Choosing sunscreen for richly pigmented skin

Colour matching, preventing pigment change, and choosing the right texture can all improve usage (1,500 words, 8 minutes)

In a recent article featured in the New York Post newspaper, three prominent Black dermatologists shared their guidance on selecting suitable sunscreens for patients with diverse skin tones.

Among the aspects they addressed, the experts emphasized the importance of considering aesthetics when choosing sunscreens.

“Some sunscreens have higher amounts of titanium and zinc oxide in them, and so can leave a white cast,” Dr. Jeanine Downie told the newspaper. “Sometimes this [white cast] can be rubbed in and other times it cannot.”

Dr. Downie is the director of Image Dermatology in Montclair, N.J., and specializes in cosmetic dermatology.

One tip to help mitigate this white cast is for an individual to warm sunscreen in the hands by rubbing their hands rapidly together, and then firmly massaging the sunscreen into their face, Dr. Downie said.

In addition to choosing a sunscreen that matches a person’s skin tone, the dermatologists recommend sunscreens that contain antioxidants such as vitamin C or niacinamide which can help to mitigate the risk of hyperpigmentation.

“When selecting a sunscreen, individuals with darker skin tones should look for those that contain active ingredients such as zinc oxide, titanium dioxide, avobenzone or Mexoryl SX, which provide broad-spectrum protection against UVA and UVB rays,” said Dr. Michelle Henry in the article. “Sunscreens containing antioxidants like vitamin C, niacinamide, or green tea can also be advantageous for mitigating free radical damage and preventing hyperpigmentation.”

Dr. Henry is a dermatologist and Accreditation Council for Graduate Medical Education fellowship-trained Mohs micrographic, reconstructive and cosmetic surgeon.

The consistency of sunscreen suitable for dark skin tones will depend on individual preference and skin type and if their skin is dry, oily, normal or a combination, Dr. Henry said.

“For instance, some individuals may prefer lighter, more fluid formulas that are readily absorbed by the skin, while others may prefer thicker creams or lotions,” she said. “The key is to select a sunscreen that feels comfortable on the skin and does not cause any skin irritation or breakouts.”

Drs. Henry and Downie, along with dermatologist Dr. Sumayah Jamal, provide a list of 25 suggested sunscreens for patients with skin of colour in the article.

From the literature on sun protection in skin of colour

Dermatology patients' knowledge of sunscreen guidelines at a university hospital in Saudi Arabia

In this observational study, researchers assessed the knowledge and attitude of dermatology patients regarding sunscreen use as recommended by the American Academy of Dermatology.

A total of 288 participants completed a questionnaire to measure their knowledge and attitude regarding sunscreen use. The most prevalent skin types were Fitzpatrick type III (21.9%) and IV (21.4%).

Most of the participants reported they had heard about sunscreen (93.4%) and had used sunscreen in the past (72%). Women and participants with a postgraduate education were more likely to use sunscreen. Also, women, participants with non-photosensitive disorders, and participants with Fitzpatrick I, II, and III skin types were more likely to profess knowledge about sunscreens.

A total of 80% knew the worst time for sun exposure, but only 20.5% of the participants knew that sunscreen should be applied daily throughout the year, and 13.5% knew the correct minimum recommended SPF. A total of 34% were aware of the minimum time allowed for sunscreen application prior to sun exposure, and 20% were aware of the longest period allowed between reapplications. Only 4.5% knew the proper amount of sunscreen to cover the entire body.

Photoprotection for people with skin of colour: Needs and strategies

The authors of this paper note that individuals with skin of colour are at significant risk of skin damage caused by ultraviolet radiation, including the development of photodermatoses and photoaging changes. They write that pigment disorders made worse by sun exposure are among the most common conditions leading to dermatology consultations by patients with skin of colour.

There is an unmet need for better education on photodamage, as well as more efficient and suitable photoprotection in these populations, the authors write.

They identified some challenges related to the development of targeted sunscreens for individuals with skin of colour:

• Optimal cosmetic appeal (leaving no white residue and not disrupting skin tone)

• Providing broad-spectrum protection (ultraviolet (UV)B/UVA] protection with a high sun protection factor, as well as protection against long-wave UVA (UVA1) and visible light

• The potential inclusion of depigmenting agents for patients with pigmentary disorders

Outdoor clinical testing with reference sunscreens to determine differences in skin response between populations of different ethnicity: A combined data analysis from 128 subjects

This study is an analysis of data from two previously published clinical studies that assessed erythema and pigmentation responses in outdoor conditions with three reference sunscreens under natural sunlight. These studies followed an almost identical protocol but were conducted in two different locations and two ethnic groups: broadly, Chinese (Singapore), and White European (Mauritius).

The analysis included 128 subjects (53 were Chinese from Singapore and 75 were White European from Mauritius and Singapore). The three studied products were reference sunscreens: P3 (sun protection factor [SPF] 15), P5 (SPF 30) and P8 (SPF 50+). In the study, the participants were exposed to outdoor sunlight for two to three hours, depending on the baseline individual typology angle (pigmentation).

Investigators found that among participants with baseline ITA > 41, individuals in the White European group were more erythematous and also had a higher rate of photoprotection failure particularly at SPFs 15 and 30.

Photoprotection in skin of colour

This review highlights important physiologic and clinical considerations of photoprotection in skin of colour.

The authors suggest that patients with skin of colour should be encouraged to utilize multiple methods of photoprotection, ranging from avoidance of sunlight during peak intensity hours, seeking shade, wearing sun-protective clothing and wide-brimmed hat, and applying sunscreen.

They write that ideal sunscreens for skin of colour populations include those with UVA-PF/SPF ratios of 2/3 or higher, and tinted sunscreens to protect against visible light.

Although there have been increased efforts recently, more research into photoprotection for skin and targeted public education are required, they write.

VIDEO: A dermatologist's favourite tinted sunscreens | Dr. Jenny Liu, Minneapolis

At the intersection of skin and society

Findings from the Black Canadian National Survey (BCNS) research project by York University’s Institute for Social Research (ISR) in Toronto show that Black Canadians see workplaces as the epicentre of racial discrimination and unfairness.

According to a press release, the researchers at the ISR conducted a national web survey of more than 5,000 respondents The report for the Black Canadian National Survey, considered the first-of-its-kind, was released today looking at the experiences of Black Canadians across the country, as well as the effects of racism on other non-white groups. The researchers conducted a national web survey, a national Black community web survey, and a wiki survey. Their goal was to provide disaggregated data to better understand race-based structural vulnerabilities and systemic barriers so that evidence-based strategies and plans can be created to close equity gaps and promote a level playing field.

The survey project was led by York University Professor Lorne Foster of the Faculty of Liberal Arts and Professional Studies and ISR director in partnership with the Canadian Race Relations Foundation.

In the release, Foster said the finding that workplaces are the epicentre of experiences of discrimination was one of the biggest surprises he experienced. He added that employers should keep human rights principles and equity, diversity, and inclusion goals front and centre.

The survey found 75% of Black Canadians experience racism in the workplace and think it is a problem. As well, 70% of other non-white people also see workplace racism as a serious or very serious problem, while 56% of White Canadians believe it is a minor issue or not a problem.

In addition, 47% of Black people surveyed reported they believe they have been treated unfairly by an employer in hiring, pay, or promotion in the last year, compared to 15% of Canadians in general.

“What this survey confirms is there is not only a strong legacy of racism in Canada, but it has profoundly and enduringly permeated our systems and structures,” said Foster. “Even more disturbing, however, is how racism is moving from blatant and overt to more subtle, covert expressions of it.”

“A proactive examination of organizational culture, attitudes, norms and shared perspectives in workplaces, health care, child serves, education, policing and the criminal justice system is urgently needed.”

Other findings include:

• 90% of Black Canadians report they consider racism in the criminal justice system a serious problem, as do 82% of Indigenous people

• In every region of Canada, Black people report being unfairly stopped by police in the last 12 months more than any other group

• 70% of Black Canadians said they think racism is a problem in healthcare, as do 59% of Indigenous people

• 80% of both Black and Indigenous Canadians say that racism is a severe problem In childcare and social services, particularly in child protection and foster care systems

More details on the survey’s findings, including an examination of the criminal justice system, health care, and social services can be found in the press release and the full report, available here.

Foster speaks about his findings in two videos, here:

and here:

This week

June 26 is National Cancer Wellness Awareness Day in Canada

June 27 is National Sunglasses Day in the U.S.

July is National Cleft and Craniofacial Awareness & Prevention Month in the U.S.

Something to think about in the week ahead…

— David Ben-Gurion, Israeli statesman, [1886-1973]

Next week

Skin Spectrum Weekly is taking a break for the Canada Day long weekend. We will return on July 10 2023 with Toronto dermatologist Dr. Yvette Miller-Monthrope discussing scalp psoriasis in patients with darker skin types and Afro-textured hair during a presentation at the 8th annual Skin Spectrum Summit.

If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?

Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper print providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:

• Dr. Jerry Tan (Windsor, Ont.) discusses recent findings on the presentation and prevalence of truncal acne

• Drs. Jaggi Rao (Edmonton), Maxwell Sauder (Toronto), and Jason Rivers (Vancouver) discuss skin cancer prevention and how to increase the adoption of sun-safe habits among the population.

• An essay from Dr. Munirah Aljaser (Montreal) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Aljaser wrote on the challenge of changing the cultural perception that lighter-coloured skin is more beautiful.

• Plus regular features, including the popular column “Vender on Psoriasis” by Hamilton, Ont. dermatologist Dr. Ron Vender

Read a recent digital edition here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.

The Women in Dermatology e-newsletter updates new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.

Season two of the Shear Listening Pleasure podcast with Dr. Neil Shear has launched. Listen to the eighth episode here, where Dr. Shear speaks with dermatologist Dr. Sonja Molin (Kingston, Ont.) about allergology, patch testing, and the growth of Queen’s University’s dermatology division.

And if you’re looking for a web destination for all things derm, please visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.

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