Many individuals attempt to be proactive about their overall health, but they often underestimate the importance of taking care of their skin-that is, until a dermatologic issue occurs.
Many individuals attempt to be proactive about their overall health, but they often underestimate the importance of taking care of their skin—that is, until a dermatologic issue occurs.
Although sunburn is the most common dermatologic issue caused by excessive exposure to ultraviolet radiation (UVR), UVR can also contribute to premature aging, cataracts, and wrinkles (also known as photoaging).1 Moreover, studies dating back to the 1950s show a strong correlation between chronic, excessive, and unprotected sun exposure and carcinoma of the skin.1
It is important to increase awareness about sun protection and avoiding excessive exposure to UVR to decrease the incidence of skin cancer, premature skin aging, and other long-term dermatologic issues.1 According to the Skin Cancer Foundation, skin cancer is the most common form of cancer in the United States: more than 3.5 million cases are diagnosed every year; in 2012 alone, an estimated 76,250 individuals were diagnosed with malignant melanoma.1,2 The foundation also reports that an estimated 90% of nonmelanoma skin cancers are associated with excessive exposure to UVR sun and up to 90% of the visible dermatologic changes commonly attributed to aging are caused by the sun.1,2 Moreover, the foundation reports that 42% of the population gets an episode of sunburn at least once a year and that an individual’s risk of developing skin cancer may double if 5 or more episodes of sunburn are experienced at any age.1-3 Having 1 or 2 cases of blistering sunburn during childhood may even double an individual’s chance of developing melanoma later in life.3,4
If detected early, melanoma can be treated and many cases of nonmelanoma skin cancers can be cured.1 For additional information on the 2 types of UV rays, UVA and UVB, and how they can damage the skin, see Table 1.1,5-8
Risk Factors for Sunburn and Development of UVR-Induced Problems
While all types of skin complexions have the potential to burn or develop other UVR-induced issues due to excessive sun exposure, certain factors may put some individuals at greater risk. Examples include1,9:
• Having fair skin
• Having an autoimmune disease
• Using immunosuppressive drugs
• Family history of melanoma
• Previous growth on skin caused by UV exposure
• Individuals with a history of 1 or more serious or blistering sunburns
• Infants and children, since their skin is more sensitive than adult skin
• Individuals taking certain pharmacologic agents associated with photosensitivity reactions
• Having blonde or red hair
• Individuals who use tanning beds or sun lamps
• Being exposed to the sun during peak hours (10:00 am to 4:00 pm) without using UV protection
How Sunscreen Products Work
Sunscreens protect the skin by absorbing or reflecting UVA and UVB rays. Their routine use is crucial in protecting the skin from both the short- and long-term damaging effects of sun exposure, as they can decrease incidences of sunburn, premature skin aging, photodermatoses, and skin cancer.1 Many studies have demonstrated that when applied correctly, sunscreen can block most of the sun’s harmful UV rays.1
In June 2011, the FDA announced updated requirements for all OTC sunscreens, stating that all sunscreens labeled “broad spectrum” (meaning they protect against both UVA and UVB rays) must pass the FDA’s new standardized broad-spectrum procedure, which measures a product’s UVA protection relative to its UVB protection.1,10 More detailed information about this FDA ruling can be found at www.fda.gov/ Drugs/ResourcesForYou/Consumers/ BuyingUsingMedicineSafely/Under standingOver-the-CounterMedicines/ ucm258468.htm.
Finding the Best Sunscreen
Pharmacists should be prepared to assist patients in selecting a sunscreen product that suits their individual needs. Sunscreen products are available in various forms (lotions, creams, and sprays) and SPF ranges, and can be water-resistant, as well. The higher the SPF, the more effective the product is at preventing sunburn1; however, an SPF higher than 30 may not afford extra protection. Topical sunscreen products can be divided into 2 categories: chemical and physical. See Online Table 2 for additional information on both.1,11-13
Table 2: Types of Sunscreen
Absorb and block the transmission of UVR to the epidermis.
Reflect then scatter UVR, rather than absorb the rays.
May contain amino benzoic acid and its derivatives, anthranilates, benzophenones, cinnamates, dibenzoylmethane derivatives, or salicylates.
Often used on small areas, such as the nose or top of ears, and contain zinc oxide or titanium. Especially useful for individuals allergic to the ingredients found in chemical sunscreens.
Adapted from references 1, 11-13.
When selecting a sunscreen, a consumer may consider several factors to find the product that best suits his or her needs, including cost, skin type and complexion, reasons for use, ease of use, formulation, SPF, history of sunburn, and medication history (since some pharmacologic agents may be associated with photosensitivity reactions).1,14,15 Many of these products—such as broad-spectrum sunscreens, lip balms, cosmetics, and skin moisturizers—contain a combination of ingredients. The Environmental Protection Agency recommends the use of a broad-spectrum sunscreen with a minimum SPF of 30 even on cloudy days.1,13 Sun protective clothing and sunglasses are also recommended.
In order to achieve optimal photoprotection, consumers must understand how to properly apply and reapply sunscreen products, as directed, to maintain protection while in the sun.1 Sunscreens should be applied liberally to all exposed areas at least 15 to 30 minutes before sun exposure and as often as the product label recommends, or at least every 2 hours.1,12-14 In general, an estimated onehalf teaspoon should be applied thoroughly to each exposed area to obtain adequate coverage and protection, and sunscreen should be reapplied especially after swimming, towel drying, or excessive sweating.1,12-14 According to the FDA, sunscreens labeled “water resistant” must maintain their SPF after 40 minutes of water immersion, while those labeled “very water resistant” must maintain their SPF after 80 minutes of water immersion.1,12-14 If an individual works outdoors, it is recommended that sunscreen should be reapplied often throughout the day.1,12-14
Despite constant reminders about avoiding overexposure to the sun, many individuals will still experience sunburn because they do not always use sunscreen when outdoors—especially during the summer— or they apply sunscreen incorrectly. During counseling, pharmacists can provide patients with pertinent information about the various products available for proper photoprotection, make suggestions about how to prevent and treat sunburn (Online Tables 3-6), and remind patients that sun protection is equally important during the winter since snow reflects up to 80% of the sun’s rays, which can cause sunburn and damage to exposed skin.1
Table 3: Tips for Sun Protection
Adapted from references 1, 12-16.
Pharmacists are also in a pivotal position to identify patients at risk for possible photosensitivity reactions due to the use of certain pharmacologic agents (eg, tetracyclines, antidepressants, antihistamines, estrogens, sulfonamides, nonsteroidal anti-inflammatory drugs). These patients should be advised to always use a sunscreen when outdoors, especially for extended periods of time.
Table 4: Treating Sunburn
Adapted from references 1, 17-18.
For more in-depth information on the importance of UV ray protection, visit the following websites:
• American Academy of Dermatology: www.aad.org/media-resources/statsand- facts/prevention-and-care/sunscreens
• The Skin Cancer Foundation: www .skincancer.org/prevention/sun-protection/ sunscreen/the-skin-cancer-foundations- guide-to-sunscreens
Table 5: Examples of Sunscreen Products
Table 6: Protecting the Eyes from Sun Damage
Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.