One day while Ali Cannavino was getting a facial, an esthetician warned her that tanning was causing early signs of sun damage. "She told me, 'You need to stay out of the sun.' It was a rude awakening."
These days, the Baltimore resident, 32, no longer sunbathes. A reformed sun catcher, the social media/cyber-security professional is one of countless Americans who will rub, spritz and slather on sunscreen this summer in an effort to shield their skin from the damage — and sometimes disease— caused by the sun's powerful rays. She's also among those concerned about choosing the right products from a veritable ocean of options.
Hundreds of lotions, creams, sprays, gels, lip balms, serums and more run the gamut from familiar drugstore brands to upscale lines that retail for more than $100, generating sales of some $399 million annually, according to marketing firm IBISWorld. And their ingredient listsrangefrom barely pronounceable chemicals to those touted as natural, organic or even vegan.
"I like the idea of products without a lot of chemicals and I'm exploring that more," said Cannavino. "But I have a fear that without certain ingredients, they won't get the job done."
The stakes are high. Skin cancer is the most common type of cancer in the U.S., according to the American Cancer Society; it's estimated that one in five Americans will receive a diagnosis in their lifetime. Moreover, the National Cancer Institute reports that last year approximately 10,000 Americans died from melanoma, a rare yet fast-spreading form of skin cancer.
While scientific data doesn't conclude that sunscreen alone lowers the risks of certain skin cancers, the American Academy of Dermatology and many physicians widely recommend it.
"I spend a lot of my day cutting out skin cancer, so I'm definitely pro sunscreen," said Dr. Zaineb H. Makhzoumi, a dermatologic surgeon and assistant professor in the Department of Dermatology at the University of Maryland School of Medicine. "My patients often ask, 'What brand? What SPF?'"
To help consumers understand what they're buying and the protection it offers, we turned to local experts and the analysis of the Environmental Working Group, a nonprofit based in the nation's capital that evaluated nearly 800 sunscreens, using safety, efficacy and other criteria. Here's what to know when stocking up for the season:
UVA versus UVB protection
Dr. Chesahna Kindred, a board-certified dermatologist at MedStar Good Samaritan Hospital in Baltimore whose practice includes treatment of skin cancer, says sunscreen can serve as a defense against ultraviolet (UV) radiation, invisible rays that come from natural sunlight or artificial light sources like tanning beds and sunlamps.
"I tell my patients to remember that the 'A' in UVA rays is associated with aging and wrinkling," Kindred said, "while the 'B' in UVB rays stands for burn, as in sunburns."
A product's sun protection factor (SPF) refers to its ability to block UVB radiation, but not UVA rays. An SPF of 30 would filter 97 percent of those harsh rays, while an SPF of 50 would block 98 percent and so on, though many experts stress that SPF higher than 50 is not necessary.
Today, most sunscreens are made to "guardagainst both types of UV rays," said Kindred, who advised that consumers check labels for terms such as "broad spectrum" or "multi-spectrum"protection.
Sunscreens fall into two categories: chemical sunscreens and physical sunscreens.
Physical sunscreenscontain mineral-based ingredients such as zinc oxide, titanium dioxide or both. They sit on the surface of the skin and deflect UV rays.
While physical sunscreens once had a reputation for being thick and chalky, newer versions are silkier, and rub on with the ease of lotion. White streaks, often seen on lifeguards, have been replaced by flattering tints.
Physical sunscreens include such brands as Honest Mineral Sunscreen SPF 50+ ($13.95 at honest.com; other retailers' prices may vary), which the Environmental Working Group's 2016 Guide to Sunscreens gave high marks for "excellent UVA protection," and Coola Baby SPF 50 Mineral Sunscreen (Unscented Moisturizer) ($36 at coolasuncare.com), which EWG called "a top choice for sun protection."
Chemical sunscreens contain carbon-based compounds such as oxybenzone and octisalate as active ingredients. They are designed to penetrate the skin, absorb the sun's UV rays and convert them into heat that's released from the skin.
Most sunscreens contain a mix of chemicalabsorbers and physical filters as active ingredients, Makhzoumi said.
Oxybenzone, commonly used in chemical sunscreens, was among the ingredients Environmental Working Group deemed "worrisome." Though it's approved by the FDA for use in sunscreen, some studies have shown that it can disrupt or interfere with hormones.
Chemical sunscreens include products such as Neutrogena Pure & Free Baby Sunscreen Stick SPF 60 ($8.49 at neutrogena.com), which the guide gave high marks for UVA protection but noted some ingredients raised "high" health concerns, and Coppertone Oil-Free Faces Sunscreen Lotion SPF 50 ($6.97 at walmart.com), which the guide said provided "moderate" UVA protection and had ingredients that posed "moderate" health concerns.
Botanicals and "natural" sunscreens
Both chemical and physical sunscreens may boast "botanicals" and other infusions that suggest Mother Nature's bounty: think shea butter, aloe, lavender, green tea, cucumber, lemon oil and Vitamin E, to name a few.
Thesetypesofingredients, which estheticians say can heal, soothe and protect the skin, are being used in conjunction with sunscreen treatments atmany spas across Baltimore and beyond.
The Spa At The Ivy in Mount Vernon offers a $200 "Citrus Essence Facial" featuring Natura Bisse products (not evaluated by the Environmental Working Group) they say can repair and prevent further sun damage.
"This nutrient-rich facial drenches your skin with powerful antioxidants, including Vitamin C," says Ayana Ridley, spa director. "It not only revitalizes your senses with citrus; it's an anti-aging treatment as well."
Afterward, clients get a boost from mineral cosmetics with sunscreen.
The Spa at the Four Seasons Hotel in Harbor East and the Gaylord National resort's Relache Spa in National Harbor are also incorporating sun protection products deemed "natural" into their treatments.
"We always provide a sunblock with any facial treatment," says Toni Sullivan, director of the Spa at the Four Seasons Hotel. "In the spa, we carry Coola Suncare products," which she noted are organic and natural.
The Gaylord National team also recently began using Coola, as well as moisturizers with SPF from the HydroPeptide and Eminence skin care lines. (The Environmental Working Group gave a HydroPeptide moisturizer with SPF 30 moderate ratings, while the Eminence products evaluated earned good to moderate overall marks.)
"It is important to maintain your skin after a facial and continue to use moisturizer with SPF, which is particularly important at this time of year when UVA levels are at their peak," said Debra Myers, spa director at Relache.
While the FDA does not have formal definitions for the terms "natural" and "organic" in personal care products, "natural" typically refers to products withno artificial ingredients, while "organic" generally refers to pesticide-free products. Formulations vary, but experts say most sunscreens marketed as "natural" or "organic" have mineral bases such as zinc oxide, long considered effective.
Natural sunscreens include brands such as Nature's Gate Aqua Vegan Sunscreen SPF 50 ($8.99 at walgreens.com, other retailers' prices vary), which the Environmental Working Group's guide says "scores well" overall, and Jason Sun Mineral Sunscreen SPF 30 ($8.54 at amazon.com), which was rated as having "good UVA protection."
Even brands that bill themselves as eco-conscious may contain nanoparticles that some groups say can be harmful.
Though the jury is still out on how nanoparticles in personal care products impact health, the minuscule particles of titanium dioxide or zinc oxide are sometimes used to make formulations more sheer or clear. Environmental advocacy group Friends of the Earth issued a report that warned of potential damage to DNA and cells; it also published a guide to avoiding sunscreens with nanoparticles. Green America, a nonprofit, has recommended consumers avoid most nanoparticles, although the Environmental Working Group says nano-zinc oxide doesn't present a large threat.
Some brands tout their sunscreens as "non-nano," but such claims aren't federally regulated.
The bottom line
Consumer advocacy organizations such as the Environmental Working Group say there have been some improvements in sun protection, but more needs to be done to improve the quality of sunscreens.
In its research for its annual guide to sunscreens, the organization concluded that nearly three-fourths ofthoseevaluated had "inferior protection" and "worrisome ingredients."
"Most of the products sold in the U.S. aren't as good as they should be," said Sonya Lunder, a senior analyst with the nonprofit who holds a master's degree of public health in environmental health sciences. "Many don't offer enough protection against ultraviolet rays."
Though misleading or bogus label claims such as "all-day protection," "waterproof" and sunblock were banned by the FDA in 2011, Lunder said stronger regulations are needed.
The bottom line: don't believe the hype.
"I'd say to be cautious about labels," said Kindred. "Just because there's a claim doesn't mean it's true. Be an informed consumer."
More important, Kindred and other experts stress that sunscreen is just one part of a holistic approach to sun protection, which includes limiting time outdoors during peak sunlight, seeking shade while outside and covering up with lightweight shirts, pants and hats.
Cannavino, for one, has taken that advice to heart. "I have a great collection of floppy hats," she said.