Effect of Sunscreen Application Under Maximal Use Conditions on Plasma Concentration of Sunscreen Active Ingredients: A Randomized Clinical Trial
Open accessAbstract
Importance: The US Food and Drug Administration (FDA) has provided guidance that sunscreen active ingredients with systemic absorption greater than 0.5 ng/mL or with safety concerns should undergo nonclinical toxicology assessment including systemic carcinogenicity and additional developmental and reproductive studies. Objective: To determine whether the active ingredients (avobenzone, oxybenzone, octocrylene, and ecamsule) of 4 commercially available sunscreens are absorbed into systemic circulation. Design, Setting, and Participants: Randomized clinical trial conducted at a phase 1 clinical pharmacology unit in the United States and enrolling 24 healthy volunteers. Enrollment started in July 2018 and ended in August 2018. Interventions: Participants were randomized to 1 of 4 sunscreens: spray 1 (n = 6 participants), spray 2 (n = 6), a lotion (n = 6), and a cream (n = 6). Two milligrams of sunscreen per 1 cm2 was applied to 75% of body surface area 4 times per day for 4 days, and 30 blood samples were collected over 7 days from each participant. Main Outcomes and Measures: The primary outcome was the maximum plasma concentration of avobenzone. Secondary outcomes were the maximum plasma concentrations of oxybenzone, octocrylene, and ecamsule. Results: Among 24 participants randomized (mean age, 35.5 [SD, 1.5] years; 12 (50%] women; 14 [58%] black or African American; 14 [58%]), 23 (96%) completed the trial. For avobenzone, geometric mean maximum plasma concentrations were 4.0 ng/mL (coefficient of variation, 6.9%) for spray 1; 3.4 ng/mL (coefficient of variation, 77.3%) for spray 2; 4.3 ng/mL (coefficient of variation, 46.1%) for lotion; and 1.8 ng/mL (coefficient of variation, 32.1%). For oxybenzone, the corresponding values were 209.6 ng/mL (66.8%) for spray 1, 194.9 ng/mL (52.4%) for spray 2, and 169.3 ng/mL (44.5%) for lotion; for octocrylene, 2.9 ng/mL (102%) for spray 1, 7.8 ng/mL (113.3%) for spray 2, 5.7 ng/mL (66.3%) for lotion, and 5.7 ng/mL (47.1%) for cream; and for ecamsule, 1.5 ng/mL (166.1%) for cream. Systemic concentrations greater than 0.5 ng/mL were reached for all 4 products after 4 applications on day 1. The most common adverse event was rash, which developed in 1 participant with each sunscreen. Conclusions and Relevance: In this preliminary study involving healthy volunteers, application of 4 commercially available sunscreens under maximal use conditions resulted in plasma concentrations that exceeded the threshold established by the FDA for potentially waiving some nonclinical toxicology studies for sunscreens. The systemic absorption of sunscreen ingredients supports the need for further studies to determine the clinical significance of these findings. These results do not indicate that individuals should refrain from the use of sunscreen. Trial Registration: ClinicalTrials.gov Identifier: NCT03582215.
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Due to concerns about systemic absorption from sunscreen at recommended levels, titanium dioxide and zinc oxide are the only ingredients generally recognized as safe and effective (GRASE) by the US FDA.
“Due to recent concerns that the application of sunscreen at recommended levels may lead to systemic absorption [116], titanium dioxide and zinc oxide are the only ingredients that are generally recognized as safe and effective (GRASE) by the US FDA [115].”
From Photoprotection for skin of color (2022) · cites this paper as [116]
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- Authors
- Matta, M. K., Zusterzeel, R., Pilli, N. R., Patel, V., Volpe, D. A., Florian, J., Oh, L., Bashaw, E., Zineh, I., Sanabria, C., Kemp, S., Godfrey, A., Adah, S., Coelho, S., Wang, J., Furlong, L.-A., Ganley, C., Michele, T., & Strauss, D. G.
- Affiliations
- United States Food and Drug Administration (US)
- Spaulding Clinical Research (United States) (US)
- Corresponding author
- Strauss, David G.
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2019-06-04
- Volume
- 321
- Issue
- 21
- Pages
- 2082
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC6549296
- OpenAlex
- W2943530066
- Cited by
- 335
- References
- 12
- Citations by year
- 2026: 39 · 2025: 43 · 2024: 43 · 2023: 29 · 2022: 39 · 2021: 48 · 2020: 62 · 2019: 31 · 2018: 1
- FWCI
- 45.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Dermatology › Skin Protection and Aging
- Health Sciences › Medicine › Dermatology › Contact Dermatitis and Allergies
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Toxic Organic Pollutants Impact
- Keywords
- sunscreen, systemic absorption, plasma concentration, avobenzone, benzophenone-3, octocrylene, sunscreen active ingredients, topical absorption, sunscreen formulation, sunscreen safety
- MeSH terms
- Acrylates, Adult, Benzophenones, Camphanes, Female, Humans, Male, Maximum Allowable Concentration, Pilot Projects, Propiophenones, Skin Absorption, Sulfonic Acids, Sunscreening Agents, Skin Cream, Healthy Volunteers
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