OTCs Today
Daniel L. Krinsky, RPh, MS
Summer is just around the corner, which means more folks will spend more time in the sun. As the most accessible health care provider, pharmacists need to be prepared to answer questions and make recommendations about sunscreen. Consider the following important information as you counsel patients on sun safety and the benefits of using sunscreen.
Ultraviolet radiation (UVR)
Clouds filter very little (10%–30%) UVR. What they do filter is the infrared radiation that contributes to the sensation of heat, creating a false sense of security against a burn. White- or light-colored surfaces (e.g., snow, sand) reflect the UVR that strikes them. Water reflects at most 5% of UVR, allowing the remaining 95% to penetrate and burn the swimmer.
According to the therapeutic definitions, topical sunscreens can be divided into two major subgroups: chemical sunscreens and physical sunscreens. Chemical sunscreens absorb and thus block the transmission of UVR to the epidermis. Physical sunscreens are generally opaque; instead of absorbing UVR, they reflect and scatter it. Broad-spectrum sunscreens are designed to protect against both ultraviolet A and ultraviolet B rays, and those with a sun protection factor (SPF) value of 15 or higher may reduce the risk of skin cancer and early skin aging if used as directed along with other skin protection measures.
Allergies and sensitivities
When a patient is treated with a drug that can produce a photosensitivity reaction, prevention of UVR exposure is necessary. Patients may develop phototoxic or photoallergic reactions to any sunscreen or other inactive ingredient in the product. Although it may not be possible to figure out which specific ingredient a patient is sensitive to, patients who have a history of sensitivity to sunscreens would do well to use a fragrance-free, hypoallergenic product.
Caregivers should be extremely cautious about sun exposure in children, especially infants. The American Academy of Pediatrics recommends that children younger than 6 months be kept out of direct sunlight. FDA requires that sunscreen products be labeled with the statement “For children under 6 months of age: consult a doctor.” Parents and caregivers can apply a small amount of sunscreen with an SPF of 15 or higher to small areas such as the face or back of the hands to test for reactions.
Proper application
The two major causes of poor sun protection with sunscreen use are application of inadequate amounts and infrequent reapplication. FDA-approved labeling recommends that sunscreens be applied 15 to 30 minutes before UV exposure and at least every 2 hours thereafter. For maximum effectiveness, sunscreens must be applied liberally to all exposed areas of the body. The average adult should apply approximately 1 ounce, spread over all potentially exposed areas, for sufficient protection.
Water-resistant products should be reapplied after 40 or 80 minutes of swimming or sweating (as designated on the label) and immediately after towel drying. Sunscreen manufacturers are prohibited from claiming their products are “waterproof,” “sweatproof,” and “sunblock” because these terms overstate product effectiveness.
A 2020 study assessed maximum plasma concentration of six sunscreen active ingredients from four commercially available sunscreen products: lotions, aerosol sprays, nonaerosol sprays, and pump sprays. Researchers found that active ingredients are systemically absorbed with single or multiple applications; these data support the need for additional studies to determine the clinical significance of these findings. As of this writing, FDA and many professional associations still recommend the use of sunscreen products for the reasons discussed here.
Counseling pearls
Many people assume they’re knowledgeable when it comes to sunscreens and protection from the sun’s harmful rays, until they get a sunburn. Find ways to educate your patients and customers on the optimal ways to protect against the potential dangers of UVR while still providing opportunities for outdoor fun and activities. Shelf talkers and signage in the appropriate OTC sections of the pharmacy can facilitate dialogue.
And don’t forget to practice what you preach!