SUNSCREENS

Skin damage from radiation is cumulative

whether sunburn occurs or not.

Annual incidence:
 500,000 cases of basal cell CA occur.

 100,000 cases of squamous cell CA occur.

 20,000 cases of malignant melanoma

occur.
ULTRAVIOLET RADIATION
SPECTRUM
UVA (Longwave Radiation)
 Range 320-400 nm
 Erythrogenic activity is weak, however
penetrates dermis
 Responsible for development of slow natural
tan
 Most drug-induced photosensitivity rxn
occurs
 UVA may augment the effects of UVB
ULTRAVIOLET RADIATION
SPECTRUM

UVB (Middlewave Radiation)

 Range 290-320 nm
 Erythrogenic activity is the highest
 Produces new pigment formation, sunburn,
Vit D synthesis
 Responsible for inducing skin cancer
ULTRAVIOLET RADIATION
SPECTRUM

UVC (Shortwave or Germicidal Radiation)

 Range 100-290 nm.
 Does not reach the surface of the earth.
 Is emitted from artificial ultraviolet
sources.
ULTRAVIOLET RADIATION
SPECTRUM
 Long-term hazards of skin damage
from radiation:
– Malignancy:
• Squamous cell epithelioma
• Actinic keratosis
• Basal cell carcinoma
– Premature aging
• nevus, seborrheic keratosis, solar lentigo
• wrinkles, lines, etc
SUNSCREEN CLASSIFICATIONS
 Physical
– Opaque formulations containing:
• titanium dioxide
• talc, kaolin
• zinc oxide
• ferric chloride
• icthyol, red petrolatum
– Mechanism: scatters or reflects UV
radiation due to large particle size
 SUNSCREEN CLASSIFICATIONS

 Chemical
– Formulations containing one or more:
• PABA, PABA esters
• benzophenones
• cinnamates
• salicylates
• digalloyl trioleate
• anthranilates
– Mechanism: absorbs UV radiation
 SUNSCREENS

 Sun Protection Factor (SPF) =

MED of Photoprotected Skin
MED of Unprotected Skin
– MED is minimum dose of radiation which
produces erythema
– SPFs are determined indoors using xenon
lamps which approximate the spectral
quality of UV radiation
SUNSCREENS

 Factors which influence effectiveness of SPFs

– Difference in skin types.

– Thickness of the applied sunscreen.

– Time of day.

– Altitude: each 1,000 ft increase adds 4% to the intensity of

erythema producing UV radiation; thus intensity is about
20% greater in Pocatello than at sea level.
– Environment: snow/white surfaces reflect 70-90%, and
when directly overhead water reflects nearly 100% of UVR.
– Vehicle: determines skin penetration of sunscreen.
SUNSCREENS

Category Skin Type SPF

I Always burns, never tans 15 >
II Burns easily 15
III Burns moderately, (avg caucasian) 10-15
IV Burns minimally, tans well (olive skin”) 6-10
V Rarely burns, tans profusely (brown skin) 4-6
VI Never burns (black skin) none
 SUNCREEN AGENTS
PABA (Para-aminobenzoic acid)
 Very effective in the UVB range (200-320 nm).
 Most effective in conc of 5% in 70% ethanol.
 Maximum benefit when applied 60 min prior to
exposure (to ensure penetration and binding to stratum
corneum).
 Does NOT prevent drug/chemical-induced
photosensitivity rxn.
 Contact dermatitis can develop.
 May produce transient drying/stinging from alcohol
content (may be alleviated by adding 10-20% glycerol).
 May stain clothing.
SUNCREEN AGENTS

PABA Esters (Padimate A, Padimate O,

Glyceryl PABA)
 Also very effective in UVB range (280-320)

 Most effective in conc. 2.5-8% in 65% alcohol

 May penetrate less effectively than PABA

 Similar application and adverse effect

 Less staining
 SUNCREEN AGENTS

Benzophenones (oxybenzone, dioxybenzone,

sulisobensone)
 Slightly less effective than PABA.
 Absorbs from 250-400 nm spectrum (ie, UVA & UVB).
 Combined with PABA or PABA ester improves
penetration and is superior to either agent used alone
(200-400 nm wavelength coverage).
 Beneficial in preventing photosensitivity rxns.
 Contact dermatitis is rare.
SUNCREEN AGENTS

Cinnamates and Salicylates

 Minimally effective, absorb UVB spectrum.
 Generally used in combination with one of the
above.
SUNCREEN AGENTS

Anthranilates
 Minimally effective, absorbs UVA spectrum
250-322 nm.
 Usually combined with UVB agent to broaden
spectrum.
USE IN YOUNG CHILDREN

 Not recommended in children < 6 mos

(due to theoretical concern that percutaneous
absorption may be greater and excretory
functions may not be mature enough to
handle).
 No reported cases of toxicity.
 Recommend clothing (hats, etc).
 TANNING
 Tan Accelerators
– Contain tyrosine - necessary for production
of melanin, no evidence to support efficacy
 Sunless Tanners
– Dihydroxyacetone darkens outermost layer
– Use at night, sunscreen during day
 Tanning Booths
– Newer types use light source composed of
95% UVA, < 5% UVB (even 1% may
increase incidence of skin cancer).
PHOTOSENSITIVITY REACTIONS

 Photoallergic Reactions
– Radiation alters drug, becomes antigenic or acts
as hapten.
– Requires previous exposure.
– Not dose related.
– Induced by chemically related agents.
– Eruption may present as urticarial, eczematous,
bullous, or sunburn-like reactions.
– Usually caused by topical agents.
 PHOTOSENSITIVITY REACTIONS

 Phototoxic Reactions
– Radiation alters drug to toxic form, causes
tissue damage.
– Does not require previous exposure.
– Dose related.
– No cross-sensitivity.
– Within several hours of exposure - appears
as exaggerated sunburn.
CHOOSING SPF RATING

HIGH SPF SUNSCREENS

 Can achieve higher SPF by combining
two or more agents.
 SPF 30 (3%) vs 15 (6%) of radiation
penetrating skin.
SUNSCREEN PRODUCTS

PABA/Ester Oxybenzone Other

Coppertone yes cinnamate
PreSun yes yes
Bull Frog yes cinnamate
Q.T. Quick Tanning cinnamate
Formula 405 Solar Lotion cinnamate
OTC BURN THERAPY

 Burn Depth
– First degree erythema, no blistering
– Second degree erythema and blisters
– Third degree No blisters, leathery
white, mottled
– Fourth degree “Charred”
CLASSIFICATION OF BURNS
(American Burn Association)
Minor Burns:
 Second degree burn < 15% BSA
(10% in children)

 Third degree burn < 2% BSA not involving

eyes, ears, face, hands,
– excludes electrical or
feet, or perineum).
inhalation injuries and all
poor risk patients.
Estimation of Burned Area

Rule of nines Body Area

 Head 9%
 Arm 9%
 Leg 18%
 Anterior Trunk 18%
 Posterior Trunk 18%
 Perineum 1%
OTC Treatment of Minor
Burns/Sunburns
 Ice/cool water
 Cleansing - water and nonirritating soap
 Dressings (usually only for second degree burns)
– Nonadherent primary layer of sterile fine-
mesh gauze
– Absorbent intermediate layer to draw and
store exudate
– Supportive outer layer of rolled gauze
bandage
Formulation

 Homomenthyl salicylate 080

 Mineral oil 500
 Isopropyl myristate 420
Formulation (cream)

 Suncreen agent 50
 Emulsifyer 75
 Cetyl alcohol 10
 Isopropyl myristate 150
 Liquid paraffin 170
 Glycerol 30
 Water to 1000