Long-Term Benefits of Daily Photo-Protection With a Broad-Spectrum Sunscreen in United States Hispanic Female Population

March 2020 | Volume 19 | Issue 3 | Original Article | 236 | Copyright © March 2020


Published online February 17, 2020

Pearl Grimes , Rebat Halder , Michele Verschoore , Janet Wangari-Talbot , Kumar Pillai , Peter Foltis , Charbel Bouez , Angelike Galdi , Deena Abdelhalim , I-Chien Liao , Qian Zheng

aThe Vitiligo and Pigmentation Institute of Southern California, Los Angeles, CA bDepartment of Dermatology, Howard University, Washington, DC cL’Oreal Research and Innovation, Paris, France dL’Oreal Research and Innovation, Clark, NJ

Abstract
The skin of color population has been growing significantly in the United states and globally. This requires specific dermatological attention and patient care strategies due to unique physiological conditions and clinical manifestations regarding skin of color. Concerning photoaging, although people with higher Fitzpatrick phototypes (III and above) in general have fewer visible signs of aging such as lines and wrinkles, they are more susceptible to certain pigmentary-related conditions including uneven skin tone, ashy skin and blotchiness, post-inflammatory hyper- and hypo-pigmentation, Melasma, and seborrheic keratosis.

Effective photoprotection against harmful UVA and UVB radiation has been successful in skin cancer prevention as well as protection against solar damage. However, in skin of color communities, there are high levels of sun seeking behaviors and a lack of photoprotection with sunscreen, as a result, photoaging with dyschromia is common and certain cancer risks are growing. Historically, majority of clinical evidence for photoprotection was collected based on studies with lower skin phototypes. There is in general a lack of knowledge on the long-term impact of daily photoprotection on skin of color. In this current study, we investigated the skin benefits of daily sunscreen use with SPF 30/PPD 20 (Persistent Pigmentation Darkening rating = UVA protection) for 12 months, in phototype IV and V Hispanic females in the US, versus a real life population of the same age and phototypes without daily sunscreen in their routine. This study is to our knowledge the first one to demonstrate the benefits of long-term daily use of sunscreen on signs of aging and pigmentary concerns in patients with higher phototypes.

J Drugs Dermatol. 2020;19(3): doi:10.36849/JDD.2020.4836

INTRODUCTION

The demographics of the United states are evolving with a large increase in racial and ethnic diversity driven by international migration of Hispanic, African, and Asian populations leading to a minority-majority shift in ~2050 towards persons of color (Fitzpatrick III, IV, V, and VI).1 Specifically, the Hispanic population is projected to be among the fastest growing population in the US, projected to increase from 55 million in 2014 to 119 million in 2060, a change of +115%.1

Subjects with skin of color are heterogeneous with multiple shades and tones and different reactions to intrinsic and extrinsic aging factors due to structural and physiologic differences.2,3 Skin of color individuals have fewer visible signs of aging (deep wrinkles, fine lines, rough surface texture, and sun spots). However, darker skin tones are more susceptible to certain skin conditions including post-inflammatory hyperpigmentation (may occur after acne, eczema, injury, laceration, melasma, post-inflammatory hypopigmentation, pityriasis alba (round, light patches covered with fine scales), dry or “ashy” skin, dermatosis papulosa nigra, and/or greater risk of keloid development.2,3 The incidence of skin cancer among US Hispanics has also increased 1.3% annually from 1992 to 2008.4

Photodamage is characterized histologically by degeneration of the connective tissue and abnormalities in keratinocytes and melanocytes. Clinically, it manifests primarily with wrinkles, dyschromia, texture changes, and, in more severe cases skin cancer.5 Formulations containing broad spectrum sunscreens against both UVA and UVB play an essential role in the prevention of photodamage and UV-induced skin cancers.6,7,8 However, the majority of clinical research on photoprotection has been conducted on subjects with Fitzpatrick types I to III skin and have reported improvements in signs associated with skin aging and texture.9,10 Verschoore et al was the first to conduct a short-term