An estimated 1 in 5 Americans will develop skin cancer in their lifetime, according to the American Academy of Dermatology.1 Although use of sunscreen and related products is an important component of sun protection and skin cancer prevention, many patients who apply SPF-containing products on the face may be missing areas of high skin cancer risk.
A recent study published in PLoS One found that 16.6% of individuals who use SPF-containing moisturizers missed important areas of the face, especially the eyelid region, compared with 11.1% of those who used sunscreen.2 For eyelids in particular, 20.9% of SPF moisturizer users missed this region compared with 14.0% of sunscreen users.2
To help dermatologists ensure patients are adequately protected from UV radiation, Rita Pichardo, MD, associate professor and director of the International Fellowship Program in the Department of Dermatology at Wake Forest School of Medicine in Winston-Salem, NC, spoke with Consultant360 about sun protection types and strategies. She was not affiliated with the PLoS One study.
Consultant360: With the findings from the PLoS One study in mind, what can dermatologists recommend to their patients when it comes to the use of sun protection strategies as a whole?
Dr Pichardo: This is an interesting study that highlights the lack of patient education in terms of applying sunscreen in areas of high skin cancer risk. I believe the clinical visit is the ideal occasion to discuss with the patient strategies to avoid sun exposure without protection.
In general, I feel that the moisturizers with SPF 30 to 50 that are recommended for daily protection are more cosmetically accepted than a heavy sunscreen, especially for men. This indicates that the vehicle is an important factor when we select the correct sunscreen to recommend to our patients. On the eyelids, we should recommend using sunglasses with photochromic lens with 100% UVA and UVB protection to ensure the extra protection needed for this area.
Within the last decade, our educational campaigns geared towards avoiding skin cancer risk have been focused on screening high risk populations and general education, such as avoiding sun exposure from 11:00 am to 3:00 pm, applying sunscreen with SPF 30 or higher in an even layer, and re-applying sunscreen every 2 hours. However, in my experience, I have noticed that many patients do not apply sunscreen on ears, lips, and eyelids. This could be due to a lack of education and awareness of the high risk of skin cancer in these areas.
C360: Especially with the summer approaching, how can dermatologists educate their patients on safe and effective sunscreens to use, both in the summer and year-round?
Dr Pichardo: Many of my patients express feelings of confusion when they have to decide what product to choose. There are many brands, different vehicles, and lots of publicity around sun protection. It is important for patients to keep several vital aspects in mind when selecting a sunscreen, such as skin type, daily activities, time spent outside, work, age, and hobbies. I like to recommend a moisturizer with SPF 30 or higher or a facial sunscreen every day before the patient leaves their home. For outside activities, I recommend my patients to apply a physical block or a combination of physical block with minimal chemical ingredients with SPF 50 or up, and then re-apply it every 2 hours. I pay attention to the vehicle (cream, spray, or stick) in order to recommend a product that a patient will use compared with a product that is not acceptable for the patient’s skin type or activities.
C360: Patients with skin of color have expressed concerns about some sunscreens leaving an ashy appearance on their skin. For patients with this concern, what can dermatologists recommend?
Dr Pichardo: Patients with skin of color also need sun protection, as they can develop skin cancers. Recommending a sunscreen for these patients is more challenging, as most ideal sunscreens have zinc oxide or titanium dioxide, which leaves a whitish or ashy appearance on the skin. There are several brands that combine micronized zinc oxide in a lower proportion with octinoxate. Micronized and nano-scale zinc oxides provide safe, reliable, broad-spectrum protection against UVA and UVB radiation with much better cosmetic results. I recommend the "clear" products instead of "tinted" for people of color to avoid the ashy appearance.
1. Skin cancer. American Academy of Dermatology. https://www.aad.org/media/stats/conditions/skin-cancer. Accessed on May 6, 2019.
2. Lourenco EAJ, Shaw L, Pratt H, et al. Application of SPF moisturisers is inferior to sunscreens in coverage of facial and eyelid regions [Published online April 3, 2019]. PLoS One.https://doi.org/10.1371/journal.pone.0212548.