Hawaii Bans Sunscreen in an Effort to Protect Coral Reefs

Written By: Jamee Bonner

In an effort to protect its marine environment, Hawaii becomes the first state in the nation to ban synthetic sunscreen that is harmful to the coral reefs. The law specifically prohibits the sale and distribution of sunscreen containing oxybenzone and octinoxate, which will take effect in 2021.

“At first this may seem like a shocking decision that leaves tourists choosing between sunburns, skin cancer, or injuring our coral reefs, but it is crucial to realize only sunscreens containing two specific ingredients are included under the ban,” explained dermatology physician assistant Lindsey Smith. “There are still plenty of sun protective options to consider when visiting Hawaii including many sunscreens.”

The two additives included in the ban — oxybenzone and octinoxate – are said to cause, “mortality in developing coral; increase coral bleaching that indicates extreme stress, even at temperatures below 87.8 degrees Fahrenheit; and cause genetic damage to coral and other marine organisms.” A study published in the journal Archives of Environmental Contamination and Toxicology from 2015, found that 14,000 tons of sunscreen end up in and around coral reefs each year in Hawaii and in the Caribbean.

Sunscreens containing oxybenzone and octinoxate are known as synthetic sunscreens and soak into the top layers of our skin. Synthetic sunscreens protect us by absorbing UV rays, and then converting them into infrared rays. While they make up a large portion of sunscreens on the market due to their more cost effective price point they are not the only options available. Sunscreens containing titanium dioxide and zinc oxide are known as mineral sunscreen and are not affected by Hawaii’s recent legislation. It works by forming a protective layer on the skin and physically reflecting UV rays.

“All sunscreens, including chemical sunscreens, have safe ingredients that have not been scientifically proven to be toxic or hazardous to humans. The effect of chemical sunscreens on the coral reef does warrant more research and exploring other options when traveling. Mineral sunscreens are the types of sunscreen I recommend anyway, so it does not make a really significant change in my opinion, “ said Smith.

Which one should I be using?

Most dermatologist would agree that the best sunscreen is the one that you will use. Both types of sunscreens are effective and it all comes down to your circumstance and situation. What matters most in ensuring broad-spectrum protection from UVA and UVB rays, and diligently using whatever type you choose.

The American Academy of Dermatology Association has expressed concern that the restrictions could lead to an increase in skin cancer, particularly melanoma, which the organization says is already 30% higher in Hawaii than the national average. Nevertheless, doctors see this as an opportunity to increase their efforts in educating the public on the importance of sun protection.

“When visiting Hawaii consider investing in a mineral sunscreen or if all else fails use additional sun safety practices such as seeking shade, wearing protective clothing, and limiting time in the sun between 10am and 4pm,” said Smith.

As far as sunscreen usage in Utah no changes need to be made. Continue to wear SPF 30 sunscreen of any brand and type, reapply every 1-2 hours, and remain aware of how much time you are spending in the sun.

Written by Jamee Bonner


I am going through some major hair loss right now and each time I shower and brush my hair I feel like this lady below, seriously though!

hair loss

My baby is now almost four months old and I am currently going through a type of hair loss called Telogen Effluvium. I was hopeful I would not get it this time around because the delivery and first three months were much less traumatic, but it is here and I hope it is at the peak and will start to slow down.

There are many types of hair loss, but I will be talking about this one since it is pretty common and I am currently experiencing it:) Did you know that is can be normal to lose up to 100 hairs a day due to the normal hair cycle? I don’t know about you, but 100 hairs seemed like a ton to me. What is a normal hair cycle?  The hair growth cycle can be divided into three cycles: 1. Anagen – actively growing hair 2. Catagen – Transition phase lasting 2-3 weeks where growth stops and follicle shrinks and 3. Telogen – Resting phase for 1-4 months (up to 10% of hairs in a normal scalp).

Now think about this, if there is a shock to your system, such as child birth, your hair cycle can reverse the ratio and your Anagen (growing) hairs can be triggered into Telogen (resting) phase.

Telogen Effluvium is a non-scarring type of hair loss where over-shedding occurs 2 to 6 months after an inciting event that stops active hair growth.

It is commonly caused by the following stressors:

  1. Fever, weight loss, pregnancy/childbirth
  2. Illness, psychological stress (Accident, death, divorce, etc..)
  3. Surgical operations, medications and others


You will not go bald with Telogen effluvium, even though you will feel like it! It is self-correcting and rarely influenced by any treatment that can be given. The biggest thing in treatment of this condition is fixing the inciting event.

Now I want to mention one thing about hair vitamins that seem to be all the rage right now. If you have some sort of social media account I am sure you have seen celebrities and bloggers push Sugar Bear Hair vitamins. These blue gummy candies look cute but they are not going to help your hair grow! They contain vitamin A and C and a couple different B vitamins and Biotin. Biotin is not the holy grail when it comes to hair loss and there are actually very weak studies to suggest that Biotin improves hair, unless you have a Biotin deficiency which is really rare. I am not saying it won’t help, the power of placebo is real, and it won’t hurt so you can give it a try. However, a deficiency in Iron, Ferritin, vitamin B12, folic acid can slow hair growth. In short, my opinion is eating a healthy diet high in protein, fruits and vegetables is probably better for your hair than blue gummy bears:)




50 Shades of Red


April is Rosacea Awareness Month, which is fitting since the spring can be considered “rosacea season” due to the weather changes causing many to flare this time of year. Rosacea is more common than you may realize and can often be misdiagnosed as Acne.

What is Rosacea?

  • Rosacea is a fairly chronic inflammatory disorder of the hair and oil (pilosebaceous unit) glands on the face that is coupled with increased capillary reactivity which leads to flushing and superficial blood vessels.
  • It most commonly affects adult women with fair skin and Celtic origins.

What does Rosacea look like?

  • The rash usually involves the face symmetrically. Early on flushing is characteristic along with prominent blood vessels causing the characteristic “red face”.
  • Papules and pustules can develop and it can look similar to acne, but the biggest difference with acne is that there are no comedones (black heads and white heads) present.
  • Late stages of Rosacea can cause deep red bumps and nodules underneath the skin and can lead to disfigurement of the nose, forehead, eyelids, ears and chin. Men more commonly  have this type.
  • The eyes can also be involved. You may notice dry, red eyes and a gritty sensation and it rarely can lead to more serious problems such as; corneal ulcers.

What triggers Rosacea flares?

  • Increase in skin temperature in response to heat stimuli
    • Exercise, sun exposure, hot baths, hot or spicy foods/liquids
  • Alcohol and caffeine
  • Emotional stress
  • Change in environment (cold, hot, humidity, wind etc..)
  • Medications
  • Facial creams or oils, Topical steroids

Is there a treatment for Rosacea?

  • Unfortunately the exact cause of Rosacea is unknown and there is no cure, but it can be controlled. Recurrences are very common and it usually waxes and wanes, but it can also spontaneously resolve over a few years.
  • Avoiding triggers is key!
  • Topical make-ups in a green tinted base help to camouflage the redness. Make sure to use gentle products that are fragrance free.
  • Topical treatments include; Metronidazole cream, Soolantra cream, Sodium Sulfacetamide, topical antibiotics.
  • Oral medications are usually more effective than topical treatments and tetracycline antibiotics are the mainstay of therapy.
  • Isotretinoin has been used for severe cases.
  • Laser therapy is very effective for treating the redness and any facial disfigurement.

Melanoma does not always play fair

Most melanomas I see look funky and problematic before a biopsy is ever done. However, recently I had another scary case that took me by surprise and served as a reminder that melanoma does not always play by the rules.  I had a patient come in to see me concerned about a new spot on their back. At a quick glance I thought it may be simply an inflamed flesh colored mole or possibly a Basal Cell type of skin cancer. The picture below is not a picture of my patient, but it is very similar to the spot.


If you are not too familiar with skin cancers, in general, Basal Cell and Squamous Cell skin cancers are more common and generally less aggressive. They can become a big problem locally, but they do not commonly kill you. Melanoma, by comparison, is much more serious and more likely to be fatal.

Now back to the patient. During the exam I noticed two other areas that were much more atypical looking, but thankfully we still performed a biopsy on that initial pink spot. I ended up doing three biopsies on this patient and all biopsies came back as skin cancer, but the one that looked “not s0 concerning” came back as a melanoma metastasis that was very deep. I was quite surprised.  As always, the worst part was having to tell the patient that not only do they have melanoma, but a very serious one that was already at an advanced stage.

The ABCDE’s of Melanoma are a helpful tool when looking at your own spots.  Like I said earlier, most melanomas follow these rules and look abnormal. The more uniform a spot is, the better. The more variety in color and pattern in the lesion, the more likely it needs to be checked.


However, as the story above illustrates, melanoma does not always play fair. And our patient had an amelanotic variant, which means it didn’t have a brown or black color from melanin in the skin.  Amelanotic melanaoma, in my opinion, is the scariest melanoma because it lacks pigment, making it look more like a basal cell carcinoma, acne, or even like nothing at all.  Luckily, these are not too common.

Now, not every mole is a perfect brown round circle.  In fact, most of them are not and yet most of them are still benign. This is where something called the “ugly duckling” rule comes in to play. The ugly duckling sign refers to how similar the moles look to each other. If you have a mole that looks a little funny, but happens to look pretty similar to other spots then that is usually a good sign. If you have a mole that does not follow the rules and you can not find another spot on your body that appears similar, then it is an ugly duckling and deserves further evaluation.

The key is early detection for all types of skin cancers, and when it is all said and done any new or changing spot should be evaluated by a dermatologist.  No one will fault you for coming in for a spot that was benign. I always tell my patient’s that it is better to be safe than sorry. If you never have had your skin checked, now is as good a time as any. Also, if you go get your skin checked then you might as well really get it checked. That means don’t be afraid to get naked and show your skin, and make sure that whoever is doing your exam checks everywhere because some types of Melanoma occur where the sun does not shine.

Lindsey Smart Smith  PA-C

References: American Academy of Dermatology, Spot Skin Cancer