The topic of the bi-annual International Sun Protection Conference, held on June 6-7 2017, at the Royal College of General Practitioners in London and organized by Jack Ferguson, PhD., was “Sun Exposure vs. Protection: Getting the right balance?” Indeed, this outstanding gathering of experts yet again highlighted both key advances in sun care research, technology and the challenges in delivering the relevant messages to the consumers.
For years, sun protection and sun avoidance have been the strategies promoted by dermatologists, governments and industry, even though there are health benefits derived from the sun. These strategies were based on the vast amount of data on the chronic and acute damage caused by overexposure to the sun, including sunburn, skin cancer and skin aging. In recent years, however, there has been an increasing awareness that certain groups of the population (e.g. children playing on computers or women with indoors lifestyles in religious communities), suffer from deficiencies in vitamin D, possibly due to under-exposure to the sun. Vitamin D, sometimes referred to as the 'sunshine vitamin', is important in the formation and maintenance of healthy bones and general good health. Other benefits of sun exposure, not related to vitamin D, include reduction in blood pressure, suppression of autoimmune disease and a feeling of wellbeing.
The issue of protection against short and long term skin damage by the sun is complex. A comprehensive debate at the conference focused on sun protection that gives exposure to the benefits of the sun while still providing the desired protection from UV damage. Further topics entailed the quality of protection (delving into the UVA/UVB balance, IR, blue light and visible light protection]), sun care technologies, testing and worldwide regulations affecting the sun products and their claims.
Professor Robyn Lucas, PhD., from The Australian National University, Canberra, Australia discussed the “Yin and Yang of Sun Exposure: Achieving a balance for good health.” As a physician and epidemiologist, she lauded the journey that Australia made with sun protection since the 1980’s. She pointed out the optimal amount of sun exposure and individual variability, highlighting that 20% of her audiences were sunburnt last weekend. Whilst the incidence of skin cancer is rising, strong educational messages, funded by the government, have caused the incidence to lower in younger age groups. Looking at the assessment of vitamin D status in health and disease (e.g. autoimmune disease, obesity, myopia), she further discussed the pattern of sun exposure. High intermittent peak of exposure runs a high risk of melanoma. She called for simple, evidence-based messages to be clear and relevant for the public. Based on the evidence from clinical trials and the Australian experience, she confirmed that this daily sun protection is effective in reducing skin cancers.
Richard Weller. MD., from the University of Edinburgh and RelaxSol Ltd, introduced new technology able to maintain the benefits of sunlight whilst protecting against melanoma. Nitrox-DTM is a patented formulation of cosmetically approved ingredients that permits the sun-derived nitric oxide and vitamin D benefits. It can provide the optimal balance between safe sun protection and healthy sun exposure. Further, the need for broad protection in sun care with a focus on visible and IR light (Croda, UK), IR assessment of hazard and risk to the skin (Bioderma, France) and the skin pigmentation effect of blue light (CIPD, Mauritius) were debated.
The use of “High SPF Sunscreens: Why hold back on sun protection?” was presented by Joshua Williams, PhD., from Johnson & Johnson, USA. He investigated consumer usage and the actual protection of suncare in a randomized, double blind, split face, in-use study in a skiing environment. 100+ SPF proved significantly more effective in protecting against acute sunburn than the SPF 50+. Are high SPF products beneficial or are we protecting or ‘chemicalizing’ children? The debate stressed the importance of in-use trials, real-time usage and compliance in retaining full protection from damaging effects of sun in highly exposed environments.
In his keynote, Professor Paul Matts from P&G, UK, asked “Who are we serving?” The desperate need for impeccable public education in sun protection! Stressing that skin cancer is on the rise, he urged the industry to translate technical complexity to simple claims for the consumer and prevent the media from distributing fake news. He has shown that arbitrarily segmenting a continuous light spectrum is unhelpful and not serving the consumer. He outlined the role of UVA wavelengths in oxidative stress and the variability of UVA/UVB exposure pattern throughout the year. He concurred with Dr Lucas about Australia getting the message right and pointed at the backlash of consumers saturated with conflicting or unclear messages; sometimes the ‘fear of cancer’ message performs worse than ‘vanity and prevention of photo-ageing’ in consumer communication.
Helioscreen, Coty and L’Oréal from France took to the podium in relation to in vivo and in vitro SPF testing, its variability and validation. A new method, Hybrid Diffuse Reflectance Spectroscopy for non-erythemal in vivo testing and tolerability and efficacy of sunscreens during sweating and physical activity was discussed by Institut Dr. Schrader and proDerm from Germany. Future changes to SPF testing and the likelihood of new UV filters being accepted by the FDA were brought up by Dermatest Pty Ltd, Australia and P&G USA.
In terms of sun care ingredients, the safety of Titanium Dioxide, and the nano-challenge, were addressed by German Merck and BASF, as well as new ingredients in enhancing skin UV protection involved folates, acetyl zingerone, NAD and marine mycosporine-like amino acids. Beiersdorf, Germany, proposed anti-inflammatory activity of sun care products and DSM reviewed segregation of individual screen constituents relative to product application. In his final talk, John Staton from Dermatest, suggested that ultimately the sun, not an artificial light source, should be a shared primary reference light source for sunscreen efficacy.
In conclusion, the forum agreed on the need to communicate credibility of evidence-based products and standardize methodology and labeling, to have confidence that the product will be relevant to the client, and stop the controversy in the media. Transparent, simple messages and great product aesthetics are key, driving consumer compliance: people should not only tolerate but love their sun care. The sun brings a feel-good factor and specific groups in society should consider vitamin D supplementation. Finally, with wearable diagnostics getting popular, patches and apps on smartphones offer personalized options. These devices should not, however, encourage people back into sun-tanning mentality with reliance on these apps. However, they must enable the industry to teach young people about prevention, exposure and correct sunscreen application to prevent skin cancers.
