Sun Protection Updated

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Summer is officially here. That means that most of us are in the sun much more frequently. Most vacations and general summer fun occurs outdoors – either hiking, biking, swimming or playing tennis. Even just the walk around the neighborhood or gardening can give us hours of sun exposure.

There is much evidence that sun exposure, particularly sunburns, can lead to skin cancer, which accounts for 40% of all cancers. Melanoma, the most dangerous form, is one of the leading causes of cancer deaths.

Avoiding burns, and sun exposure in general, which can also cause wrinkles and sun damaged skin, is another conundrum.

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Unsafe Skin Protection
Oxybenzone, the leading active ingredient in most popular sunscreens, can be dangerous in and of itself. The non-profit Environmental Working Group offshoot site Cosmetics Database gives sunscreens with oxybenzone a very poor rating. The reason for this is that when exposed to sunlight, oxybenzone can break down into byproducts that are actually carcinogenic. There is evidence for possible reproductive danger as well. Researchers recommend that this be avoided in children. 3

Avobenzone, another popular active ingredient, breaks down in sunlight and causes allergic reactions as well as possible hormone disruption. Health researchers are calling for more research into the bioaccumulation affect of these products on humans as well as wildlife. 5
The Cosmetics Database guide to sunscreens (http://www.ewg.org/2014sunscreen/8-sun-safety-strategies/) also points out that rates of melanoma have tripled in the past 35 years, and there is no evidence that sunscreen has done anything to reverse that trend. While the sunscreen industry is booming, the evidence that their products will prevent cancer has been lacking. The FDA, National Cancer Institute and International Agency for Research on Cancer agree that the data do not support the assertion that sunscreens alone prevent skin cancer. (The proven major risk factors for melanoma are fair skin, indoor tanning, number of moles on the skin, freckles, family history, UV exposure and severe sunburns.) 2

Impactful tidbits from the Cosmetics Database article I found interesting:
• Sunscreen increased rates of melanoma (Gorham 2007)
• Outdoor workers have lower rates of melanoma than indoor workers
• Increased Vitamin D (which we get from the sun) may reduce skin cancer risk

One fear that many health providers share is that people using sunscreen believe that they are protecting themselves from cancer, and therefore may spend more time in the sun, soaking up those UV rays. One study showed that while the sunscreens studied did prevent burns and photoaging, they actually increased growth of melanoma. 6
Retinal Palmitate, now found in many popular sunscreens, has it’s own problematic effects. In some FDA sponsored studies it has been shown to increase skin cancer.
PABA, another common ingredient in sunscreen, may also cause damage to the skin. Researchers found that application of normal amounts of PABA can damage melanocytes in the skin, the cells that are responsible for tanning and our natural defense against sun damage. 4

So why would we lather our bodies with products that could cause cancer when exposed to sunlight? Well, the truth is that most people are not aware of much of what they rub into their skin. Or they think that we don’t absorb them into our bodies. This is just appalling to me, considering that many drugs are delivered through the skin – such as hormone patches or nicotine patches. Along with the problematic sun protection ingredient, many contain other chemicals such as phthalates (which can be hormone disruptors) and petrochemicals as part of the vehicle for the lotion. Two free apps that I use when shopping for sunscreens and any other body care products are Think Dirty and the Cosmetics Database. You can scan the barcode of the product and get an instant rating while you shop – without having to have a degree in chemistry!

FDA logjam of new sunscreen chemicals
Recently an article in the San Francisco Chronicle pointed out that our European and Canadian counterparts have many more choices in sunscreen products, yet the FDA has them in a log-jam here, with 8 new chemicals pending review for years or over a decade before a decision is made on their safety. One that has great promise for protecting both UVA and UVB rays, is ecamsule (also referred to as Mexoryl), thought by some health experts to be better than anything we have available so far in this country. 1

Myself along with many of my colleagues recommend physical blockers, such as zinc oxide or titanium dioxide, rather than the chemical ones. The downside is that they are not as sweat- or waterproof, and therefore need to be reapplied more frequently. Protecting your skin with hats and clothing is also effective and should particularly be used with children, who are much more at risk for developing cancer if they are burned in the sun.

Is protection possible from internal ingestion of a fern extract?
Native peoples of Honduras and Guatemala have been using the extract of the fern plant Polypodium leucotomos for centuries. Scientists have found that this extract protects skin from oxidative damage, sunburn, photoaging and prevents tumors from beginning to grow in relation to UV exposure. On research study in healthy human volunteers showed that it prevented UV damage, UV related reddening of the skin, and offered photoprotection of the Langerhans cells. 7

Research has shown that this extract apparently bolsters our skin’s natural defenses against more rapid aging caused by UV rays. It prevents the rays of the sun from breaking down photoprotective molecules. 8

According to Michael Downey in a recent issue of Life Extension magazine, the extract “not only prevents, but also repairs, the sun’s damaging effects on the skin. It prevents sunaged skin by directly inhibiting MMP (matrix metalloproteinase) expression, preventing the breakdown of collagen in the first place. It repairs sun-aged skin by stimulating new production of collagen and elastin – healing and regenerating photoaged skin after exposure to ultraviolet radiation.” 11 (Life Extension is one of the manufacturers of the product. That said, the research in the article is well documented.)

This idea of protecting out skin from the inside out is appealing to me as a naturopathic doctor. Whenever people come in for help with skin issues, applying some treatment to the outside is nothing more than a Band-Aid to me. Collagen damage can’t just occur on the surface. I love the idea of protecting our cells from the inside. The mechanism of this effect on many cells in the body has been, and continues to be, well researched. 9 Not only for the prevention and treatment of sun-induced skin damage, but also promising scientific evidence for treatment of melasma and vitiligo. 10

Final thoughts
My ongoing conversation with my very pale dermatologist includes the fact that my perspective on my body is that I have it while here to use and enjoy. This includes my heart, lungs, eyes and yes, my skin. I don’t want to give any organ unnecessary burden, but if I have to stay inside and avoid having any fun in the sun, then it is just not worth it to me. Just like I will not cut down on increasing my heart rate or allowing my liver some toxins to eliminate, I will not give up my tennis matches or hikes with good friends. I will however be as wise as possible, by using safe and effective skin protection strategies.

References:

1. Colliver, V. May 27, 2014. Fresh sunscreen ingredients stuck in FDA backlog. San Francisco Chronicle.
2. Skin cancer on the rise. Environmental Working Group EWG 2014 Guide to Sunscreens. http://www.ewg.org/2014sunscreen/8-sun-safety-strategies/
3. Gilaberte Y. Sun protection in children: realities and challenges. Actas Dermosifiliogr. 2014 Apr;105(3):253-62. doi: 10.1016/j.adengl.2013.05.006. Epub 2014 Mar 21.
4. Xu C et al. Photosensitzation of the sunscreen octyl p-dimethylaminobenzoate by UVA in human melanozytes but not in keratinocytes. Photochem Photobiol. 2001 Jun;73(6):600-4.
5. Schlumf M et al. In vitro and in vivo estrogenicity of UV screens. Environ Health Perspect. 2001 Mar;109(3):239-44.
6. Wolf P et al. Effect of sunscreens and UV radiation-induced enhancement of melanoma growth in mice. J Natl Cancer Inst. 1994 Jan 19;86(2):99-105.
7. Gonzalez S et al. Topical or oral administration with an extract of Polypodium leucotomos prevents acute sunburn and psoralen-induced phototoxic reactions as well as depletion of Langerhans cells in human skin. Photodermatol Photoimmunol Photomed. 1997 Feb-Apr;13(1-2):50-60.
8. Gonzalez S et al. Fernblock, a nutriceutical with photoprotective properties and potential preventive agent for skin photoaging and photoinduced skin cancers. Int J Mol Sci. 2011;12(12):8466-75. doi: 10.3390/ijms12128466. Epub 2011 Nov 29.
9. Rodriguez-Yanes E et al. Oral administration of polypodium leucotomos delays skin tumour development and increases epidermal p53 expression and the antioxidant status of UV-irradiated hairless mice. Exp Dermatol. 2014 May 24. doi: 10.1111/exd.12454. [Epub ahead of print]
10. Ahmed AM et al. A randomized, double-blinded, placebo-controlled trial of oral Polypodium leucotomos extract as an adjunct to sunscreen in the treatment of melasma. JAMA Dermatol. 2013 Aug;149(8):981-3. doi: 10.1001/jamadermatol.2013.4294.
11. Downey M. Protect Against Sun-Induced Skin Aging from the Inside Out. Life Extension. July 2014.

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