Do Sunscreens Have You Covered?

SIZZLE ALERT After two hours at the beach, Ilene Sofferman had to reapply sunscreen to her 9-year-old daughter, Alison. The product had an S.P.F. 30 rating
Photo by: Hiroko Masuike
Source: New York Times, July 5th, 2007
Author: NATASHA SINGER

http://tinyurl.com/2963g6

AS the noon sun began to cook bathers in Long Beach, N.Y., last Sunday, members of the Sofferman family lounged on towels, each wearing a sun lotion chosen with the care usually given to picking out a new bathing suit.

Denise Sofferman and Ilene Sofferman, sisters who both work in the apparel industry in Manhattan, had put on tanning oil, their bodies already golden brown. Denise’s daughter, Lauren Levy, 21, a student at the University of Pennsylvania, had protected her pale skin with a heavy-duty S.P.F. 50 product formulated for children. Ilene’s 9-year-old daughter, Alison, had received a head-to-toe coating of S.P.F. 30.

Two hours later, the daughters were sunburned, their backs as pink as watermelon.

“It says waterproof, but Lauren didn’t even go swimming,” said Denise Sofferman, reapplying sunscreen to her daughter.

Ilene Sofferman, smearing another coat of lotion on Alison’s pink face, read from the back of the sunscreen bottle. “They have all these different marketing terms —S.P.F., UVA, UVB, waterproof, sweat-resistant — but you have to figure out what they mean by trial and error,” she said.

After decades of warnings about the dangers of sun exposure, an increasing number of Americans are making sunscreen part of their skin-care routines. Americans bought 60 million units of sunscreen last year, a 13 percent increase compared with 2005, according to Information Resources Inc., which tracks cosmetics sales.

But the increased demand has spurred an explosion of lotions, sprays, pads and gels with such diverse marketing claims — All-day Protection! Ultra Sweatproof! Total Block! Continuous Protection! Ultra Sport! Instant Protection! Extra UVA Protection! — that the Soffermans are not alone in their confusion over how to choose the most effective sunscreen.

Ashley Meade, a media planner in Manhattan, went to the beach last Sunday for the first time this summer. “I am physically pale, I am not meant to tan, and I am freaked out about the idea of skin cancer and wrinkles,” she said. Before she left for the beach on Sunday morning, she patted an SPF 30 towelette on her face and put a lower protection product on her body, she said. “The label on the wipes says `apply evenly before sun exposure and then as needed,’ but you have to ask yourself how you are supposed to know what `as needed’ means," she said. “I probably need to put more on my body too. I can feel my kneecaps roasting.” Indeed, by the end of the afternoon, Ms. Meade’s legs were pink.

In the nearly 30 years since the Food and Drug Administration issued its first regulations for sunscreen as an over-the-counter drug intended to reduce sunburn risk, the science surrounding skin and cancer has expanded dramatically.

Julie Demaio, who works in advertising in Manhattan, carried a supply of products to the beach because she uses different levels of sun protection for each body part. “I want some parts more tan than others,” Ms. Demaio explained as she sat on the beach in a lounge chair. “I put SPF 4 on my legs, SPF 8 on my arms, and SPF 30 on my face.” She added: “I even put an SPF on my hair so my scalp doesn’t burn.” Ms. Demaio said she viewed her sun protection strategy as a delicate system that straddled a line between getting tan and getting a sunburn. “I know I am not supposed to want a little color, but I do,” she said. “If my chest and legs get red, I will put on more sunscreen.”

Critics have clamored for the F.D.A to update the rules, saying that the standards have not kept pace. At the same time, they complain, the agency has allowed manufacturers to make vague and improbable-sounding marketing claims, leaving consumers confused and, worse, misled about what to use and how to use it to protect themselves.

The pressure on the agency has been mounting in recent weeks. Last month, reports by Consumer Reports and by the Environmental Working Group, a nonprofit group in Washington, found that a variety of popular sunscreens lacked sufficient broad protection against the sun’s harmful rays. And in May, Richard Blumenthal, Connecticut’s attorney general, sent a scathing petition to the F.D.A. saying that unclear sunscreen labels and inflated marketing put people at risk.

“Most sunscreens are deceptively and misleadingly labeled, most perniciously to give consumers a false sense of security,” Mr. Blumenthal said last week. “In my view, the F.D.A.’s failure to act is unconscionable and unjustifiable in any public sense.”

John Bailey, the executive vice president for science at the Cosmetics, Toiletry and Fragrance Association, an industry trade group, said that the directions on sunscreens adequately convey coverage. “These are very beneficial products which should be used to protect against the adverse effects of sunlight,” said Dr. Bailey, who has a Ph.D. in chemistry.

Nonetheless, the F.D.A. seems poised to address the labeling issue. Although it has been planning since 1999 to confirm new rules, Rita Chappelle, a spokeswoman for the F.D.A., said the agency expected to issue new sunscreen standards in the coming weeks. But until they are released, Ms. Chappelle said the agency would not answer questions about forthcoming regulations.

Ilene Sofferman, who manages a swimwear boutique on the Upper East Side, likes to use an SPF 30 sunscreen on her nine-year-old daughter Alison. “She has very fair skin and you don’t want her to burn,” said Ms. Sofferman. “SPF 30 means it blocks out 30 percent of the sun’s rays, right?” Dr. James M. Spencer, a dermatologist who specializes in skin cancer in St. Petersburg, Fla., said that SPF 30 means that a sunscreen filters out 97 percent of the rays that can cause sunburn. Still, Alison’s skin turned pink after a few hours of sun exposure. “People tend to apply only a quarter to a half of the amount of sunscreen they need,” said Dr. Spencer. He recommended using a shot-glassful of sunscreen for the body and a teaspoonful for the face -- to be reapplied immediately after swimming. As Ms. Sofferman applied a new layer of sunscreen to her daughter’s face, she said she believed that sunscreen works, albeit imperfectly. “It would be worse if you didn’t have it,” said Ms. Sofferman.

One fact about sunscreens is indisputable: They can impede sunburn and lower the incidence of at least one form of skin cancer in humans.

Dr. Allan C. Halpern, chief of dermatology at Memorial Sloan-Kettering Cancer Center in Manhattan, said that the regular use of sunscreen can inhibit squamous cell carcinoma, a cancer that kills 2,000 to 2,500 Americans a year.

In a study of about 1,600 residents of Nambour, Australia, volunteers who were given sunscreen to use every day for four and a half years had 40 percent fewer squamous cell cancers than a control group who maintained their normal skin-care routines. Even 10 years after the study concluded, the volunteers assigned to use sunscreen during the trial period had fewer cancers.

Dan Schwartzberg, from Harrison, N.Y., said he thinks putting on sunscreen is annoyingly time-consuming. Plus he hates the greasy texture. But, ever since he got sunburned in Mexico, he has started wearing SPF 30, he said. “I almost wouldn’t go swimming so that I could avoid having to put suncreen on again,” said Mr. Schwartzberg, who works in broadcast marketing. “Don’t tell me I am supposed to reapply it every few hours!” he said from his perch on a beach chair. “That’s such a hassle, I’d rather go to the movies.”

“It shows that using sun protection for almost five years gives you an intense, longer-term benefit against squamous cell carcinoma,” said Dr. Adèle C. Green, deputy director of the Queensland Institute of Medical Research in Brisbane, Australia, which ran the study.

Dr. Halpern said that sunscreen should also protect against melanoma, the deadliest skin cancer, and basal cell carcinoma, because the product can inhibit harmful ultraviolet rays that can contribute to the diseases.

Yet even after new F.D.A. labeling rules are published, it may take two years for the changes take effect.

Michelle Hainer, a freelance writer in Manhattan, took a tote bag to the beach last Sunday with a variety of sunscreens in it. But she said she gravitates toward lower-protection products that allow her to tan. “I’m bad. I’m a sun worshipper. I have been baking since I was 12,” said Ms. Hainer. “Usually I put on SPF 4, but today I am wearing SPF 8.” But on her chest, which has gotten sunburned over the years, Ms. Hainer said she uses an SPF 55 product recommended by her dermatologist after she had an appointment for a skin cancer check. “I know it is an oxymoron to be worried about skin cancer and love the sun,” said Ms. Hainer, 29. “I am worried I will look like a wrinkled old prune by the time I am 35.”

Dr. James M. Spencer, a dermatologist in St. Petersburg, Fla., who specializes in skin cancer, said that he hopes the updated standards will clarify how much protection sunscreens provide, the dose needed to achieve significant protection, and the frequency with which a sunscreen should be reapplied.

The F.D.A. in 1978 first proposed a system of labeling products with an S.P.F. or Sun Protection Factor, which measures how effective the product is in preventing burn caused by the sun’s ultraviolet B rays. UVB radiation can also be a factor in skin cancer.

Dr. Spencer said that an S.P.F. 15 product screens about 94 percent of UVB rays while an S.P.F. 30 product screens 97 percent. Manufacturers determine the S.P.F. by dividing how many minutes it takes lab volunteers to burn wearing a thick layer of the product by the minutes they take to burn without the product.

But people rarely get the level of S.P.F. listed because labels do not explain how much to use, said Dr. Vincent A. DeLeo, chairman of dermatology at St. Luke’s-Roosevelt Hospital Center in Manhattan.

Iris Halem, from Oceanside, N.Y., is fastidious about putting sunscreen on her children. “I am neurotic about sunscreen,” said Ms. Halem. “I don’t use anything less than SPF 50.” Last Sunday at Long Beach, she applied sunscreen every 30 minutes to her seven-year old twins, Benny and Dena. At the beach, she also likes the twins to wear t-shirts along with their bathing suits. “I put a good amount of sunscreen all over them,” said Ms. Halem. “And don’t forget the top of the ears. They burn first."

“Sunscreen is tested at 2 milligrams per square centimeter of skin, which means you should be using two ounces each time to cover your whole body,” Dr. DeLeo said. “But for most people an eight-ounce bottle lasts the whole summer.”

People who apply S.P.F. 30 too sparingly, for example, may end up with only S.P.F. 3 to S.P.F. 10, according to the Web site of the British Columbia Centre for Disease Control, www.bccdc.org/downloads/pdf/rps/reports/RIN15.pdf, which has comprehensive guidelines.

Victoria Lutzky, 12, of Sutton Place, N.Y., went the extra mile for her sun protection. She enjoyed a view of the ocean while sitting under an SPF 50 tent.

“The S.P.F. is a terrible system to guide consumers,” Dr. Spencer said. “Nobody is using sunscreen the way it is measured in a lab.” He said he hopes that the new standards will call for S.P.F. to be replaced with a system defining sun protection as high, medium or low.

Until then, Dr. Spencer said that people should use about a shot glass of sunscreen for the body and a teaspoon for the face to best achieve the S.P.F. protection listed on labels. It should be reapplied every few hours and immediately after swimming or sweating.

Dermatologists said that the agency is also likely to introduce a rating system for the sun’s ultraviolet A rays, which can contribute to cancer and skin aging. Many products already contain UVA screening agents, but under the current rules there is no rating for them.

Manufacturers are catching on that some consumers seek UVA protection. In print advertisements this month, Neutrogena and Banana Boat have been battling for UVA supremacy, including graphs in which each shows their product offering the highest coverage.

But Dr. David M. Pariser, the president-elect of the American Academy of Dermatology, said that without a standardized UVA rating system, consumers can’t be sure how much a sunscreen provides.

“Right now, we don’t know whether doubling the percentage of a UVA sunscreen ingredient doubles UVA protection or not,” Dr. Pariser said. “That is part of the muddled system we hope will be cleared up.”

Until then, Dr. Pariser said to choose sunscreens that contain ingredients known to filter UVA. These include Mexoryl SX, avobenzone, titanium dioxide and zinc oxide. He also recommended a database at www.cosmeticsdatabase.com/special/sunscreens/summary.php created by the Environmental Working Group that lists products with UVA protection.

Some doctors, along with Mr. Blumenthal of Connecticut, predicted that the new sunscreen rules would prohibit outsized marketing terms.

“ ‘All-day protection’ is just plain false since sunscreen has to be frequently reapplied,” Mr. Blumenthal said. “And ‘waterproof,’ which may be O.K. for an adult taking a quick dip in the pool but not for kids who are in and out of the water all day, is just plain deceptive.”

Dr. Green in Australia said the best way to prevent skin cancer is to stay out of the sun during peak hours and wear sun-protective clothing. But Dr. Halpern said you can’t keep Americans wrapped up.

“There is only a small subset of American society that is willing to wear long-sleeved shirts and wide-brimmed — defined as four inches wide — hats on a sunny day at the beach,” he said. “Until we can get that behavior, the next best thing is sunscreen. Put on two coats, so you won’t miss any spots.”

Precautions

Protection from the sun’s harmful rays requires more than slapping on a coating of cream. There are multiple precautions to take, according to interviews with doctors.

• Avoid outdoor activities during peak sun hours of 10 a.m. to 4 p.m.

• Wear protective clothing, sunglasses and wide-brimmed hats.

• If you are prone to burn, use a sunscreen with S.P.F. 30 or higher.

• Apply about a teaspoon of sunscreen to your face and a shot glass of it to your body.

• Make sure your sunscreen contains at least one ingredient known to filter UVA rays, such as zinc oxide, titanium dioxide, avobenzone or Mexoryl SX.

• Reapply sunscreen frequently, and immediately after swimming.