With summer in full swing and another holiday weekend approaching, most of us will be heading out into the great outdoors, be it the beach, the pool, the golf course , the tennis court , a backyard BBQ or park. I thought it would be a good time to touch on the subject of skin care/protection and the use of sunscreens.
Recent research shows that most people know that sunscreen is important when heading outdoors for an exteneded period of time, but nearly a third say they never use it.Today it’s no scret that the sun’s ultraviolet rays can damage your skin (aging) and contribute to skin cancer, so protecting your skin from the sun is important, but remember not all sunscreens are created equal.
Here’s a quick “FAQ” regarding sunscreen and it’s use.
Q. Why are sunscreens important for our well being?
A. There is a dark side to the sun. The government has placed ultraviolet radiation (UVR) both from the sun and from tanning machines on its list of known human carcinogens. UVR produces DNA damage that may lead to mutations in genes involved in the pathogenesis of skin cancer. Therefore, along with other sun safety strategies, sunscreens that absorb or block UVR serve an important protective function.
The US Environmental Protection Agency (EPA) estimates that the sun causes 90 percent of nonmelanoma skin cancers and 65 percent of melanomas.1,2 Each year, there are an estimated million or more new cases of the nonmelanoma skin cancers basal and squamous cell carcinoma (BCC and SCC). The incidence of invasive melanoma, the most serious form of skin cancer, is estimated to be 59,940 this year, with deaths estimated to be 8,100, according to the American Cancer Society.3
Photoaging is another long-term result of sun exposure. While not threatening to life, it is threatening to quality of life. Excessive unprotected time in the sun leads to premature wrinkling, sagging, a leathery texture and hyperpigmentation.
Sunburn, the most obvious example of UVR damage, occurs when signaling molecules in the upper layer of the skin and histamines released from mast cells (immune cells) affect the blood vessels, resulting in erythema, edema, and burning and stinging sensations. This DNA damage can be the first step towards skin cancer. Intermittent intense UVR exposure, often producing sunburn, is believed to be more closely associated with melanoma than is chronic sun exposure. One blistering sunburn in childhood or adolescence doubles the risk of melanoma later in life; five sunburns by any age doubles the risk as well.4
UVR also weakens immune surveillance mechanisms, allowing tumor cells to proliferate more freely. This effect adds to the immunosuppression induced by other causes, including cancer chemotherapy and antirejection drugs for transplants.5 Sunscreen is one vital tool that can help prevent all of these UVR-induced assaults on the body as part of a comprehensive photoprotection program, along with sun avoidance or use of shade during peak sunlight hours (10 AM to 4 PM), and protective clothing, including a wide-brimmed hat and UVR-blocking sunglasses.
Q.What are the major risk factors for skin cancer?
A. Heredity has a major role; entire families can be melanoma-prone. In general, fairskinned individuals, skin types I and II, living between 0º and 45º north or south latitudes, are at highest risk for skin cancer. They have blond or red hair, blue or hazel eyes, burn easily and tan minimally or not at all. People with many moles or any large, atypical moles are also at higher risk.
Finally, not just intermittent intense exposure, but also chronic lifetime exposure adds to skin cancer risk. Studies have shown that chronic sun exposure is most associated with the development of squamous cell carcinoma and intermittent sun exposure with basal cell carcinoma6,7 as well as melanoma.
Q. Should sunscreen be used only by people at high risk?
A. Although people with dark skin are not as high-risk as those with light skin, they develop skin cancer too and should use sunscreen. Dyspigmentation is also a major concern for many dark-skinned individuals, and can be minimized by photoprotection, including regular sunscreen use. For adequate protection against melanoma, nonmelanoma skin cancers and photoaging, everyone over the age of six months should use sunscreen daily year-round, in any weather. (Infants should be kept out of the sun or protected with clothing and an umbrella or stroller hood.)
Sunscreen should not be neglected on overcast days, as 70-80 percent of the sun’s rays – above all, long-spectrum UVA rays – go through clouds and fog. In addition, according to the World Health Organization, UVR levels rise by about 10-21 percent for every 1000 feet of altitude, and reflection from sand, water, snow or concrete magnifies their effects by up to 80 percent.
Q. What is the protocol for applying sunscreen?
A. It should be applied one-half hour before going outside. Because sunscreen tends to be rubbed or washed off with sweating and water exposure, it should be reapplied at least every two hours, and immediately after swimming or heavy sweating. At least one ounce (two tablespoons) is needed to cover the entire body surface.
As facial skin is thin and highly exposed, it is particularly important to apply sunscreen there liberally. Many sunscreens are now incorporated in facial moisturizing creams; in routine daily activity, if the face is untouched and there is no sweating, it is acceptable to apply the sunscreen just once at the beginning of the day.
There is no need to throw away last year’s left-over sunscreens. Shelf life is at least two years; many now have an expiration date stamped on the container.
Q.What does Sun Protection Factor (SPF) measure, and what are its limitations?
A. The SPF rating is a reliable measurement of protection against UVB (short-spectrum) wavelengths (290-320 nanometers; 1 nm is a billionth of a meter). SPF is the comparative ratio between the minimal erythemal dose (MED) in skin protected with sunscreen and the MED in unprotected skin. For example, if it takes 20 minutes without protection to produce erythema, an SPF 15 sunscreen might prevent reddening 15 times longer—about five hours. That figure is theoretical, however, and sun damage can occur even without reddening, so dermatologists normally advise reapplying after approximately two hours.
The Skin Cancer Foundation considers SPFs of 15 or higher acceptable UVB protection. Such sunscreens also provide some protection against UVA wavelengths (320-400 nm), though the SPF rating refers only to UVB protection. No FDA-approved measurement standard exists yet for UVA protection in the US, even though UVA penetrates more deeply into the skin than UVB, reaching the dermis. In the past, experts believed that UVB causes burning and skin cancer, while UVA causes photoaging, but the truth has proven more complex. In addition to producing sunburn, UVB can contribute to photoaging, and both UVA and UVB exposure can lead to skin cancer.
Broad-spectrum sunscreens combine UVBand UVA-absorbing chemicals and/or physical blockers, and give the most protection. However, they do not provide complete coverage in the UVA1 range (340 – 400 nm).
Q. Many people mistakenly believe that an SPF 30 rating gives twice as much sun protection as an SPF 15 and an SPF 50 more than three times that much. What is really the difference?
A. In vitro tests have shown that SPF 15 sunscreens filter out 93% of UVB rays, while SPF 30 protects against 97% and SPF 50 98%.
Q. Has the skin cancer protection afforded by sunscreen been documented?
A. There is strong evidence that sunscreens protect against development of the precancerous skin condition actinic keratosis (AK), as well as SCC. Studies performed in Australia and in the US have shown that regular use of sunscreen significantly decreases AK development. 8,9 Since AKs can be a precursor to SCC, it has been presumed that sunscreen may help prevent SCC. More recently, in a 4 1/2- year study involving over 1300 individuals, Australian researchers demonstrated that regular sunscreen use resulted in fewer SCCs, but did not significantly reduce BCCs.10
Q. What is the FDA’s position on SPF limits?
A. Though the FDA’s Monograph on Sunscreens is not final, it currently proposes that sunscreen manufacturers not be allowed to claim an SPF rating above 30; the highest rating would be 30+. The Foundation’s Photobiology Committee disagrees, pointing out that high-risk individuals can benefit from higher SPFs up to 45 or 50.
Q. What tests have been devised for measuring UVA protection?
A. Labeling of UVA protection in sunscreen is routine in a number of countries, including Australia, Japan and Germany, but the FDA has not issued official guidelines for products sold in the US.
Currently, the most widely used in vivo testing method in Europe and Asia is the Persistent Pigment Darkening test (PPD).11 The subjects are exposed to a UVA light source, with and without sunscreen. After two to three hours, the appearance of darkening of the exposed skin is used as a biological endpoint.
A variation of the PPD method is the Protection Factor in UVA (PFA) test. Also an in vivo test, it uses either pigment darkening or erythema following UVA exposure as the endpoint.12
Another widely used test is an in vitro determination of a product’s critical wavelength. In this method, the absorption spectrum of the sunscreen is plotted against wavelength; the wavelength where 90 percent of absorption occurs is defined as the critical wavelength. Therefore, the more potent the UVA protection, the longer the critical wavelength. Most consider a critical wavelength of 370 nm or longer as being a good broadspectrum sunscreen.13
Q. Is there any truth to the claim that a “base tan” helps prevent skin cancer?
A. No. Tanning is the skin’s response to DNA damage that may affect the melanocytes and keratinocytes.14 The activation and proliferation of these cells increase the risk of skin cancer and photoaging. UV tanning lamps can be as or more dangerous than the sun; in fact, their use has now been documented to be associated with skin cancers.15
There is no such thing as a healthy tan. Therefore, if people insist on being bronzed, they should be advised to use self-tanners, now offered by many cosmetics companies. The active ingredient, dihydroxyacetone (DHA), interacts with proteins in the skin to cause darkening without requiring UV exposure. Some self-tanners include sunscreen, but even if one with an SPF is used, a separate sunscreen should be applied after two hours outdoors.
Q. What are the basic sunscreen ingredients, and what protection does each offer?
A. The FDA listed 16 active sunscreen ingredients in its 1999 Monograph. In July 2006, a product called Anthelios SX that contains ecamsule (Mexoryl SX) was approved. The FDA provides the approved concentration of each ingredient, and this often is included on the product’s label. [See Table 2.]
Active Ingredient / UV Filter Name Maximum FDA-approved Concentration, % Range of Protection
Aminobenzoic acid- 15 UVB
Avobenzone- 3 UVA1
Cinoxate- 3 UVB
Dioxybenzone- 3 UVB, UVA2
Ecamsule (Mexoryl SX)- 3 UVA2
Ensulizole (Phenylbenzimidazole Sulfonic Acid)- 4 UVB
Homosalate- 15 UVB
Meradimate (Menthyl Anthranilate)- 5 UVA2
Octocrylene- 10 UVB
Octinoxate (Octyl Methoxycinnamate)- 7.5 UVB
Octisalate (Octyl Salicylate)- 5 UVB
Oxybenzone- 6 UVB, UVA2
Padimate O- 8 UVB
Sulisobenzone- 10 UVB, UVA2
Titanium dioxide 25 Inorganic/Physical-
Trolamine salicylate- 12 UVB
Zinc oxide 25 Inorganic/Physical-
(UVB, UVA2, UVA1)
Table 2. FDA-Approved Sunscreen Ingredients
Sunscreen ingredients fall into two categories: inorganic and organic absorbers/ filters (formerly known as physical blockers/ sunblocks and chemical absorbers, respectively) of UVR. Titanium dioxide and zinc oxide, commonly used today in micronized form for better cosmesis, are inorganic and are used singly or combined with other active ingredients to protect against both UVB and UVA (titanium dioxide across the UVA2 spectrum 320340 nm; zinc oxide against both UVA2 and UVA1340380nm).
Organic sunscreen ingredients that provide only UVB absorption are usually combined with others that cover some UVA wavelengths. UVB-absorbing organics include the cinnamates, with octinoxate (octyl methoxycinnamate) being the best known and most widely used; and the salicylates, most often octisalate (octyl salicylate) and homosalate. The benzophenone group of organics, including dioxybenzone, oxybenzone, and sulisobenzone, brought coverage into the UVA range, specifically protecting against UVA2 as well as UVB.
Avobenzone, introduced in the early 1990s, extended protection into the UVA1 range (340400 nm); it is currently the best UVA1 filter available in the US. It also offers some absorption across the UVA2 range. However, it does not provide adequate UVB protection, so it must be used in combination with UVB-absorbing chemicals. Until recently, the effectiveness of avobenzone was limited by its being photounstable, degraded by over 50 percent after one hour of sun exposure. Now, it has been photostablilized by combining it with other photostable UV filters, such as octocrylene and/or oxybenzone.16 In patented new technologies such as HelioplexTM or Active Barrier Complex, diethylhexyl 2,6-naphthalate (DEHN), an electron acceptor, is used as another stabilizer of avobenzone.
Anthelios SX, the broad-spectrum sunscreen product most recently approved by the FDA, includes the new ingredient ecamsule, also known as Mexoryl SXTM, which has been used in Europe and Canada for some years. Unlike avobenzone, Mexoryl SX is a photostable new generation of UV filter; it protects against the entire UVA2 spectrum. The formulation in Anthelios SX, combining Mexoryl SX with two other key active ingredients, avobenzone and octocrylene, is extremely stable, resulting in broad-spectrum coverage. Some tests show it to be effective in vitro for as much as five hours. (HelioplexTM technology is said to have a comparable effect.) Marketed as a daily facial moisturizer with sunscreen, it has an SPF of 15.
Q. What other ingredients may be included in sunscreens?
A. Antioxidants, which can neutralize free radicals to some degree, are sometimes added to sunscreens, though their impact is not universally accepted. Vitamin E (alpha tocopherol) gives some protection against UV-induced DNA damage and vitamin C (L-ascorbic acid) against sunburn. The free radicals are produced by melanin and other skin tissues exposed to light. A number of sunscreens today list “free radical protection” on the package.
Some products now combine sunscreen with the insect repellent DEET (diethylmethylbenzamide), oil of citronella and a biochemical substance known as IR3535. (When DEET and sunscreen are used separately, the repellent has been found to dilute the sunscreen below its stated SPF.) No good data are available on the efficacy of the combined products. One concern about them is the method and frequency of application, since sunscreens are to be reapplied liberally and frequently, while most insect repellents are to be applied no more often than every 6 hours. The FDA is considering specific regulation of these combination sunscreens in its Monograph, and the EPA also plans an evaluation.17
Q. Do moisturizers, tinted foundation, lipstick and other cosmetics containing an SPF 15 sunscreen provide as much protection as sunscreen used alone?
A. The cosmetics neither increase nor decrease the photoprotective value of the sunscreen. They have the great advantage that most women apply them every day. Some products for men also combine moisturizer and sunscreen. It’s important, however, to use a separate sunscreen or reapply the cosmetics every two hours when outside.
For the best results, if you are using a moisturizer and a separate sunscreen, the moisturizer should go on first, then sunscreen, then makeup. If you are also using a topical medication, that should be applied before everything else, then the rest of the layering process is repeated.
Q. Are sunscreens more aesthetically pleasing and convenient than in the past?
A. Today, sunscreens with excellent cosmesis and easier application are widely available. Consumers have a choice among lotions, creams, gels, sprays and sticks. Some are specially designed to appeal to children. “Micronized” versions of zinc oxide and titanium dioxide that render them invisible have greatly increased their popularity. And advanced technologies employing delivery systems such as liposomes enable sunscreen ingredients to stay on the skin surface better and keep their effectiveness longer.
Q. Sunscreen still has its detractors. Some have claimed that it encourages excessive sun exposure by making people think they are totally protected from UVB and UVA, and thus increases their skin cancer risk. Is this valid?
A. Most photobiologists and dermatologists strongly disagree. Thorough analysis of all available data has failed to show any correlation between the use of sunscreen and an increase in melanoma or any other skin cancer.18,19
However, it must always be remembered that broad-spectrum sunscreen is just one of several vital measures that need to be practiced in anyone’s photoprotection program.
Q. Is unprotected sun exposure necessary to prevent vitamin D deficiency?
A. This is a highly controversial issue.20,21 Vitamin D is synthesized when the skin is exposed to UVR. Its active form, 1,25dihydroxy Vit D 3, regulates calcium metabolism, essential for bone and muscle health, and recent epidemiologic studies have shown that individuals with adequate serum vitamin D levels had a lower incidence of internal cancers and multiple sclerosis. However, the action spectrum for cutaneous vitamin D synthesis is in the UVB range, known to be photocarcinogenic.
Therefore, for individuals at risk for vitamin D insufficiency, such as those who are elderly, homebound, or dark-skinned, a balanced diet with adequate intake of food rich in vitamin D (e.g., salmon and fortified milk) is the most appropriate way to maintain a good vitamin D level. If necessary, vitamin D supplements can be added. Because of its deleterious effects, intentional, unprotected sun exposure should not be used as a way to increase vitamin D level.
Q. How do sunscreens fit into an overall sun protection program?
A. The sun is an inevitable and enjoyable part of life, so daily use of a broad-spectrum SPF 15+ sunscreen, applied liberally, must be a key part of any comprehensive sun protection program. The Skin Cancer Foundation also recommends seeking the shade, especially from 10 AM to 4 PM; avoiding sunburn; and covering up with clothing, including a broadbrimmed hat and UV-blocking sunglasses.
Q. What is the easiest way to know if a sunscreen provides proper protection?
A. Besides checking the ingredient label, consumers can look for The Skin Cancer Foundation’s Seal of Recommendation on the label or in the packaging. The Seal is awarded to sun protection products that meet the rigorous requirements of the Foundation’s Photobiology Committee. Manufacturers must confirm that the product has an SPF of 15 or greater, validated by testing on 20 people, does not produce phototoxicity or contact irritation and has substantiated claims for water resistance. Following the FDA guidelines, a “water resistant” product must maintain its SPF after 40 minutes of water immersion, and a “very water resistant” product after 80 minutes.
By the end of the year, manufacturers who claim their products are broad-spectrum will also be required by the Foundation’s Photobiology Committee to provide documentation of proper UVA protection.
Q. How will sunscreens continue to evolve?
A. Repair enzymes added to the mix will actually help correct any sun damage that occurs. To eliminate photosensitivity and allergic reactions, the ingredients will be less photoreactive. The availability of new photostable filters will continue to improve overall photostability. And sunscreens will be even more aesthetically pleasing and easier to apply.
Consumer Reports tested sunscreens. (Most promise to guard against both UVA and UVB rays) Here are some of the top picks:
*** Best sunscreen: Neutrogena Ultra Sheer Dry-Touch Sunblock SPF 55
Est. $9 for 3 ounces
Sunscreen reviews say Neutrogena Ultra Sheer Dry-Touch Sunblock is an excellent general-use sunscreen. It has avobenzone and oxybenzone for broad-spectrum protection against short- and long-wave UVA rays (the main culprit… responsible for long-term skin damage). It also has Helioplex, which can help the active ingredients protect skin for up to five hours. Neutrogena claims this sunscreen will neither run into the eyes nor sweat or towel off. User reviews are generally positive. Keep in mind that although Neutrogena calls this product a sunblock, no sunscreen can completely protect you from damaging rays. SPF 30 and 45 formulations contain antioxidants and are more lightweight, but the SPF 55 formula is recommended most often.
*** Best sunscreen for sensitive skin and babies: Blue Lizard Suncream Sensitive SPF 30+
Est. $12 for 5 ounces
If you have sensitive skin or just want a chemical- and fragrance-free sunscreen, we found excellent reviews for Blue Lizard Sensitive. Instead of chemical sunscreens that could irritate sensitive skin, Blue Lizard… Sensitive and the identical Blue Lizard Baby formulas contain zinc oxide (10 percent) and titanium dioxide (5 percent), which act as a physical barrier against broad-spectrum UVA and UVB rays. Blue Lizard Suncream is water-resistant. Because this sunscreen is thicker and creamier than others, it can take longer to apply.
*** Sport-formula sunscreen: Banana Boat Sport Performance Dri-Blok Sunblock Lotion SPF 30
Est. $9 for 6 ounces
Reviewers say that active people will appreciate the matte finish of Banana Boat Sport Performance Dri-Blok Sunblock Lotion SPF 30. This water-resistant sunscreen won’t sweat off as quickly as others. The lightweight… formula goes on like a lotion but dries to a powder finish, unlike regular sunscreen formulas that often leave skin feeling slippery and sticky. The Sport Performance formula is identical to the kids’ formula. Both contain avobenzone (2.5 percent) for UVA protection, along with a small amount of aloe and vitamins A and E.
*** Best inexpensive sunscreen: No-Ad Sunblock Lotion SPF 45
Est. $10 for 16 ounces
While we found the best reviews overall for Neutrogena Ultra Sheer sunscreen, No-Ad Sunblock offers similar (though not quite as long-lasting) protection for much less. No-Ad SPF 45 contains avobenzone for protection… against broad-spectrum UVA and UVB rays. It is labeled as “very water resistant,” which means that it will maintain the indicated SPF for 80 minutes in the water, unless it is rubbed off. No-Ad also contains aloe, which is known to be soothing with antioxidant properties. It also contains fragrance, however, so No-Ad sunscreen may not be suitable for those with sensitive skin.
*** Best Spray Sunscreen– Neutrogena Ultra Sheer Body Mist Sunblock Spf 70
Est. $14 for 5 Oz.
It provides broad spectrum UV protection in an ultra light sheer mist.
Stabilized with helioplex, it provides superior balanced broad spectrum protection against UVA aging
This weightless formula applies easily to even hard to reach areas.
Ultra sheer body mist sunblock is waterproof, sweatproof and resists running into eyes.
This one touch continuous spray works at any angle.
We hope you will found this helpful. Not only is over-exposure dangerous but not being mindful of sun exposure it can ruin your vacation, holiday or weekend (suffering with a bad sunburn can be easily prevented). Now get out there, get active and have fun!
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