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Sunscreen Allergy: A review and an UpdateVincent St Aubyn Crump FRCP (UK), FRACP23 January 2014This review will not discuss any of the controversial adverse effects of sunscreens reported in the media, like disruption of the hormone system, inhalation of nanoparticles or any other toxic concern. It is specifically concerned with the objective, scientifically proven adverse effects of sunscreen on the skin.IntroductionDoctors and public health campaigns encourage photoprotection, in order to reduce the growing prevalence of skin cancers and early skin aging. In New Zealand, in 2010 about one-half of adults and adolescents reported that they wore sunscreen, while doing outdoor activities at the week-end (National Research Bureau, 2010). A recent study in Europe (Suppa M, 2014) showed that over 80% of the patients reported use of sunscreens. Also a recent systematic review of 16 interventional studies, found 5 studies that specifically demonstrated an increased use of sunscreens. With the increased use of sunscreens it is not surprising that there has been an increase in reports of adverse reactions to sunscreens. Adverse reactions to sunscreens include four kinds of contact dermatitis: irritant, allergic, phototoxic and photoallergic. These reactions (that are usually associated with a visible rash) are caused by the active chemical UV filters (absorbers), preservatives, fragrances, and bases like lanoline, but not the UV blockers (Zinc oxide and titanium dioxide). The benzophenones (especially benzophenone-3) and dibenzoylmethanes (Avobenzone or Parasol 1789) are the main culprits at the moment.However, non-allergenic (patch test-negative) “irritant” reactions, often with very little visible signs, due to ‘stinging’ compounds in sunscreens are probably the commonest cause of adverse reactions in someone with “sensitive” skin. The objective diagnosis of sensitive skin is very difficult, as it is based on subjective descriptions from the patients. The estimated prevalence of ‘sensitive skin’ in Europe, the United States, and Japan is 50% among women and 30% among men11.SunscreensUVB is the major cause of sunburn and increased skin cancer risk, while UVA contributes to ageing of the skin, as well as skin cancer risk. A broad-spectrum agent is necessary to block or filter the effects of both UVA & UVB.Sunscreens are traditionally divided into chemical absorbers and physical blockers on the basis of their mechanism of action.Chemical sunscreens function best to prevent sunburn from UV-B radiation. They do this by absorbing ultraviolet (UV) radiation and incorporate its energy into the sunscreen molecule and converting the ultraviolet energy into less dangerous wavelengths. They provide more limited protection from UV-A radiation. There are approximately 120 chemicals that work as UV filters.Physical sunblock generally comprise zinc oxide, titanium dioxide, or a combination of both. Similar to clothing, they physically reflect and scatter UV radiation, dissipating the energy in the surrounding environment. However, sun avoidance remains the best form of UV protection. Sunscreen Groups (refer Sunscreen table at end of document)The FDA classifies sunscreen active ingredients as either physical (also known as Inorganic), which acts as barriers that reflect or scatter radiation and light similar to clothing or Chemical (also known as Organic) agents, which absorb photons of UV radiation, and converts it to a lower energy level or longer wavelength. Each chemical sunscreen absorbs a specific range of wavelength. The Physical or Inorganic sunscreen active ingredients are the only active sunscreen agents that should be labelled as “hypoallergenic”, since on their own they are inert as far as allergies are concerned.The most common sunscreens on the market today include avobenzone, oxybenzone, octocrylene, homosalate, octisalate, and octonoxate. Active Ingredients in Sunscreen Products:(Source: Environmental Protection Agency)Clinical Features of sunscreen allergyA sunscreen rash is often clinically indistinguishable from a photosensitive rash of any cause.General features of a “photosensitivity” rashEczematous reaction in the sun-exposed areas, such as the “V” of the anterior neck, the backs of the hands, the forearms. Typically, the upper eyelids, upper lip, and area under the chin and behind the ears are sparedAny skin area that receives sufficient light and is exposed to the photosensitising Clinical features of the different sunscreen reactions:Reaction to sunscreen independent of UV exposure: Contact dermatitis Allergic Contact Dermatitis: Usually requires previous sensitisation. Onset is usually within 48 hours of exposure. The rash is usually confined to the area of exposure, with spread to the immediate surrounding areas. Very itchy, red, thickened skin with vesicles (water blister) in the acute stage, but becomes scaly and more thickened in the chronic stage.Irritant Contact Dermatitis: The rash is confined to the area of exposure, has sharp margins, and with little spreading outside the area of direct contact.“Cosmetics Intolerance Syndrome (CIS) ” or “Sensitive Skin Syndrome” Sensitive skin is a common term used by patients, health care providers, and the cosmetic industry, and is a very complex clinical challenge for everyone. This is probably one of the most frequently reported adverse reactions to sunscreens. Skin sensitivity is a subjective (sensory) irritation, and Howard Maibach7, an expert in dermatotoxicology, coined the term cosmetics intolerance syndrome. The reactions are described as burning, stinging, or itching, often without any visible rash. It tends to start within 30 to 60 minutes of applying the sunscreen, and often disappears within 2 hours or up to 2 days after exposure. The reaction usually occurs on the face, especially around the eyes. The explanation is “a biochemical irritation” in a ‘sensitive’ skin. This reaction was the most common reaction seen with the (old) PABA sunscreens, which contributed to the popularity of the “PABA-free” label. After a while some patients with CIS may develop reactions to all skin care products, a condition known as “status cosmeticus”, a term coined by AA Fisher2, and is the most severe form of CIS.Reaction to sunscreen requiring UV exposure after application of sunscreenPhotoallergic reactions: Rash looks no different from the rash due to allergic contact dermatitis. Confined to the areas of exposure to both the allergen and light, with possible spread to the immediate surrounding areas. Sunscreens are the commonest cause of photoallergy in the United States.Phototoxic reactions: Rash is confined to the sun-exposed areas (usually the face, the “V” of the upper chest, backs of the hands, and forearms, and sparing of the upper eyelids, beneath the chin and behind the ears), the rash is more painful than itchyConditions that mimic sunscreen allergy: Other photosensitive-like rashesPhotosensitivity Drug reactionSolar urticariaAtopic dermatitisPolymorphous light eruptionSystemic lupus erythematosusSeborrheic dermatitisRosaceaIngredients in sunscreen causing adverse reactions include:Active chemical agents (absorbing the UV)FragrancesPreservatives: Methylisothiazolinone, Quaternium 15, parabensIrritants: Cinnamic acid compounds, Lactic acid, Urea, Lanoline (wool alcohol), alcohols, alpha hydroxyl acids, and propylene / butylene glycol.Prevalence of Contact dermatitis to sunscreen agentsThe first commercial sunscreen was developed in 1928, but increased usage did not start until in the 1980s following public health campaigns informing of the dangers of sun exposure. The number of sunscreen products available has increased exponentially, and includes occult sources such as moisturisers, hairsprays, shampoos, makeup, and even in some clothing fabrics.Contact allergy to UV filter was first published in the 1940s, but allergic contact dermatitis was most commonly implicated to inactive ingredients in sunscreens in the 1960s. Para-amino-benzoic acid (PABA) was one of the first sunscreens to be introduced in the United States, and sensitisation was documented as early as 1947. PABA causes allergic, photoallergic and irritant dermatitis. Reports of these reactions steadily increased throughout the 1960s and 1970s. This has led to their near removal from sunscreens, and today PABA products are only rarely used in sunscreen formulations; and PABA-free sunscreens are widely promoted. But like all other contact allergens, when their sensitising potential becomes known and they lose popularity, it is only a matter of time before the sensitising potential of their replacements become known.The prevalence of adverse reactions to sunscreen is not known in the general population, but in a patch test clinic the prevalence of allergy to the active sunscreen ingredient is probably less than 1%. However, adverse reactions to sunscreens (all the ingredients included) are not uncommon. One Australian study reported that 19% of adults complained of some sort of adverse reactions to their sunscreen.The prevalence of sunscreen sensitisation in individuals referred for evaluation of photosensitivity is also very high. In a Photopatch test (application of chemicals to the back for 48 hours and then irradiate the skin with UVA light after removal of the patch with the chemicals) clinic in France, 15.4% of positive reactions were related to sunscreens, and 72% were deemed relevant.Fischer and Bergstrom found that only 5% of pharmaceutical customers complaining of adverse reactions from sunscreens were allergic to active sunscreen ingredients, with most other allergies detected to fragrances like Balsam of Peru.It is important to realise that contact allergy also exists in very young children. When 85 healthy asymptomatic children (Denver, CO area) ages 6 months to 5 years were patch tested with the 24 panel allergen T.R.U.E. TEST, 20 (24.5%) reacted to one or more allergens (Bruckner et al 2000).Risk Factors for Sunscreen AllergyUse of sunscreen products on damaged skin (active eczema)Pre-existing photodermatoses (sun-related skin conditions)AtopyOutdoor occupationDiagnosis of Sunscreen allergyAllergic and photoallergic contact dermatitis is diagnosed with a patch test and a photopatch test, respectively, whereas irritant and phototoxic contact dermatitis are clinical diagnoses of exclusion.A standard patch test with a battery of 60 allergens, which includes all the inactive ingredients in the sunscreen, should always be done along with the “Sunscreen chemicals”. The sunscreen chemicals are applied on the back in duplicate. At 48 hours the patches are removed, and one of the sunscreen battery is irradiated with 5 KJoules and read in 30 minutes for photocontact urticaria and read again in 24 hrs. A positive reaction at the non-irradiated site, which is stronger at the irradiated site, is interpreted as a photo-augmented allergic contact dermatitis. Equal positive at the irradiated and non-irradiated sites are interpreted as allergic contact dermatitis. Sunscreen AllergensA case series report in the Australasian Journal of Dermatology (3) reported on their experience with sunscreen allergy between 1992 and 1999 and also review the international literature on sunscreen allergy. There were a total of 21 allergic reactions to sunscreen chemicals observed in 19 patients over the 8 years. There were:9 positive photopatch reactions to oxybenzone, 8 to butyl methoxy dibenzoylmethane,3 to methoxycinnamate and 1 to benzophenone. No positive reactions were observed to para aminobenzoic acid. Six patients also had positive patch tests to components of the sunscreen base.In their experience, sunscreen chemicals are the most common cause of photoallergic contact dermatitis.In another study reporting on 7 years experiencing of photopatch testing with sunscreen allergens in Sweden (Berne B), of 355 patients with suspected photosensitivity tested 7.9% had an allergic reaction, and 80% of these were of photocontact origin. This is an important point, since doing patch tests only (without photo testing) will miss the majority of cases of sunscreen allergy. The allergens were: Benzophenone-3 (Eusolex 4360) was the most common allergen -16 reactions15 photocontact allergic reaction1 allergic contact reactionisopropyl dibenzoylmethane (Eusolex 8020) – 12 reactions8 photocontact, 4 contactbutyl methoxydibenzoylmethane (Parsol 1789 – 6 reactions6 photocontact reactionsphenylbenzimidazole sulfonic acid (Eusolex 232) – 2 reactionsIn that study, 1 case of contact urticaria from benzophenone-3 was accidentally found, this suggests that Immediate-type testing for urticaria is useful.PABA and Ester DerivativesPABA was one of the first sunscreen agents to be used in the United States. One of the main advantages of PABA is that it penetrates the horny layer of the skin and, binds to proteins in the epidermis, which provides prolonged protection, even after swimming and showering. One disadvantage was that photo-oxidation of PABA causes it to turn yellow, and this results in staining of clothes. However, the main reason for its loss in popularity was the increasing numbers of reported irritant, allergic, and photoallergic reactions that it caused in the 1960s, 1970 and 1980s. The majority of the patients who claim to be “allergic” to PABA (and some of the other sunscreens) actually have irritant reactions, especially when alcohol is used as the vehicle.The ester derivatives of PABA including glyceryl PABA, octyl dimethyl PABA (Padimate O), dimethyl PABA (Padimate A), replaced the use of PABA in sunscreens following the reports of allergy in 1960s to 1980s. However, all these derivatives have been reported to cause adverse reactions as well, and most are no longer available for commercial use in many countries. Because of problems with PABA formulations, manufacturers emphasized the PABA-free claim, and several sunscreens are marketed as “hypoallergenic” because they are PABA-free.Benzophenones were first used in sunscreen products in the 1950s, and the first description of a contact reaction to benzophenones in sunscreen products was published in 1972 (Ramsay DL). This chemical is probably one of the most common causes of photocontact allergy. Benzophenones were named the American Contact Dermatitis Society’s Allergen of the year for 2014. This was based on the fact that bezophenone-3 is the most common sunscreen contact and photocontact allergen in North America, and also because of its widespread use in cosmetics. Benzophenone-3 is used in the US more than all of the other benzophenones combined. The most recent 10-year retrospective analysis of the North American Contact Dermatitis Group data (Warshaw EM) showed that 70.2% of the positive patch tests to sunscreen were due to benzophenone-3. It was also the leading cause of sunscreen allergy in Australia (Nixon RL).Benzophenone-3 seems to cause more photoallergic contact dermatitis than allergic contact dermatitis. Therefore, if a photopatch test is not done (as well as the regular patch test), the diagnosis will be missed.Benzophenone-4 has been reported to cause all 4 types of contact dermatitis and it is reported as one of the top 5 sunscreen allergen in several studies. In addition to causing contact and photocontact delayed-type hypersensitivity reactions, benzophenones has been reported to cause immediate-type hypersensitivity: photocontact urticaria (hives), contact urticaria, and anaphylaxis.For patch testing, a 10% oxybenzone concentration in petrolatum is used, and generally serves as a marker to benzophenones.Dibenzoylmethanes are UV absorbing chemicals widely used in continental Europe. Numerous cases of photocontact allergy has been reported with 4-tert-butyl-4-methoxy dibenzoylmethane or Avobenzone. In a recent survey of availability of UV filters in the UK, the most frequently occurring UV filter was Avobenzone. The other sensitizer isopropyl dibenzoylmethane (Eusolex 8020) has been withdrawn, but the number of reports of allergy & photoallergy to Avobenzone is causing some authors to predict that a third “epidemic” of sunscreen allergy to this agent, similar to those of PABA in the 1960s and benzophenones in 2014.Cinnamates are group of chemicals used in flavourings, fragrances, and less frequently sunscreens. In sunscreens they are often combined with benzophenones. They are often used in sunscreens marketed as “waterproof’.Contact urticaria from cinnamates used in other skin care product have been reported, but not to sunscreens containing cinnamates.Salicylates were first used in cosmetics as Benzyl salicylates, and this was the first sunscreen used in the United States in 1928. Currently octyl salicylate and homosalate are the major salicylate component of sunscreen. Allergic contact dermatitis from salicylates have been reported only rarely (Dromgoole SH).Hypoallergenic sunscreen alternatives: Physical Blockers or Inorganic sunscreenThe only 2 physical sunscreen agents are Zinc oxide and titanium dioxide. The physical sunscreen agents include titanium dioxide and zinc oxide, separately or in combination. They reflect the UV light, bouncing it away from the skin. Zinc oxide blocks (reflects) UVA I, UVA II & UVB rays (320-400nm), and is therefore considered as a broad-spectrum sunscreen. Titanium dioxide only blocks UVA II & UVB (320-340 nm wavelength). These agents have the best safety profile of the choices currently available on the market. These agents have not been reported to cause irritant, phototoxic, allergic, or photoallergic dermatitis, and may even prevent photoallergic reactions to other chemical sunscreens. These mineral sunscreens were traditionally very messy (and opaque), but the new advanced formulations contain fine micro-pigments which are smoother, lighter and easier to blend into the skin.Misleading Sunscreen Labels & the dynamic state of sunscreen allergens:Reading sunscreen labels is not very easy as the list of ingredients can be very extensive, and there are several synonyms for the known contact allergens. Several sunscreen manufacturers use labels like “hypoallergenic”, “Allergy”, “Natural”, and “sensitive” to mislead consumers into believing that their products are safe for patients with known allergies. New allergens are constantly replacing older allergens in sunscreens. Therefore, sunscreen manufacturers have to work very closely with the doctors who manage patients with contact dermatitis. The Piz Buin story below highlights this point very well.Piz Buin Allergy Sunscreen Recently the healthcare company Johnson & Johnson changed the formula for its Piz Buin 1 Day Long suncream after more than 150 people told BBC Watchdog about allergic reactions. The preservative known as MI (Methylisothiazolinone), which has been causing an epidemic of contact allergy to several well-known cosmetics in Europe and in New Zealand, was found to be the likely cause of reactions. This ingredient was removed and the new sunscreen, which is labelled as “Piz Buin Allergy Sunscreen has several well-known contact allergens (highlighted in bold letters below):Ingredients of Piz Buin Allergy Sunscreens: Aqua, Octocrylene, C12-15 Alkyl Benzoate, Ethylhexyl Salicylate, Glycerin, Butylene Glycol, Dimethicone, Silica, VP/Eicosene Copolymer, Cyclohexasiloxane, Methylene bis-benzotriazolyl tetramethylbutylphenol (nano), Styrene/Acrylates Copolymer, Butyrospermum Parkii Butter, Butyl Methoxydibenzoylmethane, Bis-Ethylhexyloxyphenol Methoxyphenyl Triazine, Diethylamino Hydroxybenzoyl Hexyl Benzoate, Cetyl Alcohol, Chrysanthemum Parthenium Flower Extract, Hydroxyphenyl Propamidobenzoic Acid, Pentylene Glycol, Propylene Glycol, Acrylates Copolymer, Sodium Polyacrylate, Caprylyl Glycol, Cyclopentasiloxane, Linseed Acid, Glyceryl Stearate, PEG-75 Stearate, PEG-8 Laurate, Potassium Cetyl Phosphate, Decyl Glucoside, Steareth-20, Sodium Dodecylbenzenesulfonate, Cetearyl Alcohol, Xanthan Gum, Disodium EDTA, Ascorbyl Palmitate, Phenoxyethanol, Potassium Sorbate, Parfum.From the ingredient listed above Octocrylene, Ethylhexyl Salicylate, and Butyl Methoxydibenzoylmethane are sunscreen agents which have been reported to cause allergic, photoallergic and irritant dermatitis in several case reports and larger studies. Also fragrance is one of the commonest contact allergen found in cosmetics, and Phenoxyethanol, propylene glycol, and cetearyl alcohol are preservatives with which commonly cause allergic contact dermatitis.Other examples of misleading sunscreen labeling include:Sunsense Sensitive, which is free of chemical sunscreen agents but contains a well-known preservative sensitizer, parabens.Neutrogena Pure and Free baby Sunscreen also has no chemical sunscreen agents, but has the strong sensitizer methylisothiazolinone.Active Ingredients in Neutrogena Pure and Free baby sunscreen: Titanium Dioxide (4.9%), Zinc Oxide (4.7%)Inactive Ingredients: Alumina, Arachidyl Alcohol, Arachidyl Glucoside, Ascorbic Acid (Vitamin C), Avena Sativa (Oat) Kernel Extract, Beeswax (Apis Mellifera), Behenyl Alcohol, Benzyl Alcohol, BHT, Bisabolol (L-Alpha), Butylene Glycol, Butyloctyl Salicylate, Cetyl Dimethicone, Dimethicone, Dimethicone PEG 8 Laurate, Dipotassium Glycyrrhizate (Licorice Root), Disodium EDTA, Ethylhexl Glycerin, Glyceryl Stearate, Hydroxyethyl Acrylate/Sodium Acryloyldimethyl Taurate Copolymer, Isohexadecane, Methicone, Methylisothiazolinone, Pantothenic Acid, PEG 100 Stearate, PEG 8, Polyaminopropyl Biguanide, Polyhydroxystearic Acid, Polymethylmethacrylate, Polysorbate 60, Potassium Sorbate, Retinyl Acetate (Vitamin A), Silica, Stearic Acid, Styrene Acrylates Copolymer, Tocopheryl Acetate (Vitamin E), Triethoxycaprylylsilane, Trimethylsiloxysilicate, Trisiloxane, Water, Xanthan Gum“Hypoallergenic sunscreens”: Safer Sunscreens for allergic individuals or individuals who want to reduce their chances of becoming allergic: Sunblockers Free of UV chemical filters and reduced contact allergensSunscreens free of UV filter chemicalsAbsolutely Natural Sunscreen (fragrance only possible allergen)Aubrey Organics Natural SunscreenAva Anderson Non-Toxic SunscreenAveeno Baby Natural Protection Face Stick, SPF 50Babo Botanicals Clear Zinc sunscreenBadger SunscreenBlue Lizard Australian Sunscreen SensitiveCalifornia babyCaribbean Solutions SunscreenElemental Herbs SunscreenInvisible ink – Zinc oxide (inert). Only possible sensitizer is phenoxyethanolJuice Beauty Oil-Free Moisturizer, SPF 30Loving Naturals sunscreenMDSolar Sciences Mineral Crème?sunscreen Mexitan Tropical Sands sunscreenNatural Instinct natural sunscreenSoleo Organics natural sunscreenSunology Natural SunscreenSuntegrity? Skincare natural Mineral sunscreenSunumbra natural SunscreenTrue natural All Natural SunscreenUVNatural SunscreenVanicream SunscreeenWotNot sunscreenSunscreens free of UV chemical filters and low in allergenic allergens:Blue Lizard baby, Australian sunscreenActive Ingredients: Titanium Dioxide (5%), Zinc Oxide (10%)Inactive Ingredients: Beeswax, C12-15 Alkyl Benzoate, Caprylyl Glycol, Chlorphenisen, Disodium EDTA, Ethylhexyl Palmitate, Ethylhexyl Stearate, Hexyl Laurate, Hydrogenated Castor Oil, Methyl Glucose Dioleate, Octododecyl Neopentanoate, Phenoxyethanol, Polyglyceryl-4 Isostearate, Propanediol, Purified Water, Sorbitan Oleate, Stearic Acid, Trimethylated Silica/Dimethicone, VP Hexadecene Copolymer, Cetyl Dimethicone Copolyol, PEG 7 Hydrogenated Castor Oil, Tocopheryl Acetate (Vitamin E).Babo Botanicals Clear Zinc SunscreenActive Ingredients:?Zinc Oxide (22.5%; Non-Nanoparticle)Inactive Ingredients:?Vitis Vinifera (Grape) Juice, Water, Camelia Sinensis (Green Tea) Extract (Certified Organic Ingredients), Glycerin, Caprylic Capric Triglyceride, Rosa Canina (Rose Hip) Fruit Oil (Certified Organic Ingredients), Buriti (Mauritia Vinifera) Fruit Oil, Simmondsia Chinensis (Jojoba) Seed Oil (Certified Organic Ingredients), Hydrolyzed Jojoba Esters, Glyceryl Stearate, Methylcellulose, Stearic Acid, Olea Europaea (Olive) Oil (Certified Organic Ingredients), Shea Butter (Certified Organic Ingredients), Pyrus Malus (Apple) Fruit Oil, Xanthan Gum, Caprylyl Glycol, Sodium Benzoate, Potassium Sorbate, Ethyhexyl Glycerin.Vanicream sunscreenActive Ingredients:?Titanium Dioxide (3%), Zinc Oxide (6%)Inactive Ingredients:?C20-40 Alcohols, Caprylyl Glycol, Cetyl PEG/PPG 10/1 Dimethicone, Cocoglycerides, Dicaprylyl Carbonate, Dimethicone, 1,2-Hexanediol, Hydrogenated Castor Oil, Hydrogenated Polyisobutene, Magnesium Chloride, Octadecene, PEG-30 Dipolyhydroxystearate, Pentylene Glycol, Phenyl Trimethicone, Purified Water, Silica, Silica Dimethyl Silylate, Squalene, Stearyl Dimethicone, Tridecyl Salicylate, Triethoxycaprylylsilane, Ubiquinone (Coenzyme Q10)Natures gate Pure Mineral sunscreenActive Ingredients: Titanium Dioxide (8.3%), Zinc Oxide (2%)Inactive Ingredients:?Allantoin, Aloe Barbadensis Leaf Juice, Butyrospermum Parkii (Shea) Butter, Caprylic/Capric Triglyceride, Carthamus Tinctorius (Safflower) Seed Oil, Cetearyl Alcohol, Cetearyl Wheat Straw Glycosides, Chamomilla Recutita (Matricaria) Flower Extract, Dehydroxanthan Gum, Diisopropyl Adipate, Dimethicone, Ethylhexylglycerin, Euterpe Oleracea (Acai) Fruit Extract, Glycerin, Glyceryl Stearate, Glyceryl Undecylenate, Macrocystis Pyrifera Extract, Mimosa Tenuiflora Bark Extract, Phenoxyethanol, Polysorbate 80, Propylheptyl Caprylate, Prunus Armeniaca (Apricot) Kernel Oil, Rosmarinus Officinalis (Rosemary) Leaf Extract, Silybum Marianum (Milk Thistle) Seed Extract, Stearic Acid, Stearyl Alcohol, Triethoxycaprylylsilane, Viola Tricolor (Wild Pansy) Extract, VP/Eicosene Copolymer, Water.Sunscreen tableType of UV FilterActive IngredientRange of protection & FunctionCommentPhysical (sunblock)Zinc OxideUVA1, UVA2, & UVB(broad spectrum)PhotostableDoes not penetrate the skinPhysical (sunblock)Titanium dioxideUVA2 & UVBDoes not protect against UVA1PhotostableChemical absorberAvobenzone -Persol 1789 -Eusolex 9020 -Escalol 517 -Butyl - MethoxydibenzoylmethaneBest UVA protection(Absorbs full spectrum of UVA)Very widespread use Very high rates of skin allergyVery photounstableStabilized with addition of other UV filtersChemicalTinsorb S-Bemotrizinol-Anisotriazine-Escalol S- BEMTAVA1, UVA2, & UVB1New from German company BASFChemicalTinsorb M-Methylene bis benzotriazolyl- tetramethylbutylphenolUVB1, UVA1 & UVA2New from GermanyFairly photostableChemicalMexoryl SX- EcamsuleUVA1 & UVA2New from LaRochePhotostableChemicalMexoryl XL- Ecamsule- Drometrizole..UVA2PhotostableChemicalHelioplex(Avobenzone + Oxybenzone)UVB & UVA1StableChemicalOctinoxate- Octyl methoxycinnamate- OMC- EHCM- Escalol 557- Parsol MCX- Eusolex 2292- Tinsorb OMC- Uvinol MC80Readily absorbed by the skin and helps other ingredients to be absorbed more readily.UnstableChemicalCinoxate- 2 ethoxymethyl p-methoxycinnamate- Phiasol- Give Tan- SundareUVBStableChemicalOctocrylene- Uvinul N539T- OCR- EusolexUVB & UVA2PhotostableChemicalBenzophenones:Oxybenzone- Benzophenone-3- BP-3- Uvinul M40- Esolex 4360- Escalol 567UVA2 & UVBA penetration enhancerPhotostableChemicalSulisobenzone- Benzophenone-4- BP4- Uvinul MS40- Escalol 577UVB & UVA2PhotostableChemicalDioxybenzone - Benzophenone-8UVB & UVA2ChemicalEnsulizole- Phenylbenzimiazole- PBSA- Eusolex- Parasol HSUVB & UVA2StableChemicalOctisalate- Octyl salicylate- Ethylhexyl salicylate- EHS- Escalol 587UVBEmollient & water resistant propertiesUnstableChemicalHomosalate- homomethyl sLICYLTE- HMSUVBHelps sunscreen to penetrate the skinUnstableChemicalAminobenzoic Acid- PABAUVBOne of first active ingredient in sunscreensBanned in Europe & not used much in any countryChemicalPadimate O- Octyldimethyl PABA- OD PABA- EHDP- Escalol 507UVBPABA derivativeReferencesFischer & Berystoim K. Evaluation of customers’ complaints about sunscreen cosmetics sold by the Swedish pharmaceutical company Contact Dermatitis 1991:25:319-322. Fisher AA ‘Status cosmeticus’ : A cosmetic intolerance syndrome. Cutis 1990; 46: 109-10Berne B, Ross AM. 7 years experiencing of photopatch testing with sunscreen allergens in Sweden Contact Dermatitis. 1998; 38(2):61-4 Bruckner et al. Does Sensitisation to Contact Allergens Begin in Infancy? Pediatrics 2000; 105:1.e3.Cook, Natasha; Freeman, Susanne Report of 19 cases of photoallergic contact dermatitis to sunscreens seen at the Skin and Cancer Foundation. Australasian Journal of Dermatology. 42(4):257-259, November 2001. Dromgoole SH, et al. Sun screening agent intolerance: contact and photocontact sensitisation and contact urticaria. J Am Acad Dermatol 1990; 22:1068-78Maibach HI, Lev-Tov. The sensitive Skin Syndrome. Indian J Dermatol 2012; 57:419-23Nixon RL. Contact Dermatitis to sunscreens. Dermatitis 2012;23:140-141Ramsay DL, Cohen HJ, et al. Allergic reaction to benziphenones. Simultaneous occurrence of urticarial and contact sensitivities. Arch Dermatol 1972; 105:906-8 Suppa M, Argenziano et al. Selective sunscreen application on nevi: frequency and determinants of a wrong sun-protective behaviour. J Eur Acad Dermatol Venerol 2014;28(3):348-354 Stander S et al. Putative neuronal mechanisms of sensitive skin. Exp Dermatol. 2009;18:417-23Warshaw EM, Wang MZ, Maibach HI, et al. Patch test reactions associated with sunscreen products and the importance of testing to an expanded series: retrospective analysis of North American Contact Dermatitis Group data 2001 to 2010. Dermatitis 2013;24(4):176-182Fowler JF, Fisher AA. Fisher’s Contact Dermatitis. 2008. 6th Edition. Pg 70.Escalas-Taberner J et al. Sensitive skin: A complex Syndrome. Actas Dermosifiliogr. 2011;102(8):563---571 ................
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