Shopping for sunscreen: Are all brands equal?

Emily S. Ruiz, MD, MPH
Emily S. Ruiz, MD, MPH, Contributor

Last week in the playground another mom remarked that she had just ordered all her sunscreen from Europe: “They have much better ingredients. I ordered one with Tinosorb.” This conversation ironically occurred on the same day that I was asked to write this post and I realized that my sunscreen knowledge was a bit passé. As I started to research sunscreen ingredients — in both medical journals and blogs — I discovered why Americans are compelled to go to international markets to find the “best” products.

What is indisputable is the need to protect skin from both UVA and UVB — the type of cancer-causing rays that reach the Earth’s surface. But to ensure you are using a sunscreen that protects from both forms of UV rays, it is important to understand sunscreen labeling in the US. The SPF number is primarily a measure of protection against UVB, whereas the “broad spectrum” label designates UVA coverage. When purchasing a sunscreen, the American Academy of Dermatology recommends selecting one with an SPF of at least 30, with broad-spectrum coverage, and that is water resistant. Although it seems straightforward, just under half of the products marketed on Amazon fall short.

How do you choose?

So now the hard part: selecting a good sunscreen. There are two types of products, organic filters (or chemical blockers) and inorganic filters (or physical blockers). The physical blockers are fairly straightforward as there are two common ingredients, zinc oxide and titanium dioxide. You may associate these products with a white appearance, common in the 1980s, but newer formulations are more cosmetically acceptable. One drawback to the newer formulations is that the titanium-based products offer less UVA protection. That’s not true of the newer zinc-based products. So, bottom line, zinc-based sunscreens offer excellent protection against both UVA and UVB rays, and there are a number of nice products available on the US market.

Chemical blockers are much harder to navigate given the number of filters available, and chemical sunscreens are often marketed as combination products. One of the more common filters is oxybenzone, which protects against both UVA and UVB, and is common in the US market. This ingredient is controversial for two reasons. Of all the chemical filters, it’s the one most likely to cause an allergic reaction. That said, the rate of reaction is actually very low given the number of individuals who use products containing it.

Oxybenzone also has an estrogen effect (meaning it can act like an estrogen cream). The estrogen controversy stems from animal studies, but humans would have to apply large quantities in order to achieve the same effects. The product has been used in this country since the 1970s without any reports of harmful side effects in humans. Other chemical products include salicylates (e.g. octisalate, homosalate, and trolamine salicylate), which are weak UVB absorbers so they need to be combined with other filters; cinnamates, which are potent UVB absorbers; and avobenzone, which is a UVA absorber but can become ineffective in the presence of certain other ingredients.

Sunscreen envy: New ingredients not yet available in the US

There are new ingredients in the pipeline awaiting FDA approval, and yes, these are the ones available in Europe. You may wonder why these effective filters are not available here. The reason is how sunscreens are regulated. In the US, sunscreens are regulated as over-the-counter drugs, whereas in Europe they are classified as cosmetics and not held to the same regulatory standards. There is one newer filter available in the US called Ecamsule (Mexoryl SX), which is a UVA absorber and is available from Amazon as a combination product. Tinosorb is one of the filters awaiting approval and protects against both UVA and UVB.

So, who needs sunscreen?

The easy answer is everyone, but light-skinned individuals are more susceptible to the harmful effects of UV rays. Certain individuals with underlying conditions, such as compromised immune systems, are even more prone to cancer formation. Keep in mind that you can use a great sunscreen, but if you don’t apply it correctly then you are not getting adequate protection, and most people only apply 25% of the recommended amount. It is recommended to apply the following amounts to different areas of the body: 1 teaspoon to the face, head, and neck; 1 teaspoon to each arm and forearm; 2 teaspoons to the front and back of the trunk; and 2 teaspoons to each thigh and leg. And don’t forget to reapply every 2 hours or after getting wet.

One last important point: make sure to check expiration dates and if a bottle doesn’t have one, mark the date of purchase and discard after three years.

Related Information: Skin Care and Repair

Comments:

  1. Joe DiNardo

    One note about Oxybenzone safety – it was stated that it has been used “since the 1970s without reports of harmful side effects in humans” … in 2014 it was voted “Allergen of the Year” by the American Contact Dermatitis Society (reference – Ashley R. Heurung, BS, Srihari I. Raju, MD, Erin M. Warshaw, MD, MS. Contact allergen of the year – Benzophenones. Dermatitis 2014, 25: 3-10.) … in short, Oxybenzone is not a good chemical for our bodies and/or the environment!

  2. Chris on maui

    For what it’s worth, after yesterday mornings posts I decided to look into sunscreens available here in our “environmental” local surf and dive shops, organic groceries and the not local Whole Fuds. The active ingredients in the vast majority of reef safe touted products contained either or both Zinc Oxide and Titanium Dioxide, both listed as “non-nano” and “uncoated”, whatever those two terms actually mean.

    Thanks for posting the film Dr Bowley. The Hawaii leg. not taking it up is not surprising in this state, unfortunately.

    Be well all

  3. Chris on Maui

    Reef death unfortunately is a growing problem and in looking for sunscreen products that do not harm reefs, one is Avasol (avasol.com). Communicating with them about their products, they stated: “Usually, when people claim “reef safe” they just mean the the product does not contain Oxybenzone. Avasol never has and never will contain Oxybenzone, or anything toxic. But the claim of reef safe, or even Organic does not mean that it is safe for people, or the ocean.

    Our concern with reef damage started a decade ago, when scientific studies showed the damage that sunscreen was doing. Now a huge concern is nano particle sized zinc oxide and titanium dioxide. Avasol does not contain these either.”

    I believe it is a product to look into. So stay outside & wet, swimming, surfing, paddling, diving, voyaging sailing etc., and work on keeping our oceans as clean as possible – it is a large endeavor to accomplish – you’ll need a lot of sunscreen to fish out the plastic in the ocean gyres – check out also the young sailor writing “swellvoyage.com”. Aloha and malama pono

    • Dr. James E. Bowley

      Thanks much for the tip, Chris.
      And yes, indeed, all products need to be tested for the harm they might do to ocean, land, reefs, animals (including humans!), and plants etc. If only our EPA and FDA (too often controlled by politicians) would be more concerned about the health of the whole planet/environment than about corporate profits.

  4. CatherineT

    Another point about oxybenzone that should be mentioned is its impact on the environment, particularly in killing coral reefs.

  5. Mary B

    I purchased Neutrogena oil-free moisture with sunscreen (broad spectrum spf 35) and had a very serious reaction using this. I have been trying to figure out which ingredient caused the difficulty. After reading your post on sunscreen, I think the ingredient may be oxybenzone. It is listed as 6% of the active ingredients. It also contains 3% avobenzone, 12% homosalate. My entire face flared red and eyes swelled almost shut. It looked like I had endured a match in the boxing ring. I then took benedryl to stop the inflammation. I now hear that benedryl may exacerbate sun sensitivity. This is crazy!! Your article minimized the effect of oxybenzone and I’m not sure that’s good advice. You can never know for sure, but that ingredient seems to be the culprit in my case. I’m now shy about using anything on my face for fear I’ll have a similar reaction.

  6. Ben

    Dear Emily
    I am a big fan of the only Organic Certified Mineral sunscreen on the market by Laboratoires de Biarritz.
    It is good for me and good for the environment. Doesn’t whiten and no nanoparticles.
    Checkout https://laboratoires-biarritz.ch/
    its my personal favorite

  7. Paul Verchinski

    The FDA does not have sunscreen requirements so anything goes in the US. I buy mine in Australia which has ver ystringent requirments .

  8. Jerry Yurow

    I am a burn survivor whose dermatologist recommended Anthelios (SPF 60-70). It is usually available at CVS stores in my area.

  9. Larry Eisenberg

    Consumer reports gives more specific information and recommends specific brands. Frankly much more informative that this article.

  10. andrew goldstein

    Apply…”1 teaspoon to the face, head, and neck; 1 teaspoon to each arm and forearm; 2 teaspoons to the front and back of the trunk; and 2 teaspoons to each thigh and leg.”

    What? That’s a total of 2 tablespoons of sunscreen per application, repeated every two hours. Way too greasy for me. What about the liquid spray formulations? This sounds like a recommendation based on industry-sponsored research where after a couple of applications, you’ve consumed half the tube.

    • Mary

      I agree–couldn’t afford to put that much sunscreen on every day! And it’s very reminiscent of the instructions and warnings on other products meant to make sure you use up or throw away what you’ve bought and replace it quickly. Dr. Ruiz, would you answer our questions about this?

    • Diana Rivera Rodriguez

      And you think spray will be diffetent? There are sprays out there. You spray and then you have to spread it on your skin. Unless you want to spray half a can to cover the space. And spraying you face? Ok – you can cover the eyes. BUT – I agree with you that they say apply every 2 hrs. I suppose they are refering when you are out on the beach. Because if you are at work, if you are a woman – re-apply suncreen means wash face, re-apply sunscreen, re-apply makeup – every 2 hours !!!!! ????? Because there is a chance that the lights in commercial places (offices, hosp., factories, stores etc.) emit UVA rays. And there are people who’s work has them coming in and out of buildings – walking in the sun from and to the car and the sun they get through the car windows. And then there is the people that work outside in the sun all the time. Re-apply every 2 hours? I wish someone would tell me about this. Because in every article I have read it says re-apply but they don’t explain who has to re-apply – if everybody all the time or only when you are on the beach. I have been using zinc or titanium which are the ones that give you the ghost looking appeareance (and the oiliness – (I who hate lotions) because I’m allergic to the others. And I’ve been using it because I have melasma since I was 30 y/o (I’m 60 now) and my father and his mother had skin cancer. I hate it and I don’t use it when I stay home even though my aparment is fillled with sunshine every where and every day (I live in the Caribbean). And still the melasma keeps showing up in differnt places on my face. The whiteting cream for melasma that I don’t recall it’s name right now is of no use. And it’s expensive. So congratulations to me but l ike I said I wish someone would explain this q 2hrs. re-application. I would also like to know why I still get the melasma and how to get rid of it. I’ll be thankfull for the help.

  11. Dr. James E. Bowley

    Thanks for this helpful information; I was unaware (but not surprised) that better products were available in Europe.

    I realize you were only considering issues regarding human skin in this post, but i wondered if you have considered the effects of some of the chemicals in sunscreens on the larger environment? There’s a growing number of scientists, including those at the NOAA, who believe that some of the ingredients are very harmful in the ocean. Hawaii is considering banning sunscreens (2017 session) with oxybenzone because it harms the coral reefs . Here’s a short documentary by The Redford Center and Fagan Films with some of scientific evidence, http://www.thecoverupfilm.com/reefs-at-risk/.

    I would like to know your thoughts on this. Thanks.

  12. Jennifer M

    Is there any science yet available about Mexoryl SX or Tinosorb? The blog post is interesting, but it doesn’t address the question of why we should be envious of these new products – does science suggest they may be more effective than Zinc with fewer health risks to other US filters? Currently shopping online for sunscreen is a real challenge – for example, all brands that were top rated by consumer reports received terrible ratings from ewg.org.

  13. Diane Thomas

    Thank you for this helpful information. I have a question about whether the ingredients in chemical sunscreens, particularly benzones, can cause cancer as is noted on many internet sites. A friends’s dad, who was a chemist, told her that benzones are used as catalysts in lab experiments by exposing them to light, and that they could be dangerous in sunscreens. He has since passed away, and I have never been able to find a reliable answer to this question from an unbiased source. They may even be mixing up the term with benzenes. What do you say?

    • Nancy kardon

      Our skin absorbs directly all the chemicals we put on it.Without scientific study one could say massive absorption over years would have to have an effect on the body chemistry.

      Which ones are the least harmful and can still protect us. Does such a one exist?

      There is a massive cosmetics industry in the US oblivious to this Non- harm radar.

      Scientists Please respond about sunscreen risks. Would it not be. Eat to stay out of the sun as much as possible except for our vitamin D absorption?

      Nancy Kardon
      Iyengar Yoga Scarsdale

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