FDA VS SPF What do we tell our patients about sunscreen?

Titbits from the 5th Combined Dermatology Congress of SA:

Once a year, there is great anticipation as the dermatologists of South Africa get together to learn about the latest research and novel treatments from both international and local keynote speakers. This year was no exception. We came away enlightened and newly inspired to bring the latest in dermatology back to our own practices. From the inimitable Mrs Sabrina Shah-Desai with her unique blend of humour and pearls in teaching anatomy and injectables (Oh the lasting impression the image of her ‘resting bitch face’ for Botox treatments has made 😊) to Prof Amy Paller and our very own Prof Dlovu whose contribution to dermatology made me feel about 2 feet tall. What a congress and the greatest appreciation for Prof Khumalo and her team for bringing us such a fantastic line-up of speakers.

In this setting of esteemed and inspirational leaders in our field, it was a great honour to present on two topics I am known to be passionate (OK, a little obsessed) about: clean beauty and the minefield of a topic that is sunscreen and its safety. 

I am known to joke that buying a serum or sunscreen have never been so complicated. But cosmetic ingredient safety is not really something I take lightly. 

Between navigating conflicting opinions about which ingredients to trust and being bombarded in the media by marketing campaigns promising astonishing results from your home-care products, it is enough to make your head spin. Take this together with the latest storm over the safety of chemical filters in sunscreens and the confusion deepens. In fact, I am surprised how few of my patients are aware that two sunscreen filters have been banned outright in Hawaii and Key West in Florida with another 10 of the most common chemical filters under investigation and no longer considered GRASE (or Generally Recognised as Safe and Effective). 

So for those of you unwilling to listen to the full hour of nitty-gritty behind these two topics (and why not ) this is where we stand currently: 

• We have the evidence that certain ingredients such as parabens, phthalates and oxybenzone (a sunscreen chemical filter) can mess with our hormones (think infertility).
• We have the evidence that what we choose to put on our skin impacts our environment and is contributing to coral bleaching
• We have good research casting enough doubt whether ingredients in our skincare products are implicated in cancer. We have an adverse event reporting system where between 2004 and 2017, cancer related reports caused by cosmetics represented 41% of all adverse events related to cosmetics.
• We have the understanding that with advances in technology, we are being exposed to smaller molecules (do the terms nanoparticles or liposomes ring a bell?) which can penetrate our skin more easily. Yup this means they are more effective but at what cost?
• We also are more aware of the concept of bioaccumulation: this sounds scary because it is: this basically means that we are being exposed to these questionable ingredients across so many of our products that they are building up in our bodies at doses which are significant.

But it is not all doom and gloom. What can you be doing?

• Make use of resources such as the Environmental Working Group Skin deep database, CosDNA, INCI decoder and the Think Dirty app to check how safe your products are
• Check out the ‘Build your own report’ option at the top right hand corner of the EWG Skin deep website – it takes only a few seconds to plug in your ingredients and get an immediate answer
• Ditch and switch out any products containing ingredients such as parabens, petroleum, mineral oil, PEGs and especially fragrance
• Use physical or mineral sunscreens containing zinc oxide or titanium dioxide or the newer, ‘safer’ chemicals such as Tinosorb
• Cover up! Protective clothing still remains the best way of keeping safe in the sun.

The bottom line is that until regulations are tightened to ensure our safety and until the CTFA, our SA watchdog, grows itself some teeth,  it’s up to us to empower ourselves. When it comes to the safety of my patients and my family, ‘innocent until proven guilty’ doesn’t cut it. 

Because sometimes the grass is greener and cleaner on the other side.