The frequency of reactions to sunscreens: results of a longitudinal population-based study on the regular use of sunscreens in Australia

Potential Applications of Lilium Plants in Cosmetics: A Comprehensive Review Based on Research Papers and Patents

The application of cosmetics is indispensable in our current society. In recent years, with an increasing awareness of the long-term health benefits of naturally sourced ingredients, plant-based cosmetic products have gained increasing attention. Lilium belongs to the Liliaceae family, which is one of the main plant families used in cosmetics for skin care treatment. A large number of studies have shown that Lilium plants are rich in components such as phenolic acids, flavonoids, and polysaccharides, with high potential for cosmetic applications. However, the application of lilies in cosmetics has not been systematically reported. This knowledge gap can easily lead to the neglect of its application in cosmetics because lilies are most familiar as ornamental plants. Integrating academic papers and patent publications, we analyzed the potential cosmetic application ingredients in lily, as well as their applications in cosmetics and related efficacy. Patent analysis showed that applications for lily-related cosmetic patents are mainly concentrated in East Asia, including China, Korea, and Japan. The application of lilies involves all aspects of cosmetics, such as sunscreens, facial cleansers, facial masks, conditioners, and so on. Its functions are also rich and diverse, including antiaging, radiation protective, whitening, moisturizing, freckle removal, acne treatment, and hair regeneration promotion. In addition, lilies are compatible with the application of other herbs. Moreover, with a change in people’s consumption concepts and the consideration of long-term health benefits, lily-based food and medicine innovation with health care and beautification effects may be a promising direction.

Ultraviolet filter, fragrance and preservative allergens in New Zealand sunscreens

BACKGROUND/OBJECTIVES

Allergic contact dermatitis, photoallergic contact dermatitis and irritant reactions to sunscreens are common reasons for dermatology consultation. Patch testing for contact allergy relies on up-to-date knowledge of allergen exposures. The aim of this study was to investigate contact allergens and photoallergens in sunscreens commercially sold on the shelves of supermarkets and pharmacies in New Zealand.

METHODS

A comprehensive market data review of suppliers' websites was performed from March to August 2019 to obtain a list of the commonly sold sunscreens in our region. Ingredients were collated and analysed according to International Nomenclature of Cosmetic Ingredients (INCI) names. Ultraviolet (UV) filters, preservatives and fragrances were included for analysis. Place of sale and cost of sunscreens were also recorded.

RESULTS

Ninety-five sunscreens were analysed: 36% sold in supermarkets, 43% in pharmacies and the remainder available in both. The most frequent UV filters were butyl methoxydibenzoylmethane (contained in 70% of products) followed by octocrylene (63%) and homosalate (50%). The common photoallergen benzophenone 3 was found in 19% of products. Phenoxyethanol was the most common preservative (68%) followed by disodium EDTA (30%) and propylparaben (26%). Two sunscreens contained methylisothiazolinone. Sixty-one per cent contained at least one fragrance, the most frequent being limonene (17%) and linalool (13%). There was an average of 1.1 New Zealand baseline series allergens per product (range 0 to 6, standard deviation 1.27).

CONCLUSION

Common allergens including those with high sensitising potential were frequently found in New Zealand sunscreen. Knowledge of ingredients used by manufacturers is useful in dermatological assessment of skin contact reactions.

Oxidative-Stress-Induced Cellular Toxicity and Glycoxidation of Biomolecules by Cosmetic Products under Sunlight Exposure

Cosmetics, commonly known as ‘makeup’ are products that can enhance the appearance of the human body. Cosmetic products include hair dyes, shampoos, skincare, sunscreens, kajal, and other makeup products. Cosmetics are generally applied throughout the face and over the neck region. Sunlight has different wavelengths of light, which include UV-A, UV-B, UV-C, and other radiations. Most cosmetic products have absorption maxima (λmax) in the range of visible light and UV-R. The effect of light-induced photosensitization of cosmetic products, which results in the production of free radicals through type-I and type-II photosensitization mechanisms. Free-radicals-mediated DNA damage and oxidative stress are common consequences of cosmetic phototoxicity. Cosmetic phototoxicity may include percutaneous absorption, skin irritation, eye irritation, photosensitization, mutagenicity, and genotoxicity. Oxidative stress induces membrane lipid peroxidation, glycoxidation, and protein covalent modifications, resulting in their dysfunction. Natural antioxidants inhibit oxidative-stress-induced cosmetic toxicity. Sunlight-induced photodegradation and accumulation of cosmetic photoproducts are also a matter of serious concern. India has tropical weather conditions throughout the year and generally, a majority of human activities such as commerce, agriculture, sports, etc. are performed under bright sunlight conditions. Thus, more focused and dedicated research is warranted to explore the effects of cosmetics on oxidative stress, glycoxidation of biomolecules, and photoproducts accumulation for its total human safety.

Can natural products improve skin photoprotection?

Abstract Due to increased UV radiation on the Earth’s surface, caused by depletion of the stratospheric ozone, people have become more susceptible to different types of skin damage, such as erythema, sunburns, and cancer; this is especially of concern in tropical countries. Thus, efforts to improve awareness as well as the use of sunscreen are increasing worldwide. However, synthetic UV filters have been associated with deleterious effects such as photosensitization. Natural products have been used by ancient cultures for several purposes, including protecting the skin from the sun. However, there is still doubt today whether photoprotection is a real phenomenom or whether it is simply tanning of the skin. Plants have self-protective mechanisms and produce secondary metabolites that can protect themselves from UV radiation. Yet, can phytochemical compounds protect human skin? This review discusses the paradoxical effect of chemical UV filters and the influence of phytochemicals in in vitro and in vivo tests of photoprotection.

Supplementation with 5-formyltetrahydrofolate alleviates ultraviolet B-inflicted oxidative damage in folate-deficient zebrafish

Ultraviolet (UV) is an omnipresent environmental carcinogen transmitted by sunlight. Excessive UV irradiation has been correlated to an increased risk of skin cancers. UVB, the most mutagenic component among the three UV constituents, causes damage mainly through inducing DNA damage and oxidative stress. Therefore, strategies or nutrients that strengthen an individual's resistance to UV-inflicted harmful effects shall be beneficial. Folate is a water-soluble B vitamin essential for nucleotides biosynthesis, and also a strong biological antioxidant, hence a micronutrient with potential of modulating individual's vulnerability to UV exposure. In this study, we investigated the impact of folate status on UV sensitivity and the protective activity of folate supplementation using a zebrafish model. Elevated reactive oxygen species (ROS) level and morphological injury were observed in the larvae exposed to UVB, which were readily rescued by supplementing with folic acid, 5-formyltetrahydrofolate (5-CHO-THF) and N-acetyl-L-cysteine (NAC). The UVB-inflicted abnormalities and mortality were worsened in Tg(hsp:EGFP-γGH) larvae displaying folate deficiency. Intriguingly, only supplementation with 5-CHO-THF, as opposed to folic acid, offered significant and consistent protection against UVB-inflicted oxidative damage in the folate-deficient larvae. We concluded that the intrinsic folate status correlates with the vulnerability to UVB-induced damage in zebrafish larvae. In addition, 5-CHO-THF surpassed both folic acid and NAC in preventing UVB-inflicted oxidative stress and injury in our current experimental zebrafish model.

Plant-based active photoprotectants for sunscreens

Excessive exposure to the sun's radiation is the major exogenous mediator of skin damage, which accelerates skin ageing and increases the risk of developing skin cancer. Compounds with photoprotectant activity are extremely useful for decreasing the effect of ultraviolet (UV) radiation on the skin; however, numerous sun filters, especially organic sunscreens, are allergenic. Therefore, the development of formulations containing plant extracts, which may be potentially safer, is extensively being explored. Plant-based cosmetics are commonly used to avoid skin ageing because they contain antioxidant agents that minimize free radical activity, and numerous studies have investigated the skin-protectant effects of related plant species. In addition to their antioxidant properties, plant-based cosmetics protect the skin against solar radiation because they contain polyphenols such as flavonoids and carotenoids. Therefore, this study aims to present a review of plant species commonly used in sunscreens to protect the skin against damage due to sunlight exposure.

Benzophenone 1 induced photogenotoxicity and apoptosis via release of cytochrome c and Smac/DIABLO at environmental UV radiation

Solar UV radiation is main factor of photocarcinogenesis, photoageing, and phototoxicity; thus, protection from UV radiation is major concern. Sunscreens containing UV filters are suggested as sun safe practices, but safety of UV filters remains in controversies. Benzophenone-1 (BP1) is commonly used in sunscreens as UV blocker. We assessed the photogenotoxicity and apoptotic parameters in human keratinocytes (HaCaT cells) by western blot, immunocytochemistry, flowcytometry, comet assay and TEM imaging. Our results exposed that BP1 photosensitized and generated intracellular ROS (2.02 folds) under sunlight/UVR. Decrease in cell viability was recorded as 80.06%, 60.98% and 56.24% under sunlight, UVA and UVB, respectively. Genotoxic potential of BP1 was confirmed through photomicronuclei and CPDs formation. BP1 enhanced lipid peroxidation and leakage of LDH enzyme (61.7%). Apoptotic cells were detected by AnnexinV/PI staining and sub G1 population of cell cycle. BP1 induced up regulation of apoptotic proteins Bax/Bcl2 ratio, Apaf-1, cytochrome c, Smac/DIABLO and cleaved caspase 3 was noticed. Down regulation of pro caspase 3 was inhibited by Z-VAD-fmk (inhibitor of caspase). Thus, study established the involvement of BP1 in photogenotoxicity and apoptosis via release of cytochrome c and Smac/DIABLO. These findings suggest sunscreen user to avoid BP1 in cosmetics preparation for its topical application.

Primary irritation index and safety zone of cosmetics: retrospective analysis of skin patch tests in 7440 Korean women during 12 years

BACKGROUND

Cosmetics are products used over long periods by the public, and their safety is very important. Several types of human tests are used widely for the evaluation of cosmetics including single patch tests, in-use tests, human repeated insult patch test (HRIPT). However, there is no clear and well-defined published objective and standardized criteria for primary skin irritation in regard to the large variety of cosmetic products.

METHODS

This study analysed human patch tests conducted from May 2001 to December 2012 with 4606 materials of prototype or finished cosmetic products on 7440 normal Korean women aged 18-60 years. The tested products were patched under occlusion for 24 or 48 h, and skin tolerance was assessed twice at 30 min and 24 h after patch removal using a 5-step scale according to the CTFA guidelines.

RESULTS

Human patch tests for cosmetics were performed of 4606 cases, and 30-33 subjects participated in each case. The response in each case was calculated based on total subject number, skin reaction intensity and the number of respondents. The calculated response was standardized using the z-score, and a safety zone was provided in terms of human primary irritation in accordance with the human skin reaction evaluation criteria and usage or formula of cosmetics.

CONCLUSIONS

This study established the safety criteria for irritation in the cosmetics field.

[Solar protection products: efficacy and risks]

Solar protection products (SPP) containing chemical filters and/or mineral filters are extensively used today in photoprotection; however, concerns continue to be voiced about their efficacy and about their possible dangers. A rapid review of photoprotection strategies shows that SPP owe their photoprotective effect to the absence of other photoprotection methods having clearly established efficacy in healthy subjects; in addition, they exhibit real protective efficacy against the majority of harmful effects of solar radiation, provided they have been devised in keeping with the specifications clearly set out in the recommendations of the French Medicines Agency (Afssaps). Such efficacy is dependent on their correct usage, recently reiterated by Afssaps in its recommendations to end-users concerning the good use of solar products: application of adequate quantities of such products, selection of the appropriate photoprotection class based on phototype and conditions of exposure, and regular renewal of applications in the event of prolonged exposure and after bathing or profuse sweating. Solar filters have long been known to cause contact allergic dermatitis, irritative dermatitis and photosensitisation, and a particular risk has appeared with the use of octocrylene. However, debate has centred primarily on the risk of endocrine disturbance potentially induced by chemical filters, certain of which exhibit established transcutaneous penetration. The risk of mimicry of an effect of oestradiol has been raised on the basis of a series of studies, almost all of which were carried out by the same team, and which mainly concerned 4-methylbenzylidene-camphor (4-MBC) following oral absorption in the rat. The risk of this type of effect with SPPs under normal conditions of use seems fairly remote according to the current state of knowledge; in any event, within the context of the "National Fertility Action Plan", Afssaps has been formally requested to analyse the risk associated with cosmetic substances that are "reprotoxic" and/or affect endocrine function, as a result of which various filters are currently being reassessed for such risk. The greater alleged safety of mineral filters, based on the absence of introduction of risk of photosensitisation (as a result of which they are preferred for use in young children), no longer seems so clear since the introduction of titanium dioxide (TiO2) and zinc oxide (ZnO) in the form of nanoparticles. Afssaps drew up a risk assessment report concerning cutaneous penetration, genotoxicity and oncogenesis for TiO(2) and ZnO in nanoparticle form; further studies are needed before any general conclusions may be drawn. The European Scientific Committee on Consumer Safety (SCCS) is also carrying out an evaluation of the use of TiO(2) and of ZnO as UV filters. Finally, current data do not suggest that SPPs exert any harmful effects by inhibiting the beneficial effects of the sun, in particular, vitamin D synthesis.

Proteção à radiação ultravioleta: recursos disponíveis na atualidade em fotoproteção

A radiação ultravioleta pode provocar danos ao DNA, imunossupressão, alterações químicas e histológicas na epiderme, envelhecimento precoce, cataratas e carcinogênese, dentre outras deteriorações. A fotoproteção previne estes e outros efeitos danosos da radiação ultravioleta. Protetores solares, vestimentas, acessórios adequados e exposição segura ao sol são ferramentas essenciais da fotoproteção. Neste artigo, são apresentadas e discutidas as principais formas de fotoproteção, incluindo os protetores solares com filtros inorgânicos e orgânicos, a avaliação da eficácia dos mesmos e atualizações envolvendo o tema

New insights about infant and toddler skin: implications for sun protection

The skin is increasingly recognized as a component of the innate immune response, in addition to its role as a physical barrier. Although the deleterious effects of solar ultraviolet radiation (UVR), including immunosuppression and cutaneous tumorigenesis, are widely acknowledged, most studies to date have concentrated on adult skin. Despite the more sensitive nature of infant and toddler skin, little is known about its responses to UVR exposure, whether acute or long-term. Accumulating evidence suggests not only that the skin's barrier protection remains immature throughout at least the first 2 years of life but also that accumulation of UVR-induced changes in the skin may begin as early as the first summer of life. Such evidence not only affirms the importance of sun protection during the infant and toddler years but underscores the need for more research to establish evidence-based standards of care in this area. In this article we review recent studies in which differences between the skin properties of infants and young children and those of adults were compared, and we discuss the implications of these differences for sun-protection practices.

Photoprotection

Sun exposure is the main cause of photocarcinogenesis, photoageing, and photosensitivity; thus, photoprotection is an important issue. In a skin cancer prevention strategy, behavioural measures--eg, wearing sun protective clothes and a hat and reducing sun exposure to a minimum--should be preferred to sunscreens. Often this solution is deemed to be unacceptable in our global, outdoor society, and sunscreens could become the predominant mode of sun protection for various societal reasons (eg, healthiness of a tan, relaxation in the sun). The application of a liberal quantity of sunscreen has been shown to be by far the most important factor for effectiveness of the sunscreen, followed by the uniformity of application and the specific absorption spectrum of the agent used. The sunscreen market--crowded by numerous products--shows various differences worldwide. Nevertheless, sunscreens should not be abused in an attempt to increase time in the sun to a maximum. Controversies about safety of sunscreens and clinical recommendations are discussed.

Sun protection in Iranian kidney transplant recipients: knowledge, attitude and practice

BACKGROUND

Kidney transplant recipients (KTR) are at increased risk of developing skin cancer. The purpose of this study was to evaluate the knowledge, attitude, and practices of KTRs regarding skin cancer after transplantation and to identify the role of education in motivating these patients to practice sun-protective behaviours.

METHODS

Two hundred and fifty KTRs in a referral hospital were interviewed using a questionnaire. All patients received a skin cancer information booklet after completion of the questionnaire. Six months later, these patients were invited and interviewed again about their skin cancer-prevention practices.

RESULTS

The patients consisted of 153 men and 97 women patients with a mean age of 35.9 +/- 14.2 years and mean of 49.7 +/- 53.1 months after their transplantation. A total of 102 patients (40.8%) mentioned receiving skin care advice after transplantation. Nonetheless, the majority of patients did not have appropriate skin cancer-prevention practices. Patients who had received advice on skin care after transplantation were significantly more likely to do skin self-examination (chi-squared test; P < 0.001) and have less sun exposure daily (Mann-Whitney test; P = 0.019) than those who did not. Half of the patients (125 patients) participated in the second part of the study 6 months after the first interview and providing skin care instruction booklet. Although regular skin self-examination and sunscreen use was significantly increased (P = 0.006 and P = 0.001, respectively), but daily sun exposure was not changed significantly (P = 0.64).

CONCLUSIONS

Post-transplantation education does not necessarily lead to patients' awareness about their increased risk of skin cancer, and subsequent motivation to practice effective sun protection. Health professionals and dermatologists in particular need to establish better methods of dissemination of information, repeatedly and at the proper time.

Effects of polyphenols on skin damage due to ultraviolet A rays: an experimental study on rats

BACKGROUND

Ultraviolet (UV) radiation causes many acute and chronic conditions such as oedema of the skin, sunburn, immunosuppression, photo-ageing and skin cancer. The use of antioxidants has become of paramount importance in prevention of the damage caused by ultraviolet radiation. Epigallocatechin-3-gallate (EGCG), one of the main components of green tea, has been reported to have anti-inflammatory, antioxidant and anticarcinogenic properties.

AIM

The aim of this experimental study was to investigate to what extent EGCG prevented acute skin damage caused by UVA.

MATERIAL AND METHOD

The sample contained 2% EGCG, which was prepared in hydrophilic ointment (USP XXIV) as the vehicle. Twenty-four 12-week-old Wistar albino rats are included in the study and divided into four groups, each containing six rats. Group I was formed to be the control group, which was not applied any topical medication or exposed to UV radiation. Group II was formed to observe acute effects of UVA on the skin, Group III was formed to observe effectiveness of topical EGCG on the skin applied 30 min after exposure to UVA, and Group IV was formed to observe topical EGCG applied 30 min before exposure to UVA. All groups were examined for sunburn cells, leucocyte infiltration, dermo-epidermal activity, collagen changes and elastic fibre pathologies on 24 and 72 h. Statistical analysis was performed using spss 11.5, and chi-squared test was used for the evaluation of parameters.

RESULTS

Group IV showed a statistically significant decrease in sunburn cells and dermo-epidermal activation compared with Group II. Group II showed significant increase in all parameters compared with Group I, showing the effects of UV exposure alone, and no difference was detected in Group II and III.

CONCLUSION

These results show a protective effect of EGCG when applied topically before UVA exposure. No benefit was detected when EGCG was applied after UV exposure.

Benzophenone 4: an emerging allergen in cosmetics and toiletries?

Chemical ultraviolet (UV) filters have, over the last few decades, been increasingly used not only in conventional sunscreen products but also in many cosmetics and toiletries. Allergic contact dermatitis as well as photoallergic contact dermatitis reactions have been well documented as a consequence of such use. Over a 3-year period, we recorded the number of positive patch test reactions to a selection of chemical UV filters that we added to our usual cosmetics/facial series. Our objective was to investigate whether any of these filters produced significant numbers of positive patch test results in the absence of photostimulation. Our results show that not only did benzophenone 4 (2-hydroxy-4-methoxybenzophenone-5-sulphonic acid: sulisobenzone) produce significantly more positive patch test results than the other UV filters that were tested, but also it was the third most frequently positive result overall. Our findings would support the inclusion of benzophenone 4 when patch testing to investigate likely contact dermatitis from cosmetics and toiletries.

Photopatch testing of 1155 patients: results of the U.K. multicentre photopatch study group

BACKGROUND

Photoallergic contact dermatitis can be difficult to diagnose if not appropriately investigated. Currently, the most common U.K. photoallergens appear to be sunscreen chemicals. The investigation of choice is photopatch testing (PPT), which is probably underused. In part, this is due to differences in methodology and results interpretation.

OBJECTIVES

To conduct PPT using a group of sunscreen chemicals, defined indications and a standardized methodology including interpretation and relevance of reactions in patients attending for investigation at 17 centres across the U.K., Ireland and the Netherlands.

METHODS

Patients (n = 1155) who fulfilled the inclusion criteria were investigated with PPT using sunscreen chemicals in addition to suspected topical products. Readings were taken at 24, 48 and 72 h following standardized ultraviolet A irradiation (5 J cm(-2)). The clinical relevance of any reaction was recorded.

RESULTS

Of the 1155, 130 had allergic reactions (11.3%). Of these, 51 had photoallergy (PA) (4.4%), 64 had contact allergy (CA) (5.5%), and 15 patients had combined PA and CA (1.3%). Multiple PA was seen in some. The most common photoallergen was benzophenone-3 (27 reactions; 21%). Most reactions (60%) were clinically relevant. The most common indication for testing in patients found to have PA was a history of reacting to a sunscreen (41%). The other 59% had an exposed-site dermatitis/skin problem or a photodermatosis. Some centres (n = 8) performed readings after the standard 48-h reading, and an extra 32 PA and 22 CA reactions were detected, which were not evident at 48 h. A new photoallergen (octyl triazone) was detected in two patients.

CONCLUSIONS

Sunscreen PA and CA are probably equally uncommon. Most reactions, of both reaction types, were relevant clinically. A large proportion of patients (59%) found to have PA was unaware of reacting to a sunscreen chemical, suggesting that PA should be considered as an explanation in any exposed-site dermatitis. Although this study focused on reactions at 48 h postirradiation, readings performed up to 96 h, while inconvenient, add value by detecting additional relevant responses. A previously unknown photoallergen was found, highlighting the need for awareness of novel photoallergens in the marketplace. A standardized PPT method not only encourages more use of this investigation, but also facilitates comparison of results between centres and so will improve our understanding of PA.

Prevalence of male and female pattern hair loss in Maryborough

Maryborough, in central Victoria has an approximate population of 8000 and census data is well matched for Australia overall. Australia has compulsory voting and registration on the electoral roll. To determine the age-related prevalence of balding among men and women in Maryborough we conducted a postal survey of 5000 men and women aged 20 or older, and 427 were invited to attend for examination. Additional data was collected on dandruff, presence of gray hair. Supplementary questionnaires were sent to 340 children aged 5-9, attending a coeducational primary school. 1456 adults (34.1%) responded to the questionnaire. 396 attended for examination. The prevalence of androgenetic alopecia (AGA) increased with advancing age. 98.6% of men had bitemporal recession and severity was significantly associated with vertex and mid-frontal hair loss (p <0.01) but not age (p = 0.06). In all, 64.4% of women had bitemporal hair loss, and similar to men there was a significant association with mid-frontal hair loss (p =0.042) but not age (p =0.467). One hundred and forty children with completed questionnaires were examined. All 72 females and 68 males were assessed as stage 1 on the mid-line part and with no bitemporal recession (frequency stage 1 = 100%, 95% CI (confidence interval) 97.4%-100%). A significant but weak positive association existed between presence of gray hair and history of dandruff (p<0.01). The prevalence of mid-frontal hair loss increases with age and affects 57% of women and 73.5% of men aged 80 and over.

Topical and systemic photoprotection

Sunscreens are a valuable method of sun protection. Several new compounds are now available. It is important to remember, however, that photoprotection includes more than the use of sunscreens. There are a number of sun-protective behaviors that people can use to decrease their exposure to ultraviolet (UV) radiation. Dermatologists and other health professionals can work toward changing public policy, greatly increasing the ability of people to access shade. In addition, there is growing evidence about the effectiveness of other sun-protective agents. The only systemic medication for sun protection is beta-carotene, which is effective in erythropoietic protoporphyria (EPP).

Barriers to sun safety in a Canadian outpatient population

BACKGROUND

It has long been recognized that compliance with recommended sun safety practices is suboptimal, yet few investigations have explored the barriers that people face in practicing good sun safety. In this context, barriers can exist at the following three levels: knowledge of sun safety, acquisition of sun safety information, and implementation of specific sun protective measures.

OBJECTIVE

The investigation reported herein sought to elucidate barriers to sun safety that individuals face. Ultimately, this study aimed to qualify the possible barriers that lead to a misalignment of current recommendations and sun safety practices.

METHODS

The study design was observational, and the instrument used for data collection was a self-administered questionnaire. Thirty-four outpatients of the RK Schachter Dermatology Centre of Sunnybrook and Women's College Health Sciences Centre (SWCHSC), Toronto, Ontario, as well as 27 outpatients of the Sport Care facility of SWCHSC were enrolled in the study. They represent the target population of those who are at greater risk of developing sun-related skin lesions. Data were analyzed using standard parametric and nonparametric techniques. Comparisons were made between the two outpatient groups and between other groups within the sample.

RESULTS

In general, level of sun safety knowledge was fairly high, though compliance to sun safety measures was suboptimal in both populations. There were no significant differences regarding level of knowledge between the 2 outpatient groups. Deficiencies in knowledge centered around risk factors for skin cancer. Frequently cited barriers to sun safety include inconvenience (34% of respondents), forgetting to use sun safety measures (49%), a desire to be tanned (33%), and protective clothing being too hot to wear (56%). High compliers were notable for their great likelihood of being counseled by a physician about sun safety ( P < 0.025) and their slightly higher mean knowledge scores.

CONCLUSIONS

These data support that knowledge alone does not predict compliance and that sun awareness campaigns should be evaluated based on their ability to affect behavior.

Photosensitive dermatitis due to sunscreen allergy in a child

We report a case of photoallergic contact dermatitis to two sunscreen agents, methoxycinnamate and oxybenzone, occurring in a 6-year-old Asian boy.

Report of 19 cases of photoallergic contact dermatitis to sunscreens seen at the Skin and Cancer Foundation

We report on our experience with sunscreen allergy between 1992 and 1999 and also review the international literature on sunscreen allergy. There were a total of 21 allergic reactions to sunscreen chemicals observed in 19 patients over the 8 years. There were nine positive photopatch reactions to oxybenzone, eight to butyl methoxy dibenzoylmethane, three to methoxycinnamate and one to benzophenone. No positive reactions were observed to para aminobenzoic acid. Six patients also had positive patch tests to components of the sunscreen base. In our experience, sunscreen chemicals are the most common cause of photoallergic contact dermatitis.

Tanning preparations

Increasing consumer awareness as to the hazards of UV light should fuel ongoing interest in self-tanning products. As a result of the benign toxicologic profile of DHA, products containing DHA represent a safe alternative to UV-induced tanning. The results obtained with these products depend on the final formulation, the individual application technique, and the consumer's complexion type. Greater experience in formulation combined with increasing sophistication on the part of the consumer should lead to continuing growth in interest and satisfaction with the use of DHA-containing sunless or self-tanning products. Individuals need to be informed that these products do not offer significant protection against UV-B. If formulated with standard sunscreens, consumers should be cautioned that the duration of UV protection is more short-lived than the color change.

Modern approaches to photoprotection

UV light reacts with skin to produce undesirable changes, including photoaging and skin cancer. Sunscreen strategies are useful for protection against UV-B and short-wave UV-A, but complete protection against long-wave UV-A has not been achieved. Because UV-A is especially efficient at generating reactive oxygen species, it is being recognized increasingly as an important cause of photoaging and skin cancer.

Sun-induced skin changes

Chronic sun exposure is responsible for changes in skin texture, pigmentation, vascularity, maturation, and production of neoplasms. A 78% decrease in the lifetime incidence of basal and squamous cell carcinoma has been reported with regular use of SPF 15 sunscreen for the first 18 years of life. Actinic keratoses, sun-induced premalignant lesions of the skin, can be eliminated by mechanical and medication therapies. 5-fluorouracil therapy can be effective treatment for widespread actinic damage.