Mechanisms of sunscreen failure

Use of multiple correspondence analysis to explore associations between caregivers and sun protective habits during summer vacations

BACKGROUND

Childhood exposure to ultraviolet radiation (UVR) plays an important role in the development of keratinocyte carcinomas and melanomas. Therefore, sun protective measures ought to be implemented during early childhood. Young children are largely dependent upon adult care providers in order to achieve proper sun protection.

OBJECTIVES

To develop effective photoprotection in children, it is necessary to understand caregivers' attitudes and knowledge about UVR exposure. This study aimed to explore the variables associated with sun protective behaviour in parents and grandparents during summer vacations.

METHODS

A multinational, cross-sectional study was conducted using a web-based online survey with a representative sample of parents and grandparents of children aged ≤ 12 years, who cared for their children/grandchildren for at least 2 weeks during the summer of 2021, in five countries (France, Germany, Spain, Italy and the USA). Multiple correspondence analysis (MCA) was used to explore in an unbiased way the possible relationships among all the variables and to identify specific profiles.

RESULTS

A total of 6190 adult participants responded to the questionnaire: 5104 parents (average age 42.0 years, 54.3% women) and 1086 grandparents (average age 64.2 years, 55.5% women). MCA allowed discrimination of two groups of respondents based on their answers: a profile with 'unprotected sun exposure habits' vs. those with 'protective sun exposure habits'. Parents fell in closer proximity to the 'unprotected sun exposure habits', and 'sunburn reported in youngest child'. Grandparents adopted more cautious behaviours than parents. Nevertheless, grandparents fell in proximity to 'having exposed the grandchild to the sun between 11 h and 17.00 h', 'not using an umbrella' and 'not using sunglasses'.

CONCLUSIONS

Although grandparents appear to adopt more cautious behaviours than parents, many gaps in proper sun protection behaviour were observed in both groups of caregivers.

Review on photoprotection: a clinician’s guide to the ingredients, characteristics, adverse effects, and disease-specific benefits of chemical and physical sunscreen compounds

Photoprotection is a critical health prevention strategy to reduce the deleterious effects of ultraviolet radiation (UVR) and visible light (VL). Methods of photoprotection are reviewed in this paper, with an emphasis on sunscreen. The most appropriate sunscreen formulation for personal use depends on several factors. Active sunscreen ingredients vary in their protective effect over the UVR and VL spectrum. There are dermatologic diseases that cause photosensitivity or that are aggravated by a particular action spectrum. In these situations, sunscreen suggestions can address the specific concern. Sunscreen does not represent a single entity. Appropriate personalized sunscreen selection is critical to improve compliance and clinical outcomes. Health care providers can facilitate informed product selection with awareness of evolving sunscreen formulations and counseling patients on appropriate use. This review aims to summarize different forms of photoprotection, discuss absorption of sunscreen ingredients, possible adverse effects, and disease-specific preferences for chemical, physical or oral agents that may decrease UVR and VL harmful effects.

Dynamic visualization of ultraviolet dose on skin with sunscreen applied using minimum erythema dose

BACKGROUND

Visualizing the ultraviolet (UV) dose on skin serve as an intuitive approach to ensure appropriate sunscreen usage and reduce the risk of erythema. UV dose is determined by a number of external factors, such as properties of sunscreens, weather, and type of outdoor activity. We propose a framework for visualizing UV doses that considers various external factors.

MATERIALS AND METHODS

First, the skin of a three-dimensional human model was represented using triangular meshes, and various static postures and dynamic motions were simulated to express outdoor activities. Then, we evaluated the persistency and insufficiency properties of sunscreen, which are time dependent and directly affect the effectiveness of the sunscreen skin protection factor (SPF) during UV exposure. Finally, to calculate the UV dose in real time, we tracked the trajectory of the sun and motion of the skin while considering the time-dependent properties of sunscreen.

RESULTS

An S/W system was implemented based on the proposed framework to visualize the distribution of UV doses through dynamic color changes in exposed skin areas. The color types include true colors, which represent the minimum erythema dose (MED), and pseudo colors representing states before 1 MED is reached. We devised various examples to discuss the usability of the proposed framework.

CONCLUSION

The system conveniently displays the MED according to an individual's skin phototype. When the properties of a wide range of commercial sunscreens are added to the system database, it is expected that the rate of appropriate sunscreen usage by customers will increase.

Enhancing the sweat resistance of sunscreens

BACKGROUND

While sunbathing of performing outdoor sport activities, sunscreens are important for protection of uncovered skin against ultraviolet (UV) radiation. However, perspiration negatively affects the performance of a sunscreen film by weakening its substantivity and uniformity through the activation of two mechanisms, namely sunscreen wash-off and sunscreen redistribution.

MATERIAL AND METHODS

We used a perspiring skin simulator to investigate the effect of sunscreen formulation on its efficiency upon sweating. Specifically, we modified the sunscreen formulation by incorporating a hydrophobic film former and adding water-absorbing particles. Sunscreen performance before and after perspiration is assessed by in vitro sun protection factor measurements, direct detection of changes in the sunscreen distribution using UV reflectance imaging, and by coherent anti-Stokes Raman scattering (CARS) microscopy for microscopic characterization of the UV filter relocation.

RESULTS

The results show that incorporating a hydrophobic film former can decrease sunscreen wash-off due to sweating, while an excessive amount of film former might negatively affect the sunscreen distribution. The addition of water-absorbing particles, on the other hand, had either a negative or positive impact on the sunscreen substantivity, depending on the particle properties. While the addition of large water-absorbing particles appeared to increase sunscreen redistribution, smaller particles that could form a gel-like structure upon contact with water, appeared to change sunscreen wetting and sweat droplet spreading, thereby decreasing sunscreen wash-off and sunscreen redistribution.

CONCLUSIONS

We find that using a combination of hydrophobic film formers, which increase water resistance, and small water-absorbing particles, which change the wetting behavior, can make sunscreen formulations more sweat-resistant and less runny.

Xeroderma Pigmentosum: General Aspects and Management

Xeroderma Pigmentosum (XP) is a rare genetic syndrome with a defective DNA nucleotide excision repair. It is characterized by (i) an extreme sensitivity to ultraviolet (UV)-induced damages in the skin and eyes; (ii) high risk to develop multiple skin tumours; and (iii) neurologic alterations in the most severe form. To date, the management of XP patients consists of (i) early diagnosis; (ii) a long-life protection from ultraviolet radiation, including avoidance of unnecessary UV exposure, wearing UV blocking clothing, and use of topical sunscreens; and (iii) surgical resections of skin cancers. No curative treatment is available at present. Thus, in the last decade, in order to prevent or delay the progression of the clinical signs of XP, numerous strategies have been proposed and tested, in some cases, with adverse effects. The present review provides an overview of the molecular mechanisms featuring the development of XP and highlights both advantages and disadvantages of the clinical approaches developed throughout the years. The intention of the authors is to sensitize scientists to the crucial aspects of the pathology that could be differently targeted. In this context, the exploration of the process underlining the conception of liposomal nanocarriers is reported to focus the attention on the potentialities of liposomal technology to optimize the administration of chemoprotective agents in XP patients.

Development of a novel rinse-off method for improved sunscreen exposure assessment

Recent legislative measures restricting the sale of sunscreens containing certain ultraviolet light filtering ingredients (UVFs) have been based on a perception of risk to aquatic life despite the lack of a robust data set to support these decisions. Concerns were focused on the potential for recreational swimmers' and divers' sunscreen use to result in exposures to coral already stressed due to climate change, disease, and other local conditions. In published environmental risk assessments for UVFs, exposure estimates were based on episodic environmental monitoring or estimates of typical sunscreen use, arbitrarily assuming the portion rinsed off from skin in seawater. To improve the accuracy of exposure estimates and thereby develop more robust risk assessments, we measured the amount of the UVFs, avobenzone, homosalate, octisalate, octocrylene, and oxybenzone released to seawater from four sunscreen products (two lotions, one spray, one stick) in a novel porcine skin model of typical human sunscreen use. Sunscreen was applied to porcine skin, allowed to briefly dry, then exposed to four rinse cycles in artificial seawater. The mass of each UVF in seawater, partitioned from seawater onto glassware, and extractable from skin after rinsing were determined. The proportion rinsed from skin varied by UVF, by formula type, and by application rate. Less than 1.4% of applied octisalate, homosalate, and octocrylene was detected in seawater samples (independent of formula) increasing to an average of 4% and 8% for avobenzone in stick and lotion forms, and to 24% for oxybenzone in lotions. The initial data show substantial differences in rinse-off among formulation types and sunscreen application rates, and stress the importance of using UVF-specific rinse-off values rather than a single value for all UVFs. This new method provides a tool for more robust exposure estimates, with initial data supporting lower rinse-off values than adopted in published risk assessments. Integr Environ Assess Manag 2021;17:961-966. © 2021 Johnson & Johnson Consumer Companies Inc. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

In vitro skin model for characterization of sunscreen substantivity upon perspiration

OBJECTIVE

The resistance of sunscreens to the loss of ultraviolet (UV) protection upon perspiration is important for their practical efficacy. However, this topic is largely overlooked in evaluations of sunscreen substantivity due to the relatively few well-established protocols compared to those for water resistance and mechanical wear.

METHODS

In an attempt to achieve a better fundamental understanding of sunscreen behaviour in response to sweat exposure, we have developed a perspiring skin simulator, containing a substrate surface that mimics sweating human skin. Using this perspiring skin simulator, we evaluated sunscreen performance upon perspiration by in vitro sun protection factor (SPF) measurements, optical microscopy, ultraviolet (UV) reflectance imaging and coherent anti-Stokes Raman scattering (CARS) microscopy.

RESULTS AND CONCLUSION

Results indicated that perspiration reduced sunscreen efficiency through two mechanisms, namely sunscreen wash-off (impairing the film thickness) and sunscreen redistribution (impairing the film uniformity). Further, we investigated how the sweat rate affected these mechanisms and how sunscreen application dose influenced UV protection upon perspiration. As expected, higher sweat rates led to a large loss of UV protection, while a larger application dose led to larger amounts of sunscreen being washed-off and redistributed but also provided higher UV protection before and after sweating.

Prevalence and correlates of sun protections with sunburn and vitamin D deficiency in sun-sensitive individuals

BACKGROUND

Sun sensitivity is an inherent risk factor for skin cancer. Sun protection is important in sun-sensitive individuals to reduce sunburns for skin cancer prevention. However, concerns have arose regarding the possible impact of sun protection on vitamin D deficiency.

OBJECTIVE

To examine the prevalence and correlates of sun-protective behaviours (staying in the shade, using sunscreen and wearing long sleeves) with sunburn and vitamin D deficiency in sun-sensitive individuals.

METHODS

This was a cross-sectional study of 2390 US non-Hispanic white adults aged 20-59 years in the National Health and Nutrition Examination Survey 2011-2014. Sun sensitivity was defined as self-reported tendency to severe sunburn when exposed to the sun for half an hour after months of non-sun exposure, and single serum 25(OH)D levels less than 50 nmol/L was determined as vitamin D deficiency. We calculated adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) using multivariable logistic regression taking into account the complex survey design.

RESULTS

Sun-sensitive individuals had higher odds of frequently staying in the shade (aOR = 3.08; 95% CI 2.19-4.33) and using sunscreen (aOR = 1.93; 1.44-2.59) but not associated with sun exposure time (aOR = 0.91; 0.62-1.32). Yet, sun-sensitive individuals had significantly higher likelihood of sunburns (aOR = 1.93; 1.45-2.55), and no increased likelihood of vitamin D deficiency (aOR = 1.15; 0.84-1.58). Among sun-sensitive individuals, being younger, male and spending more time outdoors were associated with increased odds of sunburns and the risk of sunburn was reduced with frequently staying in the shade and engaging in multimodal sun protections.

CONCLUSION

Sun-sensitive individuals more frequently used sun protection methods yet they still were significantly more likely to experience sunburns and the risk of vitamin D deficiency was not increased. Education on proper application of sunscreen combined with other sun-protective techniques is important to reduce sunburn in sun-sensitive populations.

Incidence and public health burden of sunburn among beachgoers in the United States

The beach environment creates many barriers to effective sun protection, putting beachgoers at risk for sunburn, a well-established risk factor for skin cancer. Our objective was to estimate incidence of sunburn among beachgoers and evaluate the relationship between sunburn incidence and sun-protective behaviors. A secondary analysis, of prospective cohorts at 12 locations within the U.S. from 2003 to 2009 (n = 75,614), were pooled to evaluate sunburn incidence 10-12 days after the beach visit. Behavioral and environmental conditions were cross-tabulated with sunburn incidence. Multivariable logistic regression was used to estimate the association between new sunburn and sun-protective behaviors. Overall, 13.1% of beachgoers reported sunburn. Those aged 13-18 years (16.5%), whites (16.0%), and those at beach locations along the Eastern Seaboard (16.1%), had the highest incidence of sunburn. For those spending ≥5 h in the sun, the use of multiple types of sun protection reduced odds of sunburn by 55% relative to those who used no sun protection (Odds Ratio = 0.45 (95% Confidence Interval:0.27-0.77)) after adjusting for skin type, age, and race. Acute health effects of sunburn tend to be mild and self-limiting, but potential long-term health consequences are more serious and costly. Efforts to encourage and support proper sun-protective behaviors, and increase access to shade, protective clothing, and sunscreen, can help prevent sunburn and reduce skin cancer risk among beachgoers.

The lupus patient traveller: a guide to the rheumatologist

With an increasing number of international journeys occurring daily, there is also an increase in the need for appropriate medical advice for patients who will undertake such travel. In this context, the lupus patient presents a great challenge to the rheumatologist. However, the demand for such information by patients is low, and it has proven difficult for the medical community to adequately provide it. In this article, we carried out a literature review of the medical recommendations made for the lupus patient in order to guide the rheumatologist through the topic of travel medicine.

The Role of Dispensing Device and Label Warnings on Dosing for Sunscreen Application: A Randomized Trial

Drug manufacturers are expected to provide labeling information needed to yield safe and effective product use. However, it is not clear that consumers dose sunscreen, an over-the-counter drug, appropriately; in fact, existing evidence suggests underdosing as a common phenomenon. The objective of this study was to evaluate the effect of dispensing device and labeling on self-administered doses of sunscreen in young adults. To investigate those effects, a 2 × 2 factorial laboratory experiment crossing dispensing device (two levels) with labeling treatment (two levels) was conducted. Participants applied sunscreen from each of the four treatments; dosing concentration, measured in mg/cm², served as the response variable. Participants (n = 94) were recruited on the campuses of Michigan State University (East Lansing, MI) and California Polytechnic State University (San Luis Obispo, CA). Each participant applied sunscreen from each unique treatment to sites on their arms and legs (four applications). Postapplication, a survey was completed to characterize demographics, risk perception, and sunscreen use patterns. Results indicate participants applied approximately 30% less sunscreen from the pump bottles than the squeeze bottles (difference estimate of 0.3059 mg/cm², standard error = 0.0607, p < .0001); there was no evidence of a difference based on label treatments. Post hoc recognition tests indicated only 55% of participants were able to recognize the two experimental labels they had viewed immediately following sunscreen application. Sunscreen application density was directly related to level of worry regarding skin cancer and frequency of sunscreen use (α = .05). Our results suggest the dispensing device used to deliver sunscreen impacts the dosage amount consumers apply.

Photoprotection practices, knowledge and sun-related skin damage in Spanish beach handball players

Background

Outdoor sports are a risk activity for skin cancer, especially if adequate sun protection measures are not used. The aim of this study is to examine the photoprotection habits of outdoor (beach) handball players, and to determine the relation between duration of sports practice, photoprotection behaviour and sun-related damage to the skin.

Methods

This cross-sectional study is based on a health survey of sun exposure and protection habits and practices conducted among beach handball players in southern Spain. This survey provided data for a descriptive and comparative analysis, by groups and gender, of photoprotection and skin self-examination practices.

Results

Among the whole sample, 76.9% had suffered at least one sunburn event during the last year. By groups, 73.97% of the older participants (Group I, University students) and 81.25% of the younger ones (Group II, youngers players) reported this outcome, and the difference was statistically significant (p = 0.003). With respect to photoprotection, 68.5% of the players in group I and 66.7% of those in group II used sun cream with a protection factor of 30 or higher, although 52.1% of group I and 35.4% of group II did not reapply it. As concerns self-examination, 94.5% of group I and 87.5% of group II had not examined their body for skin damage during the previous year. Medical examination revealed the presence of lentigines and freckles among many players, with no significant differences between the two groups.

Conclusions

Beach handball players are highly exposed to the effects of ultraviolet radiation and often take insufficient measures of sun protection. Programmes should be designed and implemented to raise awareness among adolescent and young adult sport competitors of the risks of skin cancer associated with their sports activity and to encourage them to improve their photoprotection and skin monitoring practices.

Prevalence of Sun Protection Use and Sunburn and Association of Demographic and Behaviorial Characteristics With Sunburn Among US Adults

Importance

Monitoring sun protection and sunburn over time at the population level can provide valuable information about progress toward skin cancer prevention goals and inform future intervention efforts.

Objective

To examine the prevalence of sun protection use (shade, sunscreen, and clothing) and sunburn and the association between sunburn and individual characteristics and health behaviors in the US population.

Design, Setting, and Participants

In this cross-sectional study using a nationally representative sample of 31 162 US adults from the 2015 National Health Interview Survey-Cancer Control Supplement, household interviews of civilian, noninstitutionalized US adults were conducted throughout 2015 in person and completed on the telephone when necessary. Data analysis was performed from August 16, 2016, to September 6, 2017.

Main Outcomes and Measures

The prevalence of sunburn and use of sun protection and their association with demographic characteristics, sun sensitivity, and health-related behaviors and conditions using multivariable logistic regression modeling.

Results

A total of 31 162 respondents (mean [SD] age, 47.0 [0.36] years; 13 932 male [44.7%] and 17 230 female [55.3%]) were included in the analyses, with 34.2% experiencing sunburn in 2015. Sunburn prevalence was higher among younger age groups (51.2% in adults 18-29 years old; 95% CI, 48.8%-53.7%), non-Hispanic white individuals (42.5%; 95% CI, 41.2%-43.9%), and those with sun-sensitive skin (50.2%). However, sunburn was also prevalent among black (13.2%; 95% CI, 11.6%-15.1%) and Hispanic (29.7%; 95% CI, 27.6%-31.9%) individuals, demographic groups that are often considered to be at low risk of skin cancer. The most frequent sun protection behaviors were staying in the shade (37.1%; 95% CI, 36.3%-38.0%) and using sunscreen (31.5%; 95% CI, 30.7%-32.3%) followed by wearing long clothing to the ankles (28.4%; 95% CI, 27.6-29.1). Sun avoidance behaviors (seeking shade and not going in the sun) were significantly (39.5% vs 35.1%; P < .001) associated with a lower prevalence of sunburn. Those who used self-applied sunless tanning products (45.0% of users vs 36.1% of nonusers; P < .001), those who engaged in aerobic activity (37.9% of aerobic exercisers vs 32.8% of non-aerobic exercisers; P < .001), binge drinkers (45.1% of binge drinkers vs 35.0% of non-binge drinkers; P < .001), and overweight or obese individuals (37.9% of overweight or obese individuals vs 34.4% of non-overweight or obese individuals; P < .001) were more likely to experience sunburn compared with the respective comparison groups.

Conclusions and Relevance

Sun sensitivity was significantly associated with a higher sunburn prevalence, independent of race/ethnicity, suggesting a need to consider sun sensitivity when identifying target demographic groups for sun safety interventions. Efforts to improve vigilance and consistency with use of sun protection are needed. In addition, those who engage in physical activity, use sunless tanners, or use sunscreen for tanning purposes may require additional intervention strategies to address the unique barriers they face in staying adequately protected.

Association Between Sun Protection Behaviors and Sunburn Among U.S. Older Adults

BACKGROUND AND OBJECTIVES

Skin cancer incidence rates are highest among U.S. older adults. However, little is known about sun protection behaviors and sunburn among adults aged 65 years and older.

RESEARCH DESIGN AND METHODS

We used data from the 2015 National Health Interview Survey to examine the association between sun protection behaviors (sun avoidance, wearing protective clothing, and sunscreen use) and likelihood of having experienced sunburn in the past year.

RESULTS

Just over one in ten older adults (13.2%) had experienced sunburn in the past year; sunburn prevalence was nearly twice as high (20.4%) among sun-sensitive older adults. Men, ages 65-69 years, non-Hispanic whites, and those with skin that burns or freckles after repeated sun exposure were more likely to have been sunburned in the past year compared with the respective comparison groups. The only sun protection behavior significantly associated with sunburn was sunscreen use. None of the sun protection behaviors were significantly associated with a decreased risk of sunburn.

DISCUSSION AND IMPLICATIONS

The prevalence of sunburn among older adults suggests opportunities to reduce skin cancer risk within this demographic group by preventing overexposure to the sun. The lack of reduced sunburn risk among those who regularly used sun protection may be related to inadequate or inconsistent use of sun protection or the way the sun protection behaviors were measured. Multi-sector approaches to facilitate sun-safety among older adults are warranted and could include targeted efforts focused on those most likely to get sunburned, including men and those with sun-sensitive skin.

An environmental risk assessment of three organic UV-filters at Lac Bay, Bonaire, Southern Caribbean

Although organic UV filters (OUVFs) benefit human health by preventing skin burns and cancer, several studies revealed that organic UV filters can induce developmental and reproductive toxicity to aquatic organisms. Discharge of OUVFs occurs predominantly at marine recreational hotspots, such as Lac Bay, Bonaire, and is predicted to increase significantly due to growing tourism worldwide. Unfortunately, there is no insight what the current and future discharge of OUVF at Lac Bay is. Therefore, this study aimed to 1) measure concentrations and estimate the risk of specific OUVFs to different nursery habitats at Lac Bay, and 2) compare measured and predicted concentration based risk assessment outcome. Results showed that at least one of the three nurseries at Lac Bay had a potential for adverse effects. Furthermore, predicted environmental concentrations of UV filter discharge can be applied to gain more insight in the order of extent of OUVF discharge by marine tourism.

Personal care product use among adults in NHANES: associations between urinary phthalate metabolites and phenols and use of mouthwash and sunscreen

Personal care product use is a well-established pathway of exposure for notable endocrine disrupting compounds (EDCs), including phthalates, parabens, triclosan, benzophenone-3 (BP3), and bisphenol-A. We utilized questionnaire data from the National Health and Nutrition Examination Survey 2009-2012 cycles to examine the associations between use of sunscreen and mouthwash and urinary concentrations of phthalate metabolites and phenols in a nationally representative population of US adults (n=3529). Compared with individuals who reported "Never" using mouthwash, individuals who reported daily use had significantly elevated urinary concentrations of mono-ethyl phthalate, methyl and propyl parabens, and BP3 (28%, 30%, 39%, and 42% higher, respectively). Individuals who reported "Always" using sunscreen had significantly higher urinary concentrations of triclosan, methyl, ethyl, and propyl parabens, and BP3 (59%, 92%, 102%, 151%, and 510% higher, respectively) compared with "Never" users of sunscreen. Associations between exposure biomarkers and sunscreen use were stronger in women compared with men, and associations with mouthwash use were generally stronger in men compared with women. These results suggest that sunscreen and mouthwash may be important exposure sources for EDCs.

Increasing Incidence of Melanoma in the Elderly: An Epidemiological Study in Olmsted County, Minnesota

OBJECTIVE

To estimate the age- and sex-adjusted incidence of melanoma in adults 61 years or older in Olmsted County, Minnesota, from 1970 through 2009.

PATIENTS AND METHODS

Using Rochester Epidemiology Project resources, 397 patients were identified who were 61 years or older and who received a first lifetime diagnosis of melanoma from January 1, 1970, through December 31, 2009, in Olmsted County. The incidence of melanoma and the overall and disease-specific survival rates were compared by age, sex, year of diagnosis, and stage of disease.

RESULTS

From 1970 through 2009, age- and sex-adjusted incidence increased significantly (P<.001) from 17.0 (95% CI, 8.6-25.4) to 124.6 (95% CI, 108.9-140.3) per 100,000 person-years, with a 4-fold increase in women and a more than 11-fold increase in men. In men, incidence rates increased with age (P<.001) and over time (P<.001). In women, incidence rates increased over time (P<.001) but were constant across all age groups studied (P=.90). The dramatic increase in the incidence of melanoma was observed mainly for stages 0 and I tumors in both men and women (>55-fold increase). Disease-specific survival increased across the decades (P<.001); when year of diagnosis was compared to mortality, hazard ratios were 0.94 (95% CI, 0.90-0.99; P=.010) and 0.93 (95% CI, 0.89-0.98; P=.006) for men and women, respectively.

CONCLUSION

The incidence of melanoma in older men and women increased significantly over the past 4 decades in Olmsted County, with men experiencing higher rates of increase than did women.

UV filters interaction in the chlorinated swimming pool, a new challenge for urbanization, a need for community scale investigations

Sunscreen products and some personal care products contain the Ultraviolet (UV) chemical filters, which are entering the surface water. Public concerns about secondary effects of these compounds are growing because of the contamination of the aquatic environment that may reach to potentially toxic concentration levels. This article highlights the reaction of certain UV filters with hypochlorite disinfectant in the presence of sunlight. Due to urbanization and industrialization, use of outdoor plastic swimming pools is increasing. The relatively smaller volume of these pools compared to larger pools may increase the concentration of the UV filters in the pool and their potential interactions with materials of human origin (urine, sweat, cosmetics, skin cells, and hair) to the levels of toxicity concerns for children through the creation of disinfection by products (DBP). Based on our analysis, the minimum concentration levels of 2.85, 1.9, 1.78 and 0.95g/L, respectively, for EHMC, OC, 4-MBC and BP3 UV filters in children pools are predicted. Therefore, this article calls for an urgent investigation of potential toxic effects of the UV filters, the creation of DBPs and their subsequent impacts on human health.

Skin Cancer Prevention, Tanning and Vitamin D: A Content Analysis of Print Media in Germany and Switzerland

BACKGROUND

Print media are a major source of health information.

OBJECTIVES

To analyse press coverage related to skin cancer prevention.

METHODS

We conducted a content analysis of print media articles pertaining to skin cancer prevention, solaria and vitamin D published in Germany and Switzerland over a 1-year period between 2012 and 2013.

RESULTS

Overall, 2,103 articles were analysed. Applying sunscreen was by far the most common sun protection recommendation. A considerable number of articles on solaria and vitamin D advocated exposure to ultraviolet radiation to enhance physical appearance and vitamin D photosynthesis, often without mentioning any precaution measures. In total, 26.8% of the articles contained misleading or erroneous statements mostly related to sunscreen use and vitamin D issues.

CONCLUSIONS

Print media can serve as powerful education tools to foster skin cancer prevention. However, misleading or erroneous reports may negatively impact sun-safe behaviour.

Non-melanoma Skin Cancer in Canada Chapter 2: Primary Prevention of Non-melanoma Skin Cancer

BACKGROUND

Non-melanoma skin cancer (NMSC), including basal and squamous cell carcinoma (BCC and SCC), represents the most common malignancy.

OBJECTIVE

To provide guidance to Canadian health care practitioners regarding primary prevention of NMSC.

METHODS

Structured literature searches were conducted, using search terms including prevention, sunscreen, and sun prevention factor. All recommendations concern guidance that physicians should regularly discuss with their patients to help establish photoprotection habits. The GRADE system was used to assign strength to each recommendation.

RESULTS

Ultraviolet exposure is the major modifiable risk factor for NMSC. Aspects of photoprotection, including effective sunscreen use and avoidance of both the midday sun and artificial tanning, are discussed. Several widespread misunderstandings that undermine responsible public health measures related to sun safety are addressed.

CONCLUSIONS

Photoprotection represents both an individual priority and a public health imperative. By providing accurate information during routine patient visits, physicians reinforce the need for ongoing skin cancer prevention.

Chemical contaminants in swimming pools: Occurrence, implications and control

A range of trace chemical contaminants have been reported to occur in swimming pools. Current disinfection practices and monitoring of swimming pool water quality are aimed at preventing the spread of microbial infections and diseases. However, disinfection by-products (DBPs) are formed when the disinfectants used react with organic and inorganic matter in the pool. Additional chemicals may be present in swimming pools originating from anthropogenic sources (bodily excretions, lotions, cosmetics, etc.) or from the source water used where trace chemicals may already be present. DBPs have been the most widely investigated trace chemical contaminants, including trihalomethanes (THMs), haloacetic acids (HAAs), halobenzoquinones (HBQs), haloacetonitriles (HANs), halonitromethanes (HNMs), N-nitrosamines, nitrite, nitrates and chloramines. The presence and concentrations of these chemical contaminants are dependent upon several factors including the types of pools, types of disinfectants used, disinfectant dosages, bather loads, temperature and pH of swimming pool waters. Chemical constituents of personal care products (PCPs) such as parabens and ultraviolet (UV) filters from sunscreens have also been reported. By-products from reactions of these chemicals with disinfectants and UV irradiation have been reported and some may be more toxic than their parent compounds. There is evidence to suggest that exposure to some of these chemicals may lead to health risks. This paper provides a detailed review of various chemical contaminants reported in swimming pools. The concentrations of chemicals present in swimming pools may also provide an alternative indicator to swimming pool water quality, providing insights to contamination sources. Alternative treatment methods such as activated carbon filtration and advanced oxidation processes may be beneficial in improving swimming pool water quality.

Oxidative stress mediated Ca(2+) release manifests endoplasmic reticulum stress leading to unfolded protein response in UV-B irradiated human skin cells

BACKGROUND

Exposure of skin to ultraviolet (UV) radiation, an environmental stressor induces number of adverse biological effects (photodamage), including cancer. The damage induced by UV-irradiation in skin cells is initiated by the photochemical generation of reactive oxygen species (ROS) and induction of endoplasmic reticulum (ER) stress and consequent activation of unfolded protein response (UPR).

OBJECTIVE

To decipher cellular and molecular events responsible for UV-B mediated ER stress and UPR activation in skin cells.

METHODS

The study was performed on human skin fibroblast (Hs68) and keratinocyte (HaCaT) cells exposed to UV-B radiations in lab conditions. Different parameters of UVB induced cellular and molecular changes were analyzed using Western-blotting, microscopic studies and flow cytometry.

RESULTS

Our results depicted that UV-B induces an immediate ROS generation that resulted in emptying of ER Ca(2+) stores inducing ER stress and activation of PERK-peIF2α-CHOP pathway. Quenching ROS generation by anti-oxidants prevented Ca(2+) release and subsequent induction of ER stress and UPR activation. UV-B irradiation induced PERK dependent G2/M phase cell cycle arrest in Hs68 and G1/S phase cell cycle arrest in HaCaT. Also our study reflects that UV-B exposure leads to loss of mitochondrial membrane potential, activation of apoptotic cascade as evident by AnnexinV/PI staining, decreased expression of Bcl-2 and increased cleavage of PARP-1 protein.

CONCLUSION

UV-B induced Ca(2+) deficit within ER lumen was mediated by immediate ROS generation. Insufficient Ca(2+) concentration within ER lumen developed ER stress leading to UPR activation. These changes were reversed by use of anti-oxidants which quench ROS.

Ultraviolet radiation and the athlete: risk, sun safety, and barriers to implementation of protective strategies

Ultraviolet (UV) radiation plays a pivotal role in the development of both melanoma and non-melanoma skin cancers. Numerous factors potentially place athletes at high risk for developing these cancers. Various prevention strategies ameliorate this risk, including avoiding sun exposure during peak UV exposure hours, applying sunscreen with a sun protection factor of 30 or above before participating in outdoor sports, wearing hats and sunglasses, and reducing exposure with long pants and long-sleeve shirts. The literature, however, cites several barriers to these prevention approaches, including sports' competition rules, the lack of availability of sunscreen, and the lack of information about sun safety behaviors. Sun safety education programs prove effective in getting athletes to participate in prevention strategies. This article reviews the effect of UV radiation on athletes' skin and provides sports medicine clinicians with suggestions to improve the sun safety behaviors of their athletes.

Sun exposure behavior and protection: recommendations for travelers

BACKGROUND

Although there have been recent advances in the development of photoprotective clothing and broad-spectrum sunscreens, few peer-reviewed publications have focused on photoprotection recommendations for travelers.

METHODS

In order to describe the adverse health effects of excessive ultraviolet (UV) radiation exposures; review recent studies of public perceptions regarding photoprotection and sun exposure behaviors; identify special populations at increased risks of drug-induced photosensitivity reactions and UV-induced skin cancers; and recommend several effective photoprotection strategies for travelers, Internet search engines were queried with the key words as search terms to examine the latest references on photoprotection and the epidemiology of UV-associated skin cancers.

RESULTS

Observational studies have demonstrated that the public knows little about proper sunscreen protection, selection, and use, and often abuses sunscreens for intentional UV overexposures. Cohort studies have identified special populations at increased risks of UV-associated skin cancers without the proper use of sunscreens and photoprotective clothing including children, fair-skinned persons, patients taking photosensitizing drugs, and organ transplant recipients (OTRs). Clinical investigations support the regular use of broad-spectrum sunscreens to prevent the development of premalignant actinic keratoses (AK) in all sun-exposed subjects, especially OTRs; to prevent the development of squamous cell carcinomas from new AK in sun-exposed subjects, especially OTRs; to possibly prevent the development of cutaneous malignant melanomas in children and adults; and to possibly prevent the development of basal cell carcinomas in OTRs.

CONCLUSIONS

Recommended photoprotection strategies for travelers should include avoiding intense sunlight, wearing photoprotective clothing, wearing sunglasses, and selecting the right sunscreen for their skin type. Travel medicine practitioners should counsel travelers about photoprotection and encourage travelers to take advantage of recent advances in the development of more effective broad-spectrum sunscreens and photoprotective clothing for themselves and their children.

Sunscreen use and melanocytic nevi in children: a systematic review

We conducted a systematic review of the association between melanocytic nevi (MN) in childhood and sunscreen use. A bibliographic search was conducted between November 2008 and January 2009 using the following key words on MEDLINE and EMBASE: child*, in combination with naevi, nevi, naevus, nevus and sunscreen, sun protection. We also used Medical Subject Headings [sunscreening agents], or [radiation protection] with [nevus, pigmented]. A first screening was done on title and abstract reading. Randomized trials and cohort and cross-sectional studies analyzing the relationship between the use of sunscreen and MN in children were selected. Three reviewers abstracted data from each article. The three sets of results were compared for concordance and rereviewed if necessary. Fifteen articles were included (20,743 children). The studies were not consistent in terms of the ages of the children, MN count methods, or sunscreen use assessment. Owing to this heterogeneity, we were unable to pool the studies and conduct a meta-analysis. Twelve studies did not report that the use of sunscreen had a protective effect against MN development. Three studies reported a lower MN count when sunscreen was applied. This systematic review underlines the methodologic differences between studies. Eight of 15 studies reported a positive association between sunscreen application and MN count. Differences in MN counts, overexposure to sun, and inadequate sunscreen application on fair-skinned children could explain the disparity in the results. There is still no evidence of a protective effect of sunscreen against MN development in children.

Counselling on sun protection, a survey of French paediatricians

BACKGROUND

High sun exposure during childhood is an important risk factor for skin cancers at adulthood. Paediatricians are first in line to provide sun protection (SP) information.

OBJECTIVE

To describe paediatricians' attitudes towards SP counselling and compare French and American paediatricians' behaviours.

METHODS

Methodology used by the American Academy of Pediatrics in 2001. Validation of the French version of the questionnaire. Survey of all 1108 paediatrician members of the Association Française de Pédiatrie Ambulatoire (AFPA) RESULTS  More than 90% of paediatricians agreed that skin cancers are a Public Health concern, that preventing episodic high sun exposures during childhood would reduce the risk of adult melanoma, and that it is a paediatrician's role to educate parents/patients on SP. Three quarters reported counselling all of their patients. The most important SP recommendation was to avoid sun during peak hours, followed by sunscreen use. Only 48.3% of paediatricians rated SP as very important to their patients' health, at the 8th rank among selected preventive care topics. The most frequently identified barrier to SP counselling was cost of sunscreens followed by lack of sufficient time.

CONCLUSIONS

The majority of paediatricians believe that prevention of skin cancers is a worthy issue and it is their role to educate patients, but less than half of them consider SP as an important topic among selected preventive care issues. Although paediatricians seem to know SP measures well, their (counselling?) seems to respond to patients' preoccupations more than to expert recommendations. French and American behaviours show some major differences.

New combination of ultraviolet absorbers in an oily emollient increases sunscreen efficacy and photostability

Introduction

It is now recognized that to adequately protect skin from sun damage, sunscreens require a photostable combination of ultraviolet (UV) filters with a suitable level of UVA protection. The total amount of UV filters should be as low as possible to avoid adverse skin reactions, potential environmental impact, and to ensure acceptable texture for better application and usage.

Methods

A synergistic combination of UV filters was selected to obtain a high sun protection factor (SPF) and UVA protection factor (UVA-PF). An oily vehicle was then added to the formula to improve the solubility and the photostability of the lipophilic UV filters.

Results

The combination of filters, i.e., terephthalylidene dicamphor sulfonic acid (TDSA), bis-ethylhexyloxyphenol methoxyphenyl triazin (BEMT), and butyl methoxy dibenzoyl methane (BMDM), obtained an elevated SPF as well as a high UVA-PF. Isopropyl lauroyl sarcosinate (ILS), a derivative of a natural amino acid (sarcosine, also known as N-methylglycine) was introduced in this formulation in order to dissolve the oil-soluble UV absorbers and to photostabilize BMDM. The new sunscreen formulation obtained with this combination is photostable and contains a reduced amount of UV filters compared to other sunscreens with the same level of efficacy.

Conclusion

This report described the steps resulting in the formulation of a new combination of UV filters in an oily emollient, which presents a high UVA-PF (UVA-PF = 38) and a SPF 50+, is photostable, and offers good protection against UV-induced biological damage.

Sun exposure and sun protection habits in high school students from a city south of the country

BACKGROUND: Effective solar protection is an uncommon practice among young people, increasing the likelihood of sunburn, sunstroke and skin cancers. This fact is more significant in the south of Brazil, where the prevalence of white skinned population is larger, being more prone to sun damage. OBJECTIVES: To study the practices of sun exposure and sun protection in high school students from the city of Carlos Barbosa - RS. METHODS: Cross-sectional study involving 775 students, enrolled on the first half of 2010, who had signed the consent form. We used a non-identifiable, self-administered questionnaire, with questions about related topics. Statistical analysis was performed using Chi-square or Fisher exact and t-Student tests. The study was approved by the Research Ethics Committee under the number 2010-115H. RESULTS: Most students are exposed to the sun at the more critical periods, remaining exposed for more than an hour. Five hundred and seventy-six students (74,3%) reported using sunscreen, but less than 10% did it during all months of the year. Female teenagers are most likely to use sunscreen (p <0.001) and to spend less time exposed to sunlight (p <0.001). CONCLUSION: Most high school students from Carlos Barbosa had unsuitable sun exposure and sun protection habits, characterizing a high risk behavior for skin diseases. The existence of public programs for clarification of the risks to the population and the subsidization of sun protection products were suggested by these young people.

Sunscreen use: controversies, challenges and regulatory aspects

Mismatches between skin pigmentation and modern lifestyle continue to challenge our naked skin. One of our responses to these challenges is the development and use of sunscreens. The management of sunscreens has to balance their protective effect against erythema, photocarcinogenesis and photoageing owing to the potential toxicity of the ultraviolet (UV) filters for humans and the environment. The protection against UV radiation offered by sunscreens was recently standardized in the European Union (EU) based on international harmonization of measurement techniques. Four different categories of sun protection have been implemented along with recommendations on how to use sunscreen products in order to obtain the labelled protection. The UV filters in sunscreens have long been authorized for use by the EU authority on the basis of data from studies on acute toxicity, subchronic and chronic toxicity, reproductive toxicity, genotoxicity, photogenotoxicity, carcinogenicity, irritation, sensitization, phototoxicity and photosensitization as well as on environmental aspects. New challenges with respect to the safety of UV filters have arisen from the banning of animal experiments for the development of cosmetics. Future debates on sunscreens are likely to focus on nanoparticles and environmental issues, along with motivation campaigns to persuade consumers to protect their skin. However, more efficient sunscreen use will also continue to raise questions on the benefit in preventing vitamin D synthesis in the skin induced by sunlight.

Vacations to sunny destinations, sunburn, and intention to tan: A cross-sectional study in Denmark, 2007-2009

Background: Denmark has experienced an increase in melanoma incidence since the 1960s. Exposure to ultraviolet radiation is the main preventable cause of this cancer. We examined current travel to, and sun-related behaviour of Danes at, sunny destinations in relation to their risk for sunburn. Method: A population-based sample of 11,158 respondents aged 15—59 years completed three questionnaires in 2007—2009 that included items on exposure to ultraviolet radiation. Using logistic regression analysis we examined the relations between sunny vacations, sun-related behaviour, demographic factors and risk for sunburn. Results: During 2007—2009, 44.8—45.8% of the respondents travelled to a sunny destination at least once a year; 24% became sunburnt, and 69% tanned intentionally. The odds ratio for sunburn in general for people who went on a sunny vacation as compared with those who did not was 1.6 (1.5—1.7). Sunscreen use (1.9; 1.4—2.6) and intentional tanning (3.4; 2.8—4.1) were positively associated with sunburn on vacation. Conclusions: Taking a vacation in a sunny place is a risk factor for sunburn, especially for young people. The recommendation for sunscreen use should be re-evaluated, as intention to tan is the most important factor in sunburn on vacation and should be targeted more strategically.

Fotoproteção e exercício físico

As medidas de fotoproteção são divulgadas como procedimentos essenciais na prevenção de doenças cutâneas e manutenção da saúde e beleza. Os exercícios físicos regulares também são indicados para alcançar o estilo de vida saudável; no entanto, a prática esportiva expõe a maior radiação solar. O objetivo deste artigo é revisar as medidas fotoprotetoras na prevenção dos danos causados pelo Sol na pele dos desportistas. Abordam-se o histórico da fotoproteção, o espectro eletromagnético, os efeitos das radiações e os riscos de exposição durante as atividades físicas. Implementar estratégias, como a escolha do horário, local, roupas e acessórios, complementados pelo uso de filtros solares, minimizam os riscos decorrentes das radiações ultravioletas A e B (UVA e UVB) durante a prática esportiva ao ar livre. Dentre os produtos disponíveis no mercado, devem-se preferir aqueles que ofereçam segurança, ampla proteção, boa cosmética, estabilidade química em diferentes condições de calor e umidade, fotoestabilidade e baixo custo. O atleta deve ser orientado pelos profissionais da área da saúde sobre os riscos inerentes às suas atividades cotidianas e esportivas. O autoexame de pele é parte essencial na prevenção dos problemas dermatológicos, pois auxilia na detecção precoce. O futuro da fotoproteção no esporte está no investimento em medidas educativas desde a infância, reduzindo assim os danos solares cumulativos. A exposição solar deve ocorrer de modo cauteloso e com o mínimo de sequelas, mediante comportamento de fotoproteção, para proporcionar melhor qualidade de vida.

Prevalence of sunburn and sun-related behaviour in the Danish population: a cross-sectional study

BACKGROUND

In Denmark, the incidence of melanoma has been increasing since the 1960s. Intermittent exposure to ultraviolet radiation and a history of sunburn and sunbed use are known risk factors. We describe the association between use of protective measures, sun-related behaviour and experience of sunburn in the Danish population three months after the start of the campaign.

METHOD

A population-based sample of 3,499 persons aged 15-59 years completed a questionnaire that included items on exposure to ultraviolet radiation. We examined the relations between sunburn and sun-related behaviour by logistic regression analysis.

RESULTS

Within the previous 12 months, 35% of the study population had experienced sunburn. Sunburn became less frequent with age (odds ratio (OR) 4.44; 15-19 vs. 50-59) and skin type (OR 2.57; I vs. III). Sunburn was negatively associated with shade and clothing and positively with use of sunscreens. We found no significant difference in sunscreen use between intentional tanners who experienced sunburn and those who did not. A larger fraction of unintentional tanners with sunburn than those who were not sunburnt had used sunscreen. Sunscreen was used to prolong the time spent in the sun by 66% of sunburnt people; however, we found no association between duration of sun exposure and sunscreen use.

CONCLUSIONS

Future campaigns to reduce the prevalence of sunburn in the Danish population must especially target young persons and intentional tanning, and they should emphasize that sunscreen cannot be used to extend the time spent in the sun and that shade and clothing provide the best protection against sunburn.

Application of sunscreen preparations among young Polish people

BACKGROUND

The efficacy of sunscreens is assessed on the basis that 15-20 g/m(2) (1.5-2 mg/cm(2)) is applied. However, expecting people to apply such large amounts is perhaps unrealistic.

AIM

To evaluate the application of sunscreen usage by young people.

MATERIALS AND METHODS

Forty-nine subjects (24 females and 25 males) in the age range 18-32 years (mean 23.1 years) were included in the study. They were asked to apply sun protection factor (SPF) to the whole of their own skin surface in just the same way that they would customarily do it during/prior to sun exposure. Two agents were applied: emulsion with SPF30 and a fatty cream with SPF > 60. The amount of preparation used/m(2) was calculated. Statistical analysis was performed using the Student's t-test.

RESULTS

The average amount of both preparations used was about half that expected to achieve correct sun protection (p < 0.00001). The mean applied amount of the fatty cream was 9.6 +/- 5.3 g/m(2) (50.7% of the ideal value) and the emulsion 9.2 +/- 5.5 g/m(2) (48.6% of the ideal value). Neither gender (male/female) nor type of agent (emulsion/fatty cream) affected the amount used.

CONCLUSIONS

Young people customarily apply less than 10 g of SPF/m(2). It is therefore unrealistic and possibly even misleading of manufacturers to assess SPF ratings as if people applied 15-20 g of SPF/m(2). Perhaps it is for manufacture's to increase the efficacy of their products rather than for consumers to be asked to apply twice as much?

Sunscreens: expectation and realization

BACKGROUND

The technical performance of sunscreens has improved dramatically over the past 20 years, so have we now succeeded in delivering protection that meets consumers' expectations?

METHODS

From a public health perspective, the desire to prevent sunburn and protect against skin cancer are the two major drivers for using sunscreen. This review examines how well consumers can expect to realize these expectations.

RESULTS

Sunscreens are used regularly by a minority of people, even during recreational summer exposure. The failure of sunscreen to prevent sunburn is almost always due to the way that sunscreens are applied rather than technical failure of the product. The mismatch between the labelled protection (sun protection factor) and that delivered in practice is a contributory factor to this 'failure'. Sunscreens have been shown to be effective in reducing the incidence of squamous cell cancer and with promising benefits for basal cell cancer. However, the evidence that they are effective in melanoma remains lacking.

CONCLUSION

The formulation and extinction of sunscreens have undoubtedly improved over recent years. Yet the notion that sunscreens provide unequivocal protection against the deleterious effects of sun exposure by everyone who uses them remains elusive.