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Sunscreen Use

Making Sense of Sunscreen and Tanning Products

Volume 9, Number 3 – May/June 2005

Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, and Janet M. Pollard, MPH, Extension Associate-Health

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Inside HealthHints....

SAY

Sunscreen Use: Making Sense of Sunscreen and Tanning Products

Many people already know that harmful effects can result from sun exposure. In fact, many people report using sunscreen when they go out in the sun…or, at least protecting their children with sunscreen.

Still, the majority of Americans also consider a tan a mark of beauty. We also have false ideas about sun protection:

While all of these are false ideas, to be honest, our societal image of health and a truly healthy image doesn’t match up when it comes to the sun exposure issues.

AGENT ONLY

Say/Do Format

This issue of HealthHints is written with “say/do” notations at the top of each section heading to allow county Extension agents and other community educators to use it for short programs. The newsletter can also be used for its usual informational purposes.

SAY

Skin: A Marker for Health…An Under-protected Organ

Did you know the skin is the largest organ of the body? That’s right, the skin is the largest and most visible organ of the entire human body and is vital for protecting and regulating the body.4 The skin has many functions.

In fact, your skin is a good reflection of your health. Very red skin can indicate high blood pressure, while sagging, leathery skin may indicate a long-time smoker or sun-worshiper.6 Your skin is more than a simple wrapping or covering; it is a complex organ that can become susceptible to disease. The skin is a window to the body’s internal world and can help doctors and dermatologists diagnose and treat medical problems related to it.5

SAY

Sun’s Harmful Effects: Not Just “Skin-Deep”

Many people know the importance of exercising and eating right to protect their hearts and other internal organs. The skin, however, is also an organ that needs to be kept healthy from both the inside and the outside. While drinking water is essential for keeping the skin hydrated,7 protecting the skin from the sun’s harmful ultraviolet rays is essential in the prevention of:

Premature Aging and Skin Damage

The sun’s rays can cause premature aging of the skin, including:

Precancerous skin growths known as actinic keratoses (raised, reddish, rough-textured growths often found on the face, neck, hands, and forearms), may also develop.8

Cataracts and Other Eye Problems

Cataracts are a type of eye damage in which loss of transparency in the lens of the eye clouds the vision.8 Studies show that too much exposure to ultraviolet rays can damage the retina. Overexposure can burn the cornea, and repeated exposure over many years can change the structure of the lens so that it begins to cloud, forming a cataract.9 Other kinds of eye damage may include pterygium (tissue growth that can block vision), skin cancer around the eyes, and degeneration of the macula (the part of the retina where visual perception is most acute).8

Immune Suppression

The immune system is the bodily system that protects against and fights disease or infection. Scientists have found that overexposure to ultraviolet radiation may suppress proper functioning of the body’s immune system and the skin’s natural defenses. All people, regardless of color, might be vulnerable to immune suppression effects.8

Skin Cancer

There are three common types of skin cancer that can develop. In fact, the incidence of skin cancer in America is epidemic; 1 in 5 Americans will develop skin cancer in their lifetime, and 1 American dies of this disease every hour.

Nonmelanoma skin cancers (basal cell and squamous cell) are less deadly than melanoma, but left untreated they can spread and cause disfigurement and serious health problems.8

SAY

Ultraviolet Radiation: UVB and UVA

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

Note: 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,9 sometimes at levels 10–15% higher than that of natural sunlight.10 For more on tanning beds, see the “Let’s” Talk About Tanning” PowerPoint Leader Lesson (http://fcs.tamu.edu/health/lower_your_cancer_risk/tanning_leader_lesson.ppt).

SAY

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.11 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+.12 To see the UV Index for your area, go to one of the following websites, or contact your local weather service: http://www.cpc.ncep.noaa.gov/products/stratosphere/uv_index/uv_current.html or
http://iwin.nws.noaa.gov/iwin/us/ultraviolet.html.

SAY

Protecting Your Skin with Sunscreen: Preventing Sun’s Harmful Effects

One of the most important things you can do for your skin is to wear sunscreen every day.7 Yes, you heard correctly—every day. Just for Caucasians with fair skin, you ask? No, for everyone, regardless of skin type or color.2 Even if your skin does not burn from the sun’s rays, your skin is still damaged by ultraviolet radiation exposure. Just on sunny days, you ask? No, every day—even cloudy days—because 80% of the sun’s ultraviolet rays pass through the clouds.2

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,13 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.”14 The message that 80% of skin damage from sunlight exposure occurs before age 18 has long been presented and has potentially been a reason that adults shrug off their need for sunscreen. Recent research, however, suggests that Americans actually get less than 25% of their lifetime UV dose by age 18.1 In either case, 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”1 as well as your children. In fact, “although nothing can completely undo sun damage, the skin sometimes can repair itself.”15“Sunscreens used on a regular basis actually allow some repair of damaged skin.”13

SAY

Sunscreen Application: Who, When, and How Much

If you plan to spend even 20 minutes outdoors on any given day, you should apply sun screen.2 Make it a habit to apply sunscreen as part of your “beginning-of-the-day” ritual. Apply it after a shower or bath or before applying makeup. You can also purchase makeup with sunscreening ingredients; just make sure they have an SPF of 15 or higher (see more on SPF later). In fact, sunscreen should always be applied to dry skin 15–30 minutes before going outdoors13 to allow it to absorb into the skin.

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.1 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 children under 6 months of age. Do not use sunscreen on children under 6 months of age. Sunscreen can irritate infant’s skin.16 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 over-heating. Cover their heads with a wide-brimmed hat, and use infant sunglasses with 99–100% UV protection because infant’s developing eyes are particularly vulnerable to sunlight.16 (Be sure to read the label for UV protection rating; we’ll discuss this more later.)

SAY / DO

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 cover the exposed areas of the body properly.13,16

To see how much this is, try this activity. Take a tube of squeezable cake icing, and fill a shot glass with the icing. Now see how many cupcakes or muffins you can ice with it. How many cupcakes/muffins were iced? Cake icing is thicker than most sunscreen products, but you can see that you would probably need more icing to finish a dozen cupcakes.

Think about the areas of your body exposed to the sun. In the summertime, even more areas are exposed when wearing shorts, short sleeves, or bathing suits. Use sunscreen liberally, uniformly, and thickly to cover all exposed areas.17 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.13

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 (see more on water-resistant sunscreens later in this issue of HealthHints). 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.13

SAY

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. Some will be personal preference, while others are necessity in protecting against harmful effects from the sun. For instance, the form of sunscreen is basically personal preference. You can buy sunscreen in creams, gels, lotions, ointments, 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:

Note: The term “sunblock” is no longer used on sunscreening products since sunlight cannot be completely blocked by these products; rather it is either chemically absorbed or physically deflected.

SAY

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 (SPF) 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.13 SPF ratings can range from minimal (2–11 SPF), to moderate (12–29 SPF), to high (30+ SPF).21

“The SPF number gives you some idea of how long you can stay in the sun without burning.”16 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, 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 2 1/2 hours).13 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% of the sun’s UVB rays; SPF 15 deflects 93% of the sun’s UVB rays, and SPF 2 deflects 50% of the sun’s UVB rays.13 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.

SAY

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.16 To be sure the sunscreen protects against UVA radiation, check for any of the following common ingredients:

For a complete listing of all 16 possible active ingredients, see FDA’s Sunscreen Drug Products for Over-the-Counter Human Use (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=352).

SAY

Choosing the Right Sunscreen: Water Resistance – Sweating and Swimming

When choosing a sunscreen, ideally it should be water-resistant so that it cannot be easily removed by sweating or swimming.13 These sunscreens stay on the skin longer even if they get wet, but they are not actually “waterproof” since no product is completely waterproof.4 Rather, they should be labeled as “water-resistant” or “very water-resistant.”21 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 (1 1/2 hours) of sweating/perspiring or water activity.21 Like other types of sunscreen, water-resistant sunscreens still need to be reapplied often when sweating or swimming, and especially after towel drying when it can be rubbed off. Check the product label for reapplication directions.

SAY

Medication and Sunscreen: Not Always a Good Mix

Many commonly used medications can make your skin more sensitive to the sun’s rays. If you are taking medication, even over-the-counter medication, ask your doctor or pharmacist if the medication will make your skin sun sensitive. Some medications that may cause increased sun sensitivity include:

Some herbal products, such as bergamot oil, used to flavor Earl Grey tea, can cause increased sun sensitivity. Talk with your doctor or pharmacist about herbal products you use in addition to medications.

SAY

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 3 years.13 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.13

To store sunscreen:

SAY

Consider Your Environment: Altitude and Reflective Surfaces

The sun’s reflective powers are great.13 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.22

So, 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.23 The sun’s rays reflect 17% on sand and 80% on snow; and remember, 80% of the sun’s UV rays pass through the clouds.13 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 percent to 80 percent higher than at sea level for the same latitude.”23

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 at least every 2 hours.

SAY / DO

What About Sunscreens Combined with Insect Repellent?

Another environmental concern, especially during the summer months, is insects and the illnesses associated with them, such as West Nile Virus and Lyme Disease. Be cautious in considering products that combine ingredients, such as insect repellent and sunscreen. Because sunscreen needs to be applied liberally and often, it is better to use a separate sunscreen followed by a light application of insect repellent.24 The ingredient DEET (N, N-diethyl-meta-toluamide) is found in most insect repellents and should not be applied more than is necessary. DEET, unlike sunscreen ingredients, is not water soluble and will last up to 8 hours. “Repeated application may increase potential toxic effects of DEET.”25

Researchers have also reported that “the rate of DEET absorption into the skin skyrockets when DEET-based repellents are mixed with oxybenzone, a common ingredient in sunscreens. When DEET and oxybenzone are mixed, DEET absorption into the skin increases to 30.2 percent from the normal 9.6 percent.”26

So, choose separate sunscreen and insect repellents that fit the needs of your family, and avoid combined insect repellent and sunscreen products for your safety. For information on how to choose an appropriate insect repellent for your family, see the Texas AgriLife Extension Service’s Insect Repellent, Health Information for Texans (http://fcs.tamu.edu/health/family_health/insect_repellent.php).

Note: If you are using this material for programming, distribute the insect repellent fact sheet listed above to your participants.

SAY / DO

Sunscreen Alone is Not Enough: Other Protective Measures

Though sunscreen offers some protection, it does not block out all ultraviolet rays.22 For prevention of skin cancer and damage, sunscreen alone is imperfect.3 Sunscreen needs to be combined with other protective measures, which include:

Weave isn’t the only factor, however; darker colored fabrics actually absorb UV rays and provide better protection than white or light-colored fabrics. Dry clothing provides better protection than wet. Long sleeved shirts with high collars and long pants or skirts provide maximum coverage to the skin.22

You can also purchase fabrics treated specifically for sun protection; see the manufacturer’s label for a Ultraviolet Protection Factor (UPF) rating. The higher the UPF, the higher the protection from the sun’s UV rays. The UPF indicates how much of the sun’s UV radiation is absorbed by the fabric. For example UPF 20 indicates the fabric only allows 1/20th of the sun’s UV radiation to pass through it, reducing your skin’s UV radiation exposure by 20 times where it is protected by the fabric. UPF ratings should range from UPF 16–50+. Fabrics with a UPF of less than 15 should not be labeled as sun-protective. Note that sun-protective clothing may lose its effectiveness if it is too tight, stretched out, damp or wet, or has been washed or worn repeatedly.16

Note: If you are using this information in a program, distribute the “Safer Sun in Seven Steps” information from the website listed above. Also, distribute the fact sheet from the Mayo Clinic entitled “The Darker Side of Tanning,” which covers 10 important tips to remember about sunscreen (http://www.mayoclinic.org/executive-health/pdfs/awa-sunscreen.pdf). You may also use the handout “Sun Safety Tips” for an easy-to-read list from the American Academy of Dermatology (http://www.aad.org/NR/rdonlyres/01B9DA04-2861-425A-9920-BC6F4713BD4C/0/Sun_Safety.pdf).

SAY

Sunless Tanning Products: Not Without Risk

“Some think turning light skin darker gives off an aura of good health. But a suntan actually signals skin damage.”27 Still, many strive for a tanned appearance as the summer sun rises…others want to maintain this appearance even through the winter months. Thus, many are turning to sunless tanning products. Before you make this choice, you should know the associated risks.

There are 3 main types of sunless tanning products being marketed today; 2 of the 3 are unapproved by the FDA and, therefore, are not deemed safe for your use:

Tanning Accelerators

Tanning accelerators are products marketed with claims that it speeds up the skin’s melanin production.28 The skin produces a pigment called melanin when exposed to the sun to try to protect itself from burning.27 Tanning accelerators generally supply doses of tyrosine (an amino acid) or its derivatives, sometimes in combination with other substances. The FDA, however, has stated that the marketing claims that these products speed up melanin production have not been substantiated in scientific literature.28“The agency notes that any product purporting to ‘accelerate the tanning process’ or ‘stimulate the production of melanin’ is claiming to affect the structure and function of the body and therefore is a drug. The agency is not aware of any data demonstrating that tyrosine or its derivatives are effective in stimulating the production of melanin. Thus, any product containing tyrosine or its derivatives and claiming to accelerate the tanning process is an unapproved new drug.”28

Tanning Pills

There are no pills approved for tanning uses by the FDA.4 “Pills that contain large doses of canthaxanthin are sometimes marketed as ‘tanning pills.’ Although FDA has approved canthaxanthin for use as a color additive in foods, where it is used in small amounts, its use as a tanning agent is not approved. Imported tanning pills containing canthaxanthin are subject to import detention as products containing non-permitted color additives.

When a person ingests canthaxanthin in large quantities, the substance is deposited in various parts of the body, including the skin, where it imparts a color ranging from orange to brownish. Tanning pills have been associated with side effects, particularly a condition called ‘canthaxanthin retinopathy,’ the formation of yellow deposits in the retina of the eye.”14 According to the American Academy of Dermatology, canthaxanthin has also been reported to cause liver injury and a severe itching condition called urticaria.4

DHA Sprays and Lotions

Dihydroxyacetone (DHA)- containing sunless tanning products have been approved by the FDA for use as a tanner since 1977 and have typically been used in over-the-counter (OTC) lotions and creams.27 DHA is the only color additive currently approved by the FDA for this purpose. DHA interacts with the dead surface cells in the outermost layer of the skin to darken skin color.27 Its use is restricted to external application, which means that it shouldn’t be sprayed in or on the mouth, eyes, or nose.27

There are several types of DHA-containing sunless tanning products marketed as sunless tanners, self-tanners, tanning extenders, or bronzers. These products can be difficult to apply, and the chemicals may react differently on various areas of your body, resulting in uneven coloring.

The term ‘bronzer’ refers to a variety of products used to achieve a temporary tanned appearance. Some are applied topically to stain the skin temporarily. Usually, soap and water will remove them. They may streak after application and, when wet, some may stain clothing.

Among other products marketed as bronzers are tinted moisturizers and brush-on powders. These also produce a temporary effect, similar to other types of makeup. Still others are combination products that also contain DHA.”14

During the last few years, some companies have offered a sunless option that involves spraying customers in a tanning booth with the color additive DHA.27

DHA should not be inhaled, ingested, or used in such a way that the eyes and eye area are exposed to it because the risks, if any, are unknown. For consumers who choose to get DHA spray in tanning booths, the FDA recommends protective measures for the eyes, nose, and mucous membranes.27

When using DHA-containing products as an allover spray or mist in a commercial spray “tanning” booth, it may be difficult to avoid exposure in a manner for which DHA is approved, including the area of the eyes, lips, or mucous membrane, or even internally. Consequently, FDA advises asking the following questions when considering commercial facilities where DHA is applied by spraying or misting:

If the answer to any of these questions is “no,” the consumer is not protected from the unapproved use of this color additive. Consumers should request measures to protect their eyes and mucous membranes and prevent inhalation.29

Warning

Even if you choose to use an approved sunless tanning product, most do not contain sunscreen, which is still necessary to prevent excessive damage from the sun’s rays, or they only contain a small amount (e.g., SPF 4).30

FDA regulations require all tanning products that do not contain sunscreen to have the following warning statement on the label:

Warning—This product does not contain a sunscreen and does not protect against sunburn. Repeated exposure of unprotected skin while tanning may increase the risk of skin aging, skin cancer, and other harmful effects to the skin even if you do not burn.

Tanning products that do not contain sunscreens and do not protect against the harmful effects of UV light are regulated as cosmetics. FDA requires this warning statement so that consumers are fully informed that such products do not provide protection from the sun.3

Remember…

Protect your skin and that of your family members every day with a “broad-spectrum” sunscreen of SPF 15 or higher— preferably water resistant—and reapply every 2 hours or as needed. Apply liberally to cover exposed areas of skin. Follow additional protective measures as outlined in this issue of HealthHints, including:

FYI
Want to know how sunburn affects work productivity? See the latest…“Study finds Texas
beachgoers not the only ones getting burned by too much sun” (http://www.aad.org/
public/News/NewsReleases/Press+Release+Archives/Skin+Cancer+and+Sun+Safety/).

References

  1. Pallarito, K. (2004). Shielding your skin from the summer sun. Retrieved May 16, 2005. From http://www.healthfinder.gov/news/newsstory.asp?docid=520318.
  2. American Academy of Dermatology (2005). Sunscreen 101. Retrieved May 17, 2005. From http://www.aad.org/public/News/NewsReleases/Sunscreen101.htm.
  3. 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.
  4. United States Food and Drug Administration (2003). FDA and you: News for health educator and students (Issue No. 3, Spring/Summer 2003). Retrieved May 20, 2005. From http://www.fda.gov/cdrh/fdaandyou/issue03.html#4.
  5. American Academy of Dermatology (2005). Your skin and your dermatologist. Retrieved May 19, 2005. From http://www.aad.org/public/Publications/pamphlets/YourSkinandDerm.htm.
  6. 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.
  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. United States Environmental Protection Agency (2004). Health effects of overexposure to the sun. Retrieved May 20, 2005. From http://www.epa.gov/sunwise/uvandhealth.html.
  9. Federal Trade Commission (1997). Indoor tanning. Retrieved May 20, 2005. From http://www.ftc.gov/bcp/conline/pubs/health/indootan.htm.
  10. 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.
  11. Centers for Disease Control (2004). Choose your cover skin cancer prevention campaign: Question and answers. Retrieved May 16, 2005. From http://www.cdc.gov/ChooseYourCover.qanda.htm.
  12. 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.
  13. American Academy of Dermatology (2005). 2005 facts about sunscreen. Retrieved May 19, 2005. From http://www.aad.org/aad/Newsroom/factsunscreen.htm.
  14. 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.
  15. 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.
  16. Federal Trade Commission (2001). Sunscreens and sun-protective clothing. Retrieved May 20, 2005. From http://www.ftc.gov/bcp/conline/pubs/health/sun.htm.
  17. Mayo Clinic (2004). Sunscreen agents (topical). Retrieved May 17, 2005. From http://www.mayoclinic.com/invoke.cfm?objectid=267393E6-1CF6-4E7B-90257E94622E671B.
  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. 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.
  22. Mayo Clinic (2005). Sun protection quiz. Retrieved May 17, 2005. From http://www.mayoclinic.com/invoke.cfm?objectid=CB3FC3F6-160D-4B23-82A840660ADF17C5.
  23. 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.
  24. Mayo Clinic (2005). Keep mosquitoes at bay. Retrieved May 17, 2005. From http://www.mayoclinic.com/invoke.cfm?objectid=F30BE580-B5BE-42A9-A320E0C92254105D.
  25. American Academy of Pediatrics (2003). Follow safety precautions when using DEET on children. Retrieved May 16, 2005. From http://www.aap.org/family/wnv-jun03.htm.
  26. Duke University Medical Center (2004). Caution urged on mosquito repellant for kids. Retrieved May 16, 2005. From from http://www.healthfinder.gov/news/newsstory.asp?docid=519866.
  27. Meadows, M. (2003). Don’t be in the dark about tanning. Retrieved May 20, 2005. From http://www.fda.gov/fdac/features/2003/603_tan.html.
  28. United States Food and Drug Administration (2002). Tanning accelerators. Retrieved May 20, 2005. From http://www.cfsan.fda.gov/~dms/costan3.html.
  29. United States Food and Drug Administration (2003). DHA-spray sunless “tanning” booths. Retrieved May 20, 2005. From http://www.cfsan.fda.gov/~dms/cos-tan4.html.
  30. American Academy of Dermatology (2005). Sunscreens. Retrieved May 17, 2005. From http://www.aad.org/public/Publications/pamphlets/Sunscreens.htm.

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Last updated: 7 January, 2008

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