BNF for Children 2011-2012

582 13.8 Sunscreens and camouflagers BNFC 2011–201213 Skin13.8 Sunscreens andcamouflagers13.8.1 Sunscreen preparations13.8.2 Camouflagers13.8.1 Sunscreen preparationsSolar ultraviolet irradiation can be harmful to the skin. Itis responsible for disorders such as polymorphic lighteruption, solar urticaria, and it provokes the variouscutaneous porphyrias. It also provokes (or at leastaggravates) skin lesions of lupus erythematosus andmay aggravate some other dermatoses. Certain drugs,such as demeclocycline, phenothiazines, or amiodarone,can cause photosensitivity. All these conditions (as wellas sunburn) may occur after relatively short periods ofexposure to the sun. Solar ultraviolet irradiation mayprovoke attacks of recurrent herpes labialis (but it is notknown whether the effect of sunlight exposure is local orsystemic).The effects of exposure over longer periods includeageing changes and more importantly the initiation ofskin cancer.Solar ultraviolet radiation is approximately 200–400 nmin wavelength. The medium wavelengths (290–320 nm,known as UVB) cause sunburn. The long wavelengths(320–400 nm, known as UVA) are responsible for manyphotosensitivity reactions and photodermatoses. BothUVA and UVB contribute to long-term photodamageand to the changes responsible for skin cancer andageing.Sunscreen preparations contain substances that protectthe skin against UVA and UVB radiation, but they are nosubstitute for covering the skin and avoiding sunlight.Protective clothing and sun avoidance (rather than theuse of sunscreen preparations) are recommended forchildren under 6 months of age.The sun protection factor (SPF, usually indicated in thepreparation title) provides guidance on the degree ofprotection offered against UVB; it indicates the multiplesof protection provided against burning, comparedwith unprotected skin; for example, an SPF of 8 shouldenable a child to remain 8 times longer in the sunwithout burning. However, in practice users do notapply sufficient sunscreen product and the protectionis lower than that found in experimental studies. Somemanufacturers use a star rating system to indicate theprotection against UVA relative to protection againstUVB for sunscreen products. However, the usefulness ofthe star rating system remains controversial. The EUCommission (September 2006) has recommended thatthe UVA protection factor for a sunscreen should be atleast one-third of the sun protection factor (SPF); productsthat achieve this requirement will be labelled witha UVA logo alongside the SPF classification. Preparationsthat also contain reflective substances, such astitanium dioxide, provide the most effective protectionagainst UVA.Sunscreen preparations may rarely cause allergic reactions.For optimum photoprotection, sunscreen preparationsshould be applied thickly and frequently(approximately 2 hourly). In photodermatoses,they should be used from spring to autumn. Asmaximum protection from sunlight is desirable, preparationswith the highest SPF should be prescribed.Ingredient nomenclature in sunscreenpreparationsrINN INCIamiloxate isoamyl p-methoxycinnamateavobenzone butyl methoxydibenzoylmethanebemotrizinol bis-ethylhexyloxyphenol methoxyphenyltriazinebisoctrizole methylene bis-benzotriazolyl tetramethylbutylphenolecamsule terephthalylidene dicamphor sulfonic acidensulizole phenylbenzimidazole sulfonic acidenzacamene 4-methylbenzylidene camphoroctinoxate octyl (or ethylhexyl) methoxycinnamateoctocrilene octocryleneoxybenzone benzophenone-3The European Commission Cosmetic Products Regulation(EC) 1223/2009 requires the use of INCI (InternationalNomenclature of Cosmetic Ingredients) for cosmetics andsunscreens. This table includes the rINN and the INCIsynonym for the active ingredients of sunscreen preparationsin BNFCBorderline substances The preparations marked‘ACBS’ cannot be prescribed on the NHS except forskin protection against ultraviolet radiation in abnormalcutaneous photosensitivity resulting from genetic disordersor photodermatoses, including vitiligo and thoseresulting from radiotherapy; chronic or recurrent herpessimplex labialis. Preparations with SPF less than 30should not normally be prescribed. See also Appendix 2.Anthelios c (L’Oréal Active)XL SPF 50+ Melt-in cream (UVA and UVB protection; UVB-SPF 50+), avobenzone 3.5%, bemotrizinol 3%, drometrizoletrisiloxane 0.5%, ecamsule 1%, octocrilene 2.5%, titaniumdioxide 4.2%, net price 50 mL = £3.63. ACBSExcipients include disodium edetate, stearyl alcoholNote For INCI synonyms, see table aboveDelph c (Fenton)Lotion (UVA and UVB protection; UVB-SPF 30), octinoxate4.8%, oxybenzone 1.5%, titanium dioxide 2%, net price200 mL = £3.57. ACBSExcipients include cetostearyl alcohol, fragrance, hydroxybenzoates(parabens), imidureaNote For INCI synonyms, see table aboveSunsense c Ultra (Crawford)Lotion (UVA and UVB protection; UVB-SPF 50+), avobenzone2%, ensulizole 2%, enzacamene 4%, octinoxate 6%,oxybenzone 2%, titanium dioxide 3%, net price 50-mL bottlewith roll-on applicator = £4.11, 125 mL = £6.86, 500-mLpump pack = £15.54. ACBSExcipients include butylated hydroxytoluene, cetyl alcohol, fragrance,hydroxybenzoates (parabens), propylene glycolNote For INCI synonyms, see table above