What sunscreen is safe

Is sunscreen safe ?

Yes according to the American Academy of Dermatology ¹ and the U.S. Food and Drug Administration ² sunscreen is safe to use. No published studies show that sunscreen is toxic to humans or hazardous to human health. Scientific studies actually support using sunscreen. If used properly, regular sunscreen use can reduce risk for skin cancer – reduce melanoma ³; reduce squamous cell carcinoma ⁴ and prevent or delay photoaging of the skin ⁵, ⁶, ⁷. Using sunscreen, seeking shade and wearing protective clothing are all important behaviors to reduce your risk of skin cancer.

Research shows that wearing broad-spectrum sunscreen products that filter both UVB radiation and UVA radiation and that have a sun protection factor (SPF) of at least 15 can:

• Prevent sunburn.
• Reduce your risk of skin cancer and premature aging.

Sunscreen products are regulated as over-the-counter drugs by the U.S. Food and Drug Administration. In 2011, the U.S. Food and Drug Administration (FDA) updated regulations on sunscreen labeling to help consumers select and properly use sunscreens ⁸. The FDA announced that sunscreen products meeting modern standards for effectiveness may be labeled with new information to help consumers find products that reduce the risk of skin cancer and early skin aging, in addition to helping prevent sunburn. The regulation allows sunscreens that pass the FDA’s test for protection against ultraviolet A (UVA) and ultraviolet B (UVB) radiation to be labeled as “broad spectrum.” UVA and UVB radiation contribute to sunburn, skin cancer, and premature skin aging. Sunburn is primarily caused by UVB radiation.

Under the new rules, manufacturers of sunscreens labeled as broad spectrum and SPF 15 or higher may state that the products will help prevent sunburn and reduce the risk of skin cancer and early skin aging. Products that have SPF values between 2 and 14 and pass the FDA’s test may be labeled as broad spectrum, but the manufacturers may not state that these products reduce skin cancer risk or early skin aging.

• Any product that is not broad spectrum, or that is broad spectrum but has an SPF between 2 and 14, must carry a warning stating that the product has not been shown to help prevent skin cancer or early skin aging.

Today on every sunscreen labels, you’ll see whether the sunscreen:

• Is Broad Spectrum, which means the sunscreen protects against UVB and UVA rays and helps prevent skin cancer and sunburn.
• Has an SPF of 30 or higher. While SPF 15 is the FDA’s minimum recommendation for protection against skin cancer and sunburn, the AAD recommends choosing a sunscreen with an SPF of at least 30.
• Has a Skin Cancer/Skin Aging Alert in the Drug Facts section of the label, which means the sunscreen will only prevent sunburn and will NOT reduce the risk of skin cancer and early skin aging
• Is Water Resistant (effective for up to 40 minutes in water) or Very Water Resistant (effective for up to 80 minutes in water). This means the sunscreen provides protection while swimming or sweating up to the time listed on the label.
• Sunscreen manufacturers now are banned from claiming that a sunscreen is “waterproof” or “sweat proof,” as the FDA has determined that those terms are misleading.

Even when using a water-resistant sunscreen, you should reapply after getting out of the water or after sweating.

What is UV radiation ?

Radiation is the emission (sending out) of energy from any source. There are many types of radiation.

Ultraviolet (UV) radiation is a form of electromagnetic radiation. The main source of UV radiation (rays) is the sun, although it can also come from man-made sources such as tanning beds and welding torches.

Radiation exists across a spectrum from very high-energy (high-frequency) radiation – like x-rays and gamma rays – to very low-energy (low-frequency) radiation – like radio waves. UV rays have more energy than visible light, but not as much as x-rays.

Higher energy UV rays often have enough energy to remove an electron from (ionize) an atom or molecule, making them a form of ionizing radiation. Ionizing radiation can damage DNA in the cells in our body, which in turn may lead to cancer. But because UV rays don’t have enough energy to penetrate deeply into the body, their main effect is on the skin.

Ultraviolet light (lightwaves 200-400nm) from the sun can cause sunburn if your skin is exposed for too long. It is always best to try to avoid excessive sun exposure between the peak hours of 10 a.m. to 4 p.m. – this is when UV rays are the strongest.

Scientists often divide UV radiation into 3 wavelength ranges:

UVA Light (Ultraviolet A):

• UVA rays are the weakest of the UV rays. They can cause skin cells to age and can cause some indirect damage to cells’ DNA. UVA rays are mainly linked to long-term skin damage such as wrinkles, but are also thought to play a role in some skin cancers.
• Ultraviolet A1 (UVA 1) 340-400nm and Ultraviolet A2 (UVA2) 320-340nm
• Levels of UVA is consistent throughout the year regardless of season
• UVA penetrates into the lower dermis of the skin
• Penetrates glass
• 95% of UV is UVA
• Causes tanning of the skin
• Immunosuppressive
• An important contributor to melanoma
• Cause of most aging effects on the skin, such as wrinkling
• Causes many photodermatoses
• Cause of phototoxic reactions to various drugs
• The light that sun-beds mainly use. Remember that there is no such thing as a safe sun tan. The FDA is currently investigating whether suntan beds should be banned for people under the age of 18.

UVB Light (Ultraviolet B):

• UVB rays have slightly more energy than UVA rays. They can damage the DNA in skin cells directly, and are the main rays that cause sunburns. They are also thought to cause most skin cancers.
• 290-320nm
• Levels of UVB light increase during the summer, at noon, and are higher on the equator
• Can only penetrate the surface layer, the epidermis
• Does not go through glass
• SPF of sunscreens are determined by the amount of UVB that it blocks
• More carcinogenic than UVA
• Causes sunburns on the skin
• Required for Vitamin D production

Sunscreens are the first and foremost defence to sun damage. First, you will need to choose the right sunscreen.

UVC Light (Ultraviolet C):

• UVC (200-290nm) rays have more energy than the other types of UV rays. Fortunately, because of this, they react with ozone high in earth’s atmosphere and do not reach the ground. Therefore UVC rays are not normally a risk factor for skin cancer. But they can also come from some man-made sources, such as arc welding torches, mercury lamps, and UV sanitizing bulbs that kill bacteria and other germs (such as in water, air, food, or on surfaces).

The easier way to remember about the UV rays: UVA = Aging = Tanning = Cancer; UVB = Burn = Cancer. Both can damage the skin and increase your risk of developing skin cancer.

Many people believe the UV rays of tanning beds are harmless. This is not true. The best thing to do is not use tanning beds (or booths).

People who may be exposed to artificial sources of UV at their job should follow appropriate safety precautions, including using protective clothing and UV shields and filters.

The Effects of Ultraviolet Light

The skin has evolved to protect us from the harmful effects of ultraviolet light. Sunscreens were first developed to prevent sunburns by blocking UVB; they allowed us to prolong our time in the sun, but that resulted in increased exposure to UVA. Modern sunscreens attempt to block the whole spectrum of UV light, so are called broad spectrum.

Ultraviolet light can be generally categorized as UVA or UVB light, and refer to the different wavelengths, and have varying characteristics.

Ultraviolet Light Short-term negative effects:

• Sunburn/Tan
• Light aggravated conditions
• Photosensitive rashes
• Allergic reactions
• Drug and chemical photo toxicity

Ultraviolet Light Medium-term negative effects:

• Photodamage
• Photo-aging

Ultraviolet Light Long-term effects:

• Skin cancer
• Photo-aging

Can you still get Sun damage on windy, cloudy or cool days ?

YES. You can get sun damage on windy, cloudy and cool days. Sun damage is caused by ultraviolet (UV) radiation, not temperature. A cool or overcast day in summer can have similar UV levels to a warm, sunny day. If it’s windy and you get a red face, it’s likely to be sunburn. There’s no such thing as ‘windburn’.

Sun damage is also possible on cloudy days, as UV radiation can penetrate some clouds, and may even be more intense due to reflection off the clouds.

Does a “fake tan” that darkens the skin, protect your skin from the sun damage ?

NO. Fake tanning lotion does not improve your body’s ability to protect itself from the sun, so you will still need sun protection. Some fake tans have an SPF rating. However, this gives very little protection and should not be relied on for continued protection.

Do people with olive skin not at risk of skin cancer ?

FALSE. People with olive skin can get skin cancer too. Regardless of skin type, exposure to UV radiation from the sun and other artificial sources, such as solariums, can cause skin to be permanently damaged. People with skin types that are less likely to burn can still receive enough UV exposure to risk developing skin cancer. And generally when skin cancers do occur, they are detected at a later, more dangerous stage. Care still needs to be taken in the sun.

If you tan but don’t burn, do you still need to bother with sun protection ?

There’s no such thing as a safe tan. If skin darkens, it is a sign of skin cells in trauma, even if there is no redness or peeling.

Skin darkens as a way of trying to protect itself because the UV rays are damaging living cells. If you tan easily, you are still at risk of skin cancer and need to use sun protection.

Can you still get sun burn in the car through a window ?

You can get burnt through a car window. Untinted glass commonly used in car side windows reduces, but does not completely block transmission of UV radiation.

This means you can still get burnt if you spend a long time in the car next to a untinted side window when the UV is high. More commonly, people are burnt in cars with the windows down, where they can be exposed to high levels of UV radiation.

What is broad spectrum sunscreen ?

FDA meaning:The sunscreen can protect you from the sun’s harmful ultraviolet A (UVA) and ultraviolet B (UVB) rays.

Why you want broad spectrum sunscreen:

It can protect your skin from the sun’s UVA (aging) rays and UVB (burning) rays, which helps prevent:

• Skin cancer
• Early skin aging (premature age spots, wrinkles, and sagging skin)
• Sunburn

About Sunscreen SPF numbers

Another confusing thing about SPF is the number that follows it. This number tells you how much UVB light (the burning rays) a sunscreen can filter out.

To simplify things, you may want to think of the sun protection factor (SPF) as the “sunburn protection factor”.

The sun protection factor (SPF) relates to the amount of time it takes for redness to appear on the skin compared to when no product is used at all. The test is done in a laboratory.

For example, if it takes 10 minutes for unprotected skin to show redness, then an SPF30 sunscreen correctly applied, in theory, will take 30 times longer or 300 minutes to burn. However, it is hard to achieve this level of protection in real life – factors such as skin type, ultraviolet (UV) levels, swimming/drying and how much sunscreen you apply can affect the level of protection. That’s why we always recommend applying liberally every two hours or after swimming, sweating or towel drying. It is also important to apply 15 minutes beforehand before being exposed to UV.

To maximise the protective benefit of sunscreen, apply as directed and whenever possible in conjunction with other sun protection measures such as protective clothing, hats, and sunglasses. When UV levels are at their highest, the most effective protection is to seek shade.

Here’s what the science tells us about how much UVB light different SPF’s can filter out:

• SPF 15: 93% of the sun’s UVB rays
• SPF 30: 97% of the sun’s UVB rays
• SPF 50:  98% of the sun’s UVB rays
• SPF 100: 99% of the sun’s UVB rays.

The American Academy of Dermatology recommends using an SPF 30 or higher.

It’s important to know that no sunscreen can filter out 100% of the sun’s UVB rays. That’s why it’s important to also wear protective clothing and seek shade.

Can you can stay out longer in the sun when you are wearing SPF50+ than you can with SPF30+ ?

NO. No sunscreen is a suit of armor and sunscreen should never be used to extend the amount of time you spend in the sun.

Though it may sound like there is a big difference, SPF50+ only offers marginally better protection from UVB radiation, which causes sunburn and adds to skin cancer risk. SPF30+ sunscreens filter about 96.7% of UV radiation, SPF50+ sunscreens filter 98% of UV. Cancer Council recommends applying a sunscreen that is SPF30 or higher before heading outside, every two hours, after swimming, sweating, or towel drying.

Can you not use Sunscreen when using cosmetics with SPF ?

NO. Unless cosmetics are labelled with an SPF 30 or higher rating, you should wear additional sunscreen under your makeup if you’re going to be in the sun for an extended period.

Foundations and moisturizers that contain sunscreen are fine when outside for short periods, such as a quick trip to the shops at lunchtime. For longer periods of time in the sun, use a separate sunscreen and reapply it every two hours – not just once in the morning. Be aware that most cosmetic products offer either no protection or protection that is much lower than the recommended SPF30.

What is waterproof sunscreen ?

There’s actually no such thing as waterproof sunscreen. Sweat and water wash sunscreen from our skin, so the FDA no longer allows manufacturers to claim that a sunscreen is waterproof. Some sunscreens are water resistant.

What is water resistant sunscreen ?

FDA meaning: How long (either 40 or 80 minutes) the sunscreen will stay on wet skin. The sunscreen must undergo testing before it earns the water resistant designation.

Water resistant:

The sunscreen stays effective for 40 minutes in the water. At that time, you’ll need to reapply.

Very water resistant:

The sunscreen stays effective for 80 minutes in the water. Yes, after 80 minutes, you’ll need to reapply.

Even if your skin remains dry while using a water resistant sunscreen, you’ll need to reapply the sunscreen every 2 hours.

Why reapply sunscreen ?

Once applied, sunscreen only lasts so long on our skin. The sun’s rays break down some sunscreens. Others clump and lose their effectiveness.

To continue protecting our skin from the sun when outdoors, we must reapply sunscreen:

• Every 2 hours
• After toweling off
• When sweating*
• After being in water*

*When using water resistant sunscreen, you’ll need to reapply every 40 to 80 minutes.

The key points are these:

• Wearing sunscreen is an important tool in the fight against melanoma. Research has shown that daily sunscreen use can cut the incidence of melanoma in half.
• The second is that although sunscreen is a critical tool in the fight against skin cancer, it cannot completely ward off the sun’s harmful UV rays. In order to best reduce your risk of skin cancer, it is equally important to seek shade and wear protective clothing in addition to applying sunscreen to all exposed skin.
• For maximum protection, everyone should generously apply a water-resistant, broad-spectrum sunscreen with an SPF of 30 or higher.
• A tan is a sign that your skin has been injured. Whether you’re exposed to the sun’s ultraviolet (UV) rays or visit an indoor tanning salon, every time you tan, your skin is damaged. As this damage builds, you speed up the aging of your skin and increase your risk for all types of skin cancer, including melanoma, the deadliest form of skin cancer.
• Avoid the sun during peak hours. Generally, this is between 10 a.m. and 4 p.m. — regardless of season. These are prime hours for exposure to skin-damaging ultraviolet (UV) radiation from the sun, even on overcast days.
• Unprotected sun exposure is the most preventable risk factor for skin cancer.
• Scientific evidence supports the benefits of using sunscreen to minimize short-term and long-term damage to the skin from the sun’s rays. Preventing skin cancer and sunburn outweigh any unproven claims of toxicity or human health hazard from ingredients in sunscreens.

However, a study the Centers for Disease Control and Prevention ⁹, appeared in the Journal of the American Academy of Dermatology found that the majority of Americans are not using sunscreen regularly to protect their skin from damage caused by the sun’s ultraviolet (UV) rays, according to a new survey. Only about 30 percent of women and less than 15 percent of men regularly use sunscreen on both the face and other exposed areas of skin, the survey suggested ⁹. Women may be more likely to use sunscreen on the face because of the anti-aging benefits, or because many cosmetic products contain sunscreen. However, it is important to protect your whole body from the sun, not just your face. Men may view sunscreen as “nonmasculine, messy, or inconvenient,” the authors wrote, noting that sunscreen advertisements tend to target women more than men. The study also revealed a consistent relationship between sunscreen use and household income. For both men and women in the study, sunscreen use was significantly lower among those with lower household incomes.

Current estimates are that one in five Americans will develop skin cancer in their lifetime ¹⁰, ¹¹. Melanoma, the deadliest form of skin cancer, is now the most common form of cancer for young adults 25-29 years old, and the second most common form of cancer for adolescents and young adults 15-29 years old. In addition, Caucasians and men over 50 years of age are at a higher risk of developing melanoma than the general population.

How to choose sunscreen

Brand matters less than how you use the product. Look for water-resistant, broad-spectrum coverage with an SPF of at least 30. Check the sunscreen’s expiration date. Also, find a sunscreen you like. If you don’t care for the sunscreen, you’re not as likely to use it consistently.

When choosing sunscreen, be sure to read the label before you buy. The US Food and Drug Administration regulations require the labels to follow certain guidelines ¹².

• Choose a sunscreen with “broad spectrum” protection. Sunscreens with this label protect against both UVA and UVB rays. All sunscreen products protect against UVB rays, which are the main cause of sunburn and skin cancers. But UVA rays also contribute to skin cancer and premature aging. Only products that pass a test can be labeled “broad spectrum.” Products that aren’t broad spectrum must carry a warning that they only protect against sunburn, not skin cancer or skin aging.

• Make sure your sunscreen has a sun protection factor (SPF) 30 or higher. The SPF number is the level of protection the sunscreen provides against UVB rays. Higher SPF numbers do mean more protection, but the higher you go, the smaller the difference becomes. SPF 15 sunscreens filter out about 93% of UVB rays, while SPF 30 sunscreens filter out about 97%, SPF 50 sunscreens about 98%, and SPF 100 about 99%. No sunscreen protects you completely.

• The FDA requires any sunscreen with SPF below 15 to carry a warning that it only protects against sunburn, not skin cancer or skin aging.
  “Water resistant” does not mean “waterproof.” No sunscreens are waterproof or “sweatproof,” and manufacturers are not allowed to claim that they are. If a product’s front label makes claims of being water resistant, it must specify whether it lasts for 40 minutes or 80 minutes while swimming or sweating. For best results, reapply sunscreen at least every 2 hours and even more often if you are swimming or sweating. Sunscreen usually rubs off when you towel yourself dry, so you will need to put more on.

• There’s no such thing as waterproof sunscreen ². People should also be aware that no sunscreens are “waterproof.” All sunscreens eventually wash off. Sunscreens labeled “water resistant” are required to be tested according to the required SPF test procedure. The labels are required to state whether the sunscreen remains effective for 40 minutes or 80 minutes when swimming or sweating, and all sunscreens must provide directions on when to reapply.

Consider the pros and cons for different applications, including:

• Creams. If you have dry skin, you might prefer a cream — especially for your face.
• Lotions. Lotions are often preferred for application on large areas. Lotions tend to be thinner and less greasy than creams.
• Gel. Gels work best in hairy areas, such as the scalp and a man’s chest.
• Stick. Sticks are useful when applying sunscreen around the eyes.
• Spray. Parents often prefer sprays because they’re easy to apply on children. Because it’s difficult to know how well you’re applying spray, apply a generous and even coating. Or consider using a gel or cream first and using a spray to reapply sunscreen later. Also, avoid inhaling the product. Don’t apply spray near heat, an open flame or while smoking.

What about the reported health risks associated with some ingredients found in sunscreens ?

The U.S. Food and Drug Administration (FDA) regulates sunscreens. Before an ingredient can be used in sunscreen, the ingredient must be approved by the FDA for this use. Here is the real science behind some of the ingredients now in the news.

Oxybenzone: This is one of the few ingredients in sunscreen that effectively protects our skin from harmful UVA and UVB rays. Here are the facts about oxybenzone ¹³:

• Approved by the FDA in 1978.
• No data shows that oxybenzone causes hormonal problems in humans.
• No data shows that oxybenzone causes any significant health problems.
• FDA approved for use by people 6 months of age and older.

Retinyl palmitate: This ingredient helps protect our skin from premature aging. Here are the facts:

• No study shows that it increases the risk of skin cancer in humans.
• Retinyl palmitate is a form of vitamin A that is found naturally in the skin.
• One form of vitamin A, retinoids, has been used for decades to prevent skin cancer in people who have a high risk of developing skin cancers.

Is nanotechnology safe ?

Before nanotechnology could be used in sunscreens, considerable research was conducted. Sunscreens containing nanoparticle-size ingredients cannot get into the body when applied to healthy or sunburned skin. Your outermost layer of skin prevents nanoparticles from entering into the deeper layers of the skin.

In 2009, environmental activist organisation, Friends of the Earth (FOE), commenced a campaign raising concerns about the possible adverse effects of the nanoparticles used in some sunscreens. They suggested that micronising metal particles such as zinc oxide and titanium dioxide – useful ingredients of sunscreens seeking to protect against UVA and UVB radiation because they reflect the Ultraviolet (UV) radiation – may allow those ingredients to penetrate bodily organs and so increase cancer risk.

A study published in early 2014 exposed human immune cells (called macrophages) to zinc oxide nanoparticles to see how they would respond. The study showed that the human immune system effectively absorbed the nanoparticles and broke them down.

The study did not look at whether the particles are absorbed through the skin and into the bloodstream. So far, the current weight of evidence suggests that titanium dioxide and zinc oxide nanoparticles do not reach living skin cells; rather, they remain on the surface of the skin and in the outer layer of the skin that is composed primarily of dead cells.

Nanoparticles are used in sunscreens to prevent active ingredients from leaving a white residue on the skin. By doing this, you get better UV protection and more even coverage.

In circumstances of scientific uncertainty around public health problems, good quality reliable research is the best way to guide our decisions. Moreover, scientists continue to monitor research and welcome any new research that sheds more light on this topic.

A key concern is whether people reducing their use of sunscreen due to fear would result in more cases of skin cancer. If this is an (inadvertent) outcome of the Friends of the Earth campaign, it would be tragic and a major setback to cancer prevention efforts.

To protect your skin, dermatologists recommend using a sunscreen that offers:

• SPF 30 or greater.
• Broad-spectrum protection.
• Water resistance.

Studies prove that using sunscreen reduces the risk of developing skin cancer. Other things you can do to reduce your risk are to seek shade and wear clothing that protects your skin from the sun.

What’s the difference between a chemical sunscreen and physical sunscreen ?

Each of these protects your skin differently and contains different active ingredients. Here’s a summary of the basic differences:

A chemical sunscreen:

• Protects you by absorbing the sun’s rays
• May contain one or more of many possible active ingredients.
• UV absorbers use ingredients such as Oxybenzone, Octocrylene, 4-Methylbenzylidene camphor and Butyl methoxy dibenzoylmethane.including oxybenzone or avobenzene

A physical sunscreen:

• Protects you by deflecting the sun’s rays
• Contains the active ingredients titanium dioxide and/or zinc oxide

Some sunscreens use both types of active ingredients, so they contain one or more active ingredient found in physical sunscreen and chemical sunscreen.

What causes sunscreen reactions ?

Reactions to sunscreen are rare and can be a result of a sensitivity or allergy to any of the many ingredients used in these products ¹⁴. Some people may have a reaction to a fragrance, preservative, UV absorber or another component of the sunscreen.

Sensitivities to sunscreen are complex and can range from mild to severe. Reactions can be linked to a range of co-factors, including sunlight or other allergens, and can also be caused by or made more severe if sunscreen is used with some medications or other topical creams and lotions.

Some reactions occur soon after applying the sunscreen, while others (e.g. allergic reactions) can develop after a couple of days or even years of using the same product.

Reactions occur in a very low proportion of the population – fewer than 1% of all users – but while uncommon, can be upsetting for those affected.

As with all products, use of sunscreen should cease if an unusual reaction occurs. Individuals or families experiencing reactions should seek a referral to a dermatologist to understand what may have caused the reaction and gain advice on ingredients that should be avoided in the future.

• If you are concerned that you might have a reaction to a new sunscreen, apply some to a small area of skin on the inside of your forearm. If the skin does not react adversely, you should be able to use the sunscreen as directed without concern. This should be adequate assurance in most situations.

What are the different types of reactions ?

Contact dermatitis

The most common sunscreen reaction is called ‘contact dermatitis’ and occurs in people who have a sensitivity to an ingredient found in sunscreen or cosmetics with a sunscreen component. There are two types of contact dermatitis – irritant and allergic.

Irritant contact dermatitis

Irritant contact dermatitis is a reaction that can occur after applying sunscreen and is more common in people who have a history of eczema or sensitive skin. It causes an irritation in the area of the skin where the sunscreen was applied, and can appear as mild redness or as a stinging sensation (without any redness).

Allergic contact dermatitis

Allergic contact dermatitis is the less common type of contact dermatitis and occurs in people who have developed a sensitivity to an ingredient found in the sunscreen or cosmetics with SPF protection. This reaction is the result of an allergy to an ingredient, such as fragrances or preservatives, and can occur even if you have haven’t had a reaction to these ingredients or sunscreens in the past, as allergies can develop over time. An itchy, blistering rash occurs on skin where the product has been applied, and can sometimes also spread to other areas.

Photocontact dermatitis

A rarer type of sunscreen reaction is called ‘photocontact dermatitis’. This type of reaction usually occurs where the product has been applied to the body and exposed to sunlight. In some people, there is an interaction between a sunscreen ingredient and ultraviolet light which leads to a skin reaction. This is usually a result of an allergy to the active ingredients, but it can also be due to a reaction to the fragrances or preservatives in the product. The reaction may look like severe sunburn or eczema, and most commonly occurs on the face, arms, back of hands, chest and lower neck.

How you can avoid having a sunscreen reaction or allergy ?

As sunscreens contain multiple active ingredients, it can be difficult to determine whether you will have a reaction – and, if you do, what component of the sunscreen caused it. For this reason, Cancer Council recommends performing a patch test before applying any sunscreen, where a small amount of the product is applied on the inside of the forearm to check if the skin reacts, prior to applying it to the rest of the body. While the patch test will show whether the skin is sensitive to an ingredient in the sunscreen, it will not indicate an allergy, as this occurs after repeated use of the product.

If you have a known sunscreen allergy, the best way to avoid a problem is to not use any product containing the substances you are sensitive to.

Diagnosis of Contact dermatitis

Patch testing

Your doctor may be able to diagnose contact dermatitis and identify its cause by talking to you about your signs and symptoms, questioning you to uncover clues about the trigger substance, and examining your skin to note the pattern and intensity of your rash.

Your doctor may recommend a patch test to see if you’re allergic to something. This test can be useful if the cause of your rash isn’t apparent or if your rash recurs often.

During a patch test, small amounts of potential allergens are applied to adhesive patches, which are then placed on your skin. The patches remain on your skin for two to three days, during which time you’ll need to keep your back dry.

Skin patch testing can be helpful in determining if you’re allergic to a specific substance. Small amounts of different substances are placed on your skin under an adhesive coating. Your doctor then checks for a skin reaction under the patches and determines whether further testing is needed.

What happens during patch testing ?

If patch testing is recommended, the following will happen:

• Patches containing small amounts of substances to which you may be allergic will be applied to your skin, usually on your back.
• You keep the substances on your skin for a specific amount of time, usually 2 days.
• You return to your doctor’s office so that the doctor can check your skin for reactions.
• You may need to keep some patches on your skin for a longer time and see your doctor again in a few days.

To find out if the allergen is causing your rash, you will need to avoid that substance. For example, if the test shows that you have a nickel allergy, you may need to:

• Stop wearing jewelry and clothing (zippers, fasteners) that contains nickel.
• Cover your cell phone with a case to avoid touching the metal.
• Get a pair of eyeglasses made without nickel.

If your skin clears when you avoid the allergen, it is likely the cause of your rash.

Figure 1. Contact dermatitis – skin patch testing

Contact dermatitis treatment

Treatment is the same for both types of contact dermatitis.

Your doctor may prescribe medications. Examples include:

• Steroid creams or ointments. These topically applied creams or ointments help soothe the rash of contact dermatitis. A topical steroid may be applied one or two times a day for two to four weeks.
• Oral medications. In severe cases, your doctor may prescribe oral corticosteroids to reduce inflammation, antihistamines to relieve itching or antibiotics to fight a bacterial infection.

Avoid what is causing your rash. If avoiding the cause will be difficult, ask your dermatologist for help.

For example, if you are allergic to latex but must wear exam gloves, your dermatologist can recommend another type of glove that you can wear. If you must work outdoors where poison ivy grows, your dermatologist can recommend a protective barrier cream and clothing that can help.

Treat the rash. Once you can avoid the cause, your rash should clear. To relieve your symptoms, a dermatologist may recommend the following:

Mild reaction: Antihistamine pills, moisturizer, and a corticosteroid that you can apply to your skin. Most patients apply the medicine twice a day for 1 week and once a day for 1 to 2 weeks.

Oatmeal baths can relieve discomfort.

Do sunscreens contain endocrine disruptors ?

There is no evidence of any chemicals approved for use in sunscreens disrupting the endocrine system ¹⁵. The endocrine system consists of a number of glands, including the pituitary and thyroid glands, which secrete hormones into the body’s circulation to regulate a number of critical functions such as sleep, metabolism and reproduction. “Endocrine disruptors” describes man made chemicals that affect this system – disrupt activities in the estrogen, androgen, and thyroid hormone systems; exposure to them may result in hormone-related health problems such as obesity and infertility. American sunscreens are regulated by the U.S. Food and Drug Administration (FDA), a government agency that ensures manufacturers use only active ingredients and formulas that are safe and effective. This includes monitoring the latest scientific evidence and adjusting the list of approved ingredients accordingly. Online campaigners based in the US and Europe have expressed concerns that sunscreen may contain endocrine disrupting chemicals, such as oxybenzone and octinoxate. However the FDA reported that there was insufficient evidence to support the claim that chemicals in sunscreen interfere with the endocrine system in humans. Moreover, the endocrine disruption studies were based on the ingestion (swallowing) of the chemicals, rather than their application on the skin, which results in much lower absorption into the body. If some Americans wish to make a personal decision to avoid certain ingredients, there are a variety of sunscreens in the market to choose from. Approximately one in five Americans will be diagnosed with skin cancer by the age of 70. The majority of skin cancers in US are caused by exposure to UV radiation in sunlight. The Cancer Council recommends a combination of sun protection measures to prevent skin cancer. This includes seeking shade when UV levels are high, and wearing sun-protective clothing, sunscreen, a hat and sunglasses.

Do face creams/moisturisers containing sunscreen increase your risk of skin cancer ?

Face creams and moisturisers do not cause skin cancer. If you are going to be indoors for most of the day, with only incidental sun exposure, a cosmetic with SPF30+ is adequate to protect from sunburn, but, like sunscreen, will only be effective for two hours. If you are going to be outdoors in the sun, we recommend you use sunscreen rather than a moisturiser that contains SPF. Use a sunscreen that is SPF 30+, water-resistant and broad spectrum, which means it protects against both UVA and UVB. If you are going to wear sunscreen and moisturisers or cosmetics, it’s best to apply your sunscreen first – on dry, clean skin. This will allow the sunscreen to disperse effectively. Some people mistakenly believe an SPF20 moisturiser and an SPF10 foundation used together form a protection of SPF30. This is not true. You will only be protected to the level of the highest SPF product – in this case, SPF20. Sunscreens on the American market have been approved by the FDA as safe and effective.

Are chemical sunscreens safe to use ?

To minimise the risk of developing skin cancer, sun protection – including but not limited to the use of sunscreen – should be used when UV levels are 3 or above. In America, many people need to rely on sunscreen every day, often over large areas of their body, so it is vital that all sunscreens are safe, effective and good quality. The FDA regulates sunscreens ensuring that only approved ingredients, including chemicals, which have been assessed for quality and safety, are used in each product. Given there has been many rigorous scientific reviews, there is now very strong evidence that the list of commonly used active ingredients used in sunscreen do not pose a concern for human health. Some sunscreens may market themselves as organic or natural – these products often use physical blockers, such as zinc, to help protect against UV. Cancer Council recommends using an SPF30 or higher sunscreen that is broad spectrum, water resistant and FDA approved. As long as your sunscreen meets these requirements, what brand or ingredients you choose is up to you. To check if something is FDA approved, look for the reference to say that the product compiles with FDA. Be wary of products that aren’t FDA approved, aren’t actually a sunscreen or are homemade as these products won’t have been properly tested for effectiveness and may not provide proper sun protection. Sunscreen should not be used as the only line of defence against the sun, be sure to protect yourself in five ways to minimise the risk of skin cancer – slip on sun protective clothing, slop on SPF30+ or higher sunscreen, slap on a broad brim hat, seek shade and slide on sunglasses – when the UV is 3 or above. Those who are worried about sunscreens might choose to primarily rely on other forms of sun protection, including protective clothing.

Safe sunscreen ingredients

Here is a list of FDA approved sunscreen active ingredients ¹⁶:

• 2-ethylhexyl-4-phenylbenzophenone-2-carboxylic acid
• allantoin (with aminobenzoic acid)
• amiloxate (isoamyl p-methoxycinnamate)
• aminobenzoic acid (PABA)
• avobenzone
• bemotrizinol
• bisoctrizole
• bornelone (5-(3,3-dimethyl-2-norbornyliden)3-pentene-2-one)
• camphor
• cinoxate
• diethylhexyl butamido triazone
• digalloyl trioleate
• diolamine methoxycinnamate (diethanolamine methoxycinnamate)
• dioxybenzone
• dipropylene glycol salicylate
• drometrizole trisiloxane
• ecamsule
• ensulizole (phenylbenzimidazole sulfonic acid)
• enzacamene (4-methylbenzylidene camphor)
• ethyl 4-[bis(hydroxypropyl)] aminobenzoate (roxadimate)
• glyceryl aminobenzoate (lisadimate, glyceryl PABA)
• homosalate
• lawsone (w/ dihydroxyacetone)
• meradimate (menthyl anthranilate)
• octinoxate (octyl methoxycinnamate; ethylhexyl methoxycinnamate)
• octisalate (octyl salicylate; ethylhexyl salicylate)
• octyl triazone (ethylhexyl triazone)
• oxybenzone (benzophenone-3)
• padimate a (5 percent or higher)
• padimate a (up to 5 percent)
• red petrolatum
• sodium 3, 4-dimethylphenyl-glyoxylate
• sulisobenzone
• titanium dioxide
• trolamine salicylate
• zinc oxide
• zinc phenol sulfonate

What sunscreens can be used by people with sunscreen allergies ?

Sunscreen ingredients are similar across all brands, and sensitivities to sunscreen are complex, so simply changing the brand of sunscreen may not eliminate a reaction.

• A dermatologist is best placed to diagnose any reaction and help determine which ingredients should be avoided in the future.

Sunscreens that use ingredients that reflect UV away from the skin, such as zinc oxide and titanium dioxide, have not been reported to cause contact allergy. However some people do not like to use products with these ingredients as they tend to be heavier creams that do not absorb well into the skin. Others may like to try a sunscreen that has been specially formulated for sensitive skin. A dermatologist will be able to provide product advice.

What does the term “sensitive skin” mean on sunscreen ?

The FDA does not define this term for sunscreen.

In general, if a sunscreen label says “sensitive skin,” it often means that the sunscreen:

• Contains one or both of these active ingredients — titanium dioxide and zinc oxide
• Does NOT contain fragrance, oils, PABA (aminobenzoic acid), or active ingredients found in chemical sunscreens, which can irritate sensitive skin
• Is hypoallergenic.

What does the word “sports” mean on sunscreen ?

The FDA has NOT defined this term for sunscreen.

When you see the word “sports” on sunscreen, it usually means that the sunscreen will stay on wet skin for either 40 or 80 minutes. To be sure, check the label. You may also see the words “water resistant” or “very water resistant.”

To protect your skin, you’ll need to reapply sports sunscreen:

• When sweating (every 40 or 80 minutes)
• After toweling off
• After getting out of the water (or every 40 or 80 minutes)
• Every 2 hours (when not sweating or in the water)

Is it best to use sunscreen that contains insect repellant ?

If a sunscreen label says it contains insect repellant, the American Academy of Dermatology recommends looking for another sunscreen.

While both products provide important protection, the American Academy of Dermatology recommends buying separate products because:

• Sunscreen should be applied liberally and often
• Insect repellant should be applied sparingly and less often than sunscreen.

Are spray sunscreens safe ?

The FDA continues to evaluate the safety and effectiveness of spray sunscreens. The challenge in using sprays is that it is difficult to know if you have used enough sunscreen to cover all sun-exposed areas of the body, which may result in inadequate coverage. When using spray sunscreen, make sure to spray an adequate amount and rub it in to ensure even coverage.

To avoid inhaling spray sunscreen, never spray it around or near the face or mouth. Spraying the sunscreen into your hands and then applying it can help you avoid inhalation while also ensuring adequate coverage. When applying spray sunscreens on children, be aware of the direction of the wind to avoid inhalation.

What does the word “baby” mean on sunscreen ?

Like the word “sports,” the FDA has not defined this term for sunscreen.

In general, when you see the term “baby” on sunscreen, it means the sunscreen contains only these active ingredients:

• Titanium dioxide
• Zinc oxide

These ingredients are less likely to irritate a baby’s sensitive skin.

Should You Put Sunscreen on Infants ?

According to the U.S. Food and Drug Administration, applying sunscreen on infants aged 6 months and younger isn’t a good idea ¹⁷.

Chemicals used in sunscreen can harm newborns, instead babies and infants under 6 months of age should avoid the sun altogether. Young babies can’t regulate body temperature properly, making them especially prone to overheating and dehydration, the FDA says.

The FDA recommends:

• Keep infants out of the sun as much as possible.
• If infants do go outside, avoid the sun when ultraviolet rays are strongest, between the hours of 10 a.m. and 3 p.m.
• Create a canopy over baby’s carrier or stroller.
• Dress baby in lightweight, tight-weave long pants; a long-sleeve shirt and wide-brimmed hat.
• Watch baby carefully for signs of overheating and dehydration.
• Give baby breast milk or formula regularly.
• If baby develops a sunburn, get out of the sun immediately and apply a cold compress as soon as possible.

Children 6 months of age and older ¹⁸:

• Use a sunscreen that contains zinc oxide or titanium dioxide, which is most appropriate for the sensitive skin of infants and toddlers ¹⁹.
• Even when using sunscreen, keep children in the shade and dress them in clothing that will protect their skin from the sun, i.e., long-sleeved shirts, pants, and wide-brimmed hats.

How to apply and store sunscreen

Apply 30 minutes before you go outside. This allows the sunscreen (of SPF 15 or higher) to have enough time to provide the maximum benefit.
Use enough to cover your entire face and body (avoiding the eyes and mouth). An average-sized adult or child needs at least one ounce of sunscreen (about the amount it takes to fill a shot glass) to evenly cover the body from head to toe.

Frequently forgotten spots:

• Ears
• Nose
• Lips
• Back of neck
• Hands
• Tops of feet
• Along the hairline
• Areas of the head exposed by balding or thinning hair

Know your skin. Fair-skinned people are likely to absorb more solar energy than dark-skinned people under the same conditions.

Reapply at least every two hours, and more often if you’re swimming or sweating.

• Limit time in the sun, especially between the hours of 10 a.m. and 2 p.m., when the sun’s rays are most intense.
• Wear clothing to cover skin exposed to the sun, such as long-sleeved shirts, pants, sunglasses, and broad-brimmed hats.
• Use broad spectrum sunscreens with SPF values of 15 or higher regularly and as directed.
• Reapply sunscreen at least every two hours, and more often if you’re sweating or jumping in and out of the water.

Storing your sunscreen

To keep your sunscreen in good condition, the FDA recommends that sunscreen containers should not be exposed to direct sun. Protect the sunscreen by wrapping the containers in towels or keeping them in the shade. Sunscreen containers can also be kept in coolers while outside in the heat for long periods of time. This is why all sunscreen labels must say: “Protect the product in this container from excessive heat and direct sun.”

Can you still use the sunscreen you bought last summer, or do you need to purchase a new bottle each year? Does it lose its strength?

Dermatologists recommend using sunscreen every day when you are outside, not just during the summer. If you are using sunscreen every day and in the correct amount, a bottle should not last long. If you find a bottle of sunscreen that you have not used for some time, here are some guidelines you can follow:

• The FDA requires that all sunscreens retain their original strength for at least three years.
• Some sunscreens include an expiration date. If the expiration date has passed, throw out the sunscreen.
• If you buy a sunscreen that does not have an expiration date, write the date you bought the sunscreen on the bottle. That way, you’ll know when to throw it out.
• You also can look for visible signs that the sunscreen may no longer be good. Any obvious changes in the color or consistency of the product mean it’s time to purchase a new bottle.

Prevent skin cancer

Follow these tips to protect your skin from the damaging effects of sun exposure and reduce your risk of skin cancer:

• Apply broad-spectrum SPF 30 or higher sunscreen with water resistance. A sunscreen that offers the above helps to protect your skin from sunburn, early skin aging and skin cancer ²⁰. When you are going to be outside, even on cloudy days, apply sunscreen to all skin that will not be covered by clothing. Apply sunscreen to dry skin 15 minutes BEFORE going outdoors. Reapply approximately every two hours, or after swimming or sweating. Use a broad-spectrum, water-resistant sunscreen that protects the skin against both UVA and UVB rays and that has an SPF of at least 30. Learn how to apply sunscreen.

• Use one ounce of sunscreen, an amount that is about equal to the size of your palm – “1 ounce, enough to fill a shot glass”. Thoroughly rub the product into the skin. Don’t forget the top of your feet, your neck, ears, and the top of your head.

• Seek shade. Remember that the sun’s rays are strongest between 10 a.m. and 2 p.m. If your shadow is shorter than you are, seek shade.

• Protect your skin with clothing. When going outside wear a long‐sleeved shirt, pants, a wide‐brimmed hat and sunglasses.

• Use extra caution near water, sand or snow as they reflect and intensify the damaging rays of the sun, which can increase your chances of sunburn.

• Get vitamin D safely. Eat a healthy diet that includes foods naturally rich in vitamin D, or take vitamin D supplements. Many people can get the vitamin D they need from foods and/or vitamin supplements. This approach gives you the vitamin D you need without increasing your risk for skin cancer. Do not seek the sun. If you are concerned that you are not getting enough vitamin D, you should discuss your options for getting vitamin D with your doctor.

• If you want to look tan, consider using a self-tanning product, but continue to use sunscreen with it. Don’t use tanning beds. Just like the sun, UV light from tanning beds can cause wrinkling and age spots and can lead to skin cancer. The United States Department of Health & Human Services and the World Health Organization’s International Agency of Research on Cancer have declared UV radiation from the sun and artificial sources, such as tanning beds and sun lamps, as a known carcinogen (cancer-causing substance) ²¹.

• Check your skin for signs of skin cancer. Your birthday is a great time to check your birthday suit. Checking your skin and knowing your moles are key to detecting skin cancer in its earliest, most treatable stages.

If you spot anything changing, growing or bleeding, see your dermatologist.

How do you treat a sunburn ?

It’s important to begin treating a sunburn as soon as possible. In addition to stopping further UV exposure, dermatologists recommend treating a sunburn with:

• Cool baths to reduce the heat.
• Moisturizer to help ease the discomfort caused by dryness. As soon as you get out of the bathtub, gently pat yourself dry, but leave a little water on your skin. Then apply a moisturizer to trap the water in your skin.
• Hydrocortisone cream that you can buy without a prescription to help ease discomfort.
• Aspirin or ibuprofen. This can help reduce the swelling, redness and discomfort.
• Drinking extra water. A sunburn draws fluid to the skin surface and away from the rest of the body. Drinking extra water prevents dehydration.

Do not treat sunburns with “-caine” products (such as benzocaine).

If your skin blisters, you have a second-degree sunburn. Dermatologists recommend that you:

• Allow the blisters to heal untouched. Blisters form to help your skin heal and protect you from infection.
• If the blisters cover a large area, such as the entire back, or you have chills, a headache or a fever, seek immediate medical care.

With any sunburn, you should avoid the sun while your skin heals. Be sure to cover the sunburn every time you head outdoors.

Although it may seem like a temporary condition, sunburn—a result of skin receiving too much exposure from the sun’s ultraviolet (UV) rays—can cause long-lasting damage to the skin. This damage increases a person’s risk for getting skin cancer, making it critical to protect the skin from the sun.

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