Expert advises continued sunscreen use with ‘total photoprotection package’

MAUI, HAWAII — New developments in photoprotection should prompt dermatologists to remind patients that photoprotection involves more than just sunscreen, according to a presenter here at Maui Derm for Dermatologists 2020.

Henry W. Lim, MD, department of dermatology, Henry Ford Hospital, Detroit, said that that the first new development came when the FDA announced its proposed rule last year calling for evaluation of the safety and efficacy of sunscreen ingredients. Lim noted that there are 12 ingredients that do not currently have enough safety data to receive the FDA’s generally regarded as safe and effective, or GRASE determination.

A second component of the proposed rule suggests raising sunscreen’s maximum SPF level from 50 to 60, Lim continued. “There have been two studies — one before the proposed rule was announced and the second after — that showed when comparing SPF-100 to SPF-50 in real-world situations, the SPF-100 was much more effective,” he said.

A final rule on sunscreen is expected in September, according to Lim.

The second new development — the FDA’s decision to review sunscreen ingredients — is a “very, very hot topic nowadays,” Lim noted. The agency has thus far conducted two studies in this area, some of which he said “pushed the envelope” on the maximum sunscreen usage.

As reported by Healio, the first study examined absorption of four active sunscreen ingredients: avobenzone, ecamsule, octocrylene and oxybenzone. Researchers found that these ingredients were absorbed systemically and remained in plasma for at least 3 days after the last application. When used under maximal use conditions — at least every 2 hours — plasma concentrations of these sunscreen ingredients exceeded the FDA threshold of 0.5 ng/mL.

Healio also reported on the second study involving sunscreen ingredients that Lim discussed. The newer study involved avobenzone, oxybenzone, octocrylene, homosalate, octisalate, and/or octinoxate via an aerosol spray, lotion, nonaerosol spray or pump spray. Sunscreen was applied at 2 mg/cm² to 75% of body surface area over 4 days. It was applied once on day 1 and four times during the remaining 3 days at 2-hour intervals. Researchers found the ingredients were systemically absorbed through the skin, resulting in exposure levels that also exceeded the FDA threshold for safety testing.

Lim told attendees that these developments should prompt clinicians to advise patients that it is OK to keep using sunscreen while the FDA evaluates the comments from the proposed sunscreen rule and conducts further studies on its ingredients.

“These results do not indicate that individuals should refrain from the use of sunscreen. Using sunscreen is perfectly fine right now,” he said.

Lim said clinicians should also use these new developments as springboard for discussing what he stated was a total photoprotection package.

“This involves seeking shade; wearing photoprotective clothing, a wide-brimmed hat, and sunglasses; and applying SPF of 30 or higher broad-spectrum sunscreen to other exposed areas.

“Sunscreen is an important component to photoprotection, but it is not the only component,” he said. – by Janel Miller

Reference: Lim HW. Hot topic: Controversies in photoprotection. Presented at: Maui Derm for Dermatologists; Jan. 25-29, 2020; Maui, Hawaii.

Disclosures: Lim reports serving as an investigator for six companies including Estee Lauder and Ferndale; serving as a consultant for four companies including Pierre Fabre and ISDIN; and speaking at educational sessions for Eli Lilly and Pierre Fabre.