Sunscreen and prevention of skin aging: A randomized trial

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. © 2013 American College of Physicians.