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NEWS | June 23, 2022

Doctors recommend sunscreen for all skin complexions

By Janet A. Aker MHS Communications

Individuals with darker skin complexions, or skin of color, are sometimes less likely to use sunscreens and protect themselves from excessive sunlight, dermatologists say.

But the dangers of too much sunlight – from sunspots to skin cancer – are real risks for everyone regardless of skin complexion, doctors say.

Research does show that melanin, the natural pigments that affect skin tone, confer some natural protection against the risk of skin cancers caused by the ultraviolet rays in sunlight.

But everyone, of any complexion, is still at risk for sun-related skin cancers.

And aside from cancer, some other sun exposure risks and potential skin problems are actually more common in people with darker skin tones.

"More important to me, and my skin of color patients, is the increased risk of pigmentary issues," said Navy Lt. Cmdr. (Dr.) James Contestable, a dermatologist from Camp Lejeune Naval Medical Center, North Carolina.

"Post-inflammatory hyperpigmentation, brown spots, and melasma are more common in skin of color. For this reason, I recommend high-quality zinc oxides, iron oxides (found in tinted sunblock), and sunblocks that contain antioxidants and free radical quenchers," he said.

Hyperpigmentation is among the most common reasons darker-skinned people seek the care of a dermatologist, according to the National Institutes of Health.

Ultraviolet and infrared radiation from the sun is key in making melasma worse, experts say.

"The role of UVA and visible spectrum light in the development of pigmentary issues have come into focus over the past decade," Contestable noted.

"Zinc provides broad UVA protection, and iron oxides provide good visible spectrum light protection. Finally, tinted sunblocks offer the advantage of avoiding the dreaded pasty white cast that can reduce adherence to sunscreens, specifically in the skin of color population," he commented.

Contestable recommends the use of sunscreens that contain both a transparent "chemical" sunscreen and a broad spectrum "physical" blocker of UV rays like zinc oxide because of their "synergistic effect."

Misperceptions

A recent study published in the Journal of the American Academy of Dermatology found that individuals with darker skin complexions are less likely to use sunscreens and practice other behaviors despite having experienced sunburns, which can be a precursor to skin cancer.

There are continuing misconceptions about the need for people with skin of color to use sunscreen daily and to stay out of the sun and wear protective clothing, and sunglasses like lighter-skinned people are advised to do, according to experts.

Some individuals with skin of color are unaware of the need for photoprotection to protect against skin cancer due to the belief that their naturally dark skin tone is more capable of providing protection against skin damage from sun exposure, the study suggests.

Use Sunscreen Daily

Some people with desk jobs don't feel they need to use sunscreen or sun blockers daily because they are not out in the sun much.

Contestable's answer to that? "UVA and visible light pass through windows. Visible light is produced by our lighting fixtures inside, including computer screens and cell phones. Therefore, sunscreen still has a role even when indoors."

"This is especially important in those who have pigmentary disorders such as melasma or post-inflammatory hyperpigmentation."

"I also say: "How did you get to work? You typically have to walk from the car to the office, and every bit of sun protection helps."

SPF Level?

Contestable said he believes the target SPF level "should be the same for all skin types."

"There is a hotly debated issue" about sunscreens with higher SPFs, Contestable said.

"Some experts will say that SPF 30 blocks 97% of UVB rays, 'so why use a higher SPF?' Their opinion is that with higher SPF, there is less overall gain as SPF 50 blocks 98% of UVB rays and SPF 100, 99%," he said.

For patients of all skin tones, Contestable recommends anywhere from SPF 30 to SPF 100 because "it doesn't cost much more to get the higher SPF."

Secondly, "in real-world use, we know that most people only apply 25%-50% of the amount of sunscreen needed to achieve the SPF on the label. My hope is that if someone applies half the amount of SPF 50 then they may achieve SPF 25, and there is some research that supports this linear relationship."

Most people should just find a sunscreen that they like – and will use! Those with specific skin concerns or skin problems should get a personalized sunscreen and sun protection plan from their dermatologist, Contestable recommends.

Sun Exposure Tips

Here are recommendations for sunscreen use and sun exposure from the Centers for Disease Control and Prevention that apply to people of all skin colors.

  • Use sunscreen or sun blockers daily
  • Apply 15 minutes before you go out so the product can be absorbed into the skin
  • Stay out of the sun as much as possible
  • When in the sun, wear a broad-brimmed hat, long-sleeve shirt and long pants, and sunglasses
  • Use products with SPF 15 or higher
  • Make sure the product label says broad-spectrum and water-resistant
  • One-half teaspoon is enough to cover the face and neck, or one arm. One ounce – about the size of a full shot glass -- is recommended for full body coverage so a six-ounce bottle doesn't last long
  • Reapply at least every two hours and after any water exposure, no matter the SPF.