PracticalDermatology

Avoiding UV exposure is the best way to prevent skin aging and skin cancers, but dermatologists consistently face the challenge of getting patients—especially children and adolescents—to comply with UV avoidance recommendations. In the last edition of Practical Dermatology® magazine, I advocated for strategies to expand UV protection for kids (you can read the article online at PracticalDermatology.com). Here, I share some tactics to enhance adherence with UV avoidance recommendations, especially for younger patients.

Avoid Scare Tactics

Patients in general, and especially adolescents, will not react well to scare tactics. It is essential that patients understand the dangers associated with cumulative UV exposure—namely skin cancer and premature skin aging. However, the risk of developing skin cancer in their later years (or even in their 30s) is generally not sufficient motivation for teens, adolescents, and even adults to adopt healthy UV behaviors. Furthermore, most individuals assume treating skin cancer is a matter of a simple excision. We know that all too often that is not the case.

Perhaps surprisingly, for many patients the fear of wrinkles may be stronger than fear of skin cancer. Likely, this is because we all see people with wrinkles and discoloration every day, even in our own families. It’s easier to conceptualize skin aging, and most of us want to minimize or avoid those aging effects. Especially when aesthetically minded younger patients ask about products and services, it’s a great time to emphasize that prevention, using SPF and UV avoidance, is the best tool against skin aging.

Support Modeling

While scare tactics don’t work, modeling does. For us as dermatologists, modeling can take a few forms. Ideally, we model UV avoidance for our own children and family so that they see us applying sunscreen and wearing UPF rated clothing when appropriate and carrying a hat and sunglasses with us everywhere. But our patients aren’t in our homes, and for most of us, the majority of our patients are not children. We can use our social media outlets to model appropriate behavior. If you’re sharing a more personal moment on your channels, be sure you are following your own sun safety advice in the snaps.

There are opportunities to support modeling. We can reach our adult patients—many of whom are moms and dads—and emphasize to them the importance of both practicing and modeling UV avoidance strategies. Especially if you dispense or recommend specific SPF products in your practice, then remind patients to let their children see them using the products and to provide sunscreens to their children.

We can also work with our communities as educators. Offer to speak to the local swim club or daycamp—at least to the staff. The younger kids inevitably look to their counselors and lifeguards as “cool” and are eager to emulate them. If these young leaders spend their time outdoors in tank tops with no hats, the kids around them will want to do the same. But, if we can get these role models to wear UPF clothing and hats, and to regularly apply sunscreen, then the children around them might very well do the same.

Go Beyond SPF

SPF is important, and all patients should use broad-spectrum sunscreen SPF 30 or higher every day (ideally) or at least when they will be spending time outdoors. However, sun avoidance and use of UPF clothing are also critically important. Individuals who wear sun-protective clothing, including hats, reduce their need for SPF. For example, wearing a long-sleeve UV-filtering shirt eliminates the need to apply sunscreen to the trunk and arms. Remarkably, patients still seem not to fully understand the science of UPF or, perhaps more accurately, do not recognize that standard clothing does not provide significant protection against UV radiation.

Two points that resonate with patients:

UPF clothing can be worn over and over, making it cost effective.

UPF clothing doesn’t expire; sunscreen does.

Follow the Buzz

For many patients/consumers today “chemical” has a negative connotation; therefore, many are reluctant to use chemical UV blockers. Additionally, there have been concerns about the potential absorption of chemical sunscreens (though we still don’t know precisely what happens when these chemicals are absorbed) and the impact of chemical sunscreens on coral reefs.

There’s little benefit in giving patients a dissertation on the latest scientific research. Instead, be prepared to address any clearly inaccurate information patients may believe is factual. Consider compiling and sharing a list of reliable resources where they can learn more on their own time.

Make Recommendations

As important as addressing ingredient concerns is being prepared to make recommendations to meet each patients’ specific needs. I tend to prefer sunscreen formulation with physical blockers, but I have some recommendations at the ready for patients who want chemical-only formulations, those who want physical-only sunscreens, and those who want combination formulations.

Importantly, patients who reject physical UVB blockers as inelegant may need to be educated about advancements in formulation. Micronized zinc and titanium dioxide can now be incorporated into elegant, residue-free formulations patients will actually use.

In addition to ingredients, think about formulation types. I tend to recommend against sprays for a few reasons. When applied outside, these may be blown around, and it can be difficult to determine how much product is actually applied to the skin. Plus, there are concerns about inhalation of the aerosolized particles. Identify patient-friendly formulations at various price points in lotion, cream, stick, powder, and other bases so that you can give patients guidance on specific products to look for.

Skin Cancer is Preventable

Estimates have suggested that up to 90 percent of skin cancers may be preventable. Yet skin cancer rates are on the rise, and we seem to be seeing more skin cancers in patients in their fourth and fifth decades of life. Clearly, we need to work harder to educate patients on UV risks and avoidance and find strategies to enhance compliance with UV protection strategies.