As we spend more time outside, it’s important to remember to protect our skin from the sun’s rays. While we know sunscreen is needed, it’s also important to know how to select the right sunscreen. Which chemicals in sunscreens should we avoid? How are manufacturers ensuring their products are safe and effective? And what ingredients provide the best protection against overexposure to the sun? We spoke to David Andrews, PhD, deputy director of investigations and a senior scientist at Environmental Working Group (EWG), about what to look for when buying a protective sunscreen, how to minimize our risk to harmful exposures, a step-by-step approach to protecting our skin, and EWG’s handy sunscreen guide.

Transcript

Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered Podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. Even though we usually associate summertime with sunscreen, the truth is we need sun protection all year long. In today's episode, we're going to focus on all things sunscreen and sun protection.

What are the safest steps to protecting ourselves and our skin? How do we make sense of all the labels, SPF, broad spectrum, UVA, UVB, chemical, mineral, and how can we be sure that we're using the safest and most effective products?

To guide us through this topic is our guest, Dr David Andrews. Dr Andrews is Deputy Director of Investigations and a Senior Scientist at Environmental Working Group. His work focuses on finding ways to protect public health by educating consumers and driving change to government policies and regulations. Dr Andrews has been researching sunscreens for more than 15 years and has published a peer reviewed study on sunscreens with EWG colleagues and a book chapter with researchers in Australia. Welcome to the WebMD Health Discovered podcast, Dr Andrews.

David Andrews, PhD: It’s a pleasure to speak with you today.

Pathak: Before we jump into our conversation, I'd love to ask about your own personal health discovery, your aha moment around the work that you do specifically around sunscreens.

Andrews: I've actually been at EWG for just over 15 years now. My oldest just turned 16. So, I also have a few kids and know their response to sunscreen, some positive and some negative. What stood out to me was when I started researching the efficacy of sunscreens. In particular, I'm coming at sunscreen and sunscreen use from the perspective of really long term skin damage and increased skin cancer risk. What really stood out is kind of the lack of scientific knowledge still on what exactly causes in particular increased melanoma risk, and that linkage to sunscreens and some of the uncertainty that has enabled what is somewhat subpar sunscreens in terms of providing UVA protection. So providing protection from a portion of the spectrum.

Part of that is really a reflection of how sunscreen use has changed incredibly over the decades and the initial products were really just to prevent sunburn. In my family growing up we referred to them as sunburn creams. But it was really that change in use and kind of the lack of really strong protection in the UVA region that stood out to me.

One piece that really stood out is when the FDA published what was more or less their more recent change to sunscreen regulations in 2011. They discussed how sunscreen use was associated with reduced risk of skin damage and skin harm when you use the products because it reduced the amount of UV rays that hit your skin.

But the FDA also noted that the few studies that had looked at sunscreen users found that they actually changed their behavior and spent more time in the sun and were actually getting slightly increased sun damage. There's this juxtaposition of we know UV rays and sun rays can cause skin harm and sunscreens reduce the amount of those UV rays. But if we're using sunscreen and changing our behavior, then we may actually be negating some of the benefits of sunscreen. Those complex science issues have really drawn me into this issue and have kept me kind of focused on trying to understand this and provide guidance to the public for the last 15 years.

Pathak: That's so interesting. Let's start with some definitions of some common terms. We all think of sunscreen as helping to protect us from damaging rays from the sun. Help us break down those components of solar radiation that we're talking about UVA, UVB, visible light, and infrared. Help us think about those different types of solar radiation that we're trying to protect ourselves from.

Andrews: It does get very complicated with the terms. The UV radiation or ultraviolet radiation is sun radiation we cannot see. The radiation is broken into two parts, typically, UVB and UVA, at least in the context of sunscreens. Those UVB rays are the rays most associated with acute damage that's turning your skin red and sunburns. UVB rays are also associated with increased skin cancer risk. But UVA rays are also associated with increased cancer risk as well as skin aging, long term skin damage and impacts on the skin immune system. So the ability to heal from sun damage.

But the original sunscreens primarily just block the rays that cause sunburn and actually led to increased UVA radiation. So it's those two portions of the spectrum that I often refer to. UVB is the portion that causes direct skin damage. You see the impact right away or within 24 hours. The UVA rays penetrate deeper into the skin and are associated with long term skin harm.

Pathak: Tell us about SPF and broad spectrum and some of these terms that we see on the sunscreens that we're buying. What are these different components? What are we supposed to be looking for when we're looking for a good protective sunscreen?

Andrews: I think of a good sunscreen or the ideal sunscreen as something similar to a shirt. A shirt actually provides perfect uniform protection against UVA, UVB rays, and even blocks visible light. People can't see you through your shirt typically, and so that is kind of the ideal. The SPF value in sunscreens is representative of the sun protection value. It comes from a measure of skin redness.

The way sunscreens are tested, they apply small amounts on people's back, expose them to high intensity radiation for a short period of time, equivalent to, solar exposure, much stronger than the sun, and then look a day later and see how read the skin turned. That SPF number is the direct reflection on primarily UVB protection. The UVA protection or the broad spectrum protection is not incorporated into that SPF or UVB value, although there are some standards in the United States for how much UVA protection is required. The issue is those standards in the United States are very low. They actually lag the rest of the world. In part, that is due to the ingredients available to sunscreen manufacturers in the United States. The underlying concern here is that people are being overexposed to UVA radiation, which is leading to long term skin damage and skin harm.

Pathak: Can we have it all? Do we have products available to us in the United States that provide strong protection and also minimize the risk from certain chemical exposure. Is that a unicorn or can we find that on our shelves in the US?

Andrews: There are good options available. That is an important takeaway. Primarily these are products that are using zinc oxide. These are mineral based sunscreens. Sometimes they can be a little bit whitening, although formulations have improved significantly over the last decade. These zinc oxide mineral based sunscreens do a very good job of providing UVA and UVB protection, They do so without the use of concerning ingredients. There is a space there, and there's definitely options available to consumers, and we have typically directed people to first try those products and potentially you need to try a few different products to find one that works for you. But these zinc oxide based products are the best available option on the market currently

Pathak: What are some of the things we're looking out for if you have skin of color?

Andrews: That's a really interesting question. I think it reflects a deficiency in both that SPF value and the current structure in the regulations from the FDA on how sunscreens are tested, and how the effectiveness is communicated. Primarily, these are products tested on very light skin types, that are looking for that skin redness.

I don't have a direct answer to that question of if there is no skin redness, how can you be sure that you're protecting the skin because of that lack of direct feedback other than the advice of if you're going out in the sun, especially for prolonged periods, consider covering up using a sunscreen or seeking shade.

I think it's important to come back to that, though, that in the context of sun damage, and sunscreens, the sunscreens alone are not the complete solution here. It is a mixture of wearing a shirt, covering up, seeking shade, and using sunscreens to reduce that overall exposure.

Pathak: I definitely want to talk a little bit more in depth around your step by step approach to thinking about all of the different tools we have in our arsenal to protect us from solar radiation. But I wanted to go back to an earlier point you made around some safer ingredients that you're looking for such as looking for zinc oxide. What is the converse of that? What are some of the ingredients that you would really recommend people stay away from?

Andrews: I should note that the FDA proposed changes to sunscreen regulations four or five years ago now that have not been finalized. They highlighted that all of the non mineral ingredients, these are oxybenzone, avobenzone, a large portion of the sunscreen market in the US. The active ingredients were absorbing into the skin at levels where they were being systemically distributed throughout the body and the FDA was looking for more safety data on all of those ingredients for them to stay on the market because people use sunscreens daily. They apply them to a large part of their body and FDA said we don't have adequate data for any of these ingredients for long term use to ensure that they're not causing harm.

There are a few ingredients that raise higher concerns. One in particular that stood out is oxybenzone, which a number of studies have associated with both allergic type skin reactions as well as some impact on endocrine disruption and changing hormone levels. There's still some uncertainty there, but we thought there was enough evidence and available alternatives that consumers should look elsewhere. That is one ingredient in particular that raises concerns. It's also the ingredient that's absorbed at much, much higher levels than any other sunscreen ingredient.

Pathak: If I'm understanding you correctly, it's a chemical of concern, an ingredient of concern. The FDA is still looking at long term data to see if the amount which is absorbed into our bloodstream from the skin is going to cause long term harm. But there is enough evidence to suggest that there's some risk as it relates to endocrine disruption and some allergic type reactions.

Andrews: Correct. From a providing guidance perspective, we think consumers should seek out alternatives. The FDA has actually requested that companies and the manufacturers do additional safety testing to validate some of those studies. But as far as I know, that testing is not moving forward.

Pathak: You mentioned that there are certain ingredients that are available to people in other parts of the world that may not be available to us. Can you tell me what those are? Are they safer? Is there a different standard in other parts of the world than we have? How do we make sense of some of our protections compared to the rest of the world?

Andrews: This is a really interesting issue and sunscreens in the United States and the formulations available to consumers have been largely unchanged for the last decade. One of our big concerns is the lack of strong UVA protection. I mentioned earlier UVA rays are associated with increased skin cancer risk, as well as long term skin damage.

It is worth noting that using a tanning bed, which has actually been classified as a known human carcinogen due to increased melanoma risk in young women, exposes you primarily to UVA rays, similar to using an unbalanced sunscreen. The importance of sunscreens that reduce UVA radiation is critical and the options available to formulators in other countries or sunscreen manufacturers, there are a half dozen ingredients at least that are formulated to significantly reduce UVA radiation. Those ingredients have been in use for over a decade around the world. In part, that's because sunscreens are considered cosmetics in the rest of the world, so the ingredients don't have to go through any specific safety testing before they're used. Whereas in the United States, they're considered over the counter drugs, and the FDA has said people are going to be applying these to their body for long periods of time, we want a comprehensive evaluation of the toxicity of these ingredients before widespread use. The problem is we're really stuck a little bit in a Catch 22 because FDA doesn't actually have that information, that safety testing data for most of the ingredients on the US. market. Nor do they have it for the ones available internationally. But the internationally available ingredients seem to be better from an efficacy perspective, and have less known, health concerns or toxicity concerns. So the marketplace is really stuck here where the FDA says we don't have enough data to keep most of the ingredients on the market in the United States, but we also don't have enough data to let new ingredients into the United States in sunscreens. We've been stuck in this status quo for what is going on over a decade now.

Pathak: The status quo at this point is we don't potentially have the most effective ingredients for UVA, and the logic that is sort of preventing that from being used in the US market is not being used to protect us from some of the chemicals that currently are available to us in the US.

Andrews: Right. More or less. That's where we are. We don't have adequate safety data for most of the ingredients in the US outside of zinc oxide and titanium dioxide. And so those mineral ingredients, the FDA says there is actually adequate data. and they are effective from a UVA perspective. They are the best option, but there's a significant portion of the population that still will not use those mineral based ingredients for aesthetic reasons.

And so recognizing that we think there's an important need to look towards some of those international ingredients and look for a way that the safety of those can be fully substantiated to FDA standards so that there is market access. We think there's really a public health need for more performance based sunscreens, especially in the UVA portion of the spectrum.

Pathak: So what is the full arsenal of tools that we have to protect our skin? And how do you sort of think about it?

Andrews: Rash guards, shirts, hats, and sunglasses are a fantastic place to start, especially when swimming in sensitive marine environments. There have been a lot of concerns raised about the impact of sunscreens on coral and coral damage. Wearing a rash guard eliminates most sunscreen use, especially in those environments.

But even day to day, going to the pool and going outside or to the beach, starting with a shirt or rash guard is a fantastic way to go and incredibly effective at reducing UV radiation. Sunscreen is another tool, though, and available to be used. As long as it's not being used to significantly change your behavior, so where you're applying the sunscreen and then spending three times as long in the sun, you may be negating the benefits of it.

But everything from clothing, seeking shade, bringing an umbrella and potentially limiting time during the sunniest part of the day, those are all effective strategies at reducing sun exposure.

Pathak: And how does your group fit in? How do you see yourself fitting in the work that you do with how we can think about the behavioral components and dressing appropriately for the weather. How should we think about it along with what's FDA approved and accessible to us?

Andrews: We're both trying to educate consumers in the public about sunscreens, the importance of protecting yourself from damaging UV rays, as well as providing guidance on what we think are the best available sunscreens on the US market based on the ingredients and the known hazards of those ingredients as well as the efficacy of the active ingredients in reducing UV rays. A large part of our message is to the public, but we also do interact with FDA. We provide comments on all of their regulations and try to reach out to them and shift the market entirely in the direction of safer and more effective sunscreens.

Pathak: I wanted to come back to SPF as well. I have a lot of patients ask me, so what exactly does that number mean? Is there a number beyond which there's no benefit? Can you help us think through SPF and broad spectrum what we're seeing on the label.

Andrews: The SPF number on that label is where companies are supposed to have their product tested on individual skin and they look at skin redness a day later. The problem is, there's a lot of ways to optimize or game the system in terms of the SPF value, and that's particularly concerning. We have actually recommended that consumers stick with an SPF 50 or lower. Some of this depends on your skin type and your skin pigmentation, but we don't really see any benefit to going above SPF 50.

In particular, we're concerned that the higher SPF numbers are less balanced protection. So actually providing a lower ratio of UVA to UVB ray protection. This is actually something that's known in the industry. I was quite shocked reading comments submitted to FDA over a decade ago, where a major manufacturer had purchased a competitors product, an SPF 100, submitted it blindly to five labs, and the results came back with everywhere between an SPF 37 and a 75. No one reproduced the SPF 100. There's a lot of uncertainty in those actual numbers, but we think sticking with an SPF 30 to 50 is in the optimal range for most people.

Pathak: Oftentimes, and I will definitely put this under the category of mom guilt, when your kid comes home and they are peeling and you recognize that, wow, we did not do a good job sunscreening or protecting you from the sun.

What is the best thing to do in the post, in the follow up? Are there tips that you have in terms of fixing something that you may have messed up to prevent future damage? What are the best tips that you have there, if any?

Andrews: It happens to everyone, especially everyone who has kids. And I think, after some exposure, sometimes I'll reuse sunscreen and apply it to them even after the fact, because a lot of products have anti inflammatories in them. But at that point, it is largely both reducing some of the inflammation on the skin, but also using it as a learning opportunity to try to make change in the future. No one's perfect all the time, but ultimately we are trying to take action to reduce the odds of long term skin damage. The difficult part here is that the damage we're most concerned about can occur decades later and so it's just trying to do as well as we can to reduce the odds of that ever occurring.

Pathak: I love to close all of my episodes with bite sized action items for anyone who's listening so they can make a sustainable change in the way they're living day to day. Can you give us just a few tips, your takeaways that folks should think about when they're thinking about protecting themselves from the sun.

Andrews: I'd recommend checking out our website, ewg.org. We actually have a full sunscreen report. We've also got our scientific research embedded in that report and some simple recommendations there too, and that is a tool to help you choose safer and more effective sunscreens, really just flipping over the bottle, looking at some of the ingredients in there and becoming educated on what those ingredients are and the effectiveness of those ingredients, as really a first step in increasing your knowledge in this space and ultimately at the same time, in the summer, having fun and getting outside, I think, is important to emphasize also.

Pathak: Thank you so much for being with us today. I really appreciate your time.

Andrews: My pleasure.

Pathak: We've talked with Dr David Andrews about all things sunscreen, and also really thinking about sunscreen as just one of the tools that we have to protect ourselves from the sun's rays. To find out more information about Dr Andrews and his work, visit ewg.org/sunscreen. We'll have that link in our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you're interested in or questions for future guests, please send me a note at webmdpodcast@webmd.net. This is Dr Neha Pathak for the WebMD Health Discovered podcast.