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Summary: Background: Sunscreen use can prevent skin cancer, but there are concerns that it may increase the risk of vitamin D deficiency. Objectives: We aimed to review the literature to investigate associations between sunscreen use and vitamin D3 or 25 hydroxyvitamin D [25(OH)D] concentration. Methods: We systematically reviewed the literature following the Meta‐analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. We identified manuscripts published in English between 1970 and 21 November 2017. Eligible studies were experimental [using an artificial ultraviolet radiation (UVR) source], field trials or observational studies. The results of each of the experimental studies and field trials are described in detail. Two authors extracted information from observational studies, and applied quality scoring criteria that were developed specifically for this question. These have been synthesized qualitatively. Results: We included four experimental studies, three field trials (two were randomized controlled trials) and 69 observational studies. In the experimental studies sunscreen use considerably abrogated the vitamin D3 or 25(OH)D production induced by exposure to artificially generated UVR. The randomized controlled field trials found no effect of daily sunscreen application, but the sunscreens used had moderate protection [sun protection factor SPF) ~16]. The observational studies mostly found no association or that self‐reported sunscreen use was associated with higher 25(OH)D concentration. Conclusions: There is little evidence that sunscreen decreases 25(OH)D concentration when used in real‐life settings, suggesting that concerns about vitamin D should not negate skin cancer prevention advice. However, there have been no trials of the high‐SPF sunscreens that are now widely recommended. What's already known about this topic? Previous experimental studies suggest that sunscreen can block vitamin D production in the skin but use artificially generated ultraviolet radiation with a spectral output unlike that seen in terrestrial sunlight.Nonsystematic reviews of observational studies suggest that use in real life does not cause vitamin D deficiency. What does this study add? This study systematically reviewed all experimental studies, field trials and observational studies for the first time.While the experimental studies support the theoretical risk that sunscreen use may affect vitamin D, the weight of evidence from field trials and observational studies suggests that the risk is low.We highlight the lack of adequate evidence regarding use of the very high sun protection factor sunscreens that are now recommended and widely used. Linked Editorial: Wolf. Br J Dermatol 2019; 181:881–882. Plain language summary available online [ABSTRACT FROM AUTHOR]

Summary: 维生素 D 对骨骼健康至关重要,它是皮肤受阳光中紫外线(UVR)的照射后产生的。UVR 也是皮肤癌(英国最常见的癌症类型)的主要原因。因此,人们一直担心防晒方法(例如使用防晒霜)会影响维生素 D 的产生。 来自澳大利亚的 QIMR Berghofer 医学研究所和澳大利亚国立大学的研究人员首次系统性回顾了 1970 年至 2017 年期间发表的所有实验性研究、现场试验和观察性研究,共计 75 项研究,以了解防晒霜使用对维生素 D 水平的影响。 研究人员发现,尽管实验研究(在实验室环境中使用人造光源)支持使用防晒霜可能影响维生素D的理论风险,但现场试验和观察性研究的大量证据(发生在涉及自然阳光的现实生活场景中)表明其风险较低。 研究人员解释,实验研究中的条件并不能反映现实世界条件,因此该结果不能用于向公众提供实用建议。 该综述的作者得出结论,几乎没有证据表明使用防晒霜在现实生活中会降低维生素 D 水平,在某些情况下,使用防晒霜和维生素 D 水平升高相关。因此,对维生素 D 水平的顾虑不应干扰皮肤癌的预防建议。未来的预防路径应考虑目前已广泛推荐的高防晒系数的防晒霜。 Linked Article: Neale et al. Br J Dermatol 2019; 181:907–915 [ABSTRACT FROM AUTHOR]

Summary: Vitamin D is essential for bone health and is produced by the skin in response to ultraviolet radiation (UVR) from sunlight. UVR is also the main cause of skin cancer, the UK's most common type of cancer. Therefore, there have been several concerns that sun protection methods such as using sunscreen can affect vitamin D production. Researchers from the QIMR Berghofer Medical Research Institute in Australia, and the Australian National University, systematically reviewed for the first time all published experimental studies, field trials, and observational studies published between 1970 and 2017, totalling 75 studies, in order to understand the effect of sunscreen use on vitamin D levels. The researchers found that while the experimental studies (using artificial light sources in a laboratory setting) support the theoretical risk that sunscreen use may affect vitamin D, the weight of evidence from field trials and observational studies (taking place in real‐life situations involving natural sunlight) suggests that the risk is low. The researchers explain that the conditions in the experimental studies did not reflect those of the real world, so the results cannot be used to inform practical recommendations for the public. The authors of this review concluded that there is little evidence that sunscreen, when used in real‐life settings, decreases vitamin D levels and in some cases sunscreen use was associated with higher vitamin D levels. Therefore, concerns about vitamin D levels should not interfere with skin cancer prevention advice. Future trails should consider high sun protection factor sunscreens which are now widely recommended. Linked Article: Neale et al. Br J Dermatol 2019; 181:907–915 [ABSTRACT FROM AUTHOR]