Dermatologic Therapy, Vol. 25, 2012, 244–251 © 2012 Wiley Periodicals, Inc.

Printed in the United States · All rights reserved

DERMATOLOGIC THERAPY
ISSN 1396-0296

Sunscreens: Obtaining adequate

photoprotection
Mark E. Burnett,* Judy Y. Hu† & Steven Q. Wang*
*Department of Dermatology, Memorial Sloan-Kettering Cancer Center,
New York, New York and †Department of Dermatology, Laser & Skin
Institute, Chatham, New Jersey

ABSTRACT: Adequate photoprotection plays a paramount role in reducing the burden of both photo-
aging and photocarcinogenesis. The scope of photoprotective strategies employed by the public, from
most to least effective, includes: sun avoidance, seeking shade, the use of protective clothing, and the
application of sunscreen. Among these options, sunscreen use remains the strategy most frequently
employed by the public – a reversal of the preferred order of photoprotection. Given this trend, it is clear
why sunscreens invariably take center stage in any discussion regarding obtaining adequate photopro-
tection.

KEYWORDS: Ultraviolet radiation, sunscreens, photoprotection

Introduction and most importantly, proper behavior patterns by

Adequate photoprotection plays a paramount role
in reducing the burden of both photoaging and
photocarcinogenesis. The scope of photoprotec-
tive strategies employed by the public, from most
to least effective, includes: sun avoidance, seeking
shade, the use of protective clothing, and the appli-
cation of sunscreen. Among these options, sun-
screen use remains the strategy most frequently
employed by the public – a reversal of the preferred
order of photoprotection. Given this trend, it is
clear why sunscreens invariably take center stage
in any discussion regarding obtaining adequate
photoprotection.
Reaching the goal of adequate photoprotection
through sunscreen use, however, requires the con-
vergence of three factors: technological advance-
ments in sunscreen formulation, regulations and
standards for assessing and labeling sunscreens,
Address correspondence and reprint requests to: Steven Q.
Wang, MD, Dermatology Service, Memorial Sloan-Kettering
Cancer Center, 160 E 53rd St., New York, NY 10022, or email:
wangs@mskcc.org.
the public pertaining to the use of sunscreens. Sci-
entific advancements in the development of novel
and effective UV filters or formulation technology
can pave the way for improved ultraviolet radiation
(UVR) protection. Equally important, however,
have been improvements in the sensory profiles of
newer sunscreens, leading to increased frequency
of usage and adequate volumes of application.
Regulatory standards for assessing and enforcing
the efficacy of sunscreen have played a major role
in incentivizing these technical advancements. As
such, a lack of timely change in appropriate stan-
dards on labeling and testing of sunscreens can
lead to a slowing in the innovation rate, a trend
evidenced by the paucity of ultraviolet A (UVA) pro-
tection offered from most US sunscreens until
recently (1). In contrast, because of the regulatory
framework in other parts of the world, especially in
Europe and Australia, sunscreens in those regions
have offered superior UVA protection for years.
Lastly, the best sunscreens are the ones being used
properly and frequently. Therefore, continued edu-
cation pertaining to sunscreen knowledge and
understanding, as well as sun behavior patterns,
remain important aims.

244

In this review, we will discuss the aforemen-
tioned set of factors in the context of adequate
photoprotection from sunscreens, specifically by
highlighting key technical advancements and
recent regulatory changes in the United States as
well as a focus on the limitations of changing
behaviors toward photoprotection.
Benefits of sunscreen use:
photoaging and photocarcinogenesis
prevention
Both solar and artificial UVR are major contribu-
tors toward the development of skin cancers and
acceleration of the skin aging process. Ultraviolet
B (UVB) exerts damaging effects directly to DNA,
the molecular structure of which acts as a chro-
mophore for UVB (2), manifested as the formation
of pyrimidine dimers in the double helix (2,3). In
contrast, UVA not only causes both direct damage
to DNA (4,5), but also generates reactive oxygen
species that indirectly damage DNA and other
important intracellular structures. Without timely
and accurate repair of this damage, mutations in
the genome and cellular machinery of epidermal
cells accumulate, leading to the development of
both nonmelanoma and melanoma cancers.
Photoaging is a chronic process, developing over
a period of years to decades, and is characterized
clinically by rhytides, dyspigmentation, telang-
iectases, and keratoses (6).
At the cellular and molecular level, UVR induces
the activation of matrix metalloproteinases, which
degrade collagen and epidermal keratin filaments
and facilitate the deposition of abnormal elastin
(7–25). Together, the alteration and breakdown of
these proteins results in rhytid formation in the
overlying epidermis (8,26,27). Furthermore, UVR
exposure stimulates the production of alpha mel-
anocyte stimulating hormone by keratinocytes
via a p53-mediated pathway (28). On a long-term
basis, chronic UV exposure induces irregular pig-
mentation, resulting in permanently uneven tone
characterized by the development of lentigines and
ephelides.
Frequent and proper use of sunscreens has
shown to prevent skin aging (25,29–31) and reduce
the risk of actinic keratoses (32–34), nonmelanoma
(35,36), and melanoma (37) skin cancers. In terms
of photoaging prevention, solar elastosis is dimin-
ished in skin protected by sunscreen (31). In fact,
sunscreen has been shown to protect against
dermal degradation of procollagen and elastin
Sunscreens: Obtaining adequate photoprotection
fibers (29). The bulk of available evidence of skin
cancer prevention from sunscreen use is derived
from studies conducted by Green et al. (35,37).
The investigators showed a statistically significant
reduction of 35% (confidence interval 0.43–0.98)
in the incidence of squamous cell cancer (SCC)
within the cohort assigned to daily sunscreen
use (35). In addition, a 50% reduction in the risk of
melanoma was seen among the individuals who
used sunscreens (37). Of note, the study was con-
ducted using a sunscreen with an SPF of 16, which
had unstable and inadequate UVA protection. Fur-
thermore, the control group was allowed to use
sunscreens, indicating that the actual protective
benefit from sunscreen use may be significantly
greater than the results of these studies suggest.
This is especially true if a similar study were
repeated with modern sunscreens that had high
SPF ratings and contained stable UVA-protective
ingredients. In fact, these data played a major role
in influencing the US Food and Drug Administra-
tion (FDA) to issue labeling guidelines on sun-
screens in June 2011. When the ruling becomes
effective in June 2012, broad spectrum sunscreens
with SPF >15 can display the claim “if used as
directed with other sun protection measures, (sun-
screens) decrease the risk of skin cancer and early
skin aging caused by the sun” on their labels.
Obtaining adequate photoprotection
with sunscreens
Technical considerations
Over the past two decades, sunscreen technology
has made enormous strides to achieve superior
UV protection and provide an improved sensory
profile. Whereas early sunscreens provided low
UVB protection and virtually no UVA protec-
tion, modern sunscreens now incorporate novel
UV filters, UV boosters, and photostabilizers that
provide considerable protection against both UVA
(320–400 nm) and UVB (290–320 nm) radiation.
In terms of UV protection, the major area of
progress has been the extension of coverage to the
long UVA-I (340–400 nm) range. Among the 17 UV
filters currently approved by the FDA (Table 1),
only two of these filters, avobenzone and zinc oxide
(ZnO), can absorb long UVA-I radiation. Avoben-
zone is inherently photo unstable, with an activity
level that degrades by 50% after 1 hour of UV expo-
sure. Furthermore, when avobenzone is combined
with octinoxate, a common UVB filter, the degra-
dation of both compounds is accelerated. Thus,
245
Burnett et al.

Table 1. Sunscreen filters currently approved under the 2011 FDA monograph
Maximum Peak absorption UV action
Sunscreen filter concentration l (nm) spectrum
Inorganic filters 25%
Titanium dioxide UVB, UVAb
Zinc oxide UVB, UVAb
Organic filters
UVA filters
Benzophenones
Oxybenzone (benzophenone-3) 6% 288, 325 UVB, UVA II
Sulisobenzone (benzophenone-4) 10% 366 UVB, UVA II
Dioxybenzone (benzophenone-8) 3% 352 UVB, UVA II
Dibenzoylmethanes
Avobenzone (butyl methoxydibenzoylmethane, 3% 360 UVA I
Parsol 1789)
Anthralates
Meradimate (menthyl anthranilate) 5% 340 UVA II
Camphors
Ecamsulea (terephthalylidene dicamphor 10% 345 UVB, UVA
sulfonic acid, Mexoryl SX [L’Oreal, Paris, France])
UVB filters
Aminobenzoates (PABA derivatives)
PABA (para-aminobenzoic acid) 15% 283 UVB
Padimate-O (octyl dimethyl PABA) 8% 311 UVB
Cinnamates
Cinoxate (2-ethoxyethyl p-methoxycinnamate) 3% 289 UVB
Octinoxate (octyl methoxycinnamates (OMC)) 7.5% 311 UVB
Salicylates
Octisalate (octyl salicylate) 5% 307 UVB
Homosalate (homomenthyl salicylate) 15% 306 UVB
Trolamine salicylate (triethanolamine salicylate) 12% UVB
Others
Octocrylene 10% 303 UVB, UVA II
Ensulizole (phenylbenzimidazole sulfonic acid) 4% 310 UVB
Adapted from Wang and Lim (JAAD, 2011 Oct: 65 (4): 863–869).
a
Only allowed as a component of certain sunscreen formulations approved under a new drug application.
b
UV absorption spectrum varies by particle size.

sunscreens containing avobenzone must be stabi-
lized with other molecules or UV filters. Among
these, octocrylene, a UVB filter, is widely used
in the United States for this purpose. Another
combination of photostabilizers and UV filters,
comprised of octocrylene, oxybenzone, and dieth-
ylhexyl 2,6 naphthalate, has been shown to deliver
photostabilization at a level above 80%. This com-
bination is patented by Neutrogena and trade-
marked as “Helioplex” (Neutrogena, Los Angeles,
CA, USA). In addition to avobenzone and ZnO, tita-
nium dioxide molecules (TiO2) with specific sizes
can also provide long range UVA protection. In the
United States, there are a number of new active
filters (Table 2) awaiting approval from the FDA via
the Time and Extent Application (TEA) process. All
filters currently pending review via the TEA process
have met the specific requirements for approval. It
is anticipated that approval of these filters will
provide manufacturers with substantial options
with which to formulate products providing supe-
rior UVA coverage.
Aside from new filters and photostabilizers, the
vehicle compounds into which modern sunscreens
are formulated have also boosted the UV protective
properties of these products. This is because ingre-
dients comprising the vehicle have decidedly syn-
ergistic effects on the degree of UV protection
provided by the UV filters in the final formulation.
In fact, the vehicle is equally if not more important
than the type and concentrations of the UV filters
utilized. This is because vehicles that dissolve and
disperse UV filters in a uniformed fashion can
enhance overall UV protection. Excess UV filters
from a poorly formulated product tend to accumu-
late in the natural valleys of the skin, leaving poor

246

Table 2. UV filters currently undergoing review for approval by the FDA
Sunscreen filter
UVB & UVA filters
Terephthalylidene diacamphor sulfinic acid (ecamsule)
Bis-ethylhexyloxyphenol methoxyphenyl triazine
(Tinosorb S [BASF, Ludwigshafen, Germany];
bemotrizinol)
Methylene-bis-benzotriazolyl tetramethylbutylphenol
(Tinosorb M; bisoctrizole)
UVB filters
Diethylhexyl butamido triazone (iscotrizinol)
Methylbenzylidene camphor (enzacamene)
Isoamyl methoxycinnamate (amiloxate)
Ethylhexyl triazone (octyl triazone)
Adapted from Wang and Lim (JAAD, 2011 Oct:65 (4): 863–869).
coverage on the elevations, or ridges. Uneven cov-
erage results in poor photoprotection, yielding a
low net effective SPF. In contrast, a well-formulated
product can deliver UV filters evenly, providing a
uniform coating to both the ridges and valleys. To
deliver consistently even coverage, additives and
film formers have been developed that ensure this
goal is achieved with every application (38,39).
Technical advancements that have improved the
visual and sensory profiles of sunscreen are also of
important note. Sunscreens incorporating the
macro-sized inorganic filters TiO2 and ZnO have
long been utilized by the sunscreen manufacturing
industry. However, TiO2 and ZnO molecules of a
sufficient size frequently extend into visible light
range when applied, leaving an unacceptable
opaque white appearance on the skin. Because
these products are not cosmetically elegant, sun-
screens containing inorganic filters were not
widely accepted until recently. To overcome this
visual drawback, modern sunscreens now use
nano-sized TiO2 and ZnO molecules, which are
manufactured as primary particles of a size on the
order of <100 nm. At this size, TiO2 and ZnO mol-
ecules are no longer the short range of visible light,
overcoming the undesired white appearance while
providing superior UV protection.
Aside from improvements in the visual profile
of modern sunscreen products, technical break-
throughs have also improved their sensory profiles.
Consumers often complain that most sunscreen
products on the market are too greasy and oily. For
example, octocrylene, a UVB filter also used as a
photostabilizer for avobenzone, has an extremely
oily texture. Compounding the texture issue is the
need for sunscreens designed for aquatic, sport,
and outdoor activities to be water and sweat resis-
Sunscreens: Obtaining adequate photoprotection
Maximum Peak absorption UV action
concentration l (nm) spectrum
10% 345 UVB, UVA
10% 310, 343 UVB, UVA
10% 305, 360 UVB, UVA
3% 312 UVB
4% 300 UVB
10% 310 UVB
5% 314 UVB
tant. Although water-resistant polymers have been
designed, which hold the sunscreen formulation
onto the skin surface, these ingredients can leave a
tacky or sticky feel to the product. To improve the
tactile and sensory profiles of sunscreen products,
silicones, silicas, and other slipping agents are
added to reduce the unpleasant and sticky feeling.
The addition of polymeric surfactants, such as
acrylate cross polymers, can also provide rapid
emulsion-breaking characteristics that allow to the
product to spread easily on the skin and improve
the overall textural profile after drying.
Regulatory considerations
In the United States, sunscreen is regulated by the
FDA as an over-the-counter drug. In general, the
FDA’s range of power allows for the implementa-
tion of specific criteria and guidelines governing
the use of: active ingredients, manufacturing stan-
dards, testing procedures, claim substantiation,
and product labeling. As such, the impact of an
FDA ruling can be profound, extending from the
efficacy claims of a product to changing consumer
behaviors. As discussed above, there are currently
only 17 UV filters approved by the FDA for sale in
the United States. In comparison with Europe, Asia,
and Australia, sunscreen manufacturers in the
United States have significantly fewer UV filters at
their disposal. Approval of additional UV filters
under the TEA review process by the FDA will
provide US sunscreen manufacturers with a
broader range of choices and superior UV filters
that extend coverage into the UVA-I range. This
change has the potential to substantially improve
the range of available sunscreen products.
247
Burnett et al.
The ruling recently issued by the FDA regarding
the testing and labeling of UVA claims by sunscreen
manufacturers is a long-awaited step toward stan-
dardizing and testing the photoprotective proper-
ties of sunscreens sold within the United States. A
summary of this ruling has been well covered else-
where (1). Briefly, the new guidelines state that, in
order to be labeled as “broad spectrum,” a sun-
screen must now have a critical wavelength (CW)
of ⱖ370 nm. To meet this criterion, at least 90% of
the total absorbance of the filter must fall below this
CW value when measured using UV wavelengths
ranging in size from 290 to 400 nm.
The FDA ruling also outlined specific labeling
requirements. Sunscreens that qualify to be classi-
fied as “broad spectrum” must display both “broad
spectrum” and “SPF” in the same color and font.
The display must be either in the same line or oth-
erwise adjacent to each other on the product label.
Sunscreens that pass the broad spectrum test and
with an SPF ⱖ15 may also display the following
claim “if used as directed with other sun protection
measures, (sunscreens) decrease the risk of skin
cancer and early skin aging caused by the sun.”
These guidelines underscore the importance
that the FDA now places on photoprotection as a
public health benefit and is an important element
in the ongoing process of developing superior sun-
screens. Prior to this mandate, no regulatory stan-
dards for the labeling of UVA protection existed. As
a result, manufacturers marketed products with
claims of “broad spectrum” and/or UVA protec-
tion, although the extent and degree of protection
varied (40). In fact, Wang et al. have reported that
very few sunscreens sold in the United States as
having “broad spectrum” or UVA coverage actually
contain sufficient concentrations of UV filters, and
in optimal combinations, to provide adequate
UVA-I protection (41).
In summary, the recent FDA regulatory ruling
has elevated the standards for sunscreens manu-
factured in the United States. Furthermore, the
new labeling guidelines should facilitate sunscreen
selection by consumers by clarifying which prod-
ucts provide adequate UVA protection. Most
importantly, the skin cancer and photoaging pre-
vention claims now allowed on sunscreens have
the potential to substantially alter consumer
behavior by encouraging use. A number of impor-
tant issues still await FDA ruling, indicating that
the impact of regulatory measures on photoprotec-
tion will continue to unfold. Specifically, pending
issues include: (i) whether new UV filters under
the TEA review will be approved; (ii) if SPF of
sunscreens should be capped at 50+; and (iii) if
248
particular dosage forms, such as powder and spray,
should be eliminated.
Consumer knowledge and behavior
consideration
Despite advancing sunscreen technology and
favorable regulatory changes, knowledge and
behavior at the level of the individual consumer
ultimately play the most important role in obt-
aining adequate photoprotection. In fact, any
sunscreen incorporating the most technical
advancements would fail to provide adequate pho-
toprotection if not properly used, or not used at
all. The behavioral barriers to proper sunscreen
use and other photoprotective strategies are
closely related to the knowledge, motivation, and
behavior patterns of the consumer. Despite
decades of collective efforts from the medical com-
munity, government, and nonprofit agencies, more
work is needed to change public behavior and
understanding. Studies have shown that approxi-
mately half of children do not protect themselves
adequately from solar radiation (42–49). This trend
is especially true among younger adults, where a
recent study showed that less than 40% of the sur-
veyed teenagers used sunscreen and 83% reported
having at least one sunburn during the past
summer (50).
Going forward, knowledge of the importance of
photoprotection and the associated health benefits
should be emphasized. Behavior changes can be
achieved through sustained campaigns emphasiz-
ing the protective benefits against skin cancer and
skin aging. However, instead of relying exclusively
on a fear-based message (i.e., skin cancer), targeted
marketing campaigns such as those emphasizing
appearance-based benefits (i.e., wrinkle preven-
tion) can work even better, especially among young
and middle-aged women. In addition to focusing
on the protective benefits associated with sun-
screens use, attention should be directed to clari-
fying the concerns and controversies associated
with their safety. Headlines in the popular press
have generated substantial concerns regarding the
hormonal effects associated with oxybenzone,
photocarcinogenic potential of retinyl palmitate,
and phototoxicity of TiO2 and ZnO. The sensa-
tional, and often negative media coverage, calls
into question the safety of sunscreens. This, in turn,
deters consumers from using sunscreens and even
reinforces unhealthy attitudes and behaviors
toward sun exposure.
However, many of the controversies regarding
the safety of sunscreens have been generated from

studies performed under settings that do not reflect
actual usage in humans. In the case of oxybenzone,
for example, Wang et al. (51) calculated that it
would take more than 277 years of daily topical
application of a sunscreen containing oxybenzone
for a human to receive an equivalent amount of
exposure as the rats used in the study (52). Further-
more, the calculation was carried out under unre-
alistically conservative conditions in which the
authors did not take into account the excretion of
oxybenzone in humans. In the case of retinyl palmi-
tate, physicians have been prescribing various
forms of retinoids for over 40 years to manage acne,
psoriasis, and even skin cancer. To date, there is no
published evidence indicating that topical retin-
oids increase the risk of photocarcinogenesis.
Empowering the public with proper knowledge
regarding the safety and benefits of sunscreen
requires sustained effort. Even so, actual behavior
changes by the public may be slow to develop.
Often, prevention of skin cancer and photoaging do
not resonate with teenagers or young adults. Among
this demographic group, skin cancer and photoag-
ing are far removed from the considerations of daily
life. Instead, young adults are often unfortunately
interested in following beauty standards set by our
society and culture such as having a tan.
Aside from misaligned motivational barriers,
intrinsic limitations exist for consumers. The
public is instructed to apply sunscreen at a concen-
tration of 2 mg/cm2 with each use and is reminded
to reapply every 2 hours. To achieve this level of
coverage, however, the average adult would require
a full 1.4 ounces of product. In practice, most
people apply only a quarter or half of the necessary
amount (53). As a result of inadequate application,
the effective SPF provided is only 1/3 of the labeled
SPF. In terms of reapplication, only 30% of sur-
veyed responders are aware that sunscreen must
be applied 30 minutes prior to UV exposure, with
reapplication required every 2 hours (53).
To that end, the ultimate determinant of
adequate photoprotection from sunscreens is con-
sumer behavior. Knowledge and motivation both
play fundamental roles in changing behavior.
Given current trends of sunscreen use and under-
standing, however, much work remains in directing
the public to adopt adequate photoprotective
practices.
Conclusion
The idea of obtaining adequate photoprotection
with sunscreen has advanced from preventing
Sunscreens: Obtaining adequate photoprotection
sunburns to reducing the risk of skin cancer and
slowing down the process of photoaging. Over the
last several years, the armamentarium of sun-
screen technology providing comprehensive pro-
tection against the detrimental effects of UVR
has been growing. Modern sunscreens now have
powerful UV filters, enhanced photostability, and
improved sensory profiles. The recent FDA ruling
has set clear guidelines on the testing and labeling
of UVA protection. Despite these positive trends, it
is the individual consumer who will ultimately
determine whether sunscreen use can provide
them with adequate photoprotection. The benefits
of effective sunscreen products cannot be derived
if they are used incorrectly. This sentiment is
shared by the FDA, which now recognizes the
health benefits of sunscreen when used appropri-
ately and frequently. However, the available data
indicate that a great deal of work remains to be
accomplished before significant changes in con-
sumer behavior take hold. As such, efforts should
be focused on educating the public on the proper
use of sunscreens as well as encouraging the pri-
oritization of more effective photoprotective strat-
egies such as sun avoidance, seeking shade, and
wearing protective clothing.
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