Sunburn, Suncreen, or Artificial Tan: Which is Best?

Is enjoying the beach or pool part of what you do in the summer? If so, do you protect yourself from the UV rays put out by our sun? Conversely, how will you protect others from being blinded by the radiant whiteness of your skin? It seems that simply spending time outside requires a person to make numerous science-based decisions.

UV is a Carcinogen

First, is exposure to the sun as harmful as we are told it is? Yes and no. According to the World Health Organization, UV light is a carcinogen. It is worse in those with fair skin and under 18 years of age. Over-exposure to sunlight can cause basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. The prior two types of skin cancer are common, but rarely cause death unless they are neglected or the person is immunocompromised.  In comparison, even though only <3% of skin cancers are melanoma, it is responsible for almost all skin cancer deaths.

Other effects of UV exposure include “sagging cheeks, deeper facial wrinkles, and skin discoloration,” damage to the eyes, and sun allergies, resulting in itchy red rashes and even blisters. Not so attractive and probably better avoided.

CDC Recommendation

This is why the Centers for Disease Control and Prevention advise that one should avoid UV damage between 9 am and 3 pm by staying in the shade, wearing sunglasses, wearing UVA and UVB protective sunscreen, and wearing sun protective clothing.

Note that they aren’t recommending never going out or always wearing sunscreen. After all, there are some benefits to being out in the sun. Exposure to UV light triggers our cells to produce vitamin D, which is crucial for maintaining bone health. Sunshine is an excellent treatment for psoriasis. And there is even some clinical data indicating that UV exposure may cause endorphin release–in other words, sunshine may help fight depression!

Moderate amounts of sunshine early or late in the day are fine — and probably a good idea.  But, extended tanning times on the beach or by the pool are definitely out, even if you “prepared” your skin by visiting a tanning salon. By the way, tanning beds are not safer than outdoor tanning.

Sunscreen Pros and Cons

But what about suntan lotion? Won’t that allow one to spend the day at the beach or by the pool? Doesn’t faithful application reduce the risk of developing skin cancer? And, while we are asking questions, are the chemicals that block UVA and UVB safe? According to a review of the peer-reviewed literature, the answers are probably not, probably not, and probably not.

Faithful and generous application of UVA and UVB-blocking sunscreen will reduce the chances of getting a sunburn, but does NOT appear to significantly reduce one’s risk of dying from skin cancer. There has only been one peer-reviewed study showing that sunscreen protects against cancer — and that was for squamous cell carcinoma. In comparison, suntan lotion offered no protection at all from basal cell carcinoma and the more deadly melanoma. Astonishingly, some studies even indicated that the use of these agents increased the cancer risk! For this reason, the American College of Preventive Medicine sees no reason to recommend the daily use of sunscreen (p. 85).

Chemicals Galore

Nonetheless, as epidemiological data show a steadily rising incidence of skin cancer, sunscreens continue to sell. Some of these creams claim to be chemical-free because they only contain the chemicals zinc oxide (ZnO) and titanium dioxide (TiO2). However, these ingredients have a distinct drawback: they often appear as a visible white film. Therefore, ZnO and TiO2 creams are now being manufactured as less visible nanoscale particles, concomitantly making it more likely that they will be absorbed through the skin, enter cells, and the bloodstream. There have not been any studies on the effect of ZnO and TiO2 in children and babies.

Other sunscreens contain chemicals like oxybenzone, OMC, and 4-MBC, all of which have been repeatedly shown to be present in the plasma and urine of individuals using the product (an indicator that they are absorbed). A study of nursing women showed that 78.8% of them regularly used products containing sunscreen, and 76.5% of their human milk samples contained the chemical that they were using. This makes sense given that fat-containing substances (creams) are readily absorbed by cells — the chemicals in sunscreen (and any other chemicals on the skin, like DEET) are given a free ride into the body. What they do there is largely unknown.

Sunless Tanners

It would seem that those who would like to sport a healthy-looking tan without the UV-associated risks of wrinkling and skin cancer, as well as the toxicity associated with sunscreen, have no alternative but to use a sunless tanner. These creams and sprays have an additive that offers no protection against sun damage, but can give the illusion of a tan for 5-7 days. The active ingredient dihydroxyacetone (DHA) reacts with amino acids in dead cells to form orange-brown colored melanoidins. DHA is said to be safe, provided it is used in moderation and only applied to the skin, not the mucus membranes. But this verdict may change.  DHA induces DNA breakage in bacteria and skin cells, and of course, DNA damage may lead to cancer. Additionally, it appears that the chemical accelerates photo-aging by increasing the formation of free radicals. Back to square one.

What to Do?

So, what is the answer? You decide. My goal is to give you the balanced information that will enable you to make an informed decision. See you at the pool–I’ll be the white one in the hat and long sleeves.