Sun Protection by Beach Umbrella vs Sunscreen With a High Sun Protection Factor

Abstract

IMPORTANCE Sun-protective behavior affects skin cancer prevention. Shade works by physically shielding skin from direct harmful UV rays; however, skin may still remain exposed to reflected and indirect UV rays. There is no current standard metric to evaluate shade for its effectiveness in sun protection, and there is insufficient clinical evidence that a beach umbrella alone can provide adequate sun protection.OBJECTIVE To directly measure sunburn protection offered by a standard beach umbrella compared with that provided by sunscreen with a high sun protection factor under actual use conditions. DESIGN, SETTING, AND PARTICIPANTSA single-center, evaluator-blinded, randomized clinical study was conducted from August 13 to 15, 2014, in Lake Lewisville, Texas (elevation, 159 m above sea level), among 81 participants with Fitzpatrick skin types I (n = 1), II (n = 42), and III (n = 38). Participants were randomly assigned to 2 groups: 1 using only a beach umbrella, and the other using only sunscreen with a sun protection factor of 100. All participants remained at a sunny beach for 3½ hours at midday. Clinical sunburn evaluation of each individual for all exposed body sites was conducted 22 to 24 hours after sun exposure. INTERVENTIONSThe shade provided by a beach umbrella or protection provided by sunscreen with a sun protection factor of 100. MAIN OUTCOMES AND MEASURESSunburn on all exposed body sites 22 to 24 hours after sun exposure.RESULTS Among the 81 participants (25 male and 56 female; mean [SD] age, 41 [16] years) for all body sites evaluated (face, back of neck, upper chest, arms, and legs), the umbrella group showed a statistically significant increase in clinical sunburn scores compared with baseline and had higher postexposure global scores than the sunscreen group (0.75 vs 0.05; P < .001). There was a total of 142 sunburn incidences in the umbrella group vs 17 in the sunscreen group. Thirty-two of the 41 participants (78%) in the umbrella group showed erythema in 1 or more sites vs 10 of the 40 participants (25%) in the sunscreen group (P < .001). Neither umbrella nor sunscreen alone completely prevented sunburn. CONCLUSIONS AND RELEVANCEA beach umbrella alone may not provide sufficient protection for extended UV exposure. It is important to educate the public that combining multiple sun protection measures may be needed to achieve optimal protection.

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“…Despite all the evidence of UVR as a main risk factor for NMSC, there are still some open questions. One is the rare finding of NMSC on the back of the neck despite being a body area with enormous UVR exposure during work and outside activities and probably the most prominent area, at which most human beings had experienced at least one sunburn before . Another open question is why some individuals develop solar elastosis rather than NMSC despite severe cumulative lifetime UVR exposure.…”

“…One is the rare finding of NMSC on the back of the neck despite being a body area with enormous UVR exposure during work and outside activities and probably the most prominent area, at which most human beings had experienced at least one sunburn before. 12,13 Another open question is why some individuals develop solar elastosis rather than NMSC despite severe cumulative lifetime UVR exposure. Previous studies found that wrinkling may protect from NMSC, but so far the protective factors have not yet been identified.…”

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“…The perceived effect on motivation was similar between participants with different Fitzpatrick skin type in both tanning bed avoidance (n/%=142/91.0 agreement in skin type 1-2 vs. 179/90.0 agreement in [3][4][5][6] and increased use of sun protection (n/%=144/92.3 agreement in skin type 1-2 vs. 176/88.4 agreement in 3-6; Fig. 8) and also similar between the age groups ( Fig.…”

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“…Only the higher use of shade was significantly associated with a higher presence of AKs. ere are not studies that evaluate the preventive effect against NMSC of solar protection measures different from sunscreen [20]; although a beach umbrella alone (only shade) did not provide sufficient protection for extended UV exposure compared to sunscreen [21].…”