Photoprotection Part II. Sunscreen: Development, efficacy, and controversies Rebecca Jansen, MD,a UliOsterwalder,MS,b Steven Q. Wang, MD,c Mark Burnett, MD,c and Henry W. Lim, MDa Detroit, Michigan; Monheim, Germany; and New York, New York CME INSTRUCTIONS The following is a journal-based CME activity presented by the American Academy of Date of release: December 2013 Dermatology and is made up of four phases: Expiration date: December 2016 1. Reading of the CME Information (delineated below) Ó 2013 by the American Academy of Dermatology, Inc. 2. Reading of the Source Article http://dx.doi.org/10.1016/j.jaad.2013.08.022 3. Achievement of a 70% or higher on the online Case-based Post Test 4. 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After completing this learning activity, participants should be able to describe the evolution of sunscreen technology; summarize new photoprotective technologies; Elsevier: http://www.elsevier.com/wps/find/privacypolicy.cws_home/ and discuss and explain current sunscreen controversies. privacypolicy 867.e1 867.e2 Jansen et al JAM ACAD DERMATOL DECEMBER 2013 In addition to the naturally occurring, physical, and systemic photoprotective agents reviewed in part I, topical ultraviolet radiation filters are an important cornerstone of photoprotection. Sunscreen develop- ment, efficacy, testing, and controversies are reviewed in part II of this continuing medical education article. ( J Am Acad Dermatol 2013;69:867.e1-14.) Key words: oxybenzone; photoprotection; photostability; Sun Protection Factor; sunscreen; sunscreen controversies; ultraviolet filter. SUNSCREENS: Ultraviolet filters TOPICAL CAPSULE SUMMARY Principles of ultraviolet PHOTOPROTECTIVE radiation absorption AGENTS d Ideal sunscreens provide uniform by organic ultraviolet Key points protection across the ultraviolet B and filters. In order to absorb d Ideal sunscreens pro- ultraviolet A light range while ultraviolet radiation (UVR), vide uniform protection maintaining sensory and tactile features an organic ultraviolet (UV) against ultraviolet A and that enhance the user’s experience. light filter must contain a ultraviolet B light. d Sunscreen efficacy depends on suitable chromophore that d p Ideal sunscreens have ultraviolet filter type (organic or has conjugated -electron aesthetically pleasing inorganic), photostability, and the systems. Increasing the num- compositions that en- addition of Sun Protection ber of conjugated double hance compliance. Factoreboosting agents. bonds in the molecule shifts the absorption maximum to d New US Food and Drug Administration The notion of the ‘‘ideal longer wavelengths and also regulations regarding sunscreen testing sunscreen’’ gives rise to a larger absorp- and labeling aim to improve the clarity Since the first commercial tion cross section and, there- of photoprotection of sunscreens. sunscreen was introduced in fore, stronger absorption. In 1928, the use of sunscreens d While there are controversies involving general, the larger the mo- as an integral part of photo- sunscreen ingredients, formulations, and lecular weight of the chro- protection strategy has ex- side effects, based on current data, the mophore, the more the panded worldwide. Table I riskebenefit ratio indicates that it is absorption maximum will highlights the historical de- appropriate to include the use of 1-4 be shifted towards longer velopment of sunscreens. sunscreen as an important component wavelengths. This is the rea- Two factors must be ad- of photoprotection strategy. son that UVB light filters have dressed to produce an 5 smaller molecular weights ‘‘ideal’’ sunscreen. It compared to UVA light or should provide uniform protection across the broad-spectrum filters. range of ultraviolet B light (UVB) and ultraviolet Currently, all organic UV absorbers used in sun- A light (UVA), a property referred to as ‘‘spectral