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Sunscreen use and UV avoidance remain critical for patients of all skin tones. In conjunction with the Annual Meeting of the AAD in Boston last month, Henry W. Lim, MD, FAAD, former chair of the department of dermatology at Henry Ford Hospital in Detroit, highlighted developments in skin protection.

“While people with darker skin have a lower risk for skin cancer, it can still develop. However, what we are learning is that the darker your skin tone, the higher your risk that UV rays and visible light from the sun will cause dark spots, also known as hyperpigmentation, on your skin,” Dr. Lim says. “For that reason, we recommend sun protection for everyone.”

Combined with other UV avoidance strategies—like wearing protective clothing and seeking shade—sunscreens remain an important tool. “By tailoring the sunscreen formulations to an individual’s skin tone, people are more likely to protect themselves from the sun, therefore reducing their risk of skin cancer,” says Dr. Lim. He recommends using a tinted sunscreen that contains iron oxides—listed under “inactive ingredients”—that increase protection against visible light and UVA radiation. Dermatologists across the country continue to eye sunscreen developments and advocate for patients to protect themselves.

Formulation Features

“Titanium dioxide and zinc oxide continue to lead the way as far as sunscreen ingredients,” says Corey L. Hartman, MD, FAAD, of Skin Wellness Dermatology in suburban Birmingham, AL. “The problem has been inelegance with these ingredients leaving an iridescent cast on darker skin tones.”

Dr. Hartman says the use of new ingredients like squalane and glycerin is “making these physical sunscreens easier to blend into all skin tones. Iron oxides, as found in tinted sunscreens, also continue to be huge, and add another layer of protection especially for melasma.”

“I’m really excited about the newer formulations of sunscreens or smart sunscreens as I like to call them,” says Anthony Rossi, MD, a Mohs surgeon at the David H. Koch Center for Cancer Care at Memorial Sloan Kettering. “We’re really seeing a revolutionary advancement in how the physical sunscreen ingredients are being manufactured and micronized. We know those are great sun protectants. They’re broad spectrum. However, the ability to actually go on smooth and not produce a white cast has always been a barrier for people to use.”

Susan Weinkle, MD of Weinkle Dermatology in Bradenton, FL, agrees. She says she encourages her patients to reach for physical sunscreens every day. “I especially like a new product, HydraTint Pro Mineral Broad Spectrum Sunscreen SPF 36 from Alastin. This blends really nicely into most skin tones, leaving no visible residue and can even serve as a base make-up so patients can skip one step in the mornings if they wish. There is a non-tinted version for patients who prefer that.”

Assessing Risks

Patient knowledge of the risks of blue light exposure have increased since 2020, Dr. Hartman suggests. “The pandemic slowdown allowed for a great deal of skincare education, and many new products were launched containing iron oxides, which garnered a great deal of attention.”

Michael H. Gold, MD, Medical Director of Gold Skin Care Center and Tennessee Clinical Research Center in Nashville, says younger patients are often aware of blue light and its impact, “but in my practice, it is rarely brought up by patients.”

“Our patients are aware of the effect of blue light when it comes to their eyes, when it comes to their sleep,” suggests Hassan Galadari, MD, Assistant Professor of Dermatology at the UAE University. “But unfortunately they are unaware of the changes that can occur on the skin, whether it’s increasing photoaging, the presence of wrinkles that will start popping up fairly early.

“This is something that’s very important for us as dermatologists to tell them that blue light can definitely affect them in the long term, even though, interestingly enough, blue light has been used as a therapeutic agent for many years. Unfortunately, staring at the phone, especially at night, just before going to bed is not going to do wonders for the areas around the eyes.”

Regardless of whether patients bring up blue light, Dr. Weinkle sees the topic as a way to encourage daily sunscreen adherence. When patients understand that they are exposed to damaging light energy all day everyday—inside and outside, on sunny days and cloudy days—they are more likely to use sunscreen on a consistent basis, she says. “Practicing in Florida, where we get so much sun, I still need to educate,” Dr. Weinkle says. “Patients don’t know that UVA rays—the ones that cause aging and melanoma—are present at the same levels year-round, even on cloudy days.”

Future Directions

“Sunscreens are adapting other ‘active’ ingredients, such as antioxidants, to really help boost the UV blocking potential and the potential to help aid in skin health,” says Dr. Rossi. “All of these are new and exciting advancements in sunscreen.”

Dr. Weinkle welcomes formulation advancements that would increase sunscreen durability. In the meantime, she emphasizes patient education and adherence. “Even patients who apply sunscreen each morning aren’t protected because they don’t reapply. A round of golf takes four hours; that means golfers should re-apply sunscreen at the ninth hole. But they don’t. Patients come in with sunburns saying, ‘But I wore sunscreen!’ Inevitably, they applied sunscreen once in the morning and then spent hours outdoors without reapplying.”

Dr. Weinkle cautions on over-emphasizing SPF rating. “Any broad-spectrum sunscreen SPF 30 or higher will be effective if applied and re-applied properly. If patients find a formulation that fits that bill, that they like, that they will use, I am not going to push them to use something with a higher SPF rating.”

Dr. Gold reminds that most skin cancers are a direct effect of sun exposure. “I hope that we continue to be able to recommend that these products are needed and necessary for our patients in order to reduce the number of skin cancers,” he says.

“I’m always hopeful that products will continue to evolve to be inclusive of not just skin color and darker tones, but also skin types: oily, dry, sensitive, etc. FDA will hopefully, finally, complete their sunscreen regulation guidelines, which will lead the industry in the right direction,” Dr. Hartman suggests.

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