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Shopping for Sunscreen | What People With Eczema-Prone Skin Should Remember When Buying SPF

Updated: May 1

Here is an ironic fact: some chemical sunscreen ingredients are actually common causes of photoallergic contact dermatitis. This means that the sunscreen ingredients may not on their own trigger contact dermatitis but may do so once exposed to light. This sounds a little crazy that some ingredients that you are applying to protect your skin from UV exposure are relatively common triggers for contact dermatitis but only when you are exposed to light! This can also have a major impact on those with eczema. Read more...
 

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sunscreen eczema

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What is eczema? What are its symptoms?



Think of the word “eczema” as a basket term that refers to a state of skin sensitivity but it does not necessarily tell you why or the cause. There are numerous causes of this type of sensitivity such as allergies, irritation, reactions to temperature changes, excess dryness, genetics, contact reactions, sweat, genetics, and several other factors. The symptoms include itching, irritation, and a cycle of worsening as a result of itching that triggers further skin breakdown and irritation as a result. Classically the skin may have a cracked inflamed and dry flaky appearance.





Video: Techei



Can you speak to the effects of fragrance in SPF products on eczema-prone skin? Should those with eczema avoid sunscreens containing fragrances?



Fragrances in products is a really important topic and are in dire need of clarification. Fragrances are ingredients added to products to impart a pleasant odor or smell. The natural ingredients in products, including sunscreen products, have an inherent smell. This smell may or may not be a pleasant one.


If your goal is to have a product that is true without actual fragrances, i.e., without added ingredients used to impart a pleasant odor, then these products will usually be labeled “fragrance-free”. The problem here is that these products may not smell so great. I have evaluated some fragrance-free sunscreens and they can have a really “earthy” smell- not one that I find the slightest bit pleasant.


Many products will actually be labeled “unscented”. This term ironically references a product that likely has fragrances added to neutralize the smell or odor of a product to make it less offensive. The problem- there is fragrance in it! The reality is that if you are seeking a product without fragrance then this isn’t it.


What I have also come to find in reviewing products is that many products may not add specific traditional fragrances tested in our patch tests such as balsam of Peru and fragrance mix, they may still add several floral, food-derived, and botanical extracts to impart a scent. This again means you are getting scent added to your products.


The main point I have here is that if you are actually specifically allergic to fragrances as confirmed by patch testing performed by your Dermatologist, then you have a true allergic contact dermatitis as a cause of your eczema and you need to avoid these ingredients to reduce the chances of aggravating your eczema. If you are not specifically allergic to fragrances that you can find on a product label, there is a good chance that you are going to have a really hard to avoiding fragrances altogether and it may not be as necessary as you think. If your preference to avoid fragrance is that it affects your sense of smell, contributes to nausea, or some other aspect not directly related to an allergic reaction, choosing an unscented product may be reasonable even though it has added fragrances.



 

sunscreen eczema

sunscreen eczema

 

Can you speak to the differences between chemical and physical SPF?



Chemical sunscreens work by absorbing light. Once the sunscreen maxes out its ability to absorb light, the rest flows over to your skin. The challenge: it’s unclear when this could occur based on the intensity and time of UV exposure. Have you ever said, "I literally wore tons of sunscreen and reapplied and still got sunburned!" The answer may be that the ability of your chemical sunscreen to work was maxed out while in the sun. There is no indicator we have to say when this occurs. This is actually why we tend to recommend reapplying sunscreen every 2 hours, every if you are not swimming or sweating. The hope is to replenish the ability of your sunscreen to work at its maximal effectiveness. The challenge your sunscreen will face however is when you are in regions with intense UV exposure as we approach closer to the equator for example.


This is the distinction with physical sunblocks such as zinc or titanium. Physical sunblocks block UV by shielding the skin directly. They do not absorb UV, they block it physically.



What properties do chemical sunscreens have that can make them irritating for those with eczema? Are physical sunscreens better for those with eczema?



Here is an ironic fact: some chemical sunscreen ingredients are actually common causes of photoallergic contact dermatitis. This means that the sunscreen ingredients may not on their own trigger contact dermatitis but may do so once exposed to light. This sounds a little crazy that some ingredients that you are applying to protect your skin from UV exposure are relatively common triggers for contact dermatitis but only when you are exposed to light! The most common sunscreen ingredients that can trigger this are oxybenzone (benzophenone-3), avobenzone, octocrylene, PABA, and cinnamates.


Mineral or physical sunscreens are not common causes of contact allergies.



Video: Techei



Can you explain why patch tests are important? How can people do a patch test with sunscreens?



Patch testing is absolutely necessary to really pinpoint the true cause of your skin reactions or, at the very least, rule out possible triggers. I have performed thousands of patch tests and find that patients and I can often be surprised by the results. When it comes to sunscreens, the potential exists for the reaction to be related to the active ingredients, preservatives, fragrances, and/or dyes. In my experience, reactions to the preservatives tend to be a very common trigger and can require lots of label reading to determine an alternative.



Can you explain what the skin barrier is and how it relates to eczema?



To understand the skin barrier as it relates to eczema I often give the analogy of the skin as a cobblestone street or a brick wall. If you think of our skin as a brick wall, when it is cold out or we use irritating products in excess, the mortar that holds the bricks together starts to dissolve. This makes our body and skin far more sensitive to the environment. If you are applying a product that you are actually allergic to, then your immune system will mount a reaction to the brick wall and cause it to break down leading to signs and symptoms of itching and irritation.




What are some barrier-replenishing ingredients you recommend readers seek out in sunscreen? Please also discuss the benefits of each ingredient.



There are two ways to look at the question of seeking barrier-replenishing ingredients. One way is to focus on ingredients that play a role in hydrating and protecting the skin. This could include ingredients such as ceramides, hyaluronic acid, and even some anti-inflammatory ingredients such as niacinamide. The other way to seek barrier replenishment is to avoid ingredients that aggravate the skin barrier by triggering inflammation. There are some sunscreens products that may be marketed as anti-aging and include ingredients such as retinols, salicylic acid, and other alpha and beta hydroxy acids.



Can you speak to the importance of choosing at least SPF 30? This is important for all skin types, but is it that more important for those with eczema to stick to this rule? Can sunburns irritate eczema?



SPF ratings are so poorly understood and very confusing. SPF stands for sun protection factor. This is an FDA-regulated claim where companies test skincare products -lotions, moisturizers, creams, and sprays- for how much UV protection is offered. More specifically, SPF tells us how much a product is protecting our skin from experiencing sunburn from UVB exposure. It does not tell us how much UVA is being blocked or absorbed by the product.



Here is the SPF system:


sunscreen eczema spf table


These percentages tell you how much UVB is blocked with ideal use- applying a generous amount of sunscreen. One challenge is that some sunscreen ingredients are not necessarily photostable and they also start to become less effective with sweat, swimming or moisture. Avobenzone for example is known for its instability in UV light and often will have other ingredients added to stabilize it in sunscreen formulations.



The FDA has stated that SPF ratings do not inform us of the time of effectiveness of sunscreen products in the sun. The reason is simply because the amount of UV radiation varies widely based on the time of day and location in the world. Although I know there are a lot of sources that attempt to simplify understanding SPF ratings by stating that higher SPFs last longer, this may not be as simple as you think.



Choosing the right SPF is not always about the number, it's about the use. Studies have shown that when people use higher SPF they may tend to spend longer in the sun thinking that they can.

Focus on the ideal use of sun protection through various modalities. Sunscreen is one option for exposed areas. Choose sun protection based on your skin’s needs. If you tend to burn easily, choose higher SPF values. Remember higher SPF values are less aesthetically elegant to apply, especially when you have skin of color. Choosing an SPF of 50 may look obvious when applied and may not be necessary for the added 1.3% UVB blockage it can offer. I tend to recommend an SPF of 30 and reapplication every 2 hours when not sweating or swimming and more frequently if this is the case.




Also remember that SPF tells us nothing about UVA blockage which is what is responsible for photosensitive reactions to hormones, medications, and premature aging of the skin. Higher SPFs will do nothing about this. Looking for Broad Spectrum coverage is helpful. Even better is sun-protective clothing as it blocks both UVA and UVB.


As much as we talk about sunscreen as a way to protect our skin from UV, remember that the industry wasn’t made for this purpose. Historically sunscreen use was designed to allow you to “skip the burn and go straight to a tan”. The goal was only to block enough UVB rays so that UVA could get through and darken your skin without burning as easily. Once we learned that UVB was linked to skin cancer, SPF ratings and increasing SPF ratings were introduced. We now know that UVA has its own problems and is linked to premature aging of the skin and increasing our skin’s susceptibility to UVB damage by thinning the skin over time. Even though the words “broad spectrum” on sunscreen indicate the presence of ingredients that could potentially block UVA, the reality is that this term does not tell us the percentage of UVA blocked. It could be 5%, it could be 98%- who knows. There is a reason why people say that they wore an SPF of 100 and still turned red or burned. The industry has a lot to address to merge health benefits with consumer needs and marketing.



sunscreen eczema


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