Assessment of prevalence of sunscreen use and related practices among people living in Saudi Arabia: A cross-sectional survey-based study.

BACKGROUND: The use of sunscreen significantly reduces the risk of skin cancer and helps maintain skin health; however, improper use can decrease its effectiveness. This study aimed to investigate the prevalence and factors associated with sunscreen use in Saudi Arabia as well as identifying areas of weakness in sunscreen practices. METHODS: A cross-sectional survey-based study was conducted with a diverse population sample in Saudi Arabia. Participants were asked about their sunscreen usage habits, motivations, and knowledge of proper application techniques. Demographic information, including age, gender, and skin type, were also collected. RESULTS: A total of 2321 individuals participated in the study. More than two-thirds of the participants reported using sunscreen either always, regularly, or often, primarily to maintain a light skin color and prevent skin cancer. Factors associated with sunscreen use included younger age (18-40 years old), female gender, history of sunburn, and fair skin. Despite the majority reporting healthy sun exposure habits, several shortcomings were identified in sunscreen practices, including incorrect application and suboptimal reapplication frequency. CONCLUSION: While sunscreen use is common among the study population, there is a need for improved education on proper application techniques. National awareness campaigns, especially those utilizing popular social media and digital platforms in Saudi Arabia, should focus on disseminating accurate sunscreen use guidelines to maximize sun protection and skin health.

Impacto de los filtros ultravioleta en el entorno natural / Environmental Impact of UV Filters

Los filtros ultravioleta (UV) se han convertido en compuestos de uso diario para millones de personas. Sin embargo, algunos de ellos no son biodegradables al 100% y las plantas de tratamiento de aguas residuales muchas veces no son capaces de filtrarlos correctamente. Todo ello está llevando a su diseminación ambiental y a la detección de distintos filtros UV en el suelo, las aguas continentales, los océanos y en múltiples organismos (algas, corales, peces, mamíferos, incluso aves terrestres). Además, algunos filtros UV, especialmente la benzofenona-3 y el octocrileno se han mostrado tóxicos en estos organismos. Entre sus efectos tóxicos destacamos el blanqueamiento de los corales y problemas metabólicos, enzimáticos y de capacidad reproductiva en prácticamente cualquier organismo. Existen datos preliminares sobre la posible bioacumulación de estos filtros UV en humanos, al detectarse en muestras de orina y leche materna. Sin embargo, el estudio del impacto medioambiental de los filtros UV presenta muchas limitaciones (AU)

UV filters are used daily by millions of people. Not all of these filters, however, are 100% biodegradable, and many wastewater treatments plants are ill-equipped to filter them properly. As a result, UV filters are increasingly reaching the environment. Various types have been detected in soil, continental water, oceans, and numerous organisms, including algae, corals, fish, mammals, and even land birds. In addition, some filters, benzophenone-3 and octocrylene in particular, are toxic to these organisms. Toxic effects include coral bleaching and interference with metabolic, enzymatic, and reproductive activities in practically all organisms. Preliminary data suggest that UV filters may be bioaccumulating in humans, as they have been detected in urine and breast milk. It should be noted, however, that research into the environmental impact of UV filters holds challenges and limitations (AU)

[Translated article] Environmental Impact of UV Filters / Impacto de los filtros ultravioleta en el entorno natural

UV filters are used daily by millions of people. Not all of these filters, however, are 100% biodegradable, and many wastewater treatments plants are ill-equipped to filter them properly. As a result, UV filters are increasingly reaching the environment. Various types have been detected in soil, continental water, oceans, and numerous organisms, including algae, corals, fish, mammals, and even land birds. In addition, some filters, benzophenone-3 and octocrylene in particular, are toxic to these organisms. Toxic effects include coral bleaching and interference with metabolic, enzymatic, and reproductive activities in practically all organisms. Preliminary data suggest that UV filters may be bioaccumulating in humans, as they have been detected in urine and breast milk. It should be noted, however, that research into the environmental impact of UV filters holds challenges and limitations (AU)

Los filtros ultravioleta (UV) se han convertido en compuestos de uso diario para millones de personas. Sin embargo, algunos de ellos no son biodegradables al 100% y las plantas de tratamiento de aguas residuales muchas veces no son capaces de filtrarlos correctamente. Todo ello está llevando a su diseminación ambiental y a la detección de distintos filtros UV en el suelo, las aguas continentales, los océanos y en múltiples organismos (algas, corales, peces, mamíferos, incluso aves terrestres). Además, algunos filtros UV, especialmente la benzofenona-3 y el octocrileno se han mostrado tóxicos en estos organismos. Entre sus efectos tóxicos destacamos el blanqueamiento de los corales y problemas metabólicos, enzimáticos y de capacidad reproductiva en prácticamente cualquier organismo. Existen datos preliminares sobre la posible bioacumulación de estos filtros UV en humanos, al detectarse en muestras de orina y leche materna. Sin embargo, el estudio del impacto medioambiental de los filtros UV presenta muchas limitaciones (AU)

Influencia de los cuidadores y sus hábitos de exposición solar sobre la fotoprotección de los niños / Influence of caregivers and their sun exposure habits on the photoprotection of children

Introducción: la exposición solar durante la infancia es el factor etiológico más determinante para el desarrollo de neoplasias cutáneas en la edad adulta. La Organización Mundial de la Salud (OMS) propuso en 2002 seis medidas de fotoprotección básicas. El objetivo es analizar la relación e influencia de los cuidadores y sus hábitos de exposición solar sobre los aplicados en los niños. Material y métodos: estudio transversal sobre hábitos fotoprotectores de 163 cuidadores y sus niños (1-14 años), obtenidos mediante dos encuestas validadas cumplimentadas por el cuidador. Resultados: la media del grado de cumplimiento en los niños de las 6 medidas de fotoprotección de la OMS fue de 2,3/4. En los cuidadores, el grado de cumplimiento fue mayor en caso de ser varón, procedente de país europeo, con estudios superiores y con piel muy clara. El cumplimiento es significativamente menor conforme aumenta el número de horas al día que toma el sol en la playa y su número de quemaduras. En lo relativo al menor existe mayor cumplimiento si cursa Educación Infantil, tiene fototipo tipo I, acude a playa o piscina un mayor número de días al año y durante más horas al día y tiene menor número de quemaduras. Conclusiones: el cumplimiento de las medidas básicas en nuestra población es relativamente bajo, quedando reflejada la relación proporcional existente con los hábitos de sus progenitores, por lo que es fundamental realizar estrategias de prevención dirigidas a los progenitores para favorecer hábitos de exposición solar saludables en las generaciones venideras (AU)

Introduction: sun exposure during childhood is the most determining etiological factor for the development of skin neoplasms in adulthood. The World Health Organization (WHO) proposed six basic photoprotection measures in 2002. The objective is to analyze the relationship and influence of caregivers and their sun exposure habits on those applied to children.Material and methods: cross-sectional study on photoprotective habits of 163 caregivers and their children (1-14 yo), obtained through two validated surveys completed by the caregiver.Results: the mean degree of fulfillment in children with the six WHO photoprotection measures was 2.3/4. In caregivers, the degree of fulfillment was higher in the case of being male, from a European country, with higher education level and with very light skin. Accomplishment is significantly lower as the number of hours a day they sunbathe on the beach and the number of burns increases. With regard to the minor, there is greater accomplishment if they attend early childhood education, have a type I phototype, go to the beach or swimming pool a greater number of days a year and for more hours a day and have fewer burns.Conclusions: fulfillment with the basic measures in our population is relatively low, reflecting the proportional relationship existing with the habits of their parents, so it is essential to carry out prevention strategies aimed at parents to promote healthy sun exposure habits in the generations to come. (AU)

Enhanced Sunscreen Effects via Layer-By-Layer Self-Assembly of Chitosan/Sodium Alginate/Calcium Chloride/EHA.

The sunscreen nanocapsules were successfully synthesized by the way of layer-by-layer self-assembly using charged droplets (prepared by emulsification of LAD-30, Tween-80 and EHA (2-Ethylhexyl-4-dimethylaminobenzoate)) as templates. Chitosan/sodium alginate/calcium chloride were selected as wall materials to wrap EHA. The emulsions with the ratio of Tween-80 to EHA (1:1) were stable. A stable NEI negative emulsion can be obtained when the ratio of Tween-80 and LAD-30 was 9:1. Chitosan solutions (50 kDa, 0.25 mg/mL) and sodium alginate solutions (0.5 mg/mL) were selected to prepare nanocapsules. The nanocapsules were characterized via some physico-chemical methods. Based on the synergistic effects of the electrostatic interaction between wall materials and emulsifiers, EHA was effectively encapsulated. DLS and TEM showed that the sunscreen nanocapsules were dispersed in a spherical shape with nano-size, with the increasing number of assembly layers, the size increased from 155 nm (NEI) to 189 nm (NEII) to 201 nm (NEIII) and 205 nm after solidification. The release studies in vitro showed sustained release behavior of the nanocapsules were observed with the increase of the number of deposition layers, implying a good coating effect. The sunscreen nanocapsules could control less than 50% the release of EHA after crosslinking of calcium chloride and sodium alginate, which also could effectively avoid the stimulation of the sun protection agent on the skin.

No Negative Association Between Sun Protection and Bone Health.

According to this study: The practice of sun protection is not associated with bone-related health complications, such as an increased risk of osteoporotic fractures.Sun protection should be encouraged for all patients, including those at risk for decreased bone mineral density and fractures.

Protective effects of gallocatechin gallate against ultraviolet B induced skin damages in hairless mice.

Epigallocatechin gallate (EGCG) has the effect to protect skin from ultraviolet B (UVB) induced damages, but it is unstable under ambient conditions, being susceptible to become brown in color. Gallocatechin gallate (GCG), an epimer counterpart of EGCG, is more stable chemically than EGCG. The potential effects of GCG against UVB-induced skin damages has not been available. The objective of this study was to investigate the protective effects of GCG against UVB-induced skin photodamages. GCG was topically applied on the skin of hairless mice at three dosage levels (LL, 12.5 mg/mL; ML 25 mg/mL; HL, 50 mg/mL), with EGCG and a commercially available baby sunscreen lotion SPF50 PA+++ as control. The mice were then irradiated by UVB (fluence rate 1.7 µmol/m2 s) for 45 min. The treatments were carried out once a day for 6 consecutive days. Skin measurements and histological studies were performed at the end of experiment. The results show that GCG treatments at ML and HL levels inhibited the increase in levels of skin oil and pigmentation induced by UVB irradiation, and improved the skin elasticity and collagen fibers. GCG at ML and HL levels inhibited the formation of melanosomes and aberrations in mitochondria of UVB-irradiated skin in hairless mice. It is concluded that GCG protected skin from UVB-induced photodamages by improving skin elasticity and collagen fibers, and inhibiting aberrations in mitochondria and formation of melanosomes.

Algae Metabolites as an Alternative in Prevention and Treatment of Skin Problems Associated with Solar Radiation and Conventional Photo-protection

Abstract The histological structure and biochemistry of the skin is affected by solar radiation having adverse effects ranging from sunburns, premature aging that includes wrinkles, spots, dryness, and loss of collagen to cancer development. The skin has defense mechanisms to prevent damage caused by radiation, but when radiation exposure is excessive these mechanisms are not strong enough to protect the skin. The use of sunscreen is the most common practice of photo- protection. The active ingredients of these cosmetic protective formulations are generally from synthetic origin and have presented several drawbacks at the level of photo-stability, systemic absorption and can generate contact and photo-contact dermatitis. This review illustrates skin solar radiation problems, common sunscreen ingredients limitation and mentions how algae can be an alternative according to studies that have evaluated the photo-protective potential of extracts and compounds isolated by different techniques.

Adverse Reactions to Sunscreens.

Adverse reactions to sunscreens are uncommon in relation to their widespread use [Loden et al. Br J Dermatol. 2011;165(2):255-62; Jansen et al. J Am Acad Dermatol. 2013;69(6):867 e861-814; quiz 881-862] and can be related to both active and inactive ingredients in sunscreen products [DiNardo et al. J Cosmet Dermatol. 2018;17(1):15-19; Barrientos et al. Contact Dermatitis. 2019;81(2):151-52]. Pathogenetically, the main cutaneous adverse reaction patterns to sunscreens can be divided into allergic and irritant contact dermatitis, phototoxic and photoallergic contact dermatitis, contact urticaria, and, in solitary cases, anaphylactic reactions [Lautenschlager et al. Lancet. 2007;370(9586):528-37]. A summary is provided in Table 1. Nearly all adverse effects due to active sunscreen ingredients reported to date are related to the organic UV filters, which are sometimes also referred to as "chemical UV filters." This imbalance is attributable to the lipophilic character and small molecular size of the organic UV filters that allow skin penetration, which is the basic requirement to initiate the sensitization [Stiefel et al. Int J Cosmet Sci. 2015;37(1):2-30]. In contrast, cutaneous adverse reactions to inorganic UV filters, initially termed "physical UV filters" owing to their firstly known "physical" mechanism of action through reflection and scattering [Stiefel et al. Int J Cosmet Sci. 2015;37(1):2-30], are only reported by case reports. Neither zinc oxide nor titanium dioxide possesses relevant skin-irritating properties or sensitization potential [Lau-tenschlager et al. Lancet. 2007;370(9586):528-37]. Adverse reactions to UV filters currently approved in the European Union as listed in the Annex VI (updated November 7, 2019) are summarized in Table 2.

Challenges in Sun Protection.

Since time immemorial, people protected themselves from solar radiation. Limiting time in the sun by seeking shade or wearing clothing was a matter of course. In the early 20th century, tanned skin - a result of exposure to sunlight - was associated with good health. At the same time, however, one also had to protect oneself against the potential of excessive exposure to avoid sunburns. Around 1945, the first sunscreen products for protection against solar radiation became available. In the years to follow and up to the recent past, a vast number of different sunscreen filters were developed and incorporated into a wide variety of product formats. Frameworks regulating filter substances and preparations and methods to characterize sunscreen products' performance parameters were developed. Over the past 50-70 years, the perception regarding the tasks of sunscreen products changed several times. It was initially promoted as a lifestyle product and had the task of preventing sun-related erythema (tan without burn). Later, the prevention of skin cancer was added. Only in recent times, sunscreen products have been increasingly advertised and perceived as beauty and lifestyle products again. Also, the use of sunscreen products for antiaging purposes is now commonplace. The different intended purposes (averting harm and prevention) and the widespread use of topical sunscreen products have promoted many investigations and generated a vast and ongoing need for consumer and patient information and education. In the following review, we analyze and discuss current topics from conflicting areas, such as sun protection products (e.g., ideal sun protection products, sun protection metrics), product safety (e.g., nanoparticulate sunscreen filters, regulatory issues), application in everyday life (e.g., wish to tan, vulnerable cohorts), as well as controversies and future challenges (e.g., risks and benefits of UV radiation).

Spectral Homeostasis - The Fundamental Requirement for an Ideal Sunscreen.

Sunscreen application to UV-exposed skin is promoted to prevent skin cancer and sun damage, within a comprehensive photoprotection strategy that also includes sun avoidance and wearing UV protective clothing. The benefits of sunscreen are verified in preventing sunburn but appear to be largely presumptive in skin cancer prevention. Contemporary science establishes UVA as a primary driver of melanoma and photoaging. Consequentially, the traditional UVB-skewed protection of sunscreens provides an intellectual and logical explanation for rising skin cancer rates and, in particular, their failure to protect against melanoma. Better protection could be achieved with more balanced UVB/UVA sunscreens, toward spectral homeostasis protection. Greater balanced protection has another advantage of attenuating fewer UVB rays, which aid synthesis of vitamin D and nitric oxide. Percutaneous absorption of Soluble Organic UV Filters leads to systemic exposure, which becomes the relevant safety consideration. It is minimized by selecting Insoluble UV Filters with low absorption potential from a molecular weight above 500 Da. The filters must also be very hydrophilic, very lipophilic, or consist of particles. The risk-benefit ratio is a medical imperative, more so for cosmetics or sunscreens, since in principle there should be no risk from their use. The production of ideal sunscreens that mimic the effective, balanced UVB/UVA attenuation of textiles and shade is now possible, while maintaining an acceptable therapeutic margin of safety in humans and a favorable ecologic profile. Sunscreens with a favorable risk-benefit ratio and good esthetic properties or other consumer-friendly attributes will improve compliance and may achieve substantial clinical benefits.

Sun Protection and Public Information.

There is enough evidence that skin cancer can be prevented by an adequate usage of primary prevention measures. However, when examining people's real-life sun protection behaviour, it was often found to be insufficient. On the one hand, some people seem unaware about their risk to develop skin cancer as they might not sufficiently inform themselves. On the other hand, a lot of people know about the risk to develop skin cancer; however, they do not adequately protect themselves. Reasons for that are individual barriers such as the usage is too time-consuming or structural barriers such as unfavourable working conditions. In addition, a lot of people use sunscreen incorrectly as they tend to use only 20%-50% of the amount needed or do not reapply it.Studies have shown that there are several prevention campaigns demonstrating the successful increase in public awareness, but still more educational effort is needed to promote a better sun protection behaviour. On the basis of the effectiveness of previous intervention campaigns, future ones should use personal interventions or multi-component media such as the Internet. For promoting health-related information via the Internet, it is important to offer comprehensive, reliable, evidence-based information and to ban misleading or false information regarding sun protection.

The Preventive Value of Sun Protection.

BACKGROUND: With more than 200,000 new cases per year, skin tumours have been the most frequently reported cancers in Germany for years. We performed a systematic review to summarise the current evidence concerning the preventive value of regular sunscreen use. METHODS: Systematic literature review of controlled and randomised controlled trials were performed in Ovid Embase and Ovid Medline on 21 January 2020. We included studies evaluating the effectiveness of sunscreens on epithelial skin cancer, actinic keratosis or photoageing, or side effects in humans. RESULTS: Five eligible trials, each involving 28 to 1,621 participants from various populations, were identified. All 4 studies on actinic keratoses showed a significant beneficial effect of sunscreens. The 2 studies on squamous cell carcinoma demonstrated significant beneficial effects of sunscreens. The 2 studies on photoageing observed a significant reduction in the sunscreen groups. The 2 studies on basal cell carcinoma reported no significant results, but both studies reported some non-significant protective effects of sunscreen use. Sunscreens as well as vehicles sometimes had side effects affecting skin and eyes. Compared with controls, sunscreens had no significant side effects on vitamin D, bone mass density and mortality. CONCLUSION: The evidence from published controlled and randomised controlled studies is limited. Especially for basal cell carcinoma, further high-quality studies including young populations are required to investigate possible protective effects of modern broad-spectrum sunscreens. The results of this systematic review do not change the current recommendations for UV protection. Sunscreens are recommended as a second-line measure against solar radiation whenever protective clothing and seeking shake are inadequate.

Percutaneous Absorption of Sunscreen Filters: Review of Issues and Challenges.

Although skin is a vital barrier to the outside world, it is permeable to certain substances used in topical pharmacotherapy. It is therefore not surprising that other xenobiotics intentionally or accidentally coming in contact with skin can cross the skin barrier. Long before the turn of the millennium, it became clear that sunscreen filters from sunscreen products can be systemically absorbed and detected in urine and plasma. Against this background, we review issues and challenges with safety assessments related to the possible percutaneous absorption of the sunscreen filters. A reference is made to the Regulation (EC) No. 1223/2009 of the European Parliament and of the Council of 30 November 2009 on cosmetic products (version 1 August 2018) and the concepts of the Maximal Usage Trial (MUsT) and Generally Recognized As Safe and Effective (GRASE), currently discussed in the United States.

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.

Performance Metrics of Sunscreen Formulations: In Vitro and In Vivo Techniques.

Effective skin protection of consumers by sunscreens can only be achieved when meaningful and reliable test methods are available to objectively measure the protection of sunscreen products. Quantitative, scientifically sound, and valid methods to detect UVB and UVA light protection as well as methods to assess sunscreen substantivity to water are required. Continuous improvement and, if necessary, extension of the test methods are important to provide optimum protection from harmful sun rays to the consumer. This work documents the historical background of the development of sunscreen test methods and provides the actual worldwide status of applied methods. Future developments and trends are discussed as far as they actually become apparent.

Perception and Transformation.

Exposure to ultraviolet radiation increases the risk of adverse health effects, predominantly skin cancer, which is the most common cancer among Caucasians. A large number of studies have shown that most of the people are aware of this risk and that sun protection behavior is a preventative measure. Nevertheless, despite the numerous public efforts made during the last decades, a large number of people still do not comply with sun protection practices recommended for sun safety. Public discussion about sunscreen safety and the idealization of a healthy tan are existing barriers for adequate protection. Research studies should continue to examine individual sun protection behavior for the development of target-orientated interventions. This will enable individuals to formulate a correct judgment of their own susceptibility and to handle perceived barriers for sun protection with a supportive environment.

Challenges in Formulating Sunscreen Products.

Developing efficient sunscreen products with an acceptable sensory feel after application on skin, that meet current regulatory market and consumer requirements, is a major challenge, exacerbated by new restrictions limiting the use of certain ingredients previously considered crucial. This paper outlines a development strategy for -formulating sunscreens along a generic professional development pathway. Each galenic system will be different and must be customized. Development starts with benchmarking, followed by UVA/UVB filter platform selection and in silico calculation/optimization of photoprotection performance for the desired SPF, UVA-PF, and other requested endpoints. Next comes the selection of the emulsifier system and other key formulation ingredients, such as oil components, triplet quenchers, and antioxidants, with sensory, rheological, and film formation functions. Preliminary cost estimation is then performed to -complete the conceptual process before the start of the practical galenic development. The successful development of modern sunscreen products is based on -comprehensive expertise in chemistry, galenic methodology, regulation, and patenting, as well as specific -market and consumer requirements. The selection of the UV filters is the first key decision and constrains later choices. Other properties, such as water resistance and preservation or active ingredients, may need to be considered. The 4 basic requirements of efficacy, safety, registration, and patent freedom become checklist items to ensure that after development, a sunscreen product has a chance of success.

The Formula for Best Sunscreen Performance: Beer-Lambert's Law Under the Microscope.

Sunscreens used for the protection of human skin work by attenuating the potentially harmful solar UV radiation. In recent years, the quantitative understanding of this attenuating effect has grown tremendously, enabling model calculations of sunscreen performance. Such calculations are based on the simulation of the UV transmission of the sunscreen film applied on human skin. However, there are 2 prerequisites assumed to hold. The first prerequisite is the applicability of the Beer-Lambert law for sunscreen films, and the second is that the thickness variation of the sunscreen film can be described with a gamma distribution of film heights. There is strong evidence from recent experimental work that both assumptions are correct. For several applications, calculations of sunscreen performance have been shown to be useful, for instance, in the design of new sunscreen formulations aiming for a certain sun protection factor or other characteristics, prediction of pre-vitamin D production in the skin in the presence of sunscreen, in vitro measurement of water resistance, and assessment of the ecotoxicological profile of a sunscreen formulation or the influence of oil polarity on UV-filter absorbance and the consequence for sunscreen performance.

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.