Sunscreens under scrutiny: While the FDA looks into some ingredients, here’s a guide to making smart choices

Jamie Prahl, 37, puts sunscreen on her son Wesley at Foster Beach. The Chicago woman says she looks for a high SPF. Of chemical ingredients that the Food and Drug Administration is reviewing the safety of, she says, “I would probably avoid that because there’s other options that don’t involve that.”

The sunscreen lotions, creams and sprays we slather on our skin, often despite being clueless about what’s in them, are about to get a closer examination.

Experts agree too much sun exposure poses a risk of skin cancer. But some doctors and consumer advocates are divided about how much we also should worry about the chemicals used to protect us.

Now, the U.S. Food and Drug Administration is looking into whether to regulate a dozen common ingredients in sunscreens.

It’s not as if choosing from among all of the sunscreens on the market wasn’t already confusing enough. A 2016 Northwestern University study found that people were spending as much as 30 times more for sunscreen than they needed to get the same protection — and about 40 percent of sunscreens in the top 1 percent on Amazon.com didn’t meet American Academy of Dermatology guidelines for effectiveness, mostly because they didn’t stand up to sweat or water.

CLICK TO HEAR STEPHANIE ZIMMERMANN ON WCIU THE JAM

Reporter Stephanie Zimmermann talks sunscreens on WCIU The Jam.

While the FDA looks at whether to update the sunscreen standards it last set in 2012, here’s some guidance to help make smart choices for you and your family:

SPF, other sunscreen basics

Know your SPF: Most people know about SPF — “sun protection factor” — numbers, which rate how well a product guards against the rays that cause sunburn.
SPF 30 or higher: People should aim for SPF ratings between 30 and 50, according to the dermatology academy, which is based in Rosemont and represents more than 20,000 dermatologists, and another organization that also publishes sunscreen information: the Environmental Working Group, a not-for-profit advocacy group.
Water-resistant: The dermatology academy recommends using a broad-spectrum sunscreen (protecting against UVA and UVB rays) of at least SPF 30 that’s water-resistant so it doesn’t easily come off.
About those super-high SPFs: The FDA is considering allowing labeling as high as “SPF 60+” and allowing marketing of products offering protection up to SPF 80. That’s despite concerns about people’s unrealistic perceptions about the effectiveness of super-high SPF sunscreens. In its sunscreen guide, the EWG cautions that SPF numbers above 50 don’t offer exponentially better protection but might give people a false sense of security that results in them ignoring another sunscreen must-do ...
Don’t forget to reapply: Higher SPFs don’t provide longer-lasting protection. You still have to reapply sunscreen. The dermatologists group recommends reapplying every two hours or right away if you are sweating or have just been swimming.
UVA vs. UVB: If you get a sunburn, that’s from too much exposure to — and not enough protection from — ultraviolet B rays. But both UVA and UVB rays can cause skin cancer. And a higher SPF alone doesn’t necessarily mean a sunscreen does a better job blocking harmful UVA rays. So experts say make sure the label promises “broad-spectrum UVA/UVB protection.”
How sunscreens protect: Their formulations fall into three categories: physical, chemical or both. Physical, or mineral, sunscreens — like zinc oxide and titanium dioxide — coat the skin and reflect the sun’s rays. Chemical sunscreens are absorbed into the skin, where they trap ultraviolet radiation before it can cause damage. Some products combine both.

All sunscreened ujp, Wesley Prahl (left) plays with Henry and William Virkler at Foster Beach. — All sunscreened up, Wesley Prahl (left) plays with Henry and William Virkler at Foster Beach.

What the FDA is proposing and why

The FDA is proposing a revamped system, based in part on new testing tools, to evaluate sunscreens.

Among the changes, it would require all sunscreens rated SPF 15 or higher to also provide broad-spectrum — UVA and UVB — protection.

Its February filing announcing plans for new sunscreen rules also said just two sunscreen ingredients — zinc oxide and titanium dioxide — are “generally recognized as safe and effective.”

Two once-common ingredients — para-aminobenzoic acid (PABA) and trolamine salicylate — were singled out to avoid. Noting the potential for allergic reactions to PABA and bleeding issues with trolamine salicylate, the FDA says “the risks … outweigh their benefits.” Both are largely gone from sunscreens anyway.

A third group of ingredients under review by the FDA is more of a mystery. It includes cinoxate, dioxybenzone, ensulizole, homosalate, meradimate, octinoxate, octisalate, octocrylene, padimate O, sulisobenzone, oxybenzone or avobenzone — ingredients that aren’t exactly household words but which are in many popular sunscreens despite a lack of research on their safety.

Oxybenzone already has raised alarms among environmental and consumer advocates. It’s thought to be an endocrine disrupter that can affect hormones. Studies have found that once it gets absorbed by the skin, it can end up in blood plasma, breast milk, amniotic fluid and urine.

Though it isn’t clear how much of a health risk that might pose, the FDA says, “The significant systemic availability of oxybenzone, coupled with a lack of data evaluating the full extent of its absorption potential, is a concern.”

The agency wants more data on oxybenzone and other chemical ingredients before deciding what to do.

Government officials in Hawaii and Key West, Florida, have moved to ban the use in the ocean of oxybenzone and octinoxate, both thought to harm coral reefs. Both bans take effect in 2021. And the nation of Palau in the western Pacific Ocean will ban 10 chemicals as of next year.

If there’s an alternative, why add oxybenzone to “your overall body burden” of chemicals, says Carla Burns of the Environmental Working Group. — If there’s an alternative, why add oxybenzone to “your overall body burden” of chemicals, Carla Burns says.

Weighing potential risks

There are plenty of sunscreens that aren’t heavy on chemicals but still protect well, says Carla Burns, a research analyst who worked on the 2019 sunscreen guide for the Environmental Working Group, which recommends that people switch now rather than wait while the FDA gathers data.

If there’s an alternative, why add oxybenzone to “your overall body burden” of chemicals, Burns says.

But that advice is at odds with Consumer Reports’ latest sunscreen rankings, which evaluated sunscreens for UVA protection, SPF rating, price and other factors. All 10 of its highest-rated sunscreens contain oxybenzone and other chemical compounds about which the FDA wants more data.

All 10 of the top-rated sunscreens in Consumer Reports’ latest rankings contain oxybenzone and other chemical compounds about which the FDA wants more data.

Consumer Reports, which is published by a not-for-profit organization and touts its evidence-based ratings, noted that oxybenzone scored well in its tests on filtering UV rays, and is “proven to prevent sunburn and can lower your risk of skin cancer and reduce skin aging.”

Dr. Shuai Xu, a dermatologist at Northwestern University Feinberg School of Medicine who has studied consumers’ sunscreen habits, agrees that the biggest concern at this point should be protecting against sun damage and skin cancer, beyond any potential risk from sunscreens’ chemical ingredients.

Dr. Shuai Xu worries that people aren’t using enough sunscreen to protect themselves.

There’s good reason to worry about skin cancer. According to the dermatology academy, it’s estimated that 9,500 people a day nationwide are diagnosed with skin cancer, and one in five Americans will develop it at some point. It’s the most common cancer in the United States, and it’s on the rise, according to the FDA.

Xu worries that people aren’t using enough sunscreen to protect themselves. He says most people apply about half as much sunscreen to their skin as they should.

And because it’s easier to rub on a chemical sunscreen, Xu says people are more likely to use them.

“The benefits from these sunscreens … greatly outweigh the theoretical risk of what these chemicals might do in your bloodstream to your body,” he says, noting that most of us come into contact with all sorts of chemical compounds all the time. “Anyone can make any chemical really scary and vilify it.”

Megan Virkler at Foster Beach, checking the label on the sunscreen she uses for her kids.

Real-world concerns

On a sunny day at Foster Beach on the North Side, Jamie Prahl of Chicago and Megan Virkler of Evanston stand by water’s edge as their boys play in the sand. All three kids are wearing shirts, and the moms are applying and reapplying sunscreen.

Both say a high SPF is important to them. What about the chemical ingredients that are now under scrutiny?

“I would probably avoid that because there’s other options that don’t involve that,” says Prahl, 37.

On a beach towel nearby, Jessica Striegel, 34, is giving her 21-month-old boy some lunch. Striegel says she made a point of getting a zinc oxide-based sunscreen and reapplies it frequently to her son’s skin, saying, “It’s something that we just started learning more about this summer.”

Jessica and Derek Striegel at Foster Beach with their 21-month-old son Finley. Jessica Striegel says she uses a zinc oxide-based sunscreen for Finley and reapplies it frequently.

Dr. David Leffell, chief of dermatologic surgery and cutaneous oncology at the Yale School of Medicine and a spokesman for the American Academy of Dermatology, says more studies need to be done on the chemicals in sunscreens, but there’s no evidence yet of harm to humans.

Still, he understands people might worry. He steers any of his own patients with such concerns to mineral sunscreens with zinc oxide.

“They do a pretty good job,” Leffell says, adding, “You don’t look like you’re wearing clown face.”

Whichever sunscreen people use, he reminds them to cover all of their exposed skin evenly and reapply it often.

Covering the skin evenly is one of the concerns with sunscreen sprays, which are popular with parents of small, squirmy children. The way people use them, they don’t always do that, according to the Environmental Working Group’s Burns, who recommends avoiding sprays for that reason and because of inhalation concerns.

And the FDA says it wants more testing on the sprays’ flammability and how much gets inhaled when they are applied.

Dr. David Leffell of the Yale School of Medicine steers patients who are concerned about chemicals to use mineral sunscreens with zinc oxide. — Dr. David Leffell steers patients who are concerned about chemicals to use mineral sunscreens with zinc oxide.

Other sun-protection tricks

There are other tactics to stay safer in the sun in addition to sunscreen — like going out in the early morning or late in the day, when the sun’s rays are less powerful. A wide-brimmed hat, big sunglasses and sun-protective clothing can help, too, experts say.

Nikki Calisoff, 46, of Lincoln Park, says she regularly slathers sunscreen on her four boys, 12, 9 and 7-year-old twins. Calisoff uses a combination sunscreen with zinc oxide and avobenzone.

But her ace in the hole is a portable shade tent. She says she takes it to the beach to give her family a break from the rays.

Yet even as she relaxes under the canopy while the kids play nearby, she says, “I’m still lathered up, even in here.”