PracticalDermatology

As soon as Johnson & Johnson (J&J) voluntarily recalled five Neutrogena and Aveeno aerosol sunscreens due to low levels of benzene in some samples, headlines came fast and furiously. Valisure, an independent lab, tested 294 suncare samples from 69 brands. Of these, 78 tested positive for benzene, with some batches—including the recalled J&J products—containing up to three times the conditionally restricted FDA concentration limit of 2ppm. CVS pulled CVS Health After Sun Aloe Vera and CVS Health After Sun Aloe Vera Spray, which are on Valisure’s list.

The lab is calling on the FDA to recall all the contaminated products and to better define limits for benzene contamination in drug and cosmetic products.

“Benzene is one of the most studied and concerning human carcinogens known to science. Its association with forming blood cancers in humans has been shown in numerous studies at trace levels of parts per million and below,” says David Light, Founder and CEO of Valisure in a news release.

Sunscreens are not dangerous

This isn’t the first sunscreen controversy. In the recent past, research showed that sunscreen actives can travel to the bloodstream, and there have been reports that chemicals in some sunscreens may damage the coral reef, leading to bans of oxybenzone and octinoxate, as well as the birth of a cottage industry of reef-safe sunscreens.

J&J did the right thing by recalling these sunscreens, and this should not deter consumers from using sunscreen, says Adam Friedman, MD, chair and professor of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC.

J&J states that benzene is not used in the manufacturing process and is currently investigating the cause of the contamination. “We can be exposed to exceedingly small concentrations in the environment (like car exhaust), but when exposures reach certain concentrations over time, it can affect how the body makes red and white blood cells and is associated with blood-borne cancers in the long term,” Dr. Friedman explains.

“Do the levels found in sunscreen mean anything clinically? We don’t know,” he says. Importantly, “there is nothing unclear about the risk of UV radiation in photoaging, sun-sensitive diseases, and skin cancer,” Dr. Friedman says. “The takeaway is more information is needed but this is not an overall sunscreen issue.”

Teachable moment

Dermatologists should view this news as an opportunity to reengage patients on the importance of regular sunscreen use. “Anytime there is attention on sunscreens in the media, dermatologists are given a chance to comment and emphasize the importance of sun protection or add our expert opinion,” says Cosmetic Surgery Forum faculty member Edit Olasz Harken, MD, PhD, co-founder of Harken Derm LLC* and an associate professor of dermatology at Medical College of Wisconsin in Milwaukee.

She used the J&J recall as a teachable moment to review potential disadvantages of spray sunscreens with patients and on social media. Sprays can result in uneven distribution on the skin unless rubbed in, she says. “Aerosolized sunscreen particles, especially if they contain chemical filters such as oxybenzone, may harm the marine ecosystems. On a windy day, sunscreen ingredients have been detected far away from the source.” And, she adds, “inhalation can potentially be harmful, causing lung irritation and even asthma attacks in susceptible individuals.”

The last word

Dermatologists all want patients to use sunscreen, but there may be something to some recalls, adds Joel Schlessinger MD, FAAD, a dermatologist and general cosmetic surgeon in Omaha, NE and the founder of Cosmetic Surgery Forum. “In this situation, I have personally chosen to avoid those sunscreens that are under study,” he says, noting only a few formulations are affected. “It isn’t a huge inconvenience, but more study is needed. We owe it to our patients and the populace at large to figure this issue out and make sure it is either addressed, fixed, or disproven before we announce ‘case closed.’”

* Harken Derm has an all-mineral sunscreen in its portfolio.

Cosmetic Surgery Forum 2021 will be held December 1-4 in Nashville. Visit CosmeticSurgeryForum.com