Sunscreens and camouflagers

13.8 Sunscreens and camouflagers

Borderline substances The preparations marked ‘ACBS’ are regarded as drugs when prescribed for skin

13.8.1 Sunscreen preparations

protection against ultraviolet radiation in abnormal

13.8.2 Camouflagers

cutaneous photosensitivity resulting from genetic dis- orders or photodermatoses, including vitiligo and those resulting from radiotherapy; chronic or recurrent herpes simplex labialis. Preparations with SPF less than 30

13.8.1 should not normally be prescribed. See also Appendix 7. Sunscreen preparations

Delph (Fenton)

Solar ultraviolet irradiation can be harmful to the skin. It Lotion , (UVA and UVB protection; UVB-SPF 30), avoben- is responsible for disorders such as polymorphic light

zone 4%, octinoxate 4.8%, oxybenzone 1.5%, titanium dioxide 2.5%, net price 200 mL = £3.53. ACBS

eruption, solar urticaria , and it provokes the various

Excipients include cetostearyl alcohol, fragrance, hydroxybenzoates

cutaneous porphyrias . It also provokes (or at least aggra-

(parabens), imidurea

vates) skin lesions of lupus erythematosus and may aggravate rosacea and some other dermatoses. Certain

E45 Sun (Crookes) drugs, such as demeclocycline, phenothiazines, or amio-

Reflective Sunscreen (UVA and UVB protection; UVB-SPF darone, can cause photosensitivity. All these conditions

50), waterproof, titanium dioxide 6.4%, zinc oxide 16%, net price 150 mL = £7.09. ACBS

(as well as sunburn) may occur after relatively short

Excipients include hydroxybenzoates (parabens), isopropyl palmitate

periods of exposure to the sun. Solar ultraviolet irradia- tion may provoke attacks of recurrent herpes labialis

SpectraBan Skin (Stiefel)

(but it is not known whether the effect of sunlight Ultra lotion (UVA and UVB protection; UVB-SPF 28), water exposure is local or systemic).

resistant, avobenzone 2%, oxybenzone 3%, padimate-O 8%,

13 The effects of exposure over longer periods include

Excipients titanium dioxide 2%, net price 150 mL = £6.54. ACBS include benzyl alcohol, disodium edetate, sorbic acid, fra- ageing changes and more importantly the initiation of

grance

skin cancer . Solar ultraviolet radiation is approximately 200–400 nm

Sunsense Ultra (Crawford) Lotion (UVA and UVB protection; UVB-SPF 60), octinoxate in wavelength. The medium wavelengths (290–320 nm,

7.5% oxybenzone 3%, titanium dioxide 3.5%, net price 50- known as UVB) cause sunburn. The long wavelengths

mL bottle with roll-on applicator = £3.11, 125 mL = £5.10. (320–400 nm, known as UVA) are responsible for many

Excipients ACBS include butylated hydroxytoluene, cetyl alcohol, fragrance, photosensitivity reactions and photodermatoses. Both UVA

hydroxybenzoates (parabens), propylene glycol

and UVB contribute to long-term photodamage and to the changes responsible for skin cancer and ageing.

Uvistat (LPC)

Sunscreen preparations contain substances that protect Cream (UVA and UVB protection; UVB-SPF 30), avoben- the skin against UVA and UVB radiation, but they are no

zone 5%, bisoctrizole 1.5%, octinoxate 7.5%, octrocrilene 4%, titanium dioxide 5.2%, net price 125 mL = £7.45. ACBS

substitute for covering the skin and avoiding sunlight.

Excipients include disodium edetate, hydroxybenzoates (parabens),

The sun protection factor (SPF, usually indicated in the

propylene glycol

preparation title) provides guidance on the degree of Cream (UVA and UVB protection; UVB-SPF 50), amiloxate protection offered against UVB; it indicates the multi-

2%, avobenzone 5%, bisoctrizole 6%, octinoxate 10%, ples of protection provided against burning, compared

octrocrilene 4%, titanium dioxide 4.8%, net price 125 mL = £8.45. ACBS

with unprotected skin; for example, an SPF of 8 should

Excipients include disodium edetate, polysorbate 60, propylene glycol

enable a person to remain 8 times longer in the sun Lipscreen (UVA and UVB protection; UVB-SPF 50), avo- without burning. However, in practice, users do not

benzone 5%, bemotrizinol 3%, octinoxate 10%, octocrilene apply sufficient sunscreen product and the protection

Excipients 4%, titanium dioxide 3%, net price 5 g = £2.99. ACBS include butylated hydroxytoluene, hydroxybenzoates (para- is lower than that found in experimental studies.

bens)

BNF 57

13.8.2 Camouflagers 645

Photodamage

13.8.2 Camouflagers

Patients should be advised to use a high-SPF sunscreen and to minimise exposure of the skin to direct sunlight

Disfigurement of the skin can be very distressing to or sun lamps.

patients and may have a marked psychological effect. In Topical treatments are used for non-hypertrophic actinic

skilled hands, or with experience, camouflage cosmetics keratosis . An emollient may be sufficient for mild

can be very effective in concealing scars and birth- lesions. Diclofenac gel is suitable for the treatment of

marks. The depigmented patches in vitiligo are also superficial lesions in mild disease. Fluorouracil cream is

very disfiguring and camouflage creams are of great effective against most types of non-hypertrophic actinic

cosmetic value.

keratosis. Imiquimod (section 13.7) is used for lesions on the face and scalp when cryotherapy or other topical

Borderline substances The preparations marked treatments cannot be used. Fluorouracil and imiquimod

‘ACBS’ are regarded as drugs when prescribed for post- produce a more marked inflammatory reaction than

operative scars and other deformities and as an adjunc- diclofenac but lesions resolve faster. Photodynamic

tive therapy in the relief of emotional disturbances due therapy in combination with methyl-5-aminolevulinate

to disfiguring skin disease, such as vitiligo. See also cream (Metvix c , available from Galderma) is used in

Appendix 7.

specialist centres for treating superficial and confluent, Covermark (Skin Camouflage Co.) non-hypertrophic actinic keratosis when other treat-

Classic foundation (masking cream), net price 15 mL (10 ments are inadequate or unsuitable; it is particularly

shades) = £10.75. ACBS suitable for multiple lesions, for periorbital lesions, or for

Excipients include beeswax, hydroxybenzoates (parabens), fragrance

lesions located at sites of poor healing.

Finishing powder Excipients include beeswax, hydroxybenzoates (parabens), fragrance , net price 60 g = £11.32. ACBS Imiquimod or topical fluorouracil is used for treating

Dermacolor (Fox)

superficial basal cell carcinomas. Photodynamic therapy Camouflage creme , (100 shades), net price 25 g = £9.05. in combination with methyl-5-aminolevulinate cream is

ACBS

used in specialist centres for treating superficial, nodular

Excipients include beeswax, butylated hydroxytoluene, fragrance, pro-

basal cell carcinomas when other treatments are unsui-

pylene glycol, stearyl alcohol, wool fat

table. Fixing powder , (7 shades), net price 60 g = £7.68. ACBS Excipients include fragrance

Keromask (Network)

DICLOFENAC SODIUM

Masking cream , (2 shades), net price 15 mL = £5.67. ACBS Excipients include butylated hydroxyanisole, hydroxybenzoates (para-

Indications actinic keratosis

bens), wool fat, propylene glycol

Cautions as for topical NSAIDs, see section 10.3.2 Finishing powder , net price 20 g = £5.67. ACBS Contra-indications

Excipients as for topical NSAIDs, see section include butylated hydroxytoluene, hydroxybenzoates (para-

bens)

10.3.2 Side-effects

Veil (Blake)

as for topical NSAIDs, see section 10.3.2; Cover cream , (27 shades), net price 19 g = £15.71, 44 g = also paraesthesia; application of large amounts may

£23.36, 70 g = £29.49. ACBS result in systemic effects, see section 10.1

Excipients include hydroxybenzoates (parabens), wool fat derivative

Finishing powder Excipients include butylated hydroxyanisole, hydroxybenzoates (para- , translucent, net price 35 g = £17.23. ACBS . Apply thinly twice daily for 60–90 days; max. 8 g daily

Dose

bens)

Solaraze c (Almirall) A Gel , diclofenac sodium 3% in a sodium hyaluronate basis, net price 50 g = £33.30 Excipients include benzyl alcohol