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Sunscreen safety... what's the bottom line?

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Last week, the Environmental Working Group released their annual Sunscreen Guide to help consumers navigate the world of safe sun protection for the whole family. Doctors, sunscreen advocates and trade groups are responding and once again, there seems to be a lot of confusion out there as evidenced by the misleading articles and headlines seen across the blogosphere and news outlets. “Sunscreen Ingredients May Increase Cancer Risk” (Care2), “Your Sunscreen Could Give You Cancer Instead of Fighting it Off” (CafeMom) and “Avoid Sunscreens with Potentially Harmful Ingredients, Group Warns” (CNN) are just a small sample of the headlines coming out as a result of the EWG’s latest guide.

As a melanoma survivor and sunscreen manufacturer, I spend a lot of time thinking about sunscreen. Not much has changed from my post last summer except that more research has been published pointing towards optimal sunscreen active ingredients and confirming the wisdom behind abiding by the precautionary principle. For those of you in search of the bottom line amidst the current confusion around sunscreen, here are my thoughts, based on what we know to be true today. Importantly, these are all points that I feel the EWG and dermatologists could support. There is a lot of common sense found in the common ground!

What we do know is that UVB rays cause basal cell and squamous cell carcinoma and UVA rays cause wrinkles and hyperpigmentation. What we are studying but don’t have an answer to yet is: why is the rate of melanoma (the most deadly form of skin cancer) rising? (“The risk of malignant melanoma developing in an American in the United States has now reached 1 in 87 (up more than 1800% since the 1930s)). (Source: The Incidence of malignant melanoma in the United States: Issues as we Approach the 21st Century, Journal of the American Academy of Dermatology, Volume 34, Issue 5, Pages 839-847, Darrel S. Rigel, Robert J. Friedman, Alfred W. Kopf)

In Sunscreens Exposed: Nine Surprising Truths the EWG cites specific hypotheses pertaining to the potential role of sunscreen with respect to the rising melanoma rates:

• People who use sunscreen tend to stay in the sun longer, thus increasing their overall radiation and subsequent cancer risk.
• Some sunscreens generate free radicals that outnumber the amount of free radicals generated from UV exposure. (Free radical damage is associated with DNA damage and cancer.)
• Greater UVA exposure: people wearing high SPF sunscreens which suppress warning signals like sunburn that tell you to get out of the sun, risk higher exposure to UVA rays. This could lead to increased cancer risk.

Unfortunately, misrepresentation of this section of the report has given rise to a great deal of confusion and even distrust of sunscreens among the public. “I get melanoma patients who come in and they say, ‘You say use sunscreens, [The EWG says] they can be dangerous. I don’t know what’s right so I am going to do what I want.’” says Dr. Rigel of WebMD.

The question is not whether or not we should wear sunscreen but rather which sunscreen to buy. As a sunscreen advocate and manufacturer, I believe a safe sunscreen must provide:

Photostablity: A safe sunscreen should not break down in the presence of UV and thus generate free radicals. Sunscreens containing a combination of ingredients such as oxybenzone and octyl methoxycinnamate photodegrade to form free radicals, as do combinations of minerals and chemicals such as oxybenzone and titanium dioxide. A better ingredient and the only one we recommend as being photostable is non-nano zinc oxide.

Broad spectrum protection: We know UVA rays cause photoaging so even if the melanoma UVA connection is not established, protection against UVA rays is a good idea.

Using the criteria above, the EWG concludes that mineral sunscreens are safer than chemical sunscreens. These minerals are titanium dioxide and zinc oxide. Unfortunately, titanium dioxide has its drawbacks. It acts as a catalyst in the presence of UV, and is used in industry to generate free radicals (the opposite of what we want to do on our skin). An in vitro study suggests that TiO2 causes DNA damage on exposure to UV.

Out of all the active sunscreen ingredients on the market, respected sources including Dr. Oz and Duke professor of Dermatology Dr. Pinnell agree, the ingredient that meets all the criteria best is zinc oxide. At bulk sizes (non nanoparticle) it is stable, it protects across the full UV/UVB spectrum and it is deemed safe by the FDA even for babies under six months of age. This is why we recommend using a sunscreen containing non-nano zinc oxide as its active ingredient.

Following is a simple cheat sheet to help you choose from among the safest and most effective sunscreens:

For safety, avoid nanoparticles and chemicals.
For effectiveness, choose a broad spectrum and photostable product. Zinc oxide is best.
For lasting protection, follow the two hour reapplication rule. This is particularly important if you choose to use chemical sunscreens, as some start to degrade within an hour after application.
Wear a hat, clothing and seek shade when you can.

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