No Safe Tan : Sunscreens, Part 2

by Food and Drug Administration (FDA)

(Page 3 of 3)

Figuring out which sun protection factor (SPF) of sunscreen to use is an individual decision, says John DiGiovanna, M.D., investigator in the dermatology branch, National Cancer Institute in Bethesda, Md. The best way to judge the number? For example, if you select an SPF of 15, realize that that means you can stay out in the sun 15 times longer than if you were wearing no sunscreen, and still get the same amount of redness," he says. Most importantly, you should find something that feels comfortable: a solution, lotion or cream and apply it daily before you go out. Many women recognize that this is the way to prevent photo-aging and they will use a sun block before they put on their makeup.

The American Academy of Dermatology and the National Institutes of Health agree that people should wear a sunscreen with an SPF of 15 or higher. But some experts wonder if sunscreens with SPF higher than 30 really make any sense.

According to Gilbertson, FDA will probably propose that 30 is the highest SPF people would need, but he adds that manufacturers are still free at this time to market sunscreens with higher numbers because these are still being evaluated. Whichever product consumers select, he adds, they should apply sunscreens liberally, beginning before exposure, and often. This advice applies to everyone, regardless of natural skin color. Even though the risk of skin cancer for naturally brown- and black-skinned persons may not be as great as for light-skinned individuals, those with dark skin should also apply sunscreens, especially during long periods of sun exposure.

Children should also wear sunscreens. Most skin cancers begin in childhood," says Sydney Hurwitz, M.D., clinical professor of dermatology and of pediatrics, Yale University School of Medicine. And the greatest exposure 50 to 80 percent of a person's lifetime exposure to the sun occurs during childhood, by the age of 18. Studies show that a history of painful or blistering sunburn during the first 10 to 20 years of life doubles the risk of skin cancer. We've got to convince teachers, parents, doctors, coaches, counsellors, and children that protection from overexposure to the sun is important. For children, putting on a sunscreen should be just like brushing their teeth everyday," he says.

For people who still want to tan despite the danger, DiGiovanna advises getting sun exposure gradually and using some sort of sunscreen. Or DeLeo mentions commercial products that tan the skin without the sun. He describes three: There's a skin bronzer that's like putting on lipstick. It's perfectly safe unless you are allergic to its components. There's a tan accelerator which contains tyrosine, a protein that produces melanin. It doesn't work, and it's a waste of money. Or there's a skin dye, which contains lawsone. This goes on clear, binds to a protein in the skin, and turns color overnight. It looks like a tan, but is not really a tan," he says. Products that contain tyrosine and lawsone when used as a skin dye have not yet been approved by the agency. Gilbertson says that FDA has banned or has proposed banning most tanning pills. But bronzers that contain approved FDA color additives such as dihydroxyacetone are safe to use, says John Wenninger, associate director for cosmetics of FDA's division of colors and cosmetics.

Check for Changes

And everyone, whether they sunbathe or not, should check their skin regularly for changes that might spell trouble. (See accompanying article.) They may also want to take advantage of the month-long Melanoma/Skin Cancer Screening Program sponsored by the American Academy of Dermatology. This public awareness effort, which makes screening available in many communities nationwide in May or June each year, is an appeal for early detection and screening of skin cancers.

"It's a great public service," says Howard Koh, M.D., associate professor of dermatology, medicine, and public health at Boston University Schools of Medicine and Public Health, and chairman of the American Academy of Dermatology's committee on Melanoma/Skin Cancer Screening Programs. He reports that since 1985, the American Academy of Dermatology has screened 359,000 people and has detected over 2, 500 suspected melanomas and almost 29,000 suspected non-melanoma skin cancers. "The good news is," he says, "that melanomas and skin cancers are an area in which screening and prevention can make a difference."

To turn the tide against sun damage, people must learn to think of pale skin as attractive, says Michael Pertschuk, M.D., clinical associate professor, University of Pennsylvania, and chief of psychological services at its Center for Human Appearance. As it has in the past, he believes the fashion industry can alter people's behavior. It's just going to take some time and an awareness on the part of fashion editors that this is an issue," he says. Once convinced about sun damage, people can act in a reasonable way to protect themselves.

The American Academy of Dermatology points out that many fashion designers think that the tanned look is out, and they are using lighter-skinned models to show off their clothes. But two studies done for the academy by Opinion Research show that not everyone is convinced: In a 1987 survey of over 1,000 people on attitudes towards sunbathing, half the teenagers and 45 percent of those under 35 said they intentionally worked on a tan. A follow-up survey in 1989 showed that the figures remained basically unchanged, although people admitted they knew that sun exposure was bad for their skin. But among adults, at least, sunscreen use was up from 35 percent to 41 percent. And Pertschuk believes that older women probably are avoiding the sun more because they are beginning to see their own skin damage show up.

In the end, there really is nothing new under the sun, except that perhaps more people are staying out of it, heeding medical warnings such as Bergstresser's: "Less sun is better. No sun is best of all."

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.