Roger I. Ceilley, MD, FAAD, FACMS, clinical professor of dermatology at the University of Iowa at Des Moines, detailed what people need to know about this crucial topic in his presentation on photoprotection at the dermatology conference. fall 2022 clinic for PAs and NPs.1
He set the stage for his in-depth analysis by noting that sunlight is the primary environmental risk factor for melanoma. Ceilley cited a study that showed that between 89% and 95% of annual cases of melanoma are caused by exposure to solar UV rays.2 “The authors concluded that avoidance of UV radiation would reduce the incidence of malignant melanoma,” he said.
However, he noted that while unprotected UV exposure may be responsible for “the vast majority” of melanoma cases, it’s not the only driver of this life-threatening skin condition. As a 2021 study reported, “indoor tanning beds, immunosuppression, family history and rare congenital diseases, moles and obesity [also] contribute to disease.3
Next, Ceilley presented evidence that sunscreen reduces the risk of melanoma. He specifically mentioned an Australian study that followed 1,621 patients and found that the risk of melanoma was significantly reduced by regular use of sunscreen.4 Another study was reviewed and concluded that sunscreen use probably reduced the incidence of skin cancer by 10-15% and that sunscreen should be part of a comprehensive sun protection strategy .5“Sunscreens are an important part of sun protection, which is avoiding the midday sun and wearing sun-protective clothing,” Ceilley said.
When it comes to SPF, the number on the package may not match the amount of sunscreen provided in average patient populations due to improper or inappropriate use. People often don’t apply the recommended amount of sunscreen, so Ceilley offered tips on how to apply it effectively. Because patients apply sunscreens at densities much lower than those used to determine the SPF value listed on the product label, an actual/actual use study concluded that an SPF 100+ sunscreen was significantly more effective than an SPF 50+ sunscreen.4 Ceilley pointed out that these results demonstrate that there is a need for sunscreen labeled with SPFs greater than 50+ to provide consumers with better choices for sunscreen products . In summary, he noted, “higher SPF sunscreens have multiple clinical benefits for users.” He pointed to a specific study that demonstrated that an SPF 80 formulation was more effective than an SPF 50 formulation in a single application pattern during a high UV test environment.6 When it comes to sun protection beyond UV, “tinted sunscreens and those containing antioxidants appear to be helpful in protecting skin from visible and infrared light damage,” Ceilley said.
Ceilley then discussed the absorption issues of topical sunscreens. In the safety studies that have been conducted, the serum levels of risk have been arbitrarily selected without scientific evidence and it has been reported that the theoretical risk of absorption has not been observed clinically, despite the fact that the tens of millions of people using sunscreen every summer weekend is indeed a large-scale experiment, according to Ceilley. Ceilley referred to the most recent controversy regarding oxybenzone in sunscreen specifically as a carcinogen. He cited a 2018 study that looked at oxybenzone and sunscreen and offered guidance for counseling patients in a clinical setting on this controversial issue.seven Ceilley suggested that in discussing with patients, it’s important to start by emphasizing that the data supports that using sunscreen reduces the risk of skin cancer. He also advised informing patients that while laboratory evidence suggests oxybenzone may have adverse environmental effects, the conditions of these experiments did not reflect real-world conditions and are therefore inconclusive. Patients can use inorganic sunscreens if they prefer, but should be advised of their drawbacks. For patients concerned about benzene toxicity, Ceilley cited research that shows sunscreen users had lower blood levels of benzene than never-users, suggesting other factors may have an influence. stronger than sunscreen.8 Ceilley also reminded healthcare professionals that the best choice of sunscreen is one that patients will use consistently and that cost and cosmetic acceptability are also factors.
Ceilley ended her talk by noting that photoprotection is an important topic for both providers and patients and that there is data showing it reduces the risk of skin cancer. Unfortunately, there is still a knowledge gap in public perception of the benefits of sunscreen and its proper use. The public needs better education on the benefits of high SPF levels, the safety of sunscreens, and a better understanding of the proper use of systemic sunscreen and skin supplements.
Ceilley is a consultant for Biofrontera, Sun Pharma and Ferndale.
1. Ceilley RI. What you really need to know about photoprotection. Presented at the 2022 Fall Clinical Conference for AM and IP, held June 3-5, 2022; Scottsdale, AZ.
2. Juzeniene A, Grigalavicius M, Baturaite Z, Moan J. Minimum and maximum skin cancer incidence rates in Caucasians estimated using sigmoidal UV dose-incidence curves. International Journal of Hygiene and Environmental Health. 2014;217(8):839-844. doi:10.1016/j.ijheh.2014.06.002
3. Saginala K, Barsouk A, Aluru JS, Rawla P, Barsouk A. Epidemiology of melanoma. Med Sci (Basel). 2021 Oct 20;9(4):63. doi: 10.3390/medsci9040063. PMID: 34698235; PMCID: PMC8544364.
4. Green AC, Williams GM, Logan V, Strutton GM. Reduction of melanoma after regular use of sunscreen: follow-up of a randomized trial. J Clin Oncol. 2011;29(3):257-263. doi:10.1200/JCO.2010.28.7078
5.Olsen CM, Wilson LF, Green AC, et al. Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular use of sunscreen. Aust NZJ Public Health. 2015;39(5):471-476. doi:10.1111/1753-6405.12470
6.Williams JD, Maitra P, Atillasoy E, Wu MM, Farberg AS, Rigel DS. SPF 100+ sunscreen is more protective against sunburn than SPF 50+ in real-world use: Results of a randomized, double-blind, split-face clinical trial of natural sun exposure. Journal of the American Academy of Dermatology. 2018;78(5):902-910.e2. doi:10.1016/j.jaad.2017.12.062
7. Mirsky RS, Prado G, Svoboda RM, Rigel DS. Oxybenzone and sunscreens: a critical review of the evidence and plan for discussion with patients. J of skin. 2018;2(5). doi:10.25251/2.5.0
8. Olsen CM, Wilson LF, Green AC, et al. Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular use of sunscreen. Aust NZJ Public Health. 2015;39(5):471-476. doi:10.1111/1753-6405.12470