SPA WELLNESS: Sun Screening

Day Spa Magazine

June 5, 2013

SPA WELLNESS: Sun Screening
 By Tracy Morin

Regardless of the extent of awareness now surrounding the importance of sun protection, melanoma rates climbed drastically from 1970 to 2009—increasing by 800% among young women and 400% among young men, according to the Public Access to Sunscreens (PASS) Coalition—which makes it more common than all other cancers combined. Hence, it has never been more crucial for spa professionals to understand the latest regulatory policies regarding the labeling of SPF products and inform clients about sun protection today—and of course to become first-line responders by screening for early signs of skin cancer.

The Regulatory Story

The U.S. Food and Drug Administration (FDA) recommends that consumers use sunscreen products to reduce the risk of various types of sun-induced skin damage, including sunburn, skin cancer and early signs of aging. According to the organization, sunburn is primarily caused by ultraviolet B (UVB) radiation, but officials note that skin cancer and early skin aging are caused by both UVB and ultraviolet A (UVA) radiation. In recent years, the FDA has increasingly taken both of these forces into account to establish new sunscreen testing and labeling requirements, designed to help consumers make more informed decisions about their sunscreen products.

Hensin Tsao, associate professor of dermatology at Harvard University and clinical director of Massachusetts General Hospital’s Melanoma & Pigmented Lesion Center in Boston, explains that the first generation of sunscreens focused on UVB, because that wavelength is what causes visible effects—i.e., sunburn. But then, scientists realized that UVA actually penetrates deeper, having damaging effects that scientists still don’t fully understand but that generally lead to oxidative damage, the altering of collagen and elastin, wrinkling and photo damage. “As more studies suggested that the combination of UVA and UVB is what promotes cancer, the next generation of sunscreens were designed to target UVA as well,” says Tsao.

To help determine a sunscreen product’s ability to assist in reducing sun-induced skin damage, the FDA has established two efficacy tests: the SPF Test (see Understanding SPF, below), which measures the level of sunburn protection provided by the sunscreen product (i.e., UVB protection only); and the Broad-Spectrum Test, which measures the UV absorbency of the sunscreen product across UVB and UVA wavelengths.
“All sunscreen products need to be labeled with the SPF value as determined by the SPF Test, and all sunscreen products are allowed to label themselves with a claim for helping to prevent sunburn based on this test,” notes Lisa Kubaska, spokesperson for the FDA’s Center for Drug Evaluation and Research. “However, only products that pass the Broad-Spectrum Test can be additionally labeled as ‘broad-spectrum’ and, the broad-spectrum term and SPF value must appear as continuous text [e.g., ‘Broad-Spectrum SPF 15’].”

The FDA further states that only products that are broad-spectrum SPF 15 or higher are allowed a claim for decreasing the risk of sun-induced skin cancer and early skin aging—if used as directed with other sun protection measures, which include avoiding the midday sun and wearing protective clothing.

Another longstanding concern of the FDA concerns the labeling surrounding a product’s water-resistance. Hence, 2011’s Water-Resistance Test. The Water-Resistance Test is a modification of the SPF Test; it requires test subjects to apply the sunscreen product, and then immerse themselves in a tub of water for either 40 or 80 minutes, after which they’re exposed to doses of UV. Products tested according to the water-resistance test may be labeled as water-resistant (40 minutes) or water-resistant (80 minutes), depending on whether they were tested using the stipulated 40- or 80-minute water immersion times.

Tsao mentions another recent development in the world of SPF: the motion afoot to cap SPF at 50. The FDA has indeed proposed labeling that limits products to a “50+” SPF. “We lacked data demonstrating that products with SPFs higher than 50 provided any additional benefit compared to products with SPFs of 50,” explains Kubaska. The organization is currently evaluating its data but, until the proposal is finalized, sunscreen products with SPFs higher than 50 are allowed to market “under FDA’s enforcement discretion,” says Kubaska.

And what's the state of common sunscreen ingredients' safety? While the FDA is continually evaluating the safety of sunscreens, currently it is “not aware of any data demonstrating that the active ingredients in currently marketed OTC sunscreen products pose any safety hazard to consumers,” says Kubaska, who adds, “We will continue to evaluate the safety of sunscreens' active ingredients according to current standards of drug safety testing as part of our ongoing review of the OTC Monograph for sunscreen drug products.”

Raising the Shield

A first step in helping spa clients protect themselves against the effects of aging (as well as more serious complications such as skin cancer) is to inform them about the critical and proper use of sun protection, with an emphasis on reapplication. Many spa pros cap massage and facial sessions with some wise words of cautionary wisdom.

“I tell patients to reapply at least every two hours, because many people think they can put on SPF 50 in the morning and they’re fine for the entire day,” says Tsao. “But after a few hours, a sunscreen that’s SPF 100 will go down to SPF 5!” He adds that clients often buy one tube or spray to last the entire summer, when they should actually be using a tube in a week or less; total body coverage requires about three grams of product.
Any delivery system—gel, cream, ointment, etc.—can be effective; the right formula is simply the one that your client will be most apt to reapply every couple of hours, says Tsao. “An SPF 30 that is broad-spectrum and water-resistant should do the job, since an SPF of 15 to 30 blocks 96% to 98% of sun damage.”

In addition to providing clients with general education, estheticians and other spa employees can literally save lives by checking skin for signs of abnormalities during services. To honor the role that beauty professionals can play in early detection, The Melanoma Foundation of New England (MFNE), based in Concord, Massachusetts, launched a program this spring called The Skinny On Skin, which educates pros on how to identify suspicious moles on areas that clients can’t readily see, such as on the scalp, neck and back. (The MFNE reports that although only 10% of melanoma occurs on the neck and scalp, these instances account for a large portion of all melanoma deaths, as they often go undetected or are caught late.)

And, since spa professionals see their clients, on average, every few weeks (more often than most people visit doctors), and are familiar with their clients’ skin, they’re in the unique position to spot potential melanoma long before anyone else. “Even dermatologists might not examine the scalp for melanoma, which can be easier to see when the hair is wet,” explains Deb Girard, executive director of MFNE. “With basic training, beauty and spa professionals can learn how to talk with clients about anything that is new or evolving. Pros and their employees can be great partners in the quest to raise awareness.” The ultimate goals of the program: To increase the frequency with which pros look for dangerous signs (using the “ABCDE” guidelines), to deliver “safe sun” messages, and to foster greater awareness of melanoma.

Sunscreen Stagnation?

The Public Access to Sunscreens (PASS) Coalition was formed this year as a “multi-stakeholder coalition of health organizations, sunscreen ingredient companies, dermatologists and citizens who are working with the Food and Drug Administration (FDA), the White House, Congress, healthcare providers, consumer organizations and sunscreen manufacturers to establish a framework for approval of the next generation of UV light active filters for over-the-counter sunscreens.”

While many consumers might assume that sunscreen technology is improving rapidly, the coalition reports that the last time the FDA approved a new sunscreen ingredient was in the 1990s—but that outside of the United States, a new generation of photo-stable, broad-spectrum sunscreens that offer UVA and UVB protection have been approved for use. And, since 2002, there have been eight pending sunscreen ingredient applications that are still awaiting approval from the FDA.

“Since the time and extent application [TEA] process was established in 2002, no new ingredients have been approved, so we’re trying to understand why—is it a resource or data issue? What are the holdups?” reports Al Pearce, senior marketing manager of personal care North America for BASF Corporation, a chemical company in Florham Park, New Jersey.

“One such ingredient approved for use in other countries is bemotrizinol, which offers broad-spectrum protection and allows products to attain a high level of SPF,” Pearce says. He advises concerned spa owners and clients to visit the PASS Coalition website to learn how to contact congresspeople and senators, and express concern.

Understanding SPF

SPF measures how long it takes for the skin to develop redness versus how long it would take without sunscreen, explains Hensin Tsao, associate professor of dermatology at Harvard University and clinical director of Massachusetts General Hospital’s Melanoma & Pigmented Lesion Center in Boston. For example, if it takes three times longer, the SPF is 3.

“SPF is a measure of this ratio—a measurement of blocking sunburn,” Tsao says. “But there is no measure of UVA, so most are determined by how much of a compound in a test tube is absorbed to estimate UVA protection.” Some ingredients that are known to absorb UVA are avobenzone and Mexoryl from La Roche-Posay; there aren’t many UVA-absorbing compounds yet, but to prove broad-spectrum protection, companies must show that the product protects against both.

Tsao adds that because there has been some “wild labeling” of SPF products in the past, he considers the new labeling rules from the FDA incredibly important for consumers.

Wearing Sunscreen Every Day Can Make You Look Younger

Time Magazine

Wearing Sunscreen Every Day Can Make You Look Younger

 By Alexandra Sifferlin

June 4, 2013

Dermatologists have long prodded their patients to apply more sunscreen, claiming it not only protects against skin cancer, but aging as well. Now there’s evidence to prove it.

In a new study, Australian researchers report that people who apply sunscreen everyday show 24% less skin aging compared to participants who only used sunscreen part of the time. The study, published in the Annals of Internal Medicine, looked at  900 people under 55 and discovered those regularly using sunscreen were less likely to have increased skin aging after 4.5 years — even those in middle age.

“Those who even had a good amount of sun damage had an improvement in the aging of the skin,” says Dr. Doris Day, a dermatologist at Lenox Hill Hospital in New York and clinical associate professor at NYU Langone Medical School who was not associated with the study. “As dermatologists, we have been saying for years and years, use SPF every day all year round. I always say, if you don’t need a flashlight to see outside, you need protection.”

The study comes out just in time for summer and coincides with the U.S. Food and Drug Administration’s (FDA) new sunscreen regulations. After a few delays, major manufacturers are now required to distinguish between which brands and products can be labeled “broad spectrum,” meaning they protect against both ultraviolet A and ultraviolet B rays. The new guidelines also mandate that products include directions to reapply regularly and prohibit brands from claiming on their labels that their sunscreens are sweatproof or waterproof.

The new regulations were highly anticipated and arguably long overdue. The European Commission started requiring these label changes in 2007. It’s a major move in the right direction for American skin protection, since skin cancer is the most common cancer in the U.S. But the new requirements are far from perfect.

For instance, the FDA has yet to follow Europe’s lead and cap the SPF value at 50+ for sunscreen products. In June 2011, the agency proposed a regulation to require any products with SPF values higher than 50 to be labeled as “50+.” The FDA has acknowledged that there is not adequate data to show products with SPF higher than 50 provide any additional protection compared to products with lower SPF values. There is also an ongoing call for more data to determine the safety and efficacy of spray sunscreens.

Some critics believe the FDA takes too long to approve sunscreen ingredients. In Europe, sunscreen manufacturers may incorporate 27 different ingredients, but in the U.S., there are only 16 approved ingredients.

Dermatologists remember how long it took L’Oreal to get an application approved to use Mexoryl SX. “Getting Mexoryl approved here took years even though it was approved in Europe and in France,” says Day. “Getting it approved in America was a whole process and people were bootlegging it. It created an aura that it was so much better.”

Currently, eight sunscreen ingredient applications are pending with the FDA, with some up to 10 years in backlog. In the video below, California Representative Sam Farr questions FDA Commissioner Margaret Hamburg in April on why it is taking so long.

The issue is partly because the FDA is stringent, which is a good thing. But bureaucracy also plays a significant role. The ingredient petition applications were filed through the FDA’s Time and Extent Application (TEA) process, which was implemented in 2002 to address gaps in the approval processes for new over-the-counter (OTC) products that were not covered by the existing OTC Drug Monographs, which are akin to a recipe book of acceptable ingredients, doses, labels and formulations. The TEA pathway is intended to be an approval process for OTC drugs whose safety has been determined by a minimum of five years of use. The FDA can also request additional data on safety and effectiveness in an attempt to prevent potential allergic reactions or skin sensitivities. The multiple steps mean the approval process is hardly a quick turnaround.

That being said, current ingredients used in the U.S. are effective. The stricter regulations are largely intended to keep brands from making false claims. ”The FDA has done a good job at simplifying how you understand what the sunscreen does,” says Day.

Perhaps they’ve done too good of a job. Day worries that the strict parameters may discourage manufacturers from continuing to refine their products and develop new ones.

There may be more options for sunscreen one day, but right now we’re best off slathering on the products that exist. The latest research shows that sunscreen guards against both skin damage and aging. Used in tandem with other protective behaviors like wearing clothing with coverage and spending time in the shade, it can help keep skin healthy.

Schumer Asks FDA to Approve More Effective Sunscreens

New York 1

Schumer Asks FDA to Approve More Effective Sunscreens

June 2, 2013

With summer around the corner, and more warm weather pushing more people to enjoy the outdoors, Sen. Charles Schumer is calling for the Food and Drug Administration to approve more effective sunscreens.

Schumer said the United States is behind the rest of the world when it comes to using sunscreens with long-range UVA filters, which block a broader range of the sun's damaging rays.

The senator also said that for the past decade, the FDA has been testing products with Sun Protection Factors (SPFs) over 50, but without concluding whether those high numbers mean more protection.

He said beachgoers and vacationers deserve to know which products work best to protect them against skin cancer.

The FDA should make its determination before beach season gets into full swing, according to Schumer, and look into whether aerosol sunscreens, which have become increasingly popular, are as effective as lotions.

We're Missing Out on the Best SPF Available


We're Missing Out on the Best SPF Available
 By Lauren Le Vine

May 28, 2013

As the sun's rays penetrate more and more of the depleted atmosphere and skin cancer incidences rise, we know we need to be diligent about applying sunscreen before venturing outside. Unfortunately, the sunscreen we're using may not offer a full range of protection from all of the sun's ultraviolet rays. New labels began to appear on suncreens in December, and this summer, many consumers will notice symbols and letters denoting "broad-spectrum coverage" that protects against both UVA and UVB rays.

Despite these new measures, the Wall Street Journal reports that in the United States, we're still not getting the most sun protection possible. Many long-rage UVA filters are currently awaiting FDA clearance to be used in our sunscreens. People have actually started purchasing their sun protection in France and the Caribbean, where these ingredients are already legal and in use.

The lack of approved UVA filters in the U.S. limits sunscreen manufacturers to only three UVA filter options, none of which have the same long-lasting protection as ingredients already found in European products. To be fair, the FDA hold-up is in part due to proper protocol, which requires them to carefully test and examine the effects of all chemicals. However, the patents have also been filed through a system known as TEA, which stands for "time and extent application," meaning the FDA can approve products that have been in use abroad for at least five years and found to be safe and effective. Some of these ingredients have been in use for over a decade in Europe.

In the meantime, just having this knowledge is powerful. You can buy European sunscreens containing Tinosorb and Ecamsule (a proprietary ingredient on which L'Oréal Paris has a patent) online. Avèe Very High Protection Emulsion SPF 50+ comes highly recommended. For the rest of your summer sun protection needs, be sure to seek out labels with UVA and UVB protection. And don't use last summer's products; sunscreen expires (I can attest to this from personal experience)!