CHOOSING THE BEST

SUN PROTECTION AGENT

FOR TRAVELING
Grace M. Kapantow
Department of Dermatology and Venereology
Faculty of Medicine, Sam Ratulangi University
Prof. dr. R.D. Kandou Hospital
Manado
 SUNLIGHT
Source of heat and light

Photosynthesis

Health:
• Vitamin D production
Benefits • Kill germs
• Increase mood by
serotonin production
 SUNLIGHT
ULTRAVIOLET (5 %)
290 – 400 nm

VISIBLE LIGHT (39 %)

400 – 780 nm

INFRARED (56 %)
780 – 5000 nm

Gonzales S, Lorente MF, Calzada YG. The latest on skin photoprotection. Clinics in Dermatology. 2008; 26, 614-626.
Benson HA. Sunscreen: Efficacy, skin penetration and toxicological aspects. In: Walters KE, Roberts MS, penyunting. Dermatologic, cosmeceutic and cosmetic
development. New York: Informa Healtcare, 2008: 419-35.
 ULTRAVIOLET LIGHT

95% UV-A 5% UV-B 290 – 320 nm

Penetration >> 320 – 400 nm Sunburn
Tanning >> Photo-aging
Erythema << Photocarcinogenesis
Free radical production
Eye: -Photokeratitis
Photosensitivity
Photodermatoses
-Cataract
Eye: cataract

UV-C < 290 nm

Filtered in
stratosphere

Benson HA. Sunscreen: Efficacy, skin penetration and toxicological aspects. In: Walters KE, Roberts MS. Dermatologic, cosmeceutical and cosmetic development. New
York: Informa Healthcare, 2008: 419-35.
 VISIBLE LIGHT

VISIBLE LIGHT
400 – 780 nm
Erythema
Pigmentation
Free radical production
Eye: retinal burn

Bessel M., et al. Effects of Visible Light on Skin. Photochemistry and Photobiology, 2008, 84: 450–462
 UV Radiation
• Highest UV radiation:
– Near the equator
– Highlands and mountains (UV increased by 4% for every 300 meter
increase of altitude)
– UV reflecting surface (snow 80%, sand 15%, and water 10%)
– At midday (when the sun is in the highest position). About 60% of
the radiation occurs at 10am to 2pm.
– Summer season
– Sky with no clouds or thin clouds

• UV light can penetrate water, at a depth of about 0.5-1 meter, UV

radiation still reaches 40%.
• Shades such as buildings and trees can significantly reduce UV radiation
(≥ 50%).
Diaz, J., et al. Sun Exposure Behavior and Protection: Recommendations for Travelers. Journal of Travel Medicine, 2013, 20(2): 450–462
Global Solar UV Index: A Practical Guide .World Health Organization, 2002. ISBN 92 4 159007 6
United States Environmental Protection Agency (EPA). A Guide to the UV Index. 2014.
 UV INDEX
Ultraviolet Index (UVI) is an international standard to measure
the strength of the ultraviolet radiation of the sun at a particular
place or on a particular day

Exposure Category UVI Range

LOW <2
MODERATE 3–5
HIGH 6–7
VERY HIGH 8 – 10
EXTREME 11 +
UV Exposure Category UV Index Fluctuation in a day

Dasgupta, A, Klein K. Oxidative Stress Induced by Air Pollution and Exposure to Sunlight. In: Dasgupta, A, Klein K. Antioxidants in Food, Vitamins and
Supplements, 2014 (cited on 20 February 2019). Assessed from: https://www.sciencedirect.com/topics/medicine-and-dentistry/ultraviolet-radiation
Global Solar UV Index: A Practical Guide .World Health Organization, 2002. ISBN 92 4 159007 6
 Travelers Outdoor Workers

Greater risk of excessive sunlight exposure

Needs photoprotection

To reduce the negative effects of sunlight radiation

Diaz, J., et al. Sun Exposure Behavior and Protection: Recommendations for Travelers. Journal of Travel Medicine, 2013, 20(2): 450–462
 Efforts or actions to prevent or
reduce the effects of sunlight
radiation on human skin
PHOTO
Barrier between sun and skin
PROTECTION
Types:
1. NATURAL
2. PHYSICAL
3. TOPICAL
4. SYSTEMIC
Palm MD, O’Donoghue. Update on photoprotection. Dermatologic Theraphy. 2007; 20, 360-376.
 PHOTOPROTECTION AGENT
1. NATURAL
• Agents in nature
• Atmosphere
• Clouds
• Pollutants
• Shades
• Agents in the skin
• Melanin
• DNA & RNA
• Proteins, Lipids, Water
• Aromatic Amino acids (tyrosine & tryptophan)
• Trans-urocanic acid
• Heme & porphyrin
 PHOTOPROTECTION AGENT

2. PHYSICAL
• Glass • Umbrella
• Sunglasses • Make up
• Clothing • Other
• Hats
 Sunglasses
• Max. UV exposure to the eyes  8 to 10 AM and 2 to 4 PM
• Choose UV-protective sunglasses with protective panels

Summary of the European standard and the Australian standard for sunglasses

European standard (EN 1836:2005)

Australian standard (AS/NZS 1067:2003)

Almutawa, F., & Buabbas, H. (2014). Photoprotection. Dermatologic Clinics, 32(3), 439–448.doi:10.1016/j.det.2014.03.016
 Clothing
UPF (Ultraviolet Protection Factor)
• The effectiveness of textile fabrics in protecting the human skin
from ultraviolet radiations.
• Ratio of the extent of time required for the skin to show redness
(erythema) with and without fabric protection.
MED* protected skin
UPF =
MED* unprotected skin
*MED (minimal erythemal dose) = quantity of radiant energy needed to produce the first detectable reddening of skin

UPF Range Protection Category Mean (%) UV blocked

15-24 Good 93.3-95.8%
25-39 Very good 96.0-97.4%
40-50, 50+ Excellent 97.5-98.0%
Das, B. UV Radiation Protective Clothing. The Open Textile Journal, 2010 3, 14-21
 Clothing
Photoprotective factors
‒ Tightly woven
‒ Synthetic materials
‒ Thicker and heavier material (denim UPF 1.700,
cotton UPF 5-9)
‒ Dark colored clothes
‒ Loose clothes
‒ Unbleached fabrics
‒ Fabrics labelled "dry cleaning only"

Diaz, J., et al. Sun Exposure Behavior and Protection: Recommendations for Travelers. Journal of Travel Medicine, 2013, 20(2): 450–462
Almutawa, F., & Buabbas, H. (2014). Photoprotection. Dermatologic Clinics, 32(3), 439–448.doi:10.1016/j.det.2014.03.016
 Hats

(A) Bucket hat (B) Broad brimmed hat (C) Legionnairee hat

• Hat should be wide brimmed (at least 4 cm) to protect the

scalp, neck, and face; and with back flaps protect the
posterior neck
• With UPF protection

Umbrella
• Wide diameter umbrella, with UV protection capacity to
ensure better protection compared to regular umbrella.
Palm MD, O’Donoghue. Update on photoprotection. Dermatologic Theraphy. 2007; 20, 360-376
Diaz, J., et al. Sun Exposure Behavior and Protection: Recommendations for Travelers. Journal of Travel Medicine, 2013, 20(2): 450–462
 PHOTOPROTECTION AGENT
3. TOPICAL (SUNSCREEN)
ORGANIC (CHEMICAL) INORGANIC (PHYSICAL)
FILTER UVB • Zinc oxide
• PABA (PABA, Padimate O, Padimate A, aminobenzoate, • Titanium dioxide
glyceryl PABA ) • Iron oxide
• Cinnamates ( octinoxate, cinoxate )
• Salicylate ( octisalate, homosalate, trolamine, salisilat )
• Magnesium oxide
• Octocrylene
• Ensulizole ANTIOKSIDAN
FILTER UVA Klasik:
• Benzophenones ( oxybenzone, sulisobenzone,
dioxybenzone )
• vitamin C, E and beta karoten
• Dibenzoyl methanes ( avobenzone or parsol 1789 )
• Anthranilates ( meradimate ) Lain-lain:
• Hydroxycinnamic acid
KOMBINASI UVB & UVA • Polyphenolics
• Mexoryl SX, terephthalylidene dicamphor sulfonic acid • Anthocyanins and tannins
• Mexoryl XL, drometrizol trisiloxane
•
• Pycnogenol®
Tinosorb S, bis-ethylhexyloxyphenol methoxyphenyl
triazine • Fernblock®
• Tinosorb M, methylene-bis-benzotriazolyl • Pomegranate
 Sunscreen (organic / chemical)
• Absorbs ultraviolet radiation.
• UVB filters, UVA filters, or combination.
• UVB filters that are often used  combination of
cinnamates and salicylates  very stable, insoluble in
water, long lasting on the skin
• UVA filters that are often used  oxybenzone and
avobenzone  easily oxidized & degraded.
• The latest UVA & UVB combination filters  Meroxyl SX,
Meroxyl, Tinosorb M, and Tinosorb S
Most common causes of allergies: PABA, benzophenones,
octyltriazone, avobenzone, cinnamates, ensulizole, sulisobenzone

Gonzales S, Gilaberte Y, Neena Philips, dkk. Current trends in photoprotection – a new generation of oral photoprotectors. The Open Dermatology Journal. 2011 ; 5, 6-14.
Gonzales S, Lorente MF, Calzada YG. The latest on skin photoprotection. Clinics in Dermatology. 2008; 26, 614-626.
 Sunscreen (inorganic / physical)
• Reflects and scatters ultraviolet radiation
• Advantages of micronized form:
• Not phototoxic / photoallergic; seldom causes irritation
• Stays on the skin surface, not absorbed systemically
• Effective against UVA, UVB, and visible light
• Photostable, suitable for adults and children

Example: zinc oxide (ZnO), titanium dioxide (TiO2), iron oxide

Baumann L, Avashia N, Castenedo-Tardan MP. Sunscreen. In: Baumann L. Cosmetic Dermatology, 2nd edition, New York: McGraw Hill, 2009: 245-55
Lim HW. Photoprotection. In: Goldsmith LA, Katz SI, Gilchrest BA, et al. Fitzpatrick’s: Dermatology in General Medicine. 8th edition. New York: McGraw Hill, 2012: 2707-13
Gonzales S, Gilaberte Y, Neena Philips, dkk. Current trends in photoprotection – a new generation of oral photoprotectors. The Open Dermatology Journal. 2011 ; 5, 6-14.
Gonzales S, Lorente MF, Calzada YG. The latest on skin photoprotection. Clinics in Dermatology. 2008; 26, 614-626.
 Factors affecting sunscreen effectivity :

Sun Protection Factor

(SPF)
the ability of sunscreen to protect the skin from
ultraviolet light (UVB) radiation

Minimal erythemal dose skin with sunscreen protection

SPF = Minimal erythemal dose skin without sunscreen protection

Rhein LD, Gripp A. Sunscreens: preventive treatment of photodamage and premature aging. In: Rhein LD, Fluhr JW. Aging skin: current and future therapeutic strategies.
Illinois: Alluredbooks, 2010: 139-218.
DeLeo VA. Sunscreens and photoprotection. In: Bolognia JL, Schaffer JV, Cerroni L, penyunting. Dermatology, 4th edition. London: Elsevier, 2018: 2310-17.
Young AR. Photobiology. In: Griffiths CEM, Barker J, Bleiker T, dkk. Rook’s: Textbook of Dermatology. 9th edition. Oxford: Blackwell publishing; 2016:9.11-13.
 UVB protection levels based on SPF
SPF a Transmission Absorption ( % ) b
Sunscreen levels of protection
4 0.250 75
based on its SPF value (FDA):
6 0.167 83.3
8 0.125 87.5 SPF 2 – <15 : Low
10 0.100 90 SPF 15 – <30 : Moderate
12 0.083 91.7 SPF 30 – 50 :
15 0.067 93.3 High
20 0.050 95 SPF > 50 :
25 0.040 96 Very High
30 0.033 96.7
40 0.025 97.5
60 0.017 98.3

a
SPF = 1 / transmission Gontijo GT, Pugliesi MCC, Araujo FM. Photoprotection. Surgical&cosmetic dermatology. 2009; 1(4): 186-91.
Wolf P. Young A. Sunscreens. In: Krutmann J, Honigsmaan H, Elmetd CA. Dermatological phototherapy and
b
Absorption % = ( 1 – T ) x 100 photodiagnostic methods. 2nd editon. Oxford: Springer. 2009: 333-47.
 UVA Protection Factor (UVAPF)
• The ability of sunscreen to protect the skin from
persistent pigment darkening (PPD) induced by ultraviolet
A exposure
• Comparison between the duration of minimum PPD
induced by ultraviolet A exposure on the skin with
sunscreen and without using sunscreen.
• Uses star (*) or plus (+) scale system.
PA + (PA *) : low potency (PPD 2-4)
PA ++ (PA **) : medium potency (PPD 4 – 8)
PA +++ (PA ***) : high potency (PPD 8-16 )
PA ++++ (PA ****) : very high potency (PPD > 16)

Baumann L, Avashia N, Castanedo-Tardan MP. Sunscreens. In: Baumann L. Cosmetic dermatology, 2nd edition. New York: McGraw Gill, 2009: 245-55.
 Substantivity
The ability of sunscreen to remain effective under
the stress of prolonged sweating and swimming

• Water resistant:
Maintains SPF 2x20 minutes of continuous water exposure
• Very water resistant:
Maintains SPF 4x20 minutes of continuous water exposure
• Sweat resistant:
Maintains SPF 30 minutes of continuous heavy perspiration

Diaz, J., et al. Sun Exposure Behavior and Protection: Recommendations for Travelers. Journal of Travel Medicine, 2013, 20(2): 450–462
Burke KE. Antiaging regimens. In: Draelos ZD. Cosmetic dermatology: products & procedures. 1st edition. Oxford: Wiley-Blackwell Publishing Ltd: 2010;480-7.
Glaser DA, Waldorf HA. Sunscreens. In: Draelos ZD. Cosmeceuticals. London: Saunders Elsevier; 2005: 139-47.
 Solubility
Formulation Characteristics
Gel Cool sensation, easy to clean, ideal for oily skin

• Lotion  most popular, easy to use, less oily,

Lotion / cream for normal and oily skin

• Cream  for dry skin

Easy to use,
Oil Oily, looks greasy
Spray / aerosol For large area and for hair

Stick For small areas (nose, lips, ears, and around the
eyes)

Palm MD, O’Donoghue. Update on photoprotection. Dermatologic Theraphy. 2007; 20, 360-376.
 Usage
• The amount of sunscreen usage recommended by FDA 
2 µL or 2 mg/cm2 with 0.5 mm thickness on skin.
• Apply 15-30 minutes before exposure, re-apply every 2-3
hours, after swimming or sweating.
• Average for adults (± 1.5 m2)  30 grams applied all over
the body
• Face (600 cm2)  1.2 grams
• Inadequate application of sunscreen  only 20 – 50% of
needed
• There are no specific international standards for
measuring the amount of sunscreen usage.
Glaser DA, Waldorf HA. Sunscreens. In: Draelos ZD, penyunting. Cosmeceuticals. London: Saunders Elsevier; 2005: 139-47.
 Teaspoon rule

1/2 teaspoon = 3 ml, 1 teaspoon = 6 ml

Glaser DA, Waldorf HA. Sunscreens. In: Draelos ZD, penyunting. Cosmeceuticals. London: Saunders Elsevier; 2005: 139-47.
 “Finger-tip unit” method
• “Finger tip unit“  measures the amount of cream or
ointment to be used in dermatology: it is a strip of
product squeezed on to the index finger, from the distal
crease to the fingertip. (0.5 gram )
• Rule of nines  the body's surface area is divided into 11
areas, each representing roughly 9% of the total
• For each area  index finger and middle finger, each
starting from the proximal finger fold to the finger tip ( 3
gram )

Taylor S, Diffey B. Simple dosage guide for sunscreams will help users. BMJ. 2002. 324:1526.
Bakker P, Woerdenbag H, Gooskens V, et al. Dermatological preparations for the tropics. A formulary of dermatological preparations and background information on
therapeutic choices, production, and dispensing. [cited on 25 Januari 2018]. Assessed from: https://apps.who.int/medicinedocs/documents/s19960en/s19960en.pdf.
Photoprotection Recommendations for Travelers

1. Avoid excessive UV exposure

 High to extreme UV radiation:
• Equatorial areas
• Highlands and mountain
• UV reflecting surfaces (snow, sand, or water)
• Midday, when sun is directly above the head
• Thin or no clouds
 Seek shades (trees, buildings, umbrella, etc)

Diaz, J., et al. Sun Exposure Behavior and Protection: Recommendations for Travelers. Journal of Travel Medicine, 2013, 20(2): 450–462
Global Solar UV Index: A Practical Guide .World Health Organization, 2002. ISBN 92 4 159007 6
Photoprotection Recommendations for Travelers
2. Wear:
Sunglasses
• UV-protective, with protective panels.
• Choose category according to activity type and weather.
For activities with extreme sun exposure it is
recommended to use special glasses (category 4-5)
Hats
• High UPF, wide brimmed (at least 4 cm), and back flaps
protect the posterior neck
Clothings
• More coverage (preferably long sleeved, long pants),
• High UPF > 40 (denim >> cotton, tightly woven, dark
colored, with UV-absorber, etc).
Palm MD, O’Donoghue. Update on photoprotection. Dermatologic Theraphy. 2007; 20, 360-376
Photoprotection Recommendations for Travelers

3. Apply sunscreen:
• Ideal sunscreen:
• Broadspectrum (SPF ≥30, UVAPF ≥PA+++),
• Contains antioxidant,
• Photostable
• Very water resistant
• Non-irritating, non comedogenic
 Zinc Oxide, Titanium Dioxide, Iron Oxide
• Apply to all parts of skin, 15-30 minutes before sun
exposure, dosage 2mg/cm2 or 2µl/cm2 , and re-apply
every 2-3 hours, after swimming, or sweating.
Palm MD, O’Donoghue. Update on photoprotection. Dermatologic Theraphy. 2007; 20, 360-376.
Moyal D, Galdi A, Oresajo C. Sunscreens. Dalam: Draelos ZD, penyunting. Cosmetic dermatology products & procedure. West Sussex: Wiley-Blackwell, 2010: 144-9.
Gonzales S, Gilaberte Y, Neena Philips, dkk. Current trends in photoprotection – a new generation of oral photoprotectors. The Open Dermatology Journal. 2011 ; 5, 6-14.
Gonzales S, Lorente MF, Calzada YG. The latest on skin photoprotection. Clinics in Dermatology. 2008; 26, 614-626.
Thank you