In a recent New York Times article, Dr. Michael F. Holick, a Professor of Dermatology, Biophysics and Physiology at Boston University Medical Center, conveyed “his enthusiasm for his favorite hormone, vitamin D.”1 Dr. Holick, who posed in a tanning bed for an interview with USA Today,2 has studied the effects of vitamin D for 30 years and has been instrumental in studying the role of vitamin D in multiple diseases. He has also been very vocal regarding the relationship between vitamin D and sunscreen, leading him on a “new crusade, encouraging people to let some sun shine on their skin and, thus, some vitamin D into their systems, a controversial idea in some corners of the dermatology world.”1
Studies Suggesting that Sunscreen Decreases Vitamin D Production
There is some evidence that sunscreen decreases vitamin D production.
Matsuoka et al studied the effect application of 5% para-aminobenzoic acid (PABA; sun protection factor 8) has on cutaneous vitamin D3 production.3 Eight subjects, four with PABA and four without PABA application, were exposed to one minimal erythema dose of UV radiation. The mean serum vitamin D3 concentration increased from 1.5 +/- 1.0 (+/- SEM) to 25.6 +/- 6.7 ng/ml in subjects who did not apply PABA, and decreased from 5.6 +/- 3.0 to 4.4 +/- 2.4 ng/ml in subjects who applied PABA. The authors concluded that PABA “prevented the photoisomerization of 7-dehydrocholesterol to previtamin D3.” To the authors, “these results indicated that the sunscreen interfered with the cutaneous production of vitamin D3.”
Querings et al evaluated levels of vitamin D in 31 renal transplant patients with age- and gender-matched controls.4 Average levels of vitamin D in transplant patients were 10.9 ng/ml compared with 20.0 ng/ml in controls (p=0.007). While the authors acknowledged that post-transplant physiology puts this patient population at risk for vitamin D deficiency, they also cited that sunscreen may play a role in the deficiency since these patients are strongly encouraged to use sunscreen.
To us, this seems like a stretch, since practicing dermatologists know how difficult it is to get patients to use sunscreen on a regular basis.
No Significant Decrease
However, other clinical trials have not found that the use of sun protection led to a significant decrease in levels of vitamin D.
Marks et al evaluated 126 patients with at least one solar keratosis over 7 months.5 Patients were randomized to receive either SPF-17 sunscreen or placebo cream. All patients were advised to avoid mid-day sunlight, to wear large hats and to practice other general sun avoidance measures. Partway through the study, the 25-hydroxyvitamin D3 levels of 11 of the patients decreased below reference range for the study, including four patients in the treatment group and seven patients in the placebo group. By the end of the study, only two patients — both in the placebo group — remained below reference range.
Sunscreens and Bone Density
Very little data exists on the relationship between sunscreen use and bone density. Farrerons et al evaluated 10 sunscreen users (SPF 15) and 18 control patients over 2 years. Bone mass index was followed four times per year, and in the end it was found that there was no significant bone loss in any of the participants, and no discrepancy was found between the groups.6
More Realistic Studies Needed
The current literature provides no definitive evidence that sun protection leads to depletion in vitamin D. We do, however, have evidence that exposure to ultraviolet rays increases one’s risk of cutaneous malignancies.
We are not suggesting that vitamin D deficiency is uncommon or should be taken lightly. But methods other than exposure to mid-day ultraviolet radiation, such as vitamin D supplements and a balanced diet, can be used to increase one’s vitamin D levels. It is also evident that more studies are needed, specifically studies that examine vitamin D production and sunscreen use the way patients actually use sunscreen in the real world.
In a recent New York Times article, Dr. Michael F. Holick, a Professor of Dermatology, Biophysics and Physiology at Boston University Medical Center, conveyed “his enthusiasm for his favorite hormone, vitamin D.”1 Dr. Holick, who posed in a tanning bed for an interview with USA Today,2 has studied the effects of vitamin D for 30 years and has been instrumental in studying the role of vitamin D in multiple diseases. He has also been very vocal regarding the relationship between vitamin D and sunscreen, leading him on a “new crusade, encouraging people to let some sun shine on their skin and, thus, some vitamin D into their systems, a controversial idea in some corners of the dermatology world.”1
Studies Suggesting that Sunscreen Decreases Vitamin D Production
There is some evidence that sunscreen decreases vitamin D production.
Matsuoka et al studied the effect application of 5% para-aminobenzoic acid (PABA; sun protection factor 8) has on cutaneous vitamin D3 production.3 Eight subjects, four with PABA and four without PABA application, were exposed to one minimal erythema dose of UV radiation. The mean serum vitamin D3 concentration increased from 1.5 +/- 1.0 (+/- SEM) to 25.6 +/- 6.7 ng/ml in subjects who did not apply PABA, and decreased from 5.6 +/- 3.0 to 4.4 +/- 2.4 ng/ml in subjects who applied PABA. The authors concluded that PABA “prevented the photoisomerization of 7-dehydrocholesterol to previtamin D3.” To the authors, “these results indicated that the sunscreen interfered with the cutaneous production of vitamin D3.”
Querings et al evaluated levels of vitamin D in 31 renal transplant patients with age- and gender-matched controls.4 Average levels of vitamin D in transplant patients were 10.9 ng/ml compared with 20.0 ng/ml in controls (p=0.007). While the authors acknowledged that post-transplant physiology puts this patient population at risk for vitamin D deficiency, they also cited that sunscreen may play a role in the deficiency since these patients are strongly encouraged to use sunscreen.
To us, this seems like a stretch, since practicing dermatologists know how difficult it is to get patients to use sunscreen on a regular basis.
No Significant Decrease
However, other clinical trials have not found that the use of sun protection led to a significant decrease in levels of vitamin D.
Marks et al evaluated 126 patients with at least one solar keratosis over 7 months.5 Patients were randomized to receive either SPF-17 sunscreen or placebo cream. All patients were advised to avoid mid-day sunlight, to wear large hats and to practice other general sun avoidance measures. Partway through the study, the 25-hydroxyvitamin D3 levels of 11 of the patients decreased below reference range for the study, including four patients in the treatment group and seven patients in the placebo group. By the end of the study, only two patients — both in the placebo group — remained below reference range.
Sunscreens and Bone Density
Very little data exists on the relationship between sunscreen use and bone density. Farrerons et al evaluated 10 sunscreen users (SPF 15) and 18 control patients over 2 years. Bone mass index was followed four times per year, and in the end it was found that there was no significant bone loss in any of the participants, and no discrepancy was found between the groups.6
More Realistic Studies Needed
The current literature provides no definitive evidence that sun protection leads to depletion in vitamin D. We do, however, have evidence that exposure to ultraviolet rays increases one’s risk of cutaneous malignancies.
We are not suggesting that vitamin D deficiency is uncommon or should be taken lightly. But methods other than exposure to mid-day ultraviolet radiation, such as vitamin D supplements and a balanced diet, can be used to increase one’s vitamin D levels. It is also evident that more studies are needed, specifically studies that examine vitamin D production and sunscreen use the way patients actually use sunscreen in the real world.
In a recent New York Times article, Dr. Michael F. Holick, a Professor of Dermatology, Biophysics and Physiology at Boston University Medical Center, conveyed “his enthusiasm for his favorite hormone, vitamin D.”1 Dr. Holick, who posed in a tanning bed for an interview with USA Today,2 has studied the effects of vitamin D for 30 years and has been instrumental in studying the role of vitamin D in multiple diseases. He has also been very vocal regarding the relationship between vitamin D and sunscreen, leading him on a “new crusade, encouraging people to let some sun shine on their skin and, thus, some vitamin D into their systems, a controversial idea in some corners of the dermatology world.”1
Studies Suggesting that Sunscreen Decreases Vitamin D Production
There is some evidence that sunscreen decreases vitamin D production.
Matsuoka et al studied the effect application of 5% para-aminobenzoic acid (PABA; sun protection factor 8) has on cutaneous vitamin D3 production.3 Eight subjects, four with PABA and four without PABA application, were exposed to one minimal erythema dose of UV radiation. The mean serum vitamin D3 concentration increased from 1.5 +/- 1.0 (+/- SEM) to 25.6 +/- 6.7 ng/ml in subjects who did not apply PABA, and decreased from 5.6 +/- 3.0 to 4.4 +/- 2.4 ng/ml in subjects who applied PABA. The authors concluded that PABA “prevented the photoisomerization of 7-dehydrocholesterol to previtamin D3.” To the authors, “these results indicated that the sunscreen interfered with the cutaneous production of vitamin D3.”
Querings et al evaluated levels of vitamin D in 31 renal transplant patients with age- and gender-matched controls.4 Average levels of vitamin D in transplant patients were 10.9 ng/ml compared with 20.0 ng/ml in controls (p=0.007). While the authors acknowledged that post-transplant physiology puts this patient population at risk for vitamin D deficiency, they also cited that sunscreen may play a role in the deficiency since these patients are strongly encouraged to use sunscreen.
To us, this seems like a stretch, since practicing dermatologists know how difficult it is to get patients to use sunscreen on a regular basis.
No Significant Decrease
However, other clinical trials have not found that the use of sun protection led to a significant decrease in levels of vitamin D.
Marks et al evaluated 126 patients with at least one solar keratosis over 7 months.5 Patients were randomized to receive either SPF-17 sunscreen or placebo cream. All patients were advised to avoid mid-day sunlight, to wear large hats and to practice other general sun avoidance measures. Partway through the study, the 25-hydroxyvitamin D3 levels of 11 of the patients decreased below reference range for the study, including four patients in the treatment group and seven patients in the placebo group. By the end of the study, only two patients — both in the placebo group — remained below reference range.
Sunscreens and Bone Density
Very little data exists on the relationship between sunscreen use and bone density. Farrerons et al evaluated 10 sunscreen users (SPF 15) and 18 control patients over 2 years. Bone mass index was followed four times per year, and in the end it was found that there was no significant bone loss in any of the participants, and no discrepancy was found between the groups.6
More Realistic Studies Needed
The current literature provides no definitive evidence that sun protection leads to depletion in vitamin D. We do, however, have evidence that exposure to ultraviolet rays increases one’s risk of cutaneous malignancies.
We are not suggesting that vitamin D deficiency is uncommon or should be taken lightly. But methods other than exposure to mid-day ultraviolet radiation, such as vitamin D supplements and a balanced diet, can be used to increase one’s vitamin D levels. It is also evident that more studies are needed, specifically studies that examine vitamin D production and sunscreen use the way patients actually use sunscreen in the real world.
