Attitudes on, Practices, and Recommendations for Visible Light Protection Amongst Dermatology Practitioners

November 2024 | Volume 23 | Issue 11 | 965 | Copyright © November 2024


Published online October 29, 2024

doi:10.36849/JDD.8159

Sara Abdel Azim MS*, Cleo Whiting BA*, Adam J. Friedman MD FAAD

Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC

*All the authors contributed equally to this work.

Abstract

Background: Iron oxides, antioxidants, and pigmentary titanium dioxide are sunscreen additive ingredients that enhance visible light protection, reduce associated hyperpigmentation, and protect against certain photosensitive dermatoses There are currently no standardized recommendations for visible light protection with these additive ingredients, leading to varied clinical recommendations.
Objectives: This study aimed to evaluate dermatology practitioners' counseling practices for visible light protection.
Methods: An electronic survey was distributed to dermatology practitioners. Survey responses were compiled for analysis, and statistical significance was calculated using a standard 95% confidence interval.
Results: 91.68% of 974 respondents actively counsel patients about visible light protection, primarily emphasizing its role in exacerbating pigmentation in patients with melanin-rich skin (70.92%). Of these, 10.34% recommended sunscreens with visible light protective additive ingredients specifically for patients with melanin-rich skin, and 48.89% recommended them for managing melasma or post-inflammatory hyperpigmentation. Iron oxide additive ingredients were most frequently recommended (90.92%), followed by antioxidants (69.08%) and pigmentary TiO2, (58.85%). 8.32% of respondents reported not counseling patients about visible light protection, with major reasons encompassing the lack of standardized guidelines (50.62%), challenges in recommending suitably tinted sunscreens (27.16%), limited availability of sunscreen options (23.46%), and insufficient supportive data (18.52%).
Conclusion: There is a need for increased education and awareness regarding visible light protection strategies and the identification of patients who may benefit the most from a targeted photoprotective strategy. Establishing standardized guidelines and broadening the availability of sunscreen options conferring visible light protection may help address these gaps.

J Drugs Dermatol. 2024;23(11):965-971. doi:10.36849/JDD.8159

INTRODUCTION

Exposure to solar radiation (SR) is associated with a range of adverse effects on the skin, including photocarcinogenesis, sunburn, photoaging, and pigmentation. While the primary focus of SR-induced pathologies has historically centered on the consequences of ultraviolet (UV) radiation, humans are exposed to visible light (VL, 400-700nm), 12 to 14 orders of magnitude greater than UV.1

Wavelengths within the VL spectrum penetrate the full thickness of the epidermis and dermis, extending into the subcutaneous adipose layer;2 whereas UVA penetration does not extend beyond the dermis, and UVB only penetrates the epidermis.3 In addition to exposure from SR, VL is transmitted from flash lamps, computers, televisions, and cell phones.2 Given its pervasive presence and profound penetrative properties, the impact of VL on the skin cannot be disregarded.

Over the past decade, a growing body of literature has strengthened our understanding of the harmful effects of VL on the skin. VL exposure is associated with erythema, post-inflammatory hyperpigmentation (PIH), melasma, and exacerbation of photodermatoses. VL has been shown to induce immediate erythema in skin phototype (SPT) I to III and immediate and prolonged erythema in SPT IV to VI.2 Exposure to VL triggers inflammation and stimulates melanocytes through the generation of reactive oxygen species (ROS), exacerbating hyperpigmentation. In SPT IV to VI, VL has been shown to induce more severe and prolonged pigmentation as compared with UVA1-induced pigmentation,4 underscoring its role in pigmentary disorders in individuals with melanin-rich (MR) skin. VL also plays a role in exacerbating solar urticaria, chronic actinic dermatitis, polymorphous light eruption, and cutaneous porphyrias.2

Accordingly, the importance of sunscreen with VL protection is gaining recognition, especially in the prevention and treatment of pigmentary disorders in individuals with MR skin, who constitute nearly 40% of the United States (U.S.) population.5 Recent studies have demonstrated that additive sunscreen ingredients, including iron oxides, antioxidants, and pigmentary titanium dioxide (TiO2) enhance VL protection and

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