Recently in Canada, there has been an effort to create consistent messaging about sun safety as there is a lack of up-to-date evidence-based guidelines regarding sun-protection measures. This review aimed to provide updated, evidence-based recommendations on sunscreen application, safety, and sun protection regarding the following topics for which there is clinical uncertainty: physical barriers, sunscreen properties, sunscreen application, and risk-benefit analysis.
ArmstrongBKKrickerA.The epidemiology of UV induced skin cancer. J Photochem Photobiol B Biol. 2001;63(1-3):8-18. doi:10.1016/S1011-1344(01)00198-1
4.
KullavanijayaPLimHW.Photoprotection. J Am Acad Dermatol. 2005;52(6):937-958. doi:10.1016/j.jaad.2004.07.063
5.
MarrettLDChuMBAtkinsonJet al. An update to the recommended core content for sun safety messages for public education in Canada: a consensus report. Can J Public Health. 2016;107(4-5):e473-e479. doi:10.17269/CJPH.107.5556
6.
BellNConnor GorberSTonelliMet al. From ABCs to GRADE: Canadian Task Force on Preventive Health Care’s new rating system for clinical practice guidelines. Can Fam Physician. 2013;59(12):1282-1289.
7.
WangSQLimHW, eds. Principles and Practice of Photo-protection. Switzerland: Springer International Publishing; 2016.
GiesP.Photoprotection by clothing. Photodermatol Photoimmunol Photomed. 2007;23:264-274. doi:10.1111/j.1600-0781.2007.00309.x
10.
SarkarAK. An evaluation of UV protection imparted by cotton fabrics dyed with natural colorants. BMC Dermatol. 2004;4(1):15. doi:10.1186/1471-5945-4-15
11.
CrewsP.KachmanS. BA. No title. Text Chem Color. 1999;31(6):17-26. doi:10.3403/00776353
12.
WrightALHartGCPeirceSC. Clothing protection factor of a replica England football shirt. Lancet. 1998;351(9117):1706. doi:10.1016/S0140-6736(05)77745
13.
GambichlerTRotterdamSAltmeyerPHoffmannK.Protection against ultraviolet radiation by commercial summer clothing: need for standardised testing and labelling. BMC Dermatol. 2001;1:6. doi:10.1186/1471-5945-1-6
14.
GhaziSCouteauCCoiffardLJM. How to guarantee adequate sun protection for a young sportsperson. 2011;2011(Band 9):470-474. doi:10.1111/j.1610-0387.2011.07660.x
15.
MoehrleMGarbeC. Solar UV-Protective Properties of Textiles. Dermatology. 2000;201(1):82. doi:10.1159/000018444
DainSJPhuongTNgoTet al. Sunglasses, the European directive and the European standard. 2010:253-256. doi:10.1111/j.1475-1313.2010.00711.x
18.
TuchindaCSrivannaboonSLimHW.Photoprotection by window glass, automobile glass, and sunglasses. J Am Acad Dermatol. 2006;54(5):845-854. doi:10.1016/j.jaad.2005.11.1082
19.
SlineyDH. Photoprotection of the eye – UV radiation and sunglasses. 2001;64:166-175.
20.
BehaviorsKSPichonLCMayerJAet al. Ethnoracial Differences Among Outdoor Workers in. 2005;28(4). doi:10.1016/j.amepre.2005.01.004
21.
OsterwalderUSohnMHerzogB.Global state of sunscreens. Photodermatol Photoimmunol Photomed. 2014;30(2-3):62-80. doi:10.1111/phpp.12112
22.
ReinauDWeissMMeierCRDiepgenTLSurberC. Outdoor workers ’ sun-related knowledge, attitudes and protective behaviours: a systematic review of cross- sectional and interventional studies. 2013;(Cmm). doi:10.1111/bjd.12160
23.
WilliamsJDMaitraPAtillasoyEWuM-MFarbergASRigelDS. SPF 100+ sunscreen is more protective against sunburn than SPF 50+ in actual use: Results of a randomized, double-blind, split-face, natural sunlight exposure clinical trial. J Am Acad Dermatol. 2018;78(5):902-910.e2. doi:10.1016/j.jaad.2017.12.062
24.
RussakJEChenTAppaYRigelDS.A comparison of sunburn protection of high–sun protection factor (SPF) sunscreens: SPF 85 sunscreen is significantly more protective than SPF 50. J Am Acad Dermatol. 2010;62(2):348-349. doi:10.1016/j.jaad.2009.05.025
25.
PissaviniMDiffeyB.The likelihood of sunburn in sunscreen users is disproportionate to the SPF. Photodermatol Photoimmunol Photomed. 2013;29(3):111-115. doi:10.1111/phpp.12033
26.
PetersenBWulfHC.Application of sunscreen − theory and reality. Photodermatol Photoimmunol Photomed. 2014;30(2-3):96-101. doi:10.1111/phpp.12099
27.
CouteauCPaparisEEl-Bourry-AlamiSCoiffardLJ.Influence on SPF of the quantity of sunscreen product applied. Int J Pharm. 2012;437(1-2):250-252. doi:10.1016/j.ijpharm.2012.08.019
28.
FaurschouAWulfHC.The relation between sun protection factor and amount of sunscreen applied in vivo. Br J Dermatol. 2007;156(4):716-719. doi:10.1111/j.1365-2133.2006.07684.x
29.
BimczokRGers-BarlagHMundtCet al. Influence of applied quantity of sunscreen products on the sun protection factor – a multicenter study organized by the DGK Task Force Sun Protection. Skin Pharmacol Physiol. 2007;20(1):57-64. doi:10.1159/000096173
30.
Ou-YangHStanfieldJColeCAppaYRigelD.High-SPF sunscreens (SPF ≥ 70) may provide ultraviolet protection above minimal recommended levels by adequately compensating for lower sunscreen user application amounts. J Am Acad Dermatol. 2012;67(6):1220-1227. doi:10.1016/j.jaad.2012.02.029
31.
AutierPDoréJFNégrierSet al. Sunscreen use and duration of sun exposure: a double-blind, randomized trial. J Natl Cancer Inst. 1999;91(15):1304-1309. doi:10.1093/jnci/91.15.1304
32.
SohnMHêcheAHerzogBImanidisG.Film thickness frequency distribution of different vehicles determines sunscreen efficacy. J Biomed Opt. 2014;19(11):115005. doi:10.1117/1.JBO.19.11.115005
33.
CouteauCDeméACheignonCCoiffardLJ.Influence of the hydrophilic-lipophilic balance of sunscreen emulsions on their water resistance property. Drug Dev Ind Pharm. 2012;38(11):1405-1407. doi:10.3109/03639045.2011.653362
DiffeyBLGriceJ.The influence of sunscreen type on photoprotection. Br J Dermatol. 1997;137(1):103-105. doi:10.1046/j.1365-2133.1997.17761863.x
36.
MoloneyFJCollinsSMurphyGM.Sunscreens: safety, efficacy and appropriate use. Am J Clin Dermatol. 2002;3(3):185-191. doi:10.2165/00128071-200203030-00005
37.
MohammedYHHolmesAHaridassIet al. Support for the safe use of zinc oxide nanoparticle sunscreens: lack of skin penetration or cellular toxicity after repeated application in volunteers. J Invest Dermatol. 2019;139(2):308-315. doi:10.1016/j.jid.2018.08.024
38.
FilipePSilvaJNSilvaRet al. Stratum corneum is an effective barrier to TiO2 and ZnO nanoparticle percutaneous absorption. Skin Pharmacol Physiol. 2009;22(5):266-275. doi:10.1159/000235554
39.
StokesRPDiffeyBL.A novel ex vivo technique to assess the sand/rub resistance of sunscreen products. Int J Cosmet Sci. 2000;22(5):329-334. doi:10.1046/j.1467-2494.2000.00027.x
PogodaJMPreston-MartinS.Solar radiation, lip protection, and lip cancer risk in Los Angeles County women (California, United States). Cancer Causes Control. 1996;7(4):458-463. doi:10.1007/BF00052672
42.
GabardBAdemolaJ.Lip sun protection factor of a lipstick sunscreen. Dermatology. 2001;203(3):244-247. doi:10.1159/000051758
43.
MaierHSchaubergerGBrunnhoferKHönigsmannH.Assessment of thickness of photoprotective lipsticks and frequency of reapplication: results from a laboratory test and a field experiment. Br J Dermatol. 2003;148(4):763-769. doi:10.1046/j.1365-2133.2003.05032.x
44.
GagliardiLBonadonnaLBrianeescoRet al. A study on sunscreen products: determination of PaO (period after opening) [article in Italian]. Rivista Italiana Delle Sostanze Grasse. 2008;85(2):107-119.
JungGWTingPTSalopekTG.Stability of sunscreens and sunblocks following exposure to extreme temperatures. J Am Acad Dermatol. 2012;66(6):1007-1009. doi:10.1016/j.jaad.2011.10.010
47.
SchalkaSdos ReisVMCucéLC.The influence of the amount of sunscreen applied and its sun protection factor (SPF): evaluation of two sunscreens including the same ingredients at different concentrations. Photodermatol Photoimmunol Photomed. 2009;25(4):175-180. doi:10.1111/j.1600-0781.2009.00408.x
48.
AutierPDoréJFCattaruzzaMSet al. Sunscreen use, wearing clothes, and number of nevi in 6- to 7-year-old European children. European Organization for Research and Treatment of Cancer Melanoma Cooperative Group. J Natl Cancer Inst. 1998;90(24):1873-1880. doi:10.1093/jnci/90.24.1873
49.
MarrettLDChuMBAtkinsonJRosenCF. An update to the recommended core content for sun safety messgaes for public education in Canada: A consensus report.
50.
DiazANealeREKimlinMGJonesLJandaM.The Children and Sunscreen Study: a crossover trial investigating children’s sunscreen application thickness and the influence of age and dispenser type. Arch Dermatol. 2012;148(5):606-612. doi:10.1001/archdermatol.2011.2586
51.
HeerfordtIMTorsnesLRPhilipsenPAWulfHC. Sunscreen use optimized by two consecutive applications. 2018:1-11.
52.
ElliottTNehlEJGlanzK. A controlled trial of objective measures of sunscreen and moisturizing lotion. Cancer Epidemiol Biomarkers Prev. 2009;18(5):1399-1402. doi:10.1158/1055-9965.EPI-08-0492
53.
BodekærMÅkerströmUWulfHC.Accumulation of sunscreen in human skin after daily applications: a study of sunscreens with different ultraviolet radiation filters. Photodermatol Photoimmunol Photomed. 2012;28(3):127-132. doi:10.1111/j.1600-0781.2012.00651.x
54.
Ou-YangHMeyerKHouserTGroveG. Sunscreen formulations do not interfere with sweat cooling during exercise. Int J Cosmet Sci. 2018;40(1):87-92. doi:10.1111/ics.12440
55.
SambandanDRRatnerD.Sunscreens: an overview and update. J Am Acad Dermatol. 2011;64(4):748-758. doi:10.1016/j.jaad.2010.01.005
56.
de GálvezMVAguileraJBuendíaEASánchez-RoldánCHerrera-CeballosE.Time required for a standard sunscreen to become effective following application: a UV photography study. J Eur Acad Dermatology Venereol. 2018;32(4):e123-e124. doi:10.1111/jdv.14626
57.
SayreRMDowdyJCLottDLMarloweE.Commentary on ‘UVB-SPF’: the SPF labels of sunscreen products convey more than just UVB protection. Photodermatol Photoimmunol Photomed. 2008;24(4):218-220. doi:10.1111/j.1600-0781.2008.00360.x
58.
BandiPCokkinidesVEWeinstockMAWardE. Sunburns, Sun protection and indoor tanning behaviors, and attitudes regarding sun protection benefits and tan appeal among parents of U.S. adolescents—1998 compared to 2004. Pediatr Dermatol. 2010;27(1):9-18. doi:10.1111/j.1525-1470.2009.01074.x
59.
J BrileyJL LynfieldYChavdaK. Sunscreen Use and Usefulness in African-Americans. Vol 6.; 2007.
RodríguezEValbuenaMCReyMPorras de QuintanaL.Causal agents of photoallergic contact dermatitis diagnosed in the national institute of dermatology of Colombia. Photodermatol Photoimmunol Photomed. 2006;22(4):189-192. doi:10.1111/j.1600-0781.2006.00212.x
62.
Avenel-AudranMDutartreHGoossensAet al. Octocrylene, an emerging photoallergen. Arch Dermatol. 2010;146(7):753-757. doi:10.1001/archdermatol.2010.132
AginPPRubleKHermanskySJMcCarthyTJ. Rates of allergic sensitization and irritation to oxybenzone-containing sunscreen products: a quantitative meta-analysis of 64 exaggerated use studies. Photodermatol Photoimmunol Photomed. 2008;24(4):211-217. doi:10.1111/j.1600-0781.2008.00363.x
65.
Buck LouisGMKannanKSapraKJMaisogJSundaramR. Urinary concentrations of benzophenone-type ultraviolet radiation filters and couples’ fecundity. Am J Epidemiol. 2014;180(12):1168-1175. doi:10.1093/aje/kwu285
66.
JanjuaNRMogensenBAnderssonA-Met al. Systemic Absorption of the sunscreens benzophenone-3, octyl-methoxycinnamate, and 3-(4-methyl-benzylidene) camphor after whole-body topical application and reproductive hormone levels in humans. J Invest Dermatol. 2004;123(1):57-61. doi:https://doi.org/10.1111/j.0022-202X.2004.22725.x
67.
GhazipuraMMcGowanRArslanAHossainT. Exposure to benzophenone-3 and reproductive toxicity: A systematic review of human and animal studies. Reprod Toxicol. 2017;73:175-183. doi:10.1016/j.reprotox.2017.08.015
DownsCAKramarsky-WinterESegalRet al. Toxicopathological effects of the sunscreen UV filter, oxybenzone (benzophenone-3), on coral planulae and cultured primary cells and its environmental contamination in Hawaii and the U.S. virgin Islands. Arch Environ Contam Toxicol. 2016;70(2):265-288. doi:10.1007/s00244-015-0227-7
70.
SchneiderSLLimHW. Review of environmental effects of oxybenzone and other sunscreen active ingredients. J Am Acad Dermatol.2019;80(1):266-271. doi:10.1016/j.jaad.2018.06.033
71.
Blume-PeytaviUTanJTennstedtDet al. Fragility of epidermis in newborns, children and adolescents. J Eur Acad Dermatology Venereol. 2016;30:3-56. doi:10.1111/jdv.13636
72.
SchlumpfMDurrerSFaassOet al. Developmental toxicity of UV filters and environmental exposure: A review. Int J Androl. 2008;31(2):144-151. doi:10.1111/j.1365-2605.2007.00856.x
73.
PhillipsTJBhawanJYaarMBelloYLoPiccoloDNashJF. Effect of daily versus intermittent sunscreen application on solar simulated UV radiation–induced skin response in humans. J Am Acad Dermatol. 2000;43(4):610-618. doi:10.1067/mjd.2000.107244
ColeCAppaYOu-YangH. A broad spectrum high-SPF photostable sunscreen with a high UVA-PF can protect against cellular damage at high UV exposure doses. Photodermatol Photoimmunol Photomed. 2014;30(4):212-219. doi:10.1111/phpp.12124
76.
MeinkeMCHaagSFSchanzerSGrothNGersondeILademannJ. Radical protection by sunscreens in the infrared spectral range. Photochem Photobiol. 2011;87(2):452-456. doi:10.1111/j.1751-1097.2010.00838.x
77.
HughesMCBWilliamsGMBakerPGreenAC. Sunscreen and prevention of skin aging: A randomized trial. Ann Intern Med. 2013;158(11):781-790. doi:10.7326/0003-4819-158-11-201306040-00002
78.
IannaconeMRHughesMCBGreenAC. Effects of sunscreen on skin cancer and photoaging. Photodermatol Photoimmunol Photomed. 2014;30(2-3):55-61. doi:10.1111/phpp.12109
79.
SéiteSMoyalDRichardSet al. Mexoryl® SX: a broad absorption UVA filter protects human skin from the effects of repeated suberythemal doses of UVA. J Photochem Photobiol B Biol. 1998;44(1):69-76. doi:10.1016/S1011-1344(98)00122-5
80.
van der PolsJCWilliamsGMPandeyaNLoganVGreenAC. Prolonged prevention of squamous cell carcinoma of the skin by regular sunscreen use. Cancer Epidemiol Biomarkers & Prev. 2006;15(12):2546 LP - 2548. doi:10.1158/1055-9965.EPI-06-0352
81.
DarlingtonSWilliamsGNealeRFrostCGreenA. A randomized controlled trial to assess sunscreen application and beta carotene supplementation in the prevention of solar keratoses. JAMA Dermatology. 2003;139(4):451-455. doi:10.1001/archderm.139.4.451
82.
HirstNGGordonLGScuffhamPAGreenAC. Lifetime cost-effectiveness of skin cancer prevention through promotion of daily sunscreen use. Value Heal. 2012;15(2):261-268. doi:10.1016/j.jval.2011.10.009
83.
GreenASiskindVBainCAlexanderJ. Sunburn and malignant melanoma. Br J Cancer. 1985;51(3):393-397. doi:10.1038/bjc.1985.53
84.
SilvaES daTavaresRPaulitschF da SZhangL. Use of sunscreen and risk of melanoma and non-melanoma skin cancer: A systematic review and meta-analysis. Eur J Dermatol. 2018;28(2):186-201. doi:10.1684/ejd.2018.3251
85.
SavoyeIOlsenCMWhitemanDCet al. Patterns of ultraviolet radiation exposure and skin cancer risk: The E3N-SunExp study. J Epidemiol. 2018;28(1):27-33. doi:10.2188/jea.JE20160166
86.
RueeggCSStenehjemJSEggerMet al. Challenges in assessing the sunscreen-melanoma association. Int J Cancer. 2018. doi:10.1002/ijc.31997
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