INTRODUCTION
Patients with skin of color (SOC) are at risk for skin cancers and photoaging and have a unique predisposition to pigmentary disorders that are exacerbated by ultraviolet light exposure. Sun protection with a Sun Protection Factor (SPF) > 15 sunscreen has been shown to not only decrease the incidence of melanoma and non-melanoma skin cancers, but also improve and prevent the exacerbation of certain ultraviolet (UV)-sensitive conditions, such as post-inflammatory hyperpigmentation (PIH), melasma, and Lichen Planus Pigmentosus (LPP).1 Despite this, the use of sunscreen among SOC patients have been shown to be inadequate, with barriers such as a poor blend with some skin complexions and lack of awareness being attributed as its drivers. Recent studies have also highlighted issues related to cultural and communication barriers that affect the way dermatologists relate to their skin of color patients.2 The purpose of this article is to provide practical tips to dermatologists interested in improving sunscreen adherence in their SOC patient population.
Tip 1: Explore the reasons why your SOC patient does not currently wear sunscreen to better target your recommendations. Explicitly dispel the myth that SOC patients do not need sunscreen.
Malignant melanoma and keratinocyte carcinomas are the most common malignancy in the US, accounting for 40% of neoplasms in Whites.1 The incidence of skin cancer is significantly lower in people of color when compared to Whites, contributing to the myth that SOC patients do not need SPF sunscreen. However, there is a considerably increased risk of morbidity and mortality in skin of color patients compared to whites with skin cancer, which can be attributed to biologic and socioeconomic differences that are still being studied.1 Additionally, in a study evaluating the correlations between melanin content and the degree of UVA- and UVB-induced DNA damage in normal appearing skin in various ethnic groups, it was found that although DNA damage is most severe in lighter skin, even low exposure to UV radiation induced appreciable DNA damage in all skin types.3 This should be emphasized to patients to dispel the misconception that SOC is immune to UV-induced DNA damage.
Tip 2: Highlight how poor sunscreen adherence may be relevant to their current dermatology visit (eg, worsening pigmentary changes in PIH and melasma).
Despite increased photoprotection provided by darker skin, it should be mentioned to patients that individuals with skin of color are more susceptible to developing certain pigmentary disorders, such as PIH, melasma, and LPP. Acne and dyschromia were previously shown to be the top two reasons African-Americans visit dermatology offices.4 Pigmentary disorders are worsened by ultraviolet exposure. These conditions can be cosmetically disfiguring, impacting one’s quality of life and self-esteem; therefore, photoprotective methods such as daily sunscreen use, with SPF of at least 30, are essential to halt the worsening of these conditions.
Consider other common skin conditions and how they may impact sunscreen use and adherence. Patients with atopic dermatitis may experience photosensitivity or aggravation when exposed to sun, which can be improved with sunscreen use.5 Given drier skin, these patients may benefit from more moisturizing sunscreens or moisturizers with SPF. These patients may also have more sensitive skin and should avoid oxybenzone containing products to avoid potential allergic contact dermatitis. In patients with oily or acne-prone skin, recommend the patient to cleanse the skin prior to the application of sunscreen and to use less greasy formulations, mineral sunscreens with low absorption, or oil-absorbing moisturizers with SPF. It is crucial that patients with rosacea apply sunscreen daily.
Skin of color patients may also present to clinic with concerns of premature aging and photoaging, which can be moderated by regular sunscreen use. It is a common misconception that sunscreen is less crucial in skin of color patients given that there is less apparent photoaging in darker skin. However, in skin of color, both intrinsic aging and photoaging significantly impact skin function and composition despite additional photoprotective properties of increased melanin.1 Additional cutaneous manifestations of photoaging in ethnic skin include the development of solar lentigines and dermatosis papulose nigra, which may be considered unsightly to some patients.
