‘Allergen Free' Sunscreen? Take a Closer Look
SAN DIEGO — More than half of popular sunscreens advertised as 'hypoallergenic,' 'allergen free,' and 'allergy free' contain at least one allergen that could trigger allergic contact dermatitis (ACD), a new study reported.
'We discovered an exorbitant amount of sunscreens with marketing claims that were not accurate,' said University Hospitals, Cleveland, dermatologist Chandler Rundle, MD, co-author of the report, which was presented here at the annual meeting of the Society for Investigative Dermatology. 'While the most reliable claim was 'sensitive skin,'' he told Medscape Medical News , 'more than a quarter of products [with that label] still had a relevant allergen.'
Sensitivity to sunscreen is common, but actual allergy to ingredients appears to be quite rare. A 2013 study reported that only 0.9% of 23,908 patch-tested patients had sunscreen coded as an allergen. Still, 'ACD on the face, eyelids, ears, or other sensitive areas can be deeply concerning to patients and negatively impact their mental wellness,' Rundle said. 'ACD can go undiagnosed or undertreated for months and even years.'
For the new study, he and his coauthors looked for North American Contact Dermatitis Society Core Allergens in the ingredients of 200 sunscreens. All the products were among the 40 sunscreens listed first — either by popularity or 'relevance' — when searches were performed on the websites of Amazon, CVS, Target, Walgreens, and Walmart.
Of the 200 sunscreens, 88.5% had at least one allergen, 35.5% had at least two, 18.5% had at least three, and 2.0% had at least five.
The top five most commonly identified allergens were fragrance (53.5%), phenoxyethanol (44.5%), ethylhexylglycerin (29.5%), propylene glycol (18%), and methacrylate (17.0%).
Allergens were more commonly found in non-tinted (64.6%) vs tinted (35.3%) products and in chemical (64.5%) and physical (65.9%) vs combination (26.7%) products.
Products with lower sun protection factor (SPF) levels (< 30 SPF, 45.5%; SPF 30-60, 62.2%) were less likely to contain allergens than products with the highest levels (> 60 SPF, 76.9%). Also, products labeled as 'gentle' were more likely to contain allergens (66.7%) than those with 'dermatologist recommended' (55.9%), 'hypoallergenic,' 'allergen free, 'allergy tested' (52.9%), and 'sensitive skin' (26.2%) claims on their labels.
Study lead author Andrew B. Fay, a student at Loma Linda University School of Medicine, Loma Linda, California, noted that 'companies can legally label products as 'fragrance-free' even if they contain fragrance chemicals as long as those ingredients serve another purpose, like moisturizing or preserving, and are not used 'solely to impart an odor to a product.''
Fay told Medscape Medical News that the US Food and Drug Administration doesn't regulate claims like 'allergen-free,' 'hypoallergenic,' and 'dermatologist recommended.'
Other studies have reached similar conclusions about allergens in sunscreens. A 2011 study examined 201 sunscreens and found that a high proportion contained the allergens oxybenzone (68%), fragrance (63%), and vitamin E (53%).
The new study reported that 7.5% of products analyzed contained oxybenzone, and vitamin E was not listed.
Walter Liszewski, MD, assistant professor of dermatology and preventive medicine at Northwestern University, Chicago, who was not involved in the study, told Medscape Medical News that there are common misconceptions about skin reactions to allergens.
Patients may think they are allergic because they develop rashes after exposure, he said. 'The reality is that most rashes people get from sunscreens aren't due to an allergy. Rather, it's because the sunscreens are so irritating. They're just inherently irritating on the skin.'
Sunscreens with higher SPFs are especially irritating, said Liszewski, who specializes in ACD. 'Many patients who complain of having sunscreen allergies are just using sunscreens with too high of an SPF.'
He advised dermatologists to 'not be afraid to encourage [sensitive] patients to use a lower SPF like SPF 30, SPF 20, or even SPF 15. If a patient can tolerate a low SPF sunscreen, it suggests that their sensitivities to the sunscreen are due to irritancy and not an allergy. But if they continue to develop rash with a lower SPF, then that patient should be referred to a patch test expert to undergo allergy testing.'
Mineral-based sunscreens such as those with titanium or zinc are other options for sensitive patients, Liszewski said, although they can leave a white residue on the skin and sometimes sting or burn.
Fragrance-free products can also be helpful, he said, although he agreed with Fay that this phrasing is a sticky area on the marketing front. A sunscreen may include a claim that it's fragrance-free, he said, when it contains an ingredient such as lavender oil for a purpose other than odor, such as serving as a moisturizer.
While the lavender oil 'is not intentionally being used as a fragrance, [the sunscreen] is going to have a strong lavender scent,' Liszewski said.
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