The Centers for Disease Control (CDC) recently released two new studies that have struck a chord among the Dermatologic community.1 The reports contain compelling statistics indicating that despite an increase in sun protective behaviors overall, 50 percent of adults younger than age 30 reported being sunburned at least once in the last year. This means that despite sunscreen education, people are still not doing a good enough job at applying sunscreen. The other report found that young adults continue to tan indoors, with the highest rates of indoor tanning among white women aged 18-21 years (nearly 32 percent).
These numbers underline the importance of raising awareness for UV protection for all patients, particularly young patients. Practicing dermatologists have a unique opportunity to do this each day in the clinic by talking to their patients presenting for other skin complaints, such as acne. By addressing the dangers of tanning in young patients, dermatologists have the ability to help patients develop sun protective behaviors that will benefit them for the rest of their lives.
All patients, but specifically acne patients, come to the dermatologist for prescription medications to improve their skin as well as advice on over-the-counter products to use. So it is important to be familiar with what is available to consumers to give educated recommendations to your patients. Ahead I will discuss some specific facial sunscreens available for patients with different skin types, including acne-prone skin.
Sun Protective Care
Treating acne patients, we have the opportunity to instill the importance of using sunscreen in young people. By educating teens and 20-something year olds on the association of sunburns early in life with skin cancer later, we can help save lives.
Sun protection is especially important in acne patients because many acne medications can make the skin sensitive to sunburn. Both topical and oral retinoids lead to stratum corneum thinning, thereby increasing sunburn risk. Oral tetracycline antibiotics (eg. tetracycline, doxycycline) are known to make the skin sensitive to ultraviolet radiation, but the cause is unclear. It has been postulated that the drug itself binds cellular components (such as ribosomes), making them sensitive to phototoxic reactions from UVA light. Moreover, as the drug is degraded in the phototoxic reaction, bi-products are photosensitive and contribute further to phototoxicity from light in the visible spectrum.2 Unlike tetracycline and doxycycline, minocycline is less associated with photosensitivity.
The latest advancements in formulation technology allow us to select from a wide variety of sunscreens for our patients. Just as acne medication regimens can be tailored to suit patients' skin types and preferences, the same can be done for sunscreen choices. Whether your patient's skin is dry or oily, sensitive or not, there is a sunscreen available to suit your patients' unique needs.
Examples of Facial Sunscreen Choices Based on Skin Type
Acne-Prone Skin. For my patients with acne, I typically recommend moisturizers with sunscreen for use in the morning. They provide UV protection while moisturizing and helping minimize irritation potential of topical acne medications. There are several new products designed for patients with acne. Being “oil-free” (using dimethicone rather than petrolatum), they are also of benefit in patients with with oily skin. (Dimethicone helps absorb oil on the skin's surface and can actually help the skin appear less oily. )These include Cetaphil DermaControl Moisturizer SPF30, with zinc and licorice root extract, as well as Neutrogena Clear Face Sunscreen, with botanical extracts. Cetpahil Dermacontrol SPF 30 uses oleosome technology to lower the concentration of chemical blockers needed in the product to achieve the same sun protection coverage, allowing for the light formulation. EltaMD UV Clear SPF 46 has also been designed for acne-prone patients, containing niacinimide to soothe the skin.
Oily Skin. Some patients with oily skin prefer a sunscreen that is as light as possible, especially during the humid summer months. If the skin is well hydrated, they may not require a moisturizer at all, but rather a straight facial sunscreen. La Roche Posay Anthelios 60 Ultra Light Sunscreen Fluid is an extremely light product that may be an appropriate choice. This product contains “Cell-Ox Shield” technology that partners antioxidants and sun spheres to boost sunscreen ingredients for maximal protection. Alternatively, Neutrogena Pure and Free Liquid SPF 50 has a similar light feel on the skin, as does Shiseido Extra Smooth Sun Protection Lotion SPF 38.
Red or Rosacea-Prone Skin. Anti-inflammatory botanical extracts in many over the counter products may help soothe irritated skin, such as in patients with rosacea. Moreover, recent evidence suggests a role of skin barrier dysfunction in the pathogenesis of rosacea.3 So products that improve and hydrate the skin may be of therapeutic benefit for the disease. Aveeno Ultra Calming Daily Moisturizer SPF 15 contains feverfew, a botanical similar to chamomile, which helps reduce irritated skin. Eucerin Redness Relief Daily Perfecting Lotion SPF 15 has been formulated with a licorice root extract that also soothes red skin.
Dry Skin. While each of these products can be used on all skin types, the creamier vehicle of CeraVe AM lends itself for use in patients with dry skin or those who prefer a thicker base. CeraVe AM provides an SPF 30 protection and contains a ceramide-rich formulation which may help repair skin barrier function.
Sensitive Skin. For patients who cannot tolerate chemical sunscreen ingredients, a strictly physical blocker agent is appropriate. SkinCeuticals Physicial Fusion UV Defense SPF 30 contains zinc and titanium but no chemical sunscreen ingredients. Moreover, both tinted and sheer options are available depending on patients' preferences and skin tone. Neutrogena Pure and Free Baby Faces SPF 50+ contains only physical blockers and is fragrance free and tear-free. While this product is marketed as part of a baby sunscreen line, it is an appropriate choice for any age group.
Extra Sun-Sensitive Skin. Patients with extremely fair skin may be more sensitive to the sun than are other patients. For those who cannot tolerate the sun or who burn easily, La Roche Posay Anthelios 40 Sunscreen Cream is a thick product containing a mix of chemical and physical blockers that is of particular benefit to patients with extra sun-sensitive skin.
Mineral Susncreens. Several companies now offer mineral sunscreens alternatives, which have a unique feel on the skin. These products contain physical blockers and are typically non-greasy. Aveeno Natural Protection Sun Block Lotion SPF 30 is an oil-free, hypoallergenic product. Solar Protection Formula also offers mineral sunscreens in their TiZo2 and TiZo3 products. The difference in these products is their color, where TiZo3 has a flesh colored tint, and TiZo2 is untinted.
While some products are mentioned here by name, many others are available. Your own selections will depend on several factors, including brand loyalty, technological innovation of a specific product, peer recommendations, costs, and other personal preferences. The wide variety of facial sunscreens represents the vast, new technologies developed to address different skin needs. As dermatologists, we must be aware not only of how to prescribe prescription drugs, but also how to recommend overthe- counter products to pair with these medications. We play a crucial role in guiding patients on their skin care regimens, and we must take skin type into consideration when making our recommendations.
Given the recent delay in the FDA-mandated sunscreen label changes, we must continue to educate patients on the need for broad spectrum UV coverage. No matter what brand patients ultimately choose, they should be educated to look for specific sunscreen ingredients including titanium dioxide, zinc oxide, avobenzone, oxybenzone, or ecamsule. Moreover, we should reinforce the proper amount of sunscreen needed for appropriate protection (about a half-teaspoon for the face) and the need to reapply every few hours.
As dermatologists, we are facilitators of skin health, be it in treating acne or encouraging UV protection. Sun exposure goes hand-in-hand with the dermatoses we see every day, as UV light is associated both with skin cancer and affects the course of many common skin conditions. Thus, we must stress to our patients that sun protective behaviors can influence the skin health today and in the future.
Dr. Zeichner has served as a consultant or investigator for Allergan, Beiersdorf, Galderma, Medicis, Onset, Pharmaderm, Promius, and Valeant.
Joshua Zeichner, MD, FAAD is an Assistant Professor and Director of Cosmetic and Clinical Research in the Department of Dermatology at Mount Sinai Medical Center in New York.
- http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6118a1.htm?s_cid=mm6118a1_w (Accessed 6/5/12)
- Hasan T, Kochevar IE, McAuliffe DJ, et al. Mechanism of tetracycline phototoxicity. J Invest Dermatol. 1984 Sep;83(3):179-83.
- Borkowski AW and Gallo RL. The coordinated response of the physical and antimicrobial peptide barriers of the skin. J Invest Dermatol. 2011 Feb;131(2):285-7.