Journal of the Dermatology Nurses' Association:
Sarah Neider, MA, Center for Surgical Dermatology, Westerville, OH.
The author declares no conflicts of interest.
Correspondence concerning this article should be addressed to Sarah Neider, MA, 8704 Seabright Dr., Powell, OH 43065. E-mail: email@example.com
ABSTRACT: The purpose of this article is to present a brief overview on sunscreen and is not intended to be a full review. Statistical information on skin cancer is presented along with an overview of skin protective measures in addition to sunscreen. A brief description of the definition of ultraviolet (UV) radiation is reviewed and includes the basic differences between UVA and UVB. Chemical blockers versus physical blockers are explained and include a table listing of 17 active ingredients approved by the United States Food & Drug Administration. The table also differentiates physical and chemical blockers and which UV rays each type of blocker helps to protect against. A review of the Food & Drug Administration’s guidelines regarding sunscreen is discussed to include the two key factors in sunscreen labeling. Finally, proper usage and patient information regarding sunscreen application are reviewed.
As a medical assistant in a fast-paced dermatology practice, my goal is to educate every patient I care for throughout the day on the importance of sun protection. This brief article is an overview of the most common questions I encounter on a daily basis and suggestions for answers that are of clinical significance yet well received by patients.
1. Why should I wear sunscreen?
With over 3.5 million skin cancers diagnosed annually in the United States, skin cancer has become the most common type of cancer. That number averages to approximately one in five Americans that will develop skin cancer in their lifetime (Skin Cancer Foundation, 2013). The incidence of malignant melanoma is rapidly growing at a faster rate than other forms of cancer (Melanoma Research Foundation, 2011). Avoiding tanning beds and intentional tanning, seeking shade whenever possible, and wearing sun-protective clothing including a wide-brimmed hat are all important measures in skin cancer prevention (National Council on Skin Cancer Prevention, 2013). In the event of any skin left exposed, sunscreen is necessary.
2. What’s all the talk about ultraviolet (UV) radiation?
UV radiation is invisible light omitted from the sun that can be divided into two components: UVA and UVB (Hellwig, Gripentrog, & Templeton, 2012). UVA is less intense of the two; however, it is much more prevalent and penetrates deep into the dermis. It is also predominantly responsible for tanning and photoaging. In addition, UVA damages the skin’s deoxyribonucleic acid and can cause skin cancer, particularly melanoma. UVB affects the epidermis causing sunburns and plays a major role in causing skin cancer (DeNoon, 2011).
3. What is the difference between chemical and physical blockers?
Chemical blockers form a film on the surface of the skin and absorb the radiation before it is able to enter the skin. Physical blockers contain nondissolving particles that reflect UV rays away from the skin (Hellwig et al., 2012). Currently, the United States Food & Drug Administration (2012) approves 17 active ingredients for sunscreen (Table 1).
4. What should I look for when purchasing sunscreen?
In order for sunscreen to pass the United States Food & Drug Administration (2012) test to be labeled as a sunscreen, it must fulfill two requirements: be broad spectrum, which means it can protect against both UVA and UVB rays and carry a sun protection factor (SPF) of at least 30. “Waterproof “and “sweatproof” have been replaced by the term “water resistant.” To be labeled as such, the sunscreen must prove to retain its SPF when a person goes in water or sweats and state on the label how long the resistance is retained, 40 or 80 minutes (American Academy of Dermatology, 2013a).
5. My makeup is SPF 15; is that enough protection?
I often get this question from patients when reviewing skin education with them. My answer to that is simple: “No.” Clinical sunscreen application guidelines require an application of 2 mg/cm2. This is typically an unrealistic expectation because this amount would leave an obvious white layer on the skin. In terms of makeup such as liquid foundation, the amount that would suffice would typically be undesirable. On average, consumers apply only 25%–50% of the application guideline amount. At this rate of application, an SPF of 50 may only provide the protection of a 15. SPFs 70 and 100 may only provide the protection of around 30 when applied at 50% and around 15 when applied at 25% (Johnson, 2012).
6. Is there anything else I should know?
It is recommended that everyone wear sunscreen everyday as harmful UV rays are constantly being omitted. It should be applied generously to skin not covered by clothing including the face and ears. One ounce is considered sufficient to cover unexposed skin. Be sure to apply 15 minutes before going outdoors. Most importantly, remember to reapply every 2 hours or after swimming or towel drying (American Academy of Dermatology, 2013b).
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