Sun Screens and Photo

protection

Presenter : Dr
Moderator: Dr M Alok
Ramam Comments: Dr
Mamta
 Immediate and
Persistent
Erythema
pigment
Edema
darkening
Thickening of
epidermis and
dermis

Photo aging(UVA
>UVB)
Immuno suppresion Not relevant to
(UVA>UVB) brown skin
Photo
carcinogenesis (UVB
>UVA)
Effect of Solar radiations

Visible Radiations
Effects and side effects poorly explored

Enough data suggesting biological effects

Erythema, pigmentation

Free radical production and DNA damage

 Effect of Solar radiations
Photodermatoses
Idiopathic
PMLE UVA>UVB
CAD UVB>UVA>Visibl
H. vacciniforme e
Drug and
chemical Actinic prurigo UVA>UVB
induced Solar urticaria UVB=UVA
UVA=Visible>UV
Exogenous: photoirritant UVA>>Visible
B
Defective Exogenous: photoallergy UVB
DNA repair Endogenous: porphyria Visible

Xeroderma pigmentosum UVB

Connective Cockayne syndrome UVB
tissue disease Smith-Lemli-Opitz UVA

Lupus erythematosus UVB>UVA

Dermatomyositis Not known
 Natural Physical

Systemic Topical
Natural
Photoprotective agent
Physical
Systemic
Topical

Absorbs most of Decrease intensity of

UVC ,UVB UVR

Absorbs most of Protection against UVR

UVB , and
Some amount of visible light
UVA
 Photo protective agent
Natural
Physical
Systemic UV PROTECTION
Topical UVB > FACTOR
UVA (UPF)

UPF should be greater

than 30
Average UVA transmission
<5%

Wool , Polyester : High

For Photo sensitive patient UPF
UPF > 30 Cotton ,Linen ,rayon <
15
Summer cotton T-
Shirt: 5-9
 Photoprotective agent
Natural A wide-brimmed hat
Physical (>7.5 cm)
Systemic SPF 7 for nose, 3 for
Topical cheek,
5 for neck, and 2 for chin

Medium-brimmed hats (2.5-

7.5 cm)
SPF 3 for nose, 2 for cheek
and neck, and none for chin
Narrow-brimmed hats (<2.5 cm) provide
only SPF 1.5
for the nose, and minimal, for other areas
 Photo protective agent
Natural
Physical Facial foundation without sun
Systemic screen
Topical SPF : 2-6
With sun screen:15

Effective up to 4
hours
 Photo protective agent
Natural Should meet a standard of Clear glasses absorb majority of
Physical <0.001% permissiveness for UVB radiation
Systemic <0.01% for UVA light radiation. below 320 nm but not UVA
Topical

Xeroderma
pigmentosum
Oculo cutaneous
albinism

Best protection by sunglasses with Darkly tinted glasses block longer

a wraparound style or side shields. wavelengths
including UVA and visible light
 Photoprotective agent
Natural
Physical
Systemic
Topical

No effective systemic photoprotective

agent available
 Sun
Screens
 What is a sunscreen?

Mixtures of chemical and/or physical UV

filters with suitable vehicle
Applied to skin surface
Attenuate incident radiations (mainly
UV) by
Absorption
Scattering
Reflection

Thus intercepting them before they

reach the skin and cause damage
 1. UV filters 2. Vehicle 3. Efficacy

Classifiable
Organic (Chemical) – absorption
Inorganic (Physical) – absorption and scattering

Not all UV filters attenuate all wavelengths

UVB filters
UVB + UVA2 filters
UVA1 filters
UV Broad spectrum filters

A mixture/ combination of these used commonly

 1. UV filters 2. Vehicle 3. Efficacy
Organic filters
PABA and its derivatives
UVB
PABA PABA
derivative
Cinnamat First widely available organic UV filter
es
Most potent UVB filter
Salicylate
s Potent contact reactant and carcinogenic
Others Stain skin and clothes yellow
Triazones
Padimate O
Most commonly used PABA derivative
Safer and most potent UVB blocker
PEG-25 PABA
Eliminates stinging and staining property
 1. UV filters 2. Vehicle 3. Efficacy
Organic filters
UVB Cinnamates
PABA
derivative Amiloxate
Cinnamat
Octinoxate
es
Salicylate Most popular UVB filters
s
No staining and rare irritant potential
Others
Triazones Less effective than PABA derivatives and low water
resistance so frequent reapplications
Relatively photounstable
 1. UV filters 2. Vehicle 3. Efficacy
Organic filters
Salicylates
UVB
PABA Homosalate
derivative
Cinnamat Octisalate
es Weakest organic UVB agents
Salicylate
s Relatively safe – added in high concentrations
Others Highly photostable and photostabilize other
Triazones ingredients
Hydrophobic – act as solvents for other ingredients.
 1. UV filters 2. Vehicle 3. Efficacy
Organic filters
Others
UVB
PABA
derivative Octocrylene
Cinnamat
es
Salicylate Weak UVB agent
s
Others Costly & difficult to integrate in products
Triazones Improves photostability of others
Ensulizole/ Phenyl benzimidazole sulfonic
acid(PBSA)

Water soluble and lighter less oily feel

Used in daily moisturizers
 1. UV filters [Link] [Link]
Organic filters
Triazones – Newer agents
UVB
PABA
derivative Octyl triazone/ Uvinul T 150
Cinnamat
es
Salicylate 2nd most effective modern UVB filter
s
Limited solubility
Others
Triazones Used widely in Europe
Dioctyl butamide triazone (DBT)

Improved version of Uvinul T 150

Increased solubility
Most effective modern UVB agent
 1. UV filters 2. Vehicle 3. Efficacy
Organic filters
Benzophenones
UVB
PABA
derivative Oxybenzone (Benzophenone 3)
Cinnamat
es Sulisobenzone (Benzophenone 5)
Salicylate High irritation potential
s
Photolabile
Others
Triazones Free radical generation leads to decrease in
UVB + UVA2 sunscreen efficacy
Benzophe
nones
 1. UV filters 2. Vehicle 3. Efficacy
Organic filters Avobenzone
UVB
First FDA approved UVA1 filter
PABA
derivative Highly photolabile – 50-60% decrease in
Cinnamat efficacy within 1 hour
es
Photounstabilizes other ingredients too
Salicylate
s Avobenzone/ Octinoxate unstable but
Others popular combination
Triazones Salicylates, Octocrylene, Tinosorb S help
UVB + UVA2 stabilize
Benzophe Lots of research directed to stabilize
nones
avobenzone
UVA1
 1. UV filters 2. Vehicle [Link]
Organic filters
UVB
PABA
derivative DHHB/ Uvinul A Plus
Cinnamat
Successor of Avobenzone
es
Salicylate Improved photostability
s
Similar efficacy
Others
Triazones
UVB + UVA2
Benzophe
nones
UVA1
 1. UV filters 2. Vehicle 3. Efficacy
Organic filters
UVB Ecamsule/ Mexoryl SX/ TDSA
PABA Strong photostable broad UVA spectrum
derivative
protection
Cinnamat
es Minimal safety concerns
Salicylate
s
Others
Triazones
UVB + UVA2
Benzophe
nones
UVA1
 1. UV filters 2. Vehicle 3. Efficacy
Organic filters
UVB Tinosorbs
PABA Tinosorb S/ BEMT/ Bemotrizinol
derivative
Cinnamat
es
Oil-soluble, photostable
Salicylate
s Improves photostability of
Others avobenzone, & avobenzone
Triazones /octinoxate
Tinosorb M/ MBBT/ Bisoctrizole
UVB + UVA2
Benzophe
nones
Microfine organic particles - First organic UV
UVA1
filter with physical sunscreen qualities
Broad
spectrum Not only absorbs but scatters and reflects
too
Tinosorbs
Mexoryls
 1. UV filters 2. Vehicle 3. Efficacy
Organic filters
Mexoryls
UVB
PABA Mexoryl XL/ DTS
derivative
Cinnamat
es
Oil-soluble, photostable
Salicylate
s Combined with Mexoryl
Others SX, avobenzone, TiO2,
Triazones and octocrylene
UVB + UVA2
Benzophe
nones
UVA1
Broad
spectrum
Tinosorbs
Mexoryls
 1. UV filters 2. Vehicle 3. Efficacy
Organic filters Inorganic filters
UVB Titanium Dioxide
PABA
derivative Zinc Oxide
Cinnamat Scatter, reflect, or absorb solar radiation in
es the UV, visible, and even infrared ranges
Salicylate Appear white- cosmetically unpleasant
s
TiO2 more photo reactive, and less
Others cosmetically acceptable than ZnO.
Triazones
Micronization and adding Iron Oxide
UVB + UVA2
No systemic absorption/contact reactions
Benzophe
nones
UVA1
Broad
spectrum
Tinosorbs
Mexoryls
 1. UV filters 2. Vehicle [Link]
Organic filters
Inorganic filters
UVB
PABA
derivative Micronized TiO2 and ZnO
Cinnamates micronized form (10–50 nm) vis-a-vis nonmicronized form (200-
Salicylates 500 nm), results in less scattering of visible light
Others Leads to absorption spectrum shift towards UVB, but
Triazones Microfine ZnO more effective in UVA absorption than TiO2.
UVB + UVA2 Due to photo catalytic activity coated with silica or
Benzophenon dimethicone to preserve efficacy
es
Combination with carrabua wax and cinnamates- stable
UVA1 dispersion, ideal viscosity, and a significant increase in SPF up
Broad to about 50
spectrum
Tinosorbs
Mexoryls
Inorganic filters
 1. UV filters 2. Vehicle 3. Efficacy
Two important aspects of sunscreen vehicle
Polarity: Like dissolves like
Hydrophilic/ highly polar : Water, glycerine,
glycerol
Hydrophobic/ least polar : mineral oils and silicone
Viscosity
 1. UV filters 2. Vehicle 3. Efficacy
Emulsion
based Stabilized dispersion of one liquid in another; Oil in water, water in
Ethanol-Oil oil,
based Thinner emulsions: Lotions, Thicker emulsions: Creams
Oil based Can integrate all kinds of UV filters thus providing maximum
Water flexibility

based Main component water: cost reduction, minimal residual material

on skin thus better aesthetics.
 1. UV filters 2. Vehicle 3. Efficacy
Emulsion
based
Thin sprays to liquids to gels, by adding varied conc. of
Ethanol-Oil polymeric thickeners
based
clarity, fast drying nature, and pleasant cooling sensation
Oil based upon application
Water
Minimal residue after application
based
Rapid evaporation may leave behind uneven layer, lowering
effective SPF

Can be drying or stinging

 1. UV filters 2. Vehicle 3. Efficacy
Emulsion
based
Thin oils and oily sprays to thick gels and ointments, to solid stick
Ethanol-Oil formulations
based
Oil based Greasy feeling, poor package compatibility, high cost

Water Do not stay in place leading to uneven layer and poor SPF
based
Useful only for small areas like lips and nose.
 1. UV filters [Link] 3. Efficacy
Emulsion
based
Ethanol-Oil Limited availability because of limited no. of water soluble
sunscreens
based
Oil based Poor water and sweat resistance
Water
Suitable for extremely oily and acne prone skin types
based
 1. UV filters 2. Vehicle 3. Efficacy
UV efficacy How much protection from UVB/ sunburn
targets UVB sunburn protection factor (SPF)
UVB
SPF MED is the minimum dose of UVR required to
produce barely perceptible erythema

Ratio of MED on sunscreen-protected skin over

MED on unprotected skin

Source of radiation: xenon arc solar simulator

Radiation: 290-400, UVA + UVB

Tested sunscreen applied in a concentration of

2mg/cm2
 1. UV filters 2. Vehicle 3. Efficacy
UV efficacy
How much protection from UVB/ sunburn
targets
UVB UVB sunburn protection factor (SPF)
SPF

Myth : SPF 30 is not twice as effective as SPF 15 because SPF 30

blocks 97% of UVR while SPF 15 blocks 94% of UVR.

Fact : SPF 30 is twice effective than SPF 15 because the former

allows only 3% of UVR to pass through to skin while the latter
allows 6%.

Myth : Thus higher the SPF prescribed the better

Fact : Incremental gain with increasing SPF is too little

 1. UV filters 2. Vehicle 3. Efficacy
UV efficacy How much protection from UVB/ sunburn
targets
SPF – FDA 2011 recommendations
UVB
SPF Sunscreen drugs with SPF greater than 50 would be
labeled as 50+

The expansion of SPF changed to “sunburn protection

factor”

Further grading of SPF into:

Low SPF: 2-15
Medium SPF: 15-30
High SPF: 30-50
Highest SPF:>50
 1. UV filters 2. Vehicle 3. Efficacy
UV efficacy
targets
UVB
How much protection from UVA1 and
SPF
UVA2
UVA 4 Star rating system
US-FDA by combining UVA-PF and UVA1/UV
EU
UK
US-FDA How much protection
How much protection
2011 from UVA1
from UVA2 (photoimmunosuppres
(persistent pigment sion and Photoaging)
darkening) UVA1/UV –measured In
UVA-PF – measured In Vitro
Vivo
 1. UV filters 2. Vehicle 3. Efficacy
UV efficacy How much protection from UVA2/ darkening
targets UVA-PF – In Vivo test component
UVB
SPF
UVA Minimal Pigmenting Dose is the minimum dose of UVA
(320-400) required to produce persistent pigment darkening
US-FDA
lasting from 2 to 24 hrs. post irradiation
EU
UK Ratio of the MPD in sunscreen-protected skin to the MPD in
US-FDA unprotected skin
2011
High UVA-PF ≠ broad spectrum UVA protection since it
measures mainly protection against UVA2
 1. UV filters 2. Vehicle 3. Efficacy
UV efficacy
How much protection from UVA1
targets
UVB UVA1/UV – In Vitro test component
SPF
UVA
US-FDA
EU Ratio of UVA1 (340-400 nm) absorbance to total UV (290-400
nm) absorbance
UK
US-FDA
Measures the quantity of UV radiation transmitted through
2011
roughened optical-grade quartz plates before and after the
application of the sunscreen at 2 mg/cm2 .

Weighted towards measuring protection against UVA1

 1. UV filters 2. Vehicle 3. Efficacy
UV efficacy
How much protection from UVA1 and UVA2
targets
4 Star rating system
UVB
SPF
Final star rating assigned using both UVA1 and UVA2 efficacy
UVA
US-FDA Rating Star UVA1/UV UVA-PF
If discordance between the two in-vitro and in- vivo test results
EU No UVA protection None <0.2 <2
then lower of the two considered
UK Low * 0.2-0.39 2 to<4
Medium ** 0.4-0.69 4 to<8
US-FDA AHigh
four-star product transmits
*** 10 times less
0.7-0.95 UVA-I radiation than a
8 to<12
2011 one-star
Highest **** >0.95 >12
 1. UV filters 2. Vehicle 3. efficacy
UV efficacy SPF Equivalence
targets
UVB Requirement to provide the consumer with a minimum level of UVA
SPF protection in relation to the SPF.
UVA
US-FDA This should be a UVA PF of at least 1/3 of the SPF to carry the UVA
EU
seal.
UK
Corresponds to about 3 star level protection
US-FDA
2011
 1. UV filters 2. Vehicle 3. efficacy
UV efficacy
targets
UVB
SPF
UVA
US-FDA
EU
UK
US-FDA
2011
In vitro Critical wavelength (CW) as the only method in assessing UVA or
broad spectrum
Protection.
CW is defined as the wavelength at which 90% of the total area under
the absorbance curve resides, with the absorption measures across the
UV spectrum from 290 to 400 nm.
Only product with CW 370 nm labelled as broad spectrum.

J Am Acad Dermatol. 2011;65(4):863-9.

Current status of the sunscreen regulation in
the United States: 2011 Food and Drug
When to
prescribe
sunscreen…
 When to prescribe sunscreens?
Photodermatoses Disease most protective sunscreen
Pigmentary Connective tissue disease (LE, DM) Mexoryl SX +Mexoryl XL + TiO2 +
disorders Avobenzone
Malignancy DHA useful
Photoimmunosupp
ression & Lupus. 2010 ;19(9):1036-46.
Photoaging Photosensitivity, phototesting, and photoprotection in
cutaneous lupus erythematosus.
Kuhn A, Ruland V, Bonsmann G
Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune disease involving well-defined skinlesions that
can be categorized as acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), or intermittent CLE (ICLE). It is
commonly accepted that ultraviolet (UV) exposure can induce and exacerbate skin lesions in patients with certain
subtypes of CLE. Phototesting with UVA and UVB irradiation using a standardized protocol has proven to
be a reliable model to study photosensitivity in CLE and to analyse the underlying pathomechanisms of the disease. In
addition to UV-mediated induction of apoptosis, the molecular and cellularfactors that may underlie the abnormal
long-lasting photoreactivity in CLE include mediators of inflammation such as cytokines and chemokines, inducible
Ann oxide
nitric N Y (NO)
Acad Sci. 2007
synthase (iNOS), ;1108:35-40.
and cellular adhesion molecules.

Sun-induced life-threatening lupus nephritis.

Schmidt E1, Tony HP, Bröcker EB, Kneitz C.
Arthritis Rheum. 2004 ;50(9):3045-6.
Use of sunscreens to protect against ultraviolet-induced lupus
erythematosus.
Herzinger T, Plewig G, Röcken M
octocrylene as the UVB
The sunscreen that was effective in all patients with CLE contained
protectant; mexoryl SX, mexoryl XL, and parsol 1789 as the UVA protectants;
 When to prescribe sunscreens?
Photodermatoses
Disease most protective sunscreen
Pigmentary
disorders PMLE (UVA >UVB ) Broad-spectrum sunscreens
Malignancy
Photoimmunosupp
ression &
Photoaging

Br J Dermatol. 2004 Nov;151(5):1066-70.

Provocation testing in polymorphic light eruption using fluorescent ul
traviolet (UV) A and UVB lamps.
Das S, Lloyd JJ, Walshaw D, Farr PM.
A positive papular response to broadband UVA exposure was seen in 38 patients [56%, estimated 95%
population confidence interval (CI) 43-67.9]. Thirty-four patients (50%) had a positive papular response to
narrowband UVB exposure (95% CI 37.6-62.4). The probability of a positive provocation test following
irradiation with both lamps was 80.9% (95% CI 69.5-89.4).
 When to prescribe sunscreens?
Photodermatose
s
Pigmentary Disease most protective sunscreen
disorders
CAD (UVA >UVB ) Broad-spectrum sunscreens
Malignancy
Photoimmunosu
ppression & Genodermatoses Broad spectrum High SPF
Photoaging (UVB >UVA)

Porphyrias Physical broad spectrum sunscreens,

(Visible) DHA and iron oxide
 When to prescribe sunscreens?
Photodermatosis
MELASMA
Pigmentary
disorders Sun avoidance and sun protection essential to achieve and maintain
Photoimmunosuppre the results of
ssion & Photoaging depigmenting treatments.
Tanning and Broad-spectrum sunscreen (UVA ,UVB, Physical block) with SPF of at
pigmentation least 30.
Cutis.
Found1983
to;32(1):92, [Link] prevention of chloasma in pregnancy
be effective
The efficacy of a broad-spectrum sunscreen in the treatment of
melasma.
Vázquez M, Sánchez JL.
In a randomized trial, 96 % of women using a topical combination
of Hydroquinone and broad-spectrum sunscreen achieved a slight to marked
improvement versus 81% of those using hydroquinone alone.
Photochem Photobiol. 2008;84(2):450-62.
Effects of visible light on the skin.
Mahmoud BH1, Hexsel CL, Hamzavi IH, Lim HW

J Eur Acad Dermatol Venereol. 2007 Jul;21(6):738-42.

Evaluation of the effectiveness of a broad-spectrum sunscreen in the
prevention of chloasma in
pregnant women.
Lakhdar H1, Zouhair K, Khadir K, Essari A, Richard A, Seité S, Rougier A
 When to prescribe sunscreens?
Photodermatosis
Pigmentary
disorders
Malignancy
Photoimmunosu Post procedure to prevent hyperpigmentation
ppression & Travelling to high altitudes, snow areas and beach
Photoaging
For people with white
skin
 When to prescribe sunscreens?
Photodermatosis May reduce the risk of developing actinic keratoses and squamous
Pigmentary cell carcinoma
disorders Does not decrease incidence of new Basal cell carcinoma
Malignancy Lancet. 1999;28;354(9180):723-9.
Photoimmunosu Daily sunscreen application and betacarotene supplementation in pre
ppression & vention of basal-cell and squamous-cellcarcinomas of the skin:
Photoaging a randomised controlled trial.
Green A1, Williams G et al
In a community-based randomised trial with a 2 by 2 factorial design, individuals were assigned to
four treatment groups: daily application of a sun protection factor 15-
plus sunscreen to the head, neck, arms, and hands,
and betacarotene supplementation (30 mg per day); sunscreen plus placebo
tablets; betacarotene only; or placebo only. Participants were 1621 residents of
Nambour in southeast Queensland, Australia. The endpoints after 4.5 years of follow-up were
the incidence of basal-cell and squamous-cell carcinomas both in terms of people treated for newly
diagnosed disease and in terms of the numbers of tumours that occurred.
Results:1383 participants underwent full skin examination by a dermatologist in the follow-up period.
250 of them developed 758 new skin cancers during the follow-up period. There were no significant
differences in the incidence of first new skin cancers between groups randomly
assigned daily sunscreen and no daily sunscreen (basal-cell carcinoma 2588 vs 2509 per 100,000;
rate ratio 1.03 [95% CI 0.73-1.46];squamous-cell carcinoma 876 vs 996 per 100,000; rate ratio 0.88
[0.50-1.56]). Similarly, there was no significant difference between the betacarotene and placebo
groups in incidence of either cancer (basal-cell carcinoma 3954 vs 3806 per 100,000; 1.04 [0.73-
1.27];squamous-cell carcinoma 1508 vs 1146 per 100,000; 1.35 [0.84-2.19]).
Conclusion: Cutaneous squamous-cell carcinoma, but not basal-cell carcinoma
 When to prescribe sunscreens?
Photo dermatosis May reduce the risk of developing actinic keratoses and squamous
Pigmentary cell carcinoma
disorder Does not decrease incidence of new Basal cell carcinoma
Malignancy Lancet. 1999;28;354(9180):723-9.
Photoimmunosup Daily sunscreen application and betacarotene supplementation in pre
pression & vention of basal-cell and squamous-cellcarcinomas of the skin:
Photoaging a randomised controlled trial.
et al J Am Acad Dermatol.2006 ;55(5):741-60
Skin cancer
In a community-based in skintrial
randomised ofwith
color
a 2 by 2 factorial design, individuals were assigned to
four Gloster
treatment HM Jr1,: Neal
groups daily K application of a sun protection factor 15-
plus sunscreen
Caucasian toskin isthe70 times
head, neck, to develop
more likely arms, skin and hands,
and betacarotene supplementation (30 mg per day); sunscreen plus placebo
cancer compared with black skin with factors in addition to
tablets; betacarotene only; or placebo only. Participants were 1621 residents of
sunlight which may be important.
Nambour in southeast Queensland, Australia. The endpoints after 4.5 years of follow-up were
the incidence of basal-cell and squamous-cell carcinomas both in terms of people treated for newly
diagnosed disease and in terms of the numbers of tumours that occurred.
Results:1383 participants underwent full skin examination by a dermatologist in the follow-up period.
250 of them developed 758 new skincancers during the follow-up period. There were no significant
differences in the incidence of first new skin cancers between groups randomly
assigned daily sunscreen and no daily sunscreen (basal-cell carcinoma 2588 vs 2509 per 100,000;
rate ratio 1.03 [95% CI 0.73-1.46];squamous-cell carcinoma 876 vs 996 per 100,000; rate ratio 0.88
[0.50-1.56]). Similarly, there was no significant difference between thebetacarotene and placebo
groups in incidence of either cancer (basal-cell carcinoma 3954 vs 3806 per 100,000; 1.04 [0.73-
1.27];squamous-cell carcinoma 1508 vs 1146 per 100,000; 1.35 [0.84-2.19]).
Conclusion: Cutaneous squamous-cell carcinoma, but not basal-cell carcinoma
 When to prescribe sunscreens?
Photodermatosis Association between melanoma and sun screen more ambiguous.
Pigmentary Sun protection still recommended.
disorder In Asian population typically acral distribution.
Malignancy
Photoimmunosupp
ression &
Photoaging
Tanning and
pigmentation Ann Intern Med. 2011;154(3):190-201.
Behavioural counselling to prevent skin cancer: a systematic review
for the U.S. Preventive Services Task Force.
Lin JS1, Eder M, Weinmann S

J Clin Oncol. 2011 :20;29(3):257-63.

Reduced melanoma after regular sunscreen use: randomized trial
follow-up.
Green AC, Williams GM, Logan V, Strutton GM
 Compliance
SPF decreases exponentially as the amount of sunscreen
applied decreases.
Amount used in calculating SPF is too much for practical
application
In a mathematical study out of
Amount applied
How it is spread
UV absorbing properties of sunscreen
the first two determined 90% of variance in photo
protection achieved.

Photochem Photobiol. 2001 Jul;74(1):61-3.

Sunscreens and UVA protection: a major issue of
minor importance.
 Compliance
Sunscreen-
sunburn paradox
Amount to be In tropical sun exposure SPF of 15 should be adequate but often
applied is not. Many factors contribute
Frequency of People normally apply much less sunscreen than used in the
application SPF testing process
Sunscreen is normally spread haphazardly
‘Physical’ sunscreens cosmetically less acceptable
Sunscreens can be removed by water immersion, sand
abrasion and toweling.
The timing of sunscreen application influences the protection
achieved.
Sunscreen- Compliance
sunburn paradox
Amount to be 2 mg/cm2, which equals 6 teaspoons of lotion (approx.
applied 36 grams) for the body of one average adult person
Frequency of
‘‘Teaspoon rule’’
application

Slightly more than

Head & neck Each arm
half a teaspoon (3ml)
Slightly more than one Chest and abdomen, The
teaspoon (6ml) back, Each leg
Sunscreen-
sunburn Compliance
paradox
Amount to be
applied
Frequency of
application Sunscreen should be applied 20 minutes before sun exposure, and
be reapplied every 2 to 3 hours.
One study suggested applying sunscreen 15 to 30 minutes
before going out to the sun, followed by reapplication 15 to 30
minutes after sun exposure to compensate for improper initial
application.

J Am Acad Dermatol. 2001;45(6):882-5.

When should sunscreen be reapplied?
Diffey BL
 Safety and Side effects
Contact Br J Dermatol. 2006;155(4):737-47.
Br J Dermatol. 2006;155(4):737-47.
reactions Photopatch testing of 1155 patients: results of the U.K. multicentre
Photopatch testing of 1155 patients: results of the U.K. multicentre
Vitamin D photopatch study group.
photopatch study group.
synthesis Bryden AM, Moseley
Multicenter H, Ibbotson
prospective SHUK
study, etand
al the Netherlands photopatch
Bryden AM, Moseley H, Ibbotson SH et al
Systemic testing 1155 patients to 11 established organic sunscreen agents and 1
absorption commercial sunscreen applied “as is” in addition to suspected topicals
Hormonal
activity Sunscreens - most common photoallergens in UK

Allergic reaction in 11.3%(130/1150). Out of them Photoallergic

contact dermatitis - 4.4% (51/1155), Allergic contact dermatitis - 5.5%
(64/1155), Photoallergic and allergic contact dermatitis- 1.3%
(15/1155)

Most common allergens were oxybenzone and avobenzone

Contact Safety and Side effects
reactions
Vitamin D Contact Dermatitis ,1997;37(5):221-32
synthesis Contact and photocontact sensitivity to sunscreen. Review of a 15-
Systemic year experience and
absorption review of the literature
Hormonal Schauder S ,Ippen H
activity 15-year retrospective review of 402 German patients with clinical
photosensitivity, patch and photopatch tested with 11 UV absorbers and
facial cosmetics.

UV absorbers – the most common photocontact allergens.

20% had an allergic or photoallergic contact dermatitis to UV absorbers

The most frequent photosensitizer was isopropyl dibenzoylmethane,

and a smaller proportion of patients also had allergic or photoallergic
reactions to benzophenone 3 and PABA.
 Safety and Side effects
Indian J Dermatol Venereol Leprol. 2011;77(2):148-55.
Contact Evaluation of photopatch test allergens for Indian patients of photod
reactions
ermatitis: preliminary results.
Vitamin D Jindal N1, Sharma NL, Mahajan VK, Shanker V, Tegta GR, Verma GK.
synthesis
Systemic
absorption Indian studies lacking. One study with 30 patients of photodermatitis and 10
Hormonal controls were patch- and photopatch tested with 20 common
activity photoallergens.
Sunscreens not amongst top 3.
Fragrence mix, PPD and Parthenium were the commonest photoallergens.
3.3% showed positivity to sunscreen ingredients.
 Safety and Side effects
Contact
reactions
Theoretically sunscreens can prevent Vitamin D synthesis but
Vitamin D
practically not been found to do so mainly due to
synthesis
Systemic
absorption Inadequacies in their application to the skin
Hormonal
activity sunscreen users may expose themselves to more sun than
non-sunscreen users

Br J Dermatol. 2009 ;161(4):732-6.

Does chronic sunscreen use reduce vitamin D production to
insufficient levels?
Norval M1, Wulf HC

Arch Dermatol. 1995;131(4):415-21.

The effect of regular sunscreen use on vitamin D levels in an
Australian population. Results of a randomized controlled trial.
Marks R1, Foley PA, Jolley D, Knight KR, Harrison J, Thompson SC
 Safety and Side effects
Contact
reactions
Vitamin D
synthesis
Systemic
absorption
Favorable human safety profile for commonly used organic
Hormonal and inorganic UV filters.
activity

No evidence that the inorganic UV filters, titanium dioxide

and zinc oxide, penetrate beyond the stratum corneum of
normal, undamaged skin regardless of particle size.

Organic sunscreens found to penetrate skin and measured in

the blood and urine of human subjects, but systemic exposure is
limited.
 Safety and Side effects
Contact
reactions
Vitamin D
synthesis
Systemic Estrogenic activity: padimate O, octinoxate, homosalate and
absorption oxybenzone
Hormonal
activity Anti-androgen and anti-progesterone activity: Homosalate and
oxybenzone.

Clinical relevance of hormonal activity no consensus.

Combination of filters may have amplified hormonal activity so final

product’s safety should be checked too.
Routine sunscreen application not recommended.

Rehearse in your mind the action spectrum of the photodermatoses

you are treating and prescribe sunscreen accordingly.

Look for adequate UVA protection factors.

Don’t be intimidated by the weird sounding UV filters. Start looking

at the names of the chemicals in the sunscreen brand you are
prescribing, just like you would on a topical steroid brand.

Choose the right vehicle type for the individual pt. and the site of
application.
Do not run the SPF race! Usually lower the SPF, better is the
aesthetics and skin feel characteristics and hence patient
compliance.

Remember the teaspoon rule.

Reinforce frequent application.
Devote time and effort in counselling the patient and ensuring
adequate compliance.
Always remember there is no better alternative to physical sun
protection and sun avoidance measures
Thank u…..

Special thanx
to …
Dr M Ramam
Dr Neha
Dr Mamta