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There have been a lot of worrisome reports recently about the health effects of sunscreens with chemical ingredients such as oxybenzone and avobenzone, substances shown to protect skin from the sun’s ultraviolet (UV) rays, which can cause sunburns and skin cancer.

Some experts are concerned that these chemicals may be absorbed through the skin, leading to skin irritation, hormonal disruption — even skin cancer. The Food and Drug Administration recently called for more research on the safety and effectiveness of these chemicals. In May, a preliminary study by FDA researchers found that the chemicals may be absorbed into the skin at levels higher than previously believed. And a report published in March suggests there may be risks to developing fetuses when pregnant women are exposed to oxybenzone.

Adding to the confusion, the American Academy of Dermatology (AAD) says sunscreen is safe, but the American Academy of Pediatrics (AAP) tells parents it’s best to not use sunscreens with oxybenzone on their kids.

With about 5 million cases of skin cancer diagnosed each year — more than 90 percent of those attributed to UV exposure — experts don’t want Americans to stop using their sunscreens.

Don Huber, director of product safety at Consumer Reports, says, “There is overwhelming evidence that sunscreen protects against skin cancer and other harmful effects of the sun, so consumers need to continue to use it while scientists do more research on the safety of sunscreen ingredients.”

So what’s the bottom line for you and your family this summer when it comes to sun-protection safety? Here’s what you need to know right now.

What the data shows

Safety concerns about chemicals in sunscreens exist because these ingredients can be absorbed through the skin. With many Americans now using these products more frequently and in larger amounts than in the past, this concern has grown.

“We’ve been asking that people use sunscreen on a daily basis all year-round and apply it every few hours during prolonged sun exposure,” says Henry Lim, a dermatologist at the Henry Ford Hospital in Detroit and immediate past president of the AAD. That raises the question of whether ingredients that were thought to be safe when used occasionally — once or twice a week at the beach or pool, for instance — could be harmful in larger daily doses.

The FDA previously reviewed the safety and effectiveness of all active ingredients used in sunscreens today and said it would allow them under certain conditions. But the agency is now asking the sunscreen industry to provide additional safety information on 12 common chemical sunscreen ingredients, including oxybenzone, avobenzone, homosalate, octinoxate, octisalate and octocrylene.

“This request for additional data does not mean that the FDA has concluded that these 12 ingredients are unsafe,” says Theresa Michele, director of the division of nonprescription drug products at the FDA. “The goal here is to get the data and validate the safety and effectiveness of all these ingredients.”

The toxicity of some of the above-mentioned ingredients has been more thoroughly researched than others, and few studies have been done with the actual sunscreens you buy at the store, Huber says, so the FDA’s decision to get more data is a good one.

In response to the FDA’s proposed sunscreen safety changes, the Personal Care Products Council, a trade association that represents sunscreen manufacturers, issued a statement saying that the 12 ingredients in question had been found to be safe and effective in Europe and in other countries. While noting that it looked forward to working with the FDA to address the agency’s questions, the council also said that the “precise studies proposed by the FDA are not the only ways to obtain the data they need.”

Concerns about oxybenzone

Of the 12 ingredients the FDA is investigating, the one most often flagged as potentially worrisome is oxybenzone. This chemical is widely used in sunscreens because it effectively protects against UV rays, those that are mostly responsible for sunburn (UVB) and skin cancer (UVA).

There’s evidence that oxybenzone is absorbed through the skin more than was once thought, and in some studies, researchers have found detectable levels of it in human blood and breast milk. Based on animal studies, there’s concern that it could interfere with the normal function of a number of hormones, including estrogen.

In a 2001 study, researchers from the University of Zurich in Switzerland found that rats who ate food with oxybenzone mixed in had a 23 percent increase in uterine size.

“There’s a difference between eating a substance and absorbing it through the skin, however,” Huber says. A study published in the Archives of Dermatology calculated that the average-size American woman would have to apply sunscreen to 100 percent of her body every day for nearly 35 years to get the same dose of oxybenzone as the rats did. And, according to Lim (a co-author of this study), there have been no studies that have shown any harmful effects in humans, despite the evidence of absorption.

Still, a paper recently published in the journal Reproductive Toxicology suggests that pregnant women who use sunscreen with oxybenzone daily might absorb enough of the chemical to increase the risk of a birth defect called Hirschsprung’s disease. Children with this condition are missing nerves in the lower colon or rectum, which prevents stool from moving through the bowel normally. The report’s findings don’t prove that oxybenzone exposure causes the condition, but it’s another piece of information that underscores the need for more research on oxybenzone and other sunscreen ingredients.

The AAP advises parents to avoid using sunscreens with oxybenzone on children, if possible.

“Studies in laboratory animals and other laboratory studies show that this chemical can mimic the actions of hormones that naturally occur in the human body. This is called endocrine disruption,” says Sophie J. Balk, an attending pediatrician at the Children’s Hospital at Montefiore in the Bronx and a member of the AAP Council on Environmental Health. “As pediatricians, we are concerned about the effects of chemicals on fetuses, infants and children because their endocrine systems and other organ systems are rapidly growing and developing. There’s no research to prove adverse effects of oxybenzone on children, but there is concern.”

She notes that while a majority of the studies are specific to oxybenzone, the AAP is concerned about all chemical active ingredients in personal care products.

There is also some evidence that oxybenzone may be harmful to coral reefs, and some communities have passed legislation to ban the sale of sunscreens that contain it.

Limits of mineral products?

The FDA says that there’s enough evidence to conclude that titanium dioxide and zinc oxide — ingredients that are used in mineral (sometimes called “natural”) sunscreen products — don’t warrant the same health concerns as chemical sunscreen ingredients such as oxybenzone. That’s because they sit on the surface of the skin and aren’t absorbed. But some experts, including those at Consumer Reports, note that they also don’t necessarily protect the skin as well as sunscreens with chemical ingredients.

“The AAD has always urged consumers who are concerned about chemical sunscreens to use mineral ones,” Lim says. “But because titanium dioxide and zinc oxide work by deflecting rather than absorbing UV rays [as chemical ingredients do], they are not as efficient filters as most chemical ingredients.”

Mineral sunscreens have consistently underperformed in CR’s testing, not always testing at the claimed SPF label on the package and failing to provide adequate protection from either UVA or UVB rays. None of the 18 sunscreens in our ratings that contain only titanium dioxide, zinc oxide or both scored high enough to receive a recommended designation from CR. But some did better than others and could be alternatives if you’re concerned (see below).

Protect yourself in the sun

“Patients often ask me about the health risks of sunscreens,” says Joshua Zeichner, director of cosmetic and clinical research in the department of dermatology at the Mount Sinai Hospital in New York City. “I’ve even had patients wonder if it’s safer to go without.”

But, says Lim, “the negative effects of sun exposure — skin cancer and premature skin aging — are very well known. And using sunscreen has been shown to decrease those risks.” That’s why the FDA isn’t recommending that consumers avoid any of the active ingredients (including chemical ones) currently in sunscreen, many of which have been in use in the United States for more than 20 years without proved claims of negative health effects.

That advice applies to pregnant women and children, too. The American College of Obstetricians and Gynecologists recommends that pregnant women use sunscreen and doesn’t have a policy on the safety of the ingredients in it. And despite its concerns about oxybenzone, the AAP stresses that using some form of sunscreen is better than not using sunscreen.

“We want kids to be outside playing and enjoying the outdoors, being mindful of the importance of sun protection,” Balk says. “Using sunscreen is one way to prevent sunburn. Clothing and hats can provide an important barrier against UV rays. A child wearing a swim shirt and swim shorts will need less sunscreen, since parts of the body will be covered. And timing outdoor activities before 10 a.m. and after 4 p.m. avoids peak sun.”

(According to the AAP, babies under 6 months should be kept out of the sun or covered with protective clothing, with sunscreen used only on small areas, such as the face, if protective clothing and shade aren’t available.)

Lim also advises consumers to think of sunscreen as just one part of a total sun-protection plan that also includes covering up with clothing (or a rash guard), wearing a broad-brimmed hat and seeking the shade or staying indoors between 10 a.m. and 4 p.m. This approach will help you shield your skin and allow you to skip applying sunscreen on covered body parts.

If you’re particularly concerned about the possible effects of oxybenzone, there are chemical sunscreens without it. Walgreens Hydrating Lotion SPF 50 and Hawaiian Tropic Sheer Touch Ultra Radiance Lotion SPF 50 scored well in our ratings.

And if you want to use a mineral sunscreen, our tests show that California Kids Super Sensitive Lotion SPF 30+, Badger Active Natural Mineral Lotion SPF 30 (Unscented) and Goddess Garden Everyday Natural Lotion SPF 30 will offer some protection, although not as much as our top-rated products.

 Copyright 2019, Consumer Reports Inc.

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