Clinical Focus: ACNE
Address the Need For
Sun Protection In Your
Acne Patients
Innovations in technology are paving the way for products that address skin care and sun
protection needs.
By Joshua Zeichner, MD
T
he Centers for Disease Control (CDC) recently released
two new studies that have struck a chord among the
Dermatologic community.1 The reports contain com-
pelling statistics indicating that despite an increase in
sun protective behaviors overall, 50 percent of adults younger
than age 30 reported being sunburned at least once in the last
year. This means that despite sunscreen education, people are
still not doing a good enough job at applying sunscreen. The
other report found that young adults continue to tan indoors,
with the highest rates of indoor tanning among white women
aged 18-21 years (nearly 32 percent).
These numbers underline the importance of raising aware-
ness for UV protection for all patients, particularly young
patients. Practicing dermatologists have a unique opportunity
to do this each day in the clinic by talking to their patients pre-
senting for other skin complaints, such as acne. By addressing
the dangers of tanning in young patients, dermatologists have
the ability to help patients develop sun protective behaviors
that will benefit them for the rest of their lives.
All patients, but specifically acne patients, come to the der-
matologist for prescription medications to improve their skin
as well as advice on over-the-counter products to use. So it is
important to be familiar with what is available to consumers
to give educated recommendations to your patients. Ahead I
will discuss some specific facial sunscreens available for patients
with different skin types, including acne-prone skin.
Sun Protective Care
Treating acne patients, we have the opportunity to instill the
importance of using sunscreen in young people. By educating
teens and 20-something year olds on the association of sun-
burns early in life with skin cancer later, we can help save lives.
Sun protection is especially important in acne patients
46  PRACTICAL DERMATOLOGY    june 2012
because many acne medications can make the skin sensitive
to sunburn. Both topical and oral retinoids lead to stratum
corneum thinning, thereby increasing sunburn risk. Oral tetra-
cycline antibiotics (eg. tetracycline, doxycycline) are known to
make the skin sensitive to ultraviolet radiation, but the cause is
unclear. It has been postulated that the drug itself binds cellular
components (such as ribosomes), making them sensitive to
phototoxic reactions from UVA light. Moreover, as the drug is
degraded in the phototoxic reaction, bi-products are photosen-
sitive and contribute further to phototoxicity from light in the
visible spectrum.2 Unlike tetracycline and doxycycline, minocy-
cline is less associated with photosensitivity.
The latest advancements in formulation technology allow us
to select from a wide variety of sunscreens for our patients. Just
as acne medication regimens can be tailored to suit patients’
skin types and preferences, the same can be done for sunscreen
choices. Whether your patient’s skin is dry or oily, sensitive or
not, there is a sunscreen available to suit your patients’ unique
needs.
Examples of Facial Sunscreen Choices
Based on Skin Type
Acne-Prone Skin. For my patients with acne, I typically rec-
ommend moisturizers with sunscreen for use in the morning.
They provide UV protection while moisturizing and helping
minimize irritation potential of topical acne medications.
There are several new products designed for patients with
acne. Being “oil-free” (using dimethicone rather than petrola-
tum), they are also of benefit in patients with with oily skin.
(Dimethicone helps absorb oil on the skin’s surface and can
actually help the skin appear less oily. )These include Cetaphil
DermaControl Moisturizer SPF30, with zinc and licorice root
extract, as well as Neutrogena Clear Face Sunscreen, with

botanical extracts. Cetpahil Dermacontrol SPF 30 uses oleo-
some technology to lower the concentration of chemical
blockers needed in the product to achieve the same sun pro-
tection coverage, allowing for the light formulation. EltaMD
UV Clear SPF 46 has also been designed for acne-prone
patients, containing niacinimide to soothe the skin.
Oily Skin. Some patients with oily skin prefer a sunscreen
that is as light as possible, especially during the humid sum-
mer months. If the skin is well hydrated, they may not require
a moisturizer at all, but rather a straight facial sunscreen. La
Roche Posay Anthelios 60 Ultra Light Sunscreen Fluid is an
extremely light product that may be an appropriate choice.
This product contains “Cell-Ox Shield” technology that part-
ners antioxidants and sun spheres to boost sunscreen ingredi-
ents for maximal protection. Alternatively, Neutrogena Pure
and Free Liquid SPF 50 has a similar light feel on the skin, as
does Shiseido Extra Smooth Sun Protection Lotion SPF 38.
Red or Rosacea-Prone Skin. Anti-inflammatory botanical
extracts in many over the counter products may help soothe
irritated skin, such as in patients with rosacea. Moreover,
recent evidence suggests a role of skin barrier dysfunction in
the pathogenesis of rosacea.3 So products that improve and
hydrate the skin may be of therapeutic benefit for the dis-
ease. Aveeno Ultra Calming Daily Moisturizer SPF 15 contains
feverfew, a botanical similar to chamomile, which helps reduce
irritated skin. Eucerin Redness Relief Daily Perfecting Lotion SPF
15 has been formulated with a licorice root extract that also
soothes red skin.
Dry Skin. While each of these products can be used on
all skin types, the creamier vehicle of CeraVe AM lends itself
for use in patients with dry skin or those who prefer a thicker
base. CeraVe AM provides an SPF 30 protection and contains
a ceramide-rich formulation which may help repair skin barrier
function.
Sensitive Skin. For patients who cannot tolerate chemi-
cal sunscreen ingredients, a strictly physical blocker agent is
appropriate. SkinCeuticals Physicial Fusion UV Defense SPF
30 contains zinc and titanium but no chemical sunscreen
ingredients. Moreover, both tinted and sheer options are
available depending on patients’ preferences and skin tone.
Neutrogena Pure and Free Baby Faces SPF 50+ contains only
physical blockers and is fragrance free and tear-free. While this
product is marketed as part of a baby sunscreen line, it is an
appropriate choice for any age group.
Extra Sun-Sensitive Skin. Patients with extremely fair skin
may be more sensitive to the sun than are other patients.
For those who cannot tolerate the sun or who burn easily, La
Roche Posay Anthelios 40 Sunscreen Cream is a thick product
containing a mix of chemical and physical blockers that is of
particular benefit to patients with extra sun-sensitive skin.
Mineral Susncreens. Several companies now offer min-
Clinical Focus: ACNE
eral sunscreens alternatives, which have a unique feel on
the skin. These products contain physical blockers and are
typically non-greasy. Aveeno Natural Protection Sun Block
Lotion SPF 30 is an oil-free, hypoallergenic product. Solar
Protection Formula also offers mineral sunscreens in their
TiZo2 and TiZo3 products. The difference in these prod-
ucts is their color, where TiZo3 has a flesh colored tint, and
TiZo2 is untinted.
Conclusion
While some products are mentioned here by name, many oth-
ers are available. Your own selections will depend on several fac-
tors, including brand loyalty, technological innovation of a spe-
cific product, peer recommendations, costs, and other personal
preferences. The wide variety of facial sunscreens represents
the vast, new technologies developed to address different skin
needs. As dermatologists, we must be aware not only of how to
prescribe prescription drugs, but also how to recommend over-
the-counter products to pair with these medications. We play
a crucial role in guiding patients on their skin care regimens,
and we must take skin type into consideration when making
our recommendations.
Given the recent delay in the FDA-mandated sunscreen label
changes, we must continue to educate patients on the need for
broad spectrum UV coverage. No matter what brand patients
ultimately choose, they should be educated to look for specific
sunscreen ingredients including titanium dioxide, zinc oxide,
avobenzone, oxybenzone, or ecamsule. Moreover, we should
reinforce the proper amount of sunscreen needed for appro-
priate protection (about a half-teaspoon for the face) and the
need to reapply every few hours.
As dermatologists, we are facilitators of skin health, be it in
treating acne or encouraging UV protection. Sun exposure goes
hand-in-hand with the dermatoses we see every day, as UV
light is associated both with skin cancer and affects the course
of many common skin conditions. Thus, we must stress to our
patients that sun protective behaviors can influence the skin
health today and in the future.  n
Dr. Zeichner has served as a consultant or investigator for
Allergan, Beiersdorf, Galderma, Medicis, Onset, Pharmaderm,
Promius, and Valeant.
Joshua Zeichner, MD, FAAD is an Assistant
Professor and Director of Cosmetic and Clinical
Research in the Department of Dermatology at
Mount Sinai Medical Center in New York.
1. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6118a1.htm?s_cid=mm6118a1_w (Accessed 6/5/12)
2. Hasan T, Kochevar IE, McAuliffe DJ, et al. Mechanism of tetracycline phototoxicity. J Invest Dermatol. 1984
Sep;83(3):179-83.
3. Borkowski AW and Gallo RL. The coordinated response of the physical and antimicrobial peptide barriers of the skin. J
Invest Dermatol. 2011 Feb;131(2):285-7.
june 2012    PRACTICAL DERMATOLOGY   47