Papers of particular interest, published recently, have been highlighted as: •• Of major importance

1. Young AR, Claveau J, Rossi AB. Ultraviolet radiation and the skin: photobiology and sunscreen photoprotection. J Am Acad Dermatol. 2017;76(3s1):S100–s9.https://doi.org/10.1016/j.jaad.2016.09.038.

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2. Yeager DG, Lim HW. What’s new in photoprotection: a review of new concepts and controversies. Dermatol Clin. 2019;37(2):149–57.https://doi.org/10.1016/j.det.2018.11.003.

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3. Mancuso JB, Maruthi R, Wang SQ, Lim HW. Sunscreens: an update. Am J Clin Dermatol. 2017;18(5):643–50.https://doi.org/10.1007/s40257-017-0290-0.

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4. Centers for Disease Control and Prevention. Sun safety.https://www.cdc.gov/cancer/skin/basic_info/sun-safety.htm. Accessed October 4 2019.

5. World Health Organization. Sun protection.https://www.who.int/uv/sun_protection/en/. Accessed October 6 2019.

6. American Cancer Society. Choose the right sunscreen.https://www.cancer.org/latest-news/choose-the-right-sunscreen.html. Accessed October 6 2019.

7. American Academy of Dermatology. Say yes to sun protection.https://www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/prevent/say-yes-to-sun-protection. Accessed October 4 2019.

8. Skin Cancer Foundation. Sunscreen.https://www.skincancer.org/skin-cancer-prevention/sun-protection/sunscreen/. Accessed October 4 2019.

9. DeLeo VA. Sunscreen regulations and advice for your patients. Cutis. 2019;103(5):251–3.

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11. Wang J, Pan L, Wu S, Lu L, Xu Y, Zhu Y, et al. Recent advances on endocrine disrupting effects of uv filters. Int J Environ Res Public Health. 2016;13(8).https://doi.org/10.3390/ijerph13080782.

12. Ghazipura M, McGowan R, Arslan A, Hossain T. Exposure to benzophenone-3 and reproductive toxicity: a systematic review of human and animal studies. Reprod Toxicol. 2017;73:175–83.https://doi.org/10.1016/j.reprotox.2017.08.015.

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13. Ruszkiewicz JA, Pinkas A, Ferrer B, Peres TV, Tsatsakis A, Aschner M. Neurotoxic effect of active ingredients in sunscreen products, a contemporary review. Toxicol Rep. 2017;4:245–59.https://doi.org/10.1016/j.toxrep.2017.05.006.

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14. Wang SQ, Burnett ME, Lim HW. Safety of oxybenzone: putting numbers into perspective. Arch Dermatol. 2011;147(7):865–6.https://doi.org/10.1001/archdermatol.2011.173.

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15. Hayden CG, Roberts MS, Benson HA. Systemic absorption of sunscreen after topical application. Lancet. 1997;350(9081):863–4.https://doi.org/10.1016/s0140-6736(05)62032-6.

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16. Grande F, Tucci P. Titanium dioxide nanoparticles: a risk for human health? Mini-Rev Med Chem. 2016;16(9):762–9.https://doi.org/10.2174/1389557516666160321114341.

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17. •• Schneider SL, Lim HW. A review of inorganic UV filters zinc oxide and titanium dioxide. Photodermatol Photoimmunol Photomed. 2018.https://doi.org/10.1111/phpp.12439Review of human and environmental safety concerns related to ZnO and TiO₂UV filters.

18. Filipe P, Silva JN, Silva R, Cirne de Castro JL, Marques Gomes M, Alves LC, et al. Stratum corneum is an effective barrier to TiO2 and ZnO nanoparticle percutaneous absorption. Skin Pharmacol Physiol. 2009;22(5):266–75.https://doi.org/10.1159/000235554.

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19. Osmond MJ, McCall MJ. Zinc oxide nanoparticles in modern sunscreens: an analysis of potential exposure and hazard. Nanotoxicology. 2010;4(1):15–41.https://doi.org/10.3109/17435390903502028.

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20. Senjen R. Submission regarding SCCS opinion on zinc oxide (nano form), 2012.https://ntn.org.au/wp-content/uploads/2012/11/NTA-SCCS-submission-Oct-2012-1.pdf. Accessed October 16 2019.

21. US Food and Drug Administration. Nonprescription sunscreen drug products—safety and effectiveness data; Guidance for Industry; Availability. Fed Regist. 2016;81(226):84594–5.

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22. US Food and Drug Administration. Sunscreen drug products for over-the-counter human use: proposed rule. Fed Regist. 2019;84(38):6204–75.

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23. Nelson R. Final OTC Sunscreen monograph postponed, FDA Leadership Confirmshttps://hbw.pharmaintelligence.informa.com/RS149446/Final-OTC-Sunscreen-Monograph-Postponed-FDA-Leadership-Confirms. Accessed November 30 2019.

24. •• Matta MK, Zusterzeel R, Pilli NR, Patel V, Volpe DA, Florian J, et al. Effect of sunscreen application under maximal use conditions on plasma concentration of sunscreen active ingredients: a randomized clinical trial. JAMA. 2019;321(21):2082–91.https://doi.org/10.1001/jama.2019.5586Open-label, randomized human study demonstrating that within one day, four common organic UV filters applied according to label instructions in a controlled environment were detected in plasma at concentrations exceeding those set by the FDA to require further toxicity studies.

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25. Califf RM, Shinkai K. Filling in the evidence about sunscreen. JAMA. 2019;321(21):2077–9.https://doi.org/10.1001/jama.2019.5528.

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26. American Academy of Dermatology. American Academy of Dermatology comments on recent study on absorption of sunscreen ingredientshttps://www.aad.org/media/news-releases/study-sunscreen-ingredients. Accessed October 7 2019.

27. •• Hiller J, Klotz K, Meyer S, Uter W, Hof K, Greiner A, et al. Systemic availability of lipophilic organic UV filters through dermal sunscreen exposure. Environ Int. 2019;132:105068.https://doi.org/10.1016/j.envint.2019.105068In a one-day real-life human exposure scenario, organic UV filters reached higher absolute plasma concentrations compared to a longer but more environmentally controlled trial.

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28. •• Mohammed YH, Holmes A, Haridass IN, Sanchez WY, Studier H, Grice JE, et al. Support for the safe use of zinc oxide nanoparticle sunscreens: lack of skin penetration or cellular toxicity after repeated application in volunteers. J Invest Dermatol. 2019;139(2):308–15.https://doi.org/10.1016/j.jid.2018.08.024In healthy human skinin vivo, there was no evidence that coated or uncoated ZnO-NP applied to limited body surface area for up to five days penetrated below the stratum corneum or caused cellular toxicity or apoptosis.

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29. Gulson B, McCall M, Korsch M, Gomez L, Casey P, Oytam Y, et al. Small amounts of zinc from zinc oxide particles in sunscreens applied outdoors are absorbed through human skin. Toxicol Sci. 2010;118(1):140–9.https://doi.org/10.1093/toxsci/kfq243.

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30. Gulson B, Wong H, Korsch M, Gomez L, Casey P, McCall M, et al. Comparison of dermal absorption of zinc from different sunscreen formulations and differing UV exposure based on stable isotope tracing. Sci Total Environ. 2012;420:313–8.https://doi.org/10.1016/j.scitotenv.2011.12.046.

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31. Wright PFA. Realistic exposure study assists risk assessments of ZnO nanoparticle sunscreens and allays safety concerns. J Invest Dermatol. 2019;139(2):277–8.https://doi.org/10.1016/j.jid.2018.09.014.

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32. •• Pelclova D, Navratil T, Kacerova T, Zamostna B, Fenclova Z, Vlckova S, et al. NanoTiO2 Sunscreen does not prevent systemic oxidative stress caused by UV radiation and a minor amount of NanoTiO2 is absorbed in humans. Nanomaterials (Basel). 2019;9(6).https://doi.org/10.3390/nano9060888In human subjects, sunscreen containing TiO₂-NP failed to prevent oxidative stress or inflammation in UV-exposed skin. Low quantities of TiO₂-NP were detected in plasma and urine six hours following application, but local skin penetration was not proven definitively.

33. Naess EM, Hofgaard A, Skaug V, Gulbrandsen M, Danielsen TE, Grahnstedt S, et al. Titanium dioxide nanoparticles in sunscreen penetrate the skin into viable layers of the epidermis: a clinical approach. Photodermatol Photoimmunol Photomed. 2016;32(1):48–51.https://doi.org/10.1111/phpp.12217.

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34. •• Schneider SL, Lim HW. Review of environmental effects of oxybenzone and other sunscreen active ingredients. J Am Acad Dermatol. 2019;80(1):266–71.https://doi.org/10.1016/j.jaad.2018.06.033Comprehensive appraisal of the data concerning environmental impact of organic UV filters.

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35. Tsui MM, Leung HW, Wai TC, Yamashita N, Taniyasu S, Liu W, et al. Occurrence, distribution and ecological risk assessment of multiple classes of UV filters in surface waters from different countries. Water Res. 2014;67:55–65.https://doi.org/10.1016/j.watres.2014.09.013.

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36. •• Downs CA, Kramarsky-Winter E, Segal R, Fauth J, Knutson S, Bronstein O, et al. Toxicopathological Effects of the Sunscreen UV Filter, Oxybenzone (Benzophenone-3), on Coral Planulae and Cultured Primary Cells and Its Environmental Contamination in Hawaii and the U.S. Virgin Islands. Arch Environ Contam Toxicol. 2016;70(2):265–88.https://doi.org/10.1007/s00244-015-0227-7In laboratory conditions, coral larvae exposed to oxybenzone at concentrations similar to and higher than those in seawater manifested signs of toxicity, mortality, and bleaching, helping spur sunscreen ingredient bans, despite objections to the realistic applicability of these findings.

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37. Danovaro R, Bongiorni L, Corinaldesi C, Giovannelli D, Damiani E, Astolfi P, et al. Sunscreens cause coral bleaching by promoting viral infections. Environ Health Perspect. 2008;116(4):441–7.https://doi.org/10.1289/ehp.10966.

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40. Hawaii State Legislature. S.B. No. 2571. Relating to water pollution.https://www.capitol.hawaii.gov/session2018/bills/SB2571_CD1_.htm. Accessed October 21 2019.

41. Xu VX. Palau bans many kinds of sunscreen, Citing Threat to Coral New York Times. 2018.

42. Filosa G. Key West bans the sale of sunscreens that hurt coral reefs in the Keys. Miami Herald. 2019.

43. Forgione M. U.S. Virgin Islands’ ban on harmful sunscreens to go into effect Jan. 1 Los Angeles Times. 2019.

44. Beitsch R. Sunscreen bans aimed at protecting coral reefs spark debate—among scientists. Washington Post. 2019.

45. Wood E. Impacts of sunscreens on coral reefs. Report by the International Coral Reef Initiative (ICRI) 2018.https://www.icriforum.org/sites/default/files/ICRI_Sunscreen_0.pdf. Accessed October 21 2019.

46. •• Sirois J. Examine all available evidence before making decisions on sunscreen ingredient bans. Sci Total Environ. 2019;674:211–2.https://doi.org/10.1016/j.scitotenv.2019.04.137Response from industry to legislation prohibiting sale and distribution of organic UV filters.

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53. Skin Cancer Foundation. What the Skin Cancer Foundation wants people to know about Hawaii’s proposed ban on the sale and distribution of sunscreens containing oxybenzone and octinoxate.https://www.skincancer.org/press/2018-hawaii-proposed-ban-on-sunscreen-oxybenzone-and-octinoxate/. Accessed October 21 2019.

54. Mirsky RS, Prado G, Svoboda RM, Rigel DS. Oxybenzone and sunscreens: a critical review of the evidence and a plan for discussion with patients. Skin-J Cutan Med. 2018;2(5):264-8.https://doi.org/10.25251/2.5.0.

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57. •• Corinaldesi C, Marcellini F, Nepote E, Damiani E, Danovaro R. Impact of inorganic UV filters contained in sunscreen products on tropical stony corals (Acropora spp.). Sci Total Environ. 2018;637–638:1279–85.https://doi.org/10.1016/j.scitotenv.2018.05.108Coral fragments showed evidence of bleaching when exposed to ZnO-NP, but not TiO₂-NP, in a controlled environment using filter concentrations that may have been unrealistically high.

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