Devin Pinaroc, FNP-C

Splashing in the pool, hiking favorite trails, and sipping iced tea at cookouts, summer is upon us. People enjoy outdoor activities during the summer months, and solar radiation exposure becomes a concern with the sun shining higher, hotter, and lingering longer into the evenings. 

Not only does sun exposure increase the risk of developing skin cancer, but it can also stimulate premature aging and creates several undesired skin changes, like fine and coarse wrinkles, mottled pigmentation, and loss of elasticity (Chien & Kang, 2021). Clinicians have a responsibility to educate patients about the harmful effects of solar radiation and how to protect themselves. 

 

Prevention Techniques

All patients should engage in prevention and protection from the sun, even those with highly pigmented skin. Sunscreen, sunglasses, hats, and other protective clothing should be utilized to aid in shade. Staying indoors or seeking shade during peak hours (10am-2pm) will help in avoiding the strongest UV irradiation (ADD, 2019). Sun protection should be practiced daily even during cloudy and rainy days. Water, snow, and concrete can reflect up to 90% of UV rays and should be especially observed during pool/lake days (Chien & Kang, 2021). 

 

Sunscreen Application  

While no sunscreen blocks 100% of UV rays, the American Academy of Dermatology (ADD) advises use of broad spectrum, water resistant sunscreen of at least SPF 30 or higher for effective protection from solar rays (2019). SPF efficacy studies used 2 mg/cm^2 and should be the goal dose of application (Narla & Lim, 2020). Reapplication should ultimately be directed by the bottle, but sunscreen will likely need to be reapplied every 2 hours or after sweating/swimming (Chien & Kang, 2021). While sunscreen spray preparation may be more convenient and quicker, caution patients about inability to measure the amount of sunscreen used and inconsistency of protection. Ensure patients apply an adequate amount by creating a thick layer on the skin surface and then lightly rub into the skin with any preparation. 

 

Vitamin  D Concerns

Many patients are concerned about sunscreen causing vitamin D deficiency. Clinicians should reassure patients that the usual amounts applied have not shown in research to affect Vitamin D levels (Chien & Kang, 2021). Vitamin D can easily be obtained from common fortified foods, and oral supplementation is cost-effective, easy, and well tolerated without an increased risk for skin cancer (ADD, 2019). 

 

Sunscreen Safety Questions

Within the last 5 years the FDA questioned the safety of several UVR filters used in sunscreens after reviewing percutaneous absorption safety data and found inadequate information to determine effect on health (Young & Rossi, 2017). Animal trials revealed high concentrations of some UVR filters from percutaneous absorption, resulting in endocrinological changes and deformities (Young & Rossi, 2017). While concerning, other research found reaching comparable levels in humans was highly unlikely and “unattainable” (Young & Rossi, 2017). Stll, the FDA is pushing manufacturers for more answers on how much is absorbed and effects of absorption to regulate safety (ADD, 2019).

The FDA continues to promote the use of sunscreen despite the lacking data and has proposed a 3 tiered safety grouping to classify sunscreen ingredients that specifies ingredients as safe, unsafe, and unknown.  (ADD, 2019). The FDA considers Titanium dioxide and Zinc oxide as “generally recognized as safe and effective” (GRASE), and para-aminobenzoic acid (PABA) and trolamine salicylate as not GRASE (Young & Rossi, 2017). There are 12 other UVR filters with insufficient safety data whose safety determination is yet to be known (Young & Rossi, 2017). 

Despite the unknowns regarding sunscreen safety and lack of uniformity among brands, any UV radiation has known damaging, potentially fatal, effects. Clinicians should encourage daily adequate sunscreen use coupled with other forms of sun protection. 

 

Want To Know More…

 

Ultraviolet radiation and the skin: Photobiology and sunscreen photoprotection

Sunscreen Application, Safety, and Sun Protection: The Evidence

Review of environmental effects of oxybenzone and other sunscreen active ingredients

 

References 

American Academy of Dermatology. (2019). Sunscreen FAQs. American Academy of Dermatology Association. https://www.aad.org/public/everyday-care/sun-protection/sunscreen-patients/sunscreen-faqs#:~:text=Is%20a%20high%2Dnumber%20SPF,of%20the%20sun’s%20UVB%20rays 

Chien, A. L., & Kang, S. (2021, April 1). Photoaging. UpToDate. https://www.uptodate.com/contents/photoaging?search=sun+daamage&source=search_result&selectedTitle=1~54&usage_type=default&display_rank=1#H16665025 

Narla, S., & Lim, H. W. (2020). Sunscreen: FDA regulation, and environmental and health impact. Photochemical & photobiological sciences : Official journal of the European Photochemistry Association and the European Society for Photobiology, 19(1), 66–70. https://doi.org/10.1039/c9pp00366e

Young, A. R., Claveau, J., & Rossi, A. B. (2017). Ultraviolet radiation and the skin: Photobiology and sunscreen photoprotection. Journal of the American Academy of Dermatology, 76(3S1), S100–S109. https://doi.org/10.1016/j.jaad.2016.09.038 https://www.jaad.org/article/S0190-9622(16)30880-5/fulltext#secsectitle0035