Sunday, 20 May 2012

Sunscreen Selection in Australia

With the number of skin cancers diagnosed in Australia almost DOUBLING in the last ten years,  it really is high time that those of us who work in the skincare industry as medical practitioners double our efforts to help guide patients in the selection of appropriate sunscreen.

Choosing an appropriate sunscreen can have both short and long term effects.. I see a lot of clients who report that despite sunscreen use, they sometimes still get sunburnt on a sunny day, and this is an indication that their sunscreen choice or possibly application technique, isn't ideal.  In the long term, this puts them at high risk of unnecessary photoaging changes in their skin (pigmentation, solar elastosis, wrinkles, etc) but also dramatically increases the risk of developing basal (BCC) or squamous (SCC) cell carcinomas, and the frighteningly deadly melanoma.  I've been a doctor for nearly 20yrs now(!) and have met many thousands of people from a wide spectrum of backgrounds, but it seems to me that just about everyone in Australia who grew up in the era pre sunscreen use (1970s) will get a BCC or SCC eventually, and that is even despite many of the baby boomer generation using sunscreen diligently since the late 1970s..when chemical sunscreens really took off.

So what is going on?

Those of you who know me will know how passionate I am about using mineral sunscreen, as opposed to chemical sunscreen.

Mineral sunscreen has been around since...??I'm actually not sure!  Maybe it came in after was definitely used by cricketers in the early 1970s, and I think surf lifesavers in Australia were onto it even well before then.  Anyway, back then it was thick, white or pastel coloured, extremely effective but hard to get off, would stain clothes, and really wasn't cosmetically acceptable for the general population.  It was great to protect one's nose or lips, but you really would never go out in public looking like you had just left a clown audition.

So, along came chemical sunscreen, and much to the delight of the general population, especially the baby boomers who loved the outdoor lifestyle, this was a product that was light, was transparent, easily absorbed into the skin and could even be added to moisturisers or foundations, and best of all, was super cheap to make...a boom industry was born and two of Australia's largest and most successful pharmaceutical companies (Ego and Hamiltons) have ridden on the back of the sunscreen sheep ever since.   They're also really great at promoting their products to Australian general practitioners and dermatologists.  I don't think I've ever seen a dermatology practice that hasn't been brimming over with free samples of chemical sunscreen...or one that had any samples of the mineral variety!

Unfortunately though, the promises made by the chemical sunscreen industry need to be looked at a little more thoroughly than the average person seems to.  I love being the 'sunscreen cop', so here's my list of why I really, really dislike chemical sunscreens:

1.  Many people are highly allergic to chemical sunscreen and will break out into an intensely itchy rash if it is applied anywhere on their skin.
2.  Go swimming with chemical sunscreen on your face and it will sting your eyes in an instant.
3.  This is the really important part of this blog post, chemical sunscreen is almost always PHOTOCHEMICALLY UNSTABLE..which is a technical way to say that it gets degraded by the very thing that it is blocking..UV light.  So, regardless of whether your chemical sunscreen is SPF 15+ or 30+ on the label, the reality is that after just 2 hours of sun exposure, your lovely product has an SPF of 0+, unless you have noticed the small print on the label that tells you to reapply every 2hours!  Oops, you didn't see that?   Maybe you did, but like 99.9% of the people I see, you didn't realise why that was important, and given how impractical such advice is, it really isn't an option for you to do that on a regular basis!
4.  (You didn't really think I had finished my rant did you?) The chemical reaction that the ingredients undergo with UV light, not only consumes the chemical ingredient, but in trapping the UV energy in the product, also creates free radicals on the skin!  Why on earth would someone want to use a product that increases free radicals, when we are so keen normally to remove them via use of antioxidants (either dietary or topically applied)!
It just doesn't sound like a logical thing to use to protect your skin, does it?
5.  Lastly, the SPF rating system only refers to UVB protection, so most chemical sunscreens were developed to protect from UVB, not UVA.  (And by the way, please bear in mind that any cosmetic company can put a SPF15+ rating on any product with a trace of sunscreen ingredient in it without having to prove that it works.  So if you want to know that your sunscreen has been scientifically tested by an independent laboratory, you need to buy SPF30+.)

On the other hand, mineral sunscreens are much better today than they were 40years ago.
Here's my list of why I prefer, use and recommend mineral sunscreens:

1.  They're photochemically stable...meaning they don't need to be reapplied every 2hours.  Unless you're in the surf, running a marathon or have a bad habit of touching or wiping your face, these ingredients will stay on and keep doing their job until you remove them.  If in doubt, reappy once during the day or for prolonged sun exposure.
2.  They're more water won't run into your eyes the moment you put your head under water
3.  They can be readily formulated to be tinted, or virtually transparent these days, making them much more cosmetically acceptable than in earlier years.
4.  They rarely cause allergic's far more likely that a person getting a rash from a mineral sunscreen has a preservative allergy than a true mineral sunscreen allergy.
5.  The spectrum of UVA cover is generally far better than most chemical sunscreens, which usually only cover the UVB spectrum.  Although some newish patented chemical sunscreens from L'Oreal claim to have great UVA protection and to be photochemically stable, these claims remain to be proven, given that no independent laboratory testing occurs on any product with SPF <15+.  Some of these products have already been removed from the market overseas, so it remains to be seen if they will undergo independent scientific verification in Australia.  The well known formulations of La Roche Posay became available in Australia in 2012 and contain the patented Anthelios sunscreen..which is a mix of titanium dioxide and avobenzone.  Avobenzone is a good UVA chemical sunscreen..but is famous for also being extremely unstable on light exposure so requires further chemical sunscreen additives to become stabilised enough for general use.
6.  The mineral ingredients used (zinc oxide, titanium dioxide) are non-patented naturally occuring compounds so they're cheap (but not as cheap as chemical sunscreen), there's lots of scientific research and reviews of these products available. Some research lately has become commercially minded, as the big pharmaceutical companies realise that an increasingly educated public are a threat to their chemical sunscreen profit margins.  Nanoparticle risk?  Scary how much publicity this issue has had when the 'research' into the issue was resoundingly dismissed as inadequate by the Therapeutic Goods Administration.  Nanoparticles have been shown to aggregate and agglomerate when put into a cream carrier.  If 10x nanoparticles join together, as is their natural tendency, they are no longer small enough to be classified as nanoparticles!  That is, they become incapable of penetrating the skin barrier.

I'm not sure about you, but I'd much rather 'risk' using a mineral sunscreen than a chemical one any day!!
And when I hear that the incidence of skin cancer has almost doubled in the last ten years in Australia, I really do think I can understand why that has happened.  I only need to think of all the thousands of men and women I've met who thought they were protected by wearing chemical sunscreen ("every day, doctor"), so went about their happy lives in the great outdoors, not ever reapplying their 'wonder product'.