Sunscreen for sensitive skin: the AAD's advice

For sensitive skin, the American Academy of Dermatology (AAD) recommends a mineral sunscreen: one whose active ingredients are zinc oxide, titanium dioxide or both. It should also be SPF 30 or higher, broad-spectrum, water resistant and fragrance-free. This guide explains each point, shows how to read a sunscreen label, and covers what patch-test studies found about sunscreen allergies. It is part of Skinli's guide to sensitive skin.

Skinli gives general education and is not a doctor. Skinli has tested no sunscreen, and no source read for this guide tested a product made for sensitive skin, so this page names no brand. The general comparison of the two types is in mineral vs chemical sunscreen. Choosing a daily face sunscreen is covered in how to choose a sunscreen for your face. Rosacea, a skin condition that the AAD says often makes skin sensitive and easily irritated, has its own guide, and so does acne: sunscreen for rosacea and sunscreen for acne-prone skin.

What dermatologists advise for sensitive skin

The AAD's page on sunscreen labels says: "Dermatologists recommend physical sunscreen, also called mineral sunscreen, for people with sensitive skin." It explains how to tell which kind you have: "If the active ingredient in your sunscreen is titanium dioxide, zinc oxide, or both, you have a physical sunscreen."

The AAD describes sensitive skin as skin that "may sting or burn after product use". Its sunscreen pages give advice for several kinds of reaction:

Your skin	What the AAD advises
Sensitive skin	"Use a sunscreen with the words "sensitive skin" on the label." Physical (mineral) sunscreen
Allergy-prone skin	"Avoid sunscreen that contains fragrance, parabens, or oxybenzone"
Skin stings or burns when sunscreen goes on	"Use a sunscreen that contains only zinc oxide and titanium dioxide." Many sunscreens for children use only these two
Rosacea	Only zinc oxide and titanium dioxide. "A fragrance-free sunscreen that contains zinc oxide, titanium dioxide, or both is least likely to irritate your sensitive skin"
Sensitive skin while using a retinoid	"look for a physical sunscreen containing the ingredients titanium dioxide and/or zinc oxide"
Pregnancy	A physical sunscreen with zinc oxide, titanium dioxide or both, "to avoid skin irritation"
Around the eyes	"use a sunscreen stick around your eyes" so that sunscreen does not drip into them

If you use a retinoid, retinol for sensitive skin explains how to start it slowly.

Mineral sunscreen is one part of the AAD's advice. The other part applies to every sunscreen. The AAD names three basics: SPF 30 or higher, broad-spectrum protection and water resistance.

SPF, the sun protection factor, is the number that shows how much of the sun's UVB rays a sunscreen filters out. The AAD says "SPF 15 filters out 93% of the sun's UVB rays" and "SPF 30 filters out 97% of the sun's UVB rays." The AAD and the NHS both advise SPF 30 or higher. The US Food and Drug Administration (FDA) gives a lower minimum: it advises sunscreens with SPF values "of 15 or higher", and a sunscreen below SPF 15 must carry a warning.

Broad-spectrum means the sunscreen protects against both kinds of ultraviolet rays from the sun, UVA and UVB. UK labels show UVA protection with stars, and the NHS asks for "at least 4-star UVA protection".

How to read a sunscreen label

Sunscreens are drugs under US law, the FDA says, so their labels follow drug rules. These are the parts to check on sensitive skin.

Active Ingredients. The AAD says: "You'll find a section labeled "Active Ingredients."" Zinc oxide, titanium dioxide or both in that section means a mineral sunscreen.

The words "sensitive skin". The AAD says: "Again, the FDA does not define the term "sensitive skin" for sunscreen." It explains what the words often mean on a sunscreen. The product often contains titanium dioxide or zinc oxide, often leaves out fragrance, oils, PABA and the active ingredients of chemical sunscreens, and is often called hypoallergenic. The AAD says those left-out ingredients "can irritate sensitive skin". Use the words as a guide, then check the Active Ingredients section and the rest of the list yourself.

"Baby". The AAD says sunscreens labeled for babies often use zinc oxide or titanium dioxide, and that "These ingredients are less likely to irritate a baby's sensitive skin."

Other names for oxybenzone. If you want to avoid oxybenzone, the AAD lists the other names it can carry on a label: benzophenone-2, benzophenone-3, diosybenzone, mexenone, sulisobenzone and sulisobenzone sodium.

Inactive ingredients. Fragrance and parabens sit here, and so do the tints in a tinted sunscreen. The AAD advises allergy-prone skin to avoid fragrance and parabens. It also says to "Look for iron oxide within the list of inactive ingredients" if you want a tinted sunscreen that helps against dark spots.

Water resistance. US rules allow two claims: "Water Resistant (40 minutes)" and "Water Resistant (80 minutes)". The AAD says: "Not all sunscreens offer water resistance." US rules also ban the words "sunblock", "sweatproof" and "waterproof" on sunscreen labels, and both the FDA and the AAD say there is no such thing as a waterproof sunscreen.

Warnings. Every US sunscreen label must say: "Stop use and ask a doctor if rash occurs."

Age. The AAD says "The FDA requires that all sunscreens retain their original strength for at least three years." An old bottle can still cause trouble: "Expired sunscreens may break down and cause irritated skin or even an allergic skin reaction." The guide does sunscreen expire covers how to read the date.

What patch-test studies found

A patch test is how a dermatologist finds a skin allergy. The American Contact Dermatitis Society says small patches holding common allergens are placed on the back for 2 days and checked again after 4 to 7 days. The North American Contact Dermatitis Group publishes the combined results of these tests, and its data shows how often sunscreen is the cause.

The North American Contact Dermatitis Group reported data for 2001 to 2010 in 2013. "Of 23,908 patients patch tested, 219 (0.9%) had sunscreen coded as an allergen source." The study says: "Both active and inactive ingredients in sunscreen may cause contact dermatitis." The top three allergens it linked to sunscreen were benzophenone-3, which is oxybenzone, then DL-alpha-tocopherol, then a fragrance mix.

The same group reported on oxybenzone again for 2013 to 2020. Of 19,618 patients tested, 0.5 percent reacted to benzophenone-3 and 1.6 percent to benzophenone-4. The study names "PCPs and sunscreens" as common sources. PCPs are personal care products such as lotions and cosmetics.

A 2014 review looked at octocrylene, another chemical sunscreen ingredient. It found that allergy to octocrylene "is seen mainly in adult patients who have previously used topical products containing the non-steroidal anti-inflammatory drug ketoprofen". Topical means put on the skin. Octocrylene allergy from sunscreen also occurs in children, the review says, but far less often.

Some reactions need sunlight as well as the product. MedlinePlus says some sunscreens cause a skin reaction only if the skin also gets sun.

These numbers come from people who were already being tested for a suspected allergy, so they cannot give the share of all sunscreen users who react. They do show which ingredients come up most often. The AAD's view on safety is clear: "the science doesn't show that any sunscreen ingredients now available in the U.S. are harmful to human health."

White film and tinted mineral sunscreen

Mineral sunscreens can leave a white film on the skin. For rosacea, the AAD says "dermatologists recommend choosing either a micronized mineral sunscreen or tinted mineral sunscreen." Micronized means the minerals are ground finer. The AAD also says: "A tinted sunscreen that matches your skin tone can help you avoid the white residue."

A tint can add protection. The AAD says: "When this sunscreen is also a tinted sunscreen with iron oxide, you better protect your skin from developing dark spots." This matters for sensitive skin, because the AAD's page on dark spots in darker skin tones says a product that irritates the skin "can cause dark spots on your skin."

The AAD's rosacea page lists one more helpful ingredient: silicone, which can appear on a label as dimethicone or cyclomethicone. The same page says that if a sunscreen label says "unscented", choose another sunscreen, because unscented products can still contain a fragrance that masks other smells.

How to apply sunscreen on sensitive skin

Enough of it. "When applying sunscreen to your face, use at least 1 teaspoon", the AAD says. It adds that "Most people only apply 25-50% of the recommended amount of sunscreen." The NHS says: "If sunscreen is applied too thinly, the amount of protection it gives is reduced."

Early enough. The FDA says: "Apply 15 minutes before sun exposure." The AAD gives the same 15 minutes. The NHS advises two coats, one "30 minutes before going out" and one "just before going out".

Often enough. The AAD says to "reapply sunscreen every two hours, and immediately after swimming or sweating."

No spray on the face. The FDA says "spray sunscreens should never be applied directly to your face."

In the right order. The AAD's order of products is: wash your face, apply any medication or treatment, apply moisturizer and/or sunscreen, then apply makeup. Makeup with SPF protects only under two conditions. The AAD says "you'd have to use a makeup that has SPF 30 or higher. You'd also have to reapply your makeup every two hours."

With retinoids. Retinoids are the group of ingredients that includes retinol. The AAD says they "can make skin more sensitive to sun", and advises using them only at night with sun protection every day.

Test a new sunscreen, and when to stop

Test a new sunscreen before it goes on your face. The AAD's method is to apply it to "a quarter-sized spot on your skin where the product won't be rubbed or washed away, such as the underside of your arm or the bend of your elbow", twice a day for 7 to 10 days. If a reaction appears, "gently wash the product off as soon as possible, and don't use it again." The full method is in how to patch test a new skincare product.

Babies need extra care. The FDA says: "Infants are at greater risk than adults of sunscreen side effects, such as a rash."

Stop a sunscreen that causes a rash, as the label says, and ask a doctor. Stinging can be a sign of rosacea: the NHS lists "a burning or stinging feeling when using water or skincare products" among its first signs. See a dermatologist if a rash spreads, blisters, lasts or keeps coming back, or if every sunscreen you try causes a reaction. Patch testing can find the ingredient behind it, so you know which names to avoid on the next label.

Get medical help right away for swelling, trouble breathing, nausea or vomiting after using a product. The AAD lists these as signs of a life-threatening allergic reaction.