Advertisement

Evaluation of “reef safe” sunscreens: Labeling and cost implications for consumers

  • John Tsatalis
    Affiliations
    Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
    Search for articles by this author
  • Brandon Burroway
    Affiliations
    Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
    Search for articles by this author
  • Fleta Bray
    Correspondence
    Correspondence to: Fleta Bray, MD, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave, RMSB, Room 2023-A, Miami, FL 33136
    Affiliations
    Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
    Search for articles by this author
Published:November 07, 2019DOI:https://doi.org/10.1016/j.jaad.2019.11.001
      To the Editor: In 2013, an in vitro study at the National Oceanic and Atmospheric Administration (NOAA) identified benzophenone-2, a common chemical in sunscreen, as toxic to corals.
      • Downs C.A.
      • Kramarsky-Winter E.
      • Fauth J.E.
      • et al.
      Toxicological effects of the sunscreen UV filter, benzophenone-2, on planulae and in vitro cells of the coral, Stylophora pistillata.
      Since then, several in vitro studies identified additional ultraviolet filters as toxic to coral. The NOAA currently cites 8 toxic sunscreen chemicals.
      • National Ocean Service
      • National Oceanic and Atmospheric Administration (NOAA)
      Skincare Chemicals and Coral Reefs.
      Although these ex situ studies have been scrutinized for inaccurately reflecting reef conditions and testing chemicals at unrealistically high concentrations,
      • International Coral Reef Initiative
      Action plan of the International Coral Reef Initiative (ICRI) Secretariat (2016-2018).
      ,
      • Lim J.W.
      Update on photoprotection: what dermatologists need to know.
      they have received widespread publicity leading to legislative and marketing changes. In 2019, Key West, Florida, followed Hawaii in banning sunscreens containing oxybenzone and octinoxate. Sunscreen brands have responded by implementing “reef safe” labeling.
      This study aimed to determine what proportion of sunscreens labeled as “reef safe” met the legislative ban and NOAA criteria. A secondary aim was to determine whether “reef safe” sunscreens cost more than regular sunscreens.
      We conducted an online search of the largest online retailer, Amazon, in June 2019 to identify the most popular sunscreens and included all those with at least 150 reviews. We separated these by whether they did and did not make a claim to be “reef safe”. We analyzed and recorded the price-per-ounce cost and ingredients of each product. Products with zinc oxide or titanium dioxide were considered to contain nanoparticles unless otherwise stated. Data were analyzed using SPSS 25.0 software (IBM Corp, Armonk, NY).
      We evaluated 97 products, with 52 (54%) labeled as “reef safe”. The 52 products marketed as “reef safe” were analyzed to determine whether the labeling reflected NOAA and legislative criteria. Fig 1 outlines the percentage of sunscreens labeled as “reef safe” and the proportion of compliant products. Table I lists the cost of each sunscreen type.
      Figure thumbnail gr1
      Fig 1The “reef safe” label is an unregulated term commonly used in sunscreen marketing. The term has no strict definition. aHawaii and the Florida Keys have issued legislative bans on the use of oxybenzone and octinoxate-containing sunscreen. bThe National Oceanic and Atmospheric Administration (NOAA) proposes more stringent criteria for “reef safe” sunscreen, citing 8 sunscreen chemicals as toxic to coral: oxybenzone and octinoxate, octocrylene, benzophenone-1, benzophenone-8, octyl-dimethyl– para-aminobenzoic acid (OD-PABA), 4-methylbenzylidene camphor, 3-benzylidene camphor, nano-titanium dioxide, and nano-zinc oxide. Sunscreens were considered to be nano-sized unless otherwise stated on package labeling.
      Table ICost of sunscreen according to labeling and compliance with various “reef safe” standards
      Product typeNo.Average cost (95% CI) in dollars/ozP value
      Products labeled as “reef safe”523.84 (3.07-4.61).027
      Products not labeled as “reef safe”452.61 (1.83-3.38)
      Products free of oxybenzone and octinoxate663.94 (3.20-4.68)<.001
      Products contain oxybenzone and/or octinoxate311.83 (1.43-2.24)
      Products meet NOAA criteria284.55 (3.96-5.13)<.001
      Products do not meet NOAA criteria692.75 (2.04-3.46)
      CI, Confidence interval; NOAA, The National Oceanic and Atmospheric Administration.
      Representative products were obtained from a single distributor, and the number of reviews was used as a proxy for popularity; both are limitations of this study. Many labels failed to specify the size of zinc or titanium dioxide particles. We considered these as nanoparticles. This could have caused underestimation of NOAA compliance.
      A proportion of the “reef safe”–labeled sunscreens do not meet legislative (4%) or NOAA (48%) criteria. In theory, the label should help consumers select safe products. However, the current United States Food and Drug Administration sunscreen labeling regulation lacks a formal “reef safe” definition, allowing companies to meet standards of “truthful and non-misleading” labeling without providing evidence.
      • Center for Drug Evaluation and Research
      Labeling and Effectiveness Testing: Sunscreen Drug Products for Over-The-Counter Human Use—Small Entity Compliance Guide.
      Clearly, defining “reef safe” could resolve this issue.
      Our study suggests “reef safe” sunscreen— whether defined by label, legislative standards, or NOAA criteria—may be more expensive than regular sunscreen. This substantiates concerns that sunscreen bans may create an increased economic burden that disproportionately affects individuals of lower socioeconomic status.
      Although efforts to preserve reefs and improve sunscreen safety should not be ignored, the existing literature provides insufficient evidence to conclude that these sunscreen ingredients threaten reef safety.
      • Lim J.W.
      Update on photoprotection: what dermatologists need to know.
      Future research efforts should clarify the impact of these sunscreen ingredients under authentic reef conditions and sunscreen concentrations. In the meantime, it is important for legislators to consider the public health impact of sunscreen bans.

      References

        • Downs C.A.
        • Kramarsky-Winter E.
        • Fauth J.E.
        • et al.
        Toxicological effects of the sunscreen UV filter, benzophenone-2, on planulae and in vitro cells of the coral, Stylophora pistillata.
        Ecotoxicology. 2014; 23: 175-191
        • National Ocean Service
        • National Oceanic and Atmospheric Administration (NOAA)
        Skincare Chemicals and Coral Reefs.
        (Available at:)
        • International Coral Reef Initiative
        Action plan of the International Coral Reef Initiative (ICRI) Secretariat (2016-2018).
        (Available at)
        • Lim J.W.
        Update on photoprotection: what dermatologists need to know.
        Dermatol World Am Acad Dermatol. 2019; (Available at)
        • Center for Drug Evaluation and Research
        Labeling and Effectiveness Testing: Sunscreen Drug Products for Over-The-Counter Human Use—Small Entity Compliance Guide.
        U.S. Food & Drug Administration, Rockville, MD2012 (Accessed August 13, 2019)