Ever since the New York Times reported on its How Safe Is Sunscreen? piece last month, New York dermatologist Julie Russak, MD has been fielding a “surge of questions” from patients—to which she has a simple reply.
“Here’s the lowdown: Sunscreens do protect us from skin cancer, and that’s a fact,” she says. “We must then decide which sunscreen to use.”
Decisions, decisions—mixed with what Dr. Russak refers to as a “sea of misunderstanding”—has made the whole sunscreen discussion one of summer’s biggest debates. So what are we doing wrong? And are we doing anything right? Here, top derms set the record straight.
Are our bodies really absorbing the chemicals found in sunscreens?
Yes, the latest findings regarding sunscreens reveal that some chemicals get absorbed into our bodies. But, there’s an asterisk attached to that statement—and it’s kind of a big one. “The findings highlight absorption but do not actually reveal detrimental effects of the chemicals themselves,” Dr. Russak explains. “Our body and our skin already absorb so much, and we want them to: Think of the skin care we hope our body absorbs for efficacy, every day. So, it’s not uncommon or alarming to understand we absorb these chemicals.”
To answer that question further, it’s important to understand that there are two types of sunscreen: chemical and physical. As Dr. Russak explains, chemical sunscreens have chemical filters that sit on the skin and absorb UV radiation and prevent it from damaging our cells. “Physical sunscreen literally holds physical molecules that reflect UV radiation. They don’t absorb and aren’t chemically modified by UV. They reflect the radiation and protect the skin.”
The bottom line: “As of now, we simply don’t know enough regarding the consequences of specifically absorbing these chemicals,” Dr. Russak says. “Therefore, what I tell my patients right now is to use physical sunscreen: It’s stable, it sits on top of your skin and reflects UV radiation. Physical sunscreen gives you the needed protection from the sun, and studies are being done now and we should understand a bit better by the end of the year when the FDA hopes to offer an official guidance on the matter.”
Is oxybenzone in sunscreen safe?
This is the big, probably buzziest bad guy right now. “Yes, we have known oxybenzone has potential risks as a hormone mimicker, and that it is readily absorbed through the skin,” says Melville, NY dermatologist Kally Papantoniou, MD. “The FDA this year has confirmed that systemic absorption of oxybenzone from topical use exceeds the U.S. FDA threshold. There is also concern for increased risk in children because their skin can absorb more easily.”
Omaha, NE dermatologist Joel Schlessinger, MD has a similar stance—specifically when it comes to kids. “Recent data has shown that it does achieve blood levels in most people who use a product that contains it. Additionally, despite the fact that it has a low rate of contact dermatitis, some individuals do have allergies to it,” he says. “My feeling is that if a physical/mineral sunscreen can do the same job to protect against sunlight, it should be tried first. Additionally, I wouldn’t use it on children if other options, such as EltaMD Pure, are available.”
So why do sunscreens still have it—and what about the coral reefs?
Dr. Schlessinger points out that oxybenzone has been used for many years in sunscreens, especially since PABA was found to cause side effects. But, what may come as a surprise is that “it’s actually an organic material that is found in nature, including plants and flowers, but also in many plastic products, as well as nail polish and toys,” he says. “Sunscreens often incorporate it as it helps to avoid sun damage from both UVA and UVB rays, meaning that it is a broad-spectrum sunscreen protector. The question on safety tends to be around two things: endocrine disruption in children and allergy to the materials in it. There is also a lingering question as to its effect on the reef/coral. It appears that it can lead to bleaching of coral, but the jury is still out on this.”
What do you tell patients who are concerned with sunscreen ingredients?
This is where opinions get a bit divided. “I share many of the same concerns, but I still use sunscreens with chemical filters, as they are much more broad of a protection than mineral/physical sunscreens,” Dr. Schlessinger says, adding that the safest thing of all is to avoid the sun whenever possible and wear protective clothing and hats that have sun protection (UPF) in them. “Clearly, there are other issues with sunscreens, including allergies to the ingredients, which are usually less likely to occur with physical/mineral-based sunscreens.”
Dr. Russak stands firm on looking for a mineral-based sunscreen with zinc and titanium only, as these options do not contain preservatives or other unknown fillers and she thinks they are the best choice all skin types. Dr. Papantoniou is also on board with the belief that zinc and titanium are the safest ingredients for sunscreens, and notes that they have been used safely for many years. “They are more inert than chemical-based sunscreens, we even use zinc as a major ingredient in diaper ointment!”
I’m still confused! What advice do you have for choosing the best sunscreen?
Dr. Russak recommends looking at your sunscreen selection in a similar way you look at grocery shopping: “If you are at the store and looking for a sunscreen and see a laundry list of ingredients mentioned in the ingredient list, put it back. The best rule of thumb is the same for foods: simple, straightforward ingredients that get the job done.”
And beyond liking mineral blockers, Dr. Papantoniou has a penchant for sunscreens that also contain antioxidants such as green tea polyphenols, vitamin C and resveratrol, which also help protect skin from oxidative stress. “A sunscreen that has a minimum SPF of 30 is also preferred for daily protection, and for anti-aging, an SPF of 50 is even better.”
Guidelines will be changing over the next few years as the FDA is addressing this issue and is continuing to work on sunscreen regulations (the final monograph is due by the end of November), Dr. Schlessinger says. And, not to take a pessimistic turn, with that review will come new ingredients getting their turn under the microscope. “There will likely be others who join the list of products that can get into the bloodstream and potentially cause harm,” he says.