Moisturisers with sun protection factor (SPF) provide less sun protection than the equivalent strength sunscreen in real-world scenarios, and people are more likely to miss areas of their face when using them, according to a new study being presented at the British Association of Dermatologists’ Annual Meeting in Edinburgh (3rd-5th July 2018). Doctors are warning people not to rely on moisturisers with SPF for their main sun protection needs, particularly if spending extended periods in the sun.

Using a specially modified camera that only sees UV light, the researchers from the University of Liverpool assessed how effectively people apply sunscreen and sun protection factor (SPF) containing moisturiser to their face. When an area of skin is successfully covered, the product absorbs the UV light and this area appears black in the photos – the lighter the area the less successful the absorption.

Over two separate visits, people were asked to apply sun protection, in the first visit sunscreen, and in the second moisturiser with SPF. Pictures were then taken with the modified camera to see how effectively people applied the two products.

Analysis of the photos showed that when applying moisturiser people missed 16 per cent of their face on average, whereas when applying sunscreen this dropped to 11 per cent. When just the high-risk eyelid areas were analysed sunscreen users missed 14 per cent compared with 21 per cent with moisturiser. The eyelid area is a common site for skin cancers.

In addition to this, the study suggests that people do not apply the moisturiser as thickly as sunscreen, and therefore do not receive the full benefits of the SPF. The photos of people using the moisturiser are noticeably less dark on average, this indicates that the product is absorbing less UV light.

On average men were significantly better at applying the products than women, other groups that proved better at it were people with darker skin tones and older participants.

Participants were asked to rate their perceived ability to apply the products before and after viewing the images. For sunscreen, perceived ability dropped from 90 per cent positive to 42 per cent, and moisturiser from 85 per cent to 38 per cent, indicating that participants were not aware of their failure to achieve adequate coverage.

Mr Austin McCormick, Consultant Ophthalmic and Oculoplastic Surgeon, and one of the researchers, said:

“This research is very visual and fairly easy for people to understand: the darker the image, the more sun protection people are getting.

“We expected the area of face covered with moisturiser to be greater than sunscreen, in particular the eyelids because of the perception that moisturiser stings the eyes less than sunscreen. In fact we found the opposite: the area of the face covered effectively was greater with sunscreen than moisturiser. In addition, where it was applied, the moisturiser provided less UV protection than sunscreen.

“Although skin moisturiser with SPF does provide sun protection, our research suggests that it’s not to the same degree as sunscreen. We do recommend moisturisers and makeup that contain UV protection – it is better than no protection at all, but for prolonged periods in the sun we recommend the application of sunscreen with high SPF.”

Matthew Gass of the British Association of Dermatologists, said:

“Unfortunately, moisturiser with SPF just doesn’t perform particularly well in real world situations compared to sunscreen. Although it may say factor 30 on the box, this study is just further evidence that lab testing conditions for these products don’t reflect how they are used.

“Another important thing to take away from this research is that people often miss areas of their face when applying sun protection, a good way to prevent this from becoming an issue is to wear sunglasses and reapply sunscreen regularly. This should help protect the bits you miss from being exposed to excessive sun.”

When products are tested for their SPF, they are tested at a density of 2 mg per cm². SPF used in moisturisers is tested the same way as sunscreens, so an SPF 15 moisturiser should provide an SPF of 15, however, as this study demonstrates, they are likely to be applied a lot more thinly than sunscreen, and less uniformly. Applying less SPF will reduce the protection to a higher degree than is proportionate – for example, only applying half the required amount can actually reduce the protection by as much as two-thirds.

It is also worth noting that moisturisers containing an SPF may not contain any UVA protection and as a result will not protect against UV ageing, and are less likely to be rub-resistant and water resistant.

-Ends-

Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference.

The conference will be held at the Edinburgh EICC from July 3rd to 5th and is attended by approximately 1,300 UK and worldwide dermatologists.

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk

Study:

Application of SPF moisturizers is inferior to sunscreens in terms of percentage coverage of facial and eyelid area

E. Lourenco, H. Pratt, K. Hamill, G. Czanner, Y. Zheng and A. McCormick

University of Liverpool, Liverpool, U.K.

In recent years, the popularity of SPF containing moisturizers has steadily increased. Indeed, as reported SPFs are equivalent to sunscreens, more users are turning to moisturizers for their sun-protection needs. However, there has been little research into moisturizer application habits compare to using sunscreen in terms of coverage achieved. Previously, we have demonstrated that during sunscreen application, users have a tendency towards missing or incompletely covering the eyelid and medial canthus regions. We aimed to determine if these tendencies differed in SPF moisturizer users. A study population of 60 (14 men, 46 women, age 18–57) were exposed to UV light and photographed using a tripod mounted, UV-sensitive DSLR camera on two separate visits. At visit one, images were acquired before and after applying SPF30 sunscreen, while at visit two, SPF30 moisturizer was used instead. Images were processed for facial landmark identification followed by segmentation mapping of hue saturation values to identify areas of the face that had been missed. Analyses revealed that application of moisturizer was significantly worse than sunscreen in terms of the area of the whole face missed (11.1% missed with sunscreen 16.1% for SPF moisturizer P < 0.001 paired t-test). This difference was primarily due to decreased coverage of the eyelid region (14.3% sunscreen, 21.1% moisturizer P < 0.001), face excluding the eye area; 9.7% missed with sunscreen, 12.4% SPF moisturizer (P < 0.001). Secondary analyses demonstrated significantly better coverage in men, people with darker skin tones and older participants. Upon study completion, we asked participants to rate their perceived ability to apply the products before and after viewing the images, sunscreen dropped from 90% positive to 42%, and moisturizer from 85% to 38%, indicating that participants were not aware of their failure to achieve adequate coverage. Together these data indicate, that despite potential advantages moisturizers have in terms of increased frequency of application, the areas of the face that are at higher cancer risk are likely not being adequately routinely protected, and importantly, participants are unaware that they are at risk.

Sun protection tips:

1. Spend time in the shade during the sunniest part of the day when the sun is at its strongest, which is usually between 11am and 3pm in the summer months.

2. Avoid direct sun exposure for babies and very young children.

3. When it is not possible to limit your time in the sun, keeping yourself well covered, with a hat, T-shirt, and sunglasses, can give you additional protection.

4. Apply sunscreen liberally to exposed areas of skin. Re-apply every two hours and straight after swimming, sweating or towelling to maintain protection.

Checking for skin cancer:

There are two main types of skin cancer: non-melanoma, the most common, and melanoma, which is less common but more dangerous. The following ABCDE rules describe a few changes that might indicate a ‘melanoma’, which is the deadliest form of skin cancer. As skin cancers vary, you should tell your doctor about any changes to your skin, even if they are not like those mentioned here. If your GP is concerned about your skin, make sure that you are referred to a dermatologist, the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS.

Asymmetry – the two halves of the area may differ in shape or colour

Border – the edges of the area may be irregular or blurred, and sometimes show notches

Colour – this may be uneven. Different shades of black, brown and pink may be seen

Diameter – most melanomas are at least 6mm in diameter. Report any change in size, shape or diameter to your doctor

Evolution – if you see progressive changes in size, shape or colour over weeks or a few months, you must seek Expert help.

If in doubt, check it out! If your GP is concerned about your skin, make sure you see a dermatologist, the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS.

Non-melanoma skin cancer

Non-melanoma skin cancers can occur on any part of the body, but are most common on areas of skin that are most often exposed to the sun such as your head and neck (including lips and ears) and the backs of your hands. They can also appear where the skin has been damaged by X-rays, and on old scars, ulcers, burns and persistent wounds.

Non-melanoma skin cancers vary greatly in what they look like. They tend to appear gradually on the skin, and slowly get bigger over time. They will not go away on their own without treatment. Some possible signs include:

– A scab or sore that won’t heal. It may also bleed occasionally

– A scaly or crusty patch of skin that looks red or inflamed

– A flesh coloured, pearly lump that won’t go away and appears to be growing in size

– A lump on the skin which is getting bigger and that may be scabby

– A growth with a pearly rim surrounding a central crater, a bit like an upturned volcano

About us:

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk