Skin cancer is one of the most common forms of the disease in the United States. One in 5 Americans will develop skin cancer in their lifetime and it is currently estimated that 9500 people in the United States are diagnosed with skin cancer every day.1  

Due to their accessibility, pharmacists are often the first health care professional who patients reach out to, making them a valuable resource to provide sun safety information. Despite it being fall, sun safety is important year-round and even needs to be considered for winter sport activities, such as snowboarding and skiing.

Before making a recommendation on sunscreen, some of the most important factors to consider include UV protection, sun protection factor (SPF), and main ingredients. The 2 main types of rays that are radiated from the sun are ultraviolet A (UVA) and ultraviolet B (UVB) rays. UVA rays cause premature aging of the skin and are able to penetrate window glass, whereas UVB rays contribute to sunburn and do not penetrate window glass.2

Also important when counseling patients is a recommendation on SPF, a number that is calculated to determine the ratio of the minimal erythemal dose of UV radiation on the skin with sunscreen versus UV radiation on the skin with no sunscreen.3 For example, prompting a patient to choose a sunscreen with a SPF of 30 would allow the patient 30 times longer in the sun prior to burning than if the patient weren’t wearing any sunscreen.

SPF 30 allows approximately 3% of UVB rays to reach the skin.4  If selecting a water resistant product, the sunscreen’s label will state its efficacy in water for 40 minutes or 80 minutes per federal guidelines.2 For maximum benefit, sunscreen should be applied to dry skin 15 to 20 minutes before going outdoors.

When outdoors for an extended period of time, including during all 4 seasons, sunscreen should be reapplied every 2 hours or after swimming or sweating.1 Patients should be reminded that the sun’s rays are strongest between 10 am and 2 pm.1

With these components considered, the American Academy of Dermatology recommends using a product that is water-resistant and contains broad spectrum protection against both UVA and UVB rays, and has an SPF of 30 or higher.2 

There are 2 types of sunscreens that can be recommended, which are either chemical- or mineral-based. Commonly used chemical sunscreens include Neutrogena, Banana Boat, Hawaiian Tropic, and Sun Bum. Chemicals regularly used in sunscreens are oxybenzone, benzphenone-1, avobenzone, octisalate, octocrylene, homosalate, and octinoxate.2 These chemicals protect the skin by absorbing the UV light and releasing it as heat.

There is growing evidence that indicates the chemicals from sunscreens are causing hazards to marine life.3 Chemicals from sunscreens enter the environment by washing off of users while they are swimming in the ocean or showering.

The chemicals affect marine life by impairing growth, photosynthesis in green algae, and can cause bleaching of the ocean coral. Lastly, the chemicals can also affect fish by decreasing fertility and reproduction.5

Mineral sunscreen is an alternative to chemical sunscreens with the primary formulations being made up of zinc oxide and titanium dioxide. Some examples of mineral sunscreens include Badger, Think Sport, Raw Elements, and Sunology.

Mineral sunscreens were designed to reflect, scatter, and absorb UV radiation. An important factor to consider when recommending mineral sunscreens is the ability of zinc oxide to attenuate both UVA and UVB, whereas, titanium dioxide is only able to attenuate UVB. Mineral sunscreens are often a better choice compared with chemical sunscreens due to less irritation of the skin, as well as being more environmentally friendly.3

In children, mineral sunscreens are usually recommended due to less irritation than chemical sunscreens. Caution should be used with spray-applied sunscreens in children due to inhalation issues. Other ways to limit a child’s exposure to the sun would include keeping them out of direct sunlight, and/or dressing the child in sun-protective clothing.6

Lastly, skin cancer screening recommendations advise the patient to check head-to-toe every month for any changes in their skin. Any moles, spots, open sores, or growth that changes should be immediately seen by a dermatologist for evaluation. The best way to check for warning signs of skin cancer is the ABCDE method:
 
  • Asymmetry: most melanomas are asymmetrical.
  • Border: melanoma borders tend to be uneven whereas moles have a smoother border.
  • Color: multiple colors are a warning sign.
  • Diameter: the size of the lesion is a pencil eraser or greater indicates a warning for melanoma.
  • Evolving: any change in size, shape, color or elevation is worrisome.7

Pharmacists can play an active role in making their patients aware of sun hazards and sun safety protocols. Some key points that pharmacists should mention while counseling patients include:
 
  • Sunscreen should be applied 15 to 20 minutes before going outdoors
  • The sun is strongest during the hours between 10 am and 2 pm.
  • For best protection, it is advised to use a SPF of 30 or higher and reapplication should occur every 2 hours or after swimming/sweating.
  • Use of sunscreen, secondary safety measures, and evaluation for melanoma are important discussion points to cover with patients.

References
  1. Skin Cancer. American Academy of Dermatology. https://www.aad.org/public/everyday-care/sun-protection/sunscreen-patients/sunscreen-faqs.
  2. Sunscreen FAQs. American Academy of Dermatology. https://www.aad.org/public/everyday-care/sun-protection/sunscreen-patients/sunscreen-faqs.
  3. Bernstein E, Sarkas H, Boland P, Bouche D. Beyond sun protection factor: An approach to environmental protection with novel mineral coatings in a vehicle containing a blend of skincare ingredients. J Cosmet Dermatol. 2019;19(2):407-415. doi:10.1111/jocd.13007
  4. Wang S. Ask the Expert: Does a High SPF Protect My Skin Better? - The Skin Cancer Foundation. Skin Cancer Foundation. https://www.skincancer.org/blog/ask-the-expert-does-a-high-spf-protect-my-skin-better/.
  5. Sunscreen Chemicals and Coral Reefs. Oceanservice.noaa.gov. https://oceanservice.noaa.gov/news/sunscreen-corals.html.
  6. McMahon P. Is Sunscreen Safe?. Children's Hospital of Philadelphia. https://www.chop.edu/news/health-tip/sunscreen-safe.
  7. Self-Exams. The Skin Cancer Foundation. https://www.skincancer.org/early-detection/self-exams/.