Skin protection is important for reducing the risk for cancers, as well as for anti-aging and cosmetic reasons, in people of all complexions. However, many people of color often underestimate the dangers of the sun.
Healio spoke with Cheryl M. Burgess, MD, FAAD, medical director at Center for Dermatology and Dermatologic Surgery in Washington DC and on the board of directors of the American Academy of Dermatology and the Skin of Color Society, regarding how to address sun protection and cancer prevention in patients of color.
Q. What are some of the main dermatologic concerns for people of color?
A. One of the main concerns with skin of color is uneven complexion or discoloration of the skin, whether it is from acne, eczema or something inflammatory on the skin that leaves blemishes or dark spots as it heals.
We often prescribe lightening agents, but the products make the skin sensitive to light. I recommend to patients the need to use lightening products at night, but also they will need to use a sunscreen during the day.
We also have a lot of patients with sun sensitivity such as polymorphic light eruption, in which they experience itching or hives when exposed to the sun We see patients with melasma, which can be affected by indoor lighting as well. Education is key with skin of color because some ethnic groups have a higher incidence of melasma, such as the Latino community.
Q. How do you explain to patients of color that they need to use protection from the sun?
It has taken a long time to educate people of color that there are a multitude of reasons why we use sunscreen to protect our skin. Of course, there is daily protection, but a lot of people of color feel that a certain percent of their complexion or pigment is protective, and it is, but that is only protecting you from a few minutes of being out in the sun.
I try to explain that if you notice your complexion is different from the color of the skin on your buttocks or the color of the skin on your breast, you have chronic sun damage. One of my most difficult tasks as a physician is telling patients that sunscreen is not just for the beach or summertime.
Many patients come in to discuss anti-aging not realizing No. 1 anti-aging cream is sunscreen. Before we start discussing other types of anti-aging products, we need to talk about sun protection.
Q. What types of cancers do you see in skin of color patients, and how do you work to educate them about these cancers?
Most skin of color people do not think they can get skin cancer, however, we commonly find squamous cell and basal cell carcinomas and melanomas in the skin of color population.
Melanoma is the most deadly skin cancer, and one of the reasons is due to delayed detection.
I like to use analogies my patients can relate to and often tell them how Bob Marley died of a malignant melanoma that appeared on his foot that he thought was a bruise. I always mention Bob Marley because it is a real-life tale that helps patients to understand.
Q. What type of sun protection do you recommend for people with melanin-rich skin?
That is a dilemma because you have your physical sunscreen that contains zinc oxide, titanium dioxide and iron oxide that is more protective, but when they are placed on brown skin, they tend to be very chalky and ashy in nature, and that turns off a lot of patients.
You also have the chemical sunscreens containing avobenzone. Chemical sunscreens ingredients go on the skin and vanishes, not leaving an ashy or purplish glow; therefore, people love that aspect of chemical sunscreens. However, chemical sunscreens are beginning to be banned in many places such as Australia and the Florida Keys because they are affecting water natural environments, therefore, I do not know how much longer they are going to be around.
I try to demonstrate to my patients how to use the physical sunscreens so they disappear on the skin.
Q. Do you have any advice for your fellow dermatologists about treating skin of color patients in terms of sun protection?
A. Talk about aging and skin cancers; and to get a thorough adequate medical history to find out if there are other conditions a patient may have that would be photosensitizing. In skin of color, it is probably going to involve a discussion for a number of topics, not just the sun and try to use analogies to explain to patients why they need to protect their skin. -by Rebecca L. Forand
Disclosure: Burgess reports she is an advisor for Isdin.