It’s May so we are in Skin Cancer Awareness Month! This is the time that understanding the importance of sun protection AND knowing your skin are emphasized. Just in time for that, the Journal of the American Medical Association (JAMA) published a polarizing paper on systemic absorption of chemical sunscreens showing they can be detected in plasma (i.e., liquid of blood). This understandably brings up concerns about what these chemical could do. At this point, we don’t know and more research is needed but there are some important points to consider:

  1. This study is specifically in regards to four CHEMICAL sunscreens: avobenzone, oxybenzone, octocrylene, and ecamsule. I generally avoid these for a few reasons I’ll explain below, but for some people the benefits of use may outweigh the–to date undefined—potential risks.
  2. This is a preliminary study with only 24 participants. While it did show concentrations of all 4 sunscreens exceeding the FDA threshold, this is not a reason to blindly stop using any/all sunscreen. What is does mean is that we can expect the FDA to require further toxicology studies on these ingredients and that additional clinical studies will be conducted to determine the significance of these findings.
  3. The participants applied sunscreen as directed: 2 mg/cm2 4 times a day to 75% of body surface area for 4 days. This is approximately equivalent to a shot glass of sunscreen applied 4Xs/daily for four days. All four chemical sunscreens were detected in plasma at levels higher than the FDA threshold after the last application on 1 day. This is a concern; however, I know very few (any?) people who apply that much sunscreen 4X/day. Real life application probably results in lower plasma concentrations. Further studies will hopefully help clarify this.
  4. The FDA will already be labeling all of the above except ecamsule with “insufficient evidence” of being generally regarded as safe and effective (aka GRASE) later this year. Therefore they will require further testing to look into safety and these ingredients risk being removed from the market pending findings of such research. Physical sunscreens–zinc oxide and titanium dioxide–will be labeled generally regarded as safe and effective.

The good news is you don’t have to wear sunscreen to protect your skin from the sun–though it does make it a lot easier! Seeking shade, avoiding mid day sun when the UV Index is high (see this blog for more on UV Index), wearing protective clothing/long sleeves, wearing wide brimmed hats, using sunglasses, and taking polypodium leucotomas (e.g., Heliocare) are all other measures that are effective in avoiding burning and other adverse effects of excess sun. You can also apply physical blocking sunscreens that we believe are safe if you want to stay away from chemicals that are absorbed into the body. Physical sunscreens have the benefit of being pretty inert. Their job is to sit on your skin and block the ultraviolet rays, whereas chemical sunscreens absorb UV. I have never seen an allergy to physical sunscreens–though chemical blockers can and do cause allergic skin rashes in those susceptible. Because I have always had a preference for physical blocking sunscreens we have never carried any sunscreens at VibrantSkin that contain any of the concerning chemicals researched in this study. All of our sunscreens are 100% physical blockers with the one exception of Epionce Ultra Shield Lotion; it contains homosalate and octisalate. Both of these ingredients are made from salicylic acid, are generally well tolerated, and rarely cause allergic reactions.

So what’s the take home point? If you want to be cautious, avoid sunscreens containing avobenzone, oxybenzone, octocrylene, and ecamsule and use physical blockers (zinc oxide and titanium dioxide) and other sun protective measures. Stay tuned for updates from pending studies as they will help determine the significance of these early findings and guide both regulators and consumers in defining sunscreen ingredient safety.

Since it is skin cancer awareness month, I want to take the opportunity to advise you to check over your skin (see this video for how to do a self-skin exam) and seek out a board-certified dermatologist (MD certified by the American Board of Dermatology, DO certified by the American Osteopathic Board of Dermatology, or either MD or DO certified by National Board of Physicians and Surgeons) for any new, changing or concerning skin lesions. Skin cancer can affect people of any skin color (see this video of young U of Kentucky football player who battled melanoma). Visit prior blog here for more on the ABCDEs of melanoma. Lastly, if desired, sign up for our second annual free skin cancer screening that will be on Wednesday May 22, 2019. Space is limited so call right away to reserve your spot.

Have a great month!

Warmly,

Kesha Buster, MD FAAD (board-certified dermatologist)

 

References:

https://jamanetwork.com/journals/jama/fullarticle/2733084

https://jamanetwork.com/journals/jama/fullarticle/2733085


 

May Specials!

Approved Uses
BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to temporarily improve the look of moderate to severe forehead lines, crow’s feet lines, and frown lines between the eyebrows in adults.
IMPORTANT SAFETY INFORMATION
BOTOX
® Cosmetic may cause serious side effects that can be life threatening. Get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX® Cosmetic:

Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months.
Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing.
BOTOX® Cosmetic dosing units are not the same as, or comparable to, any other botulinum toxin product.
There has not been a confirmed serious case of spread of toxin effect when BOTOX® Cosmetic has been used at the recommended dose to treat frown lines, crow’s feet lines, and/or forehead lines.
BOTOX® Cosmetic may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of taking BOTOX® Cosmetic. If this happens, do not drive a car, operate machinery, or do other dangerous activities.
Serious and/or immediate allergic reactions have been reported. They include: itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Get medical help right away if you are wheezing or have asthma symptoms, or if you become dizzy or faint.
Do not receive BOTOX® Cosmetic if you: are allergic to any of the ingredients in BOTOX® Cosmetic (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® (rimabotulinumtoxinB), Dysport® (abobotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); have a skin infection at the planned injection site.
Tell your doctor about all your muscle or nerve conditions, such as ALS or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including difficulty swallowing and difficulty breathing from typical doses of BOTOX® Cosmetic.
Tell your doctor about all your medical conditions, including: plans to have surgery; had surgery on your face; have trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (it is not known if BOTOX® Cosmetic can harm your unborn baby); are breast-feeding or plan to (it is not known if BOTOX® Cosmetic passes into breast milk).
Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Using BOTOX® Cosmetic with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received BOTOX® Cosmetic in the past.
Tell your doctor if you have received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (tell your doctor exactly which product you received); have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; take a sleep medicine; take aspirin-like products or blood thinners.
Other side effects of BOTOX® Cosmetic include: dry mouth; discomfort or pain at the injection site; tiredness; headache; neck pain; and eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids and eyebrows, swelling of your eyelids and dry eyes.
For more information refer to the Medication Guide or talk with your doctor.
To report a side effect, please call Allergan at 1-800-678-1605.
Please see BOTOX® Cosmetic full Product Information including Boxed Warning and Medication Guide.
Terms and conditions
Rebate is valid for Brilliant Distinctions® members only. Patient must be a Brilliant Distinctions® member at time of treatment to redeem. Only 1 rebate per member. The Own Your Look “Your 4” Experience rebate #3 can be combined with the $100 JUVÉDERM rebate on any two 1.0 mL products within the JUVÉDERM® Collection of Fillers. Year of Brilliance gift cards cannot be combined with this rebate or any other BOTOX® Cosmetic rebate. Allergan reserves the right to alter or cancel the program with no advance notice or obligation.
* Appropriate patients save $100 on 2 JUVÉDERM® syringes at their third BOTOX® Cosmetic treatment. Rebate may be applied to any 1.0 mL JUVÉDERM® product purchase. Treatments must be administered in the same visit.
Max of 50 Units free. Injection fee may be added. Units over 50 may be charged to the patient. Upon entering the free treatment code, practices will receive a 50-Unit vial within 7 to 10 business days. Tracking information will be available in the Brilliant Distinctions® provider portal. Vial will be reimbursed. All other charges are at the discretion of the provider.
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