population. Dermatologists should familiarize themselves with other factors that complicate sunscreen selection such as oily skin, which may play a factor in patients of color.
Clinicians unfamiliar with sunscreen products can encourage their patients to look for brands that utilize mineral based and reference “for all complexions” or “skin types” on the label. However, a carefully curated list would be most beneficial for patients. When constructing this list, take into consideration the protective effects iron oxide has on specific concerns for PIH and melasma exacerbation. Iron-oxide sunscreens are often tinted, which is a useful tip that clinicians can share with their patients. A blanket statement on the importance of sunscreen without further inquiry into patient concerns regarding dyspigmentation, skin cancer, and photoaging would be a disservice to this skin of color patient population. Understanding nuances that make sunscreen use appealing and beneficial in diverse patients is the level of expertise people of color seek to encounter when visiting a board-certified dermatologist.
This responsibility does not fall on dermatologists alone. Finding sunscreen brands that meet demands of darker complexions on the market can be very frustrating for patients and physicians alike. It is unacceptable for there to be so few options for people of color to choose from when there is infinite product availability and variation for the majority. Dermatology governing bodies and individual dermatologists should leverage relationships with the FDA and sunscreen manufacturers to call to action development of products that satisfy the needs of ethnic groups who remain often overlooked and left out of the conversation. While some sunscreen companies are beginning to engage patients with skin of color through marketing, more companies need to follow suit.
Sunscreen manufacturers must become more transparent in their labeling of products. The overwhelming number of products found in drug stores and online boutiques should enforce labeling that clearly states a sunscreen can be used “for all complexions”. We must call on the action of the FDA to ensure that sunscreen companies are not just stating they are “inclusive,” but are actually effective and visually desirable for all skin types. This may require the FDA to expand recommendations for testing populations and hold clinical trials that are influenced by the criticisms and opinions of darker Fitzpatrick-typed participants. This use of inclusive labeling will not only ensure people of color are aware of the preferred sunscreens for their skin type but will provide a simplified consumer experience when purchasing these products in stores.
Sunscreen use in skin of color is a multi-faceted issue that requires the active attention and participation of all healthcare stakeholders. Apart from popular magazines and celebrity focused articles, there is currently no specific literary review or database that compiles sunscreen options available for people of color. Stronger efforts toward increasing the diversity of sunscreen products in minority neighborhoods, raising awareness regarding the need for sunscreen for patients of color not solely for skin cancer prevention but also for certain pigmentary disorders and hyperpigmentation purposes, and closing the knowledge gaps of dermatologists regarding the many types of sunscreens and the appropriate indications for their use in this community are initial steps necessary to move towards inclusion. We must rely on dermatologists to be allies in spaces where the needs of diverse populations go unnoticed. Healthcare providers, sunscreen manufacturers, and regulatory government entities must each play a role in ensuring that people of color feel a part of photoprotective efforts and can find products that are essential to their health and overall wellbeing.
Clinicians unfamiliar with sunscreen products can encourage their patients to look for brands that utilize mineral based and reference “for all complexions” or “skin types” on the label. However, a carefully curated list would be most beneficial for patients. When constructing this list, take into consideration the protective effects iron oxide has on specific concerns for PIH and melasma exacerbation. Iron-oxide sunscreens are often tinted, which is a useful tip that clinicians can share with their patients. A blanket statement on the importance of sunscreen without further inquiry into patient concerns regarding dyspigmentation, skin cancer, and photoaging would be a disservice to this skin of color patient population. Understanding nuances that make sunscreen use appealing and beneficial in diverse patients is the level of expertise people of color seek to encounter when visiting a board-certified dermatologist.
This responsibility does not fall on dermatologists alone. Finding sunscreen brands that meet demands of darker complexions on the market can be very frustrating for patients and physicians alike. It is unacceptable for there to be so few options for people of color to choose from when there is infinite product availability and variation for the majority. Dermatology governing bodies and individual dermatologists should leverage relationships with the FDA and sunscreen manufacturers to call to action development of products that satisfy the needs of ethnic groups who remain often overlooked and left out of the conversation. While some sunscreen companies are beginning to engage patients with skin of color through marketing, more companies need to follow suit.
Sunscreen manufacturers must become more transparent in their labeling of products. The overwhelming number of products found in drug stores and online boutiques should enforce labeling that clearly states a sunscreen can be used “for all complexions”. We must call on the action of the FDA to ensure that sunscreen companies are not just stating they are “inclusive,” but are actually effective and visually desirable for all skin types. This may require the FDA to expand recommendations for testing populations and hold clinical trials that are influenced by the criticisms and opinions of darker Fitzpatrick-typed participants. This use of inclusive labeling will not only ensure people of color are aware of the preferred sunscreens for their skin type but will provide a simplified consumer experience when purchasing these products in stores.
Sunscreen use in skin of color is a multi-faceted issue that requires the active attention and participation of all healthcare stakeholders. Apart from popular magazines and celebrity focused articles, there is currently no specific literary review or database that compiles sunscreen options available for people of color. Stronger efforts toward increasing the diversity of sunscreen products in minority neighborhoods, raising awareness regarding the need for sunscreen for patients of color not solely for skin cancer prevention but also for certain pigmentary disorders and hyperpigmentation purposes, and closing the knowledge gaps of dermatologists regarding the many types of sunscreens and the appropriate indications for their use in this community are initial steps necessary to move towards inclusion. We must rely on dermatologists to be allies in spaces where the needs of diverse populations go unnoticed. Healthcare providers, sunscreen manufacturers, and regulatory government entities must each play a role in ensuring that people of color feel a part of photoprotective efforts and can find products that are essential to their health and overall wellbeing.
DISCLOSURES
The authors have no conflict of interest to declare.
REFERENCES
1. Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007. 80(5):387-94.
2. Akinboro A, Ezejiofor O, Olanrewaju F, Oripelaye M, Olabode O, Ayodele O, et al. The impact of acne and facial post-inflammatory hyperpigmentation on quality of life and self-esteem of newly admitted Nigerian undergraduates. Clin Cosmetic Investig Dermatol. 2018;11:245-252.
3. Agbai O, Buster K, Sanchez M, Hernandez C, Kundu R, Chiu M, et al. Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-762.
4. Boukari F, Jourdan E, Fontas E, Montaudié H, Castela E, Lacour J, et al. Prevention of melasma relapses with sunscreen combining protection against UV and short wavelengths of visible light: A prospective randomized comparative trial. J Am Acad Dermatol. 2015;72(1):189-190.e1.
5. Dumbuya H, Grimes P, Lynch S, Ji K, Brahmachary M, Zheng Q, et al. Impact of iron-oxide containing formulations against visible light-induced skin pigmentation in skin of color individuals. J Drugs Dermatol. 2020;19(7).
6. Matta M, Florian J, Zusterzeel R, Pilli N, Patel V, Volpe D, et al. Effect of sunscreen application on plasma concentration of sunscreen active ingredients. JAMA. 2020;323(3):256.
7. Hernandez C, Calero D, Robinson G., Mermelstein R, Robinson JK. Comparison of sunscreen availability in Chicago Hispanic and non-Hispanic neighborhoods. Photodermatol Photoimmunol Photomed. 2012;28(5):244-249. doi: 10.1111/j.1600-0781.2012.00688.x
2. Akinboro A, Ezejiofor O, Olanrewaju F, Oripelaye M, Olabode O, Ayodele O, et al. The impact of acne and facial post-inflammatory hyperpigmentation on quality of life and self-esteem of newly admitted Nigerian undergraduates. Clin Cosmetic Investig Dermatol. 2018;11:245-252.
3. Agbai O, Buster K, Sanchez M, Hernandez C, Kundu R, Chiu M, et al. Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-762.
4. Boukari F, Jourdan E, Fontas E, Montaudié H, Castela E, Lacour J, et al. Prevention of melasma relapses with sunscreen combining protection against UV and short wavelengths of visible light: A prospective randomized comparative trial. J Am Acad Dermatol. 2015;72(1):189-190.e1.
5. Dumbuya H, Grimes P, Lynch S, Ji K, Brahmachary M, Zheng Q, et al. Impact of iron-oxide containing formulations against visible light-induced skin pigmentation in skin of color individuals. J Drugs Dermatol. 2020;19(7).
6. Matta M, Florian J, Zusterzeel R, Pilli N, Patel V, Volpe D, et al. Effect of sunscreen application on plasma concentration of sunscreen active ingredients. JAMA. 2020;323(3):256.
7. Hernandez C, Calero D, Robinson G., Mermelstein R, Robinson JK. Comparison of sunscreen availability in Chicago Hispanic and non-Hispanic neighborhoods. Photodermatol Photoimmunol Photomed. 2012;28(5):244-249. doi: 10.1111/j.1600-0781.2012.00688.x
AUTHOR CORRESPONDENCE
Prince Adotama MD prince.adotama@nyulangone.org
