INTRODUCTION
All skin phototypes can be damaged by sun exposure; however, many individuals with darker skin perceive their need for the use of sunscreen to be low.1 People with skin of color (SOC) can be burned by sun exposure although identifying a sunburn in darker skin can be more challenging than in lighter skin. The difficulty in seeing a sunburn is likely one reason why darker individuals tend to underestimate photosensitivity.1 A lack of education about cumulative photodamage and its impact on aging, as well as the use of photoprotection for preventing and minimizing pigmentary problems is also a likely reason.2 Finally, many dark-skinned individuals report finding sunscreens to be greasy feeling and to leave a cosmetically unacceptable white residue on their skin.2
It is important for both patients and healthcare providers to be aware that skin cancer rates have been rising in the United States (US) for the past 25 years and skin cancer is currently the most common malignancy in the US.3 Although the incidence of skin cancer in individuals with darker skin is lower than in those with lighter skin, skin cancer in SOC often is diagnosed at an advanced stage and has a less favorable prognosis compared to lighter skin tones.3 SOC has more epidermal melanin, which is capable of filtering somewhat more ultraviolet (UV) radiation than fairer skin.4 Minimizing UV radiation exposure is the most preventable environmental risk factor for skin cancers, since UV light damages DNA and indirectly damages cells via reactive oxygen species.4 In addition to increasing the risk for skin cancer, UV exposure can also induce and exacerbate photosensitive disorders such as melasma and postinflammatory hyperpigmentation (PIH).5
Unfortunately, a 2015 US National Health and Interview Survey reported that just 10.9% of non-Hispanic Blacks and 24.7% of Hispanic individuals used sunscreen with SPF greater than of equal to 15 always or most of the time.6 Most individuals with SOC choose to wear sun protective clothing or seek shade instead of using sunscreen.2 Lower use of sunscreen in those with SOC may be due to underestimation of the risk and preventability of skin cancer.2 In 2012, Buster et al conducted a survey and reported that both Black and Hispanic individuals were less likely than White participants to understand that skin cancer can be prevented.7 Further, less than half of Asian/Pacific Islanders (36.1%) and Hispanic (43.4%) individuals in a later survey reported using sunscreens to prevent signs of skin aging such as wrinkles.8 However, studies involving people with SOC have shown that prevention of skin darkening is a strong motivator
It is important for both patients and healthcare providers to be aware that skin cancer rates have been rising in the United States (US) for the past 25 years and skin cancer is currently the most common malignancy in the US.3 Although the incidence of skin cancer in individuals with darker skin is lower than in those with lighter skin, skin cancer in SOC often is diagnosed at an advanced stage and has a less favorable prognosis compared to lighter skin tones.3 SOC has more epidermal melanin, which is capable of filtering somewhat more ultraviolet (UV) radiation than fairer skin.4 Minimizing UV radiation exposure is the most preventable environmental risk factor for skin cancers, since UV light damages DNA and indirectly damages cells via reactive oxygen species.4 In addition to increasing the risk for skin cancer, UV exposure can also induce and exacerbate photosensitive disorders such as melasma and postinflammatory hyperpigmentation (PIH).5
Unfortunately, a 2015 US National Health and Interview Survey reported that just 10.9% of non-Hispanic Blacks and 24.7% of Hispanic individuals used sunscreen with SPF greater than of equal to 15 always or most of the time.6 Most individuals with SOC choose to wear sun protective clothing or seek shade instead of using sunscreen.2 Lower use of sunscreen in those with SOC may be due to underestimation of the risk and preventability of skin cancer.2 In 2012, Buster et al conducted a survey and reported that both Black and Hispanic individuals were less likely than White participants to understand that skin cancer can be prevented.7 Further, less than half of Asian/Pacific Islanders (36.1%) and Hispanic (43.4%) individuals in a later survey reported using sunscreens to prevent signs of skin aging such as wrinkles.8 However, studies involving people with SOC have shown that prevention of skin darkening is a strong motivator
