With summer coming, questions about sunscreens are just around the corner. How often should sunscreen be used?
Are ingredients such as oxybenzone and avobenzone endocrine disruptors that are absorbed by the body in the products? Are they dangerous to humans and coral reefs? Will the use of sunscreen lower Vitamin D levels in humans? What are the "safest" sunscreens?
It has only been a few decades since a suntan ceased to convey "status" and began to represent unnecessary health risks in some people's minds. Before the industrial revolution, when people still worked in the fields, a suntan carried the stigma of marking someone as working class, a peasant, or an agricultural laborer.
Then, in the 1920s, when most laborers had moved to indoor factories and developed skin pallors, perfume magnate Coco Chanel began to sport a suntan, establishing it as a desirable signal of privilege, leisure, and beauty-the badge of someone who didn't work in a factory.
The pursuit of a suntan by Caucasians continued for at least 60 years with the popularity of both sunbathing and tanning products seemingly impervious to dermatologists' claims that all that radiation invited cancers, premature skin aging, and wrinkles. Suntans were so popular that sunbeds and tanning booths debuted for people living in Northern climates who wanted a year-round tan. These man-made "sun" producers, popular among the college-aged, are 15 times stronger than the Mediterranean sun.
A turning point in the United States' suntanning craze came in 1997 when the makeup artist for the beach TV show Baywatch revealed that cast members used sunless tanning lotion with a stain and didn't have real suntans. Soon, "fake tan" products, sunblocks, and sunscreens with tint began to appear on drugstore shelves, often made by the same companies that previously sold "deep tanning" products.
There is some confusing science around the benefits and risks of sunlight. For example, even though many people are getting less sun than before the "sunscreen revolution," the incidence of skin cancer is on the rise.
Some researchers suggest that's because of decreases in ozone and increased sun intensity. Others say it is because of our indoor lifestyles.
Yet, according to some research, there are also risks from low sun exposure such as increased incidences of breast cancer, colorectal cancer, hypertension, cardiovascular disease, metabolic syndrome, multiple sclerosis, Alzheimer's disease, autism, asthma, Type 1 diabetes, and myopia. Some sources suggest that insufficient sun exposure may be responsible for 340,000 deaths in the United States and 480,000 deaths in Europe per year, a 2020 research review notes.
While some skin doctors assert that there's no such thing as safe sun exposure and a suntan is actually skin "damage," other medical experts draw a distinction between healthy sun exposure and dangerous sun exposure-especially incurring a sunburn.
"An examination of the current state of the scientific research shows that severe sunburns are linked to increased risk of melanoma but non-burning sun exposure is linked to reduced risk of melanoma," notes a research review published in the ??International Journal of Environmental Research and Public Health. "Our conclusion is that non-burning UV exposure is a health benefit and-in moderation-should be recommended as such."
Certainly, humans have lived for epochs without avoiding sun exposure, and asking whether we've lost our natural adaptation to the sun is a valid question. If people no longer go outside and receive gradual sun exposure and a "protective" suntan could that explain why fair-skinned people, who are at a much higher risk of skin cancer, develop skin cancers?
Even as Americans absorbed increasingly emphatic warnings about sun dangers, health concerns about the products that were supposed to protect them also surfaced. While ingredients such as oxybenzone, avobenzone, homosalate, octinoxate, octisalate, and octocrylene-called "chemical" sunscreens-had already been studied for FDA approval, in 2019, the agency announced that further safety studies were necessary because absorption may be higher than previously thought, Consumer Reports reported. Moreover, some experts worried that risks had risen as use went from occasional to constant.
"We've been asking that people use sunscreen on a daily basis all year-round and apply it every few hours during prolonged sun exposure," Henry Lim, a dermatologist, pointed out.
The FDA announcement followed research in the Journal of the American Medical Association (JAMA) in 2019 that found using the recommended amount of four different sunscreens for just one day increased levels of avobenzone, ecamsule, octocrylene, and oxybenzone in the bloodstream. Worse, one chemical, oxybenzone, a possible endocrine disrupter, had been found in amniotic fluid, urine, blood, and human breast milk, the researchers wrote.
The suspicion that oxybenzone and other sunscreen agents act as endocrine disruptors isn't new. Research in the journal Hormones in 2015 found that some sunscreen ingredients can produce estrogenic/anti-estrogen and androgenic/anti-androgenic activity in animals.
"Many ingredients affect the estrous cycle, spermatogenesis, sexual behavior, fertility, and other reproductive parameters in experimental animals," wrote the researchers. "Their presence in aquatic environments may reveal a new emerging environmental hazard."
The researchers were right. In 2021, the National Ocean Service cautioned that sunscreen chemicals "threaten corals and other marine life" in serious ways. That includes accumulating in the tissue of coral, which can deform young coral and kill them. It can also induce defects in young mussels and sea urchins. Even dolphins, which are mammals with many physiological similarities to humans, are threatened as sunscreen chemicals can accumulate in their tissue and be transferred to their young.
(For a detailed breakdown of the science and environmental risks, you can visit Beachapedia, a wiki-style website developed by the collaborative effort of the Surfrider Foundation activists, scientists, and staff.)
Some of us remember when lifeguards wore a white mound of zinc oxide on their noses to prevent sunburn. Decades later, zinc oxide remains one of our best sun protection options. Both environmental and health sources agree that sunscreens with mineral filters such as zinc oxide and titanium dioxide are safer than "chemical sunscreens" such as those listed above. Mineral sunscreens scatter and reflect the sun's rays while chemical sunscreens absorb the sun's rays and convert them into heat, releasing them from the body, according to Piedmont, a private, not-for-profit health care provider in Georgia.
There is one caveat, though, Beachapedia notes: the zinc oxide and titanium need to be micro-sized and not nanoparticles.
"Zinc oxide and titanium dioxide at the micro-sized level (0.1 to 10.0 micrometers (um) or 100 to 10,000 nanometers (nm) wide) are better able to remain on your skin and not leach into the marine environment. These micro-sized particles are also unable to permeate the skin or blood-brain barriers within the body," it notes.
The potential for nanoparticles to penetrate the skin and cross the blood-brain barrier is an ongoing focus for researchers and regulators.
Other sources, though, disagree. The well-respected Environmental Working Group (EWP) notes that nanoparticles are used by sunscreen makers to improve texture and sun protection but that a "large number of studies have produced no evidence that zinc oxide or titanium dioxide nanoparticles can cross skin in significant amounts."
Still, Epoch Times readers who want to pursue pure mineral sunscreens such as those with zinc oxide need to beware. Some products that advertise they are "clear zinc" have added a chemical sunscreen to achieve a clear look. Other products that are only zinc can promise that they are "clear," but can leave a pasty white cast. Do your homework! Good products are out there.
Besides the risks of sun exposure and possible endocrine-disrupting actions of chemical sunscreens, there is another sun exposure consideration: Will constant use of a sunscreen cause a Vitamin D deficiency, which is likely the cause of some of the conditions linked to low levels of sun exposure?
Vitamin D, after all, is an essential hormone produced by our skin when it absorbs the sun's rays. This critical nutrient "spurs bone growth," "gives an important boost to the immune system," and staves off diseases such as osteoporosis, according to the Skin Cancer Foundation.
The foundation advocates vitamin D supplements to make up for any loss of vitamin D due to the use of sunscreen.
"If cod liver oil is not your thing," says the foundation (though it is packed with Vitamin D) "and if you don't want to do the juggling and math required to take in all your vitamin D through foods, simply mix in supplements."
Few people in their 40s who were sunbathers in their teens, 20s, and 30s have escaped some of the unwanted "perks" of sun exposure. These include skin lesions such as lentigines, seborrheic keratosis, actinic keratoses, moles, freckles, skin tags, and, of course, wrinkles. Some of those that didn't take responsible precautions have suffered worse. We do need sunlight, but the sun does come with risks, especially for fair-skinned people who spend most of their time indoors.
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