Sunscreen compliance with American Academy of Dermatology recommendations: A 2022 update and cross-sectional study

To the Editor: In 2014, 2017, and 2020, Yazdani Abyaneh et al,1Yazdani Abyaneh M.A. Griffith R.D. Falto-Aizpurua L. Nouri K. Evaluation of sunscreens distributed by 2 major US retailers for meeting recommendations by the American Academy of Dermatology.J Am Acad Dermatol. 2014; 71: 1011-1012Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Eber et al,2Eber A.E. Walocko F.M. Tsatalis J. et al.Update on sunscreens distributed by major US retailers that meet American Academy of Dermatology recommendations.J Am Acad Dermatol. 2017; 77: 377-379Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar and Zheng et al3Zheng C. Choragudi S. Akhtar S. Rajabi-Estarabadi A. Nouri K. 2020 update on sunscreen compliance with American Academy of Dermatology recommendations.J Am Acad Dermatol. 2021; 84: 1174-1175Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar assessed sunscreen products sold at Walmart and Walgreens for their compliance with American Academy of Dermatology (AAD) recommendations (broad-spectrum protection, water resistance for 40 to 80 minutes, and a sun protection factor [SPF] of at least 30).4American Academy of DermatologyHow to select a sunscreen.https://www.aad.org/public/everyday-care/sun-protection/sunscreen/how-to-select-sunscreenDate accessed: March 20, 2022Google Scholar In 2020, Zheng et al3Zheng C. Choragudi S. Akhtar S. Rajabi-Estarabadi A. Nouri K. 2020 update on sunscreen compliance with American Academy of Dermatology recommendations.J Am Acad Dermatol. 2021; 84: 1174-1175Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar found that 91.1% of sunscreens distributed by Walmart and 92.1% of those by Walgreens met all 3 AAD recommendations.3Zheng C. Choragudi S. Akhtar S. Rajabi-Estarabadi A. Nouri K. 2020 update on sunscreen compliance with American Academy of Dermatology recommendations.J Am Acad Dermatol. 2021; 84: 1174-1175Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar However, tanning or bronzing sunscreens showed decreased compliance by 20% and 57.1% at Walmart and Walgreens, respectively. In 2021, the Food and Drug Administration proposed regulatory changes on sunscreen labeling to ensure the safety and efficacy of over-the-counter sunscreens. Our study expands upon previous work to assess compliance with AAD recommendations in products available at Walmart and Walgreens, in addition to those available at 2 beauty-focused retailers, Ulta and Sephora, considering they are among the largest beauty retailers in the United States with a revenue of over 1.7 billion US dollars in online sales in 2020. We analyzed sunscreen products sold by Walmart, Walgreens, Ulta, and Sephora. We used a similar methodology as Yazdani Abyaneh et al1Yazdani Abyaneh M.A. Griffith R.D. Falto-Aizpurua L. Nouri K. Evaluation of sunscreens distributed by 2 major US retailers for meeting recommendations by the American Academy of Dermatology.J Am Acad Dermatol. 2014; 71: 1011-1012Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar: Ulta>“skincare”>“suncare”>“sunscreen”; Sephora>“skincare”>“sunscreen”; Walmart>“personal care”>“sun care”>“sunscreen”; Walgreens>“personal care”>“sun care”>“shop sun care”>“shop all sun care.”1Yazdani Abyaneh M.A. Griffith R.D. Falto-Aizpurua L. Nouri K. Evaluation of sunscreens distributed by 2 major US retailers for meeting recommendations by the American Academy of Dermatology.J Am Acad Dermatol. 2014; 71: 1011-1012Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Those labeled “lip balm” or “moisturizer,” lacking an SPF value on the label, cosmetic products with sunscreen or without a main packaging label, were excluded. A total of 229 Ulta and 178 Sephora products were reviewed. After accounting for repetition, 138 and 77 products from Ulta and Sephora, respectively, were included for analysis (Table I). A total of 374 products from Walmart and 633 from Walgreens were reviewed, with 258 and 282, respectively, included for analysis (Table I). 100% of those evaluated from Ulta and Sephora offered broad-spectrum protection, with 96.4% and 98.7% of products having an SPF ≥30, respectively. Of all the sunscreen products examined, 65.5% of Ulta and 42.9% of Sephora products met all 3 recommendations delineated by the AAD.Table IProportion of sunscreen products meeting American Academy of Dermatology recommendations in 2022ProductsUlta, n (%)Sephora, n (%)P value (Ulta vs Sephora)Walmart, n (%)Walgreens, n (%)P value Walmart (2022 vs 2020)P value Walgreens (2022 vs 2020)Total search hits229178374633Products evaluated13877258282Products with SPF ≥30133 (96.4)76 (98.7).32225 (87.2)269 (95.4).01∗Statistical significance determined as P < .05 with χ2 test..06Products with broad-spectrum coverage138 (100)77 (100)1†Value determined using P < .05 with Fisher’s exact test.250 (96.9)282 (100).471†Value determined using P < .05 with Fisher’s exact test.Products with water resistance (40-80 min)95 (68.8)33 (42.9).0002∗Statistical significance determined as P < .05 with χ2 test.230 (89)270 (95.7).0004∗Statistical significance determined as P < .05 with χ2 test..04∗Statistical significance determined as P < .05 with χ2 test.Products meeting all 3 AAD recommendations91 (65.9)33 (42.9).001∗Statistical significance determined as P < .05 with χ2 test.197 (76.4)259 (91.8)< .00001∗Statistical significance determined as P < .05 with χ2 test..94AAD, American Academy of Dermatology; SPF, sun protection factor.∗ Statistical significance determined as P < .05 with χ2 test.† Value determined using P < .05 with Fisher’s exact test. Open table in a new tab AAD, American Academy of Dermatology; SPF, sun protection factor. Approximately 87.2% of Walmart and 95.4% of Walgreens sunscreen products provided an SPF ≥30, with 96.9% and 100% offering broad-spectrum protection, respectively. Of the sunscreens examined, 76.4% of those distributed by Walmart and 91.8% from Walgreens met all 3 AAD recommendations. The 2 bronzing products reviewed from Ulta adhered to all 3 AAD recommendations. Of the bronzing products evaluated at Walmart and Walgreens, only 9.1% and 37.5% met all 3 AAD recommendations (Table II).Table IIComparison of sunscreens with and without tanning and bronzing advertised in compliance with American Academy of Dermatology recommendationsCategorySunscreens with tanning or bronzing on primary display, n (%)Sunscreens without tanning or bronzing on primary display, n (%)P valueUltaTotal no. of products2136Products with SPF ≥302 (100)131 (96.3)1†Value determined using P < .05 with Fisher’s exact test.Products with broad-spectrum coverage2 (100)136 (100)1†Value determined using P < .05 with Fisher’s exact test.Products with water resistance (40-80 min)2 (100)93 (68.4)1†Value determined using P < .05 with Fisher’s exact test.Products meeting all 3 AAD recommendations2 (100)89 (65.4).55†Value determined using P < .05 with Fisher’s exact test.WalmartTotal no. of products22236Products with SPF ≥303 (13.6)222 (94.1)< .00001∗Statistical significance determined as P < .05 with χ2 test.Products with broad-spectrum coverage15 (68.2)235 (99.6)< .00001∗Statistical significance determined as P < .05 with χ2 test.Products with water resistance (40-80 min)22 (100)208 (88.1).14†Value determined using P < .05 with Fisher’s exact test.Products meeting all 3 AAD recommendations2 (9.1)195 (82.6)< .00001∗Statistical significance determined as P < .05 with χ2 test.WalgreensTotal no. of products8274Products with SPF ≥303 (37.5)266 (97)< .00001∗Statistical significance determined as P < .05 with χ2 test.Products with broad-spectrum coverage8 (100)274 (100)1†Value determined using P < .05 with Fisher’s exact test.Products with water resistance (40-80 min)7 (87.5)263 (96).24Products meeting all 3 AAD recommendations3 (37.5)256 (93.4)< .00001∗Statistical significance determined as P < .05 with χ2 test.AAD, American Academy of Dermatology; SPF, sun protection factor.∗ Statistical significance determined as P < .05 with χ2 test.† Value determined using P < .05 with Fisher’s exact test. Open table in a new tab AAD, American Academy of Dermatology; SPF, sun protection factor. Our study shows a statistically significant decrease in adherence to AAD recommendations for products distributed by Walmart from 2020 to 2022 (P < .01). Both beauty retailers showed a significant difference in compliance with recommendations compared with larger retailers, with Sephora having 33.5% and 53.5% lower compliance than Walmart and Walgreens, respectively. Although not the main product sold by beauty-focused retailers, sunscreen may be offered to increase customer acquisition and retention while inadvertently including products that do not follow all recommendations. People should be educated on the importance of choosing a sunscreen that offers the most optimal level of protection against UV light when selecting the sunscreen of choice. None disclosed.