The Great Sunscreen Debate: Who Needs It, and Other Conundrums

Nov 12, 2019 | Trending Topics

You’ve probably heard that you need sunscreen, so you go to the drug store to buy some and you find a sea of choices. What is the best SPF to get? Is physical better than chemical sunscreen?

You finally pick one, then you have to think about when you should apply it, how much and how often. It. Is. A lot. Sunscreen questions are one of the most common types of questions I answer in my Dermatology clinic and I am not surprised. It is confusing but I am here to help! Keep reading for some great sun screen tips and a discussion about controversies around this necessary skin care step.

1. Sun screen and skin of color

People with skin of color (usually Asians, Hispanics, and African Americans) should be wearing sunscreen. Patients with skin of color CAN develop skin cancer. The frequency is lower compared with fair-skinned, Caucasian individuals but it does occur. Skin of color includes a wide range of skin tones, and individuals with lighter skin tones will have a higher probability of developing skin cancer compared with those with very dark skin tones. However, in general, the frequency is lower than fair-skinned Caucasians. I typically recommend my patients with skin of color wear SPF 15 to 30 daily depending on their skin tone.

2. FDA –proposed rules and what this means for you

The FDA-proposed rules are asking for additional safety data on many of the UV filters used in sunscreen. The rationale is that the way the general public uses sunscreen now is very different from 20 or 30 years ago. People go out in the sun more, do a lot of outdoor activities, and apply sunscreen to a large body surface area and more frequently. Thus, the FDA wants to make sure that the level of safety from absorption is supported by good studies. The study you have probably been hearing about on the news lately, showed that the 4 active UV filters studied—avobenzone, oxybenzone, octocrylene, and ecamsule—are absorbed into the bloodstream when applied under maximal use conditions. This means that participants applied sunscreen every 2 hours for a total of 4 applications over 8 hours during the day and applied it to 75% of the body surface. This is a high amount compared to what is commonly used; it is about a shot glass full of sunscreen used from head to toe. We know from multiple studies that the average individuals use sunscreen at about half this amount. However, under these maximal use conditions, the study did find absorption of the UV filters.

I tell my patients that while the FDA is investigating, this, there is NO consensus that chemical sunscreens are dangerous. In addition, sunscreen and all of the UV filters have been in use since the 1970s. At this time, there is no data that shows sunscreen is associated with any internal or systemic disease. However, I do advise my patients to use barrier sunscreens (zinc and titanium based) and avoid the chemicals mentioned in the study.

3. Environment effects of sunscreen

There has been tons of discussion/debate about sunscreen and coral reef bleaching. This is a very controversial issue with thought leaders chiming in on both sides of the debate. What is known is that in the laboratory setting, active ingredients of sunscreen can result in coral reef bleaching. However, the more recent studies that examined the level of UV filters in the water around Hawaii island, which were very carefully done, showed the amounts are significantly lower compared to what is needed to induce bleaching of coral reefs in the laboratory setting. In other words, the amount in real world settings is significantly lower than what is reported in the lab to cause toxicity in coral reefs.

This is one of those things that I tell patients to error on the side of caution and to avoid sunscreens that contain oxybenzone and octinoxate or just choose one that says “coral reef safe”

4. Concerns about overall safety of sunscreen

All too often, I hear patients tell me they don’t use sunscreen because “it causes cancer” or “it is too irritating”. I believe the risk of skin cancer far outweighs any risks sunscreen may have. What I recommend to patients and educate them on is a comprehensive approach. The entire sun protection package includes: staying in the shade; wearing sun protective clothing, and there are a lot of great options that are thin and well-ventilated; wear a wide-brimmed hat to protect the face and neck; wear sunglasses, and only use sunscreen on exposed areas.

For people who are concerned about the organic (=chemical) UV filters in sunscreen, I suggest they use “mineral” sunscreens, which are ones that contain titanium dioxide and zinc oxide.

5. You don’t like the “look” of sunscreens

There are several limitations with mineral sunscreens. (zinc based) The biggest one is that they are not very efficient UV filters. In order for them to attain the higher SPF numbers, these sunscreens have to use higher concentrations of zinc and titanium dioxide, which causes them to have a somewhat ashy and white appearance when applied to the skin.

Thankfully, there are now sunscreens with titanium oxide and zinc oxide that are tinted. People can use these types of sunscreens to match their skin and these are quite good in terms of not making the skin look visibly white or ashy. Another option is to get an invisible zinc sunscreen.

The most important thing to remember is that everybody, no matter the skin type or skintone, needs sunscreen every single day of the year. (yes, on cloudy days too). When choosing, pick something you feel good about using every day.

I am here to help you achieve your best skin ever!

Here’s to your perfect skin!


Photo of Perfect Skin Code owner Kimberly Brown
Kimberly Brown

Perfect Skin Code was created by Kimberly Brown, a Physician Assistant in Dermatology, when she decided to create products for her patients who had trouble finding effective yet gentle skin care products.

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