The Importance of Wearing Sunscreen Regardless of Skin Tone

We may have different skin types, but we are all prone to skin damage. Learn why people of all skin tones should wear sunscreen.

The Importance of Wearing Sunscreen Regardless of Skin Tone

Quick Summary

  • The sun’s UVA and UVB rays are powerful and have damaging effects on skin regardless of skin color.
  • Wearing sunscreen daily with frequent reapplication can prevent skin from being damaged by the sun, lessening skin cancer risk, and decreasing skin aging.
  • Sunburns aren’t necessary for photodamage to occur. Be cautious and sun safe to prevent photodamage, hyperpigmentation, and skin cancer.
  • Skin cancers found in people with darker skin tones tend to be discovered at a later stage resulting in a worse prognosis.

Sunscreen is one of the most important tools available to protect against photodamage and burns caused by the sun. It should be applied daily with numerous re-applications to protect against the sun’s harmful ultraviolet A rays (UVA), ultraviolet B rays (UVB), infrared light, and visible light. Proper sunscreen use can prevent sun burns, skin damage, and skin cancer.1,2

However, sunscreen is often misconstrued as only being needed by fair skinned individuals who burn easily. Many people with darker skin tones believe they do not need sunscreen protection since they “do not burn.” While people of darker skin tones burn less easily, the sun still causes subclinical DNA damage that predisposes individuals to earlier skin aging, hyperpigmentation, and skin cancer. For this reason, sunscreen should be used by people of all skin tones.1

Sun Damage and Skin Tone

Melanin is a naturally produced pigment in our skin. It is our body’s primary defense mechanism against UV damage, and its concentration confers individuals their skin tone. Increased melanin can provide individuals of darker skin tones natural UV protection of up to a sun protection factor (SPF) of 13.4.3

There is a common misconception that because darker skin individuals have more melanin in their skin and don’t burn as easily, that they are totally protected from the effects of the sun. This notion, however, is untrue.3 The sun’s harmful radiation, especially UVA and UVB rays, contributes to DNA damage, skin aging, and development of skin cancers, while UVB rays, infrared light, and visible light cause skin inflammation, hyperpigmentation, and sunburns.2,3

Numerous studies have shown that individuals with darker skin tones such as African Americans and Hispanics rarely or never wear sunscreen.4 Although the incidence of skin cancer is lower among people of color, skin cancer rates have been increasing, and significant disparities in health outcomes for skin cancer exist between people of lighter and darker skin tones – and are getting worse.3,5

Skin Cancer

Melanoma rates have skyrocketed in the U.S. over the past 30 years – doubling from 1982 to 2011 and still climbing.6,7 In addition, melanoma incidence has increased in the Hispanic population by 20% over the past two decades.8 While skin cancers are only responsible for 1-2% of all cancers in darker skin individuals, they often have a poor prognosis, with a high mortality rate.7 This is due to detection at later stages, when metastases have already occurred, and worse access to post-diagnosis follow-up and care.5 This contributes to a significantly lower 5-year survival rate among darker skin tone individuals compared to those with fair skin tones.4,9,10 The most common location among individuals of darker skin tones is on the lower limbs or hips.5

Lack of sunscreen use increases the risk for developing skin cancers such as basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma, and melanoma. Of note, people with darker skin tones are at a higher risk of developing a specific type of melanoma called acral lentiginous melanoma (ALM).5 ALM affects the palms, soles, and subungual surfaces.9 ALM is problematic especially in darker skinned individuals as these cancerous lesions are often missed or overlooked by individuals or during examinations by a medical professional. Unfortunately, because lesions may go undetected for an extended period, when they are diagnosed it is often too late for curative excisional treatment.9,11

Since skin cancers affect people of all skin tones, monthly self-examinations and annual skin checks from a dermatologist are of the utmost importance to catch malignancies in their early stages when they are most effectively treated. In between getting skin checks from a dermatologist, daily photoprotection and regular self-skin checks are helpful in individuals of all skin tones to prevent skin cancer. Increased awareness by the public and medical professionals can help prevent sun damage and catch cancers earlier when they do occur.

Proper Sunscreen Use

Table 1: Proper Sunscreen Use

Proper Sunscreen Use

Recommendations1,12,13

When

Daily, regardless of weather

Type

Lotion > spray; physical = chemical

Protection

Broad-spectrum (UVA & UVB)

SPF

30+

Durability

Water-resistant 40+ minutes

Application

All exposed areas of the body

Amount

1 ounce (enough to fill a shot glass)

Reapplication

Every 2 hours (sooner if sweating, swimming) or immediately after towel drying

Bonus

“Double application” or consecutive applications may optimally protect the skin14

Tinted versus clear

Only tinted sunscreens protect against visible light damage and hyperpigmentation15

 

Other Sun-Protective Behaviors

Table 2: Other Sun-Protective Behaviors

Sun-Protective Behaviors

Recommendations

Clothing

Ultraviolet protection factor (UPF)-rated clothing, or tightly woven lightweight fabrics

Sunglasses

Polarized

Hats

Wide-brimmed hats

Avoidance

Avoid prolonged exposure from 10am – 4pm

 

Take-Home Points

People with darker skin tones, such as Hispanics and non-Hispanic Blacks, need to protect their skin from the sun just like people with fair skin. Subclinical photodamage accumulates over time causing early skin aging and increasing the risk for life-threatening malignancies. In addition, sunlight can exacerbate photosensitive conditions and induce hyperpigmentation and melasma. Therefore, applying sunscreen daily, refraining from extensive sun exposure when possible, and wearing photoprotective clothing are key to preventing photodamage, hyperpigmentation, and skin cancer. Increased awareness about the importance of proper sun protection in people of all skin tones can help prevent skin cancer.

* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.

References

  1. sunscreen.pdf. Accessed July 12, 2021. https://www.epa.gov/sites/production/files/documents/sunscreen.pdf
  2. Sklar LR, Almutawa F, Lim HW, Hamzavi I. Effects of ultraviolet radiation, visible light, and infrared radiation on erythema and pigmentation: a review. Photochem Photobiol Sci Off J Eur Photochem Assoc Eur Soc Photobiol. 2013;12(1):54-64. doi:10.1039/c2pp25152c
  3. Cestari T, Buster K. Photoprotection in specific populations: Children and people of color. J Am Acad Dermatol. 2017;76(3S1):S110-S121. doi:10.1016/j.jaad.2016.09.039
  4. Ask the Expert: Is There a Skin Cancer Crisis in People of Color? The Skin Cancer Foundation. Published July 5, 2020. Accessed July 12, 2021. https://www.skincancer.org/blog/ask-the-expert-is-there-a-skin-cancer-crisis-in-people-of-color/
  5. Qian Y, Johannet P, Sawyers A, Yu J, Osman I, Zhong J. The ongoing racial disparities in melanoma: An analysis of the Surveillance, Epidemiology, and End Results database (1975-2016). J Am Acad Dermatol. 2021;84(6):1585-1593. doi:10.1016/j.jaad.2020.08.097
  6. Guy GP, Thomas CC, Thompson T, et al. Vital signs: melanoma incidence and mortality trends and projections - United States, 1982-2030. MMWR Morb Mortal Wkly Rep. 2015;64(21):591-596.
  7. USCS Data Visualizations. Accessed July 12, 2021. https://gis.cdc.gov/grasp/USCS/DataViz.html
  8. Skin Cancer & Skin of Color. The Skin Cancer Foundation. Accessed July 26, 2021. https://www.skincancer.org/skin-cancer-information/skin-cancer-skin-of-color/
  9. Agbai ON, Buster K, Sanchez M, et al. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-762. doi:10.1016/j.jaad.2013.11.038
  10. Gloster HM, Neal K. Skin cancer in skin of color. J Am Acad Dermatol. 2006;55(5):741-760; quiz 761-764. doi:10.1016/j.jaad.2005.08.063
  11. Gupta AK, Bharadwaj M, Mehrotra R. Skin Cancer Concerns in People of Color: Risk Factors and Prevention. Asian Pac J Cancer Prev APJCP. 2016;17(12):5257-5264. doi:10.22034/APJCP.2016.17.12.5257
  12. Sunscreen FAQs. Accessed July 12, 2021. https://www.aad.org/public/everyday-care/sun-protection/sunscreen-patients/sunscreen-faqs
  13. Sunscreen. The Skin Cancer Foundation. Accessed July 12, 2021. https://www.skincancer.org/skin-cancer-prevention/sun-protection/sunscreen/
  14. Heerfordt IM, Torsnes LR, Philipsen PA, Wulf HC. Sunscreen use optimized by two consecutive applications. PloS One. 2018;13(3):e0193916. doi:10.1371/journal.pone.0193916
  15. Lyons AB, Trullas C, Kohli I, Hamzavi IH, Lim HW. Photoprotection beyond ultraviolet radiation: A review of tinted sunscreens. J Am Acad Dermatol. 2021;84(5):1393-1397. doi:10.1016/j.jaad.2020.04.079
 
 
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