Sunscreen

People enjoy the sunshine at Kokomo Beach's lazy river, which was busy with people lounging on inner tubes on a summer day Tuesday, June 25, 2019.

Now that summer has arrived, outdoor activities have officially been kicked into high gear for millions of people across the country, which means lathering up with sunscreen.

However, according to data provided earlier this year by the U.S. Food and Drug Administration, there are certain chemicals in sunscreens that are being absorbed into the human body at rates high enough to cause concern about possible toxicity in the bloodstream.

FDA’s study and proposal

According to its website, the FDA has been regulating sunscreen to ensure safety and effectiveness standards since the 1970s.

In February, the agency took significant action when it released a proposal aimed at addressing sunscreen ingredient safety, dosage forms, the sun protection factor (SPF) and broad-spectrum requirements.

The proposal was aimed specifically at non-prescription and over-the-counter chemical sunscreens, the agency noted. The FDA also proposed new updates on labels of sunscreen products, making it easier for consumers to understand exactly what they are putting on their bodies.

During the study — which appeared last month in the Journal of the American Medical Association — 24 adults applied either a sunscreen spray, lotion or cream to their bodies four times a day for four consecutive days, with each person covering three-quarters of his or her body during each application.

Researchers then drew 30 blood samples from each participant over the course of a week to determine whether the chemicals found in sunscreens really do absorb into a person’s skin.

The result was that levels of such chemical sunscreen ingredients as oxybenzone, avobenzone, octocrylene and ecamsule did increase in a person’s bloodstream after sunscreen use, the agency said. Researchers said further testing is needed to determine what levels of absorption are considered safe and if an increase in those chemical levels also increase the risk for birth defects, cancer or other medical issues.

Another byproduct of the study is that the FDA is proposing to raise the maximum proposed labeled SPF from 50+ to 60+, and it’s also requiring any sunscreen labeled SPF 15 or higher to be broad spectrum — which protects the body from both the UVA and UVB rays of the sun. The agency is also urging sunscreen manufacturers to put new alphabetical labeling on their products, along with requiring sunscreens with SPF below 15 to include the words “See Skin Cancer/Skin Aging alert” on the front panel.

According to the FDA, sunscreen manufacturers have been given a November 2019 deadline to comply with the new labeling requirements.

Where does that lead consumers?

While the new FDA findings and proposal can be confusing for consumers, Dr. Melanie Kingsley, director of Cosmetic Dermatology and Laser Surgery at IU Health, said she hopes people won’t become too concerned with the results that they don't use sun protection at all.

“I think that overall the question is are these chemicals leading to cancer?” she said. “People are reading it [FDA’s findings] and thinking, ‘Wait, if I wear these types of sunscreen, it’s going to cause cancer,’ and that’s not true. It’s more important to wear sunscreen than not because you’re going to get skin cancer and have sun damage [if you forego sunscreen].”

Kingsley also said that she believes the heightened education when it comes to overall sunscreen use is possibly what led to the study in the first place, noting that sun protection has become a regular in most people’s lives. She added that it’s important for people to understand what’s going on their skin or in their bodies.

Community Howard Regional Health radiation oncologist Dr. Tracy Price agreed with Kingsley’s interpretation of the FDA study, saying that she hopes the new labeling will be more user-friendly and informative.

And like Kingsley, Price also said that she hopes the FDA’s results won’t deter people away from putting on sunscreen altogether.

“You don’t want the benefits [of wearing sunscreen] to be overshadowed,” she said. “Having some sunscreen trumps not using it at all.”

Risky behavior

The consequences of not wearing any or not wearing enough adequate sunscreen are high, both Kingsley and Price said. In fact, they can even be deadly.

According to the American Academy of Dermatology, skin cancer is the most commonly diagnosed cancer in the country, with an estimated 9,500 people diagnosed every year. Those same statistics also show that around 20% of Americans will be diagnosed with skin cancer sometime in their lifetimes.

And it’s also one of the most preventable forms of cancer, the doctors said.

“Think about the number of hours that you spend on a normal basis every day of the year outside,” Kingsley said. “If you don’t have your sunscreen, that cumulative damage that adds up from that daily exposure that most people don’t even think about is quite significant.”

Kingsley also noted that sun damage doesn’t just appear overnight either, she said, but it’s the result of DNA damage over time.

“A sunburn is the worst thing,” she said. “A sunburn is such an intense shock to your skin and cells. And the DNA damage over time, even though you don’t see it, that’s when if you have moles, those moles might turn into a melanoma because of that exposure and the changes in the DNA.

"So starting at a young age, you need to be good about sun protection, not only because of skin cancer, but because of age wrinkles and sun spots too.”

And for someone that tends to see the worst case scenario when it comes to skin damage, Price said it’s often risky behavior that leads patients into her office.

“I think in this generation now, we’re seeing a lot of our baby boomers where sunscreens and sun protection wasn’t generally reinforced,” she said. “You think about those farmers in the field years ago in the blistering heat, and they probably didn’t have any protection. The general rule is that cancers can often take 10 to 20 years to develop. So outside of prevention, we also talk about early detection.”

Price even said melanoma — the deadliest form of skin cancer — can be cured if caught early enough.

But it all comes down to sun protection, the doctors said, something that even FDA researchers agree with when it comes to skin care.

Protecting your skin

Because your skin is exposed to sun on even a cloudy or wintery day, Kingsley and Price both said it’s important to wear at least SPF 30 sunscreen on a daily basis if you’re going to be outside.

Kingsley said she also encourages her patients to use physical/mineral sunscreens — containing zinc oxide and titanium dioxide — as opposed to chemical ones because the physical sunblock bounces the sun’s rays off of the skin as opposed to absorbing the chemicals as the FDA study concluded.

As far as types of sunscreen, Kingsley also noted that she urges people to use creams over sprays, at least for the first coat of sunscreen. When you reapply, she said, that’s when you can opt for the spray.

“The creams are going to be the best because they’re going to be the thickest, and you can definitely rub them in well,” she said. “I like them, especially if you’re using a zinc cream, because you can see where you’ve gone because it leaves behind a white residue. With the spray, the wind might get it, you might miss a spot and you still have to rub in the sprays anyway.”

Make sure to also focus on one body part at a time, Kingsley said, while remembering to reapply the sunscreen around every 90 minutes to two hours, regardless of what it states on the label.

Along with proper sunscreen, Kingsley said there are other ways you can protect your skin from the sun this summer too, such as wearing clothing with UV protection already built into them, wearing hats and just simply limiting your exposure to the sun’s damaging rays.

“I don’t want people to not enjoy the sun,” she said. “It’s great for your mood, and it is good in small amounts to get a little sun on your skin and have your vitamin D, but try your best to not get sunburned or super tan either. That’s a sign of DNA damage. Down the road, that sun overexposure from today, that just might turn into skin cancer 20 years from now.”