What does a sunscreen label tell you?

In preparation for discussing the new sunscreen labels, I reviewed a post I wrote a year ago - here - and found that I really don't have new news. The labels do contain new language and unresolved issues are still unresolved.  But at least the labels are now on the products.

I will proceed with the post because as someone who can barely function on cloudy days, sun protection is very important to me.  It is also important because my job as a health educator is to remind people to be safe and smart about their time in the sun.  Evidence does support a link between sun exposure, especially sun burn, and skin cancer and early skin aging.*  (FYI: shoe hide skin is not becoming and your skin will become shoe hide like if you don't protect it.)

When you spend time in the sun:

wear sunscreen, and
make sure that the label says both of these things:

• broad spectrum
• SPF 30 (or more)

It is also good if the sunscreen has a seal from the Skin Cancer Foundation,** of which there are several types:

• Daily Use
• Active
• International
• Traditional

Click here to get the definitions straight from the source, but in case you don't click, I'll provide a brief rundown: the daily use is for people who are exposed to the sun for short bursts of time in their everyday life, for example, going from the car to a store, checking the mail, etc.  Active use is the seal I look for and it is for extended periods of sun exposure while engaging in outdoor recreation, like running, cycling, walking the beach. The international seal is for outside the US and is a little different than the daily and active seal I just described, but it is undergoing a revision so I don't have more details.  Lastly, the traditional seal is for products that block the sun (e.g., glasses, hats) that are not sunscreen.  All products which carry the Skin Cancer Foundation (SCF) seal have undergone rigorous testing (the manufacturer submits data to the scientific advisory committee at SCF). Not all of the products that have passed the 'test' have the seal on their label.  You can search for recommended products, by category here.  Although in my store visit yesterday, I did not see any spray-on products with the seal, I did see some on the SCF website. 

The new label on sunscreen - where the manufacturer uses terms like broad spectrum and includes the SPF factor - may also say that the product protects against skin cancer and early skin aging.  The reason the manufacturers can make this claim (as long as its SPF greater that 15 and broad spectrum) is because the company has to provide scientific evidence to the FDA that the product offers broad spectrum protection and spf 15 or higher, and those two factors have been empirically tested in regards to the protection they offer against skin cancer and early skin aging (think wrinkles). 

In addition, the label will now tell you how long you can wear the sunscreen while swimming or sweating before the sunscreen needs to be reapplied.  In other words, the sunscreen can be water resistant, but that declaration has to come with a time frame that has been tested.

The issue of  whether or not SPF protection over 50 is possible, has not been resolved, nor has the issue about spray-on sunscreens (they may not cover the body completely and may have toxic fumes).  However, any sunscreen with SPF under 15 has to have a warning that it does NOT protect you from either sun damage or skin cancer.  

I echo the sentiments of many others when I say, use lotion not spray, choose between SPF 30 and 50 and reapply every two hours, but I add this caveat.. . unless you are employed as an outside worker, 2 hours of direct sun a day is bordering on too much.  You need more than sunscreen  - long sleeves, hats, sunglasses for example.

I ran out of my sunscreen last weekend.  I had the spray-on kind, but after reading that the concerns about the fumes and full body protection continue, I opted for a lotion this time.  I agree that SPF 30 is sufficient.  I did choose a product with the SCF Recommendation Active.  Here are photos of my label.  Notice the information about how long this lotion is expected to protect me.

You can see the broad spectrum and SPF declarations and that this lotion is water resistant with the 80 minutes in parenthesis.  I have read that it might be a good idea to avoid oxybenzone, so I like that this product is free of it.  (Oxybenzone may have endocrine effects (related to hormone secretion/disruption)).  I later noticed that this compound is in the sunscreen lotion I recently purchased for my face. This  bothers me.  However, there is no scientific consensus on oxybenzone risks and               many dermatologist still                                                                       recommend it.  Read more here and here.)

The SCF seal is on the back of the bottle.  In the section that begins, Sun Protection Measures, is the language about sun exposure and risk for cancer and early skin aging and how products with broad spectrum and spf + 15 can protect against this risk.

*Epstein, J. H. (1983). Photocarcinogenesis, skin cancer, and aging. Journal of the American Academy of Dermatology, 9(4), 487-502.

**I read in a newspaper article that the companies who wish to submit their product information for a test to receive the SCF seal, must pay a fee or make a donation.  I do not know if that is true, but I have emailed a contact person at the SCF to find out. Meanwhile, the other information about broad spectrum and SPF language is by law and regulated by the FDA.

The Sunscreen Study

A few weeks ago, the popular press (print, online and TV) was a buzz about a study that showed a reduction in the look of skin aging with regular use of sunscreen.  I made a note to find that study because I wondered how the finding was determined.  I wanted to know who the comparison group was.

Here is the study citation:
Hughes, M. C. B., Williams, G. M., Baker, P., Green, A. C. (2013). Sunscreen and prevention of skin aging: A randomized trial. Annals of Internal Medicine, 158(11), 781-790. doi: 10.7326/0003-4819-158-11-201306040-00002

The study took place in Australia and involved about 900 adults who were under the age of 55.  The authors noted, and I found interesting, that having old looking skin when you are under age 55 is related to the affect of the sun only, not that of the sun and getting old.  

Otherwise and to be honest, the research design in this particular study was hard for me to follow.

People in the study were randomly assigned to one of two or four conditions (my confusion). The study was not just about sunscreen and aging. The researchers also wanted to know if taking a beta carotene supplement would reduce the signs of photoaging.  It looks like people were assigned to a group where they were asked either to apply sunscreen every day (and they were supplied with the sunscreen) or to use sunscreen on their own and at their will.  These same people (2 groups) or more people (4 groups) were assigned (blindly) to take beta carotene pills every day or to take a placebo  pill.  In other words, the people did not know which pill they were taking. I can't tell if the people in the sunscreen group were the ones randomly assigned into pill groups.  It would make more sense to have 4 groups, but then it would also make more sense to report it as two separate studies.  However, the pills didn't help and they are not the point of this blog.

The main point is that no one was assigned to a no sunscreen  group (because that would be unethical) and more importantly, no one was assigned to a lotion only group.

All the people in the study were assessed for the signs of aging in 1992 before they began the study and most of them were assessed again four years later.  The assessment consisted of a visual exam of the skin on their hands.  The exam was done by trained professionals and they graded the skin on a scale from 1 to 6.  People in the daily sunscreen group had lower grades on this visual inspection than those in the other groups - at the second time.  Lower grades are good.  There was no difference in the grade for those who took the supplements.  (They also answered questions about their daily sun and other lifestyle habits).

I am 100% in favor of sunscreen and I do believe that it prevents damage from both UV A and B rays.  From this study alone, I am not convinced that sunscreen is as effective or more effective than  body lotion for preserving a youthful skin appearance.  

I am especially baffled by using the hands as the assessment.  It would seem that the face would get more sun exposure and that the hands would tend to get washed a lot during the day so as not to be truly 'sun screened.'

I have youthful skin - so say I :).  I attribute mine to stopping smoking many years ago, eating healthy, getting daily exercise (blood and oxygen flow) and by applying body lotion from my head to the bottom of my feet every single day - because my Mom told me to.

So wear your sunscreen, hats and glasses but do these other things as well.