A broad spectrum SPF-60 sunscreen with active ingredients of titanium dioxide, zinc oxide, and methylene bis-benzotriazolyl tetramethylbutylphenol offered effective photoprotection versus a non-sunscreen control product. Ecamsule-containing sunscreen was effective at preventing UV-induced lupus erythematosus, as was a titanium dioxide–based sunscreen ( Herzinger et al., 2004). However, ecamsule is only available in L’Oreal products in the United States. (2000) compared different active ingredients in the photoprotection of patients with lupus and found that although all offered some protection, Mexoryl™ (ecamsule) is the most effective. However, the studies in question did not analyze the wide range of sunscreens available in the United States. Previous studies have demonstrated that adequate sunscreen use effectively photoprotects against UV-induced lupus ( Herzinger et al., 2004, Kuhn et al., 2011, Stege et al., 2000). Further limitations have arisen from environmental concerns on the coral reefs over the use of oxybenzone (benzophenone-3) and octinoxate, which have resulted in legislation to ban their use in Hawaii ( Fulton, 2018). Some are thought to be superior in stability and with a broader absorption spectrum compared with what is currently available on the U.S. Food and Drug Administration (FDA) approval. Eight other ingredients have been approved outside of the United States but do not have U.S. Currently, 16 approved ingredients in the United States can be used in sunscreens to filter UV light. The armamentarium of effective sunscreens in the United States faces additional challenges compared with Europe. Additionally, allergic contact dermatitis from allergenic ingredients in sunscreen may be uniquely debilitating to this patient population because an episode of contact dermatitis can be difficult to distinguish from a flare of the autoimmune condition. These patients are very dependent on sunscreens as part of their treatment because inadequate sun protection can directly cause a flare up. This is particularly important for patients with autoimmune skin conditions. Overall, the consequences of improper sunscreen selection and usage include inadequate sun protection and allergenic responses to the ingredients in sunscreens. Additionally, sunscreens may contain potentially allergenic ingredients, which could cause allergic and photoallergic contact dermatitis and exacerbate symptoms. However, the lack of established criteria for adequately effective sunscreen selection creates confusion when counseling patients on the choice of a sunscreen. Adequate sunscreen use effectively photoprotects against ultraviolet (UV)-induced lupus ( Fulton, 2018, Herzinger et al., 2004, Stege et al., 2000). The photosensitivity component of lupus erythematosus, dermatomyositis, and other autoimmune skin conditions requires assiduous sun protection, including the use of broad spectrum sunscreens with maximal sun protection factor (SPF).
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