Breaking barriers: Making sunscreens accessible and inclusive for all skin tones
Study finds prices higher, tone selection limited for sunscreen products suitable for darker skin types (1,500 words, 7 minutes)
Efforts are needed to enhance the availability and affordability of sunscreens catering to people with darker skin tones. This is the conclusion of a study published in Dialogues in Health (September 23, 2024; 5:100194).
“Guidelines for skin cancer prevention state that all individuals, regardless of skin pigmentation, use sunscreen when exposed to harmful [ultraviolet] rays,” authors Emerson D Basch and Grace C Hillyer, EdD, MPH, write in the study’s introduction. “Despite these well-known recommendations, the use of sunscreen is low overall but is lowest among persons of colour due largely to the lack of perceived skin cancer threat from UV exposure.”
Dr. Hillyer is an Assistant Professor in the Department of Epidemiology at Columbia University in New York. Basch is a student at Avenues: The World School in New York.
For this study, the researchers recorded the number of products on the shelf, SPF level, application, colouration, and cost at three beauty supply chain stores and three pharmacy, health, and wellness stores in or near Harlem in New York City in the spring of 2023. They then visually matched the number of skin tones for tinted sunscreen to the Fitzpatrick skin phototypes scale.
Of 385 sunscreen products identified, the investigators found 78.7% were traditional white sunscreen, followed by sheer (15.3%) and tinted (6.0%) products. Beauty supply stores offered more tinted sunscreen options than pharmacy, health, and wellness stores (n=17,15.3% vs. n=6, 2.2%, p<0.001). Of the tinted sunscreen products, 19 brands offered only a single tone. Tinted sunscreen was significantly more expensive, with an average cost of US$24.59 [standard deviation $14.71] per ounce vs. $6.85 [SD 8.66] for traditional and $9.38 [SD 8.92] for sheer sunscreen.
“Traditionally, sunscreens contain sun-reflective ingredients that create a white cast, which is not desirable for persons with melanated skin,” the authors write in their conclusion. “Our research indicates that there is still work to be done to increase the availability and affordability of sheer sunscreens or have a wide variety of tones. Affordable sunscreen that matches various skin tones is essential for skin health and can influence skin cancer prevention efforts, thereby reducing disparities in prevention efforts.”
Bottom line: There continues to be a deficiency in aesthetically acceptable, affordable sunscreen products for patients with darker skin. This deficiency may contribute to poorer skin health outcomes in these populations as it may discourage the use of sunscreen products as part of photoprotective behaviour.
From the literature on dermatology in skin of colour
Understanding the perception of sunscreen utility in African Americans
This study examines the perception of sunscreen utility in dyschromia and photoaging among patients who identify as African American or Black.
Researchers recruited participants from the Case Western Reserve University Academic Dental Clinic in Cleveland. The 151 participants (96 women and 57 men) completed an electronic survey that contained questions related to sunscreen use, knowledge of the sun's role in hyperpigmentation and photoaging, and whether sunscreen could be used for hyperpigmentation and photoaging.
Consistent with previous reports, participants used less sunscreen (20.5%) than White individuals (43.5%). Most participants didn't attribute the sun to hyperpigmentation or photoaging (80.1% and 58.3%, respectively). Participants with dark or brown spots were significantly more likely to not attribute the sun to hyperpigmentation than those without spots (p=0.003).
The investigators note that this study's limitations include a small sample size, recall and reporter bias, question misinterpretation, and lack of question neutrality.
Cost analysis of sunscreens targeted towards skin of colour
Investigators analyzed the cost and SPF level of sunscreens marketed toward patients with darker skin. They identified relevant sunscreen products through a TikTok social media analysis using the hashtags: “sunscreen for skin of colour” and “sunscreen for dark skin.”
Researchers selected each hashtag's ten most popular posts based on TikTok algorithms. For the 16 identified sunscreens, the authors reported their price in U.S. dollars, price per fluid ounce, and SPF. Prices were obtained directly from the company’s website for eleven out of sixteen sunscreens. Researchers used the lowest price from online retailers for the remaining four sunscreens.
The average cost of the identified sunscreens was $31.20 ($24.92/fl oz). Prices ranged from $13.99 to $45. The authors noted SPF levels ranged from 30 to 50, aligning with the American Academy of Dermatology recommendations. In comparison, one recent study found that the average cost of sunscreen targeted towards lighter skin tones was $11.32/fl oz.
Subjective and objective assessment of colour match of universal tinted sunscreens in Fitzpatrick skin phototypes I-VI
In this study, investigators assessed colour match and subject satisfaction for seven universal tinted sunscreens across various price ranges in all Fitzpatrick skin phototypes.
Researchers applied the products at concentrations of 1 and 2 mg/cm2 to the dorsal arms of 30 subjects with Fitzpatrick skin types I-VI. They used photography, colourimetry, and subject and investigator surveys to determine the colour match.
At the recommended 2 mg/cm2 concentration, colourimetry analysis revealed two of the seven products were suitable matches for Fitzpatrick skin types I and II, while six out of seven were determined to be a good match for Fitzpatrick skin types III to IV. However, only one product was found to be a good match for Fitzpatrick skin types V to VI at the recommended concentration.
At the intersection of skin and society
A partnership between Australian and Canadian universities uses virtual reality (VR) to break down barriers for Indigenous students seeking opportunities to study abroad, reports The PIE News, a news outlet for the international education sector.
According to the news report, this is the first program of its kind to combine Indigenous educational travel with immersive VR technologies. As part of the program, some 20 Indigenous students from three Canadian universities visited the University of Wollongong in Australia.
“Only 3% of college students have had an international experience abroad and only 10% at the university level,” said Imad Al-Sukkari, Director at Cambrian College, while speaking at the 2024 Canadian Bureau for International Education conference.
These rates are even lower among Indigenous students, according to the article. Indigenous students cited financial barriers, family obligations and a lack of awareness of opportunities during the project’s research phase.
Before the in-person trip to Australia, students participated in an immersive project in which VR replicas of real places and historical artifacts were created to learn more about their Indigenous history.
The VR was also used to prepare students for the physical experience of travelling from Canada to Australia, recreating Toronto Pearson airport and the feeling of turbulence, and what to expect when arriving at the Wollongong campus.
“It started from a conversation we had with an elder [of Canada’s Indigenous community] who was talking about how colonization affected Turtle Island and that families felt like they had been cut off through the colonization process,” Kelly Watson, global engagement director at Georgian College in Barrie, Ont. told delegates at the conference.
“So, it was really about connectivity and connecting those people back to their roots and core,” she said.
Indigenous teams from Georgian College, Cambrian College (Sudbury, Ont.), and Algonquin College (Mississauga, Ont.) were involved in building the VR world, choosing what assets, artifacts, and lessons should be included to help elevate the Indigenous voice.
First annual Indigenous Skin Spectrum Global Summit
Mark your calendars for the first Indigenous Skin Spectrum Global Summit in Montreal on April 5, 2025.
The Indigenous Skin Spectrum Global Summit is designed to highlight the unique dermatologic challenges facing Indigenous populations worldwide and share expert knowledge on how physicians can support equitable health for these populations.
Presentations at the Global Summit will provide updated information on:
Social determinants of health
Supporting rural and remote communities
Diagnosis and treatment of the most common conditions faced by Indigenous patients worldwide
The latest therapies for the management of these conditions
Summit chair Dr. Rachel Asiniwasis (Regina) leads a world-renowned faculty that includes Dr. Rachel Pugh (Australia), Dr. Carsten Sauer Mikkelson (Denmark), Dr. Monique Mackenzie (New Zealand), Dr. Anna Chacon (Florida), Dr. Dana Slape (Australia), Dr. Carolyn Jack (Montreal), and other thought leaders.
More details on the Global Summit will appear in future editions of Skin Spectrum Weekly.
This week
November 25 is International Day for the Elimination of Violence Against Women
November 29 is the National Day of Listening in the U.K.
December is International Sharps Injury Prevention Awareness Month
Something to think about in the week ahead . . .
—James Joyce, Irish novelist (1882 to 1941)
Next week
Katie Wilson, vice-chair of the American Medical Association’s Committee for American Indian Affairs, provides an overview of American Indian/Alaskan Native skin health in the United States as part of the fourth annual Indigenous Skin Spectrum Summit presentation.
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