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CHAPTER 29 SUNSCREENS
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TABLE 29-1 Three Types of Tests to Determine Sunscreen Ef cacy SUN PROTECTION FACTOR (SPF) Goal To protect skin against UVB (and some UVA) wavelengths Testing on humans to compare time of exposure necessary to induce mild skin reddening, or minimum erythema dose (MED), in absence of the product with time needed to induce the same MED in the presence of the product UVA PROTECTION FACTOR (UVAPF) To protect skin from developing persistent pigment darkening (PPD) induced by UVA exposure Testing on humans to compare the time of exposure necessary to induce mild skin darkening in the absence of the product with the time required to induce the same level of darkening in the presence of the product BROAD-SPECTRUM PROTECTION AND PHOTOSTABILITY To provide broad-spectrum protection against UVB and UVA; to prevent rapid degradation from UV exposure
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Laboratory testing to measure the absorbance of light at each wavelength, arriving at a relative ratio of absorbance in the UVB and UVA ranges as well as photostability The most common measure of broadspectrum ef cacy is critical wavelength (CW)a Photostability is measured as the ratio of the absorbance of the formula before irradiation to the absorbance of the formula after irradiation with a particular UV amount Result This ratio SPF This ratio UVAPF Broad spectrum, if CW 370 nmb; the photostability value Beta-value a The FDA may use the same test with a slightly different measurement, considering the ratio of longer wavelength UVA1 (340 400 nm) compared to the total UV (UVA UVB absorbance) b This is the standard in the European Union (EU) and will be soon adopted in the Association of Southeast Asian Nations (ASEAN)
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TABLE 29-2 EU and ASEAN Standards for Sunscreens SPF 6 PPD one-third of the SPF value (eg, the PPD 5 for an SPF 15 product; PPD 10 for SPF 30) CW 370 nm LABEL Products that meet all 3 criteria labeled as broad spectrum; products that do not labeled as NOT providing UVA protection
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Physical Sunscreens
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Barrier sunscreens, known more commonly as physical sunscreens, scatter or reflect UV radiation and are rarely associated with allergic reactions These sunscreens block the widest range of light including UV, visible, and infrared spectra, and are recommended for use especially when intense sun exposure, such as at the beach or at high altitudes, is expected Patients with sensitive skin are more likely to tolerate this type of sunscreen, as opposed to the chemical variety Titanium dioxide (TiO2), magnesium oxide, iron oxide, and zinc oxide (ZnO) are the primary ingredients in physical sunscreens The older formulations require a thick layer of application, melt in the sun, stain clothing, and can be comedogenic Some of these agents are so opaque that they are visible and, consequently, often cosmetically unacceptable to most people Some manufacturers have marketed opaque products in bright colors specifically designed for use by children Cosmetically acceptable translucent or colloidal suspensions that consist of micronized preparations of ZnO and TiO2 have been recently developed These formulations are popular because they remain on the skin s surface and are not systemically absorbed This minimizes irritation and sensitization, and maximizes their safety profile 27 In fact, there have been no reports of contact allergy to these components28 In the early 1990s, microfine ZnO became available29 Microfine ZnO absorbs appreciably more UV light in the long-wave UVA spectrum from 340 to 380 nm The only other sunscreen ingredient approved for use in the US that protects against this UVA spectrum is the organic chemical avobenzone Because avobenzone is photolabile in UV light, its protective ability is uncertain30 Notably, ZnO and TiO2 are not photolabile However, new photostable formulations of avobenzone have been developed Formulations containing micronized ZnO or TiO2 are the most often recommended products for sensitive skin types; however, ZnO or TiO2 products are not interchangeable Microfine TiO 2 effectively attenuates UVB (290 320 nm) and UVA2 (320 340 nm); however, it is less effective than ZnO in the UVA1 range ( 340 nm)29 Microfine ZnO has a particle size of less than 02 m At this size, visible light scattering is minimized and the particles appear transparent in thin
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and anticancer substances In a recent study, the nitroxides TEMPO, PCM, and PCA were used because of their known capacity to trap reactive free radicals in skin exposed to UV irradiation The effects of UV radiation on the nitroxides can be measured because they reduce to hydroxylamines The nitroxide PCA is found universally in skin and is solely reduced by UV-generated free radicals and reactive oxygen species (ROS) making it possible to estimate the penetration of UVA and UVB irradiation UV irradiation decreases the PCA intensity, and this reduction has been shown to be engendered mainly by UVA radiation Therefore, using ESR, the in vivo detection of UV-generated free radicals/ROS via the reduction of the nitroxide PCA in human skin should be possible23 An additional method used to assess UVA radiation damage is comparing the accumulation levels of p53, which is known to be a very important tumor suppressor gene Mutations in p53 have been noted in more than 90% of squamous cell carcinoma, 50% of basal cell carcinoma, and 60% of actinic keratoses24 Expression of p53 is used to quantify skin damage associated with UV-related skin damage and can be used to evaluate the effectiveness of sunscreens In a recent study, two sunscreens with identical SPF but varying UVA protection factors were evaluated using the PPD method25 The PPD is a measure of the amount of darkening pigment that is present a day or so after sun exposure24 The SPF of the sunscreens was 7, while the UVA protection factor (UVA-PF) determined in vivo using the PPD method was 7 for one product and 3 for the other The amount of p53 was also measured in skin exposed to UV radiation The results showed that only partial protection was afforded by the two sunscreens with identical SPF, but there was a lower level of p53 in the areas of skin treated with the sunscreen of higher UVA protection factor The results portrayed a marked increase in the amount of p53 in the skin with increasing exposure to higher levels of UVA radiation These results confirmed
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that SPF based on erythemal reaction caused by UVB does not accurately predict the level of protection conferred against UVA damage from sun exposure25
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