New 2016 — Public Proof About Zinc
My clinical experience and research have dictated that the brand or cost of a sunscreen do not necessarily determine their effectiveness for rosacea.
A product's ingredients, and the skill with which they are formulated, determine suitability.
Selecting optimal sunscreens for daily use in rosacea treatment is an exercise in choosing products with certain qualities, containing some ingredients, avoiding others, and preferentially having other properties I outline below.
Step 1: Avoid products containing zinc and/or titanium dioxide as their only sunscreening agents.
This may seem counterintuitive as these physical sunblocks are known to be suitable for sensitive skin, however in their modern ultrafine, "clear" or "nanoparticle" forms they do not protect adequately against UVA, the solar wavelength implicated in the long-term worsening of rosacea symptoms (and most visible signs of skin aging).
Effective sunscreens for rosacea must provide excellent long-lasting UVA protection.
Only traditional opaque zinc and titanium (entirely unsuitable for routine use over the entire face) provide high levels of UVA protection). You can read more about this little-recognized problem in adverse effects of physical sunscreens.
The second reason it's worth avoiding zinc and titanium is their skin whitening effect (which becomes more of a problem the more protective a physical sunscreen becomes).
Thirdly, their tendency to become encrusted on shirt collars, highly resistant to cleaning, will have you wanting to avoid application, or applying less effective amounts to limit the issue.
While most patients are happy to spend some extra time applying sunscreen properly after 4-6 months of using a physical block even the most stalwart and compliant are tired of looking white and the damage to their clothing, which becomes apparent on anything other than white cotton.
Step 2: Choose products containing either a combination of microfine zinc (7-12%) and a chemical block, or a product containing 4-5 chemical blocks.
In the first instance, where zinc isn't the only block, the combination with a chemical sunscreen (usually octinoxate or octyl methoxycinnamate), allows for a much more acceptable sunscreen.
However, a product containing 4-5 chemical sunscreens will provide much better protection, with none of zinc's downsides.
Part of this step is ignoring the SPF rating, which only measures a product's ability to prevent visible skin burning due to UVB.
Rosacea patients need products that meet their need for long-lasting UVA protection.
For a sunscreen made with zinc and octinoxate or octyl methoxycinnamate, look at the product's active ingredient listing for 8-12% zinc and 5-10% octinoxate or octyl methoxycinnamate.
For a sunscreen made with 4-5 chemical sunscreens, look for 5-10% octinoxate, oxybenzone or octyl methoxycinnamate in additon to 2-5% of each of the following: 4-Methylbenzylidene Camphor (also known as avobenzone or Parsol), Butyl Methoxydibenzoylmethane and Octocrylene.
Anything less than a combination of 4 of these sunscreen agents at 2-5% won't yield an optimally protective sunscreen for rosacea.
I like Attend SPF 50+ because it contains 8 time-release sunscreens, making it one of the most protective sunscreens available anywhere, and is specifically formulated for rosacea.
Ideally, patients use a non-US sunscreen because the FDA has failed to approve a single new sunscreen agent since 1996 (citing a "backlog") and creating a situation where the US now has the most inferior sunscreens in the developed world.
For more information about this conundrum see my US sunscreen fiasco references. Order your sunscreen in from Europe, Japan or Australia where the sunscreens contain newer and safer ingredients which provide higher protection (particularly UVA protection) at much lower chemical exposure and don't look, feel or smell like the dated and inadequate sunscreens we're used to in the US.
Step 3: Choose a product for daily facial use (avoid outdoor/beach and highly waterproof products).
To avoid harsh cleansing and sunscreen residues which can get in the way of other skin care and topically-applied medications, choose a sunscreen for routine, daily facial use.
These stay put during daily activities, but can be removed with normal cleansing.
Step 4: If possible, use a sunscreen product with antioxidants.
Label from Blue Lizard SPF 30+ for Face indicating green tea and caffeine:
Label from La Prairie Cellular Anti-Wrinkle Sun Cream SPF 30 sunscreen indicating green tea:
Advertisement for sunscreen containing an antioxidant (in this case "Cell-Ox Shield" which is an extract of Senna alata).
Providing they are present in high enough concentrations and able to be absorbed by skin, antioxidants significantly increase the benefits of sunscreens to rosacea patients because they have anti-inflammatory effects.
Key antioxidants to look for are the purified, isolated active constituents of grape seed extract, green tea and silymarin.
For further information, see Antioxidants Useful In Sunscreens for Rosacea.
These ingredients should appear close to the beginning of ingredient labels. Low concentrations aren't effective, they merely support marketing claims.
A sunscreen product containing useful levels of antioxidants will bear a symbol (such as "4M" or "6M") or note indicating it should be used before 4-6 months of opening and will be packaged in an airless pump or glass bottle. Examples include Kinerase Pro+ SPF 30 Lotion and Cream with Kinetin and Rosacea Treatment Clinic SPF 50 Sheer Matte Tinted Daily Face Protectant.
Antioxidants work better in combinations than in isolation, so ideally a product will contain high levels of at least 2 antioxidants. Three or more is optimal.
Dietary intake of antioxidants, with preference to whole foods before supplements, also makes a difference, although not nearly so much as topical application.
Step 5: If possible, choose a preservative-free sunscreen.
Label from La Prairie Cellular Anti-Wrinkle Sun Cream SPF 30:
It's often the preservatives in sunscreens which cause irritation, and not the sunscreen agents themselves.
Preservatives such as the parabens (for example propylparaben, methyparaben and ethylparaben) and phenoxyethanol have been shown to worsen skin's response to UV and provoke burning, stinging and irritation in rosacea patients.
Increasingly innovative products are making their way on to the market preserved by very high levels of skin-beneficial antioxidants and airless packaging in place of preservatives. Keep a look out for these.
Step 6: If you have extremely reactive skin, choose a sunscreen with ceramides and/or niacin or niacinamide.
Label from La Prairie Cellular Anti-Wrinkle Sun Cream SPF 30:
If your skin is prone to burning, stinging and prickling, it's because things are penetrating it too quickly or which would normally remain on the outside.
Together with appropriate skin care, ceramides and niacin/niacinamide restore healthy skin barrier function.
An example of a sunscreen containing multiple ceramides and a high concentration of niacinamide is De-Sensitising Barrier Fluid SPF 50 from Australia.
You can use also use these ingredients in products other than sunscreens.
A healthy diet containing adequate essential fatty acids also promotes healthy skin barrier function.
Step 7: Avoid the department store, beauty salon and day spa.
I added this last step with some hesitation. While there are no doubt some exceptions, finding a suitable sunscreen for rosacea through these retail channels is like looking for a needle in a haystack.
The usual problems with sunscreens from these sources is irritating fragrance, inadequate UV protection and endless irritating ingredients which serve negligible benefit or merely purported function.
The drug store, pharmacy or specialist clinic are where you'll find the best sunscreens for rosacea.
Author: Jeremy Cleckley