Sunscreen Use for Photoprotection in Skin of Color: A Literature Review
July 2024 | Volume 23 | Issue 7 | 575 | Copyright © July 2024
Published online June 17, 2024
Valerie D. Callender MDa, Lisa R. Ginn MDb, Charles M. Boyd MDc, Mona Gohara MDd, Corey L. Hartman MDe, Valerie M. Harvey MDf, Tanya T. Khan MDg, William Kwan MDh, Wendy E. Roberts MDi
aCallender Dermatology & Cosmetic Center, Glen Dale, MD
bSkin@LRG, Chevy Chase, MD
cBoyd Beauty, Detroit, MI
dDermatology Physicians of Connecticut, Branford, CT
eSkin Wellness Dermatology, Birmingham, AL
fTidewater Physicians Multispecialty Group, Newport News, VA
gKhan Eyelid and Facial Aesthetics, Dallas, TX
hLasky Skin Center, Beverly Hills, CA
iRancho Mirage, CA
Abstract
Background: To understand the prevalence and types of publications addressing darker skin types within the existing evidence base for sunscreen use.
Evidence Review: PubMed was searched from 1988, the time point at which the first skin of color (SOC) article was identified, through December 2022 using PubMed's Medical Subject Headings terms and keyword searches in title and abstract, with and without terms for SOC and ethnicity. Identified articles were reviewed for relevance, de-duplicated, and categorized; results are summarized.
Findings: Of the 5927 articles on sunscreen overall, only 314 (5.3%) articles addressed SOC, with the majority published since 2007 and representing only 4% to 7% of total publications annually except in 2022 when the proportion of SOC articles was 23.5%. Of the articles on SOC, many reported sunscreen knowledge and patient behaviors (29%), but very few reported clinical trials (5%). The 3 conditions most often discussed were melasma, post-inflammatory hyperpigmentation, and dyschromia. South Asian ethnicities (India, Pakistan, Bangladesh) had the highest representation within the literature, followed by Hispanics.
Conclusions and Relevance: Although it was assumed there would be fewer papers discussing the use of sunscreen in darker skin types, the scale of the disparity revealed by this study is stark. The increase in a number of articles in 2022 suggests an increasing focus on SOC, but further discussion of the issues presented here will help the SOC community address gaps in the evidence base and better inform discussions on sunscreen and photoprotection between clinicians and patients.
J Drugs Dermatol. 2024;23(7):575-577. doi:10.36849/JDD.8250
INTRODUCTION
Misperceptions around the use of sunscreen for photoprotection for individuals with darker skin types result in the underutilization of this effective means to reduce the sequelae of sun exposure. The Physicians Council for Diversity, Equity, and Inclusion evaluated the prevalence and types of publications addressing darker skin types within the broader sunscreen medical literature. We hypothesized that a lack of clear guidance on the use of sunscreen in patients with darker skin types was due not only to the limited primary clinical evidence but also to poor representation in the broader dermatologic literature.
MATERIALS AND METHODS
PubMed was searched from 1988, the time point at which the first "skin of color" (SOC) article was identified, through December 2022 using PubMed's Medical Subject Headings terms (sunscreening agents) and free-text searches (eg, sunscreen, skin aging, melasma, post-inflammatory hyperpigmentation, dyschromia) in title, abstract, or keywords, with and without terms for SOC and race/ethnicity to capture peer-reviewed English-language literature presenting human data. Articles were included based on review of the titles and available abstracts for association with SOC or Fitzpatrick skin types IV-VI, specified racial and ethnic groups, and relevance
