Shedding Light on Questions About Sunscreens

(full update August 2024)

Most skin cancers are preventable by seeking shade, wearing protective clothing, and using sunscreen appropriately.2-4 Sunscreen is often used incorrectly (or not at all).4,5 Help your patients use sunscreens correctly and educate them about the known benefits and theoretical risks.5 Recommend a water-resistant, broad-spectrum sunscreen with SPF of at least 15 to 30 for most people. Patients on medications that cause photosensitivity should be counseled to minimize sun exposure and to use broad-spectrum sunscreens when sun exposure can’t be avoided. This chart answers some frequently asked questions about the use and safety of sunscreens.

Clinical Question

Pertinent Information

What’s the best general advice on sun protection?

Use a broad-spectrum sunscreen with an SPF of at least 15 (per FDA) or 30 (per the American Academy of Dermatology and Health Canada).6-8

Apply sunscreen every morning to face, neck, and hands.5

Limit time in the sun, especially between 10AM and 2PM when the sun’s rays are the strongest.6,7

Apply sunscreen 15 minutes before sun exposure for the best effectiveness.7,9

Reapply sunscreen at least every two hours, as well as right after sweating or swimming.7

Protect the skin from the sun with long-sleeved shirts, pants, and broad-brimmed hats.7

Use a lip balm with SPF 30 or higher to protect the lips.6

What’s the difference between sunscreen product formulations?

There are many formulations of sunscreen: creams, gels, lotions, oils, sprays, sticks, oils, pastes, and others.7

Help patients find a formulation they like, that they find easy to apply, and that feels good on their skin (to improve compliance).5

Gels might be preferable for hairy areas (e.g., scalp, male chest), a cream for dry skin and the face, and sticks for areas around the eyes.6

Patients with acne should choose a chemical sunscreen labeled as non-comedogenic.

A mineral sunscreen may be preferable in patients with sensitive skin.11

Some patients may find sunscreen sprays convenient. Educate patients on proper use of sprays:6

  • Avoid inhaling sunscreen sprays.
  • Sprays should not be applied directly to the face or head but rather sprayed onto hands and then spread onto the face.
  • Some sunscreen sprays (e.g., those containing alcohol) are flammable. Avoid spraying sunscreen while smoking, near heat sources, or around open flames.

What do the various terms on sunscreen labels mean?

SPF (sun protection factor): SPF describes the amount of UVB protection (i.e., protection against sunburn) that a sunscreen provides.7,13 SPF values are not related to time but rather to the amount of UV exposure. UV exposure is harder to judge (compared to time) as it depends on the time of day, cloud cover, and the amount of sunscreen applied. Generally the higher the SPF, the better the protection against sunburn.7

Broad spectrum. UVB rays cause sunburn, UVA rays cause early skin aging, and both UVA and UVB rays cause cancer. Broad-spectrum sunscreens have proven effectiveness against both UVA and UVB radiation.8,9 Sunscreens that are not broad spectrum are labeled as being able to help prevent sunburn, but NOT skin cancer or early skin aging.13

Water resistant. Terms such as “waterproof” and “sweat proof” are not permitted on sunscreen labeling. The correct terminology is “water resistant,” and the label must indicate whether the sunscreen remains effective for 40 minutes or 80 minutes while a person is swimming or sweating.9,13

Chemical (also called organic) sunscreens (e.g., avobenzone, octisalate) have UV filters that absorb UV radiation. These must be used in combination to provide UV protection equal to mineral sunscreens.14

Mineral sunscreens (titanium dioxide and zinc oxide) provide broad-spectrum UV protection by absorbing, reflecting, or refracting UV radiation.14 These are sometimes called inorganic, natural, or physical sunscreens.

What’s the best sun protection for infants? 

Keep infants under six months out of direct sunlight.6,15

Use lightweight clothing that covers the arms and legs and brimmed hats to protect them from sun.15

The American Academy of Pediatrics suggests a small amount of sunscreen (SPF 15 or higher) may be applied to limited areas of infants under six months if there is no way to avoid the sun.15 Health Canada does not recommend use of sunscreen on infants under six months.8

Physical sunscreens (zinc oxide, titanium dioxide) and those labeled for use in children may be less irritating.6,15

How much sunscreen should generally be applied on an adult?

Apply sunscreen generously to all exposed skin.8 Most people apply only one-quarter to one-half of the recommended amount.5

The average sized adult should apply a total of about seven teaspoons (35 mL), or about a handful, of sunscreen per full-body application.10 A total of seven teaspoons can be distributed as about one teaspoon for each of the following: each arm, each leg, the face and neck, front of the torso, the back.5,10 The total amount should be adjusted based on body surface area (less for children and more for patients who are obese).

When should sunscreens be discarded?

Expiration of sunscreens is generally up to three years from manufacture. If there is no expiration date on the sunscreen, the date of purchase and a discard date of three years in the future should be written on the bottle.17

Discard sunscreens at least by the expiration date on the package.17

Keep sunscreens out of direct sunlight and away from heat (e.g., the inside of a parked car).

Discard sunscreen if it’s been exposed to high temperatures or if there are changes in its color or consistency.17

Are sunscreen recommendations different for patients with different skin colors?

Everyone needs sunscreen to prevent cancer, regardless of their skin color or tone.18

Patients with the darkest skin tones may have a natural SPF of up to 13; however, the recommendation for sunscreen of at least 15 (per FDA) or 30 (per the American Academy of Dermatology and Health Canada) applies to all skin tones.18,19

Patients with darker skin tones do not sunburn as quickly as those with lighter skin tones; however, they do have the same risk for skin damage (e.g., sun spots, premature aging, cancer).19

Patients with dark skin tones have lower rates of skin cancer compared to lighter skin tones; however, they have higher mortality rates from skin cancer (potentially due to later diagnosis).19

Tinted or sheer products with invisible drying are often preferable in patients with dark skin to improve acceptance. Some products specifically target darker skin tones.18

How well does clothing protect against sun? 

Tightly woven, dark, dry clothes reflect almost all UV rays.20

If light passes through an item held up to the sun, UV rays will also pass through to skin.20

Wet clothes allow about half of UV rays to pass through to skin.20

Clothing labeled with a UPF (ultraviolet protection factor) rating indicates that it’s protective against UV rays.20 The Skin Cancer Foundation (US) recommends a UPF of at least 30, and describe a UPF of 30 to 49 as very good protection and a UPF of 50+ as excellent protection. European standards recommend a UPF of at least 40.2,20

What if a sunscreen and another topical product (e.g., insect repellent, moisturizers) are both needed? 

Use separate sunscreen and insect repellent products.22

  • Sunscreen must be applied more generously and more frequently than insect repellent.22
  • Apply sunscreen first, allow it to dry (about 30 minutes), then apply the insect repellent.22,23

Most topical medications (e.g., diclofenac solution) should be applied first (~15 to 30 minutes before sunscreen) and allowed to dry thoroughly before applying sunscreen. Consult the topical medication’s product labeling. There are some topical meds (e.g., fluorouracil) that recommend limiting/avoiding sun exposure and others (e.g., diclofenac gel) that recommend avoiding sunscreen on areas treated with the topical med.24

Evidence is lacking as to whether moisturizers should be applied before or after sunscreen. Generally, apply the sunscreen last, about 15 to 30 minutes later. Always allow the first product to dry prior to applying the next to avoid diluting the products.25

Are chemical sunscreen ingredients (e.g., oxybenzone, octinoxate) safe? 

Oxybenzone is highly photoallergenic.5

In vitro and animal studies (using [often oral] doses “unrealistic and unattainable” in humans) suggest that some chemical sunscreens could be associated with endocrine, reproductive, or neurological adverse effects.21

  • Animal data suggest there may be estrogenic effects of orally administered oxybenzone. However, an estimated 35 to 277 years of daily topical exposure in humans would be needed to reach the same levels.5,26 No estrogenic effects have been reported in humans since oxybenzone was introduced in the US in 1978.5 
  • The American Academy of Pediatrics suggests parents consider oxybenzone-free sunscreen for children due to its “mild hormonal properties”.31

Some pregnant women may prefer to use physical sunscreens that are not absorbed (e.g., titanium dioxide, zinc oxide) rather than chemical sunscreens.

  • The use of oxybenzone-containing products has been associated with the birth defect Hirschsprung disease (a lack of nerve development in the bowel).32

Studies report some absorption of chemical sunscreens, but no evidence of negative health effects.21,27-29

  • Two small randomized controlled trials (n=24 and n=48) showed absorption of sunscreen ingredients (avobenzone, oxybenzone, octocrylene, homosalate, octisalate, octinoxate) exceeding FDA’s upper limit for waiving toxicology studies.28,29
    • These results do not indicate that these ingredients are unsafe or that they should necessarily be avoided, only that they must undergo additional toxicological studies.3,27-29

Are nanoparticle formulations safe? 

Physical sunscreens (titanium dioxide or zinc oxide) containing micronized particles can be hard to apply, may leave a white residue and stain clothing, and are comedogenic.39 Smaller, nanoparticles (range of 1 to 100 nm) were designed to overcome some of these problems.39

The nanoparticles in sunscreens are coated to prevent their degradation to reactive oxygen species (i.e., free radicals, which are cytotoxic and carcinogenic).21,39

  • Free radicals generated from non-coated or improperly coated nanoparticles in sunscreens are believed to be inactivated by the skin’s natural antioxidant protections.33-35

Nanoparticles should not be inhaled (i.e., a risk with sunscreen sprays) or ingested due to effects on lungs and the GI tract.34

Nanoparticles do not appear to penetrate the skin.21

The benefits of using a sunscreen (even with nanoparticles) to reduce skin cancer risk far exceeds any potential risks of nanoparticles.39

The only way to avoid nanoparticles in sunscreens is to choose a chemical sunscreen. Manufacturers are not required to label particle size on sunscreens which makes it hard to avoid using nanoparticles in physical sunscreens.39 Sunscreens labeled “non-nano” are unregulated and may be misleading.34

What sunscreens are best for using when swimming near coral reefs?

The country of Palau (an island in the South Pacific ocean) became the first to ban the sale and use of ten chemicals found in sunscreens (e.g., oxybenzone) which have been shown in a lab setting to have potential detrimental effects on coral reefs.37

Hawaii has a similar ban of oxybenzone- and octinoxate-containing sunscreens.14 US Virgin Islands have banned oxybenzone, octinoxate, and octocrylene.36 Other countries and cities (e.g., Aruba, some beaches in Mexico) also ban certain chemical sunscreens.36

There are many chemical sunscreens available that do not contain oxybenzone or octinoxate.

  • Oxybenzone is only found in about 13% of non-mineral sunscreens available in the US.47
  • Many sunscreens are now labeled as “reef safe”; however, keep in mind that this term is not regulated. Up to half of sunscreens labeled “reef safe” do not meet the National Oceanic and Atmospheric Administration criteria.16,21

Climate change (with rising water temperatures) has the largest impact on the bleaching of coral reefs.5,14,21 However, oxybenzone and other chemicals found in sunscreens have also shown potential associations with coral bleaching.21,38

There is also concern that nano-sized particles (less than 100 nanometers) of zinc oxide and titanium dioxide sunscreens may contribute to coral bleaching.21,38,40

Does sunscreen protect against melanoma (the skin cancer with the highest mortality rate)? 

Over 8,000 Americans (1,300 Canadians) are projected to die of melanoma in 2024.1,30

Regular use of sunscreen helps prevent melanoma and squamous cell carcinomas.1

  • Regular use of an SPF 16 sunscreen for five years reduced the risk of melanoma over the subsequent ten years by about 50% (22 cases in the control group [sunscreen use at their discretion] to 11 cases in the treatment group [daily application and regular reapplication]) [Evidence Level A-1].41,42

Does sunscreen prevent a person from getting enough vitamin D? 

Most people get at least some of their vitamin D through exposure to sunlight.43 It has been suggested that five to 30 minutes of sun exposure (without sunscreen) between 10 AM and 4 PM daily (or at least twice per week) to the face, arms, legs, or back will generally provide adequate vitamin D-producing UV rays.43

Sunscreen with an SPF of 8 or more seems to block UV rays that produce vitamin D. However, most people do not apply enough sunscreen to all exposed skin often enough to block all vitamin D-producing UV rays.43

People with very little sun exposure (e.g., those in the more northern latitudes in winter, homebound patients) must include good sources of vitamin D in their diet or take a supplement to achieve recommended intake.6,43

Do higher SPFs offer more protection?

As SPF values increase, the difference in protection gets smaller. SPF 15 sunscreens filter about 93% of UVB rays, SPF 30 filter about 97%, and SPF 50 filter about 98%.44

Small studies have indicated a potential increase for benefit in reducing sunburn with 100+ SPF sunscreens; however, data are still lacking to recommend these high SPF sunscreens [Evidence Level B-1].45,46 

  • One study (n= 199) in adults showed more sunburn (higher erythema scores) on skin protected with a sunscreen with an SPF of 50+ compared to skin protected with sunscreen with an SPF of 100+.45
  • Another small study (n=55) showed that with repeat sun exposure over five days, patients using a sunscreen with SPF of 100+ had less sunburn than those using a sunscreen with an SPF of 50+.46

Due to a lack of data that sunscreens with SPF over 60 provide any clinically meaningful benefit, FDA proposes a sunscreen labeling cap of 60+.12 Canada’s labeling cap is 50+.9

Is indoor tanning safer than tanning in the sun?

Indoor tanning is NOT safer than tanning in the sun.48

UV tanning beds and booths are considered carcinogenic to humans, similar to tobacco and asbestos.48

Indoor tanning exposes individuals to UVA and UVB rays similar to tanning in the sun but often at a higher rate which can make it more dangerous than the sun.48

Indoor tanning is not recommended for those under 18 years. Many states and provinces have banned indoor tanning for those under the age of 18 years.49,50

Sunless tanners (as lotions, creams, sprays) give skin a tanned look without exposure to the sun. They are generally considered a safer alternative to tanning in the sun.51 The “tan” from a sunless tanner does not protect against skin damage from the sun. Advise individuals to continue to use sunscreen.52

Are oral “sunscreens” effective?

Oral “sunscreens” (e.g., Heliocare, SunPill) are typically classified as dietary supplements as they contain vitamins, antioxidants, and other ingredients.53

They might help reduce skin damage from sun exposure, but they are NOT a substitute for topical sunscreens.53,54

The FDA has issued repeated warnings for these dietary supplements that make unproven claims of protection from the harms of sun exposure (e.g., premature aging, sunburn, and cancer).54

Levels of Evidence

In accordance with our goal of providing Evidence-Based information, we are citing the LEVEL OF EVIDENCE for the clinical recommendations we publish.

Level

Definition

Study Quality

A

Good-quality patient-oriented evidence.*
  1. High-quality randomized controlled trial (RCT)
  2. Systematic review (SR)/Meta-analysis of RCTs with consistent findings
  3. All-or-none study

B

Inconsistent or limited-quality patient-oriented evidence.*
  1. Lower-quality RCT
  2. SR/Meta-analysis with low-quality clinical trials or of studies with inconsistent findings
  3. Cohort study
  4. Case control study

C

Consensus; usual practice; expert opinion; disease-oriented evidence (e.g., physiologic or surrogate endpoints); case series for studies of diagnosis, treatment, prevention, or screening.

*Outcomes that matter to patients (e.g., morbidity, mortality, symptom improvement, quality of life).

[Adapted from Ebell MH, Siwek J, Weiss BD, et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician 2004;69:548-56. https://www.aafp.org/pubs/afp/issues/2004/0201/p548.html.]

References

  1. Skin Cancer Foundation. Skin cancer facts & statistics. February 2024. https://www.skincancer.org/skin-cancer-information/skin-cancer-facts. (Accessed July 10, 2024).
  2. Li H, Colantonio S, Dawson A, et al. Sunscreen Application, Safety, and Sun Protection: The Evidence. J Cutan Med Surg. 2019 Jul/Aug;23(4):357-369.
  3. American Academy of Dermatology. American Academy of Dermatology comments on follow-up study on absorption of sunscreen ingredients. January 21, 2020. https://www.aad.org/news/2020-01-21-study-on-absorption-of-sunscreen-ingredients. (Accessed May 11, 2020).
  4. American Academy of Dermatology. 5 common sunscreen mistakes – and how to avoid them. https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/common-sunscreen-mistakes#:~:text=Using%20too%20little.,isn't%20covered%20by%20clothing. (Accessed July 10, 2024).
  5. Mancuso JB, Maruthi R, Wang SQ, Lim HW. Sunscreens: an update. Am J Clin Dermatol 2017;18:643-50.
  6. American Academy of Dermatology. Sunscreen FAQs. https://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreen-faqs. (Accessed July 10, 2024).
  7. FDA. Sunscreens: how to help protect your skin from the sun. May 17, 2024. https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm239463.htm. (Accessed July 11, 2024).
  8. Health Canada. Important sunscreen safety tips for Canadians. June 19, 2018. http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2018/66966a-eng.php. (Accessed July 11, 2024).
  9. Health Canada. Primary sunscreen monograph. November 25, 2022. https://webprod.hc-sc.gc.ca/nhpid-bdipsn/dbImages/mono_primary-sunscreen-monograph_english.pdf. (Accessed July 12, 2024).
  10. Government of Canada. Sunscreens. November 7, 2017. https://www.canada.ca/en/health-canada/services/sun-safety/sunscreens.html. (Accessed July 12, 2024).
  11. Canadian Dermatology Association. Sunscreen FAQ. https://dermatology.ca/public-patients/sun-protection/sunscreen-faq/. (Accessed July 12, 2024).
  12. FDA. FDA proposed order: sunscreen drug products for over-the-counter-human use; proposal to amend and revise the deemed final order established by the CARES Act. https://www.fda.gov/media/153964/download#:~:text=FDA%20had%20previously%20proposed%20(in,value%20should%20be%20SPF%2060%2B. (Accessed July 24, 2024).
  13. FDA. Labeling and effectiveness testing: sunscreen drug products for over-the-counter human use – small entity compliance guide. Current as of March 22, 2018. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/labeling-and-effectiveness-testing-sunscreen-drug-products-over-counter-human-use-small-entity. (Accessed July 12, 2024).
  14. Heymann WR. Here comes summer (and sunscreen conversations)! J Am Acad Dermatol. 2020 Apr;82(4):821-822.
  15. American Academy of Pediatrics. Sun safety: information for parents about sunburn & sunscreen. June 18, 2024. Sun Safety: Information for Parents About Sunburn & Sunscreen - HealthyChildren.org. (Accessed July 12, 2024).
  16. National Ocean Service. Skincare chemicals and coral reefs. https://oceanservice.noaa.gov/news/sunscreen-corals.html. (Accessed July 25, 2024).
  17. Gibson LE. Is sunscreen from last year still good? When does sunscreen expire? January 9, 2024. http://www.mayoclinic.com/health/sunscreen-expire/AN01968. (Accessed July 12, 2024).
  18. Healthline Media. The sunscreen gap: do black people need sunscreen. September 27, 2019. https://www.healthline.com/health/black-people-need-sunscreen#1. (Accessed July 10, 2024).
  19. Sharkey L. What dark-skinned people need to know about sun care. February 2, 2024. https://www.healthline.com/health/can-black-people-get-sunburn. (Accessed July 10, 2024).
  20. Skin Cancer Foundation. Sun-protective clothing. Last reviewed June 2019. https://www.skincancer.org/prevention/sun-protection/clothing/protection.(Accessed July 12, 2024).
  21. Abdel Azim S, Bainvoll L, Vecerek N, DeLeo VA, Adler BL.Sunscreens Part 2: Regulation and Safety. J Am Acad Dermatol. 2024 May 20:S0190-9622(24)00786-2.
  22. Skin Cancer Foundation. Ask the expert: which is better, a combination insect repellent and sunscreen or separate products? July 14, 2022. https://www.skincancer.org/blog/ask-the-expert-which-is-better-a-combination-insect-repellent-and-sunscreen-or-separate-products/. (Accessed July 12, 2024).
  23. US National Library of Medicine. Bug repellent safety. Reviewed April 28, 2023. http://www.nlm.nih.gov/medlineplus/ency/article/001969.htm. (Accessed July 12, 2024).
  24. Clinical Pharmacology powered by ClinicalKey. Tampa (FL): Elsevier. 2024. http://www.clinicalkey.com. (Accessed July 12, 2024).
  25. Brucculieri J. Is sunscreen more effective if you apply it before or after moisturizer? March 1, 2018. https://www.huffingtonpost.ca/entry/when-to-apply-sunscreen_n_5a95d6ebe4b0e6a5230236b2. (Accessed July 12, 2024).
  26. Wang SQ, Burnett ME, Lim HW. Safety of oxybenzone: putting numbers into perspective. Arch Dermatol. 2011 Jul;147(7):865-6.
  27. American Academy of Dermatology Association. Is sunscreen safe? April 18, 2022. https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/is-sunscreen-safe. (Accessed July 25, 2024).
  28. Matta MK, Zusterzeel R, Pilli NR, et al. Effect of Sunscreen Application Under Maximal Use Conditions on Plasma Concentration of Sunscreen Active Ingredients: A Randomized Clinical Trial. JAMA. 2019 Jun 4;321(21):2082-2091.
  29. Matta MK, Florian J, Zusterzeel R, et al. Effect of Sunscreen Application on Plasma Concentration of Sunscreen Active Ingredients: A Randomized Clinical Trial. JAMA. 2020 Jan 21;323(3):256-267. Erratum in: JAMA. 2020 Mar 17;323(11):1098.
  30. Canadian Cancer Society. Melanoma skin cancer statistics. May 2024. https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/statistics#:~:text=1%2C300%20Canadians%20will%20die%20from,850%20will%20die%20from%20it. (Accessed July 10, 2024).
  31. American Academy of Pediatrics. Sun safety: information for parents about sunburn and sunscreen. June 18, 2024. https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Sun-Safety.aspx. (Accessed July 22, 2024).
  32. DiNardo JC, Downs CA. Can oxybenzone cause Hirschsprung's disease? Reprod Toxicol. 2019 Jun;86:98-100.
  33. McSweeney PC. The safety of nanoparticles in sunscreens: An update for general practice. Aust Fam Physician. 2016 Jun;45(6):397-9.
  34. Environmental Working Group. Nanoparticles in sunscreens. May 23, 2024. https://www.ewg.org/sunscreen/report/nanoparticles-in-sunscreen/#.WxpdWEgvyUk. (Accessed July 22, 2024).
  35. Kim KB, Kim YW, Lim SW, et al. Risk assessment of zinc oxide, a cosmetic ingredient used as a UV filter of sunscreens. J Toxicol Environ Health B Crit Rev. 2017;20(3):155-182.
  36. People4ocean. 7 holiday destinations that have banned chemical sunscreens. December 13, 2022. https://www.people4ocean.com/blogs/blog/7-holiday-destinations-that-have-banned-chemical-sunscreens#:~:text=packing%20sunscreen...-,Hawaii,that%20sell%20sunscreen%20in%20Hawaii. (Accessed July 15, 2024).
  37. Perrigo B. Why a sunny Pacific island is banning sunscreen. November 7, 2018. Time. https://time.com/5447739/palau-sunscrren-ban-coral/. (Accessed July 23, 2024).
  38. National Oceanic and Atmospheric Administration. The effects of ultraviolet filters and sunscreen on corals and aquatic ecosystems. September 2019. https://repository.library.noaa.gov/view/noaa/22758/noaa_22758_DS1.pdf. (Accessed July 25, 2024).
  39. NPR. Many common sunscreens may harm coral. Here’s what to use instead. July 2, 2018. https://www.npr.org/sections/health-shots/2018/07/02/624379378/many-common-sunscreens-may-harm-coral-heres-what-to-use-instead. (Accessed July 23, 2024).
  40. Fort Wayne Dermatology Consultants. Is your sunscreen reef safe? https://fwderm.com/is-your-sunscreen-reef-safe/#:~:text=There's%20more%20to%20consider%20than,sunscreen%20regardless%20of%20the%20ingredients. (Accessed July 24, 2024).
  41. Green AC, Williams GM, Logan V, Strutton GM. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol. 2011 Jan 20;29(3):257-63.
  42. Bigby M, Kim CC. A prospective randomized controlled trial indicates that sunscreen use reduced the risk of developing melanoma. Arch Dermatol. 2011 Jul;147(7):853-4.
  43. National Institutes of Health. Vitamin D. Updated September 18, 2023. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. (Accessed July 23, 2024).
  44. American Cancer Society. How to use sunscreen. June 26, 2024. https://www.cancer.org/cancer/risk-prevention/sun-and-uv/how-to-use-sunscreen.html. (Accessed July 23, 2024).
  45. Williams JD, Maitra P, Atillasoy E, et al. SPF 100+ sunscreen is more protective against sunburn than SPF 50+ in actual use: Results of a randomized, double-blind, split-face, natural sunlight exposure clinical trial. J Am Acad Dermatol. 2018 May;78(5):902-910.e2.
  46. Kohli I, Nicholson CL, Williams JD, et al. Greater efficacy of SPF 100+ sunscreen compared with SPF 50+ in sunburn prevention during 5 consecutive days of sunlight exposure: A randomized, double-blind clinical trial. J Am Acad Dermatol. 2020 Apr;82(4):869-877.
  47. Environmental Working Group. Dramatic decline: oxybenzone use plummets to only 13 percent of non-mineral sunscreens. May 23, 2023. https://www.ewg.org/news-insights/news-release/2023/05/dramatic-decline-oxybenzone-use-plummets-only-13-percent-non#:~:text=Oxybenzone%20is%20still%20allowed%20for,into%20the%20safety%20of%20oxybenzone. (Accessed July 15, 2024).
  48. Alberta Health Services. Indoor Tanning. https://www.healthiertogether.ca/living-healthy/limit-uv-rays/indoor-tanning/. (Accessed July 23, 2024).
  49. American Medical Association. Indoor tanning restriction for minors. 2015. https://www.ama-assn.org/media/9796/download. (Accessed July 23, 2024).
  50. Skin Cancer Foundation. Indoor tanning legislation: here’s where we stand. March 27, 2024. https://www.skincancer.org/blog/indoor-tanning-legislation-heres-stand/. (Accessed July 23, 2024).
  51. Mayo Clinic. Sunless tanning: what you need to know. May 24, 2019. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sunless-tanning/art-20046803. (Accessed July 23, 2024).
  52. FDA. Tanning products. April 26, 2019. https://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/Tanning/ucm116434.htm.(Accessed July 23, 2024).
  53. Texas Medical Center. Shining a light on the facts about sunscreen pills. July 23, 2018. https://www.tmc.edu/news/2018/07/shining-a-light-on-the-facts-about-sunscreen-pills/. (Accessed July 24, 2024).
  54. FDA. Statement from FDA commissioner Scott Gottlieb, M.D., on new FDA actions to keep consumers safe from the harmful effects of sun exposure, and ensure the long-term safety and benefits of sunscreens. May 22, 2018. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm608499.htm. (Accessed July 23, 2024).

Cite this document as follows: Clinical Resource, Shedding Light on Questions About Sunscreens. Pharmacist’s Letter/Pharmacy Technician’s Letter/Prescriber Insights. August 2024. [400860]

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