Addressing Sunscreen Safety: A Review of EWG’s 2024 Guide to Sunscreens

Recent findings from the Environmental Working Group (EWG) highlighted potential shortcomings in sunscreens available in the US market. The organization’s 2024 Guide to Sunscreens¹ reported that only one-fourth of approximately 1700 SPF products meet the criteria for adequate sun protection, further underlining differences in regulatory processes in the US, Europe, and other parts of the world.

Moreover, EWG reported that approximately 1700 studied sunscreens still contain ingredients that pose potential health risks, including oxybenzone, octinoxate, homosalate, octisalate, and avobenzone. Most of these ingredients have exhibited prior evidence of skin penetration and skin allergy or other concerns.¹ Titanium dioxide and zinc oxide are currently the only proposed safe and effective active ingredients in sunscreens.²

Dermatology Times recently spoke with Adewole Adamson, MD, MPP, a board-certified dermatologist based in Austin, Texas, and an assistant professor in the Department of Internal Medicine (Division of Dermatology) at Dell Medical School at the University of Texas at Austin. Adamson is also a health services researcher and specializes in caring for patients at high risk for melanoma of the skin, evidence-based medicine, and health policy.

Additionally, Adamson is the director of the melanoma and pigmented lesion clinic at Dell Seton Medical Center at The University of Texas. Following the EWG’s report, he delved into the implications of these findings, the regulatory landscape surrounding sunscreen ingredients, and what clinicians should discuss with patients who express concerns with the headlines stemming from the report.

Dermatology Times: The EWG recently reported that only 1 in 4 sunscreens is safe to use. Can you provide your perspective on this report? What should clinicians know about it, and what should they tell their patients?

Adamson: None of their data is actually based on any information that involves actual clinical or actual patient use in the real world. I do not think that patients should change their behavior related to putting on whatever sunscreen it is that they use based on this data.

DT: How does the approval process and regulation for sunscreens compare in the US vs European or Asian countries, for example?

Adamson: The difference between the regulatory mechanisms are that fundamentally, in the EU [European Union] and abroad, sunscreens are regulated as cosmetics. The amount of rigor that has to go in, in terms of introducing new sunscreen filters is a bit less in the United States, where sunscreen is regulated like a drug. Therefore, unfortunately, we have not had very many sunscreen filters that have been approved over the last generation. As a result, we have…fewer selections when it comes to the types of sunscreen that we can use.

DT: As a clinician, what common concerns have you encountered from patients about sunscreen efficacy or safety?

Adamson: There’s a lot of concern about sunscreen absorption. Some of that stems from a study that came out in the Journal of the American Medical Association a few years ago showing that certain chemical sunscreens add chemicals that actually were found in the blood, raising concern that some of these chemicals could…be harmful to human health.³

What I would say is 2 things: One is the way in which the study was conducted was a maximal use study.These were people that were putting sunscreen on their entire body multiple times a day, without washing it off, and that is not how people use it in everyday practice. The study also showed that, indeed, there were some sunscreen ingredients that ended up being able to be found in the blood, but just because there’s some in there does not mean that it then causes actual harm. There was just enough that we required some more studies in order to make sure that they are indeed safe to use. In the 50-[to] 60-year history of using sunscreen, there has been no credible evidence that it has been harmful to human health. In fact, the opposite has been shown to be the case––that it has prevented a lot of people from developing skin cancers.

DT: When addressing patient concerns and skepticism, what are some pearls and tips for clinicians regarding education and choosing the right sunscreen?

Adamson: What I would advise my fellow dermatologists to say is that there is no data to support that sunscreen is harmful to human health, period. There are some in vitro studies that show some of the ingredients, if they are found at very high doses in animals, that they could potentially cause harm. That is not the same as them causing harm in people. That would be the most important thing that I want to communicate to fellow dermatologists.

Second, if patients have a lot of concerns about chemical sunscreens, then [dermatologists] should suggest that their patients use physical sunscreens or mineral sunscreens that have titanium dioxide or zinc oxide, which are 2 ingredients that do not end up in the blood when they are applied to the skin in the form of sunscreen.

References

1. Only 1 in 4 sunscreens deemed safe by EWG, offering balanced UVA and UVB protection. News release. EWG. May 1, 2024. Accessed June 10, 2024. https://www.ewg.org/news-insights/news-release/2024/05/only-1-4-sunscreens-deemed-safe-ewg-offering-balanced-uva-and
2. FDA proposes sunscreen regulation changes. US Food and Drug Administration. February 2019. Accessed June 10, 2024. https://www.fda.gov/media/124654/download#:~:text=Two%20ingredients%20(zinc%20oxide%20and,e%20ective%20for%20sunscreen%20use
3. Matta MK, Florian J, Zusterzeel R, et al. Effect of sunscreen application on plasma concentration of sunscreen active ingredients: a randomized clinical trial. JAMA. 2020;323(3):256-267. doi:10.1001/jama.2019.20747