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I’ve never had to have a doctors note (nor written one for someone) to buy something that is already approved on the list. My understanding though is it should be something your “condition” needs. For example, I purchased a very expensive stethoscope with my funds and could do that because I have high blood pressure. For your, everyone has skin so go ahead and buy sunscreen.

Some times you do need physician letters but for items that specify you need it. For example, exercise equipment is on that list and I have written a letter saying I recommended exercise and had specific amounts of use per week for their condition as treatment. Even this could be applied to a number of conditions, from weight loss to depression to high blood pressure.

Also, double check with your plan administrators about carryover. Under my employer's plan (this is employer specific), I am allowed to roll over a certain amount from 2022 to 2023 funds.

I pretty much bought skin stuff, a scale, COVID masks, and a heating pad for my back (I sit at a desk all day and back hurts at end). Do you think this would be fine?

Skin stuff really needs to be specified more to be able to tell. Search items here: https://fsastore.com/fsa-eligibility-list

Heating pads are allowed and are listed on FSA approved items. Same for the scale.

Everything I bought on the Amazon had FSA eligible.

You only need a letter of medical necessity for certain items. You don't for sunscreen.