Worst 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 troubled skin, 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 worst cities for your skin earned their spots.

10. Tulsa, Oklahoma

Tulsa rounds out the list of the top ten of the worst cities for your skin because it has the highest skin-cancer death rate in the country with 4.1 deaths per 100,000 people, according to the National Cancer Institute. Moreover, the people of Tulsa fall short on exercise: According to the Centers for Disease Control, only about 25 percent of adults in the city engage in vigorous physical activity for more than 20 minutes three times a week.

In Tulsa, the sun can be pretty intense until 5 p.m. during the summer, says Melissa Morgan, MD, a dermatologist in Broken Arrow, Oklahoma. Dr. Morgan theorizes that the high skin-cancer death rate may be due to lack of information about the way suspicious skin lesions behave and what they look like. "If sun exposure cannot be avoided, seek shade at every opportunity, apply sunscreen, and wear sun-protective clothing," she advises. Morgan also warns that baseball caps leave ears, the tip of the nose, and lips dangerously exposed, and can't be counted on to offer complete protection.

9. Fort Worth, Texas

The Fort Worth area has a high number of tanning beds (though one could argue that even one is too many). "There's one on every corner. The tanning industry has a foothold in the city, and the whole culture makes women, especially younger women, feel that they need to have a tan all year-round," says Lisa Garner, MD, clinical professor of dermatology at the University of Texas Southwestern Medical School in Dallas and a dermatologist in Garland, Texas.

To limit the damaging habit, a law was passed in 2009 to block the access of tanning beds for minors under the age of 16. "A lot of people still use them, especially college women, and I even have patients who are over 50 or 60 who still use them," Dr. Garner explains. "There are studies to indicate that it's an addictive behavior." Add to this the intense sun during the long summers and a low number of dermatologists per capita, and you have our ninth worst city for the skin.

Aside from any necessary damage control, Garner cautions her patients to prevent burns in the first place by avoiding the hot Texas sun all year-round during the times of day when your shadow is shorter than you are. "In the wintertime, you can still get a large dose of UVA rays, which we believe is more responsible for the development of melanoma than UVB rays," says Garner. (UVA rays are also the main source of radiation in tanning beds.)

8. Memphis, Tennessee

According to data from the Centers for Disease Control and Prevention, Memphis has the least physically active population in the United States, a finding that has been corroborated in other studies. The city also has a low dermatologist- per-capita rate, at three dermatologists per 100,000 people. "Memphis has been under-served by dermatologists, and it takes too long to see one if you don't already have one," says Michael Schneider, MD, a dermatologist in Germantown, Tennessee. The area is known to have a high heat and UV index with oppressive humidity during the long summers.

Despite the ranking, Dr. Schneider sees a bright side. "From my observation, I think the 30-somethings and younger crowd know the importance of physical exercise and sun protection," he says. "It's awfully hard to break bad habits for the older crowd." For Memphis residents of all ages, as well as those who live in other mid-southern cities, Schneider stresses the importance of reapplying broad-spectrum SPF 30 sunscreen every two hours. "We just sweat it right off," he says. Additionally, he suggests wearing very light sun-protective clothing "when possible and affordable."

7. Charlotte, North Carolina

Charlotte is one of the worst cities for the skin on our list because of its high ozone and pollution levels, with 26.2 high-ozone days out of the year. The American Lung Association also ranked Charlotte as the tenth worst city for ozone pollution in the US in 2010. Why is it so polluted? It may have something to do with the lack of air flow in the city on the hottest days of the year, which can be related to its geographic location: in the middle between the Appalachian Mountains and the Atlantic Ocean. Coal-powered plants might also play a factor, as well as population growth.

However, the smog should not hinder residents from being proactive about their skin care. "Ozone and pollution levels have an effect on the skin, but the most damaging risk factor is sun exposure," says Elizabeth Rostan, MD, owner and director of Charlotte Skin and Laser in Charlotte. Dr. Rostan believes that for the most part, Charlotte's residents know what's good and bad for their skin health, and that the city is actually a "great place" for the skin, despite our ranking. "We have great dermatologists in the area and excellent access to them. We have a health-conscious population, and we don't see a lot of smokers. People just have to be careful and limit outdoor exposure on the days when the ozone levels peak," she says.

6. San Diego, California

According to the National Cancer Institute, sunny San Diego has 29.1 melanoma- incident cases per 100,000 people, making it the city with the most melanoma cases in the country. "San Diego is dry and sunny and closer to the beach than Los Angeles or Sacramento, so people spend more time outdoors," says Jessica Wu, MD, assistant clinical professor of dermatology at University of California and a dermatologist in Los Angeles.

"The city also has beach weather all year-round, and because of this, people wear less clothing and so more skin is exposed," Dr. Wu says. Additionally, people who grew up there may have had a job, such as a lifeguard, that required being outdoors in their youth, which may account for big doses of sun damage that added up over the years. San Diego also has its number of high-ozone days, clocking in at 33.8 days out of the year, and a fair share of tanning salons.

The one silver lining of skin health for San Diego is that people are very physically active, with 41.2 percent of adults engaging in vigorous physical activity for more than 20 minutes three times a week. Residents can help decrease the number of melanoma cases by being more vigilant about sunscreen use when they're engaging in water-related activities. "It's especially important to choose a water-resistant formula and reapply after getting out of the water," Dr. Wu says. It also helps to wear a long-sleeved rash guard with UPF (ultraviolet protection factor).

The measures taken by the California governor's office to ban indoor tanning for minors will also help.

5. Los Angeles, California

The second most populous city in the US is on the worst list because it has the highest number of high-ozone days in the nation — 92.3 days, to be exact. (That's more than 25 percent of the year.) Because the city is surrounded by a ring of mountains, the basin traps the pollutants that spill out of the unending traffic of the freeway. Furthermore, the city has a very low number of dermatologists per capita at 2.13 dermatologists per 100,000 people, which means the wait may be longer than usual to see one.

The good thing about LA, however, is that it has a high number of skin-care specialists who can help guide you in taking care of your skin, even if it means you visit a specialist while you wait for your dermatologist appointment. For such a sunny city, too, it has a low number of melanoma rates and skin-cancer death rates. Dr. Wu recommends that Angelenos check the UV index before they head outside, and be extra-vigilant about reapplying sunscreen on these high-UV- index days.

4. Sacramento, California

The state capital of the Golden State comes in on the worst list because one third of the adult population has had at least one sunburn this year, which coincides with a slightly higher than average skin-cancer death rate. "This is not surprising as Sacramento is one of the best cities for sunshine and good weather, and we have a very active population with lots of boaters, bicyclists, and runners [who don't use full sun protection]," says Suzanne Kilmer, MD, founder of Laser and Skin Surgery Center and a dermatologist in Sacramento. The city also has a relatively high number of high-ozone days at 44.7 days out of the year, which comes in third after Los Angeles and Fresno, California.

Luckily, Sacramento has a respectable number of dermatologists per capita at nine per 100,000 people, because it houses a dermatology residency program at University of California—Davis. It also has a physically active population. "As a whole, we are pretty good about sunscreen, but the problem is that it needs to be fully protective with both UVA and UVB coverage," Dr. Kilmer says. For that, she recommends zinc-oxide sunscreen. "It's a physical block that doesn't degrade with time, like chemical sunblocks." She also advises that people stay out of the midday sun and use a sunscreen with antioxidants — even when driving. "The sunlight through the car window will trigger DNA damage," she says.

3. Fresno, California

This city tucked inside the valleys of Northern California usually gets a bad rep for its air quality, and the number of high-ozone days — 66.2 days out of the year — is beaten only by the number of high-ozone days in Los Angeles. "The bad air quality is due to the pollution from the Bay Area, which gets trapped in the valley, and there are particulate matters being generated by agriculture," says Catherine A. Hoffman, MD, a dermatologist in Fresno with the Permanente Medical Group.

The city also has a low number of dermatologists per capita. "We've had a dermatologist shortage for years," says Dr. Hoffman. Furthermore, the area has seen an increased use of tanning beds. Hoffman also notes that the Chukchansi Park, home of the San Francisco Giants, does not provide shade for spectators.

On the upside, Hoffman sees that there is more awareness about the sun. "In the 30-to-50-year-old group, the women are much more informed, although the older women and the teenagers just don't know the guidelines," she says. The key to following a sun-protection regimen is to find a convenient product that you will remember to use, Hoffman says. For those who are struggling in the tough economy, she recommends products such as Rit Sun Guard, which can be added to a laundry load to impart sun-protective qualities to clothing. "This is less expensive than regular sun-protective clothing," she adds.

2. Phoenix, Arizona

The runner-up for the worst city for your skin has a combination of intense, unrelenting sunshine for much of the year, a low number of dermatologists per capita, and a significant number of high-ozone days. Combine this with an arid climate and a lifestyle that focuses on the outdoors, and you have the makings of a skin hazard. "I've seen higher rates of melanoma, fine lines, and wrinkles even in teenagers and people in their young 20s," says Jennifer Linder, MD, a dermatologist in and Scottsdale, a suburb of Phoenix and San Francisco. "If you grew up there and weren't careful, you could have some serious damage."

To protect and combat the insidious UV rays, Arizonans must "think very smart about their skin," says Dr. Linder. To that end, dermatologists try to raise awareness as much as possible and educate the public. For instance, the Phoenix Dermatology Society has helped raise funds to donate sun-shade structures to the Phoenix Zoo, and the skin-care company PCA Skin has also donated shade structures to schools.

Linder also encourages parents to dress their children in protective clothing and tells her patients never to leave the house without sunscreen. "Pack it in backpacks or purses or in your car, and reapply every two hours," Linder says. To help prevent the bone-dry desert conditions from wreaking havoc on the skin, Linder recommends that people be diligent about using lotions and creams with dimethicone, shea butter, or hyaluronic acid.

1. Las Vegas, Nevada

Sorry, Las Vegas, your residents lose when it comes to their skin. Over a fifth of those who live in Sin City smoke, which is one of the largest percentages in the country. "We have a bigger smoking population than in other places, and we know that's not good for the skin because it damages blood vessels that bring nutrients to and support healthy skin tissue," says Robert B. Strimling, MD, a dermatologist in Summerlin, a suburb of Las Vegas.

The large number of smokers, combined with the city's elevated location 2,030 feet above sea level and the sun-baked desert climate that parches the skin, forms a trifecta that promotes unhealthy skin. "The dryness is rough on people — it tends to accentuate wrinkles, contributes to dandruff, seborrheic dermatitis, and psoriasis," Strimling says. "It can also cause rashes due to itchy skin." In addition, the city has its share of high-ozone days, at 22 days out of the year.

Despite all these ticks on the checklist against healthy skin, all is not lost. As a skin-cancer surgeon, Strimling sees a fair amount of melanoma patients but thinks that the patients are becoming more proactive. "My patients are concerned about their health and are open to being educated," he says. "The bottom line is: Get in, get checked, and get educated. If you do that, you can thrive in a place like Las Vegas," Strimling adds.

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