THE LABEL SPF CANNOT BE USED TO ESTIMATE SAFE SUN EXPOSURE TIME

How SPF Testing Fails to Replicate Real Sunlight and its Impact on Your Health

North American consumers should not rely on label claims - whether it is the SPF or claims of UVA and Broad spectrum protection. Most of our brand name sunscreens would not pass European or Australian criteria for UVA-PF (UVA- Protection Factor) and their better standards for Broad Spectrum coverage. Proper and adequate UVA protection may be the most essential property for a sunscreen to actually prevent skin cancer and photoaging. The global market, particularly in North America is dominated by UVB- BIASED sunscreens with inadequate UVA protection, despite label claims saying ‘BROAD SPECTRUM’ UVA/UVB. Even the EWG (Environmental Working Group) recognizes this reality in their 2017 Sunscreen Report. More on this in my next BLOG. 

There are over 25 stakeholder and professional coalitions with Comprehensive Cancer Control (CCC) plans  that publicise a prevention strategy. Language may differ but they all focus on key elements of sun avoidance, never burn or tan from UV exposure, wearing protective clothing with a tight weave, wear UV protective sunglasses, and generously apply a sunscreen with sun protection factor (SPF) 15 or higher and both UVA/UVB protection. Sunscreen use is the weakest link in the protocol. Rising cancer rates show that the current approach has failed and critical analysis argues that ineffective UVB-BIASED sunscreens dominating the N.American market are a driving factor.  Australia where balanced sunscreens using better UVA filters are plenty,  are actually seeing skin cancer rates levelling off or falling in certain provinces. Two landmark studies from Australia show that effective sunscreens applied daily can potentially reduce all forms of skin cancer. In N. America the grim reality is otherwise:

• Skin cancer is now the most common cancer in the United States with the incidence essentially doubling for all skin cancers in 40 years,  and they now account for more than 50% of all human cancers - i.e. skin cancer cases outnumber all other cancers combined. 

• In 2017, over 160,000 Americans are expected to be diagnosed with melanoma, which is the leading cause of cancer death in women ages 25-30 and the second leading cause in women ages 30-35.  In ages 15-29, melanoma is the second most commonly diagnosed cancer. From 1970 to 2009, the incidence of melanoma increased by 8-fold among young women and 4-fold among young men. In the USA, one person dies of melanoma every 54 minutes (almost 10,000/year).  4000 Americans die in a year from Squamous Cell Cancer (SCC) .

Preventing sunburn (early effect) or UVA damage (early and late effects), and damage to the genetic and immune apparatus of the skin is the essence of effective photoprotection. The label SPF is supposed to quantify a sunscreen’s ability to prevent that early sign of sun damage. The SPF as measured by FDA and Health Canada mandated tests give a poor estimate of the sunscreen’s actual performance in sunlight. 

The premise that SPF can be used to plan your exposure time is based on several invalid assumptions. Recent studies confirm that the lab or label SPF is inaccurate, when compared to the real life value obtained in sunlight. The lamp used in calculations for label purposes, only emits 290-400 nm based on the false assumption that the erythema reaction was mediated only by UVR (UVB and UVA). Visible Light (VL at 400-740 nm)) and Infra-red (IR at beyond 740 nm)) could be responsible for up to 20-30 % of the erythema response. Sunlight has more UVA (up to  5X ) than the testing lamp emission. Industry and physicians continue to advise consumers that the SPF can be used to calculate the safe exposure time for protected skin outdoors. We know differently -  fair individuals mostly get sunburned with prolonged outdoor exposure or during tropical vacations, despite using high SPF sunscreens and stringently following all the re-application instructions.   Media reports in 2015-2017 from Consumer Reports, the BBC in the UK, CBS, NBC, and CNN in the USA, have all presented data that up to 50% of brand name sunscreens fail to achieve even 50% of their labelled SPF values. 

Science now confirms this travesty. The label SPF is inaccurate when compared to the real life value obtained in sunlight. A landmark study  presented at the 26th Annual Meeting of The Photomedicine Society (Orlando, Florida, February 2017), showed that  50 commercially available sunscreens with label SPF 50 or more had SPF values of 6-10  when measured in sunlight (Hughes S. and  Cole C.). No wonder, as testing lamp emission spectrum is far removed from that of actual terrestrial radiation, and the intensity used in testing is different from sunlight. The compliance factor also adds another real life problem as most  users apply < than the 2 mg/cm²  as done for the lab test. Scientists also now provide the principles in physics that explain why the SPF test cannot be accurate (Diffey B, Osterwalder U, 2017).  They report that labelled SPF, determined by in vivo assay using a UV solar simulator, overestimates the SPF that would be expected in natural sunlight.  Products labelled SPF50+ may not be able to achieve a protection against sunlight of more than 25-fold., or SPF 25. The popular interpretation of the SPF to mean how much longer skin covered with sunscreen takes to burn in sunlight compared with unprotected skin, can no longer be defended.

Any falsely high SPF reading can be further  manipulated by adding anti-redness agents (similar to aspirin) that artificially increases the MED (Minimal Erythema Dose) used to determine the SPF, for the sunscreen containing these anti-inflammatory chemicals. Sunscreens are replete with SPF boosters- bisabolol, niacinamide, salicylate compounds, and numerous others. This may be very harmful to a consumer. The false (often high SPF 50-100) values distort the reality of what protection to expect. If you are very fair – Type 1- always burns never tans- you may actually burn within 5 minutes with extreme sun exposure. An SPF 30 conveys the impression that it is safe to stay out for up to 150 minutes and SPF 50 for up to 250 minutes. A real life SPF 10 in sunlight means you should multiply your 5 minute burn time by only 10 for a safe 50 minute exposure, then get out the sun or re-apply your sunscreen liberally if you stay out longer. A boosted SPF is falsely elevated by interfering with the biologic endpoint or early warning signal of redness, the first sign of sunburn. It is no longer commensurate to the amount of radiation being prevented from reaching your skin,  but related to delayed redness. You are actually burning but have no way of knowing this as your early warning signal has been blunted. This false sense of security may make you remain outdoors i/o seeking shade. You will experience more sun damage and incur the risks of skin cancer and photoaging. This  is only related to UVB exposure - think of the damage resulting from the more harmful UVA radiation that you are now receiving in high levels, particularly since most N. American sunscreens have inadequate UVA-PF values.

• Use no more than half the label  SPF when calculating your outdoor exposure time, and if you are redhead or extremely fair use a factor of 10.
• It is better to use the other elements of a photoprotection strategy – avoid sun exposure, wear UV protective clothing, wear head gear and UV protective sunglasses etc. - to the extent you can, and use a sunscreen with a safe UVA filter like zinc oxide in adequate concentrations.
• The particle type sunscreens that use zinc oxide, titanium dioxide, encapsulated octinoxate, drometrizole trisiloxane (Mexoryl XL™), terephthalylidene dicamphor sulfonic acid (Ecamsule or Mexoryl SX™),  biscotrizole (MBBT or Tinosorb M™), bemotrizinol (BEMT or Tinosorb S™),  and others are large in size, sit on the skin avoiding any entry into blood and the various attendant risks. Only the first five are available in Canada. Mexoryl XL™ and SX™ are patented to L’Oreal and regrettably are usually combined with undesirable soluble hydrocarbon filters, which should be stringently avoided. All except titanium dioxide and encapsulated octinoxate are UVA filters, and when mixed with other safe UVB filters achieve dispersions of spectral homeostasis (balanced UVA/UVB protection). In this situation where a sunscreen behaves like a neutral density filter, the label SPF may be closer to the Real Life SPF value in sunlight.  Look for products that have > 20% zinc oxide alone, or 15 % with 7.5% titanium dioxide or encapsulated octinoxate. 
• For maximum protection and to avoid all the controversy on hormone disruption and environmental hazards, use only sunscreens  with particle based or large molecular weight filters in the right combination. The high UVA protection achieves that flat balanced protection where the ratio UVA-PF/SPF approaches 1, and the label SPF comes closer to the Real Life value in sunlight. Strictly avoid all small molecular weight soluble hydrocarbon filters – avobenzone, oxybenzone, homosalate, octisalate, octocrylene, regular octinoxate, and 4-methylbenzilidene camphor. All may enter blood and only avobenzone has any UVA attenuation. It still gives a significant UVB bias where up to 30% of UVA between 340-400 nm – the most damaging UV rays are transmitted to your skin.

© Denis K. Dudley MD, October 2017. All rights reserved.

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.

The Latest Science in Sunscreens and Protection: What You Need To Know

For this third post, I thought I would pass on interesting and relevant scientific news from recent meetings I attended with my wife, Dr. Sharyn Laughlin. The Annual Meeting of the Photomedicine Society and the Annual Meeting of The American Academy of Dermatology were held in March 2014.

More evidence was presented by Dr. Thomas Ruenger for the role of UVA in inducing enzymes that promote the breakdown of collagen and elastin as an important mechanism for photoaging. The findings presented also show that the effect of longwave UVA is the most pronounced and much greater than the effect of UVB. Over the past decade, there has been a volume of evidence from scientific studies that confirm the important effect that UVA has on photoaging and the induction of cellular damage, leading to all forms of skin cancer. This should come as no surprise to anyone – including those who still do not acknowledge the inherent dangers of UVB-biased sunscreens that give unbalanced protection, and allow the effects of UVA to be mostly unabated and cumulative.

Our Skin: A Work of Art Worth Saving

Not everything in science needs a study. Many definitive studies cannot be done in humans for ethical and practical reasons. Sometimes critical thinking, cognitive analysis, deductive reasoning – fancy terms for common sense – is all that is required. UVA penetrates to the deeper dermis where the important elements regulating genetics, immunity, and cell function reside, while UVB barely penetrates through the epidermis. UVA is ubiquitous, essentially the same at any latitude and time of day, and is 15-16 times more potent than the dose of UVB that only accounts for 5% of the UV band. It should be logical that the adverse effects of UV radiation may have more to do with UVA than UVB. Erythema or redness of the skin, the first sign of sunburn, and the eventual sunburn, is commonly believed by many people (even some physicians), to be UVB (290-320 nm) mediated skin damage, with a minor contribution from UVA-2 (320-340 nm). It is the basis of the sun protection factor (SPF) that is a label standard that indicates the degree to which a sunscreen reduces the sunburn reaction. The new labelling rules to be adopted in N. America changes the meaning of SPF to denote sunburn protection factor, a more accurate definition. It should convey to the consumer that SPF is a measure of the sunscreen’s ability to reduce or protect from sunburn but is not an adequate measure of protection to other adverse effects of the sun. The erythema-sunburn reaction and its genesis is actually more complex and is also related to UVA-1 effects.

Anyone who has had a sunburn by not applying a sunscreen on a very cloudy day has experienced a UVA sunburn. It is a deeper burn and much more painful that the usual sunburn that starts with UVB initiation. A sunscreen that completely blocks only UVB will not always prevent sunburn and over time a gradual or delayed sunburn develops to the UVA part of the sun. UVB is more efficient in causing sunburn and produces the immediate redness. UVA accounts for 95% of UV exposure and this higher absolute amount contributes to erythema. The early or mainly UVB initiated sunburn reaction, is a protective response telling you to get out the sun when the damage is early and more superficial. Continued sun exposure, even with a sunscreen of high SPF, but minimal UVA-1 protection, eventually leads to a more severe sunburn and the deeper damage that causes irreversible consequences- photoaging and the DNA changes that may lead to cancer many years down the road. SPF values > 15 can only be attained if the UV filters used are reducing transmission of UVA-2 and UVA-1, but is primarily a measure of UVB attenuation.

Industry consultants continue to push the trend arguing for high SPF sunscreens with values > 50 even approaching 100. There is a minor photometric basis for using a higher SPF. Looking at the transmission, rather than what is blocked does show that SPF 30 gives twice the protection than SPF 15, a SPF 60 twice that of SPF 30 and four times SPF 15. An SPF 15 blocks 93.3% of incident UV compared to 96.6% with SPF 30, a difference of 3.3% for doubling the concentration of filters. However, considering what gets through by counting photons of light shows that only half the amount gets through with the higher SPF. The higher SPF also compensates for the lower application amounts used by consumers in practice than the amount applied for laboratory SPF testing. There is some truth in a consumer thinking that a higher SPF allows you better protection and a SPF 30 allows you to stay out twice as long as a SPF 15. The danger is that the higher SPF will have some UVA protection but not nearly enough, if it does not contain one of the limited number of filters that give adequate UVA-1 protection. I am cynical enough to think that industry pushes high SPF sunscreens knowing that the public assumes they are better in every respect. Given a choice between a SPF 30 and a SPF 50, always select the more balanced sunscreen with better UVA-1 protection. This is easy to do in the UK or Europe. Look for Boots 4 or 5 stars in the UK or a UVA-PF to SPF ratio of > 1/3 in Europe. The more this ratio approaches 1, the better the sunscreen is for affording you balanced and proper protection. North American consumers have no such ability  to use the label metrics for selection. The new rule of using a Critical Wavelength (CW) of 370 nm or greater as proof of truly broad spectrum activity, particularly the most important UVA-1 extinction, will not necessarily be valid.

The CW is a measure of the wavelength at which 90% of the area under the absorption or extinction curve occurs. This relates to broad spectrum activity as to achieve this CW of 370 nm, usually requires a significant UVA absorbance. However, the threshold of 370 nm can be attained by some sunscreens with little overall UVA-PF, particularly in the more problematic UVA-I spectrum approaching 400 nm. Sunscreens with low UVA-PF  and those with moderate UVA-PF can both have the same CW of 370 nm. The shape of the extinction curve is a factor and a UVB biased sunscreen SPF 30, with inadequate or a low UVA-PF  < 10 can attain the same CW of 370 nm as a sunscreen with UVA-PF of ≥ 10. One would fail the EU criteria but both would pass in the USA and Canada, under new regulations being enforced this year. My preference for adequate UVA protection is that SPF 30 values should have a UVA-PF exceeding 20 with the ratio approaching 1. More about these considerations in a later post.

The other important topics discussed at these meetings included the use of anti-inflammatory(AI) agents

Can a diet rich in anti-oxidants protect you from the sun?

or antioxidants (AO) in sunscreens, and the role for oral photoprotection as a component of a sun protection strategy. The use of AI ingredients will be discussed in detail in a future post. Dr. Salvador Gonzales  reviewed the present status of oral nutrients that afford some measure of UV protection, and its use in oral photoprotection is increasing in Europe at an annual rate of about 5%. He also reminded us that a lifetime UV radiation exposure is attained 1/3 through vacation, compared to 2/3 from every day or non-vacational time. This supports our view that a balanced sunscreen is for daily use all year round. In addition 70-80% of sunburns occur can occur in your backyard. Dr. Mary Matsui presented evidence that certain nutrient and botanical ingredients applied on the skin are a source of non-sunscreen photoprotection. The list of useful agents for oral or topical photoprotection is extensive. Some of these and other agents also may reduce skin damage from visible light (400-770 nm) and near infrared (IRA at 770 -1400 nm), now shown to be relevant in addition to UV in the genesis of adverse effects from sunlight. This an area I am presently researching at CyberDERM. While developing a balanced sunscreen that mimics the UV protection afforded by black clothing or shade, we are identifying the single best antioxidant to add to the formula. Some of the effects of UV and IRA on inducing immune suppression may also be reduced by oral therapy. Longer wavelengths UVA-1 near 400 nm and visible through IRA at 400- 1400 nm, tend to produce deeper damage to the dermis. Oral antioxidants may be more rational and efficient than topical application. The concept of skin therapy from within via the dermal blood vessels is not new. I recall an ad-campaign from many years ago- “have you taken your skin care today”? For therapy to cell damage in the dermis, ingestion and delivery by the dermal blood supply seems more logical than topical administration, which requires absorption through the epidermis, and the agent is not always sure to reach the deep dermis. We are also working on an antioxidant mix for oral supplementation that best achieves all the objectives. For now it appears that taking 2 Gms. of Vitamin C and 1200 IU of Vitamin C increases the minimal erythema dose –  the visible sign of sun damage – by 20% after 1 week and 40% at 3 months (Gonzales et al). Flavonoids and the subgroups- anthocyandins, catechins, flavonols, and isoflavones – all play important roles in modulating and inhibiting the various adverse effects. A diet rich in blue and red berries, red or purple grapes, 1-2 glasses of red wine/day, dark chocolate, green and white teas, apples, broccoli, onions and scallions, kale, soybeans, hot peppers, apricots and celery, provides Flavonoids. This diet with Vitamin C and E as described above may be a useful adjunctive measure to using a balanced sunscreen and sun avoidance  for those at greater risk of cancer and photodamage. These nutrients, along with ingesting curcumin, resveratrol, and pomegranate, are already recommended for a myriad of health benefits. Skin cancer is considered an occupational disease in some provinces of Germany, and in Canada we need a National Occupational Strategy for those involved in outdoor work. For these workers and anyone at higher risk for skin cancer, a dietary approach as outlined is a complementary and responsible self- help initiative.