• Crystal Aguh

Don’t Become a Raisin in the Sun: Debunking 5 myths about Sunscreen Use in Skin of Color

Photo credit to Twenty20.com

Daily use of sunscreen is advantageous for many reasons. The most well-known, and arguably most important, benefit is a decreased risk of skin cancer(1-3). Sunscreen shields the skin from harmful ultraviolet (UV) rays that damage skin cells, but there are several lesser known benefits of sunscreen as well (1,2). Unfortunately, studies have shown that blacks are less likely to practice sun-protective measures, including wearing sunscreen, despite the many noted benefits of its use (4). Below are some of the myths my patients have shared with me that have prevented them from using sunscreen.


“Black people don’t get skin cancer” False.

Unfortunately, though we are less likely to develop skin cancer, blacks are more likely to die from skin cancer than whites, often because we are diagnosed at more advanced stages (2,5). I have seen each of the three most common types of skin cancers (basal cell carcinoma, squamous cell carcinoma, and melanoma) in multiple black patients during my time at Johns Hopkins hospital (1-3). Thus, protecting our skin and knowing the warning signs of skin cancer are important. You can find helpful tips for recognizing a suspicious lesion and choosing a sunscreen at the end of this post.


“I already have low Vitamin D and using sunscreen will only make it worse” False.

While wearing sunscreen may block UV rays in the skin, studies have shown no significant decrease in vitamin D levels in people who use sunscreen on a daily basis (6). Vitamin D, which plays an important role in preserving bone health and a healthy immune system, is synthesized in the skin following exposure to a sufficient amounts of sunlight, so maintain adequate levels of this vitamin is important (7). If you are looking to boost your levels of Vitamin D, try an over the counter supplement and take it as directed by your physician.


Photo credit to Twenty20.com

“I’m young so I don’t have to use sunscreen now” False.

There are benefits to using sunscreen today. Anyone who seeks a more even, blemish free skin-tone should start with sunscreen. Discoloration and dark marks are more common in darker skinned patients due to increased levels of pigment and accordingly are among the most common complaints of black patients in dermatology clinics (8). Sun exposure makes dark marks darker, and increases the amount of time needed for dark marks to resolve. Strict sun protection is critically important to the success of any treatment plan geared at reducing discoloration on the skin and is something I recommend to all of my patients regardless of their skin tone.






“People with dark skin don’t get wrinkles a.k.a. ‘black don’t crack’ ” Mostly True

Melanin, the source of pigment in our skin, protects us from the harmful aging effects of UV radiation and sunscreen use only enhances the natural protection people with skin of color enjoy (9). Black skin has an average inherent sun protection factor (SPF) of 13.4 compared to 3.4 for whites and translates to twice the amount of sun protection (2,9). This difference partially explains the youthful appearance many people of color maintain well into old age. Incorporating sunscreen into your daily routine has the potential to do wonders for your anti-aging regimen.


Photo credit to Twenty20.com

“Now that I’m convinced that wearing sunscreen is important, choosing just one will be easy!” False.

As a dermatologist, I long for the day in which this statement will no longer be a myth. It’s not uncommon to see sunscreens lining entire aisles of pharmacies and beauty stores and this sight can be daunting. Focusing on a few characteristics about your chosen sunscreen is key:

  1. First, only use sunscreens with broad spectrum coverage, as they protect against both UV-A and UV-B rays.

  2. Look for sunscreens with an SPF of at least 30 or greater. Sunscreens with an SPF of higher than 30 provide a nearly equivalent amount of protection from the sun, so don’t go crazy shelling out a ton of money for sunscreen with an SPF of 100 because the incremental benefit is minimal.

  3. If you have sensitive skin, look for sunscreens with zinc oxide and/or titanium dioxide as other chemical ingredients can be irritating. Once you find a brand you like, use it daily and re-apply it every 2-3 hours to maximize benefit.


Worried about skin cancer? Here are things to look for:

  1. Melanoma, the deadliest form of skin cancer, occurs most commonly on the hands and feet in non-white patients(2). Pay close attention to any changing moles in these areas, as well as any dark streaks in the nail that are growing or getting darker.

  2. Be on the lookout for any bumps or scabs that bleed very easily and have not healed for several months as these may be signs of basal or squamous cell cancers.

  3. Remind your gynecologist, dentist, and eye doctor to let you know about any brown or scaly spots in these areas that are concerning; skin cancer can be found anywhere!

  4. If you are unsure if something looks suspicious, see a dermatologist who can perform a full skin examination and assess your skin cancer risk.



References

  1. van der Pols, Jolieke C., et al. "Prolonged prevention of squamous cell carcinoma of the skin by regular sunscreen use." Cancer Epidemiology Biomarkers & Prevention 15.12 (2006): 2546-2548.

  2. Halder RM, Bridgeman-Shah S. Skin cancer in African Americans. Cancer 1995; 75:667-73.

  3. Mora RG, Burris R. Cancer of the skin in African Americans: a review of 128 patients with basal cell carcinoma. Cancer 1981; 47:1436-8.

  4. Friedman, Lois C., et al. "Early detection of skin cancer: racial/ethnic differences in behaviors and attitudes." Journal of Cancer Education 9.2 (1994): 105-110.

  5. Gloster HM, Neal K. Skin cancer in skin of color. J Am Acad Dermatol 2006; 55:741-760

  6. Marks, Robin, et al. "The effect of regular sunscreen use on vitamin D levels in an Australian population: results of a randomized controlled trial." Archives of dermatology 131.4 (1995): 415-421.

  7. Holick, Michael F. "Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease." The American journal of clinical nutrition 80.6 (2004): 1678S-1688S

  8. Alexis, Andrew F., Amanda B. Sergay, and Susan C. Taylor. "Common dermatologic disorders in skin of color: a comparative practice survey." Cutis 80.5 (2007): 387-394.

  9. Fisher, Gary J., et al. "Mechanisms of photoaging and chronological skin aging." Archives of dermatology 138.11 (2002): 1462-1470.

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Johns Hopkins Department of Dermatology,

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