How Pharmacists Can Help Protect Patients’ Skin From Sunburn, Skin Cancer

Summer is winding down, but there is still time to spend time outdoors in the hot, sunny weather. Summer is a great time take advantage of the benefits the sun can provide, including helping us make vitamin D, which is needed for bone function and health. However, it is important to keep in mind the damage the sun can cause to our skin if we do not take appropriate measures to protect it.

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As pharmacists working in retail stores, there are many sunscreen products available for patients to purchase. We can be a valuable resource to patients, friends, and family by helping them choose the right sunscreen product.

What is Sunburn?

The sun emits ultraviolet (UV) radiation and is classified into 3 primary types based on their wavelengths: ultraviolet A (UVA), ultraviolet B (UVB), and ultraviolet C (UVC). Most of the radiation that reaches the earth is UVA, and this type of radiation penetrates the skin deeper and is more constant throughout the year; however, some UVB also reaches the earth.²

Too much exposure to UV radiation can lead to sunburn, which is an inflammatory reaction to UV radiation damage to the outermost layer of the skin.³ The most common types of sunburn are first- and second-degree sunburn.

First-degree sunburn is damage to the skin’s outer layer and usually heals on its own within a few days to a week.⁴ Second-degree sunburn is damage to the dermis layer of the skin and will lead to blisters on the damaged skin. This type of sunburn may take weeks to heal and may need medical treatment.⁴ Third-degree sunburn is very rare and would require emergency medical treatment.⁴

Best Practices for Treating Sunburn

Now that we’ve covered what sunburn is and how to avoid it, we can now focus on how it can be treated. Sunburn treatment generally involves pain relievers and creams to relieve swelling, itching, or discomfort.

For pain relief, pharmacists can recommend OTC pain relievers, such as ibuprofen (Advil, Motrin, etc.) and acetaminophen (Tylenol). Other OTC products that can be purchased are aloe vera lotion, gel, or calamine lotion.

When recommending aloe vera products to patients, try to recommend 100% aloe vera gel to avoid any irritating ingredients, including alcohol.⁵ Aloe vera can also be refrigerated before applying for an additional soothing effect.

At-home remedies to relieve sunburn discomfort include applying a cool, damp towel to the area for about 10 minutes several times a day. It is important to counsel patients to drink plenty of water to avoid dehydration and to leave blisters alone until they heal.⁴

After a few days, the affected area may begin to peel, which is the body’s way of removing the damaged skin. Advise your patients not to peel the skin and to let it fall off naturally. Additionally, patients should continue using moisturizer while the skin is peeling.⁵ It is also important to advise patients against using numbing products, such as lidocaine or benzocaine, on sunburned skin because these products may be additionally irritating or trigger an allergic reaction on the damaged skin.⁵

Most sunburn will go away on its own within a few days to a week, but patients should seek medical care if they have any concerns about their sunburn, or if they experience chills, a fever greater than 102 degrees Fahrenheit, have signs of dehydration including dizziness, fatigue, reduced thirst, etc., have signs of infection, or if they have a baby younger than 1 year of age with a sunburn.⁴

Ways to Prevent Sunburn

Sunburn can be painful and detrimental to the skin, so it is best to understand how it can be avoided. There are multiple ways to protect your skin from the sun's rays, including limiting the amount of time spent in the sun, wearing protective clothing such as long-sleeved shirts and hats, and wearing sunscreen.

When applying sunscreen, an average-sized adult needs 1 ounce of sunscreen to cover their entire body, which would be enough sunscreen to fill a shot glass. Sunscreen should be applied 15 minutes before going outside and reapplied every 2 hours; reapplication should be done more frequently if sweating or swimming.

It is not recommended that infants 6 months of age or younger wear sunscreen. They must avoid the sun and use protective clothing, such as hats and rash guards if they cannot avoid sun exposure. Sunscreen should not be left in direct sunlight and should be protected from excessive heat. Good options for storage include a bag or purse, wrapped in a towel, or in a cooler.⁶

Considerations When Recommending Sunscreens

There are 2 different kinds of sunscreens available: chemical (organic) and physical (mineral). Chemical sunscreens are more commonly used as they absorb to reduce penetration of the UV rays through the skin, and physical sunscreens are less popular as they sit on top of the skin to block the sun’s rays. Physical sunscreens are often oily and hard to rub in, leaving a white tinge to the skin.⁷

There are many different formulations of sunscreens available, such as lotions, creams, sticks, gels, oils, butters, pastes, and sprays, and the directions for application vary from product to product. It is important to read the label so that the sunscreen is applied the correct way and that you are choosing the most appropriate product.

Broad spectrum sunscreens protect against UVA and UVB radiation and are a good choice for preventing sunburn and skin cancer. Another component to look at on the label is the sun protection factor (SPF). The higher the SPF value, the more sun protection it provides.

To be adequately protected, it is recommended to choose a sunscreen with an SPF of at least 15, but a person with fair skin will want a higher SPF, such as 30 to 50.⁶ SPFs greater than 50 are not shown to have that much more protection from the sun's rays, as SPF 50 blocks 98% of UVB radiation, whereas SPF 100 blocks 99% of UVB radiation.⁸

A common misconception is that patients with darker skin tones do not need to wear sunscreen because the melanin in their skin absorbs ultraviolet rays before they can damage the skin. However, this is not true, as melanin is not enough to protect against skin cancer, and sunscreen use by people of color is still recommended.⁹

The label will also indicate if the sunscreen has an expiration date. If there is no expiration date, the sunscreen is good for 3 years from the time of purchase. After this time, or once the product has surpassed the expiration date, it is recommended to dispose of the product because it may not be as effective any longer.⁶

When looking at the active ingredients in sunscreens, there are some that the FDA lists as GRASE, generally recognized as safe and effective, and some that are not. The 2019 FDA Proposed Rule states that zinc oxide and titanium dioxide are GRASE for use in sunscreens, whereas aminobenzoic acid (PABA) and trolamine salicylate are not GRASE for use in sunscreens due to safety concerns.

There are 12 other active ingredients that are not GRASE for use in sunscreens due to the need for additional data.⁸ The environment may also be taken into consideration when choosing sunscreens. So far, there are no environmentally or reef-safe sunscreens on the market.

Further research is needed to develop a sunscreen that is both safe for consumers and the environment.⁷ Be sure to follow these recommendations so that the skin is adequately protected and further sun damage is prevented.

Skin Cancer Screening and Recommendations

Skin cancer is the most commonly diagnosed cancer in the United States, and UV radiation is among the various risk factors causing it. Asymptomatic adolescents and those with no history of premalignant or malignant skin lesions can be screened for skin cancer by doing a visual skin examination.

Pharmacists can help patients identify a potential melanoma by looking at skin lesions that follow the “ABCDE” rule: asymmetry, border irregularity, nonuniform color, diameter greater than 6 mm, and evolving over time. Another screening method is the “ugly duckling” sign, which is used to identify skin lesions that stick out from others on the patient’s body.

These screening methods can be taught to patients so that they may be able to identify suspicious moles themselves; however, a biopsy is the only way to definitively diagnose skin cancer. If there is a skin lesion that meets these criteria, it is important to refer these patients to a dermatologist so they can be further evaluated.¹¹

Many patients may approach the counter this summer and ask for advice on which sunscreen to buy or if they should be worried about a mark on their skin. Pharmacists can provide individualized recommendations on how to best protect patients skin and avoid sunburn, provide OTC treatment and at-home remedies for sunburn, and screen for skin cancer so that our patients can stay healthy and safe.

References

1. Wein H. Sun and skin. National Institutes of Health. January 6, 2020. https://newsinhealth.nih.gov/2014/07/sun-skin#:~:text=Over%20time%2C%20UV%20damage%20can,cancer%20in%20the%20United%20States.
2. UV radiation. Centers for Disease Control and Prevention. July 3, 2023. Accessed July 11, 2023. https://www.cdc.gov/nceh/features/uv-radiation-safety/index.html#:~:text=Types%20of%20UV%20Radiation%20Rays,some%20UVB%20radiation%20reaches%20earth.
3. Sunburn. The Skin Cancer Foundation. June 14, 2023. Accessed July 11, 2023. https://www.skincancer.org/risk-factors/sunburn/.
4. professional CC medical. Sunburn. Cleveland Clinic. Accessed July 11, 2023. https://my.clevelandclinic.org/health/diseases/21858-sunburn
5. Sunburn. Mayo Clinic. October 8, 2022. Accessed July 11, 2023. https://www.mayoclinic.org/diseases-conditions/sunburn/diagnosis-treatment/drc-20355928.
6. Sunscreen: How to Help Protect Your Skin from the Sun. Food and Drug Administration. May 24, 2023. Accessed July 11, 2023. https://www.fda.gov/drugs/understanding-over-counter-medicines/sunscreen-how-help-protect-your-skin-sun
7. Hamblen H. The Environmental Impacts of Reef-Safe Sunscreen and How to Choose the Best One. EARTH.ORG. March 28, 2022. Accessed July 20, 2023. https://earth.org/reef-safe-sunscreen/
8. Alexander H. Should you use very high SPF sunscreen? The University of Texas MD Anderson Cancer Center. May 28,2021. Accessed July 20, 2023. https://www.mdanderson.org/cancerwise/should-you-use-very-high-spf-sunscreen.h00-159460845.html#:~:text=Double%20SPF%20does%20not%20always%20mean%20double%20protection&text=The%20SPF%20rating%20only%20refers,rays%20from%20reaching%20your%20skin.
9. Why Sunscreen Is Still an Important Tool for People of Color. Health Essentials: Skin Care and Beauty. Cleveland Clinic. July 11, 2023. Accessed July 20, 2023. https://health.clevelandclinic.org/sunscreen-for-black-people/
10. Guan, L.L., Lim, H.W. & Mohammad, T.F. Sunscreens and Photoaging: A Review of Current Literature. Am J Clin Dermatol 22, 819–828 (2021). https://doi.org/10.1007/s40257-021-00632-5
11. Recommendation: Skin Cancer: Screening. US Preventive Services Task Force. April 18, 2023. Accessed July 11, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/skin-cancer-screening#fullrecommendationstart