Public health authorities and regulations in Europe protect the population against the damaging effects of excessive solar ultraviolet radiation through, among other means, monitoring marketed sunscreens and enforcing compliance with sun protection factor labelling requirements. In-market control processes are fundamental and complementary to other public health initiatives in a context of suboptimal sunscreen use in real-world settings. However, the laboratory testing method used for determining the sun protection factor of sunscreens is known to produce variability of results. The combination of an inherently variable testing method with the necessary rigidity of regulations generates volatility in the decision-making process followed by regulators during official in-market controls and exposes sunscreens to be susceptible to accidental mislabelling challenges. This leads to a paradoxical situation that may leave most sunscreens incorrectly labelled in the market and to a potential dilemma for authorities. The issue may get further amplified when non-official sources echo and broadcast uncontrolled messages about sunscreens to the public. Amending current regulation with a tolerance level to compare results that accommodates the variability of results from sun protection factor tests would ease decision-making, bring robustness to an uncertain legal landscape, make more efficient the efforts to convey consistent public health messages about the benefits of sunscreen use and better protect users. There are precedents of using tolerance levels for regulatory decision-making in other fields, and a review of the applicable legal landscape in Europe reveals that implementing it for sunscreens would only require one change to current cosmetics law.

The Middle East and North Africa region, including Lebanon, is well known for its excessive cosmetics expenditure. While the use of beauty products is increasing, it is unclear if customers are aware of the products' safety and proper use.

To explore Lebanese women's knowledge and attitudes toward cosmetics use.

A cross-sectional study was conducted from January to May 2021 among a sample of adult Lebanese women. Data were collected using an electronic questionnaire divided into 3 sections (sociodemographic characteristics, cosmetics knowledge, and attitude) and shared via social media platforms. Knowledge and attitude scores were then calculated. Descriptive and regression analysis was performed using Statistical Package for the Social Sciences. P value < .05 was considered statistically significant.

A total of 1,051 females completed the survey, and the age range of the majority 744 (70.8%) was between 18 and 20 years. The mean score of participants' knowledge was 7.54 ± 2.7 (range 0-14) with 658 (62.6%) of the respondents being knowledgeable about cosmetics. The study sample exhibited an overall positive attitude toward cosmetics. A significant association was observed between the area of residency and monthly income of respondents and their knowledge toward cosmetic products (P < .001).

The self-administered questionnaire may have resulted in information bias and it targeted only those having internet access, and the age group 18 to 20 years was overrepresented.

The study sample demonstrated a good level of knowledge as well as a positive attitude toward cosmetics. However, raising awareness on the acute and chronic side effects of cosmetics is warranted.

The sun protection factor has nowadays become a familiar metric to understand sunscreen effectiveness. This value is displayed on the label of sunscreens and it is established by translating the results obtained from standardized testing methods to regulatory labeling criteria. The ISO24444, a widely accepted method to measure the sun protection factor, is designed to determine the validity of a single test, but it lacks criteria to compare results and many regulators only endorse the method as a valid means to label sunscreens. This supposes a challenge for manufacturers and regulators routinely using the method to take decisions on product labeling when confronted with disparate results for the same product.

Analytical review of the statistical criteria used by the method to determine test validity.

For the same product, results from independent tests (of 10 subjects each) separated less than ×1.73 can be considered as the same from the point of view of compliance to the standard.

This range of sun protection factor values far exceeds the ranges for labeling and categorizing sunscreens as per current regulations and thus opens the possibility that sunscreens are unknowingly mislabeled. These findings can be summarized in a "discriminability map" to assist comparing results from different tests and to better inform the labeling of sunscreen products and thus increase confidence to prescribers and consumers.

The incidence of skin cancer and actinic keratosis has increased worldwide. Measuring the public awareness, attitude, and knowledge about these diseases and the skin protection behaviors are highly important to undertake preventive measures.

To investigate skin cancer and actinic keratosis-related knowledge, sun protection behaviors, and sunscreen usage among Jordanians, a questionnaire was developed. The questionnaire was provided as a google form to individuals via social media and the data were analyzed using SPSS^® 23.

A total of 1277 individuals, aged 18-65 years filled the questionnaire. The median melanoma and actinic keratosis knowledge score were 7 (4-9) and 4 (0-9), respectively. The melanoma knowledge was higher among females, those with a medical background, a high level of education, and in the central region, whereas the AK knowledge was higher among those with a medical background. Overall, 75.9% of the participants used sunscreen at least often to prevent sunburn, uneven skin tone, or tanning, 72% were using sunscreen with an SPF of 30 at least. However, 45.3% and 49.2% of sunscreen users did not comply with application, and reapplication times, respectively. Moreover, 58.4% of participants applied less than the recommended amount of sunscreen.

Our study revealed that public awareness of actinic keratosis is low among Jordanians. Although it was found that a high proportion of Jordanians use sunscreens there are deficits in sunscreen practice indicating an urgent need to design effective interventions to increase awareness of actinic keratosis and correct use of sunscreen via health campaigns or healthcare professions.

Patients with atypical mole syndrome (AMS) have a 3- to 20-fold higher risk of developing malignant melanoma (MM) than individuals without. The most modifiable risk factor for developing MM is the ongoing ultraviolet exposure.

To assess awareness, knowledge, and attitudes towards sun protection among patients with MM and AMS.

From January 2020 till December 2021, a written survey was administered to patients with MM and AMS and a control group who attended a specialist mole clinic at the Dermatology Department of the University Hospital of Heraklion in Heraklion, Crete, Greece. Demographic data and photoprotective practices, knowledge, and perceived barriers were collected. Relevant statistical analyses were performed using SPSS IBM 25.

In total, 121 subjects consented and participated in the survey. Their mean age was 43.92 ± 12.55 years. There were 66 (54.4%) females and 55 (45.4%) males. Forty-seven (38.8%) patients had AMS, 26 (21.5%) had a past medical history of MM, and 48 (39.7%) attended the clinic for a full skin checkup for their naevi without having AMS or MM. Although 104 (86%) participants reported using sunscreen with the majority of them (59/121 = 48.8%) wearing sunscreen with a sun protection factor of > 50, only 22 (18.2%) patients did so every day and only 20 (16.5%) all year round. Approximately 74.4% of patients recalled having received advice on how to protect their skin from sunlight, and 73% were interested in receiving education about sun protection. The most mentioned barriers in photoprotection were concerns over adequate vitamin D and lack of time.

Despite mentioning having received adequate education in photoprotection, adherence to photoprotection practices is suboptimal in patients with MM and AMS.

The proper application of sunscreen is important to ensure protection of the skin against ultraviolet (UV) damage. Sunscreens are used in various ways in real world situations, which alters their UV protection efficacy. In this study, we simulated typical consumer use of sunscreen, which is often sequentially covered with facial makeup, in a laboratory study.

We compared the sun protection factors (SPF) of sunscreen and makeup products after consecutive layering of the products.

The SPF of each sunscreen and makeup product was dramatically lower than stated on the label upon application of a typical amount used by a consumer, which is lower than recommended. For high-SPF products, the drop in effective protection was proportionally greater than those for the low-SPF products upon application of lower doses. However, layering sunscreen and makeup products greatly increased the effective SPF compared with that achieved by single application of each product, even when the amount of each product used was below the recommended level.

Layering sunscreen with makeup may compensate for insufficient sunscreen application in real-life conditions by providing an additional source of UV protection and improving the homogeneity of coverage. Our results suggest that recommending consecutive application of sunscreen and makeup products may be a practical and useful approach to improving UV protection that would not require additional steps in the facial care routines of many individuals.

Over five million people are diagnosed with skin cancers each year. With the sun's ultraviolet radiation exposure being the major risk factor for all skin cancers, sunscreen use is a vital preventative measure. However, in the US, sunscreen use remains inadequate. Furthermore, research regarding sunscreen use amongst rural populations has been particularly sparse. To identify the prevalence of sunscreen use and identify correlates thereof, a cross-sectional study was conducted on a sample of patients from rural Tri-State Appalachia. A total of 212 patients participated in this study. Findings showed that young individuals, females and those with higher educational attainment were more likely to utilize sunscreen. Furthermore, individuals with skin types prone to burning were four times as likely to utilize sunscreen. Overall, sunscreen use amongst residents in the Tri-State area was low, emphasizing the need for targeted interventions to prevent the incidence of skin cancer amongst this population.

The use of sunscreen can reduce the risk of UV-induced skin lesions. Health authorities have provided recommendations for the correct use of sunscreen use: Sufficient amount of sunscreen should be applied at least 30 min before the sun exposure and should be reapplied every 2 h.

We aimed to research the practice of sunscreen use in a population-based and representative sample in Germany.

For this cross-sectional survey, 3000 German residents aged 14-45 years were surveyed in standardized telephone interviews in 2018. Survey participants provided data on the frequency of sunscreen use in summer, timing of (re-)application and their skin characteristics. The data were weighted by age, sex, educational level and federal state to ensure the national representativeness of the sample.

Overall, 79.4% of respondents used sunscreen always, often or sometimes when being exposed to the sun. However, 87.2% of sunscreen users did not follow the recommendations on timing of application, 59.5% did not comply with the timing of reapplication. We also saw, that people potentially used too little sunscreen. These data did not differ noticeably by skin types of participants.

Our study revealed deficits in use of sunscreen in Germany, indicating that people here pay little attention to the recommendations of health authorities, regardless of their skin type. There is therefore an urgent need for targeted public information on this issue. Improving public knowledge on correct sunscreen use through educational campaigns or individual counselling by health professionals could be a first step.

To evaluate the knowledge, attitude, perception, and practice of medical and pharmacy students toward the usage of sunscreen as protection for the skin against ultraviolet (UV) radiation.

This cross-sectional study was conducted among final year medical and pharmacy undergraduates at the International Islamic University Malaysia. Validated questionnaires were distributed to 134 medical students and 100 pharmacy students. Descriptive and inferential statistics were used where appropriate.

One hundred and sixty-one out of 234 participants completed the questionnaires. The participants comprised 101 medical students (75.4%) and sixty pharmacy students (60.0%). The majority of the respondents were females (102; 63.4%), and 59 (36.6%) were males. The median of the knowledge scores of the final year medical students was significantly lower than that of the final year pharmacy students (P < 0.001). The female students showed significantly higher knowledge scores than the male students (P = 0.027). This study reported that 24 (39.3%) pharmacy students were influenced by the media to use sunscreen, whereas 35 (34.7%) medical students were influenced the most by friends to use sunscreen. The final year pharmacy students had a better perception compared to the medical students, with the total perception score of the final year pharmacy students being significantly higher than that of the final year medical students (P = 0.020). Most of the participants were also aware of the harmful effects of UV radiation and had a positive reaction toward the usage of sunscreen to prevent those harmful effects.

The knowledge and perception of final year pharmacy students were significantly higher than the knowledge and perception of final year medical students with regard to the usage of sunscreen.

The history of medicine is replete with examples of debunked myths, and in daily clinical dermatological practice, we must still counter many misconceptions regarding pigmented lesions, both with patients and other medical practitioners. Debunking myths and attempting to explain the reasons for these erroneous beliefs are the purposes of this review. The literature review has been partially guided by the results obtained from an online questionnaire conducted on an Italian website (www.vediamocichiara.it) from February 15, 2015 to March 15, 2015. The remaining discussed were selected on the basis of the existing literature and our personal experience. In order to explore these misconceptions, the following are the seven most salient questions that require investigation: (i) Is it dangerous to excise moles?; (ii) Is it dangerous to traumatize moles?; (iii) Are plantar moles worrisome?; (iv) Is it necessary to selectively apply sunscreen to moles?; (v) Is it inadvisable to partially biopsy a melanoma?; (vi) Do moles turn into melanoma?; and (vii) Is it necessary to perform sentinel lymph node biopsy for thin melanomas and for atypical Spitz naevi? Myths are ubiquitous, being prevalent in dermatological practice, with many of them concerning pigmented skin lesions. By encouraging critical analysis by patients and medical practitioners, the birth and perpetuation of myths can potentially be minimized, for the ultimate benefit of patients. This requires a scientific approach to be rigorously applied to dermatology, with critical questioning of unsubstantiated hypotheses including those emanating from the mass media as well as from respected sources.

To assess the knowledge, attitudes and behaviour towards sun protection measures in a sample of Australian adults.

A multicentre, cross-sectional study was undertaken during 2014 using a population-based survey of 416 individuals over the age of 18. The knowledge, behaviour and attitudes towards sun protection measures in this group of adults were assessed. The impact of educational level and employment status on responses was also evaluated.

Sunscreen is the most common sun-protective measure. Daily sunscreen use is below 20%. Forgetfulness was the largest barrier to sunscreen use. A total of 85% of respondents did not apply a sufficient amount of sunscreen. Only 32% of individuals reapplied sunscreen every 2 hours and 20% never reapplied it. In the preceding year, one or more sun burns were suffered by 46% of the participants in the survey. In all, 36% of individuals rarely or never check their sunscreens expiry date and less than 50% of individuals replaced their sunscreen each year. Furthermore, 65% were unaware that sunscreens stored above 25°C were less effective than when stored correctly as per manufactures labelling.

This study highlights a number of significant deficiencies that future sun-protection programmes could target in order to improve the general public's knowledge and attitudes towards sun protection. There is also a need for this to be translated into the public's sun-protection behaviour.

Sunlight stimulates a multitude of important biological effects on skin, causing, amongst other pathological changes, photocarcinogenesis. Sunscreens are designed to provide protection against these harmful properties of ultraviolet radiation, and public health campaigns have been employed to encourage their use. Despite this, there has been a continued rise in the incidence and mortality of the most harmful skin cancer, malignant melanoma. This review article therefore looks at the role of ultraviolet radiation in causing skin cancer; summarizes the available evidence on both the beneficial and harmful effects of sunscreen use; and concludes with practical advice on how we might advise our patients to best protect themselves from photocarcinogenesis.

Skin cancer is both common and responsible for significant morbidity and mortality. Opportunities for both primary and secondary prevention are available to both dermatologists and non-dermatologists. Counseling selected patients about ultraviolet avoidance and proper use of sunscreens is recommended. Due to technical and financial barriers, no study has conclusively confirmed the benefits of skin cancer screening. Both dermatologists and non-dermatologists often do not perform total body skin examinations during clinical encounters, despite high acceptance rates by patients. Many non-dermatologists would benefit from additional education pertaining to the diagnosis of cutaneous malignancy. Teledermatology may have a role in areas with poor access to dermatologists. There are ample opportunities for more to be learned in the future.

Although there have been recent advances in the development of photoprotective clothing and broad-spectrum sunscreens, few peer-reviewed publications have focused on photoprotection recommendations for travelers.

In order to describe the adverse health effects of excessive ultraviolet (UV) radiation exposures; review recent studies of public perceptions regarding photoprotection and sun exposure behaviors; identify special populations at increased risks of drug-induced photosensitivity reactions and UV-induced skin cancers; and recommend several effective photoprotection strategies for travelers, Internet search engines were queried with the key words as search terms to examine the latest references on photoprotection and the epidemiology of UV-associated skin cancers.

Observational studies have demonstrated that the public knows little about proper sunscreen protection, selection, and use, and often abuses sunscreens for intentional UV overexposures. Cohort studies have identified special populations at increased risks of UV-associated skin cancers without the proper use of sunscreens and photoprotective clothing including children, fair-skinned persons, patients taking photosensitizing drugs, and organ transplant recipients (OTRs). Clinical investigations support the regular use of broad-spectrum sunscreens to prevent the development of premalignant actinic keratoses (AK) in all sun-exposed subjects, especially OTRs; to prevent the development of squamous cell carcinomas from new AK in sun-exposed subjects, especially OTRs; to possibly prevent the development of cutaneous malignant melanomas in children and adults; and to possibly prevent the development of basal cell carcinomas in OTRs.

Recommended photoprotection strategies for travelers should include avoiding intense sunlight, wearing photoprotective clothing, wearing sunglasses, and selecting the right sunscreen for their skin type. Travel medicine practitioners should counsel travelers about photoprotection and encourage travelers to take advantage of recent advances in the development of more effective broad-spectrum sunscreens and photoprotective clothing for themselves and their children.

This study analyzed the content of sun-care product advertisements in five major U.S. parenting magazines with high circulation: Family Circle, Parents, Family Fun, Parenting (Early Years), and Parenting (School Years). The study examined what information sun-care product advertisements tell parents about skin cancer prevention and about sunscreen use for themselves or for their children based on the Health Belief Model concepts of perceived benefits and perceived barriers. Results showed that the most commonly mentioned benefit of the product was that it blocks ultraviolet A (UVA) and ultraviolet B (UVB) rays. One-third of the ads promoted the product's effectiveness in overcoming four of the barriers that prevent people from using sunscreens: eye irritation, skin irritation, an unpleasant smell, and the need to reapply sunscreen too often or after physical activity. However, only a few of the ads provided information about the consequences of unprotected sun exposure or mentioned methods of sun protection or skin cancer prevention other than sunscreen use. We discuss the implications of these messages for parents' ability to understand correctly how to protect their children from damaging sun exposure.

UVA induces tissue damage via the production of radical oxygen species. Adding antioxidants to UV filters in sunscreens is a novel photoprotective strategy. The topical application of antioxidants in sunscreen can potentially neutralize the UVA-induced free radicals.

We sought to assess the degree of free radical protection offered by sunscreens with antioxidants and attempted to differentiate the contribution of free radical protection from that of the UV filters.

Twelve sunscreen products were purchased. The degree of UVA protection (UVA-PF) was measured via an in vitro assay according to a European guideline (Colipa). In addition, an electron spin resonance (ESR) spectroscopy-based assay was used to measure the radical skin protection factor (RSF) and antioxidant power (AP) of each product.

The sun protection factor (SPF) values of the sunscreens ranged from 15 to 55, and the UVA-PF values ranged from 2.4 to 28.2. The RSF values ranged from 2.4 to 27.1. There is a high correlation between RSF and UVA-PF. The AP values for nearly all the products were 0, and two products (#4 and #9) had very low AP values of 16 and 12, respectively.

The study only evaluated a small number of sunscreen products, and only ex vivo and in vitro methods were used to assess the products.

The idea of combining UV filters with antioxidants is appealing. Current sunscreen products on the market offer free radical protection, but the majority of the radical protection is from UV filters rather than antioxidants.

Depletion of the stratospheric ozone layer has led to increased solar UV-B radiation (280-315 nm) at the surface of the Earth. This change is likely to have had an impact on human exposure to UV-B radiation with consequential detrimental and beneficial effects on health, although behavioural changes in society over the past 60 years or so with regard to sun exposure are of considerable importance. The present report concentrates on information published since our previous report in 2007. The adverse effects of UV radiation are primarily on the eye and the skin. While solar UV radiation is a recognised risk factor for some types of cataract and for pterygium, the evidence is less strong, although increasing, for ocular melanoma, and is equivocal at present for age-related macular degeneration. For the skin, the most common harmful outcome is skin cancer, including melanoma and the non-melanoma skin cancers, basal cell carcinoma and squamous cell carcinoma. The incidence of all three of these tumours has risen significantly over the past five decades, particularly in people with fair skin, and is projected to continue to increase, thus posing a significant world-wide health burden. Overexposure to the sun is the major identified environmental risk factor in skin cancer, in association with various genetic risk factors and immune effects. Suppression of some aspects of immunity follows exposure to UV radiation and the consequences of this modulation for the immune control of infectious diseases, for vaccination and for tumours, are additional concerns. In a common sun allergy (polymorphic light eruption), there is an imbalance in the immune response to UV radiation, resulting in a sun-evoked rash. The major health benefit of exposure to solar UV-B radiation is the production of vitamin D. Vitamin D plays a crucial role in bone metabolism and is also implicated in protection against a wide range of diseases. Although there is some evidence supporting protective effects for a range of internal cancers, this is not yet conclusive, but strongest for colorectal cancer, at present. A role for vitamin D in protection against several autoimmune diseases has been studied, with the most convincing results to date for multiple sclerosis. Vitamin D is starting to be assessed for its protective properties against several infectious and coronary diseases. Current methods for protecting the eye and the skin from the adverse effects of solar UV radiation are evaluated, including seeking shade, wearing protective clothing and sunglasses, and using sunscreens. Newer possibilities are considered such as creams that repair UV-induced DNA damage, and substances applied topically to the skin or eaten in the diet that protect against some of the detrimental effects of sun exposure. It is difficult to provide easily understandable public health messages regarding "safe" sun exposure, so that the positive effects of vitamin D production are balanced against the negative effects of excessive exposure. The international response to ozone depletion has included the development and deployment of replacement technologies and chemicals. To date, limited evidence suggests that substitutes for the ozone-depleting substances do not have significant effects on human health. In addition to stratospheric ozone depletion, climate change is predicted to affect human health, and potential interactions between these two parameters are considered. These include altering the risk of developing skin tumours, infectious diseases and various skin diseases, in addition to altering the efficiency by which pathogenic microorganisms are inactivated in the environment.