Photoprotection for Individuals With Skin of Colour

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• This literature review details the available evidence regarding the benefits of photoprotection for individuals with skin of colour. Photoaging, photocarcinogenesis, and photoexacerbation of pigmentary disorders are among the conditions for which photoprotection is beneficial. Sunscreen practices for individuals with skin of colour often require targeted formulations to ensure compliance.

• There are many benefits of photoprotection for individuals with skin of colour, and the knowledge of targeted sunscreen formulations can help dermatologists educate their patients.

–  Joshua R. Ortego, MD

Written by

 

 

Rishi Chopra MD, MS, FAAD

Our understanding of the role of photoprotection in patients of color is still primitive and unfortunately has resulted in a paradigm where physicians infrequently recommend sunscreen use and patients infrequently use sunscreen. Studies demonstrate that ultraviolet radiation has a remarkably disparate impact on dark and light skin. Intrinsically, skin of color is better protected against photocarcinogenesis and photoaging, but it is predisposed to photoexacerbated pigmentary conditions. Accordingly, recommendations for patients should be customized based on skin type. The authors of this study performed a literature review to elucidate the need for photoprotection in this population as well as discuss strategies to improve sunscreen use.

Compared with light skin, dark skin has greater melanin content in the superficial epidermis, more efficient DNA repair mechanisms, a thicker dermis, and more numerous/larger fibroblasts, which altogether confer significantly superior protections against ultraviolet (UV)-induced aging or carcinogenesis. Recommendations for sunscreen use may seem controversial in this context. However, recent studies indicate that UVA1 and high-energy visible light (blue/violet light) induce pigmentation in dark but not light skin. As hyperpigmentation disorders, such as post-inflammatory hyperpigmentation and melasma, significantly impact the quality of life in patients of color, sunscreen formulations should not only protect against UVB and UVA2 but also UVA1 and visible light.

The authors provide a valuable review of the optimal properties of a sunscreen tailored towards skin of color. They highlight the critical role of cosmesis in patient compliance and importantly contrast that cosmetic elegance is valued least by dermatologists when recommending a sunscreen. Correspondingly, although zinc oxide, titanium dioxide, and iron oxide significantly protect against high-energy visible light and are commonly recommended, their white residue on pigmented skin is undesirable to patients. Tinted sunscreens, on the other hand, can blend with darker skin tones and also block visible light. Moreover, burgeoning research on hyperpigmentation has resulted in an exciting armamentarium of antioxidants, peptides, and de-pigmenting agents that may be incorporated into sunscreens to simultaneously protect and treat patients with pigmentary disorders.

The lack of emphasis on photoprotection for skin of color remains a significant unmet need in dermatology. This study provides a comprehensive review of present challenges and future solutions, and it is a must-read for any healthcare provider making sunscreen recommendations. It is important to recognize that targeted strategies to improve photoprotection inevitably rely on a clear definition of "skin of color," which is notoriously difficult to classify. The commonly utilized Fitzpatrick skin type is outdated and less useful in darker skin types. New objective measures that quantify pigmentation are in development. However, until these scales are extensively validated, it is imperative that we employ an all-inclusive and nuanced approach to our photoprotection recommendations.

Abstract

Skin of colour or pigmented skin has unique characteristics: it has a higher eumelanin-to-pheomelanin ratio, more mature melanosomes, an increased amount of melanin distributed in the upper layers of the epidermis, and more efficient DNA repair compared with lighter skin. However, individuals with skin of colour are at a significant risk of skin damage caused by ultraviolet radiation, including the development of photodermatoses and photoageing changes such as uneven skin tone, and are predisposed to pigmentary disorders. In fact, one of the most common conditions leading to dermatology consultations by patients with skin of colour is photoexacerbated pigmentary disorders. Unfortunately, individuals with skin of colour may be less prone to engage in photoprotective measures, including the use of sunscreens. Physicians are also less likely to prescribe sunscreens for them. There is thus a clear need for better education on photodamage and for more efficient and suitable photoprotection in populations with skin of colour. However, this need has thus far only partially been met, and the development of sunscreen products designed to provide optimal photoprotection for people with skin of colour remains a challenge. Targeted sunscreens for individuals with skin of colour require optimal cosmetic appeal (leaving no white residue and not disrupting skin tone). They should include broad-spectrum [ultraviolet (UV)B/UVA] protection with high sun protection factor, as well as protection against long-wave UVA (UVA1) and visible light, as these wavelengths are capable of inducing or augmenting pigmentary disorders. They may also contain depigmenting agents for patients with pigmentary disorders.

The British Journal of Dermatology

Photoprotection for people with skin of colour: needs and strategies

Br J Dermatol 2023 Feb 10;188(2)168-175, J Krutmann, J Piquero-Casals, D Morgado-Carrasco, C Granger, C Trullàs, T Passeron, HW Lim 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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