GRAND CAYMAN – Are your patients noncompliant about sun protection? Do they want to use photoprotection but aren’t sure what is best for them? Perhaps they are confused by the multitude of sunscreen manufacturer’s claims or even some claims by consumer and environmental advocates.
Patients are often confused by how much sun protection factor they actually need and marketing hype often makes things worse, according to Dr. Vincent DeLeoof the department of dermatology at the University of Southern California, Los Angeles. “The use of the words ‘babies, natural, hypoallergenic, or organic’ all mean absolutely nothing when it comes to an SPF’s actual efficacy,” he said at the meeting provided by Global Academy of Medical Education.
The degree of confusion surrounding these products was illustrated in a survey of 114 patients at Chicago dermatology clinic. Of those surveyed, 80% said they purchased a sunscreen product to prevent sunburn (75%) and to prevent skin cancer (66%); having the highest SPF, a sensitive skin formulation, or being water resistant were reasons the products were chosen. But 62% could not identify information explaining its role in cancer prevention, and 77% could not identify how well the product would prevent sunburn. And nearly all participants were unsure how products prevented photoaging (JAMA Dermatol. 2015 Sep;151:1028-30).
Adding to the confusion, Dr. DeLeo said, are warnings issued by some consumer advocacy groups about sunscreens that are not based on actual clinical or animal studies, but from data simulation. For example, he said there are no data to substantiate claims from such groups that oxybenzone has estrogenic effects in humans.
Consumer advocacy groups who say that sunscreens interfere with vitamin D levels may have a point, however, Dr. DeLeo noted, adding that it is time public health officials look into this issue, particularly with regards to revising recommended levels of vitamin D upward for the elderly, dark-skinned persons, and breastfed babies.
Although the Food and Drug Administration does not directly test sunscreens, it issued a 2014 guidance to manufacturers regarding which ingredients can be used and at what concentrations. Based on the FDA’s 2011 final rule on Labeling and Effectiveness Testing of OTC sunscreen products, the highest SPF currently allowed is “50+” without specifying actual numbers above 50, although Dr. DeLeo said this could be revised if industry is able to demonstrate efficacy at higher SPF values.
In an interview, however, he said that this is not likely to happen anytime soon. Citing a recent study of 40 commercially available sunscreens, including top brand names, professional skincare lines, and eponymously labeled products sold at drug store chains, more than half failed to reach the SPF level they purported to have and nine did not provide adequate broad spectrum protection.
“The takeaway is that the FDA is probably correct. Sunscreens should not be labeled higher than 50,” he said.
With the Sunscreen Innovation Act passed in 2014, the FDA is now evaluating data on new sunscreen agents that have proven effective overseas. So far, these agents have not been approved, Dr. DeLeo said in the interview.
With regards to the currently available products, “what patients really need to know is pretty simple,” Dr. DeLeo said during his presentation. An important point is that sunscreens – which work by forming a film on the stratum corneum, preventing the penetration of radiation – are effective only if used properly, he said.
A concept that is helpful for patients to understand is that while an SPF 30 product allows a person to stay in the sun twice as long as an SPF 15 product, with the same amount of protection from burning, it does not block twice as many burn rays, he noted. “When you combine them, it’s not additive, it dilutes” he said. For example, if an SPF 10 product is mixed with an SPF 20 product, the SPF is 15.
According to Dr. DeLeo, other important messages about sunscreen for patients are as follows:
• Use SPF 30 or higher.
• Apply 20-30 minutes before exposure to give the product a chance to create an effective barrier on the skin; and reapply every 2 hours or after going in the water or sweating outside.
• Use lotions or sprays, based on patient preference.
• For pregnant women or parents who don’t want to use chemical sunscreens, inorganic physical screens can be considered, although they will likely be less effective.
• Babies younger than 6 months of age can tolerate very small amounts of sunscreens.
Still, Dr. DeLeo said that the most foolproof form of photoprotection is to stay out of the sun, particularly between 10 a.m. and 4 p.m.