Sunscreen Facts for Smarter Sun Safety
Medical Review By: Evelina Ingersoll, APRN
Most of us know enough to pack sunscreen before hitting the beach, spending the day at the lake or pool or working outdoors. But which sunscreen should you choose? How should you apply it and how much should you apply? And does it expire?
Read on for answers to frequently asked questions that will help you get the maximum protection from sunscreen.
Does everyone need to use sunscreen?
Yes. Overexposure to ultraviolet (UV) rays from the sun can cause sunburn, dark spots, leathery skin and skin cancer. The risk of developing skin cancer is higher if you have fair skin and burn easily, but anyone can get it, regardless of their skin tone or age. Even young people get melanoma, one of the deadliest types of skin cancer.
Many men are resistant to wearing sunscreen, but they need it too.
How does sunscreen work?
There are two basic types of sunscreens: chemical and mineral.
Chemical sunscreens sink into the skin and absorb the sun’s rays. Those rays are converted into heat, which is released from the body. Mineral sunscreens, also known as physical sunscreens, contain zinc oxide and/or titanium dioxide. They sit on top of the skin and work by deflecting the sun’s rays.
What is SPF and what SPF do I need?
SPF stands for sun protection factor. It’s a measure of how well the product protects against UVB rays (the burning rays). The higher the SPF, the more protection the product offers.
According to the FDA, it’s a common misconception that SPF relates to how much time it takes to get burned (for example, that SPF 15 means you can stay in the sun 15 times longer than you could without sunscreen before you get burned). It’s actually a measure of how much UV radiation it takes to produce a sunburn on protected skin.
The American Academy of Dermatology suggests using sunscreen with an SPF of at least 30, which blocks 97% of UVB rays. You can buy sunscreen with higher SPF, but no sunscreen blocks 100% of the sun’s rays. Also, a higher SPF doesn’t mean you can use less or reapply less often.
When do I need to use sunscreen?
Use it every day that you’ll be outside, however briefly. Sun damage can start after as little as 10 minutes, and the effects are cumulative. Even walking from the car to the office or store without sunscreen can add to the damage.
You’ll also want to wear sunscreen when you’re sitting indoors next to a window, when you’re in the car and when you’re on a plane or train if you have a window seat. Window glass filters some, but not all, UVA rays, which cause premature skin aging as well as skin cancer. (UVB rays, the “burning” rays, don’t pass through windows, which is why you can’t get sunburned through a window.)
RELATED: 4 Surprising Times You Need to Wear Sunscreen
Don’t save the sunscreen for warm, sunny days. Most of the sun’s UV rays pass through clouds. Snow, sand and water all reflect those rays.
How much sunscreen should I use on my body?
Squeeze strips of sunscreen along the lengths of your index finger and middle finger. This should be about the right amount to cover your face, neck and ears.
Don’t rely on the SPF in your moisturizer or makeup for sunscreen protection if you’ll be outside for any significant length of time. It’s unlikely that you can use enough or reapply often enough to get the benefit you’d get from a sunscreen with the same SPF.
Remember that lips get sunburned, too. Use a lip balm with an SPF of 30 or higher.
When should I apply sunscreen?
Chemical sunscreens don’t work until they have been absorbed into the skin, which can take 10 minutes or more. That’s why experts recommend applying sunscreen at least 15 minutes before going outside. Mineral sunscreen stays on top of the skin and starts working right away.
Apply sunscreen after applying your moisturizer, not before.
How often should I reapply sunscreen?
If you’re spending the day outdoors, reapply every two hours or after swimming, sweating or toweling off. Even water-resistant sunscreens can wear off or rub off; there are no totally waterproof sunscreens. Chemical sunscreens are typically more water-resistant than mineral sunscreens.
The FDA requires that sunscreen labels indicate when to reapply, after either 40 or 80 minutes when swimming or sweating.
How do I choose the best sunscreen?
The American Academy of Dermatology recommends that everyone choose sunscreen with:
- Broad-spectrum protection
- SPF 30 or higher
- Water resistance
Sunscreens labeled “broad spectrum” protect the skin from both UVA and UVB rays. Both rays can cause skin cancer.
Beyond these three factors, choosing the best sunscreen is a matter of personal preference. When it comes down to it, the best sunscreen is the one you’re most likely to use.
Lotions, creams and gels all work well. Creams are best for people with dry skin. Because they are thicker, they may be better for the face than lotions. You can also choose sunscreen made specifically for children, for sensitive skin or for faces. You can even use different types of sunscreen for different parts of the body.
Men may prefer a gel sunscreen for hairy areas such as the scalp or chest.
Does sunscreen spray work?
Sprays work only if you’re able to get full coverage, which can be tricky. Follow these tips:
• Hold the can close to your skin and spray generously.
• Rub the spray in, even if the label says you don’t need to. You can’t always tell where you’ve sprayed and where you haven’t.
• When using spray sunscreen for your face, spray it into your hands first, then apply it to your face. Spray sunscreen can irritate the eyes and the lungs if inhaled.
• Be careful when using spray sunscreen on a windy day. Even a slight breeze can redirect the spray, and you’ll end up unprotected. There’s also a greater chance of inhaling it or getting it in your eyes. (People nearby may also inhale it.)
• Don’t spray while smoking or near a grill or other source of fire. Aerosol sprays can be flammable.
Does sunscreen expire?
Yes, but it has a long shelf life. The FDA requires sunscreens to post an expiration date unless testing shows that the product will remain stable for at least three years.
Go by the expiration date. If there’s isn’t one, discard the product after three years. If you notice color or consistency changes, it’s best to replace it.
Does sunscreen interfere with vitamin D absorption?
Our bodies produce vitamin D from sunlight that strikes our skin, so daily use of sunscreen may result in decreased vitamin D production. More studies are needed, but most research to date shows no association between sunscreen use and vitamin D deficiency in healthy people.
If you’re concerned about getting enough vitamin D, have a conversation with your doctor. You can get more vitamin D through your diet or dietary supplements.
Does it matter where I store my sunscreen?
Yes. Keep it out of direct sun. If you’re on the beach or by the pool, wrap it in a towel or keep it in the shade. On the hottest days, keep it in your cooler if you have one.
Article written by: Ann Pietrangelo, an author and freelance writer specializing in health and wellness.
Why EltaMD Sunscreen Is One of the Best Sunscreens for Your Face
Medical Review By: Evelina Ingersoll, APRN
You may have a go-to brand of sunscreen you buy year after year, or perhaps you choose whatever is most affordable at the drugstore. But have you ever wondered if the sunscreen you use is the best one for your skin or your health?
News that the FDA is investigating the safety of certain ingredients in chemical sunscreen has driven more people to consider mineral sunscreen. These sit on top of the skin and act as a physical barrier against UV rays. They don’t penetrate the skin as chemical sunscreens do. One brand in particular has become a top choice of many dermatologists and consumers alike: EltaMD sunscreen.
What’s behind its popularity?
"EltaMD sunscreens are more natural than chemical sunscreens, and they’re an exceptionally good choice for people with sensitive skin and those who have conditions such as acne and rosacea,” says Evelina Ingersoll, APRN, a certified advanced practice registered nurse at Water’s Edge Dermatology.
“When we give our patients free samples of EltaMD sunscreen, they love it so much that they almost always come back a week later to buy the full-size product,” said Ingersoll.
No white residue
Many mineral sunscreens give skin a white cast, which turns some people away.
"The minute you say ‘zinc oxide,’ which is the base of EltaMD sunscreen and other mineral sunscreens, people start to groan," said Ingersoll. "They picture a thick, sticky paste that’s hard to apply and leaves noticeable residue on their face. And it’s true that some mineral sunscreens are like that."
EltaMD sunscreens are an exception, Ingersoll noted. “They are lightweight and transparent, which is great for anyone, but especially for people with dark skin, who may have avoided mineral sunscreen in the past.” Their lighter, smoother texture also means they look good under makeup.
Less irritation
Several ingredients in chemical sunscreens can aggravate sensitive skin and certain skin conditions, such as rosacea. “Oxybenzone is notorious for this,” Ingersoll said.
EltaMD sunscreens don’t contain irritating ingredients or additives such as fragrance, another common trigger of skin reactions. The lack of fragrance also makes EltaMD sunscreens a good choice for anyone who shies away from sunscreen because they dislike the smell.
Free of suspect chemicals
Zinc oxide is “generally recognized as safe” (GRAS) by the FDA when it’s used in sunscreen. That’s not currently the case for chemical sunscreen ingredients. The FDA has asked for additional safety data on a handful of them to make sure they don’t pose a threat to human health.
Among those ingredients is oxybenzone. The American Academy of Pediatrics recommends that parents avoid using sunscreen containing it on their children. “The concern is that we know very little about the kind of effects that oxybenzone and other hormone-disrupting chemicals could have on children’s small bodies,” Ingersoll said.
EltaMD sunscreen is also free of parabens, which are preservatives commonly found in cosmetic products. Some research suggests they may mimic the effects of estrogen in the body and could potentially trigger the growth of certain types of breast cancer cells.
An acne-friendly choice
EltaMD sunscreens are noncomedogenic, meaning they’re unlikely to clog pores.
“This sets them apart because other mineral sunscreens are quite heavy and can block your pores,” Ingersoll said. She recommends EltaMD UV Clear Broad-Spectrum SPF 46 to acne patients. It contains niacinamide (vitamin B3).
“Niacinamide is a very helpful ingredient because it helps treat acne and the skin discolorations it can cause,” she explained. “It also reduces redness, which is a common problem for people with acne.”
Better-looking skin
A sunscreen’s job is to protect your skin from UVA and UVB rays that cause cancer and premature skin aging. Every broad-spectrum sunscreen does this, provided you apply enough and choose one with a high enough SPF. But some contain “bonus ingredients” that can boost hydration and make your skin look more youthful.
Many EltaMD sunscreens include hyaluronic acid, which is particularly effective in maintaining skin’s moisture and giving you a dewy look. EltaMD UV Restore Broad-Spectrum SPF 40 features vitamin C and vitamin E, antioxidants that fight skin-aging free radicals.
Wearing a broad-spectrum sunscreen, no matter which one, is critical to reducing the risk of skin cancer. EltaMD sunscreens do cost more than drugstore brands, but if there’s room in your budget, dermatologists say they’re a smart investment.
“When you consider how much these sunscreens do, they’re definitely worth the price,” said Ingersoll.
Article Written By: Jessica Brown, a health and science writer/editor based in Brooklyn, New York. She has written for Prevention magazine, jnj.com, BCRF.org and many other outlets.
Medical Review By: Evelina Ingersoll, APRN
Mineral vs. Chemical Sunscreen: Which Is Best?
Medical Review By: Evelina Ingersoll, APRN
You’ve probably heard that when it comes to buying sunscreen, you should choose one that provides broad-spectrum protection (to guard against both UVA and UVB rays) and has SPF 30 or more. But when it comes to mineral vs. chemical sunscreen, which is the smarter option?
Many or most of the sunscreens you find at the store are chemical sunscreens, which penetrate the skin. They work by absorbing UV rays and converting them to a small amount of heat, which the body releases.
Mineral sunscreens, also called physical sunscreens, sit on top of the skin. They work by blocking and reflecting the sun’s rays.
Both types offer protection against sunburn, premature aging, and skin cancer, so it comes down to a personal choice. To decide what’s best for you, consider the facts below. Keep in mind that some sunscreens contain both chemical and mineral ingredients.
Ingredients
Chemical sunscreens contain one or more chemicals, such as oxybenzone, avobenzone, octisalate, octocrylene, homosalate, and octinoxate. Mineral sunscreen contains titanium dioxide and/or zinc oxide.
Because chemical sunscreens take time to sink into your skin, you should apply them15 to 30 minutes before going outside. “Otherwise, you could get burned while the sunscreen is being absorbed,” said Evelina Ingersoll, APRN, a certified advanced practice registered nurse at Water’s Edge Dermatology. Mineral sunscreen is effective right away.
The main concern with chemical sunscreens is their ability to enter the bloodstream.
One pilot study conducted by FDA scientists tested four chemical sunscreens and found that all of the chemicals tested (avobenzone, oxybenzone, octocrylene, and ecamsule) were absorbed into the blood at levels higher than those the FDA recommends for chemicals that have not been tested for toxicity. Oxybenzone showed up in the blood in far higher concentrations than the other ingredients.
More research is needed to confirm the study results and determine what effects, if any, absorption might have on a person’s health. Meanwhile, the FDA stresses that people should continue to use sunscreen and follow other sun safety practices, such as wearing protective clothing, hats, and sunglasses.
If you’re concerned about the potential risks of chemical sunscreen, mineral sunscreen may be the way to go. Titanium dioxide and zinc oxide are the only two sunscreen ingredients that currently meet the FDA’s criteria for “generally recognized as safe and effective.”
“Mineral sunscreen is also a good choice if your skin is sensitive or you’re prone to acne or rosacea, since some chemical sunscreens can cause irritation or breakouts,” said Ingersoll.
Environmental Friendliness
Mineral sunscreen is considered to be safer for the planet. Some chemical sunscreens contain ingredients, including oxybenzone, octinoxate, and octocrylene, that can be harmful to marine life and coral reefs. These chemicals may be released into the ocean when you swim, and they can enter waterways when you wash off your sunscreen during your shower.
For these reasons, the National Ocean Service recommends using mineral sunscreen if you plan to swim in the ocean. And it’s a must if you live in or travel to Hawaii. That state has banned the sale and distribution of chemical sunscreens to help protect the environment.
Look and Feel
Chemical sunscreens are typically thinner and tend to go on more easily. Most don’t turn the skin white. Mineral sunscreens may feel heavier, but on the upside, they are more moisturizing.
Mineral sunscreens can be chalky and give the skin a white cast, depending on the product — think of lifeguards with white noses. But newer, more advanced formulas don’t leave a thick residue. Some are tinted, making them a particularly good choice for people with darker skin.
Water Resistance
Most mineral sunscreens are less water-resistant than chemical sunscreens. If you sweat a lot or swim, you’ll need to reapply mineral sunscreen more often.
Price
Some people may prefer chemical sunscreens because they’re usually less expensive than mineral ones. However, as mineral sunscreen grows in popularity, it’s becoming easier to find more affordable options. Several popular drugstore brands, including Neutrogena, Cetaphil, Coppertone, and Aveeno, now offer mineral sunscreens.
Whatever sunscreen you choose, the key to getting the protection you need is this, said Ingersoll: “Wear it every day, reapply it often, and use enough. Most people use less than half of the recommended amount.”
Written By: Jessica Brown, a health and science writer/editor based in Brooklyn, New York. She has written for Prevention magazine, jnj.com, BCRF.org and many other outlets.
4 Surprising Times You Need to Wear Sunscreen
Medical Review By: Tanya Sperber, APRN
You know you’re supposed to wear sunscreen every day, even on cloudy days and in winter, but there are times when you probably wouldn’t think to bother with it. For example, what’s the point if you’re going to spend most of your day in your office?
Surprise! You can be exposed to ultraviolet (UV) rays in some common places that aren’t exactly outdoors. Over time, this exposure may contribute to an increased risk of wrinkles and skin cancer.
Prepare to slather on sun protection when you find yourself in the following situations.
Sitting by a window
Windows protect you from the sun’s rays, right? Yes and no. Glass blocks most UVB rays, the ones that cause sunburn. That’s why many people assume it’s fine to sit by a sunny window without wearing sunscreen. But according to the Skin Cancer Foundation, more than 50% of UVA rays, which are the main cause of premature aging and also contribute to some skin cancers, pass through glass.
If you’re sitting next to a window, or even if you’re a few feet away from it, it’s a good idea to wear sunscreen. For maximum protection, choose a broad-spectrum sunscreen with an SPF of 30 or higher.
"The best way to incorporate sunscreen in your regimen is to find one you love," said Tanya Sperber, APRN, a board-certified advanced practice registered nurse with Water's Edge Dermatology. "Elta MD Elements is a lightweight tinted sunscreen women can apply everyday prior to applying makeup. This sunscreen provides all the benefits of a physical barrier sunscreen without feeling heavy on the skin, apply makeup over or just apply sunscreen and go. A great non-tinted option for men is Elta MD Sheer - it works well for men with facial hair, rubs in completely and if you’re not sweating or swimming, you’re protected all day with a barrier zinc sunscreen."
If your desk or favorite perch is near a window, consider installing UV-blocking window film for extra protection. These block up to 99.9% of UV radiation and are available in a variety of tints. You can have window film professionally installed or buy it at a home improvement store and install it yourself.
Driving your car
Does the left side of your face have more wrinkles or age spots than the right? Driving may be the reason.
While the windshield of your car blocks most UVA (and UVB) rays, your side windows may provide less protection. A 2016 study found that while windshields in a car blocked an average of 96% of UVA radiation, the side windows blocked an average of just 71%.
The difference is due to the types of glass. Windshields are made of two plates of glass with a layer of plastic between to make them shatterproof. Side windows don’t have that plastic layer, which is what provides most of the windshield’s UVA protection.
Experts suspect that weaker UVA protection from side windows may help explain why skin cancer is more common on the left side of the body. So, if you have a daily commute or spend long periods of time in a car, wear sunscreen. Do so even if the side windows are tinted, since the level of UVA protection that tinted windows provide varies. Remember to apply it to your arms, hands, and face.
Keep the sunscreen handy, but don’t store it in the car. The heat that gets trapped in the car can break down the chemicals in sunscreen and make it less effective.
You can also protect yourself by installing UV-blocking window film on your car’s side windows.
Traveling by plane
If you find yourself in a window seat on your next flight, you’ll need more than your boarding pass before takeoff: You’ll need a thorough application of sunscreen, too.
At 30,000 feet, the sun is much stronger than at ground level, and windows on planes (and buses and trains) may not provide adequate protection from UVA rays.
While the risk of sun damage and skin cancer appears to be higher for pilots and flight crew members than passengers, it’s still smart to wear sunscreen when you fly. Just remember that the Transportation Safety Administration currently allows no more than 3.4 ounces of sunscreen in a carry-on.
Getting a gel manicure
Love gel manicures? You’re not alone. Gels make manicures last longer compared to nail polish, but they have to be set using nail lamps that emit high-intensity UVA light.
The risk of UV damage and skin cancer from the lamps, if any, is probably low. A recent review of medical literature did not find evidence of an increased risk of skin cancer in people under 40 who’ve had gel manicures. Still, the American Academy of Dermatology suggests applying sunscreen to your hands protect yourself. If you prefer, you can wear dark, opaque gloves with the fingertips snipped off.
If you get gel manicures regularly, consider saving them for special occasions.
Article Written By: Jessica Brown, a health and science writer/editor based in Brooklyn, New York. She has written for Prevention magazine, jnj.com, BCRF.org and many other outlets.
Sun Safety
Summertime is fun time to spend outdoors. But in sunny Florida, that means more exposure to the sun’s ultraviolet (UV) rays. Those UV rays can damage unprotected skin in as little as 15 minutes and even lead to skin cancer. Here are some tips to keep you sun safe all year long.
Seek Shade
One of the easiest ways to reduce your exposure to damaging UV rays is to get in the shade. Seek shade under a tree, umbrella or another shelter in order to reduce your risk of sun damage. You’ll help your skin look younger longer and lower your risk of developing skin cancer.
Protective Clothing
Cover up with long-sleeved shirts and long pants when you can to protect your skin from the sun’s harsh UV rays. There are clothing options available that contain a UV protectant built into the fabric. Also, remember that a wet t-shirt provides less UV protection than a dry one, and darker colored clothing protects better than light-colored clothing. Don’t forget to top it off with a hat with a brim all the way around that shades your face, ears, and back of the neck. If you choose a baseball cap instead, be sure to protect your ears and the back of your neck with sunscreen of at least 30 SPF.
Sunglasses
Choose sunglasses that are labeled UV protectant to reduce the risk of developing cataracts. Most of the sunglasses sold in the U.S. block both UVA and UVB rays. Sunglasses also protect the skin around your eyes from sun damage, and wrap-around sunglasses are an excellent option to block UV rays that might sneak in from the side.
Wear Sunscreen
Choosing the right sunscreen can be daunting, so we recommend following these four rules to make it easier:
- Broad-spectrum – Broad-spectrum sunscreen protects the skin from both ultraviolet A (also known as UVA) and ultraviolet B (also known as UVB) rays. Both of these rays can cause skin cancer.
- SPF 30 or higher – The sun protection factor (SPF) rating indicates how well a sunscreen protects you from the sun by blocking harmful UVB rays. Choose a sunscreen with SPF 30 or higher to make sure you are protected.
- Key ingredients – Look for active ingredients like ecamsule, avobenzone, titanium dioxide, sulisobenzone or zinc oxide. Beware of products that include oxybenzone or octinoxate which are harmful to the environment. Some areas of Florida have banned the sale of sunscreen with oxybenzone and octinoxate because these chemicals can damage coral reefs.
- Avoid tanning oils – They generally do not provide enough protection against the harmful effects of the sun.
How to Apply Sunscreen & How Often
To get the maximum protection from your sunscreen, follow these recommendations:
- One ounce of sunscreen is considered the right amount. Cover all exposed areas of the body thoroughly. Don’t skimp. Many people don’t use enough sunscreen.
- Apply sunscreen 15 to 30 minutes before going in the sun. Don’t forget the tips of the ears, feet, back of the legs and bald spot (if you have one). Reapply sunscreen every two hours and use a UV-protective lip balm to cover your lips.
- If you are exercising or are in the water, it’s a good idea to get a sunscreen that is resistant to water and sweat. The FDA defines water resistant to mean that the SPF level stays effective after 40 minutes in the water. Very water-resistant means it is effective after 80 minutes of swimming. These sunscreens are not waterproof, so reapply regularly.
Protecting your skin from the harmful rays of the sun can help you look younger and prevent skin cancer. Just to be on the safe side, be sure to get a skin cancer screening every year, so if you do develop skin cancer, it can be detected and treated early.
Schedule a skin cancer screening at your nearest Water’s Edge Dermatology office.
Dark Spots & Hyperpigmentation
No one wants dark spots and skin discoloration, but the fact is millions of Americans have them. Hyperpigmentation is a general term that refers to a condition where the skin is discolored or darkened. Dark spots caused by hyperpigmentation can make you look older and can be the result of several factors including acne scarring, sun damage or inflammation from an eczema flare-up. Melasma is a type of hyperpigmentation that appears as a form of skin discoloration and is made worse by sun exposure. It affects more than five million Americans, mostly women. In order to properly treat these conditions, it’s important to understand the differences between them.
Hyperpigmentation
Hyperpigmentation includes any darkening of the skin. Acne, sun exposure, and skin rashes can stimulate the pigment-making cells of the skin, called melanocytes. When that happens, those cells often produce a surplus of pigment into lower levels of skin, causing a dark spot. The deeper the pigment, the harder it is to treat. It works much in the same way as a tattoo. The severity of skin darkening varies. When skin is consistently exposed to harmful UV rays without sunscreen protection, it will be more difficult to treat than a dark spot left over from a pimple that has been shielded from the sun.
Melasma
Melasma is a type of hyperpigmentation, more commonly seen in women and especially women with darker skin tones. It is believed to be triggered by UV exposure and hormones that increase during pregnancy and after starting oral contraceptive use or other hormonal therapies, which can make melasma tougher to treat than traditional hyperpigmentation.
You can usually tell if you have melasma based on the appearance of the spot, which typically appears as symmetric blotchy hyperpigmented patches on the face, often on the cheeks, nose, forehead, chin, and upper lip. It can occur on the neck and forearms as well as other parts of the body prone to sun exposure. Melasma generally is worse in the summer and improves in winter. It can also appear during pregnancy or after starting birth control or other hormonal treatments. Visible light and heat often contribute to melasma spreading. Some dermatologists recommend using makeup with iron oxide to help block visible light.
Treatment
Hyperpigmentation can be treated using chemical peels or with a variety of over-the-counter products that contain skin brighteners such as vitamin C, kojic acid, niacinamide, hydroquinone, and azelaic acid. Melasma is more difficult to treat. Because melasma remedies that work for one person do not necessarily work for another, it is difficult to identify one effective treatment. Many dermatologists recommend a combination of sunscreen to protect the skin, brightening ingredients, and laser treatments for patients with melasma.
Melasma often responds to treatment with lasers in low energy, such as the Clear + Brilliant laser which uses low energy fractionated technology for melasma, sun damage, and skin texture. At least three treatments are needed monthly followed up by treatment every six months to maintain results. Talk with your dermatologist to determine the right plan for your skin.
Skin Protection
Always use sunscreen to protect your skin. Use a moisturizer with sunscreen and apply sunscreen with an SPF of 30 or higher every two hours when you plan to be in the sun or even inside sitting near a window. Hyperpigmentation and melasma can likely be avoided by incorporating sunscreen into your daily skin regimen.
At Water’s Edge Dermatology, our board-certified physicians and medical support team can create an effective treatment plan to treat your hyperpigmentation or melasma.