Sunscreen: Difference between revisions

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→‎Recent legal changes concerning sunscreen: changed the order to keep one side of the story together and then let the other issue follow
Gerriet42 (talk | contribs)
The exact number and type of the epidemiological studies is confusing here. Here the main point is, that there was more evidence for harmful effects of sunscreen than for protective effects.
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'''Sunscreen''' (also known as '''sunblock''', '''suntan lotion''') is a [[lotion]], spray or other [[topical]] product that is supposed to protect the skin from the [[sun]]'s [[ultraviolet]] (UV) radiation. The use of sunscreen does reduce [[sunburn]] and other skin damages which are caused by [[direct DNA damage]]. However the effect of sunscreen-use on the incidences of [[malignant melanoma]] - which is caused by the [[indirect DNA damage]] - is still under dispute<ref name=Diepgen2002> {{cite journal |author=S. Bastuji-Garin; T.L. Diepgen |title=Cutaneous malignant melanoma, sun exposure, and sunscreen use: epidemiological evidence. |journal=The British journal of dermatology |volume=146 |issue=1 |pages=24-30 |year=2002 |issn=}}</ref><ref name=Marshall2003>{{cite journal |author=Stephen W. Marshall, Charles Poole, Anna E Waller, |title= SUNSCREEN USE AND MALIGNANT MELANOMA RISK: THE JURY IS STILL OUT |journal=American Journal of Public Health |volume=93 |issue=1 |pages= |year=2003|issn=}}</ref> due to three case-control studies, one epidemiological study, and one prospective study showing an increased melanoma risk for sunscreen users.<ref name=Garland>{{cite journal |author=Garland C, Garland F, Gorham E |title=Could sunscreens increase melanoma risk? |url= http://www.ajph.org/cgi/reprint/82/4/614 |journal=Am J Public Health |volume=82 |issue=4 |pages=614-5 |year=1992 |pmid=1546792 |issn=}}</ref><ref name=Westerdahl2000> {{cite journal |author=Westerdahl J; Ingvar C; Masback A; Olsson H |title= Sunscreen use and malignant melanoma. | journal= International journal of cancer. Journal international du cancer |volume=87 |pages=145-50 |year=2000 }}</ref><ref name=Autier> {{cite journal |author=Autier P; Dore J F; Schifflers E; et al |title=Melanoma and use of sunscreens: An EORTC case control study in Germany, Belgium and France |url= |journal=Int. J. Cancer |volume=61 |issue= |pages=749-755 |year=1995 |pmid= |issn=}}</ref><ref name=Weinstock> {{cite journal |author=Weinstock, M. A. |title=Do sunscreens increase or decrease melanoma risk: An epidemiologic evaluation. |url= |journal=Journal of Investigative Dermatology Symposium Proceedings |volume=4 |issue= |pages= 97-100 |year=1999 |issn=}}</ref><ref name=Vainio> {{cite journal |author=Vainio, H., Bianchini, F. |title=Cancer-preventive effects of sunscreens are uncertain. |url= |journal=Scandinavian Journal of Work Environment and Health |volume=26 |issue= |pages=529-31 |year=2000 |issn=}}</ref> It is widely accepted in the scientific literature that the confidence which sunbathers had in sunscreen and the missconception that "sunburn causes melanoma" is to blame for the increase of melanoma incidences. This effect of sunscreen-use has caused several [[sunscreen#Lawsuits against sunscreen manufacturers|lawsuits against the manufacturers]]. Some researchers say that the absence of a sunburn encourages sunscreen users to stay in the sun longer which lead to an increased melanoma risk. Other researchers blame the [[sunscreen#absorption of photoactive sunscreen ingredients into the skin|penetration of sunscreen into the skin]] and the associated harmful effects on the living tissue.<ref name="Hanson">{{cite journal |author=Hanson Kerry M.; Gratton Enrico; Bardeen Christopher J.|title=Sunscreen enhancement of UV-induced reactive oxygen species in the skin |url=http://dx.doi.org/10.1016/j.freeradbiomed.2006.06.011||journal=Free Radical Biology and Medicine|volume=41|issue=8 |pages=1205-1212 |year=2006 }}</ref>
'''Sunscreen''' (also known as '''sunblock''', '''suntan lotion''') is a [[lotion]], spray or other [[topical]] product that is supposed to protect the skin from the [[sun]]'s [[ultraviolet]] (UV) radiation. The use of sunscreen does reduce [[sunburn]] and other skin damages which are caused by [[direct DNA damage]]. However the effect of sunscreen-use on the incidences of [[malignant melanoma]] - which is caused by the [[indirect DNA damage]] - is still under dispute.<ref name=Diepgen2002> {{cite journal |author=S. Bastuji-Garin; T.L. Diepgen |title=Cutaneous malignant melanoma, sun exposure, and sunscreen use: epidemiological evidence. |journal=The British journal of dermatology |volume=146 |issue=1 |pages=24-30 |year=2002 |issn=}}</ref><ref name=Marshall2003>{{cite journal |author=Stephen W. Marshall, Charles Poole, Anna E Waller, |title= SUNSCREEN USE AND MALIGNANT MELANOMA RISK: THE JURY IS STILL OUT |journal=American Journal of Public Health |volume=93 |issue=1 |pages= |year=2003|issn=}}</ref>. This dispute arose from the fact that the epidemiological studies which suggest a positive correlation between sunscreen use and melanoma<ref name=Garland>{{cite journal |author=Garland C, Garland F, Gorham E |title=Could sunscreens increase melanoma risk? |url= http://www.ajph.org/cgi/reprint/82/4/614 |journal=Am J Public Health |volume=82 |issue=4 |pages=614-5 |year=1992 |pmid=1546792 |issn=}}</ref><ref name=Westerdahl2000> {{cite journal |author=Westerdahl J; Ingvar C; Masback A; Olsson H |title= Sunscreen use and malignant melanoma. | journal= International journal of cancer. Journal international du cancer |volume=87 |pages=145-50 |year=2000 }}</ref><ref name=Autier> {{cite journal |author=Autier P; Dore J F; Schifflers E; et al |title=Melanoma and use of sunscreens: An EORTC case control study in Germany, Belgium and France |url= |journal=Int. J. Cancer |volume=61 |issue= |pages=749-755 |year=1995 |pmid= |issn=}}</ref><ref name=Weinstock> {{cite journal |author=Weinstock, M. A. |title=Do sunscreens increase or decrease melanoma risk: An epidemiologic evaluation. |url= |journal=Journal of Investigative Dermatology Symposium Proceedings |volume=4 |issue= |pages= 97-100 |year=1999 |issn=}}</ref><ref name=Vainio> {{cite journal |author=Vainio, H., Bianchini, F. |title=Cancer-preventive effects of sunscreens are uncertain. |url= |journal=Scandinavian Journal of Work Environment and Health |volume=26 |issue= |pages=529-31 |year=2000 |issn=}}</ref> outnumber those which show any protective effect. It is widely accepted in the scientific literature that the confidence which sunbathers had in sunscreen and the missconception that "sunburn causes melanoma" is to blame for the increase of melanoma incidences. This effect of sunscreen-use has caused several [[sunscreen#Lawsuits against sunscreen manufacturers|lawsuits against the manufacturers]]. Some researchers say that the absence of a sunburn encourages sunscreen users to stay in the sun longer which lead to an increased melanoma risk. Other researchers blame the [[sunscreen#absorption of photoactive sunscreen ingredients into the skin|penetration of sunscreen into the skin]] and the associated harmful effects on the living tissue.<ref name="Hanson">{{cite journal |author=Hanson Kerry M.; Gratton Enrico; Bardeen Christopher J.|title=Sunscreen enhancement of UV-induced reactive oxygen species in the skin |url=http://dx.doi.org/10.1016/j.freeradbiomed.2006.06.011||journal=Free Radical Biology and Medicine|volume=41|issue=8 |pages=1205-1212 |year=2006 }}</ref>


Sunscreen is a topically applied product which is intended to stay on the surface of the human skin. The uppermost 0.1 mm of the human skin consist of dead cells ([[stratum corneum]]). Those sunscreen chemicals which stay within the uppermost layer (topical sunscreen) act as an inert filter of the UV-radiation. The reduction of the UV-intensity leads to less tanning, less sunburn and a lower risk for malignant melanoma. However, sunscreen molecules which penetrate into the deeper layers of the human skin (absorbed sunscreen) have harmful effects on the living tissue.<ref name=Damiani2004> {{cite journal |author=Armeni, Tatiana; Damiani, Elisabetta; et al. |title= Lack of in vitro protection by a common sunscreen ingredient on UVA-induced cytotoxicity in keratinocytes. | journal= Toxicology |volume= 203(1-3) |pages=165-178 |year=2004 }}</ref><ref name=Knowland1993> {{cite journal |author=Knowland, John; McKenzie, Edward A.; McHugh, Peter J.; Cridland, Nigel A. |title= Sunlight-induced mutagenicity of a common sunscreen ingredient. | journal= FEBS Letters |volume= 324(3) |pages=309-313 |year=1993 }}</ref> Upon UV-irradiation the sunscreen chemicals act as photosensitizers which produce [[free radicals]]. This effect is due to the inferiour [[photoprotection|photochemical properties of sunscreen ingredients]] compared to those of [[melanin]] and DNA (see [[photoprotection]]).
Sunscreen is a topically applied product which is intended to stay on the surface of the human skin. The uppermost 0.1 mm of the human skin consist of dead cells ([[stratum corneum]]). Those sunscreen chemicals which stay within the uppermost layer (topical sunscreen) act as an inert filter of the UV-radiation. The reduction of the UV-intensity leads to less tanning, less sunburn and a lower risk for malignant melanoma. However, sunscreen molecules which penetrate into the deeper layers of the human skin (absorbed sunscreen) have harmful effects on the living tissue.<ref name=Damiani2004> {{cite journal |author=Armeni, Tatiana; Damiani, Elisabetta; et al. |title= Lack of in vitro protection by a common sunscreen ingredient on UVA-induced cytotoxicity in keratinocytes. | journal= Toxicology |volume= 203(1-3) |pages=165-178 |year=2004 }}</ref><ref name=Knowland1993> {{cite journal |author=Knowland, John; McKenzie, Edward A.; McHugh, Peter J.; Cridland, Nigel A. |title= Sunlight-induced mutagenicity of a common sunscreen ingredient. | journal= FEBS Letters |volume= 324(3) |pages=309-313 |year=1993 }}</ref> Upon UV-irradiation the sunscreen chemicals act as photosensitizers which produce [[free radicals]]. This effect is due to the inferiour [[photoprotection|photochemical properties of sunscreen ingredients]] compared to those of [[melanin]] and DNA (see [[photoprotection]]).

Revision as of 03:54, 26 March 2008

Template:Totallydisputed

Sunscreen (also known as sunblock, suntan lotion) is a lotion, spray or other topical product that is supposed to protect the skin from the sun's ultraviolet (UV) radiation. The use of sunscreen does reduce sunburn and other skin damages which are caused by direct DNA damage. However the effect of sunscreen-use on the incidences of malignant melanoma - which is caused by the indirect DNA damage - is still under dispute.[1][2]. This dispute arose from the fact that the epidemiological studies which suggest a positive correlation between sunscreen use and melanoma[3][4][5][6][7] outnumber those which show any protective effect. It is widely accepted in the scientific literature that the confidence which sunbathers had in sunscreen and the missconception that "sunburn causes melanoma" is to blame for the increase of melanoma incidences. This effect of sunscreen-use has caused several lawsuits against the manufacturers. Some researchers say that the absence of a sunburn encourages sunscreen users to stay in the sun longer which lead to an increased melanoma risk. Other researchers blame the penetration of sunscreen into the skin and the associated harmful effects on the living tissue.[8]

Sunscreen is a topically applied product which is intended to stay on the surface of the human skin. The uppermost 0.1 mm of the human skin consist of dead cells (stratum corneum). Those sunscreen chemicals which stay within the uppermost layer (topical sunscreen) act as an inert filter of the UV-radiation. The reduction of the UV-intensity leads to less tanning, less sunburn and a lower risk for malignant melanoma. However, sunscreen molecules which penetrate into the deeper layers of the human skin (absorbed sunscreen) have harmful effects on the living tissue.[9][10] Upon UV-irradiation the sunscreen chemicals act as photosensitizers which produce free radicals. This effect is due to the inferiour photochemical properties of sunscreen ingredients compared to those of melanin and DNA (see photoprotection).

While it is known, that sunscreen which gets into contact with living tissue is having a damaging effect on this tissue,[9][10][11][12] many medical doctors claim, that sunscreen does not pass the epidermal barrier into the human skin in amounts large enough to cause damage. The dispute whether sunscreen is photocarcinogenic or not ultimately ends in the question, whether the harmful effects of the absorbed sunscreen are dominating over the UV-filtering effect of the topical sunscreen.[13]

Recent legal changes concerning sunscreen

In August 2007, FDA proposed to disallow manufacturer claims on bottles that using sunscreens prevents cancer and to change SPF to refer to Sunburn Protection Factor instead of Sun Protection Factor (FDA proposed changes). This was done due to the epidemiological results in conjunction with some mechanistic studies which show that sunscreens prevent inflammation only and not necessarily the causes of melanoma.
However, the FDA is proposing to retain the language which states "UV exposure from the sun increases the risk of skin cancer, premature skin aging, and other skin damage. It is important to decrease UV exposure by limiting time in the sun, wearing protective clothing, and using a sunscreen" (page 49073). In these comments, the FDA also noted that DHA "appears to be a potent inducer of thymine dimers, premutagenic deoxyribonucleic acid (DNA) lesions" and "FDA has tentatively concluded that the available evidence fails to show that sunscreen use alone helps prevents skin cancer or premature skin aging." (page 49079)

Dosing

Dosing for sunscreen can be calculated using the formula for body surface area and subsequently subtracting the area covered by clothing that provides effective UV protection. The dose used in FDA sunscreen testing is 2 mg/cm2.[14] Provided one assumes an "average" adult build of height 5 ft 4 in (163 cm) and weight 150 lb (68 kg) with a 32 in (82 cm) waist, that adult wearing a bathing suit covering the groin area should apply 29 g (approximately 1 oz) evenly to the uncovered body area. Considering only the face, this translates to about 1/4 to 1/3 of a teaspoon for the average adult face.

Contrary to the common advice that sunscreen should be reapplied every 2-3 hours, some research has shown that the best protection is achieved by application 30 minutes before exposure, followed by one reapplication 15-30 minutes after the sun exposure begins. Further reapplication is only necessary after activities such as swimming, sweating, and rubbing.[15]

However, more recent research at the University of California, Riverside indicates that sunscreen needs to be reapplied within 2 hours in order to remain effective. Not reapplying could even cause more cell damage than not using sunscreen at all, due to the release of extra free radicals from absorbed chemicals.[8]

History

The first effective sunscreen may have been developed by chemist Franz Greiter in 1938. The product, called Gletscher Crème (Glacier Cream), subsequently became the basis for the company Piz Buin (named in honor of the place Greiter allegedly obtained the sunburn that inspired his concoction), which today is a well-known marketer of sunscreen products. Some internet articles suggest that Gletscher Crème had a sun protection factor of 2, although a research citation is not readily available online.

The first widely used sunscreen was produced by Benjamin Greene, an airman and later a pharmacist, in 1944. The product, Red Vet Pet (for red veterinary petrolatum), had limited effectiveness, working as a physical blocker of ultraviolet radiation. It was a disagreeable red, sticky substance similar to petroleum jelly. This product was developed during the height of World War II, when it was likely that the hazards of sun overexposure were becoming apparent to soldiers in the Pacific and to their families at home.

Franz Greiter is credited with introducing the concept of Sun Protection Factor (SPF) in 1962, which has become a worldwide standard for measuring the effectiveness of sunscreen when applied at an even rate of 2 milligrams per square centimeter (mg/cm²). Some controversy exists over the usefulness of SPF measurements, especially whether the 2 mg/cm² application rate is an accurate reflection of people’s actual use [citation needed].

Newer sunscreens have been developed with the ability to withstand contact with water and sweat.

Active ingredients

The principal ingredients in sunscreens are usually aromatic molecules conjugated with carbonyl groups. This general structure allows the molecule to absorb high-energy ultraviolet rays and release the energy as lower-energy rays, thereby preventing the skin-damaging ultraviolet rays from reaching the skin. Some ingredients, such as avobenzone, undergo significant chemical change upon exposure to UV light[14]. So-called physical blockers, Titanium dioxide and Zinc oxide also reflect and scatter UV radiation [citation needed]. However, the active ingredients of sunscreen are many times less efficient than melanin at dissipating the energy of the photon into nonreactive forms of energy. Melanin dissipates the energy as harmless heat within only a few femtoseconds (10-15s) through a process called internal conversion.[16] Due to the extremely short excited state lifetime the melanin has not enough time to react with other molecules - thus avoiding indirect DNA damage. In comparison the active ingredients of sunscreens do not efficiently dissipate the energy of the UV-photon as heat. The excited state lifetime of these substances is in the ps or even in the ns range (1000 to 1000000 times longer than the lifetime of melanin).[17]

The following are the FDA allowable active ingredients in sunscreens:

Recently FDA approved:

  • Mexoryl® SX (USAN Ecamsule, INCI Terephthalylidene Dicamphor Sulfonic Acid) - UVA absorber used in combination with other ingredients for UVB

Others approved within the EU[18] and other parts of the world[19] include:

  • 4-Methylbenzylidene camphor ((INCI), USAN Enzacamene)
  • Tinosorb® M (USAN Bisoctrizole, INCI Methylene Bis-Benzotriazolyl Tetramethylbutylphenol)
  • Tinosorb® S (USAN Bemotrizinol, INCI Bis-Ethylhexyloxyphenol Methoxyphenyl Triazine)
  • Mexoryl® XL (INCI Drometrizole Trisiloxane)
  • Neo Heliopan® AP (USAN Bisdisulizole Disodium, INCI Disodium Phenyl Dibenzimidazole Tetrasulfonate)
  • Uvinul® A Plus (INCI Diethylamino Hydroxybenzoyl Hexyl Benzoate)
  • Uvinul® T 150 (USAN Octyl Triazone, INCI Ethylhexyl Triazone)
  • Uvasorb® HEB (USAN Iscotrizinol, INCI Diethylhexyl Butamido Triazone)
  • Parsol® SLX (INCI Polysilicone-15)
  • Amiloxate ((USAN), INCI Isoamyl p-Methoxycinnamate)

A lot of the ingredients not approved by the FDA are relatively new and developed to absorb UVA.[20]

Melanin

The hormone alpha-melanocyte stimulating hormone is made when the body is exposed to sunlight and is responsible for the development of the pigment melanin. Research is being done to create stable artificial forms of the hormone[citation needed]. A promising candidate, melanotan, might be useful in the prevention of skin cancer, by causing tanning without the need for exposure to dangerous levels of UV[citation needed].

Sun protection factor

The SPF (sun protection factor) of a sunscreen is a laboratory measure of the effectiveness of sunscreen. The higher the SPF, the more protection a sunscreen offers against UVB (the ultraviolet radiation that causes sunburn). In August of 2007, the FDA proposed new rules that would change this term to 'Sunburn protection factor' because the SPF test measures how well sunscreens protect the skin against sunburn only, other harmful effects of the sun.[21].

In theory, SPF is the inverse of the proportion of UVB that penetrates the sunscreen and causes sunburn[22]. Thus a sunscreen with an SPF of p blocks a proportion (p−1)/p of UVB. For example:

Sun Protection Factor Proportion of UVB transmitted Proportion of UVB blocked
SPF 10 10.00% 90.00%
SPF 20 5.00% 95.00%
SPF 30 3.33% 96.66%
SPF 60 1.66% 98.33%

In theory the SPF is a multiplier that can be applied to the time taken to burn. For example, someone who would burn after 12 minutes in the sun would expect to burn after 2 hours (120 minutes) if protected by a sunscreen with SPF 10. In practice the protection from a particular sunscreen depends on factors such as:

  • The skin type of the user.
  • The amount applied and frequency of re-application.
  • Activities in which one engages (for example, swimming leads to a loss of sunscreen from the skin).
  • Time of day and season.
  • Percentage of UV reflected or scattered by the environment, for example snow or sand.
  • Amount of sunscreen the skin has absorbed.

The SPF is an imperfect measure of skin damage, because invisible damage and skin aging is also caused by the very common ultraviolet type A, which does not cause reddening or pain. Normal sunscreen does not block UVA as effectively as UVB, and an SPF rating of 30+ may translate to significantly lower level of UVA protection according to a study from 2003 by researchers funded by the RAFT trust. Some broad spectrum sunscreens do provide significant UVA protection. According to a 2004 study, UVA also causes DNA damage to cells deep within the skin, increasing the risk of malignant melanomas.

Due to consumer confusion over the real degree and duration of protection offered labeling restrictions are in force in several countries. In the United States in 1999 the FDA decided to institute the labelling of SPF 30+ for sunscreens offering more protection, and a similar restriction applies in Australia. This was done to discourage companies making unrealistic claims about the level of protection offered e.g "all day protection", and because an SPF over 30 does not provide significantly better protection.

Possible adverse effects

Some individuals can have mild to moderate allergic reactions to certain ingredients in sunscreen, particularly the chemical benzophenone, which is also known as phenyl ketone, diphenyl ketone, or benzoylbenzene. It is not clear how much of benzophenone is absorbed into the bloodstream, but trace amounts can be found in urinalysis after use.

Sunscreens are effective in reducing sunburn, but not necessarily the risk of cancer. A study published in April 1992, entitled "Could sunscreens increase melanoma risk?" reported that the greatest increase in melanoma occurred in those regions where sunscreen use is most prevalent.[23] The authors point out that "the SPF of sunscreens concerns solely their ability to absorb ultraviolet B (UVB) light. Even sunscreens with high SPF factors can be completely transparent to ultraviolet A (UVA), which includes 90 to 95% of ultraviolet light. UVA blocking ingredients, which have commonly been added to most sunscreens since 1989, block only half the UVA spectrum and provide a protection factor against delayed UVA induced erythema of only 1.7 at usual concentrations. Both UVA and UVB have been shown to mutate DNA and promote skin cancers in animals. UVA also penetrates deeper into the skin than UVB... two studies suggest that sunscreens may not be effective in preventing skin cancer. A large case-control study showed higher risks of melanoma in men who used sunscreens, and a large prospective study showed a higher incidence of basal cell carcinoma in women who used sunscreens."

Recently, there has been increased attention to the possibility of adverse health effects associated with the synthetic compounds in most sunscreens.[24] Recent studies found that some sunscreens generate harmful compounds that might promote skin cancer. The three commonly used ultraviolet (UV) filters -- octylmethoxycinnamate, benzophenone 3, and octocrylene -- eventually soak into the deeper layers of the skin after their application, where they act as photosensitizer and thereby amplify the free radical production from UV-light (indirect DNA damage). UV rays absorbed by the skin can generate harmful compounds called reactive oxygen species (ROS), which can cause skin cancer and premature aging. The researchers found that once the filters in sunscreen soak into the lower layers of skin, the filters react with UV light to create more damaging ROS.[8] To reduce ROS generation and damage, the researchers recommend reapplying the sunscreen often in order to keep the sunscreen that has penetrated into the skin in the dark - so that the filters in the skin can not react with UV light. Future possibilities may include the development of sunscreens which stay at the surface of the skin, or mixing sunscreens with antioxidants that can neutralize ROS.[25]

A significant reduction in sun exposure inhibits the production of vitamin D. The use of sunscreen with a sun protection factor (SPF) of 8 inhibits more than 95% of vitamin D production in the skin.[26] However, excessive sun exposure has been conclusively linked to some forms of skin cancer and signs of premature aging. Season, geographic latitude, time of day, cloud cover, smog, skin type, and sunscreen all have an effect on vitamin D production in the skin.[27] Fifteen minutes per day of direct exposure to the sun (i.e. without sunscreen) is a generally accepted guideline to follow for optimum vitamin D production.[28]

Controversy about the safety of sunscreen

Epidemiological connection between malignant melanoma and sunscreen use

All medical statistics, that have investigated the effect of sunscreen use, have found an increase of malignant melanoma cases associated with sunscreen use. Garland et al. have compared the population of Queensland with the rest of Australia, because in Queensland the use of sunscreen has been promoted the earliest and the strongest compared to the rest of Australia. The increased sunscreen consumption in Queensland has led to a steep rise in the number of melanoma cases. At the time of this study (1992) Queensland had the highest incidence number of melanoma cases in the world. In other parts of Australia the use of sunscreen had been promoted only later, and the melanoma rates increased in these other parts with the same a delay. [3]

Philippe Autier et al .have performed a case-control study with 418 melanoma cases and 438 healthy controls in France Belgium and Germany. [5] They have investigated groups of people who had sunburns in their childhood and those who did not, they have investigated those who were aware of health hazards associated with exaggerated UV-exposure and those who were not aware. These corrections were made to account for convoluting factors like childhood sunburns which might trigger sunscreen use and increase skin cancer risks. They found higher risks for melanoma within each group for those individuals that use sunscreen. Thereby they excluded the convoluting factors, and it had been shown, that it is the sunscreen use itself that causes the skin cancer.

They stated that "due to the divorce between public health messages and results from epidemiological studies, prevention programmes should not affirm that sunscreen use prevents cutaneous melanoma."

Furthermore they underlined the importance of truthful information to the public: They found that the regular sunscreen user unaware of the dangers linked to exaggerated UV-exposure have a 12 times higher risk when compared to aware subjects who never use sunscreen.

Within the group of people unaware of the dangers linked to exaggerated UV-exposure the sunscreen users have a 3.36 times higher risk for melanoma than the non-user.

Westerdahl et al. [4] have performed a case-control study on 571 patients with malignant melanoma and 913 healthy controls. All the patients and controls were asked about their history of sunburn, hair color, sunbathing habits (how long, how often) and - of course - use of sunscreen. They had found a significantly elevated risk for developing malignant melanoma associated with regular sunscreen use. Several adjustments were made with respect to the history of sunburns, hair color and other factors. They state that even in two groups that differ neither in sunbathing frequency nor in duration of each sunbathing session an increased risk for melanoma was found for those who always use sunscreen.

Lawsuits against sunscreen manufacturers

The results from the epidemiological studies have lead to lawsuits against sunscreen manufacturers.

Unfortunately all these lawsuits limit themselves to the absence of UV-A filters, even so the absorption of sunscreen into the skin has contributed to the higher melanoma rate in sunscreen users as well (see below).

Sunburn and malignant melanoma

Arrows indicate a causal connection

It is certainly true that a statistical correlation exists between the number of sunburns and the risk to develop melanoma. This statistical correlation has in the past been interpreted as a causal connection. The medical community took this correlation as an indication that sunburns cause melanoma. This has been shown to be wrong in several studies. Wolf and Kripke have shown that protecting against sunburn does not imply protection against other damaging effects of UV-radiation [29] Genetic studies have investigated the mutations in the melanoma of skin cancer patients. The mechanism of DNA damage which produced the melanoma can be identified from the kind of mutation, and it was shown that malignant melanoma in healthy humans originate from direct DNA damage only in 8% of the cases and melanoma originate from the indirect DNA damage in 92 % of the cases [30] . Since the direct DNA damage is connected to sunburn it can be said that sunburn causes only 8 % of the melanoma cases and the indirect DNA damage (which is often amplified by sunscreen because it penetrates into the skin[8]) is responsible for 92 % of all melanoma cases.

(Indirect DNA damage is caused by reactive oxygen species (ROS), oxidative stress and free radicals)

Mechanisms of melanoma generation by the use of sunscreen

There are several contributors to the increased melanoma risk among sunscreen users:

  • Since the medical community had send out the message that sunburn "causes" melanoma, many people feel safe as long as they slap their sunscreen on. In reality the cause of melanoma is the indirect DNA damage not the sunburn-causing direct DNA damage. One contributor to the harmful effects of sunscreen is the changed behaviour of the sunscreen user compared to the non-user. Sunscreen prevents any warning signal that the human skin usually generates when exposed to solar radiation. This absence of a warning signal gives a treacherous feeling of safety to the sunscreen-user. Since they are not afraid of a sunburn the sunscreen-users stay in the sun much longer and therefore they are exposed to a larger dose of radiation. This increases in turn the indirect DNA damage which is responsible for the development of almost all melanoma.[5]
  • UVB radiation stimulates the skin to generate more protective melanin. The UVB filters in sunscreen suppress this stimulus. Then the human body fails to recognise the danger and the skin does not produce this substance that would offer an efficient natural protection against UVB and UVA. Furthermore it can be speculated that the reduced tanning effect in the sunscreen user will cause him to spend more time in the sun thereby increasing the dose of harmful radiation.
  • Another substantial contributor was the false assumption that little or none of the topically applied sunscreen would be absorbed into the skin. This has been proven wrong several times (see for example [31][32][33]).The medical community has treated sunscreen like an inert filter that does not get into contact with living tissue. Today it is well established that sunscreen does penetrate the epidermal barrier into the human skin in amounts which are large enough to cause serious damage due to an increase of photogenerated free radicals.[8] Photocatalytic substances can damage biological tissue even at very small concentrations. While non-catalytic substances need to be fairly concentrated to do harm, a photocatalyst combined with UV-irradiation can be harmful even at concentrations as low as 10 μmol/l. [11] This is due to the repeated reaction of such a catalyst - one photocatalyst molecule can produce millions of free radicals (and more). This catalytic property of the sunscreen chromophore seems to have eluded the medical doctors who did not understand the language of many warning photochemists.

At this time, sunscreen is not tested (in Europe, Japan and Australia) for photocarcinogenic effects before it is released onto the market. In the US such testing became compulsory in 1978, and since then only 3 new substances have managed to fullfill these new requirements - illustrating how difficult it is to create a sunscreen ingredient that is not photocarcinogenic.[34] Even in the US most of the sunscreens that are sold had their ingredients permitted to the market before testing for photocarcinogenic effects became compulsory. Furthermore it is important to know that those tests for photocarcinogenic properties are comparing two test animals that stay in the sun for the same amount of time. And there are other restrictions of these tests as well. For example the animal has not been naked for 100000 years - a time scale that is evolutionary relevant and humans have developed better defense mechanisms than those animals.

In summary the factors that lead to a higher melanoma risk in Sunscreen users are:

  1. Changed behaviour of the sunscreen user due to a false sense of security
  2. Skin penetration through the epidermal barrier and the ensuing photosensitization effect of sunscreen

Animal tests

Experiments on mice have shown a protective effect of sunscreens against melanoma. The following experiments were performed in 1982, 1985 and 1990 - after this the animal protection policies do not allow animal testing for cosmetic products any more. In these experiments the mice were treated with sunscreen, and then immediately irradiated for only 10 minutes[35] [36] or for 3 to 7 minutes[37] after this time the irradiation stopped and the next sunscreen + irradiation treatment was done after a 2 day break. Within these 10 minutes the sunscreen does not penetrate through the epidermal barrier. For this reason the mice were not affected by the photosensitaziation effect of the sunscreen chemicals as it is described in [8]. Despite the obvious discrepancy between such an experimental design and a real situation of sunscreen use, these experiment have been widely used as arguments to promote the use of sunscreen. Obviously human use has a different time-pattern because most sunscreen users stay in the sun longer than 10 minutes. This longer time allows the sunscreen to diffuse into the skin which leads to free radical generation inside the skin.

Photochemical properties of sunscreen ingredients vs. melanin

Melanin has an extremely efficient photoprotective mechanism that dissipates the energy from the UV-radiation as harmless heat. This property is crucial to avoid the indirect DNA damage. In this mechanism the excited state of the melanin gives of the energy into the vibrational modes of the molecule (heat) by a process that is called internal conversion. This way melanin does not act as a photosensitizer. This photochemical process has been optimized by nature for melanin out of necessity. The internal conversion of melanin is so fast, that more than 99.9 % of the energy is dissipated as heat.[38]

Sunscreen ingredients do not posses this photoprotective property. They do not efficiently dissipate the absorbed energy. In fact many of those chemicals (e.g.: PABA, Benzophenone or Coumarin) are used as photosensitizers in chemical reactions. Coumarin is used as a dye in lasers. The property that makes it suitable for such an application is the long-lived excited state. Exactly this property makes it unsuitable for use in sunscreen. It will act as a photosensitizer starting indirect DNA damage - all the while preventing sunburn. Chemicals with a long lived excited state - substances that are used in chemistry as photosensitizers - should not be used in sunscreens. And yet they are.

absorption of photoactive sunscreen ingredients into the skin

Those medical doctors who endorse the use of sunscreen assume that little or none of the topically applied sunscreen would be absorbed into the skin. They treat sunscreen like an inert filter that does not get into contact with living tissue in relevant amounts. In order to judge the rightfulness of this assumption the reader needs to know that photocatalytic substances can do harm to living tissue even at very low concentrations when illuminated. This effect of even very low concentrations is due to the fact that photocatalytic substances produce free radicals when illuminated with UV-light (or a reactive oxygen species) and then return to their original state - they are catalytic and they don't get consumed. This cycle can be repeated until a million free radicals are generated by each sunscreen-molecule. Concentrations as little as 10 μmol/l [11] or 25 μmol/l [12] have been shown to kill living tissue. The concentrations that are reached inside the human skin can be estimated from the recommended dose of 2 mg/cm2 [14] , the molecular weight of the specific ingredient (most of them are around 200 g/mol), their maximum concentration in a final sunscreen formulation and the fraction of sunscreen that is absorbed into the skin. Those who are endorsing the use of sunscreen report that after 24 hours "only" 10 % of the sunscreen ingredients have been absorbed into the skin.[39] With an allowed concentration for the UV-filter of 8% and a molar mass of = 277 g·mol-1 the resulting concentration is 57 μmol/l if the filter spreads out over a 1 cm deep layer. Assuming a 1 mm thick layer the concentration will be 570 μmol/l.

References

  1. ^ S. Bastuji-Garin; T.L. Diepgen (2002). "Cutaneous malignant melanoma, sun exposure, and sunscreen use: epidemiological evidence". The British journal of dermatology. 146 (1): 24–30.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  2. ^ Stephen W. Marshall, Charles Poole, Anna E Waller, (2003). "SUNSCREEN USE AND MALIGNANT MELANOMA RISK: THE JURY IS STILL OUT". American Journal of Public Health. 93 (1).{{cite journal}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  3. ^ a b Garland C, Garland F, Gorham E (1992). "Could sunscreens increase melanoma risk?". Am J Public Health. 82 (4): 614–5. PMID 1546792.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ^ a b Westerdahl J; Ingvar C; Masback A; Olsson H (2000). "Sunscreen use and malignant melanoma". International journal of cancer. Journal international du cancer. 87: 145–50.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ^ a b c Autier P; Dore J F; Schifflers E; et al. (1995). "Melanoma and use of sunscreens: An EORTC case control study in Germany, Belgium and France". Int. J. Cancer. 61: 749–755. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  6. ^ Weinstock, M. A. (1999). "Do sunscreens increase or decrease melanoma risk: An epidemiologic evaluation". Journal of Investigative Dermatology Symposium Proceedings. 4: 97–100.
  7. ^ Vainio, H., Bianchini, F. (2000). "Cancer-preventive effects of sunscreens are uncertain". Scandinavian Journal of Work Environment and Health. 26: 529–31.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ^ a b c d e f Hanson Kerry M.; Gratton Enrico; Bardeen Christopher J. (2006). "Sunscreen enhancement of UV-induced reactive oxygen species in the skin". Free Radical Biology and Medicine. 41 (8): 1205–1212. {{cite journal}}: Cite has empty unknown parameter: |1= (help)CS1 maint: multiple names: authors list (link) Cite error: The named reference "Hanson" was defined multiple times with different content (see the help page).
  9. ^ a b Armeni, Tatiana; Damiani, Elisabetta; et al. (2004). "Lack of in vitro protection by a common sunscreen ingredient on UVA-induced cytotoxicity in keratinocytes". Toxicology. 203(1-3): 165–178. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  10. ^ a b Knowland, John; McKenzie, Edward A.; McHugh, Peter J.; Cridland, Nigel A. (1993). "Sunlight-induced mutagenicity of a common sunscreen ingredient". FEBS Letters. 324(3): 309–313.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ^ a b c Mosley, C N; Wang, L; Gilley, S; Wang, S; Yu,H (2007). "Light-Induced Cytotoxicity and Genotoxicity of a Sunscreen Agent, 2-Phenylbenzimidazol in Salmonella typhimurium TA 102 and HaCaT Keratinocytes". Internaltional Journal of Environmental Research and Public Health. 4 (2): 126–131. {{cite journal}}: Cite has empty unknown parameter: |month= (help)CS1 maint: multiple names: authors list (link)
  12. ^ a b Xu, C.; Green, Adele; Parisi, Alfio; Parsons, Peter G (2001). "Photosensitization of the Sunscreen Octyl p-Dimethylaminobenzoate b UVA in Human Melanocytes but not in Keratinocytes". Photochemistry and Photobiology. 73 (6): 600–604. {{cite journal}}: Cite has empty unknown parameter: |month= (help)CS1 maint: multiple names: authors list (link)
  13. ^ Knowland, J. S. (1993). "Reply of Dr. Knowland to Gasparro's comment". FEBS Letters. 336: 186.
  14. ^ a b c http://www.fda.gov/ohrms/dockets/dailys/00/Sep00/090600/c000573_10_Attachment_F.pdf
  15. ^ Diffey B (2001). "When should sunscreen be reapplied?". J Am Acad Dermatol. 45 (6): 882–5. PMID 11712033.
  16. ^ "ultrafast internal conversion of DNA". Retrieved 2008-02-13.
  17. ^ Cantrell, Ann; McGarvey, David J; (2001). "3(Sun Protection in Man)". Comprehensive Series in Photosciences. 495: 497–519. CAN 137:43484. {{cite journal}}: Cite has empty unknown parameter: |month= (help)CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  18. ^ CL1976L0768EN0150010.0001 1..107
  19. ^ Australian Regulatory Guidelines for OTC Medicines - Chapter 10
  20. ^ Manage Account - Modern Medicine
  21. ^ US FDA (2007) "Sunscreen Drug Products for Over-the-Counter Human Use; Proposed Amendment of Final Monograph; Proposed Rule", http://www.fda.gov/OHRMS/DOCKETS/98fr/07-4131.pdf
  22. ^ Herog, B (2005) "Prediction of Sun Protection Factors and UV-A Parameters by Calculation of UV Transmissions through Sunscreen Films of Inhomogeneous Surface Structure." in Sunscreens: Regulations and Commercial Development, Third Edition, ed N. Shaath
  23. ^ Garland C, Garland F, Gorham E (1992). "Could sunscreens increase melanoma risk?". Am J Public Health. 82 (4): 614–5. PMID 1546792.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  24. ^ Experts explore the safety of sunscreen | Straight.com
  25. ^ UCR: Sunscreens Can Damage Skin, Researchers Find
  26. ^ Holick M (2004). "Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease". Am J Clin Nutr. 80 (6 Suppl): 1678S–88S. PMID 15585788.
  27. ^ Holick M (1995). "Environmental factors that influence the cutaneous production of vitamin D". Am J Clin Nutr. 61 (3 Suppl): 638S–645S. PMID 7879731.
  28. ^ "Dietary Supplement Fact Sheet: Vitamin D". National Institutes of Health. Retrieved 2006-06-10.
  29. ^ Wolf P; Donawho C K; Kripke M L (1994). "Effect of Sunscreens on UV radiation-induced enhancements of melanoma in mice". J. nat. Cancer. Inst. 86: 99–105.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  30. ^ Davies H.; Bignell G. R.; Cox C.; (2002). "Mutations of the BRAF gene in human cancer". Nature. 417: 949–954. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  31. ^ Hayden, C G J; Roberts, M S; Benson, H A E (1997). "Systemic absorption of sunscreen after topical application". The Lancet. 350 (9081): 863–864. {{cite journal}}: Cite has empty unknown parameter: |month= (help)CS1 maint: multiple names: authors list (link)
  32. ^ Walters, K. A.; Roberts, M. S. (2002). "Percutaneous absorption of sunscreens". Book: Bronaugh, R. L.; Maibach, H.I. eds. Topical absorption of dermatological products. / New York: Dekker; 2002: 465–481. {{cite journal}}: Cite has empty unknown parameter: |month= (help)CS1 maint: multiple names: authors list (link)
  33. ^ Treffel, P.; Gabard, B. (1996). "Skin penetration and SPF of ultraviolet filters from two vehicles". Pharm. Res. 13: 770–774. {{cite journal}}: Cite has empty unknown parameter: |month= (help)CS1 maint: multiple names: authors list (link)
  34. ^ Lautenschlager, Stephan; Wulf, Hans Christian; Pittelkow, Mark R. (2007). "photoprotection". Lancet. 370: 528–37.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  35. ^ Wulf HC; Poulsen T; Brodthagen H; Hou-Jenson K; (1982). "Sunscreens for delay of ultraviolet induction of skin tumors". J Am Acad Dermatol. 7: 194–202.{{cite journal}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  36. ^ Reeve VE; Greenoak GE; Gallagher CH; Canfield PJ; Wilkinson FJ (1985). "Effect of immunosuppressive agents and sunscreens on UV carcinogenesis in the hairless mouse". Aust J Exp Biol Med Sci. 63: 655–655.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  37. ^ Flindt-Hansen, HP; Thune P, Larsen, TE (1990). "The inhibiting effect of PABA on photocarcinogenesis". Arch Dermatol Res. 282: 38–41.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  38. ^ Meredith, Paul; Riesz, Jennifer (2004). "Radiative Relaxation Quantum Yields for Synthetic Eumelanin". Photochemistry and photobiology. 79 (2): 211–216.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  39. ^ N. J. Lowe, Physician's guide to sunscreen , Kap. 8, 1991.

See also

External links

* FDA monograph on sunscreen
* FDA monograph on dosing, mechanism of action, and photodegradation of sunscreen (PDF file)