for joining me in this very special life today.
And I've been so, so excited for this.
If you can tell, I have my beach clothes on too.

(05:56):
I love it, to one point.
Yeah.
To make it seem like I'm in the Philippines as well.
Well, anyways, we have Dr. Mara here, Dr. Jaja, Dr. Chesca, all from the Philippines.
And I've never had guests from Asia and specifically the Philippines.
She's so special to me because, I mean, for those who don't know, I am Filipino.
No one can tell here in the US.

(06:17):
If you could first please introduce yourself to everybody.
Hi everyone.
Good evening.
I'm Dr. Francesca C. Alvarado.
I'm a board certified dermatologist practicing here in Makati, Philippines.
So my special interests are of course skin care, particularly sunscreen and sun protection.
I'm also a dermatologic and laser surgeon.

(06:38):
So I also do procedures.
Basically, that's it.
Super enjoying the company and of course, glad and honored to be with all of you.
Yay.
That's my turn.
So hi guys.
I'm Dr. Mara Evangelista Huber.
I'm also known as dermatology.
I'm a dermatologist and a dermatopathologist based in Manila, Philippines.
I love creating content.

(07:00):
And one of my favorite topics in my content would be sun protection because I'm a dermatologist,
so I see sun damage at a microscopic level.
So thank you so much for having me.
Hi guys.
I'm Dr. Jari Shlaoang, but for short, Dr. Jaja for easier.
So I'm known as the Derma Mama PH, so near to Dr. Mara's account.

(07:20):
So actually I'm practicing at St. Luke's Quezon City and also affiliated with Skin 101.
So I'm into making content when pandemic started.
So that's when I started my online presence.
And eventually people are also being aware about the skin care awareness.
So IG is really my first love and that's where I get to connect with all of you.

(07:40):
So it's really an honor to be invited here and hopeful for a really, really productive
night.
Yay.
Yes.
And I guess I'll introduce myself for all of your audiences who are tuning in who may
not know who I am.
Hi, my name is Christian.
Christian France or Chris.
I'm based in New York.
I'm a nurse here, but I started my journey online, not only about healthcare, but also

(08:02):
I started back in high school documenting my severe acne journey and navigating through
that extremely harsh and painful process that that's where I fell in love with skin care
and all things skin and products.
And again, it's such an honor to have our three beautiful board certified dermatologists
here.

(08:23):
I feel like I'm in the presence of artistas right now.
I feel like I'm in the artista panel.
Oh my goodness.
No, we are in the presence of an artista panel.
I was going to say that.
International ones.
Yes.
So I started this series called Friends of France when the pandemic started because I
worked in the COVID ICU here in New York City.

(08:43):
And during that time, I saw there's so much misinformation online about different parts
of medicine coming from those who do not have the education or training to talk about certain
things.
So in my mind, I'm like, why don't we give a platform to actual educated and trained
experts who know what they're talking about.
They have the authority to talk what they're talking about.
And a very important topic is about all things sun protection and skin protection.

(09:09):
Right, basically the title of our live today is it's more sun in the Philippines.
So it's just an act to, I guess, the slogan, it's more fun in the Philippines.
So just diving right into it.
I know you're all board certified derms.
You're all trained in hair, skin, and nails.
And for sure, you have seen the expanse of skin cancer and all the harms and the effects

(09:30):
of prolonged exposure from the sun.
But first, I want to just for the basics for the general public who may not know, what
is it about the sun that we have to be worried about?
I know we hear the word UV radiation or UV rays, but what is this all about?
Like, why do we have to care about UV radiation?
Whoever wants to go first.
I'll answer.

(09:51):
So ultraviolet radiation or the UV rays, acetestes radiation, it's mostly non-ionizing radiation
because radiation can be non-ionizing and ionizing.
Things like x-rays, non-ionizing actually includes most of the ultraviolet spectrum

(10:12):
and some of it is ionizing, but we're not going to talk about that.
And it can come from both natural, which as you know, the sun and artificial sources like
certain lights and tanning beds.
So the reason it's really important is the skin is actually the main reason that we are
protected from UV.
So UV can penetrate the skin and pretty much nothing else.

(10:35):
So the skin has to be extremely good at stopping UV from coming through because if it doesn't,
then the UV will go inside the skin to our organs.
And what UV does, it's a known carcinogen meaning it can really affect cellular components
like DNA and proteins.
And by doing that, it can cause changes, which can translate into, as we'll talk about perhaps

(10:57):
later, photo aging and photocarcinogenesis, which is cancer from UV radiation.
I would like to add to that.
So that translates into many things that we can experience.
For example, the most common is sunburn.
You go out, forget to apply sunscreen, don't get protected from the sun, don't stay in
the shade.
Of course you're going to get a nasty sunburn.

(11:18):
And aside from the sunburns, it's actually a very uncomfortable feeling, but it also
increases your risk for skin cancer.
So that's kind of like sunburns and then skin cancer.
But at the same time, there's also photo aging and the manifestations of photo aging, which
means early signs of aging on the skin that is brought about by the exposure.

(11:41):
So if you're scared of wrinkles, if you're scared of pigmentation, these changes as
well are caused by UV.
Yeah, and to add to that, I think one of the most common skin concerns would be dark spots,
pigmentation, and even melasma.
So I think it's really important to raise awareness on the importance of sun protection.
Even though you invest on all those lightening, brightening ingredients, but then you miss

(12:02):
your sunscreen, then it defeats the purpose.
So protecting our skin against UV damage is really the number one most important priority.
Yeah, I think especially in the Philippines from what I've noticed, right?
When it comes to the sun, I think the most concern is, oh, I don't want to get tan.
You're home with them, right?
That's true.
Very true.
Yeah, I think it's a very societal thing.

(12:25):
A societal expectation of sun exposure.
The first thing that comes to our minds is the tanning effect, right?
But like the three doctor said, that there is an expanse of effects from the sun that
we do not see, right?
And I know we'll talk about sunscreens later, but I want to link this to the idea of broad
spectrum sunscreens, right?
We hear of, oh, it protects us from both UVA and UVB rays.

(12:48):
We'll hear that, oh, UVA are the effects that you don't see right away.
You know, UVB is...
Can someone explain the difference between UVA and UVB for people who may not know?
Okay, I'll do that.
So we need a randomizer.
So UVA, for short, it's for A for aging.

(13:08):
That's what we usually inform our patients and also our friends regarding the differences
within UVA, UVB, and UVC.
UVC won't really penetrate, not much, in our atmosphere, but UVA and UVB.
So between the two, UVA stands for aging.
So that's for the aging signs, premature skin aging.
UVB is the one that process burning.

(13:29):
So B for burn.
So that's the easier way to think about the differences between the two.
It is important for your sunscreen to be broad spectrum because it states that it protects
our skin against both UVA and UVB.
It's important to note that UVA penetrates more deeply.
So even though it's related to, do I still need to wear sunscreen even when indoors,

(13:52):
but then you're near the glass window or your car, right?
So UVA usually penetrates deeply, so UVA passes through.
So that's the reason why it's really important still to choose a sunscreen that's broad spectrum.
Yeah, and to add to what Jaja said, so basically UVA, UVB, and UVC, they're classified based
on wavelengths.
So ultraviolet light is still a type of light and light has wavelength.

(14:17):
So generally speaking, the shorter the wavelength, the more damaging it is.
So UVC has the shortest wavelength and thank God that is filtered by the ozone layer.
So please Lord, let us not destroy our ozone layer guys.
And then UVB would have shorter wavelengths than UVA.
So UVB is more damaging than UVA.

(14:39):
But then the depth of penetration also depends on the wavelength.
Longer wavelengths penetrate deeper.
So because UVA has the longest wavelength, it penetrates deeper than UVB.
So that's why Jaja mentioned that it really impacts aging because it goes deeper where
collagen is located.
For UVB, it penetrates more superficially in the epidermis and in the superficial dermis.

(15:05):
And this is why it can cause skin cancers in those locations.
I want to say that new studies have shown that both UVB and UVA contribute to skin aging
and skin cancer, which is why it's not always UVA only for aging, not always UVB only for
sunburn.
Both can contribute, but like Jaja said, one contributes stronger than the other.

(15:28):
And that is why broad spectrum matters.
Sun usually covers both UVA and UVB.
So the filters, whether it's a mineral or a chemical filter, will cover both UVA and
UVB.
Yeah, yeah.
I think that's so important to know, right, Docs?
For the general consensus, it's just the sun, right?
We don't really think of the specifics of it, right?

(15:50):
It's when it comes to the wavelength.
And I think that's why it's so important to know those information because it can inform
the way that we take care of ourselves or the types of sunscreen that we use or what
we're looking for in a product or the ingredients list or whatnot.
But beyond all of that, I wanted to nitpick on Dr. Mara for a bit, being a dermatopathologist.

(16:13):
For those who may not know, a dermatopathologist thinks of fellowship in dermatology, right,
where they really focus on the pathology of skin cells and tissue for the hair and the
nails as well, looking through microscopes.
Now I wanted to ask, when we talked about sun damage or damage from UV rays, again,
you talked about DNA damage and skin cancer and tanning.

(16:35):
And these are things that we can probably see from the get-go, right?
Oh, you got a tan.
Oh, I have melasma.
I see it in the mirror, right?
Oh, I see right eyes or wrinkles after many, many years of prolonged sun exposure.
Now I wanted to know to the cellular level, which is your expertise as a dermatopathologist,
what do we see different in skin cells or skin tissues that are damaged from the sun?

(17:01):
So that's a good question.
It really depends if you're looking at the acute, the things that occur faster.
So you have acute and chronic, which occur longer, like decades after sun exposure.
So of course, for acute changes, you know sunburn, that happens.
It's like an overdose, a mega dose of UV exposure.
And we do see that in, but you know, honestly, very rarely are these patients biopsied.

(17:27):
But if they were biopsied, biopsied means you take a sample of the skin, I look at it
under the microscope.
If I do look at it under the microscope, I will see cells called apoptotic keratinocytes
or cells that basically press the self-destruct button and they died.
And I can see that under the microscope.
We call them sunburn cells.
So another thing that's probably more immediate is tanning.

(17:50):
So I always hear from patients, oh, I have a tan, I'm protected.
And I'm sure people who are skin enthusiasts by now know that a tan is actually a sign
of damage.
And tanning can be immediate, which is basically once you have a lot of sun exposure, melanin,
which is our natural sunscreen, there's sort of an increase in melanin.

(18:10):
And that's how you can see the immediate pigment darkening.
And that is a response of the skin to protect it from the sun.
And sometimes three days after, not only are you extruding melanin into the surface, you
have even more melanocytes being produced.
So you can see this under the microscope as the skin cells having more pigment than usual.

(18:32):
And you may also have an increase in the number of melanocytes, because there's like a normal
number of melanocytes, which is the cell producing your pigment, melanin.
And these can increase in number.
So those are the two things I can usually detect under the microscope.
For chronic changes, so photo aging would be the most common.
And photo aging is just an umbrella term for accelerated aging of the skin due to the sun

(18:57):
and can manifest as wrinkles, coarse skin, textural changes, like cobblestone, and even
EC bruising.
We call it solar purpura, which I'll explain later.
So for those with photo aged skin, you'll see changes in the epidermis compared to areas
that are not aged by the sun.

(19:18):
So sometimes it's thinner, sometimes it's thicker.
But remarkably, there is definitely a, because you can stain for collagen under the microscope.
So you can see there's a reduction in the staining of collagen, meaning there's a reduction
in collagen.
And you also see, which is like my number one marker for sun damage is something called
solar elastosis.
So normal collagen is like pinkish under the microscope.

(19:41):
But then if it's sun damage, pinkish, beautiful collagen network becomes this purple mush.
And the moment I see it, and it can be very, very thick, I'm just like, this person had
a lot of sun damage.
And more often than not, along the way, they'll develop skin cancers.
So I think those are the most common.
Other things that are not usually talked about to be poikiloderma, which is like reddish

(20:03):
brown mottling with white areas.
Under the microscope, you can see that an increase in blood vessels.
Under perfora, which I've mentioned a while ago, the blood vessels burst easily when it's
impacted by trauma.
I don't usually see this in the microscope, but it's also because of collagen breakdown,
because it's collagen that keeps your blood vessels like strong and resilient.

(20:23):
So they burst quickly, usually in the age 70s to 80s.
Photo-cancerous genesis, like I've mentioned.
But I didn't want to go into the detail of how cancer looks like under the microscope.
But definitely once you develop cancer two or three decades after chronic sun exposure,
you will see, you'll pretty much spot cancer very quickly.
And that can be voicicell carcinoma, stemocell carcinomas, or melanoma.

(20:47):
So all of those things are directly related to chronic sun exposure.
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(24:00):
Especially when it comes to skin cancer, I guess it gives really the emphasis of why
it's so important to protect ourselves from the sun, right?
And also, I don't think you'd want that purple mushy skin cells, right, as opposed to the
pink cells.
Yeah.
I think that's a pretty big good way.
So now I think the biggest question is, how do we protect ourselves from all of these

(24:22):
effects, right?
I mean, especially in the Philippines.
The last time I've been home was five years in 2018.
And each time, I grew up in the Philippines for the first six years.
I grew up in the farm, actually, for my first six years before I came here.
And I just remember how hot and how humid it is there, right?
No matter where you go, the sun is always following you, right?

(24:45):
I guess that's why there's a slogan there in the Philippines, like, Amuy Araw, where
you smell like the sun, something like that, right?
Yeah, I hear this, Chris.
Which part of the Philippines was that?
We're from Nueva Ecija, actually.
But we stay in Manila now mostly.
Yeah, so especially there, it's all farms, right?

(25:08):
It's all farming up north, and it's just closer to the equator, too.
It's like the sun is just bearing down on you.
That's true for the whole Philippines.
Now, the question is, how do we protect ourselves from all of these effects that we've been
saying?
Maybe let's talk to Dr. Chesca.
Well, for sure, for sure, sunscreen.

(25:29):
Okay, but there are so many nuances behind sunscreen.
A lot of people are asking, should I wear it indoors?
Should I wear it every day?
Should I wear it in the different time, et cetera, and all these things?
How much of it to apply?
So I think that's a really, really lengthy discussion.
But definitely, the reason for saying that you can wear sunscreen when you're indoors

(25:52):
is if you particularly live in a really bright area, and then the sun passes through glass,
particularly UVA, so that can still cause those effects, particularly with those related
to aging, but also skin cancer.
Second is, it depends on what SPF the minimum, because it depends if you're staying indoors
or if you're going outdoors.

(26:14):
If you're staying indoors, SPF 15 should be fine if you're applying the right amount,
which is roughly two milligrams per centimeter square, or an estimate of two finger length.
But if you're going outside, definitely it would be better to apply a higher SPF.
But it's a very personalized, individualized approach to each patient.

(26:34):
Definitely, I'm sure Dr. Bara and Dr. Jaja would agree.
One answer for one patient may not be the same for the other patient.
And aside from that, sunscreen is not the only thing, of course, but it's actual sun
avoidance, of course.
So that's like from 10 a.m. to 4 p.m. or 3 p.m. you try to actively avoid the sun, stay
in the shade.

(26:55):
Well, there are some people who actually work under the sun, so their sun protection is
also different, perhaps wearing protective gear, UPF clothing, etc.
Oh, did I already turn it off?
Because it's a lot, it's really a lot.
I think sunscreen is really a big, big area of discussion, especially right now that more

(27:16):
people are aware regarding the importance.
I've got patients like, look, what's the best sunscreen?
Chemical, physical, or mixed type, or tinted sunscreen.
So I think at the end of the day, it's really personalized, much like skin care.
Sun care is really personalized.
So when people ask, it matters on what line of work or how much exposure you get.

(27:36):
So in a day, or skin type as well, because it really matters on the overall formulation.
Some people like it more creamy, but some doesn't like they want to have a gel formulation.
So it really depends at the end of the day on what really suits you and what you all
think.
The best sunscreen is what you will consistently wear.
So it's really a personal choice.

(27:57):
But then like what Dr. Cheska said, at least the bare minimum, at least SPF 30, broad spectrum.
And if it's water, it's an added benefit for you.
Yeah, I think when it comes to sun protection, the first thing that comes to mind now, especially
as informed consumers and public is sunscreen.
Sunscreen, right?
Yeah.
I like explaining to my patients that sun protection for me is two tiered.

(28:20):
The first is you want to limit the amount of sun rays that get into your skin.
And that's really what sunscreens are for.
It limits the amount that gets to your skin.
And that's also what sun protective measures are for.
Avoiding the sun, using a hat, using UPF clothing, all of this is to avoid the sun's rays from

(28:41):
getting the skin.
And then the second tier is to, I think people understand, hopefully they understand by this,
no sunscreen can completely stop all of the rays from coming in.
So the second tier would be if the sun's rays do hit my skin, how do I repair the damage
that that sun's rays would have cost on my skin?

(29:04):
And that is another angle that I focus on sun protection.
And that's another reason why antioxidants are all the rage these days.
They are not really like sunscreens.
They do not filter UV rays, but theoretically they are able to repair the damage that the
sun could cause.
However, while sunscreens are really tightly regulated and require a lot of testing and

(29:29):
regulation, antioxidants, especially oral ones, do not require the same level of really
strict evidence-based efficacy.
So that's just the problem with oral supplements and even the topical antioxidants that we
put on our skin.
Now that being said, we can increase our antioxidant capacity just by eating fruits, vegetables,

(29:54):
because all of these things are rich in antioxidants.
I always say I wish I were a plant, a plant flourishes under the sun, a flower flourishes
under the sun.
And honestly, that is where antioxidants come from, right?
Because we can see that all of these plants have antioxidants and we are trying to ingest
all of it to help ourselves.

(30:14):
So that's just a two-tiered approach that I think was worth mentioning and why, again,
antioxidants are so popular.
Yeah.
I mean, I feel like there's been a boom in, oh, vitamin C, E, ferulic, right?
To limit this reactive oxygen species and hopefully protect us from the damages that
we get from the sun, right?
I think also consumers can become very polarized, right?

(30:34):
I'll do this and I don't have to do this anymore because I'm doing this already.
And I think we also see this with questions such as, oh, if I wear a hat or if I use the
umbrella, do I still need to use a sunscreen if I'm protecting myself, right?
And I think that still roots from the fact that there's a lot of education that we need

(30:56):
when it comes to sun protection, right?
And I wanted to also point out what Dr. Mara said about sunscreens not really blocking
all of the UV rays that we have, right?
Or that we are exposed to.
And I guess that creates nuances in how much sunscreen we're supposed to put.
Again, like Dr. Czeska said, the avoidance of the sun as much as we can.

(31:17):
And I wanted to nitpick Dr. Jaja on this one for this question.
She created a video recently on TikTok regarding the term sunscreen and sunblock.
And honestly, growing up in the Philippines, I feel like the only term I heard was sunblock.
And then here in the US, I don't think I've ever heard the word sunblock here in the US

(31:37):
growing up.
I started using sunscreen when I was 16 years old and I knew it as sunscreen all along,
but I never heard the word sunblock.
Dr. Jaja, based on your video, what are the logistics of the terms between sunscreen and
sunblock?
Are they different?
Are they the same?
Yeah, actually, at an early age, sunblock is the usual term.
But then it was retracted because sunblock, there's a misconnotation that when you apply

(32:00):
your sunblock, it completely blocks all of the UV rays.
So there's a misconception there.
So people may have the misconception, ah, I don't need to seek shade anymore or wear
protective UVF clothing anymore.
So that's the reason why they change it to sunscreen because you're just screening out
a little, some of the percent of the UV ray that penetrates our skin.
So right now, the accepted term is sunscreen to avoid the misconception of blocking completely

(32:25):
all the UV rays from penetrating your skin.
So that's the reason why sunscreen is the more accepted term right now.
Yeah.
Yeah.
Thank you for that.
Yeah.
I've always wondered, like, wait, I've never heard the word sunblock here in the US for
as long as I can remember, even the bottles.
And so that's so helpful to know.

(32:45):
Now we've talked quite a few about sunscreen and again, such an important topic.
And we also mentioned other things in a way so that we can protect ourselves from the
sun, right?
From the immediate reaction of the sun when we go outside, when it comes to going outside
the door, being right next to a window.
Now what are ways that we can now target more of the long term effects that we get from

(33:08):
the sun, right?
Stubborn things such as melasma or exacerbation of hyperpigmentation, right?
Or even things like wrinkles, right?
That we know are byproducts of like photogenic or skin aging, which is by prolonged exposure
to the sun.
What are ways, I guess let's do it one by one, melasma, which is a very common skin

(33:28):
concern, especially in the Philippines.
I just want to share, I remember that my aunt, I think from being outside in the Philippines
on sun for so long, her biggest concern was melasma, right?
Especially here in this area.
And I remember she used to have this set of skincare that has numbers one, two, three

(33:48):
or something that's like, oh, you use this.
And then which has become so famous, right?
Because melasma is such a stubborn issue.
I guess one, how does sun exposure lead to melasma?
And two, what are your favorites or what have you seen to be the most efficacious ways to
treat and target this?
That's a really good question.

(34:09):
And actually, I remember my mentor saying this, whoever can find the cure for melasma
deserves a Nobel prize because it's so difficult to treat.
So it's a chronic condition as well.
So well, you have genetic factors that make you more susceptible to having melasma.
Second, of course, is your race, which is part of genetics as well, your sun habits

(34:32):
or at least sun protection habits.
And even, well, the kind of skincare that you use.
You have sunscreen in your regimen, you have antioxidants, you have exfoliants.
Are you exfoliating too much so that you're exposing your skin to the sun easier?
So it's actually a really delicate balance.
Of course, with melasma, it's a very photosensitive condition because it's very well triggered

(34:57):
by UV radiation.
But actually, aside from UV, it's also triggered by visible light.
So it's a pigmentation disorder and you tend to produce more pigment.
And as mentioned by Dr. Mara earlier, even the number of your melanocytes can also increase.
So with treating melasma, you have to strike a delicate balance between silencing your

(35:21):
melanocytes from producing so much pigment.
And at the same time, you also want to, well, in general, on those spots in the whole face
or technically the whole involved areas.
And at the same time, there are other ways to, well, kind of get rid of pigment by extruding
it through exfoliation to some degree.

(35:42):
But if you overdo it, like I said, you're basically stripping your skin's protection
and making it more exposed to UV.
It's very complex.
Actually, the first line, of course, are still lighteners and of course, sun avoidance.
That's the most important.
And one should not be without the other.
So for example, you don't want to do the lighteners and not wear your sunscreen, right?

(36:05):
And then there are some procedures, of course, that can work, but it's no guarantee.
And definitely relapse is very common.
So relapse meaning you can have it again or you can have new patches on other areas.
So that's the difficult thing about melasma.
I would like to ask my colleagues if they have anything to add.

(36:27):
I think I just want to add that because melasma is also due to chronic UV exposure, many times
it develops two or three decades after the intense sun exposure that you have.
What I find really interesting now is I have many 30s, 40s, 50s patients with melasma and
really they didn't use sunscreen when they were younger.

(36:49):
And now when I have patients and even go to events where I meet the Gen Zs or the young
millennials and I ask them, so do you use sunscreen?
Yes.
And my God, they're like, I use it too.
I use my one fourth teaspoon and I'm just, girl, you are not going to get melasma.
Two decades down the road, you got it.
I am like so slightly jealous that they just have this information that we are giving because

(37:14):
two decades after, two decades down, they are going to reap that benefit.
Whereas even the ones my age nowadays using sunscreen and they're like, don't try using
sunscreen.
I'm so proud of you and how much?
And they're like, yeah, like, you know, this amount, just this size because you know it
really stinks my skin.
And I'm just like, oh, girl.
So but that's just as the world we were born at, but hopefully two decades down, these

(37:37):
people will have really glowing skin because they were protected from the sun.
We're not going to have so much patients.
So many different things.
Okay, it'll be a different thing.
Yeah, we're going to be like extinct.
I wanted to touch also on what Dr. Cheska said, talking about different lights as well,
right?

(37:58):
And Dr. Maris said earlier, because of different types of lights and radiations, we've been
talking a lot about UV rays and when it comes to the effects on the skin and especially
on the lasma, right?
I wanted to also point out the concept of blue light, which has also been on the news
a lot recently.
I actually had an episode with a Lasik surgeon, Dr. Dainizu, a few months ago, and she was

(38:23):
talking about the concept of blue light and coming from the sun when it comes to eye health
and eye damage and possibly the genesis of cataracts or macular degeneration.
I wanted to know what are its effects on the skin itself?
Do we have to be as worried about blue light or as they call it, high energy visible HEV

(38:44):
light compared to UV radiation and do our sunscreen protect around it?
Most of the visible light that we're exposed to definitely still comes from the sun.
Of course, some will say that, yeah, but we're exposed also to monitors, to screens a lot
of times in the day, but the studies so far have been conflicting.

(39:04):
There are studies that show that even just like the mere exposure can trigger pigmentation,
but at the same time, there are studies that say that you will need to be exposed to it
for tens of thousands of hours before you lose any kind of pigmentation, but definitely
visible light from the sun can trigger pigmentation more.

(39:24):
I think that's kind of where antioxidants come in and tinted sunscreen.
So well, to be honest, the term blue light itself, I don't really know where that came
from and why it's being singled out because as far as the pathologic or at least the clinical
aspects of pigmentation are concerned, that's still from visible light from the sun.

(39:48):
Of course, we still need more studies.
It's not invalidate as well the possibility.
For the moment, I would say in general, visible light is something that we can protect ourselves
from by using tinted sunscreen.
So there have been studies of iron oxides particularly, so that's something that you
can look for in your sunscreen as an extra that helps particularly protect against visible

(40:11):
light.
I first heard about blue light during the pandemic because everyone was in on their
gadgets.
So that's the first time I've heard actually that blue light protection, but then in reality,
all visible light still number one source will be from sun rays, sunlight.
So at the end of the day, like what Dr. Ocheska said, yeah, having iron oxide can have an
enhanced protection against blue light.

(40:31):
But then if you're ever using any type of sunscreen, it still have protection against
the visible light aside from the UV light.
So if you have the iron oxide, then enhanced protection against blue light is there in
your sunscreen.
Yeah.
And if I may add, the reason it's called high energy visible light is because as I've mentioned
a while ago, light is a spectrum and the wavelengths also determine the capacity to damage.

(40:56):
So shorter wavelengths will have more damage.
So in the visible light, there are different colors.
That's why it's visible light.
You can see the colors.
So visible light is actually close to ultraviolet light and blue light is the closest one in
terms of wavelength and well, in terms of the energy to UV light.
That's why people are concerned that it may have similar effects.

(41:18):
But if you look at clinical trials, the effect of UV is very well documented.
I think for blue light or visible light or high energy visible light, whatever you want
to call it, there are only about three clinical studies establishing that it may potentially
have an effect.
If you're thinking that it can worsen pigmentation in darker skin types, it may worsen photo

(41:39):
sensitive conditions or people who are already sensitive to light in the first place, then
visible light can make it worse.
And like Cheska said, it may have a role with auto aging.
So if you remember a while ago, I mentioned that UV can directly damage DNA.
Visible light doesn't work like that.
It doesn't damage DNA.
However, it's thought that perhaps visible light can release reactive oxygen species

(42:05):
or like your free radicals.
And then this can in turn cause photo aging.
So I hope that added to the discussion.
Yeah, yeah.
Super helpful.
Thank you so much.
Yeah.
And you know, I feel like the overlying message of all of this is that, you know, when it
comes to sun protection, there's an array of things that we need to be protected from,
right?
Again, it's not just the tan, it's not just the future or down the road new lasma, but

(42:29):
also things pressing like skin cancer, right?
Or especially melanoma, right?
Well, I wanted to also tag on Dr. Jaja on this.
You're a visiting consultant physician, right?
In both the hospital and the clinic.
I wanted to see like in the day to day basis, what is the rate of incidences that you see
were like, oh, this mole is kind of making me suspicious.

(42:50):
Or how often would you say that you see the chronic effects of sun exposure, like skin
cancer in the patients that you see?
Actually, the dangers are there is of having a suspect in mold.
It depends on the ABCDE.
That's what we usually advise our patients to watch out for like a, asymmetry, b, the
border is regular or irregular already.
If there's different, c stands for color.

(43:13):
Your mole has different shades.
It's a time that it may be a suspicious mole and diameter around more than 0.6 millimeter
and e stands for evolution, meaning it's evolving, changing in appearance.
So that's the usual signs that we want our patients to watch out for, especially if you're
high risk because you have to take into consideration your risk factors to have the sun damage,

(43:34):
right?
Like your line of work, how much exposure do you get from UV rays and also your skin
type.
Like if it's your fairer skin type versus more thin tone people because fairer skin
type meaning they have less melanin.
So they have less protection against UV damage.
The reason why in clinics usually fair skin tone, you might have more risk of having skin

(43:57):
cancer than like morena, we have more melanin.
So you have to take into consideration all these factors and really alert your patients
regarding the possible risk and really have a regular mole checkup as well.
We have the mole mapping with our dermal stocking.
So it's really important that you have any suspicious looking mole through your book

(44:17):
on appointment with your dermatologist ASAP because early detection really matters when
it comes to managing skin cancer.
Yeah, definitely.
But with early detection, you know, sometimes people come in to get your help as board certified
derms when quote unquote it's kind of too late, right?
Like where it's already developed and already there.

(44:39):
And sadly for most, especially here in the United States, when I talk to your derm colleagues
here, they say, yeah, I mean, you see so many patients who already had melanoma, right?
They could count with their fingers how much melanoma they can diagnose, right?
Even the first visit of the patient, right?
Initial visit.
And I wanted to tag along Dr. Cheska here who did the fellowship in dermatologic and

(44:59):
laser surgery.
Is it in Thailand?
Yeah, it's in Thailand.
Yes.
Sawadee kap.
Well, and I wanted to tag along in this topic of skin cancer.
And we were talking earlier about possibly treating again, the chronic exposure to the
sun.
What are the options for people who have, let's say already have skin cancer?

(45:23):
What are the modalities, the surgical modalities that the field of dermatology can offer for
these people?
All right.
So definitely if we have a suspicious omniscient whether or not we don't know yet if it's
skin cancer, we're thinking at the back of our minds that it's probably a cancer.
We can take a sample of it or get it as a whole.
As with margins, so margins means that, for example, you have a single lesion there and

(45:46):
then you're going to go beyond the borders of the margin, like two, three, or even five
millimeters to get that thing out of it.
So that's called ingestion.
And then there's also a skin saving surgery called most micrographic surgery where it's
done by stages.
So you try to get as little skin out as possible, try to get the cancer out, but you also want

(46:09):
to preserve the cosmetic outcomes.
And that way the dermatologist acts both as the surgeon and the pathologist.
So what they do is we remove through one stage and then look at it under the microscope.
Do we see signs of cancer still remaining?
So we go further and then sometimes it can take a whole day, but sometimes it can be

(46:29):
really quick.
So it really depends.
For pre-cancerous lesions, there are actually nonsurgical options as well.
For example, there is electrodesiccation.
If you've heard of coterie, so it's actually called electrosurgery as a general term.
So we try to burn off that piece of skin that is diagnosed as pre-cancerous or even some

(46:50):
really mild forms of cancer can be done through nonsurgical means.
So they have to be burned off either through the electrosurgery or even laser sometimes.
And there are also other ways to destroy that piece of skin.
For example, freezing it.
It's called cryosurgery or cryotherapy.
Sometimes chemical fields that reach the deeper layers of the skin can also manage pre-cancerous

(47:14):
lesions or skin cancers.
There's an emerging field right now or an emerging treatment called photodynamic therapy,
PDT.
Mind you, it's not the same as LED treatment.
It's different because LED treatment involves putting a patient under light.
And these are usually for just non-cancerous conditions.
So photo aging, well, sometimes anti-aging, photo aging, anti-aging, and skin texture

(47:40):
improvement.
And however, in photodynamic therapy, you actually have to apply a drug that makes the
skin cells more sensitive to light and absorb it better.
So that's another option.
Not very much available here yet because of the availability of the drug that you actually
apply.
And actually there are so many things that a board-certified dermatologist can do for

(48:02):
you.
It's very helpful if not skin cancer for photo aging.
There are lasers or flash lamps.
If you're familiar with IPL, it can also address both the fragility or the fragile vessels
and at the same time the pigmentation.
There are also resurfacing lasers that can remove or at least, well, try to ablate, destroy

(48:23):
the top layer of your skin so that you make way for new skin.
Also at the same time, stimulate new collagen.
So many.
Really so many.
Skin pigmentation, oxygens, lasers, chemical fields, et cetera.
So each patient treatment is individualized for sure.
And it definitely helps to consult with your board-certified dermatologist so that you

(48:45):
can figure out with them what works best for your budget, your timeline.
Are you moving?
Are you flying out?
These things you have to consider.
Yeah.
The lifestyle of the patients.
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We have a section that's coming up, which I have been so excited to do.
We're going to do a ala boya bunda section here in our live stream today, where I'm just

(52:10):
going to say the most common Googled statements when it comes to skincare, or specifically
sun care and sun protection.
And I just say it, and you can all blurt out if it's true or false for you.
If anyone wants to explain themselves, or explain their answers, or disagree, you can

(52:30):
freely do so.
So I guess I just start it.
And for this very first one, I don't know how prevalent this thinking is in the Philippines,
but here especially, there's a subgroup of people who completely believe this statement,
and that is, sunscreen is toxic and bad for my health.
True or false, dog?

(52:52):
False.
False.
Yeah, false.
Yeah, I feel like there's this...
I was talking to, I don't know if you know that, Dr. Daniel Segui.
I saw him recently in Seattle for a celebration.
And we were just talking about how we did a live stream before.
We actually did a podcast episode before, two years ago.
And we received so much hate messages after our live, because we were talking about sunscreen.

(53:16):
And we realized that here in the United States, there's a huge subgroup of people who believe
that sunscreen is toxic and actually cancerous.
How is the safety of sunscreens for you?
Before I answer the part where how the sunscreen safety is, I think I wanna...
So I have a master's in clinical trials.
One of my most important jobs is to understand which evidence, which research works are really

(53:43):
high yield and are rooted in scientific evidence.
So I think the biggest problem is that there are studies that further this narrative of
sunscreen toxicity.
So a lot of the people who are naysayers will say, but there is a study and there are studies.
There are studies.
For people who do not understand research methodology, they will just say that there's

(54:08):
a published paper.
But unfortunately, number one, a lot of these studies that claim toxicity are done in the
in vitro level, whether just in cells or maybe in animals, mostly in petri dishes really.
And that doesn't translate into humans necessarily.
And usually you have mega doses of certain compounds tested on a tiny cell versus you...

(54:31):
It's a reverse, right?
Of a huge human and like a tiny dose of something else in the real world.
So I think that for some of them, they believe they are scientifically rooted because studies
exist, but a lot of these studies are flawed.
And that's why it's harder because they feel that they are in the side of science, but
then research, it's not created, it's not equal at all.

(54:53):
And you really need someone with a background not only in research, but in the scientific,
basically the field itself.
That's why I'm grateful for chemists to speak up because dermatologists, we're not experts
in formulation and formulating sunscreens or even the science of sunscreens.
I won't pretend to understand how it's made and tested, but I do know that sunscreens,

(55:13):
especially in the US, these are regulated as drugs and you need to really have a certain
level of proof for both safety and efficacy to get products out there, especially in the
Western world.
So for me, are sunscreens safe?
Yes, because they are regulated.
And for those who have questions about why do studies exist according to that, like I

(55:36):
said, studies are not created equal.
Super helpful.
True or false, the higher the SPF, the better the sunscreen.
False!
Maybe you're answering it wrong.
I think it's different.
Me, true, mathematically speaking.
So if you look into the figures, technically yes, but it depends on the experience and

(56:00):
if people actually reapply because if you don't reapply, whether it's SPF 30, 15, 30
or 50, well, you're still going to get a sunburn, you're still going to get these effects of
you too.
So I agree with you guys, it depends.
Also, the amount of sunscreens, what type of sunscreen, and also your daily activities,
if you're more sweat prone or you're not taking care of your skin, so it really depends.

(56:25):
Kinda true.
True.
Explain yourself, Dr. Mare.
Like Chaska said, numerically speaking, we would like higher SPF because the truth is
a lot of people don't even use the product enough to get to the SPF in the label.

(56:45):
So as you know, there are certain amounts that you have to spread on your face and if
you get that amount right and even spread it adequately, then you'll get like SPF 50.
Unfortunately, based on my experience, there are some sunscreens that the usability or
the compatibility with the consumer goes beyond the SPF label.

(57:06):
So if, for example, you have an SPF, let's say 30 that you love and adore and use daily
and apply correctly and like Chaska said, reapply if needed, that's still better than
an SPF 30 that's just in your shelf and you never touch because it's pasty and sticky
and for some reason breaks you out and makes you itchy.
So I would say in its absolute sense, yes, but reality is there is really this loss in

(57:30):
translation in how people use sunscreens and that matters too.
Thank you.
True or false, the SPF from makeup and body lotions are enough to protect my skin.
Cows!
Makeup, I'm sure, falls, but with body lotions, trumps.

(57:52):
With makeup, it's usually how it goes.
When we apply makeup, we don't want to apply a really thick layer.
However, these products are tested the same way as how they would test like a regular
sunscreen.
So for example, if the product says SPF 30, at least so it's a foundation with SPF 30,
you still have to apply that two finger rule.

(58:14):
You still have to follow that two finger rule, but that's going to translate into like a
really thick layer of makeup on your face and it's not going to be cosmetically acceptable.
So yeah, with that one, at least for the face.
Good, the next one.
True or false, if I have a dark complexion or I have darker skin, I don't need sunscreen.
False.

(58:34):
False.
False.
False.
False.
Yay.
For false.
Feel free to explain if anyone wants to.
If not, we'll go to the next one.
True or false.
I think we talked about this already.
I only need to wear sunscreen when it's sunny and when I'm outside.
Yeah, false.
False.

(58:54):
I think this goes back to what we were talking about, of UVA penetration through glass and
the windows.
Actually, I was also with Dr. Joyce Park, the other night, and she was telling me about
how did you know that a lot of new patients are pilots because I guess it's like the intense
of the sun and they don't really wear sunscreen because they think that they're protected

(59:16):
from the windows or the glass of the actual airplane, right?
Which I found super, super interesting.
This one, this is a big one that I see a lot on TikTok.
True or false.
I'll get vitamin D deficiency if I wear sunscreen.
False.
False.
False.
Please explain.
Yeah.
I actually have a really deep dive to this topic on a post I did with Dr. Zena Willsmore,

(59:40):
who's based in the UK.
She's also a derm.
The really long explanation can be found there, but my conclusion there was first off, we
do need UVB to produce vitamin D, but a reminder that you really need just a little amount
of UVB to produce vitamin D.
And number two, sunscreens do not filter 100% of the sun's rays.

(01:00:05):
So you are getting UVB even though you're wearing sunscreen.
In fact, studies have shown that the deficiency is probably more likely with other sun protection
measures like avoiding the sun and also wearing protective clothing.
That it will give you a higher risk of vitamin D deficiency than using sunscreen.
And lastly, it's also very unlikely that you cover yourself adequately and completely enough

(01:00:30):
with sunscreen to stop some UVB from coming in.
Now that being said, there are people who are at higher risk for vitamin D deficiency.
I won't talk about that, but if you are at higher risk, then always talk to your doctor
before starting vitamin D supplements.
So for example, when we collaborated, me and Dr. Zena in the Philippines, vitamin D supplements,
not a thing really.

(01:00:50):
But then in the UK, it's a different set of guidelines.
So vitamin D supplementation varies per region because UV can vary per region.
So if you want to go into a deeper explanation than that, please check out my post somewhere
in my Instagram feed.
Yeah.
And I do want to add when it comes to, I think, a geographical connotation when it comes to

(01:01:11):
vitamin D deficiency, me and all of my friends from high school, we are all vitamin D deficient
here in New York City.
Because especially during the winter and the summer, not so much, our levels actually changed.
But during the winter, just so happens for like we're all twinning with vitamin D supplementation
from our primary care positions.
So that's a very good point, doc.

(01:01:33):
And for the last fast talk question, I know it's getting late there, true or false, tanning
beds are okay as long as they don't burn too much.
False.
False.
But you know tanning beds, it's not really common in the Philippines.

(01:01:54):
And besides, you're probably not going to burn as much as you'll tan because tanning
beds are generally UVA, right?
And it's like 10 to 15 times higher the energy, UVA energy than the sun.
So it's like, and if I may just because I'm obsessed with clinical studies, sorry, I'm
doing studies, one of my favorite studies was that there was like, I think about 63

(01:02:16):
women with melanoma, they developed it before their 30s.
And I think 61 out of the 63, like 97% of those women who developed melanoma before
their 30s, they use tanning beds.
So that's how intense tanning beds can be as a photocarcinogen.
Yeah, I feel like...
I think it's not going to be a problem here in the Philippines because people are so afraid

(01:02:39):
to tan.
So if they can avoid that.
Definitely I'm all for, like you know, you love your own color.
I think it's more of your own skin type, your color.
But I also want to like give that reminder that actively tanning and actually getting
like a really bad tan, even a sunburn is a sign of sun damage.

(01:03:04):
Some dermatologists would say it's like your skin's screaming for help.
Yeah, but the best thing to do is appreciate your natural color, what you're born with.
Try to like know the limitations of how much you're going to tan and at the same time,
you're also going to get whiter because like the whitening marketing here is like really

(01:03:26):
big, right?
And people expect really big results from whitening products.
But I think what's more important is to focus more on healthy skin than more than anything.
Love it, love it.
Yeah, these are all so informative and again, thank you so much for joining me.
And I think that's the final question since we are talking about sun protection.

(01:03:46):
Each of you dogs, you know that question, if you were stranded on the island, what are
the three things you would bring?
If you were stranded, well the Philippines is an island, but if you were stranded in
a foreign island with nobody and no internet connection, you could only bring one sunscreen.
What would be your go-to sunscreen to bring with you?

(01:04:07):
We would go for Jaja first.
We need the fans.
We're Jaja.
So this is a sponsor word, right?
So full disclosure, this is just my personal go-to sunscreen.

(01:04:32):
So I personally use lighter weight gel base, so the Japanese brand actually.
So I've been using it since I was, actually I started being strict with my sunscreen application
mid-late 20s, unlike right now, right?
It's really rampant.
So I think it's my go-to sunscreen.
So if I were, I would be stranded in an island, I'll be bringing that.

(01:04:53):
Very good.
Japanese brand.
She's a media friend.
She's an artiste.
You have disclaimer rights on there.
Maybe Dr. Cheskerman?
So actually I'm not very picky with regard to sunscreen.
I will just grab whatever I can.

(01:05:16):
So I would grab anything that's SPF 50, SPF 50 plus, only because I'm a bit, sometimes
I kind of forget, you know, to reapply myself.
So I'll get anything as long as it's sunscreen and it's FDA tested and it's a good brand
and it's reputable.
We're very, very good at this, no?

(01:05:37):
You have to know, it's very strict here.
So yeah.
We don't want to be mistaken for indoors.
You got it.
And I guess Dr. Meryl, what is the general sunscreen that you would bring with you?
You know, if this is a real scenario, I wouldn't even bring sunscreen because that would mean
I'm going to run out.

(01:05:58):
What I will bring is a UV umbrella.
That's what I'm going to bring.
It's going to last me.
Honestly, you know, sunscreens can be expensive and just a cheat sheet.
I use a relatively expensive sunscreen for my face, but a cheap ass one on my body because
that's the truth.
And now that I'm going to be in an island and I can't free stock, I am going to bring

(01:06:22):
an umbrella.
I was going to say UPF clothing, but I don't have soap to wash the clothes and I don't
want it to be like sweaty and smelly and sticky, but an umbrella I can use, right?
For months at a time and maybe write a name, help me SOS or whatever on top of the umbrella.
So that's my answer.
I'm speechless.
I didn't get any answer that I wanted for this question.

(01:06:46):
Everyone here is media trained.
I want to know your agency.
This is so good media training.
Oh my gosh.
Well, this is amazing.
Dr. Mara, Dr. Cheska, Dr. Jaja.
It's, you know, I've learned so much and hopefully our viewers have as well and our feature podcast
listeners when the episode will be out.

(01:07:07):
You know, these are such important topics that I think we don't have the luxury of listening
to from actual experts.
So it's so amazing to be able to, I mean, honestly, until now, I'm so surprised that
we were able to get us four here in one live.
I was just thinking about it.
Actually, I was thinking about it like late last year.

(01:07:29):
Now it's like, I wonder how possible it will be, but you know, it's possible.
And we finally did it.
So I'm so, so thankful for each one of you for sharing your expertise and your wisdom
and just your generosity and all of these topics.
Oh my gosh.
Thank you so much to each one of you.
Thank you for having us.

(01:07:50):
It was absolutely fun.
And I learned from my colleagues and I'm really looking forward to meeting you when you're
here.
Yes.
It's funny because I'm going to be meeting Dr. Mara one day and Dr. Cheska another day
and Dr. Jaja another day.
Why are we doing it all one day together?
Yes.
Yes.
You know, I-
We can have fun at our venues.
Yes.

(01:08:11):
Yes.
I feel like, I feel like this is not the last time we will have a live stream like this
or Conrad.
There's so much more to talk about.
And obviously dermatologists are not just skin doctors, but they're hair, skin and nails.
And there is so much more to talk about.
And I'm just so humbled and grateful that you joined me.
Thank you.

(01:08:31):
Thank you so much, dogs.
I hope you have a great rest of the night.
You too.
Good night.
Thanks for watching.
Can I just greet my mom from here?
Because she said she was asking for a shout out, but I'm not sure if she's still here.
Hi, mom.
That's not her.
That's not their expert doctor too.
Hello.
That's very Filipino.
Hi, mom.

(01:08:52):
No.
That's true.
Thank you, thank you, Chris.
Yeah.
Thank you.
Have a good night.
Thank you.
Bye.
Have a good night.
Good night, everyone.
Bye.