When should sunscreen be applied: The balance between health benefit and adverse consequences to humans and the environment.

OBJECTIVE: To propose a strategy for using sunscreens that optimizes the balance between skin health and adverse effects to humans and the environment. METHODS: A model was developed to explore the relationship between sunscreen usage and personal sun exposure throughout the year in populations resident at different latitudes. RESULTS: There is little biological justification in terms of skin health for applying sunscreen over the 4-6 winter months at latitudes of 45° N and higher, whereas year-round sunscreen is advised at latitudes of 30° N and lower. Avoiding sunscreen application at times when it is biologically unnecessary results in an annual reduction in sunscreen use of 25%. Furthermore, using products containing UV filters over the winter months at more northerly latitudes could lead to a higher number of people with vitamin D deficiency. The single largest use of sunscreen is on a sun-seeking holiday and encouragement to make more use of clothing and shade would appreciably reduce the sunscreen burden to the environment. CONCLUSION: We need to use sunscreens wisely so that we gain the health benefit from their use while at the same time limiting possible harm to ourselves and the environment.

OBJECTIF: Proposer une stratégie d'utilisation des protections solaires qui optimise l'équilibre entre la santé de la peau et les effets indésirables pour l'homme et l'environnement. MÉTHODES: Un modèle a été développé pour explorer la relation entre l'utilisation de crème solaire et l'exposition au soleil toute l'année pour des populations vivant à différentes latitudes. RÉSULTATS: En ce qui concerne la santé de la peau, l'application de crème solaire pendant les 4 à 6 mois d'hiver se justifie peu sur le plan biologique à des latitudes de 45° N et plus, alors qu'elle est conseillée toute l'année à des latitudes de 30° N et moins. L'absence d'utilisation de crème solaire à des moments où cela est inutile sur le plan biologique permet de réduire l'utilisation de crème solaire de 25 % par an. Par ailleurs, l'utilisation de produits contenant des filtres UV les mois d'hiver à des latitudes plus nordiques pourrait conduire à un nombre plus élevé de personnes carencées en vitamine D. L'utilisation la plus importante de protection solaire a lieu lors d'un voyage où l'on cherche là s'exposer au soleil, et l'incitation à se protéger davantage à l'aide de vêtements et de l'ombre réduirait sensiblement l'impact des produits de protection solaire sur l'environnement. CONCLUSION: Nous devons utiliser judicieusement les produits de protections solaires afin que leur utilisation apporte un bénéfice pour la santé tout en limitant les risques potentiels pour nous-mêmes et pour l'environnement.

Correction: A library of action spectra for erythema and pigmentation.

Correction for 'A library of action spectra for erythema and pigmentation' by Alois W. Schmalwieser et al., Photochem. Photobiol. Sci., 2012, 11, 251-268, DOI: .

Melanin distribution in human epidermis affords localized protection against DNA photodamage and concurs with skin cancer incidence difference in extreme phototypes.

Epidermal DNA damage, especially to the basal layer, is an established cause of keratinocyte cancers (KCs). Large differences in KC incidence (20- to 60-fold) between white and black populations are largely attributable to epidermal melanin photoprotection in the latter. The cyclobutane pyrimidine dimer (CPD) is the most mutagenic DNA photolesion; however, most studies suggest that melanin photoprotection against CPD is modest and cannot explain the considerable skin color-based differences in KC incidence. Along with melanin quantity, solar-simulated radiation-induced CPD assessed immediately postexposure in the overall epidermis and within 3 epidermal zones was compared in black West Africans and fair Europeans. Melanin in black skin protected against CPD by 8.0-fold in the overall epidermis and by 59.0-, 16.5-, and 5.0-fold in the basal, middle, and upper epidermis, respectively. Protection was related to the distribution of melanin, which was most concentrated in the basal layer of black skin. These results may explain, at least in part, the considerable skin color differences in KC incidence. These data suggest that a DNA protection factor of at least 60 is necessary in sunscreens to reduce white skin KC incidence to a level that is comparable with that of black skin.-Fajuyigbe, D., Lwin, S. M., Diffey, B. L., Baker, R., Tobin, D. J., Sarkany, R. P. E., Young, A. R. Melanin distribution in human epidermis affords localized protection against DNA photodamage and concurs with skin cancer incidence difference in extreme phototypes.

Ultraviolet erythema: dose response and mediator diffusion.

The earliest contribution made by Jan van der Leun to the field of photobiology was studying the mechanism of UV-induced erythema in human skin - a subject he chose for his PhD in the 1960s. His contribution to this topic encouraged us to continue this work and over a number of years in the 1980s and 1990s, we carried out several studies on quantitative aspects of UV erythema. A major part of Jan's thesis focused on diffusion processes in UV erythema and his observations led him to conclude that erythema induced by radiation with wavelengths of around 300 nm was due to the actions of a diffusing mediator arising in the epidermis, whereas radiation at shorter wavelengths around 254 nm, caused erythema by exerting a direct effect on the dermal blood vessels. By taking his data and combining them with our own studies on the dose response of UV erythema to radiation of different wavelengths, we were able to show that, contrary to Jan's conclusions, the mediator diffusion theory he developed did indeed predict that both UVB and UVC induced erythema could be explained by the action of diffusing mediators.

Sunburn at the seaside.

BACKGROUND/PURPOSE: The purpose of this paper is to estimate the contribution to our erythemal exposure at the coast of solar ultraviolet (UV) both reflected from, and transmitted into, the ocean. METHODS: The reflection of solar UV radiation from, and transmitted into, seawater was calculated using a numerical model under a number of atmospheric conditions to estimate erythemal exposure on the skin of supine/prone and ambulant people. RESULTS: The results were expressed as UV Indices. Even under the most extreme insolation with the sun directly overhead, where the ambient UV Index may be around 14, reflected UV from the ocean contributes an erythemal exposure to the skin equivalent to a UV Index of about 0.7. For typical ocean waters, with the sun high in the sky, the UV index within the water is about 7 at a depth of 2 m. CONCLUSION: Whilst our eyes often sense a high level of reflected sunlight from the ocean, especially when the sun is low in the sky, our skin does not share that experience. The reason people get sunburnt at the seaside has more to do with the absence of shade than with reflectance by the water surface or even beach sand.

Labelled sunscreen SPFs may overestimate protection in natural sunlight.

Limited evidence exists to indicate that sunscreen protection factors determined in the laboratory are higher than those in natural sunlight. In this article we propose an explanation for this difference and estimate the expected SPFs of sunscreen products in natural sunlight and those expected from laboratory testing. Our results indicate that the labelled SPF, determined by in vivo assay using a UV solar simulator, overestimates the SPF that would be expected in natural sunlight to the extent that for products labelled SPF50+, it may not be possible to achieve a protection against sunlight of more than 25-fold. The popular interpretation of the SPF that it can be thought of as how much longer skin covered with sunscreen takes to burn in sunlight compared with unprotected skin, can no longer be defended.

An appraisal of the need for infrared radiation protection in sunscreens.

Many sunscreens incorporate agents that are said to protect against infrared (IR) damage in the skin but we lack any real data on their benefit in the context of normal human behaviour in the sun. The object of this study was to examine typical IR exposure levels to the sun and industrial sources in order to decide whether there is a need for sunscreens to contain agents that protect against IR radiation, specifically the IR-A waveband. We reviewed claims currently made by products offering protection against IR-A and studies on the biological and clinical effects attributed to IR-A, and compared IR-A exposure levels from these studies with those typically received from the sun and from industrial sources. We found that annual levels of IR-A exposure resulting from typical behaviour in the sun are commensurate with those experienced occupationally by workers exposed to industrial sources of IR, such as steel and glass furnaces. Yet these workers appear to suffer little in the way of chronic skin damage. We conclude that there is not compelling evidence to demonstrate that observable, deleterious cutaneous effects are occurring at doses of solar IR radiation corresponding to those experienced by populations in their normal environments and for this reason we believe it is premature to incorporate IR protection into topical sunscreens and to make claims related to ageing of the skin that consumers may expect to see.

Suntanning with sunscreens: a comparison with sunbed tanning.

BACKGROUND/PURPOSE: Acquiring a tanned skin, either by sunbathing, sunbed use, or a combination of both, is a desirable objective for many people. The objective here was to compare the ultraviolet (UV) exposure resulting from a 2-week vacation spent sunbathing with sunscreen-protected skin, with that from a typical course of 10 sessions on a sunbed. METHODS: A numerical analysis combining data on sunlight and sunbed UV levels, time spent tanning and spectral absorption properties of different types of sunscreen. RESULTS: The analysis showed that unless a sunscreen provides optimal broad-spectrum protection, a 2-week sunbathing vacation that avoids sunburn on sunscreen-protected skin can result in a higher cumulative UV exposure than a typical 10-session sunbed course. The lowest exposures for a given sun protection factor (SPF) are obtained when sunscreen delivers broad-spectrum protection that approaches the ideal of uniform absorption at all wavelengths throughout the UV spectrum. CONCLUSION: In extreme cases of recreational sun exposure where sunscreens providing suboptimal broad-spectrum protection are used, the UV insult to the skin is likely to result in higher cumulative exposures than commonly employed sunbed practices.

Modelling vitamin D status due to oral intake and sun exposure in an adult British population.

A mathematical model is described for estimating changes in plasma 25-hydroxyvitamin D (25(OH)D) levels throughout the year as a consequence of varying the oral intake of vitamin D and the behaviour outdoors of white British adults resident in different regions of the UK. The model yields seasonal and geographical patterns of 25(OH)D concentrations that agree closely with observational studies. Use of the model allows estimates to be easily made of the sun exposure and oral intake necessary to avoid vitamin D deficiency in defined proportions of the population, as well as strategies that would lead to vitamin D sufficiency throughout the year. The analysis demonstrates that addressing concerns about insufficient vitamin D levels, especially during the winter, may be achieved by modifying oral vitamin D intake over the winter, increasing summer sun exposure or a combination of both.

The likelihood of sunburn in sunscreen users is disproportionate to the SPF.

BACKGROUND/OBJECTIVE: Sunburn is a common feature in sunscreen users. The purpose of this paper is to estimate the expected frequency and magnitude of sunburn resulting from typical use of sunscreens labelled SPF15 and SPF30 by people spending long periods outdoors in strong summer sunshine. METHODS: By combining the probability distribution of the measured sun protection factor (SPF) in vivo with those for the average application thickness and the uniformity of application over the skin surface, a simulation model was developed to estimate the variation in delivered protection over the exposed skin surface from consumer use of sunscreens. RESULTS: While either sunscreen, if delivering the nominal SPF over the entire exposed skin, would be sufficient to prevent any erythema, the simulation indicates that the combination of the average quantity applied with the variability in thickness over the skin surface will lead to erythema, especially in SPF15 sunscreen users. CONCLUSION: People who intend spending long periods outside in strong sunshine would be better advised to use SPF30 labelled sunscreens than SPF15 sunscreens, and to apply the product carefully over exposed skin if they wish to minimize their risk of sunburn and, by implication, skin cancer.

Is sunscreen alone effective at preventing sunburn on a high-solar beach vacation: A modeling study?

Beach holidays in areas of strong sunlight are popular and sunscreen is often the primary means of photoprotection favored by many people. The object of this study was to estimate how effective sunscreen is in preventing sunburn under high ultraviolet (UV) levels. We used a computational model to determine how the quantity, frequency, substantivity, and labeled SPF of applied sunscreens impact on the predicted erythemal response in unacclimatized skin over the course of a 7-day holiday in a high-solar environment. Our results indicated that sunscreen on its own may be insufficient to prevent sunburn in white skin on a sun-seeking holiday that combines prolonged exposure with high UV levels. Nevertheless, sunscreens have a valuable role to play on a beach holiday especially if an SPF30 or higher is chosen, the product is applied liberally and uniformly, application is started early into the sun exposure period and repeated at 2-hourly intervals throughout the day, and the product binds well to the skin. The main limitation of our investigation is that it is not an observational study but rather a computational model and while all models are wrong, some, including this one, are useful.

A library of action spectra for erythema and pigmentation.

The first action spectra for erythema and delayed pigmentation in human skin were determined 90 years ago by Karl Hausser and Wilhelm Vahle in Germany, and since then a number of studies have been undertaken to redefine these action spectra. In this paper we give an overview of the action spectra for erythema and pigmentation that have been published during this 90-yr period, as well as indicating their uncertainties and shortcomings.

Measurement errors in the assessment of exposure to solar ultraviolet radiation and its impact on risk estimates in epidemiological studies.

To date, many studies addressing long-term effects of ultraviolet radiation (UVR) exposure on human health have relied on a range of surrogates such as the latitude of the city of residence, ambient UVR levels, or time spent outdoors to estimate personal UVR exposure. This study aimed to differentiate the contributions of personal behaviour and ambient UVR levels on facial UVR exposure and to evaluate the impact of using UVR exposure surrogates on detecting exposure-outcome associations. Data on time-activity, holiday behaviour, and ambient UVR levels were obtained for adult (aged 25-55 years old) indoor workers in six European cities: Athens (37°N), Grenoble (45°N), Milan (45°N), Prague (50°N), Oxford (52°N), and Helsinki (60°N). Annual UVR facial exposure levels were simulated for 10,000 subjects for each city, using a behavioural UVR exposure model. Within-city variations of facial UVR exposure were three times larger than the variation between cities, mainly because of time-activity patterns. In univariate models, ambient UVR levels, latitude and time spent outdoors, each accounted for less than one fourth of the variation in facial exposure levels. Use of these surrogates to assess long-term exposure to UVR resulted in requiring more than four times more participants to achieve similar statistical power to the study that applied simulated facial exposure. Our results emphasise the importance of integrating both personal behaviour and ambient UVR levels/latitude in exposure assessment methodologies.

Erythema and Acclimatization Following Repeated Sun Exposure: A Modeling Study.

The development of a computational model is described that allows time-varying erythema and acclimatization to be determined following repeated exposure to solar ultraviolet (UV) radiation. Good agreement was observed between experimental data and model predictions. Results are presented that illustrate how daily, adventitious sun exposure over the course of a year can result in occasional erythema generally in the late spring/early summer, while at the same time showing how the photoadaptive response of the skin changes throughout the year at different latitudes and for different sun-reactive skin types. The model is predicated on three physiological responses; the erythemal response as a function of increasing UV dose, the time courses of erythema and adaptation in response to a single UV exposure. Mathematical models complement observational data and the outputs from the model may help in planning future experimental studies, as well as providing insights into mechanistic responses.

Sunscreen and the Precautionary Principle.

The Precautionary Principle is a decision-making device designed to help us when we deal with uncertain risks. Despite a number of case-control and prospective studies over several years, there remains some uncertainty as to whether sunscreens are unequivocally effective in reducing the risk of skin cancer, and we examine how useful the principle is in deciding whether sunscreen should be included in the sun protection toolbox as a public health measure. We conclude that the Precautionary Principle can be a useful tool supporting public health recommendations to use sunscreen as a means of reducing the morbidity and mortality of skin cancer, but we show that it is not without its shortcomings.

Natural and Simulated Solar Radiation.

The extra-terrestrial solar spectrum corresponds approximately to a black body of temperature about 5,800 K, with the ultraviolet region accounting for almost 8% of the total solar energy. Terrestrial solar spectral irradiance peaks at around 500 nm in the blue-green region, whereas the diffuse component peaks in the UVAI-blue region of the spectrum, with the infrared component comprising almost entirely direct radiation. Several factors impact on the magnitude and spectral profile of terrestrial solar spectral irradiance, and these include solar elevation, reflection from land and sea, air pollution, altitude above sea level and cloud cover. Measurements of erythemal UV from a number of ground-based networks around the world indicate an approximate 4-fold difference in ambient annual exposure between Australia and countries in northern Europe. In the absence of measured data, models to compute solar UV irradiance are a useful tool for studying the impact of variables on the UV climate. Simulated sources of sunlight based on a xenon arc lamp can be configured to give a close match to the spectral output of natural sunlight at wavelengths less than about 350 nm, and these are invaluable in the laboratory determination of sunscreen performance, notably the Sun Protection Factor (SPF). However, the divergence -between natural and simulated solar spectra at longer wavelengths may explain why SPFs measured in natural sunlight are less than those determined in the laboratory.

Is casual exposure to summer sunlight effective at maintaining adequate vitamin D status?

BACKGROUND/PURPOSE: The advice that an adequate vitamin D status can be achieved by short, casual exposure to summer sunlight is ubiquitous. This review will examine the value of this advice. METHODS: The results of experimental studies on changes in serum 25-hydroxyvitamin D [25(OH)D] concentrations following ultraviolet exposure are interpreted in the context of human exposure to sunlight. RESULTS: It is shown that current advice about modest sun exposure during the summer months does little in the way of boosting overall 25(OH)D levels, while sufficient sun exposure that could achieve a worthwhile benefit would compromise skin health. CONCLUSIONS: Failure to understand the nature of human exposure to sunlight has led to misguided advice concerning the sun exposure necessary for an adequate vitamin D status.

Drivers for Sun Protection in Black South Africans.

Sun protection behavior studies are almost exclusively carried out in populations with fair skin for the obvious reason that people with unpigmented skin are more susceptible to the health impacts of excess solar ultraviolet radiation exposure. In a dataset of 1271 Black South Africans, we analyzed factors related to sun protection applied when spending time outdoors including awareness of skin cancer, gender, age and Living Standards Measure (LSM) where 1-4 equate to the lowest, 5-7 intermediate and 8-10 the highest LSM status. The most important driver for Black South Africans to use sun protection was whether they were aware of skin cancer (OR: 2.6 for those who were aware versus those who were not, P < 0.0001). Sunscreen was preferred by respondents in LSM 8-10 whereas people in the lowest group (LSM 1-4) favored shade, umbrellas and hats. One in two respondents claimed to use some form of sun protection, which appears to be higher than deeply pigmented populations in other countries.