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Sun protection

June 2005

Sunscreens—the ultimate cosmetic.

One decade ago, a sun protection factor (SPF) of 15 was considered a complete blocker of ultraviolet radiation (UV). The logic behind that cutoff point was that sunscreens with this SPF number would always prevent erythema and that preventing erythema would prevent all the ill effects of UV exposure. Today, we know that both of these assumptions were wrong and we tend to recommend higher SPF. Consumers apply only about one-quarter to one-half thickness of the layer of sunscreen material used to measure the SPF in the laboratory. That means that less than 50% of the SPF number claimed on the label is spread on the consumer’s skin, meaning that a sunscreen with an SPF 30 will give the real protection of an SPF of 15. Therefore, recommend 60 when you want a real protection of 30! Significant injury, DNA damage, mutations, and carcinogenesis can and do occur also with cumulative suberythemal UV exposure. Thus, erythema induction, a criterion that defines SPF, is not a good indicator of UV damage. We also need higher SPF values to prevent the damage caused by suberythemal doses of UV. The value of the SPF claimed on the label is diminished by environmental factors that are not taken into account during SPF measurements in the laboratory, such as sweating, water immersion, rubbing off, and photodegradation. There are some misunderstandings and confusion about the mode of action of physical sunscreens. It was originally considered that, in contrast to organic sunscreens, the inorganic metal oxides (zinc oxide and titanium dioxide) acted as scatterers or reflectors of UV light, as a mirror. This is not the case with modern micronized forms of metal oxides. It has been shown that both zinc oxide and titanium dioxide mobilize electrons within their atomic structure while absorbing UV radiation. Thus, although metallic oxides are not inert per se, in their coated form they are stable, non-toxic, and safe and they act as highly efficient UV attenuators. Therefore, we recommend our patients to use this type of sunscreens. We should exert all our influence upon our patients not to expose themselves to excessive sunlight, to routinely use generous layers of sunscreen agents, and to wear protective clothing. To wait for the dust to settle around the issue of the effectiveness of sunscreens in preventing melanoma, while the ideal sunscreens—topical, systemic, whatever—are at our disposal, is a luxury we cannot afford.

Acta Dermatovenerol Croat. 2003;11(3):158-62

Protective effects of curcumin against oxidative damage on skin cells in vitro: its implication for wound healing.

BACKGROUND: Curcumin, isolated from turmeric, has been known to possess many pharmacologic properties. It has been proven to exhibit remarkable anticarcinogenic, anti-inflammatory, and antioxidant properties. Turmeric curcumin may be a good potential agent for wound healing. METHODS: To further understand its therapeutic mechanisms on wound healing, the antioxidant effects of curcumin on hydrogen peroxide (H2O2) and hypoxanthine-xanthine oxidase induced damage to cultured human keratinocytes and fibroblasts were investigated. Cell viability was assessed by colorimetric assay and quantification of lactate dehydrogenase release. RESULTS: Exposure of human keratinocytes to curcumin at 10 microg/mL showed significant protective effect against hydrogen peroxide. Interestingly, exposure of human dermal fibroblasts to curcumin at 2.5 microg/mL showed significant protective effects against hydrogen peroxide. No protective effects of curcumin on either fibroblasts or keratinocytes against hypoxanthine-xanthine oxidase induced damage were found in our present studies. CONCLUSION: The findings indicate that curcumin indeed possessed powerful inhibition against hydrogen peroxide damage in human keratinocytes and fibroblasts.

J Trauma. 2001 Nov;51(5):927-31

Sun exposure, sunscreens, and skin cancer prevention: a year-round concern.

OBJECTIVE: To review the role of sunlight in skin aging and skin cancer formation, and to provide guidelines on the use of sunscreens to minimize the adverse effects of sun damage. DATA SOURCES: A MEDLINE search of applicable articles on ultraviolet (UV) radiation, melanoma, sunscreens, and skin cancer, evaluating both human and animal studies. Published and unpublished original research as well as clinical experience were also used. DATA SYNTHESIS: The interaction of UV radiation and skin type plays a central role in melanoma formation. Mortality from melanoma is highest in geographic locations near the equator, where UV intensity is greatest. The incidence of melanomas in light-complected individuals (skin types I-III) is several times higher than those with darker skin types (types IV-VI), even in similar geographic regions. The UVB portion of the spectrum appears to be primarily responsible for skin cancer formation and photoaging, while short wave UVA rays play a significant contributing role. Regular sunscreen use has been shown to reduce the formation of precancerous actinic keratoses (AK) lesions by 36%. A dose-response relationship has also been found between the amount of sunscreen used and AK formation. CONCLUSIONS: Sunscreens have now been shown to reduce the carcinogenic effects of sunlight in humans. Patients should be advised of the long-term consequences of sun exposure and the benefits of regular sunscreen use.

Ann Pharmacother. 1996 Jun;30(6):662-73

Sunscreen isn’t enough.

Topical sunscreens act by absorbing or scattering UV radiation and are widely available for general public use as a consumer product. Surveys carried out in the UK find that sunscreen use is regarded as the most important, and by implication the most effective, sun protection measure. But is perception borne out by reality? Sunscreens applied at the thickness tested by manufacturers need only possess an SPF of 15 to prevent sunburn even for all day exposure in tropical sunshine. Yet behavioural studies show that high SPF (>15) sunscreens do not always prevent sunburn. That the protection achieved is often less than that expected depends upon a number of factors: application thickness and technique; type of sunscreen applied; resistance to water immersion and sand abrasion; and when, where and how often sunscreen is re-applied. These factors provide ample evidence that the numerical measure of protection indicated on the product pack is generally higher than achieved in practice. This mismatch between expectation and realisation may be one contributing factor why sunscreens have been reported to be a risk factor in melanoma.

J Photochem Photobiol B. 2001 Nov 15;64(2-3):105-8

Effect of daily versus intermittent sunscreen application on solar simulated UV radiation-induced skin response in humans.

BACKGROUND: Acute and chronic skin damage occurs as a consequence of solar UV radiation exposure. To diminish such skin damage, the dermatologic community advocates the daily use of sunscreens as part of a sun avoidance strategy. OBJECTIVE: We determined the effectiveness of a sunscreen product with a sunscreen protection factor (SPF) of 15 applied daily in preventing UV-induced histologic damage in human skin compared with the protection afforded by sunscreens with equal or higher SPF applied intermittently. METHODS: Twenty-four subjects were exposed to 2 minimal erythema doses of solar-simulated UV on 4 consecutive days. Three sunscreen products were applied to the buttock of each subject. One SPF 15 product was applied daily before exposure to UV and, to simulate intermittent product use, an SPF 15 or SPF 29 product was applied on 3 of 4 days, with one missed application on days 2, 3, or 4. Skin biopsy specimens were taken and processed for routine and immunohistochemical staining. Changes in number of sunburn cells and Langerhans cells as well as degree of inflammatory infiltrate and lysozyme immunostaining were determined. RESULTS: There was a statistically significant increase in the number of sunburn cells, degree of inflammation, and intensity of lysozyme staining, and there was a decrease in the number of Langerhans cells at sites where sunscreen application was missed as compared with unirradiated control and daily SPF 15 sunscreen-treated sites. CONCLUSION: Our data suggest that daily use of a sunscreen reduces the skin damage produced by UV exposure compared with intermittent use of equal or higher SPF products. The daily application of sunscreens in appropriate quantities reduces the harmful effects of solar UV radiation on skin. Compliance is essential for maximal benefit of sunscreens.

J Am Acad Dermatol. 2000 Oct;43(4):610-8