Promoting sun protective behaviour for people with darker skin tones
Shade-seeking, wearing protective clothing, and choosing the right sunscreen for the situation can protect skin of colour from a range of problems (1,500 words, 7 minutes)
Everyone should be taking steps to protect their skin from sun damage, regardless of their skin tone. Cumulative exposure to ultraviolet (UV) radiation contributes to wrinkling, premature aging, the development of discoloured patches of skin, and skin cancer. Year-round protection with avoidance and the daily use of sunscreen is key.
This is the key message of a patient-directed article from Boston University.
“Sun exposure can contribute to pigmentation issues,” Dr. Lisa Shen said in the article. “Patients with darker skin are more likely to experience melasma and postinflammatory hyperpigmentation—those dark marks left behind by acne—and exposure to UV rays can actually make them worse. The best way to prevent that from happening is by protecting the skin from visible light and UV radiation.”
Dr. Shen is the associate medical director of pediatric dermatology at the Boston Medical Center and an associate professor of dermatology at the Boston University School of Medicine.
Patients often have questions about how to best protect themselves from the sun.
Dr. Shen noted the importance of the use of sun hats and UV-protective clothing.
Shade-seeking is also important, but this is a behaviour that is more common among individuals with skin of colour. A literature review that examined photoprotection in different ethnic groups (American Journal of Clinical Dermatology, 2022; 23(2): 195–205) found that in the U.S., both non-Hispanic Blacks and Hispanics were more likely to wear sun-protective clothing and seek shade compared to non-Hispanic Whites. Rates of those protective behaviours in these groups have also increased over the past decade.
However, the rate of sunscreen use remains low.
Dr. Shen had several recommendations for sunscreen selection that physicians could pass on to their patients with skin of colour.
Her tips include:
Chemical sunscreens containing agents such as avobenzone, oxybenzone, and octinoxate tend to be more water- and sweat-resistant
Physical, or mineral, sunscreens containing zinc oxide and titanium dioxide are gentler on pores and overall better for sensitive skin
Tinted sunscreens—which can protect against visible light—can be difficult to find in non-white shades. Dr. Shen mentioned Black Girl Sunscreen, Fenty Beauty, and Melé. Anthelios from La Roche-Posay is another option.
Sunscreen expires. Patients should check expiry dates and replace as needed.
Bottom line: Sun exposure contributes to premature aging, pigment changes and other conditions in all skin types. Individuals with darker skin types can often do more to protect themselves. Choosing the right sunscreen provides better protection and can make the experience of using sunscreen better.
From the literature on sun protection in skin of colour
A validation study of behaviours towards sun protection among Filipino using a Filipino-translated version of the Readiness to Alter Sun-Protective Behaviour questionnaire (RASP-B)
This study was conducted to determine the behaviours towards sun protection among patients at a single medical centre using the Readiness to Alter Sun-Protective Behaviour Questionnaire (RASP-B).
The 12-item RASP-B questionnaire was translated and validated for use in the study.
A total of 278 respondents participated in the study. The researchers found most participants were already in the “action” state of the RASP-B, engaging in significantly higher levels of sun-protective behaviour than participants in the earlier “pre-contemplation” and “contemplation” stages. More males were in the pre-contemplation and action state. Investigators found that sex, civil status, and body mass index were not associated with the state of change of the participants.
Recommendations from a Chinese-language survey of knowledge and prevention of skin cancer among Chinese populations internationally: Cross-sectional questionnaire study
Researchers compared attitudes and practices regarding skin cancer risks and prevention between Chinese Asian and North American Chinese populations and between Fitzpatrick scores.
The investigators conducted a 74-question internet survey focusing on Han Chinese participants. They recruited participants over six months from July 2017 through Jan. 2018 using advertisements in Chinese on popular social media platforms.
Of the 113 completed responses collected (participation rate of 65.7%), 95 (84.1%) were ethnically Han Chinese, of which 93 (96.9%) were born in China and 59 (62.1%) were female. The mean age of these 95 participants was 35.8 (SD 13.3) years; 72 (75.8%) participants were born after 1975. More North American Chinese reported that Chinese Asian populations received annual skin checks (4/30, 4.2% vs 0/65, 0%; p=0.009) and believed that their clinician provided adequate sun safety education (13/30, 43.3% vs 15/65, 23.1%; p=0.04). Participants with higher Fitzpatrick scores less frequently received sun safety education from a clinician (4/34, 11.8% vs 22/61, 36.1%; p=0.02). More participants with lower Fitzpatrick scores used sunscreen (41/61, 67.2% vs 16/34, 47.1%; p=0.05), but alternative sun protection use rates are similar across groups.
Changes in levels of omega-O-acyl ceramides and related processing enzymes of sun-exposed and sun-protected facial stratum corneum in differently pigmented ethnic groups
Researchers report differences in the ceramide composition and levels of omega-O-acylceramide processing enzymes in sun-exposed and sun-protected facial stratum corneum (SC) among Albino African, Black African and Caucasian women living in South Africa.
To measure these levels, researchers took tape strip samples from the sun-exposed cheek and sun-protected skin behind the ear.
They found no significant differences in total ceramide levels or ceramide subtypes between the Black African and Caucasian women in either the cheek or behind-the-ear samples. Also, they found that both the levels of total ceramide as well as selected omega-O-acylceramide species were increased in Albino Africans compared to both other groups. On the cheek, investigators found the EOS, EOH, and AS ceramides were increased relative to the Caucasian women, while the EOP and EOdS ceramides were elevated relative to the Black African women. Behind the ear, EOP and EOdS ceramides were elevated compared with the Black African women and EOdS ceramide was in Caucasians.
The researchers observed decreases in mass levels of the 12R-LOX and eLOX3 enzymes on cheeks compared with the behind-the-ear sites in all ethnic groups. On the behind-the-ear sites, 12R-LOX was particularly lower in the Albino Africans compared with the Black African and Caucasian women. On the cheeks, mass levels of the SDR9C7 enzyme were also lower in the Albino Africans.
Correlation between objective measures of sun exposure and self-reported sun protective behaviour and attitudes in predominantly Hispanic youth
Researchers conducted a study in predominately Hispanic 4th and 5th-grade classrooms in Los Angeles County, a high UVR environment, during the spring. They used electronic UV dosimeters to objectively measure the association between UVR exposure and acculturation, sun protective behaviour and knowledge, and family interventions obtained using baseline questionnaires completed by 125 participants.
They found that wanting to get a tan was associated with lower median time spent outside (1.73 min versus 22.17, AUC 82.08, Sensitivity 0.78, Specificity 0.73) and standard erythemal dose (SED) on weekends but was positively associated with sun protective knowledge. Researchers also found that sun protective knowledge and family discussion of sunscreen were inversely associated with objectively measured time outside. Students spent a median of 30.61 (IQR 19.88) minutes outside per day (SED 0.30, IQR 0.20), with only 35.70% of it occurring during non-school hours.
VIDEO: Doctor V - Mineral Vs Chemical Sunscreen For Skin Of Colour, Brown Or Black Skin
Dr. Vanita Rattan, London
At the intersection of skin and society
Earlier this year, the Black Pharmacy Students' Association from the University of Alberta held a pop-up clinic to provide information on how dermatologic conditions display on skin of colour.
As reported by CBC News, students in the group say university textbooks focus on diagnosing White skin, and there isn't enough information available on how conditions present on darker skin.
"Our learning and curriculum were lacking a lot in black health," said Aisha Ibrahim, co-president of the Black Pharmacy Students' Association.
"We saw a deficit in that, and we wanted to rectify that and get more information out to the public."
During the clinic, students, pharmacists and dermatologists shared information on topics that included treating acne and identifying eczema.
Ravina Sanghera, a pharmacy professor at the school, helped organize the pop-up event. Sanghera, who has helped rewrite some textbooks to include more diverse discussions and photos, said she wants her children, who have different skin tones, to have access to adequate dermatology care when needed.
"[I'm] always wondering if clinicians are equipped to notice signs and symptoms on your skin and how they would treat it," said Sanghera.
The students' association event also addressed myths around skincare and the need for sun protection in darker skin types.
Ibrahim said that growing up, she never worried about sunscreen because of a belief that her darker skin meant skin cancer wasn’t a concern.
"It wasn't until I started learning more about this, got into sciences … I learned that this is completely false," she said.
This week
July is UV Safety Awareness Month in the U.S.
July is Good Care Month in the U.K.
July 10 is Chronic Disease Day
Something to think about in the week ahead. . .
— Thomas A. Edison, U.S. inventor (1847-1931)
Next week
Toronto dermatologist Dr. Yvette Miller-Monthrope discusses 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:
A review of advances in cosmetic dermatology with Drs. Monica Li (Vancouver), Jessica Asgarpour (Toronto), Jason Rivers (Vancouver), and Andrei Metelitsa (Calgary).
Drs. Andrei Metelitsa (Calgary), Charles Lynde (Markham, Ont.) and Irina Turchin (Halifax) discuss new treatments for plaque psoriasis.
An essay from Dr. Shakira Brathwaite (Toronto) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Brathwaite wrote on the need for health systems to “see colour” and recognize the differences in needs and challenges dermatology patients with different skin types experience.
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.