How Safe Is Your Sunscreen? Latest FDA Findings for Healthcare Professionals

As healthcare professionals, it's crucial to stay updated with the latest safety guidelines and recommendations, especially when it comes to common health interventions like sunscreen use. Sunscreen is one of the most effective ways to protect against skin cancer and other forms of skin damage caused by ultraviolet (UV) radiation. However, recent studies and ongoing investigations by the U.S. Food and Drug Administration (FDA) have raised questions about the safety of certain sunscreen ingredients. While these evaluations are ongoing, the American Academy of Dermatology (AAD) and other professional bodies continue to advocate the use of sunscreen as an essential measure to protect skin health.

The Importance of Sunscreen

Sunscreen plays a vital role in preventing sunburn, photoaging, and skin cancers, including melanoma, squamous cell carcinoma, and basal cell carcinoma. The American Academy of Dermatology recommends using a broad-spectrum sunscreen with an SPF of 30 or higher. Broad-spectrum sunscreens protect against both UVA and UVB rays, two types of ultraviolet radiation that can damage the skin.

According to the American Academy of Dermatology, skin cancer is the most common cancer in the United States, with one in five Americans expected to develop skin cancer in their lifetime. Regular use of sunscreen has been shown to reduce the risk of developing skin cancer significantly. Despite these benefits, concerns have been raised about the safety of some sunscreen ingredients, leading to recent investigations by the FDA.

FDA's Current Evaluation of Sunscreen Ingredients

The FDA is responsible for ensuring the safety and effectiveness of sunscreens. As part of its ongoing efforts to review the safety of over-the-counter (OTC) drugs, the FDA is currently evaluating several active ingredients commonly found in sunscreens. This evaluation focuses on the absorption of these ingredients into the bloodstream and their potential systemic effects.

A study published in the Journal of the American Medical Association (JAMA) in 2019 examined the systemic absorption of four active sunscreen ingredients: avobenzone, oxybenzone, octocrylene, and ecamsule. The study found that all four ingredients were absorbed into the bloodstream at levels higher than the threshold established by the FDA, raising concerns about their potential safety. This discovery led to a call for further research to determine whether these ingredients pose any risk when absorbed systemically.

The FDA has requested additional safety data from sunscreen manufacturers to understand better the long-term effects of these ingredients when absorbed into the body. The key concern is whether chronic exposure to these ingredients could lead to hormone disruption, skin allergies, or other systemic side effects. However, it's important to note that the FDA has not recommended discontinuing the use of sunscreens, as the proven benefits of sunscreen in preventing skin cancer and sunburn outweigh the theoretical risks associated with absorption.

Understanding the Ingredients Under Scrutiny

1. Oxybenzone: One of the most commonly used ingredients in chemical sunscreens, oxybenzone is effective in protecting against UVA and UVB rays. However, it has been found in human blood, urine, and breast milk, leading to concerns about its potential endocrine-disrupting effects. Some studies suggest that oxybenzone may affect hormone levels, particularly in children and pregnant women, but the evidence is not conclusive.
2. Avobenzone: Known for its broad-spectrum UVA protection, avobenzone is a critical ingredient in many sunscreens. It is relatively stable when exposed to the sun and is often combined with other ingredients to provide comprehensive UV protection. The FDA's concern is primarily about the systemic absorption and long-term safety profile of avobenzone.
3. Octocrylene: This ingredient serves as both a UV filter and a stabilizer for other ingredients like avobenzone. Octocrylene has been linked to skin allergies and is also absorbed into the bloodstream. The FDA is reviewing its safety profile to ensure that there are no harmful effects associated with its use.
4. Ecamsule: This relatively newer ingredient provides effective UVA protection and is commonly found in sunscreen formulations. Like the other ingredients, it is under review to determine its safety profile, particularly regarding its potential systemic effects when absorbed through the skin.

The FDA's Stance and Future Directions

The FDA has emphasized that while these studies are ongoing, people should not stop using sunscreen. The primary reason is the well-documented benefits of sunscreen in preventing skin cancers and other skin-related issues caused by UV exposure. The FDA's position is based on the principle of "better safe than sorry"—continuing to use sunscreen while more comprehensive safety data is collected is a more prudent approach than risking UV exposure without protection.

In addition to reviewing the safety of these ingredients, the FDA is also considering other factors, such as:

• Formulation Types: Sunscreens come in various formulations, including lotions, sprays, and sticks. Each type has a different absorption rate and safety profile. The FDA is examining how the formulation affects the absorption and efficacy of sunscreen ingredients.
• Usage Patterns: Different people use sunscreens in different ways, from frequent reapplication in outdoor activities to occasional use during casual exposure. The FDA is looking into how these varying usage patterns impact the systemic absorption of ingredients.
• Pediatric Safety: Special attention is being given to the potential effects of sunscreen ingredients on children, whose skin may absorb these chemicals differently than adults.

Recommendations for Healthcare Professionals

As healthcare professionals, it is essential to guide patients on the safe and effective use of sunscreen. Here are some key points to consider when discussing sunscreen use with patients:

1. Reinforce the Benefits of Sunscreen: Emphasize that sunscreen is one of the most effective tools available to prevent skin cancer, premature aging, and other harmful effects of UV radiation. Patients should continue to use sunscreen daily, especially when spending time outdoors.
2. Recommend Broad-Spectrum Sunscreens: Encourage patients to use broad-spectrum sunscreens with an SPF of 30 or higher. Broad-spectrum sunscreens protect against both UVA and UVB rays, which are both harmful to the skin.
3. Suggest Mineral-Based Sunscreens: For patients concerned about the absorption of chemical ingredients, recommend mineral-based sunscreens that contain zinc oxide or titanium dioxide. These ingredients are not absorbed into the bloodstream and are considered safe and effective.
4. Educate on Proper Application and Reapplication: Remind patients to apply sunscreen generously and reapply every two hours, or immediately after swimming or sweating. Many people do not apply enough sunscreen, reducing its effectiveness.
5. Discuss Additional Sun Protection Measures: While sunscreen is essential, it should be part of a comprehensive sun protection strategy that includes seeking shade, wearing protective clothing, hats, and sunglasses, and avoiding the sun during peak hours.

Addressing Common Concerns and Myths

1. Myth: Sunscreen Is Not Needed on Cloudy Days: Even on cloudy days, up to 80% of UV rays can penetrate the skin. Encourage patients to use sunscreen every day, regardless of the weather.
2. Myth: Higher SPF Sunscreens Offer Complete Protection: While higher SPF sunscreens provide more protection against UVB rays, they do not offer 100% protection. Patients should be educated that no sunscreen can block all UV rays and that other protective measures are still needed.
3. Concern: Sunscreen and Vitamin D Deficiency: Some patients may worry that using sunscreen will lead to vitamin D deficiency. However, studies have shown that the regular use of sunscreen does not significantly impact vitamin D synthesis. Encourage patients to get their vitamin D levels checked and consider supplements if needed.

Conclusion: A Balanced Approach to Sunscreen Use

While the FDA continues its investigation into the safety of sunscreen ingredients, the overarching message is clear: do not stop using sunscreen. The benefits of sunscreen in preventing skin cancer and sun damage far outweigh the potential risks associated with systemic absorption of certain ingredients. Healthcare professionals should continue to advocate for sun safety and educate patients on the proper use of sunscreen as part of a comprehensive skin health strategy.

As research continues, it's likely that the FDA will provide clearer guidelines on which ingredients are deemed safe and which may require reformulation. Until then, staying informed about ongoing studies and educating patients based on the best available evidence is the most prudent course of action.