BANGOR, Maine (WABI) - Given the overcast and cold from this spring's very slow start, you might not be thinking about sunscreen. However, this past month in the Journal of the American Medical Association*, there is a very concerning article on new risks of sunscreen. While most of us view these products as a way to avoid cancers of the skin, new research demonstrates that the active ingredients in most commercially available products are being absorbed into the bloodstream at higher levels than the FDA previously realized. Although there is no research directly implicating these absorbed chemicals in the development of human cancers, many of us are concerned. Whenever we put any compound into our system that is not naturally found there, the possibility of inducing a cancer needs consideration. Indeed one of the common ingredients in sunscreen, oxybenzone, has already been linked to lower testosterone levels in men as well as premature deliveries in women. To make matters worse, we also know that trace amounts of this chemical and another common sunblock ingredient, oxynoxate, have been implicated in the death of ocean coral reefs, and they have been recently banned for use in Hawaii!
So what's a responsible sunbather to do? Well the simplest answer is that sun 'bathing' is really never a good idea, as it has been definitively shown that this will increase the chances of skin cancer, not to mention cause premature wrinkles. Still we all enjoy being outside and there are many physical and mental health benefits of getting out in the sun. As physicians we want to encourage people of all ages to get off the couch, step away from the electronic screens, and get moving in the great outdoors! The question then becomes what is the safest way to do this without incurring some other unforeseen risk?
Let's review the 'expert' advice:
1) First, it is always wise to wear a wide brimmed hat and clothing to include longer sleeves/pants if we are going to spend a significant time outside, even if we apply sunscreen.
2) If we have to be out, it is best to avoid the peak hours of sun intensity from 11 am to 3 pm.
3) The use of a sunscreen that contains the safest and most biologically inert chemicals should be encouraged. It should be applied about every 2 hours, and more frequently if a person is in the water. Sprays should be avoided. Important areas are the face and the external ears which have the highest amounts of squamous cell cancer in older adults.
So now what are the safest chemicals in sunscreen? That is the multi-million dollar question.
According to the JAMA article, in addition to oxybenzone, the chemicals avobenzone, octocrylate, and ecamsule, were all detected an hour after application in the bloodstream in levels that are higher than previously realized. The compounds that are the most inert and safest are the old-fashioned zinc oxide as well as the pricier titanium dioxide. Neither of these naturally occurring minerals seem to get absorbed nor have they been implicated in human disease. While many of us remember the white noses of lifeguards who lathered on the zinc oxide, the newer formulations can avoid this less than ideal cosmetic appearance. A quick review on Google or Amazon shows many options that are in the range of $9-15 per tube. Admittedly that might be a bit higher than the brand you used last summer, but consider this: the alternatives may have hidden consequences.
So get out there, put on your hat, and enjoy some sun -- if you can find it!
*JAMA May6, 2019 doi:10.1001/jama2019.5586