Sunscreen Practices and Preferences of Skin of Color Patients

June 2024 | Volume 23 | Issue 6 | 456 | Copyright © June 2024


Published online May 28, 2024

Jennifer Y. Wang BAa,c, Paras Patel BAb,c, Raichel Philip BAa, Margaret Kabakova BSa, David Bitterman BAc,d, Kayla Zafar BAc,d, Sharon A. Glick MD FAADa, Jared Jagdeo MD MSa,c

aDepartment of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, NY
bRowan University School of Osteopathic Medicine, Stratford, NJ
cDermatology Service, Veterans Affairs New York Harbor Healthcare System -- Brooklyn Campus, Brooklyn, NY
dNew York Medical College, Valhalla, NY 
eSt. George's University School of Medicine, Grenada, West Indies

Abstract
Sunscreen is an essential way to protect against photodamage from ultraviolet (UV) radiation. Despite the recognized benefits of sunscreen in preventing skin damage from UV light, its use varies across different patient groups. This cross-sectional, questionnaire-based study aims to uncover the sunscreen usage patterns, preferences, and barriers among non-Hispanic White (NHW) and skin of color (SOC) individuals. Our findings demonstrate that NHW individuals are more likely to wear sunscreen daily (31% NHW vs 25% SOC) and reapply sunscreen at least once a day (76% NHW vs 45% SOC) compared with SOC individuals. SOC individuals demonstrate a willingness to use sunscreen, but they face barriers such as cost (2% NHW vs 16% SOC), lack of knowledge in finding suitable products (22% NHW vs 41% SOC), and concerns about white cast (7% NHW vs 25% SOC). SOC individuals are less likely to know the difference between mineral and chemical sunscreen (49% NHW vs 29% SOC), less likely to learn about sunscreen from dermatologists (36% NHW vs 22% SOC), and more likely to prefer sunscreen from brands owned by people of color (13% NHW vs 47% SOC).  In addition to analyzing the broader categories of NHW and SOC, subgroup analysis was conducted on specific subgroups, including Black, Asian, and Hispanic groups. Herein, we highlight differences in motivations, sunscreen preferences, sources of information, and knowledge levels about sun protection between NHW and SOC individuals. By uncovering the unique needs and challenges faced by SOC individuals, we aim to improve culturally competent patient education and promote effective sun protection practices across diverse populations.

J Drugs Dermatol. 2024;23(6):456-462.     doi:10.36849/JDD.8268

INTRODUCTION

Sunscreen is a photoprotective topical product that is an easy and effective way to prevent skin damage caused by ultraviolet (UV) radiation exposure.1 While the benefits of sunscreen are widely recognized, sunscreen usage can vary significantly across different patient groups.2-4

Melanin is the pigment that gives skin its color and is believed to provide protection against ultraviolet light.5,6 Melanin is hypothesized to absorb and disperse UV rays, which reduces the risk of skin damage.5,6 People with darker skin have higher melanin levels, which contributes to a common but incorrect belief that they are not susceptible to UV damage and skin cancer.5 While less prevalent in skin of color (SOC) patients, individuals with SOC are still at risk of developing skin cancer and photoaging.7 SOC patients often present with more advanced and aggressive skin cancer, leading to increased morbidity and mortality rates.5,7 Additionally, SOC patients are more likely to experience pigmentation-related issues, such as melasma or cutaneous lupus erythematosus, which can worsen from sun exposure.8,9

It is evident that there is a need for SOC individuals to wear sunscreen. Despite this, sunscreen use in SOC individuals, particularly African Americans, is lower than in non-Hispanic White (NHW) individuals.2-4 Sunscreen use in Asian Americans is also lower than in NHW individuals.10 Asian Americans, similar to African Americans, are at an increased risk for delayed skin cancer diagnosis.10

Sunscreen usage is influenced by a combination of factors including cultural perceptions, knowledge levels, product availability, and personal preferences. Herein, we identify and analyze the sunscreen usage patterns, preferences, and barriers among individuals with skin of color. This includes assessing their sunscreen habits, motivation for use, preferences, knowledge levels, and barriers to use. These insights offer a valuable opportunity for physicians to enhance their educational strategies for patients with skin of color regarding sun protection. Simultaneously, this knowledge can assist sunscreen manufacturers in tailoring their products to better meet the specific preferences of this demographic, potentially leading to improved sunscreen application and adherence. 
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