Is Sunscreen Helpful or Harmful?

When it comes to selecting sunscreen, there are a lot of choices: creams, lotions, sticks, and aerosols or sprays, with different ingredients used.

Recently, Johnson & Johnson voluntarily recalled five of its aerosol sunscreen products after high levels of benzene — a known human carcinogen — were detected.

The recall involves four Neutrogena sunscreens — Beach Defense aerosol sunscreen, Cool Dry Sport aerosol sunscreen, Invisible Daily Defense aerosol sunscreen, and Ultra Sheer aerosol sunscreen — as well as Aveeno Protect + Refresh aerosol sunscreen.

Johnson & Johnson said in a statement that the recall is out of an abundance of caution. “While benzene is not an ingredient in any of our sunscreen products, it was detected in some samples of the impacted aerosol sunscreen finished products. We are investigating the cause of this issue, which is limited to certain aerosol sunscreen products,” it said.

To understand what all this means, Health Matters spoke with Dr. Shari Lipner, a dermatologist at NewYork-Presbyterian/Weill Cornell Medical Center, who explains what consumers need to know about sunscreen, its ingredients, and why it’s still important to wear it to prevent skin cancer and protect the skin from damage.

Health Matters: What do we know about the Johnson & Johnson sunscreen recall?
Dr. Lipner: While this report raises concerns, it is important to keep in mind that this is just one report, and the claims need to be validated. The FDA regulates over-the-counter sunscreen products. We will know more once the FDA reviews this report and determines if the benzene levels detected actually exceed the FDA’s limits.

With these recent reports, would you still recommend people use sunscreen?
Yes. Sunscreen plays a key role in protecting our skin from the sun. As a dermatologist, I see the impact of sun overexposure every day in my office. It is the most preventable risk factor for skin cancer, including melanoma, the deadliest form. While we are awaiting information from the FDA on benzene levels, I advise my patients to seek shade; wear sun-protective clothing; and use non-spray, broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to exposed skin. That is the best way to reduce your risk of skin cancer.

Can you explain what the FDA is doing to protect consumers when it comes to sunscreens?
The FDA issued a proposed rule that asks manufacturers to provide more data about the safety of several sunscreen ingredients. There are already two ingredients that are “generally recognized as safe and effective,” or GRASE, and those are titanium dioxide and zinc oxide. But there are 12 other chemicals that need further evaluation in order to determine whether they can be classified as GRASE. The FDA is asking for more information, but certainly, based on the data we have now, they still recommend that we use sunscreen.

What are those 12 ingredients?
Those ingredients are cinoxate, dioxybenzone, ensulizole, homosalate, meradimate, octinoxate, octisalate, octocrylene, padimate O, sulisobenzone, oxybenzone, and avobenzone. The FDA is specifically looking at these ingredients in terms of absorption by the skin and the health risk of absorbed chemicals.

One of the ingredients, oxybenzone, has been rumored to be a hormone disruptor. Is this true?
Some studies have been done — mostly in vitro studies in rats — in which oxybenzone exhibited some estrogen activity. However, in these studies they used an extremely high concentration of oxybenzone, much higher than humans would get. Researchers estimated that it would take 277 years of daily application of a sunscreen containing 6% oxybenzone to obtain a comparable level of exposure in humans. There have been other studies as well. Oxybenzone was applied to the skin of human volunteers, and researchers saw that there were no biologically significant alterations in the reproductive hormones. So at this time there’s not enough evidence to claim that it’s a hormone disruptor. It has been used safely since 1978.

Do young children or pregnant women need to be concerned about these ingredients?
Generally, it is not recommended to use sunscreen on babies younger than 6 months old. The best way to protect them is to keep them out of the sun. But certainly, for young children, pregnant women, people with sensitive skin, or any person who may be nervous about these ingredients, I would recommend a physical sunscreen. Those are sunscreens that contain the two ingredients that the FDA recognizes as safe and effective: titanium dioxide and zinc oxide.

What is the difference between a chemical sunscreen and a physical sunscreen?
A chemical sunscreen works like a sponge. It absorbs the sun’s rays, and that involves some of the ingredients that are being called into question now. Chemical sunscreens are easy to rub into the skin, and they generally do not leave a white residue. Physical sunscreens act like a shield. They sit on the surface of the skin, and they deflect the sun’s rays. They usually leave a white residue.

What should people do to protect their skin?
I always recommend that patients use a sunscreen that is broad-spectrum, meaning it protects against UVA and UVB rays; is water-resistant; and is SPF 30 or higher. I encourage people to reapply every two hours, especially if you are sweating, swimming, or rubbing off sunscreen. I advise my patients to pick a sunscreen that they are going to use every day. So if you like the way a cream feels, use a cream. If you think you are more likely to use a gel or a stick, use that.

But sunscreen is just one part of a big picture. You also want to seek shade. The sun’s rays are strongest between 10 a.m. and 2 p.m. So try to stay in the shade during that time of day. What you wear is important too. Dress to protect yourself from the sun: Wear a lightweight and long-sleeve shirt, pants, wide-brim hat, and sunglasses.

So, in your opinion, are there some sunscreen ingredients that are safer than others?
We have been using these sunscreens for many, many years safely. The FDA is gathering more data, and I think that is helpful. Personally, I would use both the physical and chemical sunscreens. But if anyone is concerned, they can use the physical sunscreens instead. While concentrations of benzene in sunscreen are being investigated, patients should avoid using the specific sunscreens that were recalled.

Learn more about how you can protect your skin this summer and test your skin cancer IQ.

Shari Lipner, M.D., Ph.D., is a board-certified dermatologist at NewYork-Presbyterian/Weill Cornell Medical Center and an associate professor of clinical dermatology at Weill Cornell Medicine. She treats patients with common problems of skin, skin cancers, and cosmetic concerns, as well as nail conditions. She has authored more than 200 manuscripts and book chapters on skin conditions and cosmetics, lectures nationwide, and is frequently called upon by the media for her expert opinion.