Cosmetic Versus Medicine: How Does Your Country Define Sunscreen?

August 2018 | Volume 17 | Issue 8 | Original Article | 899 | Copyright © 2018

Elissa Tong BMed,a,b Gayle Fischer OAM FACD MD,a,b Saxon D. Smith MBChB MHL PhD GAICD FACDa,b,c

aRoyal North Shore Hospital, St Leonards, New South Wales, Australia bNorthern Clinical School, University of Sydney, St Leonards, New South Wales, Australia cThe Dermatology and Skin Cancer Centre, Gosford, New South Wales, Australia

Abstract

Skin cancer (melanoma and non-melanoma) is the most commonly diagnosed cancer in the United States of America, and non-melanoma skin cancer is the most common cause of Australian hospitalisations with cancer as the principle diagnosis, having a huge cost to the country’s health care system. Primary and secondary skin cancer prevention is globally inadequate, with only 3 in 10 American adults using sun protection routinely. Evidence suggests that regular sunscreen use in Australians prevents both melanoma and non-melanoma skin cancers, and American research has found that daily sunscreen use reduced the incidence of melanoma - the most skin cancer deaths – by half. Despite this, in many countries and regions around the world, a major ongoing divergence remains on the classification of sunscreen as either a cosmetic product or a form of medical therapy, which in turn affects the consumers’ attitudes towards the use of sunscreen. This is also affected by the increasing use of the internet, which has made the purchasing of products internationally convenient and easy for consumers worldwide, including sunscreen products, which are frequently marketed online. There is variation between each country or region and their regulations of sunscreen affect the consequent labelling claims of sunscreen products. This affects the unsuspecting consumer’s choices in purchasing sun protection, which may be misinformed. Australia, Canada, and the US are the only countries to classify sunscreen as a form of medical therapy. This paper explores the current classification of sunscreen products in countries and regions around the world and discusses the impact of these discrepancies and similarities on the attitudes of consumers towards sunscreen use. Finally, we make suggestions on changes that can be made to encourage sunscreen use and safe sunscreen purchasing. J Drugs Dermatol. 2018;17(8):899-904.

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INTRODUCTION

Skin cancer (melanoma and non-melanoma) is the most commonly diagnosed cancer in the United States,1,2 with melanoma being responsible for over 9000 US deaths annually. Melanoma is the 3rd most diagnosed cancer in Australians,3 and non-melanoma skin cancer is the most common cause of Australian cancer-related hospitalizations, representing a major health-care cost burden.4 Primary and secondary skin cancer prevention is globally inadequate,5 with only 3 in 10 American adults using sun protection routinely.6Internet purchasing of sunscreen products is possible for consumers worldwide. However, countries have unique sunscreen regulations. Sunscreen products purchased internationally may not meet standards required by the consumer’s respective local regulation. This can create confusion for consumers who do not understand the differing international regulations.Benefits of Sunscreen as PhotoprotectionSunscreen protects against exposure to solar ultraviolet (UV) radiation (UVR), which is comprised of UVA (320-400 nm) and UVB (290-320 nm) rays.7 It was originally developed to minimize sunburn, which is caused by primarily UVB.8 However, UVA is responsible for other effects after exposure at lower UVR than needed to induce erythema. Therefore, the ideal sunscreen should protect against both UVA and UVB radiation.Exposure to UVR acutely causes initial erythema (sunburn) and then pigmentation (tanning), the measurements of which form the basis of testing the sun protection factor (SPF) and UVA protection of sunscreens.9 Chronic and harmful effects of UVR include photoaging and importantly, skin carcinogenesis.8Sun protection inhibits effects of exposure to UVR.8 It has been demonstrated that sunscreen prevents non-melanoma and melanoma skin cancers, photo-immunosuppression and signs of photoaging.10 The 1992 Nambour Skin Cancer Prevention Trial in Queensland, Australia demonstrated a lower incidence of squamous cell carcinoma in participants who used SPF 16 sunscreen daily than in participants who used no sunscreen.11 Recent research revealed that daily sunscreen use reduces melanoma incidence by half.11

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