title: The relation between sunscreen layer thickness and vitamin D production after ultraviolet B exposure: a randomized clinical trial.
abstract: BACKGROUND
  Sunscreens absorb ultraviolet B (UVB) and it is a major concern that sunscreen use may lead to vitamin D deficiency.
  
  
  OBJECTIVE
  To investigate the relation between the amount of sunscreen applied and the vitamin D serum level in humans after UVB exposure under controlled conditions.
  
  
  METHODS
  Thirty-seven healthy volunteers with fair skin types were randomized to receive an inorganic sunscreen with sun protection factor (SPF) 8 of 0 mg cm(-2) , 0.5 mg cm(-2) , 1 mg cm(-2) , 1.5 mg cm(-2) , or 2 mg cm(-2) thickness on the upper body, approximately 25% of the body area. Participants were irradiated with a fixed UVB dose of 3 standard erythema doses 20 min after sunscreen application. This procedure was repeated four times with a 2- to 3-day interval. Blood samples were drawn before the first irradiation and 3 days after the last to determine the serum vitamin D level expressed as 25-hydroxyvitamin D(3) [25(OH)D].
  
  
  RESULTS
  The vitamin D serum level increased in an exponential manner with decreasing thickness of sunscreen layer in response to UVB exposure. For all thicknesses of sunscreen, the level of 25(OH)D increased significantly after irradiation (P<0.05), except for the group treated with 2 mg cm(-2) , in which the increase in 25(OH)D was not statistically significant (P=0.16).
  
  
  CONCLUSIONS
  Vitamin D production increases exponentially when thinner sunscreen layers than recommended are applied (<2 mg cm(-2) ). When the amount of sunscreen and SPF advised by the World Health Organization are used, vitamin D production may be abolished. Re-evaluation of sun-protection strategies could be warranted.
authors.affiliation: Department of Dermatology, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark. afau16@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Faurschou
authors.forename: D M
authors.initials: DM
authors.lastname: Beyer
authors.forename: A
authors.initials: A
authors.lastname: Schmedes
authors.forename: M K
authors.initials: MK
authors.lastname: Bogh
authors.forename: P A
authors.initials: PA
authors.lastname: Philipsen
authors.forename: H C
authors.initials: HC
authors.lastname: Wulf
mesh_terms: D000293:Adolescent; D000328:Adult; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008297:Male; D013473:Sunscreening Agents / Q000008:administration & dosage / Q000494:pharmacology*; D014466:Ultraviolet Rays; D014807:Vitamin D / Q000031:analogs & derivatives / Q000096:biosynthesis*; D055815:Young Adult
chemical_list: D013473:Sunscreening Agents; D014807:Vitamin D; C104450:25-hydroxyvitamin D