Dr. Jane Explains

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Seven COVID-19 Points: Simplify the Information Overload

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Information overload. It is as though what we hear in one ear disappears thru the other. But understanding the crucial importance of the COVID-19 antibody test can provide a more panoramic picture of the pandemic and help us move-on and get back to some normality of daily living.

To simplify information and provide brevity, here is a list of seven COVID-19 antibody facts that could better solidify the information: 

  1. The COVID-19 nasopharyngeal swab (nose/throat) detects whether someone does or does not have an active virus infection, Currently, it is not very accurate (low sensitivity) if 30 out of 100 people with the highly contagious COVID-19 virus test “negative” and  believe they do not have the infection.   On the other hand, (Eurosurveillance) almost 20% of infected individuals will have no symptoms: you may have it and you don’t know it.   Thankfully broader testing is becoming mainstream as we open our doors and testing expands to both “essential” and “nonessential” businesses. In addition, swabs will become more accurate as technology advances.
  2. Antibodies are blood proteins the body produces in response to a bacterial or viral infection. Antibodies help the fight against these invaders.  The COVID-19 is a viral infection for which traditional antibiotics are not effective. Though the use of some antibiotics and anti-malarial medications are being studied, none have U.S. *FDA-approved benefits enough to eradicate the virus (but, we are getting close to an anti-viral remedy). 
  3. Antibody tests are very helpful in determining who experienced prior COVID-19 viral infection but not very useful for early-onset (“acute”) diagnosis because of the time it takes the body to develop an antibody response. The short and quick: Antibody testing is a method of determining who has been infected in the recent past and/or the last few weeks/months. Antibody levels are measured through blood tests (serum).

 Let me expand on this:

  • The IgM antibody will be positive within a few days of the infection, remain elevated for 1-2 weeks then quickly disappear as the infection clears
  • The IgG antibody will be positive as the infection clears and continue to rise as the body heals.  Elevated IgG levels can be an indicator of protection from the virus. Within a week or two of an acute infection, there may be an overlap of both IgG and IgM in the blood then the IgG will continue to remain positive as the IgM levels decline.
  • The difference between the nasopharyngeal swab and the serum antibody test is the nasopharyngeal swab detects the virus, and the blood test checks for the body’s response to the virus.
  • An antibody test result could help us feel more confident to leave our homes. Optimally, the approved antibody test would need a low level of false negative results (high sensitivity). The antibody test may (along with other indicators) help determine whether someone (or groups of people) are immune and can return to work, school, athletics, restaurants, etc. It could guide us in determining whether to relax rules of social distancing and allow patients to undergo non-urgent surgical procedures or routine/preventative medical office visits. We could all experience a better hair-day once we visit our hairdressers!

For now, we let the experts work their microscopes, collect their data, and provide us with the latest updates and treatment strategies. We will all return to some kind of normalcy in the next few months as our social culture adjusts to account for some understandable germaphobia. Our government and medical leaders have begun to pave the path for future strategies in addressing the next pandemic wave whether it is another round of COVID-19 or something more destructive. 

*FDA: Food and Drug Administration

**diagnostic medical tests, sensitivity is the extent to which actual positives are not overlooked (so false negatives are few), and specificity is the extent to which actual negatives are classified as such (so false positives are few

**In addition, individuals with elevated COVID-19 antibodies could offer their plasma for matched-recipients in dire need of aggressive treatment.

Short Nails: Healthier Fashion Trend Option in Fight to Reduce Infection

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For the last several seasons, fashionably long nails have been trending among celebrities including Katy Perry, Lady Gaga, and Gwen Stefani. Unfortunately, acrylic extensions and longer natural nails may harbor pathogens that could provide a “safe harbor” for bacterial, viral, and fungal infections. With greater public health concerns for the COVID-19 virus, perhaps one method of reducing infection spread could be to shorten your finger nail length and perhaps avoid acrylic nails.

As far back as 1999, a study in the journal of Clinical Infectious Diseases found that 86% of a volunteer group of health care workers with artificial nails had bacteria such as Staphylococcus aureus or yeast present under the nail compared to only 25% of a control group without artificial nails. Published in October 2002, the CDC reported that health care workers with acrylic nails harbored more bacteria under their nails and on their fingertips both before and after handwashing than those who had natural nails.

In 2008 hand cultures among 69 nurses working in an ICU demonstrated increased numbers of bacteria associated with nail tips measuring more than 2mm. Another study found that if nail tips were longer than 2mm (1/8 inch), hands were more likely contaminated with the bacteria Staphylococcus aureus.

The Joint Commission (2009) instructed medical staff members to hold their palm in front of their nose: If they can see their nails over the fingertips, they need to trim the nails (see picture below).

In the United Kingdom, the specifies nails must be short. Both World Health organization (WHO) and the UK’s National Health Services (NHS) defined short nails as less than 0.5cm or ¼ inch. The CDC also recommends cutting nail tips to ¼ inch. The CDC very clearly spells out when and how clean your hands with soap and water and the proper use of alcohol gel (CDC.gov).

As far as gel nail polish, a study in the American Journal of Infection Control (2018) demonstrated no difference in microorganisms on nails with gel polish, however, they did conclude that gel nails may be more difficult to clean using alcohol hand gel. The NHS recommends healthcare workers refrain from using any form of nail polish.

Just like my nails, I will keep this blog short: Short nails, proper cleaning, and keeping hands away from the face (except when eating or applying lipstick) are recommendations based on true facts and are essential in an effort to decrease your likelihood of catching or transmitting disease.

Coronavirus versus Influenza: 2019-2020

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Coronavirus concerns are valid, and the contagion and level of disease severity is a large concern for our nation and the world. Like MERS and SARS, the 2019-nCov in Wulhan, China initially appeared to be spread from animals (camels, cattle, cats and bats) to people. More recently, however, person-to person spread via respiratory droplets seems to be the mainstay of transmissibility. How easily the virus spreads person-to-person is still in question. The CDC is taking this public health threat seriously and the medical community will soon understand the ease of transmissibility and disease severity (unfortunately) as the infection spreads across communities.

In the meantime, this year’s flu virus should be higher on our list of health concerns.  The CDC reports 15 million cases with up to 140,000 hospitalizations and 8200 deaths. More than 50% of those affected are in people under age 25. The hospitalization rate is 24.1 per 100,000 people.  Mortality is estimated at 2.0 per 100,000 (CDC).

Only 50% of children age 6 months to 17 years receive the flu shot while approximately 68.7% of adults age 65 and older receive the vaccine. These two groups are among the most vulnerable to flu-related complications.

Last year (2018), approximately 80.000 people in the U.S. died of flu-related complications (CDC). According to the World Health Organization (WHO), the flu virus is responsible for up to 5 million cases of severe illness globally and kills up to 650,000 people annually.

There is no doubt that this new coronavirus 2019-nCov could cause significant morbidity and mortality if allowed to multiply among people. In the meantime, managing current disease contagion by minimizing spread of this year’s flu virus should be prioritized. Flu shots are still available at your local medical clinics and pharmacies.

*MERS: Middle Eastern Respiratory Syndrome

*SARS: Severe Acute Respiratory Syndrome

CDC: Centers for Disease Control and Prevention

Vitamins to avoid with cancer

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Like water and oil, vitamin supplements do not blend well with breast cancer and (very possibly) other cancers. Many of our patients take vitamin supplements with the notion they will achieve greater health. For our cancer patients, however, a different approach should be considered.

A recent study released by the Journal of Clinical Oncology  suggests  using antioxidant supplements during chemotherapy for breast cancer could negatively impact treatment efficacy. Many cancer therapies rely on the generation of reactive oxygen species (ROS). The use of antioxidants could therefore negate any treatment gains and potentially reduce treatment benefits thru their anti-. 

The study involved 1,134 breast cancer patients on similar chemotherapy regimens. Patient’s use of antioxidant vitamins: C, A, and E, carotenoids, and coenzyme Q10 were associated with a 41% increase risk for breast cancer recurrence when used both before and during chemotherapy. 

In addition, the use of non-antioxidant vitamins iron and vitamin B12 supplements were also shown to increase the risk of breast cancer recurrence and death. Iron allows the production of ROS which contributes to malignant transformation; in addition, tumors rich in iron content will tend to multiply. Iron may also interfere with antitumor immunity. Reasons for B12 supplement interference with cancer recovery and poorer outcomes is not certain but its negative effects were evident in the study.

Two items of interest from this study:

  1. General use of multivitamins either before or during chemotherapy had no effect on cancer recurrence or recovery
  2. omega-3 polyunsaturated fatty acid (an anti-oxidant) was associated with a decreased risk of cancer recurrence when levels were “derived from fish-intake” (i.e. eating fish) and not from supplements. 

Bottom line: Eat healthy, colorful, natural foods especially if you have been or are currently being treated for cancer. Unless prescribed by your doctor, the use of supplements should be avoided. IF you have no history of cancer, eat a balanced diet and consider exchanging your vitamin supplements for fresh foods.

Some Old Wives Tales or Experienced Wives Tales?

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First, I do not like the term “old” when it comes to the term’s historical folklore. Miriam-Webster dictionary defines “Old Wives Tales” as “…a false belief or idea”. More bothersome, is the use of the word “old” when it comes to a wife.  So outdated. 

What if some of these remedy beliefs were true? Or all they just a bunch of dirt? 

Digging thru a few of the wives’ tales, I found interesting truths in some but not all the common myths.

  1. Starve a Fever and Feed a Cold: false. Medieval beliefs surrounding body fluids (bile, blood and phlegm) impacted treatment strategies that were not always in the best interest of the patient. The flushing associated with high fever “indicated” excess blood and fasting may have been the prescribed option to slow down metabolism.  On the other hand, excess phlegm and fatigue associated with a cold were “fed’ with food fuel to boost healing metabolism. Truth be told: both illnesses NEED food and fluids to fend off and fight infection.
  • Take Vitamin C to fight a cold: (maybe) true. The “everything is better with Vitamin C” phenomenon was famously spread thru chemist, Linus Pauling. He believed in megadoses of Vitamin C for multisystem cures. While daily Vitamin C requirements are 90milligrams (75mg for women), up to 200mg daily vitamin C may, in fact, help decrease number of respiratory infection sick days by one or two (Harvard Med). Taking a supplement is fine, but more than 400mg Vitamin C daily is excreted in the urine and therefore wasted (literally). It is best to obtain your vitamins thru healthy foods which are thus far more bio-available (easier absorbed thru the intestine).  Good examples of Vitamin C rich foods include a medium-sized orange which has about 51mg of Vitamin C and a medium bell pepper with approximately 95mg. 
  • Carrots can improve vision: (Not entirely) true.  Carrots are rich in beta carotene which when converted to Vitamin A enables cells within the eye to capture light. This is essential to normal vision and lack of Vitamin A can lead to night blindness (hence, the link between Vitamin A and eyesight). Carrots are rich in lutein, which along with beta carotene contain antioxidants which help prevent eye damage by free radicals. Other foods rich in Vitamin A include red meats (especially liver), and fish.
  • Cracking your knuckles can cause or worsen arthritis: (mostly) false. Cracking of the knuckles occurs when stretching the capsule and fluids around the joints. The stretching of the capsule allows gases to expand within the joint space and bubbles form that eventually “pop”. While straining a knuckle (or other joint) might increase the risk for arthritis with repeated over stretching, no study has linked “cracking” knuckles or other joints directly with the degenerative disease.
  • Sugar makes kids hyperactive: false. A 1995 study in the Journal of the American Medical Association demonstrated no association between a high sugary snack and hyperactivity. An earlier study in the Journal of Abnormal Child Psychology (1994) did show that parents who believed their children were affected by a high sugary diet were more likely to perceive their children as hyperactive after a sugary snack.  The caveat is that most likely there are a select number of children who may be more sensitive to sugary sweets. I will leave this one to the parents to sort out.
  • You can catch a cold from being outside in wintry weather: false. It is true that many common viruses such as the flu thrive in cooler temperatures. There is evidence that exposure to cold weather may adversely affect the climate inside our nasal passage and immune system. However, a study published about 40 years ago in the New England Journal of Medicine demonstrated no evidence of a link between cold exposure and the common cold. 
  • The flu shot causes the flu: false. The flu shot contains inactivated virus. It can not give you the flu. The nasal flu vaccine is a weakened virus that will not transmit the flu in someone with a healthy immune system.Understandably, some individuals feel achy and tired after a flu vaccine, but it is not the flu. In addition, the flu shot may have been received in an environment where there was exposure to other respiratory illnesses (a pharmacy or medical clinic). 


There are many more “experienced” wives’ tales to sort thru but hopefully I have clarified a few. In the meantime, stay warm, eat healthy, and get your flu shot.

My Dry Skin is Cracking Me Up

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Like razor blades dug into my skin, so are the deep fissures created by the dry cracks of my hands. The never-ending repeated hand-washing between patients is a routine ritual that leaves my hands wanting for moisture. But my complaints pale in comparison to my patient with a severe form of skin dryness known as ichthyosis.His skin, like snowflakes, falls to the floor of the exam room as I gently remove his socks. It is not painful for him, but terribly bothersome and (understandably) embarrassing. He needed an urgent solution.

Turning my office into a classroom and the computer a chalkboard, I write out our treatment strategy: “Skin Care 101”. As this is a common condition, I will share the seven step-by-step directions to managing severe dry skin.

  1. Cool it down. Instead of hot showers and baths, use cool or warm water and limit shower and bath time to under 10 minutes. Blot skin dry; do not rub the skin and use moisturizer generously immediately after drying the skin (while it is still moist) so it will better absorb the ointment.
  2. Lay off the lotions. Instead, use an ointment or cream. Lotions tend to contain additives that can irritate or dry the skin.  Olive oil, jojoba oil and shea butter are fine. Severe dry skin may require lactic acid, urea, glycerin, lanolin, mineral oil, petroleum, or hyaluronic acid (per the American Academy of Dermatology). Discuss these options with your medical provider.
  3. Send away your scents. Avoid scented skin care products and consider avoiding deodorant soaps when dry skin conditions worsen. These products may contain alcohol or other irritants that are too harsh for dry, sensitive skin. If you are using topical retinoids or alpha-hydroxy acids, hold treatment for a few days in order to allow your skin to retain its natural oils.
  4. Cover up. Consider moisturizing hand gloves and socks at night. I realize that this seems very glamorous for bedtime, but it helps the skin retain the moisture. There are several hand gloves and socks on the market specifically for hand and feet dryness.
  5. Keep the cream close. Keep a hand cream and lip balm with you during the day so that are more likely to replenish your hands and lips regularly.
  6. Wash and wear your clothing with care. Consider hypoallergenic laundry detergent. Use silk underclothing; it will glide over your skin more easily and be less likely to rub against dry and irritated skin.
  7. Fan the flame. Avoid sitting close to high temperatures such as a heater or furnace. Instead, consider bundling up and using a humidifier to maintain air moisture.

Your medical provider should be certain you have no medical conditions that cause severe dry skin. Low thyroid, autoimmune diseases, and inflammatory skin conditions such as psoriasis or eczema are among other causes that need to be considered and treated.

For my patient, a prescription of urea cream along with a written list of numbered instructions should help lessen his discomfort and soothe his dry, irritated skin. While there is no definitive cure for the scaling and dryness, we can keep ahead of the condition and keep his skin healthier. 

Careful Consideration Needed for Children’s Dietary Supplements

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As I wonder thru the supermarket, there is a bountiful sea of color with an array of trendy packaging along Aisle 16. Melatonin, elderberry, probiotics, protein and other nutritional supplements overfill the shelves; they are full of spectacular healthy promises. But, is it OK to buy these products for our family? Are the pharmaceutical costs worth the anticipated health benefits?

Annually, these supplements can impact your bank account and cost you hundreds or even thousands of dollars. More importantly, how do the physical benefits of (non-FDA approved) supplements stack up against potential risks?

Approximately 30% of children in the United Status use dietary supplements and approximately 6.7% will use herbal and nonvitamin supplements. In the United States, the most common dietary supplements (nonvitamin) include fish oil, melatonin, and probiotics.

In 1994, legislation allowed nonvitamin supplement products to enter the market without FDA approval.  Since that time, (according to the Harvard T.H. Chan School of Public Health), the numbers of these supplements have increased from 4000 to over 80,000 products on the market. Dietary supplements are no longer treated as drugs but as “special foods” and therefore bypass regulation which would oversee their contents.

A study published in Hepatology Communications (June 2019) used a form of chromatography and mass spectrometry to investigate contents in 272 herbal and dietary products collected from patients. Scientists found that 51% of studied herbal and dietary supplements were “mislabeled” and the “chemical contents” did not match the label ingredients. Apparently, the “appearance enhancement, sexual performance, and weight loss products” were more likely to be mislabeled and some of the discovered ingredients contained material that have been known to cause liver injury. 

I will often remind patients that because a supplement comes from “natural” sources, does not mean it is healthy. For instance, tobacco come from natural sources and has been linked to many diseases including cancer. 

Where does this leave us when it comes to our family’s health? I advise using caution when purchasing nonvitamin supplements and herbs. Instead, reassess your family’s dietary habits. A colorful diet with green vegetables, red fruit, fresh meats, etc., is far healthier than choosing a capsule or powdery substance to make up for poor food choices. In addition, it is vitally important to teach our kids about healthy eating so that they will be more likely to adopt their own healthy selections when they become adults.

Dr Meir Stamfer, a professor of nutrition and epidemiology at the Harvard School of Public Health recommends that healthy adults take a multivitamin and extra Vitamin D. Most importantly, be sure to share a list all supplements and vitamins with your medical provider as some ingredients may have drug interactions with your child’s existing prescription or over the counter medicine.

If you plan to live longer then plan to live better with these 5 steps

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Coming clean on my obsession with the dog’s health, I brush their teeth and exercise them outdoors daily. Weekly, I bathe them indoors and I restrict their diets to dog-healthy snacks in limited quantities. Dogs with good dental health and maintained within normal weight limits have less joint arthritis, heart conditions and have improved quality of life.

If it were that easy to manage our own health. Alas, we are not hand-fed healthy habits and therefore need to keep more strict with our own lifestyle choices. If we are going to live longer, we should live better. Based on a recent medical article in The Lancet(July 11, 2019) there are five lifestyle behaviors that could positively impact both quantity and quality of life

  1. Calorie restrictionand healthy diet choices (with adequate nutrition): The Lancetsummarized both short and long-term effects of a nutritionally balanced calorie diet on risk factors for healthy, lean, or slightly overweight young and middle-aged people. The study found that there was a potential for 2 years of moderate calorie restriction to significantly reduce multiple heart risk factors. These benefits could be applied to “long-term population health benefits” by reducing blood sugar, blood pressure, cholesterol and inflammation levels.

In addition, there are several studies demonstrating that fresh foods such as vegetables, nuts, berries, whole grains, seafood, poultry and olive oil reduce the risk for Alzheimer’s disease. This form of dementia negatively impacts quality of life of the patient and family members.

  • Exercise: The recommended dose of exercise is 150 minutes a week. Biking, walking, swimming, evening gardening or yard work counts. Work daily to close the rings on your IWatch or meet your steps. While 10,000 steps a day is generally recommended, another study suggests that the actual goal is closer to 8000 steps a day. You choose! 
  • Don’t smoke…anything(enough said). 
  • Limit alcohol: the study recommended one glass of wine daily as a reasonably healthy choice. Most medical experts recommend under 10 ounces of wine daily for men and 5 ounces for women
  • Regularly meet with friends and engage in mentally stimulating activities: Reading books and playing board games 3-4 times weekly can be socially stimulating and help to decrease brain-aging. Alternatively, watching TV is a passive activity that requires significantly less brain power. In addition, an NIH-AARP* study found that geriatric participants who watched 5 or more hours of TV daily were 65% more likely to have a walking disability within 10 years compared to similar age individuals who watched less than 2 hours daily.

Review numbers 1-5 above and adjust lifestyle to better accommodate a more graceful aging experience. Researchers found that individuals who pursued 4 or 5 healthy behaviors were 60 % less likely to develop Alzheimer’s compared with participants who scored 0 or 1.  The average age of the group was 73 years old.

If you plan to live longer, you should plan to live better.

*NIH-AARP: National Institute of Health and American Association of Retired Persons (combined study)

Five Signs Your Cellular Device is Hurting You

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Weekly notifications pop up on my mobile device with the number of hours I spend working (browsing, reading, etc.) on my iPhone. Time that I spend both wisely and unwisely. Approximately 3 hours and 35 minutes a day on cellular devices (emarketer.com) and up to 11 hours a day are spent on screens (Nielson.com) in the U.S. After a review of the medical literature, it is important I share the top five ramifications of electronic device overuse:

  1. Texting thumb:  This term usually refers to one of two conditions, either ‘trigger thumb” or “thumb arthritis,” according to Dr Matthew Nevitt MD, Baylor Scott and White Orthopedic hand specialist. Inflammation of the thumb joint and its tendons may be due to repeated rapid motions of the thumbs with texting and can be quite painful. “Trigger thumb” refers to constriction of the tendon in the thumb. A result of over use, there may be painful popping or locking of the joint. These orthopedic problems may require rest and splinting. In more severe cases, a steroid injection or surgical intervention for relief of discomfort may be necessary
  2. Occipital horn: Extended time spent hunched over electronic devices may cause small bone spurs on the back of the neck. Sadly, these bony changes are now seen in young people age 18 thru 25 according to the University of the Sunshine Coast in Queensland, Australia.  The occipital horns may not cause pain, but they are a symptom of stress on the neck. Over time, prolonged poor posture (neck flexion) could lead to neck arthritis promoting further spinal bony changes. Study authors believe the changes stem from early use of texting devices in childhood.
  3. Computer Vision Syndrome (CVS): Between 50% and 90% of people who work at a computer screen will report a range of eye strain and pain. Focusing and refocusing along with rapid eye movements needed to adjust to screen changes can promote blurred vision, double vision, and dry irritated eyes. Decrease the brightness, add a glare filter, and adjust the contrast to a more comfortable level. Keep your monitor slightly below eye level and work 20 to 28 inches from your face (WebMD).
  4. Sleep disturbance: The blue light emitted from the screens can delay the release of melatonin and therefore interfere with sleep. Teens’ sleep rhythms (circadian patterns) are vitally important to pubertal hormone development and brain maturity.  Remove all screens from your children’s rooms at night and change the background screen thru your device settings: “Display and Brightness”.
  5. Distracted driving: Distracted driving was found to be responsible for up to 68.3% of motor vehicle crashes according to the Virginal Tech Transportation Institute. Researchers suggest that the emergence of texting and browsing online is the single greatest factor accounting for the increased numbers of US motor vehicle accidents. Encourage your family to put the phone down and (far) away from reach while behind the wheel.

Bottom line: Get away from your mobile device as often as possible. Your hands and neck will feel better, you will sleep better, look better, and drive better. Good luck!

Clearing up concerns on sunscreen product safety

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Topical sunscreens are good tools for preventing skin cancer, but it turns out many formulations may be harmful not helpful. Realizing this, the US Food and Drug Administration (FDA) updated regulatory requirements for sunscreen products by reclassifying them as drugs.  After testing several common topical sunscreen ingredients, the FDA discovered elevated serum (blood) levels of avobenzone, oxybenzone, ecamsule, and octocrylene. The American Medical Association (May 6, 2019) recently confirmed these findings. It turns out that these chemicals can enter the bloodstream after just one day of use and can remain in the body for at least 24 hours after application. 

The February 2019 FDA proposal ensures that sunscreen’s active ingredients are more closely regulated. The FDA study did not find the ingredients would cause health issues, but further studies are pending.

Not all products absorbed thru the skin are dangerous, however, at levels above the acceptable 0.5ng/mL (nanograms per milliliter) there are potential safety concerns.  Elevated blood levels of some ingredients could increase the risk for cancer and birth defects, while other chemicals could adversely affect hormone levels in adolescent boys and men. In some cases, pregnancy duration could be shortened resulting in low birth-weight babies. 

With over 12,000 sunscreen products on the market, regulation could have the FDA working in over-time. According to a sample analysis of more than 1300 products, the Environmental Working Group reported that over 60% of the sunscreen products do not offer enough sun protection or contain potentially harmful chemicals.  

Since the 1970’s there have been many scientific advances in sunscreen contents which has led to greater broad-spectrum protection against UVA and UVB rays. In addition, several products are more potent, and which could lead to greater levels of chemical absorption thru the skin. Others sunscreen products combine insect repellents which add more substances. These combination lotions, if highly absorbed thru the skin, could lead to additional health risks. 

The use of sunscreen sprays and powders should be avoided because the aerosolized particles could enter the lungs leading to chronic lung conditions. I do not recommend their use, especially in children.

This information should not deter you from using sunscreens. Recently, I published an article reviewing the necessity of sunscreen product to prevent skin cancer. Reducing numbers of skin cancer cases is most important as it is highly prevalent and the most common cancer in the US with rising numbers of cases due to excess sun exposure. Due to recent concerns, consider looking for products with zinc oxide and titanium dioxide which are not absorbed thru the skin. Don’t forget to wear protective clothing in addition to hats and sunglasses.