Outdoor sunscreen testing with high-intensity solar exposure in a Chinese and Caucasian population

Personalized Photoprotection: Expert Consensus and Recommendations From a Delphi Study Among Dermatologists

BACKGROUND

Recommending comprehensive personalized photoprotection requires an accurate assessment of the patient's skin, including phototype, lifestyle, exposure conditions, environmental factors, and concomitant cutaneous conditions as well as deep knowledge of the available options: sunscreen ingredients (type of filters, spectrum coverage, sun protection factor, enhanced active ingredients), oral photoprotection, and other methods of sun protection and avoidance.

OBJECTIVES

To establish consensus-based recommendations endorsed by an international panel of experts for personalized medical photoprotection recommendations that are applicable globally.

METHODS

A two-round Delphi study was designed to determine the degree of agreement and relevance of aspects related to personalized medical photoprotection. Items with ≥ 80% agreement and relevance were considered approved.

RESULTS

A list of 28 recommendations for personalized medical photoprotection was approved by a panel of dermatology professionals from seven different countries. Recommendations were categorized as: (1) updated perspectives in photoprotection, (2) clinical management, (3) skin cancer prevention, (4) dark skin phototypes and skin prone to hyperpigmentation, and (5) age and lifestyle.

CONCLUSION

This study established recommendations for the implementation of personalized medical photoprotection worldwide, highlighting areas needing further scientific and clinical evidence.

Application habits and practices of regular sunscreen users in the United States: Results of an online survey

A nationwide online survey assessed claimed usage of sunscreen products in 2283 self-identified regular sun protection factor (SPF) consumers (RSPFC) in the United States. Subjects applied sunscreen most frequently when spending more than 3 h in the sun. Sunscreen usage peaks during the summer, with sunny weather prompting 99% usage of beach/recreational SPF products but drops to approximately 50% and 30% on partly cloudy and cloudy days, respectively, regardless of SPF product category. About half of RSPFC augment sunscreen product usage by limiting time in the sun and wearing a hat. SPF products are not reapplied by approximately 20-60% of RSPFC, depending upon product category, and reapplication was less than 33% on cloudy and partly cloudy days. Primary reasons for reapplication were water exposure, number of hours in the sun, and being active/sweating, most notably for beach/recreational SPF products. Importantly, in children, 45% of parents reported "redness" as a signal for reapplying sunscreen product. Only 10% of respondents correctly identified sunscreen products as drugs. Based on these results, while sunscreens may share common ingredients and efficacy measures, their usage by consumers varies widely depending on product type, season, weather, gender, age, and geographical location.

Outdoor clinical testing with reference sunscreens to determine differences in skin response between populations of different ethnicity: A combined data analysis from 128 subjects

BACKGROUND

Two previously published clinical studies by our group assessed erythema and pigmentation responses in outdoor conditions with three reference sunscreens, comparing their effectiveness under the full spectrum of natural sunlight. These studies followed an almost identical protocol but were conducted in two different locations and in two ethnic groups: broadly, Chinese (Singapore) and White European (Mauritius). We analysed the data from these two study populations to compare differences in skin response according to ethnicity.

METHODS

The analysis included 128 subjects (53 were Chinese from Singapore and 75 were White European from Mauritius and Singapore). Products used were the reference sunscreens P3 (sun protection factor [SPF] 15), P5 (SPF 30) and P8 (SPF 50+) from ISO norm 24444:2019. Participants were exposed to outdoor sunlight for 2-3 h, depending on baseline ITA. Endpoints were erythema at 24 h: clinical score and colorimetry (Δa*) and pigmentation at 1 week based on colorimetry (ΔL* and ΔITA).

RESULTS

Among those with baseline ITA > 41, there were differences in erythemal response between the Chinese and White European groups, the White European group being more erythematous and also having a higher rate of photoprotection failure particularly at SPFs 15 and 30.

CONCLUSION

Differences in skin response to sun influenced by ethnicity should be taken into account when making recommendations on sun safety.

Evaluation of a Sunscreen Product Compared with Reference Standards P3, P5 and P8 in Outdoor Conditions: a Randomized, Double-Blinded, Intra-individual Study in Healthy Subjects

INTRODUCTION

The shortcomings of standardized sunscreen testing have been discussed in recent years, noting differences between how sunscreens perform in indoor clinical (in vivo) laboratory testing compared with real-life conditions. We previously developed an outdoor clinical method for ranking sunscreens by performance level. We used this method to test the performance of a new broad-spectrum sunscreen against International Organization for Standardization (ISO) reference products P3, P5 and P8.

METHODS

Sixty-five healthy volunteers with individual typology angle (ITA) ≥ 28° (light to intermediate skin colour) participated in an outdoor study in Mauritius. Test areas were marked on their backs, which were treated with the different products: one commercially available broad-spectrum sun protection factor (SPF) 50 sunscreen [investigational product (IP)] and the three reference products P3 (SPF 15), P5 (SPF 30) and P8 (SPF 50+) from ISO norm 24444:2019 for SPF testing. The test areas were exposed for 2-3 h, depending on the baseline skin colour. They were also compared with an unprotected positive control area and a non-exposed negative control area. Clinical and colorimetry assessment of erythema and pigmentation were performed at 24 h and 8 days, respectively.

RESULTS

Overall, according to this outdoor clinical testing method, the sunscreens' efficacy was ranked in an appropriate order given their established SPF levels, with higher SPFs giving greater protection against erythema and pigmentation. Between the different levels of SPF, the differences were statistically significant, for both clinical and colorimetry assessments. The new broad-spectrum SPF 50 IP performed similarly to the SPF 50+ (P8) reference product. Even the highest SPF products, SPF 50 and SPF 50+, had some instances of photoprotection failure.

CONCLUSION

These findings confirm the feasibility of this outdoor clinical testing method in ranking sunscreens and provide further evidence, in addition to standardized SPF and UVA protection factor (UVAPF) testing, on how this new broad-spectrum SPF 50 sunscreen performs in extreme outdoor solar exposure: in line with reference product P8 (SPF 50+).

TRIAL REGISTRATION NO

ISRCTN95394014.

[Characterization of sun protection performance: Quo vadis?]

Die Aufgabe der ersten Sonnenschutzmittel war es, die Entstehung von Sonnenbrand zu verhindern und, dem Zeitgeist der 1950/60er-Jahre folgend, die Bräunung der Haut nicht zu beeinträchtigen. Schnell entstand die Notwendigkeit, die Schutzleistung zu quantifizieren. Ursprünglich unter Zuhilfenahme des natürlichen – heute eines künstlichen – Sonnenlichts wurde eine Methode zur Bestimmung eines Sonnenschutzfaktor (SPF) entwickelt. Dieser ist heute formal als das Verhältnis zwischen minimaler erythemwirksamer UV-Dosis auf mit Sonnenschutzmittel geschützter und minimaler erythemwirksamer UV-Dosis auf ungeschützter Haut definiert (ISO 24444:2019). Drei Beobachtungen stellen die Eignung der Methode infrage: 1) Zwischen-Labor-Variabilität: Trotz strenger Normierung sind Resultate von SPF-Bestimmungen aus verschiedenen Labors und Regionen sehr großen Schwankungen unterworfen. 2) Natürliches vs. künstliches Sonnenlicht: Das Strahlungsspektrum des künstlichen Sonnenlichts unterscheidet sich von dem des natürlichen Sonnenlichts. Die mit künstlichem Sonnenlicht bestimmten SPFs (wie auf allen derzeit im Handel befindlichen Sonnenschutzmitteln abgebildet) sind im Vergleich zur SPF-Bestimmung mit natürlichem Sonnenlicht deutlich zu hoch. 3) Erythembelastung: Bei der Bestimmung des SPF werden die Probanden potenziell schädlicher Strahlung ausgesetzt. Vor diesem Hintergrund werden alternative Methoden – In-vitro-SPF, hybride diffuse Reflexionsspektroskopie (HDRS) und In-silico-Berechnungen – vorgestellt. Diese haben das Potenzial, die heutige mit erheblichen Einschränkungen verbundene Methode abzulösen. Als Sofortmaßnahme wird die Rückbesinnung auf die für alle verständliche Beschreibung niedriger, mittlerer, hoher und sehr hoher Schutz empfohlen, in Zukunft unter Berücksichtigung des Spektrums des natürlichen Sonnenlichtes.