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The Effect of Regular Sunscreen Use on Vitamin D Levels in an Australian Population: Results of a Randomized Controlled Trial

The Effect of Regular Sunscreen Use on Vitamin D Levels in an Australian Population: Results of a... Abstract Background and Design: Studies published have suggested a possibility that regular use of sunscreen to prevent skin cancer may put the population, particularly elderly people, at risk of vitamin D deficiency. We aimed to determine whether regular use of sunscreens in the normal adult population, as recommended by public health authorities for the prevention of skin cancer, may put individuals at risk of vitamin D deficiency. A randomized double-blind control trial of the daily use of a broad-spectrum sunscreen (sun protection factor [SPF] 17) vs placebo cream over a summer period in Australia was conducted in 113 people aged 40 years and over, with sampling stratified by age. All participants had at least one solar keratosis. Serum samples taken at the beginning and at the end of the study were analyzed for 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3. Results: Mean levels of 25-hydroxyvitamin D3 rose significantly by the same amount in both groups over the period of the study (placebo, +12.8 mmol/L; sunscreen, + 11.8 mmol/L). Mean levels of 1,25-dihydroxyvitamin D3 increased significantly in the pla- cebo group only (placebo, +10.8 pmol/L; sunscreen, +1.3 pmol/L), but for no subject in either group was the level of 1,25-dihydroxyvitamin D3 outside the reference range either at the start or at the end of the study. There were no significant differences by age, sex, and skin type in the change in 25-hydroxyvitamin D3 or 1,25-dihydroxyvitamin D3 over the study period. Conclusions: No person, including those aged 70 years and over, developed any vitamin D levels outside the normal reference range during the period of the study. The data suggest that over an Australian summer sufficient sunlight is received, probably through both the sunscreen itself and the lack of total skin cover at all times, to allow adequate vitamin D production in people who are recommended to use sunscreens regularly. More work is required to elucidate the relationship between 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3, particularly during the different seasons of the year.(Arch Dermatol. 1995;131:415-421) References 1. Holick MF. The photobiology of vitamin D and its consequences for humans . Ann N Y Acad Sci. 1985;453:1-13.Crossref 2. Fraser DR. The physiological economy of vitamin D . Lancet . 1983;1:969-972.Crossref 3. Reichel HK, Koeffler HP, Norman AW. The role of the vitamin D endocrine system in health and disease . N Engl J Med. 1989;15:980-990.Crossref 4. Stern PH. Vitamin D and bone . Kidney Int. 1990;38( (suppl 29) ):517-521. 5. Tjellesen L, Nielsen B, Christiansen C. Seasonal fluctuations in serum concentrations of vitamin D metabolites . BMJ. 1982;284:196.Crossref 6. Chesney RW, Rosen JF, Hamstra AJ, Smith C, Mahaffey K, De Luca HF. Absence of seasonal variation in serum concentrations of 1,25-dihydroxyvitamin D despite a rise in 25-hydroxyvitamin D in summer . J Clin Endocrinol Metab. 1981;53:139-142.Crossref 7. Stamp TC, Round JM. Seasonal changes in human plasma levels of 25-hydroxyvitamin D . Nature. 1974;247:563-565.Crossref 8. Marks R, Hill D, eds. The Public Health Approach to Melanoma Control: Prevention and Early Detection . Geneva, Switzerland: International Union Against Cancer; 1992. 9. Matsuoka LY, Ide L, Worstman J, McLaughlin JA, Holick MF. Sunscreens suppress cutaneous vitamin D3 synthesis . J Clin Endocrinol Metab. 1987;64:1165-1168.Crossref 10. Matsuoka LY, Worstman J, Hanifin N, Holick MF. Chronic sunscreen use decreases circulating concentrations of 25-hydroxyvitamin D: a preliminary study . Arch Dermatol. 1988;124:1802-1804.Crossref 11. Garland FC, White MR, Garland CF, Shaw E, Gorham ED. Occupational sun- light exposure and melanoma in the US Navy . Arch Environ Health. 1990;45: 261-267.Crossref 12. Ainsleigh HG. Beneficial effects of sun exposure on cancer mortality . Prev Med. 1993;22:132-140.Crossref 13. Thompson SC, Jolley D, Marks R. Does regular use of sunscreen reduce the risk of skin cancer in humans: results of a randomized controlled trial of sunscreen in people with solar keratoses in Australia . N Engl J Med. 1993;329: 1147-1151.Crossref 14. Australian Standard 2604-1986 . Sunscreen Products: Evaluation and Classification . Sydney, Australia: Standards Association Australia; 1986. 15. Turnbull H, Trafford DJH, Makin HLJ. A rapid and simple method for the measurement of plasma 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 using Sep-Pak C18 cartridges and a single high performance liquid chromatographic step . Clin Chim Acta. 1982;120:65-76.Crossref 16. Dean B, Kolavcic MS, Wark JD, Harrison LC. Chromatography of serum on Sep-Pak C18 corrects falsely elevated vitamin D metabolite levels measured by protein binding assay . Clin Chim Acta. 1988;176:169-178.Crossref 17. Hollis BW. Assay of circulating 1,25-dihydroxyvitamin D involving a novel singlecartridge extraction and purification procedure . Clin Chem. 1986;32:2060-2063. 18. Reinhardt HA, Horst RL, Orf JW, Hollis BW. A microassay for 1,25-dihydroxyvitamin D not requiring high performance liquid chromatography . J Clin Endocrinol Metab. 1984;22:597-609. 19. Calkins J. Measuring devices and dosage units . In Calkins J, ed. The Role of Solar Ultraviolet Radiation in Marine Ecosystems . New York, NY: Plenum Press; 1982:169-179. 20. Diffey BL. A comparison of dosimeters used for solar ultraviolet radiometry . Photochem Photobiol. 1987;46:55-60.Crossref 21. Clayton D, Hills M. Statistical Models in Epidemiology . Oxford, England: Oxford University Press; 1993. 22. Becker RA, Chambers JM, Wilks AR. The New S Language: A Programming Environment for Data Analysis and Graphics . Pacific Grove, La: Wadsworth; 1988. 23. Pathak MA, Fitzpatrick TB, Greiter FJ, Kraus EW. Principles of photoprotection in sunburn and suntanning, and topical and systemic photoprotection in health and diseases: sunscreens . J Dermatol Surg Oncol. 1985;6:575-579.Crossref 24. Cole CA, Forbes PD, Davies RE. An action spectrum for UV photocarcinogenesis . Photochem Photobiol. 1986;43:275-284.Crossref 25. Poskitt EME, Cole TJ, Lawson DEM. Diet, sunlight and 25-hydroxyvitamin D in healthy children and adults . BMJ. 1979;1:L221-223.Crossref 26. Sheltawy M, Newton H, Hay A, Morgan DB, Hullin RP. The contribution of dietary vitamin D and sunlight to the plasma 25-hydroxyvitamin D in the elderly . Hum Nutr Clin Nutr. 1984;38:191-194. 27. Hill D, White V, Marks R, Theobald T, Borland R, Roy C. Melanoma prevention: behavioral and non-behavioral factors in sunburn among an Australian population . Prev Med. 1992;21:654-669.Crossref 28. Prystowsky JH. Photoprotection and the vitamin D status of the elderly: a concern for dermatologists . Arch Dermatol. 1988;124:1844-1848.Crossref 29. Fine RM. Sunscreens and cutaneous vitamin D synthesis . Int J Dermatol. 1988; 27:300-301.Crossref 30. Garland CF, Garland FC, Gorham ED. Rising trends in melanoma: an hypothesis concerning sunscreen effectiveness . Am J Epidemiol. 1993;3:103-110. 31. Kligman EW, Watkins A, Johnson K, Kronland R. The impact of lifestyle factors on serum 25-hydroxyvitamin D levels in older adults: a preliminary study . Fam Pract Res J. 1989;9:11-19. 32. Loomis WF. Rickets . Sci Am. 1970;223:77-91.Crossref 33. Juttmann JR, Visser TJ, Buurman C, de Kam E, Birkenhager JC. Seasonal fluctuations in serum concentrations of vitamin D metabolites in normal human subjects . BMJ. 1981;282:1349-1352.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

The Effect of Regular Sunscreen Use on Vitamin D Levels in an Australian Population: Results of a Randomized Controlled Trial

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1995.01690160043006
Publisher site
See Article on Publisher Site

Abstract

Abstract Background and Design: Studies published have suggested a possibility that regular use of sunscreen to prevent skin cancer may put the population, particularly elderly people, at risk of vitamin D deficiency. We aimed to determine whether regular use of sunscreens in the normal adult population, as recommended by public health authorities for the prevention of skin cancer, may put individuals at risk of vitamin D deficiency. A randomized double-blind control trial of the daily use of a broad-spectrum sunscreen (sun protection factor [SPF] 17) vs placebo cream over a summer period in Australia was conducted in 113 people aged 40 years and over, with sampling stratified by age. All participants had at least one solar keratosis. Serum samples taken at the beginning and at the end of the study were analyzed for 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3. Results: Mean levels of 25-hydroxyvitamin D3 rose significantly by the same amount in both groups over the period of the study (placebo, +12.8 mmol/L; sunscreen, + 11.8 mmol/L). Mean levels of 1,25-dihydroxyvitamin D3 increased significantly in the pla- cebo group only (placebo, +10.8 pmol/L; sunscreen, +1.3 pmol/L), but for no subject in either group was the level of 1,25-dihydroxyvitamin D3 outside the reference range either at the start or at the end of the study. There were no significant differences by age, sex, and skin type in the change in 25-hydroxyvitamin D3 or 1,25-dihydroxyvitamin D3 over the study period. Conclusions: No person, including those aged 70 years and over, developed any vitamin D levels outside the normal reference range during the period of the study. The data suggest that over an Australian summer sufficient sunlight is received, probably through both the sunscreen itself and the lack of total skin cover at all times, to allow adequate vitamin D production in people who are recommended to use sunscreens regularly. More work is required to elucidate the relationship between 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3, particularly during the different seasons of the year.(Arch Dermatol. 1995;131:415-421) References 1. Holick MF. The photobiology of vitamin D and its consequences for humans . Ann N Y Acad Sci. 1985;453:1-13.Crossref 2. Fraser DR. The physiological economy of vitamin D . Lancet . 1983;1:969-972.Crossref 3. Reichel HK, Koeffler HP, Norman AW. The role of the vitamin D endocrine system in health and disease . N Engl J Med. 1989;15:980-990.Crossref 4. Stern PH. Vitamin D and bone . Kidney Int. 1990;38( (suppl 29) ):517-521. 5. Tjellesen L, Nielsen B, Christiansen C. Seasonal fluctuations in serum concentrations of vitamin D metabolites . BMJ. 1982;284:196.Crossref 6. Chesney RW, Rosen JF, Hamstra AJ, Smith C, Mahaffey K, De Luca HF. Absence of seasonal variation in serum concentrations of 1,25-dihydroxyvitamin D despite a rise in 25-hydroxyvitamin D in summer . J Clin Endocrinol Metab. 1981;53:139-142.Crossref 7. Stamp TC, Round JM. Seasonal changes in human plasma levels of 25-hydroxyvitamin D . Nature. 1974;247:563-565.Crossref 8. Marks R, Hill D, eds. The Public Health Approach to Melanoma Control: Prevention and Early Detection . Geneva, Switzerland: International Union Against Cancer; 1992. 9. Matsuoka LY, Ide L, Worstman J, McLaughlin JA, Holick MF. Sunscreens suppress cutaneous vitamin D3 synthesis . J Clin Endocrinol Metab. 1987;64:1165-1168.Crossref 10. Matsuoka LY, Worstman J, Hanifin N, Holick MF. Chronic sunscreen use decreases circulating concentrations of 25-hydroxyvitamin D: a preliminary study . Arch Dermatol. 1988;124:1802-1804.Crossref 11. Garland FC, White MR, Garland CF, Shaw E, Gorham ED. Occupational sun- light exposure and melanoma in the US Navy . Arch Environ Health. 1990;45: 261-267.Crossref 12. Ainsleigh HG. Beneficial effects of sun exposure on cancer mortality . Prev Med. 1993;22:132-140.Crossref 13. Thompson SC, Jolley D, Marks R. Does regular use of sunscreen reduce the risk of skin cancer in humans: results of a randomized controlled trial of sunscreen in people with solar keratoses in Australia . N Engl J Med. 1993;329: 1147-1151.Crossref 14. Australian Standard 2604-1986 . Sunscreen Products: Evaluation and Classification . Sydney, Australia: Standards Association Australia; 1986. 15. Turnbull H, Trafford DJH, Makin HLJ. A rapid and simple method for the measurement of plasma 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 using Sep-Pak C18 cartridges and a single high performance liquid chromatographic step . Clin Chim Acta. 1982;120:65-76.Crossref 16. Dean B, Kolavcic MS, Wark JD, Harrison LC. Chromatography of serum on Sep-Pak C18 corrects falsely elevated vitamin D metabolite levels measured by protein binding assay . Clin Chim Acta. 1988;176:169-178.Crossref 17. Hollis BW. Assay of circulating 1,25-dihydroxyvitamin D involving a novel singlecartridge extraction and purification procedure . Clin Chem. 1986;32:2060-2063. 18. Reinhardt HA, Horst RL, Orf JW, Hollis BW. A microassay for 1,25-dihydroxyvitamin D not requiring high performance liquid chromatography . J Clin Endocrinol Metab. 1984;22:597-609. 19. Calkins J. Measuring devices and dosage units . In Calkins J, ed. The Role of Solar Ultraviolet Radiation in Marine Ecosystems . New York, NY: Plenum Press; 1982:169-179. 20. Diffey BL. A comparison of dosimeters used for solar ultraviolet radiometry . Photochem Photobiol. 1987;46:55-60.Crossref 21. Clayton D, Hills M. Statistical Models in Epidemiology . Oxford, England: Oxford University Press; 1993. 22. Becker RA, Chambers JM, Wilks AR. The New S Language: A Programming Environment for Data Analysis and Graphics . Pacific Grove, La: Wadsworth; 1988. 23. Pathak MA, Fitzpatrick TB, Greiter FJ, Kraus EW. Principles of photoprotection in sunburn and suntanning, and topical and systemic photoprotection in health and diseases: sunscreens . J Dermatol Surg Oncol. 1985;6:575-579.Crossref 24. Cole CA, Forbes PD, Davies RE. An action spectrum for UV photocarcinogenesis . Photochem Photobiol. 1986;43:275-284.Crossref 25. Poskitt EME, Cole TJ, Lawson DEM. Diet, sunlight and 25-hydroxyvitamin D in healthy children and adults . BMJ. 1979;1:L221-223.Crossref 26. Sheltawy M, Newton H, Hay A, Morgan DB, Hullin RP. The contribution of dietary vitamin D and sunlight to the plasma 25-hydroxyvitamin D in the elderly . Hum Nutr Clin Nutr. 1984;38:191-194. 27. Hill D, White V, Marks R, Theobald T, Borland R, Roy C. Melanoma prevention: behavioral and non-behavioral factors in sunburn among an Australian population . Prev Med. 1992;21:654-669.Crossref 28. Prystowsky JH. Photoprotection and the vitamin D status of the elderly: a concern for dermatologists . Arch Dermatol. 1988;124:1844-1848.Crossref 29. Fine RM. Sunscreens and cutaneous vitamin D synthesis . Int J Dermatol. 1988; 27:300-301.Crossref 30. Garland CF, Garland FC, Gorham ED. Rising trends in melanoma: an hypothesis concerning sunscreen effectiveness . Am J Epidemiol. 1993;3:103-110. 31. Kligman EW, Watkins A, Johnson K, Kronland R. The impact of lifestyle factors on serum 25-hydroxyvitamin D levels in older adults: a preliminary study . Fam Pract Res J. 1989;9:11-19. 32. Loomis WF. Rickets . Sci Am. 1970;223:77-91.Crossref 33. Juttmann JR, Visser TJ, Buurman C, de Kam E, Birkenhager JC. Seasonal fluctuations in serum concentrations of vitamin D metabolites in normal human subjects . BMJ. 1981;282:1349-1352.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Apr 1, 1995

References