Why Current Sunscreens Are Failing the Public

Sunscreens have been in the news lately. I thought that it would be timely to focus this blog on the issues. The EWG has named Neutrogena as the number # 1  sunscreen brand to avoid in their 2015 annual “Hall of Shame” report. It has gone viral. However many other leading brands continue to use the soluble filters that attain tissue levels and are implicated as hormone disruptors and carcinogens. 

These filters include :

• oxybenzone, avobenzone, homosalate, octisalate, octocrylene, 4-methyl benzilidene camphor and regular octinoxate. 

Better and safer particle based insoluble filters include :

• zinc oxide, encapsulated octinoxate,  titanium dioxide, and Tinosorb S and Tinosorb M (still awaiting FDA and Health Canada approval)

Here is an excerpt from the EWG report naming Neutrogena as the number 1 sunscreen to avoid:

“The Environmental Working Group (EWG) has released their 2015 guide to sunscreen, and among the worst brands for sun protection is the number one culprit for toxicity and false advertising, Neutrogena.“Neutrogena’s advertising hype is further from reality than any other major brand we studied. It claims to be the “#1 dermatologist recommended suncare brand, yet all four products highlighted on Neutrogena’s suncare web page rate 7, in the red – worst – zone in our database,” says EWG.  Not only do many Neutrogena sunscreens contain harmful chemicals like oxybenzone and methylisothiazolinone –– but their advertised SPF levels of over 70 have been debunked by the U.S. Food and Drug Administration. According to the federal department, SPF levels max out at about 50. Europe, Australia and Japan have already banned brands from advertising SPF levels over 50. EWG states 80 per cent of Neutrogena sunscreens contain oxybenzone, “a hormone-disrupting sunscreen filter” and 33 per cent contain retinyl palmitate, “a form of vitamin A linked to skin damage”. 

Taking it a Step Further:

What the document does not say is that the entire class of soluble filters – benzophenone, homosalate and others likely have the same effects and that all the leading brands that use these filters are equally harmful. This would include most Johnson and Johnson, L’Oreal, Coppertone, Proctor and Gamble, Banana Boat products, and 85 % of available sunscreens (EWG Hall of Shame 2015). The same filters give UVB biased protection and do not prevent cancer and photoaging. They are likely a factor in rising skin cancer rates. There are a growing list of adverse effects like reproductive problems, autism spectrum disorders and ADHD linked to hormone disruptors that must include soluble sunscreen filters – oxybenzone, avobenzone, homosalate, octisalate, octocrylene and others.  Each person should make their own choice between two classes of sunscreens.  Either choose sunscreens with small molecular weight soluble filters that obtain tissue levels, give incomplete or UVB-biased protection  to prevent sunburn but little protection against skin cancer and photoaging, and probably have harmful effects due to hormone disruption and carcinogenic effects. The alternative is to choose a balanced sunscreen with insoluble particle type filters that remain on the skin,  give you balanced UVB/UVA or better protection, and have no possible adverse effects.

A Word on Recent Controversy:

CBS news just reported a Consumers Report from May 2015 that 11/34 sunscreens failed to achieve their SPF claims at only 16-70% of their labelled value. This mirrors another report from a consumer group in the UK reported on the BBC website that only 1 in 5 consumers in Britain understand that the SPF only predicts UVB or sunburn protection and are aware of  or understand that the Boots-Diffey star system of 1-5 stars is an index of UVA protection and the balance or ratio of UVA/UVB protection. The BBC also reported in May a consumer group testing of Boots and Hawaiian Tropic sunscreens in the UK, showed the majority did not meet their SPF claims. You do not need studies to prove this – just ask most fair-skinned consumers on holiday – most end up with a sunburn despite using the typical brand names and re-applying them every 2-3 hours as instructed. 

SPF values are manipulated by adding anti-inflammatory agents that do not extinct any UV radiation but decrease the redness on skin and mask the biologic marker and first warning signal for injury to the skin. The solar lamps in labs have a sharp fall at 370 nm and a cut-off of 400nm- unlike sunlight where the curve continues to rise. Studies measuring SPF in actual sunlight show that even high SPF sunscreens at 30-100 usually only attain 10-20% of their labelled SPF claims. It was reported at the Annual Photomedicine Meeting in San Francisco this year that as an example Neutrogena Ultra-Sheer SPF 65 had a SPF value of only 10 in sunlight. The MED responses were assessed by luminary dermatologists not a lab technician!

Ways Forward:

We have always said that using SPF, UVA-PF, and CW values to establish the level of protection is the regulatory hurdle to assure adequate sun protection- an SPF of 30-50, a UVA-PF of a minimum 10 for SPF 30 and a minimum of 17 for SPF to meet or exceed the EU criteria of a UVA-PF/SPF ratio >1/3, and a CW of >370 nm as the secondary measure of balanced protection. This should be expressed on a label as a global standard in a very easy and transparent system to understand for sun protection- minimal, medium, high, and very high.

We advocate that sunscreens be UVA dominant with the ratio as close to 1 as possible, given the new studies over the past 10 years that prove UVA is the main factor in cancer and aging. UVB produces superficial injury as a shorter wavelength and lower intensity- it initiates sunburn and the DNA damage cycle, and modulates the process. UVA1 produces deeper DNA injury in the dermis, produces local and systemic inhibition of the immune system, and completes the damage cycle for photoaging and cancer. The majority of mutations in the keratotic basal layer where most cancers arise are UVA fingerprint mutations (not UVB as previously assumed), from hallmark studies over the past decade. UVA does not vary with latitude, or time of day, is present on cloudy days, is 15 X more intense than UVB, penetrates car and window glass, and is a deeper penetrating longer wavelength. It is easier to decrease your UVB exposure than to hide from UVA. Over 40 years it was counter-intuitive for dermatologists to believe that UVB was the main culprit in cancer and photoaging. Most still do. 

The entire protection strategy that includes the use of UVB-biased sunscreens has failed as is evident from rising cancer rates. In N. America rising skin cancer rates are due in part to ineffective sunscreens with partial UV or UVB-biased coverage. 5 million NMSC cases in the USA now cost the health care system 8.1 billion (up from I million in 1987). In the UK skin cancer has shown an alarming increase of 40% in the past 4 years. In Canada rates rise at a steady 2-3% per annum and melanoma was the 2^nd fastest rising cancer in 2014-15. It is now the leading cause of cancer death in girls aged 15-30 years. Balanced UVA dominant sunscreens could reduce skin cancer rates in 4 decades- NMSC by up to 80% and melanoma by up to 55%.

Final Recommendations: 

Until Tinosorb S and Tinosorb M are approved by the FDA and Health Canada, the only filter or combination of filters in N. America that meet the requirements for safety and balanced protection are as follows:

·       Zinc oxide alone, zinc oxide plus titanium dioxide, or zinc oxide plus encapsulated octinoxate are safe among those available here. Mexoryl SX and LX are also molecules that are > the 500 Dalton rule for no percutaneous entry- both are owned by L’Oreal and are never used without other undesirable filters from the soluble group.

·       Any filter has to used after expert consideration of the absorption curve and transmission metrics, the concentration of each filter, and the proper dispersion of actives within inactive ingredients. The Honest Company (Jessica Alba) fiasco demonstrates this. They had a 20%  ZnO but complaints of poor esthetics were an issue. They reduced the ZnO to 9% - no other active. Anyone with a basic knowledge of Photometrics would know that the true SPF or Real Life SPF in sunlight can only be 12-15 maximum. Each filter based on its UVB/UVA2 absorption efficiency has a finite SPF units per 1% concentration. This only provides minimal UVB or sunburn protection for < 1 hour in the full sun for a very fair-skinned person. If it was dispersed poorly this could fall to around 15 minutes- hence all those sunburns seen on mother-baby blogs. At 9% a second primary and safe UVB filter would be required –either titanium dioxide or encapsulated octinoxate in a concentration of 7.5% to attain a true SPF of around 25-28. Zinc oxide at >15 % with 7.5% of either titanium dioxide or encapsulated octinoxate will reach SPF 30 plus and have adequate UVA protection. 

Chart with Theoretical Maximum SPF Units per 1% of Active

Filter	Max. # of SPF Units per 1% of Active
UVB
Octinoxate	2.8
Homosalate	1.5
Titanium Dioxide	2.6
Octisalate	1.6
Oxybenzone	2.3
Octocrylene	2.1
UVA
Avobenzone	1.9
Zinc Oxide	1.6
Tinosorb M	2.2
Tinosorb S	3.1

Simply Zinc™ (CyberDERM) with 22% gives the best balanced protection and Every Morning Sun Whip ™ is not far behind. We believe both are the most esthetic zinc oxide sunscreens found anywhere. Consumers love the products knowing they are safe even for pregnancy and give maximal protection. My dermatologist wife needed a sunscreen to actually prevent skin cancer and photoaging, and as a high risk obstetrician, I needed to know filters did not pass into maternal blood and reach the fetus. A safe, effective, and esthetic sunscreen was hard to find, so we made our own.

Finally, at the World Congress in Dermatology, we learned that there may be evidence that the soluble filters are also photocarcinogenic and induce skin cancer in susceptible subjects- another reason for soluble filters to be banned under The Precautionary Principle. Imagine how egregious it is that a product could cause the disease it is supposed to prevent.  However, I am not optimistic that anything will change. Finally, several of the soluble filters – octinoxate, avobenzone and octocrylene can be encapsulated that converts them to larger size, so they behave like insoluble particles and become safe. We use encapsulated octinoxate in one sunscreen. The silica capsule is inert and the molecule now sits on the skin like zinc oxide and attains the same safety profile. Encapsulation increases the size from 0.5 nm to 7 microns- larger by about 14,000 times. Industry inexplicably ignores this technology that would make some of the offending filters safe.       

                                                                            

© Denis K. Dudley MD 2015. All Rights reserved.