Ritu Saini, MD, and Andrea Szemplinski, MS, RPA-C
Skin cancers are more prevalent than ever: one out of every five Americans will get skin cancer at some point in their lives, and the disease will kill more than 12,000 people in the US in 2013.1,2 About 90 percent of the time, the risk of developing skin cancer is directly related to the amount and intensity of ultraviolet (UV) light exposure one receives from the sun.3,4,5 Fortunately, it’s easy to limit excessive UV exposure — and lower your risk of skin cancer — with the regular use of sun protection. Sunscreen is an important part of the equation, and finding the right one for your specific needs can be a challenge.6,7
Seventeen sunscreen ingredients have been approved for use in the US by the Food and Drug Administration (FDA); they include both chemical and physical substances.8 [See Table 1.] Chemical sunscreen ingredients, such as PABA (para-aminobenzoic acid) and cinnamates, absorb UV rays and convert the sun’s radiation into heat energy, while physical sunscreens (such as zinc oxide and titanium dioxide) deflect and scatter the rays before they penetrate your skin. Both types can be effective and safe if used properly. The question is, which sunscreen ingredients are right for you? For example, babies and toddlers have different sun protection needs than adults, while sunscreens made for dry skin may not suit people with acne or rosacea. The following guide should help you find the right sunscreen for your skin’s needs.
Incidental vs. intense exposure:
For starters, the kind of sunscreen you use may vary depending on the type of outdoor exposure you are expecting. For incidental sun exposure — when you are outside only for minutes at a time — a sun protection factor (SPF) of 15, which filters out about 93 percent of UV radiation, is usually sufficient. Your sunscreen should have broad spectrum protection, meaning it effectively protects against significant portions of both the ultraviolet A (UVA) and ultraviolet B (UVB) ranges of the light spectrum. Most broad-spectrum formulas contain multiple sunscreen ingredients. For extended, intense exposure, you should use a broadspectrum, water-resistant sunscreen with an SPF of 30 or higher. SPF 30 filters out up to 97 percent of the sun’s UV radiation; SPF 50 filters out up to 98 percent.
- For children’s skin: Chemicals can irritate children’s sensitive skin; PABA and oxybenzone in particular have been associated with skin reactions.9,10 The physical sunscreens zinc oxide and titanium dioxide tend to be better tolerated by people with sensitive skin and can usually be found in sunscreens for babies and children. Also, since getting children to use sunscreen is half the battle, try spray sunscreens or tubes with colorful packaging, which children may find more enjoyable to use. (Spray sunscreens should not be applied directly to the face; sprays should be misted into the hands, then spread on the face.)
- For allergy-, acne-, and rosacea-prone skin: Patients with allergy-prone skin or conditions such as acne or rosacea should avoid products containing preservatives or fragrances, as well as those containing PABA or oxybenzone. Again, the ingredients least likely to cause skin reactions are the physical sunscreens, as well as those made with salicylates and ecamsule.10 Allergy prone and rosacea patients should also avoid sunscreens containing alcohol. Patients with acne, however, may find gel formulas, which usually contain alcohol, more drying and less likely to aggravate acne. Acne-prone patients should avoid greasy sunscreens (often marketed as “creams”), since they may exacerbate breakouts; the UVB filter ensulizole has a lighter, less oily consistency than most other chemical sunscreens.11 However, people on topical acne medications, which tend to be drying, may find gels too irritating on their sensitized skin and may benefit from a light lotion or cream base. Since some acne medications increase sun sensitivity, making wearers more vulnerable to burning and skin damage, rigorous daily sun protection is especially important.
- For dry skin: Dry skin can benefit from moisturizing sunscreens. Numerous moisturizers are used in sunscreens; popular ones include lanolin, oils, and silicones such as dimethicone. Moisturizing sunscreens are often formulated as creams, lotions, or ointments, so look for these terms on the label.
- For people with melasma, a history of skin cancer, or very fair skin: For patients with a blotchy brown discoloration of the skin called melasma, those who have had skin cancer, or those who are very fair, sunscreen with an SPF of 30+ is recommended daily for extra protection. Since most people do not actually apply enough sunscreen to achieve the SPF listed on the container, frequent reapplication (after two hours out of doors or immediately after swimming or sweating heavily) is especially important.
- For darker skin tones: Individuals with darker skin who tan easily and rarely burn may feel they do not need to use sunscreen. However, like sunburn, a tan is the result of DNA damage from exposure to the sun’s harmful UV radiation. Darker-skinned people may also be wary of using physical sunscreens, especially titanium-based products, because they can look chalky and white on the skin.12 Newer preparations, however, tend to be micronized, which means the particles are small enough to allow them to blend in and disappear into the skin. Chemical sunscreens are also an option; look for a broad-spectrum sunscreen with an SPF of 15+.
- For the older person: Although older individuals may have already received large amounts of UV light exposure in their lifetime, they can still benefit from sunscreen use. At any age, unprotected sun exposure increases the risk of developing new skin cancers and precancers; it also accelerates skin aging, leading to age spots, wrinkles, sagging, and leathery skin. Older people with decreased mobility may have a hard time applying sunscreen to areas such as the legs and back; for them, spray-on sunscreens may be a great option — they are now available both in chemical and physical formulations. Sprays should be applied until an even sheen appears on the skin.
Sunscreen is an important part of a sun protection regimen that should also include seeking the shade, avoiding UV tanning, and wearing protective clothing, including a broad-brimmed hat and UV-blocking sunglasses. By educating yourself about your many sunscreen options, you can be confident that the product you choose will fit your particular needs, offering you the best protection from the sun’s harmful rays — and helping to ensure that you use it regularly. After all, the sunscreen you apply consistently is the best sunscreen of all.
Ritu Saini, MD, received her medical degree from NYU School of Medicine and completed a dermatology residency at the University of Miami. She trained in a Mohs surgery/cosmetic dermatology/laser fellowship under Perry Robins, MD, and subsequently took over his practice. Dr. Saini holds a voluntary faculty position at NYU School of Medicine.
Andrea Szemplinski, MS, RPA -C, a certified physician assistant who specializes indermatology, received a Master’s degree from New York Institute of Technology. She works with Ritu Saini, MD, and Brent Wainwright, MD, in dermatology-focused private practices in Manhattan, the Rockaways and the Bronx.
- Robinson, JK. Sun exposure, sun protection, and vitamin D. JAMA 2005; 294(12):1541-43.
- American Cancer Society. Cancer Facts & Figures 2013. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf. Accessed Jan. 22, 2013.
- Koh HK, Geller AC, Miller DR, et al. Prevention and early detection strategies for melanoma and skin cancer: current status. Arch Dermatol 1996; 132(4):436-442.
- Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer 2005; 41(1):45-60.
- Gallagher RP, Lee TK, Bajdik CD, Borugian M. Ultraviolet radiation. Chronic Dis Can 2010; 29 Suppl 1:51-68.
- Van der Pols JC, Williams GM, Pandeya N, et al. Prolonged prevention of squamous cell carcinoma of the skin by regular sunscreen use. Cancer Epidemiol Biomar Prev 2006; 15(12):2546-8.
- Green AC, Williams GM, Logan V, Strutton GM. Reduced melanoma after regular sunscreen use: randomized trial follow-up.J Clin Oncol 2011; 29(3):257-63.
- US Food and Drug Administration. CFR — code of federal regulations title 21. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=352&showFR=1. Last updated April 1, 2012.
- Scheuer E, Warshaw E. Sunscreen allergy: a review of epidemiology, clinical characteristics and responsible allergens. Dermatitis 2006; 17(1):3-11.
- Palm MD, O’Donoghue MN. Update on photoprotection. Dermatol Ther 2007; 11(5):360-76.
- Sambandan BA, Ratner D. Sunscreens: an overview and update.J Am Acad Dermatol 2010; 64(4):748-758.
- Pinnell SR, Fairhurst D, Gillies R, et al. Microfine zinc oxide is a superior sunscreen ingredient to microfine titanium dioxide. Dermatol Surg 2000; 26(4):309-14.