North American Contact Dermatitis Group Allergens in U.S. Sunscreens: Prevalence and Relationship to Product Characteristics

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Fay, Claire E. Reynolds, Colby L. Presley, Christopher Stamey, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9149182/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Sunscreens are widely used for photoprotection but are known to cause adverse reactions including irritant contact dermatitis (ICD), allergic contact dermatitis (ACD), and photoallergic contact dermatitis (PACD). Because formulations are subject to frequent change, continuous assessment of allergen prevalence remains clinically relevant. In this cross-sectional analysis, we evaluated the presence of North American Contact Dermatitis Group (NACDG) screening series allergens in top-selling sunscreen products available to United States consumers. Ingredient lists from 200 top-selling sunscreen products identified from five major retailers were reviewed for 2021 to 2022 NACDG screening series allergens. Sunscreen characteristics, including ultraviolet filter type, sun protection factor, tint status, price, and marketing claims, were recorded. Of 200 products, 178 (89.0%) contained at least one NACDG allergen. Chemical sunscreens demonstrated the highest inclusion rate (95.0%), while physical sunscreens showed lower prevalence (72.7%). Allergen inclusion remained common among products marketed as hypoallergenic, gentle, allergen-free, or dermatologist-recommended. Ingredient lists were obtained from retailer and manufacturer websites, which may not reflect current formulations. Marketing claims are unreliable indicators of allergen content. Ingredient-level review remains critical when recommending sunscreens for patients with contact sensitivity. sunscreen sunscreen allergy allergic contact dermatitis tinted sunscreen allergens Introduction Sunscreen types can be categorized by the types of ultraviolet (UV) filters used, including chemical, physical (mineral), and combination (chemical and physical) filters. 1 Alongside long-sleeved clothing, wide-brimmed hats, and shade seeking, sunscreen is a relatively accessible, cost-effective photoprotective tool for prevention of UV-induced skin damage and carcinogenesis. 2 According to industry market research, the sunscreen market is expanding rapidly, representing a $ 14.3 billion (USD) industry globally, with projections reaching $ 18.9 billion by 2030. 3 Within this rapidly growing sector, North America comprises the geographic largest market share of approximately 35%, reflective of greater public awareness and evolving consumer preferences, including cosmetic and anti-aging motivations. In the United States (US), sunscreens are regulated as over-the-counter (OTC) drugs, promoting safety and effectiveness through an extensive approval process while offering high accessibility and product selection based on consumer preference. 4 However, the formulation of sunscreen products is highly variable and subject to frequent change from manufacturers, often without public notification. Moreover, marketing claims such as “hypoallergenic,” “gentle,” “allergy tested,” or “dermatologist recommended” are under minimal regulation by the US Food and Drug Administration (FDA). 5 , 6 These marketing terms may frequently be interpreted by patients as confirmation of safety, yet do not ensure the complete absence of known irritants or contact allergens. Although observed in only a minority of users, sunscreen can cause various adverse reactions, including irritant contact dermatitis (ICD), allergic contact dermatitis (ACD), and photoallergic contact dermatitis (PACD). 7 , 8 An Australian study demonstrated 18.9% of adults (n = 114/603) using sunscreen daily reported adverse cutaneous reactions of some kind, with approximately 10% of these reactions attributable to ACD, PACD, or contact urticaria confirmed by patch testing, photopatch testing, and scratch testing. 9 ACD and PACD are of particular clinical relevance when considering adverse reactions to sunscreen, as they may require specialized diagnostic testing (patch and photopatch testing) to identify culprit allergens and necessitate diligent, lifelong avoidance of identified offending ingredients. Irritant reactions, though more common, are typically managed with product modifications without requiring extensive work-up. Additionally, ACD and PACD can lead to cross-reactivity to other chemically related ingredients, further complicating photoprotective strategies. While previous investigative efforts have catalogued the presence of allergens in select sunscreens available to North American consumers, a rapidly evolving market (e.g., the rise in tinted formulations, combination options, and international products) warrants ongoing update and analysis. 10 – 12 Additionally, an expanding number of products, rising sunscreen use, and growing consumer demand for safe and effective options further necessitate continued scrutiny. Herein, we evaluate the product characteristics, claims, and the presence of North American Contact Dermatitis Group (NACDG) core allergens in sunscreens openly available to the US population, and we write to highlight the need for regulatory reform in the name of transparency and consumer safety. Methods Sunscreen Selection To select commonly available consumer products for review, the search term “sunscreen” was queried on the following websites: 1) https://www.amazon.com , 2) https://www.target.com/ , 3) https://www.walgreens.com/ , 4) https://www.cvs.com/ , and 5) https://www.walmart.com/ . The best-selling 40 products from each site were included in this study to avoid inconsistencies in product recommendations from geographic location or browser cookies. Product duplicates across sites were intentionally included in the analysis to reflect the specific sunscreens consumers are most likely to encounter when shopping at these sites. When necessary, manufacturer websites were consulted for complete ingredient lists. Sunscreen characteristics, including chemical/physical/combination blocker, tinted/non-tinted, Sun Protection Factor (SPF), and associated marketing claims, were recorded. NACDG Allergens To identify allergen presence within products, ingredient lists from retailer and manufacturer webpages were recorded. Ingredient lists were analyzed for the presence of the 80 allergens included in the 2021–2022 NACDG screening series. 13 NACDG allergens and the number of NACDG allergens per product were recorded. Results Sunscreen Allergen Overview Among the 200 product listings analyzed, 178 (89.0%) contained at least one contact allergen from the 2021–2022 NACDG screening series. The most commonly identified allergens were fragrance (108 products, 54.0%), phenoxyethanol (88, 44.0%), and propylene glycol (32, 16.0%). Other frequently identified ingredients included benzyl alcohol (28, 14.0%), coco-glucoside (16, 8.0%), and oxybenzone (15, 7.5%) ( Table 1 ) . Table 1 Top 15 Most Commonly Identified Allergens in U.S. Sunscreens Top 15 most commonly identified allergens n (%) Fragrance 108 (54.0%) Phenoxyethanol 88 (44.0%) Propylene glycol 32 (16.0%) Benzyl alcohol 28 (14.0%) Coco-glucoside 16 (8.0%) Oxybenzone 15 (7.5%) Methylisothiazolinone 10 (5.0%) Methyl methacrylate 7 (3.5%) Sodium benzoate 6 (3.0%) Paraben 6 (3.0%) Cetearyl glucoside 6 (3.0%) Linalool 5 (2.5%) Limonene 4 (2.0%) Melaleuca alternifolia 2 (1.0%) Cinnamal 1 (0.5%) Among products labeled for "sensitive skin,” 51/66 (77.3%) included at least one allergen. A similar rate of NACDG series allergens was found in products labeled “allergen free” or “allergy tested” (42/51, 82.4%) and in those labeled “dermatologist recommended” or “dermatologist tested" (100/111, 90.1%). Allergen prevalence was lower among products labeled “hypoallergenic” and “gentle,” with at least one allergen identified in 21/27 (77.8%) and 22/31 (71.0%) products, respectively ( Table 2 ) . Table 2 Allergen Prevalence by Sunscreen Type, SPF Level, Cost, Marketing Claims, and Tint Status Type of Sunscreen Total per each n (%) containing an allergen % Chemical 141 134 95.0% Physical 44 32 72.7% Combination 15 12 80.0% Tinted/Nontinted n (%) containing an allergen % Tinted 18 16 88.9% Nontinted 182 162 89.0% SPF level n (%) containing an allergen % 60 28 28 100.0% Cost n (%) containing an allergen % $ 42 35 83.3% $$ 111 102 91.9% $$$ 26 22 84.6% $$$$ 21 19 90.5% Marketing Claims n (%) containing an allergen % Sensitive skin 66 51 77.3% Allergen free, Allergy tested 51 42 82.4% Dermatologist Recommended/Tested 111 100 90.1% Hypoallergenic 27 21 77.8% Gentle 31 22 71.0% Chemical sunscreens exhibited the highest rate of allergen inclusion, with 134/141 products (95.0%) containing at least 1 allergen. This category was followed by combination and physical sunscreens, which contained allergens in 12/15 (80.0%) and 32/44 (72.7%) products, respectively. Of the 18 tinted product listings evaluated, 16/18 (88.9%) contained at least one allergen, compared with 162/182 (89.0%) non-tinted products ( Table 2 ) . All products with SPF 60 (28/28, 100%) contained allergens, whereas 138/160 products (86.3%) with SPF 30–60 contained allergens ( Table 2 ) . Products priced < $ 10 (category $ ) contained allergens in 35/42 (83.3%) listings. In the $ 10.00- $ 19.99 range ( $ $ ), 102/111 (91.9%) products contained at least one allergen. Similarly, 22/26 (84.6%) listings priced $ 20.00- $ 29.99 ( $ $ $ ) and 19/21 (90.5%) listings priced at $ 30.00 or more ( $ $ $ $ ) contained allergens ( Table 2 ) . Discussion This analysis shows a high prevalence of known contact allergens in top-selling sunscreen products readily available to the US consumer, with 89% of all identified products containing at least one allergen from the 2021–2022 NACDG screening series. Notably, allergens were found in the majority of products marketed with sensitivity-related claims (e.g., hypoallergenic, gentle, and allergen-free), which may not accurately reflect formulation content for patients who rely on these claims to select products. These findings demonstrate the disparity between marketing terminology and true product formulae, with implications for clinicians tasked with reliable product recommendations, routine sunscreen users, and photosensitive patient populations requiring daily photoprotection. Our findings align with the high overall rates of allergen inclusion reported in a 2019 study by contact dermatitis expert Dr. Bruce Brod, which analyzed 52 bestselling sunscreens and found that none of the sampled products were allergen-free. 14 That said, not all aforementioned allergens are clinically relevant, but patients should be cautioned against relying solely on marketing claims. Product selection for patients with sensitivity concerns often favors physical filters (e.g., titanium dioxide, zinc oxide) due to their low intrinsic sensitization potential 14 – 16 ; accordingly, our findings demonstrate a higher allergen prevalence in chemical formulations (95.0%) when compared to physical options (72.7%). While “mineral” labeling alone does not guarantee suitability for patients with photosensitive disorders, as fragrance, preservatives, and other excipients remain relatively prevalent, physical sunscreens may offer a less allergenic initial recommendation if sensitivity is a primary concern. Individualized ingredient-level review remains especially critical in this patient population, even within products often marketed or perceived as safer. The cost of sunscreen products can present a significant barrier to consistent use, underscoring the importance of cost-effective sun protection counseling. 17 , 18 Here, we found no clear trend in the percent of sunscreen products containing allergens across increasing cost tiers. Allergen prevalence remained high regardless of product price. Dermatologists should counsel patients with sensitivities to incorporate cost-effective, allergen-friendly sunscreen options into their routine to best reduce adverse reactions and improve sunscreen use. Regulatory Overview US sunscreens are regulated by the FDA as OTC drugs and are closely scrutinized for safety and efficacy (e.g., toxicological assessments, SPF, and water-resistance validation). 19 However, the current regulatory system permits variability in how certain claims are applied. For example, companies can legally label fragrance-containing products as “fragrance-free”, as long as the fragrance chemicals can also be employed as an emollient or preservative, rather than being used “solely to impart an odor to a product”. 20,21 In sunscreen labeling, claims like “allergen-free,” “hypoallergenic,” and “dermatologist recommended” are not strictly defined or regulated by the FDA. 22 , 23 As a result, well-intentioned consumers may be exposed to allergens when relying on these claims as indicators of formulation safety. While permitted under current FDA regulation, these practices remain within the boundaries of the law. Examination of product ingredient lists should always be recommended to patients over trusting potentially unvalidated or unreliable claims and advertising. 24 In contrast, the European Union (EU) classifies sunscreens as cosmetic products, subjecting them to stricter labeling requirements. Limiting or eliminating allergen exposure is key to preventing ACD, and EU cosmetic regulations help reduce ACD prevalence by improving product labeling, clearly defining risk assessments, and providing usage instructions. Due to the frequency of allergenic responses as adverse reactions associated with cosmetic products, the EU also requires quantitative skin sensitization assessment, including in chemico assays, in vitro cell-based methods, and in silico predictions, for all cosmetic ingredients. 25 Labels can help prevent ACD by enabling patients and consumers to make informed choices about allergen exposures. Even labels such as “perfume” or “contains fragrances” do not provide sufficient information, and in 2005, the EU mandated the disclosure of 26 specific fragrance allergens on cosmetic labels, regardless of the ingredient’s proposed function. 26 – 28 This individual labeling requirement was expanded to 82 fragrance allergens in 2023, significantly improving transparency, helping consumers avoid known allergens, and aiding clinicians in making personalized product recommendations. 29 In the US, the Modernization of Cosmetics Regulation Act of 2022 (MoCRA) introduced allergen reporting but still does not mandate the disclosure of specific fragrance allergens. 29 If the US adopted a similar system to the EU, it would be a meaningful step toward improving transparency and protecting sensitive individuals. Clinical Implications & Considerations for High-Risk Groups Sunscreen application is a modifiable behavior that is an essential form of sun protection and helps prevent skin cancer development and exacerbation of photosensitive conditions. Patients with a history of melanoma or non-melanoma skin cancer (NMSC) and solid-organ transplantation are pathophysiologically predisposed to subsequent cutaneous malignancy due to mechanisms including cumulative UV-induced DNA damage, inflammatory microenvironment, and immunosuppression. 30 For these individuals, diligent photoprotection, including daily sunscreen, is a cornerstone recommendation in secondary cancer prevention and primary disease progression. If a patient experiences contact dermatitis in association with sunscreen application, the first action in management is to identify and avoid the causal agent. 31 However, adverse cutaneous reactions may discourage consistent sunscreen use, reducing overall photoprotection and potentially compounding risk for recurrence in patients already predisposed to subsequent malignancy or disease progression. Additional populations warranting strict photoprotection include those with autoimmune photodermatoses (e.g., systemic lupus erythematosus, dermatomyositis), genodermatoses such as xeroderma pigmentosum and Gorlin syndrome, organ transplant recipients, and those on photosensitizing medications. For these individuals, daily sunscreen use (in combination with other components of a strong sun protection practice) prevents phototoxic injury, disease flares, and cumulative sun damage. This consideration is particularly relevant for patients with Fitzpatrick skin types III-VI, who are more commonly affected by visible-light (VL)- induced pigmentary disorders (e.g., post-inflammatory hyperpigmentation and melasma) and may require consistent, cosmetically acceptable, high-surface-area sunscreen application. 32 In a similarly structured analysis of best-selling tinted sunscreens, 28/36 (80.0%) products contained at least one NACDG screening series allergen, highlighting that tinted formulations may not be reliably associated with lower allergen exposure for patients relying on them for VL protection. 33 For patients with a heightened need for rigorous photoprotection, barriers to adherence should be actively addressed. Further, clinician sunscreen selection should prioritize ingredient-level review over SPF value, marketing claims, tint status, or brand reputation. ( Table 3 ) Patients should also be counseled that higher-cost sunscreen options do not reliably confer lower allergen burden, as allergen inclusion remained relatively common (> 90%) even among those in the highest price category (> $ 30.00). ( Table 2 ) Table 3 Clinical Pearls for Dermatologist-Guided Sunscreen Selection Marketing claims such as “hypoallergenic,” “gentle,” “allergen-free,” and “dermatologist recommended” are unreliable indicators of low allergen content in sunscreen products. Improved regulatory standards and transparent allergen labeling are needed to align marketing claims with product formulation and enhance patient safety. Ingredient-level review is more informative than SPF, price point, tint status, or brand reputation when selecting sunscreens for patients with sensitive skin or contact dermatitis. While physical (mineral) sunscreens demonstrate lower rates of NACDG screening allergens than chemical formulations and may be a reasonable first-line recommendation, individual product reviews juxtaposed to a patient’s specific allergy list are necessary. Fragrance remains the most common contact allergen in U.S. sunscreens and may be present despite “fragrance-free” labeling due to regulatory loopholes. Patients with recurrent or reproducible dermatitis associated with sunscreen use should be evaluated for allergic or photoallergic contact dermatitis with patch and/or photopatch testing. Adverse reactions to sunscreen can significantly reduce adherence to photoprotection. Sunscreen cost does not correlate with allergen burden; affordable options may be equally appropriate for patients with contact sensitivity. Documentation of tolerated sunscreen products can reduce trial-and-error frustration and improve long-term adherence. Limitations This study has several limitations. Firstly, smaller, boutique, and international sunscreen brands were likely underrepresented in our sample due to retailer availability and consumer preferences. Even with 200 products, the sheer size of the sunscreen market means many formulations went unexamined. Additionally, ingredient lists were extracted from retailer and manufacturer websites, which may list outdated information or inconsistencies across retailers carrying the same product. Moreover, sunscreen formulations fluctuate sporadically, and emerging allergens may not yet be reflected in currently published screening series. Interestingly, less than 40% of positive patch test reactions to sunscreen (2001–2010) were detected by the NACDG screening series of allergens. 34 The allergens identified in the sunscreen products in this study likely underrepresent the true prevalence of allergic reactions associated with these sunscreens. Conclusion In this cross-sectional analysis of sunscreens commonly available in the US, 89% of identified sunscreen products contained one or more NACDG screening series allergens, including the majority of products that directly advertised safety and sensitivity. From our findings, physical sunscreens and those marketed as gentle demonstrated the lowest rate of contact allergen inclusion and may be recommended with greater confidence. Conversely, SPF level, tint status, price, and most marketing claims were not reliable indicators of NACDG allergen inclusion and should not be used in targeted product recommendations. Our findings point to the longstanding discrepancy between sensitivity claims and the actual formulation content and emphasize the need for transparency through a commitment to regulatory reform. Declarations Competing Interests: The authors declare that they have no conflict of interest. Funding: The authors did not receive funding for this work. Ethics approval: Not applicable. This study did not involve human participants, their data, or biological material. Data availability: Data are available from the corresponding author upon reasonable request. Patient Consent: Not applicable Author Contribution C.W.R. and C.L.P. conceived the study. A.B.F. contributed to study design, collected and analyzed the data, and wrote the main manuscript text. C.E.R. contributed to manuscript writing and reviewed the manuscript. C.L.P. contributed to study design and manuscript writing and reviewed the manuscript. C.S. contributed to study design and reviewed the manuscript. C.W.R. supervised the project. All authors reviewed and approved the final manuscript. References Committee on Environmental Impact of Currently Marketed Sunscreens (2022) and Potential Human Impacts of Changes in Sunscreen Usage, Ocean Studies Board, Board on Environmental Studies and Toxicology. et al. 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Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 16 May, 2026 Reviews received at journal 11 May, 2026 Reviewers agreed at journal 08 May, 2026 Reviewers agreed at journal 06 May, 2026 Reviewers agreed at journal 06 May, 2026 Reviewers invited by journal 06 May, 2026 Editor assigned by journal 21 Mar, 2026 Submission checks completed at journal 21 Mar, 2026 First submitted to journal 17 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Fay","email":"","orcid":"","institution":"Loma Linda University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"B.","lastName":"Fay","suffix":""},{"id":638240099,"identity":"df544024-2a03-4fd6-95b8-ca5aad7d458b","order_by":1,"name":"Claire E. Reynolds","email":"","orcid":"","institution":"Case Western Reserve University","correspondingAuthor":false,"prefix":"","firstName":"Claire","middleName":"E.","lastName":"Reynolds","suffix":""},{"id":638240100,"identity":"77bc08be-df2b-4b75-84ca-00d30946a105","order_by":2,"name":"Colby L. Presley","email":"","orcid":"","institution":"University of Minnesota","correspondingAuthor":false,"prefix":"","firstName":"Colby","middleName":"L.","lastName":"Presley","suffix":""},{"id":638240101,"identity":"630e6e06-aa20-4a71-a4fa-43b4fdfec350","order_by":3,"name":"Christopher Stamey","email":"","orcid":"","institution":"Duke University","correspondingAuthor":false,"prefix":"","firstName":"Christopher","middleName":"","lastName":"Stamey","suffix":""},{"id":638240102,"identity":"f84ef706-6d19-4440-87a8-3743e930b408","order_by":4,"name":"Chandler W. Rundle","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAo0lEQVRIiWNgGAWjYJACiQcMEnIQJhuxWhIYLIxJ1lKR2EC0FvMZuQdvJFRIpG+4dvYAw4eyw4S1yNzIS7ZIOCORu+F2XgLjjHNEaJGQyDGTSGwDackxYOZtI1rLP4l0A5CWv8RraZBIAGthJEoLzxtji4RjEoYzgVoO9pxLJ0ILe47hjQ81dfJ8t3MMH/wosyasBQUcIFH9KBgFo2AUjAJcAAB+Ljc7/FszBgAAAABJRU5ErkJggg==","orcid":"","institution":"University of Minnesota","correspondingAuthor":true,"prefix":"","firstName":"Chandler","middleName":"W.","lastName":"Rundle","suffix":""}],"badges":[],"createdAt":"2026-03-17 13:08:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9149182/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9149182/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109281749,"identity":"f34c6fef-b472-4cc0-8758-b7272b78c515","added_by":"auto","created_at":"2026-05-14 18:14:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":224616,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9149182/v1/2e3e7e88-2410-42ae-b7d7-f6f6103dbcfd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"North American Contact Dermatitis Group Allergens in U.S. Sunscreens: Prevalence and Relationship to Product Characteristics","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSunscreen types can be categorized by the types of ultraviolet (UV) filters used, including chemical, physical (mineral), and combination (chemical and physical) filters.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Alongside long-sleeved clothing, wide-brimmed hats, and shade seeking, sunscreen is a relatively accessible, cost-effective photoprotective tool for prevention of UV-induced skin damage and carcinogenesis.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e According to industry market research, the sunscreen market is expanding rapidly, representing a \u003cspan\u003e$\u003c/span\u003e14.3\u0026nbsp;billion (USD) industry globally, with projections reaching \u003cspan\u003e$\u003c/span\u003e18.9\u0026nbsp;billion by 2030.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Within this rapidly growing sector, North America comprises the geographic largest market share of approximately 35%, reflective of greater public awareness and evolving consumer preferences, including cosmetic and anti-aging motivations.\u003c/p\u003e \u003cp\u003eIn the United States (US), sunscreens are regulated as over-the-counter (OTC) drugs, promoting safety and effectiveness through an extensive approval process while offering high accessibility and product selection based on consumer preference.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e However, the formulation of sunscreen products is highly variable and subject to frequent change from manufacturers, often without public notification. Moreover, marketing claims such as \u0026ldquo;hypoallergenic,\u0026rdquo; \u0026ldquo;gentle,\u0026rdquo; \u0026ldquo;allergy tested,\u0026rdquo; or \u0026ldquo;dermatologist recommended\u0026rdquo; are under minimal regulation by the US Food and Drug Administration (FDA).\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e These marketing terms may frequently be interpreted by patients as confirmation of safety, yet do not ensure the complete absence of known irritants or contact allergens. Although observed in only a minority of users, sunscreen can cause various adverse reactions, including irritant contact dermatitis (ICD), allergic contact dermatitis (ACD), and photoallergic contact dermatitis (PACD).\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e An Australian study demonstrated 18.9% of adults (n\u0026thinsp;=\u0026thinsp;114/603) using sunscreen daily reported adverse cutaneous reactions of some kind, with approximately 10% of these reactions attributable to ACD, PACD, or contact urticaria confirmed by patch testing, photopatch testing, and scratch testing.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e ACD and PACD are of particular clinical relevance when considering adverse reactions to sunscreen, as they may require specialized diagnostic testing (patch and photopatch testing) to identify culprit allergens and necessitate diligent, lifelong avoidance of identified offending ingredients. Irritant reactions, though more common, are typically managed with product modifications without requiring extensive work-up. Additionally, ACD and PACD can lead to cross-reactivity to other chemically related ingredients, further complicating photoprotective strategies.\u003c/p\u003e \u003cp\u003eWhile previous investigative efforts have catalogued the presence of allergens in select sunscreens available to North American consumers, a rapidly evolving market (e.g., the rise in tinted formulations, combination options, and international products) warrants ongoing update and analysis.\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Additionally, an expanding number of products, rising sunscreen use, and growing consumer demand for safe and effective options further necessitate continued scrutiny. Herein, we evaluate the product characteristics, claims, and the presence of North American Contact Dermatitis Group (NACDG) core allergens in sunscreens openly available to the US population, and we write to highlight the need for regulatory reform in the name of transparency and consumer safety.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSunscreen Selection\u003c/h2\u003e \u003cp\u003eTo select commonly available consumer products for review, the search term \u0026ldquo;sunscreen\u0026rdquo; was queried on the following websites: 1) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.amazon.com\u003c/span\u003e\u003cspan address=\"https://www.amazon.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, 2) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.target.com/\u003c/span\u003e\u003cspan address=\"https://www.target.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, 3) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.walgreens.com/\u003c/span\u003e\u003cspan address=\"https://www.walgreens.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, 4) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cvs.com/\u003c/span\u003e\u003cspan address=\"https://www.cvs.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, and 5) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.walmart.com/\u003c/span\u003e\u003cspan address=\"https://www.walmart.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. The best-selling 40 products from each site were included in this study to avoid inconsistencies in product recommendations from geographic location or browser cookies. Product duplicates across sites were intentionally included in the analysis to reflect the specific sunscreens consumers are most likely to encounter when shopping at these sites. When necessary, manufacturer websites were consulted for complete ingredient lists. Sunscreen characteristics, including chemical/physical/combination blocker, tinted/non-tinted, Sun Protection Factor (SPF), and associated marketing claims, were recorded.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eNACDG Allergens\u003c/h3\u003e\n\u003cp\u003eTo identify allergen presence within products, ingredient lists from retailer and manufacturer webpages were recorded. Ingredient lists were analyzed for the presence of the 80 allergens included in the 2021\u0026ndash;2022 NACDG screening series.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e NACDG allergens and the number of NACDG allergens per product were recorded.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSunscreen Allergen Overview\u003c/h2\u003e \u003cp\u003eAmong the 200 product listings analyzed, 178 (89.0%) contained at least one contact allergen from the 2021\u0026ndash;2022 NACDG screening series. The most commonly identified allergens were fragrance (108 products, 54.0%), phenoxyethanol (88, 44.0%), and propylene glycol (32, 16.0%). Other frequently identified ingredients included benzyl alcohol (28, 14.0%), coco-glucoside (16, 8.0%), and oxybenzone (15, 7.5%) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTop 15 Most Commonly Identified Allergens in U.S. Sunscreens\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTop 15 most commonly identified allergens\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFragrance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108 (54.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhenoxyethanol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88 (44.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePropylene glycol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (16.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBenzyl alcohol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCoco-glucoside\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (8.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOxybenzone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMethylisothiazolinone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMethyl methacrylate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSodium benzoate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParaben\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCetearyl glucoside\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLinalool\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLimonene\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMelaleuca alternifolia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCinnamal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong products labeled for \"sensitive skin,\u0026rdquo; 51/66 (77.3%) included at least one allergen. A similar rate of NACDG series allergens was found in products labeled \u0026ldquo;allergen free\u0026rdquo; or \u0026ldquo;allergy tested\u0026rdquo; (42/51, 82.4%) and in those labeled \u0026ldquo;dermatologist recommended\u0026rdquo; or \u0026ldquo;dermatologist tested\" (100/111, 90.1%). Allergen prevalence was lower among products labeled \u0026ldquo;hypoallergenic\u0026rdquo; and \u0026ldquo;gentle,\u0026rdquo; with at least one allergen identified in 21/27 (77.8%) and 22/31 (71.0%) products, respectively \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAllergen Prevalence by Sunscreen Type, SPF Level, Cost, Marketing Claims, and Tint Status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of Sunscreen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal per each\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%) containing an allergen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChemical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCombination\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTinted/Nontinted\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%) containing an allergen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTinted\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNontinted\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSPF level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%) containing an allergen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e30\u0026ndash;60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCost\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%) containing an allergen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e$\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e$$\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e$$$\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e$$$$\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarketing Claims\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%) containing an allergen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSensitive skin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAllergen free, Allergy tested\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDermatologist Recommended/Tested\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypoallergenic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGentle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eChemical sunscreens exhibited the highest rate of allergen inclusion, with 134/141 products (95.0%) containing at least 1 allergen. This category was followed by combination and physical sunscreens, which contained allergens in 12/15 (80.0%) and 32/44 (72.7%) products, respectively. Of the 18 tinted product listings evaluated, 16/18 (88.9%) contained at least one allergen, compared with 162/182 (89.0%) non-tinted products \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eAll products with SPF\u0026thinsp;\u0026lt;\u0026thinsp;30 (11/11, 100%) and \u0026gt;\u0026thinsp;60 (28/28, 100%) contained allergens, whereas 138/160 products (86.3%) with SPF 30\u0026ndash;60 contained allergens \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eProducts priced \u0026lt;\u003cspan\u003e$\u003c/span\u003e10 (category \u003cspan\u003e$\u003c/span\u003e) contained allergens in 35/42 (83.3%) listings. In the \u003cspan\u003e$\u003c/span\u003e10.00-\u003cspan\u003e$\u003c/span\u003e19.99 range (\u003cspan\u003e$\u003c/span\u003e\u003cspan\u003e$\u003c/span\u003e), 102/111 (91.9%) products contained at least one allergen. Similarly, 22/26 (84.6%) listings priced \u003cspan\u003e$\u003c/span\u003e20.00-\u003cspan\u003e$\u003c/span\u003e29.99 (\u003cspan\u003e$\u003c/span\u003e\u003cspan\u003e$\u003c/span\u003e\u003cspan\u003e$\u003c/span\u003e) and 19/21 (90.5%) listings priced at \u003cspan\u003e$\u003c/span\u003e30.00 or more (\u003cspan\u003e$\u003c/span\u003e\u003cspan\u003e$\u003c/span\u003e\u003cspan\u003e$\u003c/span\u003e\u003cspan\u003e$\u003c/span\u003e) contained allergens \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis analysis shows a high prevalence of known contact allergens in top-selling sunscreen products readily available to the US consumer, with 89% of all identified products containing at least one allergen from the 2021\u0026ndash;2022 NACDG screening series. Notably, allergens were found in the majority of products marketed with sensitivity-related claims (e.g., hypoallergenic, gentle, and allergen-free), which may not accurately reflect formulation content for patients who rely on these claims to select products. These findings demonstrate the disparity between marketing terminology and true product formulae, with implications for clinicians tasked with reliable product recommendations, routine sunscreen users, and photosensitive patient populations requiring daily photoprotection. Our findings align with the high overall rates of allergen inclusion reported in a 2019 study by contact dermatitis expert Dr. Bruce Brod, which analyzed 52 bestselling sunscreens and found that none of the sampled products were allergen-free.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e That said, not all aforementioned allergens are clinically relevant, but patients should be cautioned against relying solely on marketing claims.\u003c/p\u003e \u003cp\u003eProduct selection for patients with sensitivity concerns often favors physical filters (e.g., titanium dioxide, zinc oxide) due to their low intrinsic sensitization potential\u003csup\u003e\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e; accordingly, our findings demonstrate a higher allergen prevalence in chemical formulations (95.0%) when compared to physical options (72.7%). While \u0026ldquo;mineral\u0026rdquo; labeling alone does not guarantee suitability for patients with photosensitive disorders, as fragrance, preservatives, and other excipients remain relatively prevalent, physical sunscreens may offer a less allergenic initial recommendation if sensitivity is a primary concern. Individualized ingredient-level review remains especially critical in this patient population, even within products often marketed or perceived as safer.\u003c/p\u003e \u003cp\u003eThe cost of sunscreen products can present a significant barrier to consistent use, underscoring the importance of cost-effective sun protection counseling.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Here, we found no clear trend in the percent of sunscreen products containing allergens across increasing cost tiers. Allergen prevalence remained high regardless of product price. Dermatologists should counsel patients with sensitivities to incorporate cost-effective, allergen-friendly sunscreen options into their routine to best reduce adverse reactions and improve sunscreen use.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRegulatory Overview\u003c/h2\u003e \u003cp\u003eUS sunscreens are regulated by the FDA as OTC drugs and are closely scrutinized for safety and efficacy (e.g., toxicological assessments, SPF, and water-resistance validation).\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e However, the current regulatory system permits variability in how certain claims are applied. For example, companies can legally label fragrance-containing products as \u0026ldquo;fragrance-free\u0026rdquo;, as long as the fragrance chemicals can also be employed as an emollient or preservative, rather than being used \u0026ldquo;solely to impart an odor to a product\u0026rdquo;.\u003csup\u003e20,21\u003c/sup\u003e In sunscreen labeling, claims like \u0026ldquo;allergen-free,\u0026rdquo; \u0026ldquo;hypoallergenic,\u0026rdquo; and \u0026ldquo;dermatologist recommended\u0026rdquo; are not strictly defined or regulated by the FDA.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e As a result, well-intentioned consumers may be exposed to allergens when relying on these claims as indicators of formulation safety. While permitted under current FDA regulation, these practices remain within the boundaries of the law. Examination of product ingredient lists should always be recommended to patients over trusting potentially unvalidated or unreliable claims and advertising.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn contrast, the European Union (EU) classifies sunscreens as cosmetic products, subjecting them to stricter labeling requirements. Limiting or eliminating allergen exposure is key to preventing ACD, and EU cosmetic regulations help reduce ACD prevalence by improving product labeling, clearly defining risk assessments, and providing usage instructions. Due to the frequency of allergenic responses as adverse reactions associated with cosmetic products, the EU also requires quantitative skin sensitization assessment, including in chemico assays, in vitro cell-based methods, and in silico predictions, for all cosmetic ingredients.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Labels can help prevent ACD by enabling patients and consumers to make informed choices about allergen exposures. Even labels such as \u0026ldquo;perfume\u0026rdquo; or \u0026ldquo;contains fragrances\u0026rdquo; do not provide sufficient information, and in 2005, the EU mandated the disclosure of 26 specific fragrance allergens on cosmetic labels, regardless of the ingredient\u0026rsquo;s proposed function.\u003csup\u003e\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e This individual labeling requirement was expanded to 82 fragrance allergens in 2023, significantly improving transparency, helping consumers avoid known allergens, and aiding clinicians in making personalized product recommendations.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e In the US, the Modernization of Cosmetics Regulation Act of 2022 (MoCRA) introduced allergen reporting but still does not mandate the disclosure of specific fragrance allergens.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e If the US adopted a similar system to the EU, it would be a meaningful step toward improving transparency and protecting sensitive individuals.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical Implications \u0026 Considerations for High-Risk Groups\u003c/h3\u003e\n\u003cp\u003eSunscreen application is a modifiable behavior that is an essential form of sun protection and helps prevent skin cancer development and exacerbation of photosensitive conditions. Patients with a history of melanoma or non-melanoma skin cancer (NMSC) and solid-organ transplantation are pathophysiologically predisposed to subsequent cutaneous malignancy due to mechanisms including cumulative UV-induced DNA damage, inflammatory microenvironment, and immunosuppression.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e For these individuals, diligent photoprotection, including daily sunscreen, is a cornerstone recommendation in secondary cancer prevention and primary disease progression.\u003c/p\u003e \u003cp\u003eIf a patient experiences contact dermatitis in association with sunscreen application, the first action in management is to identify and avoid the causal agent.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e However, adverse cutaneous reactions may discourage consistent sunscreen use, reducing overall photoprotection and potentially compounding risk for recurrence in patients already predisposed to subsequent malignancy or disease progression.\u003c/p\u003e \u003cp\u003eAdditional populations warranting strict photoprotection include those with autoimmune photodermatoses (e.g., systemic lupus erythematosus, dermatomyositis), genodermatoses such as xeroderma pigmentosum and Gorlin syndrome, organ transplant recipients, and those on photosensitizing medications. For these individuals, daily sunscreen use (in combination with other components of a strong sun protection practice) prevents phototoxic injury, disease flares, and cumulative sun damage.\u003c/p\u003e \u003cp\u003eThis consideration is particularly relevant for patients with Fitzpatrick skin types III-VI, who are more commonly affected by visible-light (VL)- induced pigmentary disorders (e.g., post-inflammatory hyperpigmentation and melasma) and may require consistent, cosmetically acceptable, high-surface-area sunscreen application.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e In a similarly structured analysis of best-selling tinted sunscreens, 28/36 (80.0%) products contained at least one NACDG screening series allergen, highlighting that tinted formulations may not be reliably associated with lower allergen exposure for patients relying on them for VL protection.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFor patients with a heightened need for rigorous photoprotection, barriers to adherence should be actively addressed. Further, clinician sunscreen selection should prioritize ingredient-level review over SPF value, marketing claims, tint status, or brand reputation. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e Patients should also be counseled that higher-cost sunscreen options do not reliably confer lower allergen burden, as allergen inclusion remained relatively common (\u0026gt;\u0026thinsp;90%) even among those in the highest price category (\u0026gt;\u003cspan\u003e$\u003c/span\u003e30.00). \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Pearls for Dermatologist-Guided Sunscreen Selection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarketing claims such as \u0026ldquo;hypoallergenic,\u0026rdquo; \u0026ldquo;gentle,\u0026rdquo; \u0026ldquo;allergen-free,\u0026rdquo; and \u0026ldquo;dermatologist recommended\u0026rdquo; are unreliable indicators of low allergen content in sunscreen products.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImproved regulatory standards and transparent allergen labeling are needed to align marketing claims with product formulation and enhance patient safety.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIngredient-level review is more informative than SPF, price point, tint status, or brand reputation when selecting sunscreens for patients with sensitive skin or contact dermatitis.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhile physical (mineral) sunscreens demonstrate lower rates of NACDG screening allergens than chemical formulations and may be a reasonable first-line recommendation, individual product reviews juxtaposed to a patient\u0026rsquo;s specific allergy list are necessary.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFragrance remains the most common contact allergen in U.S. sunscreens and may be present despite \u0026ldquo;fragrance-free\u0026rdquo; labeling due to regulatory loopholes.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients with recurrent or reproducible dermatitis associated with sunscreen use should be evaluated for allergic or photoallergic contact dermatitis with patch and/or photopatch testing.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdverse reactions to sunscreen can significantly reduce adherence to photoprotection.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSunscreen cost does not correlate with allergen burden; affordable options may be equally appropriate for patients with contact sensitivity.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDocumentation of tolerated sunscreen products can reduce trial-and-error frustration and improve long-term adherence.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. Firstly, smaller, boutique, and international sunscreen brands were likely underrepresented in our sample due to retailer availability and consumer preferences. Even with 200 products, the sheer size of the sunscreen market means many formulations went unexamined. Additionally, ingredient lists were extracted from retailer and manufacturer websites, which may list outdated information or inconsistencies across retailers carrying the same product. Moreover, sunscreen formulations fluctuate sporadically, and emerging allergens may not yet be reflected in currently published screening series. Interestingly, less than 40% of positive patch test reactions to sunscreen (2001\u0026ndash;2010) were detected by the NACDG screening series of allergens.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e The allergens identified in the sunscreen products in this study likely underrepresent the true prevalence of allergic reactions associated with these sunscreens.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this cross-sectional analysis of sunscreens commonly available in the US, 89% of identified sunscreen products contained one or more NACDG screening series allergens, including the majority of products that directly advertised safety and sensitivity. From our findings, physical sunscreens and those marketed as gentle demonstrated the lowest rate of contact allergen inclusion and may be recommended with greater confidence. Conversely, SPF level, tint status, price, and most marketing claims were not reliable indicators of NACDG allergen inclusion and should not be used in targeted product recommendations. Our findings point to the longstanding discrepancy between sensitivity claims and the actual formulation content and emphasize the need for transparency through a commitment to regulatory reform.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors did not receive funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u0026nbsp;\u003c/strong\u003eNot applicable. This study did not involve human participants, their data, or biological material.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eData are available from the corresponding author upon reasonable request.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePatient Consent:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eC.W.R. and C.L.P. conceived the study. A.B.F. contributed to study design, collected and analyzed the data, and wrote the main manuscript text. C.E.R. contributed to manuscript writing and reviewed the manuscript. C.L.P. contributed to study design and manuscript writing and reviewed the manuscript. C.S. contributed to study design and reviewed the manuscript. C.W.R. supervised the project. All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCommittee on Environmental Impact of Currently Marketed Sunscreens (2022) and Potential Human Impacts of Changes in Sunscreen Usage, Ocean Studies Board, Board on Environmental Studies and Toxicology. et al. Review of Fate, Exposure, and Effects of Sunscreens in Aquatic Environments and Implications for Sunscreen Usage and Human Health. National Academies, p 26381. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17226/26381\u003c/span\u003e\u003cspan address=\"10.17226/26381\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGabros S, Patel P, Zito PM (2025) Sunscreens and Photoprotection. In: \u003cem\u003eStatPearls\u003c/em\u003e. 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Dermatitis 25(6):289\u0026ndash;326. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/DER.0000000000000079\u003c/span\u003e\u003cspan address=\"10.1097/DER.0000000000000079\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou C, Lee C, Salas J, Luke J (2023) Guide to tinted sunscreens in skin of color. Int J Dermatology Published online Dec 10:ijd16954. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ijd.16954\u003c/span\u003e\u003cspan address=\"10.1111/ijd.16954\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFay AB, Bailey-Burke CL, Reynolds CE, Presley CL, Stamey C, Rundle CW (2025) Tinted but not transparent: a survey of allergen prevalence and marketing claims in U.S. Tinted sunscreens. Arch Dermatol Res 318(1):34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00403-025-04498-z\u003c/span\u003e\u003cspan address=\"10.1007/s00403-025-04498-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarshaw EM, Wang MZ, Maibach HI et al (2013) Dermatitis 24(4):176\u0026ndash;182. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/der.0b013e3182983845\u003c/span\u003e\u003cspan address=\"10.1097/der.0b013e3182983845\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Patch Test Reactions Associated With Sunscreen Products and the Importance of Testing to an Expanded Series: Retrospective Analysis of North American Contact Dermatitis Group Data, 2001 to 2010\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"sunscreen, sunscreen allergy, allergic contact dermatitis, tinted sunscreen, allergens","lastPublishedDoi":"10.21203/rs.3.rs-9149182/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9149182/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSunscreens are widely used for photoprotection but are known to cause adverse reactions including irritant contact dermatitis (ICD), allergic contact dermatitis (ACD), and photoallergic contact dermatitis (PACD). Because formulations are subject to frequent change, continuous assessment of allergen prevalence remains clinically relevant. In this cross-sectional analysis, we evaluated the presence of North American Contact Dermatitis Group (NACDG) screening series allergens in top-selling sunscreen products available to United States consumers. Ingredient lists from 200 top-selling sunscreen products identified from five major retailers were reviewed for 2021 to 2022 NACDG screening series allergens. Sunscreen characteristics, including ultraviolet filter type, sun protection factor, tint status, price, and marketing claims, were recorded. Of 200 products, 178 (89.0%) contained at least one NACDG allergen. Chemical sunscreens demonstrated the highest inclusion rate (95.0%), while physical sunscreens showed lower prevalence (72.7%). Allergen inclusion remained common among products marketed as hypoallergenic, gentle, allergen-free, or dermatologist-recommended. Ingredient lists were obtained from retailer and manufacturer websites, which may not reflect current formulations. Marketing claims are unreliable indicators of allergen content. Ingredient-level review remains critical when recommending sunscreens for patients with contact sensitivity.\u003c/p\u003e","manuscriptTitle":"North American Contact Dermatitis Group Allergens in U.S. Sunscreens: Prevalence and Relationship to Product Characteristics","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-14 18:14:31","doi":"10.21203/rs.3.rs-9149182/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-17T02:22:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T12:17:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107104872456434412610301086635931087399","date":"2026-05-08T07:47:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235588098613065161211127380169001180626","date":"2026-05-06T11:08:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56347463282543393289702540556800727518","date":"2026-05-06T05:31:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-06T04:10:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-21T12:06:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-21T12:05:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Dermatological Research","date":"2026-03-17T12:58:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"f69dc193-b9c9-4b53-927b-e73c0994e137","owner":[],"postedDate":"May 14th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-17T02:22:22+00:00","index":32,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T12:17:04+00:00","index":31,"fulltext":""},{"type":"reviewerAgreed","content":"107104872456434412610301086635931087399","date":"2026-05-08T07:47:22+00:00","index":29,"fulltext":""},{"type":"reviewerAgreed","content":"235588098613065161211127380169001180626","date":"2026-05-06T11:08:22+00:00","index":27,"fulltext":""},{"type":"reviewerAgreed","content":"56347463282543393289702540556800727518","date":"2026-05-06T05:31:04+00:00","index":25,"fulltext":""},{"type":"reviewersInvited","content":"20","date":"2026-05-06T04:10:06+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T18:14:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-14 18:14:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9149182","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9149182","identity":"rs-9149182","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}