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REVIEW ARTICLE
Year : 2012  |  Volume : 1  |  Issue : 4  |  Page : 210-216

Sunscreens


Department of Dermatology, Venereology and Leprosy, Katuri Medical College, Guntur, India

Date of Web Publication27-Dec-2012

Correspondence Address:
Aruna Chintaginjala
Department of Dermatology, Venereology and Leprosy, Katuri Medical College, Guntur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.105104

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  Abstract 

Photoprotection is an essential component of many dermatologic therapeutic programs, which includes effective sunscreens. An ideal effective sunscreen should provide broad spectrum photoprotection (290-760), photostable, non-toxic, aesthetically acceptable and affordable. Sunscreens are broadly grouped as organic and inorganic. They protect against UV-A and UV-B rays preventing photodamage. The efficacy against UV-B rays is measured by sun protection factor and there is no universal consensus against UV-A protection. Various formulations are available improving the efficacy and aesthetics. Adverse effects are noted in 15-19% of the users. Desired protection is achieved with proper selection, application and compliance to the sunscreens. In addition to effective sunscreens, alternative protection measures like protective clothing and shade are necessary to obtain the maximum benefit.

Keywords: Cosmetics, sunscreens, sunprotection factor, UV-A, UV-B


How to cite this article:
Chintaginjala A, Kamcharla L, Kolalapudi S. Sunscreens. J NTR Univ Health Sci 2012;1:210-6

How to cite this URL:
Chintaginjala A, Kamcharla L, Kolalapudi S. Sunscreens. J NTR Univ Health Sci [serial online] 2012 [cited 2020 Apr 9];1:210-6. Available from: http://www.jdrntruhs.org/text.asp?2012/1/4/210/105104


  Introduction Top


Adequate photoprotection has become an integral part of our therapeutic programs, which include protective clothing, shade, wide brimmed hat, sun glasses and effective sunscreens. With the advent of cosmetic dermatology and cosmetic procedures effective photoprotection has become almost compulsory. In the past few years many sunscreen ingredients have been developed and adequate information about these has become almost necessary. Various harmful effects of UV rays, from the sunburn, photodermatoses to the carcinogenesis are well known. We need effective ideal sunscreen to protect from all these effects. An ideal sunscreen should provide broad spectrum photoprotection (290-760), photostable, non-toxic, aesthetically acceptable and affordable. [1]

The world's first commercial sunscreen, an emulsion of benzyl salicylate and benzyl cinnamate was developed in 1928. [2] In 1940's PABA and later on PABA esters were developed covering mostly UV-B range. Later in 1980-1990, benzophenones especially avobenzone, popularly known as parsol 1789 was developed covering UV-B and UV-A range. Then physical blockers and recently their micronized forms and the newer sunscreen ingredients made the sunscreen industry more popular. [3]


  Types of Sunscreens Top


Sunscreens can be broadly grouped into chemical (organic), physical (inorganic) and combinations of both chemical and physical.

  • Chemical sunscreens are aromatic compounds and absorb UV rays. They can be UV-B protectors, UV-A protectors and broad spectrum, covering both UV-B and UV-A [Table 1]. Some of them dissipate the absorbed energy as heat and returns to normal state, capable of absorbing UV rays again. They are called photostable. Some of them degrade after absorbing UV rays and are not capable of absorbing UV energy again. They are photounstable. Some may react with the surrounding molecules like oxygen, skin proteins and lipids, producing reactive species with unwanted effects and are called photoreactive. [1]
Table 1: Sunscreen active ingredients

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  UV-B Sunscreens Top


PABA and PABA esters were prominent in the earlier days. As they irritate skin, stain clothes, cause contact allergic dermatitis and found to be carcinogenic in vitro, they are no longer popular in the sunscreen industry and manufacturers started claiming "PABA FREE" as a positive factor. [4] Salicylates are good UV-B absorbers, having peak absorption at 300nm. Octylsalicylate (octisalate), homomethylsalicylate (Homosalate) and Trolamine salicylate are currently approved ones and are exceptionally stable, non-sensitizing and have high substantivity. They are also useful in stabilizing other sunscreen ingredients such as benzophenones. [3] They are also hydrophobic and can serve as solvents for other sunscreen agents. Incontrast, trolamine salicylate is water soluble and is often found in hair products. [3] Cinnamates are effective against UV-B but with poor substantivity. They are often found in combinations with other sunscreen actives. Octylmethoxycinnamate (OMC) is most popular one with a favorable human safety profile. Phenyl benzimidazole sulfonicacid is selective UV-B filter. It is water soluble and used in product formulations to feel lighter and less oily. It is mostly used in daily use cosmetic moisturisers. [5] DBT (Diethylhexyl butamido triazone) and BMP (Benzilydine malonate polysiloxane) are newly approved UV-B filters with more efficacy (290-330).


  UV-A Sunscreens Top


Avobenzone, popularly known as parsol 1789, provides superior protection from UV-A, including the majority of UV-A I (340-400nm), with the maximum absorption at 360nm. However, it is unstable and it undergoes photodegradation and becomes inactive. [6] So, it is always combined with other stable sunscreen actives like octocrylene, salicylates, ethylbenzyliden ecamphor, tinosorb S, micronized ZnO and TiO2. [6],[7],[8],[9] TDSA (Terephthalydene dicamphor sulphonicacid, Ecamsule, mexoryl SX), DPDT (Disodium phenyldibenzimidazole tetrasulfonate), DHHB(Diethylamino hydroxybenzoyl hexylbenzoate) are newer UV-A sunscreens with superior photostability. [2]


  Broadspectrum Sunscreens Top


Oxybenzone, though primarily UV-B absorber, it gives protection well through UV-AII(320-340nm). BEMT (Bisethylhexyloxy phenolmethoxy phenyltriazine, TinosorbS) is oil soluble broad spectrum UV filter. MBBT (Methylene bisbenzotriaazolyltetramethyl butylphenol, TinosorbM), DTS (Drometriazoletrisiloxane) are photostable and improve photostability of avobenzone. [8] Siltriazole [MexorylXL] are newer broad spectrum sunscreen actives.


  Physical (Inorganic) Sunscreens Top


These are opaque, scatter and reflect or absorb both UV-B and UV-A. They are inert, non-irritating and non-sensitising. [10] Because of their larger particle size, they are thick, messy and visible. They are comedogenic and melt on exposure to sun. They are aesthetically less acceptable. But micronization (making into smaller particles 20-100nm) made them more acceptable. [11] Microfine particles tend to aggregate, leading to decreased efficacy. They are coated with dimethicone or silica, thereby reducing free radical formation and increasing photostability. [12] Titanium dioxide and Zinc oxide are more commonly used in the micronized form and gives broad spectrum protection. Because of their photostability, inorganic agents are preferred for children and sunscreen-allergic individuals. [13] Inorganic, opaque sunscreens may also protect against visible light induced photosensitive disorders. [14]


  Clinical Uses Top


Sunscreens were originally developed to prevent sunburn. However they are now used for various dermatological diseases, after cosmetic procedures and to prevent carcinogenesis [1] [Table 2].
Table 2: Clinical uses

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  Efficacy of Sunscreens Top


Sun protection factor (SPF) is the gold standard to measure the efficacy of sunscreen against UV-B. But no such universally accepted method is available to evaluate UV-A protection. SPF is the ratio of minimal erythema dose (MED) of protected skin with the sunscreen using fixed dose (2mg/sq.cm) and MED of unprotected skin. The SPF 20 product allows an individual to remain in the sun up to 20 times longer without sun burning than what that individual's unprotected skin would allow. The Sun protection is more with the higher SPF. However there is no significant difference after SPF 30 [Table 3]. SPF 30 product absorbs 96.7% UV-B, where as SPF 50 product absorbs 98% of UV-B. The difference of 1.3% absorption would not seem significant in clinical situations. SPF sometimes may cover UV-A II range but it does not indicate any UV-A I protection.
Table 3: UV-B absorption based on SPF

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There is no consensus as to the best method for UV-A protection. Though Photoprotection factor (PPF), UV-A erythema protection factor (APF), Pigment darkening protecton factor In-vitro transmission protection factor and critical wavelength were used against UV-A protection, the last two were mostly acceptable worldwide. [15],[16] In-vitro tansmission protection factor is the in-vitro method to measure the ratio between photocurrent measured by spectroradiometer through transparent TM tape and photocurrent measured through sunscreen coated tape at a given wavelength. This is in close agreement with in-vivo SPF data. Critical wavelength (CW) is defined as the wavelength, where the integral of spectral absorbance curve reaches 90% of integral from 290-400nm. [17] Depending on the CW, Long wave index (LWI), a better accepted term is noted [Table 4]. OMC has LWI of I, whereas MBBT has >5. Higher is the LWI, greater the UV-A protection. The UK uses a variation of this in vitro test called the Boots Star rating. The Star system is a ratio of two in vitro tests: The measurement of a product's UVA absorbance to its UVB absorbance. A well balanced sunscreen, with a SPF/UVA PF ratio<3, appears to provide the most effective protection against pigmentation, DNA damage, photoimmunosuppression and photodermatosis. [18] A balanced sunscreen is a combination of UV filters, which have different maximum absorbance peaks [UVB, UVA I, and UVA II] to cover the entire UV spectrum and the whole combination has to be photostable. [19]
Table 4: Relation between critical wavelength and long wave Index(LWI)

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  Sunscreen Labels Top


SPF, broad spectrum, water resistant and water proof are some of the accepted terms to label various sunscreens. SPF denotes protection against UV-B whereas broad spectrum gives protection for UV-B and UV-A. The term water resistant does not mean complete protection from water, but it only says that protection against 40 minutes of water immersion. Water proof means protection against 80 minutes of immersion in water. Some also call it 'very water resistant'. [20],[21] Substantivity is the ability of a sunscreen to maintain efficacy and withstand adverse conditions such as exposure to water and sweat. FDA permits products labeled as water resistant or very water resistant to be grouped together under the same term 'sweat resistant. [21] UV- A protection is labeled as star rating.


  Formulations Top


Formulation of sunscreen is the most important because that only determines the efficacy and aesthetics. The most important in formulation is providing a uniform film. Mostly emulsions are popular in the form of lotions and creams. As the water is the main component they improve the skin feel, reduce cost and the film formation is good. But they are greasy as all the sunscreen active ingredients are oils. Gel formulations specially water based are less greasy and more useful in acne prone individuals, but they cause stinging sensations. Sprays are convenient but less effective. Sticks are not useful in wider areas, but good in localized areas like periorbital folds. [22]


  Adverse Effects Top


15-19% sunscreen users show some or other adverse effects. [23] Immediate stinging, burning without visible erythema are common. PABA, PABA esters, Benzophenones, Avobenzone causes contact allergic dermatitis and photosensitivity. Acne may be induced or exacerbated with various vehicle formulations. Contact folliculitis with a rapid onset of small papules and pustules can occur shortly after sunscreen application. [23] Gels and sprays reduce this form of reaction.


  Failure of Sunscreens Top


Patients often complain that, despite their continued usage, they were not able to protect adequately from sunlight. Why? It could be because of improper selection of a sunscreen, improper application of the sunscreen and/or non-compliance. It is always necessary to check whether a suitable broad spectrum sunscreen is given or not. Secondly it should be applied adequately and properly. It is necessary to apply 2mg/cm 2 to get adequate advertised protection. But several studies showed that average application ranged from 0.5-1.5 mg/cm 2 , which might be the cause of lesser protection. [24],[25],[26],[27],[28] Srinivas et al evolved a practical, simple and rapid guide to advice patients on the quantity of sunscreen to be applied during each application by using string method. For face they recommended 1 ml of sunscreen for female and 1.5ml for male [29] and for entire body 35ml to cover an area of 1.73m 2 . [30] Schneider et al proposed "teaspoon rule" regarding sunscreen application i.e. slightly more than half a teaspoon [3ml] for each arm or the face and neck. [31] Sunscreen should be applied 30 minutes before going out and should be repeated every 2-3 hours. It should be applied even on cloudy days as 80% of ultraviolet radiation is still transmitted to earth's surface on cloudy days. Another important factor for failure of sunscreen is non-compliance. There are many reasons for non-compliance. The most common reason quoted by patients is that the sunscreen is sticky. Most of the sunscreen actives are oils. Usually a sunscreen formulation will combine at least two or more different actives to get broad spectrum coverage and higher SPF. The SPF is increased as the concentration of the active ingredient is increased. These higher SPF products (30 or 30+) are more sticky than the sunscreen with SPF 15 or less. The difference in protection of SPF 15 and SPF 30 sunscreen is only by 4%, but lesser SPF is more acceptable aesthetically and has better compliance. It is suggested to select a sunscreen which has SPF 15 or 20 along with a physical blocker. [32]

Another common complaint is that patients feel hot and sweaty, while using sunscreens. Some of this may be due to the fact that sunscreens are used during hot weather. Sunscreen chemical actives transform UV-B radiation to heat energy, which contributes to the feeling of the warm skin. Physical sunscreens such as Zinc oxide, titanium dioxide do not produce heat. Selecting the proper sunscreen may minimize this problem. [2] Another reason for non-compliance include the perception that sunscreen causes acne. The solution to this problem is basically selecting various sunscreen formulations through trail and error. Some sunscreens sting when applied. This is common with gel formulations. The best way to improve the compliance is to select a proper sunscreen for proper site.


  Concerns about Sunscreens Top


Some studies showed that sunscreens have weak oestrogenic activity, especially benzophenones and cinnamates. [33],[34],[35] This activity is so weak, it does not have any effect in people in-vivo.[36],[37] Some sunscreens like, Titanium dioxide becomes photoactive. Fortunately this photocatylytic effects has not shown any adverse effects in humans. Some sunscreens like avobenzone become unstable and degrade on sun exposure, which can overcome by adding more photostable actives. In the recent years, there have been concerns that nanoparticals can induce free radical formation in the presence of UV radiation. However, studies show that these particles remain on the surface of the stratum corneum, and are hence safe for human use. [38] Nanoparticals form complexes with protein, that act as haptens and induce autoimmune disease. Hence further studies are needed to determine their safety. [39] Another concern is decreased vitamin D synthesis on sunscreen usage. Evidence based studies did not find deficiencies of vitamin D or any symptoms and signs of clinical deficiency. [40],[41],[42],[43] One more concern with sunscreen use is a reported paradoxical increase in melanoma and non-melanoma skin cancers, causing more confusion. Many studies disproved this and hypothecated, this could be because of not selecting proper sunscreen and by spending prolonged time in the sun with belief that they used sunscreen, causing increased net exposure to sun resulting in increased neoplasia. [44],[45],[46],[47] Although not known to be hazardous, the use of sunscreens is not recommended for infants younger than six months [48]


  Cosmetics Top


Cosmetic products containing sunscreens are freely available to consumers, offering several advantages. By using regularly, daily protection is facilitated. They provide superior aesthetics and better acceptance. Foundation make-up even without sunscreen may provide some protection due to it's pigment content. By adding sunscreen to this, higher UV protection can easily be achieved. [3]


  Sunscreens and Hair Protection Top


Hair is a non-living structure and there is no risk of malignancy. Is it really necessary to have a sunscreen for hair protection? UV rays degrades eumelanin and pheomelanin to oxymelanin, disrupts disulphide bonds causing weakness and fracture of hair. UV rays also damage lipids in hair cortex, making hair dull, dry and lusterless. [49],[50] The whole science of hair photoprotection is currently in its infancy. Hair dyes may help to some extent in this direction. Recently shampoos, conditioners, hair gels and sprays are enriched with sunscreens. However they offer very limited protection. The best protection to the hair is using a cloth, hat, scarf or an umberella.


  Further Developments Top


Sunscreens are being developed further to give more broadspectrum protection along with better aesthetics, efficacy and safety. Newer technologies including addition of non-absorbing material to boost SPF, coating and modifying inorganic sunscreens, addition of antioxidants, [51],[52],[53],[54] encapsulation of UV absorbers [55] and microfine organic particles may improve efficiency and safety of sunscreen products. Sunspheres (Rohm and Haas) are novel sunscreen vehicles acting as SPF boosters. They are made of styrene/acrylate copolymers that do not absorb UVR and filled with water. Once these products are applied to the skin, the water escapes the SUNSPHERE, and the remaining hollow capsule scatters incident light, increasing the chance that light will contact the UV filters and improving the product's effective SPF by 50 to 70%. [56] A number of newer agents like calcitriol, caffeic acid, ferulic acid, an extract of Polypodium leucotomos plant, divalent zinc ion and 2-furildioxime (FDO) have been found to have photoprotective properties and most of these are in various stages of investigation.


  Guidelines Top


The important thing in sunscreen photoprotection is its proper usage. Presenting the patients with the instructions and guidelines certainly enhances compliance [Table 5].
Table 5: Guidelines to patients

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  Sunless Tanning Top


Tanning as photoprotection is neither popular nor that much practiced in India, compared to western world. Self-tanning or sunless tanning is being practiced and prevalent in western culture. This may be recommended, provided the user is aware of limited sunscreen potential of this method. These products contain dihydroxyacetone (DHA) as active ingredient. DHA has a modest effect on SPF, providing perhaps SPF 3 or 4. [57] Though the resultant color from these products last up to several days, the duration for UV protection is short lived. [58]


  Summary Top


Sunscreens play a major role in any overall program for photoprotection. However, proper use and application of sunscreen along with other alternative protection measures like protective clothing and shade are necessary to obtain the maximum benefit. The Australian public health protection message "Slip, Slop, Slap" has gained wide acceptance throughout the world to encourage children and adults alike to 'slip on a shirt, slop on a sunscreen and slap on a hat' to have the best photoprotection. [59]

 
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49.Hoting E, Zimmerman M. Sunlight-induced modifications in bleached, permed, or dyed human hair. J Soc Cosmet Chem 1997;48:79-91.  Back to cited text no. 49
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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  In this article
   Abstract
  Introduction
  Types of Sunscreens
  UV-B Sunscreens
  UV-A Sunscreens
   Broadspectrum Su...
   Physical (Inorga...
  Clinical Uses
   Efficacy of Suns...
  Sunscreen Labels
  Formulations
  Adverse Effects
   Failure of Sunsc...
   Concerns about S...
  Cosmetics
   Sunscreens and H...
  Further Developments
  Guidelines
  Sunless Tanning
  Summary
   References
   Article Tables

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