Sunscreen Use: Recommendations vs Real World

Deficits in use of sunscreen indicate that people pay little attention to the recommendations of health authorities, regardless of their skin type, and underscore an urgent need for targeted public information on its use.

The majority of people who use sunscreen do not follow recommendations for frequency of application and reapplication, according to data from a cross-sectional review of 3000 German residents aged 14 to 45 years published in European Academy of Dermatology and Venereology.

The rational for the study, according to researchers, came from results from international studies which showed a wide disparity of sunscreen use ranging from 6% to 80%. More importantly, they observed that large numbers of sunscreen users in many populations have a low understanding of when and how much sunscreen to use for effective prevention of skin cancer.

For the current study, data were collected via a survey distributed by the National Cancer Aid Monitoring (NCAM) group, which was originally designed to evaluate exposure to ultraviolet (UV) radiation. The follow-up survey asked questions regarding the frequency of use of sunscreen during the summer months, specifically where on the body and when it was applied, and how often it was reapplied. The respondents were asked about the lowest and highest sun protection factor (SPF) level used when out in the sun for 15 minutes or longer, and how much of the bottle they would apply with each use.

More than two-thirds of participants admitted to frequently seeking sun exposure in order to get a tan. Nearly half (46.4%, n = 1389) used sunscreen always or often, and one-third (33.0%, n = 986) reported using it some of the time.

Participants with pale skin types I-II showed a higher likelihood for using sunscreen products with a higher SPF (≥30) compared with those with darker skin. Most participants reported application of sunscreen most consistently to the face and shoulders, and less frequently to the arms (70.1%), legs (53.4%), and other parts of the body (40.8%).

The investigators found that based on current recommendations, sunscreen was significantly underutilized; only about a third of those studied reported using sunscreen whenever they were exposed to sunlight. Of those people, 15% never reapplied it, despite recommendations.

One limitation to the study was the inability to collect information on the quantity of sunscreen used with each application. Based on the general belief that a bottle of sunscreen could be used for 16.5 applications, the investigators were able to calculate that on average, participants used 12 mL each time. This represented one-third of the recommended amount to cover the body. In addition, no information on the use of other photoprotective measures was gathered. The researchers also noted that the data were based on participants’ self-reports, which may be effected by recall bias.

Overall, 79.4% of respondents reported that they used sunscreen at least sometimes while in the sun, but 87.2% did not follow the recommendations for the timing of sunscreen application. Also, 59.5% did not comply with the timing of reapplication. The results were consistent across all skin types and researchers noted that people in Germany have a lower awareness of the potential for UV-related skin damage.

Related Articles

Based on these findings, the researchers concluded that an urgent need for targeted public information on proper sunscreen use exists. “Improving public knowledge of correct sunscreen use through educational campaigns or individual counseling by health professionals could be a first step,” they proposed.


Görig T, Schneider S, Seuffert S, Greinert R, Diehl K. Does sunscreen use comply with official recommendations? Results of a nationwide survey in Germany [published online November 20, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.16100