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Can you explain the news on studies related to sunscreen safety?
For those that did not catch recent news, another study came out in JAMA last week studying more chemical sunscreens on volunteers and examined how much sunscreen was absorbed into their bloodstream.
The study looked at 6 common chemical sunscreen ingredients:
What did the researchers find?
This study confirmed that after just one day of use these chemicals were found in the bloodstream of the volunteers tested in concentrations higher than deemed safe by the FDA. Although we do not yet know of any direct health risk that these chemicals can pose as a result of being in the bloodstream, the news is alarming. During a recent interview with Everyday Health, I stressed the importance of using safe sunscreens in light of the unknown risks associated with these chemical sunscreens.
Are there any health risks found with chemical sunscreens?
The next most common question we have been asked with regards to these studies is if chemical sunscreens are absorbed into our bloodstream, what happens next? How are they impacting our health?
The reason that these sunscreens are still widely available is simply that we do not have enough information to know if they actually have a negative impact on our health from absorption. We do know that they have a positive effect on our health by reducing the incidence of skin cancer. This is important to understand.
Let’s look at Oxybenzone…
Oxybenzone is added to products to absorb UVB and some UVA rays.
From a health perspective, did you know that :
- Oxybenzone was found in the urine of 97% of people tested
- Oxybenzone can react with chlorine in swimming pools to create potentially toxic compounds
- Oxybenzone may act as an endocrine disruptor
From an environmental perspective, did you know that :
- Oxybenzone has been found in waterways worldwide
- Oxybenzone has been shown to be toxic to coral and fish impacting marine life
“The most important thing to remember when it comes to sunscreens is that we do have choices. The sunscreens tested in this study were chemical sunscreen. As a Dermatologist and a mother I have always asked my patients to choose sunblock based on the ingredient label and not the brand. Look for active ingredients that you can pronounce- zinc and/or titanium - for most brands... Also remember that sunscreen is only one component of your sun safety plan. Hats, sunglasses and sunsafe clothing will limit your need for the use of sunscreen products.”
–Erum Ilyas, MD, Practical Dermatology
What does “endocrine disruption” mean?
We hear this term a lot when it comes to chemical sunscreens. It basically means that these sunscreens can look like estrogen, one of the main female hormones, to our bodies and have similar effects.
They can also block the effects of androgen, one of the main male hormones. Some chemical sunscreens can also affect our stress response system referred to as the HPA axis (hypothalamic-pituitary axis).
What does it mean for our environment that sunscreen is in our waterways?
There are still limited studies to truly understand what the implications of finding this sunscreen in urine and in waterways mean overall. However, we have so many options to choose from, it’s reasonable to consider looking for products that choose other ingredients.
It is always important to limit our exposure overall to these products by limiting the amount needed. Choose hats, sunglasses, and sun protective clothing to protect larger surface areas of your skin to minimize the need for sunscreen products.
What is the story behind ‘Reef-Safe Sunscreen’?
Key West banned sunscreens with ingredients that are thought to be harmful to coral reefs.
There are two sunscreens in particular that have been shown to potentially impact coral reef. These are oxybenzone and octinoxate. Both are considered chemical sunscreens.
Chemical sunscreens are products that absorb UV to lessen its effects on the skin. It was discovered that coral was dying in tourist locations. Some areas can have thousands of tourists in the water on a particular day. So much so that the surface of the water can sometimes appear to have an ‘oil slick’ from all of the products people use!
Oxybenzone in many sunscreen products was shown to potentially damage the DNA of coral. This made coral sterile and unable to reproduce. Coral bleaching was another issue noted.
The good news is that we have plenty of other products to choose from. There are currently 16 FDA-approved sunscreen ingredients. This leaves us with 14 other ingredients to choose from.
Why do companies even use chemical sunscreen in the first place?
Companies that use chemical sunscreens are only using them because they are far more cosmetically acceptable to use- they do not tend to leave that whitish residue on our skin. The goal is skin cancer prevention. These products can offer UV protection to potentially reduce the risk of skin cancer.
Which ingredients are considered safe in sunscreens?
The FDA proposed changes to sunscreen labeling that would deem certain ingredients as ‘GRASE’ or generally recognized as safe and effective. The two it would deem as GRASE are zinc and titanium. These are both physical sunblocks. These are also the two I tend to recommend using. The other sunscreen ingredients are currently considered safe to use however the FDA is requesting further information on safety.
What should I look for when I shop for sunscreen?
In general, the safest sunscreens are the physical sunblocks that contain either zinc or titanium. These block the sun while chemical sunscreens absorb the sun’s rays to diffuse its effects. I had my research team go to drugstores, discount department stores, and grocery stores near my main office in King of Prussia to determine all available types of sunscreen and their ingredients.
The goal of the study was to answer the basic question:
“If I recommend sunscreens that have only zinc or titanium in them, how easy is it for my patients to find these at their local stores?”
What did they find?
The answer: It is not easy at all! Out of over 300 varieties of sunscreen products found around King of Prussia alone, only 36 sunscreens using only zinc and/or titanium as their active ingredient with no chemical sunscreens added were available.
To find that only about 10% of sunscreens readily available on the shelves of our local stores had the ingredients I recommend was a real eye-opener in just how hard it is for our patients to navigate their sunscreen options.
Oxybenzone was found in 42% of the sunscreens found in local stores in our area by our research team during the summer of 2019.
Is there a list of sunscreens you would recommend?
To make things easier, I have listed below the readily available sunscreens in our local stores that use only zinc or titanium as the active ingredient. This list is not exhaustive but a good start! Always remember that the best way to protect your skin and minimize your exposure to products is through sun- protective clothing as this will cover a much larger surface area, minimizing the need for sunscreen products, and will work throughout the day.
Aveeno Baby Continuous Protection Sensitive Skin SPF 50
Babo Botanicals Clear for Babies Fragrance Free Zinc Sunscreen Lotion - SPF 30
Badger Clear Zinc Sunscreen Cream - SPF 35
Cerave Hydrating Sunscreen Broad Spectrum SPF 30 Face
Cerave Hydrating Sunscreen Broad Spectrum SPF 50
CVS Health Broad Spectrum Lotion SPF 70
CVS Health Baby Pure and Gentle Broad Spectrum Sunscreen Stick
Neutrogena Sheer Zinc Face Dry Touch Sunscreen Broad Spectrum SPF 50
Up & Up Kids' Mineral Formula Sunscreen Lotion - SPF 50
Walgreens Brand 50 Baby Lotion
Wegmans Baby Pure & Gentle Broad Spectrum SPF50 Sunscreen Stick
Wegmans Mineral Broad Spectrum SPF 50 Sunscreen Stick
** this list is based solely on products with physical sunscreen ingredients, Zinc and/or Titanium
Related: Dr. Erum Ilyas discusses Spray Sunscreens with Oprah Daily
What should I look for in a spray sunscreen?
Spray sunscreens are popular because of their ease of application. Simply spraying sunscreen on with the minimal need to rub it in can facilitate the process of wearing sunscreen. Spray sunscreen can come in two varieties: aerosol spray or pump sprays.
Aerosol sprays for sunscreen offer the benefit of even application which means even coverage. Spray sunscreens can have the same protection as offered by traditional lotion or cream-based sunscreens if they are applied correctly. Applying until the skin “glistens” can be the visual cue to know when enough is applied. Due to the aerosol, the product can be lost to the environment or accidentally inhaled so try to position the nozzle closer to the skin - within 6 inches or less- to avoid losing the product. Be mindful of windy days or wind by the ocean or shore when applied as much of the product may be lost to the air if care is not taken to avoid this. Avoid spraying on the face directly, instead apply to the hands and rub in if necessary. And remember that aerosols are flammable and do not apply near an open flame.
Key tips for applying aerosol-based sunscreens
Pump sunscreens can offer some benefits in ease of application but do require rubbing in the product. They work by drawing the sunscreen from the bottle into a small chamber then forcing it through a small nozzle when the pump is activated. This leaves clumps of sunscreen that must be rubbed in evenly to be effective. The process is so similar to regular sunscreen applications that it is difficult to say if there is a practical advantage to using these. However, pump sunscreen has a higher chance of being a mineral-based sunscreen as the nozzle is larger and less likely to clog.
The real challenge with most spray sunscreens is that it is not common to find mineral sunscreen-based sunscreen aerosol sprays. Mineral sunscreens, which include zinc and titanium, are large particles and difficult to incorporate into an aerosol-based spray. They tend to clog the nozzle so most companies avoid using them. This means that there is a better chance than not that if you are using a spray sunscreen then chances are it is a chemical-based sunscreen.
Do you have recommendations for spray sunscreens that work best for the face?
Spray sunscreens meant for the face tend to spray mists. Even if a spray sunscreen states it is for facial use, the directions on most spray sunscreens bottles I have read do not recommend spraying directly on the face. In other words, even if your sunscreen says it is a spray sunscreen for the face, this does not mean you can spray directly on the face. Most directions tend to recommend spraying the mist into your hands and then rubbing it onto the face.
Neutrogena Ultra Sheer Face Mist Sunscreen and Coola Classic Face Mist sunscreen are good recommendations for the face.
Do you have recommendations for spray sunscreens that work best for the body?
One of the most loved sunscreen brands is EltaMD UV Aero Broad Spectrum SPF. It applies easily and is cosmetically elegant to apply. For a mineral sunscreen option for the body, I recommend SunBum Mineral SPF 50 Sunscreen Spray and Bare Republic Mineral Sunscreen Spray.
Do you have recommendations for spray sunscreens that work best for the sensitive skin?
The Baby Bum Mineral Sunscreen spray for sensitive skin is mineral-based and fragrance-free making it a reasonable choice for sensitive skin.
Do you have recommendations for spray sunscreens that work best for the swimming?
Water-resistant sunscreens tend to last in the water, remaining effective for 40 to 80 minutes depending on the label designation. Sunscreens are not considered “waterproof” as all will eventually wear off if in the water long enough. I tend to favor La Roche Posay Anthelios lotion spray sunscreen for swimming.
What do you think is better: spray or lotion/rub in sunscreen?
In terms of SPF, the SPF designated on the label can be trusted as this is based on testing and an FDA approval process to verify the product provides the protection indicated.
In terms of ease of application and compliance with sunscreen application, I find that most of my patients favor the use of sunscreen sprays.
However, I tend to favor mineral sunscreen products over chemical sunscreen ingredients. This makes this question a true challenge!
Since it is very difficult to find sunscreen sprays that are exclusively mineral sunscreens and not just “mineral based” (in other words, some mineral ingredients but still include chemical sunscreen ingredients), lotion sunscreens do tend to have a wider range of options to choose from. That being said, after my research interns did a large review of commercially available sunscreens found at our local department stores, drugs stores, grocery stores, and discount stores, once I discovered the SunBum Mineral SPF 50 Sunscreen Spray and Bare Republic Mineral Sunscreen Spray, I was able to reconcile the benefit of a spray with the need for mineral sunscreens effectively.