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How to Choose the Best Sunscreen – and Use It Well

Tuesday, June 19, 2012 - 12:16Renee Despres

Standing in front of the array of sunscreens at my local grocery store the other day, I scratched my head. What was the best sunscreen for me to buy? Was there a good reason to buy a kids’ sunscreen for my three-year old? Was SPF 15 enough? Should I pay twice as much for a sunscreen labeled SPF 70? What does SPF mean, anyway? Should it be labeled waterproof? Water-resistant? Fragrance free? Mineral-based? Sunblock? Was it safe to smear on with all those chemicals with unpronounceable names?

 Finally, I grabbed two tubes of lotion, my choices dictated by the sale prices more than anything on the sunscreen labels.

I’m not alone in my confusion. When it comes to choosing a sunscreen, consumers face a bewildering array of choices and advice. Mix changing science with marketing hype from sunscreen manufacturers, reluctant guidance from the FDA, cautionary tales from environmental groups, and ever-present internet rumors, and you’ve got a recipe for confusion. But savvy consumers can learn how to sort through the sunscreen controversy to choose the best sunscreens and learn how to use them most effectively.

Sunscreens: One Piece of the Skin Cancer Prevention Puzzle

Let’s face it. Most of us don’t relish spreading slimy, smelly white stuff all over our bodies. We do it because a) sunburns hurt and b) our mothers, dermatologists, and schoolteachers have all lectured us about the dangers of sun exposure.

In this case, as usual, mother (and your dermatologist) knows best. Skin cancers are the most common cancers, accounting for more than half of all cancers in the United States and one out of every three cancers diagnosed worldwide. More than two million cases of basal cell carcinoma and squamous carcinoma, and nearly 70,000 new melanomas, are diagnosed each year in the United States, according to data from the American Cancer Society.

Non-melanoma skin cancers occur most commonly in areas of the body that are frequently exposed to the sun, such as the ears, face, neck, and arms. Melanoma is the most deadly form of skin cancer. Melanoma occurs when the cells responsible for pigment, called melanocytes, become diseased. While melanoma accounts for only about 5 percent of skin cancers, it leads to the majority of deaths. In 2010 in the United States, nearly 9,000 deaths were attributed to melanoma, while non-melanoma skin cancers led to 2,000 deaths.

Excessive sun exposure is the primary preventable risk factor for skin cancers, and sunscreen is an important part of a comprehensive sun protection program that can help prevent those cancers. When used correctly, effective sunscreens can prevent sunburn, help to slow skin aging, and prevent most skin cancers.

Although smart use of the right sunscreen can help to reduce the risk of skin cancers, “sunscreens themselves are only part of the picture,” cautions Rebecca Tung, M.D., Division Director of Dermatology at Loyola University Health System. “You also need to wear sun protective clothing, including a hat and sunglasses.  Seek shade during the middle of the day, so you’re not bombarded by the sun’s rays.”

How Does the Sun Cause Skin Damage and Cancer?

Sunlight contains three kinds of radiation: visible light, infrared radiation, and ultraviolet (UV) light. Visible light allows us to see colors, while infrared radiation is responsible for the warmth you feel on a sunny day.  You cannot feel or see ultraviolet light, which has shorter wavelengths than visible light but longer wavelengths than X-rays. UV light falls right in the middle of the electromagnetic spectrum, with wavelengths of 100 to 400 nanometers. Scientists further classify UV light into three wavelengths: UVA, UVB, and UVC. 

  • UVA has the longest wavelengths of light on the UV end of the spectrum. Until recently, UV-A  was thought to be harmless, but evidence has linked UVA to damage beneath the skin. Excessive UVA exposure is now thought to lead to age spots, wrinkles, broken blood vessels, and cancers. UVA causes some tanning, but does not cause sunburns. Minimizing UVA exposure is more difficult than minimizing UVB exposure. UVA is not filtered out by ozone in the atmosphere, and levels of UVA remain relatively constant throughout the day. UVA waves pass through glass
  • UVB has long been linked to skin damage that leads to sunburn, aging, wrinkled skin, and skin cancer. UV-B light is partly filtered out by ozone in the atmosphere, and it varies in intensity throughout the day, peaking at noon. UV-B does not pass through glass.
  • UVC has the shortest wavelengths in the spectrum. UVC has been linked to skin damage including burns and cancers. However, it usually does not pose a problem, because it is effectively filtered out by ozone in the atmosphere. The most common artificial source of UVC is germicidal lamps.

While researchers have long recognized UVB rays as a risk factor for skin cancer, only in the last five to ten years have they turned their attention to UVA rays. “The shorter UVB rays and the longer UVA rays contribute to skin cancer production over a long period of time,” says Tung. “For years, the main focus was on SPF, which is a measure of UVB protection. But over the last 5 to 10 years, researchers have found evidence that both types of rays are implicated in causing cancer. The longer UVA rays can contribute to both nonmelanoma and melanoma  type cancers.”

Need to Know

UVA rays can penetrate glass. Protect yourself from UVA rays by applying sunscreen before and during a trip in the car or if you’ll be sitting inside near a sunny window.

Do Sunscreens Really Protect Against Skin Cancer?

Sunscreens first became widely available in the 1970s, as scientists began to recognize the relationship between sun exposure and skin cancers. But as more people began to use sunscreens, skin cancer rates rose. In the United States, skin cancer rates have been rising since 1980 at the rate of about four percent per year. Repeatedly, studies have shown that people who used sunscreen regularly appeared to be more likely to develop melanoma than were people who didn’t. And sunburn – a risk factor for skin cancers – appears to be more common among sunscreen users than among people who wear protective clothing.

The discrepancy could be due to a combination of sunscreen science and changes in people’s behavior, says Tung. Older sunscreen formulations protected only against UVB rays. These sunscreens kept people from getting sunburned. So people started spending more time in the sun, thinking they were safe. UVA radiation went right through the old-generation sunscreens, causing unseen damage under the skin.

In addition, at least a portion of the increase in skin cancer rates could be due to more public awareness and better detection. “The American Academy of Dermatology has done a great job as far as public awareness,” Tung explains. “People are paying more attention to their skin, and when they see a new or changing lesion on their skin, they often seek the care of a dermatologist.”

If someone comes to her office and asks her to check a face lesion, they’re in for a full-out skin check. “If I find any suspicious or worrisome moles , I try to take them off right at that visit,” she explains. “So more cases of skin cancer are being detected, but earlier, which generally leads to better outcomes.”

Current-Generation Sunscreens: Better, but Not Perfect

Sunscreen formulations have changed dramatically over the last 20 years, becoming more powerful and protecting against a wider range of UV rays. Today, consumers have choices, including chemical sunscreens, mineral sunscreens, or sunscreens that offer a combination of protection. 

  • Chemical sunscreens work by absorbing and neutralizing ultraviolet radiation.
  • Mineral sunscreens (i.e. sunscreens containing zinc oxide and titanium dioxide) block the rays from getting through to the skin, creating a physical barrier against damaging UV radiation.
  • Other sunscreens contain a combination of chemical and mineral ingredients

But all sunscreens are not created equal – and it can be difficult for consumers to tell exactly how much of what type of protection they’re buying. A high sun protection factor (SPF) rating only measures the amount of protection a sunscreen offers from UVB rays. A sunscreen can receive a high sun protection factor (SPF) rating even if it does not block any UVA rays at all.

In the United States, there’s no standardized way to rate a sunscreen’s UVA protective ability, although Asia, Europe, Australia, and other regions of the globe have developed standardized systems to rate sunscreens’ UVA protection. That’s important, because sunscreens’ UVA-protective abilities vary widely.

Is Your Sunscreen Safe?

Each year, close to Memorial Day Weekend, the Environmental Working Group (EWG) publishes their annual report on sunscreens, “Skin Deep.” The 2011 report rates more than 1700 sunscreens “based on safety and effectiveness,” says the EWG, which bills it as “our biggest and most fact-packed database of U.S. sunscreen products ever.”

The EWG researchers raise troubling questions about the safety of common sunscreen ingredients. They directly attack two ingredients: oxybenzone and retinyl palmitate (a form of Vitamin A).

Oxybenzone, EWG investigators note , is a potential hormone disruptor (also called an endocrine disruptor). Hormones are messenger chemicals produced by the body that govern all biological processes. Hormone disruptors can mimic hormones, interfering with their normal function.  

EWG says oxybenzone isn’t safe, but Tung suggests that while there’s no final verdict, it’s probably fine in the concentrations being used. “Oxybenzone, may have properties similar to estrogens,” she notes. “So does soy.”

Retinyl palmitate (a vitamin A derivative) is the other chemical highlighted as especially dangerous by EWG researchers. They cite a study published in 2011 by the National Toxicology Program. Results of the study suggest that when used in the presence of sunlight, retinyl A may speed the development of tumors and skin lesions in mice.

But, says Tung, that makes little sense – retinyl palmitate is used to treat cancers. “In general, research has not borne out the risk that they’re talking about,” says Tung. “It may be that if you have more sensitive skin, or if the product is irritating your skin, you may choose to use a product that does not contain retinyl palmitate. They’re saying it causes cancer; however it’s used orally or topically to prevent skin cancer. We do know that in some people it may cause sun sensitivity. But there may be a sweet spot, in terms of concentration and application.”

So should you worry about potentially harmful effects of sunscreen ingredients? Probably not, says Tung. “All sunscreen ingredients are FDA approved and tested,” she explains. “Although there’s always room for further testing of ingredients, they have passed basic safety tests.”

Tung’s position is backed up by findings of a review of evidence about sunscreen safety and efficacy published in April 2011 by a research team from Sloan-Kettering Memorial Hospital. They found that topical use of sunscreen protects against squamous cell carcinoma and does not cause vitamin D deficiency. They did not find any evidence that sunscreens adversely affect health. On the contrary, investigators concluded that the use of sunscreens remains an important part of an overall sun protection strategy and called for development of even better formulas. However, they also noted that as more people use more sunscreen, “continuous and vigilant monitoring of the overall safety of future products is also needed.”

The U.S. FDA has approved 17 chemicals for use in sunscreens; European regulatory agencies have approved 28. EWG researchers argue that the cautious approach of the FDA is preventing U.S. consumers from accessing potentially safer and more effective sunscreens.

On the other hand, that cautious approach, says Tung, might be protecting U.S. consumers from unwarranted hazards.  “It’s an ongoing conversation,” she says. “Medical science is not static. After drugs are FDA approved, they do post-marketing studies to continue to test their safety.” Tung cites PABA as one example of a drug approved then recalled by the FDA. PABA was once found in almost all sunscreens, but after widespread use and studies, an FDA panel found that it caused allergies and other skin problems. 

Many of the limitations of current sunscreen ingredients have to do with stability. “Many sun-protective ingredients are not stable when exposed to UVA radiation,” explains Tung. “In some products, manufacturers are able to stabilize those ingredients. For instance, Neutrogena has patented Helioplex, a formula containing avobenzone and oxybenzone.  When you’re looking at products, look for a combination of chemical sunscreens and physical blocks.”

New Labeling Rules

On June 14, the FDA cut through some of the confusion by announcing its final ruling on labeling, designed to help consumers understand what they are buying in a sunscreen. Starting in the summer of 2012, sunscreen manufacturers will have to adhere to the new rules for testing and labeling their products.

In response to allegations by EWG and other groups that chemicals in sunscreens cause multiple problems, including cancers, the FDA simply stated that the chemicals were “previously found to be safe, [and the FDA will] continue to monitor to remain safe.”

Here are some of the changes the FDA is requiring on sunscreen labels:

  • “Broad Spectrum” needs to mean broad spectrum. If the label says “broad spectrum,” the sunscreen must have passed a specific FDA test that measures how much UVA protection the product provides relative to its UVB protection.
  • Manufacturers can only claim the product provides health benefits if the sunscreen provides broad spectrum protection with an SPF value of 15 or higher. Sunscreens must meet these criteria if their labels say they reduce the risk of skin cancer and early skin aging if used as directed with other sun protection measures. Sunscreens that don’t pass the FDA’s broad spectrum test procedure, as well as sunscreens with an SPF value between 2 and 14, can only claim to help prevent sunburn.
  • Manufacturers can no longer claim their products are waterproof or sweatproof. They can say they are water resistant if they indicate how long the sunscreen remains effective ( 40 or 80 minutes) while the wearer is sweating or swimming. Sunscreens that are not water resistant must include a direction instructing consumers to use a water resistant sunscreen if swimming or sweating.
  • Nix the word “sunblock:” The word "sunblock" can no longer be used on labels.
  • The label must explain the two-hour rule. Manufacturers can no longer claim that their product provides “all-day protection” or provides protection for more than two hours unless it has been proven to do so.
  • The label can’t say the sunscreen starts working immediately. Manufacturers cannot claim that a product provides “instant protection” or otherwise suggest it provides provide protection immediately after it’s applied. If a manufacturer does develop a product that provides such protection, they need to submit supporting data to the FDA and obtain FDA approval before including that claim on the label.
  • Drug Facts need to be included. All sunscreens must include standard "Drug Facts" information on the back and/or side of the container.

Those changes, says Tung, represent a significant step in the right direction. However, there’s still progress to be made. “I would like to see two additional things” she notes. “First, I’d like to see the FDA fast-track safety studies for chemicals found in European sunscreens, many of which offer better and longer protection from UVA rays. Second, I’d like to see a standardized rating system that allows consumers to assess just how 'broad' their 'broad spectrum' sunscreen really is.”

How to Choose the Best Sunscreen

The new FDA rules are designed to help consumers understand what’s in their sunscreen and choose a sunscreen that offers adequate protections. They’ll narrow down the field – slightly. Many sunscreen products are effective. But those aren’t the only criteria you should use in selecting your sunscreen.

In general, says Tung, choose a sunscreen that offers a mixture of chemical and mineral ingredients. Chemical-based sunscreens are more effective and last longer, while mineral ingredients tend to be less irritating to the skin. People with extremely sensitive skin, babies, and children might fare better with mineral-based, while the average person will generally get more protection from chemical-based or combination sunscreens.

It’s not about any one agent, says Tung, but how they are combined. “What’s the best combination of using ingredients a, b, and c together?” 

Luckily, safe and effective sunscreens are available in many forms – creams, gels, sticks, lotions, sprays, and other forms. Here are some more criteria you should use as you select your sunscreen for the day:

  • Choose a broad spectrum formula that’s effective against both UVB and UVA rays. Until the FDA’s new labeling rules go into effect, consumers will have to carefully read the fine print on their sunscreens to determine whether they’re purchasing products that provide adequate UVB and UVA protection. While almost all sunscreens provide adequate UVB protection, adequate UVA protection is harder to find. Look for the following ingredients on the label:
    • Avobenzone
    • Cinoxate
    • Ecamsule
    • Menthyl anthranilate
    • Octyl methoxycinnamate
    • Octyl salicylate
    • Oxybenzone
    • Sulisobenzone
    • Titanium dioxide
    • Zinc oxide
  • Choose the appropriate sunscreen for your activity. If you’re planning to spend the day at the beach, swimming and playing volleyball, you need a water resistant sunscreen. If you’re out for a casual stroll, a “daily” or other version will do. When in doubt, go for the water or sweat resistant option.
  • Choose a sunscreen that you’ll use. Sunscreen cannot protect against UVB or UVA rays if it’s still in the tube. If you purchase a sunscreen but can’t stand the oily feel, look for an oil-free sunscreen. Go for fragrance free formulations if you don’t want it to interfere with your perfume or you don’t like scents. If a sunscreen makes you itch or feel uncomfortable, try a mineral-based formulation.
  • Choose appropriate products for babies, young children, and people with sensitive skin.  Youngsters, older people, and everyone with sensitive skin may find that products with fewer preservatives and chemicals, and more physical blocks – zinc oxide and titanium – can be less irritating.
  • Choose a moderate SPF. While the FDA recommends an SPF of at least 15, many sunscreens sport SPF numbers of 60, 70, or greater. Don’t spend extra money on sunscreens labeled SPF 50 or greater. “There’s no evidence that SPF values greater than 50 provide any additional benefit,” says Jill Lindstrom, M.D., spokesperson for the FDA. In addition, high SPF ratings may actually change people’s behavior in dangerous ways. Several studies have shown that people who wear sunscreens with higher SPF labels tend to reapply them less often, reducing their effectiveness. So if you do choose a high SPF sunscreen, stick with the every-two-hours-or-after-swimming reapplication routine.
  • Choose a combination of chemical and mineral-based sunscreens. “Chemical sunscreens do offer more coverage than their physical sunscreen cousins,” says Tung. “However, if you rely solely on chemicals, sunscreen can be irritating to skin, causing rash and other problems.” By combining chemical with mineral ingredients, manufacturers can use lower concentrations of the same ingredients, causing less irritation to sensitive skin.
  • Don’t rely on price as a guide to effectiveness.  In 2010 Consumer Reports tested 12 leading sunscreens for effectiveness at blocking both UVB and UVA rays. The winner? Target brand’s “Up and Up Sport Continuous.” It sells at Target for $8.84 for two six ounce bottles. Besides, if you fork out $30 for a four-ounce bottle of sunscreen, how likely are you to use the recommended  one ounce every two hours?
  • Avoid powders and sprays. EWG researcher raise legitimate concerns about spraying nanoparticles around your face. Nanoparticles are not meant to be inhaled. They’re so tiny that it’s almost inevitable that they’ll end up in your lungs if they’re sprayed or dusted around. In addition, the FDA is still reviewing the effectiveness of chemical and mineral sprays. While the formulation may be effective, people might not be using them well. “It’s not clear that they are being applied correctly or at high enough concentrations to do any good,” says Tung.

How to Use Sunscreen Correctly

You can choose the perfect sunscreen, but if you don’t use it well, you won’t get the sun protection you need. Only 25 percent of people use sunscreens correctly, according to the American Academy of Dermatology. People may not apply enough sunscreen, they may miss body parts that are exposed such as ears, lips, and exposed feet, and they may forget to reapply sunscreen every two hours or after swimming. Improper use of sunscreen can lead to sunburns and skin damage – putting you at greater risk of skin cancer than if you’d stayed inside or worn long sleeves.

Tweens and Teens at Greater Risk of Sun Exposure

Tweens and teens may be some of the worst sunscreen wearers, says Tung. While moms and dads can still tackle a three-year-old and smear on the white stuff, tweens are developing their own sense of independence – and putting on enough sunscreen is one way for them to negotiate that independence. Teens and even young adults are often attracted by the idea of a tan, feeling that it makes them look more attractive.

“Tweens and teens may just put a little bit of sunscreen on,” explains Tung. “If their skin already feels oily, they may say sunscreen feels too greasy. Or they may want to glow like the models in magazine. So they don’t apply it properly, and they don’t reapply it often enough.”

Making matters worse, kids are exposed to more sun than most adults. It’s a myth that 80 percent of your lifetime sun exposure occurs during the first 18 years of life, according to the Skin Cancer Foundation. The actual figure is about 25 percent. But that’s still significant. And kids are outside more than adults – especially during the summer vacation months.

So what’s the best way to approach a tween or teen about sunscreen use? Start early with the sun protection message, and repeat it at crucial developmental points, says Tung. Enlist the help of experts, such as dermatologists, to get the message to kids: every little bit of damage cumulative and can contribute to your risk of skin cancer and skin aging. And, of course, model good sun protection habits for your kids.

Using sunscreen correctly can allow you to get the most protection. Here’s how:

  • Use sunscreen as part of a broader strategy for protecting yourself from the sun.
  • Don’t rely exclusively on sunscreens for sun protection.
  • Avoid the sun during peak hours (10 a.m. to 4 p.m.).
  • Wear protective clothing with a rating of SPF 30 or greater. Protective clothing should be lightweight and include a broad-brimmed hat, UV-protective sunglasses, shoes that cover your feet, long sleeves, and long pants.
  • Keep infants out of the sun.
  • Avoid tanning salons.
  • Use about one ounce (enough to fill a shot glass) of your chosen sunscreen for your body. Use an additional teaspoon to tablespoon for your face.
  • Apply sunscreen at least 15 to 30 minutes before you go outside. “It takes that long for the chemicals in the sunscreen to interact with your skin to protect you,” says Tung.
  • Reapply sunscreen every one and one-half to two hours when you’re out in the sun
  • Reapply sunscreen every time you get out of the water, towel off, or no matter what the SPF factor or what sort of water resistance claims it makes.
  • If you’re using a moisturizer that contains sunscreen, reapply it frequently, just as you would any other sunscreen.
  • Don’t forget the little parts. Apply sunscreen to feet, hands, ears, and under your nose.
  • Use a lip balm that contains a sunscreen with an SPF of 30 or higher. If you’re concerned about swallowing chemicals, choose a mineral-based formula. Reapply frequently.
  • If you can’t (or won’t) wear a sun-protective hat, use sunscreen on your scalp. Tung advises using a spray sunscreen for this purpose – but using enough of it to protect yourself.
  • Pitch the old stuff. Chemicals can degrade over time, especially if the sunscreen has been exposed to heat or cold. Check the expiration date on your sunscreen, and throw it out if it’s more than three years old.

 

References

American Academy of Dermatology. (2011). Sunscreens. Retrieved from http://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreens

Burnett M.E. & Wang S.Q. (2011). Current sunscreen controversies: a critical review. Photodermatol Photoimmunol Photomed. 27(2):58-67. doi: 10.1111/j.1600-0781.2011.00557.x

Environmental Working Group. (2011, April). EWG’s Skin Deep: Sunscreens 2011. Available at http://breakingnews.ewg.org/2011sunscreen/

Green A.C., Williams G.M., Logan V., & Strutton G.M. (2011). Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol. Jan 20;29(3):257-63. Epub 2010 Dec 6.

Monteiro-Riviere N.A., Wiench K., Landsiedel R., Schulte S., Inman A.O., Riviere J.E. (2011, Jun 3). Safety Evaluation of Sunscreen Formulations Containing Titanium Dioxide and Zinc Oxide Nanoparticles in UVB Sunburned Skin: An In Vitro and In Vivo Study. Toxicol Sci. [Epub ahead of print]

National Toxicology Program. (2011). Abstract for TR-568 – Retinoic Acid/Retinyl Palmitate. Photocarcinogenesis Studies of Retinoic Acid and Retinyl Palmitate [CAS Nos. 302-79-4 (All-trans-retinoic acid) and 79-81-2 (All-trans-retinyl palmitate)] in SKH-1 Mice (simulated solar light and topical application study).

Personal Care Products Council. (2011, May 23). Statement by Farah Ahmed, Chair Personal Care Products Council Sunscreen Task Force, Response to the 2011 EWG Sunscreen Report. Retrieved from http://www.personalcarecouncil.org/newsroom/20110523

Skin Cancer Foundation. (2011). Sunscreens Explained. Retrieved from http://www.skincancer.org/sunscreens-explained.html

Tung, Rebecca. (July 6, 2011) Telephone Interview.

U.S. Food and Drug Administration. (2011, June 14). FDA Announces Changes to Better Inform Consumers About Sunscreen. Press Release. Retrieved from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm258940.htm