Written by Dr Dami
MBBCh, MSc, MRCP
Dermatology Specialist Registrar
Co-founder of the Skin of Colour Training Day
Trainee representative of the Skin Diversity Sub Committee (SDSC) of the BAD
The link between sun exposure and skin cancer in fairer skin types has been firmly established. In 1975, American Dermatologist, Thomas Fitzpatrick developed the Fitzpatrick scale which classified skin types based on their ability to burn or tan in response to Ultraviolet (UV) light. This was developed with white skin types in mind, with darker skin types added on as an afterthought. Likewise, when it comes to sunscreen in darker skin, the conversation seems to be an afterthought as earlier sunscreens were not created for or targeted at people with darker skin.
The reasons for this are many, however it begs the question, ‘Can sunscreen brands do anything to better represent darker skin tones?’. After much thought and several discussions with friends and colleagues, here are a few suggestions:
1. Redefine who needs sunscreens
The common objection to sunscreen use in skin of colour is that skin cancers are far less common in darker skin. To put this in perspective, it is thought that only 1 out of 100,000 people with darker skin (Asians and blacks) will get a melanoma skin cancer when compared with 40-60 out of 100,000 people with fairer skin (Predominantly Caucasian Australians and New Zealanders )1.
Whilst this is true, melanoma skin cancers in darker skin have been shown to be more advanced and more lethal when these patients present to their Dermatologists2. Although the majority of these melanomas in darker skin are ‘acral lentiginous’ in kind, meaning they develop on ‘non’-sun exposed palms and soles, melanomas do occur on other body parts which should not be ignored. To put this into context, a 24-year database showed that out of 1106 melanomas in African Americans, 547 occurred on the lower extremities/ legs, with 104 occurring on the head and neck, 143 on the upper extremities/ arms and 181 on the trunk2. If we assume that all of the extremity melanomas were on the palms and soles, this still leaves about a quarter of melanomas on other potentially sun exposed areas. Granted, the melanoma numbers are very small when compared to their Caucasian counterparts (212,721), however given the higher rates of death, an argument could be made for sun protection with a greater emphasis on mole checks.
Whilst this controversy continues, it might be best to shift gear and focus on a topic that is often left out of the conversation – Hyperpigmentation. Sunscreens can be extremely helpful in preventing or halting the progression of hyperpigmentation which is far more common than skin cancers in skin of colour.
For example, acne is one of the leading reasons patients with skin of colour see their Dermatologists. The resulting post inflammatory hyperpigmentation (dark spots) left
behind by the acne spots are often more problematic than the acne itself and carries a huge psychological and social burden on these patients. Furthermore, other pigmentation problems like melasma and conditions like lupus which are made worse by sun exposure, are commoner in darker skin types who would greatly benefit from using sunscreens.
Yet, when we look at advertising for sunscreens, these issues are hardly represented thus creating a gaping hole of untapped opportunities for many sunscreen brands.
There is a common adage amongst people of African descent that ‘black don’t crack’. Whilst melanin is protective against sun-induced ageing, darker skinned people are using cosmetic services in higher numbers these days. This is probably due to the increased number of capable providers coupled with an increase in socioeconomic mobility.
We must also recognise the impact of social media which has caused many people to place undue emphasis on their physical appearance with a growing desire to delay ageing as much as possible. As such, reducing sun induced ageing by regular sunscreen use forms one of the important tools in the anti-ageing arsenal.
2. Cosmetic Suitability
Black Girl Sunscreen has been a positive catalyst for change in the conversation about sun protection in black skin, by being aptly named but also addressing a popular customer concern amongst darker skinned users – the dreaded white cast.
This is often due to titanium dioxide and zinc oxide found in mineral sunscreens. However, with nano-technology formulations, this problem can be overcome to some degree. Alternatively, tinted sunscreens can reduce the white cast and should be an area for product development as most tints are still produced in one medium colour shade which is still too light for people with the darkest skin tones. This becomes extremely important for patients with melasma who benefit from visible light protection from the iron oxide in the tint.
Furthermore, there appears to be somewhat of a difference between which sunscreen brands are recommended for darker skin versus white skin which could very well be due to their formulations and cosmetic suitability. A study looking at website recommendations found that chemical sunscreens were frequently recommended for darker skin, whilst mineral sunscreens were often recommended for white skin3. Interestingly, none of the top 3 sunscreens recommended for darker skin (Glossier Invisible Shield, Supergoop! Unseen sunscreen and Black girl sunscreen) were recommended for white skin. Only 4 of the 30 brands examined (Elta-MD, La-Roche Posay, Drunk Elephant, and Colorescience) were recommended across the board which creates an avenue for other brands to widen their reach3.
The cosmetic suitability of sunscreens for all skin types including oily, dry and sensitive skin should also be taken into account to help solve disparities amongst consumers.
3. Focus on Global purchasing power
Mellody Hobson, former chairwoman of DreamWorks Animation would often ask in every meeting, ‘Is everyone in the room?’ In this day of increasing globalisation and connectivity, companies should think big in order to increase their bottom line rather than limiting the sale of their products to a globally smaller audience. International trade has become far more accessible and with more western countries becoming more diverse, it is pertinent now more so than ever to check if everyone is in the room when designing products, bearing in mind that the majority of the world’s population has skin of colour.
For example, it was long assumed that people with darker skin did not need or wear make-up or that they did not have the purchasing power to buy the products. In 2017, pop singer Rihanna released Fenty beauty with 40 different foundation shades to address this problem. She is estimated to have made a staggering 8-figures in profits after one year from her entire beauty collection; this caused a stir in the beauty world and encouraged other brands to diversify their foundation ranges as some brands had done previously. Although we cannot extrapolate the data from make up into skincare, it is important for brands to listen to customer requests and to take action.
4. Advertising and product testing
Sunscreen brands should include participants with a range of skin colours and skin types during the development, testing and advertising of their sunscreens. A lack of representation should not be underestimated in how consumers perceive and use a product.
Whist the Fitzpatrick system mentioned above neatly divides skin colours into 6 categories, the reality is that skin colour comes in a much wider variety of shades. A better and more economical way of categorising skin colours may be to use foundation shades instead. The advent of several foundation match websites has also made it easier to recruit and group participants more accurately by their skin tones for the purpose of product development and testing.
Finally, besides popular advertising platforms such as TV or print ads, brands may want to utilise social media avenues to capture a younger audience.
Most millennials get a lot of their skincare information from platforms such as Instagram, YouTube and Tik Tok. As such, approaching social media influencers with skin of colour can help brands tap into their huge database of followers.
These are a few points but let’s keep the conversation going – how else can sunscreen brands cater to darker skin?
1. Liu, L., Zhang, W., Gao, T. et al. Is UV an etiological factor of acral melanoma?. J Expo Sci Environ Epidemiol 26, 539–545 (2016). https://doi.org/10.1038/jes.2015.60
2. Mahendraraj, K. et al. (2017) ‘Malignant Melanoma in African-Americans: A Population-Based Clinical Outcomes Study Involving 1106 African-American Patients from the Surveillance, Epidemiology, and End Result (SEER) Database (1988-2011)’, Medicine, 96(15), p. e6258. DOI: 10.1097/MD.0000000000006258.
3. Hannah Song, M. et al. (2021) ‘Sunscreen recommendations for patients with skin of color in the popular press and the dermatology clinic’, International Journal of Women’s Dermatology, 7(2), pp. 165–170. DOI: 10.1016/j.ijwd.2020.10.008.