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Sunscreen and Prevention of Skin Aging: A Randomized Trial

Maria Celia B. Hughes, MMedSci; Gail M. Williams, PhD; Peter Baker, PhD; and Adèle C. Green, MBBS, PhD
[+] Article, Author, and Disclosure Information

From Queensland Institute of Medical Research and University of Queensland, School of Population Health, Queensland, Australia, and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.

Acknowledgment: The authors thank Mr. Toan Luong, who graded the silicone replicas.

Financial Support: By the National Health and Medical Research Council of Australia (NHMRC #922608), Ross Cosmetics, and Roche Vitamins and Fine Chemicals.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2280.

Reproducible Research Statement: Study protocol: See reference 25; also available from Dr. Green (address below). Data set and statistical code: Available from Dr. Green (address below).

Corresponding Author: Adèle C. Green, MBBS, PhD, Queensland Institute of Medical Research, Locked Bag 2000, Royal Brisbane Hospital, QLD 4029, Australia.

Current Author Addresses: Ms. Hughes and Dr. Green: Queensland Institute of Medical Research, Locked Bag 2000, Royal Brisbane Hospital, QLD 4029, Australia.

Drs. Williams and Baker: Level 2, Public Health Building, School of Population Health, University of Queensland, Herston Road, Herston, QLD 4006, Australia.

Author Contributions: Conception and design: G.M. Williams, A.C. Green.

Analysis and interpretation of the data: M.C.B. Hughes, G.M. Williams, P. Baker, A.C. Green.

Drafting of the article: M.C.B. Hughes, P. Baker, A.C. Green.

Critical revision of the article for important intellectual content: M.C.B. Hughes, G.M. Williams, A.C. Green.

Final approval of the article: M.C.B. Hughes, G.M. Williams, A.C. Green.

Provision of study materials or patients: A.C. Green.

Statistical expertise: G.M. Williams, P. Baker.

Obtaining of funding: A.C. Green.

Administrative, technical, or logistic support: P. Baker, A.C. Green.

Collection and assembly of data: M.C.B. Hughes, G.M. Williams, A.C. Green.

Ann Intern Med. 2013;158(11):781-790. doi:10.7326/0003-4819-158-11-201306040-00002
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Chinese translation

Background: Sunscreen use and dietary antioxidants are advocated as preventives of skin aging, but supporting evidence is lacking.

Objective: To determine whether regular use of sunscreen compared with discretionary use or β-carotene supplements compared with placebo retard skin aging, measured by degree of photoaging.

Design: Randomized, controlled, community-based intervention. (Australian New Zealand Clinical Trials Registry: ACTRN12610000086066).

Setting: Nambour, Australia (latitude 26° S).

Patients: 903 adults younger than 55 years out of 1621 adults randomly selected from a community register.

Intervention: Random assignment into 4 groups: daily use of broad-spectrum sunscreen and 30 mg of β-carotene, daily use of sunscreen and placebo, discretionary use of sunscreen and 30 mg of β-carotene, and discretionary use of sunscreen and placebo.

Measurements: Change in microtopography between 1992 and 1996 in the sunscreen and β-carotene groups compared with controls, graded by assessors blinded to treatment allocation.

Results: The daily sunscreen group showed no detectable increase in skin aging after 4.5 years. Skin aging from baseline to the end of the trial was 24% less in the daily sunscreen group than in the discretionary sunscreen group (relative odds, 0.76 [95% CI, 0.59 to 0.98]). β-Carotene supplementation had no overall effect on skin aging, although contrasting associations were seen in subgroups with different severity of aging at baseline.

Limitation: Some outcome data were missing, and power to detect moderate treatment effects was modest.

Conclusion: Regular sunscreen use retards skin aging in healthy, middle-aged men and women. No overall effect of β-carotene on skin aging was identified, and further study is required to definitively exclude potential benefit or potential harm.

Primary Funding Source: National Health and Medical Research Council of Australia.


Grahic Jump Location
Figure 1.

Study flow diagram of the Nambour sunscreen use and photoaging study, 1992–1996.

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Appendix Figure.

Study flow diagram of the Nambour β-carotene and photoaging study, 1992–1996.

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Figure 2.

Effect of sunscreen intervention on photoaging, according to baseline characteristics.

*P values for heterogeneity of effects were derived using score tests from generalized estimating equations, assuming independent correlations between repeated measures of skin microtopography grades.

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Summary for Patients

Sunscreen and Prevention of Skin Aging

The full report is titled “Sunscreen and Prevention of Skin Aging. A Randomized Trial.” It is in the 4 June 2013 issue of Annals of Internal Medicine (volume 158, pages 781-790). The authors are M.C.B. Hughes, G.M. Williams, P. Baker, and A.C. Green.


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