Cities for Your Skin

"Where you live has a huge influence on your skin's health and appearance," says Jessica Wu, MD, assistant clinical professor of dermatology at the University of California and a dermatologist in Los Angeles. "While most of us wouldn't move to another state just for the sake of our skin, you can reduce your odds of skin cancer and premature aging by taking more precautions if you live in a high-risk area."

"To find out which cities in the US are most likely to have citizens with glowing complexions, we analyzed data like dermatologists per capita, skin- cancer rates, climate statistics, healthy-lifestyle indicators, and more. Read on to find out how the 10 best cities for your skin earned their spots.

10. Austin, Texas

Although this city receives more than 300 days of sunshine a year, Austinites are a health-conscious bunch who know how to take care of their skin. According to the Census Bureau, the city has the most physically active population in the US, with 36.5 percent of adults engaging in vigorous physical activity for more than 20 minutes three times a week.

"People here are outdoorsy, athletic, and into being healthy," says Jason Reichenberg, MD, program director for the department of dermatology at the University of Texas Southwestern–Austin. But there is an important difference between using sun protection and being sun smart: "You can protect the skin with a broad-spectrum sunscreen, but it should not be your primary sun protection. You should be wearing a hat, and if you're swimming you should be wearing a swimming shirt that offers SPF protection," Dr. Reichenberg says. Austin makes it easy to be sun smart by offering parks packed with shady trails such as the Barton Creek Greenbelt and Ladybird Lake. "I encourage my patients to use those trails late afternoons and evenings when the sun isn't as hot," adds Reichenberg.

9. Milwaukee, Wisconsin

Milwaukee has long winters and short summers, which means less chances for sun exposure and for people to accrue sun damage, says Bradley Straka, MD, a dermatologist in Brookfield, Wisconsin. In addition, the decline of heavy industry and manufacturing has helped lessen the pollution that used to harm the city's air quality. "Milwaukee's particle-pollution levels are lower than in many other parts of the country," Dr. Straka says. Another plus? The city is on the shores of Lake Michigan and surrounded by nature, which makes it easy for one of the most physically active populations in the country to engage in outdoor recreation.

However, despite these two skin-friendly factors, there are some incidences of melanoma among the population, so just because the weather is cold for most of the year, it doesn't mean people should neglect sun protection. "It's important to wear sunscreen throughout the winter too — you can still suffer damage off the reflections in the snow," Straka explains. To prepare the skin for the long winters and to sidestep what's known as "winter's itch," or psoriatic dermatitis, Straka recommends using nondetergent-based soap and hydrating the skin daily with an antioxidant-rich moisturizer.

8. New York, New York

The most populous city in the United States is also one of the most skin- healthy cities on our list, and that's no surprise to Doris Day, MD, a clinical assistant professor of dermatology at New York University Medical Center. "I think we're a savvy group, and we tend to have an independent, efficient, and proactive approach to taking care of ourselves and our skin," Dr. Day says.

The Big Apple is noted for having one of the lowest incidences of skin cancer in the country, and thanks to smoking bans, the most recent of which prohibited smoking in public parks and beaches, New Yorkers have skin that's that much more protected. The city also boasts a high density of dermatologists. "The wait to see a dermatologist here is much shorter than in other cities," Day adds.

However, New Yorkers still have room to improve their skin health. "People here have high levels of stress and they work hard and play hard, so finding balance in their lifestyles is important," says Day. New Yorkers can also minimize sun exposure when walking by taking advantage of the shadows cast by tall buildings, recommends Day. "When it's sunny, crossing over to the shady side of the street makes a big difference," she says.

7. Boston, Massachusetts

Boston ranked seventh on our list because it contains the highest number of dermatologists per capita. The city is a hotbed of clinical research in dermatology. "You have the medical schools of Boston University, Harvard, and Mass General Hospital's Wellman Center for Photomedicine, where laser use in skin care was first developed," says Ranella Hirsch, MD, a Boston dermatologist. "We have a lot of talent and a lot of innovation — the best of both worlds," says Dr. Hirsch. This combination of advancements in both dermatology and technology makes Boston a prime location for any patient seeking top dermatologic care.

"People here are pretty active and live a healthy lifestyle," Hirsch says. "And generally, healthy people have healthy skin because the skin is a reflection of your overall well-being." One challenge Bostonians face is adapting to weather changes. "Unlike San Francisco or Miami, we have all four seasons here and the changes impact your skin, so you need to think ahead and prepare for all the environmental challenges," Hirsch says.

6. Honolulu, Hawaii

As a vacation spot known for sun and surf, Honolulu might seem a strange candidate for a top-ten spot on this list, but the capital of the Aloha State is noted for the lowest rate of air-particle pollution in the country and zero high-ozone days.

"Free radicals from pollution can cause oxidative damage and changes to the skin's DNA, and worsen the effects of ultraviolet rays on the skin," says Julie Kenner, MD, founder of Kenner Dermatology Center and a dermatologist in Kailua, Hawaii. "There's much less pollution here than in other cities."

People who live in Hawaii are also physically active, with 33.9 percent of adults engaging in vigorous physical activity for more than 20 minutes three times a week; for a state known for its natural beauty, that's hardly a surprise.

Unlike cities that have rainy seasons or cold winters, the constant sunshine may also help people stay vigilant about sun protection. Kenner sees surfers wearing hats and suspects that UV-protecting swim shirts are more socially acceptable in Hawaii than in other parts of the country. "We try to educate people on protecting against excessive UV damage and repairing the damage that's already occurred," Kenner says.

5. Chicago, Illinois

According to the Bureau of Labor Statistics, the Windy City has the highest number of skin-care specialists in the country, a number that helps the city's standing as among the best places in the nation for your skin health. In addition to the skilled aestheticians and specialists who can help guide you in taking care of your skin, the city also has five great universities that train a lot of good dermatologists, says Carolyn Jacob, MD, director of Chicago Cosmetic Surgery and Dermatology and a dermatologist in Chicago.

The city also benefits from short summers that prevent people from receiving too much sun damage, but Dr. Jacob advises her patients to "wear sunscreen year-round, and moisturize more heavily in the winter — the dryness during the long winters can really aggravate conditions like eczema, rosacea, acne, and seborrheic dermatitis."

4. Baltimore, Maryland

This East Coast city has one of the lowest incidences of melanoma in the country. Baltimore also has access to nearby health-care resources, such as Johns Hopkins University and the National Institutes of Health in Bethesda, which may attribute to the low skin-cancer death rate. "Both centers care for patients and conduct cutting-edge clinical trials on advanced-stage skin- cancer patients, which would likely lower this rate," says Rebecca Kazin, MD, an assistant professor of dermatology at Johns Hopkins University and a dermatologist in Baltimore . The port city also has only 1.7 high ozone days out of the year.

Even with low skin-cancer and melanoma rates, sun protection is still important for Baltimore residents. "Even on a cloudy Baltimore day, the sun can be quite strong and cause a sunburn," says Dr.Kazin. "I recommend a facial moisturizer with SPF 15 for everyday use, and I remind patients that they don't need to be 'lying out' at the beach to need sunscreen."

3. Seattle, Washington

"There's a high number of institutions that teach integrative medicine, good nutrition, and holistic health, and their influence may make people more health- conscious," says Robin Hornung, MD, a dermatologist in Seattle. But the climate also helps to keep Seattle in the number-three spot. With low ozone days, low pollution levels, and a high number of overcast days, the city lacks many of the skin threats of other cities.

The anomaly for Seattle, however, is that although the sun shines only 47 percent of the time, the sun is very intense when the skies are clear. "The sun sneaks up on you," says Dr. Hornung. "In the mornings it's foggy and gray out then turns brilliant and bright, so there are higher rates of sunburn here." Another potential skin-health pitfall for Seattle is the presence of indoor tanning salons.

To better protect the skin, Hornung recommends that Seattleites use a broad- spectrum facial moisturizer that contains sunscreen, with a minimum SPF of 15 in the winter and 30 in the summer. In addition, make sure to get checkups from a dermatologist, especially if you have a family history of or risk factors for skin cancer, she suggests.

2. San Francisco, California

One would have a hard time trying to find a tanning bed in San Francisco. According to research, the city has the lowest number of tanning beds per capita in the US. The runner-up best city for your skin also has a near-perfect record of skin-healthy attributes: low skin-cancer death rate, high density of dermatologists per capita, an active population, and zero ozone days.

"The data is absolutely in line with what I see," says Jennifer Linder, MD, assistant clinical professor of dermatology at University of California–San Francisco. "The fog cleans out the city every day, people love the outdoors but realize that sunscreen is important, some of the best dermatologist-training happens here at Stanford and UCSF, and there is high-quality medical care." But even for such a skin-health Eden, Linder suggests a good moisturizer and sunscreen that contain antioxidants and using it every day.

1. Portland, Oregon

"Portland is ranked just in the right spot," says Diane Baker, MD, clinical professor of dermatology at Oregon Health and Science University in Portland and a dermatologist in Lake Oswego, Oregon. In addition to a long rainy season that makes it easier to stay out of the sun, Dr. Baker credits the combination of a pollution-free environment and the decline in the amount of people smoking overall for helping Portland achieve the top position.

"It's a great place to live and have really healthy and youthful-looking skin for a long time." According to Baker, Portlanders know exactly what to do in terms of health and skin. "In general, they eat healthy, they exercise, and they are savvy about protecting their skin from the sun," she says. The data supports this: Portlanders are less likely to be smokers or have suffered a sunburn in the past year than most of the US population.

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