Relationship between sun-protection factor and application thickness

in high-performance sunscreen: double application of sunscreen is

recommended
T. Teramura, M. Mizuno, H. Asano, N. Naito, K. Arakane and Y. Miyachi
1
Research Laboratories, KOSE

Corporation, Tokyo, Japan; and

1
Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
doi:10.1111/j.1365-2230.2012.04388.x
Summary Background. High-performance sunscreen protects both healthy consumers and
photosensitive patients from strong ultraviolet (UV) exposure. The sun-protection
factor (SPF), which indicates the efcacy of UV protection, is determined using a
prescribed sunscreen application thickness of 2.0 mg cm
2
. Therefore, users should
apply at least 2.0 mg cm
2
of sunscreen to obtain the level of UV protection expected
from a product. In most cases, however, users apply insufcient amounts of sunscreen.
Aim. To determine the amount of sunscreen applied under specic conditions, and
the relationship between application thickness and SPF value in high-performance
sunscreen.
Methods. The amount of applied sunscreen was calculated under practical
conditions and conditions that directed a double application. The SPF values of high-
performance sunscreen applied at three thicknesses (2.0, 1.0 and 0.5 mg cm
2
) were
determined according to the international SPF testing method.
Results. The relationship between SPF value and application thickness correlated in
a logarithmic curve. The mean application thickness under practical conditions was
approximately 1 mg cm
2
, and directing subjects to use a double application increased
the application thickness to nearly 2 mg cm
2
.
Conclusion. Encouraging a double application of sunscreen will help users apply
products at a thickness sufcient to achieve expected SPF efcacy. We recommend that
guidance on double application of sunscreen should be posted in public locations where
sunscreen is likely to be in use.
Introduction
Exposure to ultraviolet (UV) radiation induces various
skin alterations. Wrinkle formation and melanogene-
sis induced by chronic UV radiation exposure are collec-
tively identied as photoageing.
1
From a pathological
viewpoint, UVradiationmay cause DNAinjury, immuno-
suppression and skin cancer.
2
In some photosensitive
patients, including those with xeroderma pigmentosum
and chronic actinic dermatitis, UV radiation induces
severe skinchanges.
1
UVprotectionis aneffective method
to lower the incidence of skin cancer, prevent adverse
skin reactions in photosensitive patients, and reduce
photoageing. Compared withwearing long-sleeved cloth-
ing and wide-brimmed hats or carrying a parasol,
sunscreen application is considered an effective, unre-
strictive method to protect against UVradiationexposure.
A variety of sunscreen products with efcacies ranging
from low to high can meet the requirements for UV
protection. Among these, high-efcacy products are
recommended to prevent UV-induced skin changes in
Correspondence: Dr Takashi Teramura, Research Laboratories, KOSE

Corporation, 1-18-4 Azusawa, Itabashi-ku, Tokyo 174-0051, Japan

E-mail: t-teramura@kose.co.jp
Conict of interest: TT, MM, HA, NN and KA are employees of KOSE

Corporation, which markets cosmetics containing sunscreen products. YM

has no conicts of interest to declare.
Accepted for publication 26 October 2011
Experimental dermatology Original article CED
Clinical and Experimental Dermatology
The Author(s)
904 CED 2012 British Association of Dermatologists Clinical and Experimental Dermatology, 37, 904908
healthy consumers participating in leisure activities, and
in photosensitive patients managing their daily UV
radiation exposure.
The SPF of a sunscreen is widely recognized by the
general public as an index for the efcacy of UV
protection, and consumers and patients select suitable
products by referencing SPF. Displayed using integral
numbers, SPF is determined by measuring the erythemal
response of human skin after UV radiation exposure.
3
SPF determination and evaluation of UV protection are
carried out under a prescribed sunscreen application
thickness of 2.0 mg cm
2
in the international SPF testing
method.
3
Previous studies
48
have shown that the
thickness of sunscreen applied by consumers is
< 2.0 mg cm
2
, and in products with an SPFs between
4 and 30, the SPF value reduced exponentially
911
or
linearly,
12
depending on the applied quantity. These
studies did not reveal the relationship between applica-
tion thickness and SPF value in high-performance
products. The Japanese Ministry of the Environment
recommends applying sunscreen twice (a so-called
double application) to ensure that an adequate thickness
is used.
13
Although double application is thought to be
an effective method to achieve the expected level of UV
protection, no study has provided evidence of the
relationship between the thickness applied in double
applications and the resulting SPF value.
In this study, we sought to determine the level of UV
protection achieved under practical conditions by
measuring the application thickness of sunscreen and
evaluating the SPF value of products when they were
applied twice. We also aimed to determine the relation-
ship between SPF value and application thickness in
high-SPF sunscreen. Our study provides guidance for
obtaining the level of UV protection expected from
high-efcacy sunscreen.
Methods
This study was performed according to the principles of
the Declaration of Helsinki, and approved by the ethics
board of KOSE

Corporation.
Sunscreen
A high-performance, oil-in-water emulsion sunscreen
with an SPF of 50 was used in this study. This
sunscreen contains the following UV lter combination:
zinc oxide, ethylhexyl methoxycinnamate, bis-ethyl-
hexyloxyphenol methoxyphenyl triazine, methylene
bis-benzotriazolyl tetramethylbutylphenol and diet-
hylaminohydroxybenzoyl hexyl benzoate.
Subjects and determination of application thickness
In total, 23 healthy Japanese (17 men, 6 women;
mean SD age 32.2 6.3 years, range 2653)
enrolled in the study. The difference in sunscreen
weight before and after application to the face or
forearm of each subject was calculated to obtain the
thickness applied under practical conditions. For the
evaluation of double application, subjects were in-
structed simply to use the sunscreen twice, and the
thickness used for each application was estimated
separately.
Sun-protection factor testing
SPF testing was carried out according to the interna-
tional SPF testing method.
3
For this portion of the
study, 13 healthy volunteers (5 men, 8 women;
mean 39.8 13.5 years, range 2358), with skin types
I, II or III according to the Fitzpatrick classication, were
recruited for this portion of the study. Assessment of
product application, UV exposure and minimal ery-
thema dose (MED) was performed at ambient temper-
atures (1826 C). MED was dened as the lowest dose
of UV light irradiation sufcient to produce the rst
unambiguous perceptible erythema with dened borders
over most of the eld of exposure. The exposure sites
were evaluated for MED within 1624 h after irradia-
tion. SPF testing was performed in a side-by-side study.
SPF for the sample was dened as the ratio of MED on
unprotected skin (MED
u
) to MED on sunscreen-protected
skin (MED
p
), hence SPF = MED
p
MED
u
.
Results
Thickness of sunscreen applied under practical
conditions
The average thickness of sunscreen applied to the face
and forearm under practical conditions was 1.17
0.43 mg cm
2
and 1.22 0.37 mg cm
2
, respectively
(Fig. 1). The individual application thickness varied
from 0.27 to 1.75 mg cm
2
on the face, and from 0.42
to 1.74 mg cm
2
on the forearm (Fig. 1).
Relationship between sun-protection factor value and
sunscreen-application thickness
To determine the relationship between SPF value and
the thickness of sunscreen applied, we evaluated the
SPF value of sunscreens applied at various thicknesses.
The mean SPF values of the various applied thicknesses
The Author(s)
CED 2012 British Association of Dermatologists Clinical and Experimental Dermatology, 37, 904908 905
Double application of sunscreen is recommended to achieve the desired SPF T. Teramura et al.
were 53.8 5.5 for 2.0 mg cm
2
, 44.7 3.4 for
1.0 mg cm
2
and 33.6 3.8 for 0.5 mg cm
2
(Fig. 2),
giving a percentage SPF value of 83% at 1.0 mg cm
2
and 63% at 0.5 mg cm
2
compared with 100% at
2.0 mg cm
2
. The SPF value decreased moderately in an
application dose-dependent manner. Mathematically,
the relationship tted a logarithmic curve of y = 14.55
log(x) + 44 (R
2
= 1.00) rather than a linear regression
of y = 12.82x + 29 (R
2
= 0.94).
Thickness of sunscreen applied under
double-application conditions
When subjects were instructed to use a double applica-
tion to the face, the thicknesses for the rst and second
applications averaged 1.27 0.47 mg cm
2
and
0.74 0.27 mg cm
2
, respectively, and the total thick-
ness applied was 2.01 0.66 mg cm
2
(Fig. 3). The
increased thickness of the double application was
signicant compared with that of the practical condition
(P < 0.05).
Sun-protection factor values of different application
thicknesses and frequencies
To determine the differences in SPF value between a
single and a double application of sunscreen, we
investigated the SPF values that resulted from various
application procedures. The following SPF values were
obtained: SPF was 53.8 5.53 for a single application
of 2.0 mg cm
2
, 56.8 5.74 for double applications of
1.0 mg cm
2
with a 15-min interval between the rst
and second application, and 55.7 4.98 for double
applications of 1.0 mg cm
2
without an application
interval. There was no signicant difference in SPF
between these applications. Similarly, the difference
between the two application methods to achieve
1.0 mg cm
2
was not signicant: SPF was 44.7
3.44 for a single application of 1.0 mg cm
2
and
46.6 8.41 for double applications of 0.5 mg cm
2
(Table 1). No signicant differences were observed in
SPF values achieved with either single or double
applications, which resulted in the total quantity applied
being 1.0 mg cm
2
and 2.0 mg cm
2
, respectively.
Figure 1 Thickness of sunscreen applied under in normal practice
to the face to the face (closed circles) and forearm (open circles)
was measured. Horizontal dashed line indicates average amount
applied. Statistical errors are indicated as SD.
Figure 2 Relationship between sun-protection factor (SPF) and
amount of sunscreen applied. Sunscreen was applied in varying
amounts (0.5, 1.0 and 2.0 mg cm
2
), and the data were mathe-
matically tted to a logarithmic curve of y = 14.55 log(x) + 44
(R
2
= 1.0). Statistical errors are indicated as SD.
Figure 3 Thickness of sunscreen applied on the face under double-
application conditions. The amounts of sunscreen applied during
two separate applications were measured separately, and the
sum calculated as the total application. Statistical errors are
indicated as SD.
The Author(s)
906 CED 2012 British Association of Dermatologists Clinical and Experimental Dermatology, 37, 904908
Double application of sunscreen is recommended to achieve the desired SPF T. Teramura et al.
Discussion
High-efcacy sunscreen is widely used by both healthy
consumers and photosensitive patients to prevent UV-
induced skin changes. Although previous reports have
indicated that insufcient amounts of sunscreen are
often applied under practical conditions,
48
methods for
applying sunscreen in amounts adequate to achieve the
expected level of protection have not been conrmed,
and the relationship between application thickness and
SPF value in high-SPF products has not been estab-
lished. In this study, we had two important ndings.
Firstly, double application ensures that the thickness of
sunscreen applied is close to that used during SPF
determination, which should contribute to the develop-
ment of strategies for effective sunscreen use in normal
practice. Secondly, the SPF value of a high-efcacy
product decreased logarithmically with the decrease in
the thickness of the applied sunscreen.
Studies of sunscreen application under practical
conditions have shown that the thickness applied
(measured at 0.391.3 mg cm
2
) may provide consid-
erably less protection compared with the 2.0 mg cm
2
thickness used to determine the reported SPF.
48
In this
study, our results revealed that the mean application
thickness under in normal practice was approximately
1 mg cm
2
on the face and forearm, which is only 50%
of the thickness required to reach the expected efcacy
(2.0 mg cm
2
). Bimczok et al.
12
concluded that a thick-
ness of at least 2.0 mg cm
2
was necessary to achieve
good reproducibility of SPF measurement with the
lowest condence interval.
The relationship between SPF and application thick-
ness has been determined in previous studies using
products of SPF 4 to SPF 30; these reported a strong
reduction in SPF when application thickness was
decreased.
912
No study to date has investigated the
relationship between SPF and the applied thickness of
high-performance sunscreens, thus to our knowledge,
this study is the rst to evaluate the relationship
between SPF and application thickness using a product
with a high SPF. Such data are informative for users,
who expect sunscreens to be efcacious. Our results
(Fig. 2) suggest that SPF values were not reduced
by 50% even when subjects applied only 50% of
the prescribed thickness of sunscreen. The ndings of
the present study and previous reports indicate that the
relationship between thickness of application and SPF
value has an exponential correlation in low-SPF prod-
ucts,
911
a linear correlation in products with an SPF of
around 30,
12
and a logarithmic correlation in products
with an SPF of around 50 (Fig. 2). These results indicate
that the relationship between SPF and application
thickness changes depending on the SPF range. This
effect is presumably due to a gradual plateau effect of UV
absorbers, which are present in large amounts in high-
SPF sunscreens.
The most important aspect in achieving the expected
efcacy of sunscreen is the thickness of application,
because applications of less than the prescribed amount
result in a decrease in SPF value, as outlined above. In
the present study, we determined whether applying
sunscreen twice (double application), as the Ministry of
the Environment of Japan recommends, is an effective
method for users to achieve the expected sunscreen
efcacy.
13
Our results (Fig. 3) show that double appli-
cation does ensure that the thickness applied reaches
nearly 2 mg cm
2
, the level at which expected SPF
efcacy is reached. The same results were seen with
other formulations (data not shown). Furthermore, no
signicant differences in SPF values were observed for
single applications of 2.0 mg cm
2
or double applica-
tions of 1.0 mg cm
2
, and the interval between appli-
cations had no effect on SPF value. In other words, SPF
value depends on the total amount of applied sunscreen,
irrespective of application frequency.
Double application is an effective and practical
solution for the problem of inadequate application of
sunscreen under practical conditions. Therefore, we
strongly recommend that directions for double applica-
tion of sunscreen should be posted at public locations
where these products are likely to be in use to raise
awareness about the importance of adequate sunscreen
application and to provide guidance for applying the
optimum thickness.
Conclusion
In this study, we have conrmed the usefulness of
double-application directions for reminding users to
apply sunscreen at thicknesses adequate to achieve the
expected UV protection. This method of sunscreen
application helps both ordinary consumers and
Table 1 Sun protection factor (SPF) values of various sunscreen
application amounts and frequencies.
Total application
amount
(mg cm
2
)
Application
amount (mg cm
2
)
and frequency
Interval
between
applications
SPF value
[mean (SD)]
2.0 2.0, once 53.8 (5.5)
2.0 1.0, twice None 56.8 (5.7)
2.0 1.0, twice 15 min 55.7 (5.0)
1.0 1.0, once 44.7 (3.4)
1.0 0.5, twice None 46.6 (8.4)
The Author(s)
CED 2012 British Association of Dermatologists Clinical and Experimental Dermatology, 37, 904908 907
Double application of sunscreen is recommended to achieve the desired SPF T. Teramura et al.
photosensitive patients maximize the SPF efcacy of
sunscreen, thereby reducing the incidence of UV-related
skin changes and other damage.
Acknowledgements
We thank Dr T. Ogihara, Dr K. Kameyama, Dr T.
Masunaga and Dr M. Nakanishi, of the Kose Corpora-
tion, for helpful suggestions.
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The Author(s)
908 CED 2012 British Association of Dermatologists Clinical and Experimental Dermatology, 37, 904908
Double application of sunscreen is recommended to achieve the desired SPF T. Teramura et al.
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