The second part of this CME article discusses sunscreen regulation and safety considerations for humans and the environment. First, we provide an overview of the history of the United States Food and Drug Administration\'s regulation of sunscreen. Recent Food and Drug Administration studies clearly demonstrate that organic ultraviolet filters are systemically absorbed during routine sunscreen use, but to date there is no evidence of associated negative health effects. We also review the current evidence of sunscreen\'s association with vitamin D levels and frontal fibrosing alopecia, and recent concerns regarding benzene contamination. Finally, we review the possible environmental effects of ultraviolet filters, particularly coral bleaching. While climate change has been shown to be the primary driver of coral bleaching, laboratory-based studies suggest that organic ultraviolet filters represent an additional contributing factor, which led several localities to ban certain organic filters.

As our knowledge of the harmful effects of ultraviolet radiation continues to evolve, sunscreen remains an integral part of a comprehensive photoprotection strategy against multiple endpoints of ultraviolet-mediated damage. Part 1 of this review covers sunscreen active and additive ingredient properties, mechanisms of action and gaps in coverage. Following an overview of sunscreen\'s efficacy in protecting against sunburn, photocarcinogenesis, photoaging, pigmentary disorders, and idiopathic photodermatoses, we highlight considerations for product use and selection in children and individuals with skin of color.

Most coral reefs worldwide are threatened by natural and anthropogenic impacts. Among them, the release in seawater of sunscreen products commonly used by tourists to protect their skin against the harmful effects of UV radiations, can affect tropical corals causing extensive and rapid bleaching. The use of inorganic (mineral) filters, such as zinc and titanium dioxide (ZnO and TiO2) is increasing due to their broad UV protection spectrum and their limited penetration into the skin. In the present study, we evaluated through laboratory experiments, the impact on the corals Acropora spp. of uncoated ZnO nanoparticles and two modified forms of TiO2 (Eusolex®T2000 and Optisol™), largely utilized in commercial sunscreens together with organic filters. Our results demonstrate that uncoated ZnO induces a severe and fast coral bleaching due to the alteration of the symbiosis between coral and zooxanthellae. ZnO also directly affects symbiotic dinoflagellates and stimulates microbial enrichment in the seawater surrounding the corals. Conversely, Eusolex® T2000 and Optisol™ caused minimal alterations in the symbiotic interactions and did not cause bleaching, resulting more eco-compatible than ZnO. Due to the vulnerability of coral reefs to anthropogenic impacts and global change, our findings underline the need to accurately evaluate the effect of commercial filters on stony corals to minimize or avoid this additional source of impact to the life and resilience ability of coral reefs.