How to Educate Patients on Sun Protection

The May cover story of Dermatology Times® featured an expert panel of sun protection experts, featuring Renata Block, MMS, PA-C; Christopher Bunick, MD, PhD; Doris Day, MD; and Corey Hartman, MD. The panelists discussed how dermatology providers can effectively prepare their patients for the summer sun, as well as how to warn patients about the harmful effects of sun damage.

The panelists covered a wide range of sun protection topics, including debunked sunscreen myths, sun protective clothing, recommended SPF levels and formula types, caution for specific locations, and special issues in photosensitivity.

Keep reading below for a comprehensive look at the panelists' recommendations and what you can share with patients.

Preparing Patients for the Summer Sun: Discussing Sun Protection

As the countdown to summer begins, so does the mountain of questions from patients about safe and effective sun protection products and strategies. Because these conversations may be difficult, Dermatology Times invited leading clinicians to support you as you support your patients.

One question that regularly arises from patients concerns sun protection factor (SPF) levels. The panelists agreed that SPF 30 to 50 provides adequate protection, and that increases in SPF beyond 50 results in minimal additional protection. They also emphasized the importance of reminding patients that reapplication is key to proper protection.

“I tend to recommend mineral sunscreens that contain either titanium dioxide, zinc oxide, or both. Shielding your skin by reflecting the rays of light [is] a more efficient way to achieve sun protection,” Hartman said. “Now, mineral sunscreens have traditionally not been as elegant, particularly for those with brown skin. Manufacturers are finally starting to realize this is a problem and are developing formulations that look very elegant and melt right into dark skin tones without giving an iridescent cast or white shadow.”

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Preparing Patients for the Summer Sun: Derms Debunk 5 Sunscreen Myths

Myth #1
Sunscreen is carcinogenic.

Bunick encourages clinicians to remind patients that the sunscreen itself protects individuals from skin cancer via UV damage that leads to basal cell, squamous cell, and melanoma cancers.

In May 2021, Valisure, an independent laboratory assessing product quality assurance within the health care industry, found 78 sunscreen and after-sun care products that contained high levels of benzene, a known carcinogen, as a result of the manufacturing process of aerosolized cans. Bunick, who has closely followed the benzene issue, works to educate colleagues and consumers about the long-term adverse effects of benzene and what the future may hold. “The long-term implications of what this contamination means in all types of personal hygiene products remains to be seen. The hope is [that] it means nothing, but we can’t say that right now,” Bunick said.

Day suggests physical sunscreens for those concerned about what is being absorbed. This includes the zinc and titanium products that are not micronized.

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Preparing Patients for the Summer Sun: Special Issues in Photosensitivity

Special recommendations may be needed for patients based on their medications, disorders, and alcohol consumption, the panel noted. For instance, acne medications such as doxycycline and isotretinoin might make patients more photosensitive, they said. “For patients prone to acne, [suggest they] look for the sports block gels, because they usually have more absorbed sunscreen ingredients,” Day said. Similarly, for patients prone to eczema, she said to suggest they look for sunscreens that include ceramides and hydrators. “The sun is immunosuppressive, so if you have psoriasis or eczema, we use UV rays to help suppress the immune system locally to calm the skin down.”

Hartman added that blood pressure medications (eg, hydrochlorothiazide) can make skin more reactive to sunlight, darkening, discoloration, and burning. Race, sex, and how long hydrochlorothiazide has been in the system [also] plays a role. In a recent study of 19,079 adults, Anna Chien, MD, FAAD, an associate professor of dermatology and vice chair of quality, safety, and service at Johns Hopkins University School of Medicine in Baltimore, Maryland, found that hydrochlorothiazide caused increased odds of sunburn for non-Hispanic Black individuals, particularly women.

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Preparing Patients for the Summer Sun: Location, Location, Location

Understanding patients’ travel plans can direct the conversation and yield the most appropriate advice. Our panel indicated specific sun protection recommendations based on locations and environments.

Panel’s Advice Based on Locale

Mountains and higher altitudes

Creamier sunscreens may enhance skin moisture in arid destinations, whereas a gel sunscreen may be more comfortable in humid environments. In addition to sunscreen, Day recommended supplements containing polypodium leucotomos extract for internal protection.

Beaches and pools

Encourage patients to look for water resistance ratings on their sunscreen and to reapply every 2 hours. Bunick noted that sunscreen incorporated into makeup and daily moisturizers are not necessarily water resistant. Remind patients that some tropical destinations, such as Hawaii, have banned the sale of sunscreens containing oxybenzone and octinoxate because of the damage they cause to coral reefs and the ocean’s ecosystem.

Rural areas

Education is key, especially because individuals in these areas may have limited access to dermatologic care. A 2019 study of sun protection habits in rural Texas communities showed that these residents were less likely to seek shade or use sunscreen compared with their urban counterparts. Although rural populations tended to use a higher SPF sunscreen, they were more likely to have a higher number of blistering sunburns over the course of their lives, beginning at the age of 5 years.

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To view the full cover story, click here to download the May issue of Dermatology Times.