Sunscreens And Sunless Tanners Still Get The Nod From Professionals—

Sunscreen Labeling Comes Under Fire

By Nancy K. Crevier

On Tuesday, May 29, Attorney General Richard Blumenthal formally filed a petition with the Food And Drug Administration (FDA) “urging that it implement and upgrade long-delayed rule changes for sunscreen labeling to stop claims that the FDA has already acknowledged are false and misleading.” Claims that a sunscreen product blocks all harmful rays or that it is waterproof gives consumers a false sense of security and encourages overexposure to the sun, said Mr Blumenthal in a recent press release. “[The FDA] has shelved rules that could save lives,” he said.

In 1999, the FDA updated sunscreen labeling rules that would have prohibited sunscreen makers from claiming that their products have sun protection factors (SPFs) greater than 30-plus, but did not implement them. Other rules the FDA has declined to implement, according to Mr Blumenthal’s release, are claims that a product blocks “all harmful rays,” provides “all day protection,” and is “waterproof.” Many sunscreen manufacturers advertise ultra violet-A (UVA) protection, as well as protection from ultra violet-B (UVB) rays, despite the lack of a rating system for UVA rays.

“These false claims dangerously deceive consumers into believing they are protected when they may be exposing themselves — and their children — to harmful sunrays that can lead to deadly skin cancer and other harmful conditions,” said Mr Blumenthal.

Dr Grace Federman of AdvancedDerm Care with offices in Danbury and Southbury agrees with the attorney general that sunscreen labeling needs to be amended. “Products have been mislabeled, especially the ones that claim to last for six to eight hours without reapplication. There is no product that lasts six to eight hours,” said Dr Federman. “Changing the wording ‘waterproof’ to ‘water resistant’ would be more accurate and the whole SPF thing is really controversial. There is not a huge difference in protection after SPF 15 or 30. You don’t want to give people a false sense of security,” she said. Sunscreen products must be reapplied regularly when outdoors and at least a palmful of lotion applied each time to provide protection.

According to the American Cancer Society, “More than one million cases of nonmelanoma skin cancer diagnosed yearly in the United States are considered to be sun-related. Melanoma, the most serious type of skin cancer, will account for about 62,190 cases of skin cancer….”

Every year, Danbury Hospital sponsors a free skin cancer risk assessment in May, in anticipation of the upcoming summer of sun worshipping. This year, said Pat Hough, manager of Danbury Hospital’s Praxair Cancer Center, 106 people were seen at the May 23 and 24 event. “Sixteen people were referred for further evaluation and biopsy,” she said, along with eight for dysplastic conditions. It really is important for people at risk to have their skin checked by a dermatologist.”

Skin cancer is one of the most common of all cancers and will affect an estimated 65,000 people across the nation this year according to the American Cancer Society. The Cancer Society estimates that 1,120 individuals in Connecticut will be diagnosed with melanoma this year.

The two main types are malignant melanoma and non-melanoma skin cancers. Basal cell and squamous cell cancers account for most of the non-melanoma skin cancers.

Although less common, melanoma skin cancers are far more dangerous, accounting for roughly three percent of skin cancer cases, but 79 percent of skin cancer deaths. An estimated 10,850 people are expected to die from skin cancer in the United States in 2007, 8,110 from melanoma and 2,740 from other skin cancers.

Who’s At Risk?

Those at high risk include people with long-term sun exposure, fair skin, a family history of skin cancer, anyone who makes use of indoor tanning devices, anyone who has had a severe sunburn as a child, anyone with nonhealing ulcers or nodules in the skin, and people in Southern climates. Moles that have irregular edges, uneven coloring, or increase in size are also an indication of high risk for skin cancer.

So what are experts recommending to patients who long for skin that has been tanned to the glamorous hue marketed to consumers?

Dr Federman “absolutely” recommends sunless tanners at her practice. “They are felt to be safe. The chemical in them, dihydroxyacetone [DHA], is a type of stain, like makeup. [Sunless tanners] are a great alternative,” she said.

DHA is a colorless sugar that interacts with the outer layer of the skin, producing a golden hue that can last for several days. Originally developed in the 1920s for use in the x-ray process by German scientists, it was noted that the spilled product stained the skin. During a study in the 1950s by Eva Wittgenstein at the University of Cincinnati that used DHA as an oral drug, it was again observed that when the chemical came in contact with skin, a brown color resulted. DHA was later studied as a treatment for patients with vitiligo, in which patches of skin lack color, and in the 1970s it was approved by the FDA as a cosmetic ingredient.

Because DHA develops over a period of time, Dr Federman recommends applying the sunless tanner in the evening. In the morning, she recommends applying sunscreen, as sunless tanners do not protect from UV rays.

“DHA is a simple chemical that has been used for years,” said Dr William Notaro of Danbury Hospital Department of Medicine, Section of Dermatology. “It is very safe.”

Dr Notaro also prefers people use sunless tanners as opposed to lying in the sun. “The less sun people are exposed to, the better,” he said. “There is a very small chance of reaction to the other products in a tanner, like the fragrance or preservatives, but I have had no complaints from patients. Anytime a person uses a topical product, though, it is important to do a test spot,” he recommended.

Doing a test application just once may not always show an allergic reaction, however, said the dermatologist. He suggests applying the product twice to the same spot over a period of three to four days. “If there is no reaction, you can feel safe to use the product,” he said.

Commercial booths in which a sunless tanner is evenly sprayed over the entire body is also a good alternative to sun bathing, said Dr Notaro, but he warned of the hazard of breathing in vapors during that process. “We prefer patients use the gels or lotions to avoid that problem,” he said.

He encouraged the use of a 30 SPF sunscreen for everyone, year around. He also emphasized the importance of using a sunscreen in conjunction with any sunless tanning product.

Less Desirable Options

Other options available for the pale-skinned who long for a blush of color include tanning pills, tanning accelerators, and tanning booths, but these are not good choices according to Dr Federman.

Tanning pills and accelerators should not be used, said Dr Federman. “The pills are supposed to stimulate melanin production, which increases pigmentation to the skin, but the safety of the pills has not been determined. Nor are they approved by the FDA.”

Tanning booths are a source of UV rays and should be avoided, as well, she said. “Tanning booths increase the risk of skin cancer and cause skin damage. There have even been reports that suggest tanning at booths can become an addictive behavior,” Dr Federman said.

“What dermatologists would like to see is a change in the mindset of people. We are trying to get people away from that idea that a tan is a cool thing or glamorous. Really, before the 1950s or 60s a tan was indicative of manual labor and not desirable,” Dr Federman said.

The best way to avoid the confusion surrounding sunscreen protection and to keep skin healthy is to avoid extended exposure to the sun. “There is no way to get safe color with any kind of UV ray,” she said.