An Open Letter About Sunscreen Shaming

I think a lot of us have forgotten that the bad effects caused by sun exposure have only been recently well understood.

While we’ve observed for a long time that sun exposure causes sunburn, the impact UVA has on skin’s appearance and photoaging are a relatively recent understanding and concern.

Sunscreens marketed as an appearance maintaining essential is arguably modern.

The first widely used “sunscreen” was Red Vet Pet. Used by American soldiers during WWII, it was a by-product of oil refining with a strong red hue. In the later 1940s, pharmacist Benjamin Green would base his Coppertone product on it, but it was marketed to improve one’s ability to tan.

One of the first effective commercial sunscreens, Gletscher Crème, was introduced by Franz Greiter in 1946. Rudolf Schulze published the first method to measure sun protection in 1956. It’s estimated that Gletscher Crème only had a Schulze Factor of 2.

It wasn’t until 1974 that Schulze’s method would be adapted as the Sun Protection Factor and slowly start spreading around the world.

In 1965, doctors J. Graham Smith and G. Rolland Finlayson presented their summary of the sun’s impact on skin, “The changes in human Caucasian skin commonly believed to be due to aging are primarily the effects of prolonged repeated damage to the skin from the sun”. There’s no discussion on the different effects caused by UVA and UVB.

One of the first standards to measure the UVA protection of sunscreen was published in 1994 by Brian Diffey. And it wasn’t until 2011 that the US FDA harmonized and set down rules as to what sunscreens could be labelled as “Broad Spectrum”.

Japan’s cosmetic industry would adopt the UVA protection test, persistent pigment darkening, in 1996.

The European Cosmetics Trade Association (COLIPA) wouldn’t publish their standard for testing sunscreen for UVA protection until 2009.

While sunscreen use might reduce the risk of some skin cancers, it doesn’t reduce the risk of all of them.

Wear sunscreen to prevent skin cancer messaging is often blunt and not inclusive.

Dr. Adewole Adamson a dermatologist, researcher, and professor explains:

“In Blacks, melanoma usually develops in parts of the body that get less sun exposure, such as the palms of the hands and soles of the feet. These cancers are called ‘acral lentiginous melanomas,’ and sunscreen will do nothing to reduce the risk of these cancers…

Even among Whites, there is no relationship between sun exposure and the risk of acral lentiginous melanomas. Famously, Jamaican singer Bob Marley died of such a melanoma on his great toe, but sunscreen would not have helped.”

Sometimes we forget what it feels like to not know something – once we’ve learned it. A lot of the understanding of the sun’s effects and sunscreen protection labels are relatively modern.

Not all of us had the opportunity to grow up in households or communities that were sun protection prescient. Not all of us knew the effects that prolonged sun exposure could have on our skin. Not all of us cared when we were younger.

To shame someone for not having consistently worn sunscreen throughout their life is to say that their skin – the interface of their body to the world – is irredeemable.

Would I prefer people to wear sunscreen more often?

Yes.

But you haven’t failed if you didn’t start wearing sunscreen when you were a child.

And some people just don’t care about getting wrinkles or pigmentation.

There needs to be space in the beauty community for them as well.

Visualizing how a daily sunscreen can protect the skin from UV damage

Optical coherence tomography and reflectance confocal microscopy can be used to non-invasively to visualize deep into the skin. Using these techniques we can actually see changes in the structure of the skin and its cells.

This group of researchers with funding from La Roche Posay used the imaging techniques to compare the effect of UVB exposure on skin protected with a high SPF and UVAPF sunscreen and skin that wasn’t protected.

What they found was that doses of UVB that caused long-lasting erythema (redness) caused morphological changes in the skin. Changes observed were spongiosis (abnormal accumulation of fluid), microvesicles, sunburn cells, and blood vessel dilation. None of these were observed in skin that was protected by the sunscreen.

A minimal erythemal dose or MED is the amount of UV energy that causes long-lasting redness in the skin. Just 1 MED was enough to cause morphological changes and 2 caused significantly more. This also relates to SPF. An SPF of 2 would provide enough protection to protect an average population against 2 MEDs.

If reducing your risk of developing skin cancers and preventing photoaging are a goal of yours – this is a great reminder and justification to wear your sunscreen daily!

Antonio Gomes-Neto, Paula Aguilera, Leonor Prieto, Sophie Seité, Dominique Moyal, Cristina Carrera, Josep Malvehy, Susana Puig, Efficacy of a Daily Protective Moisturizer with High UVB and UVA Photoprotection in Decreasing Ultraviolet Damage: Evaluation by Reflectance Confocal Microscopy, Acta Dermato-Venereologica (2018), DOI: 10.2340/00015555-2736