PERSPECTIVE

Sunscreens: Misconceptions and Misinformation

Sara Moradi Tuchayi1,2, Zixiao Wang3, Jiajun Yan3, Lilit Garibyan1,2, Xuefei Bai4 and
Barbara A. Gilchrest2

Over the past 70 years, sunscreens have evolved from beach products designed to prevent sunburn to more
cosmetically elegant skincare products intended to protect against multiple long-term adverse consequences
of characteristically low-intensity daily UV and visible light exposure. Sunscreen testing and labeling intended
to quantify such protection are unfortunately often misunderstood by users and have also led to illegal
misleading and potentially dangerous industry practices. Changes in regulatory requirements, better policing,
and more informative sunscreen labeling would benefit users and their physician advisors.
Journal of Investigative Dermatology (2023) 143, 1406e1411; doi:10.1016/j.jid.2023.03.1677

THE SUN-PROTECTION FACTOR:
DERIVATION, DEFINITION, AND
LIMITATIONS
Sunscreens were first commercialized
in the 1950s by Franz Greiter and col-
leagues as a means of preventing sun-
burn among fair-skinned Europeans and
Americans (Pathak et al., 1983). He
coined the term sun protection factor or
sun-protection factor (SPF) as a short-
hand measure of this protection,
defined as the sun exposure time for
sunscreen-protected skin to develop
delayed erythema divided by that of
unprotected skin (Pathak et al., 1983).
Thus, someone who would typically
develop a mild sunburn 16
24 hours
after a 30-minute exposure, when using
an SPF 10 sunscreen would develop an
equivalent sunburn after a 300-minute
or 5-hour exposure. Expressed differ-
ently, an SPF 10 sunscreen transmits to
the skin 1/SPF or 1/10 (10%) of the
energy responsible for sunburn. A
product’s SPF is determined by
exposing small squares on a test sub-
ject’s back, half of them after applica-
tion of the product, to increasing doses
of natural sunlight or solar-simulated
laboratory-generated light and then
examining the area the following day
(Pathak et al., 1983). Unfortunately, this
method is well-documented to yield
variable SPF values, depending on the
test subjects’ skin type and other vari-
ables (Andrews et al., 2022; Ricci et al.,
2020; Wang and Lim, 2011), as made
clear from the wide range of UV ab-
sorption profiles for selected commer-
cial sunscreens labeled as having SPF
values of 30e70 (Figure 1a). This SPF is
often found to differ from that deduced
by the subsequently developed in vitro
method determining the transmission of
solar-simulated UVB (290e320 nm)
through a standardized amount of sun-
screen product in a laboratory setting
(Ricci et al., 2020). Nevertheless, the
Food and Drug Administration (FDA)
and equivalent agencies in Europe and
Asia still require in vivo SPF determi-
nation and a value of at least 15 before
a sunscreen is labeled and sold (Wang
and Lim, 2011).
By the 1990s, it had also been well-
established that UVB irradiation
caused skin cancers in mice (Kligman
et al., 1980) and that DNA mutations
in humans mechanistically related to
skin cancers, such as those inactivating
the p53 tumor suppressor protein
(Brash et al., 1991). Furthermore, reg-
ular UVB-protective sunscreen use was
shown to reduce the incidence of both
squamous cell carcinomas (van der Pols
et al., 2006) and melanomas (Green
et al., 2011) in a well-controlled long-
term prospective Australian study of
human volunteers. In contrast to the
human sunburn studies, the precise
action spectrum for human photo-
carcinogenesis could not be deter-
mined, leaving open the possibility that
longer and more deeply penetrating
wavelengths (UVA, 320
400 nm)
contribute.
UVA AND VISIBLE LIGHT
PROTECTION NEEDS
Because UVA penetrates far more
deeply into the skin than UVB (Pathak
et al., 1983), it was also deemed likely
to be substantially responsible for so-
called photoaging, the wrinkling, dys-
pigmentation, and other changes that
characterize habitually sun-exposed
skin of older adults. Over time, clinical
observations and animal experiments
(Kligman et al., 1996) provided
compelling support for the belief that
even the longest and least energetic
wavelengths of the UV spectrum (UVA I,
340
400 nm) as well as visible light
(400
700 nm) contribute to this damage
as well as to melasma and other
pigmentary disorders (Boukari et al.,
2015; Kohli et al., 2018; Kullavanijaya
and Lim, 2005; Mahmoud et al., 2010;
Martini and Maia Campos, 2018) that

1
Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; 2Department of
Dermatology, Harvard Medical School, Boston, Massachusetts, USA; 3School of Physical Science and Technology, Shanghai Tech University, Shanghai,
China; and 4B.A.I. Biosciences, Cambridge, Massachusetts, USA
Correspondence: Barbara A. Gilchrest, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Fruit Street, Boston 02114,
Massachusetts, USA. E-mail: bgilchrest@mgh.harvard.edu
Abbreviations: FDA, Food and Drug Administration; SPF, sun-protection factor
Received 8 March 2023; revised 27 March 2023; accepted 28 March 2023; accepted manuscript published online 11 April 2023; corrected proof published
online 17 June 2023

ª 2023 The Authors. Published by Elsevier, Inc. on behalf of the Society for Investigative Dermatology. This is
1406 Journal of Investigative Dermatology (2023), Volume 143 an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
 S Moradi Tuchayi et al.
Sunscreen Concerns

Figure 1. Protection profiles for 13 representative marketed and one hypothetical broad-spectrum sunscreens. (a) The hypothetical sunscreen (dotted black
line) is a mineral sunscreen now being formulated but not yet marketed that does not qualify for the broad-spectrum designation. UV and visible light absorption
for marketed sunscreens were tested in vitro at 1.3 mg/cm2. All products were evaluated using the ISO 24443:2021 in vitro method for sunscreen UV-protection
effectiveness. The hypothetical sunscreen fails to qualify as broad spectrum because >90% of the area under the curve lies to the left of the 370 nm critical
wavelength (vertical black line), as required by the FDA, despite and because of providing better UVB and UVA absorption than any of the qualifying broad-
spectrum products. (b) UV and visible light absorption were also determined for the same marketed sunscreens applied at 0.5 mg/cm2. (c) UV and visible light
absorption for three marketed sunscreens representing mineral, hybrid, and chemical sunscreen types (Table 1) applied at 1.3 mg/cm2 (solid lines) versus 0.5 mg/
cm2 (dashed lines). Note the marked differences among products in the shape of the absorption curves and the effect of reduced application amount on loss of
UV protection. FDA, Food and Drug Administration; OD, optical density.

preferentially affect younger adults with
darker skin types. Unfortunately, the
precise action spectra for all these end-
points, requiring months to decades of
sun exposure, is and likely will remain
unknown. Thus, no measure equivalent
to the SPF for sunburn prevention can be
devised. Instead, the concept of broad-
spectrum protection was developed,
and sunscreen formulas were modified
to scatter or absorb wavelengths beyond
the UVB range responsible for sunburn
into at least the UVA range (Wang and
Lim, 2011).
Ambient sunlight comprises approx-
imately 0.5% UVB, 5% UVA, 45%
visible light, and 50% infrared (heat)
energy (Pathak et al., 1983), although
the specific amount of energy in each
waveband varies with season, location
of the earth’s surface, time of day, cloud
cover, and other variables. Because
UVA, unlike UVB, is relatively abun-
dant in sunlight all day and all year and
is also substantially transmitted through
standard window glass (Pathak et al.,
1983), the market for sunscreens grad-
ually expanded from beach products to
a cornerstone of year-round daily skin
care for many consumers. The resulting
demand for such sunscreens led to
parallel efforts on the part of sunscreen
manufacturers to satisfy this demand.
In recent years, the focus on appro-
priate photoprotection has shifted to
emphasize the relatively modest role of
visible light in cutaneous photo-
damage, particularly its role in mel-
asma and other hyperpigmentation
disorders (Boukari et al., 2015; Kohli
et al., 2018; Mahmoud et al., 2010;
Martini and Maia Campos, 2018). This

www.jidonline.org 1407
 S Moradi Tuchayi et al.
Sunscreen Concerns
emphasis has provided the sunscreen
industry with a welcome new story and
an expanded market of darker-skinned
individuals unconcerned by sunburn
risk or even photoaging but prone to
unwanted hyperpigmentation. The
emphasis on visible light protection
also deflects attention from the tech-
nical difficulty of providing truly broad-
spectrum UVA-blocking products that
rely on existing UV filters. Instead, tints,
red, yellow, and/or black iron oxides in
varying amounts are added to sun-
screen formulas to provide substantial
absorption throughout the UVA I and
visible light spectra (Lyons et al., 2021).
By varying the amounts of different
colored iron oxides and nonmicronized
titanium dioxide, which appears white
on the skin, the manufacturer can
create colored makeup-like sunscreen
products intended to match a user’s
skin color (Lyons et al., 2021). It is
anticipated that tinted sunscreens may
best find acceptance among users
afflicted with symptomatic visible
light
induced dermatoses, such as
porphyria or solar urticaria (Austin
et al., 2021), whereas those with more
subtle problems attributable in un-
known part to visible light may instead
wish to rely on more cosmetically
elegant broad-spectrum UVA I protec-
tion that offers modest extension into
the visible light spectrum.
Some recent sunscreen innovations
and points of advertising emphasis have
generated areas of confusion, misinfor-
mation, and questionable safety of
some products for both the user and the
environment. We present below data
generated using standard FDA-
mandated testing methods and
commercially available sunscreens to
highlight and clarify these issues.
Finally, we suggest changes in sun-
screen ingredients and product labeling
that might reduce current confusion
and guide consumers to sunscreens that
best address their specific concerns.
BROAD-SPECTRUM PROTECTION
Although the FDA-mandated descriptor
Broad Spectrum suggests to sunscreen
users minimal transmission of wave-
lengths across the UV spectrum, this is
often not the case (Figure 1a). The cur-
rent FDA definition of broad spectrum
requires only an SPF rating of at least 15
and that the wavelength cutoff for 90%
1408 Journal of Investigative Dermatology (2023), Volume 143
of the total UV energy (290
400 nm)
blocked by the product be at or beyond
370 nm3 (Figure 1a). The choice of a
370 nm critical wavelength cutoff, in
the absence of action spectra for long-
term adverse UVA effects, is arbitrary
and seemingly based primarily on the
efficacy profiles of currently marketed
sunscreens. Ironically, the definition
also encourages lower UVB protection
levels, although the in vivo SPF deter-
mination on the product label often
conceals this from the user. Such la-
beling is minimally informative, espe-
cially if the user’s goal is to prevent
unwanted consequences of sun expo-
sure such as melasma or lentigines.
Moreover, the definition results in
nonsensical exclusions for the broad-
spectrum designation (Figure 1a).
EFFECT OF APPLICATION AMOUNT
ON DEGREE OF PROTECTION
SPF determinations, as required by the
FDA, are performed with a specified
amount of sunscreen: 1.3 mg/cm2 for
in vitro determinations and 2 mg/cm2 for
in vivo determinations (Kullavanijaya
and Lim, 2005). However, studies have
documented that test subjects, when
instructed to apply sunscreen in their
customary manner, apply far less (closer
to 0.5
0.8 mg/cm2) than the FDA-
specified amount for determination of
the SPF rating in vivo (Kullavanijaya and
Lim, 2005). This greatly increases the
amount of both UVB and UVA energy
transmitted through the product to the
skin (Figure 1b and c). Given the high
SPF values for many sunscreens, such
under protection may not result in sun-
burn, but cumulative effects of years-
long less-than-expected protection
across the entire UV and visible spectra
are however difficult to assess.
CHEMICAL VERSUS MINERAL
DESIGNATION
Sunscreen-active ingredients are classi-
fied as chemical or mineral (also termed
organic or inorganic). Chemical in-
gredients, such as avobenzone, contain
aromatic ring structures and absorb UV
energy, characteristically in the UVB
range, although some also have an ab-
sorption shoulder in the UVA range
(Pathak et al., 1983). Absorption of
photons randomly causes these mole-
cules to decompose and lose their ability
to further absorb UV energy. Because
they do not absorb visible light, howev-
er, they are invisible on the skin and thus
considered cosmetically elegant. Min-
eral sunscreen ingredients, such as the
commonly used zinc oxide or titanium
dioxide, scatter wavelengths across the
entire UV (290
400 nm) and visible
(400
700 nm) spectra. They may also
absorb light of certain wavelengths
depending on their bandgaps, which are
in turn determined by their particle sizes
(Cheng et al., 2006). They are chemi-
cally inert and photostable. Unfortu-
nately, the degree of protection depends
on the amount applied, as it does for all
sunscreens, and at higher amounts of
conventional preparations, the scat-
tering of visible light gives a white cast to
the skin that is considered a cosmetic
liability by most users. Fortunately,
scattering of light by particles is size
dependent (Plass, 1966). Modifications
will be required in the manufacturing
process for zinc oxide to produce
smaller particles that retain the ability to
reflect incident light while remaining
invisible on the skin surface even at
moderately high concentrations.
Concerns regarding the traditionally
more transparent chemical sunscreens
thus include their photolabilty, usually
requiring reapplication over the course
of the day to maintain the advertised
degree of protection. In addition, it is
now well-documented that chemical
sunscreen ingredients can cause irritant
or allergic contact dermatitis (Schauder
and Ippen, 1997) and are absorbed
through users’ skin (Matta et al., 2020)
and can be detected in blood and
breast milk (Krause et al., 2012), raising
concerns about endocrine disruption
(Schneider and Lim, 2019) and other
adverse effects with regular long-term
use. Adverse environmental effects,
such as damage to coral (Ouchene
et al., 2019; Schneider and Lim,
2019), are also of concern and have
led Hawaii, Key West, and the U.S.
Virgin Islands, for example, to prohibit
the sale or use of all chemical sun-
screens (Fivenson et al., 2020).
THE DOPING PROBLEM
Without ultramicronized zinc oxide or
titanium dioxide particles, consumers
are left with a dilemma: to use a
chemical sunscreen product potentially
harmful to users and the environment
or a mineral sunscreen that typically
 S Moradi Tuchayi et al.
Sunscreen Concerns

Table 1. Both Chemical- and Mineral-Labeled Sunscreens Are Frequently penetration of these doping ingredients
Doped, Impairing the Ability of Consumers and Regulators to Identify (Figure 2c), using the same standard
Products with Medical or Environmental Concerns and Enhancing the methodology as used in studies that gave
Labeled SPF Using Non-FDALApproved Chemical Filters rise to human health concerns about the
absorption of chemical sunscreen in-
Labeled
Brand Sunscreen Name Type Doped? Likely Doping Ingredient(s) gredients (Matta et al., 2020).
These results suggest that sunscreen
SkinBetter Sunbetter Sheer SPF 70 Mineral Yes Butyloctyl salicylate
users concerned about possible adverse
Science
Neutrogena Ultrasheet Dry-touch Sunscreen Chemical Yes Butyloctyl salicylate
effects of chemical filters on their
SPF 55 health and/or on the environment may
ISDIN Photo Eryfotona Actinica Mineral No wish to avoid inaccurately labeled
Ultralight Emulsion SPF 50þ mineral sunscreens as well as chemical
Tatcha Silk Sunscreen SPF 50 Mineral Yes Tridecyl salicylate sunscreens with prohibited levels of
La Roche Anthelios Light Fluid Sunscreen Mineral Yes Butyloctyl salicylate, Diethylhexyl chemical filters. Equally, regulatory
Posay SPF 50 syringylidenemalonate
agencies might require that all known
La Roche Anthelios Mineral Sunscreen Mineral Yes Diethylhexyl
Posay Gentle Lotion SPF 50 syringylidenemalonate, Capryloyl or reasonably presumed chemical fil-
salicylic acid ters be so identified in product labels or
EltaMD UV Clear SPF 46 Hybrid No omitted if shown to be acting as non-
EltaMD UV Daily SPF 40 Hybrid No FDA
approved chemical UV filters.
Supergoop Unseen Sunscreen SPF 40 Chemical No
SkinMedica Essential Defense Mineral Shield Mineral No PROPOSED ALTERNATIVE TO THE
Broad Spectrum SPF 35
PRESENT SUNSCREEN LABELING
Summer Shade Drops Sunscreen SPF 30 Mineral Yes Ethyl ferulate
Fridays
REQUIREMENTS
La Roch Anthelios HA Mineral SPF 30 Mineral Yes Diethylhexyl Numerous concerns have been raised
Posay syringylidenemalonate, Capryloyl regarding the FDA-mandated sunscreen
salicylic acid rating system. These include the often
Supergoop Mineral Sheerscreen SPF 30 Mineral Yes Butyloctyl salicylate misleadingly high in vivo SPF designa-
Abbreviations: FDA, Food and Drug Administration; SPF, sun-protection factor. tions (Andrews et al., 2022) and the
Products are identified as doped (column 4) if they contain one or more ingredients listed on the poorly understood and arbitrary broad-
product label as a stabilizer but are known to contain a ring structure capable of absorbing UV light spectrum designation that provides very
and/or being highly similar to known chemical UV filters. In some cases, sunscreen manufacturing
literature provides UV absorption profiles for such stabilizers. little guidance to consumers on the
degree of UVA protection. These
shortcomings are compounded by the
leaves a white cast and tends to feel ingredient(s). See Table 1 for an analysis of fact that the current SPF rating system
greasy on the skin. For users content the products shown in Figure 1. suggests to consumers misleadingly
with a makeup-like sunscreen, a solu- The precise composition of all com- large differences, for example, among
tion to this problem is the addition of a mercial sunscreens remains a trade se- products blocking 99% of eryth-
skin-tone pigment to a mineral sun- cret. To address the possibility that a emogenically weighted UVB (SPF 100),
screen that masks the white cast (Austin suspected doping ingredient listed on 98% of erythemogenically weighted
et al., 2021), although users tend to the mineral sunscreen label contributes UVB (SPF 50), 97% of erythemogeni-
apply far less than recommended, to the product’s listed UVB and UVA II cally weighted UVB (SPF 30), or 95% of
decreasing protection. absorption, we performed the following erythemogenically weighted UVB (SPF
Some sunscreen manufacturers appear experiments. The suspected doping 20), especially considering that the
to have chosen the less straightforward sunscreen ingredient at 5%, the same customarily applied amounts of sun-
solution of doping, defined as the addition concentration specified on the label of screen do not achieve the labeled de-
of a non-FDA
approved UV filter the marketed mineral sunscreen as a gree of protection in any case. For
described on the label as a stabilizer to a stabilizer, was prepared in our labora- example, SPF ratings for the UVB
product described on the label as a min- tory in a standard sunscreen base lacking portion of the spectrum might better be
eral sunscreen. This component then in- other UV filters and compared with the given as the percentage of erythemo-
creases the mineral sunscreen product’s same base composition lacking the sta- genic energy blocked, that is, as SPF 95
UVB and UVA II absorption without bilizer. Unsurprisingly, the tested stabi- rather than as the present SPF 20 or,
requiring a concentration of mineral UV lizers absorb UVB and UVA II better, the somewhat lower value ob-
filters sufficient to produce the unwanted (Figure 2a). Butyloctyl salicylate is in the tained when the tested film is 0.5 mg/
white cast. In other cases, such an ingre- same salicylate family as FDA-approved cm2 rather than the currently mandated
dient is added as a stabilizer to a known chemical UV filters homosalate and 1.3 mg/cm2 (Figure 1). Meaningful UVA
chemical sunscreen to boost its UVB and octisalate, and ethyl ferulate is an analog protection ratings are far more difficult
UVA II absorption without exceeding the of the FDA-approved chemical UV filter to construct, given that the action
maximum-permitted concentration of its octinoxate (Figure 2b). Also unsurpris- spectra for the multiple delayed adverse
known, approved chemical sunscreen ingly, in vitro studies documented skin effects are unknown and may well

www.jidonline.org 1409
 S Moradi Tuchayi et al.
Sunscreen Concerns

Figure 2. Properties of ingredients described as stabilizers on the label of marketed mineral sunscreens (Table 1). (a) UV absorption for sunscreen base alone
(blue line) and for the same base with added butyloctyl salicylate 5% (red line) or ethyl ferulate 5% (green line), showing substantial UVB and UVA II protection
by the stabilizers. Note that the vertical axis is shown as 0.0
2.1, not 0.0
2.5 as in Figure 1. (b) The molecular structure of butyloctyl salicylate is virtually
identical to the FDA-approved chemical filter octisalate, and ethyl ferulate is a chemical analog of the FDA-approved chemical filter octinoxate. (c) Butyloctyl
salicylate and ethyl ferulate penetrate the skin comparably with FDA-approved chemical filters using a standard in vitro method (Krause et al., 2012). Note that
ethyl ferulate, a known chemical irritant, damages the stratum corneum under the text conditions, leading to large and variable penetration at 24 hours. Graphed
points are mean  SD of three parallel determinations. FDA, Food and Drug Administration; h, hour.

involve interactions among different
portions of the UV spectrum, including
UVB. New labeling should eliminate or
at least sideline the present rather
meaningless SPF wars and allow con-
sumers to differentiate between high
and low levels of UVA and visible light
protection as well as UVB protection in
marketed products. At present, perhaps
labels should simply provide a diagram
showing the proportion of UV energy
blocked by the sunscreen (Figure 1)
over a shaded area showing the range
of other products’ protection. Con-
cerned users or their advising physi-
cians could then select or recommend
specific sunscreens, on the basis of
specific goals for short-term and long-
term sun protection. As future research
clarifies the action spectra for photo-
aging, melasma, and other as yet poorly
understood adverse effects of chronic
sun exposure, the rating system could
be modified to convey the new
information.
Finally, because the issue of vitamin D
sufficiency has been repeatedly raised in
debates over sunscreen usage, it should
be emphasized that the action spectrum
for cutaneous vitamin D production is
well-established and solidly in the UVB
range (Wolpowitz and Gilchrest, 2006).
Population studies have shown that reg-
ular use of high SPF sunscreens is not
associated with vitamin D deficiency,
likely because maximal vitamin D
synthesis requires little UVB exposure
and/or because sufficient vitamin D is
obtained from a typical American or Eu-
ropean diet (Reddy and Gilchrest, 2010).
Hence, regular use of a true broad-
spectrum sunscreen would similarly
pose no risk, and this information might
also be added to product labels.
ORCIDs
Sara Moradi Tuchayi: http://orcid.org/0000-
0001-408X
Zxiao Wang: http://orcid.org/0000-
0003-2627-6630
Jiajun Yan: http://orcid.org/0000-0003-3286-3268
Xuefei Bai: http://orcid.org/0000-0001-5344-9221
Lilit Garibayan: http://orcid.org/0000-0002-9266-
0887
Barbara A. Gilchrest: http://orcid.org/0000-0001-
9906-1898

1410 Journal of Investigative Dermatology (2023), Volume 143


CONFLICT OF INTEREST
XB is the founder and chief executive officer of
B.A.I. Biosciences, the company marketing sun-
screen products, and performed or supervised some
of the experiments mentioned earlier. JY is a sci-
entific advisor for B.A.I. Biosciences. BAG is a paid
consultant for B.A.I. Biosciences. LG and SMT
performed many of the experiments mentioned
earlier at Wellman Laboratories, Massachusetts
General Hospital with support from a grant to Mass
General Brigham from B.A.I. Biosciences.
ACKNOWLEDGMENTS
This study was funded by B.A.I. Biosciences.
AUTHOR CONTRIBUTIONS
Conceptualization: XB, BAG; Data Curation: SMT,
LG, ZW, JY, XB, BAG; Formal Analysis: SMT, ZW,
JY; Investigation: SMT, ZW, JY, XB; Methodology:
JY, XB; Project Administration: LG, JY, XB: Re-
sources: LG, JY, XB; Supervision: LG, JY, XB;
Visualization: XB, BAG; Writing e Original Draft
Preparation: BAG; Writing - Review and Editing:
JMT, LG, ZW, JY, XB, BAG
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