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Sunscreen Use :
Making sense of sunscreen and tanning products

September 2008 – Vol. 12, No. 9

Editors: Janet M. Pollard, MPH; and Carol A. Rice, Ph.D., R.N.

The skin is the largest and most visible organ of the entire human body and is vital for protecting and regulating the body.¹ Skin has many functions:

• It controls and regulates body temperature.
• It protects against injury.
• It prevents infection as the first line of defense against the possible invasion of bacteria and other germs.^2,3

Your skin is more than a simple wrapping or covering; it is a complex organ that can become susceptible to disease. Skin is a window to the body’s internal world and can help doctors and dermatologists diagnose and treat medical problems related to it.²

Unfortunately, our societal image of healthy skin is often problematic…leaving this vital organ under-protected.

• Some believe that getting a “base tan” (getting some sun before expected, prolonged sun exposure) can prevent damaging effects.⁴
• Others believe that the sun protection factor (SPF) listed on sunscreen products allows them to stay out in the sun even longer than they might have planned.^5,6
• Individuals who have darker colored skin or who tan easily often feel sunscreen is unnecessary.

Skin is an organ that needs to be kept healthy from both the inside and the outside. While drinking water is essential for keeping skin hydrated,⁷ protecting skin from the sun’s harmful ultraviolet rays is essential in the prevention of:

• premature aging (PDF) effects and other skin damage,
• cataracts (PDF) and other eye problems,
• immune suppression (PDF), and
• skin cancer (PDF).

Ultraviolet Radiation: UVB & UVA

It is important to understand how two types of ultraviolet (UV) light rays from the sun affect our bodies:

• Ultraviolet B (UVB) rays are the short wavelength bands of light that affect the outer layer of skin and are responsible for sunburning (PDF) of the skin.
• Ultraviolet A (UVA) rays are long wavelength bands of light that penetrate more deeply and can weaken the skin’s inner connective tissue. While UVA rays are less likely to cause burning, they are more likely to contribute to skin cancer and immune system damage.⁸

Tanning beds or other indoor tanning devices are not a safe alternative to natural sunlight. They emit ultraviolet rays, which can result in the same harmful effects as natural sunlight. Although most newer indoor tanning devices no longer emit UVB, they do emit UVA,⁸ sometimes at levels 10–15 percent higher than that of natural sunlight.⁹ For more on tanning beds, see Let’s Talk about Tanning (PowerPoint).

UV Index

When you are planning to be outdoors, it can be helpful to look at the UV index to decide when you will have the least exposure to damaging UV rays. The UV Index was developed by the National Weather Service and the Environmental Protection Agency. It provides a forecast of the expected risk of overexposure to UV rays and indicates the degree of caution you should take when working, playing, or exercising outdoors.

The UV Index predicts exposure levels on a 0–10+ scale, where 0 indicates a low risk of overexposure and 10+ means a very high risk of overexposure. Calculated on a next-day basis for dozens of cities across the U.S., the UV Index takes into account clouds and other local conditions that affect the amount of UV radiation reaching the ground.¹⁰ Take special care to protect yourself and your family from the sun’s UV rays when the UV index predicts exposure levels of 5–10+.¹¹ To see the UV Index for your area, go to one of the following National Weather Service sites, or contact your local weather service: http:// www.cpc.ncep.noaa.gov/products/ stratosphere/uv_index/uv_current.shtml or http://iwin.nws.noaa.gov/ iwin/us/ultraviolet.html.

Protecting Your Skin with Sunscreen: Preventing the sun’s harmful effects

One of the most important things you can do for your skin is to wear sunscreen.⁷ Everyone, regardless of skin type or color, needs to protect their skin.² Even if your skin does not burn from the sun’s rays, your skin is still damaged by ultraviolet radiation exposure. And even on cloudy days, 80 percent of the sun’s ultraviolet rays pass through the clouds.⁵ Damage from sun exposure is cumulative throughout your life.¹ That means you won’t see the effects of sun damage immediately—it builds up over time. Sunburn may not show up for a full 24 hours after sun exposure,¹² while other signs of skin damage may not appear for years. “Skin damage from sunlight builds up with continued exposure, whether sunburn occurs or not.”¹³ Note: Some medications (PDF) make the skin more sensitive to the sun’s rays, so check the packaging and talk with your doctor about avoiding too much sun exposure. Getting a little sun is important for vitamin D (PDF) absorption, but overdoing it can lead to skin damage. Whether young or old, sunscreen is essential for sun-damage prevention. “If you’re an adult, it’s not too late to smooth on sunscreen and don a wide-brimmed hat. You really do need to protect yourself,”⁴ as well as your children. In fact, “although nothing can completely undo sun damage, the skin sometimes can repair itself.”¹⁴ “Sunscreens used on a regular basis actually allow some repair of damaged skin.”¹²

Sunscreen Application: Who, when, and how much

If you plan to spend even 20 minutes outdoors on any given day, you should apply sunscreen.⁵ Sunscreen should always be applied to dry skin 15–30 minutes before going outdoors¹² to allow it to absorb into the skin. Note: Sunless tanning products (PDF) often do not contain sunscreen, but you can purchase makeup with sunscreening ingredients; just make sure they have an SPF of 15 or higher.

When you’re done applying your own sunscreen, apply it on your kids. Children’s skin is delicate and needs protection, and they need time outdoors being active.⁴ You don’t have to keep your kids indoors, but you do need to apply sunscreen and try to keep them out of the sun during peak UV exposure hours (10 a.m. to 4 p.m.) when possible. Always be careful not to get sunscreen into the eyes during application, as this can cause irritation. The only exception to wearing sunscreen is for children under 6 months of age. Do not use sunscreen on children under 6 months of age. Sunscreen can irritate an infant’s skin.¹⁵ When outdoors, try to keep children under 6 months of age in the shade, out of direct sunlight. Place them in light-weight, long sleeve shirts and pants to cover their skin, while avoiding overheating. Cover their heads with a wide-brimmed hat, and use infant sunglasses with 99–100 percent UV protection because an infant’s developing eyes are particularly vulnerable to sunlight.¹⁵

Sunscreen Application: How much? How Often?

One of the biggest mistakes we make when it comes to sunscreen use is that we don’t use enough. To get the maximum protection from sunscreen, one ounce—one large handful or enough to fill a shot glass—is the amount needed to properly cover the exposed areas of the body.^12,15 Use sunscreen liberally, uniformly, and thickly to cover all exposed areas.¹⁶ Pay special attention to covering the face, ears, neck, etc. so as not to miss a spot. A missed area can mean a patchy area of painful sunburn. Also, be sure to use a lip balm with sunscreen SPF 15 or higher to avoid damage to the lips.¹² Another crucial step in correct sunscreen use is reapplication. Sunscreen should be reapplied at least every 2 hours. If activities involve water or heavy perspiration, a water-resistant sunscreen is recommended. These sunscreens stay on the skin longer, even if they get wet.^1,17 In testing procedures, “water-resistant” sunscreen retains its SPF after 40 minutes of sweating/perspiring or water activity; “very water-resistant” sunscreen retains its SPF after 80 minutes (1½ hours) of sweating/perspiring or water activity.¹⁷ You will still need to reapply sunscreen every 2 hours or more often if you towel dry or rub off the sunscreen in any way.¹²

Choosing the Right Sunscreen – Form: Choosing by personal preference and need

There are several factors to consider when choosing the sunscreen product that is right for you. Sunscreen comes in creams, gels, lotions, ointments, sprays, and wax sticks. These forms are all fine and can be chosen based on personal preference. You may want to consider the following information when making your sunscreen selection:

• Lotions tend to be less irritating to children,¹⁶ but there are spray on and squeeze bottle options that are both fine.
• Alcohol-based sunscreen products should be avoided on children because they can cause irritation.¹⁶
• Choose products that are PABA-free and contain the ingredient titanium dioxide and/or zinc oxide for children and individuals with sensitive skin. Titanium dioxide and zinc oxide physically deflect rather than chemically absorb ultraviolet radiation; therefore, they do not cause allergic reactions.^18,19,20
• Creams may work better on the face since gels can sting around the eyes.
• Lighter textured choices may work better for those prone to acne (just remember to apply a thick enough layer to protect yourself).¹⁹
• Lip balms with sunscreen rated SPF 15 or higher are an important and necessary form of protection for the lips.

Choosing the Right Sunscreen – SPF: Sun protection factor for UVB protection

One choice that is important to understand for your protection and that of your family is the sun protection factor rating on the product. SPF is the ingredient that protects you from UVB radiation only—the rays responsible for most sunburn. Sunscreens are classified by the strength of their SPF.¹² SPF ratings can range from minimal (2–11 SPF), to moderate (12–29 SPF), to high (30+ SPF).¹⁷

“The SPF number gives you some idea of how long you can stay in the sun without burning.”¹⁵ The SPF rating is calculated by comparing the amount of time needed to produce a sunburn on sunscreen-protected skin to the amount of time needed to cause a sunburn on unprotected skin. For example, if a sunscreen is rated SPF 2 and a person who would normally turn red after 10 minutes of exposure in the sun uses it, then it would take 20 minutes of exposure for the skin to turn red. A sunscreen with an SPF of 15 would allow that person to multiply that initial burning time by 15, which means it would take 15 times longer to burn, or 150 minutes (about 2½ hours).¹² This number, however, is imperfect, since other factors such as perspiration, humidity, rubbing or toweling off, etc. can all reduce the actual SPF value, and thus, reduce the sunscreen’s effectiveness.

It is also important to note that SPF ratings do not actually increase proportionately. In other words, an SPF of 30 is not double the protection of an SPF of 15. In fact, an SPF 30 deflects 97 percent of the sun’s UVB rays; SPF 15 deflects 93 percent of the sun’s UVB rays, and SPF 2 deflects 50 percent of the sun’s UVB rays.¹² SPF ratings over 30 have not been shown to provide greater protection from the sun’s harmful UV rays than those containing SPF 30.²⁰

Ideally, all individuals, regardless of skin tone or color, should select a sunscreen with SPF 15 or higher. For children and individuals with very sun-sensitive skin, SPF 30 may be warranted.

Choosing the Right Sunscreen – UVA protection: Chemical and physical ingredients

It is very important to find a sunscreen that offers UVA protection in addition to UVB protection. You may see the sunscreen product labeled with the term “broad spectrum” to indicate that it protects against UVA and UVB rays. Sunscreens—even those with the same SPF rating—can have different ingredients or different combinations of ingredients.¹⁵ To be sure the sunscreen protects against UVA radiation, check for any of the following common ingredients:

• benzophenones,
• oxybenzone,
• sulisobenzone,
• titanium dioxide,
• zinc oxide, and
• avobenzone (also known as Parsol 1789).¹²

For a complete listing of all 16 possible active ingredients, see FDA’s Sunscreen Drug Products for over-the-Counter Human Use.

Consider Your Environment : Altitude and reflective surfaces

The sun’s reflective powers are great.¹² That’s why it is especially important to consider reflective surfaces, such as sand, snow, ice, and water when considering your choices for sun protection. Ultraviolet rays bounce off these reflective surfaces and can burn your skin as severely as direct sunlight. For example, a wide-brimmed hat may shield your head from direct sunlight, but it won’t protect your face or neck from the UV rays that reflect off the sand, water, ice, or snow.²¹

If you think that sunscreen is just for hot, sunny summer days—think again. A skier, on an average day, receives three times the UV exposure necessary for sunburn.²² The sun’s rays reflect 17 percent on sand and 80 percent on snow. Remember that 80 percent of the sun’s UV rays pass through the clouds,¹² so don’t just reserve your sunscreen for sunny summer days.

Also note, if you are going on a mountainous summer vacation, don’t forget to pack the sunscreen. “Ultraviolet intensities at altitudes of 8,000 to 11,000 feet have been shown to be 60–80 percent higher than at sea level for the same latitude.”²²

If you’re thinking about a sunscreen that combines with insect repellent to ward off those bugs—think again. Sunscreens combined with insect repellent (PDF) should be avoided since DEET should not be reapplied as often as sunscreen.

So, remember to put sunscreen on at the beginning of each day if you plan to be outside for at least 20 minutes, and don’t forget to reapply it at least every 2 hours…but you’ll only need your insect repellent once for up to eight hours of protection.

Remember…

If you plan to be outside for 20 minutes or more, protect your skin and that of your family members with a “broad-spectrum” sunscreen of SPF 15 or higher—preferably water resistant—and reapply it every 2 hours or as needed. Apply it liberally to cover the exposed areas of skin. Follow additional protective measures as well (PDF), including:

• Seek shade.
• Avoid the sun from 10 a.m. – 4 p.m.
• Wear a wide-brimmed hat.
• Wear close fitting, wrap-around sunglasses with 99–100 percent UV protection.
• Wear protective clothing.
• Make yourself aware of your environment including the UV index, reflective surfaces, and altitude.
• Avoid tanning beds.
• Consider the risks associated with using sunless tanning products (PDF) as well as the variations in color, streaking, and staining that may occur.

By choosing and using sunscreen appropriately and often, along with these other protective measures (PDF), you can reduce or avoid the sun’s potential damaging effects and enjoy your time outdoors.

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Can I Use the Sunscreen I Bought Last Summer?

Unless indicated by an expiration date on the product, the U.S. Food and Drug Administration requires that all sunscreens be stable at their original strength for at least three years.¹² While you can use the bottle of sunscreen you bought last year, if you are using the appropriate amount, a bottle of sunscreen should not last you very long.¹² To store sunscreen:

• Keep it out of the reach of children.
• Store it away from extreme temperatures (e.g., heat/direct sunlight or freezing temperatures), which can shorten the expiration date or shelf life of sunscreen.¹⁰ Do not refrigerate.
• Do not keep outdated sunscreen products. Dispose of these products where they are out of the reach of children.¹⁶

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This document is meant for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.

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References:

1. United States Food and Drug Administration (2003). FDA and you: News for health educators and students (Issue No. 3, Spring/Summer 2003). Retrieved May 20, 2005. From http://www.fda.gov/cdrh/fdaandyou/issue03.html#4.
2. American Academy of Dermatology (2005). Your skin and your dermatologist. Retrieved May 19, 2005. From http://www.aad.org/public/Publications/pamphlets/
   YourSkinandDerm.htm.
3. Lewis, C. (2003). Sunning for science: The effects of common substances on sun-exposed skin. Retrieved May 20, 2005. From http://www.cfsan.fda.gov/~dms/fdacsun2.html.
4. Pallarito, K. (2004). Shielding your skin from the summer sun. Retrieved May 16, 2005. From http://www.healthfinder.gov/news/newsstory.asp?
   docid=520318.
5. American Academy of Dermatology (2005). Sunscreen 101. Retrieved May 17, 2005. From http://www.aad.org/public/News/NewsReleases/
   Sunscreen101.htm.
6. Thompson, L. (2003). Trying to look sunsational? Complexity persists in using sunscreen. Retrieved May 20, 2005. From http://www.cfsan.fda.gov/~dms/fdacsun.html.
7. American Academy of Dermatology (2002). Looking good no matter what your age. Retrieved May 19, 2005. From http://www.aad.org/public/News/NewsReleases/
   Press+Release+Archives/Cosmetic+Dermatology
   +-+Aging/Age.htm.
8. Federal Trade Commission (1997). Indoor tanning. Retrieved May 20, 2005. From http://www.ftc.gov/bcp/conline/pubs/health/indootan.htm.
9. American Academy of Dermatology (2005). Teens and tanning: A dangerous combination. Retrieved May 19, 2005. From http://www.aad.org/public/News/NewsReleases/
   Press+Release+Archives/Skin+Cancer+and+Sun+Safety/
   TeensTanning.htm.
10. Centers for Disease Control (2004). Choose your cover skin cancer prevention campaign: Questions and answers. Retrieved May 16, 2005. From http://www.cdc.gov/ChooseYourCover.qanda.htm.
11. American Academy of Dermatology (2005). Ultraviolet index: What you need to know. Retrieved May 19, 2005. From http://www.aad.org/public/Publications/
    pamphlets/UltravioletIndex.htm.
12. American Academy of Dermatology (2005). 2005 facts about sunscreen. Retrieved May 19, 2005. From http://www.aad.org/aad/Newsroom/factsunscreen.htm.
13. United States Food and Drug Administration (2003). Sunscreens, tanning products, and sun safety. Retrieved May 20, 2005. From http://www.cfsan.fda.gov/~dms/cos-220.html.
14. United States Department of Health and Human Services (2004). Health tip: Avoid too much sun. Retrieved May 16, 2005. From http://www.healthfinder.gov/news/newsstory.asp?
    docid=522008.
15. Federal Trade Commission (2001). Sunscreens and sun-protective clothing. Retrieved May 20, 2005. From http://www.ftc.gov/bcp/conline/pubs/health/sun.htm.
16. Mayo Clinic (2004). Sunscreen agents (topical). Retrieved May 17, 2005. From http://www.mayoclinic.com/invoke.cfm?objectid=
    267393E6-1CF6-4E7B-90257E94622E671B.
17. United States Food and Drug Administration (2004). Sunscreen drug products for over-the-counter human use. Retrieved May 20, 2005. From http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/
    cfcfr/CFRSearch.cfm?CFRPart=352.
18. American Academy of Dermatology (2005). Beauty flash: The top 10 cosmetic do’s and don’ts for women with sensitive skin. Retrieved May 19, 2005. From http://www.aad.org/public/News/NewsReleases/
    Press+Release+Archives/Cosmetic+Dermatology
    +-+Aging/DraelosCosmetics.htm.
19. American Academy of Dermatology (2005). Sun safety 101. Retrieved May 17, 2005. From http://www.aad.org/public/Parentskids/KidsConnection/
    KCSunSafety101.htm.
20. Consumer Search (2005). Sunscreen reviews. Retrieved May 19, 2005. From http://www.consumersearch.com/www/family/
    sunscreen/fullstory.html.
21. Mayo Clinic (2005). Sun protection quiz. Retrieved May 17, 2005. From http://www.mayoclinic.com/invoke.cfm?
    objectid=CB3FC3F6-160D-4B23-82A840660ADF17C5.
22. American Academy of Dermatology (2005). New research: Making the most of your sunscreen. Retrieved May 17, 2005. From http://www.aad.org/public/News/NewsReleases/
    Press+Release+Archives/Skin+Cancer+and+Sun+Safety/
    NewResearch.htm.