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Sunscreen application does not prevent vitamin D production in the majority of people

Peer Reviewed |Observational Study/Systemic Review | People

Sunscreens do not prevent vitamin D production according to a new study due to be released in the British Journal of Dermatology (BJD). The results of this study are supported by a systematic review of 75 papers on sunscreen and vitamin D also published recently by the BJD.

Vitamin D, which is vital for bone health, is produced by the skin in response to ultraviolet radiation (UVR) from sunlight. However, as well as being the primary source of vitamin D, UVR is a major cause of a skin cancer, the UK’s most common type of cancer.

In recent years, global concern about vitamin D deficiency has fuelled debates on how best to achieve healthy levels of vitamin D, known as vitamin D sufficiency, while simultaneously limiting the risk of skin cancer. Concerns have been raised that sun protection methods, including sunscreen use, may be contributing to vitamin D deficiency.

Now, three separate studies have concluded that use of sunscreen does not impact on vitamin D status in the majority of people.

In the first study, funded by the EU and conducted by researchers from King’s College London, participants were split into four groups. The participants, apart from those in the control group, then went on a week-long holiday to an area with a very high UV index.

Twenty people received a broad spectrum* sunscreen with a Sun Protection Factor (SPF) of 15, offering UVB protection and high UVA protection. Twenty people received a non-broad spectrum sunscreen, also SPF 15 but with low UVA protection. These two groups were told how to use their sunscreens correctly, so as to achieve the labelled SPF. In contrast, 22 people used their own sunscreen with no instructions on how to apply it, and 17 people formed a control group who remained in Poland.

Blood (serum) samples were taken from participants 24 hours before and 24 to 48 hours after the holiday.

SPF 15 sunscreens applied at sufficient thickness to inhibit sunburn allowed a highly significant improvement of vitamin D levels. Furthermore, the broad spectrum sunscreen enabled higher vitamin D synthesis than a low UVA protective sunscreen, possibly because the former, due to its composition, transmits more a little more UVB than the latter. The people who used their own sunscreens, also had significant vitamin D synthesis, but they all had sunburn. This was almost certainly because they did not use their sunscreens correctly. During the same period, the control group has a slight decline in vitamin D.

In the second study, researchers from the QIMR Berghofer Medical Research Institute in Australia, and the Australian National University, systematically reviewed all published experimental studies, field trials, and observational studies published between 1970 and 2017, totalling 75 studies, for the first time.

The researchers found that while the experimental studies - using artificial light sources in a laboratory setting - support the theoretical risk that sunscreen use may affect vitamin D, the weight of evidence from field trials and observational studies - taking place in real-life situations involving natural sunlight - suggests that the risk is low.

The researchers explain that the conditions in the experimental studies did not reflect those of the real-world so the results cannot be used to inform public health policy.

Observational studies which reported an association between vitamin D levels and sunscreen application most commonly found a positive relationship, supporting the conclusion vitamin D synthesis is maintained whilst wearing sunscreen.

A further review which presents the findings of an international panel of 13 experts in endocrinology, dermatology, photobiology, epidemiology and biological anthropology, who reviewed scientific literature on vitamin D and sun protection prior to an evidence review meeting also concluded that sunscreen use is unlikely to affect vitamin D production and that UVA protection does not affect vitamin D synthesis.

Professor Antony Young of King’s College London and lead author of the first study, said:

“Sunlight is the main source of vitamin D. Sunscreens can prevent sunburn and skin cancer, but there has been a lot of uncertainty about the effects of sunscreens on vitamin D.

“Our study, during a week of perfect weather in Tenerife, showed that sunscreens, even when used optimally to prevent sunburn, allowed excellent vitamin D synthesis.”

Professor Rachel Neale of the QIMR Berghofer Medical Research Institute and lead author of the second study, said:

“A common concern amongst the general public is that sunscreen use may increase the risk of vitamin D deficiency. This has the potential to undermine sun protection messages, which aim to prevent skin cancer. A 2015 survey conducted in the United States found that 20 per cent of people agreed that regularly protecting the skin leads to a risk of not getting enough vitamin D.

“These recent findings should reduce this concern, and encourage people to follow recommended sunscreen application, which could eventually lead to a reduction in the number of new skin cancer cases.”

Holly Barber of the British Association of Dermatologists, said:

“The ability to achieve adequate protection from the sun to avoid sunburn, a risk factor of skin cancer, whilst not impacting vitamin D production is really encouraging. The risk of vitamin D deficiency from sunscreen has been found to be low, and therefore is unlikely to outweigh the benefits of sunscreen for skin cancer prevention.

“Further research is required on SPF 30 and higher sunscreen, as this is what we recommend people use for optimal protection in real-life situations. People with dark skin types are at a higher risk of vitamin D deficiency, and lower risk of skin cancer, so further research is also required to see how these findings translate to people with dark skin types.”

-Ends-

Notes to Editors:

* Sunscreens that provide a balance of UVA and UVB protection are called ‘broad spectrum’, and these are generally recommended by medical experts.

Professors Young and Neale are members of the Environmental Effects Assessment Panel (EEAP) under the auspices of the United Nations Environment Programme (UNEP). The EEAP prepares annual reports for about 200 governments on the impacts of ozone layer depletion on human health.

https://ozone.unep.org/science/assessment/eeap

Study details:

Optimal sunscreen use, during a very high UV index holiday, allows vitamin D synthesis without sunburn
A.R. Young1, J. Narbutt2*, G.I. Harrison1, K.P. Lawrence1, M. Bell3, C. O’Connor3, P. Olson4, K. Grys1, K. Baczynska5, M. Rogowski-Tylman6, H.C. Wulf4, A. Lesiak2 and P.A. Philipsen4

1King’s College London, St John’s Institute of Dermatology, London, SE1 9RT, UK;
2Medical University of Lódz, Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Lódz, 90-647, Poland;
3Walgreens Boots Alliance Inc., Nottingham NG90 5EF, UK;
4Bispebjerg Hospital, Department of Dermatological Research, Copenhagen 2400, Denmark;
5Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxfordshire OX11 0RQ, UK;
6Dermoklinika Centrum Medyczne, Lódz, 90-436, Poland;
*Equal 1st author

Link to study: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.17888

The effect of sunscreen on vitamin D: a review
R.E. Neale1, S.R. Khan1, R.M. Lucas2, M. Waterhouse1, D.C. Whiteman1 and C.M. Olsen1

1Population Health Department, QIMR Berghofer Medical Research Institute
2National Centre for Epidemiology and Population Health, Australian National University

Link to study: https://onlinelibrary.wiley.com/doi/10.1111/bjd.17980

Sunscreen photoprotection and vitamin D status
T. Passeron1, R. Bouillon2, V. Callender3, T. Cestari4, T. Diepgen5, A.C. Green6, J. van der Pols7, B.A. Bernard8, F. Ly9, F. Bernerd10, L. Marrot10, M. Nielsen8, M. Verschoore8, N.G. Jablonski11, and A.R. Young12

1Université Côte d’Azur. Department of Dermatology. CHU Nice & INSERM U1065 team 12, C3M. 150, route de St-Antoine de Ginestière, 06200 Nice, France
2Schoonzichtlaan 22, Herent 3020, Belgium
312200 Annapolis Rd #315, Glenn Dale, MD 20769, USA
4Santo Inacio 500 AP 1002, Porto Alegre, 90570-150, Brazil
5Universität Heidelberg, Klinische Sozialmedizin, Voßstr. 2, 69115, Heidelberg, Germany
6Cancer and Population Studies Group, Locked Bag 2000, Royal Brisbane Hospital QLD
4029, Australia
7Level 4, 88 Musk Avenue, Kelvin Grove, Queensland 4059, Australia
8L'Oréal R&I, Scientific Directorate, 9 rue Pierre Dreyfus, 92110 Clichy, France
9University of Medicine and Pharmacy of Dakar and Cheikh Anta Diop University, Dakar,
Senegal
10L’Oréal R&I, 1 Avenue Eugène Schueller, 93600 Aulnay-sous-bois, France
11State college, 432 West Shadow Lane, PA 16803-1246, USA
12King’s College London, St John’s Institute of Dermatology, London SE1 9RT, UK

Link: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.17992

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk
 

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BAD response to sunscreen chemical concerns following JAMA study

Below is the BAD response to 'Effect of Sunscreen Application Under Maximal Use Conditions on Plasma Concentration of Sunscreen Active Ingredients'.

Dr Andrew Birnie, British Association of Dermatologists (consultant dermatologist and skin cancer surgeon), said:

“It’s worth noting that the amounts of sunscreen used in this study are significantly higher than the average person would use in normal circumstances.  Furthermore, sunscreen has been used by a large portion of the population for a number of decades and there has not been any epidemiological data that suggests users come to harm.  We agree with the researchers that people should not make the knee-jerk decision to stop using sunscreen.

“Skin cancer is the UK’s most common cancer, equalling all other cancers combined.  The link between excess sun exposure and skin cancer is well documented and indisputable.  This research on sunscreen is very much at an early stage.  The first line of defence against the sun should be shade and clothing, with sunscreen used for additional protection.”

Prof Brian Diffey of the British Association of Dermatologists (Emeritus Professor of Photobiology, Dermatological Sciences, Newcastle University), said:

“As the authors themselves have said, this was a maximal use study using generous and frequent applications of sunscreen – in practice most people apply a thinner layer of sunscreen over a smaller fraction of the body surface less often during the day, resulting in a daily amount of sunscreen about one tenth of the amount used in this study.

“This would mean that for 3 of the 4 agents studied here, the levels of active ingredients found in the plasma during typical usage would fall below the threshold value.  (The threshold value in toxicology means the value that would approximate the highest plasma level below which the carcinogenic risk of any unknown compound would be less than 1 in 100,000 after a single dose.)

“The authors suggest their findings mean we should do further to determine the clinical significance of these findings.  It is important to note there is no evidence from this study that there is any health risk.  And even at maximal use, any theoretical risk is almost certainly far smaller than the reduced risk of skin cancer that has been shown to be associated with sunscreen use.  Indeed, the authors themselves say that their results do not suggest that people should refrain from using sunscreen.

“It is important to note that each participant in the study applied the equivalent of two standard bottles of sunscreen over four days.  This is considerably greater than typical use where it has been estimated that people who use sunscreen go through about one bottle per year per person.”

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