Dermatologist Practical Guide to Encouraging Photoprotection in Skin of Color Patients

 Tip 3: Strongly consider tinted sunscreens.

Consumer studies have demonstrated that cosmetic elegance is of top importance when evaluating sunscreens.⁶ In patients with darker skin tones specifically, the white residue or cast that is left on their skin after application of many sunscreens significantly impedes regular use.⁶  These hesitancies can significantly deter patients from regular sunscreen use and should be specifically addressed with patients. Newer formulations of tinted sunscreens have been developed to accommodate a richer variety of skin tones, with different shades available. These options can help skin of color patients with challenges related to poor blending of sunscreens with their natural skin tones.

In addition to the photobiologic effects of UV radiation on the skin, visible light has now been shown to induce long-lasting pigmentation in people with darker skin types.⁷  Although broad spectrum sunscreens protect against UV radiation, they do not adequately protect against visible light, which must be visible on the skin to be protective. Tinted sunscreens provide protection against visible light by including iron oxides and pigmentary titanium dioxides. These sunscreens combine UV filters with color-based coverage. These formulations are very beneficial and should be encouraged in patients with darker skin types, especially those with pigmentary disorders. Patients with melasma, LPP, or PIH frequently complain of worsening disease with sun exposure despite regular sunscreen use.⁷ Additionally, cutaneous porphyrias, solar urticaria, and chronic actinic dermatitis are all photodermatoses with active spectrums in the visible light range.

In a recent study, it was shown that surveyed dermatologists from multiple tertiary care centers in Boston highly value cosmetic elegance of sunscreen for personal use but viewed cosmetic elegance as the least important factor when making recommendations for patient use.⁶ This may indicate that perhaps dermatology providers underestimate the importance of cosmetic elegance to patients. Cosmetic elegance can certainly be found in many over the counter products but can also be found in products that extend beyond over the counter. Additionally, a more diverse selection of product options that are presented to SOC patients may present the chance to identify a product that fits their personal criteria for good sunscreen that will encourage daily use and at a cost that is acceptable to the patient. A discussion of challenges that come with different types of sunscreens in addition to a wide array of products that may address those challenges may be concordant with increased patient satisfaction.

Dermatologists should be diligent about trying samples of different types of sunscreens to gain exposure and knowledge as to the best products that may be more suitable for SOC patients. When providing samples for patients to try and/or creating a pre-created handout for patients, it is important that the physician incorporate products that address the diverse and specific needs of many SOC patients, including products that contain iron oxides and physical sunscreens with cosmetic elegance when applied to darker skin. 

It is prudent that dermatologists understand and empathize with the frustrations that patients with darker skin types may experience when trying to find the right sunscreen on the market for their skin types. This is especially given the fact that traditionally, sunscreens have not been produced to target this particular patient population. In addition to encouraging patients to continue trying new sunscreens until the right fit is found, we also recommend monitoring progression and improvement of sun-induced photodermatoses and PIH to encourage continued use.