Principles and Practice of Photoprotection

Steven Q. Wang Henry W.
Lim
Editors
Principles and
Practice of
Photoprotection
Principles and Practice of Photoprotection
Steven Q. Wang Henry W. Lim
Editors
Principles and Practice

of Photoprotection
Editors
Steven Q. Wang Henry W. Lim
Dermatology Service Department of Dermatology
Memorial Sloan-Kettering Cancer Center Henry Ford Medical Center - New Center One
Basking Ridge, NJ Detroit, MI
USA USA
ISBN 978-3-319-29381-3 ISBN 978-3-319-29382-0 (eBook)

DOI 10.1007/978-3-319-29382-0
Library of Congress Control Number: 2016936370
Springer Cham Heidelberg New York Dordrecht London

Springer International Publishing Switzerland 2016
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Preface
Photoprotection captures the interest of physicians, academic researchers, industry

scientists, law makers, marketers, general media, and consumers. It is a dynamic
field where progresses and advancements often hinge on close collaboration of
multidisciplinary teams. In the past decade, significant development has been made
in the realm of sunscreens where novel UV filters and innovative formulation
techniques have improved both the efficacy and aesthetic components of end
products. To enhance protection from UV and even visible and infrared radiation,
there has been active research exploring the application of antioxidants,
nanotechnology, and DNA repair enzymes in photoprotection. Along the way, there
has been a general trend towards global harmonization in guidelines for both testing
and labeling claims in sunscreens. At the same time, recent clinical trials have
demonstrated the benefits of sunscreen in protecting against skin cancer and
photoaging. Continual research has shown the importance of photoprotection in
preventing photodermatoses and photoaggravated autoimmune diseases. Despite
these scientific and medical advances, there remain many myths and controversies,
especially in the general media, surrounding the safety and efficacy of sunscreens
and other photoprotective modalities. Continued education of the general public to
practice proper photoprotective behaviors is needed.
This book aims to showcase all the rich facets and themes associated with
photoprotection. Each chapter, which starts with a brief synopsis, is written by
experts in their respective fields. The contributing authors have decades of clinical,
research, or practical experience, and we are grateful to having enlisted this panel of
experts to share their knowledge on this important topic. We sincerely hope the
readers will find this book as an informative and practical guide.
Basking Ridge, NJ, USA Steven Q. Wang

Detroit, MI, USA Henry W. Lim
v
Acknowledgments
This book is dedicated to our families: Judy and Kevin and Mamie. We thank them
for their patience and sacrifice throughout the course of this project.
vii
Contents
Part I
1 Clinical and Biological Relevance of Visible

and Infrared Radiation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Kelsey Lawrence, Mohammed Al-Jamal, Indermeet Kohli,
and Iltefat Hamzavi
2 Photoprotection and Skin Cancer Prevention . . . . . . . . . . . . . . . . . . . 23
Brian P. Hibler, Stephen W. Dusza, and Steven Q. Wang
3 Photoprotection for Photodermatoses . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Daniel Gutierrez and Elma D. Baron
4 Photoprotection and Photoaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Ben J. Friedman, Henry W. Lim, and Steven Q. Wang
5 Photoprotection, Photoimmunology and Autoimmune Diseases . . . . 75
Gillian M. Murphy and Nicola Ralph
6 Photoprotection and Vitamin D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
James L. Griffith, Mohammed Al-Jamal, and Henry W. Lim
7 Photoprotection and Skin of Color . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Kesha J. Buster and Johnathan J. Ledet
8 The Controversy of Sunscreen Product Exposure:
Too Little, Too Much, or Just Right . . . . . . . . . . . . . . . . . . . . . . . . . . 125
J. Frank Nash and Paul R. Tanner
Part II
9 The Chemistry of Ultraviolet Filters . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Nadim A. Shaath
ix
x Contents
10 Chemistry of Sunscreens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

Susan Daly, Hao Ouyang, and Prithwiraj Maitra
11 Global UV Filters: Current Technologies
and Future Innovations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Uli Osterwalder and Lars Hareng
12 Organotypic Models for Evaluating Sunscreens . . . . . . . . . . . . . . . . 199
Claire Marionnet and Franoise Bernerd
13 UV Booster and Photoprotection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
M. Sohn
14 Sunscreen Photostability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Craig A. Bonda and Dennis Lott
15 Sunscreen Formulation: Optimizing Efficacy
of UVB and UVA Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Curtis Cole
16 Sunscreen Formulation: Optimising Aesthetic Elements
for Twenty-First-Century Consumers. . . . . . . . . . . . . . . . . . . . . . . . . 289
Julian P. Hewitt
17 Sunscreen Regulatory Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Farah K. Ahmed
18 Measuring Sunscreen Protection According
to the FDA Final Rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Joseph W. Stanfield, J. William Stanfield, and Eduardo Ruvolo Jr.
Part III
19 Photoprotection in the Era of Nanotechnology . . . . . . . . . . . . . . . . . 335

Adnan Nasir
20 The Role of Topical Antioxidants in Photoprotection . . . . . . . . . . . . 361
Mary S. Matsui
21 The Role of DNA Repair in Photoprotection . . . . . . . . . . . . . . . . . . . 377
Nevena Karaman-Jurukovska and Daniel B. Yarosh
22 Oral and Systemic Photoprotection. . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Salvador Gonzlez, Yolanda Gilaberte, and Angeles Juarranz
23 Photoprotection from Sunless Tanning Products
and Colored Cosmetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Zoe Diana Draelos
24 Photoprotection by Clothing and Fabric . . . . . . . . . . . . . . . . . . . . . . 417
Thilo Gambichler, Isabelle Rooms, and Lisa Scholl
Contents xi
25 Photoprotection by Glass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429

Manaf Shaban and Fahad Almutawa
26 Augmenting Skin Photoprotection Beyond Sunscreens. . . . . . . . . . . 439
Thomas Meyer, Donathan Beasley, and Kerry Hanson
Part IV
27 Education, Motivation, and Compliance . . . . . . . . . . . . . . . . . . . . . . 463

Brian P. Hibler and Steven Q. Wang
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
Part I
Chapter 1
Clinical and Biological Relevance of Visible
and Infrared Radiation
Kelsey Lawrence, Mohammed Al-Jamal, Indermeet Kohli,

and Iltefat Hamzavi
Key Points
Biologically, visible radiation has been shown to induce erythema, pig-
mentation, free radical production, and DNA damage, while infrared radia-
tion has been shown to induce erythema, thermal pain, photoaging,
cytotoxicity, DNA damage, and oxidative stress.
Visible light has been shown to be an action spectrum in solar urticaria,
chronic actinic dermatitis, and porphyrias; it is used for the treatment of
hyperbilirubinemia. Infrared radiation can cause erythema ab igne and
squamous cell carcinoma.
Lasers with wavelengths in the visible and infrared spectrum can be used
to treat vascular and pigmented lesions, keloids, etc. IPL, LLLT, and PDT
are other light sources with wavelengths in the visible and infrared spec-
trum that are also used to treat numerous dermatologic conditions.
New imaging techniques that use visible and infrared radiation have been
recently developed. The data is promising and could greatly impact the
field of dermatology in the future.
Active research is ongoing on effective photoprotective measures against
visible light and infrared radiation.
K. Lawrence, MD M. Al-Jamal, MD I. Kohli, PhD I. Hamzavi, MD, FAAD (*)

Department of Dermatology, Henry Ford Hospital,
3031 W. Grand Blvd., Suite 800, Detroit, MI 48202, USA
e-mail: [email protected]; [email protected];
[email protected]; [email protected]
Springer International Publishing Switzerland 2016 3

S.Q. Wang, H.W. Lim (eds.), Principles and Practice of Photoprotection,
DOI 10.1007/978-3-319-29382-0_1
4 K. Lawrence et al.
1.1 Introduction
The sun emits electromagnetic radiation encompassing a wide range of wavelengths

(Table 1.1). The wavelengths must be able to penetrate the ozone layer in order to
reach the earths surface. The radiation that reaches the earth is made up of 50 %
visible light, 40 % infrared radiation (IR), and 9 % ultraviolet (UV) radiation [1]. It
should be noted that in the UV spectrum, only UVB and UVA reach the surface of
the earth; UVC is filtered out completely in the hemisphere. There has been exten-
sive research into the effects of UV radiation on the skin, but until recently there has
not been much research on the effects of visible and infrared radiation on the skin.
This chapter will discuss the biological and clinical relevance of visible and infrared
radiation.
Electromagnetic radiation is made up of photons, which have the properties of
both waves and particles. When photons reach the surface of the skin, they can be
reflected, scattered, absorbed, or transmitted. Reflection occurs at the skin surface
and can be used for diagnostic purposes but is not useful therapeutically. Scattering
is altering the direction of light transmission and also affects the depth of penetra-
tion. Most of the scattering of light is done by the collagen that is present in the
dermis. However, scattering is also dependent on the wavelength, with shorter
wavelengths undergoing more scattering compared to longer wavelengths [2].
In order for a photon to exert a clinical effect, it must be absorbed. Molecules in
the skin that absorb photons are called chromophores. Absorption is dependent on
the depth of penetration of the radiation and the wavelength absorbed by the chro-
mophore. The depth of penetration into the skin varies with wavelength; the longer
Table 1.1 Electromagnetic Light spectrum Wavelength

spectrum and corresponding
Gamma ray less than 0.01 nm
wavelengths
X-ray 0.0110 nm
Ultraviolet 10400 nm
UVC 200290 nm
UVB 290320 nm
UVA 320400 nm
Visible 400700 nm
Violet 400450 nm
Blue 450495 nm
Green 495570 nm
Yellow 570590 nm
Orange 590620 nm
Red 620700 nm
Infrared-A 7001400 nm
Infrared-B 14003000 nm
Infrared-C 3000 nm 1 mm
Microwave 1 mm1 m
Radio 1 mm100 km
1 Clinical and Biological Relevance of Visible and Infrared Radiation 5
wavelengths penetrate deeper than shorter wavelengths. Therefore, blue light, which
is at the shorter end of the wavelength spectrum of visible light, can be used clini-
cally for lesions contained in the epidermis, while red light, which has a longer
wavelength, is useful for thick lesions or to target deeper structures [2, 3].
A variety of molecules can act as chromophores, some examples being amino
acids, lipids, porphyrins, photosensitizing drugs, DNA, hemoglobin, bilirubin,
melanin, and water. When a chromophore absorbs a photon, the chromophore
transitions to an excited state, transiently. The chromophore releases energy, in the
form of heat or light, when it returns to the ground state. The chromophore can then
transfer this energy to another molecule or undergo chemical changes. Multiple
photons are necessary to produce sufficient energy to cause cellular changes, which
then leads to a clinical effect [2, 4]. The amount of absorption depends on the
chromophores in the skin and the wavelength of light used. The energy absorbed is
also known as the energy density, or fluence, and is measured in joules per square
centimeter [5].
1.2 Visible Spectrum
Visible light is the portion of the electromagnetic radiation responsible for general
illumination and is visible to the human eye. The wavelength of the visible radia-
tion spectrum is from 400 to 700 nanometers (nm). Each color of light represents
a different wavelength, with blue being at the shorter end of the spectrum and red
at the longer end (Fig. 1.1). See Table 1.1 for more details on specific
wavelengths.
Visible Infrared
400nm 700nm 1mm
450 500 550 600 650 1400 3000 1,000,000 nm
Stratum Corneum
Epidermis 0.1 mm
Dermis
3-4 mm
Subcutis
Fig. 1.1 The wavelengths and their corresponding depth of penetration in the skin of each band
within the visible and infrared spectrum
1.2.1 Biological Effects
1.2.1.1 Erythema
Erythema is a cutaneous inflammatory reaction and can be associated with warmth

and tenderness; blisters can form if severe. Erythema during or immediately after
sun exposure can occur transiently in fair skin types. Delayed erythema occurs in all
skin types, with a peak occurring between 6 and 24 h after exposure [68].
Erythema is mostly caused by UVB radiation. However, UVA radiation, primarily
UVA2 (320340 nm), can contribute to skin erythema, and visible light has been
shown to induce transient erythema [9]. The minimal erythema dose (MED) is
1000-fold more for UVA when compared to UVB [10, 11]. It is thought that the
erythema caused by visible radiation is caused through a different mechanism than
UVB-induced erythema, due to the differing depths of penetration. Dilatation of the
vessels of the subpapillary plexus is the suggested mechanism for skin erythema
from visible light, while erythema from UV radiation is thought to be from dilation
of upper dermis capillaries since UV radiation does not penetrate as deeply [12].
Skin type plays a role in the timing and intensity of erythema from visible
radiation. Mahmoud et al., using a light source that emits 98.3 % visible light, found
that visible light can induce erythema, in individuals with Fitzpatrick skin types
IVVI, immediately after exposure, surrounding the area of immediate pigment
darkening. However, the erythema started to fade 30 min later and was completely
gone in 2 h. Of note, they were unable to induce any erythema in skin type II
individuals even at the highest dose tested, 480 J cm2. The authors proposed a
possible thermal effect from the reaction within the chromophores causing
vasodilation and therefore erythema. They also proposed that the increased melanin
concentration, one of the chromophores with absorption in the visible light spectrum,
in the darker skinned individuals could account for the increased heat production
and therefore the increased erythema that occurred in darker skin types [9].
However, in the study done by Porges et al., erythema was induced in individuals
with Fitzpatrick skin types II, III, and IV only but not V and VI. Although, of note,
the filter that was used did allow part of the UVA spectrum (385400 nm) to pass
through, which could account for the differing results between the two studies.
Porges et al. also proposed that thermal effects may account for the erythema
response [6, 9, 13].
1.2.1.2 Pigmentation
Skin pigmentation is classified into immediate pigment darkening (IPD), persistent

pigment darkening (PPD), and delayed tanning (DT). IPD appears immediately and
fades within 20 min. PPD persists for 224 h. Both IPD and PPD are caused from
oxidation and redistribution of preexisting melanin. DT occurs days later and is
from synthesis of new melanin [7, 14]. Most research thus far regarding pigmenta-
tion is done on UV radiation.
Kollias and Baqer used a polychromatic light source with wavelength from 390
to 1700 nm, which consists of the visible spectrum and part of the spectrum of infra-
red radiation. They were able to induce pigmentary changes; however, they did not
notice any erythema or thermal changes, even after 3 h of irradiation with a total
dose of 270 W cm2. IPD was present, and pigmentation that lasted for 10 weeks
was observed when doses greater than 720 J cm2 were used [15]. Rosen et al.
showed that visible radiation up to 470 nm can induce an IPD response; this study
was performed by using a xenon-mercury arc lamp with grating holographic mono-
chromator to select for wavelengths of 334, 365, 405, 435, or 549 nm and spectro-
photometric analysis of skin reflectance [16]. Pathak et al. identified the peak IPD
response to be between 380 and 500 nm using a fixed exposure of 45 J cm2 [17].
Ramasubramaniam et al. used midday sunlight in Bangalore, India, with filters to
determine the cutaneous effects of visible light (greater than 420 nm) and UV light
(less than 400 nm) on pigmentation on Fitzpatrick skin types IV and V. They found
there is not a significant difference in the IPD produced by UV and visible light. They
identified similarly shaped action spectra for IPD and PPD when comparing UV and
visible light. However, UV radiation is much more efficient in producing IPD, and the
PPD response by visible light is much less intense. Since UV and visible light pro-
duced similar action spectra, though, they believe it is likely the same melanin precur-
sor that UV and visible light are interacting with in order to induce these effects [18].
Mahmoud et al., using a light source that emits 98.3 % visible light, also found
that visible radiation induced immediate pigmentation on volunteers with Fitzpatrick
skin types IVVI, with the lowest effective dose being 40 J cm2 [9]. The pigment
was darker as the dose was increased. They noted that the pigment was most intense
in type V skin type volunteers. The pigmentation was still present at 2 weeks, the
end point of their study, even at the lower doses. However, they found that no
pigmentation was induced in skin type II individuals, using the same light source
and doses. The pigmentation induced in this study was more intense and lasted
longer than the pigmentation described by Ramasubramaniam et al. (ref). However,
the light source in Mahmoud et al. was artificial, while natural sunlight was used in
the study done by Ramasubramaniam et al., and the dose used was four times higher
in the study by Mahmoud et al., which could account for the differences [9, 18].
Confocal microscopy used by Mahmoud et al. showed that visible radiation induced
redistribution of melanin from the basal layer to the upper epidermis. Diffuse
reflectance spectroscopy also showed increased melanin content directly related to
the visible radiation dose [9].
Of note, Duteil et al. showed recently that not all wavelengths of visible light
have the same effect on pigmentation. Healthy volunteers of skin types III and IV
were irradiated with wavelengths from both ends of the visible spectrum and the
results compared. Blue-violet light (415 nm) induced pronounced and longlasting
pigmentation (up to 3 months) in both skin types, while red light (630 nm) did not
induce pigmentation [19].
Porges et al. used a solar stimulator to expose individuals with Fitzpatrick skin
types II, III, and IV to light from 385 to 690 nm and observed IPD and DT as well
as erythema. The IPD and erythema faded over 24 h. The DT remained unchanged
for 10 days. The threshold for PPD (greater than 80 J cm2) was slightly higher than
that for IPD (between 40 and 80 J cm2), while the threshold for DT was higher than
the threshold for IPD. Porges et al. were able to induce pigmentation in lighter skin
types, while Mahmoud et al. were not. These differences could be due to the small
amount of wavelengths outside the visible spectrum UV from 385 to 400 nm in the
study done by Porges et al. or from the limited amount of infrared radiation in the
light source in the study done by Mahmoud et al. [9, 13].
Visible light-induced pigmentation, especially in darker skin types, may be
clinically relevant by potentially playing a role in pigmentation disorders. Melasma
and post-inflammatory hyperpigmentation are much more prominent in darker
skinned individuals. This is consistent with the clinical observation that sunscreens,
which protect against UV but not visible radiation, do not fully protect the
progression of these conditions [6].
1.2.1.3 Free Radical Production
Reactive oxygen species (ROS) are chemically reactive molecules containing

oxygen. Free radicals are hazardous to living organisms and have been associated
with many pathological processes by damaging most cellular components. ROS are
continually generated as a byproduct of metabolism, and cells have antioxidants to
protect themselves from the detrimental effects of ROS. Any increase in ROS
production or decrease in defense against ROS can lead to oxidative damage. Free
radicals are a type of ROS with unpaired valence electrons. An oxygenation product
from ascorbate, the ascorbate free radical, is a marker of oxidative stress that can be
easily measured with electron spin spectroscopy [2022].
A study by Haywood observed ascorbate free radical production in ex vivo
human skin using solar-simulated light. They used sunscreen (SPF 25, containing
the UVA filter butylmethoxyldibenzoyl methane) to block UV radiation and were
therefore able to determine that visible light is responsible for 33 % of the free
radical production in the substratum corneum, while UV accounts for the rest [23,
24]. In addition, Liebel et al. showed that commercially available sunscreens had
minimal effect on reducing visible light-induced ROS, proinflammatory cytokines,
and MMP-1 expression. However, when pretreatment with a photostable UVA/
UVB sunscreen that contained an antioxidant was applied before visible light
radiation, the production of ROS, proinflammatory cytokines, and MMP-1
expression was significantly reduced [25]. This is important because current
sunscreens do not offer protection against visible light and with this information
that is clearly something to look into in the future.
1.2.1.4 DNA Damage
It has been well described that UVB is the predominant spectrum causing direct
DNA damage, and indirect DNA damage through ROS is predominantly induced by
UVA. Recently, the effects of visible light on DNA damage were studied. Edstrom
et al. irradiated normal skin with 126 J cm2 visible light which corresponds to about
a half hour outside on a Sweden summer day. An Osram xenon arc lamp with two
filters was used to block out all but the visible spectrum. This was done three times
weekly for 4 weeks while taking intermittent punch biopsies. They found that
visible light increased p53-positive cells as well as proliferation in the epidermis,
although to a lesser extent than UVA1 (340400 nm). p53 normally downregulates
bcl-2, but interestingly they found a slight increase in bcl-2 in the epidermis, which
could potentially mean the p53 gene was mutated [26].
Kielbassa et al. used a xenon arc lamp with grid monochromator and/or cutoff filters
(to make monochromatic radiation) to study the spectrum in which dimers and oxida-
tive DNA modification occur in hamster cells. From UVA1 range into the visible light
spectrum, oxidative DNA damage was observed, with a peak between 400 and 450 nm
[27]. Hoffmann-Dorr et al. analyzed the effect of visible light on direct and indirect
DNA damage on melanoma cells and human skin fibroblasts. Visible light induces
ROS, which indirectly damages DNA. They concluded that the oxidative damage from
400 to 500 nm accounted for 10 % of the total indirect damage that occurs with sunlight
exposure [28]. Liebel et al. showed that visible light radiation induced production of
ROS, proinflammatory cytokines, and MMP-1 expression. However, neither thymine
dimers are produced from visible light radiation nor TNF-alpha expression induced
[25]. Now that visible light is being used more clinically, in lasers and photodynamic
therapy (PDT), the long-term effects on DNA are becoming clinically relevant.
1.2.2 Clinical Effects
1.2.2.1 Solar Urticaria
Solar urticaria is an uncommon photosensitivity disorder, making up 0.4 % of all

urticarial cases in a 30-year retrospective study [29]. It is a type I immediate
hypersensitivity response, mediated by mast cells. Urticarial lesions occur within
minutes of sun exposure and resolve within 2 h if exposure is discontinued. Action
spectrum can be in the UVB, UVA, and visible light ranges [3033]. Augmentation
and inhibition spectrums have also been described outside of the activating spectrum,
but vary by patient; the clinical relevance of this is not yet known [31, 3335].
1.2.2.2 Chronic Actinic Dermatitis
Chronic actinic dermatitis (CAD) is a chronic eczematous, photodistributed eruption

that is most commonly seen in elderly males. The action spectrum for CAD is typically
UVB alone or UVB and UVA; however, visible light has been reported to precipitate
CAD in a few cases. Visible light can induce CAD in patients who are also affected by
UVB alone or UVB and UVA [36]. However, a few rare cases were reported to only
react to visible light, 600 nm [37]. Phototest results are almost always abnormal in
moderate to severe cases of CAD, so can be used to confirm the diagnosis [24, 37, 38].
1.2.2.3 Porphyrias
In cutaneous porphyrias, interaction of elevated levels of circulating porphyrins

with sunlight (Soret band, 400410 nm) causes cutaneous phototoxicity. Two types
of cutaneous phototoxic lesions can occur, one caused by accumulation of water-
soluble uroporphyrins and coproporphyrins and the other by accumulation of
lipophilic protoporphyrin. The accumulation of water-soluble porphyrins leads to
skin fragility and blister formation, exemplified by porphyria cutanea tarda, the
most common type of cutaneous porphyria. The accumulation of lipophilic
porphyrins leads to an immediate burning sensation in the skin after light exposure
and can also be associated with swelling, redness, purpura, and erosions; these
features are characteristics of erythropoietic protoporphyria [39].
1.2.2.4 Hyperbilirubinemia
Phototherapy is one of the methods used to treat hyperbilirubinemia in neonates.

Blue to green light phototherapy lamps are the most effective ones in lowering
serum bilirubin levels because these wavelengths penetrate the skin and are absorbed
well by bilirubin [40]. Fluorescent tubes or light-emitting diodes (LEDs) can be
used [41, 42]. Structural photoisomers of bilirubin are produced after phototherapy,
which can then be excreted through bile and urine [43]. Two other less significant
mechanisms by which phototherapy decreases serum bilirubin are through
photooxidation or photooxygenation to biliverdin, maleimides, or propentdyopents
and phototherapy-induced addition to protein-bound bilirubin [44, 45].
1.2.2.5 Acne Vulgaris Treatment
Acne lesions have been reported to decrease after exposure to blue, red, violet, or
UV light. Some individuals report an improvement in their acne after sun exposure.
The exact mechanism of action has not been completely elucidated; however, it is
believed that the light works through anti-inflammatory and antibacterial
mechanisms. Furthermore, it is known that porphyrins are produced by
Propionibacterium acnes; therefore, exposure to Soret band results in the destruction
of the bacteria. In fact, this is the rational for the use of photodynamic therapy in the
treatment of acne vulgaris [5, 4648].
1.3 Infrared Radiation (IR)
The wavelength of infrared radiation ranges from 700 nm to 1 millimeter (mm). It

is further divided into infrared radiation A (IR-A), which ranges from 700 to
1400 nm; infrared radiation B (IR-B), which is from 1400 to 3000 nm; and infrared
radiation C (IR-C) from 3000 nm to 1 mm (Fig. 1.1). Infrared radiation, especially

IR-A, is perceived as heat. The portion of infrared radiation that reaches the Earths
surface is mostly IR-A radiation. IR-A and IR-B are able to penetrate the epidermis,
dermis, and subcutaneous tissue. IR-C is almost completely absorbed by the water
in the epidermis [49].
1.3.1 Biological Effects
1.3.1.1 Physical Effects
Erythema
IR can cause erythema, typically lasting less than 1 h, and is believed to be due to
vasodilation secondary to a thermal effect. By 24 h, no erythema or pigmentation is
observed [6]. The erythema observed has been used to determine standardized ways
to measure IR doses. The minimal response dose and minimal heating dose have
been described [50, 51].
Thermal Pain
Thermal pain caused by overwarming of tissues can occur in response to IR

exposures. Even single overexposures can cause skin burns, urticarial thermalis, or
collapse of the circulatory system [49].
Photoaging
Photoaging is a term used to describe the characteristic changes that occur to the
skin after chronic exposure to sunlight, originally believed to be solely due to chronic
UV radiation. Some common symptoms of photoaging include wrinkles, telangiec-
tasias, solar lentigines, laxity, and a change of the texture to leathery. IR was first
found to contribute to photoaging when it was shown in albino guinea pigs that UV
plus IR exposure induced more photoaging than just UV radiation alone [52].
There are multiple mechanisms by which IR, mostly IR-A (7601400 nm), is
suggested to induce photoaging. Increased expression of MMP-1 is one of these
mechanisms, which leads to increased degradation of collagen [53]. It has also been
proposed that IR disturbs the electron flow in the mitochondria, which results in
insufficient energy production in dermal fibroblasts. Different signaling pathways
are then triggered, and alterations in functional and structural aspects of the skin
occur [54]. Additionally, IR has been shown to cause decreased antioxidant enzyme
activity, to stimulate angiogenesis, and to increase the number of mast cells, all of
which have been found associated with photoaging [55, 56].
1.3.1.2 Molecular Effects
Cytotoxicity and DNA Damage
IR has not been found to induce DNA damage alone [6]. IR appears to have a pro-
tective effect on UV-induced cytotoxicity and DNA damage. Menezes et al. found a
longlasting partial protection from UVA- and UVB-induced cytotoxic damage after
prior radiation with IR light [57]. Jantschitsch et al. irradiated in vivo mouse skin
with IR-A prior to UVB radiation and found decreased UVB-induced apoptosis and
DNA damage compared to irradiation with UVB alone. Decreased UVB-induced
DNA damage was seen in in vitro human skin fibroblasts after IR radiation [58].
Markers of Damage
Due to acute and chronic adverse effects described above that can occur from IR
exposure, indicators are needed in order to better understand the tissue threshold for
damage. The expression of matrix metalloproteinase (MMP)-1 has been proposed a
useful marker of early IR damage at the cellular level. MMP-1 expression increases
in response to over-warming of tissue, UV overexposure, or mechanical stress.
Other markers that have been explored include heat shock proteins, ROS, and
apoptosis-related proteins. However, results of these investigations are contradictory
in many cases, so specific conclusions cannot be elucidated at this time [49].
Oxidative Stress
IR has been shown to induce oxidative stress both by increasing formation of free radi-
cals and decreasing the antioxidant content in human skin. Zastrow et al. found that
the amount of excess free radical formation was not only dependent on the dose of
radiation but also on the skin temperature increase due to IR radiation (7601600 nm).
Using an in vitro human fibroblast model, Jung et al. showed that IR radiation at 37 C
did not induce excess free radical production, while at 39 C or higher, production of
excess free radicals was observed. Now that the detrimental effects of IR radiation
have been well described, it is clear that protection from IR radiation is necessary and
important and will be addressed further in the section on sunscreen [6, 53, 59, 60].
1.3.2 Clinical Effects

1.3.2.1 Erythema ab Igne and Squamous Cell Carcinoma
Erythema ab igne is an erythematous or hyperpigmented, reticulated dermatosis

that is caused from chronic exposure to low levels of IR. Identified causes of
erythema ab igne include laptop computers, heating pads, car heaters, electric space
heaters, hot water bottles, and heated reclining chairs. Treatment is withdrawal of
the heat source, and if done, patients have a good prognosis [61].
1.3.2.2 Acne Vulgaris Treatment
Acne vulgaris has recently been shown to be successfully treated with light in the
visible range, as discussed above, but also with light sources in the infrared spectrum.
Diode lasers have been used to reduce acne lesions. The 810 and 1450 nm diode
lasers have been used successfully. The diode lasers work by inducing short-term
thermal alteration of sebaceous glands. When the 810 nm diode laser was
investigated, it was done following the administration of indocyanine green
chromophore. The indocyanine green concentrated in the sebaceous glands and was
subsequently targeted by the diode laser. The data for acne treatment with diode
lasers is promising; however as with acne treatment with visible light sources, more
research is necessary to elucidate the long-term efficacy and cost-effectiveness of
these treatment options [5, 62, 63].
1.4 Treatment Modalities Utilizing Visible and IR Spectrum
1.4.1 Thermal Treatment Modalities

1.4.1.1 Lasers
Introduction to Lasers
Lasers can be classified by the wavelength they emit, as this is a very important
property of the laser. Examples of lasers that emit wavelengths in the visible light
spectrum are argon, KTP, copper bromide, APTD, krypton, PDL, ruby, and
alexandrite lasers. Table 1.2 lists some of the common lasers with wavelength in the
visible light spectrum and their respective wavelengths [5, 64].
There are many uses for lasers in dermatology. Some examples of what lasers
emitting wavelengths in the visible spectrum are used for include vascular lesions,
pigmented lesions, vitiligo, tattoo removal, hair removal, and keloids.
Lasers for Vascular Lesions
Common vascular lesions that have been successfully treated with lasers are port-
wine stains, hemangiomas, and telangiectasia. Vascular lesions contain oxygenated
hemoglobin, which is the molecule the laser targets for destruction when treating
vascular lesions. Oxyhemoglobin absorbs light strongly at wavelengths of 418, 542,
and 577 nm. PDL was specifically designed to treat vascular lesions based on the
Table 1.2 Lasers in the Laser Wavelength peaks

visible and IR light spectrum
Argon 488 and 514 nm
and their respective
wavelength peaks Potassium titanyl phosphate (KTP) 532 nm
Copper bromide 510 and 578 nm
Argon-pumped tunable dye (APTD) 577 and 585 nm
Krypton 568 nm
Pulsed dye laser (PDL) 585595 nm
Helium-neon laser 632.8
Ruby 694 nm
Alexandrite 755 nm
Diode 800810 nm
Nd:YAG 1064 nm
Nd:YAG (long pulsed) 1320 nm
Diode (long pulsed) 1450 nm
Erbium/glass 1540 nm
Erbium:YAG (pulsed) 2490 nm
Carbon dioxide 10,600 nm
selective photothermolysis theory and is currently the first-line treatment for vascu-
lar lesions [5, 6466].
The Nd:YAG laser has also been used successfully for a variety of vascular
lesions such as port-wine stains, hemangiomas, and facial telangiectasia. Also, the
Nd:YAG and 800 nm diode lasers have been used successfully for varicose and spi-
der veins; however, sclerotherapy remains the gold standard for these lesions [5, 67].
Pigmented Lesion Removal
Melanin has a broad absorption spectrum, from 504 to 750 nm. The wavelengths at
the shorter end of the range are more effective at removing pigmented lesions.
Longer wavelength lasers are useful for lesions with deeper pigment due to the
increased tissue penetration. The response of the tattoo to specific lasers is very
dependent on the color, depth, and nature of the tattoo pigment [5, 64, 68].
The pulsed lasers are also successful in removing tattoo pigment. The pigment is
altered by the lasers and then subsequently removed by tissue macrophages. For
black pigment, the Q-switched (QS) ruby, QS alexandrite, or QS Nd:YAG lasers are
most effective because black pigment absorbs throughout the red and infrared
spectrum. Blue and green pigments absorb best in the 600800 nm range and
therefore are best removed with ruby or alexandrite lasers. Yellow, orange, and red
pigments are removed most effectively with green light, making the 510 nm PDL or
532 nm QS Nd:YAG laser the best options for these pigments [5, 64].
The Nd:YAG laser has been found to be useful for pigmented lesions when the
pigment resides deeper in the dermis. Long-pulsed diode and long-pulsed Nd:YAG
lasers have been especially effective at eradicating pigmented lesions with terminal
hair growth, such as congenital melanocytic nevi and Beckers nevi [5, 64].
Laser Hair Removal
Light with wavelength between 600 and 1200 nm is best for hair removal because
the light can penetrate to the appropriate depth in the dermis and is able to target the
melanin in the hair shaft, hair follicle epithelium, and heavily pigmented matrix.
The energy is absorbed by the melanin-rich matrix and hair shaft, which then under-
goes a photothermal reaction and destroys the surrounding hair follicle [5, 64, 69].
Lasers currently approved for hair reduction include the long-pulsed ruby, long-
pulsed alexandrite, pulsed diode, and long-pulsed Nd:YAG [5, 64, 70]. Of note,
intense pulse light (IPL) with wavelength from 590 to 1200 nm can also be used for
hair removal and will be discussed in further detail below.
Lasers for Keloids
PDL has recently been used for the treatment of keloids and hypertrophic scars.
PDL has been shown to decrease erythema, increase pliability, and improve texture,
bulk, and dysesthesias [5, 64, 7173].
Ablative Lasers
Ablative lasers are used primarily for cutaneous facial resurfacing for severely
photodamaged skin, photoinduced facial rhytides, dyschromias, and atrophic scars.
High-energy, pulsed, and scanned CO2 and erbium:YAG lasers are the main ablative
lasers in use today, while the CO2 laser is currently the gold standard for facial
rejuvenation [5].
The short-pulsed erbium:YAG laser, 2940 nm, was designed to have the beneficial
effects of the CO2 laser while limiting the unwanted side effects. The erbium:YAG
has milder improvement than the CO2 laser but with also milder side effects and
faster recovery time [5].
Additionally, there are numerous other uses for the CO2 laser, which includes
removing a variety of epidermal and dermal lesions, treating premalignant and
malignant lesions, and excisional and incisional operations [5].
1.4.1.2 Intense Pulsed Light Therapy
Intense pulsed light (IPL) refers to a high-intensity polychromatic incoherent light

with a wavelength range from 515 to 1200 nm; different filters can be used to obtain
specific wavelengths within this range. Depending on the target structure, the right
wavelength can be selected for heating and destruction [24]. The light is delivered
in series of single, double, or triple pulse sequences. The filters that only allow
shorter wavelengths through should only be used in fair-skinned individuals because
shorter wavelength light interacts more readily with melanin in the epidermis, which
can lead to hypopigmentation or dyspigmentation. IPL has been used to successfully

treat a variety of vascular lesions and benign pigmented lesions and for hair removal.
Longer pulse durations make it possible to slowly heat deeper structures, making
this method very useful for thick port-wine stains and hemangiomas [5, 74].
1.4.2 Nonthermal Treatment Modalities

1.4.2.1 Low-Level Light Therapy
Low-level light therapy (LLLT) uses low-power light sources. LLLT can be
performed with either coherent light sources (lasers) or noncoherent light sources
(light-emitting diodes (LEDs)). LLLT is lower intensity and causes lower
temperature changes and less discomfort than other types of laser, while still being
effective [24].
LLLT works by absorption of red and near-infrared light by the protein
components of the respiratory chain in the mitochondria, mostly cytochrome c
oxidase. Absorption leads to dissociation of inhibitory nitric oxide from cytochrome
c oxidase and then increased enzyme activity, electron transport, and ATP production.
LLLT has also been shown to increase expression of genes related to cellular
migration and proliferation and also alters expression of growth factors and
cytokines [24].
Red LED LLLT has also been found to inhibit fibroblast proliferation in vitro
without affecting viability. Therefore, red LED LLLT could be a possible treatment
for scars or proliferative disorders in the future [75].
The helium-neon laser is a type of LLLT with wavelength of 632.8 nm. The
helium-neon laser has recently been shown to be another therapeutic option for
vitiligo, specifically segmental vitiligo. The mechanism by which this works is by
inducing melanocyte proliferation through the interaction with type IV collagen via
mitochondria-related pathways [76, 77].
The current uses of LLLT within the IR spectrum are to stimulate wound healing
and hair growth and for the treatment of herpes simplex. It has been shown that LLLT
stimulates wound healing by promoting contraction through the induction of fibroblast
to myofibroblast transition [78]. Recently, LLLT using a 1072 nm LED light source
has been found to be a potential treatment for herpes simplex labialis. Significantly
reduced healing times were experienced in patients treated with LLLT [79].
1.4.2.2 Photodynamic Therapy
Photodynamic therapy (PDT) is a common way visible light is used clinically. PDT
is approved for the treatment of actinic keratosis in the United States; however, there
are many off-label uses which continue to expand [80]. PDT requires a
photosensitizer, a light source, and oxygen [81, 82].
Light Source
Any light source can be used for PDT, as long as the wavelength of light coincides
with the absorption spectrum of the photosensitizer, and the penetration depth of the
light is equal to the depth of the target cells or target tissue. Protoporphyrin IX has
important absorption peaks in the red and blue wavelength regions, from 404 to
420 nm and at 635 nm. Therefore, continuous red and blue light are very commonly
used in PDT [81].
Clinical Uses of PDT
Aminolevulinic acid (ALA) is only approved in North America for the treatment of
hypertrophic actinic keratosis on the face and scalp in combination with blue light.
Methyl aminolevulinate (MAL) is approved for non-hyperkeratotic actinic keratosis
of the face and scalp in the United States [81].
There are numerous off-label uses of PDT. PDT has been used to treat noninva-
sive, nonmelanoma skin cancers (NMSCs), mycosis fungoides, Kaposis sarcoma,
extramammary Pagets disease, cutaneous B-cell lymphoma, vascular malformations,
acne vulgaris, rosacea, hidradenitis suppurativa, morphea, actinic cheilitis,
cutaneous warts, condyloma acuminata, epidermodysplasia verruciformis,
molluscum contagiosum, herpes simplex virus, onychomycosis, cutaneous
leishmaniasis, erythrasma (Corynebacterium minutissimum infection), keloids, and
hypertrophic scars [81]. PDT has also been used for photorejuvenation.
1.5 Photoprotection Against Visible and IR Spectrum
Currently available sunscreens protect against UV radiation but do not protect

against the visible spectrum of light. Up to 50 % of free radicals formed during solar
radiation are generated following exposure to visible and infrared spectra; therefore,
it would be necessary to provide photoprotection in these spectra as well. Meinke
et al. showed that antioxidants and inorganic, i.e., physical filters, along with organic
UV filters, are necessary to provide protection from the entire solar spectrum [83].
Visible light photoprotection is relevant in several clinical situations. Some
photodermatoses have action spectrum in the visible light range. Photofrin, used in
systemic PDT, has an action spectrum in the visible light range [24]. Furthermore,
visible light can induced persistent pigmentation in dark-skinned individuals, as
described before [12].
At this time there is no organic filter for visible light. The only filters that are able
to reflect and scattered visible light are optically opaque filters. Zinc oxide (ZnO)
and titanium dioxide (TiO2) are two inorganic sunscreen agents that protect against
visible light in some forms. When visible light photons encounter non-micronized
ZnO or TiO2 particles, the light gets reflected into the direction of our eyes, therefore
causing the ZnO and TiO2 to appear white. The particle size determines the
absorption range. ZnO and TiO2 used in sunscreens are micronized (particle size of
less than 100 nm in diameter) because they are then less visible on the skin and
more cosmetically acceptable. Ferrous oxide, which is pigmented and opaque, has
recently been used and found to be effective in offering sun protection in the visible
light spectrum [84].
1.6 Diagnostic Imaging
Noninvasive, diagnostic imaging is a rapidly expanding field. Confocal scanning

laser microscopy and optical coherence tomography are two ways noninvasive
imaging is being used to image the skin. Confocal scanning microscopy uses a near-
infrared light source and allows for imaging of tissue in vivo, in real time, with the
same resolution as conventional histology. The epidermis, microvascular blood
flow, and inflammatory cells can be identified. Possible uses of this imaging
technique include potentially diagnosing lesions without biopsy and detecting
tumor margins [5, 8587].
Optical coherence tomography uses low-coherence interferometry and provides
two-dimensional images up to 1.5 mm deep. The architecture of the epidermis and
papillary dermis can be visualized. However, individual cells cannot be visualized.
This imaging technique can potentially be used to diagnose skin tumors and bullous
diseases without biopsies [5, 88, 89].
There are numerous other, new imaging applications using the infrared spectrum.
Near-infrared fluorescence has been shown to accurately assist in sentinel lymph node
mapping intraoperatively [90]. Recently, infrared images of individuals faces have
been used to determine acne severity and monitor acne treatment efficacy [91]. Most
of these imaging techniques are still in the early stages of development. However, the
data is promising and could greatly impact the field of dermatology in the future.
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Chapter 2
Photoprotection and Skin Cancer Prevention
Brian P. Hibler, Stephen W. Dusza, and Steven Q. Wang
Key Points
Ultraviolet radiation is a major risk factor for the development of skin can-
cer, the most common form of cancer in the United States.
Ultraviolet radiation causes both direct and indirect damages to DNA,
leading to mutations and malignant transformation if the damage is not
repaired.
Skin cancer can be prevented by reducing intentional exposure to ultravio-
let radiation and using photoprotective strategies, including sunscreens.
Daily sunscreen application protects against the development of actinic
keratoses, squamous cell carcinoma, nevi formation, and melanoma.
2.1 Introduction
Environmental exposures to both natural and man-made substances are a major risk
factor for the development of many types of cancers. Skin serves as the interface
between the body and the environment and is frequently exposed to potentially haz-
ardous environmental elements. Viral and bacterial infections, smoking, radiother-
apy, immunosuppressant drugs, artificial ultraviolet sources for phototherapy and
tanning, and chemical carcinogens have all been shown to predispose individuals to
skin cancers [1].
B.P. Hibler, BS S.W. Dusza, DrPH S.Q. Wang, MD (*)

Dermatology Division, Memorial Sloan-Kettering Cancer Center, Basking Ridge, NJ, USA
e-mail: [email protected]

DOI 10.1007/978-3-319-29382-0_2
24 B.P. Hibler et al.
Ultraviolet radiation (UVR) from sunlight is a major risk factor for melanoma and
non-melanoma skin cancer (NMSC) [2]. Epidermal cells accumulate UVR-induced
DNA damage which can lead to DNA base mutations and malignant transformation.
This chapter discusses the biologic impact of UVR on the skin and its role in the
development of both NMSC and melanoma. In addition, the role of photoprotection
to prevent cutaneous malignancies is reviewed.
2.2 UV Radiation
Solar radiation is divided into ultraviolet (200400 nm), visible light (400700 nm),
and infrared radiation (>700 nm) [3]. UVR plays a major role in the development of
photoaging and skin cancer [4]. Due to inherent differences in biologic effects, the
UV spectrum is further subdivided into UVC (200290 nm), UVB (290320 nm),
UVA2 (320340 nm), and UVA1 (340400 nm) [4, 5]. The subdivision of the UVA
range is due to a change in the slope of the action spectrum for erythema occurring
near 340 nm, with UVA2 having more erythemogenic activity than UVA1.
The different types of UVR vary in their intensity at the Earths surface and their
effects on human skin. Nearly all of the UVC radiation from the sun is absorbed by
the ozone layer, effectively negating its effects on the human body [6]. Approximately
95 % of the solar radiation reaching the Earths surface is UVA, with the remaining
5 % UVB [7]. The intensity of UVB has been shown to increase between 4 and
10 % with every 1000 ft of elevation and by approximately 3 % for every degree of
latitude as approaching the equator [8]. UVB, being a shorter wavelength compared
to UVA, is only capable of penetrating down to the basal layer of the epidermis and
superficial dermis, while UVA can penetrate deeper into the reticular dermis [9].
Compared to UVA, the erythemogenic potential of UVB is 1000 times greater [10].
UVA is generally more closely associated with tanning and photoaging changes
such as loss of skin elasticity and wrinkling, although UVB can also produce the
same effects [4, 11]. Both UVB and UVA have been implicated in the development
of skin cancers.
2.3 DNA Damage by UVR
2.3.1 UVB Effects
UVB directly damages the DNA of keratinocytes. UVB is absorbed by DNA

molecules within the keratinocytes, leading to the formation of dimeric photoproducts
between adjacent pyrimidine bases. The two most common photoproducts are the
cyclobutane pyrimidine dimer (CPD) and the 6-4 photoproduct (6-4PP), formed at
a ratio of about 3:1 [12, 13]. The presence of these molecules prevents the replicative
DNA polymerases from passing through the template strand, thereby blocking DNA
2 Photoprotection and Skin Cancer Prevention 25
synthesis [14]. Failure to repair these defects can lead to a collapse in the replication
fork at the damaged site, causing a DNA double-strand breaks and ultimately cell
death. Furthermore, the presence of UV-induced photoproducts can interfere with
base pairing during DNA replication, leading to mutations.
Although normal cells maintain a high repair fidelity, errors in repair can lead to
cytosine (C) thymine (T) base substitution at dipyrimidine sites and CC TT
tandem base substitutions [14, 15]. These are known as UV signature mutations,
indicating damages from past UVR exposure [15]. While these mutations were once
known as UVB signature mutations, further studies have demonstrated that a high
proportion of C T transitions also occur with UVA-induced damage, but at a
lower frequency (65 % for UVA vs. 85 % for UVB) [16, 17]. The rates of repair for
6-4PP and CPD photoproducts are different. Nearly 90 % of the 6-4PP lesions are
repaired at 3 h post-UV exposure [12, 18]. In contrast, only 10 % of CPD lesions are
repaired at 3 h and 50 % at 24 h after exposure [18]. Repair capacity diminishes with
age, and there is a cumulative loss of 25 % in repair ability between the ages of 20
and 60 years; this difference may account for the increased risk of skin cancer that
begins in middle age [19]. Individuals with defective nuclear excision repair
pathways, such as patients with xeroderma pigmentosum, are exceptionally
vulnerable to UV-induced cutaneous malignancies.
2.3.2 UVA Effects
UVA indirectly damages DNA via a free radical-mediated pathway [12]. UVA
reacts with chromophores and photosensitizers, such as porphyrins, cytochromes,
heme, riboflavin, and tryptophan, which generate free radicals [2024]. In addition,
UVA reacts with oxygen species and induces the formation of reactive oxygen
species (ROS) [20]. Within 20 min of UVA exposure, expression of NADPH oxidase
in human keratinocytes increases by 2-fold [25]. NADPH oxidase converts oxygen
molecules to superoxide anions, which are ultimately converted to ROS such as
hydrogen peroxide, superoxide anion (O2), peroxide (O22), hydroxyl radical
(OH), hydroxyl ion (OH), and singlet oxygen (1O2) [26]. These short-lived free
radicals damage DNA in a myriad of ways, including cross-linking DNA to proteins
and forming single-strand and double-strand breaks [12, 27]. It is important to note
that UVB can also trigger oxidative damage [20, 28, 29].
Aside from these forms of nonspecific DNA damage, UVA-induced oxidation
leads to specific DNA base mutations. The molecule 8-hydroxyguanine (8OH-G) is
a mutagenic base that results from ROS interaction with guanine [30]. 8OH-G
is preferentially generated with UV wavelengths greater than 350 nm and hence is
thought to be UVA signature mutation [28]. This particular lesion has been shown
to create G:C T:A transversions in DNA [31]. In addition, UVA generates CPD
mutations at nearly five times that of 8OH-G mutations [32]. However, compared to
CPD mutations from UVB, the overall number of UVA-generated DNA photoprod-
ucts is significantly lower [20].
2.4 DNA Base Mutations in Malignant Transformation
Upon DNA damage, cells can either repair the mutation or, if the damage is beyond
repair, target the cell for apoptosis. The p53 tumor suppressor gene plays a major
role in regulation of cell cycle checkpoint activity, DNA repair, and apoptosis.
However, if the p53 gene becomes mutated, these protective cellular mechanisms
may fail, leading to carcinogenesis. Clones of cells with UV signature mutations
(e.g., C T and CC TT transitions) in the p53 tumor suppressor gene have been
found in sun-exposed skin, actinic keratoses, squamous cell carcinoma, basal cell
carcinoma, and melanoma, supporting its role in photocarcinogenesis [33, 34].
Under normal circumstances, p53 responds to DNA damage by blocking the
progression of the cell cycle. Immediately after UV irradiation, p53 transcription is
upregulated and DNA damage leads to the alteration of the p53 protein, allowing for
phosphorylation by other protein kinases [35]. Elevated levels of p53 that occur
after UV exposure lead to induction of p21 (also known as WAF1 or CIP1), which
is responsible for cell cycle arrest and inhibiting apoptosis [36]. The p21 protein is
capable of competitively forming a complex with cyclin-dependent kinase (CDK),
blocking its interaction with cyclin and effectively inhibiting cell entry to the S
phase where DNA replication takes place [37, 38]. Cell cycle arrest may also occur
at checkpoints during S phase or after G2 (before mitosis) to ensure DNA fidelity
[39]. By inhibiting progression of the cell cycle, the cell is providing itself time to
repair, to prevent passage of mutated DNA onto daughter cells.
Upon cell cycle arrest, DNA repair mechanisms are activated to correct the
UV-induced lesions. Two major mechanisms for DNA repair include base excision
repair (BER) and nucleotide excision repair (NER). BER is used to remove dam-
aged bases, such as the oxidized form of guanine (8OH-G) [40]. In this pathway,
DNA glycosylases remove specific damaged or inappropriate bases forming a
single-strand break, which is then repaired with small fragments of 112 nucleo-
tides [41]. NER is used to repair a variety of bulky DNA damages, including CPDs
and 6-4PPs, that commonly result from UVB exposure [42]. NER involves single-
strand incisions flanking the lesion, followed by DNA repair synthesis and ligation.
As mentioned earlier, 6-4PPs are repaired much more quickly than CPDs. This is
thought to be because 6-4PPs are more destabilizing and cause a greater degree of
unwinding in the DNA helix than CPDs [4, 43, 44]. Repair of these UV-specific
CPD and 6-4PP lesions significantly decreases the overall apoptotic response [45].
If the DNA damage is beyond repair, apoptotic pathways are activated to prevent
passage of daughter cells carrying those mutations. The molecule p53 can induce apop-
tosis through two major pathways, either the intrinsic mitochondrial pathway or the
extrinsic death receptor pathway [46]. In the mitochondrial pathway, p53 upregulates
pro-apoptotic genes, such as Bax and Bak, or p53 represses transcription of antiapop-
totic genes, such as survivin. Furthermore, p53 induces caspase activation and apopto-
sis [46, 47]. To a lesser extent, p53 activates the death receptor pathway by promoting
fas transcription and its cell-surface expression [48, 49]. Additionally, p53 induces
DDB2 (damaged-DNA binding protein 2) which promotes programmed cell death by
facilitating degradation of p21, an inhibitor of apoptosis [50]. Mutations in p53 can

effectively inhibit these protective apoptotic pathways. The unregulated passage of
DNA-carrying mutations to daughter cells during cell division leads to tumorigenesis.
Aside from the p53 gene, there are other important genes affected by UVR. UV
signature mutations have also been identified in the patched homologue (PTCH),
smoothened (SMO) tumor suppressor genes, as well as the ras oncogene [12,
5153]. Mutations in PTCH or SMO, two conducting proteins involved in the
Hedgehog pathway, have been identified in up to 90 % of all BCCs [54]. As a result,
molecules involved in this pathway represent an enticing target for novel treatment
modalities. Inhibitors of this pathway, such as vismodegib, are now being employed
to systemically treat locally advanced or metastatic BCCs. Other targeted therapies
are sure to follow as the biological mechanisms and pathways underlying malignant
transformation are further elucidated.
While p53 mutations are commonly implicated in NMSC, they are not thought
to play a major role in the development of melanoma. UVR has been shown to
stimulate the clonal expansion of melanocytes expressing BRAF mutations in
melanocytic nevi [55, 56]. The oncogenic BRAF V600E substitution has been
shown to be an early event in melanomagenesis and is the most common somatic
mutation identified in melanomas. Approximately 80 % of acquired human nevi and
primary melanomas carry BRAF mutations [57]. A recent study using BRAF V600E
mutant mice showed that UVR induced larger and more abundant nevi compared to
non-UVR-exposed skin [55]. Additionally, all mutant mice developed melanomas
within 7 months after UVR, whereas UVR did not induce melanoma in non-BRAF
mutant mice. Finally, the application of broad-spectrum SPF 50 sunscreen blocked
p53 induction, apoptosis, epidermal hypertrophy, and dermal thickening and also
delayed the onset of UVR-driven melanoma. It should be noted that all sunscreen-
protected mice did eventually develop tumors representing a significant increase
over non-UVR-exposed mice, highlighting the damaging effects of UVR and need
for enhanced photoprotection and UVR avoidance. Nevertheless, sunscreen did
produce a significant reduction in tumors in those that were exposed to UVR and
significantly prolonged the latency before tumor development, accentuating the role
of sunscreen protection in addition to UVR avoidance for those at risk of melanoma.
2.5 Epidemiology of UV-Induced Cutaneous Malignancies
Skin cancer is the most common form of cancer in the United States [5860]. Nearly
five million people in the United States are treated for skin cancer every year with
an estimated annual cost over $8 billion [6163]. Basal cell carcinoma (BCC) and
squamous cell carcinoma (SCC) account for nearly 95 % of skin cancers, and
melanoma makes up approximately 5 %. In the United States in 2014, it is estimated
that there would be over 76,000 new cases of invasive melanoma and 9710
melanoma-related deaths [64]. The risk of skin cancers is governed by both genetic
factors and exposure to UV radiation.
2.5.1 Genetic Factors
Incidence rates of BCC and SCC are 510 times greater in the Caucasians than in
darker-skinned individuals [58]. Individuals with blue or green eyes, red or blond
hair, and lighter skin type have higher risk for developing skin cancer [65, 66].
Those individuals tend to have MC1R mutation and generate more pheomelanin
than eumelanin [67]. Pheomelanin is less effective in absorbing UV, and furthermore,
upon UVA exposure, pheomelanin are pro-oxidative and generate free radicals that
can damage DNA and nearby cellular organelles. Other phenotypic traits associated
with increased risks for skin cancer include high nevus count, tendency to sunburn,
inability to tan, and a history of sunburn at a young age [6870]. Additionally,
individuals with a personal or family history of skin cancer are at an increased risk,
suggesting the presence of additional genetic factors increasing susceptibility that
have not yet been phenotypically identified.
2.5.2 Relationship to Ambient UV Radiation
The incidence of NMSC increases with higher exposure to ambient solar radiation
and is greater in individuals with higher mean daily UV radiation [71]. Ecologic
studies have shown that the incidence of skin cancer is higher in regions of low
latitude and high UV index [72, 73]. The Nurses Health Study reported an increased
risk of skin cancer in individuals who lived in areas with moderate or high UV index
(greater than or equal to 6), with more pronounced effects seen for women who
grew up in states with higher UV indices [74]. Further studies have demonstrated
that early childhood exposure to high UV radiation increases the risk of skin cancer.
A migration study from Western Australia demonstrated that immigrants from
Great Britain who arrived before the age of 10 years had similar rates of melanoma
compared with the native-born population, whereas the incidence was nearly a
quarter of the native rate in those who arrived after the age of 15 years [75]. Similar
findings in migrant populations have been documented in other countries, including
the United States [7678].
Although a strong relationship exists between ambient solar radiation and the
incidence of skin cancer, patterns of sun exposure appear to have an impact on the
type of skin cancers. Chronic UV exposure has been implicated in the development
of both precancerous actinic keratoses (AK) and SCCs [7981]. These lesions tend
to occur on sun-exposed sites, such as the head, neck, and dorsal hands. The
association between BCC and sun exposure is more complex, because a large
percentage of BCCs are located on non-sun-exposed sites [82, 83]. As a result, it is
postulated that BCC may result from intermittent UV exposure or exposure early in
life rather than cumulative UV exposure.
Likewise, the overall risk of melanoma appears to also be associated with
more intense and intermittent exposure to high levels of UVR, often stemming
from recreational activities or exposures occurring during childhood [66, 84, 85].
Melanoma is not often found on chronically sun-exposed sites, but rather is more
common on locations that are sporadically exposed, such as the trunk in males
and the legs in females [86]. However, certain subtypes of melanoma, such as
lentigo maligna melanoma or desmoplastic melanoma, are more commonly
found on chronically sun-exposed sites with a predilection for the head, neck,
and upper extremities [8790]. These lesions are often found on sun-damaged
skin in older individuals [88, 91, 92]. These observations suggest that different
subtypes of melanoma may result from either cumulative or intermittent sunlight
exposure.
2.5.3 High-Risk Occupation and Behaviors
Aside from genetic traits, individuals with certain occupations and those who
carry out high-risk behaviors have an increased probability of developing skin
cancer. Outdoor workers tend to have extensive amounts of UV radiation. A sys-
tematic review and meta-analysis of 18 studies (6 cohort and 12 casecontrol)
reported that 16 of the 18 studies (89 %) showed an increased risk of SCC in indi-
viduals with occupational UV exposure compared against individuals without UV
exposure (OR = 1.77; 95 % CI = 1.402.22) [93]. As for BCC, a meta-analysis
including 23 epidemiologic studies found a weaker, but still significant, associa-
tion between occupational sun exposure and risk of BCC (OR = 1.43; 95 %
CI = 1.231.66) [94]. The data on melanomas is mixed. While some studies have
suggested that outdoor workers may not be at an increased risk of melanoma
[95, 96], others have shown an increased risk among workers in UV-intense areas
and a strong association between melanoma incidence and both intermittent and
total UVR exposures [4, 97, 98]. These observations further emphasize the need
for adequate protection for individuals who are exposed to the damaging effects of
UVR in the workplace.
Individuals, especially young women, seeking indoor tanning are at high risk for
developing skin cancer. A recent systematic review and meta-analysis concluded
that there are an estimated 400,000 NMSCs and 6000 cases of melanoma annually
in the United States attributable to indoor tanning [99]. In a study of tanning bed
users, any use of tanning devices was associated with an increased risk of SCC
(OR = 2.5; 95 % CI = 1.73.8) and BCC (OR = 1.5; 95 % CI = 1.12.1) [100]. A
separate meta-analysis concluded that individuals with any history of indoor tanning
had an increased risk of melanoma (OR = 1.16, 95 % CI = 1.051.28) [101]. The risk
of skin cancer has a strong doseresponse relationship with tanning, thought to be
due to the accumulation of UV exposure [102]. Indoor tanning exposes users to
elevated amounts of UV radiation, and in 2009, the World Health Organization
(WHO) classified indoor tanning devices as group I human carcinogens due to
numerous studies showing the link between tanning and increased cancer risk [103].
Furthermore, the FDA recently upgraded sunlamps to moderate-risk (class II)
devices, requiring enhanced product labeling detailing the potential health effects of
use [104]. As such, use of these devices should be strongly discouraged due to the
adverse effects they can have on the skin.
2.6 Photoprotection
Numerous studies have shown that skin cancers can be prevented by reducing
intentional exposure to UV radiation and improving photoprotective strategies.
Effective photoprotection involves seeking shade, wearing protective clothing, and
applying sunscreen properly. Although sunscreen is less effective than other
protective measures, it is by far the most widely used vehicle for sun protection. A
large body of clinical research has demonstrated that sunscreens, when used
appropriately, can prevent skin cancers and precursor lesions.
2.6.1 Actinic Keratoses (AK)
A number of studies have demonstrated the protective effects of sunscreens on

the development of AK [105107]. The largest randomized controlled trial was
conducted in subtropical Nambour, Australia, where 1621 adults were randomly
assigned to two groups: daily use sunscreen vs. discretionary use of sunscreen
[107]. Individuals in the daily use group were provided with free sunscreen
(SPF 16) and instructed to apply it to all sun-exposed sites of the head, neck,
arms, and hands. No sunscreens were provided to individuals in the discretion-
ary use (control) group, but they were permitted to use sunscreens if they chose.
After the first 2.5 years of intervention, there was a 21 % reduction of AKs in the
daily use group compared to the control group in sunscreen-treated locations.
However, no significant reduction between the two groups was observed after a
further 2 years of follow-up. The acquisition rate of new AKs in the control
group markedly decreased in the second 2-year period of the trial, which the
investigators suggest may have been caused by an increase in sunscreen use by
the control group.
Similar results showing the protective effects of sunscreen on AK development
were observed in two smaller randomized controlled trials. In the first, conducted
in Victoria, Australia, investigators studied the protective effects of using daily
broad-spectrum sunscreen (SPF 17) to prevent the formation of new AKs and
induce remission [105]. A total of 431 white residents who had between 1 and 30
AKs at baseline were enrolled. Sunscreen was applied daily to sun-exposed sites
and the number of new lesions was recorded over a 7 month period. Participants in
the sunscreen group developed fewer new lesions (difference = 0.72, 95 %
CI = 0.151.28) and had 25 % remission of their existing AKs, compared to 18 %
remission in the control group (OR = 1.45: 95 % CI = 1.101.88). Overall,
participants in the vehicle control group had an average increase of one AK, while
participants in the sunscreen group actually saw a decrease in the mean number of
AKs by 0.6.
The last study was a randomized controlled trial in the United States assessing
AK prevention by sunscreen use in 37 high-risk patients with a history of
precancerous lesions or NMSC over a 2-year period [106]. The subjects in the
sunscreen group were instructed to apply sunscreen (SPF 29) every day, while the
control group applied the vehicle cream without active ingredients. After controlling
for differences in risk factors, a 36 % decrease in the annual rate of new AKs was
seen in the sunscreen group compared with the placebo group. These three studies
demonstrate that daily use of sunscreen has protective benefits for AKs.
2.6.2 Non-melanoma Skin Cancer
The same population of Australian adults from the Nambour Trial was also observed
over the same period from 1992 to 1996 to determine the effect of sunscreen use on
the development of NMSC [108]. At enrollment, participants completed a survey
and underwent a complete skin exam by a dermatologist. Any prevalent skin cancers
were removed. Those randomized to the treatment group were instructed to apply a
layer of SPF-16 sunscreen to all exposed sites on the head, neck, arms, and hands
every morning, with reapplication after heavy sweating, bathing, or long sun
exposure. The control group was permitted to use sunscreen at their discretion, and
no sunscreen was provided. Compliance for the sunscreen group was assessed by
weighing sunscreen bottles every 3 months. At follow-up clinics in 1994 and 1996,
dermatologists blinded to treatment allocation reexamined all participants, with
histologic confirmation of all clinically diagnosed skin cancers.
After 4.5 years of follow-up, the investigators observed that sunscreen use had no
effect on either the incidence of BCC or in the total number of BCC tumors.
However, the overall incidence of SCC, in terms of persons affected, was 12 %
lower in the sunscreen treatment group (n = 22) compared with the control group
(n = 25), but this difference was not statistically significant. The study found a 39 %
reduction in the total number of SCC tumors among participants assigned to the
daily sunscreen group, with 28 SCCs occurring in the sunscreen group compared
with 46 SCCs in the control group (95 % CI = 0.460.81).
A follow-up study was published in 2006 to assess for potential latency of sun-
screen use [109]. Participants were followed for an additional 8 years. There was a
rate reduction of 35 % (95 % CI = 0.430.98) in the incidence of SCC, and there was
a rate reduction of 38 % (95 % CI = 0.380.99) in the total number of SCCs diag-
nosed in the sunscreen group. When the analysis was limited to the late follow-up
period (20012004), there was a rate reduction of 51 % for both the incidence SCC
and total tumor number. In contrast, the prolonged follow-up failed to demonstrate
a statistically significant reduction in the incidence of BCC (persons affected) or
total number of BCCs occurring in the daily sunscreen group. However, there was a
25 % reduction in the total number of BCCs in the treatment group in the late fol-
low-up period (20012004), although this difference is not statistically significant
(rate ratio = 0.75, 95 % CI = 0.491.14).
2.6.3 Nevi
Having many nevi or having at least 1 atypical nevus is the strongest constitutional
risk factors for melanoma. Studies have shown that UVR promotes the growth of
nevi [110112]. Currently, there is only one randomized controlled trial conducted
in Vancouver, British Columbia, that demonstrated the protective effect of broad-
spectrum sunscreen in reducing the development of nevi in children [113].
Schoolchildren, ages 610, were randomized to either a sunscreen group and
provided with SPF 30 broad-spectrum sunscreen or control group which received
no sunscreen and were given no advice about sunscreen use. Each childs nevi were
counted at the beginning and end of the 3-year trial. Based on an initial questionnaire
and dermatologic examination, the authors found that factors such as hair color, skin
response to sun exposure, facial freckling, and sunburn score in the first 5 years of
life were all associated with nevus counts. Analysis revealed regular use of sunscreen
was associated with a significant reduction in new nevi (median counts 24 vs. 28;
p = 0.048). Additionally, a greater effect was seen for sunscreen used in individuals
with a higher degree of freckling, with models suggesting that freckled children
using sunscreen would develop 3040 % fewer new nevi than untreated freckled
children. These data demonstrate the importance of regular sunscreen use on
attenuating the development of new nevi which are a known risk factor for
melanoma.
2.6.4 Melanoma
There have been controversies regarding the protective role of sunscreens against
the development of melanoma. Some of the early casecontrol studies suggested an
increased risk of melanoma with sunscreen use [114116]. A meta-analysis of the
literature published between 1966 and 1999 found no association between sunscreen
use and increased risk of melanoma (relative risk = 1.01; 95 % CI = 0.46, 2.28)
[117]. A second review also found a similar result (odds ratio 1.0; 95 % CI = 0.8
1.2) [118]. However, these early casecontrol studies failed to account for skin
sensitivity. Specifically, individuals who are more susceptible to burning and
developing melanoma were more likely to use sunscreen, and hence there could be
uncontrolled confounding by indication. Other explanations are related to inappro-
priate application of sunscreen with low SPF and lack of UVA protection.
The controversy was largely put to rest with the results from Nambour Trial in
Queensland, Australia [119]. The participants were observed after long-term
follow-up to assess whether application of sunscreen during the first 4.5 years had
an effect on their risk of primary cutaneous melanoma. At the end of 10-year
follow-up (nearly 15 years from the start of the trial), there were a total of 11 primary
melanomas (3 invasive) in participants randomized to the sunscreen group and 22
primary melanomas (11 invasive) in the discretionary use (control) group. The study
showed a 50 % reduction in the risk of overall melanomas in the sunscreen group
(p = 0.051) and a 73 % reduction in the risk of invasive melanomas among the daily
sunscreen group (p = 0.045). These results demonstrated that daily sunscreen use
over a 4.5-year period appears to reduce the long-term melanoma incidence over a
10-year period, with the most pronounced effect seen for invasive melanoma.
It is important to note that the control group in the Nambour Trial for the AK,
SCC, BCC, and melanoma studies was not given a placebo or inactive sunscreen,
but rather was allowed to continue discretionary use of sunscreen. The design of the
trial underestimates the full protective benefits of sunscreen against melanoma.
Furthermore, the sunscreen used in the trial was SPF 16 and not UVA stable.
Modern-day sunscreens have higher SPF values and are photostable, and
theoretically they should offer superior protection.
2.7 Conclusion
UV radiation plays a key role in the development of both non-melanoma skin

cancers and melanoma. It is imperative that clinicians continue to educate the
general public regarding the benefit of ongoing photoprotection. The public message
of photoprotection should encompass seeking shade when outdoor; wearing sun-
protective clothing, hats, and sunglasses; and applying broad-spectrum sunscreens.
Current scientific evidence demonstrates that sunscreens are safe and that daily
application of sunscreen can prevent the incidence of AK, SCC, nevi, and
melanoma.
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Chapter 3
Photoprotection for Photodermatoses
Daniel Gutierrez and Elma D. Baron
Key Points
Photodermatoses represent a broad and extensive group of disorders
caused by exposure to sunlight.
Elucidation of action spectrum of a disease should be performed at the
earliest convenience to assure most adequate management of the patient.
The cornerstone of photoprotection in all photodermatoses involves the use of
long-sleeve shirts, wide-brim hats, sunglasses, appropriate types and amounts
of sunscreens, and sun avoidance during peak hours of sun intensity.
If photosensitivity is due to administration of an exogenous agent or the
result of an accumulation or deficiency of an endogenous entity, removal
of the offending agent and correction of the deficiency are paramount to
treatment.
3.1 Background
The spectrum of solar radiation is comprised of roughly 50 % visible light, 40 %

infrared, and 9 % ultraviolet (UV) radiation (UVR) [1]. UVR is considered to be of
greatest importance in healthcare due to its well-documented impact on
D. Gutierrez, BS
Department of Dermatology, University Hospitals Case Medical Center,
11100 Euclid, Ave. Lakeside 3500, Cleveland, OH 44106-5028, USA
E.D. Baron, MD (*)
School of Medicine, Case Western Reserve University, Cleveland, OH, USA
Department of Dermatology, University Hospitals Case Medical Center,
11100 Euclid, Ave. Lakeside 3500, Cleveland, OH 44106-5028, USA
Louis Stokes Department of Veterans, Affairs Medical Center, Cleveland, OH, USA

DOI 10.1007/978-3-319-29382-0_3
40 D. Gutierrez and E.D. Baron
pathogenesis and clinical course of dermatologic diseases. In brief, UVR wave-

lengths range from 100 to 400 nm and are subdivided into the following groups:
UVA, UVB, and UVC. Understanding these subdivisions within UVR is of great
importance when evaluating and managing patients with photodermatoses, which
are considered abnormal or adverse skin reactions to sunlight. The cutoffs of each
subdivision vary slightly within the current literature; in this article, the most com-
monly accepted divisions will be used: UVA at 320400 nm, UVB at 290320 nm,
and UVC at 200290 [2]. Within the UVA continuum, UVA can be further subdi-
vided into UVA1 at 340400 nm and UVA2 at 320340 nm. For phototherapeutic
applications, UVB can be divided into broadband (BB) UVB at 290320 nm and
narrowband (NB) UVB at 311313 nm.
Different UVR wavelengths penetrate human skin to varying degrees. The longer
the wavelength, the deeper it penetrates human skin. UVA, having the longest wave-
length of the UVR spectrum, will permeate deep into the dermis. UVB will extend
through the epidermis as far as the dermal papillae. Finally, UVC light, due to its
short wavelength, is completely absorbed by the Earths ozone layer; rarely is UVC
light implicated in human disease from sunlight exposure due to this. In addition to
different depths of penetration, there exists variance among the biological effects
each UVR subtype possesses on human tissues. Compounds ranging from porphyrins
and nucleotides to exogenous photosensitizing agents deemed chromophores absorb
light and produce a series of photochemical reactions. Exploiting the different wave-
lengths of light that excite different chromophores to produce desirable effects is the
foundation of phototherapy. Though some of these effects can be desirable, others are
not, and the reaction to light in these cases represents a pathologic mechanism.
The photodermatoses represent a heterogeneous group of disorders sharing the
common trait of being precipitated by light. Each photodermatosis has a different
action spectrum, or wavelength of light that will be absorbed by chromophores to
elicit a cutaneous response. Even within the same photodermatosis, individuals can
potentially have different action spectra. Knowledge of this is crucial for optimal
management of each photodermatosis.
Photodermatoses can be divided into four distinct groups: (1) immunologically
mediated photodermatoses (IMPs), (2) chemical- and drug-induced photosensitivity,
(3) photoaggravated dermatoses, and (4) inherited disorders with defective DNA
repair or with chromosomal instability [3]. In this review, we will discuss different
strategies of photoprotection and management of the photodermatoses.
3.2 Immunologically Mediated Photodermatoses
The group of IMPs consists of five distinct conditions: actinic prurigo, chronic
actinic dermatitis, hydroa vacciniforme, polymorphous light eruption (PMLE),
and solar urticaria [3]. The pathophysiology underlying each of these photoderma-
toses has not been fully characterized. However, it is hypothesized that these dis-
orders result from dysregulation of the immune system due to UVR in genetically
susceptible individuals. Each of these conditions will be discussed separately.
3 Photoprotection for Photodermatoses 41
3.2.1 Polymorphous Light Eruption
It is theorized that UVR-induced cutaneous photoantigens cause a delayed-type

hypersensitivity reaction and result in the manifestation of polymorphous light
eruption (PMLE) [4, 5]. Phototesting has consistently shown that UVA has been
more effective than combined UVA/UVB or UVB alone in eliciting pathologic
response [3]. Because the action spectrum of 90 % of those with PMLE is in the
UVA range, sunscreen selection becomes of great importance to prevent disease
exacerbations [6]. Many commercially available sunscreens focus on UVB light
absorption and are not adequate for PMLE photoprotection. Therefore, broad-spec-
trum sunscreen with high UVA protection should be utilized for those with sus-
pected PMLE.
An ideal sunscreen for patients with photodermatoses should have a sun protec-
tion factor (SPF) between 30 and 60 and should be applied adequately every 2 h
when outdoor. The amount of sunscreen applied for SPF testing, as mandated by
the Food and Drug Administration (FDA), is 2 mg/cm [2, 7]. In actual use, however,
most apply only 0.51 mg/cm [2, 8, 9]. To test the efficacy of lower-than-
recommended levels of sunscreen and UVA-specific protection in PMLE,
Bissonnette and colleagues compared two SPF 45 sunscreens, one with a high-level
UVA protection factor of 25 and another with a low UVA photoprotection factor of
5, when applied at both 2 mg/cm [2] and 1 mg/cm [2, 10]. Subjects were exposed
to progressively increasing levels of combination UVAUVB radiation for either
5 days or until an erythematous, vesicular, edematous, or popular response was
noted. When comparing application levels at 2 mg/cm [2], 0 % of those in the high
UVA protection sunscreen developed a PMLE exacerbation as compared to the
73 % of those in the low UVA sunscreen group. In contrast, 33 % of those in the
high UVA protective sunscreen group developed an exacerbation compared to those
80 % when applied at 1 mg/cm [2]. This study showed that sunscreens with both
high SPF and high UVA protective factor can successfully prevent exacerbations of
PMLE even when applied at suboptimal levels [10]. This result strengthens the
notion that both proper selection of sunscreen and proper application are crucial.
Prophylactic sun hardening, a form of desensitization to sunlight, can be admin-
istered to those with PMLE before prolonged sun exposure. Specific phototherapies
used include BB-UVB, NB-UVB, and UVA alone or with psoralen (PUVA) [11]. Of
note, NB-UVB treatments have increasingly begun to displace both PUVA and
BB-UVB at some institutions because of the ability to avoid complications includ-
ing psoralen-related gastrointestinal symptoms and lack of necessity to wear photo-
protective glasses after treatment in addition to the theorized utility and safety in
and pregnant [12]. Therefore, the most commonly used light source for hardening is
currently NB-UVB. At a temperate climate, this is delivered in springtime with
three times weekly treatment for 5 weeks. Patients are advised to continue with
2030 min periods of sun exposure weekly between the peak hours UVB light from
10 AM to 2 PM without sunscreen to preserve newly gained hardening effects [12].
To manage patients with polymorphous light eruption, prednisolone has shown
to be effective in suppressing exacerbation of symptoms [13]. Antihistamines to
treat pruritic lesions can also be considered, but should be used only as adjunct to
other therapies. Polypodium leucotomos, carotenoids, afamelanotide, and nicotin-
amide have been used as adjuncts to topical photoprotection. However, there lack of
sufficient evidence assessing their to warrant recommendation at this time in lieu of
other proven photoprotective. Above all, individuals should be counseled on the use
of physical barriers for photoprotection: sunglasses, wide-brimmed hats, and long-
sleeve shirts. Use of photoprotective clothing is a mainstay of preventing disease
exacerbation.
3.2.2 Solar Urticaria
Solar urticaria is a very rare photodermatosis that results in wheal and flare
development within minutes of light exposure with resolution within 24 h. The
presumed pathophysiology is that of a type I hypersensitivity response in which
chromophore absorption of a photon causes the formation of neoantigens capable of
recognition by IgE antibodies [14]. These antibodies then bind to the Fc receptor on
mast cells and upon re-exposure to light cause degranulation and release of
inflammatory mediators. The action spectrum is vast among patients and extends
over UV to the visible light spectrum [15] so much so that it has been reported that
even infrared radiation causes exacerbation [16]. As the action spectrum is variable,
phototesting should first be performed to determine a patients action spectrum to
best ensure adequate photoprotective strategies are used [6]. It should be emphasized
that phototesting reading needs to be done immediately after exposure as the wheal
and flare response will resolve.
General photoprotective strategies including sun avoidance, use of broad-
spectrum sunscreen with high SPF, and use of tightly woven, thick, dark fabrics are
initial precautions that can be taken to prevent acute flares. The visible light
spectrum, in particular, is difficult to protect against. For topical visible
photoprotection to be effective, the topical agent must be opaque. As such, there are
no sunscreens currently available that provide coverage against the visible light
spectrum. With respect to protection against visible light, it should be made known
that the SPF of a sunscreen does not correlate to protection against the visible action
spectrum [17]. Sunscreens with a higher concentration of iron oxides, which are
pigmented, have been shown to be better at blocking visible light when compared to
the sunscreens only containing micronized zinc oxide and titanium dioxide [17, 18].
No clinical trials have been performed evaluating the efficacy of such pigmented
sunscreens in the idiopathic photodermatoses, there exists a likelihood of benefit
given results from artificial sensitization against visible light [19].
Phototherapy, with UVA being the most commonly used light source, to facilitate
hardening provides the next step of management for more severely affected patients.
Recent evidence suggests that using wavelengths outside the action spectrum of a
patient may induce tolerance [20, 21]. UVA rush-hardening protocols have reported,
suggesting this as a viable option for treatment in the future [22]. An interesting agent
for systemic photoprotection in solar urticaria involves the use of the -melanocyte-
stimulating hormone analogue, afamelanotide. In a cohort of 5 individuals receiving a
single subcutaneous the urticarial dose necessary for eliciting wheal formation
increased [23]. Dihydroxyacetone followed by an application of naphthoquinone over
a period of 7 month yielded an SPF increase of 18 in 18 of the 30 patients tested [24].
Though quite promising, more trials are necessary in order to truly assess efficacy.
In the event of an exacerbation, topical corticosteroids and antihistamines can be
used for symptomatic treatment. Although systemic corticosteroids are more effec-
tive at controlling flares, adverse side effects prevent their long-term use. In addition,
IVIG [25, 26], plasmapheresis [27], and omalizumab [28, 29] have proven successful
in select cases, supporting the proposed antibody-mediated pathophysiology. Most
recently, a phase 3 multicenter study of omalizumab in 323 patients with chronic
idiopathic or spontaneous urticaria, diseases similar to solar urticaria, had reported
symptomatic relief in those where antihistamines had failed to alleviate symptoms of
urticaria [30]. Based on these initial findings, it appears that immunomodulatory ther-
apy should be more aggressively pursued as a treatment option for solar urticaria.
3.2.3 Hydroa Vacciniforme
Another rare photodermatosis, hydroa vacciniforme presents as one of two clinical

phenotypes: classic hydroa vacciniforme and severe hydroa vacciniforme-like
eruption. The classical variant most commonly affects children, declining in severity
as adolescence is reached. Sun exposure triggers the formation of edematous,
pruritic, or painful papules that progress to vesicles and eventually rupture. The
ruptured vesicles heal, leaving a vacciniforme or varioliform pattern of scarring.
The severe variant, in contrast, is most commonly described in adults and occurs
concurrently with constitutional symptoms of fever, weight loss, and headache. It is
frequently associated with T cell or natural killer cell lymphoma and has an
aggressive course [31]. Histologically, epidermal necrosis with predominately
neutrophilic and lymphocytic infiltrate is observed in both presentations [32]. As
with the other photodermatoses, the pathogenesis is unclear. The action spectrum of
those afflicted with the disease lies within the UVA spectra [33, 34]. However, it has
been postulated that Epstein-Barr virus (EBV) infection is involved in the
pathogenesis [31, 35, 36], especially because EBV DNA in blood and EBV-encoded
small nuclear ribonucleic acid isolated from vesicles have been found in both the
classic and severe hydroa vacciniforme-like variants.
Treatment of hydroa vacciniforme is difficult once visible lesions are present
[37]. Photoprotective strategies geared toward preventing exacerbations are
therefore critical. As with other photodermatoses, the most adequate method to
avoid disease provocations involves the use of photoprotective clothing, sunscreens,
and sun avoidance [37, 38]. Similarly, dark-tinted car windows and limiting heat
exposure have been felt to ameliorate the severity of disease [37]. In addition to
photoprotection, cases of associated with EBV should be managed by treatment of
the viral infection. Successful treatment of EBV has resulted in increased ability to
spend time in sunlight without the development of new skin lesions while also pre-
venting any systemic manifestations associated with the infection [39].
3.2.4 Chronic Actinic Dermatitis
Chronic actinic dermatitis (CAD), also known as photosensitivity dermatitis, actinic

reticuloid syndrome, photosensitive eczema, and persistent light reaction, is a
photodermatosis of unknown, most likely immunologic, etiology that presents
either as dermatitis with or without pseudolymphomatous lesions. In most severe
cases, it may also present as erythroderma. Males, of any race above 50 years of
age, are typically affected. Current literature, shows that CAD [4042]. In addition,
development of CAD in younger individuals is usually quite rare unless a history of
atopic dermatitis [43] or HIV infection is noted [40]. Acute flares of the disease are
characterized by scaly patches and papules mostly limited to sun-exposed areas.
Later, eczematous plaques with lichenification become evident due to the chronicity
of the disorder. Diagnosis of CAD includes fulfillment of the following criteria:
dermatitis to a sun-exposed area without exposure to a photosensitizer; abnormal
delayed erythema to UVA, UVB, or visible light; and histology suggesting photo-
dermatitis (epidermal spongiosis, acanthosis, and a perivascular mononuclear cell
infiltration in superficial and possibly deep dermis) [44].
Prophylactic photoprotective measures are the mainstay of management of the
disease course. Choosing a broad-spectrum high SPF sunscreen is useful to prevent
exacerbation of disease. A formulation with UV filters that are low in contact
sensitization potential is advised so as to minimize the likelihood of development of
dermatitis in patients [45, 46]. Like most photosensitive disorders, patients should
seek shade during peak hours of sunlight and photoprotective clothing. Museum
films that prevent transmission of UVR wavelengths can be used the aforemen-
tioned photoprotective strategies [47]. Given that the action spectra may lie within
the visible light continuum, lifestyle changes to restrict exposure to both natural and
artificial light sources may be necessary. Modifications of the home and work envi-
ronment may also be necessary in particularly unrelenting disease. No reports of
exacerbation of disease from neither televisions nor computer screens have been
reported in the literature [45, 48].
If avoidance of the action spectrum is unfeasible, topical corticosteroids should
be used for symptomatic relief. In particularly severe CAD, immunosuppressive
therapy is indicated, of which azathioprine is the only clinically proven, efficacious
treatment [49, 50]. Despite this, case reports have demonstrated that topical calci-
neurin inhibitors like tacrolimus [5153] and pimecrolimus [54] can aid in the treat-
ment of CAD. There exist anecdotal reports of benefit in severe CAD from other
immunosuppressants typically used for unrelenting atopic dermatitis including
mycophenolate mofetil [55] and cyclosporine [56, 57]. Hardening with artificial
light sources is usually difficult to achieve as patients tend to be exquisitely photo-
sensitive, making it difficult to increase the exposure dose. Because of the paucity
of knowledge regarding immunosuppressive agents with potential for treatment,

future clinical trials should focus on quantifying the effect of other immunosuppres-
sants used in case reports compared to that of the azathioprine.
3.2.5 Actinic Prurigo
Actinic prurigo begins in childhood as a pruritic, papular, or nodular eruption on sun-

exposed areas and appears hours to days after sun exposure. Sun exposure leads to
an immediate edematous phase that transitions into an eczematous phase followed
by a pruriginous phase [6]. Presentation of the disease varies, frequently having ocu-
lar manifestations as well as lower lip cheilitis. Unfortunately, the disease does not
remit in adulthood. Indigenous populations of the Americas [58, 59]. Patients of
Amerindian or mixed-Amerindian descent are often associated with human leuko-
cyte antigen (HLA) DRB1*0407, an HLA-DR4 subtype [58, 60, 61]. HLA-DR4, of
note, can be associated with a number of autoimmune disorders, most notably rheu-
matoid arthritis, and it has been proposed that certain HLA genes modify the response
to UVR-induced neoantigens [62]. Though an important association, lack of associ-
ated HLA association does not preclude the development of the disease [63].
Both UVA and UVB have been shown to elicit a pathophysiological response
[64]. Photoprotective strategies that should be utilized for actinic prurigo involve sun
avoidance and use of photoprotective clothing, lip balm, and broad-spectrum sun-
screens. Sunglasses blocking both UVA and UVB are strongly advocated to prevent
any ocular symptoms that may arise. For optimal protection, sunglasses should wrap
around and be fitted close to the face so as to prevent reflection of light from the
interior portion of sunglasses back onto the face. As UVA could be part of an indi-
viduals action spectrum, environmental protective strategies to limit the amount of
UVA light including UVA blocking films have been found helpful [47, 65]. It remains
important to test for deterioration of photoprotective abilities of such films and
replace them when necessary [65]. Topical corticosteroids are an effective treatment
in some patients with acute exacerbations, though their side effects preclude chronic
use. The role of phototherapy in these patients is limited. Thalidomide, through its
immunomodulatory mechanism, is the most effective treatment for this condition;
reports have shown its efficacy [6668] and its potential for safe, long-term use [68].
3.3 Chemical- and Drug-Induced Photosensitivity
Chemical- or drug-induced sensitivity represents the most diverse group of photo-

dermatoses and can be divided into exogenous and endogenous causes. Exogenous
causes involve the ingestion, administration, or application of a medication, per-
sonal care product, or occupational agent causing adverse reactions to light.
Meanwhile, photosensitivity due to endogenous agents is the result of accumulation
of compounds in the body through either acquired or inherited mechanisms.
3.3.1 Exogenous Agents
Broadly, there are two categories of photosensitivity an individual may exhibit to

exogenous agents: photoallergic and phototoxic. The pathogenic mechanism for
each will be discussed.
3.3.2 Photoallergic Reactions
True photoallergic responses are much less common than phototoxic reactions. This
type IV hypersensitivity response results from formation of a neoantigen due to any
amount of UV exposure. Photoallergic reactions are usually not observed for
13 days; most common offending agents are topical agents, usually sunscreens.
Following this period, the response manifests itself as an eczematous reaction
spreading to areas unexposed to sunlight. Spongiosis is seen histologically. For
classic photoallergic responses to develop, prior sensitization is necessary. Cross
reactivity of many molecules, however, permit the development of photoallergic
reactions from first exposure due to exposure of a structurally similar entity. The
prototypical example of this phenomenon is photoallergy due to cross reactivity
between thimerosal, a preservative used in skin antigen testing, and piroxicam. The
thiosalicylic moiety in thiomersal is highly antigenic and causes allergic responses
in some patients. Piroxicam, a nonsteroidal anti-inflammatory drug (NSAID), is
photodecomposed when exposed to UVA into molecule that is structurally similar
to the thiosalicylic moiety in thimerosal causing a photoallergic response upon the
first exposure to the NSAID [6971] Photoallergies can result from many topicals
and systemic medications.
3.3.3 Phototoxic Reactions
Phototoxic reactions are significantly more common than photoallergic reaction and
are observed within minutes to hours. These reactions occur on first exposure to an
agent in the setting of sufficient amount of agent and UVA exposure. An exogenous
agent will topically absorb photons causing it to reach an excited state. To reach the
ground state, the agent becomes involved in a series of oxygen-dependent reactions
eventually causing the formation of free radicals causing cellular damage. There are
two types of phototoxic reactions. Type I phototoxic reactions involve a photosensi-
tizer combining with cellular components or transferring hydrogen or electrons to
other molecules, forming free radicals that cause cellular damage [72, 73]. Type II
phototoxicity, on the other hand, involves the excited agent transferring electrons to
oxygen directly, causing the formation of oxygen radicals [72, 73].
In contrast to photoallergic responses, phototoxic reactions are erythematous and

sharply demarcated and only are present on sun-exposed portions of the body. There
are, however, instances in which it may be hard to distinguish between photoallergic
and phototoxic reactions simply based on morphology. Necrotic keratinocytes with
a mild inflammatory response comprised of neutrophils and macrophages are seen
histologically in phototoxic reactions.
3.3.4 Photoprotection for Exogenous Agents
The most effective way to prevent further photosensitivity is immediate removal of

the offending substance. This is not feasible many times due to the importance of
the medication in chronic disease management. In such cases, educating patients on
proper photoprotective practices is necessary. Since UVA is the primary action
spectrum implicated in these disorders, use of UVA blocking films in windows and
use of UVA protective sunscreens are sometimes recommended. Avoidance of peak
hours of sunlight should be emphasized as well.
3.3.5 Endogenous Agents
Photosensitivity from endogenous agents results from accumulation of different

compounds likely secondary to enzymatic deficiency. Examples that will be
discussed include cutaneous porphyrias, pellagra, and Smith-Lemli-Opitz syndrome.
3.3.6 Cutaneous Porphyrias
The porphyrias represent an inherited or acquired heterogeneous group of enzymatic

defects in the heme biosynthesis pathway. Table 3.1 provides a summary of the heme
biosynthetic pathway with enzymatic defects resulting in each porphyria. Each enzy-
matic defect beginning from uroporphyrinogen synthase onward produces a photo-
sensitive phenotype. Porphyrinogens accumulate and then undergo spontaneous
oxidation to the corresponding porphyrins. The resultant porphyrins are potent
endogenous photosensitizing substances. The action spectrum of the porphyrias typi-
cally involves the Soret band, a peak in blue wavelength region of the visible light
spectrum usually between 400 and 410 nm, with a less significant action spectrum in
the visible red light spectrum at about 600650 nm [74]. For this reason, UVA and
UVB blocking sunscreens are typically ineffective in preventing exacerbation upon
exposure to sunlight. Both zinc oxide and titanium dioxide sunscreens (non-nano-
sized and opaque) may be helpful as well as use of opaque photoprotective clothing.
Table 3.1 Heme biosynthethic pathway with enzymatic defects in porphyria
48
Cutaneous
Location Heme biosynthesis Enzyme Pathology Inheritance Acute manifestations Treatment options
Glycine +
succinyl-CoA
Mitochondria Aminolevulinic acid X-linked sideroblastic X-linked No N/A N/A
synthase 2 anemia recessive
Delta aminolevulinic
acid
Aminolevulinic acid ALA dehydratase Autosomal Yes N/A Intravenous hematin
dehydratase porphyria recessive
Porphobilinogen
Hydroxymethylbilane Acute intermittent Autosomal Yes N/A Intravenous hematin
synthase porphyria dominant
Cytosol Hydroxymethylbilane
Uroporphyrinogen Congenital Autosomal No Bullae, vesicles, Hydroxyurea, red
synthase erythropoietic recessive skin thickening, blood transfusion,
porphyria (Gnther hypo- and activated charcoal,
disease) hyperpigmentation, bone marrow
hypertrichosis, transplant
scarring, loss of
nails, loss of digits
Uroporphyrinogen III
Uroporphyrinogen Porphyria cutanea Type I/ No PCT: vesicles, Hydroxychloroquine
dehydrogenase tarda (PCT)/ III - bullae, erosions heal [111], Phlebotomy
hepatoerythropoietic sporadic with [111]
porphyria (HEP) type II: hyperpigmentation HEP: same as PCT
autosomal or atrophy,
dominant periorbital
hypertrichosis, milia
D. Gutierrez and E.D. Baron
HEP: similar to PCT

3
Coproporphyrinogen
III
Coproporphyrinogen Hereditary Autosomal Yes Skin lesions similar Intravenous hematin
oxidase coproporphyria dominant to PCT
Protoporphyrinogen
IX
Mitochondria Protoporphyrinogen Variegate porphyria Autosomal Yes Similar to PCT but Intravenous hematin,
oxidase dominant with milder dihydroxyacetone
symptoms [112]
Protoporphyrin IX
Ferrochelatase Erythropoietic Pseudo- No Pruritus, wheals, Afamelanotide [113],
protoporphyria dominant painful edema, cholestyramine,
Photoprotection for Photodermatoses
erythema, chenodeoxycholic
petechiae, purpura, acid [74], cysteine
lichenification, [114], beta carotene,
thick activated charcoal,
pseudovesicles blood transfusion,
intravenous hematin
Heme
All information adapted from Sassa [115] unless otherwise stated
Not shown in the above, nonenzymatic conversion of hydroxymethylbilane to uroporphyrinogen I and then to coproporphyrinogen I accounts for the photosensitivity
resulting from uroporphyrinogen synthase deficiency
49
3.3.7 Pellagra
Pellagra is a vitamin deficiency disease lack of niacin result in a classic presentation

of diarrhea, dementia with hallucinations, and photosensitive dermatitis. The presen-
tation of this photosensitivity is an erythematous, edematous eruption with eventual
scaling and hyperpigmentation. Deemed the Casal collar after its discoverer, this
eruption occurs in a C3 and C4 dermatomal distribution. The reason for photosensi-
tivity remains unclear with multiple etiologies being proposed: urocanic acid defi-
ciency, kynurenic acid accumulation, nicotinamide adenine dinucleotide and
nicotinamide adenine dinucleotide phosphate deficiency, or porphyrin accumulation
[75]. There have been no controlled phototesting studies to define the action spec-
trum of this disorder though photosensitivity varies within the UVA, UVB, and vis-
ible light spectra [75]. Avoidance of UVR along with immediate supplementation of
niacin can prevent worsening and resolution of the disease process.
3.3.8 Smith-Lemli-Opitz Syndrome
Smith-Lemli-Opitz syndrome (SLOS) is a rare autosomal recessive disease with

7-dehydrocholesterol-reductase deficiency resulting in accumulation of 7-dehydro-
cholesterol with overall low serum cholesterol levels. The phenotypic presentation
is diverse, usually presenting with craniofacial deformities (microcephaly, micro-
gnathia, ptosis, cleft lip and palate), skeletal deformities (syndactyly of second and
third toes), and CNS abnormalities (decreased frontal lobe size and cerebellar hypo-
plasia) in the setting of mental delay. Though the specific absorption wavelengths of
7-dehydrocholesteral are 274, 283, and 293 nm [76], the most severe cutaneous
responses occur following UVA exposure at 350 nm [7678]. Management involves
a high cholesterol diet and bile acid replacement [79]. A lack of studies on potential
photoprotective strategies for SLOS cases demonstrate that photoprotection with
clothing was most effective [76]. Broad-spectrum sunscreens with high SPF and
opaque films for house and car windows in preventing UVA transmission have been
reported to be beneficial [76].
3.4 Photoaggravated Disorders
Photoaggravated disorders comprise the widest and least specific group of photoder-
matoses. The only unifying factor among the disorders involves exacerbation by UVR
exposure. The list of photoaggravated disorders is extensive: acne vulgaris, atopic
dermatitis, bullous pemphigoid, carcinoid syndrome, cutaneous T-cell lymphoma,
Dariers disease, dermatomyositis, disseminated superficial actinic porokeratosis, ery-
thema multiforme, Grovers disease, lichen planus, lupus erythematosus, pemphigus,
pityriasis rubra pilaris, psoriasis, reticular erythematous mucinosis, rosacea, sebor-
rheic dermatitis, and various viral infections [3]. We will be discussing photoprotec-
tive strategies primarily in regard to lupus erythematosus and dermatomyositis.
3.4.1 Lupus Erythematosus
Lupus erythematosus may be subdivided into the following categories: systemic

lupus erythematosus, acute lupus erythematosus, subacute cutaneous lupus
erythematosus, and chronic lupus erythematosus. Chronic lupus erythematosus can
be further subdivided into lupus erythematosus tumidus, lupus erythematosus
profundus, and discoid lupus erythematosus [80]. Photosensitivity is not limited
solely to the development of cutaneous reactions but also to the development of
malaise and arthralgia in patients [81].
Briefly, UVR has been established as a trigger for exacerbations of the disease
through many now well-characterized mechanisms. In a genetically susceptible
individual, ROS cause DNA to exhibit some antigenicity resulting in the formation
of autoantibodies [82, 83]. In addition, these newly apoptotic cells generated by UV
exposure in the upper epidermal layer are cleared more slowly [84], resulting in the
persistence of the inflammatory response. Redistribution of intracellular Ro/SS-A
and La/SS-B proteins to cell surfaces following UVR exposure [85, 86] results in
cell death via antibody-dependent cellular cytotoxicity [87, 88]. UVA, on the other
hand, is able to penetrate into the deep dermis and cause oxidation of DNA most
frequently at the 8 position of guanine [89] with eventual cell apoptosis.
The photosensitivity of the subtypes of lupus varies: tumid lupus erythematosus
being the most photosensitive followed by subacute cutaneous lupus erythematosus,
systemic lupus erythematosus, and finally discoid lupus erythematosus [90]. The
action spectrum varies as well. While some studies show that phototherapy with
UVA can reduce disease severity [91, 92], both UVA and UVB have been shown to
worsen disease manifestations as well [93, 94]. Nonsolar sources of both UVA [95]
and UVB [96] have also been implicated in causing photoexacerbation of the
disease.
Sunscreens play a significant role in the prevention of exacerbation of cutaneous
lupus erythematosus. An intraindividual study regarding the efficacy of different
sunscreen formulations protecting against cutaneous LE development subjected a
cohort of 11 patients to photoprovocation using a combination of UVA and UVB
radiation [97]. All using the formulation of sunscreen with UVA blocking Mexoryl
SX and Mexoryl XL received complete protection against photoprovocation [97].
While other sunscreens without Mexoryl SX and Mexoryl XL protected some
individuals against photoprovocation, the majority of individuals did not receive
sufficient protection to prevent the development of UVR-induced skin lesions [97].
Similar findings from an intraindividual study of 25 patients comparing a vehicle
control (esters, vitamin E, parabens, o-cymen-5-ol, phenoxyethanol) to a broad-
spectrum SPF 60 test product containing ethylhexyl methoxycinnamate, titanium
dioxide, zinc oxide, and methylene bis-benzotriazolyl tetramethylbutylphenol with
vehicle products showed no cutaneous manifestations of lupus erythematosus in the
sunscreen group. Notably, 14 of the 25 developed a positive result in vehicle-treated
group [98]. Results from this study buttress those initial results of Stege and
colleagues: a broad-spectrum sunscreen of sufficient strength and proper formulation
with appropriate UV filters is capable of preventing the worsening of cutaneous
lesions seen in lupus.
3.4.2 Dermatomyositis
Dermatomyositis, a disease related to polymyositis, presents with early proximal

muscle weakness in the setting of pathognomonic erythematous to violaceous pap-
ules on metacarpophalangeal and interphalangeal edematous periorbital, heliotrope
eruptions. Other commonly afflicted cutaneous areas include the anterior chest
(V-neck sign) or upper back and shoulders (shawl sign). There remains a paucity of
information regarding the mechanisms of photosensitivity in dermatomyositis.
Cheong and colleagues utilized monochromatic irradiation to demonstrate that 5 out
of 10 total patients were photosensitive and their action spectra included UVB and
UVA light at 307.5, 340, and 360 nm, respectively [99]. Dourmishev and colleagues
found that 8 out of their 19 patients with dermatomyositis undergoing photoprovo-
cation with UBV light had comparable photosensitivity to those reported by Cheong
[100]. There is a paucity of information in the current literature regarding photopro-
tective strategies in dermatomyositis. We can only advocate that broad-spectrum
sunscreens should be used, along with general photoprotection practices.
3.5 Hereditary Photodermatoses
Hereditary photodermatoses are caused by enzymatic mutations leading to defects

in DNA repair. Those afflicted with these disorders are not solely plagued by
cutaneous complications, but have multisystem abnormalities and are at a high
propensity for developing malignancies. The following disorders can typically be
grouped under this category: ataxiatelangiectasia, Bloom syndrome, Cockayne
syndrome, HaileyHailey disease, Hartnup disease, Kindler syndrome, Rothmund
Thomson syndrome, trichothiodystrophy, and xeroderma pigmentosum [3]. Though
SLO is often considered hereditary photodermatosis, we choose to include it as a
photosensitive disorder due to endogenous accumulation of precursors photosensi-
tivity. Xeroderma pigmentosum will be discussed in depth as the model for which
photoprotection for all other hereditary photodermatoses should be based upon.
3.5.1 Xeroderma Pigmentosum
Xeroderma pigmentosum is a rare autosomal recessive disorder of DNA repair

resulting in cutaneous and ocular photosensitivity and increased propensity for
development of skin cancers. UVA and UVB light are implicated in disease patho-
genesis, the visible light spectrum is not a cause of disease manifestation. Patients
have nucleotide excision repair and can therefore not repair bulky the cyclobutane
pyrimidine dimers [89]. Inability to repair these products causes accumulation of
DNA mutations and cell apoptosis. Mutations in any of the following genes may
cause xeroderma pigmentosum: XP-A, XP-B (excision-repair cross-complement-

ing group 3 [ERCC3]), XP-C, XP-D (ERCC4), XP-G (DNA damage-binding pro-
tein 2 [DDP2]), ERCC1, and XP-V (POLH gene [encoding DNA polymerase eta])
[101]. Blistering and extensive burning in response to only minimal sunlight is the
hallmark of this photodermatosis. Typically presenting in early childhood, neonates
cry when exposed to sunlight. Extreme freckling on sun-exposed areas before
2 years of age is invariably seen. In addition, poikiloderma, xerosis, and actinic
keratosis are commonly seen. Ocular manifestations of the disorder are usually lim-
ited to the anterior eye, being the most sun-exposed portion, and consist of keratitis
and corneal opacification with vascularization. In severe cases, the palpebrae may
become atrophic or lost completely contributing to further ocular damage.
Melanomas, squamous cell carcinomas, and basal cell carcinomas are common in
this group of individuals.
Photoprotective strategies involve the utilization of adequate personal
photoprotective precautions with alteration of the environment so as to reduce
opportunities for potential UVR exposure. For example, outdoor activities should
be limited before sunrise and after sunset.
Specific attention should be given to the lighting used in homes. It has been
reported that compact fluorescent lamps [102104], energy-efficient halogen lights
[104], and mercury vapor tubes [105] can be major sources of UVA radiation. The
use of double envelope lamps can help minimize the dosage of UVR in these
scenarios [106]. Incandescent light bulbs [107] and LED lights [103] have been
recommended in the household because of the negligible UVR emitted. In homes
and in cars, film blocking UVA and UVB can be applied [108, 109].
An application of at least 30 SPF, broad-spectrum sunscreens to sun-exposed
areas should be stressed and performed every day. The importance of reapplying
every 2 h to potentially UVR-exposed areas cannot be understated. Dark, tightly
woven clothing should be layered for optimal protection. In addition, gloves should
be worn to shield the dorsum of the hands. Given the propensity for ocular
manifestations, a UVR protective face shield paired with a hood that covers the
entire head and neck should be worn when at risk for prolonged exposure to
UVR. To supplement this, tight fitting, wraparound sunglasses covering UVA and
UVB light should be worn simultaneously to assure sufficient photoprotection of
the face and eyes.
There have been few trials addressing efficacy medical therapy after sun expo-
sure to reduce skin cancer development for those with xeroderma pigmentosum.
The most notable prospective trial evaluating topical application of T4 endonucle-
ase V, encapsulated in liposomes, has been reported to decrease the incidence of
actinic keratosis by 68 % and by 30 % in patients with xeroderma pigmentosum
[110]. No adverse effects or development of antibodies against the molecule was
seen in the study group [110]. Though no additional studies have been reported
since, results from the trial suggest that targeted drug delivery of enzymes may be a
safe, therapeutic option for treating those afflicted with such devastating disease,
and more work regarding this treatment modality should be explored.
Photoprotection for hereditary photodermatoses can be cumbersome due to the

extensive methods that must be utilized, and so special considerations must be made
as to facilitate compliance with photoprotective strategies. The finances of patient
care should be assessed with families. Affordable sunscreens are suggested so as to
not economically burden families. Specialized photoprotective clothing also exists
and may be purchased.
3.6 Conclusions
Photoprotection involves a set of actions individuals can take to minimize their

exposure to the damaging effects of UVR. The use of photoprotective clothing,
wide-brimmed hats, sunglasses, and sunscreens along with sun avoidance practices
provides the cornerstone of photoprotection. Depending on the specific disorder and
the action spectra of the photodermatosis, one or more aforementioned practices can
be tailored for the prevention of disease in an individual. Follow-up with primary
care physicians and dermatologists should occur regularly to assess for changes in
disease manifestation and responses to treatment.
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Chapter 4
Photoprotection and Photoaging
Ben J. Friedman, Henry W. Lim, and Steven Q. Wang
Key Points
Photoaging refers to the long-term effects of ultraviolet radiation on chron-
ically exposed skin.
Clinical manifestations of photoaging include wrinkling, pigmentary alter-
ations, and telangiectasias.
Characteristic histopathological abnormalities underlie these clinical
manifestations.
Despite advances in skin rejuvenation technologies, photoprotection
remains the most cost efficient and effective means of minimizing the clin-
ical effects of photoaging.
4.1 Introduction
Situated at the interface between the viscera and the physical world, the skin
provides protection from numerous environmental insults in real time. Although
skin possesses remarkable resiliency, it undergoes characteristic, often undesirable
B.J. Friedman
Department of Dermatology, Henry Ford Medical Center,
Detroit, MI, USA
H.W. Lim
Department of Dermatology, Henry Ford Medical Center New Center O,
Detroit, MI, USA
S.Q. Wang (*)
Division of Dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, NJ, USA

DOI 10.1007/978-3-319-29382-0_4
62 B.J. Friedman et al.
functional and esthetic changes with time. One common paradigm in the study of
skin aging is to differentiate between intrinsic and extrinsic skin aging, of
which the first is a genetically influenced chronological process, while the latter is
driven primarily by environmental factors [1]. Ultimately, both forms of aging inter-
act in contributing to both a decline in skin structure and other cutaneous immuno-
logical, endocrinological, and neural functions. Recent work suggests that both
genetic and environmental factors in skin aging may actually share common path-
ways [2].
Of the various harmful environmental factors contributing to extrinsic aging,
ultraviolet (UV) light is considered to be the most significant and has also been the
most widely studied. Photoaging (or dermatoheliosis) refers to the effects of long-term
UV exposure and sun damage superimposed on intrinsically aging skin. Previous
work has suggested that up to 80 % of facial aging may be attributable to UV, although
other factors, such as cigarette smoking, may also promote premature facial wrin-
kling [3]. Photoaging is a universal phenomenon as the majority of light-skinned
individuals manifest some form of chronic sun damage before the age of 50 [4].
Some of the clinico-morphological manifestations of photoaging include fine
and coarse wrinkling, dyspigmentation, dry texture, increased laxity, telangiectasia,
and solar purpura. These adverse changes in skin appearance and integrity often
occur in parallel to the development of cutaneous malignances, a process referred to
as photocarcinogenesis. Persons of lighter skin tone, or low Fitzpatrick skin type,
and those with greater degrees of sun exposure (e.g., living in sunnier climates or
working outdoors) are preferentially affected by photoaging [57]. Within
individuals, sun-exposed areas such as the face, neck, extensor forearms and arms,
and dorsal hands are among the most susceptible to these changes.
Underlying the clinico-morphological features of photoaged skin are specific
histopathological alterations in epidermal and dermal structure. Ongoing research
advances in photobiology have helped illuminate various key molecular pathways
targeted by UV that induce these alterations. As the mechanisms of photoaging
continue to be better understood, newer therapeutic strategies for reversing these
processes and masking the photoaged phenotype continue to be developed. At the
current time, the most cost-effective therapy still remains primary prevention in the
form of sun avoidance, sun protective clothing, and use of sunscreens [8].
4.2 Clinical Manifestations of Photoaged Skin
The appearance of photoaged skin is characteristic, although interindividual

variation does exist. These differences may depend on factors such as skin type,
ethnic background, setting of greatest sun exposure (e.g., occupational vs. leisured),
dress and hair styling practices, damage repair capacity, and other genetic
predispositions [9, 10]. Individual features of photoaged skin may derive from
damage at various levels of the skin, with key roles played by keratinocytes,
melanocytes, endothelial cells, and fibroblasts serving as the cellular mediators of
the observed changes. Pigmentary alterations and both fine and coarse wrinkling are
4 Photoprotection and Photoaging 63
Table 4.1 Glogau classification of photoaging

Skin type Clinical manifestations
I No wrinkles
Early photoaging:
Mild pigmentary changes
No keratoses
Minimal wrinkles
Minimal or no makeup
II Wrinkles in motion
Early to moderate photoaging:
Early solar lentigines visible
Keratoses palpable but not visible
Parallel smile lines beginning to appear lateral to mouth
Usually wears some foundation
III Wrinkles at rest
Advanced photoaging:
Obvious dyschromia
Visible keratoses
Static wrinkling
Always wears heavy foundation
IV Only wrinkles
Severe photoaging:
Yellow-gray skin tone
Prior skin malignancies
Wrinkling without appreciable intervening normal skin
Cannot wear makeupcakes and cracks
Adapted from Ref. [13]
among the most prominent features seen with chronic UV exposure and are major
constituents of various photoaging scales aimed at quantifying a given individuals
degree of photodamage (Table 4.1) [1114]. Other clinical features of photoaging
include a dry leathery appearance, sallowness, vascular telangiectasia, sagging
appearance, and fragility (aka solar purpura). This is in contrast to sun-protected
skin, which ages in a more subtle fashion with increased laxity, fine wrinkling, and
the development of seborrheic keratosis. It notably lacks the pigmentary and
vascular changes characteristic of photoaging [15].
4.2.1 Pigmentary Alteration
Individuals of Caucasian and Asian descent who sustain chronic UV exposure are
prone to developing solar lentigines (SLs). These benign lesions tend to present as
fixed tan to dark brown macules and patches on chronically sun-exposed skin and
are most commonly seen after the age of 50 (Fig. 4.1a) [16, 17]. SLs can be
contrasted from ephelides, which, despite also being induced by UV and having a
similar distribution and appearance to SLs, tend to be restricted to phototypes I and
II, are dynamic (i.e., become more pigmented during the summer months), develop
a b
Fig. 4.1 Clinical manifestations of photoaging. (a) Multiple scattered solar lentigines are seen on
this sun-damaged forearm (indicated by black arrows). (b) Coarse wrinkling is seen on the neck of
this elderly Caucasian patient
early on in childhood and adolescence, and partially disappear with age [18]. SLs
are actually seen more frequently in skin types III and IV, which has been thought
to be a result of more active melanocytes in those skin types [19, 20].
There are multiple lines of evidence that support the relationship of SLs to sun
exposure, beyond the observation that SLs have a predilection for sun-exposed skin.
In one large epidemiological study (n = 962), facial SLs were associated with
cumulative lifetime sun exposure, while SLs on the back were associated with
cumulative sun exposure and a sunburn history before the age of 20 [21]. Similar
findings were captured by Ezzidine et al. who showed that SLs were associated with
lifetime sun exposure in 523 French middle-age women [20]. A smaller case control
study failed to demonstrate a link of SLs to cumulative or occupational sun exposure
(n = 118), but did find an association between SLs and both frequent sunburns and
recreational sun exposure [19]. Additional indirect evidence supporting the link
between photoaging and the development of SLs comes from the phenomenon of
so-called PUVA lentigines. Patients treated with psoralens and ultraviolet A light
(PUVA) for inflammatory skin conditions tend to develop lentigines in otherwise
sun-protected areas [22, 23]. Although PUVA lentigines have definite
histopathological differences as compared with SLs (including more active
melanocytes with longer and more numerous dendrites and a higher frequency of
basal keratinocytes containing large, single melanosomes), these may be explained
by the higher potency and/or the pulse nature of PUVA treatment as compared with
natural sunlight [24].
Hypermelanosis of the skin in the setting of chronic UV exposure may also mani-
fest as mottled or heterogeneous pigmentation, diffuse hyperpigmentation, pig-
mented actinic keratoses, and/or pigmented seborrheic keratosis [25]. Malignant
growths such as lentigo maligna and lentigo maligna melanoma represent less com-
mon causes of hypermelanosis in the skin, though they are almost exclusively seen in
the context of sun damage. Idiopathic guttate hypomelanosis (IGH) is the most well-
described yet poorly understood pattern of hypomelanosis seen in the context of skin
aging. Seen in over 80 % of those over the age of 70, IGH occurs in all phototypes,
though it is typically more apparent and striking in darker persons. IGH classically
presents as well-circumscribed and sharply defined whitish macules with a predilec-
tion for the forearms and shins. Although chronic UV exposure has been postulated
as a contributing factor to IGH, the cause may actually be multifactorial [2628].
4.2.2 Wrinkling
One of the telltale signs of skin aging is wrinkling. These rippled changes in the skin
surface presenting as variably sized creases and furrows may be most noticeable around
the forehead, eyes, cheeks, and neck (Fig. 4.1b). In some patients, wrinkles may form
interlacing patterns. Perhaps not surprisingly, studies have shown that there is a high
correlation between perceived age and the degree of facial wrinkling in persons [29].
Various forms of wrinkling have been described. Dynamic wrinkles are those that tem-
porarily result from contraction of underlying muscle fibers perpendicular to the direc-
tion of the visible skin lines. Over a period of time, these so-called facial expression
lines may further deepen and develop a static component. Static wrinkles develop in
thin stretched skin and are present even when underlying muscles are in a relaxed state.
The pathophysiology of wrinkling is complex, with likely contributions from intrinsic
skin aging, constant gravitational forces, intermittent positional pressures, repetitive facial
movements, pollution, and smoking [30]. Chronic UV exposure is thought to play a major
role in accelerating and accentuating skin lines and wrinkles, though the precise histo-
pathological correlate is still debated [31]. Furthermore, the presence of deep, coarser
wrinkles are thought to be a more prominent feature of photoaged skin as compared with
intrinsically aged skin [32]. In one recent cross-sectional study of a Mediterranean popu-
lation (n = 574), chronic sun exposure was found to be significantly associated with degree
of wrinkling (p <0.01), as assessed by the Daniell skin-wrinkling grading system [33].
Multiple other studies have demonstrated similar associations [3436].
4.2.3 Miscellaneous Phenotypes
There are a number of other phenotypic alterations that are seen with increasing age
and have a predilection for sun-exposed skin and in which chronic UV exposure is
thought to play a role. Sebaceous hyperplasia (SH) presents as small yellowish or
skin-colored papules on the face or trunk, sometimes associated with a patulous

follicle in which sebum can be extracted. UVA has been shown to be able to penetrate
deep to the level of sebaceous glands, and experiments have shown that prolonged
UV exposure in hairless mice induces prominent SH [37, 38] Colloid milia, a
papular variant of solar elastosis (see Sect. 4.3), clinically manifests as closely
spaced, dome-shaped translucent yellow papules with a predilection for the neck,
face, and dorsal hands [39]. Poikiloderma of Civatte describes a pattern of reticulate
hyperpigmentation, telangiectasia, and slight atrophy of the sides of the neck, lower
anterior neck, and upper chest. The submental area, which is sun protected, is
invariably spared in this condition [40]. Cutis rhomboidalis nuchae refers to deep
furrowing, thickening, and a leathery appearance of the skin on the nape of the neck.
Favre-Racouchot syndrome usually presents in older men as thickened yellow
plaques with superimposed cysts and comedones in the periorbital and malar areas
of the face [25].
4.3 Histopathology of Photoaged Skin
Multiple histopathological features characterize photoaged skin, which, in a given

person, may differ both qualitatively and quantitatively in comparison to sun-
protected skin. Of these features, the most recognizable and well described is solar
elastosis (SE). SE is readily visualized in hematoxylin and eosin-stained sections as
irregular deposits of basophilic material at the junction of the papillary and reticular
dermis [1]. These deposits can extend to involve a variable thickness throughout the
dermis (Fig. 4.2a). SE is thought to represent a degeneration of collagen, largely
replaced by abnormally thickened, tangled, and subsequently granular-appearing
amorphous elastin fibers [4143]. Through various quantitative assays, it has been
well documented that levels of type I and III collagen are significantly reduced in
a b
Fig. 4.2 Histopathology of photoaging. (a) Chronically sun-exposed skin demonstrating an

effaced dermal-epidermal junction along with prominent solar elastosis filling the upper dermis.
(b) Bulb-like elongation of the rete ridges with basilar hyperpigmentation, consistent with a solar
lentigo
sun-exposed skin as compared with sun-protected skin [43, 44]. Additional dermal
changes may include vasculature that is abnormally tortuous and dilated as well as
postcapillary venules displaying concentric wall thickening with deposits of base-
ment membrane-like material [45].
Epidermal thickness in photoaged skin can vary between individuals, demon-
strating either atrophy with effacement of the dermal-epidermal junction, hypertro-
phy with acanthosis, or no appreciable change [43]. Basement membrane thickening
can also be seen, which may signify chronic UV-mediated damage to the basal
keratinocytes. Melanocytes are irregularly distributed along the basal layer and can
vary widely in size, dendritic branching, and pigmentation [46, 47]. SL, when pres-
ent, demonstrates bulb-like elongation of the rete ridges with increased pigmenta-
tion of the basal keratinocytes located at the rete tips (Fig. 4.2b). Not infrequently,
biopsies of photoaged skin may display keratinocyte atypia, which presents as cel-
lular crowding of large and hyperchromatic-appearing cells. The atypia may extend
variably upward from the basal layer and is a marker of photo-carcinogenicity.
4.4 Molecular Mechanisms of Photoaging
Various cultural pressures combined with increased age expectancy have created a
great demand for therapies which can restore a more youthful appearance. Crucial
in the pursuit and ultimately the development of new antiaging therapies is achieving
a more complete understanding of how chronic UV exposure initiates and propagates
the clinical effects of photoaging. Perhaps not surprisingly, this area of photobiology
has been and continues to be a subject of great interest and research. In recent years,
there have been many new and exciting advancements in the field, which have
begun to shed light on some of the key molecular pathways involved.
4.4.1 UV and Skin Biology
Both UVA (320400 nm) and UVB (290320) appear to contribute to photoaging,
although UVA is thought to play a greater role among the two. This is largely due to
the fact that UVA penetrates more deeply in the dermis and is at least 10 times more
abundant than UVB when it reaches the earths surface [48]. UVB is predominantly
absorbed by DNA in the epidermis and in turn induces various forms of cellular
damage through the formation of cyclobutane dimers. In this manner, UVB has been
shown to be a key component in the pathogenesis of sunburn, cutaneous immuno-
suppression, and photocarcinogenicity [49]. In contrast, much of the damage
inflicted by UVA is focused on dermal fibroblasts, extracellular matrix, and endo-
thelial cells through the generation of reactive oxygen species (ROS). UVA-induced
ROS have been shown to cause damage to various cellular compartments including
lipid membranes, DNA, and mitochondria. This damage may take the form of lipid
peroxidation, DNA strand breaks, and aberrant activation of transcription factors

[50]. Epidermal melanin absorption of UV is perhaps the single most important
endogenous protective factor against the deleterious effects of UVA and UVB and
largely explains why darker individuals exhibit the clinical signs of photoaging
much later in life as compared with fair-skinned individuals [51] (see 6.5.1).
4.4.2 UV and Extracellular Matrix
Induction of matrix metalloproteinases (MMPs) is thought to represent a key step in

the development of the biochemical alterations seen in photoaged skin. MMPs
represent a family of enzymes whose primary function is to degrade extracellular
matrix (ECM). Moreover, each of the various MMPs serves to break down different
components of the ECM. For example, MMP-1 (collagenase) has been shown to
cleave collagen types 1, II, and III, while MMP-9 (92-kd gelatinase) is known to
degrade collagen types IV, V, and gelatin [52]. The function and activity of these
enzymes are regulated through complex processes, which intervene both at the level
of MRNA transcription and posttranslational inhibition by tissue-specific inhibitors
of MMPs (TIMPs) [53].
Multiple studies have confirmed the phenomenon that MMPs are induced by
both UVA and UVB [5456]. One paramount study demonstrated that in vivo expo-
sure of human skin to low doses of UVB (0.1 minimal erythema dose), within hours,
induced the expression of MMP-1, MMP-3 (stromelysin), and MMP-9 [57]. Also
upregulated within minutes of UV exposure were NF-kB and AP-1, transcription
factors known to stimulate the expression of MMPs [58, 59]. The implications of
this work were that elevated MMPs, likely stimulated by the actions of AP-1 and
NF-kB in the setting of chronic low intensity UV exposure, promote the gradual
degradation of cutaneous collagen and elastin. Repetitive damage in this manner, if
improperly repaired, has been proposed to contribute in the accumulation of solar
elastosis and other features characteristic of premature, photoaged skin [60].
In addition to promoting collagen degradation, UV has also been implicated in
reducing dermal collagen production [44]. In vivo, UV irradiation has been shown
to reduce and ultimately deplete cutaneous procollagen levels within 24 h [61].
Collagen production is normally stimulated by TGF-B2. However, it has been shown
that expression of TGF-B2 along with its receptor is markedly reduced in response
to UV irradiation [62]. The upstream mediator of these changes may be c-Jun, which
is the known inducible subunit of AP-1 [61]. In one in vitro model, overexpression
of c-Jun in fibroblasts led to the decreased expression of type I collagen [61].
Subsequent investigations have begun to further fill in knowledge gaps regarding
the specific mechanisms and mediators involved in UV-dependent collagen degra-
dation and reduced collagen formation (Fig. 4.3) [63]. As mentioned above, UV
radiation (especially UVA, but also UVB to some degree) promotes the formation of
ROS. Accumulating evidence suggests that UV-induced ROS can actually mimic
the effects of receptor ligands [7, 64, 65]. Support for this phenomenon comes from
the fact that after only 15 min of exposure to UV, receptors for epidermal growth
UVA & UVB
ROS
Inflammatory cytokines & Growth

factors, Receptor activation
NF-kB AP-1 TGF-B

Nucleus
Inflammatory cytokines MMP expression Procollagen synthesis Inhibition of MMPs
Collagen production
Collagen breakdown
Elastin accumulation
Extracellular
Matrix
Fig. 4.3 Schematic demonstrating the various key molecular steps thought to be involved in
photoaging (Adapted from Ref. [63])
factor (EGF), IL-1, and TNF-a are all activated in both keratinocytes and fibroblasts
[7]. Activation of these key proinflammatory receptors has been proposed to result
from ROS-induced oxidation and subsequent inhibition of protein-tyrosine phos-
phatases which normally function to downregulate these receptors [64, 66].
4.5 Photoprotection
Consistent use of a proper photoprotective regimen is likely as important in the

management and prevention of photoaging as it is in the defense against the acute,
harmful effects of UV [67]. The various forms of photoprotection which include
endogenous factors, sun avoidance, shade, sun-protective clothing, and sunscreens

are all likely to be important. Although there have been only a few controlled trials
evaluating the long-term effects of photoprotection on photoaging (largely due to
inherent difficulties in study design), various observational reports support its
effectiveness in prevention [68, 69]. Despite the many new expensive technologies
available for treating the clinical manifestations of photoaging, photoprotection
remains the gold standard preventive strategy. It also continues to be the most cost-
effective modality that can be offered to patients [70].
4.5.1 Natural Skin Protection
As mentioned above, darker skin types tend to display the clinical signs of
photoaging much later in life as compared with lighter skin types [51]. This is
largely attributable to the increase in melanin in darker skin, which absorbs and
scatters detrimental UV rays [6]. An increase in melanin production occurs routinely
in response to UV irradiation and is one natural defense mechanism against
photocarcinogenesis and photoaging. This tanning response has previously been
shown to be induced by oligonucleotides containing thymine dinucleotides (pTpT),
which are formed as a result of UV damage [71]. Epidermal thickness is another
inherent property of the skin influencing the penetration of UV. A reactive increase
in skin thickness is a second intrinsic protective mechanism, with one study
demonstrating increased epidermal and dermal mitotic activity 2448 h after acute
UV exposure [72].
The presence of antioxidants may also blunt the chronic effects of UV. The skin is
equipped with a wide array of antioxidants, which normally serve to provide protec-
tion against oxidative stress developing in the context cellular respiration. A few
notable ones include vitamin E, coenzymeQ10 (CoQ10), ascorbate, carotenoids,
superoxide dismutase, catalase, and glutathione peroxidase [73]. There is indirect
evidence to suggest that these antioxidants may also be important in the skins defense
against UV exposure, which, as previously discussed, is known to generate harmful
ROS (see 6.4.1). UV irradiation has been shown to transiently deplete levels of cuta-
neous antioxidants [74]. It has been postulated that if such a depletion were to persist,
increased tissue damage and subsequent premature photoaging might occur [75].
4.5.2 Sunscreen
There have been only two randomized control studies performed to date investigating
the effects of sunscreen on photoaging. The first involved 53 patients with a history
of skin cancer who were randomly assigned to apply either sunscreen or placebo at
least twice a day. Skin biopsies were taken from preauricular skin at 0, 12, and
24 months, and epithelial thickness and dermal elastosis were assessed by blinded
raters. Although 34 patients completed the study, complete data was only secured
from 16. At 24 months, there was significantly less elastosis among the sunscreen
group compared with the placebo group, but when repeated measurements were
accounted for in the analysis, no differences were observed between the treatment
groups [76].
The Nambour trial was a population-based intervention study conducted on a
community of adult residents living in Queensland, Australia, in the early 1990s
[77]. Subjects were categorized as daily sunscreen users versus discretionary
sunscreen users, depending on whether they were randomized to apply study-
provided sunscreen every day or to use their own discretion as to when/and if to
apply sunscreen. 903 adults under the age of 55 (mean age 39 years) had silicone-
based impressions taken on the dorsal left hand at baseline and then 4 years later.
The presence and severity of photoaging was assessed by blinded raters using the
Beagley and Gibson scale of microtopography grades, a previously validated
method for predicting the extent of dermal elastosis [78]. At the conclusion of the
follow-up period, the daily sunscreen group showed no detectable increase in skin
aging. Moreover, as compared with discretionary sunscreen users, daily sunscreen
users were 24 % less likely to show increased skin aging (relative odds = 0.76; 95 %
CI = 0.500.98) [79].
4.6 Conclusion
Photoaging is a progressive process that results from cumulative sun exposure,

superimposed on intrinsically aging skin. Some are more severely affected than
others, though the phenomenon is largely universal. It represents a significant cost
burden to many societies, given its aesthetic undesirability and the many existing
cultural pressures to maintain a youthful appearance. The complicated mechanisms
underlying photoaging continue to be better understood, though much still remains
unknown. Although treatment options are increasing with time, prevention with
photoprotection is the most cost-effective and safest approach to maintaining youth-
ful-appearing skin over time.
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Chapter 5
Photoprotection, Photoimmunology
and Autoimmune Diseases
Gillian M. Murphy and Nicola Ralph
Key Points
There are several autoimmune diseases that are known to be aggravated by
sun exposure, such as lupus erythematosus and dermatomyositis.
Both UVB and UVA have been implicated in lupus erythematosus, and
UVB has been implicated in dermatomyositis.
Photoprotection is an important part of management in these patients.
5.1 Photoprotection
Photoprotection may be considered as innate mechanisms determined by genetic

responses to minimize cellular damage to ultraviolet radiation (UVR) and visible
light; but also measures adopted by the individual to reduce exposure to such radia-
tion. Solar radiation has complex effects which include local effects on skin and eye
but also systemic effects, mainly immunological. Local skin effects are determined
by wavelength, the shortest wavelengths having mainly epidermal effects and lon-
ger wavelengths penetrating deeper into dermis and with visible light even through
to fat and muscle. UVB has direct effects on cellular DNA; UVA though does have
direct DNA effects and indirect effects mediated via oxidative stress. This chapter
confines discussion to adopted measures for photoprotection which for the most
G.M. Murphy, MD, FRCI, FRCP Edin (*)

National Photobiology Unit, Beaumont Hospital and Mater Misericordiae Hospital,
Dublin, Ireland
N. Ralph, MRCP
National Photobiology Unit, Mater Misericordiae Hospital, Dublin, Ireland

DOI 10.1007/978-3-319-29382-0_5
76 G.M. Murphy and N. Ralph
part include behaviour to avoid undue exposure to UVR, the use of UV protective
clothing and the use of sunscreens.
When UVR hits the skin, the photons are either absorbed, reflected back by the
stratum corneum, or scattered within the skin and subsequently absorbed by
chromophore(s). Keratin is very protective, so areas of the body with thick layers of
keratin such as palms and heels are well protected. Melanin is more complex;
dark-skinned people have mainly eumelanin as the protective pigment in skin,
whereas fair-skinned people have pigment comprised of eumelanin and
phaeomelanin, the latter being yellow/red in appearance. Eumelanin absorbs UVR
and dissipates energy harmlessly. Phaeomelanin is more photochemically active
and generates free radicals which lead to DNA damage. Over time direct DNA
damage and indirect oxidative stress, unless repaired, can give rise to the adverse
consequences of exposure to UV radiation which include photoaging, photoderma-
toses and photocarcinogenesis.
Photoprotection may be achieved by limiting ones personal UVR exposure. The
main ways to achieve this include sun avoidance at times of UVR increased intensity,
i.e., midday 3 h, awareness of the effects of latitude, altitude and prolonged
exposure especially in summer months, seeking of shade, wearing of UVR protective
clothing/broad-brimmed hat and the use of sun-protective products. The majority of
our personal exposure to UVR comes from sun exposure. Other additional sources
include artificial lighting, medical equipment, tanning booths, etc. The amount of
sunlight we receive depends on ambient UV, our surrounding environment and our
behaviour. Geographical location, cloud cover, terrain (snow, white sand, sparkling/
rippling water) and surrounding environment (urban/open space) all affect our total
exposure to UV radiation. Some of these considerations are beyond our control;
however, our behaviour while outdoors can have a significant impact on our personal
exposure to UV light. Our work environment; the time we spend outdoors, where
we take part in physical activities; and overseas holidays all affect our total UV
exposure.
Photoprotection can be achieved in four ways. The first three are essentially free
and the last, the more expensive way of protecting oneself from UV radiation, is the
most advertised method.
1. Sun avoidance considerable protection from UV exposure can be achieved by
avoiding the 3 h surrounding solar noon (for both temperate and tropical
latitudes). During this time approximately 50 % of the days total UV exposure
during summer occurs.
2. Shade this can be provided by natural objects such as trees and cliffs or by
man-made buildings, umbrellas, etc. At noon, 50 % of the UV reaching our skin
comes from direct sunlight and the other half is from scatter from the sky. Shade
will remove all of the direct sunlight that reaches our skin. Shade can also remove
part of the diffuse (scattered) sunlight.
3. Protective clothing/hats the level of UV protection is primarily based on the
tightness of the garments weave; hence tightly woven cotton offers good
protection. This has been extensively tested by the Australian Radiation
5 Photoprotection, Photoimmunology and Autoimmune Diseases 77
Protection and Nuclear Safety Agency (ARPANSA) [1] and other regulatory
agencies. It has been shown that regular clothing provides good sun protection;
hence specialized clothing is not necessary in order to be adequately protected
from the sun.
4. Sunscreens these are the most popular means of photoprotection. In order for
them to provide good protection from UV exposure, they should have safe and
effective ingredients, stability including photostability and a good physical
structure which feels comfortable on the skin so that compliance rates are high
and should be reliable (namely, realistic claims regarding their SPF/UVA
protection/water resistance).
Ideally one should practice sun avoidance during peak times, first and foremost,
followed by a combination of shade seeking, protective clothing/hat and the use of
sunscreens.
5.2 Photoimmunology
This is the study of the effects of solar radiation on the immune system. Solar
radiation is divided into different regions of the electromagnetic spectrum, UVC
(<280 nm), UVB (280315 nm) and UVA (315400 nm), which is CIE (Commission
Internationale lEclairage) [2] definition based on physiological effects by photons
in those regions. The concept that UV, which is a part of the external environment,
can affect the immune response, whose components are internal, arose from
experiments in the 1970s by Kripke et al. [3] aimed at discovering a role for the
immune response in rejecting UV radiation-induced skin cancer cells [4]. Their
work demonstrated that UV radiation exerted suppressive effects on immune
responses to UV-induced skin cancer cells and that the inhibition of tumour rejection
could be adoptively transferred by T lymphocytes in an antigen-specific manner.
Many laboratories have subsequently studied this topic and revealed details on how
UV radiation induced the suppression of immune responses (also known as immune
tolerance). This suppression was observed not only for skin cancers but also
infectious agents and chemical antigens. UVR affects the immune response by
affecting the cells and other components of the immune system to alter the balance
and functions of immune cells to infectious agents, chemicals and skin cancer. We
know sunlight is immunosuppressive, as UVB depletes Langerhans cells and
diminishes their function such that antigens are not presented efficiently to the
immune system [5, 6]. Alterations in delayed hypersensitivity also occur such that
if a universal allergen is applied to UV-irradiated skin, no response occurs; rather a
population of antigen-specific T cells displaying tolerance to the antigen emerges.
In mouse models, tolerance may be passively transferred to other mice conferring
tolerance to the antigen. These observations also apply to UV-induced skin tumours,
underwriting the importance of cell-based immunity in skin surveillance and the
prevention of skin cancer. Chronically UV-exposed skin is immunosuppressed and
Table 5.1 Autoimmune Autoimmune diseases usually exacerbated by UVR:

photoaggravated dermatoses
1. Cutaneous lupus erythematosus
Subtypes:
SLE
Subacute cutaneous lupus erythematosus (SCLE)
Discoid lupus erythematosus (DLE)
Lupus tumidus
Rowell syndrome
Lupus profundus
2. Dermatomyositis
3. Sjogrens syndrome
4. MCTD
Diseases sometimes exacerbated by UVR:
1. Pemphigus
2. Psoriasis
3. Eczema
4. Rosacea
Diseases rarely exacerbated by UVR:
1. Bullous pemphigoid
2. Epidermolysis bullosa acquisita
3. Cutaneous T-cell lymphoma
more prone to develop viral warts. Acute exposure to UVR may also precipitate
herpes simplex infections. Many viral diseases become more manifest in
UV-damaged or the exposed skin. This has also been noted in many photoaggravated
diseases.
5.3 Autoimmune Diseases
These are diseases in which impaired function and the destruction of tissue are
caused by autoantibodies formation. Autoimmune diseases include a wide variety
of disorders which can affect internal organs, muscles, joints and the skin. Some of
these diseases may be exacerbated by UV radiation; hence photoprotection is
imperative in the management of such diseases.
Photodermatoses may be classified into idiopathic photodermatoses, genoder-
matoses, photoaggravated dermatoses and photodermatoses which are secondary to
exogenous agents including photoallergy/phototoxicity. In this chapter, we will dis-
cuss photoaggravated disorders of the autoimmune category (Table 5.1).
Immunologically mediated photodermatoses with no or minimal systemic mani-
festations other than in the skin include polymorphic light eruption (PLE), juvenile
spring eruption, actinic prurigo, solar urticaria, chronic actinic dermatitis and
hydroa vacciniforme; these are covered in another chapter.
5.3.1 Lupus Erythematosus
5.3.1.1 Introduction
Lupus erythematosus encompasses a number of related conditions, the common

feature being underlying autoimmunity against nuclear constituents. Photosensitivity
is a common feature for all subsets.
5.3.1.2 History
In the mid-nineteenth century, Cazenave first coined the term lupus erythematosus
[7] and helped to differentiate it from lupus vulgaris, a cutaneous form of
tuberculosis. In the mid-twentieth century, Dubois described the spectrum of disease
seen with lupus ranging from cutaneous involvement to a multisystem disease [8].
5.3.1.3 Epidemiology
The epidemiology of lupus erythematosus varies depending on the subtype. Systemic

lupus erythematosus (SLE) is more common in females (6F:1M) with a higher prev-
alence in African-American populations compared to white populations [9].
Subacute cutaneous lupus erythematosus (SCLE) and discoid lupus erythematosus
(DLE) also occur more commonly in females but the ratio at 3F:1M is not as marked
as for SLE [10]. The mean age at presentation for SCLE is in the sixth decade. DLE
can be seen in any age group but it most commonly presents in the fifth decade [10].
The association between photosensitivity and lupus varies throughout the world with
a higher prevalence of photosensitivity in lupus in Asia compared with Africa [11].
5.3.1.4 Pathogenesis
LE represents an autoimmune disease characterized by photosensitivity, apoptosis

of keratinocytes and an inflammatory infiltrate in the superficial and/or deep
compartments of the skin. The underlying pathogenesis, while not fully understood,
reflects an interaction between host factors, such as susceptibility genes, sex
hormones and environmental factors, including viruses, drugs and ultraviolet
radiation.
UVR results in the aggravation of LE through a variety of mechanisms [1214].
UV-generated reactive oxygen species render DNA antigenic. The resultant
autoantibodies recognize both this altered DNA but also native DNA [15, 16]. UVB
displaces the typically intracellular antigens Ro/SS-A and La/SS-B to the surface of
the keratinocyte [1719], resulting in antibody-mediated cytotoxic keratinocyte
damage [20]. UV-induced destruction of keratinocytes through apoptosis occurs
even in a normal setting; however in lupus slow clearance of apoptotic cells leads to
prolonged exposure of DNA and extractable nuclear antigen to the immune system,
generating anti-DNA and ENA antibodies [21, 22]. The mechanisms underlying
this process have been reviewed recently [23, 24]. UV light also up-regulates
adhesion molecules, such as ICAM-1 [25] in patients with LE. Nitric oxide synthase
capable of inducing cytokines (iNOS) is released from keratinocytes following UV
irradiation. In patients with LE this release is delayed but prolonged [26]. The
promoter polymorphism 308A of TNF- is seen with increased frequency in SCLE
[27] and transcription is photoregulated [28].
The development of the skin lesions after UV injury may be delayed (days to
3 weeks) and the lesions may persist for months. This may make it difficult to elicit
a history of photosensitivity from the patient, as the delay between UV exposure
and exacerbation means patients may not make this association. UVA and UVB
radiation are both implicated in the pathogenesis of LE in both in vitro [29] and
in vivo [30] studies. One study documented that photosensitivity in cutaneous LE
was UVB induced in 33 % of cases and UVA induced in 14 %, and in the majority
of cases (53 %), it was mediated by a combination of UVB and UVA [14]. Nonsolar
sources of UV, such as photocopiers [31], fluorescent and some energy-saving light
sources [32], can aggravate LE. Interestingly, while UVB consistently aggravates
LE, studies documented reduction in LE disease activity with UVA-1 (340400 nm)
irradiation [3335]. Subtypes of LE appear to have varying degrees of
photoaggravation, with lupus tumidus [36] and SCLE appearing to be the most
photosensitive of the LE subtypes [37], although one study of phototesting with
UVA, UVB and visible light in 100 patients (24 with SLE, 30 with SCLE and 46
with DLE) found no association between photosensitivity and LE subtype [38].
Phototesting is not routinely required in clinical practice to make a diagnosis of LE,
as clinical history, examination, serologic studies and skin biopsy for histology and
direct immunofluorescence suffice.
Polymorphous light eruption (PLE) is seen commonly in patients with LE
(49 %), and the onset of PLE precedes the onset of LE by over 7 years in half of
patients. This suggests that there may be features of pathogenesis common to both
entities and that PLE may predispose to LE in a subset of patients [39].
5.3.1.5 Clinical Manifestations
The clinical presentation across the subtypes of LE is very diverse. The underlying
disease process however is very similar. Patients with SLE can present acutely with
internal organ damage secondary to circulating autoantibodies. No organ is protected
from the immune-mediated destruction and SLE can present with arthralgia, central
nervous system involvement, nephritis, pleuritis and vasculitis. At the other end of
the spectrum, patients with other forms of LE may develop cutaneous lesions and
never progress to systemic involvement.
Cutaneous manifestations of LE are varied and can be divided into LE-nonspecific
and LE-specific lesions. LE-nonspecific mucocutaneous manifestations include oral
ulcers, Raynauds syndrome, scarring alopecia and vasculitis. The characteristic
cutaneous manifestation of SLE is an erythematous, edematous, confluent eruption

in a malar distribution; in the majority of cases, this malar rash is associated with
underlying visceral involvement. SLE may present with erythema multiforme-like
lesions, also known as Rowell syndrome. SCLE lesions include sharply demarcated
psoriasiform plaques with fine scale and erosions and annular lesions with an
erythematous border and a collarette of scale. DLE lesions are characteristically
coin-shaped plaques on the face and neck, with fine scale and follicular plugging.
There may be scarring and hypo/hyperpigmentation. Following a diagnosis of DLE,
the probability of receiving a diagnosis of SLE is 9.8 % in the first year and 16.7 %
after 3 years. The corresponding figures are higher for SCLE, at 22 % in the first
year and 24.7 % after 3 years [9]. SLE classification criteria have been defined by
the American College of Rheumatology [40, 41].
The cutaneous lesions of DLE heal with central atrophy associated with scarring.
The cutaneous lesions of SCLE and SLE are non-scarring, although lesions of
SCLE may result in hypo/hyperpigmentation. Lupus tumidus lesions include
violaceous non-scaling papules and plaques on sun and non-sun-exposed sites.
There is a seasonal variation in manifestations of LE with skin and joint symptoms
flaring during summer months but an apparent increase in renal involvement in
winter months [42, 43].
5.3.1.6 Investigations
Histological features are central to the diagnosis of cutaneous LE. There is a

periadnexal and perivascular lymphocytic infiltrate in the dermis. At the dermo-
epidermal junction, the lymphocytic infiltrate is lichenoid with liquefactive
degeneration of the basal keratinocytes and epidermal cytoid bodies are present.
Typically in DLE follicular plugging and basement membrane thickening are
marked, although occasionally epidermal changes are not prominent and dermal
changes predominate. There are minimal epidermal features in SCLE and the
findings are a lymphocytic infiltrate with dermal vacuolar change. Mucin is abundant
in lupus tumidus and direct immunofluorescence is positive in addition to the above-
described dermal features.
5.3.1.7 Serology
SLE is the LE subtype most strongly associated with positive antinuclear antibody
(ANA) and double-stranded DNA (ds-DNA) [10]. Given the propensity of SLE to
affect internal organs, a comprehensive systemic workup including complete blood
count, complement levels and renal function tests including urinalysis should be
undertaken. The presence of anti-Ro (SS-A) and anti-La (SS-B) is associated with
an abnormal photoprovocation reaction [44]. Anti-Ro (SS-A) is found in 72 % of
patients with SCLE, 47 % of patients with acute cutaneous LE and 22 % of patients
with chronic cutaneous LE. Anti-La antibodies are found in 36 % of patients with
SCLE, 27 % of patients with acute cutaneous LE and 7 % of patients with chronic

cutaneous LE [9]. These antibodies are also associated with Sjogrens syndrome
which may overlap with SCLE. Sjogrens syndrome may also be photoaggravated
[45]. Anti-histone antibodies are commonly but not exclusively associated with
drug-induced lupus. SCLE may be drug-induced and rarely may be a paraneoplastic
disease.
5.3.1.8 Treatment
Essential lifestyle changes for patients with cutaneous lupus erythematosus are
photoprotection [46] and smoking cessation. Broad-spectrum sunscreen is required
[47] due to the implication of both UVA and UVB in the action spectrum of
LE. Vitamin D levels may be reduced in patients with cutaneous LE who practice
rigorous photoprotection; hence supplementation is often required [5]. Topical
corticosteroids and antimalarials [48] are first-line treatment options for cutaneous
LE. Second-line treatment options include dapsone [49], thalidomide [50], oral
retinoids [51] and immunosuppressant medications such as mycophenolate mofetil
[52, 53], azathioprine and methotrexate. Every patient with cutaneous and systemic
LE should be evaluated to ensure no causative drug is implicated.
5.3.2 Dermatomyositis
This is an autoimmune disease of the skin and striated muscle. It is associated with
an increased risk of malignancy, the risk being highest in the first 3 years after
diagnosis of myositis but increased for up to 5 years [54].
5.3.2.1 History
Bohan and Peter compiled generally accepted diagnostic criteria in 1975 [55, 56].
A more recent revision of the classification means that myositis is no longer required
for diagnosis [57].
5.3.2.2 Epidemiology
The incidence of dermatomyositis (DM) is 9 per million. There is a female

predominance (3:1) [58]. In Europe there is an increasing prevalence of DM relative
to polymyositis seen with decreasing latitude [59], and additionally an association
exists between surface UV radiation intensity and expression of anti-Mi2
autoantibodies [60]. Dermatomyositis may occur at any age; however two peaks are
seen: between the ages of 510 years in children and the sixth decade in adults.
5.3.3 Pathogenesis
The pathogenic trigger for dermatomyositis is thought to be antigen mimicry. It is

driven by CD8+ T cells and is associated with other autoimmune diseases and with
viral infections. The main target appears to be capillaries with immunological attack
resulting in the development of ischaemic myocyte necrosis.
Dermatomyositis is frequently photoaggravated [61, 62]. The pathogenesis of
photosensitivity in DM and LE may overlap with polymorphisms of TNF- [63]
and increased keratinocyte apoptosis occurring in both conditions [64].
5.3.3.1 Clinical Presentation
The skin and striated muscle may be affected to varying degrees. Cutaneous find-
ings accompany muscle involvement in 60 % of cases and precede it in 30 %.
Dermatomyositis sine myositis where there is no muscle involvement is described
in approximately 10 % of cases. Cutaneous findings include blue/violaceous or
erythematous plaques and patches which may be edematous affecting the face and
the V of the neck. The pathognomonic heliotrope rash refers to a lilac discoloration
of the eyelids with periorbital oedema. The dorsum of the hands may demonstrate
mauve linear plaques along the back of the fingers and dusky erythematous papules
with atrophy, termed Gottrons papules, over the joints. They tend to spare the skin
in between the joints. These Gottrons papules represent a hyperkeratotic response
to inflammation. The nail folds may be hyperkeratotic with haemorrhage. Capillary
microscopy of the nail fold vessels shows coiling and enlargement. Photosensitivity
is seen with poikilodermatous change (atrophy, hyper/hypopigmentation,
telangiectasia).
Proximal muscles are those most affected; the quadriceps and triceps are
symmetrically involved with a slow onset of weakness and myalgia. Patients may
report difficulty getting up from a seated position. Distal muscles are involved in the
advanced disease state. Involvement of the pharyngeal muscles may occur and
manifests as dyspnoea or dysphagia. Complications include myocarditis, pulmonary
fibrosis and vasculitis.
Dermatomyositis may be chronic or can spontaneously remit in 23 years. If an
underlying malignancy is present, removal can result in rapid resolution of the
symptoms.
5.3.3.2 Investigations
A muscle biopsy demonstrates CD 8+ T cells infiltrating the muscle fibres with

associated apoptosis, atrophy, regeneration and hypertrophy. Deposition of
antibodies and complement in the microvasculature precede inflammation and the
perifascicular atrophy of muscle fibres and inflammation supports a microvascular
pathology. Histology findings may be difficult to differentiate from LE. Epidermal

atrophy, a sparse lymphocytic infiltrate and a vacuolar interface change are seen.
Examination of a Gottrons papule may demonstrate acanthosis and a dense
lichenoid infiltrate.
5.3.3.3 Serology
A positive antinuclear antibody test is present in over 90 % of cases with specific

antibodies against mRNP, PM-Scl, Mi2 and Jo1 found in approximately 30 % of
cases. Elevation of creatinine kinase and aldolase indicates muscle involvement and
these enzyme levels can be monitored to track response to treatment. The diagnosis
can be confirmed by a muscle biopsy and electromyography.
5.3.3.4 Phototesting
Routine photobiologic evaluation is not usually undertaken. However, in studies,

approximately 50 % of patients with dermatomyositis have a reduced minimal
erythema dose to UVB [62].
5.3.3.5 Treatment
Drug-induced dermatomyositis should be excluded. Photoprotection with clothing

and broad-spectrum sunscreen use is advisable. First-line therapies for cutaneous
disease include topical corticosteroids and antimalarials, such as hydroxychloro-
quine [65] or chloroquine. If muscle involvement occurs, prednisolone 1 mg/kg per
day with options for steroid-sparing agents including methotrexate or azathioprine is
used. High-dose intravenous immunoglobulin [66] has been used if there is failure to
respond to first/second-line therapies or if there is significant muscle involvement.
5.3.4 Sjogrens Syndrome
This is an autoimmune disease which is characterized by its two most common

symptoms keratoconjunctivitis sicca (dry eyes) and xerostomia (dry mouth). It is
often accompanied by other disorders of the immune system such as rheumatoid
arthritis and lupus erythematosus. Patients have high levels of serum ENA predis-
posing to photosensitivity. Patients exhibit photosensitivity to UVB when photote-
sted similar to LE. The exact cause is unknown, but may be due to having a genetic
predisposition with a triggering factor such as a viral or bacterial infection. The
mucous membranes and moisture-secreting glands (lacrymal and salivary) are
affected, resulting in reduced tear and saliva production leading to the symptoms
described. The condition is much more common in females and the diagnosis is usu-
ally made in those older than 40 years of age. People with this condition may also
experience joint pains, fatigue, salivary gland swelling and xerosis. This condition
may also have systemic involvement affecting organs such as the thyroid, lung, liver
and kidneys. Due to this the cutaneous manifestations are often minimized, albeit
relatively common. Cutaneous manifestations associated with primary SS include
photosensitive rashes in the context of positive anti-Ro antibodies, alopecia, annular
erythema, B cell lymphoma, vasculitis and vitiligo [67].
5.3.5 Mixed Connective Tissue Disease (MCTD)
MCTD is often referred to as an overlap disorder as it is a disease with signs and

symptoms of a combination of disorders, mainly lupus erythematosus, polymyositis
and systemic sclerosis; however, it is a distinct clinical entity. It is considered an
autoimmune disease to which individuals who express specific HLA antigens such
as HLA-DR4 or HLA-DBQ1 are genetically predisposed [68]. Some hypotheses
implicate modified self-antigens and/or infectious agents in the pathogenesis. U1
ribonucleoprotein is a specific marker for disease. The diagnosis can be complicated
due to the fact that many of the symptoms occur chronically over years rather than
all occurring acutely.
The earliest symptoms often involve the hands whereby the fingers swell
(dactylitis) and Raynauds phenomenon occurs. With time this may evolve to
present with a LE-like photodistributed cutaneous eruption; however, its
photobiologic features have not been well studied. It may affect any age group but
is most commonly diagnosed in young females. The female to male ratio is 4:1.
People may develop systemic involvement including pulmonary, cardiac and renal
involvement. Treatment of the cutaneous manifestations of this disorder is as
described previously for lupus erythematosus. Other agents include oral hygiene to
prevent dental caries, artificial saliva (saliva substitutes, mucin based), and saliva
stimulants (organic acids, chewing gum and parasympathomimetic drugs). Artificial
tears are also used to treat decreased lacrymal gland function.
5.3.6 Pemphigus
Pemphigus erythematosus (PE), also known as Senear-Usher Syndrome, is one of

the six subtypes of pemphigus foliaceus (PF). PE affects all races and both genders.
It typically affects adults aged 5060 years, but children may rarely be affected. PE
is a rare condition in which pemphigus foliaceus occurs with a positive antinuclear
antibody, and it may represent an overlap of pemphigus and LE due to epitope
spread. Chronically sun-exposed skin such as the face and scalp develop blisters
that tend to ooze, crust and scale which may result in scarring and infection. Blisters
do not occur on mucous membranes, helping to differentiate it from other subtypes

of PF. The pathogenesis is thought to result from antibodies that attack desmosomes,
bridges that connect epidermal cells. Destruction of these connections results in the
blister formation, which are superficial and therefore rupture easily. PF can be pho-
toaggravated [69, 70], as can pemphigus vulgaris [71]. While the action spectrum
for this is unknown, photoprotection is advised.
5.3.7 Psoriasis
In the majority of patients with psoriasis, UV therapies are used to control the
disease; however there is a defined subset of patients, 520 %, whom have an
exacerbation of their psoriasis with UV exposure [7274]. They tend to be older
females with a positive family history of psoriasis and early onset of disease;
patients are more likely to have psoriasis affecting their hands [75, 76]. There is a
strong association with HLA-Cw*0602 [74]. Approximately 50 % develop PLE
following sun exposure with subsequent development of psoriasis in the lesions of
PLE, while the other 50 % have photoaggravated psoriasis with no associated PLE
[73]. In the former group, symptoms of PLE followed by psoriasis were more easily
provoked by UVA, while in the second group, UVB was the more effective
photoaggravating spectrum [76]. If there is a question regarding photoaggravated
psoriasis, patients should undergo confirmatory phototesting. Photoprotection is
advisable in these patients.
5.3.8 Atopic Eczema
This is a common inflammatory skin disease which most frequently begins in

childhood. It consists of erythematous scaly patches associated with intense pruritus
resulting in excoriations, secondary infection and a significant impact on ones
quality of life. Current therapies focus mainly on symptom control; however in
recent years significant advances have been made in translational research similar to
that which occurred in psoriasis over the past decade. The research has focused on
elucidating immune pathways in AD including Th2, Th22 and Th17 pathways. An
IL-4R antagonist (Dupilumab) is already in clinical trials with great promise and
continued research into this area may bring new medications to target this disease.
AD may flare due to a variety of reasons including infection, irritants and allergens
(ingested, inhaled, contact), or it may also flare with time, following exposure to
UVR. This diagnosis may be delayed due to the fact that the person has atopic
dermatitis long standing and it may be simply treated as a flare; however with time
it is noted that the patient is not responding to the standard treatments and the
location of the rash is occurring on photo-exposed sites (face/neck/hands/forearms).
Patients often undergo phototesting at this stage whereby they are noted to have
photoaggravated atopic dermatitis; if they are elderly, they may fall into another
cohort of patients with chronic actinic dermatitis. The action spectrum is usually
similar to the erythema action spectrum, in which case the patient may be labelled
chronic actinic dermatitis. If the patient has UVA photosensitivity, then
photosensitivity caused by a drug should be suspected.
5.3.9 Chronic Actinic Dermatitis (CAD)
This is a rare disease which mainly affects elderly men (~10 % female). It is also
rarely found in HIV. They may give a history of previous atopy or allergic contact
dermatitis to compositate [77]. They have severely lichenified, xerotic skin affecting
the face, neck and dorsal hands most commonly with sparing behind the ears and
inferior chin. Hypopigmentation may also be seen in CAD, and this seems to be
post-inflammatory hypopigmentation. Skin biopsy from the affected areas may
show an eczematous eruption particularly if biopsied following monochromator
testing, but if severe it may also resemble a cutaneous T-cell lymphoma/reticulosis;
hence, the other name it is also known by actinic reticuloid is sometimes used.
There is a dense dermal lymphocytic dermatitis with atypical cerebriform
lymphocytic cells identical to those in cutaneous T-cell lymphoma.
The eruption can be provoked by very minimal UV exposure. It is usually worse
in the summer months and may improve in some individuals in the winter months.
It is therefore more easily diagnosed in those with severe, year-round photosensitivity
and disabling effects. If left untreated it may progress to erythroderma. Phototesting
(monochromator) is essential to make the diagnosis of CAD. In the absence or
abnormal tests, the diagnosis cannot be made. The pattern of the action spectrum in
90 % of patients with CAD implicates DNA as the chromophore, as the action
spectrum is identical to the erythema action spectrum, i.e., UVB, but occurring at a
lower dose [78]. The minority of patients exhibit UVA photosensitivity, but this is
more commonly the pattern of drug-induced photosensitivity; thus drugs should be
excluded in such cases [79].
Treatment includes UV protection (clothing, hat, broad-spectrum sunscreens)
and sun avoidance during peak hours, topical tacrolimus, and, in more severe cases,
azathioprine, cyclosporine, or mycophenolate mofetil. For patients who are
extremely photosensitive (UVB, UVA extending into visible light), this condition
can be an extremely debilitating disease.
5.3.10 Rosacea
This is a common inflammatory skin condition mainly affecting the face of middle-
aged adults. Four major clinical subtypes have been identified: erythematotelangi-
ectatic, papulopustular, phymatous and ocular. Rosacea is characterized by facial
flushing, erythema, chronic inflammation in the form of papules and pustules and
fibrosis. Some aspects of the pathophysiology of rosacea has been characterized in
more detail in recent years; however the interplay of these dysregulated systems is
still poorly understood. UVR effects on rosacea have yet to be fully understood as
many trials to date show conflicting reports. Does the UVR induce damage to the
dermal connective tissue permitting vasodilatation and vascular pooling which
leads to erythema? Is it also that in the majority of rosacea patients who describe
photoaggravated rosacea, there is failure to downgrade the immune response to
UVR? Or does UVR actually have a beneficial effect by decreasing inflammation
resulting in skin clearance as seen in some patients undergoing phototherapy for
coexisting conditions?
5.3.11 Epidermolysis Bullosa Acquisita
This is a rare, acquired, chronic subepidermal bullous disease of the skin and mucosa
due to autoantibodies to type VII collagen structures which are a major component
of anchoring fibrils which attach the dermis to the epidermis. The autoantibodies
which are either bound or circulating attack type VII collagen resulting in a reduc-
tion or change of normally functioning anchoring fibrils. Patients present with skin
fragility, blistering, erosions, scarring, milia formation and sometimes loss of nails.
There is not one satisfactory treatment for this condition but some therapeutic suc-
cess has been achieved with the use of colchicine, dapsone, infliximab, intravenous
immunoglobulins and plasmapheresis [80]. There have been rare case reports of this
condition with sensitivity to both UVA and UVB radiation [81].
5.3.12 Cutaneous T-Cell Lymphoma (CTCL)
This is a type of lymphoma which presents in the skin but may evolve, often over
many years to have systemic involvement. Mycosis fungoides, first described by a
French physician Jean Luis Marc Alibert in 1806, is the most common type of
CTCL. Patients present most commonly from the 4th decade onward with patches
or plaques which can sometimes be misdiagnosed as eczema initially. Children may
be affected but it is much more common in adults and also in males more so than
females. Patients may also present with erythroderma and some progress to tumour
stage with lymphadenopathy. Pruritus is commonly associated with this condition.
Unfortunately there is no cure for this disease and the treatment is about control of
skin eruption and symptomatic relief. One of the first-line treatments is phototherapy,
both NB-UVB and PUVA. There are case reports of photosensitive mycosis
fungoides [82], whereby patients may present with actinic reticuloid-type pattern
of facial features, also known as chronic actinic dermatitis; however biopsies of the
skin combined with T-cell gene rearrangement studies confirm it to be CTCL. These
patients are not photosensitive and usually respond very well to PUVA despite the
eruption clinically mimicking CAD. This disease may progress over a very short
period of time to tumour stage or may smoulder for many decades.
Some of the photoaggravated autoimmune diseases have a known action
spectrum; however, as the exact action spectra are not fully defined for all of the
photoaggravated autoimmune diseases, a key component of their management
includes photoprotection with behavioural change, UV protective clothing and
broad-spectrum sunscreen.
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Chapter 6
Photoprotection and Vitamin D
James L. Griffith, Mohammed Al-Jamal, and Henry W. Lim
Key Points
Vitamin D is unquestionably important in the development and mainte-
nance of skeletal health but may have broader implications beyond bone
health.
There are varying definitions of vitamin D deficiency and recommended
daily requirements. Current recommendation on vitamin D screening is
that it should be done only for at-risk populations.
Real-world application of sunscreen does not impact vitamin D status,
although rigorous photoprotection practice does.
Given the low cost, broad availability, and safety profile of oral vitamin D
supplementation, replenishing vitamin D by solar and artificial ultraviolet
radiation is not advised.
J.L. Griffith, MD H.W. Lim, MD, FAAD (*)

e-mail: [email protected]; [email protected]
M. Al-Jamal, MD
Department of Dermatology, Prince Sultan Military Medical City, P.O. Box 59606,
Riyadh 11525, Saudi Arabia

DOI 10.1007/978-3-319-29382-0_6
96 J.L. Griffith et al.
6.1 Introduction
Vitamin D is a fat-soluble hormone obtained from sun exposure, diet, and oral sup-
plements with many biologic effects. It is primarily known for its crucial role in the
optimization of bone mass via its effects on parathyroid hormone and calcium and
phosphorous homeostasis. However, it also may have extra-skeletal associations,
such as cardiovascular disease, immune susceptibility, and cancers [1]. Thus, con-
cern has developed whether photoprotection would affect vitamin D status. This
chapter will discuss how humans acquire vitamin D, vitamin Ds physiologic
effects, associations with disease, impact of photoprotection, and recommendations
to patients. Terms and conversions used in the discussion of vitamin D can be
viewed in Table 6.1.
6.2 Sources of Vitamin D
6.2.1 Sunlight and Artificial Radiation
In the skin, vitamin D can be synthesized from 7-dehydrocholesterol (7-DHC)

following ultraviolet B (UVB) exposure (Fig. 6.1). 7-DHC, which is found in the
plasma membranes of keratinocytes and fibroblasts, undergoes nonenzymatic,
photodecomposition to previtamin D3 after exposure to 300 5 nm of radiation.
Previtamin D3 can then isomerize into cholecalciferol (vitamin D3) or further
degrade to inactive products, lumisterol and tachysterol, with additional UVB
irradiation. This latter pathway prevents vitamin D intoxication from prolonged sun
exposure. Cholecalciferol is then released from the keratinocyte and fibroblast
Table 6.1 Common nomenclature used in vitamin D

Abbreviations/common
nomenclature Proper nomenclature
7-DHC 7-Dehydrocholesterol
Vitamin D Refers to any form of the vitamin, especially calcitriol
Vitamin D2 Ergocalciferol
Vitamin D3 Cholecalciferol
25(OH)D Calcidiol or calcifediol (25-hydroxyvitamin D)
1,25(OH)2D3 Calcitriol (1, 25-dihydroxyvitamin D3)
24, 25 (OH)2D 24, 25-Dihydroxyvitamin D
IU International Unit (40 IU of vitamin D = 1 ng)
Serum 25(OH)D level Serum concentration is reported as nmol/L or ng/mL
(2.5 nmol/L = 1 ng/mL)
Vitamin D deficiencya Serum 25(OH)D levels below 12 ng/mL or 30 nmol/L
Vitamin D insufficiencya Serum 25(OH)D levels below 20 ng/mL or 50 nmol/L
a
Based on Institute of Medicine definition for at-risk populations [2]
6 Photoprotection and Vitamin D 97
plasma membrane and transported to the liver by serum vitamin D binding protein
for conversion to 25(OH)D by 25-hydroxylase. 25(OH)D undergoes further hydrox-
ylation to 1,25(OH)2D by primarily renal 1-alpha-hydroxylase. However, keratino-
cytes, macrophages, T-lymphocytes, dendritic cells, bone, prostate, and placental
cells also can convert 25(OH)D to 1,25(OH)2D.
As cutaneous vitamin D synthesis requires UVB radiation, factors that attenuate
or absorb UVB and the duration of exposure influence vitamin D production.
Atmospheric ozone absorbs UVB radiation. However, its absolute and relative thick-
ness in relation to the sun varies. The intensity of UVB radiation is greatly reduced
early/late in the day, at higher latitude, at lower altitudes, and in the winter when the
tilt of the earth is at its greatest. Analysis of published serum 25(OH)D levels in the
northern hemisphere indicates there is insufficient ambient UVB for adequate vita-
min D production during the winter at latitudes above 33 [3]. Additionally, UVB is
reduced further exogenously by high nitrogen dioxide and ozone levels in polluted
urban environments, such as Los Angeles, California, and Mexico City, Mexico [4].
Endogenously, UVBs effects on 7-DHC vary by skin phototype, as melanin
mitigates UVBs penetration. A 1991 study of skin pigmentation and serum vitamin
UVB
Epithelium
Lumisterol
7-DHC Pre-Vitamin D Tachysterol
(Heat) (Inactive)
Supersterol I & II
Circulation Vitamin D3 5, 6-trans-Vitamin D3
(Cholecaliferol) (Inactive)
Vitamin D
Binding Diet/Supplementation:
Protein
Vitamin D3 Vitamin D2
&
(Cholecaliferol) (Ergocaliferol)
Liver
25-hydroxylase
25(OH)D3
(Calcidiol)
Kidneys
1-hydroxylase
24-hydroxylase
1, 25(OH)2D3 24, 25(OH)2D3
(Calcitriol) (Inactive)
(Active)
Fig. 6.1 Vitamin D production and metabolism. Abbreviations: 7-DHC 7-dehydrocholesterol,

Active active in calcium regulation, Inactive no activity in calcium regulation
D3 levels found significantly higher levels in Caucasian and Asian subjects com-
pared to those of African American and East Indian descent [5]. Similar inverse
relationships between skin pigmentation and serum vitamin D3 levels were also
reported in subsequent 2004, 2010, and 2014 publications [68].
Artificial sources of UVB radiation can rapidly and effectively raise serum
vitamin D levels at suberythemogenic levels via the same mechanisms as solar
radiation without exogenous, atmospheric attenuators. However, it should be noted
that ultraviolet exposure from artificial devices or natural sunlight can increase
ones risk of skin cancers, and tanning booths are a poor source of artificial UVB for
vitamin D as they primarily emit ultraviolet A (340400 nm).
6.2.2 Diet and Supplementation
Exogenous vitamin D can be obtained through dietary intake, but only a few foods,
such as cod liver, specific fish (mackerel, sockeye salmon, tuna), beef, egg yolks,
shiitake mushrooms, and cheese, naturally contain high levels of vitamin
D. Therefore, many countries, including the United States, fortify milk, orange
juice, yogurt, cereal, and other foods to enhance the dietary sources of vitamin
D. Additionally, vitamin D can be obtained through over-the-counter multivitamins
and vitamin D supplements or prescription supplementation. Although fungal-/
yeast-derived vitamin D2 (ergocalciferol) is available over the counter and by
prescription, commercially synthesized vitamin D3 (cholecalciferol) is primarily
utilized in fortification and supplementation. Following ingestion, both forms of
exogenous vitamin D are metabolized by the liver to 25(OH)D. While the
bioequivalence of D2 and D3 remains a controversial topic [9], a 2012 meta-analysis
of randomized clinical trials found D3 superior in raising 25(OH)D levels [10].
6.3 Pathophysiologic Effects of Vitamin D
The active calcemic metabolite of vitamin D, 1, 25(OH)2D3, regulates transcription

of up to 5 % of the human genome in at least 60 human cell types [11]. It does this
by forming a heterodimeric complex with nuclear vitamin D receptor and retinoic
acid X receptor. When deficient or insufficient, the genetic expression of at least 291
genes is altered over 150 % [4]. These changes have implications on bone,
immunologic, cardiovascular, and cellular differentiation health.
Skeletally, vitamin D produces and maintains bone density through the hormonal
regulation of calcium homeostasis. It does so directly by altering gastrointestinal
absorption of calcium and phosphate while indirectly controlling parathyroid hor-
mones renal excretion and skeletal mobilization of calcium. Epidemiologic studies
have shown 71 % of children with rachitic changes on radiographic studies were vita-
min D deficient [4]. Additionally, a meta-analysis of 8 randomized controlled clinical
trials (RCTs) reported 482770 international units (IU) of vitamin D reduced hip
fractures and non-vertebral fractures by 18 and 20 %, respectively, while no reduction
was observed with less than 400 IU [12]. Interestingly, a meta-analysis of eight dou-
ble-blind RCTs reported supplementation of greater than 700 IU of vitamin D reduced
the fall risk of elderly patients by 19 % compared to those less than 700 IU [13].
These, as well as a myriad of other studies, conclusively demonstrated sufficient evi-
dence for a dose-response relationship between vitamin D and bone health to merit a
Dietary Reference Intake recommendation by the Institute of Medicine [2]. However,
it should be noted that despite a 2 to 9 times higher prevalence of low vitamin D in the
African American population compared to Caucasians, the fracture risk in the African
Americans is half that of the Caucasian population [14]. The reported lower levels of
vitamin D binding protein in African American, compared to Caucasian, hence result-
ing in similar levels of bioavailable vitamin D, may account for this finding [15].
Extra-skeletally, vitamin D appears to modulate the immune system, limit malig-
nant potential, and mitigate vascular morbidity. Binding to T cells, B cells, natural
killer, and monocyte vitamin D receptors, active vitamin D stimulates the innate
immune system and repress of the adaptive system.
Clinically, this has implications in a variety of dermatologic and non-dermato-
logic conditions. Due to vitamin Ds essential role in the containment and destruc-
tion of Mycobacterium tuberculosis, incorporation of vitamin D supplementation to
the standard tuberculoid regimen in those with vitamin D deficiency induces acceler-
ated clinical and radiographic improvement compared to the standard regimen alone
[16]. Interestingly, this beneficial effect of vitamin D also has implications prior to
clinical disease by reducing ones susceptibility and risk of progression from infec-
tion to disease [16]. Similarly, an inverse relationship between gastrointestinal can-
cer, breast cancer, all cancer mortality, and total life cancer incidence to vitamin D
levels has been indicated [16]. Metabolites of 7-DHC and 1, 25 (OH)2D3 also have
pro-differentiation and apoptotic effects [17, 18]. Dermatologists take advantage of
vitamin Ds regulation of cell differentiation and T-cell activity through the topical
management of psoriasis, atopic dermatitis, pityriasis alba, and other cutaneous con-
ditions with vitamin D analogues [19]. However, the usefulness of oral vitamin D for
these dermatologic conditions, excluding psoriasis, remains conflicted [1923].
Lastly, vitamin D has receptors on vascular smooth muscle that appear to influence
cardiovascular, cerebrovascular, and pregnancy-vasculature morbidity [24, 25].
Despite these and other published findings, the Institute of Medicine concluded
that there were insufficient prospective trials to provide adequate evidence warrant-
ing any Dietary Reference Intake recommendations for extra-skeletal medical sys-
tems. [2] The United States Preventative Services Task Force (USPSTF) was also
unable to find sufficient extra-skeletal evidence for recommendations [14].
Therefore, all daily vitamin D recommendations are based on date on skeletal health.
6.4 Photoprotection and Vitamin D
Individuals with limited sun exposure have an increased risk for vitamin D insuffi-
ciency and deficiency. A retrospective review of 165 patients with photosensitizing
conditions found those practicing strict photoprotection (e.g., xeroderma pigmentosa)
or developing symptoms within one hour of sun exposure (e.g., solar urticaria)
reliably had vitamin D deficiency in the winter [4]. Additional investigations on

erythropoietic protoporphyria and cutaneous lupus erythematosus reported approxi-
mately 2/3 of these cohorts were also at risk for vitamin D deficiency and inadequacy,
respectively [26, 27]. In the later study, lower serum levels were associated with sun
avoidance and daily sunscreen use [27]. However, approximately 50 % of healthy
individuals not practicing photoprotection, but rather residing primarily indoors due
to work, are at risk for vitamin D insufficiency [28, 29]. Interestingly, vitamin D
supplementation provided near-normal serum levels in both healthy and photo-
affected populations [29, 30].
While theoretically the use of sunscreens may cause similar vitamin D deficiency
and insufficiency as sun avoidance, a 2009 review of published evidence failed to
demonstrate the normal use of sunscreens and vitamin D insufficiency [31]. In labora-
tory setting, however, studies reported that daily application of SPF 8 can impair
90 % of cutaneous vitamin D production, and as little as 5 % of unprotected total body
surface area is needed for a notable rise in serum levels following suberythemogenic
UVB radiation in subjects with skin phototypes IIIII [4, 32]. These findings seemed
to be reflected in one of the first investigations on this topic, a randomized controlled
trial on 40 fair-skinned patients with a history of skin cancer. However, while this
study found subjects that applied para-aminobenzoic acid (PABA) sunscreen over
their entire body had significantly lower serum 25(OH)D levels compared to controls
with equivalent sun exposure, these levels remained within normal limits [4]. More
recently, a randomized, double-blind, controlled trial on 113 Australian subjects
divided evenly into daily application of SPF 17 sunscreen and placebo cream did not
observe a decrease in vitamin D production with regular sunscreen use for individuals
with adequate sun exposure [4]. Similar results were reported in two biannual, con-
trolled studies evaluating daily SPF 15 use with serum and bone markers in one study
and dual X-ray absorptiometry studies in the other [4]. A large cross-sectional survey
in the United States with 5920 adults and a smaller Australian study found no associa-
tion between frequent sunscreen use and vitamin D deficiency [4]. Both studies also
discovered individuals frequently staying in the shade, or wearing long sleeve shirts,
had significantly lower levels of vitamin D than those that did not. It has been specu-
lated that these clinical results do not mirror strict laboratory findings; in laboratory
settings, 2 mg/cm2 of sunscreen was applied (the amount required by FDA for SPF
testing), while in actual use, most individuals apply 0.51.0 mg/cm2.
6.5 Recommendations
6.5.1 Vitamin D Levels
Recommendations for vitamin D screening in asymptomatic individuals and

interpretation of the results remain a controversial topic between medical
organizations. Currently, population-wide screening is not recommended by any
national, primary care organization. However, screening is advised by the Endocrine
Society and American Geriatric Society for individuals at risk for vitamin D
deficiency due to an underlying condition or behavior [33, 34]. Once tested, deciding
the threshold for initiation of treatment varies based upon the organization focus:
nutrition repletion, treatment of vitamin deficiencies in asymptomatic individuals,
or prevention of a specific negative health outcome regardless of vitamin deficiency
[14]. To add more confusion to this matter, serum levels of vitamin D can vary
1020 % depending upon the assay method and laboratory performing the
assessment [14]. Thus, while most practitioners follow the Institute of Medicines
published guidelines, which are discussed below, vitamin D level remains a heated
debate.
In 2011, the Institute of Medicine published their evidence-based review and
suggested recommendations on vitamin D deficiency and insufficiency for skeletal
health. As serum 1,25(OH)D is under tight endocrine control, serum 25(OH)D is
used for determining vitamin D status. Serum levels can be reported as either ng/mL
or nmol/L (2.5 ng/mL = nmol/L). According to the IOM Committee, 25(OH)D
levels of 1620 ng/mL are sufficient for 97.5 % of the population. However,
approximately 50 % of the population only requires 1216 ng/mL of 25(OH)D to
cover their requirements. Therefore, levels below 20 ng/mL suggest risk for
insufficiency, and levels below 12 ng/mL indicate risk of deficiency. Levels above
20 ng/mL should not raise significant concern regarding potential adverse effects
until levels exceed 50 ng/mL [2].
While these guidelines for vitamin D status are relevant for most conditions,
special consideration should be noted for certain conditions, such as sarcoidosis.
Patients with sarcoidosis may have falsely low 25(OH)D with sufficient 1,
25(OH)2D due to macrophage conversion of 25(OH)D to 1, 25(OH)2D. Thus,
vitamin D supplementation in sarcoidosis may inadvertently cause hypervitamin-
osis D. Therefore, 1, 25(OH)2D and parathyroid hormone should be evaluated in
these patients. Low 1,25(OH)2D with normal PTH merits 400800 International
Units (IU) per day of cholecalciferol, while normal vitamin D with elevated PTH
levels warrants a consultation by endocrinology for concerns of hyperparathy-
roidism [35].
6.5.2 Vitamin D Supplementation
Based upon the IOMs recommended dietary allowances (RDAs) for adults and
allowable intake (AI) for infants less than 1 year of age, the required daily nutrition
to meet the skeletal requirements of vitamin D for 97.5 % of the population and
ensure adequate nutrition (RDA and AI, respectively) is listed by age in Table 6.2.
The upper daily intake limit unlikely to pose risk of hypervitaminosis D is 2500 IU/
day for 13 years old, 3000 IU/day for 48 year olds, and 4000 IU/day for those
greater than 9 years of age [36].
However, both adequate vitamin D levels and daily requirements of vitamin D
are highly debated (Table 6.3).
Table 6.2 IOM Age (years) Dose (IU/day)

recommended dietary
01 400
allowances and allowable
intake [36] 170a 600
>70 800
a
Pregnancy and lactation do not require additional vitamin D
supplementation above 600 IU/day
Table 6.3 Discrepancies in adequate vitamin D levels and daily requirements

Organization 25(OH)D level Daily vitamin D intake
IOM 20 ng/mL (50 nmol/L) 400800 IU
Endocrine Society 30 ng/mL (75 nmol/L) 4002000 IU
American Geriatrics Society 30 ng/mL (75 nmol/L) 1000 IU (>65 years old)
Based on Institute of Medicine (IOM) [36], Endocrine Society [33], and American Geriatrics
Society recommendations [34]
6.6 Conclusion
Vitamin D possesses a beneficial role in skeletal health and may have broader impli-
cations beyond calcemic health. While strict photoprotective measures can reduce
serum vitamin D levels, frequent sunscreen use in the real world does not appear to
impact vitamin D status. Instead, standard risk factors of low sun exposure, darker
skin types, older age with history of falls and non-traumatic fractures, obesity, mal-
absorption syndromes, severe liver or renal disease, solely breastfed infants, granu-
loma-forming disorders, and specific medications (glucocorticoids, antiepileptic,
antifungal, and autoimmune deficiency syndrome medications) may place individu-
als at increased risk for vitamin D deficiency or insufficiency [37]. While laboratory
assessment and vitamin D supplementation should be considered in these at-risk
groups, widespread testing of all individuals is not recommended. While there is
much debate about vitamin D screening, definition of deficiency, and daily require-
ments, most medical bodies agree that replacing vitamin D by solar and artificial
UV radiation or recommending against photoprotective practices is ill-advised,
given the low cost, broad availability, and safety profile of oral vitamin D
supplementation.
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Chapter 7
Photoprotection and Skin of Color
Kesha J. Buster and Johnathan J. Ledet
Key Points
UVR exposure is a risk factor for skin cancer in POC; however, melanins
photoprotective properties likely reduce this risk. Despite decreased skin
cancer incidence, POC often have increased skin cancer morbidity and
mortality.
Darker constitutive pigmentation exhibits an inverse relationship with
degree of photoaging; thus darker POC manifest photoaging much later in
life.
There is a lack of sufficient data regarding ideal photoprotection practices
for POC.
7.1 Background: What Is Skin of Color?
Race is a poorly defined term that is a political and social construct more than
a biologic phenomenon [12, 87]. Ethnicity is a somewhat broader term referring to
. . .large groups of people classed according to common racial, national, tribal,
religious, linguistic, or cultural origin or background [77]. Each of these terms is
K.J. Buster, MD (*)

Private Practice, Buster Dermatology, PC, 3915 E. 51st Street, Tulsa, OK 74135, USA
Department of Dermatology, University of Alabama at Birmingham, 1530 3rd Avenue South
EFH Suite 414,
Birmingham, AL 35294, USA
J.J. Ledet, MD
Department of Dermatology, NEA Baptist Clinic, 4802 E. Johnson Avenue,
Jonesboro, AR, USA

DOI 10.1007/978-3-319-29382-0_7
106 K.J. Buster and J.J. Ledet
multifaceted and self-defined. People of color (POC) is an encompassing phrase

commonly used in the United States to refer to ethnic and racial minorities. The
overall advantage of this phrase is . . . its flexibility in accommodating various
groups similarly disadvantaged, even if their disadvantages are based on different
variables [119]. Dermatologic health disparities have been identified in POC, par-
ticularly in regard to skin cancer [18]. Skin of color (SOC) consists of a wide spec-
trum of skin tones and racial/ethnic backgrounds. The construct SOC finds its utility
in dermatology in a number of factors including that skin diseases sometimes pres-
ent in drastically different fashion in people of darker skin color (e.g., sunburn/
erythema in dark-skinned people can resemble hyperpigmentation). Thus the der-
matologist is challenged to recognize a score of disease entities across the spectrum
of skin tones. In addition, chief complaints of POC more commonly comprise vari-
ous dyschromias, such as postinflammatory hyperpigmentation (PIH) [5, 50].
It is estimated that before the year 2050, more than half of those living in the
United States will be POC and by 2060 minorities will comprise 57 % of the US
population [17]. Data show that objective measures of pigmentation such as spec-
trometry, and colorimetry correlate poorly with self-identified racea reflection of
heterogeneous skin pigmentation found within racial groups [22]. Though racial cat-
egories can be useful (e.g., in health disparities research), the demographic ambiguity
of a diverse and racially intermixed population may limit the utility of such groupings
in dermatologic research. Mersha and Abebe [78] investigated the constraints of
racial/ethnic categories in the age of genomic research and note that these catego-
ries may not be accurate predictors of treatment outcomes. However, the American
Medical Association [6] recommends use of the terms of race/ethnicity that were used
by the original investigator/author when writing about medical studies; thus such lan-
guage will be used in this chapter except when using the unifying terms POC/SOC.
7.2 Skin Color Classification
Various systems have been developed to make the classification of skin color more
phenotypically objective. Fitzpatrick skin-type scale, originally developed for
Caucasian skin, is a frequently used and valid tool for categorizing skin according to
ultraviolet radiation (UVR) sensitivity; however, it has been identified as less useful in
POC including blacks, Asians, and likely other POC [31, 36, 92, 111, 127]. In an
evaluation of various methods to measure skin color, Daniel et al. [27] found that a
simple seven-point Likert scale for self-reported natural skin color (very fair/light to
very dark) better correlated with spectrophotometry than did the Fitzpatrick skin-type
scale. The study participants self-identified as Caucasian, Asian American/Pacific
Islander, African American, Hispanic/Latino, or other ethnicity. Similarly, the Skin
Color Chart is a tool developed by LOreal that has been validated in Caucasian,
Asian, African American, and Indian skin ([30]; Del Bino S, 2015, personal commu-
nication). It allows for evaluation of skin color on any body surface based on a fan
deck of 52 cards each with a three-centimeter hole through which skin color can be
7 Photoprotection and Skin of Color 107
a Skin colour volume L*b* plane b c

ITA= (ATAN (L*-50)/b*)x180/3.14159
80 Very light
light
Individual
75 55 Skin
Light Typology Angle
70 classification
41 ITA interm.
Intermediate
65
28
60 Tan ITA > 55 Very light
L* (Luminance)
55
10
tan
50
Brown
41 < ITA< 55 Light
45
40
28 < ITA < 41 Intermediate
brown
35 -30
Dark
10 < ITA < 28 Tan
30
25
-30 < ITA < 10 Brown dark
20
0 5 10 15 20 25 30 35 40
ITA < -30 Dark
b* (yellow chrom.)
Fig. 7.1 (a) Skin colour volume on the L*b* plane (CIELAB 1976 system). The vertical axis L*
is the luminance; the horizontal axis b* is the yellowblue component. (b) The individual typology
angle (ITA) allows skin colour classification into six groups, from very light to dark skin. (c)
FontanaMasson staining of melanin granules shows a good correlation between skin colour clas-
sification and melanin quantity and distribution (Reprinted with permission from Del Bino and
Bernerd [31])
compared to the card [30]. In addition, colorimetric parameters have been used to cre-
ate an individual typology angle (ITA)-based skin color classification system com-
posed of 6 skin tones from very light to dark (Fig. 7.1) [23, 33]. ITA is both quantifiable
and objective [33]. Visual phenotype/ethnically defined Caucasian skin had ITA val-
ues classifying it as light, intermediate, and tan [31]. Likewise defined Hispanic skin
ITA values ranged from light to brown; and African skin ITA values ranged from
intermediate to dark. Asian ITA scores showed a geographic split with northeast Asian
skin ITA values of light, intermediate, and tan, and southeast Asian skin ITA values
had a broad range from light to dark. Thus ITA-based skin color classification allows
for precise evaluation of in vivo constitutive pigmentation. Furthermore, a correlation
exists between ITA-determined skin color and DNA damage with greater levels of
UVR-induced DNA damage correlating with lighter skin color [33]. These findings
reveal that a spectrum of phenotypes exists in Caucasians and POC; thus objective
measures of constitutive skin pigmentation could serve as concrete, consistent, and
biophysiologically relevant criteria for defining skin color. Such phenotypically ger-
mane terminology is needed in dermatologic research as an alternative means of clas-
sification separate from race/ethnicity for greater clarity and consistency in medical
literature. The authors and other researchers believe that such objective measurements
could be used by dermatologists to make personalized photoprotection recommenda-
tions (e.g., maximum daily UVR exposure time, ideal sunscreens, skin cancer preven-
tion strategies, etc.) ([31]; Del Bino S, 2015, personal communication).
Research has shown that epidermal melanin largely determines constitutive
pigmentation [3, 4, 9, 110]. Though the beneficial effects of photoprotection in
reduction of photoaging and cutaneous malignancy have been demonstrated for

Caucasian individuals [42, 43, 89, 104, 117], it is less clear for POC. The role of sun
protection in prevention and treatment of disorders of pigmentation such as melasma
and postinflammatory hyperpigmentation (PIH) in skin tones across the spectrum is
evident [14, 57, 63, 70]. However, there is a lack of sufficient data regarding ideal
photoprotection practices for POC. In this chapter, the authors will review the
effects of UVR on SOC and the role of photoprotection in POC, as well as contro-
versies and recommendations.
7.3 Biological Effects of UVR on the Skin
7.3.1 Photocarcinogenesis
UVR exposure is a risk factor for skin cancer in POC including Hispanics, blacks,
and Asians [25, 37, 48, 49, 52, 59, 61, 90]; however, due to the photoprotective
effect of melanin, UVR may play a smaller role in skin cancer development in
darkly pigmented skin [37]. Basal cell carcinoma (BCC) is most common on sun-
exposed skin across the spectrum of skin types and ethnic backgrounds (Fig. 7.2a)
[35, 37, 74, 82]. Though squamous cell carcinoma (SCC) is most common on non-
sun-exposed skin in blacks [35, 48, 75, 106], several studies have shown increased
nonmelanoma skin cancer (NMSC) in sun-exposed skin of blacks [83, 90]. Risk
factors for malignant melanoma (MM) in darker POC are unclear and data are con-
flicting (see Fig. 7.2b for images). An evaluation of the Surveillance, Epidemiology,
and End Results Program (SEER) data revealed no UVR index/lower latitude asso-
ciation with MM incidence in blacks or Hispanics [34]. However, several studies
have identified an association between MM and UVR exposure in blacks (the United
States), Hispanics (the United States), and Asians (India) [52, 61, 90, 98].
Despite decreased incidence, POC often have increased skin cancer morbidity
and mortality [37, 49, 121, 124]. Groups with poorer skin cancer outcomesinclud-
ing POCmore commonly have misperceptions regarding skin cancer (including
expectation of symptoms, discounting importance of skin exams, and confusion on
prevention strategies), and these may contribute to skin cancer disparities [19].
NMSC occurs with increased frequency in geographic areas with greater UVB
exposure (SCC more than BCC) [101]. In the United States, this means areas of
decreased latitude. During the 1980s and 1990s, the Earth experienced alarming
loss of the ozone layer over midlatitudes of the Northern Hemisphere due to
increased use of ozone-depleting substances over the previous decades [85]. With
continued depletion, predictably, all humans, including POC, would have a progres-
sively increased risk of NMSC due to increased UVB reaching the Earths surface.
A US National Cancer Institute study found that for each 1 % relative increase in
UVB, there could be a 2 % increase in incidence of NMSC [101]. Similarly, a 2013
study found that NMSC incidence would increase by more than 1000 cases (26.9 %)
yearly in Korea secondary to UVB from a constant 10 % decrease in ozone
a a b c d
b a b c
d e f
Fig. 7.2 (a) Nonmelanoma skin cancers in people of color. Pigmented basal cell carcinoma in elderly
Hispanic man (right lateral orbital rim) (a); middle-aged Asian woman (right cheek) (b); middle-aged
Hispanic man (right forehead) (c); middle-aged Hispanic man (left nasal ala) (d). (b) Melanomas in
people of color. Lentigo maligna in middle-aged Hispanic woman (vermilion upper and lower lips) (a);
melanoma in middle-aged black woman (right fourth toe) (b); Hispanic woman (left fifth toe) (c);
middle-aged Hispanic man (left plantar foot) (d); elderly Hispanic man (right cheek) (e); and Asian
woman (side of left leg) (f) (Reprinted with permission from Agbai et al. [1])
concentration [65]. Fortunately, international changes in production and use of

ozone-depleting substances have led to a reversal of the damage that peaked in the
late twentieth century and now the ozone layer is only approximately 3 % less than
it was in the 1960s and 1970s [85].
The average UVB protective factor (ex vivo with solar simulator) of dark skin
has been shown to be 13.4 vs. 3.4 in fair skin, translating to UVB transmission of
7.4 % vs. 29.4 %, respectively [54]. UVA protective factor is 5.7 in dark skin and
1.8 in fair skin indicating UVA transmission of 17.5 % vs. 55.5 %, respectively.
Darker skin has greater melanin content [54, 126] which correlates with removal of
UV-induced DNA damage [108] and decreased UVR sensitivity and likely accounts
for the reduced skin cancer risk appreciated in POC. Despite the increased protection
pigmentation provides against the effects of UVR, epidemiologic studies have
shown that sunburn occurs even in darkly pigmented POC, though with decreased
frequency compared with fair-skinned individuals [20, 21]. Similarly, UVR-induced
skin damage has been documented in skin tones from very light to very dark. Light
to tan skin develops cyclobutane pyrimidine dimers (CPD) in all epidermal layers,
whereas brown and dark brown skin only form CPD in the suprabasal layers [31].
CPD develop secondary to UVR absorption and are subsequently found in skin
cancers [112]. Immediately after UVR exposure, 79100 % of melanocytes in light
skin are CPD positive, whereas 17 % in brown skin and 15 % in dark skin are CPD
positive [31]. Even at suberythemal doses, light, medium, and dark skin types incur
DNA damage [105, 109], suggesting that photoprotection can be beneficial in all
skin types. However, as noted above, the increased melanin content of darker skin
does help protect it from photodamage [54]. Numerous studies have identified an
inverse relationship between constitutive skin pigmentation and DNA damage [31
33, 97, 109]. Given this intrinsic photoprotection, the necessary level of external
photoprotection for prevention of DNA damage and subsequent skin cancer in POC
of different levels of skin pigmentation may vary.
7.3.1.1 Photocarcinogenesis and Photoprotection
Photoprotection is the backbone of prevention of acute and chronic effects of UVR,

namely, sunburn and skin cancer. There is evidence that sunscreen use in whites is
beneficial in the prevention and reduction of actinic keratoses, SCC, MM, and BCC
[28, 42, 43, 89, 113, 117]. Further research is needed to determine if these benefits
can be generalized to POC. As noted earlier in this chapter, numerous studies have
shown that melanin protects the skin, but it does not prevent all DNA damage. Del
Bino et al. [32] indicate that DNA of pigmented melanocytes from tan skin may
serve as a UVR target and, thus, photoprotection should be recommended for not
only light skin but also for moderately pigmented skin.
7.3.2 Photoaging
Photoaging has been defined as the combination of intrinsic aging and photodamage
[116]. In contrast to intrinsic (chronological) aging, photoaging is associated with
significant changes in skin composition including undesirable changes in texture,
wrinkling, increased pigmentation, greater vascularity, laxity, and cutaneous malig-
nancy [41, 103, 104, 116]. Compared to Caucasians, darker POC manifest photoag-
ing much later in life, in approximately the 5th and 6th decade [50]. In one study
comparing facial skin of black and white women from ages 20 to 50, blacks had no
obvious wrinkles, while most white women 4550 years old had wrinkles of the
lateral canthi (crows feet) and oral commissures [81]. Visual assessment has shown
that African American skin exhibits photoaging changes of hyperpigmentation and
uneven skin tone and white skin shows more severe fine lines, wrinkles, laxity, and
overall photodamage [44].
Goh [38] observed photoaging as both hyperpigmentation and wrinkles in Asian
(Singaporean, Malaysian, and Indonesian) skin. Similarly, Korean photoaging is
exhibited as pigmentary changes (hyperpigmented macules and seborrheic kerato-

ses) and wrinkles that gradually increase with age [26]. Mild hyperpigmentation is
seen in the 50s, whereas fine wrinkles develop as early as the 40s. Koreans with sun
exposure of more than 5 h/day had a 4.8-fold increase in wrinkling risk compared to
those with 12 h of daily exposure. Dermatoheliosis typically appears in Thais by
the age of 40 years, and by age 50 most exhibit extensive sun damage in the form of
wrinkles, leathery texture, mottled pigmentation, and increased seborrheic kerato-
ses [60]. Proximity to the equator and lack of efforts to use photoprotection are
implicated in greater photodamage at younger age in Thai people.
There is little in the medical literature regarding photoaging in Hispanic popula-
tions. Sanchez [99] noted that photoaging was in the top 3 diagnoses recorded in
1000 Latino patients in a dermatology private practice. Photoaging in Hispanic
patients of skin types III and IV was documented by Hernandez-Perez and Ibiett [51]
in their small preliminary study evaluating the benefits of intense pulsed light in this
population. Clinically, fine wrinkles were present and graded as moderate to severe.
Histologically, epidermal changes of photoaging include thickening and com-
paction of the stratum corneum, vacuolization and dysplasia of keratinocytes, irreg-
ular melanin deposition, and Langerhans cell loss [103]. Kotrajaras and Kligman
[60] found many of these epidermal changes in photodamaged Thai skin (mostly
skin type IV). Hispanic skin (El Salvador) exhibited epidermal disorder via loss of
polarity andin contrast to aboveepidermal atrophy [51].
The histologic hallmark of photoaging is dermal solar elastosis [104]. Exposure
of light skin (skin types II and III) to chronic (6 weeks) low levels of solar-simulated
radiation (SSR) revealed early changes of solar elastosis including decreased
procollagen I and deposition of alpha-1 antitrypsin and lysozyme on elastin fibers
[104]. Progressive collagen loss and elastin increase are associated with increased
sun exposure and age [120]. Photoaging biomarkers such as increase in matrix
metalloproteinases and alteration/loss of dermal fibroblasts can primarily be attrib-
uted to UVA [9, 11, 71].
Dermal changes in photoaged Asian skin include solar elastosis, collagen loss,
and increased glycosaminoglycans [60]. In older Thai people, the elastosis is
extensive, only differing from end-stage photodamaged Caucasoid skin by not
extending as deep in the dermis [60]. Histologic exam of Hispanic skin revealed a
range of mild to severe solar elastosis [51]. In a study comparing black and white
facial skin exposure to long-term UVR, Montagna and Carlisle [81] found no solar
elastosis in the black skin regardless of age. Oxytalan fibers were still present in the
skin of black subjects older than 50 years old, but these disappeared in white skin
after the late 20s/early 30s. Interestingly, the amount and distribution of elastic
fibers of a light-skinned black woman were similar to those in white skin. Only
minor epidermal changes were present in black skin compared to extensive altera-
tions in white skin. Similarly, Del Bino and Bernerd [31] found that UVR only
caused damage in fibroblasts of light, intermediate, and tan-colored skin, not in
brown or dark skin. These findings point to a correlation between constitutive
pigmentation and photoaging and help explain the dermal changes of photoaging
that are more appreciable in lighter skin.
In an analysis of ethnic variation in melanin content, Alaluf et al. [3] found that
the quantity of epidermal melanin in heavily pigmented (i.e., African and Indian)
skin is about double that is seen in relatively lightly pigmented (Mexican, Chinese,
and European) skin. Prior to that, Yohn et al. [126] found that melanocytes of blacks
have significantly more melanin than whites. The dispersion, size, and number of
melanosomes are also on a spectrum with darker skin exhibiting greater dispersion,
larger size, and increased numbers of melanosomes than lighter skin [3, 81, 114].
Melanosomes are largest in African skin and progressively decrease in size in
Indian, Mexican, Chinese, and European skin [3]. Increased melanin correlates with
higher constitutive pigmentation, which as aforementioned typically exhibits an
inverse relationship with degree of photoaging.
7.3.2.1 Photoprotection and Photoaging
Avoidance of sun exposure and use of sunscreen are widely accepted photoprotective
practices as they limit or eliminate UVR-induced DNA and collagen damage that
lead to photoaging [10]. UVR also induces oxidative stress (which eventually leads
to matrix metalloproteinase degradation of collagen), and antioxidants have been
shown to inhibit the UVR cascade that leads to photoaging [56]. Some antioxidants
(e.g., ferulic acid, vitamin C combined with vitamin E) also serve as photoprotectants
[66, 67].
7.3.3 Pigmentary Disorders
A number of pigmentary disorders disproportionally affect POC and the impor-

tance of photoprotection in prevention and treatment of these conditions is often
under-recognized as POC are less likely to practice sun-protective behaviors
[14, 26, 60, 69, 91]. Two such disorders are highlighted below.
7.3.3.1 Melasma
Melasma is a common, acquired pigmentary disorder of the skin, which manifests

as symmetric, irregularly shaped, hyperpigmented macules and patches on the sun-
exposed surfaces of the body. The hyperpigmentation of melasma is caused by both
melanocytosis and melanogenesis leading to an increase in epidermal and/or dermal
pigment [47]. The pathogenesis of melasma is not fully understood as it is influenced
by a variety of factors including genetic makeup, age, UVR exposure, hormonal
status, and medications [45, 80, 95]. It is most commonly found in females with
Fitzpatrick skin phenotypes IIIV and is thought to affect over five million people
in the United States making it a common reason to seek dermatologic care [45].
Visible light in addition to long-wavelength UVA and UVB has been found to
increase pigmentation in melanocompetent skin [70]. A study by Kang et al. [55]

showed skin affected by melasma to have upregulation of melanocyte markers
TYR, MITF, SILV, and TYRP1. Numerous studies have also shown a significant
vascular component in melasma verified through increased levels of vascular
endothelial growth factor and stratum corneum hydration [58, 64].
Melasma can be very psychologically distressing to those affected [8]. Many
POC are acutely aware of uneven pigmentation of their skin and having melasma
heightens this issue. Melasma pigmentation is worse in environments with more
intense UVR [96, 118].
Examination with a Woods lamp was previously thought to differentiate epider-
mal from dermal pigment; however mixed patterns are commonly seen in melasma,
and a histologic study by Sanchez et al. [100] confirmed dermal deposition of mela-
nin in all cases examined. Grimes et al. [47] examined biopsy specimens from
melasma-affected skin and perilesional normal-appearing skin in patients with
Fitzpatrick phototypes IV through VI. All specimens had increased melanin in the
dermis and epidermis compared to Woods lamp examination predicting epidermal
deposition in only some of the patients. Immunohistochemical staining with Mel-5
and electron microscopy showed that melanocytes increased in size, not number.
7.3.3.2 Postinflammatory Hyperpigmentation
Postinflammatory hyperpigmentation (PIH) is very common in POC and is a

frequent reason POC present to the dermatologist [5, 50].
PIH is an acquired hypermelanosis that may result from the overproduction of
melanin or irregular pigmentation after cutaneous inflammation or injury [46]. PIH
may be caused by numerous skin disorders such as eczema, contact dermatitis, and
acne but also can be seen after exogenous injury (e.g., burns, cuts, surgical scars, etc.).
The exact mechanism of PIH is unknown; however, studies have shown that melano-
cyte activity is enhanced after stimulation with cytokines, prostanoids, chemokines,
interleukins, prostaglandins, reactive oxygen species, and other inflammatory media-
tors [88, 115]. Epidermal melanin production increases and melanin is transferred to
the surrounding keratinocytes. Damage to basal keratinocytes leads to melanin release
into the dermis and macrophage (melanophage) phagocytosis takes place [29, 73].
Epidermal hyperpigmentation appears tan, brown, or dark brown, whereas dermal
hyperpigmentation has a blue-gray appearance [62]. UVR may worsen PIH and
reverse the progress made with therapy [50].
7.3.3.3 Photoprotection in Pigmentary Disorders
UV protection is a core element in the treatment of melasma, PIH, and other disorders
of increased skin pigmentation. However, physicians are less likely to prescribe sun-
screen for treatment of dyschromias in POC than whites. In an analysis of more than
five million patient visits for the sole diagnosis of dyschromia, Kang et al. [57] found
that sunscreen use was prescribed for 32 % of whites (3rd most common treatment
prescribed for this population), 17 % of blacks (6th most common treatment), and 7 %
for Asians (10th most common treatment). Though reasons for this discrepancy are
unclear, authors speculate that it may be it is due to dermatologists recognition of the
photoprotective effect of melanin and decreased risk of sunburning in darker skin.
However, they note that sunscreen is key in treating hyperpigmentation in all skin types.
Broad-spectrum sunscreen with good UVA protection plays a pivotal role in the
treatment of melasma as it may help minimize melasma relapses. Lakhdar et al. [63]
found that vigilant sunscreen use as the sole treatment in women (Fitzpatrick skin
types IIV) during and after pregnancy led to fewer cases of melasma. With use of
broad-spectrum (SPF 50, UVA protective factor 28) sunscreen every 2 h, nearly 80 %
of women had lighter skin or the same skin tone at the end of the study. These results
are encouraging, but outside a clinical study, compliance with sunscreen application
every 2 h is likely to be poor. This is especially likely in POC since they, as noted
earlier in this section, use sunscreen and other forms of sun protection less often.
Recently, the utility of Polypodium leucotomos extract (PLE) as a treatment for
disorders of pigmentation has been evaluated. In a randomized double-blinded pla-
cebo-controlled trial (RCT) of 40 Hispanic women with moderate to severe facial
melasma, Ahmed et al. [2] found that 240 mg of oral PLE three times daily plus
once daily (morning) application of broad-spectrum sunscreen was not significantly
better than sunscreen application alone. However, a smaller RCT (n = 21) revealed
significant improvement in women with epidermal melasma treated with twice
daily PLE and broad-spectrum (SPF 45) sunscreen compared to sunscreen alone
[72]. The skin types of the participants were not revealed in this study. Though, to
date, there is no direct research implicating PLE as a useful agent in treatment of
other common forms of hyperpigmentation in POC, this is an area worth exploring.
A 2004 study in subjects of skin phototypes II and III revealed that PLE (7.5 mg/kg
the night prior to exposure) decreased PUVA-induced acute phototoxicity as well as
PUVA-induced hyperpigmentation [79]. A 2014 article on dermatologic applica-
tions for PLE reviewed research showing promising results for photodermatoses,
pigmentary disorders, photoaging, and other dermatologic conditions [24]. Data
from such studies indicate that PLE may have additional utility in prevention and
treatment of pigmentary disorders in people of all skin types.
7.4 Conclusion
The most notable controversy regarding photoprotection in POC is the challenge of

striking a balance between minimizing the risk of sunburn, skin cancer, and
photoaging with the need for adequate vitamin D levels. POC are often at greater
risk for vitamin D deficiency, which has been associated with a number of negative
sequelae including cancer [86], diabetes mellitus [102], and death [107]. UVR is the
major source of vitamin D in most countries [122, 125], but oral supplements can
also increase vitamin D levels. The American Academy of Dermatology (AAD)
recommends oral supplementation of vitamin D in those who are deficient/at risk

for low vitamin D [1]. The Institute of Medicine notes that concerns regarding skin
cancer preclude recommending vitamin D acquisition from sun exposure and
currently lists 600 IU as the recommended daily allowance (RDA) of vitamin D for
people from age one to 70 (800 IU for those over the age of 70) [76].
A recent study (n = 29,518) revealed concerns regarding rigorous sun protec-
tion. Swedish women who practiced sun avoidance had an increased risk of all-
cause death and double mortality risk compared to women with highest sun
exposure [68]. This inverse relationship was dose dependent, inferring a potential
link to UVB and vitamin D. Similar results were found in a prior study [125].
Decreased cardiovascular disease and decreased overall mortality were associated
with increased solar UV exposure, but increased cancer and overall mortality
were associated with artificial UV (tanning bed) exposure. The fact that these
studies were done in Sweden, a country of elevated latitude (and thus lower UVB
irradiance) compared to the United States, is worth noting. Ecological studies in
the United States have also identified an inverse association between UVB irradi-
ance and at least 16 types of cancer including breast and prostate cancer [39, 40].
The association between low UVR dose and increased malignancy has been
appreciated not only in Caucasians but also POC including African Americans,
Asians, and other minorities [39]. Some advocate sun exposure based on skin type
and UV index along with photoprotection against excess UVR as an answer to
this problem [128]. However, some individuals have low vitamin D levels despite
abundant sun exposure, suggesting varied response of the skin to UVB to create
vitamin D [13]. A recent study of American blacks found low levels of vitamin D
and vitamin D-binding protein, which appeared to result in 25-hydroxyvitamin D
bioavailability equal to whites. Thus it may be that measurement of vitamin
D-binding protein is needed to determine actual vitamin D status in diverse patient
populations [94].
Some researchers note that if the negative associations with low UVR exposure
and increased morbidity and mortality are predominantly the result of low vitamin
D levels, then vitamin D supplementation and additional dietary fortification could
be key solutions [53]. The question, however, remains whether orally supplemental
vitamin D would eliminate the inverse relationship between UV exposure and
mortality/malignancy. Although it is unclear if vitamin D obtained by oral
supplementation is as effective in risk reduction as vitamin D created by the skin
through exposure to UVB, a meta-analysis of 18 RCT revealed that daily vitamin D
oral supplementation was associated with decreased overall mortalitythough the
study could make no conclusion on optimal dosing for the mortality reduction [7].
A more recent meta-analysis of 42 RCT found that oral vitamin D supplementation
for greater than 3 years significantly reduced mortality [129]. These findings serve
as strong evidence that oral supplementation is highly beneficial.
In response to the complex issues brought forth by the emerging research on
vitamin D along with the need for photoprotection to reduce sunburn, skin cancer,
and other solar effects, several organizations in the skin cancer capital of the world,
Australia, along with New Zealand, convened in 2006 and developed a position
Table 7.1 Risks and benefits of sun exposure: position statement by Cancer Council Australia, the
Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia, and the
Australasian College of Dermatologists [93]
1. For most people sun protection to prevent skin cancer is required when the UV index is
moderate or above (i.e., UV index is 3 or higher). At such times sensible sun protection
behavior is warranted and is unlikely to put people at risk of vitamin D deficiency
2. Most people probably achieve adequate vitamin D levels through the UVB exposure they
receive during typical day to day outdoor activities. For example, it has been estimated that
fair-skinned people can achieve adequate vitamin D levels (>50 nmol/L) in summer by
exposing the face, arms, and hands or the equivalent area of skin to a few minutes of sunlight
on either side of the peak UV periods on most days of the week. In winter, in the southern
regions of Australia where UV radiation levels are less intense, maintenance of vitamin D
levels may require 23 h of sunlight exposure to the face, arms, and hands or equivalent area
of skin over a week
3. Some people are at high risk of skin cancer. They include people who have had skin cancer,
have received an organ transplant, or are highly sun sensitive. These people need to have more
sun protection and therefore should discuss their vitamin D requirements with their medical
practitioner to determine whether dietary supplementation with vitamin D would be
preferable to sun exposure
4. Some groups in the community are at increased risk of vitamin D deficiency. They include
naturally dark-skinned people, those who cover their skin for religious or cultural reasons, the
elderly, babies of vitamin D-deficient mothers, and people who are housebound or are in
institutional care. Naturally dark-skinned people (Fitzpatrick skin types 5 and 6 rarely or
never burns) are relatively protected from skin cancer by the pigment in their skin; they could
safely increase their sun exposure. Others on this list should discuss their vitamin D status with
their medical practitioner as some might benefit from dietary supplementation with vitamin D
Table 7.2 AAD recommendations for photoprotection and early detection of skin cancer in people
of color [1]
Seek shade whenever possible
Wear sun-protective clothing
Wear a wide-brimmed hat to shade the face and neck as well as shoes that cover the entire foot
Wear sunglasses with UV-absorbing lenses
Apply broad-spectrum sunscreen with an SPF 30 or greater. Sunscreens without inorganic filters
(titanium dioxide and zinc oxide) are generally better accepted by people of color due to their
better cosmesis on dark skin
Apply sunscreen to dry skin 1530 min before going outdoors. When outdoors, reapply every 2
h to all exposed skin and after perspiring or swimming
Avoid exposure to indoor tanning beds/lamps
Take vitamin D supplement
Perform monthly self-skin examinations, paying close attention to subungual skin, palms,
soles, mucous membranes, groin, and perianal area
statement with recommendations that attempt to strike a balance (See Table 7.1). In
2010 the British Association of Dermatologists (BAD) made a similar consensus
statement with other national organizations advising minutes of regular midday sun
exposure without sunscreen (avoiding burning) to promote vitamin D formation
without unduly increasing skin cancer risk [15]. The AAD recommendations for
photoprotection in POC are listed in Table 7.2.
Besides oral supplementation of vitamin D, personalized photoprotection is

likely the key to the challenge of balancing the benefits of photoprotection with its
potential risks (e.g., vitamin D deficiency and its associated sequelae). It has been
suggested that modern humans take prescriptions for sun exposure and diet that are
appropriate to our ancestry, location and lifestyle [53]. Seite et al. [103] note that
effective UVR protection should be in the context of level of UVI (or similar mea-
sure of UVR exposure). Del Bino and Bernerd [31] note that objective phenotyping
of skin color can lead to improved photoprotection strategies. Moyal [84] indicated
that calculations on needed UVA protective factor have been made in Asia based on
meteorological daily dose according to season and weighted by different factors
such as skin type, anatomical skin area, realistic conditions of sunscreen use and
realistic duration of exposure to UVR and that these should be adapted to con-
sumer needs such as amount of time spent outdoors. To that effect, the BAD, in
partnership with the UKs national weather service (the Met Office), developed a
free phone app called World UV that utilizes UV index (UVI) of the users location
to provide recommendations on sun protection (either no protection required or
protection required) [16]. UVI serves as a measure of UVR at the surface of the
Earth and was developed by the World Health Organization [123], in conjunction
with other international groups, with the goal of serving as a daily tool for the gen-
eral public to use as a guide for healthy sun protection behavior. The BAD World
UV app also lists the UVI determined level of risk according to skin types 16 (from
low risk to extremely high risk for skin damage). Though Fitzpatrick skin typing
may not be ideal for SOC, this nevertheless is a practical educational tool for physi-
cians and patients alike and allows for personalized photoprotection in a simple,
modern, and informative format. As we continue to learn more about both the dam-
aging and beneficial effects of UVR, the ability to make recommendations custom-
izable to patients based on skin cancer risk factors, desired treatment outcomes,
health needs, and aesthetic concerns is likely to become a reality.
Acknowledgments The authors thank Sandra Del Bino, MsD, and LOreal Research and
Innovation for provision of Fig. 7.1.
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Chapter 8
The Controversy of Sunscreen Product
Exposure: Too Little, Too Much, or Just Right
J. Frank Nash and Paul R. Tanner
Key Points
Sunscreen products have a controversial history. Fundamental to the con-
troversies surrounding sunscreens is product use or exposure.
It is alleged too little sunscreen product is applied reducing their effective-
ness or, conversely, that too much product is used resulting in unfavorable
health effects.
The weight of evidence is supportive of daily use of sunscreens as part of
a safe sun strategy including wearing protective clothing and seeking
shade. Importantly, a consistent, simple public health message is required
and supported broadly by all stakeholders.
8.1 Introduction
Exposure to sunlight, which is crucial for human survival, can have detrimental
effects on our skin. The absence of hair covering our bodies makes human skin
vulnerable to the effects of ultraviolet radiation (UVR) in sunlight. Acute overexpo-
sure to sunlight results in erythema, i.e., sunburn, and in more extreme cases edema,
which are thought to be a manifestation of complex molecular events, including
DNA damage and the release of cytokines [10, 22, 57]. Exposure to UVR also trig-
gers melanogenesis or tanning, a protective mechanism but only to the extent that
damage is the initiating biological event [32, 49].
J.F. Nash, PhD (*) P.R. Tanner

Central Product Safety, Global Product Stewardship,
The Procter & Gamble Company, Sharon Woods Innovation Center,
11530 Reed Hartman Highway, Cincinnati, OH 45241, USA

DOI 10.1007/978-3-319-29382-0_8
126 J.F. Nash and P.R. Tanner
Beyond the acute effects of sunlight overexposure, the prevailing view is that
UVR-induced skin damage is cumulative [24, 26]. Such damage, over decades of
life, may lead directly or significantly contribute to nonmelanoma and melanoma
skin cancers [12, 68, 90] and photoaging, characterized by wrinkles, pigmentary
unevenness, and telangiectasia [25, 67].
Public health education campaigns seem to be having the desired effect since
there is general knowledge among teenagers and adults in the USA that exposure
to UVR from sunlight can cause skin cancers and photoaging [21]. The use of
sun-protective behaviors has held steady and actually increased from 2000 to
2010, although the percentage remains relatively low, i.e., less than 35 % for
women and men [15]. Nevertheless, there still are many cases of skin cancers in
the USA.1 It is possible that there is a lag between widespread sun-protective
activities and prevalence of skin cancers. However, it is equally likely that behav-
iors including indoor tanning and sunbathing contribute disproportionately to
unfavorable long-term health effects. Thus, despite gains in awareness regarding
the detrimental effects of sunlight, it would seem cosmetic/appearance benefits
make it difficult for individuals to change behavior even when they know it is
harmful [48, 78]. Further complicating the desire to intentional expose oneself to
UVR is the evidence that such behavior may have some addictive components
[27, 89].
Given the unequivocal cause-effect relationship between sunlight exposure
and skin damage as well as the health-related messages advocating active out-
door lifestyles, it would seem products whose singular purpose is to reduce the
dose of solar UVR might be of unquestionable benefit. In the simplest of terms,
sunscreens are such products. The ultraviolet (UV) filters are active ingredients
applied to sun-exposed areas of the skin with the sole purpose of reducing the
number of photons reaching areas where damage might occur. After absorbing
energy, the UV filters dissipate it in the form of heat or phosphorescence
[43, 72]. In some cases the photon energy is reflected or scattered, again reducing
the energy reaching vital cells in the skin. Thus, when shade, clothing, or hats are
not options in high-intensity exposure scenarios, sunscreens serve as the best
alternative to protect against sunlight. As well, for daily incidental exposure,
such products are, quite arguably, the most effective agents to reduce the signs of
aging.
Despite this elementary proposition and decades of use, a host of controversies
follow sunscreens. There are numerous issues, many of which have been reviewed
elsewhere [14, 47, 50, 69, 86]. What these controversies share, to a large extent, is
linked by exposure, generally too little or too much. Thus, the purpose herein is
not to repeat the arguments made by others but to consider the principle, underpinning
the controversies regarding sunscreen use.
1
www.skincancer.org.
8 The Controversy of Sunscreen Product Exposure: Too Little, Too Much, or Just Right 127
8.2 Exposure: What Does It Mean?
For sunscreen products, there are many concerns related to efficacy and safety that
might be classified as controversies. Importantly, in both cases these concerns have
a shared origin, namely, exposure. For the purposes of this paper, exposure is a
borrowed term from risk assessment where the magnitude, frequency, and duration
of use are measured or estimated [45]. In toxicology, exposure is coupled with
hazard, i.e., adverse effect, and dose-response data to determine risk. In the context
of efficacy, magnitude, or dose, frequency or reapplication and duration of use will
be discussed and how they are controversial relative to human health.
Exposure to sunlight is also part of the consideration. As stated, sunlight damages
skin. Sunscreens or more accurately UV filters are without an endogenous biological
target, i.e., lacking pharmacological activity. As such, application of such products to
the skin has no effect in the absence of sunlight. Thus, for sunscreens, the product expo-
sure is coupled inextricably to sunlight and serves as the basis for all the controversies.
8.3 Exposure: Efficacy Testing (Sun Protection

Factor or SPF)
Arguably, the most contentious issue involving sunscreens is the widely held view,
supported by numerous studies, that they are under dosed, i.e., not enough is
applied, under ad-lib conditions. This view is tied inseparably to the SPF test which
has for decades been conducted using a dose of 2 mg/cm2 [23, 29, 71]. The reason
for using 2 mg/cm2 in SPF test has little to do with consumer use. As with any
procedure that may be used to support a product claim, reproducibility is
paramount to widespread acceptance. To have a universally applied laboratory
result, the inter- and intralaboratory variability must be low; otherwise test results
become untrustworthy. One of the primary sources of variability in the SPF test and
known for many years is product application [71]. As the SPF test was being
developed into a uniform, international method, largely led by the cosmetic trade
association in Europe, Cosmetic Europe or CE, formerly COLIPA, it was agreed
that 2 mg/cm2 application dose was reproducible. There was never the intention of
this efficacy test to mirror how a consumer used the product. It is, in fact, an
unreasonable expectation given habits and practices differences and diverse product
forms, e.g., water-resistant recreational products vs. moisturizers or lipsticks. As a
result, the SPF test is conducted as a means for product comparison and not an
absolute efficacy value. Unfortunately, too many professional/nonprofessionals
interpret SPF as an in-use, absolute quantitative value of efficacy. As stated and
generally speaking, it is not.
Finally, it is worth noting that there exists a standard method for determining
in vivo SPF, ISO 24444, which has been adopted, worldwide, except for the USA,
although in all methods, the application density is the same, i.e., 2 mg/cm2.
8.3.1 What Dose Are Sunscreens Applied Under ad-lib

Conditions and Why
It is a frequent comment that patients/consumers do not use enough sunscreen

product, which, as presented above, is in reference and comparison to the amount of
product used in SPF testing. However, there are two aspects that require some
consideration. First, what are the data that ad-lib product dosage is below 2 mg/cm2,
and, second, what is the evidence that users of products under such real-world
conditions are not protected?
There are a number of studies that support the view that people do not apply
sunscreen product at 2 mg/cm2. These data are summarized in Table 8.1. For 30
years, it has been reported that under natural or ad-lib conditions, e.g., beach
or daily activities, of varying duration, product application is less than 2 mg/
cm2. While the methods vary, the majority of the studies presented in Table 8.1
are single use, i.e., apply product and measure how much was used under real-
world or laboratory conditions, with the exception of [60]. The point of all
these studies is that 2 mg/cm2 application is not what consumers use. What is
underrepresented in this list of studies is the use of different forms, e.g., sprays,
sticks, and nonrecreational sunscreen products, e.g., facial moisturizers with
UV filters.
The reasons consumers may not apply 2 mg/cm2 are complex and multifac-
eted. To begin with, the motives for selecting a sunscreen and the SPF have
some effect on application amount. For example, a recreational product that is
high SPF, e.g., 3050+, applied to large body surface areas and water or sweat
resistant may be used for high-intensity UVR exposure during mid-day sun
with little/no shade, e.g., playing golf or going to the beach. In contrast, a daily
facial moisturizer maybe selected for normal, everyday exposure, which may
be intermittent and low intensity where limited skin is exposed to sunlight.
Using these examples, a recreational product is likely applied at doses consis-
tent with the results shown in Table 8.1 but perhaps reapplied following activi-
ties such as swimming or sweating. A daily moisturizer with SPF, on the other
hand, may be applied once in the morning and not reapplied at all during the
day. Finally, given the aesthetic differences between recreational and daily use
products, the later may be applied at a dose approaching 2 mg/cm2 (Nash and
Tanner, unpublished data).
Importantly, variability in applied dose of sunscreen product is not unique to
this category but is a question for any topically applied product, drug, or otherwise.
In contrast to orally administered medicines, topically applied products do not dis-
pense a fixed amount or dose with a template for surface area to be treated to best
achieve the desired therapeutic or cosmetic effect. It is more common that product
dose is left to the patient/consumer applying the product, e.g., apply generous
amount. In this regard, aesthetics play a much greater role in topical product
application.
Table 8.1 Summary of studies evaluating sunscreen application

Measured dose
Measurement Product (mg/cm2)
Author (year) Methods technique description Mean Median
Stenberg and 50 individuals, Weight 5 creams in 0.91.3
Larko (1985) one time full body jars
[75] use
Bech-Thomsen 42 individuals at Weight Subject 0.49
and Wulf beach, ad lib, one controlled
(1992) [9] time full body use
Azurdia et al. 10 photosensitive Fluorescence Tube 0.5
(1999) [6] patients, one time
full body use
Autier et al. 124 students, Weight 2 0.39
(1999) [3] ad-lib full body sunscreens
use over summer in tubes
Azurdia et al. 6 photosensitive Fluorescence Bottle 0.11
(2000) [7] patients, single baseline
use on the head, 0.821.13
neck, arms post
assessed before/ education
after education
Neale et al. 595 individuals, Weight Cream in 0.99 0.79
(2002) [60] ad-lib home use bottle
on the head, neck,
hands, and arms
for 4.5 years
Maier et al. 28 individuals, lab Weight 2 lipsticks 0.86,
(2003) [51] study 0.98 lab
18 individuals, 1.58, 1.76
ad-lib use skiing ad-lib
Lademann 60 individuals, Tape strip, Subject <0.2
et al. (2004) ad-lib full body HPLC controlled
[46] application 0.5-4
h prior to
measurement
Szepietowski 49 young adults, Weight Emulsion 0.92
et al. (2004) one time full body Cream 0.96
[77] use
Thieden et al. 340 individuals, Subject
(2005) [79] home use over 4 controlled
months UV
tracked via
dosimeter
Reich et al. 52 individuals Weight Cream in 0.68
(2009) [70] no instructions tube 0.86
53 individuals
instructions one
time full body use
(continued)
Table 8.1 (continued)

Measured dose
Measurement Product (mg/cm2)
Author (year) Methods technique description Mean Median
Bauer et al. 13 individuals, Swabs, 1.4
(2010) [8] use on forearms spectrophoto-
meter
De Villa et al. 36 individuals, Tape strip, Emulsion 0.43 (1 use)
(2011) [16] use on forearms HPLC 0.95 (2 uses)
Diaz et al. 87 children, 1 Weight Pump, 0.75 (pump)
(2012) [17] week full ad-lib bottle, and 0.57 (bottle)
use at home roll-on 0.22 (roll-on)
Petersen et al. 20 sun seekers on Weight Subject 0.79
(2013) [66] holiday, ad-lib full controlled
body use for 6
days
Novick et al. 52 individuals, Weight Lotion, 1.1 (lotion)
(2015) [62] lotion, stick use spray, and 1.6 (spray)
on the forearm, stick 0.35 (stick)
spray assessed by
application on a
paper towel
8.3.2 What Factors Influence Topical Product Usability?
Forgetting for the moment UV filters and film-forming characteristics which are
critical for sunscreen product efficacy, attributes like the scent, feel, and optical
appearance on the skin would be expected to impact how much and how often, i.e.,
frequency, it is used. If consumers do not like the feel, e.g., sticky and greasy, scent,
e.g., chemical base odor, or on-skin appearance, e.g., shine and whiteness of the
product, they will use less and perhaps avoid reapplication. Thus, formulating better
sunscreen products is about much more than just performing well in SPF clinical
tests or having new UV filters. What dose and reapplication translate into is com-
pliance, which is rarely discussed when considering sunscreens.
Another characteristic that impacts sunscreen dose is film-forming properties
and thickness. From a technical standpoint, the ability of a sunscreen product to
form a uniform film on the skin is closely tied to efficacy [63, 74]. In fact, film
formation/thickness is likely the key reason that product application is one of the
primary sources of variability in SPF testing, as mentioned earlier. As well, the film
formation/thickness has implications related to reapplication. To understand this,
one needs to consider the topography of the skin (Fig. 8.1). Macroscopically, the
surface of the skin is made up of hills and valleys. A thin layer applied over such
topography may result in uneven coverage where valleys are filled/covered, but
peaks are not. The analogy Diffey uses is that of painting a wall with an uneven
surface [18]. The first coat/application doesnt provide adequate coverage, and
therefore two coats (reapplication) are required. However, one goal of sunscreen
Fig. 8.1 Schematic a Glass Plate

representation of
hypothetical sunscreen
product applied at the same
dose to (a) glass plate, b Non-uniform film
(b) skin as a nonuniform
film, and (c) skin as a
uniform film
c Uniform film
product development is to create products that have uniform film formation, high
efficacy, under ad-lib conditions of use. In this regard, uniform coverage may be
obtained at less than 2 mg/cm2. Certainly, the more product applied, the more likely
coverage will be achieved and in lock-step the more negative attributes such as
greasiness and product remaining on the skin, i.e., not absorbed,2 come into play.
In general, the combination of product attributes, efficacy, and experience drives
how much product is applied and/or reapplied.
8.3.3 What Is the Evidence That Sunscreens Do Not Work

Under ad-lib Use?
Studies of acute sunscreen product failure under ad-lib use conditions are limited or
a secondary objective. Some examples which have reported erythema/sunburn in
people using sunscreen include McCarthy et al. [53] and Wright et al. [88]. Again,
in these examples and other such studies, it is difficult to know if sunburn was due
to inadequate dose or missed area on the body or overexposure to sunlight or
combinations of these. For example, intentional misuse of sunscreen to prolong
time spent in the sun for tanning purposes can result in sunburn suggestive of
product failure [24]. What is not factored into product failure are the millions if
not billions of product applications where sunburn has been prevented. Finally, the
work of Green et al. in the Nambour Skin Cancer and Actinic Eye Disease Prevention
2
Absorption in this context is a term used to describe whether a consumer feels product
remaining on the skin after application. It is not used in the context of pharmacokinetics, i.e.,
absorption into the skin, but rather an aesthetic attribute.
Trial [34, 35, 41], Thompson et al. [80], Naylor et al. [59], and Gallagher et al. [28]
are suggestive that repeated, regular application of sunscreen under ad-lib use
prevent precursors as well as actual long-term skin damage supportive of the view
that ad-lib sunscreen use is efficacious.
8.3.4 What Is the Frequency and Duration of Sunscreen Use?
The use of sunscreens is not limited to amount of product applied. The frequency of
application or reapplication and duration of use are critical in understanding
exposure and efficacy. In an experimental context, these have not received as much
attention as the amount of product applied. As such, the number of prospective,
stand-alone studies is less compared to those where amount of product applied has
been investigated. Nonetheless, there are some studies that have investigated
sunscreen product reapplication [13, 16, 64, 65, 82].
The duration of use has been studied in a limited number of prospective studies.
The most important of such studies is that of Adele Green and colleagues [34, 35,
41]. Others, as mentioned above include the work of Thompson et al. [80], Naylor
et al. [59], and Gallagher et al. [28].
Consumers do not apply enough sunscreen product to achieve the labeled SPF,
but this does not mean the product failed or there is no efficacy. On the contrary, the
preponderance of data supports the view that protection from harmful UVR is
achieved under normal use conditions. There are numerous opportunities to
reinforce behaviors including reapplication and daily use, which have been shown
to have real benefits (see above) and, in theory, if started early in life would have the
greatest impact [19, 76]. Unfortunately, the controversies related to amount/dose
applied and lack of short-/long-term benefits obscure the benefits and public health
message.
8.4 Exposure: Human Safety Assessment
The preceding discussion focused on under dosing or too little sunscreen

product exposure. There is the other side of the coin that sunscreen use under ad-lib
conditions represents a human health risk from too much exposure to such
products. The focus of this controversy will be UV filters and their potential
safety concerns including inhalation, endocrine, and systemic bioavailability. Like
most sunscreen controversies, safety concerns have been addressed by others
including but not limited to nano sunscreens and ingredients beyond UV filters,
e.g., vitamin A analogs such as retinyl palmitate, and therefore the scope of the
current discussion will be limited [14, 50].
For ingredients used in topically applied products, a common approach used to
determine human safety is quantitative risk assessment (QRA). Such a method,
modeled after National Research Council [54], is used frequently to assess many
different chemicals used by humans and by design is a key part of toxicology/
product safety [37]. Many authoritative, e.g., Scientific Committee Cosmetic Safety,
and regulatory agencies, e.g., Environmental Protection Agency, around the world
use QRA as part of their approach toward ensuring consumer safety.
In the USA, there are nine UV filters commonly used in sunscreen products [83].
It is beyond the scope of this paper to review the safety of each UV filter in any
depth, and the interested reader may consider [30, 50, 58] for more information.
However, among the human safety concerns related to these UV filters and sunscreen
product exposure are: (1) spray products and inhalation, (2) endocrine disruption,
and (3) systemic absorption from lifetime exposure, i.e., cradle to grave, including
subpopulations, e.g., geriatric.
A complexity associated with safety controversies and sunscreens is what drives
the concern? Is it the product, one of the UV filters, or a combination? The attempt
here will be to outline the controversial concern and provide general comments with
support by specific examples knowing that this will be limited by design.
Sunscreen spray products became more widely available in the decade of 2000
as a convenient means of product application particularly for children. Whereas
pump sprays had been available for some time, the propellant-based continuous
sprays represent a new form that has grown and by some estimates represents up
to 50 % of recreational sunscreen product market in the USA [1, 20]. Spray products
are thought to improve coverage, dosage, and drive compliance (see Novick et al.
Table 8.1). The concern, however, is inhalation particularly among children. The
toxicological profile of UV filters following the inhalation route of administration
has not been systematically investigated. However, human exposure is intermittent,
indirect, and restricted to nasal passages and to a lesser extent the upper respiratory
tract based on the size of droplets [20]. Beyond the local effects in these tissues, i.e.,
nasal/upper part of the lung, systemic effects would be dependent on the exact UV
filter and the availability of repeat exposure data perhaps generated from another
route of administration, e.g., oral or diet. Whereas each marketed sunscreen spray
product would need a safety evaluation based on specific properties and UV filters,
in general, exposure to ingredients would be limited if not negligible.
UV filters have been shown to have endocrine effects in screening-type toxico-
logical studies with benzophenone-3/oxybenzone [84], 4-methybenzylidene-
camphor/4-MBC [56], and octyl methoxycinnamate/OMC [5], receiving the most
attention [87]. Clearly, in vitro screening studies and findings in animals are sugges-
tive of weak endocrine effects of select UV filters. The limited human studies have
found internal concentrations of select UV filters in ng/ml range with no impact on
measures of endocrine function, i.e., basal concentrations of hormones [42]. Greim,
discussing endocrine disruption, made the following observation: Overall, the sci-
ence-based knowledge on the robustness of the endocrine system, the well-under-
stood principles of substrate-receptor interactions, and the generally low exposure of
humans to potentially endocrine-disrupting chemicals make it unlikely that the latter
play a causative role in diseases and abnormalities observed in children and in the
human population in general [36]. That is not to dismiss the notion of subtle endo-
crine effects attributed to UV filters but in the context of systemic exposure follow-
ing topical application, the risk is consider by many to be minimal if not negligible.
In the context of endocrine disruption, it is worth pointing out vitamin D might
be considered as having endocrine properties and most notably is activated by
sunlight in the skin. Hence, by definition, sunscreens disrupt vitamin D by
reducing photochemical activation. So much has been written on this controversy,
and still the debate continues. Suffice it to say that the argument persists with
staunch supporters of sunscreens not affecting vitamin D under ad-lib use and
equally dedicated opponents suggesting sunscreen use has an unfavorable effect on
serum vitamin D and the risk outweighs any possible benefit [11, 31, 33, 39, 40, 44,
73]. Perhaps the only undisputable facts are that sunscreens, by design, have the
potential to reduce photochemical conversation of vitamin D, while systemic
endocrine effects mediated directly by UV filters is, at best, weak.
Systemic absorption and lifetime exposure to UV filters after topical application
came to attention of the scientific community in the late 1990s following the Lancet
publication by Hayden et al. [38]. Although studies preceding this exist, most had
minimized the idea of systemic bioavailability of UV filters, perhaps in a dismissive
manner. UV filters may penetrate into/through the skin [52, 55, 81, 85], to cite a few
examples. Most studies have found limited penetration, but as analytical detection
methods improve, it is quite likely to see more examples demonstrating systemic
absorption from clinical investigations and in biomonitoring, e.g., NHANES.
The concern related to the potential topical bioavailability of UV filters is
systemic toxicity. In years past, many risk assessments focused only on local effects,
e.g., skin irritation, sensitization, phototoxicity, or photoallergy. With evidence of
absorption following topical application, there are reasons to consider systemic
toxicity. This, again, comes down to the data for individual UV filters supportive of
repeat exposure. Importantly, the presence of a substance is not evidence of toxicity.
This seems to be a common misconception.
The examples of human safety concerns, inhalation, endocrine effects, and sys-
temic toxicity from topically applied sunscreens have been presented in a very
superficial manner. The point of these examples is that there are fears of too much
exposure to sunscreen/UV filters. This is largely independent of any benefits that
use of such products might offer. The controversy regarding too much exposure
to sunscreen products remains an active area of interest.
8.5 Conclusions
This everlasting controversy involving sunscreens is a variant of the story attributed

to Robert Southey of Goldilocks and the Three Bears. Goldilocks stubbles upon
the home of the three bears while walking in the forest. Upon entering the house,
she finds three bowls of porridge, three chairs, and three beds. She finds two of the
porridge bowls, chairs, and beds unacceptable, i.e., too hot/cold, too big, and too
hard/soft, respectively, but one just right. When the bears return home, they
eventually discover Goldilocks who in her fright flees never to be seen by the bears
again. Sunscreens are considered to be used not enough or relied upon too frequently
or by some just right. Yet, in the end, the user is confused and possibly frightened
away by all the controversy and divergent opinions.
Of course, this analogy isnt nearly as black and white for sunscreens. For years,
the same controversies find their way into articles or on websites generally coin-
ciding with the advent of summer. People dont apply enough, and the ingredients
are unsafe, i.e., too much/toxic. The controversies will not go away, but that
shouldnt be a cause to abandon efforts.
In the end, the responsibility to public health begs for a consistent message that
can be applied for all to follow. A single message to limit sun exposure and follow
the guidelines that have proven effective in Australia, namely, wear protective
clothing, use a sunscreen product on skin exposure to sunlight and seek shade/
shelter, may be the means of improving public health particularly as humans extend
the life span and therefore cumulative exposure to sunlight. Rather than confuse
people with messages of use an SPF 30 or SPF 15 daily, it should be agreed that a
consistent message would benefit the public.
Beyond consistence in messaging, it would be of value to consider practical
advice. For example, sunscreens in the USA and elsewhere are largely viewed as
recreational products to be used as needed. So the idea of daily application hardly
resonates with a typical user of such products. This is just common sense: Why
apply a recreational product on days I will have little exposure to sunlight. Yet those
days are thought to account for much of the cumulative damage [61]. Additionally,
in a heterogeneous society like the USA, significant segments of the population
including African-/Asian-Americans and Latinos may not use sunscreen products
because they believe it is unnecessary, even though photodamage occurs in all skin
types. Again, with regard to sunscreens, the idea of an SPF 30 applied daily in the
context of recreational products, i.e., those applied to large surface areas, is unlikely
and for the average person not affordable. Unfortunately, even well-meaning
conscientious advocates may be missing an opportunity.
The controversy is around just right. It is the responsible act to promote sun
safety of which sunscreens are a key part. The single message might be: wear sun-
screen, SPF 15 broad-spectrum or greater on exposed skin. Reapply as needed. If this
encourages people to try sunscreen, it is quite possible that such trail will lead to retrial
and rather than using high SPF, e.g., 3050+, a new user can begin with a SPF 15.
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Part II
Chapter 9
The Chemistry of Ultraviolet Filters
Nadim A. Shaath
Key Points
This chapter describes the mechanism of action for both Inorganic
particulates and organic ultraviolet filters. It classifies all ultraviolet filters
in commerce today and lists their physical, chemical, and spectroscopic
properties as well as their regulatory status.
Synthetic approaches for the design of the current and future UV filters are
discussed, and the photostability of ultraviolet filters is addressed.
It concludes with an analysis of the future direction in designing new,
safer, and more effective ultraviolet filters.
9.1 Introduction
The chemistry of ultraviolet filters is complex, and understanding the interaction

between UV light and those compounds provides insights on how sunscreen works.
Possessing the knowledge for a more intelligent design and development of novel
UV filters can provide efficient and stable UV protection. Although much progress
has been made in the advancement of ultraviolet filters in the past five decades,
progress is slow and often hampered by regulatory restrictions [1, 2]. For example,
little has changed in US regulations since 1978 when the Advanced Notice for
Public Record (ANPR) was issued. At the time, 21 UV filters were considered
Category I Ingredients (see Table 9.1), and their use in cosmetic formulations, at
the percentages approved, allowed manufacturers to claim appropriate SPF (sun
protection factor) on their labels.
N.A. Shaath, PhD

Alpha Research and Development, Ltd., White Plains, NY, USA

DOI 10.1007/978-3-319-29382-0_9
144 N.A. Shaath
Table 9.1 Twenty-one UVA absorbers/reflectors %

approved UV filters in
Oxybenzone 26
1978 in the USA
Sulisobenzone 510
Dioxybenzone 3
Menthyl anthranilate 3.55
Red petrolatum 30100
Titanium dioxide 225
UVB Absorbers
Aminobenzoic acid 515
Amyl dimethyl PABAa 15
2-Ethoxyethyl p-methoxycinnamate 13
Diethanolamine p-methoxycinnamatea 810
Digalloyl trioleatea 25
Ethyl 4-bis(hydroxypropyl) aminobenzoatea 15
2-Ethylhexyl-2-cyano-3,3-diphenyl-acrylate 710
Ethylhexyl p-methoxycinnamate 27.5
2-Ethylhexyl salicylate 35
Glyceryl aminobenzoatea 23
Homomenthyl salicylate 415
Lawsone with Dihydroxyacetonea 0.25
Octyl dimethyl PABA 1.48
2-Phenylbenzimidazole-5-sulfonic acid 14
Triethanolamine salicylate 512
a
These items have been deleted in the Final Monograph in 1999.
Three additional items have been added since, namely, avoben-
zone (13 %), ecamsule (up to 10 %), and zinc oxide (225 %)
With the inclusion of any of those UV filters, protection from skin cancers
was considered possible, and US companies could claim that sunscreens reduce
the risk of skin cancer and early skin aging when used as directed, if the final
sunscreen product has SPF >15 and critical wavelength 370 nm. Despite the
increased use of sun care products since then, incidences of skin cancer have
quadrupled with no sign of abatement. Are people lulled into a false sense of
security when they use sunscreens? All this sun damage begs the question: do
sun care products provide enough protection? The search for the ultimate UV
filter goes on, and protocols for superior protection are still underway with lim-
ited success.
In this chapter, I will review the approaches for designing the current UV filters
that have been approved and are available for use worldwide. Understanding how
filters work can help us to determine if they offer consumers adequate protection
from the sun.
9 The Chemistry of Ultraviolet Filters 145
9.2 Mechanism of Sunscreen Action
Electromagnetic rays interact with UV filters by either absorbing or scattering of

their energy. The dispersion of inorganic particulates scatters and reflects the
harmful rays. Inorganic particulates, however, also have the ability to absorb the UV
radiation.
When a molecule absorbs a UV photon, the electrons in its highest occupied
molecular orbital (HOMO) are promoted to its lowest unoccupied molecular orbital
(LUMO) as shown in Fig. 9.1.
This singlet excited state can be deactivated by a simple vibrational relaxation
back to the ground state, through fluorescence of the molecule, or by undergoing
photochemical reactions. On the other hand, under certain conditions, the singlet
excited state can undergo an intersystem crossing that leads to a triplet excited state
as shown in Fig. 9.2.
The energy in the triplet state may be dissipated in a number of ways, as shown
in Fig. 9.2:
Fig. 9.1 Absorption of

energy by LUMO
an organic UV filter
h
HOMO
Excited Singlet
State
Intersystem
Excited
Vibrational Relaxation
Crossing
Triplet
State
Intersystem Crossing
Flourescence
Absorption
Phosphorescence
Photoproduct
Photoproduct
Ground State
Fig. 9.2 Energy release pathways

146 N.A. Shaath
Fig. 9.3 The band gap energy in inorganic particulates Conduction band
between valence and conduction bands
e- band gap
valence band
1. Emission of a photon (phosphorescence)

2. Energy transfer to other receptor molecules (T-T transfer)
3. Photochemical reactions
The inorganic particulates, on the other hand, either scatter or absorb the UV
radiation. These particulates are semiconductors with high bandgap energy between
the valence and conduction band (between 380 and 420 nm) as shown in Fig. 9.3.
The wavelength of absorption varies with the particle size of the inorganic par-
ticulates. The smaller the primary particulate size is, the higher the bandgap energy.
9.3 Classification of Ultraviolet Filters
Ultraviolet filters can be broadly classified into two types: UV absorbers and
inorganic particulates. There are only two inorganic particulates approved: zinc
oxide and titanium dioxide. Both ingredients are considered broad spectrum since
they absorb, scatter, and reflect UVB and UVA rays depending on their particle size.
The remaining UV-absorbing molecules are classified as either UVB or UVA filters
or both.
There are about 55 ultraviolet filters that are approved for use in sunscreen prod-
ucts globally, but only 10 of them are approved uniformly for international con-
sumption [3, 4]. Table 9.2 lists their UV absorbance maxima (max) and their
specific extinction E (1 %, 1 cm), namely, the nominal absorbance at the absorption
maximum of a 1 % solution of the filter in a 1 cm optical pathway cuvette, the molar
absorption coefficient (mol1 cm1), along with the countries or regions where
they are approved. Each filter is approved or rejected according to regional require-
ments. Note that currently there are only ten UV filters that are approved uniformly
worldwide and are marked with an XXX in Table 9.2 under category country/region.
9.4 The Chemistry of Ultraviolet Filters
To illustrate the relationship between the chemical structures of all of these

approved UV filters and their UV-absorbing characteristics, I will review one of the
oldest UV filters in use, namely, PABA (para-aminobenzoic acid) and its deriva-
tives. PABA has a max of 290 nm with an extinction coefficient E1 (1 %, 1 cm)
9
Table 9.2 The properties of the 55 approved UV filters worldwide

3
max, E1(1 %, dm3
2/ E2 (1 %, 1/dm
INCI name Country/regiona UV/region 1/nm 1 cm) mol1 cm1 max,2/nm 1 cm) mol1 cm1
Benzophenone AZ UVA/B 284 10,300 340 8950
Benzophenone-1 JN, SA UVA/B 291 630 12,265 328 420 10,265
Benzophenone-2 AZ, JN, SA UVA/B 287 580 13,700 349 410 9400
Benzophenone-3 XXX ALL UVA/B 286 630 14,380 324 400 9180
Benzophenone-4 EU, US, AZ, CA, UVA/B 286 440 13,400 324 360 8400
JN
Benzophenone-5 EU, CA, JN, SA UVA/B 286 430 323 345
Benzophenone-6 JN, SA UVA/B 284 490 13,500 323 390 12,950
Benzophenone-8 US, AZ, CA, SA UVA/B 284 380 13,270 327 300 10,440
Benzophenone-9 JN, SA UVA/B 284 260 331 175
3-Benzylidene Camphor EU, SA UVB 289 890 21,360
Benzylidene camphor sulfonic acid EU, AZ, JN, SA UVB 294 860 27,600
Beta, 2-glucopyranoxy propyl JN, SA UVA/B
hydroxy Benzophenone
Bis-ethylhexyloxyphenol EU, AZ, SA UVA/B 310 745 46,800 343 820 51,900
methoxyphenyl triazine
Butyl methoxydibenzoylmethane XXX ALL UVA 357 1110 34,140
Camphor benzalkonium methosulfate EU, AZ, SA UVB 284 590 24,500
Cinoxate US, AZ, CA, JN, UVB 308 825 20,650
SA
DEA methoxycinnamate CA, SA UVB 290 880 24,930
Diethylamino hydroxybenzoyl hexyl EU, AZ, JN, SA UVA 354 925 35,900
benzoate
Diethylhexyl butamido triazone EU, SA UVB 311 1460 111,700
(continued)
147
148
max, E1(1 %, dm3

2/ E2 (1 %, dm3
1/
INCI name Country/regiona UV/region 1/nm 1 cm) mol1 cm1 max,2/nm 1 cm) mol1 cm1
Digalloyl trioleate SA UVB
Diisopropyl methyl cinnamate JN, SA UVB
Dimethoxyphenyl-[1-(3,4)]-4,4- JN, SA UVA
dimethyl 1,3 Pentanedione
Disodium phenyl dibenzimidazole EU, AZ, SA UVA 335 770 51,940
tetrasulfonate
Drometrizole JN UVA/B 300 340
Drometrizole trisiloxane EU, AZ, JN, SA UVA/B 303 310 16,200 341 300 15,500
Ethyl Dihydroxypropyl PABA CA,SA UVB 312 27,000
Ethylhexyl dimethoxy benzylidene JN, SA UVB
dioxoimidazoline propionate
Ethylhexyl dimethyl PABA XXX ALL UVB 311 990 27,300
Ethylhexyl methoxycinnamate XXX ALL UVB 311 850 23,300
Ethylhexyl salicylate XXX ALL UVB 305 165 4130
Ethylhexyl triazone EU, AZ, JN, SA UVB 314 1550 119,500
Ferulic acid JN, SA UVB
Glyceryl ethylhexanoate JN, SA UVB
dimethoxycinnamate
Glyceryl PABA CA, JN, SA UVB 297 780 18,700
Homosalate XXX ALL UVB 306 180 4300
Isoamyl p-methoxycinnamate EU, AZ, JN, SA UVB 308 980 24,335
Isopentyl trimethoxycinnamate JN, SA UVB
trisiloxane
Isopropyl benzyl salicylate AZ, JN UVB
Isopropyl methoxycinnamate JN, SA UVB
N.A. Shaath
Lawsone + dihydoxyacetone UVB

9
Menthyl anthranilate US, AZ, CA, JN, UVA 336 190 5230
SA
4-Methylbenzylidene camphor EU, AZ, CA, SA UVB 300 930 23,655
Methylene bis-benzotriazolyl EU, AZ, JN, SA UVA/B 305 400 26,600 360 495 33,000
tetramethylbutylphenol
Octocrylene XXX ALL UVB 303 340 12,290
PABA XXX ALL UVB 283 640 15,300
PEG-25 PABA EU, AZ, JN UVB 309 180
Pentyl dimethyl PABA JN UVB 310 310
Phenyl benzimidazole sulfonic ALL UVB 302 920 26,060
acid XXX
Polyacrylamido methylbenzylidene EU, SA UVB 297 610 19,700

camphor
Polysilicone-15 EU, AZ, JN, SA UVB 312 180 108,000
Salicylic acid AZ UVB 300
TEA salicylate US, AZ, CA, SA UVB 298 120 3000
Terephthalylidene dicamphor EU, AZ, CA, JN, UVA 345 750 47,100
sulfonic acid SA
Titanium dioxide XXX ALL UVA/B
Zinc oxide EU, US, AZ, CA, UVA/B
JN, SA
a
EU EU, US USA, AZ AUS/NZ, CA Canada, JN Japan, SA S. Africa. For official regulations, consult specific country/region agencies
Note: E (1 %, 1 cm) is the specific extinction, and (dm3mol1 cm1) is the molar absorption coefficient
149
150 N.A. Shaath
OR OR
+
R2N C R2N C

O O
Fig 9.4 The electron delocalization in PABA molecule
of 640 or a 1(dm3 mol1 cm1) of 15,300. That characterizes this molecule as an

efficient UVB filter which could yield SPF of over 8 by itself alone and in combi-
nations can yield SPF well over 15 in cosmetic formulations. This molecule and its
octyl (2-ethylhexyl) derivative, namely, padimate-O, were the workhorse mole-
cules for producing efficient UVB protection in the USA in the past decades. These
molecules have fallen out of favor recently as they tend to discolor and stain cloth-
ing and, most importantly, were implicated in a number of irritation cases by the
consumer. Nevertheless, these molecules served as elegant examples of how sun-
screen molecules exert their UV protection action. These molecules possess both
an electron-releasing group (NR2) and an electron-accepting group (COOR),
group that is situated in a para-position on the basic benzene (aromatic) molecule.
This configuration allows for an efficient electron delocalization, with an energy
requirement corresponding to an ultraviolet absorption of about 311 nm. Due to
symmetry consideration and the ease of electron delocalization in the molecule,
the absorption (as measured by its extinction coefficient) is quite high (990).
Figure 9.4 illustrates that process.
If this PABA molecule was substituted differently on the benzene ring, say, an
ortho-relationship instead of the para-relationship in PABA, the molecule would
behave quite differently. In fact, menthyl anthranilate, another approved UV fil-
ter in the USA that has an ortho-relationship between its amine and ester group-
ing, is no longer a UVB filter. It is considered a UVA filter with a UV absorption
of 336 nm but with a considerably weaker extinction coefficient E1 (1 %, 1 cm)
of 190. In examining the electron delocalization process in the ortho-disubsti-
tuted amine (menthyl anthranilate or meradimate), it is quite apparent that other
processes are in play in this molecule, mostly through-space hydrogen bonding
that eases the energy requirements of the electron delocalization. Since energy
and wavelength are inversely proportional to one another, lower-energy require-
ments would produce a longer wavelength absorption. The through-space extra
electron delocalization in the meradimate molecule produces a desired batho-
chromic (to higher wavelength) to UVA protection but, unfortunately, signifi-
cantly lowers the ease of delocalization since the side chain hydrogen bonding
electron transfer deviates from planarity, increases the energy requirements, and
results in a lower extinction coefficient.
These two simple processes, namely, aromatic electron delocalization (contribut-
ing to the UV absorption) and the ortho-through-space hydrogen bonding (contrib-
uting to the ease of delocalization), are the basis of designing most of the ultraviolet
Fig 9.5 The para O OR

(parabens) with a lower
HO
max vs. the ortho
(salicylates) with a higher OR O
max
O H
parabens (max=260nm) salicylate (max=300nm)
OR OR
C C
O O
H + H
R O R O
Fig 9.6 Resonance delocalizaton and through-space hydrogen bonding in salicylate
filters in the world today. Numerous similar examples to illustrate the forces at play
in UV molecules are available. For instance, compare the parabens (para-disubsti-
tuted) to the salicylate (ortho-disubstituted molecules) in Fig 9.5.
Again, as predicted, the parabens would have a low UV absorbance of about
260 nm (that would not be considered a UVB filter) but with a considerable extinc-
tion coefficient, whereas the salicylates (homosalate or octisalate) have a higher UV
absorbance of 306 nm (UVB filter) but with a lower extinction coefficient of 180
due to its ortho-through-space hydrogen bonding as shown in Fig. 9.6.
For a detailed review of the mechanism of all the other approved UV filters (cin-
namates, benzopheones, dibenzoylmethanes, camphor, and triazone derivatives),
consult other references [2].
9.5 New Molecules Appearing on the World Market
A series of molecules have recently been designed in Europe with high molecular
weights (over 500 Da) to diminish their penetration into the skin. These molecules
possess multiple chromophores that yield high extinction coefficients and also
broad-spectrum protection [5]. They are, unfortunately, not yet approved in the
USA. They are listed in Table 9.3.
In the USA, there are eight applications pending under the process termed TEA
(Time and Extent Application) that, when approved, will undoubtedly enhance the
UV protection of American consumers from the cancer-causing rays [6]. Two of the
eight TEA ingredients, bemotrizinol and bisoctrizole, when approved for use in the
USA, can be used to impart more photostable sunscreen formulations. See Table 9.4
below illustrating the properties of these two UVA ingredients.
152
Table 9.3 EU-approved UV filters for sunscreens designed with Daltons of 500 or higher
/dm3 Mol. weight
Filter type UV filter INCI name COLIPA# Trademark (supplier) mol1 cm1 max (nm) (Dalton)
UVB Benzylidene malonate S74 BMP Parsol SLX (DSM) 108,000 314 ~6000
polysiloxane
Dioctyl butamido triazone S78 DBT Uvasorb HEB (3V Sigma) 111,170 312 766
Ethylhexyl triazone S69 EHT Uvinul T150 (BASF) 119,500 312 823
UVA Disodium phenyl dibenzimidazole S80 DPDT Neo Heliopan AP (Symrise) 52,400 334 675
tetrasulfonate
Terephthalylidene dicamphor S71 TDSA Mexoryl SX (LOreal) 47,100 345 607
sulfonic acid
UVA/UVB Bis-ethylhexyloxyphenol S81 BEMT Tinosorb S (BASF/Ashland) 42,800/47,500 310/343 629
methoxyphenyltriazine
Drometrizole trisiloxane S73 DTS Mexoryl XL (LOreal) 15,900/15,500 303/341 501
Methylene bis-benzotriazolyl S79 MBBT Tinosorb M (BASF) 32,000/38,000 305/360 659
N.A. Shaath
9
Table 9.4 Specifications of bemotrizinol and bisoctrizole [7]

Commercial name: Tinosorb S, Eusolex S, Tinosorb M
CH3
Structural formula: O
N OH OH N
N CH2 N
N N
OH N N OH
O O
Molecular formula: C38H49N3O5 C41H50N6O2

Molecular weight: 627.8 g/mol 658.86 g/mol
INCI name: Bis-ethylhexyloxyphenol methoxyphenyl Methylene bis-benzotriazoyl tetramethylbutylphenol (and) aqua (and)
triazine (BEMT) decyl glucoside (and) propylene glycol (and) xanthan gum
USAN name: Bemotrizinol Bisoctrizole
CAS-no: 187393-00-6 103597-45-1
Physical Appearance: Light yellow powder Aqueous white dispersion (50 % active)
max: 310 and 340 nm 305 and 360 nm
E (1 %,1 cm): 819 (in ethanol, 340 nm) 480 (in water, 360 nm)
c (critical wavelength) 373 nm 388 nm
UVA/UVB ratio: 0.73 1
Recommended level (%) 10 % in Australia and EU 3 % in Japan 20 % (10 % active) in Australia, EU, and Japan
153
154 N.A. Shaath
9.6 Inorganic Particulates
These ingredients are chemicals that reflect, scatter, and absorb the UV radiation.
They include titanium dioxide and zinc oxide. They are available in micronized and
nanosized forms that enhance sun protection without imparting the traditional
opaqueness that was aesthetically unappealing in cosmetic formulations. These
metal oxides are reactive and insoluble in cosmetic formulations without chemical
treatment. This treatment includes coating of the metal core and dispersion and
suspension of the particles with oils, solubilizers, and emollients [8, 9]. Many users
falsely believe that natural claims are admissible if only inorganic particulates are
used in sunscreen products. Unfortunately, most of these chemical treatments ren-
der the inorganic particulates synthetic and unnatural.
There has been a shift to zinc oxide from titanium dioxide recently, mostly due
to its broad-spectrum and higher UVA protection. It is also popular since it has a
lower refractive index of 1.92.0 compared to titanium dioxides 2.52.7, which
leads to superior transparency. Recently, ZnO was also approved in Europe. In the
USA, combinations of ZnO and TiO2 with avobenzone are still not allowed.
Titanium is the ninth most common element on the Earths crust. In nature, it
exists only in combinations with other elements such as iron and oxygen. Three
titanium ores are of commercial importance: ilmenite, rutile, and anatase. Ilmenite
is a composite of oxides of iron and titanium. Rutile and anatase are also never pure
and contain various amounts of metal including those that may pose health hazards
to humans. Therefore, commercial TiO2 is always synthetic [8]. Rutile and anatase
have different crystalline structure and different physical and chemical properties.
Of the three forms of TiO2, rutile is the most thermally stable.
Zinc ranks 24th in abundance on the Earths crust but never occurs free in nature.
It is widespread around the world with important deposits located in North America
and Australia. ZnO is produced by oxidizing vapors of Zn in burners. Pure ZnO is
typically a white or yellow-white powder.
The optical behavior of ZnO and TiO2 consists mainly of scattering or absorbing the
light. The scattering from molecules and very tiny particles is predominantly Rayleigh
scattering. When the particle size is at the same magnitude as the wavelength, Mie scat-
tering predominates. The absorption, on the other hand, is a function of the number of
atoms that interact with the light in its pathway. Light with a wavelength below 420 mm
has enough energy to excite electrons in the valence band and can be absorbed by the
inorganic particulate (see Fig. 9.3). Since the bandgap wavelength of ZnO is longer
than that of TiO2, ZnO absorbs a broader-spectrum range of UV light than TiO2. TiO2
is not considered an efficient UVA absorber; rather, it is an efficient UVB absorber. The
attenuation of UVA by TiO2, therefore, mainly takes place via scattering.
When using inorganic particulates, the following parameters need to be carefully
evaluated:
(i) The type of metal
(ii) The particle size
(iii) The coating
(iv) The oil

(v) The dispersant
(vi) The loading
(vii) The absorption coefficient
Each of the above parameters may influence the behavior, the concentration, the
solubility, the potential interactions, and, most importantly, the regulatory status of
the particulate and the final cosmetic formulation.
9.7 The Photostability of UVA Absorbers
As described earlier, the exposure of UV-absorbing molecules to solar radiation

may lead to photochemical reactions that can compromise both the physical
attributes of the UV filters (color, appearance, etc.) and their chemical properties
leading to undesirable reactions and by-products [10].
Avobenzone is one of the most important UVA filters in commerce today.
Unfortunately, this molecule is photounstable. In its enol form, it exhibits an
excellent UVA absorption at 357 nm, but in its diketo form, its absorption is in the
UVC region and thereby is ineffective as a UVA or UVB filter. See Fig. 9.7.
Other studies have also shown that avobenzone (enol form) reacts with other
molecules including ethylhexyl methoxycinnamate (USAN name, octinoxate) to
yield photo-adducts [11]. It has also been reported that upon exposure to UV radia-
tion, avobenzone tends to fragment into reactive species as shown in Fig. 9.8.
Approaches to improve the photostability of the UVA filters included the use of
glass beads and microspheres and the use of ROS quenchers, triplet-triplet (T-T)
and singlet-singlet (S-S) quenchers [10]. These quenchers, also termed excited-state
quenchers (ESQ), have recently appeared on the US market to circumvent the
photo-instability issues of avobenzone. The mechanism of T-T quenching has been
extensively reviewed in the literature [12]. These UV-absorbing quenching
H
O O O O
O O
Enol Keto
Fig 9.7 The keto-enol tautomerism of avobenzone
O O O O
C
+ CH2
OCH3 OCH3
Fig. 9.8 The fragmentation of butyl methoxydibenzoylmethane (avobenzone)

156 N.A. Shaath
molecules include octocrylene, 4 methyl benzylidene camphor, methoxycrylene,

polyester 8, diethylhexyl naphthalate (DEHN), and diethylhexyl syringylidene mal-
onate (DESM).
9.8 Future Direction
This illustration of the mechanism of UV action of the molecules we have today to

combat the rising incidence of skin cancer reveals a deficiency in our arsenal for UV
protection. The design of filters in the last century relied on small absorbing mole-
cules that tend to penetrate the skin and potentially may interact with substrates in
the body. In addition, the USA clearly has inadequate ingredients to protect con-
sumers properly from the UVA radiation. The workhorse of the so-called UVA
chemical absorbers, avobenzone, is photounstable and needs to be supported with
quenchers and other ingredients to remain active as a UVA filter. In addition, protec-
tion from the infrared rays is not addressed. Whenever the subject of skin damage
from the nonionizing infrared rays has come up in the past, it was summarily dis-
missed. IR rays were thought to be benign because of their relatively low energies
and frequencies. They are the source of most of the heat produced from the sun.
Recent evidence, however, has shown that the IR rays, particularly the IRA rays
(7501400 nm) penetrate much deeper into the skin, induce significant free radicals
in the dermis and diminish the skins antioxidant capacity [13]. IRA radiation has
been reported to upregulate an enzyme that destroys the collagen fibers (the matrix
metalloproteinase-1 (MMP-1) expression) [14]. Others recently reported that the
ultraviolet filters used in todays sun care regimens prevent no more than 55 % of
the damaging free radicals from the suns UV radiation but none of the IRA-induced
free radicals [15]. It is estimated that 65 % of the energy generated by the IRA radia-
tion reaches the skins dermal layers, the tissue responsible for the skins structure
with its fibers, elastin, and collagen. IRA biological effects cause the loss of elastic-
ity and reduced firmness thus leading to the formation of wrinkles and the aging of
the skin [1619].
9.9 Conclusions
Protection from the burning (erythemal) UVB rays is a basic requirement. Protection
from the UVA rays is paramount and so is protection from the damaging heat rays
and the longer wavelength radiation of the infrared [20, 21]. In my opinion, our
ingredients are woefully inadequate, especially the currently US-approved filters.
We can no longer ignore the facts: sunscreen ingredients in cosmetics are not
adequately preventing cancer incidence in the USA. We have lulled ourselves into a
false sense of security. A cream or a lotion alone cannot, at this date, guard you
entirely from the effects of the powerful sun. Heed all practical advice: wear
protective clothing, seek shade, avoid noon sun exposure, and do use adequate and
properly applied sunscreens. Until advanced ingredients are developed and
approved, use all available measures to mitigate the effects of the total spectrum of
the solar radiation.
References
1. Shaath NA (1986) The Chemistry of sunscreens. Cosmet Toilet 101(3):55

2. Shaath NA (2005) The Chemistry of ultraviolet filters. In: Shaath NA (ed) Sunscreens: regula-
tions and commercial development, 3rd edn. Taylor & Francis, New York, pp 217238
3. Shaath NA (2010) Ultraviolet filters. Photochem Photobiol Sci 9:407418
4. Shaath NA (2007) The encyclopedia of UV filters. Allured Publications, Carol Stream
5. Herzog B, Hueglin D, Osterwalder U (2005) New sunscreen actives. In: Shaath NA (ed)
Sunscreens: regulations and commercial development, 3rd edn. Taylor & Francis, New York,
pp 291320
6. Shaath NA (2013) The archaic TEA process revisited. The Sunscreen Filter. Happi, May 2013,
pp 4851
7. www.basf.com (Full report 2012) and www.ashland.com (Sunscreens with UVA protection
2014).
8. Schlossman D, Shao Y (2005) Inorganic ultraviolet filters. In: Shaath NA (ed) Sunscreens:
regulations and commercial development, 3rd edn. Taylor & Francis, New York, pp 239279
9. Shaath NA, Walele I (2005) Inorganic particulate ultraviolet filters. In: Shaath NA (ed)
pp 281290
10. Shaath NA (2007) SPF boosters & photostability of ultraviolet filters. HAPPI, Oct 2007,
pp 7783
11. Sayre RM, Dowdy JC (2005) Unexpected photolysis of the sunscreen octinoxate in the pres-
ence of the sunscreen Avobenzone. Photochem Photobiol 81(2):452456
12. Bonda C (2005) The photostability of organic sunscreen actives: a review. In: Shaath NA (ed)
pp 321352
13. Holzer A, Athar M, Elmets C (2010) The other end of the rainbow: infrared and skin. J Invest
Dermatol 130:14961498
14. Calles C et al (2010) Infrared A radiation influences the skin fibroblast transcriptome: mecha-
nism and consequences. J Invest Dermatol 130:14241436
15. Haywood R et al (2003) Sunscreens inadequately protect against UVA induced free radicals in
skin. J Invest Dermatol 121:862868
16. Lademann J et al (2011) Interaction between carotenoids and free radicals in human skin. Skin
17. Darvin M et al (2010) Radical production by Infrared A irradiation in human tissue. Skin
18. Schiek S, Schroeder P, Krutmann J (2003) Cutaneous effects of Infrared radiation. Photodermol
19. Cho S et al (2009) Effects of Infrared radiation and heat on human skin aging in vivo. J Invest
Dermatol Symp Proc 14:1519
20. Shaath NA (2012) Infrared radiation and skin protection. The Sunscreen Filter, HAPPI, March
2012, pp 5053
21. Shaath NA (2012) Sun protection should protect from IRA damage. The Sunscreen Filter,
HAPPI, May 2012, pp 5356
Chapter 10
Chemistry of Sunscreens
Susan Daly, Hao Ouyang, and Prithwiraj Maitra
Key Points
Sun filters can be classified as organic, organic particulates, polymeric, and
inorganic particulates.
The mechanism of action of all types of sun filters is primarily UV
absorption.
A global overview of sun filter approval levels, chemical structures, and
absorbance properties is included in this chapter.
Formulators must select the right combination of filters to deliver
photostable, broad-spectrum protection, with high SPF, and optimal
aesthetics to drive consumer compliance.
Regulatory approvals, the breadth and height of a sun filters UV
absorbance, and the sun filter solubility or dispersibility are key parameters
that formulators should consider during sunscreen design.
10.1 Introduction
Human skin is exposed daily to sunlight, which contains a significant amount of ultra-
violet (UV) radiation. It is well known that UV radiation can be harmful and that UV
exposure can play a significant role in development of skin damage [23, 27]. Various
compounds have been used to protect skin from the harmful rays of the sun over the
centuries. It is only over the last 100 years, however, that synthetic UV filters have been
developed to protect individuals from sunburn and UV-induced skin cancer [35].
S. Daly H. Ouyang P. Maitra (*)

JOHNSON & JOHNSON Consumer Companies, Inc,
199 Grandview Road, Skillman, NJ 08558, USA
e-mail: [email protected]; [email protected]; [email protected]

DOI 10.1007/978-3-319-29382-0_10
160 S. Daly et al.
For practical and historical purposes, the UV spectrum has been divided into UVA1
(340400 nm), UVA2 (320340 nm), UVB (290320 nm), and UVC (100290 nm).
UVC and some of the shorter UVB wavelengths emitted from the sun are filtered out
by the ozone before they reach the Earths surface. Both UVA and UVB rays can dam-
age DNA, lipids, and proteins; produce inflammation; and ultimately result in burns,
premature aging, and carcinogenesis [27, 30, 35]. An ideal sunscreen must protect the
user from UV radiation across the light wavelength spectrum associated with harmful
effects [24, 27].
10.2 Mechanism of Action of Sun Filters
Sunscreens protect skin from these harmful rays by forming a protective barrier on skin
surface. Most sunscreen active ingredients are organic molecules with conjugated, aro-
matic chemical structures. The mode of action of these sunscreen active ingredients is
primarily UV absorption [24]. By residing on skin surface as a film, these organic
molecules effectively transform the harmful UV energy to harmless forms of energy
and prevent the UV photons from entering into the skin [25, 30]. The electrons in these
chemical structures are active because they are capable of energy transfer when hit
by UV. Quantum mechanical calculations show that the energy of radiation quanta
present in UVB and UVA lies in the same order of magnitude as the resonance energy
of electron delocalization in aromatic compounds [35].
The electrons of sunscreen UV filters can accept the energy from UV photons and
move to higher electronic energy states. This energy can then be quickly converted
to heat by non-radiation energy dissipation or to other forms of light such as fluores-
cence, phosphorescence, or infrared rays [25]. The electrons will return back to
the ground state during the energy transfer, ready to receive the next UV photon. The
lifetime of excited states of these molecules is very short; therefore, as long as the
chemical structure of the sunscreen is stable at excited states, the process of excita-
tion and returning to ground states can occur continuously and repetitively without
any loss of efficacy.
A few sunscreen active ingredients are not photostable. The chemical structures of
these non-photostable molecules can change while the chemical is in the excited state
(photochemical reactions). When that happens, the original molecules are broken down
and not capable of repeating the excitation process and more importantly cannot absorb
the next UV photons. With the degradation of the original active ingredients, free radi-
cals (including singlet oxygen) may be generated that may then react with nearby mol-
ecules to form photobyproducts. Thus, the efficacy of the sunscreen decreases because
less active ingredients remain to absorb more incoming photons.
Sun filters do not need to penetrate into the skin in order to be effective. As
soon as the sunscreen film is present on skin surface, there will be at least some
level of protection because of its inherent absorption properties. The final protec-
tion level may be enhanced as the product dries on the skin and the film structure
is optimized [32].
10 Chemistry of Sunscreens 161
10.3 Chemical Classification of Sun Filters
There are a number of different sun filters approved for the use in sunscreen products
around the globe. Currently, 16 sun filters are approved for sunscreen products in the
United States (Food and Drug Administration and Department of Health and Human
Services [14, 15, 39]), 20 in Canada [18], 28 in the European Union [12, 22], 28 in the
Association of Southeast Asian Nations [37], and 33 approved by MERCOSUR
(Southern Common Market, consisting of Argentina, Brazil, Paraguay, Uruguay, and
Venezuela) [37]. The complete listing of approved sun filters in these locations, along
with the approved concentrations, is shown in Table 10.1.
Sun filter actives can be classified into the following categories: organic (traditional
molecules or polymeric) or particulate (organic particulates or inorganic particulate), as
described in subsequent sections 3.1 and 3.2, respectively.
10.3.1 Organic Filters
Organic filters are often referred to as chemical filters, but this can be misleading
because it suggests that it is possible to have a sun filter that is nonchemical. Strictly
speaking, all active sun filter compounds, both organic and inorganic, are made up of
chemical molecules originating from the periodic table, and all function primarily by
absorbing light [26].
10.3.1.1 Organic Filters: Traditional Molecules
Traditional organic sun filters are aromatic, small molecules, with molecular weight
values <900 g/mol. Today, the most widely used organic filters include avobenzone,
oxybenzone, octocrylene, salicylate derivatives (homosalate and ethylhexyl salicylate),
cinnamate derivatives (octyl-methoxycinnamate [OMC]), triazone derivatives (Uvinul
T150 [ethylhexyl triazone]; UVASorb HEB [diethylhexyl butamido triazone]; Tinosorb
S [bis-ethylhexyloxyphenol methoxyphenyl triazine]), benzoate derivatives (Uvinul A
Plus [diethylamino hydroxybenzoyl hexyl benzoate]), benzotriazole derivatives
(Mexoryl XL [drometrizole trisiloxane]), and camphor derivatives (Mexoryl SX
[ecamsule]; terephthalylidene dicamphor sulfonic acid). Anthranilate derivatives (like
meradimate) are less commonly used filters because of low efficacy.
Avobenzone (a dibenzoylmethane derivative) is one of the most efficient UVA-
absorbing filters used around the globe, and it is the only UVA-absorbing organic sun
filter approved in the USA. However, avobenzone is prone to photo instability because
of an enol-to-keto tautomerization as shown in Fig. 10.1 [25]. The enol form of avoben-
zone absorbs in the UVA (315400 nm), while the diketo form absorbs in the UVC
(200280 nm) and is prone to degradation [25]. Other photostabilizing ingredients
must be used in combination with avobenzone to prevent light-induced degradation [7].
In order to achieve photostability of avobenzone, it must be combined with ingredients
Table 10.1 List of sun filters approved in the USA, Canada, European Union, ASEAN, and MERCOSUR; alternate names; and approved usage levels per
162
region
Filter name Other names Coverage US Canada EU MERCOSUR Australia ASEAN
Maximum allowed concentration (%)
Benzophenone-3 Oxybenzone or UVA/B 6 6 10 10 10 10
2-hydroxy-4-methoxybenzophenone
Benzophenone-4 Sulisobenzone or 2-hydroxy-4- UVA/B 10 10 5** 10 10 5**
methoxybenzophenone-5-sulfonic acid and
its trihydrate
Benzophenone-5 2-Hydroxy-4-methoxybenzophenone-5-- UVA/B * 5 10 *
sulfonic acid (benzophenone-5) and its
sodium salt
Sulisobenzone sodium
Sodium hydroxymethoxybenzophenone
sulfonate
Benzophenone-8 Dioxybenzone or UVA/B 3 3 3 3
2,2-dihydroxy-4-methoxybenzophenone
Dioxybenzone
(2-hydroxy-4-methoxyphenyl)
(2-hydroxyphenyl)methanone
Methanone (2-hydroxy-4-methoxyphenyl)
(2-hydroxyphenyl)
3-Benzylidene camphor 3-Benzylidene camphor UVB 2 2 2
Bis-ethylhexyloxyphenol Tinosorb S or (1,3,5)-triazine-2,4-bis{[4-(2- UVA/B 10 10 10 10
methoxyphenyl triazine ethyl-hexyloxy)-2-hydroxy]-phenyl}-6-(4-
methoxyphenyl) or anisotriazine
Butyl methoxydibenzoyl Avobenzone or 1-(4-tert-butylphenyl)-3-(4- UVA 3 3 5 5 5 5
methane methoxyphenyl) propane-1,3-dione
S. Daly et al.
10
Camphor benzalkonium Mexoryl SO or N,N,N-trimethyl-4-(2- UVB 6 6 6 6

methosulfate oxoborn-3-ylidene-methyl) anilinium
methyl sulfate
Diethylamino hydroxybenzoyl Uvinul A plus or UVA 10 10 10 10
hexyl benzoate benzoic acid, 2-[4-(diethylamino)-2-
hydroxybenzoyl]-, hexylester
Diethanolamine DEA methoxycinnamate UVA 10
methoxycinnamate
Diethylhexyl butamido UVASorb HEB or UVB 10 10 10

triazone benzoic acid, 4,4-((6-((4-(((1,1-dimethyleth
yl) amino) carbonyl) phenyl) amino)
1,3,5-triazine-2,4-diyl) diimino) bis-(2-)
ester) or dioctyl butamido triazone
Disodium phenyl Neo Heliopan AP or UVA 10 10 10 10
dibenzimidazole monosodium salt of 2-2-bis(1,4-
tetrasulfonate phenylene)1H-benzimidazole-4,6-
disulphonic acid) or bisimidazylate
Drometrizole trisiloxane Mexoryl XL or UVA/B 15 15 15 15 15
phenol,2-(2H-benzotriazol-2-yl)-4-methyl-
6-(2-methyl-3-(1,3,3,3-tetramethyl-I-
(trimethylsilyl)oxy)-disiloxanyl)propyl)
Ethoxyethyl Cinoxate UVB 3 3 3 6
methoxycinnamate
Ethylhexyl dimethylamino Padimate O UVB 8 8 8 8 8 8
benzoate Octyl dimethyl PABA
Ethylhexyl dimethyl PABA
Ethylhexyl methoxycinnamate OMC or octinoxate UVB 7.5 7.5 10 10 10 10
Octyl methoxycinnamate
(continued)
163
164
Filter name Other names Coverage US Canada EU MERCOSUR Australia ASEAN

Ethylhexyl salicylate Octisalate UVB 5 5 5 5 5 5
2-Ethylhexyl salicylate
Octyl salicylate
Ethylhexyl triazone Uvinul T150 UVB 5 5 5 5
2,4,6-Trianilino-(p-carbo-2-ethylhexyl-
loxy)-1,3,5-triazine
Octyl triazone
Homosalate 3,3,5-Trimethylcyclohexyl UVB 15 15 10 15 15 10
2-hydroxybenzoate
Salicilato de homomentila
Isoamyl p-methoxycinnamate Amiloxate UVB 10 10 10 10
Isopentyl-4-methoxycinnamate
Methyl anthranilate Meradimate UVA 5 5 5 5 5
4-methylbenzylidene camphor Enzacamene UVB 6 4 4 4 4
3-(4-methylbenxylidene)d-1 camphor
4 MBC
Methylene bis-benzotriazolyl Tinosorb M UVA/B 10 10 10 10
tetramethylbutylphenol 2,2-Methylene-bis-6-(2H-benzotriazol-
2yl)-4-(tetramethyl-butyl)-1,1,3,3-phenol
Octocrylene 2-Cyano-3,3-diphenyl acrylic acid, UVB 10 10 10 10 10 10
2-ethylhexyl ester
Para-aminobenzoic acid PABA UVB 15 15 15
4-Aminobenzoic acid
PEG-25 PABA Ethoxylated ethyl-4-aminobenzoate UVB 10 10 10 10
S. Daly et al.
10
Phenylbenzimidazole Neo Heliopan Hydro, Ensulizole UVB 4 4 8 8 (as acid) 4 8

sulfonic acid 2-Phenylbenzimidazole-5-sulfonic acid and
its potassium, sodium, and triethanolamine
salts
Potassium, sodium, and TEA
Phenylbenzimidazole sulfonate
Polyacrylamido Mexoryl SW UVB 6 6 6
methylbenzylidene Polymer of N-[(2 and 4)-[(2-oxoborn-3-
camphor ylidene)methyl]benzyl]acrylamide
Polysilicone-15 Parsol SLX UVB 10 10 10 10

Diethylbenzylidene malonate Dimethicone
Diethylmalonylbenzylidene Oxypropene
dimethicone
Dimethicodiethylbenzalmalonate
Triethanolamine salicylate Neo Heliopan TES UVB 12 12 12 12
Trolamine salicylate
Tris-biphenyl triazine (nano) 1,3,5 - Triazine, 2,4,6-tris UVA/B 10
[1,1-biphenyl]-4-1-; ETH-50
Terephthalylidene dicamphor Mexoryl SX UVA 10 10 10 10 10
sulfonic acid
Benzylidene camphor sulfonic Alpha-(2-oxoborn-3-ylidene)-toluene-4- 6 6 6 6
acid sulfonic acid and its salts
Titanium dioxide UVA/B 25 25 25 25 25 25
Zinc oxide UVA/B 25 25 * 25 No limit 25
ASEAN Association of Southeast Asian Nations; EU European Union; MBC methylbenzylidene camphor; MERCOSUR Southern Common Market, consisting
of Argentina, Brazil, Paraguay, Uruguay, and Venezuela; OMC octyl-methoxycinnamate; PABA para-aminobenzoic acid; US United States; UVA ultraviolet A;
UVB ultraviolet B
* Inclusion in annex VI expected
** Sum of Benzophenone-4 and Benzophenone-5
165
166 S. Daly et al.
O O O OH
hv
O O
Diketo tautomer Enol tautomer
Fig. 10.1 The keto-to-enol tautomerization of avobenzone (Scheme 2 was reproduced with
permission from Kockler et al. [25])
that are efficient in both triplet quenching and singlet quenching. Examples of triplet
quenchers are the following UV filters: octocrylene, 4-methylbenzylidene camphor
(ex-US), Tinosorb S (ex-US), or emollients such as diethylhexyl-2,6-naphthalate [7].
In addition, higher levels of oxybenzone are known to stabilize avobenzone by the
singlet quenching mechanism [7]. A combination of singlet and triplet quenchers is
most efficient in stabilizing avobenzone.
Cinnamates are very efficient UVB absorbers but also have issues with photosta-
bility. OMC is a member of the cinnamate class that is known to react with avoben-
zone to produce non-UV light-absorbing photoproducts. Hence, combinations of
avobenzone and OMC are unfavorable and should be avoided because of enhanced
photo instability [7, 33].
Salicylate derivatives are photostable, UVB-absorbing filters that have a long
history of usage. They are excellent solubilizers for crystalline UV filters, including
oxybenzone and avobenzone, however the absorption efficiency of these filters is
quite low.
Oxybenzone (a benzophenone derivative) is used in many US sunscreen formula-
tions with absorbance in the UVB (290320 nm) and the UVA2 region (320340 nm).
Padimate O is a derivative of para-aminobenzoic acid that is a liquid and is oil soluble.
It is a very effective UVB filter with one of the highest molar extinction coefficients of
the approved filters. It is not widely used in products over concern that the parent mol-
ecule, para-aminobenzoic acid, has been associated with allergic reactions. Octocrylene
is another oil-soluble UVB filter that has been widely used to provide increased sun
protection factor (SPF) values and to also boost the photostability of avobenzone when
used in combination. Ensulizole (phenylbenzimidazole sulfonic acid) is a water-soluble
filter and is used in products formulated to feel lighter and less oily, such as daily use
cosmetic moisturizers. Currently, it is not permitted to be combined with avobenzone
in the USA and must be used in combination with on other UVA absorbers (such as
zinc oxide) to provide broad-spectrum protection.
10.3.1.2 Organic Filters: Polymeric
Parsol SLX. Parsol SLX, or polysilicone-15, is made of organic chromophores

attached to a polysiloxane chain and is approved for use outside North America. The
average molecular weight is >6000 daltons [10], so it is envisioned that the mole-
cule is large enough to reduce permeation through the skin [20], making it ideal for
Table 10.2 Relative lipophilicity of sunscreen chemicals based upon their calculated partition
coefficients between octanol and water
CTFA name Other names Log P at 25 C
Glyceryl PABA 1,2,3-Propanetriol,1-(4-aminobenzoate) 0.02
Benzophenone-4 Sulisobenzone 1.51
PABA p-Aminobenzoic acid 0.74
Benzophenone-8 Dioxybenzone 2.15
Cinoxate Ethoxyethyl methoxy cinnamate 2.55
Benzophenone-3 Oxybenzone 2.63
Ethyl dihydroxypropyl PABA Ethyl-4-bis(2-hydroxypropyl-aminobenzoate) 2.84
Amyl dimethyl PABA Amyl dimethyl PABA 4.53
Butylmethoxy dibenzoylmethane Butylmethoxy dibenzoylmethane 4.86
Menthyl anthranilate Methyl-O-aminobenzoate 5.05
Octyl salicylate 2-Ethylhexyl salicylate 5.30
Homosalate Homomenthyl salicylate 5.61
Octyl methoxy cinnamate Ethylhexyl-p-methoxycinnamate 5.65
Octocrylene Octyl cyanodiphenylacrylate 5.69
Octyl dimethyl PABA 2-Ethylhexyl-p-dimethyl aminobenzoate 6.08
Modified with permission from Agrapidis-Paloympis et al. [1]
CTFA Cosmetic, Toiletry, and Fragrance Association; PABA para-aminobenzoic acid
mild applications. The polysiloxane backbone not only links the chromophores
together, but it also provides a pleasant aesthetic to skin or hair [29]. Unfortunately,
this polymeric filter only absorbs in the UVB (max = 312 nm) part of the spectrum
and needs to be combined with UVA filters to achieve broad-spectrum protection.
10.3.1.3 Organic Filters: Solubility in Cosmetic Vehicles
In order for a UV-absorbing organic filter to be an effective sunscreen, it must be solu-

ble in at least a portion of the sunscreen formulation. Todays organic sun filters are
typically oil soluble or water soluble and occasionally alcohol soluble. The sun filters
partition coefficient (log P) between octanol and water gives an indication of the rela-
tive lipophilicity, where lower log P values indicate a higher degree of water solubility,
as shown in Table 10.2 [1].
Oil-soluble filters are used in a wide variety of sunscreen products, including both
recreational and daily use products. Recreational-use sunscreen products are typi-
cally formulated for enhanced water resistance through the addition of film-forming
polymers. A high content of oily sun filter compounds can lead to a heavy and greasy
aesthetic on the skin. For products that do not require a high level of water resistance,
water-soluble sun filters may be used either alone or in combination with oil-soluble
sun filters to create formulations with enhanced aesthetic properties and potentially
improved user compliance. Ensulizole (2-phenylbenzimidazole-5-sulfonic acid),
Neo Heliopan AP (disodium phenyl dibenzimidazole tetrasulfonate) and Mexoryl
SX are examples of water-soluble sun filters.
168 S. Daly et al.
Furthermore, filter solubility is important for maintaining formulation efficacy as

some filters, including octyl triazone, benzophenone-3, butyl methylbenzylidene
camphor, and methoxydibenzoylmethane, may crystallize out of solution if not
properly solubilized [40], making the protective film less uniform on the skin. In
addition, solvent polarity has been found to affect max and critical wavelength in
formulations [1].
10.3.2 Particulate Filters
While most organic filters must be dissolved into either the oil or water phases of a
formulation to be effective, particulate sunscreens are not dissolved in either phase, and
they exist in particle suspensions. Particulate filters are commonly used in mild and
baby sunscreen products, and they have been demonstrated in several studies to stay on
the surface of the skin [8, 16]. There are two types of particulate sunscreen filters:
organic and inorganic.
10.3.2.1 Particulate Organic Filters
Methylene bis-benzotriazolyl tetramethylbutylphenol (i.e., MBBT or Tinosorb M) is

considered to be an organic particulate filter. Pure MBBT is a solid powder with a par-
ticle size in the micron range, and the commercially available Tinosorb M is a MBBT
suspension. The mechanism of action for Tinosorb M is mostly absorption with slight
contributions from particulate scattering [19].
10.3.2.2 Inorganic Particulates
The inorganic particulate sunscreen class includes titanium dioxide (TiO2) and zinc
oxide (ZnO). It is important to point out that these particulate sunscreen active ingredi-
ents also absorb UV, with very little reflection and scattering in the UV portion of the
spectrum [4], so it is not appropriate to call them physical sunscreens. While the UV
absorption action of Tinosorb M is not very different from other organic molecules, for
TiO2 and ZnO, the electrons in the crystals can freely move from the valence band to
the conductance band when exposed to UV. This is because the energy band gap in
TiO2 or ZnO is lower than the energy conveyed by UV photons, allowing UV to excite
the free electrons in these semiconductor-like materials.
Particulate inorganic sunscreen active ingredients also protect skin from harmful
UV by absorbing, reflecting, and scattering; however, recent findings indicate that the
primary means of protection is by absorption (roughly 95 %) and the remaining 5 % by
scattering and reflecting. Incident light that is absorbed or backscattered by the particle
sunscreens does not enter into the skin. Scattering of reflected photons increases the
actual optical length of the UV photons as they pass through the absorbing sunscreen
layer. The scattering by sunscreen particles depends on factors that include the volume
concentration of the particles, the relative refractive index of the particle to the medium
and/or coating, the particle size, and the scattering wavelength [11].
For the UV wavelength range, the absorption and scattering power of single TiO2 or
ZnO particles generally increases with the size of the particle, up to about 100 m. We
generally recognize, however, that absorption power increases monotonically when the
particle size is smaller. This is because the number of particles has to increase with
smaller and smaller particle size when evaluated for a fixed volume fraction (weight
percentage). Therefore, the overall absorption power for the system becomes greater
with smaller particle sizes. Based on both theoretical calculation and experimental
measurement, the light scattering of particulate sunscreen ingredients (TiO2, ZnO, and
Tinosorb M) does not contribute significantly to the attenuation of UV (290370 nm)
when compared absorption. For long UVA and visible light wavelength range (370
760 nm), however, reflection contributes much more to the protective effects of TiO2
and ZnO particles when applied on skin surface because of very limited absorption of
these ingredients within the visible wavelength range. Since absorption and scattering
of UV light depend on both the volume fraction of particles in the medium and also the
uniformity of the particles, dispersion of particles in sunscreen formulation plays a
critical role in the efficacy of UV attenuation. It is also critical to make sure the inor-
ganic particles are photostable and do not lead to generation of free radicals. Effective
surface treatment of inorganic particles ensures photostability of these inorganic sun-
screens. Examples of surface treatments include alkoxy silane, dimethicone, methi-
cone, polyhydroxystearic acid and aluminum stearate, silica, alumina, etc. Photostability
also depends on the type of the inorganic crystal. For example, antase is known to be
less stable than rutile grade TiO2.
ZnO has gained popularity as a mild, safe, and effective sun filter in the past 10 years.
It is the only other effective UVA1 filter besides avobenzone that is approved in the
USA. TiO2 has high UVB efficacy, but does not provide significant UVA protection.
On the other hand, ZnO provides very uniform UVB and UVA protection across the
whole spectrum, providing a flat spectral absorption curve [36]. Figure 10.2a shows a
comparison between absorbance of TiO2 and ZnO. It is desirable to maximize light
attenuation while limiting the scattering in the visible region, as consumers do not like
to see a white/blue haze on their skin. Formulators need to balance the particle size,
dispersion, solvent, and volume fraction to achieve an aesthetically acceptable and
effective inorganic sunscreen product.
10.4 Sun Filter Efficacy: Breadth and Height of UV

Absorbance
A key performance metric for sun filters is absorbance intensity and breadth of cover-
age. Dilute solution UV spectroscopy is used to determine filter efficacy and is com-
monly reported as a specific extinction, E(1 %, 1 cm), value. E(1,1) corresponds to the
absorbance at the peak wavelength (max) for a 1 % solution in a cuvette with a 1 cm
170 S. Daly et al.
a 0.7
0.6
0.5
Absorbance
0.4
0.3 1% TiO2
1% ZnO
0.2
0.1
0.0
290 310 330 350 370 390
Wavelength, nm
b 0.7
0.6
0.5 Avobenzone
Absorbance
0.4 Tinosorb M
0.3 Uvinul A Plus

Mexoryl SX
0.2
Tinosorb S
0.1 Mexoryl XL
0.0
290 310 330 350 370 390
Wavelength, nm
Fig. 10.2 The absorbance spectra for various sunscreen agents at 1 %; (a) TiO2 and ZnO, and (b)
key global UVA-absorbing filters
path length [35]. Table 10.3 shows the wavelength of absorbance maximum and spe-
cific extinction value for common organic filters, along with the molecular structures
and molecular weight values [35].
Avobenzone is the most efficient UVA-absorbing filter with an E(1,1) value of
1,110 (357 nm), followed by Uvinul A plus (E[1,1] is 925 [354 nm]), Mexoryl SX
(E[1,1] is 750 [345 nm]), and Tinosorb S (E[1,1] is 750 and 820 [310 and 343 nm,
respectively]). Figure 10.2b shows the absorbance spectral overlay for key UVA
filters (each at 1 %).
Although UVA protection is getting quite a bit of attention in recent years, UVB
protection is critical to appropriate protection from the sun, as the action spectra for
erythema, basal cell carcinoma, and squamous cell carcinoma are all known to be
driven by UVB [6, 9]. Uvinul T150 (ethylhexyl triazone) and Uvinul HEB (diethyl-
hexyl butamido triazone) are the two most efficient UVB filters with E(1,1) values of
1550 (at 314 nm) and 1460 (at 311 nm), respectively. Ethylhexyl diaminobenzoate,
phenylbenzimidazole sulfonic acid, and several cinnamate derivatives are also very
strong UVB absorbers. Benzophenone derivatives are modest UVB absorbers, and
salicylate derivatives are typically relatively weak UVB absorbers.
10
Table 10.3 List of sun filters, chemical structures, molecular weight, lambda max values, and specific extinction values E(1 %, 1 cm)
Molecular MAX MAX E1 E2
Filter name Chemical structure weight (g/mol) Coverage 1 2 (1 %, 1 cm) (1 %, 1 cm)
OH O
Benzophenone-3 228 UVA/B 286 324 630 400
O
O OH
O
O S O
OH
OH O

O
O S O
+
O Na
OH O OH
O
3-Benzylidene camphor 240 UVB 294 860
O
O
Bis-ethylhexyloxyphenol methoxyphenyl HO
628 UVA/B 310 343 745 820
N N
triazine N
H3CO HO O
H
O O O O
Butyl methoxydibenzoylmethane O O
310 UVA 357 1,110
CH3 CH3
CH3SO4
Camphor benzalkonium methosulfate N+ 410 UVB 284 590
O O
OH O
Diethylamino hydroxybenzoyl hexyl 398 UVA 354 925
N
benzoate
O
N
Diethylhexyl butamido triazone H 766 UVB 311 1,460
O HN O
N N O
O
N N
N H
H
ONa+
O
S O O
H
171
Disodium phenyl dibenzimidazole N N S O

675 UVA 335 770
HO OH
O S N N
H
tetrasulfonate O S O
O
ONa+
(continued)
172
Molecular MAX MAX E1 E2

Filter name Chemical structure weight (g/mol) Coverage 1 2 (1 %, 1 cm) (1 %, 1 cm)
Si
Drometrizole trisiloxane O 502 UVA/B 303 341 310 300

Si
HO O Si
N
N
N
O
Ethoxyethyl methoxycinnamate CH3O
250 UVB
O
CH3
Ethylhexyl dimethylamino benzoate O O CH3 277 UVB 311 990

EDP
N
H3C CH3
O
Ethylhexyl methoxycinnamate O
290 UVB 311 850
O
Ethylhexyl salicylate O O 250 UVB 305 165

OH
Ethylhexyl triazone O
823 UVB 314 1,550
O
O HN
O N N
N N NH
H
O O
O
Homosalate 262 UVB 306 180
O
HO
O O
Isoamyl p-methoxycinnamate 248 UVB 308 980
O
Methyl anthranilate 275 UVA 336 190

O
NH2
S. Daly et al.
4-Methylbenzylidene camphor 254 UVB 300 930

O
N OH OH N
10
Methylene bis-benzotriazolyl N N
659 UVA/B 305 360 400 495
N N
N
Octocrylene O
362 UVB 303 340
O
COOH
Para-aminobenzoic acid 137 UVB 283 640
NH2
O
PEG-25 para-aminobenzoic acid O H2N
1,265 UVB 309 180
O
N
Phenylbenzimidazole sulfonic acid O 274 UVB 302 920
S N
HO H
O
n
Polyacrylamido methylbenzylidene camphor [323.44]n UVB 297 610
CH3 CH3 CH3

H3C Si O Si O Si CH3
Polysilicone-15 CH3 R CH3 6,000 UVB 312 160190
n
92.1 92.5% CH3 O
approx. 6% O O O
R=
O
O
approx. 1.5%
O O O
n 60
COOH-N(CH2CH2OH)3
Triethanolamine salicylate 287 UVB 298 120
OH
O O
Terephthalylidene dicamphor sulfonic acid O S
607 UVA 345 750
O OH
O S
O
HO
SO3H
Benzylidene camphor sulfonic acid 320 294 860
O
173
Titanium dioxide 80 UVA/B 280350

Zinc oxide 81 UVA/B 280390
E specific extinction, UVA ultraviolet A, UVB ultraviolet B
174 S. Daly et al.
In addition to absorbance intensity, it is also important to consider the breadth of

protection. Avobenzone and Tinosorb M provide the widest long-range UVA1 protec-
tion, followed by Uvinul A plus, then Mexoryl SX, Tinosorb S, and Mexoryl XL. There
are no approved sunscreens, however, that absorb significant amounts of light in the
very longest part of the UVA spectrum and into the blue portion of the visible light
spectrum. There is emerging research showing that light coming from these parts of the
spectrum can contribute to skin pigmentation changes [3, 28].
Although extinction coefficients are widely used to provide quantitative compari-
son of sun filters, the relevancy of dilute solution spectroscopy measures to real-world
sunscreen product application must be considered. As a sunscreen product dries to
form a highly concentrated thin film, Beers law does not apply, and so real-world
sunscreen performance is most likely not dictated solely by the dilute solution absor-
bance values. The film structure and properties may be directly relevant to a sun-
screens final performance on skin as a thin film [32]. Thin-film transmission
measurements on defined substrates are now used throughout the sunscreen industry
to simulate real-world efficacy.
10.5 Combinations of Filters
There is no single sun filter available today that on its own can provide high-SPF and
broad-spectrum protection without aesthetic drawbacks. With the current state of UV
filter technology, sunscreen products today require the right combination of filters in
the formulation to obtain both high efficacy in UV protection and optimal aesthetics to
enhance compliance. Formulations containing oil-soluble filters may feel occlusive
and or greasy [30]. Combinations of different filters may be used to improve the sen-
sory profile, as well as provide broad-spectrum protection. In the USA, broad spec-
trum can be claimed if the in vitro determined critical wavelength value is 370 nm
[15]. In Europe, products must achieve a 1:3 ratio of PFA (protection factor UVA):SPF
[21]. Although many sunscreen products in the market claim broad spectrum, it is hard
to differentiate between their UVA efficacies. Not all broad-spectrum sunscreens are
created equal because they may have different degrees of UVA protection (amplitude
of absorbance curve in UVA) with different filter combinations [5].
10.5.1 US-Approved Filter Combinations
A common combination of organic filters used in the US market to achieve high-SPF,

broad-spectrum, and photostable protection is oxybenzone, octocrylene, homosalate,
avobenzone, and 2-ethylhexyl salicylate (octisalate). This five-ingredient combination
is found in many different product lines, and the proportions and concentrations are
adjusted to provide the desired protection. Octocrylene, homosalate, and octisalate
provide strong UVB protection, oxybenzone provides broad-spectrum UVB and UVA2
protection, and avobenzone provides the longer-wavelength UVA1 protection. In addi-
tion, both octocrylene and oxybenzone enhance the photostability of avobenzone by
singlet and triplet quenching.
The inorganic filters TiO2 and ZnO are often used together. ZnO is typically used
to achieve breadth of protection, while TiO2 brings higher SPF. The combination of
avobenzone and ZnO is currently not permitted in the USA [14]. The agency did not
approve the combination of ZnO with avobenzone in the latest monograph
publications.
10.5.2 Ex-US Filter Combinations
In Europe and Latin America, many more filters are approved for combination use,
such as Tinosorb S, Tinosorb M, Uvinul T150, Uvinul A Plus, Mexoryl SX, or
Mexoryl XL. In Europe, it is common to omit oxybenzone. In Latin America, many
formulations include a combination of traditional organic filters and a small amount
of TiO2. In Japan, very light and fluid textures are preferred, and mildness is very
important; TiO2, ZnO, OMC, and Tinosorb S are widely used ingredients.
10.5.3 SPF Boosting Through Formulation and Film Structure
Beyond the filter combinations selected for a sunscreen product formulation, formula-
tion excipients, emulsion structure, and the sunscreen film structure are also important
for determining the final sunscreen performance. The presence of film formers or
emollients in the formulation [31, 34], the sunscreen rheological properties [2, 17], and
the structures of the dried down sunscreen film [13, 38] have all been linked to sun-
screen performance. Figure 10.3 illustrates how surface roughness plays a role in creat-
ing holes in a sunscreen film, and that the thickness of the sunscreen film above the skin
peaks may be quite small [32]. It can be envisioned that the physical properties of the
sunscreen film may act to increase the film thickness above the peaks and reduce set-
tling into the valleys to create a more ideal film structure as in Fig. 10.3a [32].
10.6 Conclusion
A variety of organic sun filters are available for use with different properties, and it is
important for formulators to understand their chemistry to maximize efficacy and cre-
ate sunscreen products with an acceptable level of SPF and broad-spectrum protection.
With the current state of sunscreen technology, it is necessary for formulators to select
176 S. Daly et al.
a CREAM
SUBSTRATE
b m
5
0 CREAM
-5
-10
-15
-20
-25 SUBSTRATE
-30
46.9 47.0 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 48.0 48.1 48.2 48.3 48.4 48.5 48.6 48.7mm
Fig. 10.3 Sunscreen distribution on a surface (a) ideal distribution (b) real distribution
(Reproduced with permission from Osterwalder et al. [32])
a combination of sun filters to bring photostable, high-SPF, and broad-spectrum protec-

tion to consumers. There is a widespread misconception that inorganic sunscreens
operate by a different mechanism than organic sun filters; the mechanism of action for
both, however, involves UV absorbance. It is also critical for formulators to consider
the aesthetic of filters and to design formulation vehicles to maximize the sunscreen
product aesthetic, as sunscreen user compliance will continue to be the biggest chal-
lenge to protecting consumers from solar radiation.
Acknowledgment The authors would like to thank Alex Loeb, PhD, CMPP, of Evidence Scientific
Solutions (Philadelphia, PA) for editorial support that was funded by JOHNSON & JOHNSON
Consumer Companies, Inc. (Skillman, NJ).
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Accessed 30 Oct 2014
Chapter 11
Global UV Filters: Current Technologies
and Future Innovations
Uli Osterwalder and Lars Hareng
Key Points
Tremendous progress has been made in sunscreen technology over the last
two decades.
Unfortunately, in the USA, UV filter technology is lagging 15 years behind
compared to the rest of the world.
In Europe and the rest of the world, development goes on, but it is slower
than 20 years ago.
The major weakness of sunscreen and photoprotection remains the lack of
compliance by the user.
Innovation in photoprotection education, including behavior modification
and sunscreen use, is required.
11.1 Introduction
Sunscreens are used worldwide, especially by people with fairer skin phototypes
in geographic areas with high sun exposure but also by people with darker skin
to keep a uniform complexion, mainly of the face. This chapter focuses on global
sunscreens, i.e., sunscreens that contain UV filters that are available and in use
worldwide. Sunscreen is part of sun protection strategies consisting of seeking
U. Osterwalder (*)
Personal Care, BASF PCN GmbH, Monheim, Germany
L. Hareng
Regulatory Toxicology, BASF SE, Ludwigshafen, Germany

DOI 10.1007/978-3-319-29382-0_11
180 U. Osterwalder and L. Hareng
shade, covering up with clothing and hats, and wearing sunglasses. Use of sun-
screens has now been demonstrated to slow down the photoaging process and to
decrease the development of squamous cell carcinoma, basal cell carcinoma, and
melanoma [13].
A recent study confirmed the preventative role of sunscreen for malignant mela-
noma in mice, but the control sites that were covered by cloth had less melanoma,
indicating that protection by sunscreen alone could not completely prevent skin
cancer [4]. This chapter reviews what still can be done to improve sunscreens to
become a yet more effective means of photoprotection.
11.2 Current Technology and Future Innovations
The basic requirements for UV filters in sunscreens are (1) efficacy, (2) safety, (3)
registration, and (4) freedom to operate with respect to the status of intellectual
property [5]. Efficient UV absorber molecules are the basis of all sunscreens.
Efficacy indicates good UV absorbance in the spectral range between 290 and
400 nm. Good UV filters must also have the property of being able to be incorporated
in sufficient amounts into cosmetic formulations. They may be dissolved in the oil
phase or the water phase of sunscreen formulations, and thus the respective solubility
must be high enough. Alternately, filters can be used as dispersions of fine particles
of the absorbing substances.
11.2.1 Organic UV Filters
At present, all organic UV absorbers used in sunscreens possess aromatic moieties.

The substituents at the aromatic ring are of great importance for the UV spectroscopic
properties. An increase in the number of resonance structures stabilizes the excited
state, thus leading to stronger absorption at longer wavelengths [6, 7].
Figure 11.1 shows the efficacy of some of the organic UV filters. A quick
assessment of the performance of a UV filter can be simply gained by the use of a
calculation tool, generally known as the sunscreen simulator which is freely
accessible on the internet [813]. The sunscreen simulator results are presented in
Fig. 11.1 as integrated transmission through the irregular sunscreen film on the
skin. The UVB filters PABA (8 %) and EHMC (7.5 %) cover efficiently UVB and
UVA2 but transmit practically 100 % of the radiation in the UVA1 region. The
first UVA1 filter BMBM (avobenzone at 3 %) transmits about 35 % in the UVB
but less than 20 % in the UVA1 region. The modern broad-spectrum UV filters
BEMT (5 %) and MBBT (5 %) cover efficiently both UVA1 and UVB/UVA2. In
the final sunscreen product, it is always the combination of several UV filters that
determines its range and efficacy of protection. This can all be calculated on the
sunscreen simulator [8, 13].
11 Global UV Filters: Current Technologies and Future Innovations 181
100 %
UVB UVA 2 UVA 1

80 %
Transmission 60 %
40 %
20 %
0%
290 320 340 370 400
Wavelength (nm)
PABA 8 % EHMC 7.5 % BMBM 3 %
BEMT 5 % MBBT 5 %
Fig. 11.1 Transmission of organic filters (Data obtained from the BASF sunscreen simulator, with
the % applied as single UV filter in a sunscreen). BEMT bis-ethylhexyloxyphenol methoxyphenyl
triazine, BMBM butyl methoxydibenzoylmethane, EHMC ethylhexyl methoxycinnamate, MBBT
methylene bis-benzotriazolyl tetramethylbutylphenol (nano), PABA ethylhexyl dimethyl para-
aminobenzoic acid
11.2.2 Particulate Organic UV Filters
Sunscreens, especially those with a high sun protection factor (SPF), contain a consid-
erable amount of UV filters. Therefore, solubility of the active substance can be a
significant problem [5]. For this reason, particulate organic UV filters were developed
that allow high-SPF products to have relatively low concentrations of UV filters.
Examples of these UV filters include bisoctrizole and tris-biphenyl triazine [14, 15];
the former is under consideration for approval through the time and extent application
(TEA) process of the US Food and Drug Administration (FDA). These filters have
extremely low solubility in oil and in water but can thus be micronized in an aqueous
phase [1618]. Particulate bisoctrizole shows a broad absorption up to 380 nm
(Fig. 11.2). The UV absorbance spectrum of particulate bisoctrizole has a characteris-
tic shape [19]. The spectrum of the particles extends toward longer UVA1 wavelengths
with an additional shoulder around 320 and 380 nm caused by intermolecular interac-
tions of the -electrons inside the particles. Similar to small inorganic particle UV
filters, the contribution to protection by scattering or reflectance is 5 % or less [20].
11.2.3 Inorganic UV Filters
Any inorganic material that absorbs in the UV range could potentially be used in sun-
screens. Figure 11.3 shows transmission curves in the UV and also visible range of a few
inorganic materials: titanium dioxide (TiO2), zinc oxide (ZnO), cerium dioxide (CeO2),
CeO2-doped ZnO, and various iron oxides [2123]. Doping refers to the addition of
500
0.16 m
400
0.22 m
300 0.34 m
E(1.1) 0.78 m
200 4.4 m
100
0
280 300 320 340 360 380 400
Wavelength/nm
Fig. 11.2 Influence of particle size on efficacy of particulate UV filters (bisoctrizole, MBBT)
Undoped cerium dioxide CeO2 doped ZnO

Titanium oxide Zinc oxide
Yellow iron oxide Red iron oxide
Black iron oxide
100 %
UVA
UVB UVA 1 VISUAL SPECTRUM
2
80 %
Transmission
60 %
40 %
20 %
0%
280 320 340 400 450 500 550 600 650
Wavelength (nm)
Fig. 11.3 Transmission of various inorganic UV filters in UV and VIS range (280650 nm)
small amounts of foreign atoms altering the lattice properties. TiO2, ZnO, and CeO2
show good absorption in the UV range; the relatively low absorption in the visible range
makes these materials colorless, hence qualifying them to be used in sunscreens. Cerium
oxide is not listed in any countrys positive list of sunscreen actives and is also slightly
yellowish colored. The iron oxides are colored materials absorbing in the visible range
in addition to the UV spectrum, which disqualifies them for use in sunscreens; however,
they are used in other forms, such as BB creams (Blemish Balm all-in-one facial cos-
metic product) or makeup and can contribute to photoprotection [24].
11.2.4 Future Innovations
Innovation differs from improvement in that innovation refers to the notion of doing
something different rather than doing the same thing better. In the following paragraphs,
three different approaches are outlined assessing future innovations in suncare.
Table 11.1 100 years of sunscreen most important milestones

Society/marketing Technology Standards/regulatory
1925 Nobel Prize for Light
Therapy [25], Vit D [26]
Coco Channel makes First Sunscreen [28]
tanned skin popular [27]
1950 Summer holidays in the UVB, PABA [30] SPF Definition
sun become fashionable [33]
1975 and affordable More UVB (EHMC) SPF FDA
[29]
First UVA filter First UVA standards Boots,
(BMBM) AUS, PPD [34]
[30, 32]
2000 Suntan still in but Photostability [32] European recommendation on
protection becomes EHT, TDSA, DTS UVA, [35]
important bronze and Broad-spectrum UV FDA final rule (labeling)
protect filters MBBT, BEMT, [36]
DHHB [5, 31]
2025 More awareness Toward spectral Toward global harmonization
Sunbed bans homeostasis? of SPF and UVA methods/
Better compliance Ideal sunscreen? standards
New UV filters Animal test ban
UVA ultraviolet A-rays, UVB ultraviolet B-rays, AUS Australian standards, FDA Food and Drug
Administration, PPD persistent pigment darkening
Abbreviation of the INCI Name (International Nomenclature of Cosmetic Ingredients): BEMT bis-
ethylhexyloxyphenol methoxyphenyl triazine, BMBM butyl methoxydibenzoylmethane, DHHB
diethylamino hydroxybenzoyl hexyl benzoate, DTS drometrizole trisiloxane, EHMC ethylhexyl
methoxycinnamate, EHT ethylhexyl triazone, MBBT methylene bis-benzotriazolyl tetramethylbutyl-
phenol (nano), PABA ethylhexyl dimethyl PABA, TDSA terephthalylidene dicamphor sulfonic acid
11.2.5 1st Approach: The Best Predictor of Future

Behavior Is Past Behavior
Innovations in sunscreens and UV filters over the last century were driven by
changes in society, most importantly that tanned skin became fashionable
(Table 11.1).
The development of UV filters started with the UVB filters salicylates and PABA
[30]. The first UVA filter, avobenzone (BMBM) [30], was patented in 1973 and
approved in Europe in 1978. Ten years later, it was available in the USA through the
New Drug Application (NDA) route; another 10 years later, it was considered
generally recognized as safe and effective (GRAS/E) and added to the FDA
sunscreen monograph. The fact that avobenzone is not photostable triggered the
search for alternatives. These were developed in the 1990s and brought into the
market around 2000 [30]. They are all mentioned in Table 11.1 as UVA and broad-
spectrum UV filters. In parallel to the development of new UV filters, there were
successful attempts to improve the photostability of avobenzone. Indeed it is now
common to stabilize avobenzone in sunscreen with other ingredients; the most

effective ones are other UV filters such as octocrylene or bemotrizinol [32].
Extrapolation of technological progress of UV filters into the next 1015 years
shows that we can expect more of the same, e.g., better coverage of the UV range
where we still have a gap near the visible at the moment. This is illustrated by the
following four examples.
Researchers in Japan found a novel UVB absorber to enhance the efficacy of
UVA protection [37]. It is a new liquid UVB filter that could be used together with
avobenzone in sunscreens as an alternative to octocrylene. No prediction can be
made at this time when this UV filter would become available commercially.
A research group in Korea offers a solution to overcome perceived safety
concerns about conventional sunscreens [38]. They synthesized silicon-based high-
molecular-weight UV-absorbing polymers that are soluble in different solvents.
Again, there is no concrete indication when this technology could become
commercially available.
For the next two UV filters, a safety assessment by the European authorities has
already been requested. The European Scientific Committee on Consumer Safety
(SCCS) published an opinion on 2-(4-(2-(4-diethylamino-2-hydroxy-benzoyl)-
benzoyl)-piperazine-1-carbonyl)-phenyl)-(4-diethylamino-2-hydroxyphenyl)-
methanone (HAA299) in 2014 [39]. This new UV filter was developed by BASF SE
(Germany), to cover the remaining gap in long UVA1 and in the visible light range
up to ca. 450 nm. The final safety assessment in Europe is pending.
In early 2015 the European authorities published a request for a safety assessment
for another particulate organic UV filter, phenylene bis-diphenyltriazine (INCI
name), similar to the broad-spectrum UV filter bisoctrizole [40], i.e., covering the
290400 nm range. However, it is difficult to predict when this filter will become
commercially available.
11.2.6 Learnings from 1st Approach: Learning from the Past
In a foreseeable future, UV filter technology will bring UV coverage closer to ideal, i.e.,
covering the entire spectrum of UVB and UVA. But the use of sunscreen and the prac-
tice of photoprotection are still far from ideal [41]; this topic is covered in Chap. 11.3.
11.2.7 2nd Approach: General Morphological Analysis

After Zwicky
Fritz Zwicky, a Swiss astrophysicist and aerospace scientist based at the California
Institute of Technology (Caltech), called the morphological approach totality
research which in an unbiased way attempts to derive all the solutions of any
Fig. 11.4 Generic (hypothetical) sunscreen with three categories of parameters
given problem [42]. Zwicky applied this method to such diverse fields as the clas-
sification of astrophysical objects, the development of jet and rocket propulsion
systems, and the legal aspects of space travel and colonization. He founded the
Society for Morphological Research and advanced the morphological approach
for some 30 years, between the 1940s and his death in 1974.
This approach may also help us discover new relationships or configurations,
which are not so evident or which we might have overlooked by other less system-
atic methods. Importantly, it encourages the identification and investigation of
boundary conditions, i.e., the limits and extremes of different contexts and
factors.
The three steps of a systematic general morphological analysis (GMA) are, first,
setting up the whole morphological box (x parameters with n values each); second,
cross-consistency assessment in order to excluding impossible combinations and
arriving at a manageable number of internally consistent configurations; and third,
choosing single or multiple drivers, i.e., fixing one or more values of certain param-
eters in order to arrive at a handful of combinations.
The generic sunscreen in Fig. 11.4 shows the possible sunscreen variations. The
core are always the UV filters, but not every type of UV filter is suitable for every
kind of sunscreen, e.g., the particulate UV filters, inorganic or organic filters, are not
suited for clear (transparent) formulations because a dispersion is always opaque, or
certain UVA requirements can only be fulfilled with sufficient UVA or broad-
spectrum UV filters.
The influencing parameters determining a sunscreen can be grouped into three
categories: technology, marketing/society, and regulation/standards (Fig. 11.4).
Table 11.2 Morphological box with 3 parameters and 3 values (27 combinations)
Selected parameters
Target Product
UV filter segment regulation
1 Organic Toddler Cosmetics
Values 2 Inorganic Family medicinal product
Organic and
3 inorganic Sport Natural product
Use of driver (natural sunscreen) to narrow down the sunscreen product, e.g., from 27 (3 3 3)
to 3 (1 3 1)
Since each parameter can assume many values, theoretically large numbers of
combinations, representing new sunscreens, can be envisaged. To illustrate the
morphological analysis, Table 11.2 shows an example of just one parameter of
each category with three values. This gives already a theoretical total of 3 3 3 = 27
variations of sunscreens. This simplified example illustrates how these countless
combinations can be reduced. If one was to choose only natural sunscreen, e.g.,
as defined by European COSMOS (cosmetic organic standard) trade standards
[43], then only inorganic UV filters (TiO2 and ZnO) could be used and thus only 3
out of the 27 product variations are left to choose from. The fixed value of a param-
eter, in this case natural sunscreen, is called a driver in the GMA nomencla-
ture. Table 11.3 lists systematically parameters and values of sunscreens. Such a
list is of course never exhaustive; there is always room for new ideas, but the sys-
tematic approach is also a checklist that helps in considering all aspects of the
sunscreen product.
11.2.8 Learnings from 2nd Approach: General Morphological

Analysis
Innovation has to be new but must also have an impact on the market place. From
this morphological approach, it becomes apparent that the three categories,
technology, marketing, and regulatory, all play an important role. Without UV filter
technology, no progress in more efficient and broader UV coverage as well as yet
higher safety could be achieved, but if the advantage is not perceived in public, the
best technology cannot make an impact on the market [41].
Table 11.3 Lists systematically parameters and values of sunscreens

Technology Marketing/society Regulation/standards
(5 parameters) (4 parameters) (3 parameters)
1. UV filter 6. Target segment 10. Product regulation
None None None
Organic Baby, toddler, kids Cosmetics
Inorganic Family, men Quasi drug
Organic and inorganic Sport, winter, beach Therapeutic good
2. Other ingredients Tanned skin Natural product
None Sensitive skin Medical device
Emulsifier Dry skin Medicinal product (drug)
Emollient 7. Performance claims 11. SPF (sunburn protection)
Polymer None None
3. Other actives Water resistant 6, 10, 15
None IRA, RSF 20, 30
Vitamin E Prevents skin cancer 50, 50+
Bisabolol Antiaging 99, 100, 100+
Retinol A Bronze and protect 12. UVA protection
4. Formulation format Visible spectrum None
Emulsion O/W Long UVA I EU ratio 1:3), 1:2, 1:1)
Emulsion W/O 8. Free from claims FDA (370 nm)
Gel, oil, alcohol None BOOTS (3, 4, 5 star)
Water Paraben, preservative JCIA PA+, to-PA++++
5. Application format Fragrance, alcohol
Lotion, cream Mineral oil, silicone
Spray (pump) Nano, GMO
Aerosol spray Octocrylene
Stick, mousse No human testing
Powder, ointment Noncomedogenic
9. Special claims
None
Wet skin application
Refresh, cool
Natural
No skin penetration
Such a list is of course never exhaustive; there is always room for new ideas, but the systematic
approach is also a checklist that helps considering all aspects of the sunscreen product
11.2.9 3rd Approach: Delphi Survey Among Sunscreen

and UV Filter Experts
A third approach to learn more about future innovations in suncare is asking the
opinion of experts. The Delphi method has been developed by the RAND
Corporation [44]. Delphi is based on the principle that forecasts (or decisions) from
a structured group of individuals are more accurate than those from unstructured
groups [45, 46], based on the assumption that a group of experts can more accurately
predict the future.
The following question was asked to about 40 experts from all over the world
where sunscreens play an important role in sun protection: What Innovations in
sunscreens do you see happening in the next: (a) 12, (b) 35, and (c) 1015 years?
11.2.10 Learnings from 3rd Approach: Delphi Survey

Among Sunscreen and UV Filter Experts
Regarding technology innovations, the experts confirm the trend of better UVA
protection toward spectral homeostasis. Furthermore, better sunscreen formulations
are expected based on new UVB and broad-spectrum UV filters (liquid UV filters or
polymers). Some also predict the trend away from nanoparticles to continue.
Regarding marketing and performance innovations, the extension of UV
protection claims beyond just SPF, but into protection in visible light and infrared
range is predicted. Antioxidant claims are also anticipated. Furthermore a trend
toward natural sunscreens and more public education are predicted.
Regarding regulatory/standards innovation, the pending issues at the US FDA
(TEA UV filters, spray, SPF cap at 50+, etc.) are predicted to be resolved in the next
few years. A worldwide ban of animal testing in cosmetics is anticipated as well as
a ban of SPF in vivo testing on humans.
This 3rd approach is especially valuable in the context of the two previous ones. It
confirms the extrapolation of the past (1st approach), but it also brings up some new ideas
that reach outside the morphological box (2nd approach), e.g., a ban of human testing.
11.3 Efficacy (Sunscreen Performance)
Sunscreen performance depends mainly on its UV filter composition. The most

frequently used UV filters are summarized in Table 11.4. It contains globally regis-
tered UV filters plus the TEA filters awaiting approval in the USA (see regulatory
Chap. 11.5 for TEA).
The focus in sunscreen development has long been on increasing the sun protection
factor (SPF) [47]. However, there is now a consensus to cap at SPF 50+ among author-
ities of many countries, except for Brazil which allows SPF 99, and the US FDA has
yet to make a final decision. At the same time sunscreens improved significantly in
UVA protection over the last two decades [48, 49]. This progress can be demonstrated
in a comparison between Europe and the USA. In the USA often the question comes
up on how much better can a sunscreen become if it was able to incorporate the more
recently developed UV filters. After all, currently available sunscreens in the US
achieve already the worlds highest SPF and fulfill the US UVA protection criterion of
the critical wavelength CW >370 nm [50]. One way to answer this question is looking
at the transmission curve of different sunscreens. The transmission spectrum tells us
how much of the damaging UV radiation is passing through onto the skin at every
11
Table 11.4 UV filters, globally approved and pending in the USA (TEA)
UV range INCI Type/
(nm) USAN Trademark Abbr.a stateb Max. concentration limit (%)
USA (year of TEA filing) EU
290340 Global Oxybenzone Uvinul M40 BP3 o/p 6 10
Sulisobenzone Uvinul MS40 BP4 o/p 10 5
Octinoxate Uvinul MC 80 EHMC o/l 7.5 10
Octisalate Neo Heliopan OS EHS o/l 5 5
Homosalate Eusolex HMS HMS o/l 15 10
Octocrylene Uvinul N 539 T OCR o/l 10 10
Ensulizole Eusolex 232 PBSA o/p 4 8
Titanium dioxide Eusolex T2000 TiO2 i/p, d 25 25
TEA (USA) Iscotrizinol (Uvasorb HEB) DBT o/p 10 (2005) 10
Octyltriazone Uvinul T150 EHT o/p 5 (2003) 5
Amiloxate Neo Heliopan E1000 IMC o/l 10 (2003) 10
Enzacamene Eusolex 6300 MBC o/p 4 (2002) 4
290400 Global Avobenzone Parsol 1789 BMBM o/p 3 5
Zinc oxidec Z-Cote HP1 ZnO i/p, d 25 25
TEA (USA) Bemotrizinol Tinosorb S BEMT o/p 10 (2005) 10
Bisoctrizole Tinosorb M (active) MBBT o/d 10 (2005) 10
Global UV Filters: Current Technologies and Future Innovations
Ecamsule Mexoryl SX TDSA o/p 3d (2009) 10

Drometrizole Mexoryl XL DTS o/p 10 (2007) 15
a
Abbreviation of the INCI (International Nomenclature of Cosmetic Ingredients) name: BEMT bis-ethylhexyloxyphenol methoxyphenyl triazine, BMBM butyl
methoxydibenzoylmethane, BP3 benzophenone-3, BP4 benzophenone-4, DHHB diethylamino hydroxybenzoyl hexyl benzoate, DPDT disodium phenyl
dibenzimidazole tetrasulfonate, DTS drometrizole trisiloxane, EHMC ethylhexyl methoxycinnamate, EHS ethylhexyl salicylate, EHT ethylhexyl triazone, HMS
homomenthyl salicylate, IMC isoamyl p-methoxycinnamate, MBBT methylene bis-benzotriazolyl tetramethylbutylphenol (nano), OCR octocrylene, TDSA
terephthalylidene dicamphor sulfonic acid, TiO2 titanium dioxide (nano), ZnO zinc oxide (nano)
b
o organic. i inorganic. p powder. d dispersion. l liquid
c
189
Europe, annex VI listing as (nano) expected 2015

d
Approved in certain formulations up to 3 % via New Drug Application (NDA) Route
Table 11.5 Comparison of available US State of the Art Sunscreen with sunscreens modified with
TEA ingredients, and ideal sunscreen (cloth)
Modified US sunscreen Ideal sunscreen:
Best US Sunscreena with TEA ingredientsa cloth [4]
SPFcalculated 37 (labeled up to 100) 35 (labeled up to 50+) >>100
UVA-protect.: 372 381 389
CW (nm) 0.67 0.81 1
UVA/UVB 0.29 (<0.33; fail) 0.47 (>0.33; pass) 1
UVA-PF/SPF
Composition: 6 % BP3, 5 % EHS, 15 % 5 % EHS, 5 % HMS, Cloth (black)
UVB/UVA2 HMS, 10 % 1 % EHT
UVA1, OCR
Broad- 3 % BMBM 3 % BEMT, 5 %
Spectrum MBBT
Total UV 39 % 19 % n.a.
filters
NTUV dose at 3.2 1.6 1.0
1 MED actual actual actual
ideal ideal
(Calculated) ideal
0.0 1.0 2.0 3.0 4.0 0.0 1.0 2.0 3.0 4.0 0.0 1.0 2.0 3.0 4.0
a
Abbreviation of the INCI Name (International Nomenclature of Cosmetic Ingredients): BEMT
bis-ethylhexyloxyphenol methoxyphenyl triazine, BMBM butyl methoxydibenzoylmethane, BP3
benzophenone-3, EHS ethylhexyl salicylate, EHT ethylhexyl triazone, HMS homomenthyl
salicylate, MBBT methylene bis-benzotriazolyl tetramethylbutylphenol (nano), OCR octocrylene
MED 1 minimal erythema dose passes through sunscreen onto skin, NTUV normalized transmitted
UV dose
Fig. 11.5 Comparison 100 %

of UV transmission curves. UVB UVA 2 UVA 1
Sunscreen formulated with 80 %
the highest allowable
Transmission
concentrations of UV USA best

60 %
filters available in the USA
USA + TEA
(USA-Best), incorporation
40 %
of new filters into Ideal, cloth (4)
USA-Best sunscreen
(USA + TEA), and ideal 20 %
sunscreen (clothing) [4]
0%
290 320 340 370 400
Wavelength (nm)
wavelength. The difference of sunscreens at equal SPF is mainly in the UVA1 region
(340400 nm). We know now that not only the erythemally weighted UV radiation is
the cause of damage but also the extent of UVA1 radiation [5154].
As shown in Table 11.5 and Fig. 11.5, much higher protection in the UVA1 spec-
trum can be achieved by the incorporation of TEA broad-spectrum filters; further-
more, a better protection can be achieved with lower total amounts of UV filter
(19 % compared 39 %).
11.4 Safety
Sunscreen products are used widely, often daily across the whole population,
which leads to high safety requirements irrespective of the regulatory environ-
ment. Therefore a UV filter-specific safety assessment is mandatory for its regu-
latory approval. In contrast to drugs, the deposition of UV filters on the skin is
a prerequisite for their effectiveness and the uptake into the body is not intended.
The protection against the known carcinogenic effect of UV light is to be
emphasized as a health benefit of the UV filter besides its specific safety
profile.
The safety assessment approach combines all relevant toxicological data to
determine the UV filter intrinsic hazard profile that is to be compared to the expo-
sure situation under conventional use of the sunscreen product. Such a hazard pro-
file is initially determined by a basic set of studies addressing acute and topical
toxicity of the UV filter such as skin/eye irritation, skin sensitization, and photo-
induced toxicity. Furthermore, genotoxicity tests provide the basis for an adequate
assessment of a potential mutagenic or cytogenetic effect of the UV filter and the
absence of a genotoxic potential during the intended use in sunscreens is addressed
by photogenotoxicity tests.
Repeated administration of the UV filter to animals in subacute, (sub-)chronic,
or reproductive/developmental studies allows a thorough assessment of the sys-
temic or reproductive toxicity potential. These studies help to identify target organs
and are used for the determination of a UV filter-specific no observed adverse effect
level (NOAEL). If no tissue changes indicate the onset of a tumor formation after
repeated dosing, no genotoxic effects are observed, and no evident systemic uptake
of the UV filter is found, a carcinogenic potential can be excluded in a weight of
evidence without performing a definitive carcinogenicity test. However, if
carcinogenic alerts exist, animal carcinogenicity studies are considered as a last
resort to fully elucidate this endpoint [55].
Dermal penetration data [supported by studies on absorption, distribution,
metabolization, and excretion if available] represent an important pillar to
estimate the potential systemic human exposure with the UV filter during use.
Based on standard exposure parameters for the use of sunscreen products [56]
and UV filter-specific dermal penetration data, a systemic exposure dose of the
UV filter for humans can be determined. This exposure dose takes into account
the usual daily amount of sunscreen applied, the maximum concentration of the
UV filter in sunscreens, and the dermal absorption of the UV filter as
determined in the safety studies. In order to cover uncertainties due to variances
in toxicological susceptibility between animals and humans and within the
human population, the estimated human exposure dose needs to be at least
100-fold below the no observed adverse effect level identified in the relevant
animal toxicity study in order to demonstrate the safe use of the UV filter in
sunscreens [56].
11.5 Regulatory Approval Processes of UV Filters
Since safety is a prerequisite for the use of any consumer or medicinal product and
since sunscreen products are used widely, often daily and on young children, high
safety requirements apply. In Europe, UV filters must qualify for the positive list
(Annex VI) of the European Cosmetics Regulation [57, 58], and in the USA, UV
filters have to be listed in the FDA Over-the-Counter Sunscreen Monograph as
active ingredients [29]. Similar requirements exist in most countries, e.g., Australia,
Japan, China, and Brazil [5961].
11.5.1 Time and Extent Application (TEA) Process in the USA
For UV filters, the FDA sunscreen monograph [29] dictates the use of UV active
ingredients in sunscreens. All ingredients listed on the sunscreen monograph may
be combined into different sunscreens, with some important restrictions, e.g., no
avobenzone/TiO2 or avobenzone/ZnO combination is allowed. These restrictions go
back to concerns about chemical interactions leading to photoinstability. The issue
is still awaiting a final decision by the FDA [62].
Over the last two decades, new UV filters have been developed that are photostable and
cover a broad range of the UV spectrum [5, 48, 49]. The USA is the only country that has
not benefited from these innovations, because the US FDA has not added any new UV
filters to the sunscreen monograph since the addition of avobenzone in 1997 [63]. In 2002
the time and extent application (TEA) process was enacted to extend the approval process
to UV filters from abroad [64]; however, none of the eight UV filters that have been filed
through the TEA process has yet been approved (Table 11.5). There is only one UV filter
(avobenzone) for efficient UVA1 protection currently available in the USA. ZnO is much
less efficient and offers little protection beyond 370 nm and not permitted in combination
with avobenzone. On the other hand, there are a number of new UVA1 and broad-
spectrum UV filters in the TEA pipeline that have all been available in the rest of the world
for 15 years or more (bemotrizinol, bisoctrizole, ecamsule, and drometrizole).
Due to the lack of progress of the approval process, the Sunscreen Innovation
Act (SIA) was signed into law by the President of the USA on November 29, 2014,
stating defined time limits for the different steps of the approval process [65]. The
SIA had been initiated by the multi-stakeholder PASS coalition [66] and was rated
among the top health initiatives by the TIME magazine in 2014 [67]. In response,
the FDA held a meeting of its advisory committee on nonprescriptive drugs in
September 2014 [6872], where the industry had an opportunity to explain their
safety assessment approach (see Sect. 11.5). Early 2014, the FDA had already
started to send response letters to the TEA applicants requesting more data [7379].
Early 2015 it became apparent that there will not be any new UV filters on the US
market any time soon [80]. The FDA maintains that there is currently not enough
data to determine that any of the ingredients under review are generally recognized
as safe and effective [81].
11.5.2 UV Filter Use in Market in USA vs. Europe

and the Rest of the World
An evaluation at the launched products over the last few years in the high and very
high SPF category done by the market research company MINTEL [24] shows that
only a limited number of UV filters is used in the USA and Canada (North America)
compared with the rest of the world (Fig. 11.6). US sunscreens that provide the
required UVA protection are mainly composed of the five UV filters: avobenzone,
homosalate (HMS), octisalate (EHS), octocrylene (OCR), and oxybenzone (BP3).
Only avobenzone provides UVA1 protection (beyond 360 nm). The globally most
frequently used UVB filter octinoxate (EHMC) is practically not used in sunscreens
in the USA because it destabilizes avobenzone. In the rest of the world, it is used
together with other UVA/broad-spectrum UV filters. Its slight photoinstability,
partly due to internal cis/trans conversion, does not significantly affect its efficacy.
TiO2 and ZnO are less frequently used because they are not allowed in combination
with avobenzone due to FDA monograph restrictions. US manufacturers have thus
to make the decision to use either avobenzone or ZnO as UVA protection platform.
Figure 11.6 shows that in the rest of the world many more UV filters are used,
besides the global filters, mainly the TEA filters for UVA, bemotrizinol (BEMT),
bisoctrizole (MBBT), drometrizole (DBT), and ecamsule (TDSA) and the UVB
filters octyl triazone (EHT) and iscotrizinol (DBT). It should be noted that a global
filter oxybenzone (BP3) is virtually not been used anymore in Europe, having been
replaced by the new UVA filters. One reason is the mandatory declaration contains
oxybenzone because of its allergy potential. Such phasing out of oxybenzone is not
yet being possible in the US market for lack of available alternatives.
11.6 Conclusion
Tremendous progress has been made in sunscreen technology over the last two
decades, with the development of new photostable filters that covers a broad range
of UV radiation, including UVA1. Unfortunately, in the USA, UV filter technology
is lagging 15 years behind compared to the rest of the world. Until FDA provides
approval of new UV filters that have been submitted through the TEA process, it is
difficult for the sunscreen industry to introduce truly innovative new sunscreen
products in the USA.
In Europe and the rest of the world, development goes on, but it is slower than 20
years ago. The animal test ban in the European Cosmetics regulation may further
slow down technology innovations, but it could also trigger a regulatory shift away
from cosmetics toward medical device.
The major weakness of sunscreen and photoprotection remains the lack of com-
pliance by the user. To solve this problem, innovation in photoprotection education,
including behavior modification and sunscreen use, is required.
80 %
UV filters in % of SPF products launched
70 %
60 %
50 %
40 %
30 %
20 %
10 %
0%
EHMC
TiO2
OCR
EHS
BP3
HMS
EHT
PBSA
DBT
IMC
BMBM
BEMT
MBBT
DTS
TDSA
ZnO
UVB-UVA 2 Broad-spectrum/UVA 1
USA Europe
Fig. 11.6 UV filters used in sunscreens launched (After MINTEL [24]). Please see footnote in
Table 11.4 for complete list of abbreviations
Acknowledgement Thanks go to those who have contributed to the Delphi survey, although they
will remain anonymous to the reader; further to Prof. Brian Diffey for all his scientific contributions
to the topic over the last three decades and the valuable discussions; furthermore to our BASF
colleagues Drs. Bernd Herzog, Mechtild Petersen-Thiery, and Myriam Sohn for valuable
discussions; and last but not the least to the intern Felix Presencio who helped compiling and
designing tables and figures.
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tor-1427649129
Chapter 12
Organotypic Models for Evaluating
Sunscreens
Claire Marionnet and Franoise Bernerd
Key Points
The development of reconstructed skins has made possible in vitro assess-
ment of the effects of different types of UV exposure (UVB, UVA, or solar
simulation) in a three-dimensional context and in a cutaneous structure,
including different types of skin cells.
Reconstructed skin shows numerous biological endpoints which are pre-
dictive of in vivo response, hence allowing a better understanding of the
precise biological processes involved.
Reconstructed skin can be used to evaluate the photoprotection afforded by
sunscreens in vitro, providing additional biological data on sunscreen effi-
cacy to correlate with protection factors assessed in vivo.
The combination of 3-D skin models and new biological approaches such
as transcriptomic or proteomic will indisputably increase the added value
of such systems for evaluating sunscreen performance.
12.1 UV Exposure and Clinical Consequences
Skin, the largest organ of the human body, represents the main barrier ensuring a key
function of protection against external/environmental harm. Among this, solar and
especially ultraviolet (UV) rays can be considered as one of the major contributors.
The protective properties of the skin are supported by the whole skin structure in a
C. Marionnet F. Bernerd (*)

Department of Biological and Clinical Research,
LOral Research and Innovation, 1 avenue Eugne Schueller,
Aulnay sous Bois 93600, France

DOI 10.1007/978-3-319-29382-0_12
200 C. Marionnet and F. Bernerd
coordinate manner between the different compartments. The most superficial cuta-
neous layer, the epidermis, mainly composed of keratinocytes (approx. 90 %),
undergoes a stratification process and a specific and fine-tuned program of keratino-
cyte differentiation that leads to the formation of a compact stratum corneum. The
latter ultimately constitutes the first line of defense of the skin (for review, [67, 99]).
The epidermis is also the place of residence for the following: (1) melanocytes, the
pigmentary cells responsible for melanin synthesis [73], and (2) Langerhans cells, a
member of the antigen-presenting cell family involved in immune function [27]. The
underlying dermal compartment is mostly composed of extracellular matrix proteins
(ECM) synthesized by dermal fibroblasts and provides a mechanical and thermal
protective layer. It also hosts blood vessels as source of nutriments, nerve endings
and various appendages such as hair follicles, sebaceous and sweat glands [56].
Beside some beneficial effects of sunlight, such as vitamin D production, acute or
repetitive solar UV exposure can lead to harmful clinical consequences such as sun-
burn reaction associated with erythema and epidermal sunburn cells (SBC) forma-
tion but also middle- and long-term effects such as photoimmunosuppression,
photoaging mostly characterized by dermal alterations and the development of solar
elastosis and photocarcinogenesis, especially epidermal basal and squamous cell
carcinomas [65]. It is also known that hyperpigmentation, including the physiologi-
cal tanning response but also the appearance of hyperpigmented lesions such as
actinic lentigines, is directly related to sun exposure. Considering all these phenom-
ena, both compartments of the skin, dermis and epidermis, are affected. In addition,
it is now proven that all UV rays that reach the Earth surface are involved. UVB rays
(290320 nm), the most energetic wavelengths, can directly induce DNA lesions
such as cyclobutane pyrimidine dimers (CPDs) and 6,4-photoproducts. Most of the
direct UVB effects are located within the epidermis due to low penetration of these
wavelengths. Short (UVA2) or long (UVA1) UVA radiation (320340 nm and 340
400 nm, respectively) are less energetic than UVB but show progressively higher
penetration properties with increasing wavelength and can therefore reach the der-
mal compartment and its cells. Their major mode of action is the generation of reac-
tive oxygen species (ROS) that, in turn, lead to activate various signaling pathways.
12.2 Organotypic Skin Models
For both designing and evaluating the most effective photoprotection strategies, it is
crucial to understand and characterize the early biological events that occur
following UV exposure. For practical and ethical reasons in vivo studies in human
volunteers are often difficult to perform. In contrast, classical two-dimensional
(2-D) skin cell cultures poorly reproduce physiological conditions and tissue
organization, such as epidermal differentiation and cell-cell and cell-matrix
interactions. Moreover, they cannot take into account the penetration of UV rays
through the different skin compartments.
In vitro 3-D engineered skin models have been developed during the last 30 years
on the basis of human skin cell culture and organotypic reconstruction techniques and
12 Organotypic Models for Evaluating Sunscreens 201
Fig. 12.1 Main steps of in vitro reconstruction of the full-thickness skin model. First, a human skin
sample is trypsinized to separate dermis from epidermis. From both compartments, epidermal kerati-
nocytes and dermal fibroblasts are isolated and amplified in their respective culture medium. The
reconstruction starts with the production of the living dermal equivalent by mixing a collagen type I
solution with medium and dermal fibroblasts. This gel is poured into a Petri dish and left in the incuba-
tor at 37 C for 34 days to allow the contraction to proceed. Then the epidermis reconstruction starts
by seeding epidermal keratinocytes on the top of the dermal equivalent. The ring allows for control of
cell density. The culture is left for the immersion phase corresponding to the formation of a simple
epithelium covering the dermal substrate. Afterward, the whole culture is raised to the air-liquid inter-
face, fed by capillarity to promote the stratification and epidermal differentiation process. At the end
of this phase (usually 7 days), a stratum corneum is formed ( LOral Research and Innovation)
know-how. From the first reconstructed epidermis on a cell-free dermal substrate [100],
the in vitro skin models have been perfected over the past decades by adding different
cell types, improving the dermal equivalent and increasing the functionality of the
models [5, 37, 42, 75]. Reconstruction of in vitro skin models usually follows similar
key step process ([33, 40], and Fig. 12.1): (1) extraction of keratinocytes from the
epidermis of skin biopsies and amplification and (2) seeding of keratinocytes on the top
of a dermal equivalent which can be either a de-epidermized dermis (DED), an acel-
lular collagen matrix, a polycarbonate membrane, or a living dermal equivalent com-
posed of ECM and dermal fibroblasts. The keratinocytes are allowed to proliferate onto
the surface of the support by being submerged by the culture medium. During this step,
other epidermal cell types may be added melanocytes or precursors for Langerhans
cells (CD34+ cells) depending on the model to be produced. In the last step, the
whole culture system is placed in contact with air, corresponding to the air-liquid inter-
face culture period. During that phase, the culture medium is added underneath the
dermal support, and the system is fed by capillarity. This air-exposed phase period is
mandatory for the stratification and full differentiation of the epidermal structure.
Figure 12.2 illustrates different skin models.
a b c
NH Skin Reconstructed epidermis (DED) EPISkinTM
d e f
Full thickness (lattice model) Reconstructed epidermis + LC (DED) Full thickness model + MC
Fig. 12.2 Examples of organotypic skin models. (a) Normal human skin, bar = 50 m. (b)
Reconstructed epidermis on an acellular dead de-epidermized dermis (DED). (c) Reconstructed
epidermis on an acellular collagen matrix Episkin model. (d) Full-thickness skin model
composed of fibroblast-populated collagen matrix as dermal support and differentiated epidermis.
(ad) Hematoxylin-eosin staining. (e) Reconstructed epidermis on DED support; Langerhans cells
(brown) stained with Langerin antibody. (f) Pigmented full-thickness skin model. Melanocytes
(MD; green) are visualized using anti-tyrosinase-related protein (TRP)-1 antibody. Nuclei are
counterstained with propidium iodide
12.3 Effects of UV on Organotypic Models
Reconstructed skin in vitro can be used to study damage induced by UVB or by

UVA in order to determine the specific impact of each wavelengths range or that
induced by the combination of UVB and UVA, to simulate solar exposure.
Figure 12.3 illustrates the main biological effects induced by UVB, UVA or solar
simulation that are further detailed.
12.3.1 Effects of UVB Exposure on Reconstructed Skin:

A Major Impact on the Epidermis
Following UVB exposure of reconstructed human skin, major epidermal changes

were observed, affecting keratinocyte homeostasis and increasing pigmentation
process. The typical UVB-induced effects observed in human skin in vivo, such as
DNA damage formation, p53 accumulation, SBC, and apoptotic features could be
reproduced in skin reconstructed in vitro. These events represent the biological
signature of a moderate sunburn reaction.
As found in vivo and due to the direct absorption of UVB photons by DNA, DNA
damage such as pyrimidine dimers could be evidenced immediately following UVB
12
Organotypic Models for Evaluating Sunscreens
Fig. 12.3 Schematic representation of the main biological effects induced by UVB, UVA, or UV solar-stimulated radiation (SSR) exposure in a reconstructed
skin model. CPDs cyclobutane pyrimidine dimers, DCFH-DA 2, 7 dichlorofluorescin diacetate, ECM extracellular matrix, F fibroblasts, K keratinocytes, LC
Langerhans cells, M melanocytes, MMP1 matrix metalloproteinase 1, ROS reactive oxygen species, SBC sunburn cell
203
exposure in epidermal keratinocytes of reconstructed skin, using immunostaining,

LMPCR, and comet assay [12, 49, 115]. Using immunostaining, pyrimidine dimers
were detected immediately after UVB exposure, in all nuclei of epidermal cells.
Twenty-four hours later, the remaining positive nuclei persisted in upper suprabasal
and granular layers of the epidermis [12]. Pyrimidine dimers were completely
removed within the next few days by the nucleotide excision repair mechanism [15].
A direct consequence of such DNA lesions is the formation of SBC, the biologi-
cal hallmark of a sunburn reaction. In reconstructed skin models, SBC displayed
their typical histological features, i.e., a round shape, a loss of connection with the
surrounding keratinocytes, a condensed pyknotic nucleus, and an eosinophilic
cytoplasm together with a suprabasal localization 24 h post UVB exposure. Similarly
to in vivo, these are progressively removed from the epidermis within a few days
together with the formation of a parakeratotic horny layer and changes in expression
of differentiation markers [12, 55]. Parallel to SBC formation, apoptosis was
observed in viable epidermis of human reconstructed skin exposed to UVB, using
TUNEL reaction. Apoptotic keratinocytes were especially detected in the deeper
epidermal layers, with a density and a localization correlating with that of SBC [12,
55]. At the molecular level, UVB exposure altered the expression and posttranslational
modifications of several actors of the apoptotic pathway. P53 accumulated in basal
and suprabasal cells, while BCl2 expression decreased following UVB exposure
[55, 118]. Moreover, other apoptotic-related biomarkers were induced such as
galectin-7, a keratinocyte-specific protein or caspase 3 cleavage [17, 47]. Recently,
the use of reconstructed skin model enabled to show that dermal fibroblasts can
influence the impact of UVB exposure on epidermal keratinocytes by accelerating
the removal of pyrimidine dimers and reducing keratinocyte apoptosis [47]. Apart
from apoptotic SBC, structural UVB-induced alterations can be observed in the
epidermis using electron microscopy, such as the formation of dense cytoplasmic
bodies, as well as vacuolation and indentation of the nuclear envelope in basal cells
[60]. These changes were similar to those observed in normal human skin following
UV exposure [93, 94, 119]. UVB exposure also led to increased keratinocyte
proliferative activity [12, 60] in agreement with hyperplasia observed in vivo [96].
The UVB photoproduction of vitamin D3 observed in human skin in vivo can be
reproduced in models of human reconstructed skin, with the photoconversion of
7-dehydrocholesterol to previtamin D3 and its subsequent isomerization to vitamin
D3 and ultimately calcitriol formation. The percentages of main photoproducts of
7-dehydrocholesterol were shown to be identical in reconstructed skin model and in
human skin in vivo. Keratinocytes were absolutely required for calcitriol formation
in reconstructed skin [70, 95].
In addition to the multiple direct effects of UVB on human epidermis, dermal
compartment can also be impacted through the production of degrading enzymes,
such as matrix metalloproteinases (MMPs) following UVB exposure. In human
skin in vivo, increase in MMPs mRNA expression and MMP-1 activation after
UVB exposure have been reported, and its involvement in premature aging has been
pointed out [48]. Following UVB exposure of reconstructed human skin, MMP-1
protein expression was increased in fibroblasts, only in the presence of the epidermis.
This points out the indirect impact of UVB radiation on fibroblasts and ECM, via its
direct action on epidermal keratinocytes and their release of diffusible IL1 and IL6
cytokines [45, 46]. UVB also increased the expression and activity of epidermal
MMPs, such as MMP-2 and MMP-9 in a full-thickness skin model [2]. Reinforcing
the involvement of UVB in photoaging process, Kurdykowski et al. showed the
UVB modulation of hyaluronidases expression in reconstructed epidermis [66].
The use of reconstructed pigmented skin, including a mix of melanocytes and
keratinocytes seeded onto a dermal equivalent or a de-epidermized dermis, enabled
the impact of UVB exposure on pigmentation to be investigated. Sequences of
repeated UVB exposures led to an increase in proliferation, dendricity, and activity
of melanocytes and an increase in melanin production and in melanosome transfer
from melanocytes to keratinocytes, resulting in a noticeable tanning of the
reconstructed epidermis [20, 21, 38, 52, 69, 90, 116, 117].
12.3.2 Effects of UVA Exposure on Reconstructed Skin:

A Major Impact in the Deeper Layers of the Skin
Studies of the impact of UVA in reconstructed human skin revealed that this 3-D
skin model enabled to reproduce main features of UVA effects observed in human
skin in vivo.
The immediate damage following UVA exposure in human skin in vivo is the gen-
eration of reactive oxygen species (ROS) leading to oxidative stress, as well as DNA
damage, especially pyrimidine dimers and 8-oxo-7,8-dihydro-2-deoxyguanosine
(8-OHdG) accumulating in basal keratinocytes that may lead in the long term to DNA
mutations [64, 114].
In reconstructed skin, UVA exposure also led to ROS formation, as visualized
using DCFH-DA probe, in a UVA dose-dependent manner in both fibroblasts and
keratinocytes. Increasing doses of UVA induced ROS deeply in the epidermal basal
layer but also in the deepest dermal fibroblasts illustrating the high penetration prop-
erties of UVA wavelengths [80, 118]. Six hours after UVA exposure, cells of recon-
structed skin responded to this oxidative stress with the upregulation of the expression
of genes involved in oxidative stress management such as genes of the Nrf2 pathway.
For example, a strong increase in HMOX1 and TXNRD1 mRNA could be observed
in fibroblasts, together with a strong increase in TXNRD1, NQO1, and FTL mRNA
in keratinocytes. A UVA induction of ferritin protein was detected in basal keratino-
cytes of reconstructed epidermis [109]. The expression of genes involved in the
redox status of glutathione was also modulated [86]. ROS may lead to cell compo-
nents alterations in reconstructed skin, such as lipid peroxidation and protein oxida-
tion [54]. Lipid peroxidation can in turn lead to cell membrane damage and can also
act as cell signal mediators since particular oxidized phospholipids could induce
HMOX1 expression in reconstructed skin [54]. Protein oxidation phenomenon can
be amplified by pheomelanin, acting as a photosensitizing agent, as shown by
Maresca et al., in a reconstructed model including melanocytes [34, 77, 80].
As found in human skin in vivo, thymine dimers were also detected after UVA
exposure, in basal keratinocytes of reconstructed skin using immunostaining, albeit
in a much lower amount than post UVB exposure [13, 80, 114]. Immunostainings
also revealed increased levels of 8-OHdG oxidative DNA lesion in epidermal and
dermal cells nuclei following UVA exposure of living skin equivalents [36].
Furthermore, exposure to repeated low doses of UVA induced p53 mutations in
basal keratinocytes of the epidermis [63].
Regarding histological alterations, in contrast to UVB, major features of UVA
effects were located in the dermal compartment of reconstructed skin in vitro, in
correlation with previous human in vivo studies showing that repetitive exposures to
low UVA doses induced early morphological and biochemical alterations in the
dermis [11, 68, 74].
Forty-eight hours after UVA exposure of reconstructed skin, the dermal fibro-
blasts localized in the superficial portion of the dermal equivalent disappeared,
underlining the significant biological impact of UVA in deeper layers of skin and
confirming that dermal fibroblasts were more sensitive to UVA-induced oxidative
stress than keratinocytes [3, 88]. UVA cytotoxicity toward fibroblast was direct
and mostly due to apoptosis, accompanied by an upregulation of the expression of
genes related to cell death and apoptosis, such as DDIT3, IER3, BIRC3, and
NR4A1, NR4A2, and NR4A3 [13, 43, 80]. This particular impact on dermis was
emphasized by the upregulation of several MMP gene and protein expression
(e.g., MMP-1, MMP-9, MMP-3) [78, 86]. It was shown that UVA exposure, in
contrast to UVB exposure, induced the production of MMP1 by fibroblasts in a
direct manner, since the removal of epidermis immediately after UVA exposure
did not alter this effect [118]. The expression of COL1A1 gene was downregu-
lated in fibroblasts of reconstructed skin exposed to UVA rays [79, 80, 86]. The
epidermal structure and organization were to a lesser extent impacted by exposure
to UVA, with a slight impact on the upper layers and parakeratosis [13]. Higher
doses of UVA could lead to disorganization of the living epidermis together with
a reduced skin barrier function, increase in phospholipid, and decrease of ceramide
levels [103].
In vivo, UVA exposure also impacts skin immunity, with inflammatory effects and
with immune suppression [28, 57, 58]. In line with these in vivo clinical features, UVA
exposure of reconstructed skin leads to the upregulation of proinflammatory genes
and/or proteins such as IL1, IL6, IL8, GM-CSF, COX-2, or PGE2 [32, 78, 80, 92]. In
contrast, numerous genes encoding proteins involved in antiviral defense were strongly
downregulated following UVA exposure in fibroblasts and keratinocytes of recon-
structed skin, possibly related to photoimmune suppression observed in vivo [80].
Concerning pigmentation process, Duval et al., using a reconstructed epidermis
including melanocytes, showed that UVA exposure led to the production and
transfer of melanin to the neighboring keratinocytes and resulted in tanning of the
reconstructed epidermis, like UVB exposure, and as observed in vivo [38, 97].
Altogether these results illustrated the penetration properties of UVA rays as
attested by the direct UVA-induced biological damage in dermis and the particular
vulnerability to UVA rays of the deepest epidermal layer, location of epidermal
stem cells, proliferative keratinocytes, and melanocytes [59, 113]. The particular
impact of UVA on the dermal compartment observed in vivo and in 3-D models
in vitro may be involved in early events occurring during photoaging leading to
drastic alterations of dermal structure and formation of the solar elastosis, classically
observed in photoaged skin [25].
12.3.3 Effects of Solar Simulation Exposure

on Reconstructed Skin
The effects of solar-simulated radiation (SSR), including UVA and UVB, have been
studied in reconstructed human skin models. Today, two types of solar simulation
can be distinguished: UV solar-simulated radiation (UV-SSR) and daily UV
radiation (DUVR). Both include UVA and UVB rays, but in different proportion,
the DUVR spectrum including a higher UVA proportion than the UV-SSR spectrum,
in order to simulate two distinct types of sun exposure. UV-SSR spectrum mimics a
condition of exposure under a summer zenithal sunlight (i.e., sunbathing on a beach
in summer under a clear sky) and may rapidly lead to erythema in human skin
in vivo therefore maximizing UVB impact. In turn, DUVR spectrum simulates a
non-extreme condition of sun exposure corresponding to a western spring or autumn
sunlight, with a solar elevation angle lower than 45, which does not give rise to any
visible immediate clinical damage [26, 53, 83, 106].
12.3.3.1 UV-SSR
It has been shown that UV-SSR induce DNA damage in keratinocytes of recon-
structed skin, such as pyrimidine dimers, (6-4) photoproducts, photooxidative dam-
age, and single-strand breaks [19, 22, 85, 98]. This was followed by an accumulation
of p53 and an upregulation of genes controlled by p53 involved in DNA repair and
in cell cycle regulation, such as p21, MDM2, and GADD45 genes. In addition,
genes of the Nrf2 pathway were upregulated post UV-SSR exposure in keratino-
cytes [85]. The levels of HSP27, MnSOD, and PDX-2 proteins, also involved in
oxidative stress response, were upregulated after UV-SSR exposure as revealed by
proteomic profiling of reconstructed epidermis exposed to UV-SSR [62].
Histologically, changes induced by UV-SSR exposure of reconstructed skin
closely resemble to those observed in vivo and those observed following pure UVB
exposure. UV-SSR clearly impacted epidermis, with the induction of epidermal
SBC formation 24 h after exposure, as well as an absence of laminin deposition at
the basement membrane. Exposure to higher doses of UV-SSR led to an epidermal
disorganization, a thickened stratum corneum and a reduction in the number of epi-
dermal cell layers [19, 22, 46].
Repeated UV-SSR exposures also impacted the morphology of melanocytes in
reconstructed skin: they became more dendritic, as observed in vivo. Exposure of
pigmented reconstructed skin to UV-SSR induced an increase in melanin content
and tanning of the 3-D model [4, 16, 39].
As immunosuppression is one of the main clinical consequences of UV exposure

in vivo, 3-D models containing immune competent cells have been developed to
study UV effects. In a reconstructed skin model including Langerhans cells, it was
shown that UV-SSR exposure led to a significant decrease in the number of
Langerhans cells and, for the remaining ones, a change in their morphology from a
dendritic to a round cell shape [39]. These effects were reminiscent to those found
in vivo associated with photoimmunosuppression [1, 7, 31, 91, 110]. Another model
including Langerhans cells and dermal dendritic cells showed evidence of the
migration of these cells into the dermal equivalent of the reconstructed skin exposed
to UV-SSR, together with an increase in proinflammatory proteins such as TNF-,
IL1 , IL6, IL8, and COX-2 [10, 76].
In addition to these epidermal direct effects, UV-SSR exposure of reconstructed
human skin led to the increased production of MMP-1 by fibroblasts, via paracrine
activation of epidermal keratinocytes, involving IL1 and IL6 cytokines, as it was
observed after UVB exposure [46].
12.3.3.2 DUVR
While consequences of UV-SSR exposure on reconstructed skin closely resemble

those observed after UVB exposure, DUVR induced features close to those found
after UVA exposure. This may be related to the higher UVA/UVB ratio (23) in
DUVR spectrum compared to that of UV-SSR (17).
DUVR exposure can immediately induce ROS formation in both deep
keratinocytes and fibroblasts of the reconstructed skin, in a dose-dependent manner.
In response to this oxidative stress, reconstructed skin cells exhibited a modulation
of expression of numerous genes involved in antioxidant cell response, such as
genes encoding metallothionein, Nfr2 target genes and proteins, sestrins, and
methionine sulfoxide reductase A genes. The use of reconstructed skin model
allowed to determine the specific responses of fibroblast and keratinocytes to oxida-
tive stress induced by DUVR [81].
A histological analysis of reconstructed skin exposed to DUVR revealed that
alterations were mostly located in the dermal compartment, with the disappearance
of superficial fibroblasts, as observed after UVA exposure. In addition, several genes
encoding ECM and dermal epidermal components and proteins of ECM maturation
were affected by DUVR exposure. For instance, COL1A1 gene was downregulated,
whereas MMP-1 and MMP-3 genes and proteins were upregulated in reconstructed
skin exposed to DUVR [71, 79].
To a lesser extent than dermis, epidermis was impacted by DUVR exposure, with
alterations of the granular layers also resembling those observed after UVA expo-
sure, together with a thickened of the cornified layer. At molecular level, these
changes were correlated with the modulation of expression of genes involved in the
differentiation/proliferation balance, such as members of the epidermal differentia-
tion complex, KI67, K6B, or ODC1. Altogether these epidermal changes could be
linked to skin surface alterations (perturbation of hydration, skin microrelief,
epidermal proliferation and thickening) observed in vivo following DUVR expo-

sure [105, 111]. Few SBC and p53-positive keratinocytes could also be detected, as
described in vivo [71, 81, 111].
The impact of DUVR on skin immunity was evidenced by the strong increase in
the expression of genes encoding cytokines and inflammation markers such as IL1,
IL6, IL8, CCL2, ICAM1, CSF2, TNF, and COX-2. Increase in IL6, IL8, TNF-,
and CSF2 expression was also shown at protein level. In contrast, TLR1, TLR3, and
TNSF10 gene expression was downregulated [82].
12.4 Evaluation of Sunscreens in Organotypic Models
Reconstructed skins, including different types of skin cells, present a tissue organiza-
tion close to that of in vivo human skin, with a correct epidermal differentiation, a
dermal epidermal junction as well as cell-cell and cell-matrix interactions. Due to
their 3-D architecture, they are useful tools to take into account the penetration of UV
rays through the different skin compartments. Moreover major UV-induced damage
observed in vivo can be reproduced in these 3-D skin models, with wavelength spe-
cific and common skin targets within epidermal and dermal compartments (Fig. 12.3).
Another great advantage of such 3-D skin models is the possibility to apply cos-
metic/dermatologic formulations directly on the skin surface as it can be done in real-
life situations. This aspect becomes paramount when dealing with sunscreen products
that are only topically applied, forming a barrier between solar UV rays and skin cells.
By using classical endpoints and new ones such as gene expression profiling,
reconstructed skins can be used to evaluate skin photoprotection incurred by
chemical (organic) or physical (inorganic) sunscreens. Single absorbers or complex
sunscreen formulations composed of a combination of filters, to provide the largest
absorption profile comprising UVB+UVA wavelengths domains, have been tested.
Table 12.1 summarizes the different studies found in the literature.
The first approach using reconstructed skin for the evaluation of photoprotective
efficacy determined the global cellular viability, by performing the MTT
(3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) tetrazolium reduc-
tion assay [6, 92]. Augustin et al. tested photoprotection afforded by sunscreen
ingredient, Eusolex 6300 (Merck, USA), a UVB blocking benzylidene camphor
derivative (absorption peak at 300 nm), or Eusolex 8020 (Merck, USA), a UVA
blocking dibenzoylmethane derivative (absorption peak at 350 nm), both diluted at
3 % and applied topically onto skin equivalents. After exposure to UVB or UVA,
respectively, the residual cellular viability was found higher in photoprotected skin
versus control, demonstrating the photoprotective effect of the filters [6].
Commercially available sunscreen products were also tested using the same proto-
col. A sunscreen product with a SPF (sunburn protection factor) 15 containing
organic UVB or UVA filters and a sunscreen product, with ultra-high protection
including mineral filters, showed both good efficacy regarding viability of skin
equivalents following UVB or UVA exposure [6]. In an attempt to rank sunscreens
Table 12.1 Summary of studies using organotypic models for the evaluation of sunscreens
210
Protection
Sunscreena factorsb Organotypic Model Biological endpoints UV source Reference
Single absorbers (concentrations when available)
Homosalate (8 %) SPF 4.24 Full-thickness skin model MTT UV-SSR [92]
Photoplex (with PABA ester + BMDM) PFA 1.8 (LSE ) MTT UVA
Padimate O (7 %) PFA 1.31 MTT UVA
MTT UVA
Benzophenone 3 (2 %, 5 %) PFA 2.33, 3.97
4-Methylbenzylidene camphor (3 %) NA Dermal equivalent MTT UVB [6]
Isopropyl dibenzoylmethane (3 %) NA Full-thickness skin model MTT IL1 UVA
2-EHMC (5 %) SPF 5.8 Full-thickness skin model SBC, CPDs UVB [18]
Terephthalylidene camphorsulfonic SPF 5.1 Dermal fibroblasts, histology, UVA
acid (5 %) vimentin, MMP1
Drometrizole trisiloxane NA Full-thickness skin model SBC, CPDs UVB [14]
Dermal fibroblasts, histology, UVA
vimentin
Cinnamate SPF 12 Reconstructed epidermis SBC, CPDs, protein oxidation, UVB [24]
(DED model) +/ lipoperoxidation, vit E, SOD/ UVA
melanocytes Catalase ratio UVA + UVB
TiO2 (16 %) SPF 28 Full-thickness skin model 6.4 PP, CPD, photooxidative UV-SSR [104]
damage
Terephthalylidene camphorsulfonic SPF 5.1 Pigmented epidermis Pigmentation (visual, UV-SSR [39]
acid (5 %) (DED model) colorimetric L*)
Reconstructed epidermis Langerhans cells number and UV-SSR
(DED model) + morphology (dendricity)
Langerhans cells
C. Marionnet and F. Bernerd
12
Terephthalylidene camphorsulfonic acid NA Reconstructed epidermis Langerhans cells number and UV-SSR [44]
(1 % or 4 %) (Episkin model) + morphology (dendricity), SBC
Langerhans cells
Terephthalylidene camphorsulfonic NA Reconstructed epidermis DNA lesions (comet assay) UV-SSR [49]
acid (0.01 %) (Episkin)
Complex formulations (concentrations of sunscreens when available)
Chemical sunscreensc SPF 4, 8, 12, 15 Full-thickness skin model IL1 release UV-SSR [102]
Physical sunscreenc SPF 15 (Skinc)
4-Methylbenzylidene camphor (6 %), SPF 15 Full-thickness skin model MTT, IL1 UVA [6]
terephthalylidene camphorsulfonic acid MTT UVB
(1 %), BMDM (2 %)
TiO + TiO2 NA
Terephthalylidene camphorsulfonic SPF 25 PPD 5 Reconstructed epidermis MTT (phototoxicity induced by UVA [29]
acid + TiO2 (Episkin) chlorpromazine)
Terephthalylidene camphorsulfonic acid, SPF 60 PPD 12
BMDM, 4-methylbbenzylidene camphor,

TiO2
BMDM (3 %), benzophenone 3 (3 %), SPF 30 Full-thickness skin model 6,4PP, CPD, photooxidative UV-SSR [22]
2-ethylhexyl 2-hydroxybenzoate (5 %), damage
2-EHMC (7,5 %)
Cinnamate, TiO2, ZnO SPF 12 Reconstructed epidermis SBC, CPD, protein oxidation, UVB [24]
Cinnamate, TiO2, BMDM SPF 12 (DED) melanocytes lipoperoxidation, vit E, SOD/ UVA
Catalase ratio UVA + UVB
Octocrylene (7 %), BMDM (3 %) SPF 7.4 PPD Full-thickness skin model Histology, vimentin. UVA [19]
7.2 SBC, CPD, histology, vimentin UV-SSR
2-EHMC (3,75 %), ZnO (7,5 %) SPF 7.5 PPD
2.8
(continued)
211
212
Protection
Sunscreena factorsb Organotypic Model Biological endpoints UV source Reference
TiO2 (11 %), ZnO (4 %) NA Reconstructed epidermis Histology, SBC, viability, p53 UV-SSR [51]
Octyl methoxycinnamate (4 %), NA (SkinEthic RHE) protein expression
methylene bis-benzothiazolyl
tetramethylbutylphenol (4 %), TiO2
(1 %), ZnO (0.5 %)
BMDM (1.5 %), ethylhexyl triazone SPF 25,2 Full-thickness skin model Dermal fibroblasts, histology, UVA- [84]
(2 %), ethylbenzilidene camphor (5 %) in vimentin, MMP1 UV-SSR
15 % Miglyol
BMDM (1.5 %), ethylhexyl triazone SPF 22,8
(2 %), octyl methoxycinnamate (5 %) in
15 % vaseline oil
BMDM (2 %), octocrylene (10 %), SPF 15 Full-thickness skin model Dermal fibroblasts, histology, DUVR [71]
terephthalylidene camphorsulfonic vimentin, MMP1
acid (2 %)
Octyl methoxycinnamate (6 %), ZnO SPF 15
(3 %)
BMDM (3 %), terephthalylidene SPF 18
camphorsulfonic acid (3 %), octocrylene
(5 %), drometrizole trisiloxane (1 %)
Octocrylene (2.5 %), ethylhexyl SPF 27
methoxycinnamate (7.5 %), ethylhexyl
salicylate (2.5 %), ZnO (6 %)
2-EHMC, BEMT, methylene bis- NA Reconstructed epidermis Cell viability (LDH, ERK2 UV-SSR [8]
benzotriazolyl, tetramethylbutylphenol (SkinEthic RHE) release), DNA damage (thymin
dimers, DNA fragmentation),
apoptosis (TUNEL, caspase 3
activation), SBC
C. Marionnet and F. Bernerd
12
BMDM (3 %), homosalate (15 %), SPF 45 Full-thickness skin model ROS (DCFH-DA), IL1, UV-SSR [101]
ethylhexyl salicylate (5 %), octocrylene (StrataTest) IL1-RA, CPD
(4.5 %), benzophenone 3 (6 %)
BMDM (4 %), octocrylene (2.5 %), SPF 67.5- PPD Full-thickness skin model Gene expression/Protein UVA [78]
ethylhexyl salicylate (5 %), 31.1 expression
terephthalylidene dicamphor sulfonic
acid (1 %), drometrizole trisiloxane
(0.5 %), TiO2 (4.5 %), ethylhexyl
triazone (1 %), BEMT (3 %)
BMDM (3 %), octocrylene (5 %), SPF 13- PPD Full-thickness skin model Gene expression/Protein DUVR [82]
ethylhexyl salicylate (5 %), 10.5 expression
terephthalylidene dicamphor sulfonic
acid (3 %)
Commercial sunscreens SPF >20+/UVA SPF 2050 Full-thickness skin model DMPO protein-radical adduct UV-SSR [61]
protection (EpiDermTM Full
BMDM (5 %), 2-EHMC (10 %) SPF 15 Thickness)
TiO2 (7.5 %) SPF 15

UVA enhancer-TiO2 (7.5 %) SPF 15
ZnO (4.12 %), octyl methoxycinnamate SPF 30 Full thickness skin model CPDs, SBC UV-SSR [35]
(5.5 %) (EpiDerm-FT)
a
INCI names
b
Protections factors determined in vivo. NA not available in the literature
c
The composition is not available in the literature. DED dead de-epidermized dermis, 2-EHMC 2ethylhexyl methoxycinnamate, BMDM butylmethoxy diben-
zoylmethane, MTT 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, BEMT bis-ethylhexyloxyphenol methoxyphenyl triazine, SPF sunburn pro-
tection factor, PPD persistent pigment darkening [87], PFA protection factor UVA measured by delayed erythema or tanning 24 h after exposure to UVA [30],
DUVR daily UV radiation, CPD pyrimidine dimers, 6,4PP 6,4 photoproducts, SBC sunburn cells, MMP1 matrix metalloproteinase 1
213
on their photoprotection efficacy, Nelson and Gay compared three UVA filters and
one placebo having different UVA protection factors established in human skin by
scoring delayed erythema or tanning 24 h after UVA exposure [30]. Placebo, 7 %
padimate O, 2 % oxybenzones, and 5 % oxybenzones exhibited in vivo UVA protec-
tion factors of 1.15, 1.31, 2.33, and 3.97, respectively. Cytotoxicity measurements
in Living Skin Equivalent (LSE), a full-thickness skin model, exposed to UVA
allowed the authors to calculate in vitro photoprotection values of sunscreens, by
dividing the UVA50 in the sunscreen-applied skin equivalents by the UVA50 in the
unprotected samples. All the tested filters exhibited a higher photoprotection effi-
cacy compared to untreated skin. However, in vitro photoprotection values did not
fully rank sunscreens as in vivo protection factors. The authors suggested that such
discrepancy may be related to the different UVA light sources used in in vivo and
in vitro studies, due to the use of different cut-off filters (2 mm WG-345 filter
in vitro vs 3 mm WG-335 filter in vivo) [92].
Beyond cytotoxicity and because UVB and UVA induced specific damage in
human skin, endpoints related to wavelength range have been used in photoprotec-
tion studies.
In vivo, one of the first approaches to evaluate protection of sunscreens is the
determination of the SPF based on the prevention of cutaneous erythema, an end-
point mostly induced by UVB radiation. The clinical appearance of erythema has
been correlated with the formation of epidermal SBC, whose apoptotic process is
due to high levels of unrepaired DNA lesions. Moreover it has been shown in vivo
that sunscreens with appropriate SPF values are efficient in preventing UV-induced
DNA lesions [50, 72]. For these reasons, SBC and thymine dimer formation
appeared to be relevant to evaluate photoprotection against UVB or UV-SSR-induced
damage. Using these endpoints, the photoprotective efficiency of 2-ethylhexyl-p-
methoxycinnamate (2-EHMC, ParsolTM MCX), a UVB absorber, with an in vivo
SPF of 5.8, was tested in reconstructed skin exposed to UVB rays. By analyzing
thymine dimers and SBC formation after application of 2-EHMC, the authors
showed that the highest dose able to prevent SBC formation corresponded to five
times the biological efficient dose previously determined in the in vitro model [18],
in line with the in vivo SPF value (Fig. 12.4). Studying the protection afforded by
the UVB filter cinnamate, or complex formulations including cinnamate, Cario-
Andr et al. confirmed the relevance of using the prevention of SBC and CPD
formation as endpoints after UVB or UVA+UVB exposure of reconstructed epider-
mis on dead de-epidermized dermis [24].
The quantification of UV-induced lesions, i.e., pyrimidine dimers, 6,4-photo-
products, and photooxidative damage, in the epidermis of reconstructed skin by
alkaline gel electrophoresis and radioimmunoassay methods, was also used to eval-
uate chemical or physical sunscreens. This allowed the determination of a DNA
protection factor (DNA-PF) defined as the frequency of lesions induced in unpro-
tected reconstructed skin divided by the frequency of lesions induced in sunscreen-
protected samples. Results suggested that, using this method, a 1-2 DNA-PF would
correspond to an SPF 30 sunscreen [22, 104].
Fig. 12.4 Thymine dimers DNA lesions used for the evaluation of UVB photoprotection. Without
prior sunscreen application, thymine dimers are immediately formed after exposure to pure UVB
(50 mJ/cm2) as revealed by the H3 antibody. When a sunscreen absorbing in the UVB range is
applied prior to UVB exposure, the DNA lesions can be prevented. Note that the highest dose able
to prevent thymine dimer formation is fivefold the biologically efficient dose, in line with the SPF
value of 5.8 (Adapted from Bernerd et al. [18])
In addition to DNA damage and SBC formation, other UV-SSR-induced epider-

mal damages have been used in reconstructed epidermis for sunscreen evaluation
after UV-SSR exposure, such as p53 protein expression and apoptosis [8, 51].
The contribution of UVA rays to photoaging and photocarcinogenesis are now
well-established, therefore, evaluation of UVA photoprotection becomes crucial.
Major alterations induced by UVA exposure are located in the deepest layers of the
reconstructed skin, especially within the dermal compartment, with the apoptosis
of dermal fibroblasts and MMP1 release in the culture medium. Using these end-
points, the photoprotection afforded by two UVA filters, terephthalylidene dicam-
phorsulfonic acid (MexorylTM SX) and drometrizole trisiloxane (MexorylTM XL),
was assayed on a full-thickness reconstructed skin model. Each filter prevented the
disappearance of fibroblasts and the MMP1 release in culture medium induced by
UVA exposure. Since both products can also absorb UVB wavelengths, they were
also shown to prevent UVB-induced SBC and thymine dimers. In contrast,
2-EHMC, a pure UVB absorber, was unable to prevent UVA-induced dermal alter-
ations. These results demonstrated that using specific UVB and UVA endpoints, it
became possible to discriminate the biological efficacy of single absorbers [14,
18]. These in vitro results fully correlate with in vivo data that showed the effi-
ciency of MexorylTM SX in preventing dermal damage induced by repeated UVA
exposures [107].
Such UVA- and UVB-specific endpoints were also useful to assess and compare
the protection afforded by two sunscreen products with different absorption pro-
files. The tested products exhibited the same SPF values (7.4 and 7.3) but different
UVA protection factors (7.2 and 2.8, respectively, as determined by the persistent
pigment darkening, PPD, method). Following UVB exposure, the two products
showed the same protection efficiency against SBC and pyrimidine dimers in
agreement with their similar SPF values. In contrast, following UVA or UV-SSR
exposure, dose-response experiments showed that the sunscreen with the highest
UVA-PF provided a better protection with regard to dermal damage, as compared to
the other one (Fig. 12.5) [19]. These results pointed out that the SPF value is, per se,
not sufficient to reflect the efficiency of sunscreens over the entire solar UV spec-
trum and against the major biological damage induced by sun exposure. These
in vitro results were also in agreement with an in vivo study using the same sun-
screen products showing a higher efficacy of the product having a UVB-UVA bal-
anced absorption profile [108].
Because of the major contribution of UVA rays in daily UV radiation exposure
[79], the importance of UVA absorption by sunscreens was also demonstrated under
a non-zenithal UV exposure condition. Two commercial sunscreens with similar
SPF values (approx. 15) but with different absorption profiles in the UVA range
were tested on reconstructed skins exposed to DUVR. The sunscreen formulation
with the highest UVA-PF afforded a better protection of dermal damage such as
fibroblast disappearance and MMP1 release than the other one. To test if a highest
SPF could compensate a low UVA-PF, the protection against DUVR-induced dam-
age of two other sunscreen products were compared: one product having an SPF of
27 and a low UVA absorption and the other having an SPF of 18 and a well-balanced
UVB-UVA absorption profile. The study of prevention against dermal alterations
indicated that a higher SPF value did not compensate for low UVA filtration, the
SPF18 product with well-balanced UVA-UVB absorption being more effective than
the SPF27 product [71].
Endpoints related to oxidative stress have been used to study UVA or UVB+UVA
photoprotection, such as protein and lipid oxidation and antioxidant depletion.
However, protective effects of sunscreens were not fully evidenced using these
endpoints, partly due to the difficulty of spreading the cream onto reconstructed
skin samples [24].
The importance of sunscreen photostability in photoprotection has also been
addressed using a full-thickness model of reconstructed skin. A photostable
sunscreen formulation was compared to a photounstable formulation after topical
application on reconstructed skin further exposed to UVA or to UV-SSR. The results
evidenced that only the photostable product ensured an efficient photoprotection
against UVA or UV-SSR dermal damage and MMP1 production [84].
In order to assess some biological endpoints that could be related to other
clinical consequences of UV exposure such as pigmentation or photoimmuno-
suppression, photoprotection against UV-induced pigmentation or UV-induced
alterations of Langerhans cells can be tested in adapted 3-D models (Fig. 12.6).
For example, the application of the broad-spectrum absorber MexorylTM SX on
a model of reconstructed pigmented epidermis was able to prevent UV-induced
pigmentation as visually assessed and by measuring the luminance L* factor
[39]. In addition, in 3-D models comprising Langerhans cells, the same filter
preserved the morphology and the number of Langerhans cells under UV-SSR
exposure [39, 44].
Fig. 12.5 Dermal fibroblast alterations and disappearance used for evaluating UVA photoprotection.
Sunscreen A or sunscreen B was applied onto full-thickness skins prior to exposure to the same
dose of UV-SSR. Whereas sunscreen A, having the higher UVA protection factor (UVA-PF), is
able to protect the skin against dermal damage, sunscreen B is not efficient in preventing the
dermal fibroblasts disappearance (oval). No epidermal changes were observed in both cases under
such a UV-SSR exposure due to the same SPF value of both sunscreens products (Adapted from
Bernerd et al. [19])
More recent technologies such as transcriptomic and proteomic, which allow

large-scale analyses of gene and protein expression to be performed, can also be
useful in the field of photobiology. They evidenced that UV exposure induces
numerous changes in gene and protein expression, revealing the diversity of bio-
logical functions that can be altered by UV radiation [9, 23, 41, 80, 89, 112]. Gene
expression analysis was recently used to evaluate photoprotection efficacy of sun-
screens. In a reconstructed skin model, the UVA protection incurred by a broad-
spectrum sun care product was tested by studying the expression of more than 200
genes related to skin biology and stress, in dermal fibroblasts and in epidermal
keratinocytes, respectively. The results showed that UVA exposure led to the
Fig. 12.6 Reconstructed epidermis containing Langerhans cells or melanocytes for the evaluation
of photoprotection. (a) Epidermal sheets stained with anti-Langerin antibody. In control (Ctrl)
sample, the Langerhans cells are randomly distributed throughout the epidermis while in the
UV-SSR-exposed sample, Langerhans cells are sparse, and the remaining cells display a round and
non-dendritic morphology. Application of the sunscreen before UV-SSR exposure prevented these
alterations. (b) Reconstructed epidermis (DED model) containing melanocytes. The pigmentation
is increased after exposure to UV-SSR, but this increase can be limited when the sunscreen is
applied onto the sample prior to UV-SSR exposure. Pigmentation is assessed macroscopically and
by measuring the luminance L*parameter (Adapted from Facy et al. [44] and Duval et al. [39]).
MSX MexorylTM SX
modulation of gene expression in both cell types (32 modulated genes in fibroblasts
and 44 in keratinocytes). The modulated genes were involved in ECM homeostasis,
oxidative stress, heat shock response, cell growth, inflammation, and epidermal dif-
ferentiation. Application of sunscreen on reconstructed skin before UV exposure
mitigated these effects, with a reduction in the number of modulated genes (4 modu-
lated genes in fibroblasts and 11 in keratinocytes) and in the intensity of modulation
of the residual modulated genes (Fig. 12.7). The UVA-induced release of MMP1
protein and proinflammatory cytokines in the culture medium was also alleviated by
using the sunscreen (Fig. 12.7). Prevention of gene expression modulation incurred
by the sunscreen was confirmed in human skin in vivo by quantifying the expression
of five genes involved in oxidative stress response and photoaging (HO-1, SOD2,
GPX, CAT and MMP1), reinforcing the relevance of using the 3-D model to test
photoprotection on such endpoints [78].
Gene expression analysis in fibroblasts and keratinocytes of reconstructed skin
was also used to assess photoprotection efficiency of a broad-spectrum sunscreen
(SPF 13, UVA-PF (PPD) 10.5) against DUVR. Again, this method demonstrated the
protection afforded by the sunscreen, with very close gene expression profiles
between unexposed samples and DUVR exposed but protected samples, as shown
by hierarchical clustering, a decreased number of modulated genes, and a decrease
in intensity of gene modulation for the residual modulated genes [82]. Thus, gene
expression profiling constitutes a complementary approach to histological and bio-
chemical studies for assessing of photoprotection in 3-D skin models.
Fig. 12.7 The use of gene and protein expression for the evaluation of sunscreen efficacy. (a)
Modulation levels of gene expression in fibroblasts of reconstructed skin exposed to UVA. Bars
represent modulation ratios after UVA exposure for each studied transcript. Positive and negative
values denote up- and downregulation of gene expression, respectively. Note the flatter aspect of
the modulation profile when the broad-spectrum sunscreen was used (lower panel), as compared
to unprotected samples (upper panel). (b) Examples of gene and soluble-protein expression after
UVA exposure of reconstructed skin in the presence or absence of broad-spectrum sunscreen
(Adapted from Marionnet et al. [78])
12.5 Conclusion
The development of organotypic skin models has made possible the in vitro assess-
ment of the effects of different types of UV exposure (UVB, UVA, or solar simulation)
in a three-dimensional context and in a cutaneous structure including different types of
skin cells. Reconstructed skin appeared to be useful, showing predictive responses
with numerous biological endpoints closely related to in vivo clinical data. It also
allowed to increase the knowledge on the precise biological processes involved and
can therefore be used to study the photoprotection afforded by sunscreens in vitro,
providing additional biological data on sunscreen efficacy, complementing the in vivo
protection factors (SPF or UVA-PF). Although these 3-D models did not follow a strict
validation process for protection factor determination, they evidenced important con-
cepts in photoprotection, such as the need of using a well-balanced photostable sun-
screen absorbing over the entire UV spectrum of solar radiation for preserving essential
biological functions. They also revealed from a biological point of view the limits of
the SPF value for predicting the level of protection in the UVA range. The combination
of 3-D skin models and new biological approaches such as transcriptomic or proteomic
will indisputably increase the added value of such systems for evaluating sunscreen.
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Chapter 13
UV Booster andPhotoprotection
M.Sohn
Key Points
The paradox of achieving great SPF values while using small amounts of
UV filters explains the high interest in boosting the performance of the UV
filter combination. As a prerequisite for performance, the UV filters must
be uniformly dispersed and/or solved at first in the emulsion and then in the
applied sunscreen film on the skin.
Boosting the photoprotection is possible either by optimizing the efficacy
of the UV-absorbing system or by improving the film-forming properties
of the product during spreading.
The optimization of the performance of the UV filtering system includes
the combination of UVB- and UVA-absorbing molecules, the consider-
ation of the photostability of the UV filters individually and in combina-
tion, as well as the synergy of water- and oil-dispersed UV filters. The
addition of scattering particles was also shown to increase the efficiency of
the UV filter system by increasing the optical path length.
The improvement of film-forming properties and distribution of the UV
molecules on the skin can be achieved by the addition of film formers, the
choice of the sunscreen vehicle, and its viscosity.
M. Sohn
Global Technical Center Sun Care, BASF Grenzach GmbH,
Grenzach-Whylen, Germany
School of Life Sciences, Institute of Pharmaceutical Technology, University of Applied
Sciences and Arts Northwestern Switzerland, Muttenz/Basel, Switzerland

DOI10.1007/978-3-319-29382-0_13
228 M. Sohn
13.1 Introduction
The performance of a sunscreen in terms of SPF, UVA protection, and photostabil-

ity primarily depends on the intrinsic absorbance and photostability properties of
the UV filters contained in the product along with their used concentration. Over the
last decade, we observed a growing appetite for increasing sunscreen performance
with the development of products showing protection index as high as 50+. This
phenomenon was supported by the placement in the market of new UV filters from
early 2000s, exhibiting higher UV performance than the existing UV filters [1]. In
most countries, the highest permitted SPF claim is 50+. However, in South America
the maximum authorized SPF claim even attains a value up to 99. This race for
higher and higher SPF values is a general trend observed in most countries across
the globe. The tendency toward the development of sunscreen formulations with
continuously larger SPF numbers resulted in using increased amount of UV filters
challenging both the esthetics and the stability of the product. Paradoxically, there
is a wish in reducing the concentration of UV filters in new sunscreen developments
due to economical, ecological-, sensorial, or health-related reasons. Indeed, some
UV filters are accused to show poor ecotoxicological profile, to have potential endo-
crine disruptor properties, or to induce photoallergy [25]. Further, the registered
UV filters differ with respect to the regions. In the USA, for example, only 16 UV
filters are registered compared to 27in Europe.
Taken together, the requirements for achieving higher SPF values while using
smaller amounts of UV filters explain the high interest in boosting the performance
of the UV filtering system. A booster can be defined as a device or a thing that
increases power or effectiveness. For sunscreens, boosting the UV filter system
relates to the achievement of an improved ratio of UV performance to UV filter
concentration, literally attaining better UV performance with less UV filters. To
this end, two routes are often pointed out, either by enhancing the efficacy of the
UV-absorbing system or by improving the film-forming properties of the product
during spreading. These two different aspects and strategies are discussed thereafter.
13.2 Optimizing theEfficacy oftheUV-Absorbing System
13.2.1 Importance ofUVA Protection
The erythema effectiveness spectrum displays human sensitivity to erythema, an

immediate response to solar exposure. It results from the multiplication of the ery-
themal action spectrum [6] and the spectrum of the irradiation source [7] as shown
in Fig.13.1. In this graph, it is evident that human erythema originates mostly from
UVB radiation that is responsible for about 85% of this biological endpoint dam-
age. However, a non-negligible part of the erythema effectiveness spectrum also
extends over the UVA meaning that UVA markedly contributes to the erythema
formation as well.
13 UV Booster andPhotoprotection 229
UVB UVAII UVAI
1.00
0.80
Arbitrary units
0.60
0.40
Erythemal action spectrum
Solar spectral irradiance
0.20
Erythemal effectiveness spectrum
0.00
290 300 310 320 330 340 350 360 370 380 390 400
Wavelength (nm)
Fig. 13.1 Erythemal action spectrum [6], solar spectral irradiance [7], and erythema effectiveness
spectrum, in arbitrary units. Approximately 85% of erythema originates from UVB radiation, a
non-negligible part also from UVA radiation
Fig. 13.2 SPF in silico of a Sunscreens containing 2 %

combination containing 2% 12 of the UVB filter octyl triazone
with and without the UVA filter DHHB
UVB filter octyl triazone
without and with the UVA 10
filter diethylamino
hydroxybenzoyl hexyl 8
SPF in silico
benzoate (DHHB)
calculated using the BASF
6
sunscreen simulator [10, 11]
0
0 % DHHB 5 % DHHB
The addition of UVA filters are, therefore, a prerequisite to increase SPF values
[8]. Indeed, a mere UVB sunscreen that would solely block radiations from 290
to 320nm and transmit UVA radiation would reach in principle a maximum SPF of
11 only [9], because continuous level of erythemally active UVA2 radiation is trans-
mitted. As a consequence, the addition of UVA filters is a requisite to obtain a sub-
stantial rise of the SPF value.
Figure 13.2 gives the SPF in silico value of an oil-in-water (O/W) sunscreen
combination containing 2% of the UVB filter octyl triazone without and with the
UVA filter having the INCI diethylamino hydroxybenzoyl hexyl benzoate (DHHB).
Accordingly, the basic for sunscreen development and achievement of higher SPFs
is the judicious combination of UVB and UVA filters. The presence of UVA filters is
230 M. Sohn
nowadays generally the case since UVA filters are incorporated to reach the minimal
UVA protection that is required in most regions [7]. Therefore, an appropriate UV filter
system should combine UVB and UVA filters to achieve optimized UV shield [12].
13.2.2 Photocompatibility ofUV Filters
Besides their individual absorbance profile and extinction properties, UV filters are
characterized also by their intrinsic photostability and photocompatibility with
other UV filters. The two worldwide accepted UVA filter avobenzone and UVB
filter octinoxate are known to be very photounstable under UV exposure [13],
resulting in a loss of approximately 70% and 40% after ten Minimal Erythemal
Dose (MED) for avobenzone and octinoxate, respectively [14]. Moreover, their
combination leads to an increased photochemical instability due to a 2+2-hetero-
photocycloaddition [15] producing non-UV-absorbing cyclobutylketone
photoproducts. This issue often obliged sunscreen manufacturers to use either the
one or the other filter in their sunscreen development.
Regarding octinoxate, it undergoes at first a trans-cis photoisomerization that
equilibrates rapidly after UV irradiation [16]. Upon further UV irradiation, the
molecule undergoes a irreversible 2+2-homo-photocycloaddition resulting in non-
UV-absorbing cinnamate dimers [15, 17]. In the case of avobenzone, an equilibrium
mixture between the two tautomeric enol and keto forms of the molecule is present
[15, 18, 19], the enol tautomer being involved in the irreversible photocycloaddition
with octinoxate when the two filters are combined. Further, upon UV irradiation the
enol form is photoisomerized into the photoreactive keto isomer that achieves a
triplet excited state. This state is responsible for the irreversible photodegradation of
the molecule via a Norrish type I cleavage of the CO-C bond, resulting in the
formation of two radicals that can further react and form photoproducts [20]. The
complete photodegradation process of avobenzone was proposed elsewhere [15, 18].
To slow down the formation of the keto form and subsequent consequences, the
simple addition of other UV filters may compete with avobenzone for absorbing
light, thus delaying the formation of the excited keto triplet state [21]. This is,
however, only a partial protection of avobenzone and cannot avoid the generation of
excited state molecules. To overcome this limitation in photoinstability issue, some
ingredients were found to show quenching properties of the excited state to prevent
from photodegradation of the excited molecule.
For photostable UV filters, the dissipation of absorbed energy occurs through
internal conversion, and the absorbed energy is then released in the form of heat due
to an intramolecular hydrogen transfer [1]. However, in the case of the photounstable
UV filter avobenzone, the molecule can perform an intersystem crossing from the
singlet exited state to the triplet excited state, the latter showing a longer lifetime
and therefore promoting photodegradation as mentioned above. As a consequence,
the stabilization of photounstable UV filters such as avobenzone is possible either
by quenching the excited singlet state to avoid the formation of the triplet excited
Octocrylene
400
Octisalate
350 Diethylhexyl syringylidene

malonate
Benzotriazolyl dodecyl
p-cresol
300
Diethylhexyl 2.6-
naphthalate
250 Ethyhexyl methoxycrylene
E1,1
Polyester-8
200 Butyloctyl salicylate
150
100
50
0
290 310 330 350 370 390
Wavelength (nm)
Fig. 13.3 UV absorbance features of emollients promoted as photostabilizers (Data from

BASF [29])
state or by quenching the formed triplet excited state. Triplet-triplet energy transfer
from the photounstable molecule to the quencher molecule is the most common
energy transfer mechanism for photostabilization. To make this process work, the
quencher molecule must show a similar energy level to that of the photoexcited state
of the photounstable molecule to absorb the excitation energy. The quencher mole-
cule should then ideally return intact to its ground state without self-degradation. As
an example, avobenzone shows a triplet energy level close to 60kcal/mol [22].
Efficient triplet quenchers of avobenzone include other UV filters, particularly
bemotrizinol [13] and octocrylene [14], the latter showing a triplet energy level of
5560kcal/mol [23] close to that of avobenzone. The two bemotrizinol [13] and
octocrylene [14] UV filters were shown to raise significantly the photostability of
avobenzone; the recovery of 1% avobenzone equals 80% after 10MED when com-
bined with 3% bemotrizinol compared to a recovery of 25% only without bemotriz-
inol [14]. In addition to UV filters, some emollients are promoted to show triplet
quenching efficacy as well. Examples of such compounds are diethylhexyl 2,6-naph-
thalate [24], butyloctyl salicylate, tridecyl salicylate, polyester-8 [25], diethylhexyl
syringylidene malonate [26], benzotriazolyl dodecyl p-cresol, and undecylcrylene
dimethicone. Recently, the compound ethyhexyl methoxycrylene [27, 28] was
introduced for its ability to quench the singlet excited state to avoid the transfer of
the molecule from the singlet to its triplet state. To be an effective excited state
quencher of avobenzone, these ingredients most often show an inherent UV
absorbance as depicted in Fig.13.3 in terms of specific extinction E1,1. E1,1 is the
232 M. Sohn
extinction corresponding to a concentration of 1% (w/v) solution at an optical

thickness of 1cm of the tested compound. The comparison of the E1,1 values of
different compounds over the whole UV range allows a direct comparison of their
UV-absorbing performance, the greater the E1,1 value, the greater the UV-absorbing
efficacy.
These stabilizers of avobenzone exhibit substantial UV absorbance that goes
beyond the UV-absorbing performance of the registered UV filter octisalate or is
even as high as the extinction of the well-known UVB filter octocrylene. However,
in the contrary to octocrylene and octisalate, they are not registered on the positive
list in the annex VI of the cosmetic regulation as UV filters in Europe [30] and have
no SCCS opinion. This raises the issue of using compounds referred to as nonofficial
registered UV filters. The lack of a registration as official UV filters of the
UV-absorbing compounds was already addressed by several cosmetic organizations
in Europe and might be also addressed on a European level [31, 32].
To avoid the photoinstability issue of avobenzone, the use of the photostable
UVA filter DHHB is a valuable alternative. However, DHHB is not registered as a
UV filter in the USA and cannot be used there.
13.2.3 Synergy ofOil- andWater-Dispersed UV Filters
Emulsions are the main formulation type for sunscreen products counting for more
than 80% of the launched sunscreens in 20122013 worldwide [33]. Most of the
registered UV filters are oil-soluble and will, thus, be formulated into the oil phase
of the emulsion. In case of a water-in-oil (W/O) emulsion, the UV filters are distrib-
uted in the continuous oil phase directly in contact with the skin during spreading,
forming a good coverage and subsequently a uniform protective film. This may
explain why W/O sunscreens produce greater SPF values [8, 34]. In the contrary, in
oil-in-water (O/W) emulsions, the most popular emulsion type, the filters are distrib-
uted in the internal oil phase that hinders the achievement of a uniform distribution
of the UV filters after spreading. To visualize this phenomenon, an O/W emulsion
containing the oil-dispersed dye Sudan red III pigment (color index 26100) and the
water-dispersed blue pigment with the color index 42090 was observed under light
microscopy, before (Fig.13.4a), during (Fig.13.4b), and after spreading (Fig.13.4c).
Before spreading, the oil phase is contained inside the droplets (Fig.13.4a).
During spreading, the droplets merge, and the oil phase is released (Fig.13.4b);
finally, after spreading, the water evaporated, and the oil phase is predominant.
Nevertheless, a nonvolatile part of the water phase remains in the film, shown as
blue spots in Fig.13.4c. The residual water parts lack UV filters and offer no
protection, resulting in unprotected area or holes in the protection film and, thus,
in reduced UV performance. To overcome this drawback, water- and oil-soluble UV
filters may be incorporated in the two phases of the emulsion. This leads to an
enhanced efficacy as the nonvolatile water part remaining after water evaporation is
protected with the water-dispersed UV filter. The resulting sunscreen film will not
a b
Fig. 13.4 Microscopic evaluation (Olympus CKX41) of an O/W emulsion containing a red oil-
and a blue water-dispersed pigment, (a) before spreading, (b) during spreading, and (c) after
spreading. Not protecting the water part (in blue) with a water-dispersed UV filter would result in
unprotected area or holes in the sunscreen film and reduced UV efficacy
show any unprotected area and will end up in a better coverage and optimized UV
protection.
Further, the effect of the UV filter distribution in the oil and in the water phase
on the UV performance was investigated by Neuenschwander and Herzog [35]. The
Colipa P3 standard formulation containing a mixture of oil- and water-dispersed
UV filters was used [6]; the ratio between the water filter ensulizole and the oil filter
octinoxate was varied to cover a Relative Erythema Active Extinction in the oil
phase (REAE) between almost 0 and 1. A REAE of 1 corresponds to a UV filter
system based on oil-soluble UV filters exclusively, and to the opposite, a REAE of
0 corresponds to a UV filter system based on water-dispersed UV filters solely. The
SPF invitro of each formulation variant was measured and plotted against its REAE
value (Fig.13.5). In addition, the effect of the water and oil UV filter distribution on
the film irregularity, subsequently on the UV performance, was computed. To
describe film irregularity, the calibrated quasi-continuous step film model was used
[10] and is given in following exponential equation:
i c
- B
h ( i ) = A exp n (13.1)

234 M. Sohn
20
15
SPF
10
SPF in silico with oil-water distribution effect

5
SPF in silico without oil-water distribution effect
SPF in vitro
0
0 0.2 0.4 0.6 0.8 1
REAE = 0, water REAE = 1, oil dispersed

dispersed UV filters REAE UV filters solely
solely
Fig. 13.5 Variation of the SPF in silico (solid line) considering the effect of oil-water distribution,
SPF invitro (circles, n=96 measurements per formulation) as function of REAE of the UV filter
mixture; dashed line is the SPF simulation without consideration of the oil-water distribution effect
where, h(i) is the height of the film at step i, with i=1, 2,., n, where n is the num-
ber of steps the exponential function is divided into, B and C are parameters deter-
mining the shape of the film, and A is introduced for normalization. The transmission
through the quasi-continuous step film is obtained as the sum of the transmissions
through all steps of height h(i).
Using UV filters in the two phases of the sunscreen formulation, REAE between
0.4 and 0.8 appears to enhance the overall UV performance.
13.2.4 I ncrease ofOptical Path Length byUsing Scattering

Particles
Using particles that exhibit scattering properties is particularly interesting with

respect to the boosting of the UV protection. Indeed, such particles are able to
increase the optical path length of UV radiation due to their inherent scattering
properties, thereby increasing the likelihood of UV radiation to meet a dis-
solved UV filter molecule before reaching the skin surface, as schematized in
Fig.13.6.
Fig. 13.6 Boosting of UV

performance through Presence of No scattering
increase of optical path scattering particles particles
length using scattering
particles. Blue objects UV light
represent UV filter
Sunscreen
molecules, and white layer
circles represent light
scattering particles
Skin
The scattering efficiency highly depends on the particle size range relative to the
light wavelength. Further, for a particle with a given refractive index, the absor-
bance and scattering performance of a given particle run inversely, when varying the
size if scattering increases then absorbance decreases, and there might be an opti-
mum of particle size for a maximized UV attenuation.
Polymer spheres consisting of styrene/acrylates copolymer act as UV booster
material following this principle [36]. In its original product form as well as in the
finished formulation, the sphere is filled with water; the water evaporates during
spreading leaving an air-filled hollow sphere with an external size of approximately
325nm. Supplier of this material recommends using about 45% solids of the
spheres to achieve SPF boosting.
Interestingly, the particulate UV filters such as the inorganic UV filter titanium
dioxide or the organic UV filter bisoctrizole also show scattering properties and are,
therefore, able to amplify the UV performance of the used filtering system through
this additional characteristic. Since these particulate UV filters are basically selected
for their absorbing properties, the additional boosting of efficacy is achieved with-
out the need of a further ingredient that would have merely the scattering activity.
Some authors introduced a method to measure the scattering effect of particulate
UV filters using a spectroscopic setup [37, 38]. In these experiments, the impact of
scattering particles was shown on the absorbance of a dye having its maximum
absorption outside the UV range such as Evans Blue and Patent Blue V.The dye
concentration was maintained constant, and the variation of the dye absorbance was
monitored while varying the amount of scattering particles. Figure13.7b displays
the example of Patent Blue V dye in combination with the organic particulate UV
filter bisoctrizole. The variation of absorbance of a water dispersion of 1.32105 M
Patent Blue V with increasing volume fraction concentration of the increasing par-
ticulate filter bisoctrizole ranging from 0 to 18% was measured. The max of Patent
Blue V dye in water at pH 5 lies around 638nm, outside the absorption range of the
particulate UV filter (Fig.13.7a). The absorbance of the dye could be amplified
reaching a sixfold increase with increased concentration of scattering particles;
achieving a plateau from the incorporation of 5% particles (Fig.13.7b). A similar
boosting is produced using the organic particulate UVB filter with INCI tris-biphenyl
triazine and titanium dioxide particles.
The boosting effect obtained from ingredients with scattering characteristics can
also be shown with SPF invivo measurements. The combination of 5% of the
236 M. Sohn
Fig. 13.7(a) Absorbance a Patent Blue V

spectrum of Patent Blue V
dyestuff. (b) Amplification 0.15
factor of absorbance of
Patent Blue V dye with
Absorbance
0.10
increasing concentration of
the organic particulate
broad-spectrum 0.05
bisoctrizole UV filter
0.00
250 350 450 550 650 750 850
Wavelength [nm]
b
8
Amplification factor of absorbance
6
of Patent Blue V dye
4
Patent Blue V dye,
3
max in water, pH 5 = 638 nm
2
1
0
0 5 10 15 20
Volume fraction concentration of bisoctrizole (%)
il-soluble UV filter octinoxate and 4% of the particulate UV filter bisoctrizole

o
reached an SPF invivo value of 30 that is much greater than the mere addition of the
SPF invivo values of the two filters tested separately, reaching an SPF value of 9
and 5 for octinoxate and bisoctrizole, respectively [39]. The reason of this boosting
is twofold: at first spectral through the synergism between UVB and UVA filters as
clarified in Sect.13.2.1. Further, the boosting is explained through the scattering of
bisoctrizole, forward and backward scattering, contributing to about 10% of the
overall effect in the region of absorption band for bisoctrizole [40].
13.3 I mproving Film Homogeneity andDistribution

ofanApplied Sunscreen
The intrinsic absorbing properties of the selected UV filters along with their
photocompatibility are primarily responsible for the sunscreen efficacy in terms of
SPF, UVA protection, and photostability [8, 41]. Nevertheless, SPF values appear to
differ between sunscreens containing the same UV filter composition [8, 42].
Homogeneous distribution of the sunscreen product was shown to contribute to the
SPF invivo value [43]. For optimum performance, the sunscreen film should be of
uniform thickness, with an identical thickness over the covered surface area,
similarly to a perfect homogeneous distribution of UV filter solution in an optical
cell. Understandably, this state can never be attained under invivo conditions of
application due to the skin surface topography that preclude the formation of an
even sunscreen film [44]. Furthermore, manual application makes it nearly
impossible to reach film uniformity. The sunscreen film is composed of a multitude
of different thicknesses, and this irregularity of the film thickness may be the reason
for the discrepancy between predictions based on UV transmission of dilute
transparent filter solutions and clinical study results [45]. The objective for optimum
photoprotection is, therefore, to apply the sunscreen product as uniform as possible.
13.3.1 Use ofSpecifically Dispersed UV Filters
To be fully effective, UV filters must be properly dissolved and homogeneously

distributed on the skin during product application. This might be difficult to reach
especially for sunscreens with large SPF values that have high concentration of UV
filters. A solution consists to solve and disperse organic UV filters into a matrix.
This technology was recently launched for bemotrizinol UV filter dispersed into a
polymethylmethycrylate matrix. This dispersed UV filter matrix is promoted to
enhance film formation during spreading due to the suppleness of the matrix that
spreads over the skin during application resulting into a homogenous distribution of
the bemotrizinol molecules into the film and greater SPF values [46].
13.3.2 Use ofFilm Former Compounds
Many compounds claimed to boost UV performance of sunscreens are found in the

market. These excipients are supposed to perform by improving the distribution of
the UV actives on the skin. They are often referred to as film formers due to their
ability to improve the film forming of a sunscreen formulation during application.
Film formers are also often connected to the increase of water resistance. Various
classes of film formers exist for sun care application including hydrophobic or water-
dispersible ingredients; they may be based on vinylpyrrolidone derivatives, acrylic
polymer derivatives, polyester, polyurethanes, maleic derivatives, silicones, etc.
Waxes were the first ingredients that acted as film formers through their inherent
viscosity-building properties. Used to optimize emulsion stability, they also fix
the film avoiding its flow downward to the skin furrows. Any viscosity-building
ingredient will show this positive effect; however, this precludes the use in spray
application.
238 M. Sohn
The vinylpyrrolidone derivatives such as VP/hexadecane copolymer, VP/

eicosene copolymer, and tricontanyl PVP are the most popular, contained in
more than 50% of launched sunscreens over the three last year [47]. Also, the
compound with the INCI aqua (and) hydrolyzed wheat protein/PVP
crosspolymer is a crosspolymer of hydrolyzed wheat protein and polyvinyl-
pyrrolidone that is claimed to optimize film-forming properties of sunscreen
emulsions.
Film formers based on acrylic chemistry such as acrylates copolymer and acry-
lates/octylacrylamide copolymer are claimed to form a uniform film onto the
skin and boost the performance by entrapping the UV filters into the even film
matrix due to their hydrophobic nature [48]. The latter is also soluble in ethanol
and can serve as film former in the trendy clear lipo-alcoholic sprays or in
hydroalcoholic systems upon neutralization with a base.
Another representative of the acrylic-based chemistry is the acrylate grafted ole-
fin polymer found under the INCI polyacrylate 15 (and) polyacrylate 17. It
combines crystalline and amorphous polymer structures; an amorphous func-
tional acrylic polymer is grafted onto a crystalline polyethylene backbone. The
amorphous graft polymer portion is said to slow down the migration of the crys-
talline wax part resulting in a more uniform distribution of the actives throughout
the film [49]. It shows affinity for UV absorbers such as octinoxate and octisalate
resulting in more ordered structures during the drying process and a better orien-
tation of the UV segments for photoexcitation. Acrylic based polymers for film
forming include further compounds such as C8-22 alkyl acrylate/methacrylic
acid crosspolymer or acrylates/C12-22 alkylmethacrylate copolymer.
The next category of film formers comprises maleic derivatives such as the
hydrophobic copolymer with the INCI C30-38 olefin/isopropyl maleate/MA
copolymer. The maleic functionality helps the copolymer in adhering onto the
skin for efficient film-forming properties [50]. It needs to be neutralized with a
base for O/W emulsions.
Finally, the silicone ingredients being substantive to the skin offer interesting
possibilities for film-forming features. Silicones are particularly known and
originally used for their positive effect on the sensory profile, and the use of
silicones in sun care increases due to their benefit in film-forming properties
[51]. Silicone acrylate copolymers are suitable for this purpose. Indeed, the
acrylate backbone is responsible for the film forming on the skin, and the grafted
silicone functionalities improve the sensorial behavior. Further,
alkylmethylsiloxanes (AMS) based on a silicone backbone grafted with alkyl
chains of different lengths are recommended for UV performance boosting.
Alkylmethylsiloxanes boost SPF by facilitating the sunscreen spreading and
optimizing the formulation rheology. The viscosity is rebuild after spreading
enabling to maintain a homogeneous film and distribution of the UV filters. Also
silicone elastomers were shown to increase SPF values likely due to the impact
on the formulation rheology.
Table13.1 summarizes the main film former categories and their representatives.
Table 13.1 Nonexhaustive list of film former categories and representative compounds
Main categories of film
formers Compounds (INCI) Typical use solids (%) Remarks
Vinylpyrrolidone derivatives VP/hexadecane copolymer
VP/eicosene copolymer First three, most popular film formers,
13
oil-soluble, in waxy or liquid form
Tricontanyl PVP
Aqua (and) hydrolyzed wheat protein/PVP crosspolymer 0.52.5 Water dispersion (45 % solids)
Acrylic based Acrylates copolymer 12 Water dispersion (30% solids),
neutralization required
Acrylates/octylacrylamide copolymer 2 Soluble in ethanol, neutralization
13 UV Booster andPhotoprotection
required when using water

Polyacrylate 15 (and) polyacrylate 17 1.53.5 Water dispersion (30% solids), no
C8-22 alkyl acrylate/methacrylic acid crosspolymer 0.53 Water dispersion (47% solids), no
Maleic derivatives C30-38 olefin/Isopropyl maleate/MA copolymer 12 Neutralization required when using
water, act also as an anionic emulsifier
Silicone based Silicone acrylate copolymers 2 3040% solids
Alkylmethylsiloxanes 2 Substantive to skin
Silicone elastomers 4
Trifluoropropyldimethylsiloxy/trimethylsiloxy 12 50% solids, fluoro-modified
silsesquioxane (and) dimethicone silicone resin
Polyamides derivatives Polyamide-3 13 Oil structuring polymers forming
Polyamide-8 cohesive non-water-soluble film
Polyester based Polyester-5 12 Water dispersible
Polyurethane based Polyurethane-34 13 Water dispersion (3842% solids)
suitable in low viscosity products, no
239
240 M. Sohn
13.3.3 Impact ofEmulsion Type andViscosity
The abovementioned compounds are all claimed to improve film-forming unifor-

mity and subsequently sunscreen performance. The contribution of these com-
pounds on the efficacy had been evaluated by measuring the SPF value with and
without the specific ingredient. For most of them, the manufacturers stated that the
boosting was achieved through their impact on the formulation rheology and the
obtained film that was expected to be more homogeneous. For investigating the film
uniformity of an applied sunscreen, several methods were described providing
merely qualitative or semiquantitative information. For qualitative assessment,
techniques based on fluorescence resulting either from a UV filter present in the
sunscreen or from an added fluorescent marker are used to visualize the homogene-
ity of distribution of the applied product [52]. For quantitative assessment, the use
of invivo fluorescence spectroscopy gave indirect information about the film thick-
ness by converting the fluorescence intensity into an equivalent thickness of an
applied product [53].
Recently, some authors introduced a method for determining the precise thick-
ness distribution of an applied sunscreen film on epidermal membrane of pig ear
skin based on topographical measurements [34]. The biological pig skin substrate
was chosen due to its similarity to human skin that matches the product-to-substrate
affinity relevant for invivo conditions. The film thickness of the applied sunscreen
was obtained as the difference of the skin topography data before and after sun-
screen application, computed for each single measurement point. The result was
expressed as a distribution of frequencies of film thickness over the measured sur-
face area, from which the average film thickness was extracted. In parallel, the SPF
invitro was measured using the same preparations. In that study, the hypothesis that
the difference of film thickness may be responsible for the divergence of SPF per-
formance observed between sunscreens containing the same UV filter mixture was
examined. The impact of sunscreen vehicle on the SPF invitro and film thickness
distribution both measured on the same pig skin preparations was investigated. The
formulations included five different but characteristic vehicles for sun care: an oil-
in-water cream (OW-C), an oil-in-water spray (OW-S), a water-in-oil emulsion
(WO), a gel (GEL), and a clear lipo-alcoholic spray (CAS). They contained the
same UV filter combination and emollient and differed in their emulsifying and
thickening system. The authors found a positive correlation between the average
film thickness and SPF invitro measured on pig ear skin within each tested sun-
screen underlining the relevance of film thickness for interpreting UV protection
differences of formulations with the same filter composition.
Further, the viscosity of the vehicle was found to impact the average film thick-
ness and SPF invitro. OW-S sunscreen showed a smaller average film thickness and
a smaller SPF value than OW-C, film thickness equaled to 2.3 and 1.6m and the
SPF reached a value of 33 and 16 for OW-C and OW-S, respectively. The thickeners
included in OW-C and absent in OW-S appeared to be responsible for the significant
difference of film thickness and SPF invitro between the two sunscreens. The low
Fig. 13.8Connection
between sunscreen vehicle,
film forming, and delivered
UV protection
Applied
sunscreen film
Sunscreen
Sunscreen film
Skin substrate
Sunscreen Sunscreen
vehicle performance
viscosity sunscreens OW-S and CAS which lacked thickeners exhibited the smallest
average film thickness values that are connected to a greater occurrence of small
film thicknesses. Light transmittance which increases exponentially with decreasing
film thickness is inversely proportional to SPF.Subsequently, low viscosity sun-
screens OW-S and CAS yielded also the lowest SPF values. They may leave larger
areas of ridges virtually uncovered during application while accumulating in the
furrows thus leading to an irregular protective film and a lower SPF value. Therefore,
the presence of viscosity builder in the formulation seems indeed to be a prevailing
prerequisite for UV efficacy.
Further, WO exhibited both the largest average film thickness with a value of
2.9m and the highest SPF.In contrast to the other sunscreens, the UV filters of
WO are distributed in the continuous phase which does not evaporate, thus assum-
ing to form a uniform protecting film with the help of the thickeners.
This study demonstrated that SPF variation observed between sunscreens con-
taining the same filter system arose from the difference in their film thickness distri-
bution that depended on the sunscreen formulation.
Figure 13.8 shows the significant connections between the sunscreen vehicle-
related factor, the film forming, and the measured performance, that is, SPF invitro
of sunscreens.
Finally, Fig.13.9 summarizes the key parameters emphasized in this chapter that
are expected to boost the efficiency of a UV filtering system.
The high expectation of achieving greater UV photoprotection while using
reduced amount of UV filters related to economical, ecological-, sensorial, or
health-related reasons led to a high interest in understanding the factors and their
mechanisms able to influence the efficacy of the UV protection system. Besides the
appropriate selection of the UV filters, including adequate absorption profile,
photostability, and synergy, also the film thickness distribution on the skin is of high
relevance for UV protection. Assessing the effect of individual formulation
excipients on the film formation may offer a novel way to optimize sunscreen
242 M. Sohn
Fig. 13.9Parameters
promoting the boosting of
the performance of a UV
Importance
filtering system
of UVA
protection
Synergy of
Formation water and
of an oil
homogenous dispersed
sunscreen Boosting UV filters
film the UV
protection
Use of
Photocom-
scattering
patibility of
particles
UV filters
photoprotection during the development step. The effect of the distribution of the
UV filters within the applied sunscreen film on the delivered UV protection may be
a further factor to be elucidated.
AcknowledgmentsI would like to thank especially Uli Osterwalder of BASF Personal Care
and Nutrition GmbH for his great support and his confidence in me, Bernd Herzog and
Marcel Schnyder of BASF Grenzach GmbH for their valuable input, and Georgios Imanidis
of the Institute of Pharmaceutical Technology, School of Life Sciences, University of Applied
Sciences Northwestern, Switzerland, for the fruitful discussions.
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(accessed 2 February 2016)
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Chapter 14
Sunscreen Photostability
Craig A. Bonda and Dennis Lott
Key Points
Sunscreens are photochemical systems, and their behavior is best under-
stood through the science of photochemistry.
Deeper understanding of the complex photochemistry of avobenzone has
led to better formulating methods and improved sunscreen performance.
The photostability of sunscreen products is a function of the photostabili-
ties of the individual UV filters and the photochemical and photophysical
interactions between them.
Photostability will retain a leading role in sunscreen product design as
costs and regulatory issues continue to drive sunscreen formulating
worldwide.
Though significant challenges remain, the availability of photostabilizers
and, in many areas, new UV filters has allowed the sunscreen industry to
make great strides in improving photoprotection.
14.1 A Brief History
Photostability became a genuine concern to the sunscreen industry with the

introduction in Europe of avobenzone (butyl methoxydibenzoylmethane or
BMDM) in the 1980s and in the USA in the early 1990s. This photolabile
C.A. Bonda (*)

Inception Partners, LLC, 0s630 Madison Street, Winfield, IL 60190, USA
D. Lott
Florida Suncare Testing, Inc, 101 N. Bay Street, PO Box 758, Bunnell, FL, USA

DOI 10.1007/978-3-319-29382-0_14
248 C.A. Bonda and D. Lott
compound was the first and for years remained the only UV filter to be effective
at protecting skin from longer wavelength UVA radiation (320400 nm), widely
believed to be a primary cause of early skin aging and certain skin cancers [1].
Avobenzone degrades rapidly in sunlight [2] and may react chemically with other
organic compounds [3]. This spawned an arms race among both UV filter sup-
pliers and sunscreen manufacturers to discover ways to photostabilize or replace
avobenzone. Scientists in Europe focused on developing photostable UV filters to
compete with avobenzone, while other scientists in the USA and Europe focused
on discovering new photostabilizers. Both groups were successful: the resulting
new UVA filters and photostabilizers are now in widespread use throughout the
world.
Several photostable European UVA filters have been submitted for approval to
the US Food and Drug Administration for inclusion in the monograph for OTC
sunscreen drug products. In 2014, all were deemed by the FDA to have insufficient
data on which to base the requisite generally regarded as safe and effective
(GRASE) determination and were returned to their sponsors for additional informa-
tion [4]. This signals a continuing role for photostabilizers in sunscreens, especially
those to be marketed in the USA but also in other parts of the world where global
acceptability is desired and where cost considerations favor the continued use of
inexpensive avobenzone as the primary UVA filter.
14.2 Photochemistry of Photostability
The definitive source for general knowledge of organic photochemistry is Modern

Molecular Photochemistry of Organic Molecules by N.J. Turro, V. Ramamurthy,
and J.C. Scaiano (2010, University science Books, Sausolito, CA) [5]. Following is
a very brief summary of some of the key aspects as they relate to the subject at hand,
sunscreen photostability.
Organic chromophores convert the energy in a quantum of light a photon into
electronic excitation energy (Turro et al. 2010, p. 27). One photon excites one mol-
ecule, and, with rare and obscure exceptions, one and only one of a molecules
electrons is excited to a higher energy state at any one time.
Once excited, a chromophore has several photophysical pathways available to
dissipate its excited state energy. These pathways may be radiative or non-
radiative. By radiative is meant that the excited chromophore sheds some or all of
its energy by emitting a photon; non-radiative pathways expend energy kinetically
or vibrationally as heat, or by transferring energy to another molecule (Turro et al.
2010, p. 1819).
The photostable situation may be represented as follows:
R + hn *R pp R
14 Sunscreen Photostability 249
where R is a chromophore in its ground state, *R is a chromophore in its excited state,

h is the energy in a photon, and pp is energy dissipation purely by photophysical
(radiative and non-radiative) processes, thus returning the excited chromophore to the
ground state with no changes in its structure or geometry (Turro et al. 2010, p. 40).
Photostable chromophores undergo billions of such cycles photon absorption,
excitation, energy dissipation, and relaxation to the ground state with a low (not
zero!) probability that there will be a net chemical change. In contrast, photolabile
chromophores have a relatively high probability that excitation will lead to a net
chemical change. The consequence of photolability is photodegradation or photode-
composition, characterized by a loss of absorbance and the appearance of new chemi-
cal entities. In sunscreens, photodegradation results in less protection for the skin than
would otherwise be expected and exposure of the skin to unwanted photoproducts.
The photolabile situation may be represented as follows:
R + hn *R pc I T P
where pc is a photochemical process, I is a reactive intermediate, T is a thermal

chemical process, and P is a chemical product (Turro et al. 2010, p. 10).
For absorption of a photon and excitation to occur, the energy gap between
the electrons ground state orbital, known as the highest occupied molecular
orbital or HO, and its initial excited state orbital, known as the lowest unoccu-
pied molecular orbital or LU, must match exactly the energy of the photon. This
energy matching requirement is known as the resonance condition (Turro et al.
2010, p. 27).
For the UV filters used in sunscreens, the resonance condition requires encounter
wavelengths and energies that correspond to the UV portion of the solar spectrum.
The HO of an organic chromophore in the ground state contains a pair of elec-
trons. The electron pairs most commonly involved in excitation of an organic chro-
mophore are those in bonding or orbitals (e.g., c = c) and nonbonding or n orbitals
such as those found associated with oxygen in carbonyls (c = o). The transition to the
LU by the excited electron is to an anti-bonding orbital, *. Thus, the two most com-
mon transitions are represented by * and n * (Turro et al. 2010, p. 5255).
In the ground state, the two electrons in the HO are in the singlet state (Fig. 14.1)
in which the electrons are spin-paired, meaning they are spinning about opposite
vectors up and down and, in a magnetic field, are precessing 180 out of
phase. The ground state is conveniently represented by S0 and symbolized by
. This spin-paired configuration is what allows two negatively charged elec-
trons to overcome their repulsion and occupy the same orbital. The spin-paired con-
figuration is maintained in the initial transition from ground (S0) to excited state
even as the two electrons become orbitally unpaired. Thus, the initial transition after
photon absorption is known as the singlet excited state which may have more than
one energy level and is represented by S1, S2Sn and symbolized by .

Fig. 14.1 In the singlet

state, two paired electrons
spin about opposite vectors
(up and down) and, in
a magnetic field, precess
180 out of phase. The
z-axis is either aligned or
opposed to the direction of
the magnetic field
Transitions are favored between states that look like each other in the sense
that their electronic, vibrational, and spin configurations are similar (Turro et al.
2010, p. 4547, 117). Upon photon absorption, an electron in the singlet ground
state naturally transitions to a singlet excited state and almost never to a triplet
excited state. For many chromophores, the reverse is also true: an electron in the
singlet excited state will tend to relax to the singlet ground state either by dissipat-
ing its excess energy as heat (internal conversion) or by emitting a photon
(fluorescence).
The return to the ground state from the singlet excited state tends to happen
quickly; nanosecond time scales are common. Such a rapid return to the ground
state favors photostability since there is little time for chemical processes to
compete.
Figure 14.2 depicts the electron configurations of the triplet excited state which
is represented by T1 and symbolized by . An excited electron reaches a triplet

excited state by undergoing a spin flip and phase change usually as the result of a
magnetic interaction between the electrons spin and another electrons orbital
motion (Turro et al. 2010, p. 144). The transition from the singlet excited state to a
triple excited state is called intersystem crossing. The triplet excited state is meta-
stable; that is, the two electrons are unable to re-pair in their HO unless and until the
excited electron undergoes another spin flip and phase change. A chromophore in
the triplet excited state behaves as a diradical (i.e., having two unpaired electrons)
(Turro et al. 2010, p. 718). This fact coupled with its typically longer lifetime makes
the triplet excited state highly reactive and the starting point for most photochemical
reactions (Turro et al. 2010, p. 521).
Photochemists use experimental methods to determine the processes a particular
chromophore will take in a given set of conditions and record their findings on state
a b c
Fig. 14.2 In the triplet state, there are three possible orientations for the electron pair: (a) both
electron spin about up vectors; (b) the electrons spin about opposite vectors while precessing in
phase; (c) both electrons spin about down vectors
energy diagrams, also known as Jablonski diagrams, like the one in Fig. 14.3. Key
parameters for any photophysical process are its energy (E), its quantum yield (),
its rate constant (k), and its lifetime (). (Since 1/k = , it is only necessary to measure
one: either rate constant or lifetime.) Quantum yield is a measure of the efficiency
of a process and is calculated either as the fraction of absorbed photons that produce
a specific sequence or by comparing the rate of a specific pathway to the sum of the
rates of all competing pathways. For example, if 10 out of 100 excited molecules
fluoresce, then the quantum yield of fluorescence is 0.10 (10 %).
Another way for an excited chromophore to return to the ground state is by
transferring its energy to another molecule, known as the quencher, Q. Energy
transfer can be represented schematically by
*R + Q ET R + *Q
where ET is energy transfer (Turro et al. 2010, p. 390). Thus, the excited
chromophore transfers its excited state energy to the ground state quencher which
deactivates the chromophore to the ground state and raises the quencher to the
excited state. The relative efficiency of a quencher to quench the excited state of a
chromophore is characterized by a quenching rate constant, kET, where ET stands for
energy transfer. The actual rate this happens in a solution (or, presumably, in a
sunscreen) is the product of the quenching rate constant and the concentration of the
quencher, [Q], plus the sum of all other deactivation pathways, kD.
kq obs = kD + kET [Q ]
Fig. 14.3 A state energy or Jablonski diagram like this is used by photochemists to keep track
of an organic chromophores three most important states: the ground state, S0; the lowest energy
singlet excited state, S1; and the lowest energy triplet state, T1. The upward arrow on the left repre-
sents photon absorption and excitation. The downward and diagonally pointing arrows represent
photophysical processes that drain the chromophores excited state energy. Key parameters are the
energies, quantum yields, and lifetimes of each state and the rates of interstate transitions
where kq obs is the quenching rate observed experimentally (Turro et al. 2010,
p. 390391).
This is the basic mechanistic scheme for most of the photostabilizers to be dis-
cussed later in this chapter. First, we turn to avobenzone as the exemplar of a pho-
tolabile UV filter to find out why photostabilizers are needed in the first place.
14.3 Photochemistry of Avobenzone
Seminal studies published in 1995 by Schwack and Rudolph and in 1997 by Andrae
et al. contributed greatly to the early understanding of this important sunscreen
ingredient.
Fig. 14.4 Graph shows that steady-state irradiation of the enol tautomer (A) generates the keto
tautomer (B) which, when left in the dark, spontaneously converts back to the enol form (C).
(Bonda et al. [2], reprinted with permission)
To investigate the photodegradation of avobenzone, Schwack and Rudolph irra-

diated 3.5 mmol solutions of avobenzone in non-deaerated cyclohexane, isooctane,
isopropanol, and methanol for up to 8 h using a solar simulator filtered to deliver
radiation either above 260 nm or 320 nm. Photodegradation progress was monitored
by HPLC, and the photoproducts were identified by GC-MS. About 12 photoprod-
ucts were identified, all of which originated from one of two radical precursors: a
benzoyl radical or a phenacyl radical. Photodegradation proceeded in the nonpolar
solvents cyclohexane and isooctane, but not in the polar, protic solvents isopropanol
and methanol. In the nonpolar solvents, photodegradation was almost twice as rapid
under shorter wave irradiation (>260) than under longer wave irradiation (>320). To
find out why avobenzone is photolabile in cyclohexane and isooctane and photo-
stable in isopropanol and methanol, Schwack and Rudolph carried out 1H NMR
measurements of avobenzone solutions dissolved in cyclohexane-d12 and isopropa-
nol-d8 (.03 mol). In cyclohexane-d12, avobenzone exhibited 3.5 % keto form, but in
isopropanol-d8, no keto form was detected. Based on these findings, Schwack and
Rudolph concluded that avobenzone photodegradation depends strongly on the
presence of the 1,3-keto form [6]. Therefore, discovering the origins of the keto
form and its subsequent behavior under irradiation became of primary interest to
researchers.
Andrae et al. showed that photolysis with UV radiation drives the conversion of
the enol tautomer to the keto form (Fig. 14.4) [7]. They applied steady-state irradia-
tion to avobenzone in acetonitrile (1051010 M) using both a high-pressure mer-
cury lamp and a xenon light source, observing a decline in peak absorbance at
355 nm and a corresponding increase in peak absorbance at 265 nm. Based on
NMR, IR, and HPLC studies, they attributed the spectral change to the light-induced
conversion of the enol tautomer to the keto tautomer. Andrae et al. also applied a
14 ns laser pulse of 355 nm to dilute solutions of avobenzone in acetonitrile,

observing a transient species with peak absorption at 300 nm. The group attributed
the transient absorbance either to an excited E-isomer of the enol or to an enol
rotamer which were assumed to be intermediates in the conversion to the keto form
(see Cantrell and McGarvey and Yamaji and Kida below).
A number of more recent studies published in the literature provide additional
guidance to avobenzones photoinduced behavior under various conditions. Many
of the gaps in avobenzones state energy diagram have now been filled in, providing
much needed clarity to its complex photophysics and photochemistry. Following is
a sample of the many studies published in the literature.
Cantrell and McGarvey employed nanosecond laser flash photolysis at 355 nm
and 266 nm on dilute (105 M) solutions of avobenzone in acetonitrile [8]. Photolysis
at 355 nm produced transient absorbance changes with a new peak at 300 nm and
bleaching (loss of absorbance) at 360 nm. No peak at 260 nm was observed, leading
to the comment that formation of the keto form must have a low quantum yield
(see Yamaji and Kida below). They attributed the transient peak at 300 nm to a non-
chelated enol rotamer (NCE), which is a Z-isomer. Hill had earlier determined the
quantum yield of formation of the 300 nm-absorbing species to be 0.25 [9]. The
lifetime of the NCE rotamer is solvent dependent and ranges from 159 ms in
acetonitrile to 0.7 ms in butanol. Upon photolysis at 266 nm, Cantrell and McGarvey
observed a permanent loss of absorbance at 360 nm and no increase of absorbance
at 260 nm, suggesting that excitation of the keto form leads directly to avobenzone
decomposition. Nanosecond excitation at 266 nm of a pre-irradiated solution in
deoxygenated acetonitrile generated a transient absorbance spectrum from 300 to
500 nm which was attributed to the triplet state of the keto form. A further experiment
found the keto triplet to be quenched by molecular oxygen with a rate constant of 5
109 mol1 s1 and a quantum yield of singlet oxygen formation of 0.18.
Huong et al. studied avobenzone photostability in three environments: diluted
solutions in laboratory solvents of varying polarity, concentrated solutions in non-
volatile solvents, and in commercially available sunscreen products [10]. In dilute
solutions irradiated in a xenon test chamber, the study found avobenzone to be pho-
tostable or nearly so in dioxane, acetonitrile, ethyl acetate, tetrahydrofuran, ethanol,
and isopropanol and photolabile in hexane, heptane, and cyclohexane. The photola-
bility manifested as a rapid decline of absorbance at 350360 nm and a correspond-
ing increase in absorbance at 260270 nm. However, in confirmation of work
previously reported by Bonda et al. [11], Huong et al. also found that the photode-
graded solutions, when left in the dark and monitored for UV absorbance at timed
intervals, slowly recovered their initial absorption at 350360 nm, while their
absorption at 260270 also declined to pre-irradiation levels (Fig. 14.4). They also
confirmed another of the findings of Bonda et al. (1997): that as little as 1 % isopro-
panol in the hexane solution completely inhibited avobenzones loss of absorption
at 350360 nm upon irradiation. In concentrated solutions of 2 and 4 % (w/w) in
various cosmetic oils (mineral oil, isostearyl isostearate, alkyl tartrate, alkyl lactate),
photodegradation of avobenzone appeared to be relatively independent of the sol-
vent with as much as 80 % of the avobenzone converted to photoproducts. A total of
11 commercially available European sunscreen products were tested by applying

each in a measured amount to a polymethyl methacrylate (PMMA) plate and irradi-
ating it in a xenon test chamber. After irradiation, the sunscreen was extracted with
solvent and the resulting solutions analyzed by HPLC. The study found the behavior
of avobenzone in these sunscreens to be highly variable, with the loss of compound
ranging from 3 % to over 90 %. Loss of SPF ranged from 0 to 50 %.
Mturi and Martincigh employed UV spectroscopy, HPLC, GC-MS, and NMR to
investigate avobenzones photostability in solvents of differing polarity and protic-
ity [12]. As others had, they found avobenzone to be photostable in the polar, protic
solvent methanol. In polar, aprotic DMSO, loss of absorbance was attributed to
photoisomerization from the enol form to the keto form. However, in nonpolar,
aprotic cyclohexane, loss of absorbance was due primarily to photodegradation. In
moderately polar, aprotic ethyl acetate, both photoisomerization and photodegrada-
tion occurred. However, photoisomerization only occurred in the presence of oxy-
gen, while photodegradation occurred irrespective of oxygen.
In their 2013 paper, Yamaji and Kida reported on their photochemical and kinetic
studies of the enol-keto and keto-enol tautomerization processes [13]. Steady-state
photolysis of avobenzone in acetonitrile (~105 mol) produced the characteristic
decline in absorbance of the enol form at 356 nm and a corresponding increase in
absorbance of the keto form at 265 nm. This happened both in the presence and
absence of oxygen. They did not observe generation of the keto form during
photolysis of avobenzone in cyclohexane, though production of photodegradation
products was observed. Using laser flash photolysis on avobenzone in acetonitrile,
Yamaji and Kida were able to determine the quantum yield (k) of keto tautomer
formation to be 0.014 with the value being independent of dissolved oxygen. Laser
flash photolysis at 266 nm performed on the keto form produced a new absorption
band with a 390 nm peak and a broad band from 450 to 600 nm which was attributed
to absorbance of the triplet keto form. The 390 nm signal subsequently decayed at
the rate (k) of 1.6 106 s1 in the absence of oxygen (lifetime: KT = 6.25107 s)1 and
7.6 106 s1 (lifetime: KT =1.32 107 s) in aerated acetonitrile solutions. After
formation by photolysis of the enol form, the lifetime () of the keto form in the
dark was determined to be 5.1 h.
Kikuchi, Oguchi, and Yagi studied the excited states of avobenzone and a spe-
cially synthesized model of avobenzones keto form, observing the UV absorption,
fluorescence, phosphorescence, and electron paramagnetic resonance spectra (EPR)
of both compounds in ethanol at 77o K [14]. From the intersection of the UV absorp-
tion and fluorescence spectra, they were able to determine the singlet excited state
energy (ES1) of the enol form to be 25,600 cm1 (73.19 kcal mol1). By similar means,
they determined the singlet excited state energy of the keto form analog to be
27,000 cm1 (77.20 kcal mol1). From the first peak of phosphorescence, they deter-
mined the triplet excited state energy (ET1) of the enol form to be 20,400 cm1
(58.33 kcal mol1) and the triplet excited state energy of the keto form to be
24,400 cm1 (69.76 kcal mol1). From the decay of the first peak of phosphorescence,
1
KT represents the lifetime of the keto triplet.
1
Es = 73.19 kcal/mol
The enol tautomer Es = 77.20 kcal/mol The keto tautomer
OHO
* O O *
ET = 58.33 kcal/mol
H 3 * H H
OMe
OMe
O
OMe OMe
1, 3-H shift ET = 69.76 kcal/mol
h IC = .25 O O
O O
* O
350-360 nm or h
F O H O H O < 350 nm H H
O H H OMe MeO
H
H E isomer + Photodegadation
Z isomer
3O by Norrish Type I
2 cleavage
OMe 1O
Quenching by 2
OHO .014 O O ground state
oxygen
H H H Cellular
OMe OMe
Enol tautomer damage
Diketo tautomer
Fig. 14.5 A state energy diagram for avobenzone, compiled primarily from studies conducted at
low concentrations in acetonitrile solutions. Photolysis of the enol tautomer drives an increase in
the concentration of the keto tautomer, which, when excited by UVR, undergoes a Norrish type I
cleavage to produce benzoyl and phenacyl radicals. The asterisks signify that the molecule within
the brackets is in an excited state (Bonda et al. [2], reprinted with permission)
Kikuchi et al. determined the triplet excited state lifetime (phos) of the enol form to
be 30 ms and the triplet excited state lifetime of the keto form to be 190 ms.
A compounds fluorescence lifetime puts an upper limit on the lifetime of the
singlet excited state. As reported by Bonda et al. (2009), measurements conducted
at the University of California-Riverside determined the fluorescence lifetime of the
enol form to be 13 ps [15].
From these and other studies, a picture of avobenzones photophysics and
photochemistry has emerged, which is depicted graphically in Fig. 14.5.
14.4 Photostabilities of Other UV Filters
Avobenzone is not the only photolabile UV filter used in sunscreens. In fact, there
are no perfectly photostable UV filter, though some are nearly so.
Tarras-Wahlberg et al. irradiated OMC mixed with petrolatum first with 20 MED
of UVB radiation and then with 100 J/cm2 of UVA radiation. They observed slight
loss of peak absorption after the UVB dose and a much larger loss of peak absorp-
tion after the UVA dose. HPLC analysis of the sample following irradiation revealed
formation of a new peak which the researchers attributed to OMCs cis isomer,
indicating that irradiation drove conversion of the normally dominant trans isomer
to its cis counterpart, which absorbs UV with a similar peak but at a significantly
lower molar extinction coefficient [16]. Others have found that when present in high
concentrations, OMC can react with itself as two molecules undergo a [2 + 2] cyclo-
addition reaction [17].
The photostabilities of 18 UVB filters approved for the use in sunscreens in the
EU were studied in vitro by Couteau et al. [18]. Each UV filter was incorporated into
its own standardized oil-in-water emulsion. The researchers applied 30 mg of each
formulation to roughened PMMA plates. The plates were irradiated in a xenon test
Table 14.1 Photostabilities of UVB Filters [18]

UVB filters (from most to least
photostable) Rate constant of photodecay (k min1)
Iscotriazine (DBT) .00008
PABA .0001
Bisoctrizole (MBBT) .0004
Oxybenzone (OXY) .0005
Ensulizole (PBSA) .0005
Benzophenone-5 .0006
Octocrylene (OC) .0014
Enzacamene (4-MBC) .0021
Octyl triazine (EHT) .0022
Homosalate .0023
3-Benzylidene camphor .0031
Octinoxate (OMC) .0031
Polysilicone-15 .0038
Anisotriazine .0044
Amiloxate .0059
PEG-25 PABA .0061
Padimate O .0062
Octisalate .0075
Each of the 18 UV filters, listed above from most to least photostable, was incorporated into its
own standardized oil-in-water emulsion, which was applied to a substrate and irradiated in a xenon
test chamber. Measurements were taken at timed intervals and the rate constant of photodecay (k)
calculated by the equation SPF/SPF0 = ekt
chamber filtered to block radiation <290 nm. The SPF was measured at timed inter-
vals with a UV transmittance analyzer. Photodegradation of each formulation was
expressed in three ways: as the number of minutes of irradiation required to cause
the coated plate to lose 50 % of its SPF (t50%); as the number of minutes of irradiation
required to cause the coated plate to lose 10 % of its SPF (t90%); and as the rate con-
stant of photodecay (k) according to the equation SPF/SPF0 = ekt. Table 14.1 pres-
ents the results of the study in rank order from most to least photostable.
Herzog et al. studied the photostabilities of ethylhexyl methoxycinnamate
(OMC), ethylhexyl triazine (EHT), avobenzone, BEMT, and OC [19]. They
incorporated each UV filter into its own oil-in-water emulsion which they applied to
a quartz plate and irradiated in a xenon test chamber. At timed intervals, they used
solvent to extract the residual emulsion containing the UV filter from the quartz
plate and then analyzed the solution by HPLC. After 50 MED, OC and BEMT were
found to be photostable. OMC and avobenzone were strongly degraded (<20 % and
<1 % were recovered, respectively), and EHT was less degraded (approximately
50 % was recovered). The researchers noted degradation of OMC is not observed in
ethanol solutions at low concentrations. A rapid initial loss of absorption is attributed
to a change in the equilibrium between the trans and cis isomers (toward the cis)
which quickly stabilizes and after which no further drop occurs.
14.5 Sunscreen Products and UV Filter Combinations
UV filters are almost never used alone in sunscreen products, which may contain up
to six UV filters. Bimolecular interactions between UV filters of the same or
different species, or between the UV filters and inactive ingredients with which they
are paired, can have a positive, negative, or no effect on the sunscreens photostability,
as illustrated in the studies referenced below.
A major sunscreen manufacturer and marketer in the USA reported studies of the
photostabilities of numerous sunscreen products in their comments to the FDA in
2007 [20] and their follow-up supplement in 2008 [21]. In one study, commercially
available sunscreen products were applied in measured amounts to microscope
slides and exposed to natural sunlight until 7.5 MED was reached as measured by a
radiometer. The UV filters were then assayed by HPLC. Independent labs in Sydney,
Australia, Winston-Salem, North Carolina, and Ormond Beach, Florida, took part.
Some of the products were tested by all three labs, others were tested by two. The
14 products ranged from SPF 30 to SPF 80 and comprised 10 lotions, one lotion
spray, two continuous sprays, and one stick product. Four of the products contained
OMC in combination with avobenzone, and nine combined OC with avobenzone,
two of which also contained OMC. Three contained avobenzone without either OC
or OMC. The results may be found in Table 14.2, which groups the products tested
by the presence or absence of the three UV filters. Clearly, of the products tested,
the most photostable are those that contain OC and avobenzone and no OMC, or do
not contain avobenzone at all. In all 12 of the products containing them, the two
salicylates, octyl salicylate and homosalate, showed significant photolability, declin-
ing on average by about 24 % and 15 %, respectively.
Beasely and Meyer determined the impact of avobenzone photolability on SPF
and UVA-PF [22]. They started with a model SPF 50 sunscreen product which
contained 3 % avobenzone photostabilized with 7 % OC. They then prepared a
Table 14.2 % UV filters remaining after 7.5 MED of natural sunlight by HPLC
OC + Avo, no OC + Avo + Avo + OMC, no OMC, no Avo
UV Filters OMC (N=9) OMC (N=2) OC (N=2) (N=1)
Octocrylene (OC) 100 % 100 % 100 %
Oxybenzone 96.8 % 94.9 % 100 % 97.0 %
Avobenzone (Avo) 91.0 % 59.6 % 25.0 %
OMC 49.4 % 41.0 % 65.1 %
Octyl salicylate 77.8 % 75.8 % 76.3 % 75.1 %
Homosalate 86.4 % 81.4 % 86.8 % 84.2 %
14 commercially available sunscreen products were applied to microscope slides and exposed to
natural 7.5 MED of natural sunlight. The studies were duplicated or triplicated by labs in Australia,
North Carolina, and Florida. After exposure, each sunscreen was extracted from the slide by
solvent and analyzed by HPLC to determine the amount of each UV filter remaining. The two
salicylates showed significant loss in all products. Avobenzone was most photostable when
combined with octocrylene (OC) without OMC
series of four new photostable formulations identical in every way to the original
except that the avobenzone concentration was reduced by 20 %, 33 %, 67 %, and
100 % (no avobenzone), respectively, in order to simulate corresponding degrees of
avobenzone loss due to photodegradation. These products were then tested on
human volunteers and the SPF and UVA-PF determined for each and compared to
the original. As expected, the researchers found that reducing the avobenzone con-
centration had the greatest effect on UVA-PF, though SPF suffered significant losses
as well. Small losses of avobenzone (20 %) had little effect on either SPF or
UVA-PF. However, reductions of avobenzone concentrations of 33 % and 67 %
resulted in the SPF declining from 51 to about 48 and 45, respectively, and the
UVA-PF from about 18 to about 14 and 12, respectively. The formulation contain-
ing no avobenzone, which simulated a complete loss of the UVA filter due to pho-
todegradation, achieved SPF 40 and UVA-PF 8.
To approximate the environment in human skin below the surface, Damiani and
co-workers prepared liposomes containing pairs of UV filters and suspended them
in saline. The suspensions were placed in the wells of cell culture plates and irradi-
ated with UVA delivered by a commercial sun lamp. The total dose was calculated
as equivalent to about 90 min of exposure on the French Riviera on a sunny summer
day. The irradiated samples were collected, diluted with ethyl acetate, and centri-
fuged to recover the UV filters, after which UV absorption measurements were
made and compared to non-irradiated controls. The photostable combinations
paired avobenzone with bis-ethylhexyloxyphenol methoxyphenyl triazine (BEMT),
methylene bis-benzotriazolyl tetramethylbutylphenol (MBBT), and diethylamino
hydroxybenzoyl hexyl benzoate (DHHB). The combination with OC improved avo-
benzones UVA absorption by 35 %, while the combinations with OMC and EHT
showed the least photostability, losing most of their absorption throughout the entire
UVA range. Combinations of OMC with BEMT, MBBT, DHHB, and EHT were
photostable [23].
The oft-used combination of avobenzone and OMC was studied by Herzog and
co-workers (2009). They prepared a sunscreen emulsion containing 3.4 % OMC
and 2.4 % avobenzone and compared the amount of OMC recovered after irradiation
with the amount recovered from the emulsion containing OMC alone. They noted a
significant acceleration of OMC photodegradation when avobenzone was added
and attributed the increase to the availability of a second pathway to a [2 + 2]
cycloaddition (the first being the reaction of OMC with itself) stemming from the
reaction of the enol form of avobenzone with OMC. On the other hand, adding
OMC to avobenzone did not affect the amount of avobenzone recovered, indicating
that the OMC-avobenzone reaction competed successfully with formation of
avobenzones keto form to reduce the pathway to the Norrish type I cleavage.
As of this writing, the FDA does not permit avobenzone to be combined with
either TiO2 or ZnO in sunscreens marketed in the USA [24]. Both combinations are
permitted in many other venues throughout the world however. TiO2 in particular is
widely used in combination with organic UV filters.
Titanium dioxide exists naturally in three crystalline forms: rutile, anatase, and
brookite. The TiO2 grades used in sunscreens are made from rutile or anatase. Both
forms are available in a range of particle sizes, from nano to micron. In general, the
larger the particle size, the more whitening is the effect on the skin. Both TiO2 and
ZnO are semiconductors with band gaps in the solar UV range. Absorption of a
photon with energy equal to or greater than the band gap promotes an electron from
the valance band to the conduction band, which creates an electron ()/hole (+) pair.
When this happens, molecules close to or adsorbed to the particle surface can inter-
act with these charge carriers to become reduced (gain an electron) or oxidized (lose
an electron). Because of this, these metal oxides have photocatalytic properties and
can behave as either oxidant or reductant to generate reactive oxygen species (ROS)
such as hydroxyl radicals (OH) and superoxide anion (O2). These ROS in turn can
react with the organic components in sunscreens including UV filters, contributing
to their degradation [25]. Of the TiO2 crystalline forms, anatase is regarded as the
more photocatalytically active [26]. For that reason, there have been recent calls to
limit the TiO2 in sunscreens to grades derived from rutile [27]. Commonly, though
not always, the TiO2 and ZnO grades used in sunscreens are passivated (rendered
less reactive) by treating the surfaces of the particles with chemically inert sub-
stances such as silica, dimethicone, or aluminum hydroxide. Other surface treat-
ments are used to improve the particles oil or water dispersibility [28].
Kockler et al. studied the influence of TiO2 particles size on the photostabilities
of avobenzone and OC by preparing oil-in-water emulsions in which the avobenzone
and OC were dissolved in the oil phase, and various grades of TiO2 were dispersed
in the water phase [29]. TiO2 grades tested included a silica-coated rutile TiO2 with
a mean particle size of 119 nm, an uncoated anatase nano TiO2 with mean particle
size of 25 nm and an uncoated anatase micro TiO2 with a mean particle size of
0.6 m. Measured amounts of the emulsions were applied to glass plates and
irradiated for 14.6 h at 400 W/m2 in a xenon test chamber. After irradiation, solvent
was used to extract residual emulsion from the plates, and the solutions were
analyzed by HPLC. From the emulsions containing avobenzone alone or combined
with coated, micro, and nano TiO2, recovery of avobenzone after irradiation ranged
from 0 to 3.81 %. From the emulsion containing OC alone, or combined with
coated, micro, and nano TiO2, recovery of OC ranged from 88.33 to 99.98 %. From
the emulsions containing avobenzone and OC plus coated, micro, and nano TiO2,
recovery of avobenzone was 16.0 %, 12.6 %, and 0.6 %, respectively, and recovery
of OC was 98.2 %, 95 %, and 92.5 %, respectively. A separate experiment determined
that neither avobenzone nor OC adsorb onto any of the TiO2 particles surfaces. The
authors concluded that uncoated nano-TiO2 is more deleterious to both avobenzone
and OC than either micro or coated TiO2.
Nguyen and Schlossman studied avobenzone photostability in dilute solutions in
ethanol in the presence of various grades of TiO2, coated and uncoated, and one
untreated and four treated ZnO grades [30]. The ethanol solutions contained 0.04 %
avobenzone and 4 % of metal oxide. Each sample was irradiated using a UV lamp
for 1 week. Afterwards, each sample was centrifuged to remove the metal oxide
from the solution, and the solutions UV absorption and transmittance were
measured with a UV/Vis spectrophotometer. Both anatase and rutile forms of TiO2
were tested. Primary particle sizes ranged from 15 nm to 300 nm. Surface treatments
included octyltriethoxysilane, methicone, dimethicone, silica, aluminum stearate,

and C9-15 fluoroalcohol phosphate. Among the anatase samples, the one treated
with octyltriethoxysilane show the least negative effect, with 19 % of avobenzones
absorbance remaining after irradiation compared to <1 % for the other treatments.
Among the first group of rutile samples, the one treated with methicone produced
the best result with 38 % of avobenzones absorbance remaining after irradiation
compared to <1 % for the others. Among the second group of rutile samples, the one
treated with silica (primary particle size 90 nm) was the best with 76 % of
avobenzones UV absorbance remaining after irradiation compared to 28 % and
3 % for the C9-15 fluoroalcohol phosphate and aluminum stearate treated samples,
respectively. Among the ZnO samples tested, the two treated with silica fared the
best, with avobenzone retaining 49 % and 18 % of its UV absorbance compared to
<1 % and 3 % for the methicone- and silane-treated samples, respectively. The
authors concluded that when combining avobenzone with TiO2, rutile is superior to
anatase. Also, surface-treated TiO2 and ZnO are better than uncoated TiO2 and ZnO
for limiting loss of avobenzones absorbance following irradiation. They also noted
that in this study, silica-treated TiO2 proved to be superior to all other treated metal
oxides tested for limiting loss of avobenzones absorbance following irradiation.
14.6 Photostabilizing Sunscreens
According to an Internet search conducted in November 2014, there are 12

photostabilizers in use in sunscreens somewhere in the world including three UV
filters BEMT, 4-MBC, and OC that are known to have photostabilizing proper-
ties [31]. Of these, only OC is globally approved; the other two are not permitted for
use in sunscreens in the United States. The molecular structures of the photostabilizers
and other compounds discussed in this chapter may be found in Fig. 14.6.
Herzog et al. showed that one way to increase the photostability of a photolabile
UV filter like avobenzone is to increase the optical density of the system, effectively
increasing the competition for the same photons. The idea is that the fewer photons
absorbed by the photolabile UV filter, the lower will be its photodegradation. They
illustrated this by comparing ethanolic solutions of EHT of low and high optical
density. After exposure to the same amount of radiation, the solution of lower
density displayed a half-life of 61 min compared to 210 min for the solution of
higher density. The authors note that this strategy is effective only in cases where
increasing the optical density does not also increase the rate of bimolecular chemical
reactions, as it does when OMC is added to avobenzone [19].
Herzog et al. also compared and contrasted OC, a photostable UVB filter that is
known to quench avobenzones triplet excited state [32], with BEMT, a broadband
(UVA and UVB) UV filter [33]. They determined the quenching rate constants of
OC and BEMT for avobenzone, finding that OC is about 2.5 times more efficient
than BEMT in stabilizing avobenzone. The authors also concluded that BEMTs
stabilizing effect may in part be due to competition with avobenzone for photons.
Another UV filter that has considerable overlap with avobenzones absorption spec-
trum is oxybenzone (benzophenone-3). Mendrok-Edinger et al. reported that adding
2 % oxybenzone to 4 % avobenzone increases photostability to 80 % compared to
23 % without [34]. Since it is energetically unlikely that Oxybenzone quenches
a
O
OH O
HO O O
N N
O
N O
O
O HO O
Bis-ethylhexyl hydroxydimethoxy
Bemotrizinol; Bis-ethylhexyloxyphenol benzylmalonate; (HDBM)
methoxyphenyl triazine; (BEMT)
OH O
N OH OH N
N N N
N
Butyloctyl salicylate
Bisoctrizole; Methylene bis-benzotriazolyl

tetramethylbutylphenol; (MBBT)
O
O O
O HO O O
Diethylhexyl 2,6-naphthalate; (DEHN) O
O
O
Diethylhexyl syringylidene malonate; (DESM)
O
N
O
O
Enzacamene; 4-Methylbenzylidene camphor;

O (4-MBC)
Ethylhexyl methoxycrylene; (EHMC)
O OH O
N
O
O
Oxybenzone; Benzophenone-3; (OXY)
Octocrylene; (OC)
Fig. 14.6 Key chemical compounds discussed in this chapter, identified by their USAN (when
relevant), INCI name, and (abbreviation) as used in this chapter. (a) Photostabilizers including
photostabilizing UV filters, (b) Other UV Filters, (c) Antioxidants
O O O
N
R O R O
O O O R
O n n
O
O O
N
R= or R=
O O
O
O
Polyester-8 Polyester-25
O
CH3 CH3 CH3 CH3 CH3 CH3 CH3
O H3C Si O Si O Si O Si O Si O Si O Si CH3
CH3 CH3 CH2 CH3 CH3 CH3 CH3
(CH2)10
n
O O O
R= N R
O m
O
Trimethoxybenzylidene pentanedione; (TMBP)

Undecylcrylene dimethicone
b
O O O
OH O
O
N O
Octinoxate; Ethylhexyl methoxycinnamate;
Diethylamino hydroxybenzoyl hexyl benzoate; (OMC)
(DHHB)
O
O
NH O
N N O
HN N NH
O O
Ethylhexyl triazine;Octyl triazine; (EHT)

C
O HO
O
O H
O
10
Tocopherol; Vitamin E
Coenzyme Q10; Ubiquinone
Fig. 14.6 (continued)
avobenzone triplets (using the measured triplet energy of 4-methoxybenzophenone

as a proxy) [35], its competition for photons may explain the photostabilizing effect.
For excited state quenching to occur, the transfer of energy from excited UV fil-
ter to quencher must be energetically downhill (Turro et al., 2010, p. 385). That is,
the excited state energy of the quencher must be lower than the excited state energy
of the UV filter for the same multiplicity (singlet to singlet, triplet to triplet).
There are two common mechanisms by which an excited state donor (D) transfers
energy to a ground state quencher (Q). The first is a dipole-dipole interaction
(also known as Coulombic or Frster energy transfer) in which the electric field
generated by the excited electron of the donor resonates with an electron of the
quencher, essentially transferring the donors energy through space to the quencher
(Turro et al., 2010, p. 399). Thus, the donor returns to the ground state, and the
quencher is raised to the excited state. This mechanism diminishes with the inverse
sixth power of the distance between donor and acceptor (Turro et al., 2010, p. 402).
Energy transfer by the dipole-dipole mechanism is the mechanism most often
responsible for singlet-singlet quenching.
The second mechanism is known as the electron exchange mechanism (also
known as Dexter exchange). In this mechanism, the excited donor (3D*) and
quencher (Q) collide such that the donor exchanges its excited state electron for one
of the quenchers ground state electrons, returning the donor (D) to the ground state
and elevating the quencher (3Q*) to the excited state. Energy transfer by the Dexter
exchange mechanism is easily visualized as follows:
LU
HO + +
3D* Q D 3D*
The Dexter exchange mechanism is the most common one for triplet-triplet
quenching. The majority of photostabilizers on the market today (2014) function as
quenchers of avobenzones triplet excited state.
OC has long been recognized as a triplet quencher for avobenzone. Mendrok-
Edinger et al. (2009) reported that 3.6 % OC added to 4 % avobenzone in a sun-
screen emulsion conferred 90 % photostability. Lhiaubet-Vallet et al. tested
avobenzone alone and in combination with six other UV filters, measuring by HPLC
the amount of avobenzone and UV filter recovered after irradiation for four hours (!)
with a solar simulator. The UV filters tested were OMC, OC, BEMT, diethylamino
hydroxybenzoyl hexyl benzoate (DHHB), EHT, and dioctyl butamido triazone
(DBT). The combination of OC and avobenzone was the clear winner with 84 % of
the avobenzone and 100 % of the OC recovered. Next was BEMT and avobenzone,
with 72 % of the avobenzone and 96 % of the BEMT recovered. With no
photostabilizer, only 41 % of the avobenzone was recovered [36].
Polyester-8 is a low molecular weight (ca. 1900 daltons) organic polymer that is
terminated with cyanodiphenyl propenoic acid, the same chromophore as
OC. According to its manufacturer, it retains OCs ability to photostabilize avoben-
zone by a triplet quenching mechanism though with lower efficiency [37].
Undecylcrylene dimethicone (UCD) is a silicone polymer that also incorporates the
OC chromophore. The manufacturers literature states that it enhances the photo-
stability of the UVA filter avobenzone by quenching its triplet excited state [38].
Ethylhexyl methoxycrylene (EHMC) is a commercially available cosmetic
ingredient that is marketed as a photostabilizer for avobenzone and other photolabile
compounds [39]. Kikuchi and co-workers determined EHMCs excited singlet and
triplet state energies to be 72.3 kcal mol1 and 55.5 kcal mol1, respectively [40].
These excited state energies are below those measured by Kikuchi et al. (2009 and
2010) for avobenzone (73.2 kcal mol1 and 58.3 kcal mol1, respectively) and for
OMC (85.49 kcal mol1 and 55.75 kcal mol1, respectively), making the quenching
of the singlet and triplet excited states of both compounds by EHMC energetically
feasible. Researchers at the University of California-Riverside confirmed the ability
of EHMC to quench avobenzones singlet excited state. The researchers employed
a streak scope (also known as a streak camera) to measure avobenzones fluorescence
lifetime in the absence and presence of varying concentrations of EHMC. At
10 mmol concentration of EHMC, the singlet excited state lifetime of avobenzone
was reduced from 1.3 1011 s to 1.86 1012 s, shorter by about an order of
magnitude [41].
Bonda et al. (2010) compared EHMC and OC to photostabilize the combination
of avobenzone and OMC. The researchers prepared three solutions of 3 %
avobenzone and 7.5 % OMC in ethyl acetate. One solution contained 3 % EHMC,
one contained 3 % OC, and a third control solution contained no photostabilizer.
The solutions were applied to PMMA plates and allowed to dry before they were
irradiated with a solar simulator. After 25 MED, the control with no photostabilizer
retained 44.5 % of its UVA absorbance compared to 53.9 % with 3 % OC and
83.7 % with 3 % EHMC.
4-Methylbenzylidene camphor (4-MBC; USAN Enzacamene) is a UV filter that
functions as an avobenzone photostabilizer, almost certainly by a triplet quenching
mechanism. Though not permitted in the USA, it has been used in Europe for
decades at concentrations up to 4 %. Mendrok-Edinger et al. (2009) prepared a
solution of 4 % 4-MBC and 4 % avobenzone which they applied to a roughened
glass plate and then irradiated with 25 MED. Afterward, the plate was washed with
solvent, and the resulting solution was analyzed by HPLC. Subsequently, 88 % of
the avobenzone was recovered compared to 23 % from the solution containing no
photostabilizer.
Another triplet quencher for avobenzone is diethylhexyl 2,6-naphthalate (DEHN)
[42]. Mendrok-Edinger et al. (2009) found DEHN to be mildly effective. In their
experiment, less than 50 % of avobenzone was recovered after 25 MED. Bonda and
Steinberg reported that matched sunscreens containing 3 % avobenzone and either
0 % or 4 % DEHN were exposed to 10 MED of solar-simulated radiation and then
analyzed on a UV transmittance analyzer. In the sunscreen without DEHN, UVB
and UVA attenuation declined to 77 % and 64 %, respectively, while in the sun-
screen with 4 % DEHN, UVB and UVA attenuation remained at 92 % and 91 %,
respectively [43].
Polyester-25 is a low molecular weight polymer that is marketed as a photostabi-
lizer for avobenzone [44]. Based on examination of its structural components, it
would be expected to function mechanistically in a manner similar to EHMC.
A recent entry to the photostabilizer category is trimethoxybenzylidene
pentanedione (TMBP) [45]. The manufacturer tested ethanol solutions containing
3 % avobenzone, 5 % octisalate, and 15 % homosalate to which was added either
4 % OC, 2 % DESM, or 2 % TMBP, measuring UVA absorption before and after
irradiation. After 100 J/cm2, the solution containing TMBP retained about 70 % of
its UVA absorption compared to 60 % for OC and about 30 % for DESM.
Another concept is to use antioxidants to photostabilize avobenzone. Afonso
et al. investigated this strategy by combining ubiquinone (coenzyme Q-10) and
tocopherol (vitamin E) at various ratios with avobenzone in model sunscreen
emulsions [46]. They reported a 62.2 % increase in avobenzone photostability when
avobenzone was combined with ubiquinone at a 2:1 ratio and a 15.3 % improvement
when avobenzone was combined with tocopherol at a 1:2 ratio.
Bis-ethylhexyl hydroxydimethoxy malonate (HDBM) is marketed as an
antioxidant that improves avobenzone photostability. According the manufac-
turer, HDBMs triplet energy is too high to quench avobenzones triplet excited
state. Rudolph et al. tested a solution of 2 % HDBM and 2 % avobenzone in
isopropyl myristate which they spread on PMMA plate. The plate was irradi-
ated in a xenon test chamber with the equivalent of 5 MED, after which the
sample was extracted with solvent and the absorption of the solution measured.
At 355 nm, the avobenzone peak, the sample lost 41 % of its absorbance com-
pared to the control with 2 % avobenzone alone which lost 58 %. A structurally
similar compound, DESM, was also tested. DESM is marketed by its manufac-
turer as both an antioxidant and a triplet quencher for avobenzone. After irra-
diation, the solution of 2 % DESM and 2 % avobenzone lost 29 % of its
absorbance at 355 nm [47].
Butyloctyl salicylate was found by Mendrok-Edinger et al. (2001) to be moder-
ately effective in photostabilizing avobenzone. When butyloctyl salicylate was
added at 5 % to a 4 % avobenzone solution then irradiated with 25 MED, 50 % of
the avobenzone was recovered compared to 23 % without butyloctyl salicylate.
Excited state quenching by butyloctyl salicylate of avobenzone is energetically
unfavorable and is therefore ruled out [48]. As a liquid phenol, butyloctyl salicylate,
like other salicylate esters, is a protic solvent. Recalling that avobenzone is
essentially photostable in protic solvents such as isopropanol, it is likely that the
stabilizing effect on avobenzone is due to butyloctyl salicylates proticity. This
effect was previously reported by Bonda et al. (1997).
Sunscreens that combine avobenzone and OMC present a special challenge for
photostabilization. Under exposure to UVR, avobenzone and OMC engage in a
reaction known as the De Mayo reaction. The De Mayo reaction describes the reac-
tion of an enol with an alkene to produce a [2 + 2] cycloaddition followed by a retro
aldol cleavage [49]. The reaction usually proceeds through the excited enol.
However, in the case of avobenzone and OMC, the reaction probably proceeds
through the excited alkene, OMC. This view is supported by Kikuchi and Yagi who
observed the intermolecular triplet-triplet energy transfer from avobenzone to OMC
through measurements of EPR and time-resolved phosphorescence spectra [50].
First they noted that triplet-triplet energy transfer from avobenzone to OMC is
energetically favorable because avobenzones triplet energy (ET1 enol = 58.3 kcal mol1;
ET1 keto = 69.8 kcal mol1) lies above that of OMC (ET1 = 55.75 kcal mol1), while
avobenzones singlet excited state (ES1 enol = 73.2 kcal mol1) lies below that of OMC
(ES1 = 85.5 kcal mol1), thus ruling out singlet-singlet energy transfer.
Lhiaubet-Vallet et al. determined the bimolecular quenching rate constant of the

methylated avobenzone analog, BM-DBM-Me by OMC to be 7.3 109 M1 s1. For
reference, the researchers also measured the bimolecular quenching rate constant by
OC to be 3.8 109 M1 s1. By inference from
O
O O OH O HO O R2 O
R1 R2 R1
R1
R2
The De Mayo reaction
these findings, avobenzone efficiently transfers its triplet energy to OMC which
elevates ground state OMC to its triplet excited state. OMC triplets then become the
aggressive species in the previously described De Mayo reaction to photodegrade
both compounds and produce photoproducts. OCs quenching rate constant, at only
about half of OMCs, is not competitive.
Chatelain and Gabard (2001) studied the ability of BEMT to photostabilize the
OMC-avobenzone combination, finding that BEMT exerted a protective effect on
both UV filters. In sunscreens containing 5 % each of avobenzone and OMC, adding
5 % BEMT decreased photodegradation of OMC from about 65 % to about 48 %
and photodegradation of avobenzone from 45 % to about 35 %. Photostabilizing the
combination of OMC and avobenzone remains one of the great challenges in
sunscreen formulating.
14.7 Testing Sunscreen Photostability
There are many ways to measure photostability. In this section we are concerned
only with methods that measure the photostability of fully formulated sunscreen
products as opposed to solvent systems that contain one or two UV filters.
One of the easiest methods to test sunscreen photostability is to monitor the
change in transmission of an otherwise transparent plate (e.g., quartz or PMMA)
that has been coated with the sunscreen being tested while it is being irradiated by
UVR. In this method, the coated plate and suitable controls are placed in the path of
the UV beam. Transmission is monitored by a detector in line with the beam but
placed on the other side of the plate. The change in UV transmission seen by the
detector may be quite rapid for a photolabile product. For example, if the output of
the solar simulator is 150 MED/hour, the solar simulator is emitting approximately
0.042 MED per second or about 1 MED every 24 s. Theoretically, the initial output
through the product covered plate would be 5 MED/hour for an SPF 30 sunscreen.
The MED/hour would rapidly climb for a photolabile product as the sunscreens
ability to absorb UV rapidly declines. The advantage of this method is it is simple
and fast. A second advantage is that it somewhat mimics the SPF test. The sunscreen
product sees the same spectra in the photostability test as it does in the actual SPF
test. If a product is seen to deteriorate rapidly in the photostability test, then

essentially the product must be formulated with a heavier load of sunscreen actives
than a photostable product would need to obtain the same SPF. The disadvantages
of the test are that (1) the photostability of the product may be worse in sunlight than
under the solar simulator; and (2) the test does not identify which ingredient or
ingredients may be degrading.
A second method involves scanning a spot on a UV-transparent plate such as
PMMA or quartz to which a sunscreen has been applied, then irradiating the plate
and rescanning in the exact same spot. The scan should be made with a
spectrophotometer designed for this application. Most companies in the industry
use an instrument called a UV transmittance analyzer for this purpose. It is
recommended that several scans in different locations on the plate be made. The
irradiation source can be any device that emits UV energy. If a solar simulator is
utilized, it is recommended that it has a beam sufficient to cover the entire plate. Of
course, natural sunlight can be used as the UV source. In either case a radiometer or
spectroradiometer is used to measure the amount of radiation employed. This
method also has an advantage in that it is relatively simple. Another advantage is
that a variety of irradiation sources can be utilized. Another advantage is that many
of the spectrophotometers that are routinely used to test samples like this have
software that will automatically calculate such things as SPF, critical wavelength,
UVA-PF, etc. Yet another advantage is that the change in absorption at different
wavelengths can be seen. This provides some guidance as to which UV filters might
be degrading. For example avobenzone is the only UV filter approved in the USA
with a maximum absorbance at around 360 nm. If a loss of absorption is greater
around this wavelength, then it is reasonable to assume that the avobenzone is
degrading. A major disadvantage of this method is, again, it only shows where loss
of absorption occurs and does not identify each individual sunscreen.
In the next method, the sunscreen coating the plate is extracted with solvent after
exposure to UVR and analyzed by HPLC in order to measure quantitatively the
amount off each UV filter that remains. This method is much more precise than the
previous two. It also has the advantage that both broad-spectrum UVR sources and
natural sunlight can be used for irradiation.
Though this method supplies some of the best information concerning
photostability, it does have one distinct disadvantage in that it requires development
of a validated analytical method for each different UV filter combination that might
be encountered. The difficulty here is that in HPLC the peaks for different
compounds often overlap or obscure each other completely, making quantification
impossible. To be meaningful, the peaks must be separated, which is a time and
resource consuming process.
The fourth method is an in vivo one. As such it is perhaps the most revealing but
also the most difficult to perform. It is similar to the previous (HPLC) method in
that it involves assaying product to see which individual sunscreens degrade. A
measured amount of a sunscreen product is applied to a human volunteer. After
irradiation, the application site is washed with a suitable solvent (e.g., ethanol or
isopropanol), and the resulting solution is analyzed by HPLC.
The result is a real-world evaluation of how a sunscreen product performs on the

skin after UV exposure. A broad-spectrum UV source can be used for irradiation,
but even better, natural sunlight can be used.
There are disadvantages. This method is difficult and requires the most skill of
several disciplines to accomplish. The analytical method must be validated. The
ability to swab most if not all of the available sunscreen from the skin must be
validated. The ability to extract the sunscreen from the swab material must be
validated. It requires trained clinical personnel to apply the product and monitor the
subjects during all phases of the test. Institutional Review Board approval may be
required before starting the test.
For additional detail and approaches to measuring sunscreen photostability, the
reader is referred to Sayre et al. (2009) [51], Moyal et al. (2002) [52], and Ou-yang
et al. (2010) [53].
Before concluding, we offer a few words about light (radiation) sources:
A number of published studies have found that, both theoretically and
experimentally, solar simulators differ from each other in the SPF they provide and
that even solar simulators that comply with regulatory standards may not provide
the same SPF as natural sunlight [5458]. Whether or not this is due to differences
in photostability in natural sunlight compared to artificial sunlight is an open
question. Gonzalez et al. (2007) report a case in which photostability of a sunscreen
was greater in natural sunlight than in artificial sunlight. On the other hand, Lott
contends in his patent titled Natural Sunlight Photostable Composition (US
7,309,481) that wavelengths present in natural sunlight that are missing in the
artificial spectra, or are present in much less relative amounts than in natural
sunlight, are responsible (at least in part) for degradation reactions in many
sunscreens.
14.8 Summary and Conclusion
The organic UV filters in sunscreens are photochemicals that absorb the energy in
ultraviolet radiation (UVR) by converting it to electronic excitation energy. At a
molecular level, this is understood as the promotion of a single electron in an
outer or valence orbital from its lowest energy state to a previously unoccupied
orbital of higher energy, referred to as the excited state. Subsequently if physical
processes drain the excess energy so that all of the molecules of the compound
return unchanged to the ground state, then the compound is photostable. If, how-
ever, the excess energy fuels chemical processes that change some or all of the
molecules, the compound is photolabile. Photolabile compounds lose effective-
ness as UV absorbers as they are exposed to UVR. So it is with some of the
organic chromophores contained in sunscreens and, therefore, with sunscreens
themselves.
As recognition of the skin-damaging effects of UVA radiation has grown, sun-
screen scientists and photochemists have increasingly turned their attention to
understanding avobenzone, still the only effective organic UVA protectant approved
worldwide. Today, after 20 years of study, a comprehensive (though still incom-
plete) picture of avobenzones complex photochemistry has emerged. In a nutshell,
UVR exposure induces fragmentation and radical formation in a dose-related man-
ner. Exactly how this happens is not yet fully understood. What is known is that
avobenzone photodegradation is mitigated or curtailed by combining it with com-
pounds that quench its excited states. When combining avobenzone with TiO2 or
ZnO, coated is better than uncoated, and rutile is better than anatase.
All UV filters have been shown to be photolabile to some degree, though under
conditions of actual use, many can be considered to be photostable. In contrast,
the most widely use UVB filter in the world, OMC, is relatively photostable when
tested at low concentration in ethanol, but quite photolabile when tested at realis-
tic concentrations and in formulated products. When OMC and avobenzone are
combined, UVR catalyzes a photochemical reaction that degrades both com-
pounds, a result that continues to vex sunscreen formulators and for which no
complete cure has yet been found though both BEMT and EHMC have been
reported to help.
A number of photostabilizers have been developed that are more or less effective
at preserving avobenzone from photodegradation. Protic solvents help, as does
increasing optical density. The best photostabilizers quench avobenzones excited
states. Most of these are triplet quenchers; one has been shown to quench avoben-
zones singlet excited state.
Testing sunscreen photostability is straightforward: a measured amount of
product is placed on a substrate and analyzed before and after exposure to UVR and
the results compared. Ideally, the sun would serve as the radiation source. As a
practical matter, solar simulators must suffice for the foreseeable future.
The saga of sunscreen photostability has already produced a lasting dual legacy:
for consumers, the widespread availability in much of the world of photostable sun-
screens, and among sunscreen scientists, a new and deeper understanding of sun-
screen photochemistry. Just as the former promises better health for millions, the
latter portends a future of continual improvement in skin photoprotection.
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Chapter 15
Sunscreen Formulation: Optimizing Efficacy
of UVB and UVA Protection
Curtis Cole
Key Points
1. Spectral shape of sunscreen products should be designed to best protect
against the primary causes of sun damage: sunburn, skin cancer, and skin
aging.
2. A spectral absorbance shape with approximately a 3:1 ratio of SPF:UVA-PF
will provide equal protection across the UV range for the three main skin
damages.
3. Vehicle components are chosen to provide the functional and aesthetic
requirements for the use conditions, recreational use in intense sunlight
conditions, or daily moisturization for intermittent or incidental sun
exposure.
4. UV filters can be chemical (organic), physical (inorganic) filters, or a
mixture of both to provide the desired spectral shape and aesthetic
properties.
15.1 Background
Earlier publications [13] have outlined the history of development of sunscreen

products starting in the 1930s with simple oils or creams to block UVB rays and
extend the time one could stay in the sun before sunburning. The original sun
filters were phenylbenzimidazole sulfonic acid, benzyl salicylate, and para amino-
benzoic acid (PABA) derivatives. World War II soldiers were also familiar with a
C. Cole, PhD
Sun and Skin Consulting, LLC, Ringoes, NJ 08551, USA

DOI 10.1007/978-3-319-29382-0_15
276 C. Cole
red veterinary petrolatum product that provided sun protection for use in
tropical regions. During the 1960s, additional UV filters were developed includ-
ing the first filters to block (at least partially) in the UVA region, namely, the
benzophenones and the metal oxides, titanium dioxide and zinc oxide. In 1972,
the US Food and Drug Administration (FDA) initiated the current Monograph
regulatory system that permitted manufacturers to market certain drug products
without pre-market approval from the FDA, as long as the product complied with
the stipulations described in the specific drug product monograph publication.
The first Proposed Rule for the Over-The-Counter Sunscreen Product monograph
was published in 1978 [4] describing the UV-absorbing UV filters that were rec-
ognized as safe and effective for use in these sunscreen products, the allowed
concentrations and combinations permitted, and a test method to evaluate the sun
protection factor (SPF) of the product to be marketed. Only UV filters that were
already in market in 1972 and which had sufficient safety toxicology information
submitted to the FDA were considered to be generally safe and effective
(GRAS/E) and permitted in any new sunscreen products. The benzophenones
(oxybenzone, sulisobenzone, and dioxybenzone) and titanium dioxide were the
only permitted UV filters approved for use in this 1978 Proposed Rule that had
any meaningful protection in the UVA portion of the spectrum. Zinc oxide was
not considered at the time, either by omission or by lack of submitted supporting
safety and efficacy data.
During the 1980s and 1990s, photobiology research focused on the effects of
UVA radiation on skin, assessing its ability to cause skin cancer [58] by itself or
in conjunction with UVB radiation, immune suppression [911], and also to con-
tribute to the photoaging [12, 13] processes. While clearly less efficient on a pho-
ton vs photon basis compared with UVB radiation, UVA radiation is clearly
implicated in virtually all of the same photobiological damage endpoints caused by
UVB radiation, although the photochemical process is typically mediated by oxi-
dative pathways rather than direct UV absorbance and lesion/photoproduct
induction.
Development of commercial sunscreen products progressed throughout this
same period, to provide SPF values beyond the initial envisioned cap of SPF 15,
and was reaching SPF 30+ by the early 1990s. While immediate sunburn protection
was evident via the SPF test for these products, criticism of these high SPF
sunscreen products became more vocal suggesting that while extending the safe
exposure time to acute sunburn, these sunscreens were also allowing for extraordinary
UVA dose exposure as these sunscreens were primarily protecting only against
UVB radiation, with little long-wave UVA protection. The need for broad-spectrum
UVA filters was evident. It was however, not until 1996, when zinc oxide and
avobenzone were approved as Category I monograph filters that formulators could
begin to design truly broad-spectrum protection sunscreens in the USA. But, as
formulators quickly discovered, simply adding these two ingredients into
formulations was no guarantee of functional broad-spectrum performance or high
UVA protection.
15 Sunscreen Formulation: Optimizing Efficacy of UVB and UVA Protection 277
15.2 Photobiology Fundamentals for Optimizing Sunscreen

Efficacy
In order to design a sunscreen formulation for optimal UV protection, we first have

to look at the photobiology occurring in sun-exposed skin and choose the spectral
protection distribution of our filters to address the various damages within the skin.
The first and most obvious damage to address is sunburn, or erythema, which has a
well-characterized action or sensitivity spectrum. This action spectrum [14] has
been reduced to a mathematical equation used globally for calculations of sunburning
effectiveness of light sources, including solar simulators used in sunscreen SPF
testing. This action spectrum is similar in shape and magnitude to the action
spectrum for DNA absorption and pyrimidine dimmer formation published earlier
[15], suggesting that DNA damage may be an initiating chromophore for the
sunburn reaction as well. The first definitive action spectra for squamous cell skin
cancer [5, 6] showed remarkable similarity to the erythema action spectrum, as did
the action spectrum for dermal elastosis [12] as developed by Dr. Kligman and
Sayre. These three action spectra are shown graphically in Fig. 15.1. The primary
differences are in the UVA range beyond 335 nm, which is the region with the low-
est level of certainty on these action spectra. However, the relationship of the UVA
to peak UVB sensitivity is on the order of 1:1000 per photon. Factoring in the pre-
dominance of UVA in the suns spectrum (approximately 10:1) and cross multiply-
ing the action spectra with the suns spectral intensity distribution and summing the
contributions in the various regions lead to understanding the importance of each
part of the spectrum in causing these three types of damage. The estimates for the
1.0
0.1
Erythema
Relative 'sensitvity'
0.01 Skin cancer
Elastosis
0.001
0.0001
0.00001
290 310 330 350 370 390
Wavelength (nm)
Fig. 15.1 Ultraviolet action spectra describing the sensitivity of the skin for each endpoint as a
function of the wavelength of the incident UV photons (Y axis is logarithmic scale)
278 C. Cole
1E-06
Winter 60:40 UVB UVA 40 N Lat.
0.9E-06 Solar noon
Measurements
0.8E-06
0.7E-06
0.6E-06
Summer 80:20
0.5E-06
Spring 75:25
0.4E-06 Fall 75:25
0.3E-06 Winter 60:40
0.2E-06
0.1E-06
0.E+00
280 300 320 340 360 380 400
Wavelength (nm)
Fig. 15.2 Plot of erythemal energy from sunlight as a function of the time of year. This demon-
strates the predominance of UVB in causing sunburn compared to UVA The proportions of
UVB:UVA sunburning amounts are shown in the graph legends and range from 80:20 in the sum-
mertime to 60:40 in the winter. Based on noon measurements at 40 N. Lat
contributions of UVB and UVA to each of these damages depend primarily on what
solar spectrum is used, but the ranges are from 87 % UVB: 13 % UVA if using
Australian noontime sun [16] at 19 S latitude to 67 % UVB and 33 % UVA using
an average lower 48 continental United States solar spectrum (ASTM G173-03
[17] Standard tables for reference solar spectral irradiances: Direct Normal and
Hemispherical on 37 Tilted Surface. Book of Standards 14.04 2012). Measurements
taken in New Jersey in summertime in the USA indicate approximately 80:20
UVB:UVA split for sunburn potential energy [18] in the summertime and a roughly
60:40 split in winter (see Fig. 15.2). Solar simulators used for sunscreen testing
purposes are closer in spectral quality to the Australian sun standard, which is a
noontime, low elevation (90 ft. above sea level) observation at the summer sol-
stice, representing a high-level solar exposure situation. This solar spectrum yielded
an average minimal erythema dose (MED) in just over 9 min of exposure time.
These damage action spectra address some but not all of the known UV damages.
Notably missing are action spectra for basal cell skin cancer, malignant melanoma,
and immune suppression. A representative model system for studying basal cell
skin cancer has not been available for developing action spectra; however it is
clearly associated with UV exposures and actinic keratoses [19], as well as squa-
mous cell skin cancer. For many years, the action spectrum for malignant melanoma
has been debated and was proposed to be both UVA and UVB based on a fish model
[20]. More recently, deFabo has utilized a transgenic mouse model for malignant
melanoma and published preliminary action spectrum data indicating that UVB
radiation is the initiator of solar induced melanoma [21, 22]. Lastly, immune sup-
pression has been demonstrated to have strong UVB sensitivity per photon as well
as sensitivity in the UVA [23], and because of the predominance of UVA in sunlight,
UVA has been suggested to be of particular importance in environmental exposures
[24]. Sunscreens containing both UVB and UVA protection have been shown to
provide protection against immune suppression proportional to the UVA-PF of the
sunscreen [25, 26]. The biological data clearly indicate the need for sunscreens to
provide UVB and UVA protection for both acute and long-term potential damages.
15.3 How to Design a Sunscreen for Optimal Protection
First, we need to decide on what is meant by optimal protection. Clearly, protec-

tion in both the UVA and UVB portions of the UV spectrum is needed, and metrics
need to be chosen to decide when we have reached this optimal state of
protection.
The breadth of protection has been codified in many geographies to be deter-
mined via the critical wavelength test, based on references by Diffey et al. [27], an
in vitro spectrophotometric measurement of sunscreen absorbance done in thin film
on an artificial substrate. The critical wavelength is defined as the wavelength
below which 90 % of the area under the absorbance curve of the sunscreen occurs.
No considerations are made for the biological activity in the various regions of the
spectrum, nor for the spectral distribution of the solar spectrum, nor for the fact that
the absorbance scale used in the measurement is a nonlinear logarithmic scale. It is
simply an arbitrary calculation to determine how wide the protection appears in
this laboratory test. Used alone, this measure does not fully interpret the UVA bio-
logical protection provided by a product, and products with equivalent SPF and
equivalent critical wavelength can have widely different biological protection as
measured with a biologically based UVA-PF test method (with persistent pigment
darkening or erythema endpoint) (Fig. 15.3). The critical wavelength test can how-
ever be utilitarian in looking at the breadth of the protection, but as a stand-
alone measure, it can be misleading and insufficient to fully describe meaningful
UVA protection.
This now leads to the question: what is a meaningful measure of biological UVA
protection and what should be the optimal proportion of protection for the UVB
versus the UVA ranges? An acute biological endpoint is needed for a clinical
assessment of UVA protection, and several were evaluated as models [28]. The
initial test model to evaluate UVA protectiveness of sunscreens employed a
photosensitizer, 8-methoxypsoralen [29, 30] (8-MOP), a drug used in the treatment
of psoriasis that increases the sensitivity of the skin to UVA radiation via singlet
oxygen production. While indicative of protection in the UVA range, the 8-MOP
action spectrum does not resemble any known damage spectrum for normal
(non-photosensitized) skin. Given 8-MOPs status as a known photocarcinogen,
it was not found to be a viable test method for routine sunscreen evaluations. The
280 C. Cole
SPF 30 A: UVA-PF = 17.5 SPF 30 B: UVA-PF = 3.0
2.2 UVB UVA 2.2 UVB UVA

2.0 2.0
Absorbance Units
Absorbance Units
1.8 1.8
Critical wavelength = 377 nm Critical wavelength = 377 nm
1.6 1.6
1.4 1.4
1.2 1.2
1.0 1.0
0.8 0.8
0.6 0.6
0.4 0.4
0.2 0.2
0.0 0.0
290 300 310 320 330 340 350 360 370 380 390 400 290 300 310 320 330 340 350 360 370 380 390 400
Wavelength (nm) Wavelength (nm)
Fig. 15.3 Absorbance measurements for two SPF 30 sunscreens having the same critical
wavelength with different absorption distributions and very different UVA protection capabilities
as measured by spectrophotometer and UVA-PF assessments
immediate pigment darkening endpoint was investigated; however, the response

was found to be dependent on the fluence rate of the light source utilized in the test-
ing as the immediate pigment darkening response is oxygen dependent and the
resulting protection factor determined for a sunscreen tested with this methodol-
ogy depended critically on the solar simulator fluence rate [31], which would vary
with the laboratory equipment used for the test. Immune response endpoints, while
biologically relevant, required complicated exposure protocols and required
sensitization of the test subjects, a practice of interest for academic study, but not a
viable standard test methodology for routine product evaluations [32, 33].
The use of acute UVA-induced erythema as a test method endpoint was attempted
and found to be primarily useful only in phototype I individuals [34], as the initial
and most prevalent response to acute UVA exposures is pigment darkening,
exhibited in skin phototypes II and higher [35, 36]. A UVA protection factor
(UVA-PF) test [37] was developed using only this pigment darkening response as
the biological endpoint. This test is analogous to the standard SPF test, but uses only
UVA radiation for the exposure source and the minimal dose for persistent pigment
darkening as the biological endpoint in place of the minimal erythema dose used in
the SPF test. The use of the UVA-PF value has been adopted in many countries,
notably Japan, Europe, Australia, as well as some South American countries, as part
of regulations to determine broad-spectrum classification for labeling [38]. More
recently, in vitro methodology has been established that replicate the test results of
the human persistent pigment darkening ultraviolet A protection factor (UVA-PF)
determination [39, 40] alleviating the need to conduct clinical trials involving high
fluences of UVA radiation on human subjects. Persistent pigment darkening is a
signal of biological harm and is the bodys response to damage to help prevent
further damage. It is a relatively flat spectral indicator with somewhat higher sensi-
tivity in the shortwave UVAII range (320340 nm), known to be more biologically
sensitive relative to UVAI (340400 nm) for many skin damage endpoints. Notably,
only sunscreens having both high SPF and high UVA-PF values have been
demonstrated to be effective against an endogenous sun sensitivity condition, poly-
morphous light eruption (PMLE) [41], providing some validation for use of this test
methods usefulness for predicting biological protection.
We now have three measures for determining optimal efficacy, SPF, UVA-PF,
and critical wavelength to assess both the height and breadth of the UV protection
of sunscreen products. But what should be the proportion of the protection in the
various portions of the ultraviolet wavelength region? Should a sunscreen have a flat
spectral absorbance profile, or more heavily weighted in the UVB, or maybe in the
UVA portion of the spectrum? Do we have enough data to make the determination?
Refregier [42] proposed that the ratio of SPF to UVA protection should be approxi-
mately 3:1 in order to have equivalent damage distributed into the UVB and the
UVA portions of the spectrum, based on fundamental understanding of the relation-
ship between SPF and UVA protection. If a flat sunscreen spectrum is used to
attenuate the suns spectrum, then the same proportion of damage (roughly 80 %
UVB, 20 % UVA) results as with unattenuated solar UV. If, however the spectrum
of the filters used in a sunscreen is weighted in the proportion of SPF: UVA-PF = 3,
then the damage is shifted to the right side of the spectrum and distributing the dam-
age equally into the UVB and the UVA portions of the solar spectrum. Having a
spectrum with SPF:UVA-PF of >3:1 shifts the spectral damage even more deeper
into the UVA range. The choice becomes philosophical at this point as to which
distribution of damage is best, with many regulatory bodies siding with the opin-
ion that a balanced distribution is a better approach and adopting the requirement
for a SPF:UVA-PF ratio of 3.0 in order to make broad spectrum or UVA pro-
tection claims. Coupling this requirement with a critical wavelength measurement
of 370 nm, there is assurance that a product will have significant breadth and
height of UVA protection in addition to the known SPF protection provided by the
product.
With these measures established, the formulator can head to the bench to design
and optimal protection sunscreen product using the tools of the trade.
15.4 Formulating with Soluble UV Filters for Optimal

Protection
When starting to formulate a new sunscreen product, the formulator must first
ascertain the intended use of the product (recreational/water resistant or daily-
wear moisturization for incidental UV exposure), the target SPF desired, the
aesthetic or feel characteristics of the product, and the desired delivery system (oil
and water emulsions, liquid, alcohol gel, or spray) format, in order to choose the
appropriate soluble UV filter to be used. The vast majority of products for both
recreational and daily-wear utilize the oil-soluble UV filters due to their superior
ability to absorb UV photons (having a higher extinction coefficient) and deliver
good spreading and dry-down characteristics on the skin contributing to SPF and
UVA protection efficiency on a % weight basis. In the USA, avobenzone is the only
soluble UV filter that can be used to qualify a product for broad-spectrum claims,
282 C. Cole
as it is the only soluble UV filter with absorption past the 370 nm critical
wavelength. Thus, it is the most commonly used UV filter in products today in the
USA. This limited choice of UVA filters dictates much of the formulation options
open to the formulator.
While a highly efficient absorber, avobenzone unfortunately has the tendency to
break down upon UVA photon absorption [43] and requires careful formulation.
Experience has shown that combinations of avobenzone with octinoxate [44] (and
other cinnamate-based filters) or any of the PABA derivative UVB sunscreens leads
to rapid photodegradation of both the UVA and the UVB protection due to the
interaction of UV photons with these filters, resulting in rapidly diminishing
absorption during UV exposure. While capable of delivering the SPF value
determined in clinical testing, constant re-application of product with such a non-
photostable product is needed to maintain meaningful protection during extended
exposures in sunlight. PABA derivative filters have been avoided since the mid-
1980s when concerns regarding allergenicity of Padimate A became evident.
Padimate-O also known as octyldimethyl PABA has strong UVB absorption charac-
teristics, and an excellent safety profile regarding allergenicity, has, nonetheless,
little use in sunscreen products because of its similarity to the Padimate A and
because of this destabilizing effect on avobenzone.
For a photostable broad-spectrum product, the formulator must combine other
UVB filters with the avobenzone to build a broad-spectrum product. The salicylate
filters, homosalate, and octisalate are used to provide UVB protection, despite the
fact that their absorbance extinction coefficient is relatively low compared to other
filters, such that they are typically used at their maximum permitted concentrations
of 15 % and 5 %, respectively. Octocrylene is a good choice to combine with avo-
benzone for several reasons; it has a relatively strong UVB absorbance compared
with the other UVB filters, rapidly increasing SPF values with modest concentra-
tions added, but more importantly, it aids in photostabilization of the avobenzone,
helping to transition the triplet state avobenzone molecule back to ground state in a
timely manner.
The addition of benzophenone filters to this theoretical formulation provides
three additional benefits: it increases the absorbance in the UVB portion of the
spectrum, builds protection in the shortwave UVAII region between 320 and
340 nm, and provides additional photostabilization of avobenzone. This UVAII
region is not strongly served by either the primary UVB filters or by avobenzone
but is still in the biologically sensitive region known to be prone to both direct pho-
ton damage and indirect oxidative damage from reactive oxygen species and free
radicals.
For all of the above reasons, the vast majority of sunscreen products available on
the USA market today consist of combinations of avobenzone, octocrylene,
homosalate, octisalate, and oxybenzone filters. US monograph restrictions currently
prohibit the use of inorganic filters in combination with avobenzone, the most effec-
tive and broadest UVA filter.
If formulating without avobenzone as the primary UVA filter, the only option for
a broad-spectrum product requires the use of zinc oxide to provide sufficient breadth
of protection to have a critical wavelength of 370 nm. Because it is a photostable
filter, it can be combined with octinoxate, Padimate-O, or other UVB filters as
needed to achieve the desired SPF value.
Water-soluble UV filters become an option when considering daily-wear
moisturizer-type products that do not require water resistance. The best water-
soluble filter for consideration is ensulizole, which has a high and broad UVB
absorbance, but to date, the US monograph currently does not permit marketing of
products containing the combination of ensulizole with avobenzone or zinc oxide
[45, 46], so that there are no options available to formulate a broad-spectrum
product in the US market using only water-soluble filters. The only other water-
soluble filters permitted to be used are sulisobenzone and trolamine salicylate;
however they can be sticky in formulations and are not optimum choice for daily
moisturizing products, particularly those used on the face, that require more elegant
and pleasant tactile properties.
Ex-USA: Formulation options for sunscreens outside of the USA opens many
more options for combinations of soluble UV filters that can provide high SPF and
broad-spectrum characteristics. These include the triazine UVB filters, ethyl hexyl
triazine (Uvinul T-150) and diethylhexyl butamido triazine (Uvasorb -HEB), that
are triple UVB chromophores, with extinction coefficients five to ten times higher
than other UVB filters. Thus with only a few percent of these filters, significant
UVB protection can be provided. Silicone-15 is another novel UVB filter that has a
much more modest extinction coefficient but is reported to boost UVB absorption
and SPFs in a manner disproportionate to its own absorption properties. Its unique
polymeric structure with silicone allows it to provide unique and desirable skin
aesthetics to formulations.
Several other UVA1 filters are also available outside of the US market, namely,
bis-ethylhexyloxyphenol methoxyphenyl triazine (trade name Tinosorb S),
methylene bis-benzotriazolyl tetramethylbutylphenol (trade name Tinosorb M),
and diethyl amino hydroxybenzoyl hexyl benzoate (Uvinul A+). Tinosorb S is an
oil-soluble filter with absorption in the mid-UVA range with a secondary peak in the
UVB range, and while it does not extend its absorbance as far in the long-wave
UVA1 as avobenzone, it has a high extinction coefficient and can provide significant
UVA protection with low percentage quantities in formulations. It is very photostable
and can provide photostabilization to avobenzone in addition to its UVB protection
[47]. Tinosorb M is an insoluble particle (nano-size) that has a broad spectral
absorbance range that extends beyond 380 nm and is the broadest of the UVA
filters in spectral absorption.
Ecamsule (Mexoryl SX) is a mid-range UVA filter (peaking at 340 nm) that is
water soluble, and drometrizole trisiloxane (Mexoryl XL) is an oil-soluble mid-
range UVA filter, with a modest extinction coefficient. These two filters have been
proprietary filters to LOreal. They are typically combined with avobenzone or other
UVA1 absorbers for a broad-spectrum profile.
284 C. Cole
15.5 Formulating with Insoluble Filters for Optimum

Protection
In the mid-1980s, efforts began to improve the effectiveness and cosmetic attributes
of the insoluble inorganic UV filters, titanium dioxide and zinc oxide, by reducing
the particle size of these materials. Making them nano-sized (less than 100 m for
smallest dimension) did two desirable things: it increased the surface area of the
molecules per unit weight and providing higher absorption of the UV photons per
unit weight and making them more transparent in the visible portion of the spectrum
and less visible on the skin. Organic surface coatings added to the molecules
eliminated the potential surface reactivity and made them easier to formulate into
emulsions in either the water phase or the oil phase, depending on the nature of the
surface coating. While never quite achieving ultimate invisibility, significant
progress has been made through careful choices of the suspending excipients and
the emulsifiers used.
While reduction in particle size of titanium dioxide shifts the absorption spec-
trum toward higher UVB protection, and lower UVA protection, and reducing the
particle size of zinc oxide can boost the absorbance in the mid UVA1 region [48].
Anderson et al.[46] have a detailed description regarding the inorganic filter charac-
teristics and their formulation. Nano titanium dioxide and zinc oxide are typically
formulated into lotions and cream emulsion form products, which can be character-
ized as oil-in-water emulsions (oil droplets in a sea of water) or as water-in-
oil emulsion (water droplets in a sea of oil). Each form has its own unique
advantage depending on the intended use of the product and consumer preference.
Different emulsifiers are used for the two forms and with the exterior phase of the
emulsion (the sea portion) typically constituting the larger proportion of the for-
mulation by weight.
Oil-in-water emulsions with the inorganic sunscreen filters will typically have
a more traditional lotion feel and use characteristic, with easier spreading,
more rapid dry-down time, and a less oily/greasy after-feel when the water has
evaporated. This is generally the more consumer preferred form of product. In
contrast, the water-in-oil form of this type of product will have a higher oil
content and thus take more time to dry down with a heavier and perhaps more oily
after-feel. The advantages of this type of emulsion are more moisturization
(especially for very dry skin), higher efficiency of the filters to provide UV
protection per unit UV filter incorporated into the system, and more inherent
water resistance characteristics [49].
As mentioned before, inorganic filters may be combined with all of the soluble
filters in the US except avobenzone. This restriction does not apply outside of the
USA where the combination of titanium dioxide and zinc oxide with the soluble UV
filters is commonly used to augment both the UVB and UVA protection, respectively.
Additionally, ex-US, the insoluble UV filter Tinosorb M can also be added to
provide UVA1 protection beyond the range covered by zinc oxide or avobenzone.
15.6 Summary
Optimizing sunscreen formulations for efficacy with soluble UV filters or insoluble

UV filters (be they only insoluble filters, or combinations with soluble UV filters),
the objective for the spectral distribution of the protection is to provide proportional
protection across the UV spectrum, ideally in such a way as to deliver the
SPF:UVA-PF ratio of approximately 2.5:1 to 3:1. This proportion assures
proportional UVA protection, with appropriately higher protection weighting in the
more damaging UVB portion of the spectrum, distributing the penetrating damage
equally across both the UVB and the UVA regions. It should be noted that other
opinions suggest that a flat or spectra homeostasis distribution of protection is
optimal [50, 51]. This concept ignores the decades of scientific discovery and
action spectra determinations that have identified UVB as the more damaging and
life-threatening portion of the suns UV spectrum, notably DNA damage causing
skin cancers and, more recently determined, malignant melanoma [21, 22]. Limiting
the UVB protection to achieve a flat spectral distribution of protection opens the
window of skin damage to these more powerful photons, diminishing the overall
protection of the product. Consumers in extended sunlight exposure should seek out
the highest SPF product available that provides the broad-spectrum protection hav-
ing an SPF:UVA-PF ration of approximately 3:1 for best protection.
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In: Nasir A (ed) Nanotechnology in medicine. Springer Science and Business Media LLC,
New York, p 1
50. Osterwalder U, Champ C, Flsser-Mller H, Herzog B (2013) The evoluation of UVA protec-
tion. www.skin-care-forum.basf.com. Sept 2013
51. Diffey BL, Brown MW (2012) The ideal spectral profile of topical sunscreens. Photochem
Photobiol 88(3):744747
Chapter 16
Sunscreen Formulation: Optimising Aesthetic
Elements for Twenty-First-Century
Consumers
Julian P. Hewitt
Key Points
1. Good aesthetic properties (appearance and skin feel) are now seen as an
important aspect of sunscreen products, as they encourage greater con-
sumer compliance and also a means of differentiating products from the
competition.
2. Sensory panel studies indicate that what is usually desired is a product that
spreads easily with a moderately wet feeling during application but feels
smooth and dry afterwards with little or no perceivable residue.
3. With organic UV filters, judicious choice of emollients helps to optimise
both skin feel and efficacy. Improving the efficacy also enables the formu-
lator to improve aesthetic properties as lower concentrations of UV filters
are required to reach the target SPF.
4. With inorganic UV filters, developments in manufacturing and coating
technology have produced materials that are transparent on skin while still
being effective and also deliver elegant skin feel.
16.1 Introduction
Todays sun care formulator must achieve ever more challenging standards for prod-
uct efficacy while also making products cosmetically appealing. Performance and
aesthetics are in fact dependent on one another. Studies have shown that consumers
almost always use less than the recommended amount of sunscreen products [1, 2],
and this means that the effective in-use SPF is considerably less than that tested
J.P. Hewitt
JPH SunCare Technologies Ltd., Durham, UK

DOI 10.1007/978-3-319-29382-0_16
290 J.P. Hewitt
and displayed on the label [3, 4]. Among the reasons most frequently cited by con-
sumers for underuse (or complete avoidance) of sunscreens are aesthetic issues, for
example, that the products feel too greasy or sticky or they make the skin look shiny
or leave a white residue on skin. It can therefore be expected that products with
improved aesthetics encourage consumers to apply more product and therefore get
closer to the labelled SPF. Conversely, maximising the efficacy of the actives used
enables high SPF products to be created with minimal levels of UV filters, which
allows the formulator greater freedom to optimise skin feel.
Also, in many parts of the world, efficacy claims for sunscreen products are
becoming more regulated and uniform. For example, in Europe, the European
Commission Recommendation on labelling and efficacy of sunscreens [5] provides
a specific list of SPF claims that can be used: 6, 10, 15, 20, 25, 30, 50 and 50+.
Similar restrictions exist in a number of other countries. In terms of UVA claims,
many countries now have a single performance criterion for a UVA or broad-
spectrum claim, and numerical claims to indicate the degree of UVA protection are
either discouraged or explicitly prohibited. This limits the options for manufacturers
and marketers to differentiate their products from the competition based on efficacy
claims. Improving the cosmetic properties of the product has therefore become an
important alternative means of providing differentiating claims. This chapter will
discuss how this can be achieved, depending on the type of vehicle and the active
ingredients used.
16.2 Desired Aesthetic Properties for Modern Sunscreen

Products
Of course, as with any cosmetic or topical product, the optimum aesthetic proper-
ties depend very much on the personal preferences of the individual consumer and
can also be influenced by the environment in which the product is used (e.g. dry or
humid, beach or mountain), level of activity (e.g, sunbathing, walking, sports) and
area of application (face or body). However, there are some general trends that can
be identified.
A study by Vollhardt et al. [6, 2] used descriptive sensory analysis to assess the
sensory properties of over 50 different commercial sunscreen lotions with label SPF
claims of 30 or 50. Since these were products already on the market, it is reasonable
to assume that they give a good representation of the sensory properties that are
accepted/desired by consumers. The sensory parameters assessed were grouped into
three distinct phases of product application: rub-out, immediate after-feel and after-
feel 20 min later. Based on this study, the desirable properties during rub-out can be
summarised as:
Wetness should be neither too high nor too low.
Spreadability should be high.
Thickness should be low.
16 Sunscreen Formulation 291
Whiteness should be low, although the data indicate that consumers expect a
certain degree of whiteness during rub-out.
Oiliness and greasiness should be relatively low but not excessively so,
while waxiness during rub-out was lower in the products tested. This makes
sense, considering the requirement for good spreadability; a product that does
not spread well is perceived as more waxy.
Absorbency should be fast but not too fast; if a product absorbs too quickly
into the skin, it can be difficult to spread over a wide area.
The key attributes in the after-feel, particularly after 20 min, are:
Low gloss
Very low whiteness; note the contrast here with the rub-out phase while
consumers may accept some whitening during rub-out, they want no visible
residue afterwards.
Very low stickiness
High slipperiness in other words consumers are looking for a smooth feeling
on skin after application.
Low residue
Low oiliness and greasiness, with relatively higher waxiness. Again the contrast
with the rub-out phase is instructive here; while a perception of high waxiness
during rub-out would indicate poor spreadability, in the after-feel phase, it indi-
cates a dry after-feel. The prevalence of new sun care products in recent years
with claims of dry skin feel or dry touch shows that this is a desirable
property.
In summary, then, what is usually desired is a product that spreads easily with a
moderately wet feeling during application but feels smooth and dry afterwards with
little or no perceivable (either by touch or sight) residue.
16.3 Sunscreen Vehicles
Sunscreen products can be formulated in a variety of different forms:

Emulsions
O/W or W/O
Creams, lotions and sprays
Anhydrous systems
Ointments
Sticks
Aerosol sprays
Oils
Gels
292 J.P. Hewitt
Emulsions remain the predominant form for sun protection products globally, so
this chapter will focus on optimising the aesthetic properties of emulsion-based
sunscreen products.
Generally, oil-in-water (O/W) emulsions have a more preferred skin feel than
water-in-oil (W/O) systems. This can be intuitively understood; with water as the
external phase, there is an immediate sensation of wetness on the skin when an O/W
emulsion is applied. Also, as the water begins to evaporate during application, this
provides a cooling effect to the skin, which can be a pleasant sensory experience
especially for sun care products as they are often applied in hot conditions. This
cooling effect can be enhanced by the addition of alcohol or other volatile
components to the formulation.
W/O emulsions, on the other hand, with oil as the external phase, tend to feel more
oily or greasy upon application and are generally perceived as heavier. In some
niche applications, this can be welcome, for example, in sun care products for winter
sports use, where this more occlusive feel gives a greater sensation of protection in a
cold environment. Another application in which the sensory feel of W/O emulsions
can be preferred is in baby sun care products, where the protective sensation gives
parents a sense of reassurance that they have protected their child. In most beach sun
care products, though, W/O emulsions have traditionally been seen as the less pre-
ferred option in terms of skin feel. However, innovations in W/O emulsifier technol-
ogy [7, 8] mean that it is now possible to formulate W/O emulsions which have a
more elegant skin feel. This allows the sun care formulator to take advantage of the
benefits of W/O systems, such as water resistance and increased efficacy of actives
while still delivering a formulation that is aesthetically pleasing for the consumer.
16.4 Formulations Based on Organic UV Filters
In discussing the aesthetic properties of formulations containing organic UV filters,

it is convenient to classify the filters in four groups:
Liquid UV filters
Oil-soluble solid UV filters
Water-soluble solid UV filters
Insoluble particulate UV filters
Each of these will be discussed in turn.
16.4.1 Liquid UV Filters
In any cosmetic emulsion, the spreadability of the oil components exerts a significant
influence on skin feel, in particular during the application of the product. Bruening
et al. [9] described how it is desirable to impart a sensation of smoothness to the skin
throughout application. The challenge presented by liquid organic UV filters such

as ethylhexyl methoxycinnamate (octinoxate), ethylhexyl salicylate (octisalate),
homosalate and especially octocrylene is that these are slow-spreading materials
that impart a low degree of smoothness. This therefore needs to be counteracted by
the inclusion of fast-spreading emollients that give a much greater and more
immediate sensation of smoothness. Ideally, according to Bruening et al., the
formulation should include a combination of fast- and medium-spreading emollients
which, in combination with the slow-spreading liquid UV filters, create a spreading
cascade so that a consistent perception of smoothness is maintained throughout
the rub-in of the product.
One class of cosmetic emollients that are often included in skin care products to
impart a light, dry skin feel is silicone fluids. However, such materials have a
drawback in sun care formulations, which is that they tend to be poor solvents for
solid organic UV filters (see next section). However, one sunscreen material allows
the formulator to take advantage of the skin feel benefits of silicone chemistry.
Polysilicone-15 [10] is a polymeric liquid UVB filter that consists of UV-absorbing
chromophores attached to a silicone backbone. This material is not yet approved as
a UV filter in the USA but is approved in Europe, Japan, Australia and a number of
other countries.
16.4.2 Oil-Soluble Solid UV Filters
When formulating with filters such as butyl methoxydibenzoylmethane (avoben-

zone), benzophenone-3 (oxybenzone), ethylhexyl triazone (octyl triazone), or bis-
ethylhexyloxyphenol methoxyphenyl triazine (bemotrizinol), the formulators first
concern is to ensure good solubility of the active(s) in the oil phase. The UV filters
must be effectively dissolved and remain in solution throughout the lifetime of the
product and when it is applied on skin. Any recrystallisation has an adverse effect
on both efficacy and skin feel. Previous work [11] has shown that, with these oil-
soluble sunscreens, SPF efficacy increases with increasing solubility of the active in
the oil phase.
One emollient has become virtually an industry standard as a solvent for
sunscreens: C1215 alkyl benzoate. This ester is an excellent solvent for most solid
organic UV filters and also confers a light, dry emollience with a non-greasy after-
feel. However, in recent years a number of new emollients have been developed that
offer even better solvency for sunscreens and are claimed to be as good as, if not
superior to, C1215 alkyl benzoate in terms of skin feel [12], for example:
Phenethyl benzoate
Phenoxyethyl caprylate
PPG-3 benzyl ether ethylhexanoate
Ethylhexyl benzoate
Neopentyl glycol diheptanoate (and) propylene glycol dibenzoate
294 J.P. Hewitt
16.4.3 Water-Soluble Solid UV Filters
There are a number of water-soluble UV filters, but only the following are of
significant commercial importance nowadays:
Benzophenone-4 (UVB/UVA filter)
Disodium phenyl dibenzimidazole tetrasulfonate (UVA filter)
Phenylbenzimidazole sulfonic acid (UVB filter)
Benzylidene camphor sulfonic acid (UVB filter)
Terephthalylidene dicamphor sulfonic acid (UVA filter)
Of these, the last two are proprietary to LOreal, and so for most formulators, the
first three in the above list are the only water-soluble filters available. These all
require neutralisation with a suitable base in order to render them soluble. In terms
of sensory properties, these water-soluble sunscreens tend to have a drying effect on
skin feel; this is often advantageous, but the feel can be excessively dry if a high
concentration of such filters is used.
16.4.4 Insoluble Particulate Organic Filters
A relatively new class of sunscreen actives are organic UV filters that are not soluble
in either oil or water and remain in a particulate form in the final formulation. The
first of these was methylene bis-benzotriazolyl tetramethylbutylphenol (MBBT, or
bisoctrizole), which is primarily a UVA filter but has a secondary absorption peak in
the UVB. In 2014, a second material was added to this class of UV filters when tris-
biphenyl triazine (TBPT) was approved in Europe. TBPT gives high absorbance in
the UVB and UVA2 (320-340 nm), the latter being a wavelength region that is not
well covered by most other UV filters. Both of these materials are supplied as
aqueous nanoparticulate dispersions. With regard to sensory properties, both tend to
have a drying effect on skin feel (although less so than most water-dispersed
inorganic sunscreens). Also, being particulates, both can give rise to an undesirable
sensory attribute that is not observed with other organic UV filters, namely,
whitening. Both MBBT and TBPT give a low but significant light extinction in the
visible region of the spectrum; since they are most typically used at relatively low
levels in formulations, this is usually not noticeable, but at higher levels (above 5 %
active), a discernible whitening effect may be observed.
16.5 Formulations Based on Inorganic UV Filters
Titanium dioxide (TiO2) and zinc oxide (ZnO) have been used as sun-protective
agents for many years, but it was only with the development of the first fine
particle (a.k.a. microfine, ultrafine) grades of these materials in the late 1980s
that they began to achieve significant commercial usage in topical sunscreen

products. These fine particle grades provide a high degree of UV attenuation while
being substantially transparent to visible light. (NOTE: The term micronised is
often used as a generic term to describe UV-attenuating grades of TiO2 and ZnO.
This is a misnomer. Micronisation is a specific physical process, involving attrition
milling with high gas velocities, typically following a calcination step. Most
UV-attenuating grades of TiO2 and ZnO are produced without this milling step;
thermodynamic control of crystal growth is used to obtain the correct fine crystal
size.)
TiO2 is primarily a UVB filter but can also offer significant UVA protection depend-
ing on the particle size and size distribution. It is possible to formulate high SPF sun-
screen products with TiO2 as the sole active ingredient. ZnO is less effective than TiO2
in terms of UVB protection, and hence SPF efficacy, but has a relatively flat extinction
profile up to wavelengths of about 360370 nm and so is typically more effective than
TiO2 in the long-wavelength UVA part of the spectrum. The broad-spectrum protec-
tion offered by these materials is one of their major advantages as sunscreen actives.
The fact that they do not decay on exposure to UV contributes to their high efficacy.
They also have an excellent safety profile [13, 14], making them especially well suited
for the formulation of products for sensitive skin and also for babies and children.
Another market segment where they predominate is in so-called natural sunscreen
products; since they are derived from natural mineral sources, they are perceived as
being more natural than organic UV filters, which are all synthetic chemicals.
As a result of these advantages, TiO2 and ZnO have become very widely used in
sunscreen products throughout the world. However, products containing only
inorganic sunscreens still represent a relatively small share of the market; far more
common are those formulations in which inorganic filters are combined with organic
actives. In such formulations, the concentration of the inorganic is typically less
than 5 %. The fact that inorganics have not achieved even greater market penetration
can largely be attributed to aesthetic concerns, both real and perceived.
16.5.1 Improving Transparency of Inorganic Sunscreens
Historically, the biggest problem with inorganic sunscreens was whitening on skin.
The original UV-attenuating grades of TiO2 and ZnO that were developed for
personal care use, despite their fine particle size, still often gave a noticeable white
film on skin, especially when incorporated at the concentrations required for SPF
values above 15. In some applications, this is actually perceived as an advantage; for
example, young children tend not to be concerned about the cosmetic appeal of the
sun cream applied to them, but their parents like to be able to see that they have
protected their child from the sun. Those same parents, however, hate to see an
unsightly white film on themselves!
Subsequently, further development of inorganic sunscreens resulted in improve-
ments in transparency. Dransfield et al. [15] discussed how advances in the
296 J.P. Hewitt
technology of titanium dioxide for sunscreens, relating to both the manufacture and
the formulation of fine particle TiO2, resulted in improved transparency. The theory
of light attenuation by titanium dioxide [16] shows that this material becomes pro-
gressively more transparent to visible light as the mean particle size is reduced; with
a mean particle size of 20 nm (0.02 m), TiO2 is essentially completely transparent.
However, with a typical particle size distribution, such a product has very low UV
attenuation, so it has poor efficacy as a sunscreen. This was demonstrated by
Woodruff [17], who compared various grades of titanium dioxide in a standard
frame formulation. Included in this study were two aqueous dispersions of TiO2,
one of which had a mean particle size of 4050 nm and the other a mean particle
size of 1020 nm. While the latter product showed a high degree of transparency, it
gave relatively poor SPF performance, with an SPF of only 7.3 from 5 % TiO2 solids
(compared to 22.6 for the other dispersion at the same solids content).
Dransfield et al showed that by using appropriate manufacturing methods for the
TiO2 and by optimising surface treatments (coatings), solids level, dispersants and
milling processes, it is possible to produce titanium dioxide dispersions which
maintain the optimum mean particle size for UV attenuation but which have a
narrower particle size distribution than previously. Such dispersions therefore have
greater transparency to visible light, but without any loss of UV performance.
A similar approach has also been applied to zinc oxide, providing high
transparency dispersions of this material also. Another approach to making a
transparent zinc oxide is by the use of refractive index matching [18]. In this
technology, the ZnO particles are actually much larger than conventional sunscreen
grades of ZnO (of the order of a micron or more) but have a porous structure that
provides closer matching of refractive index between the particles and the emollient
in which they are dispersed, thus reducing the scattering of visible light and giving
improved transparency.
Even these more transparent materials, however, still need to be formulated
correctly in order to realise the improved transparency. The particle size and size
distribution need to be maintained, as far as possible, in the final formulation; if the
particles agglomerate, they then behave optically as larger particles, and so
whitening is increased. The SPF efficacy of inorganic sunscreens, and also
transparency, can be influenced by emulsifiers, added emollients, rheological
additives and polymers. Each of these can affect the SPF either by influencing the
dispersion degree of the active or by affecting the rheology and spreading properties
of the formulation. For example, the use of waxes to alter rheological properties has
been shown to have a dramatic effect on SPF in W/O emulsions [19]. We can
determine, in at least a qualitative fashion, the relative influences of these two
mechanisms by looking at changes in the UV/visible spectrum as parameters are
altered. If SPF varies solely as a result of changes in rheological/spreading
properties, the shape of the spectral curve does not change, indicating that the
dispersion degree of the TiO2 has not changed. If changing a particular ingredient
does affect the degree of dispersion, this is reflected in a change in the shape of the
UV attenuation curve, as well as a change in SPF. For example, if the dispersion
degree of the TiO2 is improved, the following changes typically occur in the
spectrum:
UVB attenuation increases.
UVA attenuation decreases.
Visible attenuation decreases.
As a result, SPF increases, UVA/UVB ratio decreases, and whitening also
decreases [20]. In other words, ensuring the optimum dispersion of TiO2 promotes
both high SPF and optimum transparency.
16.5.2 Improving the Skin Feel of Inorganic Sunscreens
The other aesthetic issue to be addressed with inorganic sunscreens is skin feel. The
earliest inorganic sunscreen formulations often had less-than-ideal skin feel, giving
inorganic filter systems a reputation for being dry, draggy, heavy, or sticky.
Fortunately, considerable progress has been made in improving the skin feel of
these systems.
Parameters relating to particulate filters that might be expected to influence skin
feel include particle size, surface treatments, and, in the case of dispersions, the
carrier medium in which the particles are dispersed. A study of formulations
containing oil-dispersed and water-dispersed TiO2 [21] indicated that variations in
particle size at least within the range of sizes typically seen in UV-attenuating
grades of TiO2 have little significant influence on skin feel.
The surface properties of the particles, however, do influence skin feel. All
modern UV-attenuating grades of TiO2 are surface-treated with one or more coating
materials; the main purpose of these coatings is to prevent photocatalytic activity,
but they also aid the dispersibility of the particles and affect sensory properties. The
surface treatments can be either hydrophilic or hydrophobic in nature. Hydrophilic
coatings are typically other inorganic oxides such as silica, alumina, or zirconia.
Hydrophobic surface treatments include organic moieties such as stearate,
organometallics such as isopropyl titanium triisostearate, silicones such as
dimethicone and silanes such as triethoxycaprylylsilane. Not all zinc oxide grades
are coated; ZnO has less photocatalytic activity than TiO2, so there is less of a
requirement for coating in this case. However, many grades do have a surface
treatment to aid dispersion and/or feel. The coating materials used are similar to
those used for TiO2.
Inorganics with a hydrophilic surface tend to impart a dry skin feel, which can
be perceived as draggy when the particles are dispersed in the water phase. This
effect is lessened when the particles are dispersed in the oil phase, particularly if an
effective dispersing agent is included. These dispersing agents are usually surfactants
(often polymeric), which bind to the particle surface and effectively change a
hydrophilic surface to a hydrophobic one.
298 J.P. Hewitt
Particles in which the primary surface coating is already hydrophobic, however,

generally give a more preferred skin feel. One interesting example of this is where
hydrophobic TiO2 particles are incorporated into an aqueous dispersion. A for-
mulation containing such a dispersion was compared to the same formulation
containing an aqueous dispersion of hydrophilic TiO2 [21]. The hydrophobic
material was found to give a smoother skin feel, with less drag than the hydro-
philic grade. Such aqueous TiO2 dispersions based on hydrophobic TiO2 can also
be incorporated in W/O emulsions, resulting in a very elegant, light skin feel
which is actually more like the typical skin feel of an O/W lotion rather than a
W/O system [22].
A recent paper [23] gave a further example of how coating technology can deliver
an inorganic sunscreen system with sensory properties that is perfectly suited to
modern sunscreen formulations. In this case, a transparent TiO2 grade similar to that
described earlier was surface-treated with a three-part coating system comprising an
inorganic silica coating, a hydrolysable bifunctional silane and a hydrophobising
agent. A dispersion of this TiO2 was incorporated into a W/O emulsion, which was
then compared against the same formulation prepared with a TiO2 dispersion of the
same particle size distribution, but in which the coating consisted of alumina and
aluminium stearate. The two formulations were assessed using a similar descriptive
sensory analysis protocol to that used by Vollhardt et al (see Sect. 16.2 of this
chapter) [6]; in fact the two studies were carried out by the same company. The
formulation containing the silane-coated TiO2 showed the following characteristics
in comparison to the alumina/stearate coated material:
Higher spreadability during rub-out
Higher wetness score during rub-out
Quicker absorbency
Much lower gloss in the after-feel (both immediate and after 20 min)
Less oily and more waxy in the after-feel (both immediate and after 20 min)
In summary, referring again to the study by Vollhardt et al, the new coating was
superior in all the key characteristics that were identified as being desirable for
modern sun care products.
16.6 Combination Formulations
Of course, with the exception of inorganic-only sun care products (e.g. those making
natural claims or products designed for sensitive skin and/or young children), it is
nowadays very unusual for a sun care product to contain only one active ingredient.
Even low SPF products usually contain a combination of two or more UV filters,
and such combinations are essential for higher SPF products, especially bearing in
mind current requirements for UVA protection (both regulatory and market driven).
It is here that the skill of the sun care formulator in optimising the SPF efficacy of
the formulation also plays a part in optimising the sensory properties.
It is intuitively expected that the higher the SPF, the more oily and/or greasy will
be the skin feel of a sun protection product. However, the study by Vollhardt et al.
[6] indicated that while this may be the case within a single product line, it is not
generally true. The fact that it is not can be attributed at least in part to finding the
right combinations of sunscreen actives to maximise efficacy by taking advantage
of synergies between different UV filters, allowing, for example, SPF 50 to be
achieved with active levels only slightly higher than those needed for SPF 30 [24].
The best synergies are achieved where filters complement each other, for example:
Combine filters that cover different parts of the UV spectrum, to ensure broad-
spectrum protection.
Combine organic filters with inorganic filters, which has been shown to generate
significant synergistic effects [2529].
Combine water-based filters with oil-based filters.
The last of these is of particular interest. The use of water-soluble UV filters, or
aqueous dispersions of inorganic filters, is often avoided in beach products due to
concerns over lack of water resistance. However, the addition of low levels of water-
based filters to a formulation containing an optimised combination of oil-based
filters can give dramatic increases in SPF [24]. Also, the characteristic dry skin
feel of the water-based filters helps to counteract the oily feel associated with, for
example, the liquid organic UV filters.
16.7 The Influence of Formulation Excipients on Skin Feel
Of course, the aesthetic properties of sun care formulations are influenced to a large
degree by the other components used as well as by the UV filters themselves. The
effects of emollients have been discussed in the preceding sections; the following is
a brief discussion of how other excipients can affect sensory properties.
16.7.1 Emulsifiers
What is often not appreciated is the effect that emulsifiers have on the sensory
properties of topical skin care products. In fact, it has been demonstrated that during
the rub-out phase, emulsifiers actually exert a greater influence on the skin feel than
the emollients do [30]. Many traditional O/W emulsifiers produce a skin feeling
during rub-out that is more waxy than is ideal for sun care formulations, but
nowadays there are plenty of emulsifier systems that give a more suitable feel. One
example is potassium cetyl phosphate, which facilitates good spreadability upon
application, with a smooth after-feel. It can be combined with co-emulsifiers to
deliver a range of textures and viscosities, from viscous lotions to thin sprayable
milks.
300 J.P. Hewitt
Another class of emulsifiers that are well suited for sun care are those designed
to form liquid crystal networks [3133]. Liquid crystals, in one form or another,
have actually been present in most O/W personal care emulsions for many years, but
it is only within the last 25 years or so that they have been recognised as such, and
formulators have started to deliberately make use of them to achieve specific effects.
Lamellar liquid crystalline phases have been shown to significantly improve
emulsion stability. They also have prolonged hydration properties, due to the fact
that water is bound into the lamellar structure, making it less prone to immediate
evaporation. This helps to give a skin feel that is very well-liked by consumers. For
sun care, the most suitable type of liquid crystal systems is hydrosomes, which
consist of a delocalised network of lamellar liquid crystal structures. In sun care, the
delocalised structure helps to achieve a homogeneous distribution of active
ingredients [34], thus increasing SPF efficacy. In terms of sensory properties, such
systems typically give a light and silky skin feel with excellent skin play.
16.7.2 Thickeners
There are many different types of rheology modifiers that are used in cosmetic O/W
emulsions, including acrylate polymers (e.g. carbomers), natural gums such as
xanthan gum, cellulose derivatives, silicate types such as magnesium aluminium
silicate and starch-based thickeners. Each has its own sensory characteristics, but
the optimum type to use in any given case depends very much on the emulsifier
system being used.
In W/O emulsions, waxes are often used as thickeners and as mentioned earlier
can have a beneficial effect on SPF in sun care formulations [19]. However, care
should be taken to avoid excessive concentrations of wax as this can inhibit the
spreading of the formulation, making it difficult and unpleasant to apply. Fine
particle silica can also be used as a rheological additive in W/O systems, and this
can have a beneficial effect on skin feel, as it counteracts any oiliness or greasiness
from the emollients, delivering a drier feel.
16.7.3 Film-Formers
Film-formers, which are often polymers, are frequently added to sun care
formulations for one or both of two reasons. Firstly, such ingredients can act as SPF
boosters, by giving a more even product film on skin. Secondly, they are used as
water-proofing agents. One of the most common types used are PVP copolymers
[35, 36], for example, VP/eicosene copolymer. However, these polymers can
sometimes give a sticky feel to the formulation, so a number of alternatives have
been developed that confer water resistance while enabling the formulator to
maintain a light, smooth skin feel [37].
16.8 Conclusion
There was a time when sun care products would not be very pleasant to apply and
would not be as cosmetically elegant as, say, daily skin care products, and consum-
ers would either accept this as a necessary evil of protecting themselves from the
sun or would avoid using such products altogether. Nowadays, however, consumers
expect a better sensory experience from their sunscreen products, and manufactur-
ers are increasingly using sensory claims as a way of differentiating their products
from the competition. Sensory analysis by trained panels enables cosmetic scien-
tists to better understand what consumers want in terms of skin feel, and develop-
ments in terms of both active ingredients (UV filters) and formulation excipients are
enabling formulators to develop sun care products that are pleasant to apply, encour-
aging better consumer compliance. This, in turn, makes the products more effective
under real-use conditions than may have been the case in the past.
References
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vations on a sun-holiday. Photochem Photobiol Sci 12(1):190196
2. Saecker C, Janssen A, Vollhardt J (2013) Are we done by preventing sunburn? In: Proceedings
of the Florida Sunscreen symposium, Orlando, 1821 Sept 2013
3. Ou-Yang H, Stanfield J, Cole C, Appa Y, Rigel D (2012) High-SPF sunscreens (SPF 70) may
provide ultraviolet protection above minimal recommended levels by adequately compensating
for lower sunscreen user application amounts. J Am Acad Dermatol 67(6):12201227
4. Bimczok R, Gers-Barlag H, Mundt C, Klette E, Bielfeldt S, Rudolph T, Pflucker F, Heinrich
U, Tronnier H, Johncock W, Klebon B, Westenfelder H, Flosser-Muller H, Jenni K, Kockott D,
Lademann J, Herzog B, Rohr M (2007) Influence of applied quantity of sunscreen products on
the sun protection factor a multicenter study organized by the DGK Task Force Sun
Protection. Skin Pharmacol Physiol 20(1):5764
5. European Commission (2006) Recommendation of 22 Sep 2006, on the efficacy of sunscreen
products and the claims made relating thereto. Official Journal of the European Union L
265/39L 265/43
6. Vollhardt J, Schoop R, Roos F, Janssen A, Saecker C (2013) The sensory experience of sun-
screens which properties matter? A descriptive sensory analysis of more than 50 sunscreens.
In: Proceedings of the sun protection conference 2013: sun protection for the 21st century,
London, 45 June 2013 (Summit Events Ltd.)
7. Dahms GH (1988) Cosmetic water-in-oil emulsions: application, physical properties and for-
mulations. In: Proceedings of the symposium on The formulation of cosmetic and topical
pharmaceutical products, Bristol, April 1988
8. Tadros ThF et al (1996) Use of a polymeric surfactant (ABA block copolymer) for preparation
of stable water-in-oil (W/O) emulsions and water-in-oil-in-water multiple emulsions. In:
Proceedings of the 19th IFSCC congress, Sydney, October 1996
9. Bruening S, Leonard M, Kawa R, Issberner U, Tomlinson A (2005) Role of emollients and
emulsifiers in sunscreen formulations. In: Shaath NA (ed) Sunscreens: regulations and
commercial development, vol 28, 3rd edn, Cosmetic science and technology series. Taylor &
Francis, Boca Raton, pp 449460
10. Schwarzenbach R, Huber U (2003) Optimization of sunscreen efficacy. In: Verlag fr che-
mische Industrie, H. Ziolkowsky GmbH, Augsburg, pp 131137
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and globality. In: Proceedings of the Florida Sunscreen Symposium, Orlando, 1821 Sept
2013
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safety. Crit Rev Toxicol 37(3):251277
14. Chen LL, Tooley I, Wang SQ (2013) Nanotechnology in photoprotection. In: Nasir A,
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Proceedings of the IFSCC conference, Montreux, pp 313323
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into water-in-oil emulsions. In: Proceedings of the European UV sunfilters conference, Paris,
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formulations. In: Proceedings of the 23rd IFSCC congress, Orlando, 2427 Oct 2004
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US patent 2008226727, 18 Sept 2008
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388392
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35. Gupta VK, Zatz JL (1999) In vitro method for modelling water resistance of sunscreen formu-
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Chapter 17
Sunscreen Regulatory Update
Farah K. Ahmed
Key Points
1. Sunscreen active ingredients (or ultraviolet (UV) filters) are regulated
globally under a variety of classifications e.g., over-the-counter drugs,
cosmetics, quasi-drugs and are required to be substantiated for safety and
efficacy.
2. Brief overview of the current state of sunscreen regulation around the
world, with an expanded focus in the United States, will be provided.
3. Worldwide regulation of sunscreens ensures governmental oversight over
the safety and efficacy of sunscreens.
17.1 Introduction
Sunscreen has shown to reduce the risk of developing skin cancer and prevent
UV-induced skin aging when used appropriately and in conjunction with other pro-
tection modalities. In the United States, sunscreens are regulated by the Food and
Drug Administration (FDA) as over-the-counter (OTC) drugs. In many other
countries around the world, there are sets of rigorous specifications governing the
Founded in 1894, the Personal Care Products Council is the leading national trade association
representing the personal care products industry. Our membership includes approximately 300
active member companies that manufacture or distribute personal care products, including OTC
sunscreens. We also represent approximately 300 additional associate members who provide
goods and services to manufacturers and distributors of personal care products.
F.K. Ahmed, BS, JD (*)
Vice President / Chair, Personal Care Products CouncilConsumer Healthcare Products
Association Joint Sunscreen Task Force, Personal Care Products Council,
Washington, DC, USA

DOI 10.1007/978-3-319-29382-0_17
304 F.K. Ahmed
safety profile of UV filters and product efficacy and labeling guidelines in place to
protect the consumers. To accomplish these tasks, there are regulatory bodies around
the world that create and update their individual rules pertaining to the regulation of
sunscreen products.
This chapter provides a glimpse to the world of regulation associated with sun-
screens. Specifically it will provide (1) a basic background of over-the-counter
(OTC) drug product regulation in the United States, (2) specific information on
sunscreen regulations, (3) an overview of the Sunscreen Innovation Act (SIA), and
(4) a brief summary of global sunscreen ingredient and product regulation.
17.2 Over-the-Counter Drug Product Regulations
In the United States, sunscreens primarily fall within the jurisdiction of the US
Food and Drug Administration (FDA or the Agency). FDA regulates all sun-
screens as OTC drugs.1 As such, they must meet standards for safety, efficacy,
good manufacturing practices (GMPs), and labeling. The Agency deems any
topically applied product claiming a sun protection factor (SPF) to be a sun-
screen. Examples of such products include lotions, sprays, daily moisturizers,
foundations, lipsticks, etc.
17.2.1 OTC Drug Regulatory Pathways
Two regulatory pathways exist for the legal marketing of OTC drug products: (i)
marketing in compliance with an OTC drug monograph, (ii) marketing under the
authority of an approved product-specific new drug application (NDA), an
abbreviated new drug application (ANDA), or (iii) Rx-to-OTC switch.
17.2.1.1 OTC Monograph
The majority of sunscreen products in the United States are marketed under the
OTC sunscreen monograph. An OTC monograph is essentially the recipe for mak-
ing an OTC drug product and based on ingredients FDA preapproved (or permit-
ted) active ingredients that support prescribed labeling claims and, in some
instances, testing (e.g., SPF). Designated OTC monographs represent regulatory
standards for the marketing of nonprescription drug products not covered by new
drug applications. These are OTC drugs related to categories that consumers are
able to self-diagnose, self-treat, and self-manage. Examples of OTC monograph
1
An OTC drug product is a drug product marketed for use by the consumer without the interven-
tion of a health care professional in order to obtain the product.
17 Sunscreen Regulatory Update 305
Table 17.1 Over-The-Counter (OTC) drug regulatory pathways

New drug application Monograph process
Product specific (including formulation) Ingredient- and category-specific regulations
(CFR 330358)
Confidential filing Public process no data
Application submitted for premarket No FDA product-specific premarket application
approval or preapproval
Mandated timelines No mandated timelines
Application fees (PDUFA) No user fees
Potential for marketing exclusivity No potential for marketing exclusivity
Reporting requirements Limited reporting requirements
(serious adverse events)
Comply with good manufacturing Comply with good manufacturing practices
practices
therapeutic categories include both topical and ingested forms such as sunscreens,
acne, allergy, diaper rash, cough and cold, antiperspirant, dandruff, skin protectant,
external analgesic, psoriasis, etc.
17.2.1.2 New Drug Application (NDA and ANDA)
Currently, there are four specific sunscreen formulations approved in the United
States under the new drug application (NDA) process:
Anthelios SX: avobenzone, ecamsule, and octocrylene at 2, 2, and 10 %
Capital Soleil: avobenzone, ecamsule, and octocrylene at 2, 3, and 10 %
Anthelios 20: avobenzone, ecamsule, octocrylene, and titanium dioxide at 2, 2,10,
and 2 %
Anthelios 40: avobenzone, ecamsule, octocrylene, and titanium dioxide at 2, 3, 10,
and 5%
All four NDAs were filed by LOreal.
The term human drug application means an application for approval of a new
drug (the full formulation and labeling).
The following table (Table 17.1) provides a summary of the differences of these
two pathways.
17.2.1.3 Rx-to-OTC Switch
An Rx-to-OTC switch refers to over-the-counter marketing of a product that was

once a prescription drug product, for the same dosage form, population, and route
of administration. Currently, there is no prescription (or Rx) to OTC sunscreen
products in the United States.
306 F.K. Ahmed
17.3 OTC Sunscreen Regulations
On June 14, 2011, FDA released the following sunscreen-related rulemakings: (1)
final rule on effectiveness testing and labeling for over-the-counter (OTC) sun-
screen products (final rule),2 (2) proposed rule on SPFs above 50, (3) advance
notice of proposed rulemaking (ANPR) on sunscreen dosage forms, (4) draft
guidance on OTC sunscreen drug products, and (5) request for comment on the
final rule.3
17.3.1 Final Rule on Sunscreen Labeling and Efficacy
The final rule outlines permitted and required claims, testing procedures required to
substantiate those claims, and claims that are not permitted. It is important to note
that these rules amend FDAs drug labeling regulations (i.e., 21 CFR 201) and do
not finalize the sunscreen monograph (i.e., 21 CFR 352) nor lift the stay on the
implementation of the monograph.
17.3.2 Drug Facts Panel Required
In addition, the final rule lifts the delay of the implementation of the 1999 Drug
Facts final rule and requires all sunscreen products to comply with the content and
format requirements of that rule. This includes combination cosmetic sunscreen
products such as lipsticks, foundations, and daily moisturizers that are labeled as
containing an SPF.
Under the Drug Facts rule, if the information listed under Drug Facts requires
more than 60 % of the total available surface area, the Drug Facts labeling can be
reduced as specified in the regulation.4 FDA did not provide for any additional
labeling relief under the Final Rule.
2
The final rule (76 FR 35620), codified in 201.327, establishes labeling and testing requirements
for OTC sunscreen products marketed without approved applications and containing only the
ingredients specified in the stayed 1999 final rule (aminobenzoic acid (PABA), avobenzone, cinox-
ate, dioxybenzone, ensulizole, homosalate, meradimate, octinoxate, octisalate, octocrylene, oxy-
benzone, padimate O, sulisobenzone, titanium dioxide, trolamine salicylate, zinc oxide).
3
All published in the June 17, 2011 Federal Register.
4
21 CFR 201.66(d)(10)
17.3.3 No Ingredient Issues Addressed
The final rule does not address issues related to sunscreen active ingredients,
including any new active ingredient combinations, or any sunscreen active
ingredients currently under time and extent application (TEA) review.
17.3.4 Effective Date
The final rule effective date was initially set for June 18, 2012, except for products with
annual sales less than $25,000 for which the effective date is June 17, 2013. FDA post-
poned these dates by 6 months to allow companies to comply with the final rule and
ensure no shortage of sunscreens on the market. All products labeled on or after the
effective date must meet all final rule requirements (see below for additional time/
enforcement discretion for SPF testing). Of note, FDA did not require noncompliant
products introduced or delivered for introduction into interstate commerce prior to the
compliance date, June 18, 2012, to be removed from the market; product delivered to
customers, even if in their warehouses, ready to be shipped from manufacturers ware-
houses, or imported prior to June 18, 2012, can continue to be shipped and sold; and
product imported prior to the compliance date would be protected, as would any prod-
uct delivered to customers, even if still in customers warehouses on the effective date.5
17.3.5 SPF Testing
The SPF test method was modified to require a smaller number of test subjects to deter-
mine a products SPF (10) compared to the previous methods that required 2025 test
subjects. The reference control formulation was changed from an SPF 4 formulation to
an SPF 15 formulation. The finger cot used for sample application no longer requires
pre-saturation with test product. The minimum size of the test site for product applica-
tion was reduced in area, as was the required minimum area for each individual UV
exposure. The distance between exposure sites in the test area was reduced. Product
application remained at 2 mg/cm2 with test result read at 1624 h postexposure. Solar
simulator specifications were harmonized with those in the International SPF Method.
5
Under the general interpretation of delivered for introduction into interstate commerce, other
warehoused product might also be protected but would have to be evaluated on a case-by-case
basis.
308 F.K. Ahmed
17.3.6 Broad-Spectrum Testing
FDA has abandoned the four star rating proposal indicating UVA protection pro-
vided on product labels, in favor of a simple pass/fail in vitro test for broad-
spectrum characteristics known in the industry as the critical wavelength test. The
proposed test methodology differs from previously published methodology to deter-
mine the critical wavelength in several attributes and is different from the ISO in vitro
UVA test method (in development) as well.
A sunscreen must have a critical wavelength of 370 or higher to be able to make
a broad-spectrum claim. A broad-spectrum claim is necessary in order to make
a positive use statement regarding prevention of early skin aging and skin cancer
on products with an SPF of at least 15; otherwise, a warning statement must be used
for the product uses (see below).
The FDA critical wavelength test method prescribes the use of PMMA plates with
a surface roughness from 2 to 7 m, with a sunscreen application density of 0.75 mg/
cm2, and pre-irradiation of the sample with a fixed 4 MED exposure to solar-simulated
radiation. The wavelength at which 90 % of the UV absorbance area under the curve
occurs (when summing from 290 toward 400) is defined as the critical wavelength
and is a measure of the breadth of the protection provided by the product.
17.3.7 The New Label
The FDA also issued new guidance on labeling of sunscreen products as outlined below.
Uses (indications)
Helps prevent sunburn
If used as directed with other sun protection measures (see Directions),
decreases the risk of skin cancer and early skin aging caused by the sun
[please note: the sunscreen must be broad-spectrum and SPF of at least
15 in order to use this statement]
Warnings
Skin cancer/skin aging alert: Spending time in the sun increases your risk of
skin cancer and early skin aging. This product has been shown only to help
prevent sunburn, not skin cancer or early skin aging [please note: this
statement is required for products that are not labeled as broad-spectrum or
SPF of less than 15]
Directions (for broad-spectrum/SPF 15 and water-resistant)
Apply liberally (or generously and may add and evenly) 15 min before
sun exposure.
Reapply.
After 40 (or 80) minutes of swimming or sweating
Immediately after towel drying

At least every 2 h
Sun protection measures. Spending time in the sun increases your risk of skin can-
cer and early skin aging. To decrease this risk, regularly use a sunscreen with
broad-spectrum SPF of 15 or higher and other sun protection measures including:
Limit time in the sun, especially from 10 a.m. to 2 p.m.
Wear long-sleeve shirts, pants, hats, and sunglasses.
Children under 6 months: Ask a doctor.
Directions (for broad-spectrum and/or SPF 15 and water-resistant)
sun exposure.
Reapply.
After 40 (or 80) minutes of swimming or sweating
Immediately after towel drying
At least every 2 h
Children under 6 months of age: Ask a doctor.
Directions (for broad-spectrum/SPF 15 and not water-resistant)
sun exposure.
Sun protection measures. Spending time in the sun increases your risk of skin can-
cer and early skin aging. To decrease this risk, regularly use a sunscreen with
broad-spectrum SPF of 15 or higher and other sun protection measures including:
Limit time in the sun, especially from 10 a.m. to 2 p.m.
Wear long-sleeve shirts, pants, hats, and sunglasses.
Reapply at least every 2 h.
Use a water-resistant sunscreen if swimming or sweating.
Children under 6 months: Ask a doctor.
Directions (for not broad-spectrum and/or SPF 15 and not water-resistant)
sun exposure.
Reapply at least every 2 h.
Use a water-resistant sunscreen if swimming or sweating.
Children under 6 months of age: Ask a doctor.
Note: FDA is allowing the optional direction heading for sunscreen use to appear
as the first line under Directions.6
6
The agencys reasoning for this allowance is that consumers who are using these products primar-
ily for cosmetic use may be more likely to understand that they might not receive the intended sun
protection if they do not follow the directions in the Drug Facts label.
310 F.K. Ahmed
Fig. 17.1 Illustrates the old vs. the new sunscreen labeling requirements
Water resistance claims on the principal display panel must specify either 40 or
80 min of effectiveness while swimming or sweating, based on testing. Waterproof,
sweatproof, and sun block claims are not permitted. FDA did not explicitly
allow for a sweat resistance claim (Fig. 17.1).
17.3.8 Proposed Rule on SPFs Above 50
Although FDA acknowledged that SPFs higher than 50 have been substantiated
and results are validated and repeatable, it is proposing to limit SPF to 50+
unless the agency receives data demonstrating additional clinical benefit for
SFPs above 50.
Sunscreens labeled with SPFs above 50 may remain on the market until this
proposed rule becomes final, provided they follow the appropriate SPF test.
Depending on how this proposed rule is finalized, these products may/may not be
able to continue on the market.
17.3.9 Advance Notice of Proposed Rulemaking

on Dosage Forms
FDA published an ANPR requesting additional data on OTC sunscreen products in

certain dosage forms. The agency listed those dosage forms that it currently
considered potentially eligible for inclusion in the OTC sunscreen monograph (i.e.,
oils, lotions, creams, gels, butters, pastes, ointments, sticks, and sprays).
For sprays, FDA requested additional data to address remaining questions about
effectiveness and safety. The agency also encouraged comments on potential
labeling and testing conditions for sunscreens in spray dosage forms, contingent on
receiving additional data that would be needed to allow their classification as
generally recognized as safe and effective (GRASE.)
FDA also identified certain dosage forms that it does not consider currently
eligible for review for potential inclusion in the OTC sunscreen monograph (i.e.,
wipes, towelettes, powders, body washes, and shampoos).
Sunscreens, such as those in powder form, may remain on the market until this
proposed rule becomes final, provided they follow the appropriate testing and
labeling. When this ANPR is eventually finalized, we will know which dosage
forms may continue on the market.
Although the final rule did not include ingredients, the Agency also noted that it
allowed 16 sunscreen active ingredients at the following up to concentrations:
Aminobenzoic acid (PABA), 15 %
Avobenzone, 3 %
Cinoxate, 3 %
Dioxybenzone, 3 %
Ensulizole, 4 %
Homosalate, 15 %
Meradimate, 5 %
Octinoxate, 7.5 %
Octisalate, 5 %
Octocrylene, 10 %
Oxybenzone, 6 %
Padimate O, 8 %
Sulisobenzone, 10 %
Titanium dioxide, 25 %
Trolamine salicylate, 12 %
Zinc oxide, 25 %
However, in FDAs June 14, 2011 rulemakings, the Agency did not address the eight
pending sunscreen ingredient applications requesting inclusion into the sunscreen
monograph:
312 F.K. Ahmed
Amiloxate, 10 %
Bemotrizinol, 10 %
Bisoctrizole, 10 %
Diethyl butamido triazone, 3 %
Drometrizole trisiloxane, 15 %
Ecamsule, 10 %
Enzacamene, 4 %
Octyl triazone, 5 %
As of the date of this publication, FDA has not approved any of the above
ingredients; rather, the Agency has requested additional data before it can make its
safety and efficacy determination.
17.4 Sunscreen Innovation Act
On November 26, 2014, President Obama has signed the Sunscreen Innovation Act
(SIA) into law.7 The goal of the SIA is to provide an alternative process for review for
all ingredient TEAs, including prescribed timelines for review, administrative orders
in lieu of rulemaking, and new format for data submissions. The SIA also allows for
advisory committees and requires FDA to regularly update congress and the GAO. Of
note, FDAs safety evaluations and determinations remain with the Agency.
Key aspects of the Act include:
Determining eligibility: FDA TEA eligibility requirements will be maintained an
ingredient must be used safely for at least five years in at least one country.
Eligibility determinations will be made by FDAs Division of Nonprescription
Regulation Development (DNRD). Pending ingredient submissions, already
deemed eligible by FDA, will be considered eligible for the new review and
approval process.
Transparent review: After a finding of eligibility, the ingredient application may be
submitted to the existing FDA Nonprescription Drugs Advisory Committee
(NDAC) for a safety and effectiveness recommendation or may conduct this
review on their own. During the review process, the FDA or the NDAC will
receive data from the public and communicate with the applications sponsor to
seek clarifying or request additional information. FDA will either concur or deny
the NDACs recommendation or come to its own conclusion.
Predictable and reasonable time frame: The SIA sets time frames for the various
stages of the TEA process for both pending and new applications.
Guidance: FDA must issue draft guidance on the implementation of, and compli-
ance with, the requirements with respect to sunscreen TEAs under the Act (e.g.,
format, data requirements).
7
Sunscreen Innovation Act: http://www.gpo.gov/fdsys/pkg/PLAW-113publ195/pdf/PLAW-
113publ195.pdf
Enhancing FDA accountability: FDA is required to submit reports to congress

regarding the progress of the program 12 months following enactment and every
two years thereafter.
Finalize the sunscreen monograph: Within 5 years of enactment, FDA must finalize
the remaining portion of the sunscreen monograph (i.e., the ingredient portion
but not necessarily SPF cap or dosage form). If FDA does not finalize SPF cap or
dosage form, the Agency must provide its rationale for such provisions not being
included in such regulations and a plan and timeline to compile any information
necessary to address such provisions through final regulation.
At the time of writing this chapter, the FDA has not approved any of the new UV
actives under the TEA review process. Instead as of May 2015, the FDA requested
all the manufacturers to submit additional safety and efficacy data for their respective
UV actives.
Chronological statutory timeline for all sunscreen TEAs
November 26, 2014: Enactment of the Sunscreen Innovation Act (Public Law
113195).
January 7, 2015: FDA published notice for comment of feedback letters/proposed
sunscreen orders in the Federal Register.
On or before February 6, 2015: FDA meeting request due to FDA from a sponsor of
pending application with a feedback letter.
February 23, 2015: Public comment deadline for feedback letters/proposed sun-
screen orders for pending applications with feedback letters per January 7th
Federal Register notice.
On or before February 24, 2015: Proposed sunscreen orders required for all pending
applications without feedback letters at the time of enactment.
On or before March 23, 2015: FDA meeting convened for requests submitted by a
sponsor of pending application with a feedback letter.
On or before March 26, 2015: FDA meeting request due to FDA from a sponsor of
pending application without a feedback letter at the time of enactment.
On or before April 10, 2015: Public comment deadline for proposed sunscreen
orders for pending applications without feedback letters at the time of enactment.
On or before May 10, 2015: FDA meeting convened for requests submitted by a
sponsor of pending application without a feedback letter at the time of enactment.
On or before July 9, 2015: Final sunscreen order required for all pending applications
without feedback letters at the time of enactment that do not require submission
of additional data.
On or before November 26, 2015: Draft guidance regarding the criteria for eligibility
and safety and effectiveness determinations.
On or before May 26, 2016: FDA initial report to senate HELP and house energy
and commerce committee regarding implementation of the SIA.
On or before November 26, 2016: Final guidance regarding the criteria for eligibil-
ity and safety and effectiveness determinations.
On or before November 26, 2017: Initial Government Accountability Office (GAO)
report.
314 F.K. Ahmed
Fig. 17.2 Illustrate the new sunscreen TEA timeline
Fig. 17.3 Illustrate the new sunscreen TEA timeline
On or before May 26, 2018: FDA second report to senate HELP and House E&C
regarding implementation of the SIA.
On or before November 26, 2019: Final sunscreen monograph published.
On or before May 26, 2020:
Subsequent Government Accountability Office (GAO) report.
FDA third report to senate HELP and House E&C regarding implementation
of the SIA.
Figures 17.2 and 17.3 illustrate the new TEA timeline8
8
Images by FDA
17.5 Global Sunscreen Regulation
Sunscreens are recognized by global health authorities for their ability to pro-
tect consumers from UV exposure and for their role in helping to prevent acute
and chronic damage to the skin, including reducing the incidence of skin can-
cers. These authorities are aligned in that (i) sun protection is a public health
priority, (ii) claims regarding efficacy must be proven, and (iii) sunscreen active
ingredients are reviewed for safety and require premarket approval. While the
above criteria are common among regions, regulatory classifications, available
sunscreen active ingredients and concentration limits, testing requirements,
labeling, approval process and postmarketing requirements differ. Each of these
parameters will be reviewed below for their commonality as well as for their
divergence.
17.5.1 Regulatory Classification
Regulatory classifications for sunscreens vary widely from region to region. At first
glance, one might believe that differences among these classifications are vast; how-
ever, examination of the various definitions reveals common themes. These include
the following: a product placed in contact with the various external parts of the
human body and a product to protect the skin from UV radiation. These similarities
support the common message that sunscreen products, when used as directed, no
matter what the regulatory classification, are designed to provide UV protection to
consumers and sunscreen active ingredients require premarket approval and sup-
porting preclinical/clinical information.
17.5.2 Available Sunscreen Ingredients, Concentrations,

Combinations, and Approval
The area where the greatest differences are most evident is in the wide variety of
sunscreen ingredients available to manufacturers and consumers. In the United
States, the monograph allows for 16 current sunscreen ingredients with eight
pending time and extent applications (TEAs). In other countries, up to 38 sun-
screen ingredients are available for manufacturers to formulate sun protection
products. Approvals of sunscreen active ingredients require premarket approval
and supporting preclinical/clinical information. While some approvals appear to
be more stringent, the safety and efficacy of the sunscreen ingredients must be
proven prior to use of the ingredient. This is further discussed in an earlier section
of this briefing document.
316 F.K. Ahmed
Upon examination, ten sunscreen ingredients are permitted for use globally:
1. Octisalate (ethylhexyl salicylate)
2. Homosalate (3,3,5-trimethylcyclohexyl 2-hydroxybenzoate)
3. Octocrylene (2-cyano-3,3-diphenyl acrylic acid, 2-ethylhexyl ester)
4. Octinoate (octyl methoxycinnamate)
5. Zinc oxide*
6. Oxybenzone (benzophenone-3)
7. Ensulizole (phenylbenzimidazole sulfonic acid)
8. Avobenzone (butyl methoxy dibenzoyl methane)
9. Padimate O (ethylhexyl dimethyl PABA)
10. Titanium dioxide*
*Considered to be light-scattering agents in Japan
17.5.3 Sunscreen Ingredient Safety
Globally, all sunscreen active ingredients require premarket approval, and all have
individually been tested in preclinical studies in both short-term and long-term
applications. Within limits determined by individual countries, all have demonstrated
to have acceptable preclinical and/or clinical safety profiles for human use as
directed.
17.5.4 Sunscreen Labeling
While there is no global agreement as to the SPF limits or the regulatory classification
of specific product types (recreational vs. every day), all sunscreen products no
matter where they are marketed must carry an SPF value. Communication of the
level of UVA protection can vary from a + marking in Japan, the SPF value and a
symbol indicating UVA in Europe, to a broad-spectrum claim in the United
States. All of these statements to the consumer appear on the principal display panel
of the sunscreen product.
All products need to provide information to consumers allowing safe use.
Warning statements and directions for use should be clear and concise to ensure that
even the average consumer can read and understand any risks associated with the
product as well as how to properly apply and use.
As discussed in this section, while the regulatory classification of sunscreens
varies globally, all major markets agree that sun protection is a public health priority
and consider sunscreens a necessary component in preventing both sunburn and
skin cancer. These authorities are aligned in that claims regarding efficacy must be
proven and that sunscreen active ingredients require premarket approval.
17.6 Conclusions
Both the data and regulatory requirements in the United States and globally related
to sunscreens substantiate and ensure the safety and efficacy of these products. In part,
regulations are meant to protect and enhance public health. They also play a major
role in advancing and at time slowing or impeding the technological and scientific
progresses that propel companies and industries to develop novel sunscreen products.
Needless to say, regulations can impact the state of photoprotection offered by
sunscreens.
Chapter 18
Measuring Sunscreen Protection According
totheFDA Final Rule
JosephW.Stanfield, J.WilliamStanfield, andEduardoRuvolo Jr.
Key Points
1. The sun protection factor (SPF) is an invivo test that estimates the
protective efficacy of a sunscreen against erythema.
2. The critical wavelength (CW) test is an invitro test that has been accepted
by the US Food and Drug Administration to measure the broad-spectrum
status of sunscreens.
3. Detailed description on the proper steps to conduct SPF and CW tests is
provided.
4. Common pitfalls in conducting SPF and CW tests are also outlined.
18.1 Introduction
Historically, the first known studies establishing the basis for sun protection started
in the 1930s and were published in the 1940s by H.Blum etal. and in the 1950s by
R.Schulze [1, 2]. Professor Franz Greiter invented what is known today as the con-
cept of the sun protection factor (SPF) and introduced sunscreens with SPF labels
in 1962 [3, 4]. The original proposed sunscreen monograph, issued in 1978,
J.W. Stanfield, MS (*)

President, Suncare Research Laboratories, 2518 B Reynolda Road,
Winston Salem, NC 27106-4618, USA
J.W. Stanfield
General Manager, Suncare Research Laboratories, 2518 B Reynolda Road,
Winston Salem, NC 27106-4618, USA
E. Ruvolo Jr., MS
Senior Research Fellow, Avon Products, One Avon Place, Suffern, NY 10901, USA

DOI10.1007/978-3-319-29382-0_18
320 J.W. Stanfield et al.
provided the option of an outdoor SPF test using sunlight, as well as a method using
indoor ultraviolet lamps [5].
The advantages of using a natural solar light source were cited as a closer
approximation of the actual use of sunscreens, including the heat and humidity, use
of the full solar spectrum, ability to test several sunscreen products simultaneously,
and the ability to estimate tanning efficacy. Disadvantages of using a natural solar
light source included the uncontrollable variables of weather, changing cloud cover,
changing radiation intensity, changing sun angle, and difficulties of monitoring the
constant changes of sun exposure.
The disadvantages of using the indoor solar simulators, such as xenon arc lamps
included, were the low output in the visible and infrared wavelengths, the difficulty
in measuring the output, and the time-consuming requirement of irradiating only
one test site at a time. This last factor became less significant with the introduction
of multiport systems. On the other hand, the advantages of using the xenon arc lamp
included the constant spectrum and the high UV power output.
It is important to notice that the ratio of UVA (320400nm) and UVB (290320)
radiation in sunlight from 9AM to 3PM is constant and equal to 21:1 [6]. In solar
simulators, the ratio UVA/UVB is around 8:1. This also can be a source of differ-
ence when SPF tests are performed indoors using ultraviolet lamps compared to
tests performed under natural sunlight.
Eventually the consensus of sunscreen manufacturers favored the xenon arc
lamp, especially as SPF values of products began to increase significantly. During
the period of the early 1980s, large solar simulators with 1000 and 2500W were
available and utilized in much of the indoor SPF testing. However, they required
masking and covering of exposed sites, water cooling, and cumbersome power sup-
plies and large space requirements. These large simulators were eventually replaced
by compact xenon arc solar simulators, especially as large-scale SPF testing grew.
The pioneer of the compact xenon arc solar simulator was Daniel S.Berger, from
the Department of Medical Physics at Temple University [7]. The original compact
xenon arc lamp, known as the Berger solar simulator, employed a continuous 150W
xenon arc with optics and filters that produced a uniform beam, approximately one
centimeter in diameter. Its emission spectrum in the UVB region simulated the sun
at an elevation of 70. The goal was to simulate the solar spectrum in the sunburning
UVB region, with minimal long wavelength UVA, visible light, and infrared energy.
This enabled production of erythema on the backs of volunteer subjects, with
relatively short exposure times and minimal discomfort to human volunteer subjects.
The compact solar simulator weighed 5lb and required a 35lb power supply.
The compact xenon arc lamp rapidly became the mainstay of the SPF test. The
output spectrum of the compact xenon arc lamp was considered an acceptable simu-
lation of sunlight, and the FDA and other regulatory agencies worldwide stipulated
spectra for indoor sunscreen testing, designed around the compact xenon arc lamp.
A variation of the original Berger solar simulator employs six liquid light guides
to irradiate six spots, each 8mm in diameter. Use of the multiport solar simulator
was prohibited until the 2011 US FDAs Final Rule on Labeling and Effectiveness
Testing of Sunscreen was issued, because earlier FDA rules required lamp beams at
18 Measuring Sunscreen Protection According totheFDA Final Rule 321
least one centimeter in diameter. Single port and multiport compact xenon arc solar
simulators are now available in 300W versions.
The Berger solar simulator facilitated convenient indoor testing of sunscreen prod-
ucts and made it possible for sunscreen manufacturers to develop products with SPF
ratings higher than 15 and eventually as high as 100. Other than the addition of auto-
matic shutters, solid-state power supplies, and 300W power supplies, the compact
xenon arc lamp solar simulator has not changed significantly in the last three decades.
However, the cutoff filters that are required to diminish the heating of the skin by
the compact xenon arc lamp solar simulator exaggerate the long wavelength UVB
and short UVA and cut away much of the long UVA power [3]. This causes some
overestimation of the SPF measured with compact xenon arc lamp solar simulators,
compared to that of sunlight (Colipa 1994) [9]. See Fig.18.1.
To compensate for the shortcomings of the SPF alone, additional tests of
sunscreens to demonstrate protection against UVA have been developed. Most
notable is the critical wavelength test, devised by Dr. Brian Diffey and published in
1993 [9]. The critical wavelength test will be discussed in Sect.18.4.
18.2 The SPF Test
18.2.1 Solar Simulators
The FDA Final Rule stipulates the procedures for measuring both the SPF and the
critical wavelength [10].
Continuous emission spectrum from 290 to 400nm
Emission spectrum measured at least annually and after replacement of lamp
bulb or any change in optical components, using an appropriate spectroradiometer
system that is calibrated to a NIST-traceable source
Standard sun SPF lamp

100 % UVB UVA
80 %
60 %
40 %
20 %
0%
290 300 310 320 330 340 350 360 370 380 390 400
Wavelength (nm)
Fig. 18.1 Comparison of the solar simulator and sunlight

Daily radiation intensity monitored before and after each test, or at least at the
beginning and end of each test day using an erythemally weighted radiometer
with a calibration consistent with the spectroradiometer system
No significant time-related fluctuations in the exposure plane (20%)
Good beam uniformity (20% from centerline reading)
UVAII (320400nm), 20% of total UV irradiance
UVAI (340400nm), 60% of total UV irradiance
Total irradiance from 250 to 1400nm 1500W/m2
The permissible ranges of the percent of erythemal dose contributions are shown
in Table18.1.
18.2.2 The Standard Sunscreen
As a positive control, the FDA stipulates use of a standard sunscreen, designated as

the padimate O/oxybenzone standard. The active ingredients of the padimate O/
oxybenzone standard include 7% of padimate O and 3% of oxybenzone. The com-
plete formula of the padimate O/oxybenzone standard is provided in the Final Rule.
The padimate/oxybenzone standard must be included in all SPF tests, along with the
test products. For the measured value of the test product to be valid, the mean value
of the padimate O/oxybenzone standard must fall within the standard deviation
range of the expected SPF (i.e., 163.43).
18.2.3 Test Subjects
According to the FDAs Final Rule on Labeling and Effectiveness Testing, a panel
of ten subjects is required for each test product. Multiple products may be included
on the same subjects, and each subjects test must include the padimate O/
oxybenzone standard. For each test product, a maximum of three subjects may be
rejected due to test failures from the panel and replaced.
Subjects must provide an acceptable written informed consent document and a
medical history, including any instance of skin cancer, dysplastic nevi, current use
Table 18.1Permissible Wavelength range Percent erythemal dose contribution

ranges of the percent
<290 <0.1
erythemal dose contributions
290300 1.08.0
290310 49.065.0
290320 85.090.0
290330 91.595.5
290340 94.097.0
290400 99.9100.0
of any medication associated with sun sensitivity, abnormal responses to sunlight,

or phototoxic or photoallergic responses. Each subject must be in good general
health and have Fitzpatrick skin types I, II, or III.See Table18.2.
18.2.4 Procedures
Test sites are located on the subjects back, between the shoulder blades and the
beltline, and on either side of the midline. Test sites are demarcated using an indel-
ible surgical pen. There are typically four or six horizontally oriented rectangular
sites, with typical dimensions of 5cm by 10cm. The Final Rule requires an area of
at least 30cm2 for each product test site. Within each rectangular site, five sub-sites
are required, for each UV exposure. Above the rectangular sites, a space is reserved
for a horizontal row of two sets of five sub-sites for unprotected minimal erythema
doses. Irradiated sites must be separated by at least 0.8cm. See Fig.18.2. The per-
son who evaluates the results to determine the SPF should be blinded.
18.2.5 Initial Unprotected MED Dose Administration
On Day 1, after determining that the subject is qualified for participation in the
study, the technician will administer a timed series of five UV doses, increasing in
25% increments.
After determining that the subject has no adverse response, he or she will be
instructed to avoid UV exposure and prohibited medications and given an appoint-
ment to return to the testing laboratory, within 1624h after completion of UV doses.
18.2.6 Initial Unprotected MED Dose Administration
On Day 2, the subject will return to the testing laboratory within 1624hours after
completion of the unprotected MED doses, for evaluation of responses. The techni-
cian will question the subject nondirectively to assess compliance, to identify
Table 18.2 Fitzpatrick skin 1. Always burns easily; never tans (sensitive)
types
2. Always burns easily; tans minimally (sensitive)
3. Burns moderately; tans gradually (light brown) (normal)
4. Burns minimally; always tans well (moderate brown)
(normal)
5. Rarely burns; tans profusely (dark brown) (insensitive)
6. Never burns; deeply pigmented (insensitive)
Note: Skin type is based on first 3045min of sun exposure after
a winter season of no sun exposure
Fig. 18.2 Fitzpatrick Skin

Types
Initial unprotected MED Final unprotected MED
Test product Standard sunscreen
prohibited concomitant medications and UV exposures, and to identify and record

any adverse events. If the subject is eligible to continue, a trained evaluator will
assess the responses of the UV exposed sites, under warm fluorescent or tungsten
illumination of at least 450lx, to determine the initial unprotected MED.The MED
is defined as the smallest UV dose that produces perceptible redness of the skin
(erythema) with clearly defined borders at 1624h after UV exposure. The progres-
sion of intensity of the erythema must be consistent with the UV doses.
18.2.7 A
pplication ofTest Products andthePadimate O/
Oxybenzone Standard Sunscreen forSPF
Determination
On Day 2, the technician will apply 2mg per cm2 of each test product and the stan-
dard in its respective designated rectangle. The sunscreens will be applied by spot-
ting the material across the area and gently spreading, using a new finger cot for
each, until a uniform film is applied to the entire area. The finger cots will not be
pre-moistened before the applications.
18.2.8 UV Doses forTest Product MED
After at least 15min, the technician will administer a series of five progressively
increasing, timed UV doses to the sites treated with the test products and standard.
The dose series will be determined by the product of the expected SPF of each test
product and the subjects initial unprotected MED.See Table18.3.
18.2.9 U
V Doses forRepeat Unprotected Minimal
ErythemaDose
On Day 2, the technician will administer a timed series of five UV doses, increasing
by 25% increments, to an unprotected area of the mid-back. The series of five doses
will include the initial MED in the center as shown in Table18.4.
After determining that the subject has no adverse response, he or she will be
instructed to avoid UV exposure and prohibited medications and given an
appointment to return to the testing laboratory, within 1624h after completion of
UV doses.
18.2.10 Determination oftheSPF
On Day 3, the subjects will return to the testing laboratory within 1624h after
completion of the unprotected MED doses, for evaluation of responses. The
technician will question the subject nondirectively to assess compliance, to identify
prohibited concomitant medications and UV exposures, and to identify and record
any adverse events. Then a trained evaluator, who did not participate in product
applications or administration of UV doses, will evaluate all sites that received UV
doses. The technician will determine the repeat unprotected MED as above and
compute the SPF values for the test product SPF and standard sunscreen SPF for
each subject.
The final unprotected MED used for the SPF computation will be the repeat
unprotected MED unless the repeat unprotected MED cannot be determined. In that
case, the initial unprotected MED will be used for the SPF computation.
SPF values for individual subjects will be calculated as:
SPF = Protected MED / Repeat Final Unprotected MED

The mean SPF and standard deviation (SD) will be calculated from valid SPFi
values.
Table 18.3 Multiple of expected SPF and subject initial MED for each expected SPF
Expected SPF Multiple of expected SPF and subject initial MED
<8 0.64 0.80 1.00 1.25 1.56
815 0.69 0.83 1.00 1.20 1.44
>15 0.76 0.87 1.00 1.15 1.32
Table 18.4 Multiple of expected SPF and subject initial MED for each expected SPF
Multiple of initial MEDu
0.64 0.80 1.00 1.25 1.56
The standard error (SE) will be calculated as
SE = SD / n

where n equals the number of subjects who provided valid test results.
The t value from students t distribution table corresponding to the upper 5%
point with n1 degrees of freedom will be obtained.
The labeled SPF value will be determined as the largest whole number less than
the following calculation:
Labeled SPF = Mean SPF ( t *SE )

In order for the SPF determination of the test product to be valid, the SPF value
of the padimate O/oxybenzone standard should fall within the standard deviation
range of the expected SPF (i.e., 16.33.43).
18.3 Water Resistance Testing
Water resistance testing will be performed in an indoor fresh water pool, whirlpool,
or hot tub maintained at 2332 Celsius. The pool and air temperature and the
humidity should be recorded.
18.3.1 Water Resistance (40min)
The labeled SPF will be determined after 40min of water immersion using the fol-
lowing procedure:
. Apply the sunscreen as described in Sect.18.2.7.
1
2. Perform moderate activity in water for 20min.
3. Rest out of water for 15min. Do not towel test site(s).
6. Apply the SPF standard as described above.
7. Expose test sites to UV doses as described above.
18.3.2 Water Resistance (80min)
The labeled SPF will be determined after 80min of water immersion using the fol-
lowing procedure:
1. Apply the sunscreen as described in Sect.18.2.7.

9. Allow test sites to dry completely without toweling.
10. Apply the SPF standard as described above.
11. Expose test sites to UV doses as described above.
18.4 T
he Broad-Spectrum Protection Test (Critical
Wavelength Test)
18.4.1 Background
In 1993, Diffey [8] proposed a spectroscopic method for broad-spectrum

classification of sunscreens, based on the absorbance spectrum. The broad-spectrum
rating was determined by measuring the absorbance spectrum and integrating the
area under the spectral curve from 290nm to the wavelength at which the area
reached 90% of the total area under the absorbance curve from 290 to 400nm.
The FDA Final Rule of June 17, 2011 [10] defined the method for evaluating the
critical wavelength of sunscreen test products after irradiation with a full-spectrum
UV dose of four MEDs (800 effective J/m2), as follows:
18.4.2 Test Product Application
The amount of test product applied is 0.75mg/cm2. The test product is applied to the
entire roughened surface of each of at least three PMMA plates, with a roughness
value (Ra) of 27m [11], in a series of small dots. The test product is spread evenly
using a gloved finger, with a very light spreading action for approximately 30s,
followed by spreading with greater pressure for approximately 30s. The plates are
then allowed to equilibrate for 15min in the dark. After equilibration, the plates are
irradiated with a full-spectrum UV dose of four MEDs (800 effective J/m2).
18.4.3 Irradiation
After equilibration, the plates are irradiated with a full-spectrum UV dose of four
MEDs (800 effective J/m2) using a xenon arc solar simulator. The irradiation source
must meet the requirements as described in Sect.18.2.1.
18.4.4 Measurements
After irradiation of the plates, the UV transmission is at wavelengths from 290 to 400nm
at 1nm intervals using a radiometer equipped with an integrating sphere or an ultraviolet
radiation diffuser placed between the sample and the input optics of the spectrometer, to
ensure that the radiation received by the spectrometer is not collimated. The spectrom-
eter input slits must be set to provide a bandwidth that is less than one nanometer. In
addition, the dynamic range of the spectrometer should be sufficient to measure trans-
mittance accurately through a highly absorbing sunscreen product at all terrestrial solar
UV wavelengths (290400nm). Finally the UV dose during one measurement cycle
must not exceed 0.2J/cm2, and a total area of at least 2cm2 is measured on each plate.
The transmission is measured for five locations on the reference plate coated with 15l
of glycerin and five locations on the irradiated plates using a lamp that provides continu-
ous full-spectrum radiation from 290 to 400nm and measuring the transmitted spectral
irradiance. The mean transmittance for each wavelength, T(), is computed as follows:
5
P ( l ) / 5
T (l ) = 1
5
C ( l ) / 5
1
Then
A ( l ) = - log T ( l )

where A ( l ) is the mean absorbance at each wavelength.
The critical wavelength for each plate is then calculated as follows:
lc 400
A ( l )d l = 0.9 A ( l )d l
290 290
where c = critical wavelength
A ( l ) = mean absorbance at each wavelength
d = wavelength interval between measurements
Typical results are shown in Figs.18.3 and 18.4.
18.5 Pitfalls intheSPF Test
18.5.1 Radiometry
Daily radiation intensity measurements and annual calibrations of solar simulator

spectra must be conducted properly, using National Institutes of Standards and
Technology (NIST)-traceable instruments. Technicians who obtain measurements
1.2
1.0
0.8
Absorbance
0.6
Mean A Pre
Mean A Post
0.4
CW-Pre-Irradiation
CW-Post-Irradiation
0.2
0.0
290 310 330 350 370 390
Wavelength (nm)
Fig. 18.3 Mean absorbance and mean critical wavelength before irradiation and after a full-
spectrum UV dose of four MEDs (800 effective J/m2)
1.2
1.0
0.8
Absorbance
Mean A post
P1-Post
0.6
P2-Post
P3-Post
0.4
0.2
0.0
290 310 330 350 370 390
Wavelength (nm)
Fig. 18.4 Absorbance spectra, the mean absorbance spectrum, and the critical wavelength for
each plate after a full-spectrum UV dose of four MEDs (800 effective J/m2)
must be appropriately trained. One frequent mistake is measuring the output of a

UV source using a radiometer detector that is larger than the source. For example,
a radiometer detector that is 1cm in diameter to measure a UV source that is
0.8cm in diameter. Radiometers must be calibrated according to an appropriate
documented interval, and spectroradiometers used to calibrate radiometers must
also be calibrated according to an appropriate documented interval, by a qualified
expert [12].
18.5.2 Photosensitizing Drugs
Subjects must notify the laboratory of current or recent use of any medication asso-
ciated with sun sensitivity, abnormal responses to sunlight, or phototoxic or photo-
allergic responses. Since prospective subjects often forget or overlook
photosensitizing drugs they may be taking, it is helpful to read a periodically
updated list of potentially photosensitizing drugs to the subject before enrollment in
an SPF test. Lists are available on websites such as Medscape (http://emedicine.
medscape.com/article/1049648-overview).
18.5.3 Sunscreen Application
Technicians must be properly trained in application procedures for a wide range of

sample types, including liquids, lotions, creams, and sticks. Care must be taken to
apply a uniform film across the entire test area to ensure the proper concentration of
2mg per cm2. Subjects must be monitored to avoid inadvertently removing the sun-
screens during the test procedures.
18.5.4 Visual Grading ofResponses
An evaluator who is blinded to the application sites must be properly trained to

evaluate the erythema response. Inconsistent grading can lead to high variability. In
most cases, it is best to have the same evaluator for all subjects in an SPF panel.
18.5.5 Subject Compliance
Subjects that meet the inclusion/exclusion criteria need to be available for testing.
Test subjects must be able to meetall study requirements in the appropriate time
frames. Noncompliance can lead to unreliable data or missed deadlines.
18.6 Pitfalls intheBroad-Spectrum Test
18.6.1 M
easuring theCritical Wavelength intheBroad-
Spectrum Test
According to the FDA Final Rule, the spectroradiometer used to measure the critical
wavelength must provide a bandwidth less than one nanometer (nm). The Labsphere
2000, which is widely used for ISO 24443 and COLIPA tests for critical wavelength
and UVA protection factor determination, has a bandwidth of approximately 4nm

and does not satisfy FDA requirements.
18.6.2 Application ofTest Products toPMMA Plates
As with the invivo test, application can be a factor in unreliable results. The plates
are meant to simulate the surface of human skin. Too much or too little rubbing
during application can lead to differences in film thickness which can cause high
variability.
18.7 Conclusion
The sun protection factor (SPF) is a dimensionless ratio that estimates the protective
efficacy of a sunscreen against erythema. The aim of this chapter was, step by step,
to describe compliance of UV solar simulators, the assessment of the sun protection
factor (SPF) according to the FDA Final Rule, and the determination of the critical
wavelength of sunscreens to determine the degree of broad-spectrum protection.
References
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JPhysiol 146:118125
2. Schulze R (1956) Einige Versuche und Bemerkungen zum Problem der handelsblichen
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3. Cole C (2014) Sunscreens-what is the ideal testing model? Photodermatol Photoimmunol
Photomed 30:8187
4. Urbach F (1991) Franz GrieterThe man and his work. In: Riklis E (ed) Photobiology.
Plenum Press, NewYork, p761
5. Department of health, education and welfare, FDA, USA: Sunscreen drug products for over-
the-counter human drugs; proposed safety, effective and labeling conditions. Federal register.
43/166, 3820638269, 25 Aug 1978
6. Kollias N, Ruvolo E Jr, Sayre RM (2011) The value of the ratio of UVA to UVB in sunlight.
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53(192):199
8. Diffey BL (1994) A method for broad spectrum classification of sunscreens. Int JCosmet Sci
16:4752
9. COLIPA (1994) COLIPA SPF test method. Ref 94/289
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Europe
Part III
Chapter 19
Photoprotection in the Era of Nanotechnology
Adnan Nasir
Key Points
Photoprotection is embedded in the DNA of the human species. It has
undergone additional natural and social selection through body hair loss
and skin pigment loss.
Artificial photoprotection predates recorded human history in the form of
grooming habits, clothing, and application of tattoos, muds, and clays.
Some of these may have been comprised of accidental nanomaterials.
Early sunscreens were made of organic compounds with ring structures
which absorbed ultraviolet light and emitted infrared energy. They thus
absorbed UV light, generated heat, and could only be formulated in
lipophilic vehicles.
The modern era of nanoformulation has allowed for these same sunscreens
to be incorporated in a variety of cosmetically elegant vehicles, using
smaller quantities of active ingredient, for better and more stable
photoprotection and enhanced compliance.
Nanoparticles have also been used to develop inorganic and combination
topical sunscreens, as well as entities which combat the effects of
photodamage through a variety of other mechanisms, including physical
blockade, UV absorption, free radical quenching, antioxidant activity, and
delivery of DNA repair enzymes. We are just now witnessing the rosy
fingered dawn of the nano-era of photoprotection.
A. Nasir, MD, PhD

Department of Dermatology, UNC Chapel Hill,
3100 Thurston Bowles Bldg, Chapel Hill, NC 27544, USA

DOI 10.1007/978-3-319-29382-0_19
336 A. Nasir
19.1 Introduction
By some estimates, the number of products employing nanomaterials is doubling

annually. Products containing nanomaterials include consumer products such as
food and beverages, sporting goods, clothing, coatings for surfaces, personal care
products, and medications. Sunscreens also may contain nanomaterials. Some
products may be labeled as containing such, and some products may not have labels
designating nanomaterial contents.
In dermatology, sunscreen has been a critical area of development of nanomaterials
because of its beneficial effects in the prevention of premature aging of the skin,
sunburns, prevention of photosensitivity-related drug reactions, prevention of
exacerbations of photosensitive diseases, and prevention of skin cancer.
The rate of rise of the incidence of skin cancer over the past several decades has
been dramatic. In the early 1930s, the lifetime risk of developing skin cancer was
1 in 5000. By 2004, the rate rose to 1 in 65. If current trends continue, by 2050 the
lifetime risk of skin cancer will be 1 in 10. The causes for this rise are multifactorial
and may include environmental changes such as global warming, decreased ozone
layer protection, increased use of tanning beds, increased outdoor leisure activities,
increased travel to temperate and tropical climates, legacy of tobacco use, legacy of
radiation exposure, greater awareness, better diagnosis, and as yet undetermined
environmental and occupational exposures. Skin cancer accounts for nearly half of
all of the diagnosed cancers in United States each year. More than one million cases
of skin cancer, melanoma as well as nonmelanoma skin cancer, are diagnosed each
year, and one person dies every hour due to skin cancer.
There are a variety of other consequences to photodamage beyond photocarcino-
genesis. These include photoaging, photoimmunosuppression, and activation of
photosensitive dermatoses. UV light can significantly aggravate certain skin dis-
eases such as cutaneous lupus erythematosus, porphyrias, and some genodermato-
ses such as xeroderma pigmentosum. Recent studies have shown that strict
photoprotection prevents disease-specific lesions from forming by reducing direct
damage to the skin lesions and by reducing interferon-driven inflammation [1].
19.1.1 Solar Radiation
Less than 1 % of all of the ultraviolet light reaching the surface of the earth is in the
UVC range. About 0.35 % of the total radiation reaching the earth from the sun is
in the UVB range, and 6.5 % is in the UVA range. About 43 % of the light reaching
the earth is visible, and about 49 % is in the infrared range. The effects of these latter
two portions of light spectrum on the skin are not completely understood but are
now increasingly believed to be involved in some form photodamage.
While chronic exposure to UVA and UVB has been shown to contribute to sun-
induced aging of the skin, recent studies have shown that the skin may also be
19 Photoprotection in the Era of Nanotechnology 337
damaged by wavelengths outside the ultraviolet spectrum. These include photons in

the visible and infrared wavelengths. One of the reasons the traditional sunscreens
may not be as effective as desired may be the lack of efficacy against visible and
infrared light. Photoprotection in the visible and infrared wavelengths may require
the development of invisible topical antioxidants or visible and camouflaged photon-
blocking agents [2]. Interestingly, broad band light, particularly long-wavelength
broadband light, has shown to clinically [3] and genetically [4] improve skin signs
of photodamage.
Photoprotection of the skin involves protecting the skin from damage from light
of various sources including the sun and artificial light sources. The spectrum of
radiation emitted by light is characterized by its wavelength, frequency, and energy.
The entire electromagnetic spectrum ranges from gamma rays to a.m. radio waves
beginning at wavelengths as short as 0.0001 nm all the way to 100 m or longer. The
majority of the suns energy reaching the surface of the earth is contained in the
ultraviolet, visible, and infrared spectrum. Approximately 40 % of the suns rays are
in the visible range, 50 % are in the infrared range, 7 % are in the ultraviolet range,
and less than 1 % consist of x-rays, gamma rays, and radio waves.
There is an inverse relationship between frequency and wavelength. Frequency of
radiation is an inverse function of wavelength because the speed of light is constant.
Photons of longer wavelengths have a lower frequency of radiation and vice versa.
By contrast, energy is a direct function of frequency. The higher the frequency of
photons, the greater their energy. This energy, when it impinges upon vital structures
of the skin, can lead to skin damage. High-energy, or high-frequency, photons can
cause considerable damage to the skin, while low-energy, or low-frequency, photons
may cause damage but may require a greater total dose, necessitating longer
exposures.
The depth of penetration into the skin is an inverse function of the frequency of
photon energy. High-energy photons such as those in the UVC range are actually
blocked out by the ozone layer of the atmosphere and the stratum corneum. Medium-
energy photons such as those in the UVB range penetrate to be level of the epidermis
and the dermoepidermal junction. Lower-energy photons in the UVA range can
penetrate beyond the dermoepidermal junction into the mid and deep dermis.
19.1.2 Sunscreen History
19.1.2.1 Natural Hominid Photoprotection
Hair covering the body protects against ultraviolet light, trauma, abrasion, and some
parasites and microorganisms. One Australian study assessed the protective effects
of beards and mostaches under ultraviolet radiation [6]. Facial hair was found to
give the skin an ultraviolet protection factor of 221, depending upon the solar
zenith angle and beard-mostache length. Hair also can insulate and camouflage the
skin. Adaptations of hairlessness include less drag while swimming, less snagging
338 A. Nasir
in dense undergrowth, and reduced risk of overheating. Dark skin may have
developed hand in hand with the loss of body hair. Lack of hair and abundant and
highly active eccrine glands give hominids an advantage in cooling capacity.
Through the process of natural selection, melanin levels have been optimized to
minimize ultraviolet light damage, in order to protect folic acid and DNA from solar
rays while permitting enough light to penetrate the skin to stimulate adequate
vitamin D synthesis and photo conversion. Research has recently shown that sun
protection is probably not the primary driver of skin pigmentation. Common
ancestors shared among humans and chimpanzees have light pigmentation of their
skin covered by dark hair. This lightly pigmented skin is capable of tanning. This
type of response to sun exposure is far more effective at combating skin cancer and
far more adaptive than albinism.
Approximately one million years ago, early humans lost body hair and acquired
pigmented exposed skin in order to adapt to a hot sunny climate. Several lines of
evidence, including analysis of the MC1R gene, suggest that dark pigmentation was
acquired soon after loss of body hair [7]. Tightly curled hair on the head allowed
photoprotection and cooling, allowing air to breeze through, but blocking out
sunlight. Contemporaneously with MC1R gene changes, modifications in the
stratum corneum improved the epidermal barrier against abrasion and microbes.
Stratum corneum keratinocyte response to sun exposure includes immediate dark
pigmentation, which may be due to rearrangement of melanosomes and photo
oxidation of eumelanin.
Individuals with darker Fitzpatrick skin types tend to have a more intense
immediate pigmentary response. The delayed tanning response develops from hours
to days following UV exposure. Because skin cancer, even in sunny climates, tends
to occur after the age of reproduction, selective pressure for dark skin probably was
not designed to reduce the risk of skin cancer. Nonmelanoma skin cancer is typically
not fatal, and its incidence increases with age. Melanoma, while potentially fatal
and tending to occur more frequently in younger individuals, especially young
women, is rare compared to nonmelanoma skin cancer. For millennia, the Inuit have
carved snow goggles from caribou antlers and sinew, creating form-fitting curved
eye masks with narrow slits to limit light exposure to the eyes and prevent
photokeratitis.
19.1.2.2 Folic Acid and Vitamin D as Selective Pressures
Folic acid (vitamin B9) is used for DNA repair in and to prevent neural tube defects.
Low levels of folic acid induced by photolysis can also lead to reduced fertility
because of potentially fatal birth defects [8]. Folic acid is also important in sper-
matogenesis, and reduced levels may also potentially contribute to male infertility.
Ultraviolet light exposure reduces folic acid levels. Diminished folic acid levels are
detrimental to DNA repair and embryogenesis. Selective pressure would promote
tend to promote melanogenesis to preserve optimum folic acid levels. It has been
speculated that hunters and gatherers received significant amounts of vitamin D
through their diets of fish and animal livers. With the advent of agriculture, early
Europeans required vitamin D supplementation, and those with less pigment in
their skin were able to synthesize it with suboptimal ultraviolet light exposure.
Vitamin D receptors occur in 36 different tissues, and studies show the importance
of vitamin D in the immune system, the musculoskeletal system, the intestine, the
kidney, and the reproductive system. Vitamin D deficiencies have been associated
with rickets and multiple sclerosis. Because of its effect on reproduction, preserva-
tion of folic acid levels may have exerted more selective evolutionary pressure than
preservation of vitamin D levels.
19.1.2.3 Photoprotection History
Evidence suggests that recent changes in the skin, eye, and hair pigmentation have
been due to social and sexual selection. The ancient Egyptians considered light skin
more attractive than dark skin. In the desert environment, it was difficult to maintain
fair skin. Translations of hieroglyphics from Egyptian tombs have revealed
ingredients such as rice bran extract, jasmine, and lupine extract for treating damage
to the skin and reducing the likelihood of a tan or of a sunburn. One of the components
of rice bran extract, oryzanol, has been shown to have UV-absorbing properties [9].
Examples of low-cost photoprotectants using local materials can be found in
Southern Africa. African clays have been used for cosmetic purposes, ceremonial
purposes, ritual coming-of-age ceremonies, local hygiene practices, social signaling,
camouflage, and photoprotection. Aboriginal peoples of South Africa have used
two types of clay for photoprotection: red and white. The Xhosa tribes in the
Amathole Mountain area use red clay for face painting [10]. Clays are composed of
fine grains containing traces of metals such as nanoparticulate aluminum silicates,
organic matter, bound together by water in a mineral structure. In general particle
sizes of clays range from 1000 to 2000 nm. This permits tight aggregation and
packing of clay components. These clays have been studied for their photoprotective
properties [10]. Overall, it has been determined that clays from the Amathole Range
have a low sun protection factor but a broad spectrum of activity.
Before the modern era of photoprotection, sunburn was believed to the caused by
heat rather than ultraviolet light. In 1801, Johann Wilhelm Ritter discovered
ultraviolet rays. He described properties of light with wavelengths shorter than
those in blue and referred to light in this region as infraviolet (which we now term
ultraviolet). While Hippocrates and Aristotle developed early theories of skin color
and climate, it wasnt until 1820 that Everard Home of England dispelled the notion
that heat led to sunburns. He began exploring why inhabitants of temperate climates
have darker skin than inhabitants of northern climates. He found the correlation
surprising given the fact that darker skin tends to absorb more heat and lighter skin
less heat. He would have expected dark skin in colder climates as one means of
capturing as much ambient heat as possible. Home observed this directly when he
covered one of his pale hands with a dark cloth and left the other hand exposed to
sunlight. Even though the hand covered with the dark cloth registered a warmer
340 A. Nasir
temperature, it did not sunburn compared to the exposed hand. He surmised that
skin pigment protected against sunburn and that sunburn was not due to heat. Home
concluded that it was the dark pigment in skin, or melanin, which protected the skin
from ultraviolet light-induced damage.
In 1878, Otto Veiel had shown the benefits of tannin in protecting against
ultraviolet light. The usefulness of tannin was limited by its tendency to stain the
skin. In 1922, it was demonstrated that the wavelengths of light most likely to
induce sunburn were in the 280315 nm wavelength range. By developing filters
which specifically targeted this wavelength, the first sunscreens containing para-
aminobenzoic acid, benzyl salicylate, and benzyl cinnamate were developed.
Sunscreens were initially developed, and their use proliferated during the Second
World War in order to protect soldiers deployed in the Pacific tropics and the African
desert from sunburn causing rays. Early sunscreens blocked rays in the UVB portion
of the solar spectrum. Traditional measurements of sunscreen effectiveness have
focused on this portion of the light spectrum and have not addressed protection
against UVA or UBC or visible or infrared light.
The stigma of dark skin has led to a plethora of skin-lightening products. The impact
of these products has been greatest in countries like South Africa and India. Some of
these products contain mercury and have been the target of FDA regulation and United
States. In India, controversial skin whiteners have also been developed for the vaginal
area. Skin lighteners, when permanently depleting cutaneous melanocytes, can lead to
increased vulnerability to UV light and can mask the appearance of melanoma.
Nanoparticles can be formulated in a broad range of hues and can be manufactured to
make sunscreens which blend in with a variety of skin types. They may prove useful
for individuals who have undergone temporary or permanent lightening procedures.
19.1.3 Sunscreen Composition
Sunscreens are typically suspensions of active ingredients which may be organic

or inorganic. Organic sunscreens are typically composed of molecules contain-
ing carbon, hydrogen, oxygen, and nitrogen structured to absorb ultraviolet light
in the UVB and UVA range. Organic sunscreen molecules are typically small,
from a few to several dozen Angstroms in size. Organic sunscreens typically
have a ring structures with free electrons which capture ultraviolet light energy
and become activated to a higher-energy level. This excess energy is then released
at a longer wavelength and lower energy such as infrared energy. In order to
conserve energy, multiple infrared (IR) wavelength photons may be released to
balance the energy of a single incoming high-energy ultraviolet (UV) photon.
Thus, organic sunscreens can be thought of as UV to IR converters, absorbing
UV light and releasing heat.
19.1.3.1 Organic Sunscreens
The ring structures of organic sunscreens can be configured to have different

wavelength peaks and ranges of absorption. Combining a variety of organic
molecules can give rise to a broad spectrum of UV absorption. The majority of
sunscreen organic compounds that are approved by the FDA are excellent UVB
blockers. A smaller number of UVA blockers has been approved and is under
consideration for future approval.
19.1.3.2 Inorganic Sunscreens
Inorganic sunscreens typically are clusters of ions such as zinc, iron, or titanium
coupled to oxygen. These clusters are manufactured in particles ranging in size
from 10 to 300 nm. The mechanism of action of inorganic sunscreens differs from
organic sunscreens. Inorganic sunscreen effectively blocks and absorbs UV from
the 200 to 380 nm size range with a steep drop-off after 380 nm. Thus, inorganic
sunscreens have a high utility for UVC, UVB, and UVA light.
Macromolecular clusters of inorganic sunscreens are not generally accepted
by the public because of their opacity. They leave a white residue on the skin and,
if they are used at all, tend to be under used to minimize this effect. The opacity
is due to the light scattering effect of the large clusters of inorganic sunscreens.
Typical clusters of zinc oxide and titanium dioxide tend to be 200 nm or greater.
Clusters of this size are effective at scattering light of a wavelength twice their
diameters. Thus, large clusters of 200 mm or greater tend to scatter light in the
visible range, 400700 nm. Scattering of visible light when reflected to the eyes
appears quite. Organic sunscreens do not scatter visible light because of their
small size. Compared to a 200 nm particle of titanium dioxide capable of scatter-
ing light in the 400700 nm range, a one nanometer particle of methoxycinna-
mate is unable to scatter visible light.
Small particles are small obstacles to longer wavelengths of light. Objects much
smaller than visible light rays (100 nm or smaller) do not scatter visible light
effectively. Therefore, nanoparticulate sunscreens in the 100 nm size range or
smaller appear essentially invisible. Light scatter as a function of wavelength
demonstrates this phenomenon clearly.
19.1.3.3 Nanoformulation
Formulation of sunscreens in nanocarriers may offer advantages over traditional

formulation.
342 A. Nasir
Increased Spectrum Bandwidth
For example, butyl methoxy dibenzoylmethane and octocrylene in combination con-

fer broad-spectrum ultraviolet light protection. These are trapped in high densities in
lipid nanocarriers made from rice bran oil and raspberry seed oil. Sunscreens made in
this fashion reflect 9193 % of UVA and UVB rays, respectively, in cream formula-
tions containing only 3.5 % of active ingredient and 10.5 % of vegetable oils. The
carriers have been shown to be stable with very slow release kinetics after application
(417.5 % over 24 h). This ability to combine and concentrate broad-spectrum sun-
screen components in small biocompatible and biodegradable lipid carriers leads to
greater efficacy, greater flexibility in combinatorial formulation, reduced manufactur-
ing costs from reduced amount of active ingredient required, and superior efficacy.
Increased Stability
Naturally occurring photoprotectants in plants are unstable and rapidly degraded

once the plant is destroyed. The peels of apples are rich in photoprotective antioxi-
dant compounds. These can be extracted to yield apple peel ethanolic extracts
(APETE). The inherently unstable contents of these extracts can be stabilized when
incorporated into PLGA nanocarriers. In vitro studies have shown photoprotective
effects of nano-APETE carriers on cultured dermal fibroblasts.
Enhanced Release Kinetics
Some synthetic compounds are also subject to instability and aggregation as well as
potential percutaneous absorption. One example is 4-methylbenzylidine camphor.
When incorporated into microspheres, 4-MBC particles showed the same
photoprotective capacity as the free chemical compound, greater stability, and
significantly slower release kinetics.
Enhanced Compliance
This is discussed in more detail below but occurs as a result of the combination of
benefits and reduced risks of nanoformulation.
19.2 Sunscreen Analysis
Standard methods for evaluating sunscreens include the use of photometers and
animal and human studies to evaluate minimal erythema-inducing doses. Alternatives
to human and animal testing are constantly being developed to assess the protective
efficacy of sunscreens. One nanotechnology-based methodology involves a

so-called cell dosimeter [11]. This in vitro method measures specific DNA repair
enzymes as well as cell viability after exposure to radiation with UV light. In
addition, the assay is made more sensitive through the use of xeroderma pigmentosum
cells. This assay was able to demonstrate protection of cells using sunscreens
against UVB light, but not against UVA light or natural sunlight. Skin equivalence
has also been used to measure photodamage from ultraviolet light. The results can
be assessed by cyclopyrimidine dimer formation and sunburn cell formation.
Studies using skin equivalents have shown reduced cyclopyrimidine dimer formation
and sunburn cell formation when sunscreen was applied prior to dosing with
ultraviolet light.
19.3 Topical Agents
Topical sun protective agents include metallic physical blockers such as zinc oxide, tita-
nium dioxide; organic chemical filters such as cinnamates, benzophenones, Mexoryl
SX, XL, and Tinosorb M, S; antioxidants such as hydroxycinnamic acids, polyphenols
including flavonoids-genistein, silymarin, equol, quercetin, apigenin, green tea extract,
resveratrol, staxanti, anthocyanins, tannins, pycnogenol, and others (DHA, caffeine,
polygonum multiflorum)-fullerenes, N-(4-pyrodoxylmethylene)-1-serine, creatine, and
idebenone; nonsteroidal anti-inflammatory compounds such as COX-2 inhibitors; and
after-exposure compounds which affect DNA repair, such as the enzymes photolyase,
T4 endonuclease, and DNA oligonucleotides.
19.3.1 Fabrics
Other obvious sources of sun protection include hats, umbrellas, and shade struc-
tures (natural, such as terrain and foliage; as well as artificial, such as awnings and
roofs). The term umbrella derives from the Latin umbra, meaning shade or
shadow. Originally, umbrellas were developed in ancient Egypt and contained
palm fronds for sun protection. Modifications made their way to Europe through
the Greeks. The Chinese developed waterproof umbrellas for rain protection.
Sunglasses and photochromic contact lenses and intraocular lenses provide eye
protection; however, these have proved dangerous in the sudden dark of bridges
and tunnels [22]. As already mentioned, prehistoric circumboreal inhabitants have
carved slits in bones and antlers to develop snow goggles to prevent photokerati-
tis. Photoprotective glass can be found on vehicles and on industrial and residen-
tial windows. Nanomaterials are making inroads in modifying the fabric of
umbrellas and the photoprotective properties of lenses and building materials for
consumer use.
344 A. Nasir
19.3.1.1 Traditional Cotton
Studies of fabrics have shown that the sun protective factor (UPF) attributable to
clothing is directly proportional to the structure of the fabric and the tightness of the
weave in the fabric [12]. UPF numbers consistently increase after repeated washing
of cotton garments because of shrinkage and reduction in fabric aperture diameter.
For example, for pure cotton T-shirts, UPF increased from a baseline of 1940.6
after weekly washing for 10 weeks. After repeated washing, fabric shrinkage, and
knit hole size reduction, fabric hole area decreased from 8 to 3.9 %. Simple advice
for increasing the sun protective properties of clothing is to wear only after repeated
washing. Darker fabrics may also confer slightly greater photoprotection.
19.3.1.2 Electrospun Fibers
Modification of the fiber with nanomaterials may further enhance photoprotective

properties. Magnesium l-ascorbic acid 2-phosphate (MAAP) and -tocopherol
acetate (-TAC) are stable derivatives of vitamin C and E. In one study, using the
coaxial electrospinning technique, polyacrylonitrile nanofibers were coupled with
magnesium ascorbic acid phosphate and tocopherol acetate. Core-shell blended
nanofibers showed stable release and retention of their contents over 6 h. These
fibers have the potential for incorporation into textiles or sprays for long-lasting
topical application [13].
19.3.1.3 Optical Fabrics
Incorporation of light conducting nanofibers into woven material is the basis for
nanofibers using distributed optics [1418]. Distributed optics can be used for con-
duction and redirection of light of a desired wavelength. Distributed optical fabrics
may be used for biomedical monitoring of the wearer. They may be used to camou-
flage the wearer. They may be used for delivery of phototherapy to the wearers skin.
They may also prove useful for photoprotection using optical interference.
19.3.1.4 Radioprotective Fabrics
Rubberlike fabrics containing ultrafine powders of heavy atoms in a polyurethane,

polyvinylchloride matrix have been studied for scattering X-rays and gamma rays
[19]. These fabrics may be useful for radiation protection in the military and in
medicine. Medical uses could include protection of health care workers working
with radioactive materials and devices, as well as demarcating fields of the skin for
protection from radiotherapy [20].
In one Canadian study, Pb-free shielding materials containing barium, bismuth,
and gadolinium were compared in fabrics of single layers, bilayers, and in cream
formulations [21]. The ability of bismuth containing shielding materials to attenuate
radiation in the 60130 kV range compared favorably to Pb-based compounds. The

benefit of bismuth fabric is lighter weight.
19.3.2 Liposome
19.3.2.1 Definition
These are micro- and nanoparticulate vesicles with lipid bilayers consisting of
charged ionic phospholipids and cholesterol. The amphipathic phospholipids
typically consist of a polar head bound by phosphate and glycerol to two fatty acids
with chains of 1024 carbon atoms and 06 double bonds. Cholesterol is interspersed
in this lipid bilayer. Liposomes can be small (20100 nm) or up to 1000 nm. They
can be unilamellar, oligolamellar, and multilamellar.
19.3.2.2 Background
Liposomal nanoparticulate sunscreens have been investigated for their durability in

the presence of plain water and salt water as well as during profuse perspiration. In
one study, four separate preparations of SPF 50, 30, 25, and 15 were applied at the
recommended concentration of 2 mg/cm2 to the skin of 30 healthy adult volunteers
with Fitzpatrick skin type II [23]. Study subjects were then exposed to plain water
or salt water or made to perspire heavily. For all treated groups, the SPF 25 prepara-
tion showed a decreased protection factor 8391 % of baseline, while the remaining
sunscreens maintained a 96 % or higher relative protection compared to baseline.
Liposomal formulations of sunscreens offered persistent sun protection after expo-
sure of skin to plain water, salt water, and profuse perspiration in healthy adult
volunteers with Fitzpatrick skin type II.
19.3.2.3 Daylong actinica
In a pilot study of 20 patients with cutaneous lupus erythematosus, subjects treated

with a very high SPF broad-spectrum nanoformulated liposomal sunscreen (Daylong
actinica) noted significant protection from radiation with artificial UVA/UVB light
[24]. The findings were confirmed histologically on skin biopsy.
19.3.2.4 DNA Repair Enzymes
These are so-called morning-after creams because they are designed to repair
damage to cells after maximal threshold ultraviolet light exposure. One drawback to
these types of agents is thatby giving users an exaggerated sense of confidence
they may promote, rather than prevent, excessive sun exposure.
346 A. Nasir
Photolyase
Polymorphic light eruption is a common photodermatosis which may be due to a

combination of aberrant UV-induced immunosuppression and augmented immune
reactivity to haptens converted into antigens under the influence of UV light. In a
small randomized double-blind placebo-controlled trial, the protective effects of a
DNA repair enzyme containing topical lotion (containing photolyase from Anacystis
nidulans and Micrococcus luteus) were compared to placebo and SPF 30 sunscreen
after exposure to ultraviolet light in subjects prone to polymorphic light eruption
[25]. These after-exposure topical studies demonstrated reduced polymorphic
light eruption symptoms and scores in patients treated with the repair enzymes.
These studies suggest that liposomal preparations containing DNA repair enzymes
may prevent or blunt the effects of UV light on PLE.
T4 Endonuclease
Liposomes containing T4 endonuclease V or the heat-inactivated version of the

enzyme have been shown to reduce the incidence of basal cell carcinoma by 30 %
and actinic keratosis by 68 % in small studies of patients with xeroderma
pigmentosum [26]. In more recent studies, liposomal formulations were placed on
the skin of human subjects with a prior history of skin cancer 2, 4, and 5 h after
exposure to ultraviolet light [27]. Skin biopsies were taken and confirmed the
presence of the enzyme in the tissue of treated subjects. Histology did not show
significant changes in the UV-induced erythema response or microscopic sunburn
cell formation. However there was nearly complete attenuation of IL 10 and
TNF mRNA and protein production.
T4N5 liposome containing lotions have been shown to reduce UV-induced DNA
damage in the skin of patients with xeroderma pigmentosum. The heat-inactivated
enzyme is highly stable, can refold, and can recover enzymatic activity. Because
these DNA repair liposomes can eliminate damaged DNA within a few hours of
treatment, they may prove useful for combating the effects of ultraviolet light-
induced damage to the skin.
19.3.2.5 Disaccharides
Modification of ocular UV protectors with liposomes has shown some benefit for
their use in the skin. Trehalose is a naturally occurring disaccharide which is
typically used as a protein stabilizer to reduce ultraviolet light-induced damage to
the eye when topically applied to cornea. Liposomal formulations of trehalose were
evaluated for their photoprotective effects on human keratinocyte cell lines against
l-carnosine, ergothioneine, l-ascorbic acid, and DL--tocopherol [28]. The
trehalose-laden liposomes showed the greatest protection against the formation of
UV-induced cyclobutane pyrimidine dimers, 8-hydroxy 2-deoxy guanosine, and
protein carbonylation products.
19.3.2.6 Octyl Methoxycinnamate
Sunscreens made of liposomes encapsulating octyl methoxycinnamate showed

superior efficacy and delayed release kinetics compared to non-liposomal
formulations [29]. They had a higher sun protection factor, but did not show
increased water resistance compared controls.
19.3.2.7 Lipoic Acid
Liposomes containing magnesium ascorbyl phosphate, -lipoic acid, and kinetin

were tested for photoprotection in UV-irradiated hairless mice [30]. On mouse skin,
daily application for 4 weeks resulted in reduced transepidermal water loss and
sustained skin hydration and viscoelasticity. Free radical scavenging activity and
UV-induced damage protection were noted in mice. The viscoelastic and hydration
properties of the skin were found to be similar after 4 weeks of application on
human skin.
19.3.2.8 Resveratrol
Resveratrol is a botanical polyphenol with antioxidant and free radical scavenging

properties. Oligolamellar liposomes of a variety of compositions were loaded with
resveratrol and evaluated for their properties and stability over 60 days [31]. In tests
of photoprotection after UVB irradiation, HEK 293 cell lines were tested for
viability in the presence of free or encapsulated resveratrol. Free resveratrol was
less toxic and more UV protective then its free counterpart.
19.3.2.9 CDBA
CDBA, 4-cholesterocarbonyl-4-(N,N-diethylaminobutyloxy) azobenzene, is an

azobenzene compound which has shown enhanced UVA and UVB photoprotection
and stability in nanoliposomal formulations [32].
19.3.3 Elastic Liposome
A subset of liposomes are the deformable variety known as elastic liposomes. These
are able to interdigitate between keratinocytes in the stratum corneum and epidermis
to allow for better penetration persistence and distribution upon topical application.
Elastic liposomes loaded with benzophenone-3 in the 100 nm size range at a
concentration of 20.34 % (M/M) showed significant protective effects against
ultraviolet radiation [33].
348 A. Nasir
19.3.4 Niosome
19.3.4.1 Definition
Niosomes are vesicle carriers with an aqueous core surrounded by one or more
layers of phospholipids, typically cholesterol and one or more nonionic surfactants
such as alkyl ethers, alkyl esters, alkyl amides, long chain fatty acids, and amino
acids. Thus, the surfaces of niosomes are nonionic surface active agents, from
which the name is derived. They range in size from 100 to 200 nm. Niosomes tend
to be made from biocompatible and biodegradable agents. They tend to be nontoxic
and non-immunogenic. They are stable and highly resistant to hydrolytic degradation.
They are amphiphilic and can accommodate contents of a wide range of solubilities.
Niosomes are difficult and complex to formulate and may suffer from aggregation,
leaching, or dispersion, which can limit shelf life.
19.3.4.2 Background
Niosomes tend to have greater penetration capability than standard emulsions and
are typically more stable than standard liposomes. Thin film hydration is a common
manufacturing technique and has been used to make niosomes containing minoxidil.
Niosomes and liposomes containing avobenzone and arbutin are under development
to create sunscreens which have added pigment-reduction capacity [34].
19.3.4.3 Polyphenols
Polyphenols from black tea extract have been packaged in multilamellar niosomes
[35]. These were applied topically onto the skin of nude mice and shown to have
enhanced penetration of caffeine and gallic acid than comparable controls dispersed
in aqueous solutions. Black tea extract may be useful in the future as a topical
sunscreen when delivered in a niosome vehicle.
19.3.5 Ethosome
19.3.5.1 Definition
Ethosomes have been developed as transdermal drug delivery systems. They are a
type of soft vesicle composed of phospholipids (such as phosphatidylcholine, phos-
phatidylserine, and phosphatidic acid) in a high concentration of ethanol (2050 %)
and water (from which they derive their name). Ethanol acts as a permeation enhancer,
and its content can be varied to accommodate a broad range of active ingredients.
Ethosome size can be controlled from the nm to sub-mm range. Ethosomes are non-
toxic and can be formulated in creams, lotions, gels, and patches. Ethosomes can be
formulated for pilosebaceous targeting (minoxidil), transdermal hormone delivery

(testosterone), and transdermal drug delivery (i.e., trihexyphenidyl hydrochloride for
Parkinson disease, zidovudine for HIV, acyclovir for HSV, cyclosporine for psoriasis,
bacitracin for reduced toxicity, and cannabidiol for inflammation and edema).
19.3.5.2 Background
Ethosomes tend to be associated with enhanced drug penetration. They may

therefore have greater utility in photoprotection at the dermal level, such as delivery
of antioxidants, or repair enzymes.
19.3.5.3 Cucurma Longa
Turmeric extract from Cucurma longa was formulated in liposomes, ethosomes,

and transferosomes [36]. Alcoholic extracts prepared and ratios of 0.52 % W/W
were evaluated for their interaction with the skin. Entrapment efficiency was the
highest with transferosomes, in between with ethosomes, and least with liposomes.
This study suggested that nano-vesicles are maybe useful vehicles for optimal deliv-
ery of turmeric extracts to the skin for their antioxidant, astringent, antimicrobial,
and moisturizing properties.
19.3.5.4 Apigenin
Apigenin is a bioflavonoid which has been shown to have antioxidant activity and a
number of cellular targets involving GTPase activation, membrane transport, and
mRNA metabolism/alternative splicing [37]. It has been studied as a potential topi-
cal and systemic anti-inflammatory and antitumor agent. In one trial, optimization
studies were conducted to determine ideal formulations for delivery of apigenin to
the skin. Comparisons were made of ethosomes, liposomes, and elastic liposomes.
It was found that increasing phospholipid content in ethosomes (especially Lipoid
S75), propylene glycol content, and ethanol content enhanced skin deposition and
transdermal delivery. Optimized ethosomes showed the greatest reduction of cyclo-
oxygenase-2 levels in mouse skin after exposure to UVB light.
19.3.6 Solid Lipid Nanoparticle

19.3.6.1 Background
These are colloidal vehicles comprised of solid lipid cores mixed in defined ratios
with water or an aqueous surfactant. The lipids tend to be biocompatible,
biodegradable, and nontoxic, making them ideal for cosmetics and cosmeceutical
350 A. Nasir
preparations. Because of their small size, they pack tightly, have high occlusivity,
promote skin hydration, and limit transepidermal water loss. They are relatively
easy to manufacture, easy to scale up, and easy to sterilize, and dont require special
solvents. Some solid lipid nanoparticles, for example, crystalline cetylpalmitate
nanoparticles (CCP-NP), have inherent photoprotective activity [38]. Native
CCP-NP have about 23-fold greater UV-absorbing properties compared to
traditional emulsions. This effect has been shown to give synergistic and additive
photoprotective effects to sunscreen contents. For example, CCP-NP containing
2-hydroxy-4-methoxybenzophenone (Eusolex 4360) were threefold more
photoprotective compared to reference emulsions.
19.3.6.2 Definition
Solid lipid nanoparticles are designed to disperse and solubilize lipophilic

compounds in their cores. Lipids found in solid lipid nanoparticles can be mono-,
di-, and triglycerides, cholesterol, and waxes. These can be stabilized by emulsifiers
such as amphiphilic surfactants.
19.3.6.3 Benzophenone-3
Solid lipid nano- and microparticles prepared by the solvent-free spray-congealing

technique have been tested for durability of photoprotection and percutaneous absorp-
tion [39]. Solid lipid nanoparticles of benzophenone-3 have also been created by hot
high-pressure homogenization and shown to be more stable and less cytotoxic and
phototoxic than nanopolymer [poly(-caprolactone)] encapsulated benzophenone-3.
19.3.6.4 Zinc Oxide and Octocrylene
In order to broaden the spectrum of photoprotection, combination agents are some-

times indicated. Solid lipid nanoparticles can accommodate the formulation of two
otherwise immiscible ingredients. In one study, crystalline solid lipid nanoparticles
containing water-soluble zinc oxide and lipophilic octocrylene were shown to be
stable, photoprotective in the 290400 nm bandwidth, and shown to have synergistic
protection with the nanoparticles endogenous UV-blocking properties. The synergy
allowed for reducing the concentration of active ingredients to 0.6 %.
19.3.6.5 Lutein
Lutein has antioxidant and blue light-blocking properties. Because of its poor
solubility, it is an ideal candidate for lipid nanoparticle delivery to the skin. In one
study, lutein was incorporated into nanocarriers such as nanoemulsions (NE), solid
lipid nanoparticles (SLN), and nanostructured lipid carriers (NLC) using high-
pressure homogenization [41]. All three were found to be stable. The SLN had the
lowest release (0.4 %) of content after 24 h, compared to NE which had the highest
release (19.5 %). None of the lutein in SLN permeated pig skin after 24 h. Only a
small fraction (0.06 %) of the lutein was degraded after exposure to 10 MED,
compared to 68 % in the NLC, 14 % in the NE, and 50 % for lutein powder
suspended in corn oil.
19.3.6.6 Tocopherol
Synthetic solid lipid nanoparticles were shown in one study to have inherent UV protec-
tive activity. This effect was synergistically augmented with the incorporation of tocoph-
erol acetate. Solid lipid nanoparticles containing tocopherol were twice as effective at
UV blockade than reference emulsions containing identical lipid content [5, 40, 42, 45].
19.3.6.7 Titanium
SLN prepared using conventional and hybrid methodologies were able to enhance
the photoprotectivity of titanium dioxide compared to reference emulsions [43].
They were also able to allow lower concentrations of titanium dioxide for equivalent
photoprotection.
19.3.6.8 Chitin
Chitin is poorly soluble in most aqueous formulations and emulsions. Preparations

of SLN containing 3,4,5-trimethoxybenzoylchitin were shown to act as effective
sunscreens [44]. The effect was synergistic with the endogenous UV-blocking
activity of the SLN and could be augmented with the incorporation of tocopherol.
19.3.7 Nanostructured Lipid Carrier
19.3.7.1 Background
These are second-generation solid lipid nanoparticles. The core of nanostructured

lipid carriers is a blended mixture of solid lipid and liquid lipid as a hybrid carrier.
The solid lipid is a long chain fatty acid, and the liquid lipid is a short chain fatty
acid. The ratios of the blends are 70:30 (long/short) to 99.9:0.01 (long/short).
Nanostructured lipid carriers are used to overcome unfavorable solid lipid
nanoparticle tendencies such as particle growth, unpredictable gelation, poor drug/
active ingredient loading, and drug/active expulsion during storage. Typical solid
352 A. Nasir
lipids used include bees wax, carnauba wax, Dynasan, precifac, stearic acid, apifil,
and Cutina CP. Typical liquid lipids include Cetiol V, Miglyol, castor oil, oleic acid,
davana oil, palm oil, and olive oil. Sometimes emulsifiers are added to optimize the
blend. These can include Miranol Ultra, PlantaCare, Tween 80, Pluronic F68,
Poloxamer 188, and Phospholipon 90G. In dermatology, nanostructure lipid carrier
preparations have been used for sunscreens and topical drugs (minoxidil, tacrolimus,
miconazole nitrate).
19.3.7.2 Definition
Solid lipid nanoparticles typically have a crystalline matrix with little room for
active ingredients. This often leads to drug expulsion out of the particles over time
and a rapid drop-off in efficacy. Nanostructured lipid carriers are a hybrid of a solid
lipid surrounding a liquid lipid drug carrier space. This leads to enhanced drug
loading and stable storage.
19.3.7.3 Tocopherol
Tocopherol has more potent antioxidant activity than its conjugate tocopherol ace-
tate; however, it is viscous, poorly soluble, and photo-unstable and can cause irritant
dermatitis. In one small study, the high-pressure homogenization technique was
used to create nanostructured lipid carriers and nanoemulsions of tocopherol.
Particle sizes of 67 nm NLC and 586 210 nm NE were formed. About 30 %
tocopherol was released from the NLC within 2 h, while only 4 % was released
from the NE. Both formulations were shown to retain antioxidant activity, to be
non-irritating, and to protect tocopherol from UV degradation.
19.3.7.4 Chemical Sunscreens
Ethylhexyl triazone (EHT), diethylamino hydroxybenzoyl hexyl benzoate (DHHB),

Bemotrizinol (Tinosorb S), octyl methoxycinnamate (OMC), and avobenzone
(AVO) are chemical sunscreens which offer a broad spectrum of photoprotection
into the UVA range [46]. These agents differ in their solubility, spectrum of activity,
and stability. They were incorporated into nanostructured lipid carriers and
nanoemulsions formulated to optimize topical application and their properties
evaluated. When these agents were incorporated into nanostructured lipid carriers,
their permeability into the skin was dramatically reduced, and they remained on the
stratum corneum. OMC and AVO were not as photo-stable as predicted, while the
remaining compounds retained their photostability. No significant difference was
seen in the photoprotection between nanoemulsions and nanostructured lipid
carriers.
19.3.7.5 Wax Carriers
Formulations composed of three molecules (ethylhexyl triazone, bis-

ethylhexyloxyphenol methoxyphenyl triazine, and ethylhexyl methoxycinnamate)
in a carnauba wax nanostructured lipid carrier and beeswax nanostructured lipid
carrier were synthesized in one study using hot high-pressure homogenization [47].
Particle sizes were 200 nm. The carnauba wax preparations had 45 % higher SPF
values compared to beeswax nanostructured lipid carriers, showing that the photo-
protective effects of the nanostructured lipid carrier depended as much on their lipid
composition as on their structure.
19.3.7.6 Ethylhexyl Methoxycinnamate
Ethylhexyl methoxycinnamate (EMC) is typically used as a UVB blocker; however,

it is poorly soluble and photolabile. Micro- and nanoparticles in one study were
made from rice bran wax, ozokerite, and glyceryl behenate and formulated to
contain 70 % EMC by lipid mass [48]. Nanoparticles were found to have twice the
absorbance of light at 310 nm compared to the microparticles, regardless of
composition. Native EMC lost 30 % of its efficacy after 2 h of UV exposure,
compared to 1021 % loss for the NLC formulations. No significant penetration of
EMC was shown for the NLC preparations.
19.3.7.7 Lycopene
Nanostructured lipid carriers composed of biocompatible lipids from rice oil and
cholesterol were manufactured to be loaded with lycopene. Particle sizes of
nanostructured lipid carriers ranged from 287 to 405 nm. Cholesterol was found to
reduce stability of particles and its exclusion as well as storage at 4 C or room
temperature led to the greatest stability [49, 50].
19.3.8 Microsphere
These are powders consisting of natural materials or biodegradable polymers.

Natural materials can include proteins (albumin, gelatin, collagen) or carbohydrates
(starch agarose, carrageenan, chitosan). Polymers can include PMMA, epoxy
polymers, lactides, glycolides, block copolymers, polyalkyl cyanoacrylates, and
polyanhydrides. Particle sizes tend to be less than 200 m. Microspheres can be
microcapsules, with active ingredients in the interior, or micromatrices, where the
active ingredient is dispersed evenly throughout the particle.
354 A. Nasir
The UV filter 4-methylbenzylidene camphor (4-MBC), while offering excellent

photoprotection, suffers from photo-instability, rapid drop-off in efficacy, undesirable
percutaneous absorption, and potential effects on the thyroid gland. Microspheres
containing 4-MBC formulated in oil/water emulsions have been demonstrated to have
the same photoprotective activity as native 4-BMC preparations, but with longer dura-
tion of activity and slower release from emulsions [51].
19.3.9 Gold
Gold metal particles are emerging it has excellent candidates for nanomaterials
with biologic uses. Gold nanoparticles are biocompatible, easy to synthesize,
and easy to conjugate with a number of other compounds. They have been used
for cancer diagnosis and therapy, drug delivery, and as biologic probes.
Phytolatex synthesized gold nanoparticles have been shown to enhance the sun
protection factor of sunscreen when added to native sunscreen at 24 % concen-
trations [52].
19.4 Safety
19.4.1 Hazards of Traditional Sunscreens

19.4.1.1 Dermatitis
Contact dermatitis from topical and cosmetic agents accounts for up to 4 % of

dermatology visits, and more than half of these are due to allergic contact dermatitis
[53, 54]. Irritant and allergic contact dermatitis and photo-contact dermatitis need to
be considered when dispensing sunscreen. Contact dermatitis studies in children
have shown that more than 6 % are photoallergic to traditional UV filters or vehicles.
The most common allergies are to benzophenone-3, octyl methoxycinnamate, and
para-aminobenzoic acid.
19.4.1.2 Absorption
A number of sunscreen ingredients have been detectable in the plasma follow-

ing topical administration [55]. These are largely organic compounds such as
benzophenone, octyl methoxycinnamate, and 4-MBC. Nanoparticulate and
microsphere versions of these compounds have a reduced tendency to be
absorbed and can be used in lower concentrations for the same degree of
photoprotection.
19.4.1.3 Endocrine Disruption
It is generally recommended that oxybenzone and octocrylene be avoided in children

[5658]. Vitamin D deficiencies can occur from application of sunscreen, but these
are more likely when 2 mg/m2 are applied, which is the recommended dose.
Applications of 1.5 mg/m2, which are more in the range of typical applications in
most subjects, do not significantly inhibit production of vitamin D3.
19.4.1.4 Instability
Sunscreen ingredients can degrade upon UV exposure, chlorinated water exposure,

oxidation, or exposure to high temperatures [59]. Nanoparticulate formulations of
sunscreens tend to be more stable to heat, light, and reactive oxygen species.
19.4.1.5 Narrow Spectrum of Activity
Individual components of sunscreen typically have narrow ranges of protection in

either the UVB or UVA portion of the electromagnetic spectrum. Broad-spectrum
sunscreens require mixtures of two or more ingredients to achieve adequate
photoprotection. Nanoformulations of metallic physical blockers can offer broad
protection blockage with a single ingredient.
19.4.1.6 Lack of Compliance Due to Formulation
Traditional organic sunscreen components are lipophilic and require an oil-based

vehicle for dissolution. These formulations can have a greasy feel, can be
comedogenic, and can be difficult, especially for male patients, to adopt on a regular
basis. One reason for the higher incidence of skin cancer in men, particularly over
the age of 50, may be the lack of regular sunscreen use, possibly due to formulations
which do not appeal to this segment of the population [60].
19.4.2 Benefits of Nanoformulations
19.4.2.1 Less Ingredient Required
Because of their greater efficacy, their high surface-to-volume ratio, their high
occlusivity, and their controlled stability, nanoformulations of sunscreens tend to
require lower total concentrations of active ingredient (organic or inorganic) than
their traditional counterparts. This can lead to lower manufacturing costs and
356 A. Nasir
potentially lower overall exposure to chemical agents. Some studies have shown
that high concentrations of physical blockers can cause perioral dermatitis [61].
19.4.2.2 Detoxification
Concern about hazards associated with metallic nanoparticles stems from in vitro
studies showing the generation of free radicals. Some studies showed that the level
of clastogenicity increased upon UV exposure. However, comparisons of zinc
oxide nanoparticles to known photoclastogens such as 8-MOP [62] showed sub-
stantially minimal effects (24 increase in vitro for zinc oxide, and >15,000
increase for 8-MOP). The Ames test showed no increased mutagenicity for zinc
oxide. Human studies have shown no evidence of phototoxicity. Commercial
nanoparticulate sunscreens have been coated to detoxify them. Coating of nanome-
tallic sunscreens with inert oxides of silica has been shown to eliminate the risk of
reactive oxygen species generation. Furthermore, aggregation of nanoparticles
reduces their surface-to-volume ratio and reactivity. A number of studies have now
shown very little to no dermal penetration of metallic sunscreen nanoparticles fol-
lowing application to the skin. This includes studies of intact, flexed, and stripped
skin. Minimal penetration has been noted on abraded skin. One study of hairless
mice showed slight differences in absorption of nanoparticulate zinc when com-
pared to larger particle size zinc, but no toxicity and no effect on zinc homeostasis
[6365]. Furthermore, permeability comparisons demonstrate that pig and rat skin
are 4- and 911-fold more permeable than human skin. Most of the recent studies
show minimal or no absorption.
19.4.2.3 Vehicle Flexibility
Because nanoformulation allows for the precise selection of particle size, shape,
charge, and chemical composition, nanophotoprotective agents can be manufactured
in a wide variety of formats and vehicles to allow for optimal stability, UV protection,
composition, and texture to permit the widest possible range of adoption and
compliance.
19.5 Compliance
19.5.1 Cosmetic Elegance
One of the greatest hurdles to sunscreen uses compliance. Optimal application

requires at least 2 mg/cm2 be applied evenly and smoothly across the intended
surface with frequent reapplication to account for rubbing, perspiration, and
immersion-related loss. In one study of vacationers interviewed at an airport on

their way to and returning from a vacation, many were found to have the misconcep-
tion that tanning prior to departure for a tropical vacation would lead to sunburn,
and nearly 44 % were found to be sunburned upon return [66]. Furthermore, while
many travelers understood the need to use sunscreen, many did not factor the use of
protective clothing, hats, and eyewear into their vacation plans. Studies have shown
that patients are more likely to comply with sunscreen use when using an emollient
of their choice. Typically, patients tend to prefer less greasy vehicles to greasier
ones. This is a realm in which nanoformulation enjoys a distinct advantage.
19.5.2 Viscous Fingering
Studies have shown that patient education on application technique is important in

improving the efficacy of sunscreen. A well-studied problem in the application of
sunscreen is known as viscous fingering. This is the formation of stripes and grooves
along the pattern of fingers use to apply sunscreen. This nonuniform but widely
practiced application method leads to reduced efficacy. A technique of application
developed in France in which subjects dose sunscreen, apply it, and then spread it
was shown to be readily adopted and understood by subjects and to result in more
evenly applied sunscreen and a greater quantities, more in line with what is
considered adequate. Some researchers have suggested regulations for the education
material associated with sunscreens in order to assure proper application technique
[67].
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59. Crista DM, Miranda MS, Esteves da Silva JC (2015) Degradation in chlorinated water of the
UV filter 4-tert-butyl-4-methoxydibenzoylmethane present in commercial sunscreens.
Environ Technol 36(912):13191326
60. Buller DB, Andersen PA, Walkosz BJ, Scott MD, Maloy JA, Dignan MB, Cutter GR (2012)
Compliance with sunscreen advice in a survey of adults engaged in outdoor winter recreation
at high-elevation ski areas. J Am Acad Dermatol 66(1):6370
61. Abeck D, Geisenfelder B, Brandt O (2009) Physical sunscreens with high sun protection factor
may cause perioral dermatitis in children. J Dtsch Dermatol Ges 7(8):701703
62. Dufour EK, Kumaravel T, Nohynek GJ, Kirkland D, Toutain H (2006) Clastogenicity, photo-
clastogenicity or pseudo-photo-clastogenicity: genotoxic effects of zinc oxide in the dark, in
pre-irradiated or simultaneously irradiated Chinese hamster ovary cells. Mutat Res
607(2):215224
63. Osmond-McLeod MJ, Oytam Y, Kirby JK, Gomez-Fernandez L, Baxter B, McCall MJ (2014)
Dermal absorption and short-term biological impact in hairless mice from sunscreens
containing zinc oxide nano- or larger particles. Nanotoxicology 8(Suppl 1):7284
64. Leite-Silva VR, Le Lamer M, Sanchez WY, Liu DC, Sanchez WH, Morrow I, Martin D, Silva
HD, Prow TW, Grice JE, Roberts MS (2013) The effect of formulation on the penetration of
coated and uncoated zinc oxide nanoparticles into the viable epidermis of human skin in vivo.
Eur J Pharm Biopharm 84(2):297308
65. Adachi K, Yamada N, Yoshida Y, Yamamoto O (2013) Subchronic exposure of titanium diox-
ide nanoparticles to hairless rat skin. Exp Dermatol 22(4):278283
66. Kster B, Thorgaard C, Philip A, Clemmensen IH (2011) Vacations to sunny destinations,
sunburn, and intention to tan: a cross-sectional study in Denmark, 2007-2009. Scand J Public
Health 39(1):6469
67. Fujikake K, Tago S, Plasson R, Nakazawa R, Okano K, Maezawa D, Mukawa T, Kuroda A,
Asakura K (2014) Problems of in vitro SPF measurements brought about by viscous fingering
generated during sunscreen applications. Skin Pharmacol Physiol 27(5):254262
Chapter 20
The Role of Topical Antioxidants
in Photoprotection
Mary S. Matsui
Key Points
There many reasons for interest in the photoprotective potential of topical
antioxidant botanical extracts. These include consumer demand for non-
sunscreen photoprotective ingredients, the understanding that longwave
(UVA) ultraviolet radiation in particular induces considerable oxidative stress,
and an interest in supplementing sunscreen formulations to increase stability
and protection while decreasing the use of chemical and physical sunscreens.
The botanical product most studied for topical photoprotection is derived
from Camellia sinensis, the tea plant. Topical application of the most potent
constituent, EGCG, has been shown to inhibit UV-induced leukocyte infiltra-
tion, DNA damage, immune suppression, dermal degradation, and erythema.
Other botanicals that have been demonstrated to have photoprotective
properties include genistein, resveratrol, grape seed proanthocyanidins,
Polypodium leucotomos (fern) extract, and certain combinations of ferulic
acid, vitamin C, and vitamin E.
Sunscreens formulated with antioxidants/botanical extracts may have
additive or synergistic photoprotective effects when compared with either
of these agents alone.
Variables that impact the benefits of botanical extracts or other antioxi-
dants include unknown optimal concentrations, possible interactions
between ingredients, and the instability of antioxidants. At present, there is
no labeling information requirement for ingredient concentration, and at
least one study showed that the levels of antioxidants in some off the
shelf sunscreen products were below that required for efficacy.
M.S. Matsui, PhD

Executive Director, External Research R&D Basic Science and Technology,
The Estee Lauder Companies, Inc., 125 Pinelawn Rd., Melville, NY 11747, USA
e-mail: [email protected], [email protected]

DOI 10.1007/978-3-319-29382-0_20
362 M.S. Matsui
For several reasons, there is great popular interest in the use of topical antioxidants
for skin photoprotection and antiaging therapies. Many consumers, influenced
particularly by numerous Internet sources giving nonmedical advice, information,
and testimonials, believe that naturally derived ingredients, plant extracts, and
food components are superior or healthier than chemical sunscreens. Other factors
contributing to the popularity of these types of alternative products include
dissatisfaction with the aesthetic properties of current sunscreen/sunblock products,
the perception that the chemicals in OTC products are unhealthy, unsafe, or damage
the environment and the belief that natural ingredients provide additional benefits
not found in sunscreens. Finally, there is interest in supplementing sunscreen
products by manufacturers, as there is some evidence that it is possible to stabilize
sunscreens with antioxidants [2]. This chapter will discuss the topical use of
antioxidants, primarily but not exclusively in the form of botanical extracts and will
review the scientific evidence for their efficacy against the damaging effects of
ultraviolet radiation (UVR) on human skin.
Endogenous antioxidants that scavenge for ROS include superoxide dismutase,
glutathione peroxidase, ascorbate, alpha-lipoic acid, and catalase. Excessive ROS
generated during UV exposure depletes endogenous antioxidants and causes a state
of oxidative stress in cells that can damage cellular proteins, lipids, and DNA,
trigger apoptosis, and contribute to photocarcinogenesis. A review of endogenous
antioxidant strategies and oxidant-induced cellular damage and mechanisms can be
found in Khan et al. [22]. Also, in particular, Table 1 and Fig. 1 contained in an
earlier review [1] are recommended for a concise summary of botanicals and their
mechanisms of action.
Sunscreen/sunblock ingredients protect skin from solar radiation through three
basic mechanisms: reflection, dispersion, and absorption (for review, see Schalka
and Silva dos Reis [34]). In contrast, antioxidants generally have little to no ability
to physically block UVR and act to protect the skin by other mechanisms. The
efficacy of sunscreens to protect skin against UVR is virtually universally measured
and regulated by specific, in vivo (UVB) and in vitro (UVA) assays such as sun
protection factor (SPF) which is based on UVR-induced erythema, immediate
pigment darkening, and critical wavelength. Because erythema is primarily driven
by direct DNA damage and repair and less by oxidative stress, UVR protection
provided by antioxidants is best measured by endpoints other than SPF. In addition,
it should be noted that significant damage, including DNA mutations, immune
suppression, and collagen breakdown can occur in the absence of sunburn.
There is some epidemiological evidence that higher dietary or systemic levels of
antioxidants are associated with a lower risk of nonmelanoma skin cancers and
photoaging signs in humans [3, 7, 15, 33], and there are animal/rodent studies
showing this efficacy for oral supplementation of antioxidants. There is extensive
experimental evidence that exogenous antioxidants are anti-inflammatory and
suppress oxidative stress pathways in in vitro cell culture and that topical antioxidants
are photoprotective in acute and chronic animal models of UVR-induced skin
damage. Reviews of these data can be found in Afaq and Mukhtar [1], Khan et al.
[22], and Passantino et al. [32]. This chapter will focus on the most recent data
20 The Role of Topical Antioxidants in Photoprotection 363
Fig. 20.1 UV radiation initiates production of reactive oxygen species (ROS), which is followed
acutely by secondary messengers and increased expression of proinflammatory cytokines. Long-
term, exposure results in decreased collagen production and increased collagen breakdown,
leading to signs of skin photoaging (Reproduced from Zussman et al. [44])
obtained from topical application of antioxidants/botanical extracts in human,

in vivo clinical models.
In practice, antioxidants in topical products are supplied largely as botanical
extracts, including those from green, black, white, and red teas, pomegranate,
cabbage, broccoli, soybeans, grapes, tomatoes, turmeric, ginger, algae, and
chocolate. They can include polyphenols, carotenoids, tocopherols, tocotrienols,
glutathione, ascorbic acid, flavonoids, proanthocyanidins, stilbenes, coumarins,
lignans, omega-3 polyunsaturated fatty acids, and enzymes with antioxidant activity.
There are a few antioxidants that are supplied as is, most notably vitamins C and
E. For the most part, topical antioxidant constituents overlap oral or systemic non-
sunscreen botanical ingredients that provide photoprotection, which are reviewed in
Chap. 22.
The detrimental effects of solar exposure include sunburn, UV-induced immune
suppression, skin cancer, and photoaging. Ultraviolet A (UVA) (320400 nm)
exposure induces the generation of reactive oxygen species (ROS) such as
superoxide, hydrogen peroxide, lipid peroxyl, nitric oxide, singlet oxygen, and
hydroxyl radicals which damage proteins and cellular structures. UVA-induced oxi-
dative stress is considered responsible for increased prostaglandin E2 and activation
of the epidermal growth factor receptor, both of which are involved in causing
364 M.S. Matsui
epidermal hyperproliferation and inflammation [24, 25]. It has also been shown that
ultraviolet B wavelengths (290320 nm), in addition to being directly absorbed by
DNA bases and causing mutagenic lesions such as cyclobutane pyrimidine dimers
(CPDs) and pyrimidine(6-4)pyrimidine photoproducts (6-4PPs), are also capable of
initiating oxidative stress [35]. Increased ROS generation can overwhelm endoge-
nous antioxidant defense mechanisms, resulting in oxidative stress and oxidative
photodamage of proteins and other macromolecules in the skin. These ROS are
believed to be critical mediators of the photoaging and photocarcinogenesis pro-
cesses. Exposure to either UVA or UVB can result in oxidation of amino acid resi-
dues such as lysine, arginine, and proline, which leads to the formation of carbonyl
derivatives that affect the structure and function of proteins. Other protein-related
damage includes tyrosine cross-links, amino acid interconversions, and peptide
bond cleavages. Lipid peroxidation also damages cell membranes, and a major oxi-
dative lesion in DNA is 8-hydroxy-2-deoxyguanosine (8-OHdG). The cascade of
events leading to clinical signs of photoaging is shown in Fig. 20.1. Repeated expo-
sure to ROS leads to an accumulation of cellular damage and visible signs of pho-
toaging. Considering the extent of potential damage, the most important attribute of
antioxidants is their capacity to quench reactive oxygen species (ROS) and prevent
the resulting cascade of protein, lipid, and DNA oxidation, which leads to inflam-
mation, mutation, and structural/functional damage.
Four main categories of research models are available to study the effects of
antioxidants on prevention of photodamage to human skin: in vitro chemical anti-
oxidant properties, in vitro cell-based assays, animal (mouse) in vivo, and human
in vivo models. As to the first category, chemical analytical methods, basic antioxi-
dant properties have been compiled for edible plants and foodstuff in vitro [6, 13,
23]. Screening for active ingredients to include in topical photoprotective products
can be facilitated by assays as the ferric-reducing ability of plasma (FRAP), the
oxygen radical absorbance capacity assay (ORAC) assay, and the DPPH radical
scavenging efficacy. Tissue culture work has provided considerable understanding
of basic mechanisms, and animal studies have shown the benefits of topical antioxi-
dants against UVR-induced carcinogenesis. These have been reviewed elsewhere,
and so in vivo human studies will be emphasized in this chapter.
The botanical product most studied for topical photoprotection is derived from
Camellia sinensis, the tea plant. Tea is one of the most widely consumed beverages
in the world, second only to water, and has been long regarded for its antioxidant,
anti-inflammatory, and anticancer properties. Tea is commercially available mainly
in three forms: green, black, and oolong tea, but white and red can also be found. Of
the total commercial tea consumption worldwide, about 78 % is consumed in the
form of black tea (primarily Europe, Russia, the Middle East, India, and North
America), and about 20 % is consumed in the form of green tea (primarily Asian
countries like, Japan, China, Korea, parts of India, and a few countries in North
Africa and the Middle East). Tea contains variable amounts of three main types of
polyphenols (flavonoids, stilbenes, and lignans). Flavonoids are divided into six
subclasses: flavonols, flavones, isoflavones, flavanones, anthocyanidins, and
flavanols. Of the flavonoids, the majority are monomeric flavanols called catechins.
The four main catechin compounds are ()-epigallocatechin-3-gallate (EGCG),

()-epigallocatechin (EGC), ()-epicatechin-3-gallate (ECG), and ()-epicatechin
(EC). The most extensively studied catechin with potent antioxidant, anticancer,
and anti-inflammatory properties is EGCG (reviewed in OyetakinWhite et al. [31];
Nichols and Katiyar [30]).
The benefits of tea polyphenols (TP) against UV-induced effects were first
demonstrated in human skin by [19]. This report showed that topical application
to human skin of ()-epigallocatechin-3-gallate (EGCG), the major polyphenolic
constituent in green tea, was able to inhibit UVB-induced infiltration of leuko-
cytes (macrophage/neutrophils) and generation of prostaglandin (PG) metabo-
lites, particularly PGE2. This is important because infiltration of leukocytes is a
major source of ROS in skin exposed to UVR, and PG metabolites play a criti-
cal role in free radical generation and skin tumor promotion in multistage skin
carcinogenesis.
In this and subsequent related papers, the overriding goal was to compare, in
humans, the impact of topical tea extracts against markers of UVR damage
associated with immune suppression, carcinogenesis, and photoaging. It is important
to distinguish the mechanisms of action possible for botanical photoprotection and
to exclude the possibility that green tea extracts (as well as other botanicals) act
merely as a sunscreen. Unlike sunscreens, GTPs do not appear to absorb signifi-
cantly in the terrestrial solar spectrum, as their UV absorption maxima occurs at
273 nm. Because the tea extract (particularly at the concentrations used in vivo)
does not appreciably absorb UVB wavelengths, it does not effectively filter out
erythemogenic UVR wavelengths. One implication of this is that TPs, when com-
bined with topical formulations that contain traditional sunscreens, may have addi-
tive or synergistic photoprotective effects when compared with either of these
agents alone.
In a 2001 study, skin on the back of human subjects was pretreated for 30 min
with solutions of 0.2510 % GTPs in ethanol [8]. The skin was then irradiated with
a solar simulator at twice the individuals minimal erythema dose (MED). At 24, 48,
and 72 h postexposure, erythema was quantified with a chromameter, and biopsies
were taken from the exposed sites. Even though erythema is not the most sensitive
endpoint measurement of antioxidant photoprotection, it was found to be reduced in
a dose-dependent manner at 24, 48, and 72 h postirradiation. Figure 20.2 illustrates
the clinical appearance of skin 24 h after having been treated with green TPs
followed by solar-simulated light (ssUVR). GTPs were also shown to reduce
sunburn cells and to protect against UVR-induced Langerhans cell depletion,
endpoints linked to keratinocyte programmed cell death/apoptosis, and cutaneous
cell-mediated immune responses, respectively. EGCG and ECG, the two polyphenols
that contain a galloyl group at the 3 position, were the two constituents that were
most effective against UVR damage, whereas ()-epicatechin (EC) and
()-epigallocatechin (EGC) were ineffective. In the same report, human skin was
treated with 5 % GTP, irradiated with 2 MEDs solar-simulated light, and a significant
decrease in DNA damage in the sites treated with GTPs was demonstrated by P32-
postlabeling analysis.
366 M.S. Matsui
Fig. 20.2 Clinical appearance of skin 24 h after having been treated with GTP followed 30 min
later by a 2-MED dose of solar-simulated light. At left is skin treated with vehicle alone. Middle
is skin treated with UVR and vehicle. Right is skin treated with both GTP and UVR. Photo
supplied by SK Katiyar and CA Elmets
A further study sought to examine the protective effects of topical white tea or
green tea against markers of UVR damage that are associated with immune suppres-
sion and carcinogenesis [5]. This was accomplished by performing: (1) immunohis-
tochemical analysis for oxidative DNA damage and for epidermal Langerhans cells
(LCs) from biopsies obtained after in vivo irradiation of human skin in the presence or
absence of the topical tea formulations; (2) assessments of in vivo contact hypersen-
sitivity using the contact sensitizer dinitrochlorobenzene (DNCB); and (3) an analysis
of UVR-induced epidermal LC depletion in vitro, using a skin explant model. In this
study, the SPF for the tea extracts was determined to be 1. Ten volunteers participated
in the study that assessed skin biopsies by immunohistochemical analyses and found
that both green tea and white tea partially prevented UV-induced depletion of CD1a+
cells and ssUVR-induced generation of 8-OHdG, as illustrated in Fig. 20.3a, b. Ninety
subjects were used to assess the ability of tea extracts to prevent ssUVR-induced
immune suppression using 0.75 and 2MED. The results showed a trend (in the face of
large interindividual variability) toward preservation of the ability to sensitize subjects
to DNCB, suggesting that tea-treated subjects had greater preservation of their CHS
response after ssUVR exposure, relative to untreated subjects. In a separate study,
CPDs were found to be significantly reduced after 2MED ssUVR exposure by pre-
treatment with either 0.2 % white tea or 0.5 % green tea extracts. In summary, GTPs in
general and EGCG in particular, have, in human clinical studies, been shown to reduce
UVB-induced erythema, sunburn cell formation, leukocyte infiltration, and protect
against ssUVR-induced Langerhans cell depletion, generation of 8-OHdG, and
immune suppression (CHS). Animal studies support this human evidence that topi-
cal GTP protects from UVR-induced immunosuppression [2021]. In addition, UVR
alteration of IL-10 and IL-12, critical cytokines involved in UVR-induced inflamma-
tion and immune suppression, has been shown to be modified by pretreatment with
GTPs. For example, the reduction in UV-induced DNA damage by GTPs appears to
be mediated via induction of interleukin (IL)-12 [36], previously shown to induce
NER DNA repair. Katiyar [18] has reviewed the evidence for this additional mecha-
nism of action for GTPs in particular that these phytochemicals induce DNA repair
and thereby counteract the effect of UVR exposure on photoaging and carcinogenesis.
Oxidative DNA damages levels Epidermal Langerhans cells

No UV
18 No UV 30 UV only
16 UV only
25 UV + Vehicle
14
% 8-OHd G staining
UV + Vehicle
% CD1a + staining
UV + WT
12 UV + WT 20
UV + GT
10 UV + GT
15
8
6 10
4
5
2
0 0
Treatment Groups Treatment Groups
Fig. 20.3 (a) Oxidative damage was measured via levels of 8-hydroxy-2-deoxyguanosine (OhdG)
staining in skin biopsies obtained 72 h after a single 2-MED dose of ssUVR. Untreated and
vehicle-treated skin showed increased 8-OhdG, whereas 8-OhdG levels in white tea (WT)-treated
and green tea (GT)-treated skin were not different from control unirradiated skin. (b) Biopsies
obtained 72 h after a single ssUVR dose of 2 MED showed decreased epidermal CD1a+ Langerhans
cells (LC) in untreated and vehicle-treated skin. White tea (WT) and green tea (GT) application
15 min prior and immediately after irradiation partially prevented SSR-induced LC depletion
Other flavonoids, the isoflavones found in plants such as red clover, soybean,
Psoralea corylifolia, and additional legumes, have been reported to possess signifi-
cant antioxidant, estrogenic, and tyrosine kinase inhibitory activity. Genistein is an
isoflavone and phytoestrogen typically derived from soybeans or red clover and is a
popular nutraceutical. Like GTPs, more work has been done on oral benefits (as
opposed to topical) and on other health issues such as breast and prostate cancers,
postmenopausal syndrome, diabetes, osteoporosis, and cardiovascular diseases.
Some promising work, primarily in animal and cell culture models, has been per-
formed showing genistein is also capable of providing photoprotection [14].
Hairless mice were protected against UVR-induced inflammation, edema, and
immunosuppression by topical applications of genistein, equol, isoequol, or dehy-
droequol [39]. A study published in 2003 demonstrated that topical genistein
potently inhibited UVB-induced photocarcinogenesis, decreased the levels of UVR-
induced CPDs, and blocked signs of photoaging in hairless mice [38]. Another 2003
publication examined the possible molecular signaling mechanisms for the genis-
tein beneficial effect on mediators of photoaging in human subjects [17]. UVR-
induced ROS are critical for MAP kinase activation, which leads to increased
expression of the transcription factor AP-1 (cFos/cJun), which in turn upregulates
MMP gene expression and degradation of the dermal extracellular matrix. This sec-
ond report showed that UVR-induced induction of EGF-R phosphorylation, cJun
protein, JNK MAP kinase, ERK MAP kinases, and MMP-1 was reduced by genis-
tein in human skin in vivo, thus strongly suggesting its value in prevention of
photoaging.
In a further study, genistein ameliorated the detrimental effects of UVB irradia-
tion in a human reconstituted skin model, namely, proliferating cell nuclear antigen
(PCNA) and CPDs [28]. It has been suggested that specific ratios of genistein and
368 M.S. Matsui
another isoflavone, daidzein, when combined and administered at specific ratios and
concentrations, exert a synergistic photoprotective effect that is greater than the
effect obtained with each isoflavone alone [16]. Indeed, the idea that these redox-
active compounds, which cooperate in an integrated manner in plants cells, also
may cooperate in animal cells has been reviewed before [13]. A network of
antioxidants with different chemical structures and properties may be needed for
optimal protection against oxidative damage.
Other botanical extracts that have some human experimental evidence to show
potential for topical photoprotection include resveratrol [9], grape seed [43], and
fern extract [10]. Resveratrol is a chemopreventive phytochemical found in grape
skin and seeds, red wine, peanuts, and fruits. Most works on the benefits of
resveratrol have used it as an oral supplement, but there is an array of animal studies
that support the exploration of topical resveratrol for photoprotection which have
been summarized previously [32]. Topical application of resveratrol in hairless
mice has been shown to reduce signs of oxidative stress and inflammation induced
by UVB exposure. In human subjects, daily topical application of a stabilized
resveratrol derivative, resveratrate, prior to irradiation with solar-simulated UVR
for four consecutive days, provided significant protection against erythema, mela-
nin synthesis, tanning, and sunburn cell formation compared to unprotected skin
[40]. Under the experimental conditions used, a typical antioxidant blend contain-
ing primarily ascorbate and tocopherol was not as effective against these endpoints.
The unique model used in this study, of repetitive irradiation, and further, the use of
solar-simulated UVR rather than UVB alone, has additional relevance and power to
demonstrate the value of this botanical material. Although not specifically on pho-
toprotective capabilities of resveratrol, an interesting report recently suggested that
the combination of topical resveratrol, baicalin, and vitamin E was able to reverse
the signs of skin photoaging by virtue of the blends antioxidant properties and its
ability to upregulate endogenous antioxidant defense systems [9].
The photoprotective properties of grape seed proanthocyanidins has been
demonstrated in human volunteers, also using a repetitive irradiation protocol, with
three UVR exposures (one per day) in which subjects received topical applications
of grape seed extract (GSPE) in solution or vehicle on sites that were then subjected
to 2MED solar-simulated radiation 30 min after treatment [43]. There was a
significant decrease in SBCs and p53+ cells in the GSPE+ UV group compared with
the UV group and the vehicle+ UV group. There was also significant protection
against UV-induced Langerhans cell depletion, illustrated in Fig. 20.4. Virtually all
of the very extensive research on the photoprotective properties of fern extract
(Polypodium leucotomos) have used the oral route of administration; however, there
is at least one report that it is efficacious when applied topically [10].
Ferulic acid, vitamin C, and vitamin E are not usually thought of as botanicals
but of course do exist in plantsferulic acid can be found in wheat, corn, and
legumes, among other sources. Human studies have been conducted with a topical
formulation of 15 % l-ascorbic acid, 1 % -tocopherol, and 0.5 % ferulic acid
(CEFer). In a study using subjects with Fitzpatrick skin type II or III and a protocol
in which CEFer was applied to skin over a 4-day period, skin was exposed to 2, 4,
of Langerhans cells cells per 10

High-power fields in each group

of P53 positive cells per 10

400 250 100
**
of SBCs cells per 10
200 80
300
Number
Number
Number
150 60
200
100 40
100 *
50 20
*
0 0 0
uv
v
v
uv
V
al
uv
al
al
+u
+u
+u
U
U
rm
rm
rm
E+
E+
E+
vh
vh
vh
no
no
no
SP
SP
SP
G
G
different treatment groups different treatment groups different treatment groups
Fig. 20.4 Characterization of normal skin or skin treated with 2-MED simulated solar radiation
(SSR) only or skin treated with vehicle or GSPE followed 30 min later by 2-MED SSR. Specimens
were taken 24 h after UV exposure. Skin biopsies were analyzed for sunburn cells (SBCs), p53
positive cells, and density of Langerhans cells (Modified from Yuan et al. [43])
6, 8, and 10MED on sites treated with CEFer and evaluated 1 day later [29]. CEFer
was very effective at reducing thymine dimer mutations. It also provided substan-
tial protection against erythema and upregulation of the immune suppressive cyto-
kine IL-10 and significantly decreased sunburn cells, p53 expression, and
proinflammatory cytokine mRNA expression. In another study using Chinese sub-
jects, a single, 5-MED dose of ssUVR substantially induced large amounts of sun-
burn cell formation, thymine dimer formation, overexpression of p53 protein, and
depletion of CD1a+ Langerhans cells [41]. The antioxidant complex containing
vitamins C and E and ferulic acid conferred significant protection against these
endpoints.
Interestingly, the ferulic acid papers lead to another aspect of topical antioxidant
use that has been addressed more than once, following conflicting data on tumor
incidence after long-term antioxidant application and tissue culture experiments
showing a prooxidant effect of (usually high concentrations of) antioxidants. In at
least one study, topical 5 % alpha-tocopherol promoted carcinogenesis when applied
on chronically UVB-irradiated mouse skin [4]. However, a stabilized formulation of
vitamin E combined with vitamin C and ferulic acid decreased tumor number and
tumor burden and prevented the development of malignant skin tumors in female
mice with UVB-irradiated skin.
It has recently become apparent that human skin may be at increased risk of
photoaging from infrared radiation as well as UVA and UVB. The biological
significance and mechanisms of action for visible and IR wavelengths in human
skin is discussed in Chap. 3. The relevance to this chapter is that the mechanism by
which infrared radiation (IR), in particular near-infrared radiation (IRA radiation,
760-1,440 nm), causes damage is through oxidative stress [11]. In a recent study, an
SPF 30 sunscreen was tested versus the same sunscreen supplemented with an anti-
oxidant cocktail containing grape seed extract, vitamin E, ubiquinone, and vitamin
C to evaluate protection against IRA [12]. Exposure to IRA radiation significantly
upregulated MMP-1 expression, and treatment with the SPF30 sunscreen alone did
not provide significant protection, but the MMP-1 response was significantly
reduced if the SPF30 sunscreen plus the antioxidant cocktail was applied prior to
IRA radiation.
370 M.S. Matsui
The IRA study introduces another issue that needs to be addressed when speaking
of topical antioxidants for photoprotection, which is the addition of topical antioxi-
dants to UVA/UVB sunscreens, a scenario already taking place in the consumer land-
scape. Few studies have addressed the effects of this combination, although some
have suggested that because the mechanism of action is different from sunscreens
they would be expected to add to protection provided by sunscreens. Ideally, topical
antioxidants would improve protection against photoaging and carcinogenesis caused
by UV irradiation even in the presence of broad-spectrum UVA+ UVB sunscreens.
Two separate studies using the same formulation of antioxidants and sunscreens
were published that show additional protection is possible even when an SPF 25
broad-spectrum sunscreen is used. A sunscreen containing benzophenone, avoben-
zone, and octyl methoxycinnamate was compared to the same product plus ascorbyl
phosphate, tocopherol acetate, Echinacea pallida extract, chamomile extract, and
caffeine. Because MMP1 is the major enzyme implicated in collagen damage and
photoaging of UV-irradiated human skin, the first study asked whether the addition of
antioxidants to an SPF 25 sunscreen would improve protection against solar-simulated
UVR-induced activation of MMP1 after one exposure [26]. Both sunscreen alone and
sunscreen plus antioxidants reduced the expression of MMP1 relative to unprotected
ssUVR-irradiated control skin (Fig. 20.5). With no protection, the average increase in
MMP1 was 4.75-fold; with sunscreen alone, the increase was 2.4-fold; and in skin
treated with sunscreens plus antioxidants, the increase was only 1.75-fold. The differ-
ence in protection between the sunscreen alone and the sunscreen plus antioxidants
was significant and suggests that additional benefit against sun damage can be gained
by adding antioxidants to sunscreens. In another clinical study with the same sun-
screen and sunscreen plus antioxidants formulas but using a repetitive irradiation
model [42] with exposure to 1.5 MED for 4 consecutive days, additional protection
provided by antioxidants was also shown. Antioxidants alone did not reduce erythema,
12 2 MED vs 2 MED + SS, P < 0.002

2 MED vs 2 MED + SS + AOx, P < 0.0001
Rleative MMP1 staining
10
2 MED + SS vs 2 MED + SS + AOx, P < 0.05
8
(% area)
0
No 2 MED 2 MED +
2 MED
ssUVR + SS SS+Aox
Fig. 20.5 The effect of ssUVR, sunscreens, and sunscreens plus antioxidants on MMP1 expression
in human skin in vivo. The skin of human subjects was treated as indicated: (a) no ssUVR, (b)
2-MED ssUVR, (c) 2 MED plus SSAOx, and (d) 2 MEDSS alone. Biopsies were analyzed by
immunohistochemistry using a monoclonal antibody to MMP1
reduced pigmentation by 30 %, and completely protected against Langerhans cell

depletion. Antioxidants plus sunscreens protected better against pigmentation than
sunscreens alone (for a summary of erythema and pigment data, see Fig. 20.6).
Antioxidants alone protected against UV-induced hyperproliferation, as shown by epi-
dermal thickness and cytokeratins 16 and 5/6 biomarkers, and did so better than sun-
screens alone. Most interesting, although protection against a marker of photoaging,
MMP-9, did not reach significance when either sunscreens or antioxidants were
applied separately, when they were combined, there was complete protection against
MMP-9 induction. This study demonstrates that non-sunscreen materials such as anti-
oxidants can contribute significant value when added to an SPF 25 sunscreen and
applied topically to human skin in vivo.
In contrast to these in vivo studies on specific formulations of sunscreens plus
antioxidants, which show that antioxidants can provide additional protection against
in vivo UVR-induced effects, a recent study using in vitro and ex vivo methods was
unable to demonstrate any additional benefit to sunscreens by supplementing them
with antioxidants [37]. Twelve sunscreens were tested using two methods: electron
spin resonance spectroscopy to evaluate the formulations after application to ex vivo
pig skin for their ability to reduce UVR-induced free radicals and the antioxidant
potential using the DPPH assay. The sunscreens had SPFs from 15 to 55 and had
UVA-PF values of 2.428.2. The sunscreen products contained tocopheryl acetate,
tocopheryl glucoside, ascorbyl palmitate, ubiquinone, ascorbyl tetraisopalmitate,
and plant extracts. The sunscreens themselves offered significant protection against
free radicals generated by UVR, and it was determined that the radical protection in
the tested products was derived mainly from the sunscreens UVA filters. The
antioxidants in these products appeared to offer no contribution to radical protection.
These findings would seem to indicate that broad-spectrum sunscreen will not
benefit from the addition of botanical or other antioxidant ingredients; however,
these results may not truly reflect the potential for sunscreen plus antioxidant
products. As mentioned by the authors and in the caveats below, the sunscreens
tested were off the shelf, and the concentrations of added antioxidants were
not given on the product label (and could have been very low). In addition, UVR
a b
160 120
Erythema Index at 24 hours
Melanin Index at 72 hours
140
100
120
80
100
80 60
60
40
40
20
20
0 0
Baseline UV Only Vehicle+UV SS+UV AOx+UV SS+AOx SS+AOx Baseline UV Only Vehicle+UV SS+UV AOx+UV SS+AOx SS+AOx
Control Control Control +UV Control Control Control +UV
Treatment Group Treatment Groups
Fig. 20.6 Effect of sunscreens (SS) with or without antioxidants (AOx) on (a) erythema or (b)
melanin formation after repetitive ultraviolet (UV) radiation exposure. Yellow bars, irradiated sites;
blue bars, nonirradiated sites (Modified from [42])
372 M.S. Matsui
exposure levels may not have been sufficiently challenging, or entirely relevant, as
the model was ex vivo pig skin.
Therefore, one of the caveats for phytochemical photoprotection includes the
lack of regulatory standards by which this additional protection can be measured
and then articulated on product labels. In fact, in most of the world, no concentration
needs to be given, and they must be listed as inactive ingredients. More credible
testing of finished product using relevant endpoints on human subjects should be
undertaken, the optimal concentration should be determined for individual
components and mixtures of ingredients, and the stability of ingredients need to be
carefully monitored (as antioxidants are notoriously unstable). In addition, the
bioavailability/delivery of active supplements to the skin needs to be better
understood, as both water- and oil-soluble materials can protect lipids against UVR-
induced peroxidation; however, the bioactive portion must be able to partition into
the lipid bilayers to be protective [27]. There also exists potential synergy or
antagonism between ingredients, which under certain conditions such as high
concentrations, can act as prooxidants. Finally, in part because antioxidants are
frequently supplied as semicharacterized botanical extracts, the risk of adverse reac-
tions such as allergic or irritant sensitization must be considered.
In conclusion, there is ample evidence that certain antioxidants and botanical
extracts have potential to contribute to photoprotection when used topically. While
not to be recommended as alternatives to sun avoidance, broad-spectrum sunscreens,
and protective clothing, they should be considered valuable adjuvants in the preven-
tion of photoaging and skin cancer. Supplemental photoprotection will benefit those
who have heightened personal and professional risk factors such as Fitzpatrick skin
types III; environmental risk factors such as occupational exposure, geographic
location, and elevation; extended outdoor recreational activities; patients with previ-
ous skin cancer, photosensitive dermatological conditions, or patients on medication
that renders them photosensitive; and immunosuppressed patients. However, caution
must be taken when communicating the benefits of topical antioxidants to consumers,
who may already be bombarded with misinformation, such as the statements taken
from Internet sites and which include phrases such as research says antioxidants
work better than sunscreen, our skin is so well designed that when the solar rays hit
it the antioxidants that are in the body actually move up and form a protective shield
and act just like sunscreen, and antioxidants are the exact answerthey act just like
sunscreens. Ideally, any product with a claim to enhance photoprotection with anti-
oxidants would have been clinically tested under relevant and scientifically rigorous
conditions.
Abbreviations
6-4PPs Pyrimidine(6-4)pyrimidine photoproducts

CPDs Cyclobutane pyrimidine dimers
EC ()-Epicatechin
ECG ()-Epicatechin-3-gallate
EGC ()-Epigallocatechin
EGCG ()-Epigallocatechin-3-gallate
GTPs Green tea polyphenols
IR Infrared radiation
LCs Langerhans cells
ROS Reactive oxygen species
SPF Sun protection factor
ssUVR Solar-simulated light
TPs Tea polyphenols
UVR Ultraviolet radiation
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Chapter 21
The Role of DNA Repair in Photoprotection
Nevena Karaman-Jurukovska and Daniel B. Yarosh
21.1 DNA Damage Induced by Light
21.1.1 Light Sources
Life on earth evolved utilizing solar electromagnetic energy, but at the same time,
this energy has adverse biological effects. The extent of the effects on the skin
depends greatly on the wavelength of light absorbed by its biomolecules. The most
damaging are the shorter wavelengths in the ultraviolet (UV) region because they
are most readily absorbed by the skin.
By convention, UV wavelengths are designated as UVA (320400 nm), UVB
(290320 nm), and UVC (200290 nm). The shorter the wavelength, the greater
absorption of the UV energy by earths atmosphere. UVC, the shortest wavelength
band, is effectively absorbed by atmosphere stratospheric gases and therefore fails
to reach the surface of the earth. The ozone molecules and atmosphere efficiently
filter UVB, so that only a small fraction actually reaches the earth surface (around
5 %). Its local intensity may vary with the solar zenith angle, which differs by the
time of day, the year, the latitude, and the local cloud density. For the long UV
wavelengths, 95 % of UVA energy reaches the earth with its steady presence during
the day, making it the most abundant [35].
Artificial light from incandescent light bulbs and compact fluorescent lamps
present an additional source of UV exposure, mostly UVA. The International
Commission on Illumination recommends maximal UV radiation of 30 J/m2 within
8 h. While the average daily exposure from outdoors is much lower, the cumulative
effects might be significant due to prolonged and continual daily exposures [41].
N. Karaman-Jurukovska, PhD D.B. Yarosh, PhD (*)

R&D Division, Basic Science Research Department, Estee Lauder Companies,
Melville, NY, USA

DOI 10.1007/978-3-319-29382-0_21
378 N. Karaman-Jurukovska and D.B. Yarosh
21.1.2 Direct DNA Damage
DNA directly absorbs the energy of UVC and UVB irradiation. The adsorbed energy
causes intranucleotide cross-linking by dimerization of pyrimidines and formation
of cis-syn cyclobutane pyrimidine dimers (CPDs) and pyrimidine (64) pyrimidone
photoproducts (6-4PP) [30, 49]. To a much lesser extent, purine dimers and pyrimi-
dine photohydrates are formed as well. The cyclobutane rings of CPDs are formed
between the 5,6 bonds of two adjacent pyrimidine bases (thymine, cytosine, or
5-methylcytosine). CPD formation is influenced by sequence context [42] and
formed exclusively at dipyrimidines and preferentially at TT sites. The efficiency of
CPD formation at different dipyrimidine sequences is estimated at a ratio of
55:33:11:1 for TT > TC > CT > CC [10]. In addition to the nucleotide sequences, the
chromatin structure and its environment have a significant impact on the distribution
of CPDs and the rate of their repair. Efficient repair in regions of DNA damage
requires nucleosomal rearrangements to allow DNA repair complex initiation.
The formation of (64)PPs arise through a complex electron rearrangement result-
ing in generation of a single covalent bond between position 6 and position 4 of two
adjacent pyrimidine bases [27]. The frequency of (64)PPs formation by UVB is at
the same level as the formation of CPDs but is repaired at much faster rate [49].
For a while it was assumed that UVA could not induce CPDs due to the inability
of DNA to efficiently absorb in the UVA range. However, CPDs were readily
detected upon UVA exposures [2, 33]. After exposure of cultured cells and the skin
to large doses of UVA, higher ratios of oxidized purines to CPDs are found than in
naked DNA [4]. Analysis of the CPDs produced by UVA revealed that the
predominant site for CPD formation is at TT compared to TC and CT sites and that
(64)PPs are almost undetectable.
The exact mechanism of CPD formation upon UVA irradiation is still subject of
debate. Some data suggests involvement of yet undetermined UVA chromophore
that is capable of transferring energy to DNA by photosensitization a triplet energy
transfer mechanism [13]. Other evidence supports direct DNA absorption, with
much lower efficiency than that of UVB. This absorption has a very distinctive
signature exclusive TT dimer formation [15].
Recently, a new pathway for formation of CPDs has been described wherein
fragments of melanin are excited by UV-induced reactive oxygen and nitrogen
species and then transfer the energy to DNA to form CPDs [32] This process is
remarkable in that CPDs continue to form even in the dark. The relative importance
of this photochemical reaction in the overall yield of DNA damage in intact human
skin is an exciting new area of research.
21.1.3 Indirect DNA Damage
Indirect DNA damage is a result of UV energy absorption by either proteins or

DNA-bound chromophores through photosensitization. As a result of photooxidation,
the generated superoxide radicals or singlet oxygens react with nucleotides and
21 The Role of DNA Repair in Photoprotection 379
form several kinds of base lesions. The 8-oxo-7,8-dihydro-2-deoxyguanosine

(8-oxo-dGua) is the most frequent and therefore most studied UVA-induced
oxidative base lesion. If not repaired prior to the DNA replication, 8-Oxo-dGua
mispairs with 2-deoxyadenosine (dA) and induces G T transversion mutations
which are considered the fingerprint mutations of UVA-induced oxidized guanines
in human skin carcinogenesis [4]. UVA induces DNA strand breaks and oxidized
pyrimidines at a much lower frequency.
Melanocytes that secrete UV-absorbing melanin provide localized protection
from the suns electromagnetic energy. Just in the recent decade, the accumulated
evidence reveals that the melanin, an optical absorber, free radical scavenger, and
antioxidant, can also form melanin radicals in the presence of metal ions. In such a
way, the melanin becomes a strong oxidant and might be involved in a UV-mediated
DNA damaging events [38] and as noted above perhaps even CPD formation.
Partially polymerized melanin is particularly effective in photooxidation in that it
promotes 8-oxo-dGua formation in presence of singlet oxygen [29]. In an animal
model, the incidence of UVA-induced melanoma was associated with oxidative
DNA damage, and the increase in production of 8-oxo-dGua required both UVA
and melanin [28].
21.2 DNA Repair
The knowledge of DNA repair pathways has gone from an arcane corner of nucleic
acid biochemistry to the subject of a college textbook [11]. The molecular details of
the reactions that lead to reversal, or removal and resynthesis, of damaged DNA can
be found there. Here we discuss the particular aspects of DNA repair that can
prevent photodamage and their sequelae.
DNA damage induced either directly or indirectly by sunlight is roughly
randomly distributed among the target nucleotides in the genome. However, because
the information content of the nucleotides is not randomly distributed within the
genome, the biological consequences of DNA lesions are not of equal importance.
As a result, repair of a minority of lesions, such as in the exons or on the transcribed
strand, has much greater biological importance than repair of others in the introns
or non-transcribed strands. DNA repair systems, both endogenous and therapeutic,
have indeed focused on repairing some regions, such as transcribed strands, faster
than others, in order to relieve phototoxic effects.
Here we will focus only on the main DNA repair pathways for photodamage.
21.2.1 Nucleotide Excision
Nucleotide excision employs a complex of enzymes to recognize gross distortions

in the double helix and cut out a strip of approximately 30 nucleotides surrounding
the lesion causing the distortion. The bulkier the lesion, the more readily nucleotide
excision repair recognizes it, and conversely, the more subtle the nucleotide
modification, the longer it takes to find and remove them. The great advantage of
this system is that it is not lesion specific, so that nucleotide excision repair can
remove damage that the organism has never experienced before, including modern
chemical carcinogen adducts that were invented in the last 100 years.
This pathway has many substrates, but it is not fast. It may take only 10 min to
incise UV-induced lesions [18], but following a sunburn it may take 12 h to remove
half the cyclobutane pyrimidine dimers in exposed skin [43].
21.2.2 Base Excision
Base excision repair uses one lead glycosylase enzyme that recognizes a small class
of modified bases and releases them from the phosphodiester backbone to create
vacant (abasic) sites in DNA. These sites are then repaired by a common set of
enzymes that remove the damaged regions on one strand and replace only about 4
nucleotides. The lead enzymes have narrow substrate specificity, but fortunately,
several are custom fit for DNA damage induced by sunlight. Important oxidation
photoproducts, particularly 8-oxo-dGua, are quickly and efficiently repaired by
base excision repair in about 6 h.
One strategy for enhancing DNA repair is to introduce into skin cells glycosylases
specific for cyclobutane pyrimidine dimers. This shifts the repair pathway from
nucleotide to base excision repair. Not only does it speed up repair but it also reduces
the frequency of mutagenic mistakes [46].
21.2.3 Photoreactivation
Photoreactivation is a direct reversal of DNA damage mediated by a light-activated

enzyme that uses the energy captured from light to reverse aberrant covalent bonds
formed in DNA by photon absorption from sunlight. These enzymes are found
ubiquitously in plants, reptiles, and marsupials but not mammals including humans.
It seems our photolyase gene has been hijacked by evolution to become a blue light
sensor for the circadian rhythm!
Photolyases have been found for both CPD and (64)PPs, the two most common
direct forms of photodamage. Despite being derived from another kingdom, these
enzymes perform a quick and efficient repair inside human cells [39].
21.2.4 Lesion Bypass by Polymerase
Human cells harbor a fail-safe mechanism for handling DNA photodamage. They
have polymerase (eta) that, during replication of a photodamaged DNA template,
quickly and efficiently inserts the correct nucleotide opposite a pyrimidine lesion.
Although this doesnt remove the damage, it preserves the genome integrity until an
excision mechanism can recognize and remove it. A genetic defect in this fail-safe
mechanism produces the cancer-prone xeroderma pigmentosum variant
phenotype.
21.2.5 Cellular Regulation of DNA Repair
DNA repair enzymes and pathways are closely coordinated with the rest of the
cells functions. Foremost among these coordinators is the p53 protein. Loss of its
function is a perquisite for many skin cancers. DNA damage triggers release of p53
protein from its inhibitor, which frees it to form a transcription activator for its tar-
get genes. Most of these genes code for cell cycle checkpoints, inhibitors of prolif-
eration and activators of DNA repair. Sustained activation of p53 protein leads to
apoptosis and cell death. In this way, p53 gives the cell a greater opportunity to
repair its DNA and, failing that, a road to suicide to avoid mutations and oncogenic
transformation.
A large number of DNA Damage Response (DDR) proteins, many of them
activated by p53, work together to signal that cell cycling should stop [7]. DNA
repair activity is further tied to the health status of the cell through AMPK
(5-AMP-activated protein kinase), which senses energy levels in cells and whose
activation increases DNA repair [44]. Furthermore, single-stranded breaks in DNA
produced during repair can activate poly(ADP-ribose) polymerase to consume
NAD, which saps the cell of molecules essential to production of ATP and lower
cellular energy.
DNA repair is tied not only to the cell cycle but also to the circadian
rhythm. This should not be surprising since the risk of photodamage to skin
DNA is directly related to the presence of the sun in the sky. The genes and
proteins in human cells that produce a feedback loop to create the circadian
clock (BMal1, Clock, Cryptochrome, and Period) also regulate the cell cycle
and DNA repair [ 34 ]. The peak of DNA repair capacity is late afternoon, just
as the accumulation of daytime sun damage to skin DNA is reaching its
maximum.
The DDR genes, including p53, work through regulation of transcription.
Downstream of transcription, miRNA (micro-RNA) are also modulated following
UV, and they further regulate the DDR genes by increasing or decreasing gene
silencing complexes [31]. Cell survival after UV is dependent on the proper
functioning of the gene silencing apparatus.
Many of the steps of the DDR pathways involve protein modification of the
downstream target. These modifications include classical phosphorylation,
acetylation, and, as we have discussed, poly(ADP-ribosyl)ation, which serve to
activate or inhibit enzyme activity. Another form of modification is ubiquitin and/or
SUMO (small ubiquitin-related modifier) additions to protein, which may coordinate
assembly of protein complexes or designate them for destruction to make way for a
repair response [40].
21.2.6 Therapeutic Intervention with DNA Repair
The simplest way to intervene in DNA repair is to accelerate the first step of DNA
repair, the recognition and incision of damaged bases. This has been accomplished
by encapsulating various enzymes in liposomes for delivery into skin cells, including
T4 endonuclease V [47] and M. luteus UV endonuclease [8] for CPDs, OGG1 for
8-oxo-dGua [45], and photolyase for direct reversal of CPDs [39]. These exogenous
but small enzymes are indeed able to enter the nucleus and recognize and then repair
DNA damage in mammalian skin.
The hormone -MSH protects the skin not only by inducing protective pigment
but also by inducing p53 and subsequent reduction in cell cycling and initiation of
DNA repair [14], a property that may be shared with the -MSH analog
afamelanotide, now undergoing clinical testing.
Induction and synchronization of the circadian rhythm by delivery of peptides to
skin cells has been reported to amplify DNA repair [25]. Application of such
peptides at night may therefore accelerate repair of DNA damage accumulated
during the day.
Binding of certain ligands to receptors activates DNA repair even in the absence
of a DNA damage inducing signal. IL-12 binding to its receptor increases repair of
UV-induced cyclobutane pyrimidine dimers [36]. The toll-like receptors TLR-3 and
TLR-4 mediate damage-associated pattern recognition (DAMP). Agonists of these
receptors modulate DNA repair after UV [1, 12]. They may act in part by activating
p53 [26]. Since extracellular DNA is recognized as DAMP and bound by TLRs, this
may explain the observations that dTpT and small oligonucleotides activate DNA
repair through a p53-dependent mechanism [22]. TLRs also distinguish pathogenic
from benign surface bacteria, and this may also explain the long-standing observation
that extracts of probiotic bacteria enhance DNA repair [3].
HMGB1 (high-mobility group protein B1) is a component of histones but also
participates in intercellular communication and recruitment of stem cells to the skin
from bone marrow. It is able to activate DNA repair and increase survival after UV
[21]. This may provide a new use for compounds modulating HMGB1 levels in the
skin.
21.2.7 Botanical Induction of DNA Repair
Antioxidants naturally block oxidation of DNA and are discussed in Chap. 20.
There are recurrent reports of antioxidants inhibiting the formation of cyclobutane
pyrimidine dimers by UV (e.g., [23]). One explanation might be that antioxidant
polyphenols, such as from green tea or polypodium leucotomos, induce IL-12,
which then activates the DNA repair pathways to remove cyclobutane pyrimidine
dimers [17]. Another may be that antioxidants inhibit energy transfer by oxidized
melanin fragments [32].
Topically applied ginseng saponin and silymarin reduce UV toxicity in part by

increasing nucleotide excision repair [5, 16]. Interestingly, topically applied caffeine
may improve skin health after UV by inhibiting DNA repair and forcing more skin
cells into apoptosis [20].
The depletion of ATP by poly(ADP-ribose) polymerase may be countered by
oral niacin intake and thereby prevent the energy crisis and reduction in DNA repair
following UV [19].
21.3 Clinical Consequences of Unrepaired Photodamage

to DNA
DNA damage contributes to many of the sequelae of UV exposure, as evidenced by

animal studies, by DNA repair deficiency diseases, and by enhancing DNA repair in
human skin.
Within a few days after sufficient UV exposure, mouse and human skin develop
a reduced ability to properly respond to specific sensitizing antigens [50]. DNA
damage, especially CPDs, contribute to this immunosuppression by inducing the
release of immunosuppressive soluble mediators and impairing antigen-presenting
cells. This reduced ability to respond may allow highly antigenic precancerous skin
cells to escape immune surveillance and form a tumor. Enhancing DNA repair
reduces the immunosuppressive effect of UV in humans [24, 39].
Chronic UV exposure accelerates the appearance of aging. Especially in lightly
pigmented people, this appears as an increase in skin wrinkling and uneven
pigmentation. DNA damage contributes to destruction of collagen by inducing the
expression of the collagenase MMP-1 [9]. DNA damage is also a trigger for skin
pigment production, since one of the purposes of the pigment is to absorb UV and
block additional DNA damage [6].
Finally, DNA damage is a central element in the development of skin cancers,
including squamous and basal cell carcinoma and melanoma. Mutations in tumor
suppressor genes are frequently identified in all these cancers that have the changes
characteristic of UV-induced DNA damage [37]. In animal models of DNA repair
deficiency and the human genodermatosis xeroderma pigmentosum (XP), with
defective DNA repair, the rates of UV-induced skin cancer are greatly increased.
Enhancing DNA repair in normal or XP patients reduced their development of new
actinic keratoses and basal cell carcinomas [8, 48].
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Chapter 22
Oral and Systemic Photoprotection
Salvador Gonzlez, Yolanda Gilaberte, and Angeles Juarranz
Key Points
Oral photoprotective agents could potentially be a suitable complement to
topical sunscreen photoprotection.
The effect of oral photoprotective agents is mainly systemic, by reducing
photoinduced oxidation, skin photodamage, and photoaging.
In addition to their photoprotective effect, some of these agents also have
anticancer properties.
Many botanical agents and formulations have antioxidant activity/
properties that provide photoprotection through different mechanisms.
Evaluation of the photoprotective effect of oral agents includes
photoimmunoprotection, antimutagenic, and antioxidant activities.
S. Gonzlez, MD, PhD (*)

Medicine and Medical Specialities Department, Alcal University, Madrid, Spain
Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Instituto Ramn y Cajal de Investigacin Sanitaria (IRYCIS), Madrid, Spain
e-mail: [email protected]; [email protected]
Y. Gilaberte, MD, PhD
Dermatology Service, Hospital San Jorge, Huesca, Spain
A. Juarranz, PhD
Instituto Ramn y Cajal de Investigacin Sanitaria (IRYCIS), Madrid, Spain
Biology Department, Universidad Autnoma de Madrid, Madrid, Spain

DOI 10.1007/978-3-319-29382-0_22
388 S. Gonzlez et al.
22.1 Oral Photoprotective Agents
Photoprotection typically involves applying a thin layer of barrier agents to the skin
prior to sun exposure. There are practical limitations with this approach, e.g., uneven
and/or cumbersome application, short half-life on skin, potential side effect of the
agents, lack of systemic efficiency, etc.
Oral photoprotectives do not protect the skin directly from high-energy pho-
tons; hence, they are not very efficient against solar-induced erythema. However,
they are simple to take (usually as pills), their half-life can be determined phar-
macologically, and they do have systemic effects. These products may contain
one or several active substances that promote different mechanisms of photopro-
tection, particularly related to antioxidant activities [6, 7]. These mechanisms
reload the antioxidant activities of the body after systemic loss of endogenous
antioxidants during UV exposure [8, 9]. In many cases, oral photoprotective
agents also downregulate UV-induced immunosuppression [10]. In the next sec-
tions, we provide an update on the best characteristics of these substances
(Table 22.1).
22.1.1 Vitamin Derivatives
22.1.1.1 Carotenoids
They are plant pigments present in a wide array of vegetables and fruits, most
notably tomato. Carotenoids are endowed with antioxidant activity. Although one
study did not support their efficacy on skin photoprotection [11], a modest, dose-
dependent photoprotective effect has been reported upon oral administration in
another study [12].
The most represented carotenoid in tomato is lycopene. Lycopene displays
a significant activity as a singlet oxygen scavenger. One study reported that
1012-week treatment with oral lycopene (16 mg daily) renders subjects less
prone to develop erythema in response to UV [13]. In addition, oral admin-
istration of a mixture of 2.5 mg lycopene, 4.7 mg beta-carotene, and 5 108
Lactobacillus johnsonii protected the development of UVA-induced polymor-
phous light eruption [14].
Other carotenoids, globally named xanthophylls, include astaxanthin,
lutein, and zeaxanthin. These have been shown to prevent sun-induced ery-
thema when administered orally, particularly in combination with topical
administration of the same compounds [15]. Combined oral and topical admin-
istration of lutein and zeaxanthin provided higher degree of antioxidant protec-
tion that either one alone. Astaxanthin has been shown to inhibit the production
of lipid peroxides and decrease the accumulation of polyamines induced by
UVA photons [16].
22 Oral and Systemic Photoprotection 389
Table 22.1 Oral and systemic photoprotective agents

Carotenoids
Lycopene
Xanthophylls
Nicotinamide
Combination of antioxidants:
Mixture of tocopherol and ascorbate
Mixture of lycopene, beta-carotene, alpha-tocopherol, and selenium
Seresis: carotenoids (-carotene and lycopene), vitamins C and E, selenium, and
proanthocyanidins
Dietary botanicals: Dietary flavonoids and phenolics
Green tea polyphenols
Polypodium leucotomos extract
Isoflavones
Genistein
Equol
Silymarin
Quercetin
Apigenin
Pomegranate
Citrus + rosemary extract
Cocoa extract
Resveratrol
Ferulic and caffeic acids
Pycnogenol
Sulforaphane
Forskolin
Cats claw (Uncaria tomentose) extract
Fo-Ti (Polygonum multiflorum)
Dietary non-botanicals, and others:
-3 Polyunsaturated fatty acid
Probiotics
Idebenone
N-(4-pyridoxylmethylene)-l-serine
Cyclooxygenase 2 inhibitors
Afamelanotide (melanotan I)
Melanotan II
22.1.1.2 Nicotinamide
It is the amide version of vitamin B3. It has proven useful for the management of
acne, photoaging, and photoimmunosuppression. The underlying mechanism
involves modulation of inflammatory cytokine expression and other enzymatic
mechanisms related to DNA repair [17]. Oral administration of nicotinamide or
niacin decreases photoinduced skin carcinogenesis and photoaging in mice and

prevents photoimmunosuppression and development of actinic keratoses in humans
[18, 19].
22.1.2 Antioxidant Combinations

22.1.2.1 Ascorbate + Tocopherol
These two vitamins with potent antioxidant properties are not photoprotective when
used separately [2022]. However, they enhance the photoprotective effects of each
other [23, 24]. Furthermore, T opical application of combinations of both vitamins
with melatonin also enhanced the photoprotective response against UV-induced
erythema [25]. The mechanism of this synergy is unclear, but it may depend on the
ability of ascorbate to reduce tocopherol, transferring the free radicals captured by
the latter to the medium, where they are quenched by other antioxidant systems
present in the skin [26].
22.1.2.2 Other Antioxidant Combinations
Daily oral administration of two tablets containing an antioxidant complex for 7

weeks reduced UV-induced lipoperoxide levels, sunburn, inflammation, and p53
expression; however, this combination increased pigmentation. Each tablet contains
a combination of 3 mg of tomato lycopene, 3 mg of natural alpha and beta-carotene,
5 mg of alpha-tocopherol, and 37.5 mg of organic selenium incorporated in
Saccharomyces cerevisiae in dry state [27].
22.1.2.3 Seresis
It is a proprietary combination of natural antioxidants made from grape

proanthocyanidins, carotenoids (-carotene and lycopene), vitamins C and E, and
selenium. Oral uptake of Seresis retards the onset of UVB-mediated erythema and
increased expression of matrix metalloproteinases [28].
22.1.3 Dietary Botanicals
This general term includes antioxidant and anti-inflammatory flavonoids and other
phenolics found in vegetable foodstuffs. Flavonoids are the most important natural
antioxidants due to their chemical nature, which contains phenolic rings that can
absorb free radicals to form phenoxy radicals [29]. There are different subfamilies
of flavonoids according to their chemical structure, including flavonols, flavones,

flavanones, isoflavones, catechins, anthocyanidins, and chalcones. In the next pages,
we discuss the merits of each of the major members of these subfamilies in terms of
oral photoprotection [30].
22.1.3.1 Green Tea Polyphenols (GTPPs)
The major antioxidant moiety of green tea (Camellia sinensis) is a mixture of

polyphenols derived from epicatechins, epicatechin (EC), epigallocatechin (EGC),
epicatechin gallate (ECG), and epigallocatechin gallate (EGCG). The latter
constitutes approximately 40 % of total GTPPs at the source (green tea leaves). Oral
administration of GTPPs decreases UVB-induced tumorigenesis in normal and
hairless mice [31, 32]. This effect is mainly based on their antioxidant properties:
EGCG significantly reduces the production of lipid peroxides [33]. However, it also
has additional protection mechanisms, including production of IL-12 and the
subsequent activation of IL-12-dependent DNA repair machinery. This pathway
undoes DNA damage in skin cells and skin-associated immune cells, e.g.,
Langerhans cells. GTPPs not only prevent the onset of DNA damage-related
tumorigenesis but also enhance several active mechanisms of tumor rejection, e.g.,
they impair angiogenesis required for tumor cell feeding and also activate the
cellular arm of adaptive immunity (CTL) to destroy tumor cells [31].
GTPPs also delay photoaging by preventing the UV-induced activation of the
inflammatory transcription factors AP-1 and NF-B [34]. They also inhibit MMP
expression and reduce UV-mediated collagen cross-linking [34, 35].
There are several major limitations preventing the widespread use of GTPPs
preparations. They are very sensitive to oxidation, quickly losing their activity. In
fact, their half-life in the bloodstream is <3 h [36]. Another limitation is that they are
poorly soluble in lipid preparations, which greatly limits their penetration through
the skin [37], although it favors its oral uptake and absorption. Mixing GTPPs with
nontoxic organic solvents, e.g., oleic acid, improves their stability and penetrance
[38, 39]. However, its toxicity at high doses needs to be investigated [40].
22.1.3.2 Polypodium leucotomos Extract (Fernblock)
Extracts made from leaves of the fern Polypodium leucotomos are rich in
polyphenols. These antioxidant compounds are the molecular basis for the common
use of Polypodium leucotomos extracts to treat inflammatory skin conditions in
indigenous Central American cultures. In addition, these extracts can modulate
immune phenomena in response to inflammatory insult, e.g., UV-induced sunburn.
Fernblock is active topically and orally. At a molecular level, it scavenges free
radicals, e.g., singlet oxygen, hydroxyl, and superoxide, and prevents lipid peroxi-
dation [41, 42]. Fernblock enhances the function of endogenous antioxidant sys-
tems such as glutathione S-transferase (GST) [43], and it inhibits the isomerization
and inactivation of trans-urocanic acid [44]; it also prevents oxidant DNA damage
(8-hydroxyguanine) and accelerates the repair of damaged DNA, particularly T-T
dimers [45], which underlies its ability to prevent immunosuppression [46]. Finally,
Fernblock prevents inflammation by inhibiting UV-induced expression of TNF-
alpha and inducible nitric oxide synthase [47] and COX-2 [45].
The role of Fernblock has been assessed in psoralen-UVA (PUVA) and UVB-
induced changes [4850]. In both cases, oral Fernblock administration elevated the
threshold of UV-induced tanning (melanogenic dose) and the minimum UV dose to
cause erythema (erythematogenic dose) [28] . Beyond the new threshold, Fernblock
decreased the degree of erythema (i.e., the erythema vs. time slope was less steep),
reduced the number of sunburn cells, and ameliorated skin immune cell depletion
[51, 52]. A recent study described that oral administration of Fernblock in a hair-
less mouse model delayed the onset of skin tumors and increases p53 expression in
UV-irradiated skin [53].
Topical treatment with Fernblock had comparable effects in skin sensitivity to
UV radiation and immune depletion, with similar mechanisms involved, i.e.,
inhibition of oxidation and inflammation and immune protection. In addition,
topical application assays have indicated anti-photoaging capability and long-term
immune protection, including reduced elastosis and development of skin tumors in
response to chronic exposure to UVB [54]. It has also been shown to decrease the
development of polymorphous light eruption and solar urticaria [50].
22.1.3.3 Isoflavones
These are a subfamily of flavonoids molecularly similar to mammalian estrogen.

Their ability to act as photoprotectors is a current topic of interest. Some isoflavones
or isoflavone-rich compounds are:
Genistein: It is an isoflavone obtained from fermented soy, fava, and coffee beans.
It is a potent tyrosine kinase inhibitor, and it is endowed with strong antioxidant
capability [55]. A specific mechanism that involves the transcription factor Nrf2
is activated by low doses of oral genistein and is likely involved in its high oral
tolerance [56, 57]. As a photoprotector, oral genistein inhibits UVB-mediated
skin photoaging and skin tumor formation in a rodent model [58].
Equol: It is a metabolite from the genistein analog daidzein. It is naturally enriched
in red clover (Trifolium pratense) [59]. Topically, equol confers protection
against UV photons and decreases UV-induced tumorigenesis [60] and photoag-
ing [61]. Although not tested as an oral photoprotector, a recent report indicates
high oral tolerance [62], indicating its suitability for oral photoprotection assays.
Silymarin: It is a flavonoid enriched in the seeds of milk thistle (Silybum maria-
num). Silymarin contains three species: silybin, silydianin, and silychristin.
Whereas its topical use confers photoprotection due to the silybin contained in
the preparation [63], its oral use in photoprotection has not been assessed explic-
itly. Silymarin is an inhibitor of P-glycoprotein efflux pump [64] and modulates
the bioavailability of other drugs [65], which may compromise its usefulness in
oral photoprotection schemes.
Quercetin: It is a flavonoid mainly found in oak bark and many other vegetables and
seeds. It is a very potent antioxidant with topical photoprotective effect [66], but
it has not been assessed as an oral photoprotection agent. Similar to silymarin, it
may affect the bioavailability of other drugs, e.g., paclitaxel [67], and it has an
effect on DNA cleavage [68]. Hence, its potential as an oral photoprotector is
controversial.
Apigenin: It is a flavonoid endowed with antitumor capability [69]. Topically, it
decreases tumor emergence upon exposure to UV photons in a rodent model. This
effect seems to be caused, at least in part, by inhibition of COX2 expression [70].
22.1.3.4 Pomegranate (Punica granatum, fam. Punicaceae)
The flesh, peel, and seeds of pomegranate contain high amounts of polyphenols,
including catechins, anthocyanidins (e.g., delphinidin, cyanidin, and pelargonidin),
and tannins. Pomegranate has a strong reputation as a natural antioxidant [71]. As
an oral photoprotector, the Mukhtar group has described its efficacy in preventing
photocarcinogenesis in a UVB-irradiated mouse model [72, 73].
22.1.3.5 Citrus + Rosemary Extract
Citrus contains a significant amount of flavonoids, whereas rosemary is high in

polyphenols and diterpenes. Oral administration of a combination of citrus and
rosemary extracts increased the minimal erythema dose in human patients [74].
Together with their lack of toxicity, this is a promising dietary complement with
photoprotective ability.
22.1.3.6 Cocoa Extract
Cocoa (chocolate) extracts are rich in polyphenols, mainly flavanols. These

molecules act as ROS scavengers, inhibitors of lipid peroxidation and endogenous
oxidative enzymes, e.g., NADPH oxidase, and inducers of proteins involved in
protection against stress such as Nrf2 (reviewed in [75]). Its efficacy in oral
photoprotection has been demonstrated in humans. In controlled conditions, oral
administration chocolate with high flavanol content decreased UV-mediated
erythema appearance and other immediate effects of UV exposure [76].
22.1.3.7 Resveratrol
It is a polyphenolic phytoalexin found in the peels and seeds of grapes, nuts and
fruits, and red wine. Its topical photoprotective effects are well documented [77].
Oral administration of resveratrol in a p53-sensitive mouse tumor model decreases
the onset of UV-mediated tumorigenesis [78], and this effect is related to its ability
to modulate TGF-beta [78] and NF-kB [79]. In addition, resveratrol boosts the
response to radiation therapy in hyperproliferative, precancerous, and neoplastic
conditions [80].
22.1.3.8 Ferulic and Caffeic Acids
Caffeic acid is a precursor of ferulic acid. Both belong to the family of

hydroxycinnamic acids. They are generated during the biosynthesis of aromatic
amino acids phenylalanine and tyrosine, and they are crucial intermediates of lignin
synthesis that bind to complex polysaccharides, e.g., pectins, in plant surfaces.
Their topical use in photoprotection is well documented, particularly that of
ferulic acid because it is more lipophilic than caffeic acid [81]. Ferulic acid not only
exerts a direct antioxidant effect, but it also synergizes with vitamins C and E to
double their photoprotective effect [82]. Their photoprotective effects by oral route
have not been addressed explicitly. Previous evidence indicates that oral
administration of plant extracts enriched in ferulic acid delays the onset of cancer
[83], suggesting its efficacy in oral schemes.
22.1.3.9 Pycnogenol
Pycnogenol is an extract of the bark of Pinus pinaster Ait. It is endowed with potent
antioxidant, anti-inflammatory, and anticarcinogenic properties, but it has only been
used topically to confer photoprotection [84].
22.1.3.10 Sulforaphane
It is an organosulfur compound from the isothyocyanate family commonly found in

cruciferous vegetables, e.g., broccoli. Its role in oral chemoprevention is supported
by its effect on the expression of phase II enzymes [85]. Oral treatment with
sulforaphane decreases the appearance of skin tumors in a high-susceptibility rodent
model [86] likely by inhibition of AP-1 activation [87], suggesting its potential in
photoaging and the prevention of photoinduced carcinogenesis [88].
22.1.3.11 Forskolin
It is a terpene obtained from Indian coleus (Coleus forskohlii). It is a classic activator

of the cAMP signaling pathway, and it also restores pigmentation in individuals
suffering from missense mutations in the melanocortin-1 receptor, MC1R [89].
Long-term topical application is possible without significant side effects [90].
Forskolin also exerts its photoprotective effect by increasing epithelial thickening
due to increased keratinocyte proliferation in a cAMP-dependent manner [91]. In
vitro, forskolin protects keratinocytes from UV-induced apoptosis [92]. Oral
administration of forskolin has been assessed for non-skin-related therapeutic uses,
e.g., asthma [93] and cardiovascular disease [94].
22.1.3.12 Cats Claw (Uncaria tomentosa) Extract
Cats claw is a climbing plant indigenous from the Andes region. Water-soluble
extracts from its leaves have displayed high efficacy in topical photoprotection
assays, with a remarkable ability to enhance cyclobutyl pyrimidine dimer repair
[95]. Orally, cat claw extracts have not been assayed for photoprotection, but it is
well tolerated and decreases experimental endometriosis in a rodent model [96].
22.1.3.13 Fo-Ti (Polygonum multiflorum)
It is an extract from the root of Polygonum multiflorum (PM), with a long history in
Traditional Chinese Medicine. It displays antibacterial, antifungal, and antiaging
properties and has topical photoprotective effect [97]. However, its efficacy as an
oral photoprotector remains to be determined.
22.1.4 Dietary Non-botanicals and Other Oral Photoprotective

Agents
22.1.4.1 -3 Polyunsaturated Fatty Acid
Omega-3 fatty acids have limited photoprotective properties. They modestly

decreased the appearance of sunburn cells and inflammation upon UV treatment as
well as longer-term effects of UVA exposure [98]. Its main limitation as an oral
photoprotector is that the dose required for this effect is likely larger than the gastric
tolerance threshold; plus it has an unpleasant taste.
22.1.4.2 Probiotics
Probiotics are live microorganisms that when administered in adequate amounts

confer a health benefit on the host. A nutritional supplement containing lycopene,
beta-carotene, and Lactobacillus johnsonii reduced early UV-induced skin damage
caused by simulated or natural sun exposure in humans; moreover, it provides
protection against the development of UVA-induced polymorphous light eruption
[99]. Oral administration of Lactobacillus rhamnosus GG significantly delays skin
tumors appearance in mice chronically irradiated with ultraviolet radiation [100].
22.1.4.3 Idebenone
Idebenone is a more lipophilic analog of coenzyme Q10, which has higher skin pen-
etrance. Idebenone alleviates the onset of UV-induced photoaging [101], although
this is controversial [102]. Its efficacy as an oral photoprotector has not been
addressed, but its oral administration increases nerve growth factor (NGF) production
[103], and it is beneficial in patients with Lebers hereditary optic neuropathy [104].
22.1.4.4 N-(4-pyridoxylmethylene)-l-Serine (PYSer)
It is an iron quencher that inhibits metal-dependent ROS generation with significant

effect in photoaging [105] but untested as an oral photoprotection agent.
22.1.4.5 Cyclooxygenase 2 (COX-2) Inhibitors
Chemical COX-2 inhibitors have potential as oral photoprotectors due to their

strong anti-inflammatory effects, which include decreasing erythema and dermal
neutrophil infiltration and activation, prostaglandin E2 (PGE2) levels, and the
appearance of sunburn cells [106]. However, their specific use as photoprotectors is
unlikely due to their wide-ranging pharmacologic effects.
22.1.4.6 Afamelanotide (Melanotan I) and Melanotan II
These are synthetic analog of alpha-melanocyte-stimulating hormone (-MSH), admin-

istered by subcutaneous injections. They promote melanogenesis [107]. Afamelanotide
(melanotan I) (Nle4-D-Phe7), a linear molecule, has been shown to have photoprotec-
tive effects in clinical trials, including excellent photoprotective properties for erythro-
poietic protoporphyria and solar urticaria [108, 109]. Melanotan I should be
distinguished from melanotan II, a cyclic variant which increases pigmentation at lower
cumulative doses than melanotan I, but it also resulted in decreased appetite and
increased libido. This is not part of any commercial or investigational formulation for
human use, but it can be obtained illegally on the Internet and other sources [110] for
tanning and cosmetic and recreational purposes [111]. Very recent studies report anec-
dotal coincidence of melanotan II use with the emergence of melanoma [112, 113].
22.2 Evaluating Oral Photoprotection
Non-topical forms of photoprotective agents cannot be evaluated using the SPF or

erythema protection factor scales. However, other parameters used for topical
sunscreens can be applied for oral photoprotection agents, including:
(i) Photoimmunoprotection: The oral treatment under evaluation can be assessed
for UV-induced suppression of contact- or delayed-type hypersensitivity
responses. This can be done using a unique sub-erythemal dose of UV radiation,
which enables direct comparison with SPF, but it requires a large number of
volunteers and is not cost-effective [114]. Alternatively, it can be done by using
prior contact with specific chemical irritants. The major drawback is that this is
not directly comparable to the effect of UV radiation, but it indicates whether the
treatment modulates the ability of the immune system to respond to the insult.
(ii) Antimutagenic activity: This is being developed in nonhuman models. This
parameter is assessed as the ability of the oral treatment to prevent mutations
in key genes involved in the photocarcinogenic process, e.g., p53 [115].
(iii) Antioxidant activity: In vitro schemes including UVB irradiation of
keratinocytes and subsequent staining for T-T dimers and sunburn cells could
become the new standard in measuring the photoprotective ability of a new
compound. Such measurements could be extended to in vitro antioxidant
testing. Again, the major issue is that this cannot be extrapolated to the effect
of oral administration directly (but it could be after appropriate in vivo
measurements of bioavailability, tissue distribution, and half-life).
22.3 Future Perspectives
Non-topical photoprotection is a rapidly expanding field that still lacks gold standards
and is vulnerable to counterfeit and fraud (e.g., the current situation with the distribu-
tion and effect of melanotan II). But the premise of non-topical, especially oral, pho-
toprotection holds undeniable promise. Of course, oral photoprotective agents are not
meant to completely substitute topical photoprotection. Although some substances,
e.g., forskolin, increase epidermal thickening, UV irradiation of the skin will always
damage unprotected cells. Oral supplementation is aimed at countering the long-term
effects of sun exposure, which are more related to immunosuppression, chronic
inflammation, and photocarcinogenesis. Our current view is that the field strongly
needs standardization for the assessment of the effectiveness of oral photoprotection,
particularly measurements of antioxidant activity. Active involvement of regulatory

agencies, e.g., FDA, will help with the establishment of gold standards and more
research on the myriad of new substances and combinations of substances that will
likely change the landscape of photoprotection in the next 20 years.
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Chapter 23
Photoprotection from Sunless Tanning
Products and Colored Cosmetics
Zoe Diana Draelos
Photoprotection is traditionally associated with the use of sunscreens and physical

objects, such as clothing, sunglasses, hats, umbrellas, scarves, etc., together with
behavioral modification by seeking shade, While these are some of the most
effective methods of protecting the skin from the damaging UV radiation produced
by the sun, there are other creative methods of obtaining sun protection from
products that are not traditionally considered. These alternatives include sunless
tanning products and colored cosmetics. While these are not a substitute for
sunscreens and protective clothing, they might be a useful addition to a sun-
protective regimen and are worth discussing for their additive effect. Both products
are used primarily to adorn the body through creating a colored cover over the skin
and are classified as cosmetics from a regulatory standpoint in the USA.
This chapter will examine the use of sunless tanning products and cosmetics as
sun protection adjuvants, discussing their history, chemistry, safety, and utility for
photoprotection.
23.1 Photoprotection and Sunless Tanning Products
Sunless tanning products are an interesting cosmetic category because application

of the cream simulates the tan achieved with sun exposure. While the primary
reason to use sunless tanning products is to achieve tan without exposure to the sun,
the active agent in sunless tanning products, known as dihydroxyacetone (Fig. 23.1),
was an active listed on the sunscreen monograph for many years.
Z.D. Draelos, MD
Department of Dermatology, Duke University School of Medicine,
2444 North Main Street, Durham, NC 27262, USA

DOI 10.1007/978-3-319-29382-0_23
406 Z.D. Draelos
Fig. 23.1 Chemical CH2OH

structure of
dihydroxyacetone (DHA)
is structurally a sugar C O
CH2OH
Dihydroxyacetone, abbreviated DHA, was originally synthesized in the 1920s but

rediscovered by Eva Wittgenstein, MD, in 1957 while she was studying orally admin-
istered DHA on childhood glycogen storage diseases. She observed that the children
developed skin browning where the brown saliva contacted the skin. She subsequently
applied the liquid to her own skin and noticed the tanned color. The product was
commercialized in 1959 as a successful shaving lotion, known as Man-Tan [1].
23.1.1 Chemistry of DHA
DHA is the active agent in all presently marketed sunless tanning products and is a
3-carbon sugar appearing as a white, crystalline hygroscopic powder. DHA is
formed when glycerol is fermented by Gluconobacter oxydans. It interacts with
amino acids, peptides, and proteins to form chromophores known as melanoidins
[2]. Melanoidins structurally have some similarities to skin melanin, but are not able
to function as electron donors to reactive oxygen species [3]. Tanning occurs when
melanin becomes oxidized, a reaction that cannot occur with DHA.
DHA interacts with the stratum corneum to form the melanoidins as the entire
brown color can be removed by tape stripping the skin. No DHA is found in the
viable epidermis or dermis after topical application accounting for its systemic
safety profile. Thus, the thicker the stratum corneum, the more deeply the skin will
pigment. For this reason, the brown is less intense on the face where the stratum
corneum is thin and more intense on the elbows and knees where the stratum
corneum is thicker. It also produces a much darker stain on the palms and the soles,
areas that do not normally tan.
In addition to the thickness of the stratum corneum, the color produced by DHA
is controlled by skin pH and the pH of the sunless tanning product. If the skin or the
formulation is alkaline, the DHA color will be more orange. Conversely, if the skin
or the formulation is acidic, the DHA color will be pinkish yielding a more natural
appearance. For this reason, manufacturers typically formulate their products at a
pH of 56 to yield the best color development.
The amount of water in the formulation can also affect the sunless tanning
product color. If too much water is present, the DHA color development will be less
as the water inhibits the melanoidin formation. For this reason, DHA products are
not formulated with glycerin, which is a humectant capable of attracting water.
Instead the DHA is placed in a propylene glycol and sorbitol vehicle to increase
melanoidin formation and the intensity of the stain produced.
23 Photoprotection from Sunless Tanning Products and Colored Cosmetics 407
23.1.2 Melanoidins and the Maillard Reaction
The reaction that occurs on the skin surface creating the melanoidins, which yield
the simulated tan color, is known as the Maillard reaction (Fig. 23.2). The Maillard
reaction occurs when a protein binds to a sugar. Thus, the keratin protein of the skin
reacts with the sugar DHA to create the browning reaction [4]. DHA is technically
categorized as a colorant or colorless dye. It reacts with amines, peptides, and free
amino acids in the stratum corneum. The first step is the conversion of DHA to
pyruvaldehyde with the elimination of water. Then the ketone or aldehyde interacts
with skin keratin to form an imine [5]. The remaining specifics of the reaction are
still unknown, but the resulting products are cyclic and linear polymers that have a
yellow or brown color.
The chemical reaction is usually visible within 1 h after DHA application, but
maximal darkening may take 824 h [6]. Many sunless tanning products contain a
temporary dye to allow the user to note the sites of application and to promote even
application, but this immediate color should not be confused with the Maillard
reaction.
Fig. 23.2 The Maillard reaction. The Maillard reaction involves the interaction of the DHA sugar
with the stratum corneum keratin protein to produce a pigmented substance known as a melanoidin
408 Z.D. Draelos
23.1.3 Sunless Tanning Product Formulation
As mentioned previously, sunless tanning product formulation is challenging, as

water inhibits the Maillard reaction, meaning that all DHA-containing products
need to be oil based. DHA is usually added to a creamy base in concentrations of
35 % [7]. Lower concentrations of DHA produce mild tanning, while higher con-
centrations produce greater melanoidin formation [8]. Formulators can vary the
depth of color production by controlling the DHA concentration allowing the sale of
sunless tanning products in light, medium, and dark shades. The depth of color can
also be increased by adding another source of protein to the product. For example,
applying a sulfur-containing amino acid, such as methionine sulfoxide, to the skin
first followed by the application of DHA will result in higher melanoidin formation
and a deeper simulated tan. It is important to understand this chemical reaction, as
the deeper simulated tan does not necessarily equate to increased sun protection.
One of the major cosmetic drawbacks of sunless tanning products is their distinct
and somewhat unpleasant odor, which is difficult to mask. A variety of fragrances
have been added to modern formulations in an attempt to mask the odor, but once
the fragrance evaporates from the skin surface, the characteristic DHA odor returns.
The staining reaction that occurs with DHA is limited strictly to the stratum
corneum and can be readily removed with tape stripping and exfoliation. Thus, the
product must be reapplied daily to maintain the optimal skin darkening. The color
will fade as the stratum corneum sloughs over 14 days. There are no known side
effects, except for possible irritation, from frequent application; allergic contact
dermatitis may occur, as discussed next.
23.1.4 DHA Safety
DHA is a nontoxic ingredient both for ingestion and topical application. It has a
proven safety record with only a few reported cases of allergic contact dermatitis [9].
In the 1920s, it was determined that large quantities of oral DHA did not produce
toxicity, and the LD50 in rats is over 16 g/kg. It is interesting to note that the phos-
phate of DHA is one of the intermediates in the Krebs cycle known as dihydroxyac-
etone monophosphate. Topically applied DHA reacts immediately upon contact
with the stratum corneum amines and is not absorbed for this reason. DHA has not
been detected in the urine or serum of volunteers following topical application [7].
Patients who are allergic to one sunless tanning product may be allergic to all
sunless tanning products as DHA is a common ingredient. While the reported
instances of allergic contact dermatitis to DHA are few, practical experience
indicates a much higher incidence. The author personally sees two patients per
month with allergic contact dermatitis to sunless tanning products. To confirm the
allergy, it is best to patch test the patient to the product the patient purchased under
an occlusive bandage for 48 h followed by removal and evaluation 24 and 48 h later.
23.1.5 DHA Photoprotection
The final question remains the ability of DHA to provide photoprotection. DHA
was listed on the sunscreen monograph at one time but has since been replaced
by better agents with superior UV-absorbing qualities; therefore, it is no longer
considered a sunscreen ingredient. DHA absorbs long wavelength UV in the
300380 nm range [10]. It has an SPF of 34 [11].
What does this mean? It means that no SPF rating can be assigned to DHA, as it
now has become simply a cosmetic and not an over-the-counter drug. Nevertheless,
there is some photoprotective value to DHA. It was originally used in a 3 % concen-
tration in combination with 0.25 % lawsone. The advantage to DHA is that an irre-
versible reaction occurs when the DHA sugar binds to the keratin protein that cannot
be removed by rubbing. This is not the case with modern sunscreen formulations.
While it is important to remind patients that the simulated tanned appearance cre-
ated by sunless tanning creams requires additional sunscreen use, a sunless tanning
preparation applied first several days before an extended outdoor outing with addi-
tional sunscreen applied on top 30 min before sun exposure might be helpful.
In addition, there are some formulations of sunless tanning products that contain
monographed sunscreen ingredients. DHA can be combined with organic sunscreens
that do not contain amino groups, such as octyl methoxycinnamate, homosalate,
octocrylene, and benzophenone. It also can be combined with inorganic sunscreens
(zinc oxide and titanium dioxide). The challenge with inorganic sunscreen
combinations is that the zinc oxide and titanium dioxide can discolor brown in the
bottle if 5 % DHA is combined with 5 % inorganic sunscreen after only a few days.
Nevertheless, the use of sunless tanning creams containing sunscreens may
encourage application compliance.
23.2 Photoprotection and Colored Cosmetics
In addition to novel uses of sunless tanning products for photoprotection, colored

cosmetics can also be used creatively to enhance the efficacy of traditional
sunscreens. This discussion evaluates the formulation of facial powders, facial
foundations, and lipsticks presenting ideas as to how these three popular colored
cosmetics can assist in sun protection.
23.2.1 Facial Powders
Facial powder is traditionally used to provide coverage of complexion imperfections,

oil control, a matte finish, and tactile smoothness to the skin. However, facial powder
can also increase photoprotection longevity when dusted on top of a sunscreen film
410 Z.D. Draelos
after it has completely dried; it can also increase the SPF of a sunscreen by provid-
ing an additional layer of organic sunscreen ingredients (Fig. 23.3). In addition,
there are some pigmented powder sunscreen formulations that have become very
popular for patients with multiple allergies and sensitive skin, since the powder
formulations have ewer ingredients than cream or spray sunscreens with similar
SPF values.
Facial powders are composed of talc, also known as hydrated magnesium silicate,
combined with pigments that camouflage the underlying skin. The pigments used in
face powder listed in order of increasing opaqueness are: titanium dioxide, kaolin,
magnesium carbonate, magnesium stearate, zinc stearate, prepared chalk, zinc
oxide, rice starch, precipitated chalk, and talc. It is generally accepted that the
optimum opacity is achieved with a particle size of 0.25 m. This is important
because the opacity of a facial powder directly correlates with its ability to shield
the skin from UV radiation. Opaque facial powders that are used as stand-alone
sunscreens rely on higher concentrations of titanium dioxide, a monographed
inorganic sunscreen ingredient, to achieve their SPF rating. Adding various
concentrations of iron oxides, to match the various brown tones representative of the
human population, minimizes the cosmetically unattractive whiteness of the powder.
In addition to iron oxides as the main pigment, other inorganic pigments such as
ultramarines, chrome oxide, and chrome hydrate may be used. All of the additional
pigments may increase the product SPF, even though they are not monographed
sunscreen ingredients.
Facial powders are available in two formulations: opaque and transparent. The
opaque powders, previously discussed, mitigate the penetration of UV radiation and
can be applied on top of a spray, lotion, or cream sunscreen to augment the ability
of the sunscreen to shield the skin or used alone as an SPF-rated powder sunscreen.
It also prevents the transmission of visible light. Transparent powders are more
natural appearing due their ability to allow some light to reach the skin surface,
Fig. 23.3 Facial powder. Titanium dioxide and talc that form the basis for facial powder are also
used as inorganic sunscreens
but their sun-protective ability is diminished. Transparent powders have the same
formulation as full coverage powders except they contain less talc, titanium dioxide,
or zinc oxide, since coverage is not a priority. Transparent facial powders com-
monly have a light reflective shine, produced by nacreous pigments, such as bis-
muth oxychloride, mica, titanium dioxide-coated mica, or crystalline calcium
carbonate. They are not used as stand-alone sunscreens but can be dusted over a
sunscreen for added protection.
While facial powders contain ingredients that function as sunscreens, powder
can also increase the ability of the sunscreen film to remain in place on the skin
surface. One of the most common causes of sunscreen failure is removal of the
product due to rubbing, wiping, and water contact. The sunscreen film is also
degraded as it mixes with sweat and sebum. Magnesium carbonate can be added to
facial powders to absorb sebum, thus minimizing the ability of sebum to destroy the
sunscreen emulsion. Kaolin, also known as hydrated aluminum silicate, may also
function to absorb oil and perspiration [12]. Other specialty additives in more
expensive boutique powders include partially hydrolyzed ground raw silk, corn silk,
treated starch, and synthetic resins for increased oil and perspiration absorption.
Powder can be applied to the face over sunscreen with a brush, pad, or fingers.
Brushing the powder is least effective as the particles sit on top of the sunscreen, but
represents the easiest application method. Pressing the powder into the sunscreen
film with a pad or fingers is more effective as the powder becomes embedded in the
sunscreen, increasing the longevity of both products on the face. In general, a
transparent powder can increase the SPF of a sunscreen by 2 SPF points, for
example, from an SPF of 7 to an SPF of 9, while an opaque powder can increase the
sunscreen SPF by five numerical points. It is important to remember that the powder
does not improve the water resistance of the sunscreen film to abundant sweat,
precipitation, or submersion in water. Nevertheless, facial powders are a valuable
sunscreen adjuvant for some patients.
23.2.2 Facial Foundations
Facial foundations are another important category of cosmetic that can supplement
facial photoprotection. If you take the facial powder formulation discussed
previously and add a moisturizer, you end up with a facial foundation. Older
nomenclature labeled facial foundation a liquid powder. Facial foundations are
available in a variety of formulations to include liquid, mousse, water-containing
cream, souffl, anhydrous cream, stick, cake, and shake lotion [13]. Each of these
formulations offers a different degree of facial protection, partly due to the
ingredients in the facial foundation and to the addition of monographed sunscreen
ingredients. Thus, a more modern name for facial foundations might be a pigmented
sunscreen. The role of facial foundations in photoprotection will be explored.
The most popular facial foundations are liquid formulations containing water,
oils, titanium dioxide, and iron oxides. The liquid formulations can be further
412 Z.D. Draelos
subdivided into water-based, oil-based, oil-free, and water-free forms. Water-based

formulations contain water as the highest concentration ingredient with the oil-
soluble ingredients emulsified into the water. This is important because most organic
sunscreens are oil soluble. Water-based formulations occupy the majority of the
facial foundation market because they are easy to apply and dry down quickly, can
be removed with water, and are nonocclusive making them comfortable to wear.
Water-based facial foundations are oil-in-water emulsions containing a small
amount of oil in which the pigment is emulsified with a relatively large quantity of
water. The primary emulsifier is usually a soap such as triethanolamine or a nonionic
surfactant. The secondary emulsifier, present in smaller quantity, is usually glyceryl
stearate or propylene glycol stearate. These popular foundations are appropriate for
dry to normal skin. Organic sunscreens can be added in addition to the inorganic
titanium dioxide already present in the formulation. The most popular organic
sunscreen added to the oil phase of water-based facial foundation is octyl
methoxycinnamate, a UVB filter, yielding an SPF between 8 and 30, depending on
the concentration.
The second most popular formulations are oil-based foundations where a water-
in-oil emulsion is created. These foundations are usually employed for high
coverage and camouflaging purposes because pigments are usually suspended in the
oil phase allowing a higher concentration to be easily achieved. The oil phase may
be composed of mineral oil, lanolin alcohol, vegetable oils (coconut, sesame,
safflower), and synthetic esters (isopropyl myristate, octyl palmitate, isopropyl
palmitate). The water evaporates from the foundation following application, leaving
the pigment in oil on the face. This provides facial skin with a moist feeling,
especially desirable in dry complected patients. It is also easier to achieve a higher
SPF in oil-based formulations because the sunscreen is dissolved in the oil phase
along with the pigment.
The third most popular foundation formulations are oil-free, so named because
they contain no animal, vegetable, or mineral oils. They do contain other oily
substances, such as the silicone derivatives dimethicone or cyclomethicone. Silicone
derivates behave just like oils on the skin are usually added as the oil emulsified into
water in water-based facial foundations. These foundations are usually designed for
oily complected individuals with acne, since silicone is a noncomedogenic oil.
Again, monographed sunscreen actives can be added to the oil phase.
There are some special facial foundation formulations that are not very popular
but provide unique benefits for patients unable to use traditional organic sunscreens
yet require excellent photoprotection. These individuals may present to the
dermatologist complaining of rashes, breakouts, irritation, etc., associated with
sunscreen application. It is sometimes difficult to determine which monographed
sunscreen ingredient is the cause and whether true allergic or irritant contact
dermatitis is present. For these complex patients, it may be worthwhile to consider
opaque facial foundations. These are high-coverage formulations that contain waxes
to create a thicker, occlusive, more moisturizing formula with the ability to dissolve
larger quantities of pigment. If the cream is completely without water and only
composed of oils, it is known as an anhydrous cream and possesses waterproof
characteristics. The cream can be applied to the face as dipped from a jar, wiped
from a compact, or stroked from a rod packaged in a roll-up tube [14]. For patients
with exquisite sun sensitivity, superior photoprotection is achieved by first applying
a traditional sunscreen followed by application of an anhydrous waterproof cream
foundation. For patients with the inability to use traditional sunscreens, the
anhydrous waterproof cream foundation can be used alone.
In summary, the ability of a facial foundation to provide sun protection is directly
proportional to its ability to conceal or cover the underlying skin, a quality known
as coverage. Further, the coverage of a foundation is directly related to the amount
of titanium dioxide, zinc oxide, talc, and kaolin in the formulation. Sheer coverage
foundations with minimal titanium dioxide are almost transparent and have an SPF
around 2, moderate coverage foundations are translucent and have an approximate
SPF of 45, anhydrous high-coverage foundations with large amounts of titanium
dioxide may be opaque, acting as a total physical sunblock which protects against
UV and visible light. Thus, facial foundations can be important tools for
photoprotection.
23.2.3 Lipsticks
The final colored cosmetic that has important photoprotective qualities is lipstick.
Lipsticks contain pigments that can function as sun-protective ingredients but can
also contain monographed sunscreen ingredients allowing them to possess an SPF
rating. The lips are a common site of actinic cheilitis and may also be afflicted with
squamous cell carcinoma. Lipsticks are an excellent cosmetic for preventing lip
photodamage.
Lipsticks are mixtures of waxes, oils, and pigments in varying concentration to
yield the characteristics of the final product (Fig. 23.4). Several different lipstick
formulations are currently marketed. Lipsticks labeled as long wearing are
excellent for photoprotection and are designed to remain on the lips for a prolonged
period of time. They are composed of high wax, low oil, and high pigment
concentrations, which accounts for their intrinsic SPF of 45 even though they do
not contain monographed sunscreen ingredients [15]. The waxes incorporated into
lipstick formulations are white beeswax, candelilla wax, carnauba wax, ozokerite
wax, lanolin wax, ceresin wax, and other synthetic waxes. Lipsticks combine these
waxes to achieve a desired melting point that controls the hardness of the lipstick
and the ability of the lipstick to coat the lips when applied. Oils are then selected,
such as castor oil, white mineral oil, lanolin oil, hydrogenated vegetable oils, or
oleyl alcohol, to form a film suitable for application to the lips. The thickness of the
film over the lips determines the degree of photoprotection provided and the ability
of the film to remain in place on the lips, but the photoprotection is due to the
pigments dispersed in the oil and the suspended in the waxes.
A variety of coloring agents are used in lipsticks to achieve the wide variety of
shades available in the marketplace. Since lipsticks are removed by eating, speaking,
414 Z.D. Draelos
Fig. 23.4 Lipstick. Opaque lipstick confers excellent photoprotection to the lips
and lip licking, they commonly are ingested. Thus, the US Food and Drug
Administration controls the coloring agents that can be used in lipsticks, which also
provide photoprotection. The Food and Drug Administration divides certified colors
into three groups: Food, Drug, and Cosmetic (FD&C) colors, Drug & Cosmetic
(D&C) colors, and External Drug & Cosmetic colors. Only the first two groups can
be used in lipsticks [16]. While these pigments can provide some photoprotection,
they are not monographed sunscreen ingredients. Additional monographed
ingredients can be added, converting the lipstick into an OTC drug. Most lipsticks
do not have an SPF over 30 because the addition of higher concentrations of
monographed sunscreen ingredients will give the product a bitter unpalatable taste.
The best lipsticks are those with a high titanium dioxide and pigment load that are
completely opaque when applied to the lips.
One unique type of lipstick that provides long-lasting protection contains a lip
stain [17]. These lip stains contain indelible coloring agents known as bromo acids,
consisting of fluoresceins, halogenated fluoresceins, and related water-insoluble
dyes [18]. These lipsticks are colored red and stain the lips a reddish color. The stain
produces some minimal photoprotection but is best combined with a sunscreen-
containing lip balm. The lip stain is applied first followed by the lip balm slightly
boosting the lip balm SPF.
23.3 Summary
Dermatologists typically think of sunscreen sprays, lotions, and creams when body
and facial photoprotection is required. This chapter expands the number of products
that should be considered. While sunless tanning creams offer minimal
photoprotection with an SPF of 34, they can be used as a safer tanning alternative
than sun exposure. Increased compliance might be achieved in some patients by

using a sunscreen-containing sunless tanning preparation. Superior facial
photoprotection can be achieved either by using an opaque facial powder sunscreen
or applying a facial powder over a sunscreen. Even greater facial photoprotection
can be achieved by applying a traditional sunscreen followed by a facial foundation
and then topped with a dusting of facial powder. Combine this facial photoprotection
with an opaque pigmented lipstick and the patient is now ready for an attractive day
at the beach. The creative use of sunless tanning creams and colored cosmetics can
enhance photoprotection.
References
1. Maibach HI, Kligman AM (1960) Dihydroxyacetone: a sun-tan-simulating agent. Arch

Dermatol 82:505507
2. Wittgenstein E, Berry KH (1961) Reaction of dihydroxyacetone (DHA) with human skin cal-
lus and amino compounds. J Invest Dermatol 36:283286
3. Meybeck A (1977) A spectroscopic study of the reaction products of dihydroxyacetone with
aminoacids. J Soc Cosmet Chem 28:2535
4. Wittgenstein E, Berry KH (1960) Staining of skin with dihydroxyacetone. Science
132:894895
5. Chaudhuri RK, Hwang C (2001) Self-tanners: formulating with dihydroxyacetone. Cosmet
Toilet 116:8796
6. Faurschou A, Wulf HC (2004) Durability of the sun protection factor provided by dihydroxy-
acetone. Photodermatol Photoimmunol Photomed 20(5):239242
7. Kurz T (1994) Formulating effective self-tanners with DHA. Cosmet Toilet 109(11):5561
8. Maes DH, Marenus KD (1994) Self-tanning products. In: Baran R, Maibach HI (eds) Cosmetic
dermatology. Martin Dunitz, London
9. Morren M, Dooms-Goossens A, Heidbuchel M et al (1991) Contact allergy to dihydroxyace-
tone. Contact Dermatitis 25:326327
10. Johnson JA, Fusaro RM (1987) Protecton against long ultraviolet radiation: topical browning
agents and a new outlook. Dermatologica 175:5357
11. Muizzuddin N, Marenus KD, Maes DH (1997) UVA and UVB protective effect of melanoids
formed with dihydroxyacetone and skin. Poster presentation, AAD meeting, San Francisco
12. Wetterhahn J (1988) Loose and compact face powder. In: de Navarre MG (ed) The chemistry
and manufacture of cosmetics, vol IV, 2nd edn. Allured Publishing Corporation, Wheaton,
pp 921946
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and technology, vol 1, 2nd edn. Wiley-Interscience, New York, pp 317334
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pp 124125
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technology of the cosmetics and toiletries industry. Blackie Academic & Professional, London,
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16. de Navarre MG (1975) Lipstick. In: The chemistry and manufacture of cosmetics, 2nd edn.
Allured Publishing Corporation, Wheaton, p 778
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London, pp 196207
Chapter 24
Photoprotection by Clothing and Fabric
Thilo Gambichler, Isabelle Rooms, and Lisa Scholl
Key Points
Clothing provides simple and effective broad-spectrum photoprotection.
Photoprotection by clothing is affected by several factors, including the
material, thickness, and color.
Ultraviolet protection factor (UPF) is the in vitro assessment of
photoprotection of fabric. Similar to SPF, it is weighted toward the
assessment of protection against erythema, the predominant effect of UVB.
Clothing with UPF of at least 40 is preferred.
24.1 Background
Skin cancer is the most common type of cancer in the United States. In 2006, more
than one million people were diagnosed with basal cell carcinoma (BCC) or squa-
mous cell carcinoma (SCC). Malignant melanoma (MM), the third and most often
fatal type of skin cancer, is expected to be diagnosed in approximately 60,000 people
and hold into account for over 8000 deaths in 2007. Between 1975 and 2004, the
annual age-adjusted incidence rate for MM (new cases diagnosed per 100,000 people)
nearly tripled, from about 7 to 19 cases per 100,000 [13]. Solar UV radiation is ubiq-
uitous during daylight hours. Ambient ground-level UV is comprised mainly of UVA
(320400 nm) plus a small proportion (<10 %, variable by time of day, season, and
location) of UVB (290320 nm). Within-person and between-person UV doses vary
greatly, depending on location, time of day and season, clothing habits, and skin pig-
mentation [4]. Exposure to UV radiation on the skin results in demonstrable
T. Gambichler, MD (*) I. Rooms, MD L. Scholl, MD

Department of Dermatology, Ruhr-University Bochum,
Gudrunstr. 56, Bochum 44791, Germany

DOI 10.1007/978-3-319-29382-0_24
418 T. Gambichler et al.
mutagenic effects. The p53 suppressor gene, which is frequently mutated in skin can-
cers, is believed to be an early target of UV radiation inducing neoplasms such as SCC
[5]. Fair-skinned individuals, who are more sensitive to the effects of exposure at these
wavelengths, are at higher risk of developing skin cancer. The amount of average
annual UV radiation correlates with the incidence of skin cancer. There is a direct
relationship between the incidence of nonmelanoma skin cancer and latitude. The
closer an individual is to the equator, the greater the UV energy to which they are
exposed [6, 7]. MM mortality in the United States and Canada has also been shown to
directly correlate with ambient UV exposure. The correlation of MM incidence to UV
radiation exposure is greater when ambient UVA radiation is also included [69].
Apart from sun avoidance, the most frequently used form of UV protection is the
application of sunscreens. The use of textiles as a means of sun protection has been
underrated in previous education campaigns, even though suitable clothing potentially
offers usually simple and effective broad-spectrum protection against sunlight [1014].
In Australia, Cancer Council education campaigns have long urged the use of clothing
in conjunction with hats, sunglasses, and sunscreens as UV protection [15]. However,
a number of studies have recently shown that, contrary to popular opinion, some tex-
tiles provide insufficient UV protection [16]. In addition to skin cancer formation,
photoaging and photosensitive disorders (e.g., polymorphous light eruption, lupus ery-
thematosus, porphyrias, solar urticaria, and phototoxic/photoallergic reactions) may
also be prevented by UV protective clothing. Consequently, the use of suitable textiles,
which block UVB as well as UVA radiation, has been recommended for photosensitive
patients [1721]. Most of the photosensitive diseases are provoked by wavelengths in
the UVA range [19]. In some of these disorders (e.g., solar urticaria, chronic actinic
dermatitis), even very small UV doses can lead to exacerbation. The data of several
studies indicate that some aspects of sun protection are being practiced consistently,
while others, such as the use of UV protective clothing, are not [10, 22, 23].
24.2 Ultraviolet Protection Factor Assessed In Vitro

and In Vivo
Direct and diffuse UV transmittance through fabric is the crucial factor determining
the grade/amount of UV protection of textiles. Spectroradiometers and
spectrophotometers are suitable for the assessment of the spectral irradiance. These
measurements are usually performed in the wavelength range of 290400 nm and
operated in five or fewer nm steps. They are generally made under worst-case
conditions, with collimated radiation beams at a right angle to the fabric [10, 24]. To
determine the in vitro ultraviolet protection factor (UPF), the spectral irradiance
(both source * and transmitted # spectrum) is weighted against the erythemal action
spectrum [25]. The UPF is calculated as follows:
UPF = El S l d l / El S l Tl d l
24 Photoprotection by Clothing and Fabric 419
[E = relative erythemal spectral effectiveness ; S = solar spectral irradiance in

W/m2 (Albuquerque, New Mexico, 37.8 S, 17 January 1990) *; T = spectral trans-
mission of the sample #; d = bandwidth in nm; = wavelength in nm; the integrals
( ) are calculated over the wavelength range of 290400 nm]
The UPF is defined as the ratio of the average effective UV radiation irradiance
calculated for unprotected skin to the average effective UV radiation irradiance cal-
culated for skin protected by the test fabric [26]. Intra- and interlaboratory compara-
tive trials indicate that spectrophotometry is a precise test method to determine the
UPF, in particular for samples with UPFs below 50 minimal erythema doses (MEDs)
[2729]. UPFs greater than 50 are only of theoretical interest as even in Australia,
the maximum daily UV exposure is less than 40 MEDs.
UV dosimetry has been used to measure erythemal UV exposures underneath
and above textile materials. Similarly, polysulfone films have been employed in
in vivo simulated studies as small portable badges monitoring UV doses on
mannequins and mobile subjects [10, 3033]. Ravishankar and Diffey [33]
concluded that the protection provided by textiles worn in sunlight is, on average,
50 % higher than obtained by conventional in vitro testing using collimated radiation
beams. In contrast to polysulfone films, the sensitivity curve of biological UV
dosimeters such as DLR biofilm (B. subtilis) provides good similarity to the action
spectrum for UV-induced erythema in human skin.
The DRL biofilm is a wavelength and time integrating biological UV dosimeter
weighting the UV radiation according to its DNA-damaging potential [34]. It was
shown that cycling jerseys have comparable UPF values when tested
spectrophotometrically according to the Australian/New Zealand standard or under
stationary sun exposure with DRL biofilms [36, 31]. In accordance with results
reported by Ravishankar and Diffey, however, the jerseys revealed a much higher
UPF when tested under real conditions during cycling. We also conducted a field-
based study with biofilms and found that the UPF of a garment worn during outdoor
activities was significantly higher than the UPF measured in the laboratory [10, 35].
Analogous to SPF testing of sunscreens, in vivo measurements in human
volunteers with the sun as UV source are extremely impracticable for the
determination of the UPF. In general, xenon arc solar simulators with collimated
radiation beams are used with filters to absorb wavelength below 290 nm and to
reduce visible and infrared radiation. In most studies, the in vivo method has been
conducted by in vivo checking of the UPF values measured in vitro [36, 37, 18,
3841]. Based on the skin phototype, the MED is determined with incremental
UVB doses on the upper back of a subject and is read after 24 h. To measure the
MED of the protected skin, the textile is placed on the skin of the other side of the
back [36]. The incremental UVB doses for determination of the MED of unprotected
skin are multiplied with UPF determined in vitro, resulting in incremental UVB
doses for the MED testing of the protected skin. If the in vitro method is in agreement
with the in vivo method, the ratio of the MED of protected skin to the MED of
unprotected skin results in the original in vitro UPF. Several studies [10, 36, 39, 41],
however, have shown that the UPFs determined with the in vivo method are
significantly lower than the UPF values obtained in vitro when the fabric samples
were tested on skin. The inconsistency of the data in previous studies is certainly
due to different methodologies (e.g., different test protocols, UV sources, and textile
materials).
24.3 Fabric Parameters: Type, Construction, Dyes,

and Ultraviolet Absorbers
For undyed fabrics, there are differences in the UV-absorbing properties of the fiber.
Summer clothing is usually made of cotton, viscose, rayon, linen, and polyester or
combinations thereof. Other materials such as nylon or elastane are also found in
bathing suits and nylon stockings (Table 24.1). Usually, consumers consider
lightweight non-synthetic fabrics, e.g., cotton, viscose, and linen, the most
comfortable for summer textiles [10, 42]. Comparing different types of material in
relation to the UPF is difficult and is only possible in a limited number of cases. In
the case of synthetic fibers (e.g., polyester, polyamide), the analysis is even more
difficult because the UV protection of these materials depends on the type and
amount of additives to the fiber (e.g., antioxidants or UV stabilizers). In particular,
polyester usually has good UV-blocking properties, since this fabric provides
relatively low UVB transmission. This is most likely due to a large conjugated
system in the polymer chains [43, 44]. Polyester or polyester blends may be the
most suitable type of fabric for UV protective garments. However, its permeability
for wavelength in the UVA range is frequently higher compared to other types of
fiber [18]; this is of crucial significance for many patients suffering from
photosensitive disorders. Bleached cotton and viscose rayon provide relatively low
UV protection. This was confirmed by a study of Crews et al. who reported that
bleached cotton print clothing had a UV transmission of 23.7 %, whereas unbleached
cotton print cloth showed a UV transmission of 14.4 %.
The influence of bleaching was also evident among silk fabrics in their study.
Compared to bleached textiles, unbleached fabrics such as cotton and silk have
better UV protective properties due to natural pigments absorbing UV radiation and
Table 24.1 Summary of parameters significantly influencing the UPF of apparel textiles
Fabric material UPF of cotton, viscose, rayon < linen, nylon, wool,
silk < polyestera
Fabric porosity, weight, and UPF increases with small yarn-to-yarn spaces, fabric weight,
thickness and thickness
Fabric color UPF increases with darker colors
UV absorbers UPF is improved by UV absorbers
Stretch UPF decreases under stretch
Wetness UPF decreases for wet cotton
Wash UPF increases for cotton fabrics
a
When other parameters are kept constant
other impurities. Very few studies have considered the fiber-fabric construction
processing history of fabrics to fully elucidate the UV protection abilities of fab-
rics. Sarkar [45] recently reported the effect of fabric processing treatments, both
chemical and biochemical, on the transmission of UV radiation through selected
white and undyed fabrics. He reported that chemical processing methods such as
desizing and bleaching have a deleterious effect on UV transmission through fabric
[45]. Biochemical processing such as the use of enzymes is comparatively benign
and does not adversely impact the UV protective ability of cotton fabric. Grifoni
et al. [46] studied the UV protection properties of two fabrics made of natural fibers
(flax and hemp) which were dyed with some of the most common natural dyes. UV
transmittance of fabrics was measured by a spectrophotometer, and outdoor
measurements were taken by a spectroradiometer. Experimental results revealed
that natural dyes could confer good UV protection, depending mainly on their
different UV-absorbing properties, provided that the fabric construction already
guaranteed good cover. The authors also confirmed that UPFs calculated by in vitro
measurements were generally lower than those based on outdoor data, indicating an
underestimation of the actual level of protection of tested fabrics assessed by the
in vitro test [46].
Sarkar [47] investigated the UV properties of natural fabrics dyed with natural
colorants. Three cotton fabrics were dyed with three natural colorants. Fabrics were
characterized with respect to fabric construction, weight, thickness, and thread
count. A positive correlation between the weight of the fabric and their UPF values
was observed [47]. Similarly, thicker fabrics offered more protection from UV rays.
Thread count appears to negatively correlate with UPF. Dyeing with natural
colorants dramatically increased the protective abilities of all three fabric
constructions.
The fabric construction is a primary determinant of fabric porosity followed
by fabric weight and thickness of the textile [43]. An increased density concern-
ing the weave or knitting technique (smaller yarn-to-yarn spaces) leads to a
decreased fabrics porosity and consequently less UV radiation is transmitted.
Spaces between the yarns are frequently larger in a knit than in a woven textile.
Besides, plain-woven textiles have a lower porosity than textiles using other
weaves [48].
Thickness is a useful parameter for understanding differences in UV protec-
tion between fabrics. Crews et al. [43] reported that thicker, denser fabrics
transmitted less UV radiation. Therefore, they concluded that thickness is most
useful in explaining differences in UV transmission when differences in per-
centage cover are also accounted for [49]. By contrast, Kan and Au [50] recently
found that fabric weight is the most important factor to affect the UPF while
thickness and stitch density were not the main parameters determining UV
protection.
The color of the fabric may also influence the UPF since some dyes have an
absorption spectrum extending into the UV spectrum. Enhanced UV protection of
dyed textiles depends on the position and intensity of the absorption bands of the
dyes within the UV wavelength and the concentration of the dye in the textile.
The absorbance of UV radiation can influence many substrate attributes, e.g., fluo-
rescence, photodegradation, and UV protection. Generally, dark colors provide bet-
ter UV protection due to increased UV absorption. This holds only true for the same
UV absorbent dye provided that other characteristics of the textile, e.g., fabric type
and construction, are the same [10]. However, dyes within particular hue types can
vary considerably in the degree of UV protectiveness due to their individual trans-
mission/absorption characteristics [51].
In order to improve UV protection, UV absorbers have been added recently with
different techniques [50]. UV absorbers are colorless compounds that absorb in the
wavelength range from 280 to 400 nm. Hilfiker et al. [52] found the cover factor to
be useful in predicting the maximum UPF that could be achieved by treating the
yarns with UV absorbers. Thus, fabrics could be made opaque to UV radiation with
a sufficient level of UV absorber impregnation. The corresponding UPFs approached
the theoretically predicted levels based on the cover factor. Osterwalder and Rohwer
[53] demonstrated that a UV absorber can be brought into contact with a fabric
during the wash or rinse cycle of a laundry operation. The high UV transmittance of
30 % of a thin, bleached cotton swatch in the dry state (UPF 3) can be reduced
tenfold to about 3 % (UPF >30) in ten washing cycles.
Titanium dioxide is frequently used as a UV-blocking substance in fabrics.
However, the absorptive and scattering properties of titanium dioxide particles in
the UVA wavelength range are different and depend mainly on the particle size and
geometry. Nevertheless, UV absorbers are suitable for significantly increasing UPF,
especially that of nondyed lightweight summer fabrics such as cotton and viscose
fabrics [10, 52, 5456]. Recently, Wang et al. [57] presented a facile process to
prepare uniform dumbbell-shaped ZnO crystallites. They discovered a unique
morphological effect on the UV-blocking property. The as-prepared ZnO crystallites
were characterized by different criteria including UV blocking and Raman scattering
spectra. The as-prepared structural material demonstrated a significant advance in
protective functional treatment and provided a potential commercialization [58].
Furthermore, Behler et al. [58] showed that the use of electro-spun nanofibers with
a high load of nanodiamond can provide UV protection.
24.4 Fabric Use and Environmental Effects

on the Ultraviolet Protection Factor
Moon and Pailthorpe [59] showed that stretching elastane-based garments about
10 %, in both the machine and the cross-machine directions, causes a dramatic
decrease in the measured UPF of a textile. Their consumer survey also showed that,
on average, about 15 % stretch is achieved when these textiles are worn. However,
the 15 % stretch refers to power stretch, which is only a small segment of the
clothing market. Elastane-based textiles for tight fitting should not be considered
as defined UV protective clothing. Kimlin et al. [60] reported that the UPF of 50
denier stockings decreased 868 % when stretched 30 % of their original size.
Notably, the most popular type of stockings (15 denier) provides a UPF less than 2
[61]. The maximum stretch point on the body for tight-fitting garments is the upper
back, where textiles can be stretched up to 15 %. However, realistically, the effect
of stretch on the UPF of a textile may be of significance only for garments with a
non-stretched UPF of less than 30, particularly leggings, womens stockings, and
swimsuits [10].
When textiles become wet, by humidity in the air, perspiration, or water, UV
transmission through the fabric can significantly change [62]. A marked reduction
of the UPF was observed for textiles made from cotton and cotton blends. However,
Wong et al. [63] recently reported that knitted fabrics with miss stitches retained
good UV protection even when the fabrics were stretched by 20 % of its original
dimensions. In a field-based study, it was shown that significant UV exposures may
occur underneath garments, particularly white cotton fabrics in a wet state. Similar
results were also observed in in vivo measurements of cotton and polyester blends
[37, 64, 58]. In case of fabrics made of viscose or silk, or in fabrics that have been
treated with broadband UV absorbers, the UPF frequently increases when the textile
becomes wet. This was also observed in a recent study of modal fabrics treated with
titan dioxide [37, 54]. Thus, UV protection of wet garments is not always poor.
Most of the fabrics will undergo a combination of relaxation shrinkage and
consolidation shrinkage when washed [65]. Therefore, the spaces between the yarns
will decrease and UV protection increases. The effect of laundering on the UPF puts
into perspective other fabric parameters and factors which decrease the UPF [10].
Stanford et al. [66] showed that UPFs of cotton T-shirts increased after the first
washing and did not change significantly with subsequent washing. Wang et al. [67]
observed only a moderate UPF increase of cotton fabrics after laundering. Adding
UV-absorbing agents during laundering was found to substantially enhance UPF
[67, 68]. Recently, Zhou and Crews [69] reported that UPF of cotton or cotton/
polyester blended fabrics can be significantly enhanced by repeated laundering of
the garment in a detergent containing optical brightening agent. This was not the
case for fabrics comprised entirely of polyester or nylon [69]. Prolonged wear and
tear beyond the standard lifetime of a garment may eventually cause thinning of
the individual fibers and consequently alter the UPF. Photostability of a textile and
its UV protectiveness is an important requirement for sun protective clothing [62].
Unfortunately, there are only limited data on the stability of the UV protectiveness
of a textile against UV radiation or infrared [10].
24.5 Standardization of Sun Protective Garments
The first standard for sun protective clothing was published by the Australian
Standardisation Institute in 1996. This standard, referred to as AS/NZS 4399, has
set requirements for determining and labeling the UPF of sun protective fabrics and
other items that are worn in close proximity to the skin [26]. Based on the standard,
spectrophotometrically assessed UPF is for a specific type of fabric and does not
address the degree of protection that is afforded by the design of a garment. The
effects of stretch, wetness, wear, and use are not included in the AS/NZS 4399.
According to the Australian/New Zealand standard, UPFs are classified in three
categories: UPFs of 1524 (ratings 15 and 20) offer good protection; UPFs of 2539
(ratings 25, 30, and 35), very good protection; and UPFs of 40 and higher (ratings
40, 45, 50, and 50+), excellent protection. Fabrics with a UPF of less than 15 are not
labeled. Three standard documents that pertain to the testing and labeling of UV
protective textile products were also published by the American Society for Testing
and Materials [70] and the American Association of Textile Chemists and Colorists
[71]. More recently, the European Committee for Standardization (CEN) has
developed a standard on requirements for test methods and labeling of sun protective
garments. The first part of the standard (EN 13758-1 [72],) includes all details of
test methods (e.g., spectrophotometric measurements) for textile materials, and part
2 (EN 13758-2 [73],) covers the classification and marking of apparel textiles [10].
UV protective clothing must fulfill all stringent instructions of testing, classification,
and marking including a UPF larger than 40 (UPF 40+), average UVA transmission
lower than 5 %, and design requirements as specified in part 2 of the standard to
claim the European standard as described above. A pictogram, which is marked
with the number of the standard EN 13758-2 and the UPF of 40+, shall be attached
to the garment if it is in compliance with the standard [74]. Moreover, British,
Canadian, South African, and multinational groups, including Commission on
Illumination (CIE) and also the International Organization for Standardization
(ISO), have been engaged in writing UV protective fabric standard documents [10].
24.6 Conclusions
Defined UV-blocking fabrics are important element not only in campaigns against
skin cancer but also in prevention of photosensitive disorders and photoaging. The
UPF of a garment depends on a variety of parameters, including fabric construction,
type, color, weight, thickness, finishing processes, and presence of additives such as
UV-absorbing substances (e.g., titan dioxide, brightening agents) (Table 24.2).
Moreover, UV protection of a garment during use depends on wash and wear,
including stretch and hydration [10]. Optimally, apparel textiles assigned for UV
protective clothing should be therefore measured and labeled in accordance with a
standard document (e.g., AATCC 183:1998; AS/NZS 4399:1996; EN 13758-
1:2002). Sun protective clothing needs to be designed with special types of complex
weaves allowing the passage of air to promote wearer comfort but to block the pas-
sage of sunlight through the textile. Fabrics may include UV absorbers of various
types to increase UV protection [74]. It will of course be essential to select sub-
stances that have a low potential for irritation and sensitization. Moreover, stringent
requirements for the design should be complied with garments assigned for sun
protective clothing (EN 13758-2:2203). A recent German study indicated that more
counseling on UV protective clothing is needed for young, male, and lower educated
Table 24.2 Collection of Labeled UV protective clothing with an UPF of at least 30 is

general recommendations and preferred
rules of the thumb for UV
The less the fabrics transparency to visible light, the better
protective clothing
the UV protection
The darker the color of the fabric, the better the UV protection
Polyester or polyester blends usually offer better UV
protection than other fabrics
Stretch and wetnessa textiles significantly decrease the UPF of
a garment
Looser fits are preferable; the garment should cover the skin
as much as possible
New clothing, especially cotton fabrics, should be washed
before wearing it
Despite of a high UPF, a significant amount of UVA can still
be transmitted
a
Especially cotton fabrics
individuals [42, 75]. The textile industry should be aware of the increasing demand
for labeled sun protective clothing, in particular clothing segments such as baby
wear, children wear, and leisure and outdoor worker wear [76, 77]. Light-weighted,
breathable, natural fabrics made of cotton and linen are preferred textiles. The
textile industry may consider such fabrics for the production of labeled sun protective
clothing. Nevertheless, peoples compliance of buying and wearing sun protective
clothing may be impaired by several factors such as price, lack of knowledge, and
desire to tan [10].
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Chapter 25
Photoprotection by Glass
Manaf Shaban and Fahad Almutawa
Key Points
Glass has the ability to block all ultraviolet-B (290320 nm) and a variable
amount of ultraviolet-A (320400 nm). Factors affecting ultraviolet
radiation transmission include glass type, thickness, color, and film coating.
Glass, window films, and sunglasses play an important yet possibly under
recognized role in our effort to decrease UVR damage.
Sunglasses should meet one of the national lens safety standards, be of
adequate circumference, wrap around the eye, and be as close to the
forehead as possible.
25.1 Introduction
Many governmental educational strategies have been implemented to help increase

the awareness of sun protection such as sunscreen use, avoiding sun between peak
hours (10 am2 pm), and wearing wide brimmed hats. These factors are essential,
yet there appears to be a lack of education regarding physical sun protection, such
as glass and sunglasses which shall be discussed.
Disclosures: No conflict of interest

M. Shaban, MD
Department of Dermatology, Asaad Al Hamad Center, Al Sabah,
Safat, PO BOX 25252, Kuwait City 13113, Kuwait
F. Almutawa, MD (*)
Department of Medicine, Kuwait University,
Al-Jabriya, Safat, PO Box 24923, Kuwait City 13113, Kuwait

DOI 10.1007/978-3-319-29382-0_25
430 M. Shaban and F. Almutawa
25.2 Ultraviolet Radiation
Ultraviolet radiation (UVR) consists of UVC (100290 nm), UVB (290

320 nm), and UVA (340400 nm). Approximately 90 % of the UVB radiation
and all of the UVC radiation are absorbed by the ozone layer. The remaining
UVR that reaches the earths surface consists mainly of UVA, with around
3.5 % UVB [1]. There are several biologic effects of UVR from sunlight. Acute
cutaneous affects include erythema, edema, immediate pigment darkening, per-
sistent pigment darkening, delayed tanning, epidermal hyperplasia, and vitamin
D synthesis. The chronic effects include photoaging, photocarcinogenesis, and
immunosuppression [2]. There are also several ocular effects that can occur to
unprotected eyes. These include pterygium, photokeratitis, cortical cataracts,
and climatic droplet keratopathy [3].
25.3 Photoprotection by Glass
Glass has chemical properties similar to that of a liquid with a melting point of
around 1700 C but at room temperature behaves as a solid [4]. Glass is mainly
made of silica from sand, soda ash, and limestone which are melted together and
mixed with various other chemical to change its properties and color. The float
process is the classical method of creating smooth sheet glass. Melted glass is
poured over a bath of molten tin leaving a perfectly smooth surface as it spreads and
cools [5].
25.4 Main Types of Glass
Annealed glass is the most basic type of glass produced from the float process. It is
usually the starting type of glass that can later be modified via lamination,
toughening, etc. It is often used in double glazed windows; when broken, it results
in large sharp pieces [6] (Table 25.1).
Tempered or toughened glass is created by gradual heating and sudden cooling
of the glass. It breaks into small pieces that are less likely to cause injury and is four
times stronger than annealed glass. It is commonly used in car side windows, glass
sliding doors, and shower enclosures [6].
Laminated glass is created when two laminae are fused to a middle plastic PVB
(polyvinyl butyral) layer. When this composite is broken, the pieces of glass adhere
to the plastic preventing injury and maintaining the glass integrity. This is the main
glass type used in front windshields of cars to prevent the passengers from being
ejected from the vehicle; it is also increasingly being used for the side windows to
increase passenger safety [7].
25 Photoprotection by Glass 431
Table 25.1 Common types of glass

Types of glass Comments
Annealed glass Basic flat glass
Breaks into large pieces
Toughened glass Breaks into small regular pieces
(tempered glass) Withstands higher compression than annealed glass
Laminated glass Made of several layers of glass with a middle layer of plastic
High protection from UVR
Broken pieces are held together via the plastic layer
Coated glass Coated with layers that can affect its properties, e.g., reflectivity, corrosion,
or scratch resistance
Patterned glass Flat glass with a regular pattern on its surface
Coated glass allows the glass to be modified, such as being scratch resistant,
increased reflectivity or transmissibility, and corrosion resistance. It is created by
allowing the coating vapor to bind to the surface of the glass often during the float
process.
Patterned glass is created by making a pattern on the surface of the glass. This is
usually done by passing the heated glass between rollers with an imprint on the
rollers. The glass can take on any pattern and it is often used to allow in light but to
prevent transparency [6].
25.5 UV Transmission Through Residential Glass
Glass in general has the ability to block all UVB (290320 nm) and a variable
amount of UVA (320400 nm) depending on the type of glass [8]. The various
factors that affect UVR transmission include glass type, thickness, color, and film
coating.
In the glass film industry, UVA transmission is often measured up to 380 nm; in
general, there is a sharp increase in the UVA transmission between 380 and 400 nm.
According to a study performed using 40 different films on museum glass, the
protection ranged from 86 to 99 %, only two products actually blocked 99 % of the
UVR up to 400 nm [9].
A study by Duarte et al. measured the UVA and UVB penetration through
different types of glass of varying colors at different distances from the UVA source
[7]. They found that laminated glass blocked all the UVA regardless of distance
from the UV source. At 0 cm from the UVA source, the greatest UVA transmission
was through annealed glass (74 %), followed by tempered glass (71 %) and patterned
glass (44 %).
The color of the glass also had an effect on the transmission of UVA. At 0 cm
from the light source, the amount of transmission of UVA through green glass was
0 %, followed by yellow glass (1.3 %), wine glass (31.1 %), colorless glass (36.5 %),
and blue glass (56.8 %).
The transmission of radiation was decreased with thicker glass but not significantly,
showing that the color of the glass was a more important variable than glass thickness.
Glass thickness of 0.2 cm allowed 75.7 % of UVA transmission, and the thickest glass
of 1 cm allowed 51.4 % of UVA transmission at 0 cm from the UV source [7].
25.6 UV Exposure in Automobiles
A study by Ding et al. showed that the average driving time for Australians of 45
years of age or older in New South Wales was 84 mins/day [10]. This was similar to
the result of a US study that shows that the average time in a car was 12 h per day
in 169 individuals [11]. The clinical relevance of these findings was shown by the
observation that patients with very severe polymorphic light eruption may be
triggered by UVA doses of 5 J/cm2 which can be achieved from 30 to 60 min of UV
exposure through tempered glass [8].
In a study of UV exposure in cars, for a left-sided driver in a nonconvertible car
with the windows rolled up, the maximal exposure was on the left arm (34 % of the
ambient radiation) followed by left lateral head. With the windows rolled down, UV
exposure was 25 % of the ambient UVR, and in a convertible car, this reached 61 % of
the ambient UVR [12]. The size of the car also plays a role as a study by Kimlin et al.
found that the average daily UVA exposure was 1.3 times higher in a large family
sedan when compared to a small hatchback [13]. The annual UV exposure in people
who drive as their primary occupation has been estimated to be around 35 MED which
is approximately equivalent to a 1 week of skiing without UV protection [14].
In the USA, two retrospective studies showed that there was a slightly greater
increase in basal cell carcinomas, squamous cell carcinomas, Merkel cell carcinomas,
and melanomas on the left side corresponding to the drivers side [15, 16]. In
Australia, where the drivers seat is on the right, two studies confirmed an increase
in actinic keratosis and lentigo maligna on the right side [17, 18].
A recent meta-analysis reported higher risks for melanoma among pilots and cabin
crew [19]. Another study showed an increase in mortality related to melanoma in
pilots [20]. While these observations could be accounted for by the higher probability
of intermittent, high-intensity UV exposure among pilots and cabin crew, the contribu-
tory factor of prolonged, intense UV exposure in the cockpit needs to be considered.
25.7 Automobile Glass/UV Transmission

Through Automobile Glass
It has now been made compulsory to have laminated glass in the front windshield as the
plastic layer prevents the passenger from being ejected. In contrast, safety tempered
glass is usually used in the side windows which shatter into small pieces. The factors
that affect UV penetration include glass type, color, protective films, and thickness.
The transmission through a laminated windscreen of a Volvo S60 showed a 98 %

blockage of the ambient UVA. Another study showed that a laminated 8 mm
automobile glass completely blocked UVA at 0 cm from the UVA source [7].
Moehrle et al. studied blue-tinted, green-tinted, and infrared reflective laminated
windscreens and found that they all completely blocked UVA up to 380 nm [12].
Tempered glass also blocks all UVB but allows more UVA penetrance than lami-
nated glass. A study of a tempered side window transmitted 17.6 % of UVA at 0 cm
from the source, and no UVA was detected at 25 and 50 cm from the source [7].
The most common color glass used in cars is green. However, it has been shown
by Hampton et al. that gray is the most effective color at blocking the transmission
of UVA, transmitting only 11.4 % of UVA. This is followed by dark green (22.9 %),
light green (35.7 %), and clear (62.8 %) [8].
The thickness of glass decreased the UVA transmission but not in a statistically
significant way compared to the other parameters such as color [7]. In contrast, a
study by Moehrle et al. found that the average transmission of UVA was 0.8 % for
insulative infrared reflective glass, 22.4 % for insulative blue glass, and 17.5 % for
insulative green glass [12].
25.8 Window Films
The use of window films was started in the 1960s and was boosted during the 1970s with
the energy crisis as a means to reduce heat loss to the external environment; films were
also found to reflect infrared radiation back into the interior space [21]. In the USA,
windshields have to maintain an American standard rating of 1(AS-1) which is the high-
est optical clarity allowing more than 70 % transmission of visible light [22]. The allow-
able side and back window tinting is highly variable according to state regulations [23].
Most films consist of several layers:
1. Protective release layer: This is polyester layer that is removed to expose the
adhesive layer.
2. Adhesive layer: This is made of a transparent high-quality adhesive which does
not distort and fixes the film to the glass.
3. A multilayered polyester film.
4. Metals, alloys, dyes, and UV inhibitors.
5. Scratch-resistant coating made from acrylic.
The metals, alloys, dyes, and filters work by either reflecting or absorbing the
UVR. The most common method used is an individual film layer of UV-blocking
material [24]. Bernstein et al. used fibroblast death from UVA exposure as an
endpoint to correlate the protection of a UV film on a tempered side vehicle glass
[25]. They found that before the film, the glass blocked 21 % of the UVR versus
99.6 % after the film application. Another study using a G50 sunlight control film
and tempered 3 mm vehicle glass showed that in the presence of the film, 100 % of
UVA transmission was blocked versus 82.4 % without the film [7].
25.9 Photoprotection with Sunglasses
25.9.1 UV Exposure to the Eye
The time of maximal exposure to UVR to the eyes is between 8 am to 10 am and

2 pm to 4 pm, which correlates to the suns rays being almost parallel to the eye
[14]. Almost 50 % of the UVR exposure to the eye occurs from scattering and cloud
reflection. This is seen most with UVB as shorter wavelengths scatter the most. The
scatter from grass is 25 %, water, 313 %; concrete buildings, 10 %; and snow,
94 % [26].
In general, the cornea absorbs more than 90 % of the UVB below 300 nm.
Within the UVA range, most radiation is absorbed by the lens followed by the
aqueous [3]. There is evidence to suggest a high correlation between UVR expo-
sure and the development of pterygium, climactic droplet keratopathy, photo-
keratitis, keratopathy, and cortical cataract [3]. In the eye, UVB can cause similar
effects of acute sunburn on the skin known as photokeratitis. UVB has also been
associated with a 60 % increase in the formation of cortical cataract but not
nuclear cataracts [27]. A meta-analysis by Sui et al. showed a clear correlation
between increased sunlight exposure and the development of age-related macu-
lar degeneration [28]. Cumulative blue light exposure is now thought to be the
cause of age-related macular degeneration (AMD), rather than UVA or UVB
radiation [3].
25.9.2 Sunglasses Guidelines
There are currently three major national guidelines on sunglasses: (1) the Australian/
New Zealand standards AS/NZS 1067:2003, (2) the American standard ANSI
Z80.3 updated in 2010, and (3) the European standard EN 1836:2005, which will be
replaced by the EN ISO 123121:2013 by March 2015. The new European standard
will include transmittance and refractive changes, resistance to sweat and damage,
temporal protection with highly tinted lenses, and increased coverage of the eye
[2931]. The Australian and European standards share the lens category definition
but differ on the allowed UVB transmission (Table 25.2) [32, 33]. The American
standard categorizes the lenses according to purpose, i.e., cosmetic versus
professional use (Table 25.3).
A study performed in 2003 showed that 17 % of 646 sunglasses tested under the
European standard failed to meet this standard, showing that self-regulation was
insufficient. The Australian and EU standards are now mandatory for eyeglass pro-
ducers, with the Australian requiring a third party for testing the lenses [34].
There is currently a proposal for the development of an eye-sun protection factor
(E-SPF). It integrates the UV reflectance and transmission of the lens to act as an aid
similar to skin SPF protection [26] (Table 25.4).
Table 25.2 Summary of the Australian standard (AS/NZ 1067:2003)

UVB (% LT) UVA (% LT)
Lens category Luminous transmittance (LT) (%) 280315 nm 315400 nm
0 (very light tint) 80100 5 100 %
1 (light tint) 4380 5 100 %
2 (medium tint) 1843 5 100 %
3 (dark tint) 818 5 50 %
4 very dark tint) 38 5 50 %
Data from Australian Competition and Consumer Commission [29]
LT ratio of the transmitted luminous flux to the incident luminous flux. Luminous transmittance is
usually specified with respect to one of the internationally accepted standard illuminants
Table 25.3 Summary of the US standard (ANSI Z80.3:2010)

UVB (280315 nm)
(% LT) UVA (315380 nm)
Luminous Normal
transmittance Normal Prolonged use (% Prolonged
Lens color Purpose (LT) (%) use use LT) use (% LT)
Light Cosmetic >40 12.5 1 100 50
Medium General 840 12.5 1 100 50
to dark purpose
Very dark Special 38 1 1 50 50
purpose
Strongly Special >8 1 1 50 50
colored purpose
Data from American National Standards Institute. Nonprescription sunglasses and fashion
eyewear- requirements. ANSI Z80.3:2010
Several factors affect the UV transmission of sunglasses. When sunglasses are

worn near the forehead, almost 85 % of the UVR (290350 nm) was blocked. This
was reduced to almost 45 % when it was moved 6 mm away from the forehead [35].
There are also requirements in Australia for the minimum lens diameter: in adults,
it is 28 mm and in children, 24 mm. The eye may be exposed to solar radiation when
the sun is behind the individual between 133 and 155. The light is reflected back
into the eye particularly when the lens has an antireflective coating [36]. It was
previously believed that wearing poor quality tinted lenses allowed the pupil to
dilate and increase the risk of UVA exposure as the glasses would give the wearer a
false sense of security and remain in the sun for longer. This was in contrast to a
study analyzing 400 pairs of sunglasses which showed no significant dilation of the
pupil when wearing sunglasses [35]. Many contact lens manufactures now offer UV
protection incorporated within the lenses; these are usually at least 14 mm in
diameter, thus providing protection to the limbus [26].
In general, sunglasses should comply with one of the national guidelines with
regard to lens quality, should wrap around the eye with side shields, and should be
kept as close to the forehead as possible to minimize harmful UVR reaching the eye.
Table 25.4 Examples of TUV (%) RUV (%) E-SPF

E-SPF based on transmittance
5 10 7
and reflectance in the UV
range 5 5 10
1.5 5 15
0 4 25
0 2 50
Data from Behar-Cohen et al. [26]
25.10 Summary
Glass, window films, and sunglasses play an important yet possibly under recognized
role in our effort to decrease UVR damage. The most important factors in choosing
glass with the highest UVA protection would be lamination, color, and possibly thick-
ness. Sunglasses should meet one of the national lens safety standards, be of adequate
circumference, wrap around the eye, and be as close to the forehead as possible.
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(2014) Ultraviolet damage to the eye revisited: eye-sun protection factor (E-SPF(R)), a new
ultraviolet protection label for eyewear. Clinical Ophthalmol 8:87104, PubMed Pubmed
Central PMCID: 3872277
27. Taylor HR, West S, Munoz B, Rosenthal FS, Bressler SB, Bressler NM (1992) The long-term
effects of visible light on the eye. Arch Ophthalmol 110(1):99104, PubMed
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factor for age-related macular degeneration? A systematic review and meta-analysis. Br
J Ophthalmol 97(4):389394, PubMed
29. Australian Competition & Consumer Commission (2003) Sunglasses & fashion spectacles.
Available from: http://www.productsafety.gov.au. Accessed 3 Dec 2014
30. American National Standards Institute (2010) Nonprescription sunglass and fashion eyewear
requirements. Available from: http://www.ansi.org. Accessed 3 Dec 2014
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standard and its replacements by two new EN ISO standards. Available from: http://www.
bureauveritas.com. Accessed 7 Dec 2014
32. Dain SJ (2003) Sunglasses and sunglass standards. Clin Exp Optom 86(2):7790, PubMed
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future technologies. Dermatol Ther 23(1):3147, PubMed
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Chapter 26
Augmenting Skin Photoprotection Beyond
Sunscreens
Thomas Meyer, Donathan Beasley, and Kerry Hanson
Key Points
Sun exposure generates an abundance of reactive oxygen species (ROS)
within skin, which overwhelm skins natural defenses (leading to oxidative
stress) and which over the course of our lives exact a toll on skins health
and appearance (especially photoaging).
Recent research establishes that generation of sun-induced ROS within
skin occurs from exposure not only to the ultraviolet (UV) but also to the
visible and infrared spectral regions; these results prompt thinking of new
strategies for photoprotection that go beyond the UV attenuation capacities
of sunscreen filters.
In addition to sunscreen filters, antioxidants (AOX) and quenchers of
photoexcited states (QPES) represent promising, complimentary
intervention strategies for topical products that can suppress or scavenge
ROS and thereby optimize skins protection against the harmful effects of
sun-induced ROS formation.
Selection of AOX and QPES for use in sunscreens needs to be conducted
judiciously, since they have potential to function as pro-oxidants (i.e.,
photosensitizers) when applied to skin and exposed to the sun, which
would exacerbate the burden of excess ROS formation within skin.
Addition of appropriate AOX to sunscreens can significantly improve
protection against ROS formation within skin over a broad range of low to
high SPFs.
T. Meyer (*) D. Beasley

Design Innovation, Bayer Consumer Health, Memphis, TN, USA
K. Hanson
Department of Chemistry, University of California, Riverside, CA, USA

DOI 10.1007/978-3-319-29382-0_26
440 T. Meyer et al.
26.1 Introduction
Skin is under constant assault by a strong oxidizing environment, including

pollutants, ozone, smoke, and solar radiation, which stimulates the formation of
reactive oxygen species (ROS). While skin possesses a full complement of its own
antioxidant defenses, research has shown that these defenses can be overwhelmed
easily when exposed to ultraviolet radiation (UVR) [13]. When this occurs,
oxidative stress sets in leaving ROS free to attack biomolecules (DNA, lipids,
proteins, carbohydrates) or to influence signal transduction pathways and gene
expression [4, 5]. Excess ROS are strongly linked to photoaging and are detrimental
to skins overall health [68].
Until recently, it was believed that ROS induced in skin by terrestrial solar
radiation (including UV, visible, infrared radiation) originated predominantly
from the UV portion of the solar spectrum. However, newer research suggests that
this traditional view needs to be amended based on findings that significant levels
of ROS formation are stimulated by radiation well outside the UV region.
Beginning in the mid-1990s, research began to show that, in addition to UVR,
visible radiation can generate ROS within skin [911]. In addition, and most
recently, Zastrow et al. determined the free radical effectiveness spectrum in
ex vivo human skin exposed to sun over 280700 nm, and while they observed a
maximum peak of ROS formation in the UVA region, they also found unexpect-
edly that as much as 50 % of the total ROS measured was induced by visible
wavelengths [12]. In agreement with these results, Liebel et al. recently reported
that exposures to solar relevant doses of visible radiation were as effective as UVR
in generating ROS within human epidermal equivalents [13]. Moreover, others
have also discovered that even longer wavelengths of radiation in the near-infrared
region (IRA 7701400 nm) appear capable of inducing ROS formation in human
skin and more specifically in dermal mitochondria, which have important implica-
tions for photoaging of human skin [1416]. These recent publications provide
mounting evidence that radiation outside the UV spectrum contributes signifi-
cantly to ROS generation within skin with strong links to photoaging, which
prompt thinking of new strategies for photoprotection that go beyond the UV
attenuation capacities of sunscreen filters.
In recognition of the growing importance of ROS in mediating skin responses to
solar radiation, we open this chapter with a brief review of the chemistry and
formation of ROS followed by an overview of the main intervention strategies to
help suppress or scavenge ROS within skin. We then focus on the use of antioxidants
(AOX) as an obvious strategy to help skin cope with the burden of excess ROS
formation induced by UVR exposure. While we provide a brief survey of the main
experimental techniques to assess effectiveness of AOX, we also share some simple
methods we have both developed and reported that are useful to select and confirm
that AOX are indeed appropriate for use in sunscreen products. Lastly, we demon-
strate the utility of AOX in low to high SPF sunscreens to improve their ability to
attenuate ROS formation in UVR-exposed skin.
26 Augmenting Skin Photoprotection Beyond Sunscreens 441
Table 26.1 Common ROS in skin ROS molecule Symbol

1
Singlet oxygen O2
Hydrogen peroxide H2O2
Superoxide anion O2
Hydroxyl radical OH
Alkoxy radical RO
Alkyl peroxy radical RCOO
26.2 Basics of ROS Chemistry and Formation
Reactive oxygen species (ROS) are a class of oxygen derivatives which have the
potential to initiate radical reactions, and nowhere is this potential more evident
than in a cell, where ROS can exhibit a duality in behavior. They occur naturally to
maintain healthy cell function, most clearly represented by their integral role in
mitochondrial respiration and participation in cellular signaling, and are typically
inhibited from undergoing uncontrolled radical reactions through an endogenous
network of both enzymatic and small-molecule antioxidants [17, 18]. However,
when the AOX network fails, oxidative stress ensues from ROS, initiating chain
radical reactions on cellular targets such as polyunsaturated fatty lipids, proteins,
and both mitochondrial and nuclear DNA [1922]. Failure of the AOX network in
the skin can result from a depletion in AOX as well as an increase in the concentration
of pro-oxidant ROS that overwhelms the skins intrinsic AOX network [1, 22, 23].
The end result is the same an increase in oxidative stress in the skin through ROS-
initiated radical reactions [1, 2].
ROS include both free radical and non-radical species (Table 26.1). In general
free radicals, like hydroxyl radical (OH), superoxide anion (O2), and peroxide
radical (ROO), have an unpaired electron centered on the oxygen, in contrast to
non-radical species like hydrogen peroxide (H2O2), which have full electron shells
on all atoms. Oxygen is a particularly unique ROS because of its diradical nature
and ground-state triplet character, making it a highly reactive molecule, and of
particular importance in biological systems. Its reactivity can be more fully
understood through a diagram of the distribution of its valence electrons. Recalling
that electrons in molecules are contained in molecular orbitals (MO), where each
MO can hold two electrons with opposite spins denoted by an up or down arrow, we
can see that most molecules fill their MOs with paired spins, such that no net spin
exists, and the molecule would be considered to be in a singlet state. The exception
to this rule is molecular oxygen, which, because of Hunds rule, has two electrons
with the same spin in two different molecular orbitals of equal energy (Fig. 26.1)
yielding a net spin such that the molecule exists in a triplet state (3O2). This is
an important characteristic of oxygen because, as a triplet, it can participate in trip-
let-state reactions (Fig. 26.1), which can lead to the formation of the highly reactive
singlet oxygen (1O2) as well as the superoxide anion (O2). Both are highly destruc-
tive ROS, but 1O2 warrants a particular focus because in its short lifetime (2 s in
H2O), it has the ability to act in signal transduction as well as in more destructive
442 T. Meyer et al.
reactions with saturated bonds of cellular molecules like lipids and proteins forming
derivatives of hydroperoxides, endoperoxides, and cycloaddition products. Its
highly reactive nature can be more fully understood, again, by looking at its valence
electrons (Fig. 26.1), which show that upon energy transfer by another triplet-state
molecule (i.e., triplet sensitization), one electron flips spin and joins its pair in one
of two available MOs such that there is no net spin and the molecule is considered
a singlet state. Unlike most singlet states, 1O2 is highly unstable compared to its
3
O2 ground state and thus is highly reactive.
In order to interact with skin photochemically to induce ROS formation, solar
radiation must be absorbed by chromophores resident in skin cells and extracellular
matrix. Table 26.2 lists common chromophores in the skin and the ROS that they
have been found to sensitize. Each reaction that leads to ROS generation is unique
to the energetics and kinetics of the chromophore involved; however, in general,
understanding how these molecules can generate ROS can be gained through a
Jablonski diagram (Fig. 26.2), which shows that following absorption of a photon,
b c
* *
1O O2.
2
Energy Transfer Electron Transfer
3O
2
Fig. 26.1 Abbreviated molecular orbitals for ground state oxygen (a), the lowest excited state of
oxygen (b), and superoxide anion (c). In its ground state, because of Hunds rule, the outermost
electrons of the molecule have parallel spins in the two p* orbitals, indicating a triplet state. When
excited, the one of these electrons flips a spin and can pair with the other electron in one p orbital,
thus forming an unstable and thus highly reactive singlet state. Superoxide anion forms (c) when
an extra electron is donated to 3O2 from another molecule
Table 26.2 Common chromophores in skin

Wavelength of
Chromophore excitation (nm) ROS sensitized
Bilirubin [24, 25] 400600 H2O2
Collagen: 320400 O2, H2O2, OH
Pentosidine in advanced glycation end
products (AGEs) [2628]
Collagen/elastin [29] 320400 H2O2
Copper -cytochrome C complex IV [14, 15, 30] 7701400 ROS unidentified
Melanin [31, 32] 230600 H2O2
NADH, NADPH [3335] 290405 O2,1 O2
Nucleosides (2-thiouracil, 4-thiouridine) [34, 35] 290405 O2,1 O2
Porphyrins [2427, 3638] 290700 O2, H2O2, 1O2
Riboflavin [21, 23, 27, 28, 39] 290465 O2, 1O2
Tryptophan [40, 41] 300400 O2, H2O2, 1O2
1
Urocanic acid [31, 42] 310 O2
a b Non-radical reactions: Isomerization,

Dimerization
Excited State Rxn
Radical Reactions:
Electron Transfer, H+Abstraction,
Photofragmentation
S1 Intersystem
Crossing Excited State Rxn
1
M* M* O2
Internal Conversion
Fluorescence or
T1 S1 T1
hv Absorption
hv Absorption
S0
M
S0
Fig. 26.2 (a) A Jablonski diagram showing the possible energy levels and reaction pathways of a
skin chromophore M, where S0 is the ground state, S1 is the first excited singlet state, and T1 is the
first triplet state. (b) A more detailed description of the potential excited state reactions that may
occur from S1 or T1. ROS can be formed through energy transfer through the triplet manifold to
form singlet oxygen, or other radical reactions can occur with proteins, lipids, DNA, sugars. Non-
radical reactions can lead to the formation of photoproducts
a molecule (M) is excited from the ground (S0) to, most often, the excited singlet
state (S1) (the exception being molecular oxygen as discussed above). From S1 a
molecule can dissipate the excess energy via innocuous mechanisms of internal
conversion (heat) or fluorescence (light). However, as described in Fig. 26.2b, for
444 T. Meyer et al.
ROS sensitization we become concerned when two pathways are favored: (1)
intersystem crossing to the excited state triplet manifold (T1) or (2) excited state
reactions from S1 or T1. If the molecule forms a triplet, then sensitization of singlet
oxygen (1O2) can occur through the triplet manifold with ground-state molecular
oxygen 3O2. Additionally, if the energetics and kinetics are favorable, the excited
molecule (M*) in S1 or T1 may undergo both non-radical reactions (isomerization,
dimerization) and radical reactions with proteins, lipids, nucleic acids, and sugars
(R) to form a radicalized R. Multiple radical reactions are possible, including
peroxidation. Figure 26.2 is a simplified drawing to illustrate some of the potential
pathways by which a chromophore may sensitize ROS. It is important to emphasize
that any chromophore, either endogenous in the skin or exogenously applied to the
skin if it is energetically and kinetically allowed, may sensitize ROS formation.
The information in Table 26.2 also raises the general recognition that skin
contains many different types of chromophores that may serve to sensitize ROS
formation over a broad range of wavelengths, including UV (290400 nm), visible
(400770 nm), and IRA (7701400 nm) radiation. The different wavelength regions
comprise vastly different energies and have different capacities to penetrate skin.
Owing to these factors, Grether-Beck et al. emphasized that the three different
wavelength bands likely interact with different chromophores in different cellular
compartments to exert their biological effects [15]. A good example is ROS
overproduction by IRA radiation where the main chromophore has been identified
as the copper complex of intramitochondrial cytochrome-C complex IV of dermal
fibroblasts. The resulting increase in intracellular ROS correlates with the
upregulation of the matrix metalloproteinase-1 (MMP-1) enzyme, which degrades
collagen in the extracellular matrix in a process that is associated with many of the
hallmark signs of photoaging, including coarse wrinkles and skin laxity. While
the specific ROS generated by IRA radiation have not been elucidated to date as the
research is so new, this example among others listed in Table 26.2 stresses the need
for additional skin photoprotective strategies that go beyond the traditional
protection afforded by UV filters in sunscreen products.
26.3 Topical Intervention Strategies to Reduce ROS Induced

by Solar Radiation
Topical formulations containing three unique classes of ingredients have emerged in

the scientific literature to reduce the burden of sun-induced formation of ROS within
skin, including:
Sunscreens
Quenchers of photoexcited states (QPES)
Antioxidants (AOX)
As illustrated in Fig. 26.3, the striking feature of these three ingredient is how
well they appear to complement one another to suppress formation or scavenge
Solar Radiation: UV, Visible, IRA UV

Visible
IRA
UVR Filtration Sunscreen Film
Visible, IRA, Attenuated UV

S
K Endogenous Chromophores
I
Photoexcited States (including1o2)
N
QPES (suppress ROS formation)
ROS
AOX (neutralize ROS if formed)
Decreased ROS to Interact with Skin
Fig. 26.3 Schematic illustrating the complimentary action of sunscreens, quenchers of

photoexcited states (QPES), and antioxidants (AOX) to prevent, suppress, or neutralize ROS within
skin. Sunscreens attenuate UV before it can interact with skins endogenous chromophores, while
QPES relax photoexcited states before they can sensitize ROS formation and AOX neutralize ROS
if formed. The action of all three ingredients functions to decrease the extra burden of ROS formed
within skin during exposure to solar radiation
ROS within skin. Sunscreens filter suns UV radiation at skins surface to attenuate
levels of UVR that can reach and interact with endogenous chromophores in the
underlying skin, whereas QPES and AOX each work within skin below the protec-
tive sunscreen film. QPES function upstream of ROS formation by relaxing photo-
excited states via electron transfer or energy transfer pathways before they can
sensitize the formation of ROS. Antioxidants, on the other hand, scavenge ROS
once formed before they can initiate damaging radical interactions with skin.
Sunscreens represent the first line of defense against ROS formation from UVR
when skin is exposed to the sun. While exposure to UVB and UVA both induce
ROS formation, research has firmly established that filtration of UVA rays plays a
more important role in reducing ROS formation within skin, in agreement with the
free radical effectiveness spectrum [12, 4345]. Indeed, sunscreens containing
combinations of UVB, UVA, and broadband UVA/UVB sunscreen actives can be
highly effective at reducing ROS generation within skin. For example, Flober-
Muller et al. reported a radical skin/sun protection factor (RSF) as high as 51 was
achieved for a lotion formulation containing a combination of the UVA sunscreen
diethylamino hydroxybenzoyl hexyl benzoate (5 %) with the UVB sunscreen
actives octocrylene (5 %) and octinoxate (5 %) [45]. As RSF represents the ratio of
the number of free radicals generated in unprotected skin to the number of free radi-
cals generated in protected skin, a value of 51 means that the broad-spectrum sun-
screen lotion reduced free radical generation caused by UVR exposure within skin
by about 98 %.
While their ability to protect against UVR damage associated with both acute
and chronic skin damage is undisputed, sunscreens lack ability to neutralize ROS,
and they cannot prevent ROS formation stimulated by wavelengths outside their UV
attenuation capacities (290400 nm). This latter point is important since it is now
446 T. Meyer et al.
appreciated (a) that as much as 50 % of ROS formed in human skin exposed to solar
radiation may be caused by visible radiation (400700 nm) and (b) that near-infrared
radiation (IRA, 7701400 nm) can also generate ROS in dermal fibroblasts through
mitochondrial interactions that appear to have clinical relevance for photoaging of
human skin [12, 15].
As depicted in Fig. 26.3, the protective action of sunscreens against sun-induced
ROS formation can be augmented by the inclusion of QPES or AOX along with
sunscreens. QPES is a term coined by Wondrak et al. to describe agents that can
assist excited states of skins endogenous chromophores (including singlet oxygen)
by dissipating their excess energies acquired from absorption through alternative
pathways (energy or charge-transfer reactions) that are harmless to skin [46]. QPES
neither absorb radiation directly nor become consumed during the process, so they
can continue to catalyze relaxation of skins endogenous excited states as long as
skin is exposed to the sun. In separate publications, Wondrak et al. outlined the vari-
ous mechanisms by which QPES can inactivate photoexcited states and described a
battery of test methods to identify QPES, including use of reconstructed human skin
exposed to solar-simulated UVR [46, 47]. Wondrak lists several effective QPES
agents from his and other research groups, including molecules that incorporate
secondary cyclic amines (L-proline methyl ester, ectoine, mycosporine amino acids)
or plant-derived polyphenols (genticaulein) [48]. Most recently, Jockusch et al.
identified that cyanoacrylates with fused aromatic rings effectively quenched
excited states of porphyrins to suppress formation of singlet oxygen [49]. Porphyrins
cause photosensitivity skin disorders called porphyrias, which are caused by an
abnormality in the heme metabolic pathway leading to an accumulation of porphy-
rins in the skin and other body tissues. Exposure to visible radiation (400410 nm)
triggers the disease, which manifests clinically with vesicles, bullae, and hyper- or
hypopigmentation [50].
AOX, on the other hand, help neutralize ROS once formed in skin before they
can oxidize biomolecules or influence signal transduction pathways. Classic AOX
typically function by one-electron or hydrogen atom donation to neutralize free
radicals and help terminate chain reactions. As indicated earlier, while skin has a
full complement of enzymatic (superoxide dismutase, catalase, peroxidases) and
nonenzymatic (vitamin E, ascorbic acid, glutathione) antioxidants to cope with
excess ROS formation, exposure to sun produces such an abundance of ROS that
skins own defenses become easily overwhelmed [1, 2]. Supplementation of topical
products with AOX can bolster skins natural antioxidant defenses and help prevent
UV-induced oxidative damages [18, 51, 52]. However, as will be shown below,
selection of AOX for use in sunscreens needs to be conducted judiciously. For
example, care must be taken to ensure that AOX themselves do not become strong
pro-oxidants (i.e., photosensitizers) when applied to skin and subsequently exposed
to UVR.
Thus, sunscreens with high UVA protection factors combined with QPES or
AOX represent promising complimentary intervention strategies to optimize
protection of skin against the harmful effects of sun-induced ROS formation. It
must be emphasized, however, that both QPES and AOX must be present at the right
levels and must be within close physical proximity to their intended targets within
skin in order to perform their functions successfully. Formulations must be designed
to release AOX and QPES so they become bioavailable. Many in vivo human stud-
ies now document the ability of various combinations of AOX from topical applica-
tions to exert protective effects within epidermis and dermis from ROS induced by
UVR, visible, or IRA radiation [12, 14, 50]. Especially significant is the finding that
topical AOX can reduce expression of MMP-1 within skin. MMP-1 is the main
matrix metalloproteinase enzyme responsible for degradation of collagen from
exposure to solar radiation and is now accepted as a major biomarker of photoaging
in human skin [53].
26.4 Methods to Select and Monitor AOX Performance
There are many in vitro assays based on transfer of a single electron or hydrogen
atom that have been used to assess the relative performance of AOX to quench free
radicals in solution [54]. While these methods are useful to measure antioxidant
capacities in various biological matrices (plasma, saliva, food extracts) or even track
AOX integrity and stability in finished product formulations, they have limited utility
to predict AOX efficacy in skin exposed to solar radiation. These assays neither pro-
vide any indication of AOX bioavailability within different cellular compartments of
skin nor take into account possible photochemical reactions of AOX when they are
applied to skin and exposed to solar radiation. The importance of using methods that
include exposures to solar radiation to qualify AOX for use in sunscreen products is
critical, since AOX can become powerful photosensitizers when exposed to solar
radiation. Under these circumstances, AOX can significantly increase rather than
decrease ROS formation within skin, which is exactly opposite of the intended effect.
As reported below, this is especially true for some botanical AOX.
26.4.1 Main Experimental Techniques to Monitor AOX

Performance in Skin
The ability of AOX to neutralize ROS within skin is typically assessed by employ-
ing either spectroscopic techniques to measure changes in ROS levels or biological
assays to track various biomarkers that result from ROS damage. A summary of the
experimental methods appears in Table 26.3. All of these methods involve exposure
to UVR and interestingly comprise a mixture of in vitro and in vivo methods plus
invasive and noninvasive in vivo techniques. While it is beyond the scope of this
chapter to review all these different techniques, in the remaining sections below, we
provide more complete descriptions of the methods we have used to screen AOX
and to confirm AOX compatibility for use in sunscreen products.
448 T. Meyer et al.
Table 26.3 Spectroscopic and biological assays of ROS detection

Method Characteristics
Chemiluminescence of 1O2 [13, 55] Direct noninvasive in vivo measure of human skin
Measures 1O2 emission at 1296 nm
Measures signal from total skin
Electron spin resonance in vivo [56] Direct noninvasive in vivo measure of human skin
Measures decrease in applied stable free radical
(TEMPO)
Electron spin resonance ex vivo Indirect in vitro measure of ROS
[4345] ROS trapped by spin traps
Two-photon fluorescence microscopy Indirect in vitro measure of ROS
[11, 5658] Fluorescent probes to detect ROS
Quantification with 1 m resolution up to 100 m
Biological assays (in vitro or in vivo) Detection of oxidation products of lipids, proteins,
DNA [3, 18, 21, 60]
Depletion of enzymatic and nonenzymatic AOX
(catalase, vitamin E, glutathione, ascorbic acid) [13]
Detection of MMPs, inflammatory mediators (IL-a,
PGE2, TNF), AGE [15, 18, 51, 61, 62]
AOX antioxidant, IL-1a interleukin-1, PGE2 prostaglandin E 2, TNF tumor necrosis factor ,
AGE advanced glycation end products
26.4.2 ROS Detection: Quantification by Two-Photon

Fluorescence Imaging Spectroscopy
Advances in two-photon fluorescence imaging microscopy (TPM) and fluorescence

probe technologies in the early 2000s led to the development of methodologies to
image ROS generation as a function of skin depth on a <1 um scale. The result is a
visualization of the density of ROS throughout a skin layer and/or a cell in a skin
layer following a perturbation like UV irradiation, which provides support to the
adage a picture is worth a thousand words. TPM monitors the fluorescence
intensity or fluorescence lifetime of endogenous chromophores or exogenous
fluorescence probes. TPM has been used to study the structure of the skin as well as
biochemical processes including pH, barrier homeostasis, as well as UV-induced
ROS [11, 57, 59, 7981]. Herein, we focus upon the latter.
Using TPM for ROS detection in skin requires tissue, an ROS fluorescence
probe, and a two-photon fluorescence microscope. In general, a skin tissue sample
is incubated with an ROS fluorescence probe like dihydrorhodamine (DHR) that is
non-fluorescent until reacted with ROS, whereupon the probe becomes highly
fluorescent upon two-photon excitation. For example, DHR is converted to
rhodamine 123 (R123) upon reaction with different ROS including 1O2, H2O2, and
ONOO [11, 6366]. TPM works by the simultaneous interaction of two ultrafast
(1015 s) infrared photons in an (3) process with the converted ROS probe, which
then emits photons from its excited singlet state through the fluorescence pathway.
The fluorescence can be detected using a photomultiplier detector on the microscope,

with an increase in fluorescence intensity, compared to a pre-UV irradiated control,
primarily representing an increase in ROS. Scanning mirrors can be used to image
throughout the xyz dimensions.
Figure 26.4 shows a typical series of two-photon fluorescence images of different
epidermal cell layers pre- and post-UV (solar-simulated) radiation. A rainbow scale
reflects the fluorescence intensity of the ROS probe either before UVR (DHR) or
after UVR (R123). The pre-UVR images are predominately blue-black, which
indicates as expected that R123 has not been formed through reaction of DHR with
ROS and that background autofluorescence is minimal. Post-UVR, however, the
intensity dramatically increases. All images show a large increase in fluorescence
indicating the generation of ROS. Because of the anucleated lipid-rich nature of the
stratum corneum, images of this layer appear inhomogeneous and lack apparent cell
structure. We believe that this results from the inhomogeneous labeling of the ROS
probe throughout the layer. In contrast, TPM images of the nucleated epidermal
layers show obvious cell structure, with nuclei, cytoplasm, and its organelles, as
well as intercellular spaces clearly differentiated. The images show that ROS are
generated predominately in the cytoplasm, which may result in an inability of the
ROS probe to label the cell membranes, intercellular space, and/or nuclei. Other
fluorescence ROS probes may label the keratinocytes differently than DHR.
As the images show, compared to one-photon confocal methods, TPM is intrinsi-
cally three dimensional with <1 m spatial resolution. In addition, because the near-IR
light (>800 nm) that is used in TPM is non-resonant with endogenous skin chromo-
phores (Table 26.2), the excitation is localized only in the focal region such that pho-
todamage to the tissue sample as well as background fluorescence are minimized, with
the concomitant benefit of an increased penetration depth up to the dermis [6769].
More specific details of how TPM is used to image skin can be found in several
references, but two points are worth mentioning here [6769]. First, both ex vivo
and living skin equivalents like MatTek EpiDerm have been successfully used to
detect UV-induced ROS in epidermis and yield similar results. Second, many ROS
probes like DHR have limitations: they are unspecific, reacting with multiple ROS
like 1O2, hydroxyl radical, or ONOO; they may undergo autoxidation, although this
pathway is considered minor compared to the direct DHR + ROS pathway; and they
distribute heterogeneously throughout a cell and/or cell layer. As such, the
fluorescence signal from a converted ROS probe in an experiment can represent a
lower limit to the ROS density that is generated under UVR.
To determine the effect of an ingredient, like UV filters or antioxidants (AOX) on
UV-induced ROS levels in our skin models, the fluorescence intensity of each TPM
image, or in the case of nucleated layers, the fluorescence intensity of each cell
throughout an image, is recorded. Comparisons between tissues with different
ingredients can then be made to a control tissue sample to determine the effect an
ingredient has upon the ROS level. This value is typically reported as a fraction of
the control (fROS) where fROS > 1 indicates the ingredient sensitized ROS above
the control and fROS < 1 indicates the ingredient neutralized ROS relative to the
control [11, 58, 57, 59]. A % reduction in ROS can be calculated by Eq. 26.1.
450 T. Meyer et al.
Pre-UV Post-UV
a b
c d
e f
Min Max
Fig. 26.4 Two-photon fluorescence images of skin tissue incubated with the ROS probe DHR
both before (a, c, e) and after (b, d, f) solar-simulated UV irradiation (22 mJ cm2 UVB, 660 mJ
cm2 UVA) at ca. 5 m (a, b), 20 m, (c, d) and 70 m (e, f)
% ROS Reduction = 100 - 100 ( fROS) (26.1)
26.4.3 Biomarker Assessment: Lipid Hydroperoxides
It is firmly established that exposure of skin to UVR mediates peroxidation of lipids

through ROS and that lipid hydroperoxides (LOOH) represent a useful biomarker to
monitor effectiveness of AOX within skin [60]. LOOH have been linked to immune
suppression, photoaging, and solar elastosis through breakdown of LOOH to form
small reactive carbonyl compounds and singlet oxygen [61, 7072]. Intriguingly,
LOOH has also been linked to development of a characteristic cross-hatched pattern
of fine lines in skin of hairless mice following one daily application of squalene
monohydroperoxide for 15 weeks, which contrasted starkly with the pattern of
deeper wrinkles and furrows that formed in hairless mice exposed to UVB only in
the same study [73].
We developed a straightforward, noninvasive ex vivo method that measures the abil-

ity of AOX to prevent oxidation of physiologically relevant stratum corneum lipids that
are removed from human skin and subsequently exposed to solar-simulated UVR [74].
The method utilizes a simple lotion base as a placebo into which AOX can be added.
Lotions are then applied (2 mg cm2) to rectangular areas outlined on the inner fore-
arms of human subjects, with placebo lotion applied to one site and with placebo + AOX
lotions applied to other forearm sites. After the lotions dry for at least 30 min, surface
skin layers inside the application sites are removed with tape, which are subsequently
irradiated with solar-simulated UVR (2 MED), extracted into isopropanol, and assayed
for total lipid hydroperoxide content using an assay kit from Kamiya Biomedical
(Thousand Oaks, CA). The percent reduction in LOOH formation for the AOX lotion
is then calculated relative to the maximum LOOH formed from placebo lotion without
any AOX. Figure 26.5 summarizes the results for several different types and combina-
tions of AOX. The results showcase several interesting features:
The method is capable of differentiating between AOX that reduce (antioxida-
tive) versus increase (pro-oxidative) LOOH formation.
Most of the pro-oxidants tested comprise botanical extracts.
Pro-oxidant behaviors of botanical extracts can be negated by adding vitamin E.
Vitamin E, green tea extract, and tetrahydrocurcuminoids have strong ability to
protect lipids in skins outer layers from UVR-induced oxidation.
250
200 Line denotes maximum level of LOOH formed

with placebo in the absence of Aox
Pro-oxidant
% PlaceboLOOH Formed
150
100
Antioxidant
50
0
)
5% )
1%
)
%
)
)
)
t.E %)
)
t.E 0.1%
5% )
SC %)
%
%
5%
(0 .25%
)
(0 0.1
%
1
.1
5% )
.5
.1
5
0.
C )
)
BP 1.0
)
(0 .0%
0.
TH .1%
.0
.2
5
)
(0
(0
(0
T(
(
.2
%
(
it. ET
(
)
(0
(0
.1
(0
(
C
G
)
a
.2
(0
(1
.1
.1
G
m a (0
O
TH
ic
.2
t.E
T(
(0
(0
Vi
.1
AC
.2
bl
us
a
)/G
Vi
Vi
os
(0
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Em
)/E lic
a
% erm
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ic
ic
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H
b
5%
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bl
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5% m
ic
)/T
it.
Th
m
bl
E
%
.2
)/V
5%
)/E
(0 %)/
.1
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)/E
(0
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t.E
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.0
05
(0
%
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(1
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(0
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.5
.
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us
(0
E
Vi
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E
t.
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t.E
Vi
t.
t.
er
Vi
Vi
Vi
Th
Fig. 26.5 Examples of antioxidants (AOX) showing their ability to inhibit or enhance UVR-
induced formation of lipid hydroperoxides (LOOH) in an ex vivo study using tape strips to collect
lipids from human skin in the absence or presence of different types and levels of AOX. The results
highlight the need to qualify AOX for use in sunscreen products. NAC n-Acetyl cysteine, Emblica
Phyllanthus emblica fruit extract, Vit.E vitamin E, GT green tea extract, THC tetrahydrocurcuminoids,
ROO Rosmarinus officinalis oleoresin, Rose G Rose gallica extract, BPSC bioactive photosynthetic
complex from green tea, Thermus Thermus thermophilus ferment, ET ergothiotaine
452 T. Meyer et al.
The experimental design provides additional advantages in that (a) each subject
serves as their own control; (b) the tape strips fix the lipids, AOX, and squames to
its surface in a similar spatial arrangement as existed on the skin; and (c) the method
eliminates the need to irradiate skin of human subjects.
26.4.4 The Need to Confirm That AOX Do Not Act

as Photosensitizers
As reported above, during the assessment of AOX to protect lipids removed from
human skin against UVR- induced peroxidation, we observed that many botanical
AOX behaved as strong pro-oxidants to increase LOOH levels significantly above
the maximum levels formed in unprotected skin in the absence of AOX (Fig. 26.5).
This result was also confirmed for Rosa G extract using two-photon fluorescence
imaging of the nucleated epidermis, which shows that application of Rosa G extract
(1 %) increases the ROS probe fluorescence significantly compared to the control
(Fig. 26.6). Similar results using TPM were also obtained for other botanical AOX,
including chardonnay grape extract, vitamin C complex, and fennel seed extract
(Fig. 26.6).
Botanical AOX typically comprise complex mixtures of polyphenols. Many plant
polyphenols have been shown to exert strong photoprotective effects in skin, includ-
ing catechins from green tea, proanthocyanidins from grape seeds, and anthocyani-
dins from berries, among others [75, 76]. Indeed, we also observed that green tea,
tetrahydrocurcumoids, and Phyllanthus emblica fruit extract conferred significant
protection against UVR-induced lipid peroxidation (Fig. 26.5). However, plant poly-
phenols can also be potent sensitizers of ROS formation when exposed to UVR, as
recently reported for verbascoside, isoverbascoside, and tyrosol or silibinin [77, 78].
Placebo Lotion Chardonnay vitamin C Fennel Rosa G

Without Aox Grape Extract Complex Seed Extract
Min Max Off Scale
Fig. 26.6 Two-photon fluorescence images (z = 3050 mm) of skin applied with or without
botanical extracts and obtained post-solar-simulated UVB/UVA irradiation. The images show that
each AOX becomes pro-oxidative in nucleated epidermis under UV radiation. These data are
confirmed by the LOOH test for Rosa G (Fig. 26.5) and dramatically show how under UVR some
botanical AOX become pro-oxidants
Interestingly, of the seven natural extracts tested by us in Fig. 26.5, four were found
to be strong pro-oxidants.
These data illustrate the point made in the Jablonski diagram of Fig. 26.2
depicting how a molecule including an AOX can undergo radical reactions once
it reaches its excited state following absorption of a photon and indicate that not
all AOX may be equally effective at quenching light-induced ROS. These results
also underscore the need to qualify AOX selected for use in sunscreen products
using appropriate methods to ensure that when applied to skin, they help reduce
rather than exacerbate the burden of excess ROS formation induced by sun
exposure.
26.4.5 Monitoring AOX Stability in Sunscreen Formulations
Use of AOX in finished sunscreen products necessitates that AOX remain physi-
cally and chemically stable from their point of manufacture until the product has
been used up for all practical purposes by consumers. By virtue of their ability to
scavenge ROS, AOX themselves are reactive molecules. Hence, during formula-
tion development, it is important to ensure that AOX are chemically compatible
with all the ingredients comprising a formulation and that once incorporated into a
formulation, the AOX remain stable and can continue to scavenge ROS
effectively.
An easy way to monitor AOX activity in finished formulations is by using one of
the routine in vitro techniques that measures the capacity of an AOX to quench a
free radical in solution. One such test is based on use of ,-diphenyl--
picrylhydrazyl (DPPH), which is a stable organic free radical with an intense purple
coloration (max = 515 nm). When dissolved in methanol (or other appropriate
solvent) and exposed to AOX, the purple color fades as DPPH is reduced. The
extent to which the color fades can be readily measured using a spectrophotometer,
and the color change can be used to construct a scale of relative effectiveness to rank
AOX or to track AOX stability within a given formulation. Either hydrophilic or
hydrophobic AOX can be assessed using DPPH provided the AOX are soluble in the
solvent selected to conduct the assay.
An example to illustrate the usefulness of DPPH to monitor the stability of AOX
in a finished sunscreen formulation appears in Fig. 26.7. The extent to which an
aliquot of the lotion caused the purple color of DPPH in methanol to fade (referred
to as antioxidant reducing units) was measured at regular intervals using a defined
protocol after the lotion was stored either at room temperature or 50 C for 30 days.
In this case, the results show that AOX in the formulation was stable and maintained
its activity over the entire period of the stability test. Advantages of the method are
that few formulation ingredients, including sunscreens, interfere with the absor-
bance readings at 515 nm, it is simple and fast to perform, and it provides a mea-
surement on whether the AOX capacity of the formulation remains intact or has
degraded.
454 T. Meyer et al.
10
Antioxidant Reducing Units

7
6
5 Room Temperature
50 deg.C
4
3
1
0
0 5 10 15 20 25 30 35
Time (days)
Fig. 26.7 A plot illustrating the usefulness of DPPH to monitor the stability of AOX in a finished
sunscreen product stored at room temperature or 50 C for 30 days
26.5 Benefits of AOX to Reduce ROS as a Function of SPF
TPM has proven highly effective in probing how sunscreens and AOX affect
UV-induced ROS density in the epidermis and in redefining what constitutes effica-
cious photoprotection. Sunscreens at any SPF yield some protection against the
generation of UV-induced ROS in the lower stratum corneum, from their inherent
ability to absorb UV photons at the skin surface before they penetrate deeper into
the skin; however, they afford incomplete photoprotection against ROS. For exam-
ple, Fig. 26.8 shows a series of TPM images of ex vivo skin applied with a broad-
spectrum SPF 30 sunscreen that have been irradiated with UVB-UVA radiation
from a solar simulator fitted with WG 320 and UG 11 filters (4 MED, 88 mJ cm2
UVB; 2.6 kJ cm2 UVA (Solar Light Company); note that the output from this lamp
contained negligible visible light). The control image (Fig. 26.8a) of unprotected
skin shows the maximum fluorescence detected, and by comparison, we see that a
broad-spectrum SPF 30 sunscreen affords some protection against UV-induced
ROS with a 39 % decrease (fROSSPF30 = 0.61) compared to unprotected skin
(Fig. 26.8b). In terms of photoprotection against ROS, there is room for improve-
ment, which we see with the addition of two antioxidants to the SPF 30 formulation
0.5 % vitamin E and 0.1 % Phyllanthus emblica fruit extract (Fig. 26.8c). These
data show that skin applied with the SPF30 + AOX formulation yields a dramatic
decrease in fluorescence intensity of the ROS probe, corresponding to a 73 %
decrease (fROSSPF30+AOX = 0.27) in UV-induced ROS compared to unprotected skin
and a twofold increase in ROS photoprotection compared to the SPF 30-AOX for-
mulation itself .
To gain a better understanding of the effect that SPF with and without AOX has
on ROS generation in the skin, we performed TPM experiments on a series of
formulations in a common placebo base with increasing SPF and either with or
without AOX. A comparison of the sunscreen actives and AOX appears in Table 26.4.
Base Base + Base +

Formula SPF 30 SPF 30 & AOX
a b c
Min Max
Fig. 26.8 Two-photon fluorescence images of skin (z = 5 m) incubated with DHR and a base
formula (a), the based + a broad-spectrum SPF 30 sunscreen (b), or the base + sunscreen + 0.5 %
vitamin E and 0.1 % Emblica fruit extract (c). All images are post-solar-simulated UV irradiation
(88 mJ cm2, 2.6 kJ cm2 UVA). fROS of the SPF 30 only is 0.61 (39 % reduction in ROS), and
fROS of the SPF 30 + AOX is 0.27 (71 % reduction in ROS)
Table 26.4 Sunscreen actives, antioxidant combinations, and broad-spectrum indications for the
formulas created to investigate the role of AOX to attenuate UV-induced levels of ROS in
sunscreens with increasing levels of SPF
SPF SPF SPF
Placebo 4 15 50 SPF 70
Oxybenzone 3.0 5.0 6.0
Octinoxate 2.0
Homosalate 5.0 10.0 15.0
Octisalate 5.0 5.0 5.0
Octocrylene 3.0 2.0 10.0 10.0
Avobenzone 2.0 3.0 3.0
Tocopherol (vitamin E) 0.5 0.5 0.5 0.5
Diethylhexyl syringlidene malonate (DESM) 0.9 0.9 0.9 0.9
Broad spectrum (c 370 nm) ? N/A No Yes Yes Yes
Just as increasing SPF correlates with greater erythemal protection, so does increas-
ing the SPF correlate with greater UV-induced ROS protection because of the
increasing optical density provided by the UV filters at the skin surface. This effect
can be seen in Fig. 26.9 where the fraction of UV-induced ROS detected in the lower
stratum corneum decreases with increasing SPF. The data also show that the same
formulations can yield significantly improved ROS photoprotection through the
456 T. Meyer et al.
0.7
Expected if ROS protection = SPF
without AOX
0.6 with AOX
Fraction ROS Detected
0.5
0.4 *
0.3
0.2
*
*
0.1
0.0
SPF 4 SPF 15 SPF 50 SPF 70
Fig. 26.9 The fraction of ROS detected in the lower stratum corneum based upon two-photon
images and at different SPF values. The addition of AOX improves ROS protection for each SPF,
although much less than what is predicted if ROS protection was equivalent to the SPF. Each SPF
formula without AOX was compared to the same SPF formula with AOX using an unpaired t-test
(*denotes p < 0.5)
addition of the antioxidants vitamin E and diethylhexylsyringlidene malonate

(DESM). Three additional interesting observations were detected with these data.
First, a higher SPF without AOX may provide less photoprotection against
UV-induced ROS than a formulation of lower SPF with AOX. For example, SPF 15
with AOX yields fewer ROS (12 % ROS) compared to SPF 50 without AOX (21 %
ROS). Second, although the addition of these AOX to the highest SPF tested (SPF
70) did lead to a decrease in the ROS density, these data were not statistically sig-
nificant which may illustrate that the effect was small and outside the signal-to-
noise detection limits of the experiment. The data do indicate that at most 93 % of
ROS are quenched by AOX (SPF 50). Further research might identify whether or
not greater concentrations of AOX could improve protection against UV-induced
ROS.
26.6 Conclusions
Exposure to solar radiation induces abundant levels of ROS within skin. Biologically
relevant levels of ROS originate not only from the UV but also from the visible and
IRA regions of the solar spectrum. ROS stimulated by the different portions of solar
spectrum likely provoke biological responses within different epidermal and dermal
compartments and are strongly associated with photoaging of skin. Sunscreens con-
taining high levels of UVA filters combined with QPES and AOX represent promis-
ing intervention strategies to optimize protection of skin against the harmful effects
of solar-induced ROS formation. Inclusion of AOX in sunscreen products can sig-

nificantly improve protection against ROS over a broad range of SPFs. However,
AOX need to be selected judiciously for use in sunscreens as some AOX can behave
as pro-oxidants as opposed to antioxidants when applied to skin and exposed to the
sun.
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Part IV
Chapter 27
Education, Motivation, and Compliance
Brian P. Hibler and Steven Q. Wang
Key Points
Nearly five million people are treated annually for skin cancer in the United
States, with an estimated cost of over $8 billion.
While knowledge that photoprotection from ultraviolet radiation can
reduce the incidence of skin cancer which is high, meaningful behavioral
changes have not yet been achieved.
A multifaceted approach to improve compliance is required, combining
ongoing public education as primary prevention, stricter indoor tanning
legislation, a change in social norms regarding tanned skin, and community-
level interventions at schools and the workplace.
Increased research, surveillance, and monitoring can measure the effects of
our prevention efforts and assist in designing future efforts to motivate
behavioral change and reduce the incidence of skin cancer.
27.1 Introduction
Skin cancer is the most common form of cancer in the United States and is a major
public health concern [13]. Nearly five million people in the United States are
treated for skin cancer every year, and the incidence and associated healthcare
expenditures of skin cancer continue to rise, currently with an estimated annual cost
of over $8 billion [46]. The vast majority of skin cancers are nonmelanoma skin
cancer (NMSC), which can be treated with topical medications, radiation, or sur-
gery with good prognosis. Although the risk of metastasis is low, NMSC is locally
destructive and can impair quality of life. While cutaneous melanoma makes up
B.P. Hibler, BS S.Q. Wang, MD (*)

Division of Dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, NJ, USA

DOI 10.1007/978-3-319-29382-0_27
464 B.P. Hibler and S.Q. Wang
only about 5 % of the total number of skin cancers, it is more deadly [3, 5]. In the
United States in 2014, it is estimated that there would be over 76,000 new cases of
invasive melanoma and 9710 melanoma-related deaths [7].
It is well established that ultraviolet (UV) radiation plays a major role in the
development of skin cancer [1, 8, 9]. Comprehensive photoprotective strategies
have been shown to reduce the incidence of skin cancer [10]. While the general
knowledge regarding the harmful effects of UV radiation and safe sun behaviors
in Western countries is high [11, 12], this knowledge has not always translated
into meaningful change of behavior. Studies continue to show significant levels
of sun exposure in children and adults with inadequate protection from UV radia-
tion [1319]. Only 3 in 10 adults routinely practice sun protection behaviors in
the United States [20]. Surveys found the majority (83 %) of teenagers, and
nearly half (37 %) of all adults experienced at least one sunburn in the previous
year [21, 22]. Furthermore, approximately 30 million people in the United States
use tanning beds each year, including 2.3 million adolescents [23]. Among ado-
lescents aged 1319, 11 % of males and 37 % of females report ever using indoor
tanning [24]. These numbers increase to 38 % of males and over 73 % of females
by age 40 [23].
As highlighted by these statistics, there is a dramatic need for further public
education and new motivational strategies to effectively change sun-protective
behaviors. This chapter will discuss the major participants in the public health
campaign, the current disconnect between knowledge and behaviors among the
general population, and provide suggestions for improving motivation and
compliance when it comes to skin cancer prevention.
27.2 Current Education in Photoprotection
27.2.1 The Messengers and Participants: A Collaborative

Effort
27.2.1.1 Medical Community
The medical community plays a key role in educating the public regarding proper
photoprotection. When it comes to skin cancer prevention and education,
dermatologists are the most experienced and have led the way. As skin specialists,
they are able to appeal to both health- and appearance-based motivations to change
behaviors. For example, for patients with a history of skin cancer, the annual skin
exam is the perfect time to reinforce the importance of proper photoprotection to
prevent further malignancies. Similarly, clinic visits for patients presenting for
cosmetic procedures can also be an ideal time to remind the patient that
photoprotection slows the signs of aging. In addition, the American Academy of
Dermatology (AAD), along with other organizations, has launched health cam-
paigns to educate the public about the need for photoprotection.
27 Education, Motivation, and Compliance 465
Aside from dermatologists, primary care physicians are in the unique position to
provide counseling to patients. In 2011, a systematic review for the US Preventive
Services Task Force (USPSTF) found that counseling in the primary care setting
can increase photoprotective behaviors and decrease intentional indoor and outdoor
tanning [25]. As a result, the USPSTF recommends physicians counsel fair-skinned
patients aged 1024 years to minimize their UV exposure and effectively reduce
their risk of skin cancer [26]. By incorporating together a total skin examination and
photoprotection counseling, primary care providers can efficiently combine both
primary and secondary prevention strategies into their visits.
Physicians from other specialties, such as pediatricians, obstetricians, and
gynecologists, can also deliver education guidelines. For pediatricians in particular,
evidence has shown that education to adolescents can be especially effective in
reducing UV exposure [26, 27]. Additionally, pediatric checkups are generally
oriented toward anticipatory guidance and serve as an ideal platform to integrate
cancer prevention education into the visit for both the child and parent [28]. As
individuals age, annual physical exams are a good time to plant the seed and keep
encouraging proper skin care with a consistent and clear message.
While nearly all physicians agree that education regarding photoprotection is
important, only a small percentage actually counsels their patients in practice. In a
review of over 18 billion total patient visits between 1989 and 2010, sunscreen was
mentioned at only 0.9 % of patient visits associated with a diagnosis of skin disease
[29]. Commonly cited reasons include not remembering and lack of knowledge.
Other major barriers include lack of time and lack of monetary incentive, as proce-
dures, diagnostics, and other interventions are favored over preventive care [30, 31].
27.2.1.2 Educational Programs
School-based educational programs teach children at a young age to foster lifelong

habits regarding sun protection [32, 33]. Two such programs are the SunWise School
Program started by the US Environmental Protection Agency (EPA) and the SunSafe
programs based on research funded by the National Cancer Institute, both of which
are aimed at providing a national educational program regarding sun safety to children
in primary schools [3438]. Children who were part of the SunSafe program practice
better sun safety techniques, including better sunscreen habits, than children who did
not participate [35]. A systematic review showed these health educational programs
are effective [39], and it is estimated that the SunWise program alone can prevent
nearly 11,000 skin cancer cases among students who participated in the program [34].
27.2.1.3 Government Agencies and Organizations
The US government has played a role in educating the public about skin cancer
prevention. For most areas of the United States, the National Weather Service
provides UV index measurements that the EPA publishes with suggested UV
protective measures. This set of information is useful to reduce overexposure to UV

radiation when planning outdoor activities. A study evaluating the publics response
to the UV index found that nearly 64 % of people had heard of the UV index and
almost 40 % reported changing their sun practices as a result of it [40]. Another
movement includes designation of May as Melanoma/Skin Cancer Detection and
Prevention Month. This initiative, sponsored by the AAD and endorsed by the US
Department of Health and Human Services, serves as a timely opportunity each
year to remind the public about safe sun practices as the summer approaches.
27.2.1.4 Media and Social Marketing
The traditional media, such as magazines, newspaper, radio, and television, have
played an important role in disseminating information related to the skin cancer
prevention message. Although members of the medical community are most trusted,
the media channels are the primary source where large segments of public learn
about UV risks and photoprotection [41]. In the past decades, the Internet and social
media have overtaken traditional media. In addition to distributing information,
social media can also play a role in influencing behavioral change by opening a
forum for interaction with peers and family who also engage in certain behaviors
[42]. As technologies advances, novel media approaches have been introduced to
reach larger and targeted demographics. A recent example is the development of a
short messaging service (SMS)-based sun safety intervention which improved skin
cancer prevention behaviors and knowledge among adolescents [43].
In summary, members of the medical community, educational organizations,
government agencies, and media and social marketing groups all play a collective
role in educating the public about photoprotection. Through their combined efforts,
they are able to reach a significant proportion of the public in a myriad of ways to
increase skin cancer prevention awareness.
27.2.2 Their Message: Reaching the Public
27.2.2.1 Motivating Factors
In the public health campaign, there is a health-based approach and an appearance-

based approach. In the health-based approach, an emphasis is placed on the risk of
developing skin cancer from increased UV exposure. Specifically, this approach
focuses on the disfiguration, functional limitations, and overall morbidity and
mortality associated with skin cancer. This approach typically resonates with those
with a personal or family history of skin cancer.
Alternatively, an appearance-based approach focuses on the effects of UV
exposure on premature skin aging. In studies of young adults, appearance-based
messages were more influential than health-based messages mainly because the
risk of skin cancers is too distant [44, 45]. In view of the continual interest in
cosmetic procedures and antiaging therapies, sunscreen marketed as a cosme-
ceutical with focus on its antiaging properties may increase use and compli-
ance in the younger population and ultimately have an effect on future skin
cancer rates.
27.2.2.2 Current Instructions: Overview of Guidelines

for Photoprotection
In order of importance, the photoprotective strategies include sun avoidance;

seeking shade; wearing protective clothing, hat, and sunglasses; and using
sunscreens. A list of the major skin cancer prevention recommendations from major
organizations is outlined in Table 27.1. Sun avoidance, especially during the peak
hours of UV intensity (10 a.m.4 p.m.), is the best strategy to limit unnecessary UV
exposure. However, this is not easy for most individuals to comply with, as these are
the optimal hours for working, exercising, and completing outdoor activities.
Additionally, sunlight improves psychological and emotional well-being and
generates vitamin D. In sum, total abstinence from sunlight is neither achievable nor
desirable for a large proportion of the population. Practice of proper photoprotection
should allow all of us to participate in outdoor activities, while at the same time
protecting our skin.
Seeking shade and wearing protective clothing are viable options for those who
enjoy the outdoors. Trees and shade structures may be placed strategically at
schools, parks, and public pools to provide protection in the community. In the
United States, however, local and national governments do not fund these endeavors,
and it is up to private beneficiaries and nonprofit organizations to support these
initiatives. In terms of protective clothing, tightly weaved fabrics and wide brim hats
are important to maximize coverage over all anatomic sites predisposed to UV
exposure. Compared with sunscreens, the benefits of protective clothing include
more balanced protection from both UVA and UVB rays, and there is no need for
reapplication as seen with sunscreen use. Proper photoprotection of the eyes using
sunglasses is equally important. The use of clothing for UV protection has become
more popular, especially for kids and adolescents.
Although sunscreen is less effective in preventing UV exposure compared to sun
avoidance and physical barriers, it is the most frequently used protection by the
public. The popularity of sunscreens over other measures is due to marketing by the
sunscreen and cosmetic industry and recommendation by physicians. Nevertheless,
sunscreen use has its own limitations impairing its photoprotective capabilities,
namely, poor compliance and inappropriate application. Studies have shown that
many individuals do not apply sunscreen adequately in terms of the amount, timing,
and reapplication, and they frequently use sunscreens that are not broad-spectrum
[49]. SPF values are determined by applying a 2.0 mg/cm2 concentration of sun-
screen; when in reality, most people use approximately 0.51.0 mg/cm2 [50].
Consequently, the in-use effectiveness of the sunscreen protection is significantly
Table 27.1 Key photoprotective strategies from major organizations

Resource Strategies
American Academy of Apply broad-spectrum, water-resistant sunscreen of at least
Dermatology [46] SPF 30 every 2 h
Seek shade, especially during peak hours
Wear protective clothing (long-sleeved shirt, wide brim
hat, pants, sunglasses)
Use extra caution around water, sand, and snow which may
reflect UV rays
Eat foods rich in vitamin D or take vitamin D supplements
To achieve a tanned appearance, consider a self-tanning
product and continue to use sunscreen
Avoid tanning beds
Check your skin annually for signs of skin cancer
Centers for Disease Control and Seek shade, especially during midday hours
Prevention [47] Wear clothing that covers exposed skin
Wear a wide brim hat to shade your face, head, ears, and
neck
Wear sunglasses that provide UVA and UVB protection
Use broad-spectrum sunscreen of SPF 15 or greater
Avoid indoor tanning
American Cancer Society [48] Avoid being outdoors in direct sunlight between 10 am
and 4 pm
Be careful in areas with sand, water, and snow
Wear clothing with tightly woven fabrics to protect as
much skin as possible
Wear a hat with at least a 23 in. brim all around
Wear sunglasses that block UV rays
Use broad-spectrum, water-resistant sunscreen with SPF
values of 30 or higher
Be sure to apply sunscreen properly and reapply at least
every 2 h
Avoid tanning beds and sunlamps
Protect children from the sun
Get vitamin D from your diet and supplements rather than
from sun exposure
less [50]. Moreover, to achieve the desired protection, sunscreens must be applied
30 min prior to exposure and reapplied every 2 h when outdoor. Lastly, SPF is mea-
sured based on protection against erythema or burning as an indicator of photodam-
age, which is mainly produced by UVB. Thus, the SPF rating does not indicate the
level of protection from UVA, which is known to cause reactive oxygen species-
mediated damage to cells [51, 52]. As a result, individuals must be cognizant to
choose a sunscreen that also contains UVA active ingredients affording
broad-spectrum protection. In the United States and many other countries, these are
specific testing guidelines mandated by regulatory agencies for sunscreen product
to be labeled as broad-spectrum [53].
27.3 Barriers to Behavior Change
As stated above, despite the evidence showing most people understand the harmful
effects of UV radiation, this knowledge has not translated into meaningful behavioral
change [54]. A number of barriers to making these changes have been identified. First,
in the Western societies, tanned skin is viewed as attractive, healthy, and affluent. As
a result, many individuals, especially young women, are influenced by their peers and
trends in the media to purposefully receive high doses of UV exposure to achieve a
darker and tanned appearance [12]. Second, there are health benefits associated with
UV and sunlight exposure. UV radiation, specifically UVB, is needed to synthesize
vitamin D, which is important for bone health [55]. Sunlight regulates the circadian
rhythm and natural sunlight is effective to ameliorate seasonal affective disorder [56].
Being outdoors and living an active lifestyle is important to combat the obesity epi-
demic and other public health concerns, including diabetes and heart disease [49].
Third, changing behavior for preventive health actions is intrinsically challenging as
seen in weight loss and smoking cessation programs. It is difficult to persuade indi-
viduals to make these behavioral changes when there is a lack of immediate rewards.
Furthermore, for young individuals, the future risk of skin cancer is too distant to
motivate and compel individuals to change. Lastly, maintaining these improved health
habits requires sustained commitment. Far too often, the change on the part of indi-
viduals may be disruptive and inconvenient. For example, wearing protective clothing
and applying sunscreens may be considered as hassles in ones busy daily routine.
27.4 A Multifaceted Approach: Instilling Motivation

and Compliance
The need to bridge the gap between knowledge and behavior is clear. Attempts at
further increasing public awareness regarding the association between sun expo-
sure and skin cancer risk may have diminished effects on influencing behaviors,
as most people are already aware of this connection [57]. As a result, it is neces-
sary to understand the key concepts behind behavior modification in order to
develop an effective marketing campaign that targets specific demographics and
to take a collaborative approach to improve compliance among the population.
27.4.1 Improving Compliance
A comprehensive effort is required to influence and maintain sun protection

behaviors at the population level. Ongoing public education represents the primary
prevention measure to improve photoprotection and reduce the incidence of skin
cancer. However, our endeavors must continue to build upon increasing knowledge
and move toward focusing on behavior-based interventions to encourage change.
27.4.2 Ongoing Public Education as Primary Prevention

Measure
Behavior change requires lifelong education and intervention; however, many inter-
ventions are complex, expensive, and difficult to implement. While education alone
is not an effective way to change behavior, it is the first and foremost approach to
change behaviors, especially during the early stages of behavior modification.
These stages include the pre-contemplation and contemplation stages, in which
individuals have either a favorable attitude toward sun-seeking behaviors or consid-
erable ambivalence, as is common in the case of photoprotection. These individuals
place more weight on the benefits of UV exposure, either its physiological effects
or the cosmetic appeal of having tanned skin, rather than the harmful effects of
sunbathing. For example, healthy teenagers are not concerned with the far-off
thought of skin cancer, which inhibits their progression to making sustainable
behavior change.
Education also needs to be taken into account for individuals in the other stages
of behavior modification. Those who are in the later stages of behavior modification
understand that the benefits of photoprotection outweigh the risks of unprotected
UV exposure. In those cases, education needs to be focused more on the interventional
side, with an emphasis placed on learning habits and methods to maintain healthy
lifestyle adjustments. Furthermore, photoprotection messages should offer a
comprehensive approach, including seeking shade; wearing protective clothing, hat,
and sunglasses; and applying sunscreen appropriately.
27.4.3 Moving Beyond Education to Change Behaviors
A substantial portion of US adults do not perceive cancer as preventable and are less
likely to engage in sun protection behaviors. Avoiding sunbathing and indoor
tanning is one key component of education that must be emphasized. Indoor tanners
may incorrectly believe that tanning indoors is safer and has health benefits
compared to outdoor tanning. In actuality, indoor tanning is responsible for an
estimated 450,000 NMSC and more than 10,000 melanoma cases in Europe,
Australia, and the United States each year [58]. In order to reduce the harms from
indoor tanning, it is necessary to further evaluate the attitudes and behaviors of
indoor tanners. Targeted messages should be developed that resonate with the
different groups who participate in indoor tanning and sunbathing. Additionally, the
medical professionals need to assist the Federal Communications Commission in
identifying and correcting the deceptive and misleading advertisements.
As seen in the movement to decrease the prevalence of smoking, many times

legislation is more effective than education alone. Increasing taxes on indoor tanning
salons may have similar effects as the tax increase on the cigarette industry. Under
the Patient Protection and Affordable Care Act, a 10 % excise tax on indoor tanning
services went into effect on July 1, 2010. Additionally, the FDA recently reclassified
sunlamps to moderate-risk (Class II) devices, up from Class I, requiring premarket
notification to the FDA for new tanning devices, and black box warning label
displayed on the UV tanning devices [59, 60]. Further laws or regulations have been
placed on indoor tanning in 44 states and the District of Columbia [4]. The three
types or regulations include (1) harm-reduction regulation including use of eye
protection or a time limit, (2) required parental consent or parental accompaniment,
and (3) absolute age restriction (ban) for minors under a certain age, ranging from
14 to 18 years [4]. In 2011, California became the first state to enact an outright ban
on tanning for individuals younger than 18, and since then, a number of other states
have followed suit [61, 62]. These legislations have already made an impact on
reducing the number of tanning bed users [61, 6365]. After implementation of
legislative restrictions in Utah, there was a 36 % decrease in indoor tanning among
teens [64]. Nationwide, estimates show a 42 % decrease in states with stricter
legislative policies [63]. Additionally, the increased legislation has led to a significant
increase in news coverage throughout the entire year regarding skin protection and
the risks of indoor tanning [66]. Nationwide adoption of such legislation in banning
tanning for minors under age of 18 would have a significant impact on reducing this
avoidable UV exposure.
As we continue to advocate for additional government policy to take hold, there
must be a change in social norms regarding tanned skin to support the message of
UV avoidance. The idealization of tanned skin representing health and attractiveness
is a powerful social pressure for individuals to conform to this beauty standard. In
the Western societies, pale skin was once considered beautiful and a sign of wealth,
and currently tanned skin has become associated with a life of leisure and outdoor
activities and a sign of health, fitness, and youth. This association has been further
perpetuated in the media. For many individuals, the cosmetic appeal of having tan
skin competes against the health-related concern of developing skin cancer. A shift
is needed in the way our society portrays beauty, and the fashion and entertainment
industries should be encouraged to head these efforts. The media have initiated
limited campaigns by portraying natural skin as being healthy and beautiful. The
cosmetic industry can further support this movement through promoting that beauty
is the color of the skin one was born with. In sum, sociocultural influences motivate
behaviors, and we need to realign and redefine the definition of beauty with the
assistance of the media and beauty and entertainment industries. An appearance-
based message can be more impactful than health-based message to change sun
protection behaviors.
Additional widespread strategies and programs are needed at the community-
level that facilitate both education and behavioral changes. Schools and the
workplace represent enticing opportunities to improve sun protection knowledge
and compliance. Schools can reinforce the photoprotective message introduced by
curricular changes by allowing students to wear sun-protective clothing or by

adopting the Australian no hat, no play policy that restricts children from playing
outdoors without proper protective clothing. Children receiving interactive didactic
sessions and completing take-home activities about sun protection have improved
behaviors [67, 68]. In addition to school instruction, education for outdoor
employees can increase sun protection in working professionals [69]. Environmental
approaches encouraging sun protection, such as shaded areas and workplace policies
supporting sun protection practices, are effective [4]. The ideal goal is for a domino
effect whereby these workers will disseminate this public health information to
other coworkers and clients to propagate the message. Strides should be made to
increase sun protection availability, including sunscreens, in recreational and
tourism settings. When adopting these photoprotective strategies, efforts should be
made to reach out to various ethnic communities, with educational messages and
campaigns tailored accordingly to the target demographic. Overall, multicomponent
interventions in a variety of settings are our greatest chance to effectively change
behavior and reduce skin cancer risk.
27.5 Conclusion
Despite ongoing public health campaigns to raise awareness of the skin cancer epi-
demic and need for improved photoprotection, there exists a disconnect between
knowledge and behavior. The development of successful interventions relies heavily
on a thorough understanding of the attitudes and beliefs that influence specific behav-
iors. The best strategy is to align efforts in a variety of settings that target different
demographics with a coordinated approach. Enhanced sun protection knowledge and
awareness is crucial for initiating behavioral change, and the public needs informa-
tion required to make informed choices. We should continue to support and reinforce
these efforts through community-level interventions, along with increased research,
surveillance, and monitoring to determine the utility of these approaches and measure
the effect of our prevention efforts. With this comprehensive approach, we can poten-
tially motivate behavioral change and reverse the trend of increasing skin cancer.
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Index
A Alpha-melanocyte-stimulating hormone
AAD. See American Academy of (-MSH), 396
Dermatology (AAD) American Academy of Dermatology (AAD),
Ablative lasers, 15 115, 116, 464
Acne vulgaris treatment American Association of Textile Chemists
IR effects, 13 and Colorists, 424
visible light effects, 10 American Medical Association, 106
Actinic keratoses (AKs) prevention, 3031 American Society for Testing and Materials, 424
Actinic prurigo, 45 American standard ANSI Z80.3:2010, 434, 435
Active outdoor lifestyles, 126 Annealed glass, 430, 431
Acute cutaneous affects, 430 Antioxidants (AOX)
Aesthetic properties enzymatic and nonenzymatic, 446
in after-feel, 291 fluorescence probe, 448
area of application, 290 LOOH, 450452
combine filters, 299 oxidize biomolecules/signal transduction
combine organic filters, 299 pathways, 446
combine water-based filters, 299 polyphenols, 452
consumer personal preferences, 290 spectroscopic and biological assays, 447, 448
emulsifiers, 299300 SPF, 454456
film-formers, 300 sun-induced ROS formation, 445, 446
inorganic UV filters sunscreen formulations, 453, 454
skin feel, 297298 TPM, 448450
TiO2, 295 Apigenin, 349, 393
transparency, 295297 Apple peel ethanolic extracts (APETE), 342
ZnO, 295 Atopic eczema, 8687
insoluble particulate organic filters, 294 Australian/New Zealand standards (AS/NZS
level of activity, 290 1067:2003), 434, 435
liquid UV filters, 292293 Avobenzone (AVO), 352
oil-soluble solid UV filters, 293 BEMT, 257, 259, 261, 264
O/W emulsions, 292 benzoyl radical, 253
during rub-out, 290291 bimolecular quenching rate constant, 267
thickeners, 300 butyloctyl salicylate, 266
water-soluble solid UV filters, 294 in commercially available sunscreen
W/O emulsions, 292 products, 254
,-diphenyl--picrylhydrazyl (DPPH), 364, in concentrated solutions, 254
371, 453, 454 DEHN, 265

DOI 10.1007/978-3-319-29382-0
478 Index
Avobenzone (AVO) (cont.) Coated glass, 430

DHHB, 259 Colored cosmetics
in diluted solutions, 254 facial foundations
EHMC, 264265 liquid formulations containing water,
enol-keto and keto-enol tautomerization 411412
processes, 255 oil-based foundations, 412
excited states of, 255 oil-free, 412
HDBM, 266 Sheer coverage foundations, 413
1
H NMR measurements, 253 facial powders, 409411
MBBT, 259 lipsticks, 413414
4-methylbenzylidene camphor, 265 Confocal scanning laser microscopy, 18
nanosecond laser flash photolysis, 254 Cosmetic Europe (CE), 127
NCE rotamer, 254 Coulombic/Frster energy transfer, 263264
OC, 258, 264 CPDs. See Cyclobutane pyrimidine dimers
OMC, 258, 259, 265267 (CPDs)
phenacyl radical, 253 Critical wavelength (CW) test
photocompatibility, 230232 irradiation, 327
photostability, 183184 Labsphere 2000, 330331
polyester-8, 264 measurements, 328, 329
polyester-25, 265 PMMA Plates, 327, 331
SPF and UVA-PF, 258 spectroradiometer, 330
SPF 50 sunscreen product, 258 spectroscopic method, 327
state energy diagram, 254, 256 Crystalline cetylpalmitate nanoparticles
steady-state irradiation, 253 (CCP-NP), 350
with TiO2, 259261 Cucurma longa, 349
TMBP, 265266 Cutaneous T-cell lymphoma (CTCL), 8889
UV filters, 155 Cyclobutane pyrimidine dimers (CPDs),
with ZnO, 259261 2426, 110, 364, 378, 382
Cyclooxygenase 2 (COX-2) Inhibitors, 396
B
BAD. See British Association of D
Dermatologists (BAD) Daily facial moisturizer, 128
Basal cell carcinoma (BCC), 2731, 108, 109 Daily UV radiation (DUVR), 207209,
Bemotrizinol, 231, 237 216, 218
BEMT. See Bis-ethylhexyloxyphenol DEHN. See Diethylhexyl 2,6-naphthalate
methoxyphenyl triazine (BEMT) (DEHN)
Berger solar simulator, 320321 Delayed tanning (DT), 68
Bis-ethylhexyl hydroxydimethoxy malonate Dermatoheliosis. See Photoaging
(HDBM), 266 Dermatology, 336
Bis-ethylhexyloxyphenol methoxyphenyl Dermatomyositis, 52
triazine (BEMT), 257, 259, 261, 264 Dexter exchange mechanism, 264
British Association of Dermatologists (BAD), 117 Diethylamino hydroxybenzoyl hexyl benzoate
(DHHB), 259, 352
Diethylhexyl 2,6-naphthalate (DEHN), 265
C Dihydrorhodamine (DHR), 448450
CE. See Cosmetic Europe (CE) Dihydroxyacetone (DHA)
Chronic actinic dermatitis (CAD), 9, 4445, 87 chemical structure of, 405, 406
Chronic effects, 430 chemistry of, 406
Clear lipo-alcoholic spray (CAS), 240241 formulations, 408
Clothing Maillard reaction, 407
broad-spectrum protection, 418 photoprotection, 409
UPF (see Ultraviolet protection factor safety record, 408
(UPF)) Discoid lupus erythematosus (DLE), 79
Index 479
DNA damage Ethylhexyl methoxycinnamate (EMC), 258,

BRAF mutations, 27 259, 265267, 353
cell cycle arrest, 26 Ethylhexyl methoxycrylene (EHMC),
clinical consequences, 383 264265
direct, 378 Ethylhexyl triazone (EHT), 257, 352
DNA repair Eumelanin, 76
base excision, 380 European Commission Recommendation, 290
botanical induction, 382383 European Committee for Standardization
cellular regulation, 381 (CEN), 424
mechanisms, 26 Excited-state quenchers (ESQ), 155
nucleotide excision, 379380 Eye-sun protection factor (E-SPF), 434, 436
photodamage, 379
photoreactivation, 380
polymerase, 380381 F
therapeutic intervention, 382 Fabrics
indirect, 378379 electrospun fibers, 344
light sources, 377 optical, 344
PTCH tumor suppressor genes, 27 radioprotective, 344345
p53 tumor suppressor gene, 2627 traditional cotton, 344
ras oncogene, 27 umbrella, 343
SMO tumor suppressor genes, 27 Facial foundations
SPF 50 sunscreen, 27 liquid formulations containing
UVA effects, 25 water, 411412
UVB effects, 2425 oil-based foundations, 412
DNA Damage Response (DDR) proteins, 381 oil-free, 412
DNA protection factor (DNA-PF), 214 Sheer coverage foundations, 413
DNA repair Facial hair, 337
base excision, 380 Facial powders, 409411
botanical induction, 382383 FDA Final Rule
cellular regulation, 381 broad-spectrum protection test
nucleotide excision, 379380 irradiation, 327
photodamage, 379 Labsphere 2000, 330331
photoreactivation, 380 measurements, 328, 329
polymerase, 380381 PMMA Plates, 327, 331
therapeutic intervention, 382 spectroradiometer, 330
DT. See Delayed tanning (DT) spectroscopic method, 327
DUVR. See Daily UV radiation (DUVR) Fitzpatrick skin types, 323
padimate O/oxybenzone standard
sunscreen, 324
E photosensitizing drugs, 330
EBV infection. See Epstein-Barr procedures, 323, 324
virus (EBV) infection radiometry, 328329
Ecamsule, 283 solar simulators, 321322
EHMC. See Ethylhexyl methoxycrylene standard sunscreen, 322
(EHMC) subject compliance, 330
EHT. See Ethylhexyl triazone (EHT) sunscreen application, 330
Elastic liposome, 347 unprotected MED doses, 323325
Epidermolysis bullosa acquisita, 88 visual grading of responses, 330
Epstein-Barr virus (EBV) infection, 4344 water resistance testing, 326327
Equol, 392 FDAs Final Rule on Labeling and
Erythema ab igne, 1213 Effectiveness Testing
Erythemal dose contributions, 322 of Sunscreen, 320, 322
ESQ. See Excited-state quenchers (ESQ) Fernblock, 391392
Ethosome, 348349 Ferric-reducing ability of plasma (FRAP), 364
480 Index
Fiber-fabric construction processing, 421 Individual typology angle (ITA), 107

Film formers, 237239 Infrared radiation (IR)
Fitzpatrick skin types, 323, 324, 338 clinical effects
Fitzpatrick skin-type scale, 106 acne vulgaris, 13
FontanaMasson staining of melanin erythema ab igne, 1213
granules, 107 depth of penetration, 5
diagnostic imaging, 18
molecular effects
G cytotoxicity, 12
General morphological analysis (GMA), DNA damage, 12
184187 matrix metalloproteinase (MMP)-1
Genistein, 392 expression, 12
Glass oxidative stress, 12
annealed, 430, 431 nonthermal treatment modalities, 1617
automobiles physical effects
in UV exposure, 432 erythema, 11
in UV transmission, 432433 photoaging, 11
coated, 430 thermal pain, 11
laminated, 430, 431 thermal treatment modalities, 1316
patterned, 430 wavelength, 5, 1011
sunglasses see (Sunglasses) Intense pulsed light (IPL) therapy, 1516
tempered/toughened, 430, 431 IPD. See Immediate pigment darkening (IPD)
UV transmission, residential glass, 432 IPL therapy. See Intense pulsed light (IPL)
window films, 433 therapy
Global Sunscreen Regulation, 315316 IR. See Infrared radiation (IR)
Glogau classification, 63 ITA. See Individual typology angle (ITA)
Gluconobacter oxydans, 406
GMA. See General morphological analysis
(GMA) K
Green Tea Polyphenols (GTPPs), 391 Keratin, 76
Krebs cycle, 408
H
HDBM. See Bis-ethylhexyl hydroxydimethoxy L
malonate (HDBM) Laminated glass, 430, 431
Hunds rule, 441 Lasers
Hydroa vacciniforme, 4344 ablative, 15
Hyperbilirubinemia, 10 hair removal, 15
Hypermelanosis, 65 keloids and hypertrophic scars, 15
Hyperparathyroidism, 101 pigmented lesion removal, 14
Hyperpigmentation, 200 types, 14
uses, 14
for vascular lesions, 1314
I wavelength peaks, 14
Immediate pigment darkening (IPD), 68 Lipid hydroperoxides (LOOH), 450452
Immunologically mediated photodermatoses Liposome
(IMPs) daylong actinica, 345
actinic prurigo, 45 definition, 345
CAD, 4445 disaccharides, 346
hydroa vacciniforme, 4344 DNA repair enzymes, 345346
PMLE, 4142 elastic, 347
solar urticaria, 4243 octyl methoxycinnamate, 347
Index 481
plain water, salt water and profuse cell dosimeter, 343

perspiration, 345 folic acid, 338
resveratrol, 347 inorganic, 341
Lipsticks, 413414 nanoformulation, 341342
Living Skin Equivalent (LSE), 214 natural hominid photoprotection,
Low-level light therapy (LLLT), 16 337338
Lupus erythematosus, 51 organic sunscreens, 341
Lycopene, 388, 389 photoprotection history, 339340
vitamin D, 338339
topical sun protective agents (see Topical
M sun protective agents)
Maillard reaction, 407 viscous fingering, 357
Man-Tan tanning product, 406 National Institutes of Standards and
MatTek EpiDerm, 449 Technology (NIST)-traceable
MBBT. See Methylene bis-benzotriazolyl instruments, 328
tetramethylbutylphenol (MBBT) Natural skin protection, 70
MCTD. See Mixed connective tissue disease NCE rotamer. See Non-chelated enol (NCE)
(MCTD) rotamer
Melanin, 76 NDA process. See New drug application
Melanoidins, 407 (NDA) process
Melanoma/Skin Cancer Detection and Near-infrared fluorescence, 18
Prevention Month, 466 Nevi prevention, 32
Melasma, 112113 New drug application (NDA) process, 305
8-methoxypsoralen (8-MOP) drug, 279 Niosome, 348
4-methylbenzylidene camphor (4-MBC), 354 Non-chelated enol (NCE) rotamer, 254
Methylene bis-benzotriazolyl Nonmelanoma skin cancer (NMSC), 3132,
tetramethylbutylphenol 108109, 463
(MBBT), 259
Mexoryl SX, 283
Mexoryl XL, 283 O
Mixed connective tissue disease (MCTD), 85 Octinoxate, 230
Monograph regulatory system, 276 Octocrylene (OC), 231, 232, 258, 264
Mycobacterium tuberculosis, 99 Octyl methoxycinnamate (OMC). See
Ethylhexyl methoxycinnamate
(EMC)
N Oil-in-water cream (OW-C), 240
Nanomaterials Oil-in-water (O/W) emulsions, 292
benefits of nanoformulations Oil-in-water spray (OW-S), 240241
detoxification, 356 Oil-soluble filters, 167
less ingredient required, 355356 Optical coherence tomography, 18
vehicle flexibility, 356 Optimal UV protection
cosmetic elegance, 356357 broad-spectrum classification, 280
hazards of traditional sunscreens critical wavelength, 279
absorption, 354 flat spectral absorbance profile, 281
dermatitis, 354 immediate pigment darkening response, 280
endocrine disruption, 355 insoluble filters, 284
instability, 355 8-MOP drug, 279
lack of compliance, 355 photobiology fundamentals, 277279
narrow spectrum of activity, 355 PMLE, 281
skin equivalents, 344 soluble UV filters, 281283
solar radiation, 336337 UVA-PF test method, 279, 280
sunscreens in vitro spectrophotometric measurement, 279
482 Index
Oral photoprotective agents, 389 UVA-UVB absorption, 215, 216

antimutagenic activity, 397 UV-induced pigmentation, 216, 218
antioxidant activity, 397 UV exposure and clinical consequences,
antioxidant combinations 199200
ascorbate + tocopherol, 390 in vitro skin models, 200201
Seresis, 390 Over-the-counter (OTC)
tablets, 390 drug product regulations
carotenoids, 388 monograph, 304305
dietary botanicals NDA process, 305
Cats Claw, 395 Rx-to-OTC switch, 305
citrus + rosemary extract, 393 sunscreen regulations
cocoa extract, 393 broad-spectrum testing, 308
ferulic and caffeic acids, 394 21 CFR 201, 306
flavonoids, 390391 21 CFR 352, 306
forskolin, 395 dosage forms, 311312
GTPPs, 391 Drug Facts rule, 306
isoflavones, 392393 effective date, 307
Polygonum multiflorum, 395 The New Label, 308310
polypodium leucotomos extract, no ingredient issues, 307
391392 SPFs Above 50, 310
pomegranate, 393 SPF test method, 307
Pycnogenol, 394 OW-C. See Oil-in-water cream (OW-C)
resveratrol, 394 O/W emulsions. See Oil-in-water (O/W)
sulforaphane, 394 emulsions
dietary non-botanicals OW-S. See Oil-in-water spray (OW-S)
afamelanotide (melanotan I) and Oxygen radical absorbance capacity assay
melanotan II, 396397 (ORAC) assay, 364
COX-2 inhibitors, 396
idebenone, 396
N-(4-pyridoxylmethylene)-l-Serine P
(PYSer), 396 Patched homologue (PTCH) tumor suppressor
-3 polyunsaturated fatty acid, 395 genes, 27
probiotics, 396 Patient Protection and Affordable Care Act, 471
nicotinamide, 389390 Patterned glass, 430
photoimmunoprotection, 397 PDT. See Photodynamic therapy (PDT)
Organotypic skin models PE. See Pemphigus erythematosus (PE)
epidermal structure, 201, 202 Pellagra, 50
reconstructed skin Pemphigus erythematosus (PE), 8586
SSR (see Solar-simulated radiation People of color (POC)
(SSR)) AAD recommendations, skin cancer,
UVA exposure, 203, 205207 115117
UVB exposure, 202205 biological effects of UVR
sunscreens evaluation photoaging, 110112
advantage of, 209 photocarcinogenesis, 108110
complex formulations, 209, 211213 pigmentary disorders, 112114
cytotoxicity measurements, 214 25-hydroxyvitamin D bioavailability, 115
3-D skin models, 209 risks and benefits of sun exposure, 116
epidermal and dermal compartments, skin color classification, 106108
203, 209 vitamin D
gene and protein expression, 218, 219 deficiency, 115
gene expression analysis, 218 oral supplementation, 115117
single absorbers, 209, 210 Persistent pigment darkening (PPD), 68
thymine dimers DNA lesions, 214, 215 Phaeomelanin, 76
transcriptomic and proteomic, 217 Photoaggravated dermatoses
UVA-PF, 216, 217 atopic eczema, 8687
Index 483
CAD, 87 phototoxic reactions, 4647

CTCL, 8889 prevention, 47
dermatomyositis, 52, 82 Photostability
epidermolysis bullosa acquisita, 88 avobenzone
lupus erythematosus BEMT, 257, 259, 261, 264
acute lupus erythematosus, 51 benzoyl radical, 253
chronic lupus erythematosus, 51 bimolecular quenching rate constant, 267
clinical investigations, 81 butyloctyl salicylate, 266
clinical presentation, 8081 in commercially available sunscreen
epidemiology, 79 products, 254
history, 79 in concentrated solutions, 254
pathogenesis, 7980 DEHN, 265
serology, 8182 DHHB, 259
subacute cutaneous lupus in diluted solutions, 254
erythematosus, 51 EHMC, 264265
systemic lupus erythematosus, 51 enol-keto and keto-enol tautomerization
treatment, 82 processes, 255
MCTD, 85 excited states of, 255
pathogenesis, 8384 HDBM, 266
1
PE, 8586 H NMR measurements, 253
psoriasis, 86 MBBT, 259
rosacea, 8788 4-methylbenzylidene camphor, 265
Sjogrens syndrome, 8485 nanosecond laser flash photolysis, 254
Photoaging NCE rotamer, 254
cigarette smoking, 62 OC, 258, 264
definition, 62 OMC, 258, 259, 265267
Glogau classification, 63 phenacyl radical, 253
histopathology of, 6667 polyester-8, 264
IR, 11 polyester-25, 265
molecular mechanisms, 6769 SPF and UVA-PF, 258
natural skin protection, 70 SPF 50 sunscreen product, 258
SH, 6566 state energy diagram, 254, 256
SLs, 6364 steady-state irradiation, 253
sunscreen, 7071 with TiO2, 259261
UVR biological effects, 110112 TMBP, 265266
wrinkling, 64, 65 with ZnO, 259261
Photocarcinogenesis, 62, 108110 chromophores
Photodermatoses intersystem crossing, 250, 251
chemical-and drug-induced Jablonski diagrams, 251, 252
photosensitivity non-radiative pathway, 248
endogenous agents, 47 photolabile situation, 249
exogenous agents, 4750 photostable situation, 248249
hereditary photodermatoses, 5254 quencher, 251
IMPs, 4045 radiative pathway, 248
photoaggravated disorders, 5052 resonance condition, 249
Photodermatosis, 346 spin-paired configuration, 249, 250
Photodynamic therapy (PDT), 1617 Coulombic/Frster energy transfer,
Photokeratitis, 434 263264
Photosensitivity Dexter exchange, 264
endogenous agents of EHT, 257
cutaneous porphyrias, 4749 molecular structures, photostabilizers,
pellagra, 50 261263
SLOS, 50 sunscreen photostability testing methods,
exogenous agents 267269
photoallergic reactions, 46 of UVB filters, 256257
484 Index
Phototherapy, 10 SH. See Sebaceous hyperplasia (SH)

Pigmentary disorders Sheer coverage foundations, 413
melasma, 112113 Silicone-15, 283
photoprotection, 114 Silymarin, 392
PIH, 113 Sjogrens syndrome, 8485
PIH. See Postinflammatory hyperpigmentation Skin cancer, 126, 417418
(PIH) BCC, 2730
Pinus pinaster Ait, 394 educational programs, 465
PMLE. See Polymorphous light eruption incidence of, 336
(PMLE) media and social marketing, 466
POC. See People of color (POC) medical community, 464465
Polygonum multiflorum, 395 motivation and compliance, 469472
Polymorphous light eruption (PMLE), 4142, 281 NMSC, 463
Porphyrias, 10, 4749 photoprotective strategies, 467468
Porphyrins, 446 prevention
Postinflammatory hyperpigmentation (PIH), 113 AKs, 3031
PPD. See Persistent pigment darkening (PPD) melanoma, 3233
Protection index, 228 nevi, 32
Psoriasis, 86 NMSC, 3132
Punica granatum, fam. Punicaceae, 393 public health campaign, 466467
SCC, 2730
ultraviolet (UV) radiation, 464
Q US government, 465466
Quantitative risk assessment (QRA), 132133 UV radiation
Quenchers of photoexcited states (QPES), 446 DNA damage, 2427
Quercetin, 393 intensity of, 24
subdivision of, 24
Skin Color Chart, 106
R Skin pigmentation, 68
Radical skin/sun protection factor (RSF), 445 SLOS. See Smith-Lemli-Opitz syndrome (SLOS)
Reactive oxygen species (ROS), skin SLs. See Solar lentigines (SLs)
chemistry and formation Smith-Lemli-Opitz syndrome (SLOS), 50
chromophores, 442444 Smoothened (SMO) tumor suppressor
free radical and non-radical species, 441 genes, 27
Jablonski diagram, 442, 443 Solar lentigines (SLs), 6364
matrix metalloproteinase-1 (MMP-1) Solar-simulated radiation (SSR)
enzyme, 444 DUVR, 208209
triplet-state reactions, 441, 442 UV-SSR, 207208
solar radiation Solar urticaria
AOX (see Antioxidants (AOX)) IMPs, 4243
QPES, 446, 447 visible light effects, 9
sunscreens, 444446 Solid lipid nanoparticle
Rosacea, 8788 benzophenone-3, 350
Rosa G extract, 452 CCP-NP, 350
Rowell syndrome, 81 chitin, 350
definition, 350
lutein, 350351
S titanium, 351
SCC. See Squamous cell carcinoma (SCC) tocopherol, 351
SCLE. See Subacute cutaneous lupus zinc oxide and octocrylene, 350
erythematosus (SCLE) SPF. See Sun protection factor (SPF)
Sebaceous hyperplasia (SH), 6566 Squamous cell carcinoma (SCC), 2731, 108
Senear-Usher Syndrome, 8586 Subacute cutaneous lupus erythematosus
Seven-point Likert scale, 106 (SCLE), 79
Index 485
Sun filters, 275 anhydrous systems, 291

absorbance spectra, 170 emulsions, 291, 292
alternate names, 162165 gels, 291292
approved usage levels, 162165 SunWise School Program, 465
chemical structures, 171173 Systemic lupus erythematosus (SLE), 79
efficacy, 169
extinction coefficients, 174
Ex-US filter combinations, 175 T
lambda max values, 171173 TEA process. See Time and extent application
mechanism of action, 160 (TEA) process
molecular weight, 171173 Tempered or toughened glass, 430, 431
organic filters T4 endonuclease, 346
lipophilicity, 167 Thermal pain, 11
Parsol SLX/polysilicone-15, Time and extent application (TEA)
166167 process, 192
traditional molecules, 161, 166 Tinosorb M, 283
particulate filters, 168169 Tinosorb S, 283
specific extinction values, 171173 TMBP. See Trimethoxybenzylidene
SPF boosting, 175, 176 pentanedione (TMBP)
in USA, Canada, European Union, Topical antioxidants/botanical extracts
ASEAN, and MERCOSUR, Camellia sinensis, 364
162165 chemical analytical methods, 364
US-approved filter combinations, clinical appearance of skin, 365, 366
174175 CPDs, 364
Uvinul HEB, 170 dietary or systemic levels, 362
Uvinul T150, 170 endogenous antioxidants, 362
Sunglasses flavonoids, 364365, 367
ANSI Z80.3:2010 standard, 434, 435 grape seed proanthocyanidins, 368
AS/NZS 1067:2003 standard, inactive ingredients., 372
434, 435 MMP1, 370
E-SPF, 434, 436 oxidative damage, 366, 367
UV exposure, 434 ROS, 362, 363
Sunless tanning products. See sunscreen/sunblock ingredients
Dihydroxyacetone (DHA) protect skin, 362
Sun protection factor (SPF) tea polyphenols (TP), 365
compact xenon arc lamp, 320, 321 UV-induced hyperproliferation, 371
FDA Final Rule (see (FDA Final Rule)) UV-induced Langerhans cell depletion,
natural solar light source, 320 368, 369
SunSafe programs, 465 white tea or green tea, 366
Sunscreen Innovation Act, 312314 Topical sun protective agents
Sunscreen products ethosome, 348349
ad-lib product dosage, 128 fabrics
application, 129130 electrospun fibers, 344
efficacy and safety, 127 optical fabrics, 344
glass plate, 130, 131 radioprotective fabrics, 344345
human safety assessment, 132134 traditional cotton, 344
ISO 24444, 127 umbrella, 343
non-uniform film, 130, 131 gold metal particles, 354
product failure, 131 liposome
SPF test, 127 daylong actinica, 345
thickness, 130 definition, 345
uniform film formation, 130131 disaccharides, 346
usage frequency and duration, 132 DNA repair enzymes, 345346
Sunscreen vehicles, 240, 241 elastic, 347
486 Index
Topical sun protective agents (cont.) skin cancer

octyl methoxycinnamate, 347 DNA damage, 2427
plain water, salt water and profuse intensity of, 24
perspiration, 345 subdivision of, 24
resveratrol, 347 sun avoidance, 76
microsphere, 353354 sunscreens, 77
nanostructured lipid carrier Uncaria tomentosa, 395
chemical sunscreens, 352 US Preventive Services Task Force
definition, 352 (USPSTF), 465
ethylhexyl methoxycinnamate, 353 Uvasorb HEB, 283
lycopene, 353 UV booster
solid lipid nanoparticles, 351352 bemotrizinol filter, 237
tocopherol, 352 definition, 228
wax carriers, 353 film former compounds, 237239
niosome, 348 intrinsic absorbing properties, 236
solid lipid nanoparticle key parameters, 241, 242
benzophenone-3, 350 sunscreen vehicle, 240, 241
CCP-NP, 350 UV-absorbing system
chitin, 350 erythema effectiveness spectrum, 228, 229
definition, 350 erythemal action spectrum, 228, 229
lutein, 350351 oil-and water-dispersed UV filters,
titanium, 351 232234
tocopherol, 351 oil-in-water (O/W) sunscreen, 229
zinc oxide and octocrylene, 350 optical path length, 234236
Trimethoxybenzylidene pentanedione photocompatibility, 230232
(TMBP), 265266 solar spectral irradiance, 228, 229
Two-photon fluorescence imaging microscopy UVB sunscreen, 229
(TPM), 448450, 452 UV filters
in 1925, 183
in 1950, 183
U in 1975, 183
Ultraviolet protection factor (UPF) in 2000, 183
AS/NZS 4399 standard, 423, 424 in 2025, 183
definition, 419 avobenzone, 155
DRL biofilm, 419 band gap energy, inorganic particulates, 146
elastane-based textiles, 422423 bemotrizinol and bisoctrizole, 151, 153
EN 13758-1 and EN 13758-2 Category I Ingredients, 143, 144
standard, 424 chemistry of, 146, 150151
environmental effects, 423 classification of, 146149
fabric parameters, 420422 Delphi method, 187188
labeled sun protective clothing, 424, 425 endocrine disruption, 133134
minimal erythema doses (MEDs), 419 energy absorption, 145
spectral irradiance, 418 energy release pathways, 145
sun protective garments, 423424 EU-approved UV filters, 151, 152
UPF of 40+, 424 GMA, 184187
Ultraviolet (UV) radiation inorganic particulates, 154155
autoimmune diseases inorganic UV filters, 181182
genodermatoses, 78 lifetime exposure, 134
idiopathic photodermatoses, 78 organic UV filters, 180181
photoaggravated dermatoses (see particulate UV filters, 181, 182
Photoaggravated dermatoses) photostability of, 155
photoimmunology, 7778 regulatory approval processes, 192194
protective clothing/hats, 7677 safety, 191
shade, 76 spray products, 133
Index 487
systemic absorption, 134 Vitamin D

in USA, 188190 allowable intake, 101, 102
Uvinul T-150, 283 deficiency, 115
UV solar-simulated radiation (UV-SSR), 207208 diet and supplementation, 98
levels and daily requirements, 101, 102
pathophysiologic effects, 9899
V photoprotection, 99100
Visible light recommended dietary allowances, 101, 102
biological effects for sarcoidosis, 101
DNA damage, 89 screening, 100101
erythema, 6 serum levels, 101
free radical production, 8 sunlight and artificial radiation, 9698
pigmentation, 68 terms and conversions, 96
clinical effects
acne lesions, 10
CAD, 9 W
hyperbilirubinemia, 10 Water-in-oil (W/O) emulsions, 240, 241, 292
porphyrias, 10 Water resistance, 326327
solar urticaria, 9 Water-soluble sun filters, 167
definition, 5 Waxes, 237
depth of penetration, 5 Window films, 433
diagnostic imaging, 18 Wrinkling, 64, 65
nonthermal treatment modalities, 1617
optically opaque filters, 17
thermal treatment modalities, 1316 X
wavelengths, 4, 5 Xanthophylls, 388, 389
ZnO and TiO2 sunscreen agents, 1718 Xeroderma pigmentosum, 5254

Principles and Practice of Photoprotection

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Principles and Practice of Photoprotection

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Steven Q. Wang Henry W.

Principles and Practice

ISBN 978-3-319-29381-3 ISBN 978-3-319-29382-0 (eBook)

Library of Congress Control Number: 2016936370

Springer Cham Heidelberg New York Dordrecht London

Printed on acid-free paper

Adis is a brand of Springer

Springer International Publishing AG Switzerland is part of Springer Science+Business Media

Photoprotection captures the interest of physicians, academic researchers, industry

Basking Ridge, NJ, USA Steven Q. Wang

1 Clinical and Biological Relevance of Visible

9 The Chemistry of Ultraviolet Filters . . . . . . . . . . . . . . . . . . . . . . . . . . 143

10 Chemistry of Sunscreens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

19 Photoprotection in the Era of Nanotechnology . . . . . . . . . . . . . . . . . 335

25 Photoprotection by Glass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429

27 Education, Motivation, and Compliance . . . . . . . . . . . . . . . . . . . . . . 463

Kelsey Lawrence, Mohammed Al-Jamal, Indermeet Kohli,

K. Lawrence, MD M. Al-Jamal, MD I. Kohli, PhD I. Hamzavi, MD, FAAD (*)

Springer International Publishing Switzerland 2016 3

The sun emits electromagnetic radiation encompassing a wide range of wavelengths

Table 1.1 Electromagnetic Light spectrum Wavelength

1.2 Visible Spectrum

450 500 550 600 650 1400 3000 1,000,000 nm

1.2.1 Biological Effects

Erythema is a cutaneous inflammatory reaction and can be associated with warmth

Skin pigmentation is classified into immediate pigment darkening (IPD), persistent

1.2.1.3 Free Radical Production

Reactive oxygen species (ROS) are chemically reactive molecules containing

1.2.1.4 DNA Damage

1.2.2 Clinical Effects

1.2.2.1 Solar Urticaria

Solar urticaria is an uncommon photosensitivity disorder, making up 0.4 % of all

1.2.2.2 Chronic Actinic Dermatitis

Chronic actinic dermatitis (CAD) is a chronic eczematous, photodistributed eruption

In cutaneous porphyrias, interaction of elevated levels of circulating porphyrins

Phototherapy is one of the methods used to treat hyperbilirubinemia in neonates.

1.2.2.5 Acne Vulgaris Treatment

1.3 Infrared Radiation (IR)

The wavelength of infrared radiation ranges from 700 nm to 1 millimeter (mm). It

radiation C (IR-C) from 3000 nm to 1 mm (Fig. 1.1). Infrared radiation, especially

1.3.1 Biological Effects

1.3.1.1 Physical Effects

Thermal pain caused by overwarming of tissues can occur in response to IR

1.3.1.2 Molecular Effects

Cytotoxicity and DNA Damage

1.3.2 Clinical Effects

Erythema ab igne is an erythematous or hyperpigmented, reticulated dermatosis

1.3.2.2 Acne Vulgaris Treatment

1.4 Treatment Modalities Utilizing Visible and IR Spectrum

1.4.1 Thermal Treatment Modalities

Lasers for Vascular Lesions

Table 1.2 Lasers in the Laser Wavelength peaks

Pigmented Lesion Removal

Laser Hair Removal

Lasers for Keloids

1.4.1.2 Intense Pulsed Light Therapy

Intense pulsed light (IPL) refers to a high-intensity polychromatic incoherent light

can lead to hypopigmentation or dyspigmentation. IPL has been used to successfully

1.4.2 Nonthermal Treatment Modalities