SAN DIEGO — A viral TikTok video posted by a dermatology practice in Austin, Texas, doesn’t address the usual popular skin topics such as acne or cosmetic surgery. Instead, it has racked up nearly 10 million views by exposing the reality behind a seemingly simple and cheap sun protection strategy: the T-shirt.

“A normal white T-shirt has a UPF [ultraviolet (UV) protection factor] of 5, which means that 20% of UVA/B passes to the skin. This decreases when the shirt is wet and even decreases more for a shirt that is very worn,” explained dermatologist Sarah Gee, who’s co-founder of the practice, Austin Skin.

But this doesn’t mean clothes are a poor option for sun protection, said Gee, who spoke at the Masters of Aesthetics Symposium and in a follow-up interview about nonsunscreen strategies. In fact, appropriate clothing is just one of several worthwhile nonsunscreen alternatives. “Think beyond SPF [sun protection factor],” advised Gee. “Sunscreen is extremely important, but there are other components to sun protection that make UV protection even more comprehensive.”

Gee highlighted the following sun protection strategies:

Hats: Pay Attention to the Brim

Hats are a helpful sun-blocking aid, she said, but pay attention to the width of the brim. “In general, to be deemed UV protective, the minimum recommended brim is 3 inches all the way around. But recommendations often vary,” she said.

Gee highlighted a 2018 study suggesting that a hat with a 6.7-inch brim would provide the most sun protection compared with headwear with smaller brims.

But it can be challenging to find stylish hats with brims that big or that people find usable, she said, and the study itself noted that a hat that large is “unlikely to be worn by most of the general public.”

As for hats in general, “It is important to understand that there is no hat that completely protects against the sun,” she said, “and even the best hats out there might not fully protect the ears, neck, chin, and other areas where reflective UV can hit the face.”

Clothes: Look for UPF-Rated Options

Gee is a fan of UPF-rated clothing, which she calls “the easiest and most reliable way to protect yourself from the sun.”

UPF is not the equivalent of SPF. SPF measures the level of protection a sunscreen product provides from UVB rays. UPF numbers indicate the fraction of UVA and UVB rays that get through the clothing to the skin. A UPF 50 shirt — at the level of protection recommended by the Skin Cancer Foundation as “excellent” — allows 1/50, or 2%, UV rays to penetrate the fabric and reach the skin.

UPF-rated clothing “avoids the textural issues such as greasiness that people might have with sunscreen,” Gee said, “and it avoids the concern for reapplication and not using enough SPF, both of which are the most common reasons for sunscreen failure.”

In the last 5 years, she said, the fabric texture and breathability of these products have improved. “Most of my patients who work outside say that their UPF-rated shirt cools them down when they sweat. In fact, there are some brands with some cooling technology embedded into their fabrics.”

At a session at the fall symposium of the California Society of Dermatology and Dermatologic Surgery, held shortly after the Masters of Aesthetics Symposium, Melissa L. Shive, MD, MPH, a dermatologist and dermatologic surgeon at the University of California, Irvine, also discussed UPF-rated clothing as an option for sun protection.

She noted that “regular clothes do help,” with colored tops providing a bit more protection than other clothes. However, “it’s not reliable to take a shirt, look at the sun, and see how much light comes through. That is not an accurate evaluation for how much UV protection you’re getting.”

UV Window Films, Supplements

While front windshields provide “pretty decent protection” against sun exposure, car side windows do not, Gee said at the Masters of Aesthetics Symposium. She recommended aftermarket UV window films, which the Skin Cancer Foundation says block 99% of UV rays.

Several supplements have been associated with claims that they provide protection against the sun. Products based on a botanical extract from Polypodium leucotomos, a species of fern, have the most evidential support, Gee said.

A 2015 randomized double-blind study found a 240-mg twice-daily dose of P leucotomos extract for 60 days was “a safe and effective means for reducing the damaging effects of UV radiation.”

Omega-3 fatty acids also provide protection, she said, but high doses are required. Carotenoids such as lycopene have also been linked to sun protection, Gee said.

Gee and Shive reported having no disclosures.