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Many Sunscreens May Require a Prescription

Analysis by Dr. Joseph Mercola Fact Checked

prescription sunscreen

Story at-a-glance -

  • A Florida state senator has proposed legislation to require a prescription for any sunscreen containing oxybenzone and octinoxate, the most coral-destructive chemicals
  • The U.S. Virgin Islands, Key West, Florida and Hawaii have banned the sale and distribution of sunscreens containing the two chemicals
  • Common ingredients in sunscreens damage coral DNA, decrease their defenses against bleaching and threaten their reproduction
  • Fish, sea urchins, shrimp, zebrafish and horseshoe crabs are harmed by sunscreen ingredients. Oxybenzone and octinoxate are also dangerous for humans, permeating the skin and entering the bloodstream
  • The safest sunscreens are made with zinc oxide or titanium dioxide

When it comes to the use of sunscreens, the pendulum has swung dangerously backward. People have been made to so fear the sun that we are now seeing vitamin D deficiencies, a serious problem because your cells need the active form of the vitamin to access to the genetic blueprints stored inside cells.

The authors of recent research published in the International Journal of Environmental Research suggest that low sun exposure may be correlated with the development of "specific cancers, multiple sclerosis, diabetes, cardiovascular disease, autism, Alzheimer's disease and age-related macular degeneration."1

But, just as significantly, we now know of the tremendous toll sunscreens are taking on the ocean's coral, which hosts 25% of marine life and serves as the oceans' crucial biodiversity-protecting "tropical rainforests."2 Common ingredients in sunscreens damage coral DNA, decrease their defenses against bleaching and threaten their reproduction.3

Now a Florida state senator has proposed legislation to require a prescription for any sunscreen containing oxybenzone and octinoxate, the most coral-destructive chemicals.

Already, the U.S. Virgin Islands,4 Key West, Florida and Hawaii,5 which are reef rich areas, have banned the sale and distribution of sunscreens containing the two chemicals. The Virgin Islands ban goes into effect in 2020; the others in 2021.

A Bill to Require a Prescription for Some Sunscreens

The Florida bill, introduced by Sen. Linda Stewart, prohibits the "sale, offer for sale, or distribution of certain sunscreen products to a consumer who does not have a prescription for such product."6 The "certain sunscreen products" are those that contain oxybenzone and octinoxate. The message in the bill is clear — that you must have a good health reason to use environmentally harmful sunscreen. Here are some of the well-documented risks from the two chemicals, cited in the bill:

"… oxybenzone and octinoxate cause mortality in developing coral; increase coral bleaching that indicates extreme stress, even at temperatures below 87.8 degrees Fahrenheit; cause genetic damage to coral and other marine organisms; degrade the coral's resiliency and ability to adjust to climate change factors; and inhibit recruitment of new corals …

… oxybenzone and octinoxate appear to increase the probability of endocrine disruption, and scientific studies show that both chemicals can induce feminization in adult male fish and increase reproductive diseases in marine invertebrate species, such as sea urchins; vertebrate species, such as wrasses, eels, and parrotfish; and mammals, and …

… also induce deformities in the embryonic development of fish, sea urchins, coral, and shrimp and induce neurological behavioral changes in fish which threaten the continuity of fish populations."

Pushback From the American Academy of Dermatology

Skin cancer is the most common cancer in the U.S. and the American Academy of Dermatology has opposed sunscreen legislation for this reason. This is their statement after the 2018 Hawaii law was passed:7

"The American Academy of Dermatology Association is concerned that the public's risk of developing skin cancer could increase due to potential new restrictions in Hawaii that impact access to sunscreens with ingredients necessary for broad-spectrum protection, as well as the potential stigma around sunscreen use that could develop as a result of these restrictions …

Claims that sunscreen ingredients currently approved by the U.S. Food and Drug Administration are toxic to the environment or a hazard to human health have not been proven."

Yet, a May 2019 study in the Journal of the American Medical Association revealed that oxybenzone has been found in human breast milk, amniotic fluid, blood and urine, and that the drug is readily absorbed through the human skin.8

The health implications of oxybenzone levels created in the human body through absorption are not yet known, but the fact that the chemicals permeate the skin is concerning.

In response to critics Stewart says, "I'm not doing this so everyone gets skin cancer. There are so many other sunscreens out there that are reef-safe." She adds, "The reason for this bill is just to make sure that it discourages the use of those two chemicals."9

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Sunscreens Are a Scourge on Coral Reefs

The effect of sunscreens on the world's coral is becoming devastating: Up to 6,000 tons of it are said to wash into coral reefs each year.10 In addition to the accumulation from sunscreen wearers at the beach, swimming or boating, oxybenzone and octinoxate also reach waterways through sewage treatment plants, which do not filter out such pollutants.11 (They also have a difficult time filtering out pharmaceutical drugs.)

Coral bleaching, which oxybenzone and octinoxate cause, starves coral from nutrients, increases the risk of infection and causes serious structural abnormalities. Here is how scientists, some of whom are from the National Oceanic and Atmospheric Administration, describe the sunscreen scourge in a 2016 report on coral in Archives of Environmental Contamination and Toxicology:12

"We examined the effects of oxybenzone on the larval form (planula) of the coral Stylophora pistillata, as well as its toxicity in vitro to coral cells from this and six other coral species.

Oxybenzone is a photo-toxicant; adverse effects are exacerbated in the light. Whether in darkness or light, oxybenzone transformed planulae from a motile state to a deformed, sessile condition …

Oxybenzone is a genotoxicant to corals, exhibiting a positive relationship between DNA-AP lesions and increasing oxybenzone concentrations. Oxybenzone is a skeletal endocrine disruptor; it induced ossification of the planula, encasing the entire planula in its own skeleton."

Other Marine Life Are Harmed by Sunscreens

Coral are not the only organisms threatened by sunscreen chemicals. The ingredients might harm fish, sea urchins and shrimp. Plus, a different sunscreen, octocrylene, which is similar to oxybenzone and octinoxate,13 affects brain and liver development in zebrafish, says Consumer Reports.14

Research at the University of Delaware indicates that oxybenzone could be jeopardizing the horseshoe crab population.15 Danielle Dixson, an assistant professor at the University of Delaware College of Earth, Ocean and the Environment, and her team placed clutches of horseshoe crab eggs in seawater solution that included sunscreen with a control group placed in sunscreen-free water.

The eggs exposed to sunscreen never hatched. Crab larvae that did hatch but were put in a seawater-sunscreen solution were also impaired. Compared to crabs in normal seawater, they became sluggish and barely moved, reported the researchers.

In addition to their own survival status, horseshoe crabs' eggs and larvae provide important food for migratory birds, and the crabs often spawn close to the shore where the risk of sunscreen exposure is worst.

The birds, which arrive in May from South and Central America on their way to the arctic to breed, draws thousands of spectators to Delaware every year so even tourism can be threatened. Horseshoe crabs are also eaten be sea turtles and sharks, which could then uptake sunscreen affecting the crabs.16

Prescription Requirement for Sunscreen Would Raise Awareness

If legislation requiring a prescription for sunscreens with oxybenzone and octinoxate passed, it would continue raising awareness about the dangers of such chemicals to the environment and tourism in reef-rich areas. Pacific Asian countries are also taking action. As reported by the International Coral Reef Initiative:17

"Sunscreen Pollution is a symptom of unsustainable tourism. Many places in the world that are popular with tourism are seeing rapid destruction of their wildlife and environment. Maya Beach in Thailand and Boracay Bay in the Philippines have been closed to tourism in order to protect and restore their vital coral reef resources.

To address this threat of Sunscreen Pollution, the State of Hawaii passed into law a ban on sunscreens containing oxybenzone and octinoxate. The Dutch municipality of Bonaire has similar legislation pending. The Republic of Palau has enacted an innovative and bold measure banning a number of chemicals that pose a threat to its natural resources.

By preserving the continuity of their pristine wilderness by managing for sustainable tourism, Palau is setting the standard for protecting one of the world's greatest natural treasures."

Some retailers, like REI, have said they will stop carrying sunscreen products with oxybenzone18 and World Reef Day has been declared, strongly supported by Hawaiian Airlines, which says it will "bring awareness on how coral reefs are hurt by human activity and highlight change is possible through simple, everyday choices and spreading the message."19

Safe Sun Exposure Tips

In my view, sunscreen is rarely needed and greatly overused, provided you're avoiding sunburn through sensible sun exposure guidelines. I recommend spending time in the sun daily if possible because it offers substantial health benefits. Here are some sensible sunning tips:

  • Give your body a chance to produce vitamin D before you apply sunscreen. Expose large amounts of your skin (at least 40% of your body) to sunlight for short periods of time daily.
  • Stay in the sun just long enough for your skin to turn the very lightest shade of pink. Shield your face from the sun as your facial skin is thin and more prone to sun damage, such as premature wrinkling.
  • When you'll be in the sun for longer periods, cover up with clothing and a hat or seek shade, whether natural or created by an umbrella. Clothing is your safest option to prevent burning and skin damage though a safe sunscreen, my suggestions listed below, can be applied after you've optimized your skin's daily vitamin D production.
  • Consider the use of an "internal sunscreen" like astaxanthin to gain additional sun protection. In 2018 research in the journal Nutrients reported that "astaxanthin seems protective against UV-induced skin deterioration and helps maintain healthy skin in healthy people."20 Astaxanthin can also be applied topically, which is why it's now being incorporated into a number of topical sunscreen products.
  • Consuming a healthy diet full of natural antioxidants is another highly useful strategy to help avoid sun damage. Vegetables provide your body with an abundance of powerful antioxidants that will help you fight the free radicals caused by sun damage that can lead to burns and cancer.

Yes, There Are Safe Sunscreens

If you do choose to use a sunscreen, there are only two safe choices — zinc oxide and titanium dioxide. Neither should be nanosized and they must protect against both UVA and UVB rays.

Currently, SPF protects only against UVB rays, although the U.S. Food and Drug Administration has proposed new rules that would require any SPF at or above 15 to protect against both.21 UVB are the rays within the ultraviolet spectrum that allow your skin to produce vitamin D.

A lotion or cream with zinc oxide is your safest choice because it is stable in sunlight and provides the best protection from UVA rays. Your next best is choice is titanium dioxide. Keep in mind that in order for sunscreen to be effective, you must apply large amounts over all exposed areas of your skin.

This means the product should not trigger skin allergies and must provide good protection against UVA and UVB radiation. Zinc oxide and titanium dioxide are not absorbed into your skin as the dangerous oxybenzone and octinoxate are. It is no coincidence that the sunscreens that are safest for you are also safest for coral, marine life and the environment.