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Why Dermatologists Should Be Concerned About DIY Sunscreen

Why Dermatologists Should Be Concerned About DIY Sunscreen

Mon, 06/24/2019 - 19:06

“Do-It-Yourself (DIY)” sunscreen recipes are popular on Pinterest, often making broad claims about sun protection while using questionable ingredients. Consumers who are concerned about the safety of themselves, their children, and/or the environment and seek alternatives to commercially available products may attempt to create these sunscreens and use them under the assumption that they are equivalent or better to the ones approved by the FDA.

Dr. McKenzie

Lara McKenzie, PhD, with the Center for Injury at Nationwide Children’s Hospital in Columbus, OH, and corresponding author of a recent study on the harms of DIY sunscreen.

A recent study, conducted by Julie Merten, PhD, et al, investigated posts for sunscreen-related products on Pinterest to evaluate the content, claims, and popularity of these pins among users.1 Merten et al identified 189 pins on sunscreen. The majority (95.2%) positively portrayed the effectiveness of homemade sunscreens despite over half of these recipes (68.3%) offering insufficient UV radiation protection. Nearly half (41.8%) of the pins were saved, ranging from 1 to 21,000 times, with a mean 808.4 saves.1

“What concerns me most as a public health researcher is what is at risk here,” said Lara McKenzie, PhD, with the Center for Injury at Nationwide Children’s Hospital in Columbus, OH, and corresponding author of the study, in an interview with The Dermatologist. “At best, people will get a really bad sunburn and at worst they are risking skin cancer down the road.”

Bruce Brod, MD, clinical professor of dermatology at the University of Pennsylvania School of Medicine in Philadelphia, PA, who was not affiliated with the study, echoed Dr McKenzie’s concerns. “I think some of the recommendations on homemade sunscreens, and I use the term sunscreen very loosely, are potentially dangerous for the public,” said Dr Brod in an interview with The Dermatologist.

Dr Bruce

Bruce Brod, MD, clinical professor of dermatology at the University of Pennsylvania School of Medicine in Philadelphia, PA.

Harms of DIY Sunscreen

Of the 189 pins, 33% had SPF claims that ranged from 2 to 50, with the most listed from 30 to 40. Additionally, 12.2% claimed to be water resistant, and 12.2% claimed to prevent sunburn, while only 4.2% mentioned preventing skin cancer.1 

“I was really surprised about the SPF claims that some of the recipes were making, which are unsubstantiated claims, basically, because even if you were to look at the natural protectives of some of the ingredients, I don’t think you could get high SPF. And, there is no way of knowing because if it is not lab tested, then how do we know?” said Dr McKenzie.

Dr Brod added that coconut oil, which was the most commonly listed ingredient in homemade sunscreens (66.1%),1 “has very minimal, if any, sun protecting capabilities.”

Moreover, essential oils and some of the other ingredients recommend in these products may not necessarily be safe for everyone, he said. Essential oils were the second most common ingredient (48.7%), with lavender and raspberry the most recommended oils.1 “Those oils are very popular in personal products, but in some people, they can cause severe allergic reactions of the skin,” said Dr Brod.

Other recommended ingredients included shea butter (42.3%), beeswax (38.6%), zinc (35.4%), and avocado oil (17.5%).1

Problems In the Name

While homemade versions utilize the term ‘sunscreen,’ they are not actually sunscreens, because sunscreens are regulated and reviewed by the FDA as over-the-counter drugs, said Dr Brod. “In my opinion, a website that lists [these homemade products] as sunscreens is analogous to them saying ‘here is a list of homemade heart medications or homemade diabetes medications’,” he added.

Furthermore, “17 ingredients are needed to be included in FDA-approved sunscreen for broad-spectrum coverage and these recipes do not contain any of those ingredients,” added Dr McKenzie. The new proposed regulations include changes to the packaging to make it easier for consumers to understand the information and product they are purchasing.4 However, more needs to be done to educate the public on what sunscreen is to prevent consumers from assuming a homemade product or recipe claiming to be sunscreen that lacks data on safety, efficacy, testing on SPF and water resistance will offer them the same protection.
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Misinformation About Safety

There is a lot of press on the safety and environmental concerns of sunscreen ingredients. In 2018, Hawaiian legislation banned sunscreens with oxybenzone and octinoxate following reports that these ingredients harm coral reefs.2 The city of Key West in Florida followed Hawaii and banned sunscreens containing both ingredients as well, which will go into effect in January 2021.3

In addition, the FDA issued new regulations for sunscreens, which called for more information on 12 of the active ingredients in sunscreen that lacked safety data.4 A recent study published in JAMA supported the need for nonclinical testing after the authors found higher-than-anticipated systemic absorption of 4 active ingredients.5

“The FDA still recommends using sunscreen as part of its legislative initiative,” said Dr Brod. The process for collecting more safety data is because sunscreen is used frequently and widely on the skin, he added, “this is only a positive thing.” These ingredients are not deemed unsafe by the FDA and the authors of the study published in JAMA called for further testing before making any claims regarding the safety of the ingredients based on their results.5

Dr McKenzie echoed the sentiments of the authors, saying, “we really need more data to be shared and information to be gathered. However, none of the worries about absorption or the environment, in my opinion, should override the use of FDA-approved sunscreens at this stage.”

The two ingredients that were considered generally unsafe by the FDA are no longer in use, and these include PABA and trolamine salicylate.4 The two physical blockers consider generally safe and effective are zinc oxide and titanium dioxide.4

Data on the environmental impact of sunscreens is still controversial. However, consumers have options for sunscreens, including ones perceived as environmentally friendly.

What Providers Should Do

In the Office

Dermatologists should be aware of these DIY recipes and that patients may try them. “I would encourage providers to keep making the same recommendations they are making,” said Dr McKenzie. These include using commercially available broad-spectrum sunscreens with SPF 30 or higher; using these sunscreens early, often, and reapplying when outside for long periods of time; modeling good before for children; and not using expired sunscreens.

“I talk to patients about the importance of a multifaceted approach, which has always been my practice, and not to solely rely on sunscreens but use them as one item in the sun-protection tool kit,” said Dr Brod. As most dermatologists and organizations recommend, he encourages patients to wear sun protective clothing and avoid the mid-day sun, in addition to using sunscreens. “We have a responsibility as health care providers to educate our patients to be careful,” he added.

The study1 by Merten et al is a reminder for health care providers that patients are exposed to misinformation and providers should consider clarifying that information as a part of their mission, according to Dr Brod. Likewise, both Drs McKenzie and Brod encourage consumers to exercise caution when looking up information related to health and health care.

For patients who are environmentally contentious, the Hanauma Bay State Park in Hawaii lists a few sunscreens that are safe for coral reefs.

Beyond the Office

Professional organizations play an important role in educating the public, as well as providers, on misinformation on social media. “We, reputable organizations and science-based organizations, should put the word out about how sunscreen is safe to use and why it is needed,” said Dr Mckenzie. “The voices of the bloggers and individuals who post natural products, including DIY sunscreens, are loud and we need to be loud too,” she added.

Dr Brod echoed this sentiment saying, “we need to get our message out and we need to talk to our patients using all of the reliable ways of communicating with the public.” For example, the American Academy of Dermatology (AAD) website has several resources for patients on sunscreen use.6 Dr Brod also recommends partnering with patient advocacy groups related to skin cancer and melanoma prevention.

Celebrity influencers have a major impact on consumer product uses. Although discussed in the negative contexts more often, such as Kim Kardashian or Gwyneth Paltrow, there can be positive connections made between celebrities and patient organizations that can help increase awareness regarding the harms of DIY products and/or benefits of sunscreen.

“I think when purveyors of good information and good health care partner with celebrities that can be very powerful in a positive way,” said Dr Brod. “On the other hand, it is important for us to be aware of celebrities touting information that is detrimental to health so we can redirect patients towards the right information.”

Another solution Dr McKenzie noted was blocking search options, which is how Pinterest handles misinformation related to vaccines by not allowing users to search for antivaccine posts. “I don’t know if this is the next step for DIY sunscreens, but when confronted on many platforms with so much information that is incorrect and can lead to people being in risky situation, I think it behooves us to think of solutions like this,” said Dr McKenzie.

However, this is difficult as social media platforms lack direct oversight, have different algorithms and methods for searching content, and are constantly changing. “Personally, being a safety expert, it is challenging because we often see consumer products that we know were recalled and still pinned or showing up on the site, and there are DIY and parent hack versions of things that are unsafe, untested, or not effective and can put users at risk,” she added.

The positive and negative aspects of social media, like Pinterest, is that it is unregulated and unmonitored in the United States. Consumers and health care providers should remain aware of the influences of social media on trends in skin care. Additionally, providers should be prepared to discuss appropriate sun safety tips with their family doctor or child’s pediatrician, as well as address patients concerns about safety for themselves, their children, and the environment by pointing them to sunscreens and sun safety behaviors, and resources, such as the AAD, Skin Cancer Foundation, MD Anderson Melanoma Moonshot program, among others.

References

1. Merten JW, Roberts KJ, King JL, McKenzie LB. Pinterest homemade sunscreens: A recipe for sunburn [published online May 21, 2019]. Health Commun. doi:10.1080/10410236.2019.1616442

2. Glusac E. Hawaii passes bill banning sunscreen that can harm coral reefs. New York Times. May 3, 2018. https://www.nytimes.com/2018/05/03/travel/hawaii-sunscreen-ban.html. Accessed May 30, 2019.

3. Zraick K. Key West bans sunscreen containing chemicals believed to harm coral reefs. New York Times. February 7, 2019. https://www.nytimes.com/2019/02/07/us/sunscreen-coral-reef-key-west.html. Accessed June 6, 2019.

4. FDA advances new proposed regulation to make sure that sunscreens are safe and effective [press release]. Silver Spring, MD: FDA; February 21, 2019. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm631736.htm. Accessed May 30, 2019.

5. Matta MK, Zusterzeel R, Pilli NR, et al. Effect of sunscreen application under maximal use conditions on plasma concentration of sunscreen active ingredients: A randomized clinical trial [published online May 06, 2019]. JAMA. doi:10.1001/jama.2019.5586

6. Sunscreen resource center. American Academy of Dermatology. https://www.aad.org/public/skin-hair-nails/skin-care/sunscreen. Accessed June 6, 2019.

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